Team Research Articles

P-1890. Implementation and outcomes of a fully remote tele-ID and tele-OPAT program at a regional medical center

Abstract Background Infectious diseases (ID) consult services and outpatient parenteral antimicrobial therapy (OPAT) programs have traditionally been restricted to well-equipped academic medical centers. However, the integration of telehealth technologies into ID specialty care now allows for the expansion of ID expertise to underserved medical communities, including non-academic medical centers, and community and rural hospitals. Our initiative pioneered a comprehensive tele-ID service, encompassing both inpatient consultations and a tele-OPAT service for post-discharge management. Herein, we describe the program structure and outcomes from the first year of our integrated tele-ID and tele-OPAT program, implemented at a 144-bed community hospital in Vermont. Methods The program featured an inpatient tele-ID consult service supported by local nurse tele-presenters who would facilitate physical exams for a remote ID physician using videoconferencing technology. Patients deemed appropriate for OPAT were referred to the remote tele-OPAT team which consisted of a nurse coordinator, an ID pharmacist, and the current ID physician attending the inpatient service. The nurse coordinator's responsibilities included communicating with the local case management team, home health, and post-discharge facilities to ensure orders were placed, and communications were triaged for the tele-OPAT team. The ID pharmacist reviewed OPAT regimens for appropriateness and monitored outpatient labs for safety and dose adjustments. Tele-OPAT patients were seen locally by the ID physician in a pre-existing clinic with the assistance of a nurse tele-presenter. Results Ninety patients were enrolled in the tele-OPAT program in the first twelve months. Of these, 62 (68.9%) completed therapy without adverse event (AE) or 30-day readmission. 30-day readmission occurred in 14 patients (15.6%) and 20 patients (22.2%) had a documented AE during therapy, with 10 patients (11.1%) experiencing line-related issues. Conclusion Our telehealth initiative successfully expanded ID expertise to an underserved community hospital, with a majority of patients completing therapy without AEs or readmissions, demonstrating the efficacy and safety of remote ID consultations and tele-OPAT services. Disclosures All Authors: No reported disclosures

P-1446. Impact of Social Determinants of Health on Infectious Outcomes in Patients Undergoing Amputation

Abstract Background Studies have demonstrated the impact of SDOH on outcomes following vascular surgery, but few have focused on risk factors for infectious complications following major amputation. Odds Ratios (Confidence Intervals) for Infectious Outcomes Based on Social Determinants of Health Methods Local data for the Society Vascular Surgery Vascular Quality Initiative, a multicenter registry of quality improvement, were queried for demographics, clinical, procedure, and outcomes of 371 patients with amputation as index procedure 6/1/2015 to 7/31/2023. Zip codes were used to derive CDC/ATSDR Social Vulnerability Index (SVI). The impact of SDOH and SVI on surgical outcomes with a focus on infection was evaluated by logistical regression with R v4.3.2. Primary outcomes for univariate analysis included surgical site infection (SSI), readmission for infection, composite infection-related outcome, organ system complications during index admission, mortality at 30 days, 1 year, 2 years, and 5 years, and composite surgical adverse outcome inclusive of infectious and non-infectious complications. Significant variables were selected for multivariate regression. Odds Ratios (Confidence Intervals) Additional Factors and Surgical Outcomes Based on Social Determinants of Health Results SDOH correlated with multiple parameters in univariate analysis (Fig 1, 2). Male patients had higher ASA score and uncontrolled infection as indication for amputation but were less likely to incur an SSI, or require above trans-metatarsal amputation. Publicly insured patients were more likely to be wheelchair bound or bedridden, or residing in a facility preoperatively, and had the highest risk of readmission for infection (OR=8.09), along with a higher risk of 2 year mortality. Patients with ongoing tobacco use had increased mortality at 1 (OR=1.9) and 2 years (OR=1.7). In multivariate analysis, male gender was associated with SSI (OR 0.25 CI 0.06-0.96). Composite infectious complication was associated with emergent procedure status (OR 2.96 CI 1.22-6.97). There was no significant difference in survival for SDOH derived subgroups (Fig 1) or composite surgical adverse outcome. Kaplan-Meier Survival Analysis for subgroups based on SDOH parameters Conclusion Association between demographic, clinical, and peri-operative complications, with focus on infection, provides opportunity to identify high-risk patients, and serves as a framework for additional interventions, such as close post-operative follow up, and robust involvement of social work and care management teams. Disclosures All Authors: No reported disclosures

Establishing robust infection control at a new hospital: the AIIMS Rajkot experience

The establishment of robust infection control practices is crucial in any new healthcare facility to ensure patient safety and prevent healthcare-associated infections (HAIs). All India Institute of Medical Sciences (AIIMS) Rajkot, a newly inaugurated medical institution in Western India, faced the significant challenge of implementing these practices from the ground up, beginning with its Outpatient Department services initiation on 31 December 2021. The AIIMS Rajkot initiated its infection control program by forming a Hospital Infection Control Committee and appointing dedicated Infection Control Officers and Infection Control Nurses. This initiative was supported by comprehensive training programs, the implementation of advanced infection control measures such as bundle care, HAI surveillance, and the development of outbreak investigation teams. Furthermore, the hospital focused on the continuous improvement of these practices through routine audits and the use of a digital Infection Control Risk Assessment form. The institution successfully integrated a structured infection control framework that includes rigorous training sessions, the implementation of a Hospital Infection Control Manual, and the establishment of a robust needle stick injury management team. These measures have led to improved compliance with infection prevention protocols, as evidenced by hand hygiene audits and reduced incidence of HAIs. The journey of establishing infection control practices at AIIMS Rajkot highlights the importance of a structured approach in new healthcare settings. The successful integration of these practices not only enhances patient and staff safety but also sets a standard for future healthcare facilities. The AIIMS Rajkot’s proactive measures and continuous improvement efforts serve as a model for effectively addressing the challenges of infection control in a dynamic healthcare environment.

The effects of perceived trust in coach on performance in soccer team: Mediating role of team climate

This study examined the effect of trust in coach as perceived by soccer players on team climate and team performance. The survey was conducted using a combination of in-person and online and responses were collected through a self-report questionnaire, allowing participants to provide answers based on their own experiences and perceptions. A total of 202 soccer players (N = 202, male: 135, female: 67) registered with the Korea Football Association (KFA) responded to the survey. The age range of the participants was between 14 and 29 years, with a mean age of 18.43 years. Furthermore, Participants’ team levels were categorized as middle and high school (74.7%), university (17.8%), and professional (7.5%). Descriptive statistical analysis was conducted to verify the normality of the data, while correlation analysis was performed to examine the relationships between variables. In addition, regression analysis was conducted using Hayes’ PROCESS macro to examine the mediating effects. As we expected, trust in coach was significantly related to team climate and team performance. Trust in coach was found to predict the team climate and team performance positively. Also, the mediating effect of team climate in the relationship between trust in coach and team performance was significant. These findings underscore the importance of trust and positive climate within sports teams, indicating the necessity of establishing trust between coaches and players and fostering a positive team climate for effective team management.

Contribution of Infrastructural Availability for School Growth and Sustainable Improvement in Academic Performance in Selected Secondary Schools in Tororo District

ABSTRACTThe study sought to establish the contribution of infrastructural availability to school growth and sustainable improvement of academic performance in selected secondary schools in Tororo District. The study employed a qualitative approach, and data were collected from school administrators, the management team and teachers using open‐ended questions based on interviews. Results were analysed thematically and presented verbatively. Findings showed that teaching aids, such as lesson plans, blackboard rulers, chalkboards, and textbooks are available and help improve academic performance, but overcrowded classrooms, poor ventilation and small space compared with the number of learners for a particular class are linked to lower levels of student engagement and learning. Noise levels have a significant impact on both teacher and student performance, and proper levels of natural illumination increase test results and teacher and student moods. Lack of commitment leads to skipping school and failing to complete assessment tasks. It was concluded that the Ugandan government supports the building of classrooms, libraries and laboratories in schools; teaching aids, such as textbooks lesson plans, blackboard rulers and chalkboards, raise teachers' morale to hold classes consistently, which helps schools expand and sustain improvements in academic performance. However, classrooms have poor ventilation and are overcrowded because of large enrolments. It is recommended that the government should improve the school infrastructure by renovating the classrooms, providing desks for children, making supplementary funding available to low‐performing schools and providing teachers with accommodations at schools to check the late coming, early departure and regular absenteeism of teachers on duty.

Violence Perpetrated by Learners and Management Towards Early-Career Educators in South African Township Schools

The reality in South Africa is that township school environments are not safe for early-career educators. According to South Africa’s Constitution in the Bill of Rights, every learner has the right to a free, reputable education. Although educators are obligated to facilitate this free education, the right to education does not supersede the right to safety because, without protection, more rights will be violated. This study aimed to explore forms of violence perpetrated by school management teams and learners against early-career educators in township schools in Soshanguve, South Africa. A qualitative research method was used to access deeper information on the topic. Clarke’s six steps of thematic analysis were used to analyse the data. Semi-structured interviews were used to gather information. The major findings of this study revealed four forms of violence experienced by early-career educators, which included physical and verbal violence, financial violence and sexual violence. This study recommends that parents should make a habit of checking their children’s schoolwork. This will hold learners accountable for their work. Parents should minimise engaging in conflict in the presence of their children, as this can have adverse emotional and psychological effects on them. They should provide a supportive environment for their children, which can foster a positive parent–child relationship. In addition, the community should play a proactive role in combating substance abuse by ensuring that substances are not accessible to children.

From the backroom to the boardroom: Health care chief information officers, stereotypes, and strategic leadership in the digital transformation era.

The digital transformation of the U.S. health care system is underway, but the role of health care chief information officers (HCIOs) in that transformation has been unclear. As the landscape of health care technology continues to expand, there is an increasing need to understand the influence of HCIOs, who are in a unique position to impact key strategic decisions. We seek to demonstrate the strategic importance of HCIOs in meeting the needs of digital transformation, by managing the emergence and strategic implementation of health care technologies to benefit health care organization performance. We also propose that profession-based stereotypes inhibit HCIOs as they may be viewed as behind-the-scenes technicians rather than strategic leaders. Upper echelons (UE) theory demonstrates how HCIOs' unique perspectives gained through education, experience, and the strategic decision-making process also can influence organizational performance. We build on UE to conceptualize the degree to which profession-based stereotypes moderate the decision-making of top management teams). We present two theoretical contributions. First, we introduce a profession-based stereotype moderated model of UE specific to HCIOs. Second, we offer an analysis of the role of HCIOs as strategic leaders in the digital transformation era. We call upon health care scholars and practitioners to examine HCIOs' influence and their roles in health care organization decision-making, top management team interactions, and organizational outcomes as the digital transformation in health care continues.

Is Liability of Foreignness Always Bad for Firms? A Study of the Influence of Top Management Team Foreignness on Corporate Greenwashing

ABSTRACTThis study investigates the impact of top management team (TMT) foreignness on corporate greenwashing. Drawing on social identity theory, we argue that foreign TMT members, suffering more from individual liability of foreignness (LOF), adopt a more cautious approach to uncertain environmental disclosures and are more concerned with preventing corporate misbehaviors. These lead foreign TMT members to communicate companies' environmental initiatives in a more honest manner, thereby effectively reducing corporate greenwashing. We further propose that the negative relation between TMT foreignness and greenwashing will be strengthened when a firm faces higher earnings pressure and operates in a less marketized environment, as these conditions exacerbate individual LOF on foreign TMT members. Empirical analysis of a sample of Chinese listed companies from 2010 to 2022 confirms our arguments, suggesting that hiring foreign executives can be an effective strategy for mitigating greenwashing, particularly in contexts where individual LOF is more pronounced.

External leadership knowledge integration and AI readiness in family firms: exploring the mediation effects of professionalization

PurposeAs the knowledge-based theory of the firm suggests, integrating leadership knowledge from non-family sources may be paramount in building competitive advantage, and leadership knowledge is an invaluable resource in building successful firms. In the volatile business environment, AI developments are among the key drivers of several thorough transformations, so the possible relationship between top management business talent and AI readiness has become essential. Our paper examines this link in the family business context, analyzing the possible mediation role of firm professionalization.Design/methodology/approachThe paper adopted a quantitative research approach. Data about Hungarian family firms were collected during March and April 2024. The authors used structural equation modeling, and results with and without controlling for a firm size and sector effect were compared. The final sample size contained 112 family firms.FindingsThe research findings suggest that the identified personal professionalization subdimensions have different mediation roles in the relationship between external knowledge integration in top management teams and AI readiness. Without including the control variables, the personal development and competence absorption subdimensions fully mediate this relationship, and the delegation subdimension does not have a significant mediation role. These two mediation effects become significantly weaker with the inclusion of firm size and sector control variables.Research limitations/implicationsThe results highlight the importance of competence absorption and development in family firms, especially when preparing for AI integration into business processes. In addition, the findings also emphasize that firm size may have a significant role in creating an AI-compatible business environment.Originality/valueThis paper aims to integrate the evolving field of firm professionalization with research on the effects of family involvement in corporate leadership. Professionalization dimensions are defined, and mediation roles of personal professionalization subdimensions are examined concerning the relationship between external knowledge integration in top management teams and AI readiness. The paper also highlights several new research directions that may enhance understanding the relationship between family leadership involvement and corporate outcomes.

Value creation in the green dynamic marketing capability: The role of organizational learning and green innovation

The global agreement on environmentally friendly policies puts pressure on businesses to implement good practices to increase legitimacy in a competitive environment. This research aims to examine business dynamic capabilities and value creation processes through the concept of green dynamic marketing capabilities. This concept addresses the ability of businesses to absorb, manage information and accumulate new knowledge that fuels innovative endeavors. The dynamic capability view and customer value theory are integrated to theoretically explain the value creation process of market-orientated innovative products. A total of 58 global companies in Clean200 were sampled. A quantitative approach was conducted to measure the effect of organizational learning (environment management team, environment management training, environment supply chain management) on green innovation (environmental innovation score, eco design product). The results showed that the contribution of Model-1 (0.473 or 47.3%) explained the effect of organizational learning on environmental innovation score, respectively on the variables of environment management team (2.859/0.005), environment management training (−2.971/0.003), and environment supply chain management (7.786/0.000). The contribution of Model-2 (0.448/44.8%) explains the effect of organizational learning on eco-design product, respectively on the variables of environment management team (4.280/0.000), environment management training (−6.401/0.000), and environment supply chain management (7.910/0.000). Model-3 tested the structural association variables in organizational learning and green innovation. A significant influence can be seen with a probability value smaller than 0.05. This research shows that the concept of green dynamic marketing capabilities can be used to explain the ability of businesses in response to the pressure of green global norms through the development of organizational learning towards creation of green innovation product that has impact on market performance. The implication of this research is the creation of new mindset in which green global norms challenge becomes an opportunity for businesses to improve competitiveness.

N33 Construction and Application of a Digital Management Platform for the Whole Course of Inflammatory Bowel Disease Patients Based on Action Research

Abstract Background Utilize digital technology to construct a digital platform-based comprehensive management model for Inflammatory Bowel Disease (IBD) patients, and design and develop a digital management platform for IBD patients to achieve efficient, convenient, and intelligent IBD management. Methods From October 2021 to December 2022, under the guidance of action research methodology and based on the chronic disease care model, a digital platform-based management model for the entire course of Inflammatory Bowel Disease (IBD) patients was constructed through a spiral cycle process of "diagnosis, planning, implementation, evaluation, and reflection." Leveraging digital technology and using the online hospital as a vehicle, a comprehensive management platform for IBD patients throughout the entire course of their disease was designed and developed. A total of 83 IBD patients were selected and divided into a control group of 42 cases and an intervention group of 41 cases. The control group received outpatient follow-up plus standard treatment, while the intervention group received outpatient follow-up, standard treatment, and a digital comprehensive course management model. Each group was followed up for 3 and 6 months to observe the patients' fecal calprotectin levels, Inflammatory Bowel Disease Short Health Status (IBDSHS), and patient satisfaction. Results After two rounds of action research, a comprehensive management model for IBD patients throughout the entire course of their disease has been established, comprising three major elements: a digital platform, patients, and a healthcare management team. This platform offers services such as doctor-patient interaction, health consultation, self-management support, health data upload, access to laboratory test reports, and informational support. The intervention group showed lower fecal calprotectin levels at both 3 and 6 months compared to the control group; improvements in all dimensions of the brief health status were significantly greater in the intervention group, and satisfaction was higher in the intervention group than in the control group. Conclusion This study employs action research methods, integrating the practical aspects of IBD clinical diagnosis and care in China, the characteristics of IBD, patient needs, and medical staff requirements, to construct a digital platform-based management model for the entire course of IBD patients. This model not only aligns with the trend of innovative development in China's medical services but also establishes a closed-loop management model centered on IBD patients throughout the entire course of the disease, serving as a tool for the comprehensive management of IBD patients.

Explainable AI Using OBDII Data for Urban Buses Maintenance Management: A Study Case About the DPF Regeneration

Industry 4.0, leveraging tools like AI and the massive generation of data, is driving a paradigm shift in maintenance management. Specifically, in the realm of Artificial Intelligence (AI), traditionally “black box” models are now being unveiled through explainable AI techniques, which provide insights into model decision-making processes. This study addresses the underutilization of these techniques alongside On-Board Diagnostics data by maintenance management teams in urban bus fleets for addressing key issues affecting vehicle reliability and maintenance needs. In the context of urban bus fleets, diesel particulate filter regeneration processes frequently operate under suboptimal conditions, accelerating engine oil degradation and increasing maintenance costs. Due to limited documentation on the control system of the filter, the maintenance team faces obstacles in proposing solutions based on a comprehensive understanding of the system’s behavior and control logic. The objective of this study is to analyze and predict the various states during the diesel particulate filter regeneration process using Machine Learning and explainable artificial intelligence techniques. The insights obtained aim to provide the maintenance team with a deeper understanding of the filter’s control logic, enabling them to develop proposals grounded in a comprehensive understanding of the system. This study employs a combination of traditional Machine Learning models, including XGBoost, LightGBM, Random Forest, and Support Vector Machine. The target variable, representing three possible regeneration states, was transformed using a one-vs-rest approach, resulting in three binary classification tasks where each target state was individually classified against all other states. Additionally, explainable AI techniques such as Shapley Additive Explanations, Partial Dependence Plots, and Individual Conditional Expectation were applied to interpret and visualize the conditions influencing each regeneration state. The results successfully associate two states with specific operating conditions and establish operational thresholds for key variables, offering practical guidelines for optimizing the regeneration process.

Asymmetric role of board diversity on green growth mechanism: Evidence from COP27 framework.

Corporate governance has an ethical and legal obligation to safeguard environment from the effects of business operations. In this vein, our study examines the role of board diversity in green growth, renewable energy, social inclusion, and natural capital protection. A green growth index was created using indicators endorsed by the Global Green Growth Organization to accomplish the research objectives. For the 2012-2023, a panel of 451 US non-financial firms was selected from the S&P1500 index. The proposed hypotheses were tested using a fixed effect and quantile-based GMM. The MMQR findings suggest a potential non-linear relationship between diversity in the top management team and green growth. Moreover, a diverse workforce can also encourage environmentally friendly practices. Furthermore, renewable energy has been found to benefit from US board diversity. However, a diverse boardroom can harm social inclusion in the US. In addition, workforce diversity stimulates renewable energy use and social inclusion and protects US natural capital. The impact of board diversity on green growth, renewable energy use (SDG7), and natural capital protection can be amplified by enhancing the diversity of independent directors, gender diversity, and professionals from different backgrounds. Diversity in the workforce and boardrooms is imperative to renewable energy, social inclusion and the protection of natural capital. In the US-listed firms, their marginal impact should be improved.

Internationalisation patterns of academic spin-offs

Abstract The aim of this paper is twofold. Firstly, to analyse the international behaviour of academic spin-offs to explore the internationalisation patterns followed by these companies, considering precocity, scale, and scope as the key dimensions of the internationalisation process. The second objective is to discern whether academic spin-offs that follow different patterns present distinctive characteristics. To test the hypotheses, a cluster analysis, a series of ANOVA analyses of variance and post hoc tests were performed on a sample of 161 Spanish academic spin-offs. Results show that 49% of these firms do not internationalise and that three patterns of internationalisation exist in academic spin-offs: true born global, sporadic born global, and born again global. On the other hand, the results also reveal distinctive antecedent factors among the different internationalisation patterns. Thus, international industrial networks and management team functional heterogeneity are more relevant in academic spin-offs that follow the true born global and the born again global patterns, while global technological competence is significant for all three internationalisation patterns, and international academic networks present minor importance for the internationalisation process developed by academic spin-offs.

A qualitative exploration of the barriers and facilitators to the implementation of the alcohol assertive outreach model.

Alcohol use disorder has adverse implications for individuals' health, utilisation of healthcare services, and societal costs. There are a group of individuals who frequently attend hospital for alcohol-related issues, have complex co-morbid needs, and experience barriers to engaging with specialised alcohol treatment services. To support these individuals and reduce healthcare system costs, Alcohol Assertive Outreach Treatment (AAOT) has been recommended. However, AAOT is not routinely used in the UK. Understanding the determinants of the implementation of AAOT can increase its utilisation and effectiveness. This study therefore employed the Consolidated Framework for Implementation Research (CFIR) framework to highlight barriers and facilitators to the successful and sustainable implementation of AAOT. Semi-structured interviews were conducted with twenty AAOT team staff members (team managers and outreach workers) from two North West England AAOT teams. Twenty-eight stakeholders (clinicians, commissioners, policy makers and academics across England) were also interviewed, who were considered to be key contributors to AAOT implementation, both within and external to North West England. Framework analysis based on the CFIR was conducted, whilst allowing for inductive coding where appropriate. Overall, participants recognised AAOT as acceptable and beneficial. Three main themes were identified: organisational and individual level factors, including team culture and staff characteristics; systemic partnerships and interagency communication; and an adaptable model driven by research and evaluation. Each theme relates to various CFIR domains and constructs which were perceived to influence the implementation of AAOT. Readers are encouraged to consider the findings in the development and implementation of AAOT teams, new or existing.

Effectiveness of training hospital management teams in tier three hospitals in Kiambu County and utilization of routine health information

Health information is essential for health decision-making at all levels of the health pyramid. This study investigated the effect of training HMTs in tier three hospitals in Kiambu County and utilization of routine health information. The study design was interventional, employing a quasi-experimental research design that guided the study in the 12 tier-three hospitals. There was an intervention cluster and a control cluster, each with six hospitals. The study adopted a census technique, and all 240 HMT members were included. The study used both qualitative and qualitative data collection techniques. Data was analysed using Fisher’s exact test for the bi-variate analysis, logistics regression to ascertain the statistical relationships, Mann-Whitney U-test to test the difference in means at baseline and end-line, Difference in Difference technique was used to establish the average treatment effect of the intervention. The study used thematic content analysis to analyse qualitative data. The County Health Management Teams and the Sub County Health Management Teams participated in the Key Informant interviews. The results revealed a significant association between the training and the odds of good utilization (A.O. R=9.01, p=0.0001). Those who received training are 9 times more likely to utilize RHI. The study concludes that, designing HIS should be based on the users’ desired needs and that the intervention was highly effective in promoting the use of the RHI among HMTs. The study recommends that Kiambu County Department of Health should provide strategies for sustaining effective utilization RHI and should provide guidelines to ensure all HMTs are trained to enable them manage hospitals better. The study recommends that; further research be conducted in the lower-level health facilities to generate recommendations appropriate for the different levels of health care systems, similar studies should be replicated in other countries to compare results and enable the drawing of triangulated policy recommendations and a follow-up study be done to determine whether the increase in utilization translates into improved health outcomes or efficiencies within the health system.

Effectiveness of socio-economic-demographic factors on utilization of routine health information among hospital management teams in tier-three hospitals in in Kiambu County, Kenya

This study investigated the effectiveness of socio-economic-demographic factors on utilization of routine health information among HMTs in tier-three hospitals in Kiambu County. The study design was interventional, employing a quasi-experimental research design that guided the study in the 12 tier-three hospitals. There was an intervention cluster and a control cluster, each with six hospitals. The study adopted a census technique, and all 240 HMT members were included. The study used both qualitative and qualitative data collection techniques. Data was analysed using Fisher’s exact test for the bi-variate analysis, logistics regression to ascertain the statistical relationships, Mann-Whitney U-test to test the difference in means at baseline and end-line, Difference in Difference technique was used to establish the average treatment effect of the intervention. The study used thematic content analysis to analyse qualitative data. The County Health Management Teams and the Sub County Health Management Teams participated in the Key Informant interviews. The results indicate that there was no statistically significant difference regarding the socio-economic-demographic factors before and after the intervention, (Mann-Whitney U-test results (U = 28333, p = 0.7851). The study concludes that, designing HIS should be based on the users’ desired needs and that the intervention was highly effective in promoting the use of the RHI among HMTs. The study recommends that Kiambu County Department of Health should provide strategies for sustaining effective utilization RHI and should provide guidelines to ensure all HMTs are trained to enable them manage hospitals better. The study recommends that; further research be conducted in the lower-level health facilities to generate recommendations appropriate for the different levels of health care systems, similar studies should be replicated in other countries to compare results and enable the drawing of triangulated policy recommendations and a follow-up study be done to determine whether the increase in utilization translates into improved health outcomes or efficiencies within the health system.

Implementation of multidisciplinary team decisions on the management of complex bone and joint infections: an observational study

BackgroundMultidisciplinary team (MDT) management of prosthetic joint infections (PJI) and other bone and joint infections (BJI) is increasingly put into practice. However, studies evaluating the performance of MDTs in this field are scarce. We aimed to assess our MDT for complex BJI by determining the implementation rate of team decisions, analyzing factors associated with non-implementation and evaluating the clinical outcome of patients in whom MDT decisions were not implemented.MethodsAn observational study was conducted on all patients with a PJI or other BJI of which the management was discussed during MDT meetings between 2015 and 2022 in a tertiary care academic hospital. Patient characteristics and MDT data were obtained from electronic patient records. The multidisciplinary team consisted of orthopaedic surgeons, trauma surgeons, infectious diseases specialists and clinical microbiologists. A decision was considered not implemented if the patient did not receive the management that was decided by the MDT. Factors possibly associated with non-implementation were statistically analyzed using logistic regression.ResultsThe analysis included 1321 MDT decisions on 509 patients. The overall implementation rate of MDT decisions was 92%. Reasons for non-implementation were disagreement by the treating surgeon with the MDT regarding the optimal treatment (n = 24, 23%), patient preference for a different treatment (n = 19, 18%), new clinical information not yet available during the MDT meeting that made the physician change management (n = 17, 16%) or unknown (n = 45, 43%). Trauma surgeons were more likely to not implement an MDT decision (odds ratio 2.4, p = 0.01) The cure rate of patients who received a different surgical strategy than decided by the MDT was 33%. The cure rate was lower if a patient chose to deviate from the MDT decision (46%) than when the treating physician chose to deviate from the MDT decision (77%).ConclusionThe implementation rate of decisions made by our complex BJI MDT was high. Furthermore, the current study suggests that non-implementation of MDT decisions on surgical management and non-implementation initiated by the patient lead to poor clinical outcomes. An analysis of MDT decision implementation is a useful tool to evaluate the impact of MDTs and further improve its quality.

Board–TMT task conflict: The impact on shared strategic vision and moderating effect of shared leadership

ABSTRACT In this article, we study the top management team (TMT) and board of directors as a strategic-oriented multiteam system, termed the strategic leadership system (SLS), responsible for the firm’s strategic decision-making. This SLS must collaborate effectively to enhance strategic decision-making quality. However, boards are designed to challenge TMT decisions, often leading to diverging viewpoints among these decision-making groups. Utilizing factional faultlines and information-processing perspectives, we argue that the extent of board-TMT task conflict negatively affects a shared strategic vision within the SLS. Additionally, we explore the moderating role of the extent of shared leadership within the SLS, which we define as the varying perceptions among all SLS members regarding who is recognized as the leader of the SLS. Analysis of multiple-respondent data from 387 SLS members in 41 Belgian private family firms shows that task conflict negatively impacts the shared strategic vision, particularly when leadership is perceived to be shared.

중·고등학교 축구 팀 운영 형태에 따른 학생선수의 학교생활 적응 및 진로결정 자기효능감, 사회적 지지 차이 분석

Objectives The purpose of this study was to analyze differences in student-athletes' school adjustment, career decision self-efficacy, and social support based on the type of soccer team they play on in middle and high school. Methods To achieve the objectives of this study, student-athletes from secondary school football teams and football club teams were selected as the subjects of the study. Convenience sampling was used to select the sample, and a questionnaire was distributed to collect data. A total of 425 copies of the questionnaires were selected for the study. The data was processed using the SPSS 21 programme. Frequency analysis was conducted to identify the general characteristics of the study population. Independent samples t-test was conducted to determine the differences in student-athletes' adjustment to school life, career decision self-efficacy, and social support according to the type of football team management.. Results The results of the analysis of the differences in student-athletes' adjustment to school life according to team management type showed that student-athletes in club teams had higher scores in all sub-factors of relationship with teachers, relationship with classmates, understanding and participation in class, following rules and activities, and cyber class and communication, with statistical significance. When analysing the difference in career decision self-efficacy between student-athletes with different team management styles, the results showed that club team players were higher in all sub-components of self-assessment, gathering career information, planning, goal setting, and problem solving, with statistical significance. When analysing the difference in social support between student-athletes with different team management styles, the results showed that club team members were higher in all sub-factors of daily emotional support, problem emotional support, social support, daily tool support, and problem tool support, with statistical significance. Conclusions We found that differences in the way school teams and club teams are organised affect student-athletes' adjustment to school life, career decision self-efficacy, and social support. These differences may have a somewhat negative impact on student-athletes in school teams, suggesting that the overall career guidance and sports activities of student-athletes should be reconsidered from the perspective of the educational experience.