Hospital Workforce Research Articles

Cluster randomized trial of influenza vaccination in patients with acute heart failure in China: A mixed-methods feasibility study.

Uncertainties about the efficacy of influenza vaccination for populations with heart failure (HF) in preventing cardiovascular outcomes, as well as lack of effective vaccination strategies, may contribute to low vaccine coverage rate (VCR) in China and globally. We assessed the feasibility of a strategy to promote influenza vaccines in patients hospitalized with acute HF in China and to inform the design of a hybrid effectiveness-implementation cluster randomized trial to evaluate this strategy on mortality and hospital re-admission. We conducted a cluster randomized pilot trial involving 11 hospitals in Henan Province in China, with mixed-methods evaluation between December 2020 and April 2021. A process evaluation involved interviews with 51 key informants (patients, health professionals, policy makers). The intervention included education about influenza vaccination and availability of free vaccines administered prior to hospital discharge for HF patients, while usual care included attending community-based points of vaccination (PoV) for screening and vaccination. Implementation outcomes focused on reach, fidelity, adoption, and acceptability. Recruitment rates were assessed for trial feasibility. Effectiveness outcomes were influenza VCR, HF-specific rehospitalizations and mortality at 90 days. A total of 518 HF patients were recruited from 7 intervention and 4 usual care hospitals (mean of 45 participants per hospital per month). VCR was 89.9% (311/346, 86.1-92.8%) in the intervention group and 0.6% (1/172, 0.0-3.7%) in the control group. The process evaluation demonstrated reach to patients with lower socioeconomic and education status. There was good fidelity of the intervention components, with education and PoV set up processes being adapted to local hospital workflow and workforce capacity. Intervention was acceptable and adopted by patients and health professionals. However, outside of a trial setting, concerns were raised around vaccination reimbursement costs, workforce accountability and capacity. The intervention strategy appears feasible and acceptable for improving VCR in HF patients at county-level hospitals in China. Trial registration: This pilot trial is registered with the acronym PANDA II Pilot (Population Assessment of Influenza and Disease Activity) at ChiCTR.org.cn (ChiCTR2000039081).

Use it or lose it? Identifying reasons for the low use of psychosocial support by hospital staff

BackgroundPsychosocial support programs are a way for hospitals to support the mental health of their staff. However, while support is needed, utilization of support by hospital staff remains low. This study aims to identify reasons for non-use and elements that are important to consider when offering psychosocial support.MethodsThis mixed-method, multiple case study used survey data and in-depth interviews to assess the extent of psychosocial support use, reasons for non-use and perceived important elements regarding the offering of psychosocial support among Dutch hospital staff. The study focused on a time of especially high need, namely the COVID-19 pandemic. Descriptive statistics were used to assess frequency of use among 1514 staff. The constant comparative method was used to analyze answers provided to two open-ended survey questions (n = 274 respondents) and in-depth interviews (n = 37 interviewees).ResultsThe use of psychosocial support decreased from 8.4% in December 2020 to 3.6% by September 2021. We identified four main reasons for non-use of support: deeming support unnecessary, deeming support unsuitable, being unaware of the availability, or feeling undeserving of support. Furthermore, we uncovered four important elements: offer support structurally after the crisis, adjust support to diverse needs, ensure accessibility and awareness, and an active role for supervisors.ConclusionsOur results show that the low use of psychosocial support by hospital staff is shaped by individual, organizational, and support-specific factors. These factors can be targeted to increase use of psychosocial support, whereby it is important to also focus on the wider hospital workforce in addition to frontline staff.

Hospital workforce engagement, satisfaction, burnout and effects on patient mortality: Findings from the English national health service staff surveys.

Previous studies of healthcare organizations' workforces and their performance have focused on burnout and its impact on care. The aim of this research is to expand on this and examine the association of positive organizational states, engagement and recommendation of employer as a place to work, in comparison to burnout on Hospital performance. Methods: This was a panel study of the respondents to the 2012-2019 yearly Staff Surveys of the English National Health Service (NHS) hospital Trusts with hospital performance measured by the adjusted inpatient Summary Hospital-level Mortality Indicator (SHMI). Results: In univariable regression, all three organizational states significantly and negatively correlated with SHMI, with recommendation and engagement showing a nonlinear effect. In multivariable analysis, all three states remained significant predictors of SHMI. Engagement and recommendation showed mutual correlation, with engagement being a more prevalent state than recommendation. Conclusion: Our study indicates that organizations could benefit from monitoring multiple workforce variables to preserve or enhance workforce well-being, while optimizing organizational performance. The surprising finding that higher burnout was associated with improved short-term performance requires further investigation, as does the finding of less frequent staff recommendation of work compared to staff engagement with their work.

Hospital Workforce Education and Training for Emergency Management and Disaster Response in Complex Settings.

Introduction:Understanding how to best prepare hospital staff for disasters or emergencies is critical, as there is increasing frequency and scope of these events. Considerations include: identifying key staff, their roles, strategies to support continuity of care, delivery mode of education, and resource allocation.Method:Participants experienced in disasters and major emergencies or preparation at three tertiary referral teaching hospitals were purposively selected during 2016 and 2019. An interpretive paradigm and case study design enabled the exploration of perspectives concerning effective and preferred methods for preparedness. Fifty-five allied health professionals, medical practitioners, and nurses participated in semi-structured interviews; and support staff participated in focus groups.Results:Key findings: 1. Recognition that allied health professionals and support staff are essential and must be included in disaster or major emergency preparation and plans. 2. Factors that increase the likelihood of staff deciding to be absent from work include: perception of danger, insufficient understanding of responsibilities, and hospital preparation is perceived inadequate. Staff understanding their role has a positive influence for attendance and coping during disasters. 3. Preferred and most effective method of disaster preparedness is practical learning, combined with other preparation methods. Online learning as the major mode was unpopular. 4. Challenges of inadequate resources limits managers’ ability to facilitate staff preparation and care delivery during disasters. Resources affect method, duration and multidisciplinary inclusion in disaster preparation.Conclusion:This research found disaster preparedness in hospitals is critical. Site and occupation specific differences need to be addressed. To mitigate impacts of disasters or major emergencies, preparation must include identification of required resources. Disaster preparedness and management must be inclusive of multidisciplinary staff, including allied health and support staff. Facilitation of role understanding to promote continuity of care during disasters or major emergencies is imperative to promote staff participation and effectiveness in response to disasters.

Sick Leave Determinants in the Healthcare Sector (Part II): A Review of Organizational-Level Factors.

Background: Organizational level factors may influence and contribute to sick leave in healthcare, and particularly hospital, settings. We utilize relevant publications from recent literature to provide a useful, comprehensive and evidence-based resource for readers interested in effective human resource management and healthcare or hospital workforce planning. Methods: To ensure that pertinent papers (2004 – 2022) were identified, a systematic literature review was performed searching Google Scholar, Econ Lit, PubMed, ResearchGate, ScienceDirect, Emerald Insight, Scopus, Medline, PsychInfo, and Web of Science databases. All abstracts were screened to identify papers that empirically investigated organizational level factors relevant to sickness absence in a healthcare population. A total of 452 papers were initially identified. These were reduced to 133 papers using pre-determined inclusion and exclusion criteria. Results: Key factors associated with sickness absence in healthcare staff were long hours worked, work overload, working conditions and stress, and the effects of these on personal lives; job control including lack of participation in decision making; poor social support. Other organizational-level factors such as size and type of organization reflected strong association with absence levels. Shorter distance from work and seniority of position are reported to have a strong negative association with absenteeism. Management leadership style and workload were not found to be determinants. Conclusions: Interventions that improved psychological health and levels of sickness absence used training and organizational approaches to increase participation in decision making and problem solving, increase support and feedback, and improve communication. Many of the work-related variables associated with high levels of psychosocial factors are potentially amenable to change. This is Part II of a series describing factors influencing absenteeism in the healthcare sector.

Hospital Equipment Maintenance Management for Reliable and Effective Health Care Services in Nepal

The management of biomedical engineering instruments accuracy in Nepali hospitals has been a pressing issue, largely attributed to the lack of qualified biomedical engineering operations management teams. This challenge becomes even more complex due to the vast array of biomedical equipment imported from abroad, many of which are not only diverse but also relatively expensive. The primary concern in Nepal is to establish an efficient and competent biomedical equipment accuracy management system that can optimize the precision, longevity, and reliability of these crucial medical devices. The absence of well-organized biomedical engineering operations management teams has far-reaching consequences, as it hinders the healthcare sector's ability to deliver superior and consistent services to patients, ultimately affecting diagnostic accuracy. To overcome this challenge, it is imperative to develop a well-managed and qualified biomedical engineering operations management workforce in hospitals and healthcare centers. This entails the acquisition of modern skills to effectively oversee, test, calibrate, and validate medical devices, thereby extending the lifespan of these instruments and ensuring consistent and accurate diagnostics for reliable healthcare services. The integration of such skills is essential for elevating the standards of healthcare in Nepal and enhancing the well-being of its population.

Advancing the diversity and inclusion agenda in healthcare organizations: The case of German university hospitals

Introduction: Diversity and inclusion (D&I) challenges in the hospital workforce continue to pose threats to an inclusive work environment. Acknowledging the benefits of a diverse and inclusive healthcare workforce, the Association of German University Hospitals signed the German Diversity Charter to encourage its member hospitals to apply policies to cultivate such a workplace. This policy brief explores the implementation of D&I policies aligned with the Charter in six university hospitals in Germany, aiming to identify the policy gaps and provide recommendations for improvement. Policy Options: The Charter´s commitments include a shared organizational vision of D&I as a source of great potential and the significant support of the senior management. It also includes D&I in employment processes, open communication about policies, and active employee engagement. Overall, a comprehensive D&I strategy has been shown to be vital for sustainable change. However, not all the hospitals have signed it, nor do all fully adhere to its policies. Therefore, recommendations are provided for the Association to support their constituents in working toward comprehensive D&I policies. Recommendations: Most importantly, the Association should further promote D&I awareness, enhance the support to the hospitals to improve D&I activities, and lead and monitor the implementation and outcomes of the adopted D&I strategies and policies. The comprehensive approach includes transparency; measurement and evaluation to assess the successes and failures of the strategies; the commitment by senior management to D&I efforts; and bottom-up involvement for employees to share their concerns and get involved.

The Adequacy of Hospital Response to COVID-19 Pandemic amongst Surgical Institutions in South-Eastern Nigeria.

The novel corona virus (COVID-19) was first diagnosed in Wuhan, China in December 2019. The healthcare specifically, departments of surgery in Southeastern Nigeria, are making modifications to cope and plan for the pandemic. To evaluate how well surgical institutions in Southeastern Nigeria are prepared for the anticipated influx of Covid-19 patients, existing patients and to determine the adequacy of hospital provision of essential supplies and awareness creation. A cross-sectional online study of two hundred and one (201) surgery resident doctors in surgical institutions in South-eastern Nigeria was conducted. Questionnaires were designed and distributed using online platforms. The data obtained was analyzed using the Statistical Package for the Social Sciences (SPSS). Significance was set at P < 0.05. Consent was obtained from all respondents. A total of 201 surgery resident doctors filled and submitted their questionnaires, response rate of 71.5%, out of which 50.1% agreed that hospital response to Covid-19 pandemic was inadequate, 78.3% agreed that the Personal Protective Equipment (PPEs) provided by hospitals were inadequate while about 53.8% agreed that the hospital workforce was poor and inadequate and incapable of adapting to the unstable workforce during the pandemic. About 46.2% agreed that the hospitals were conducting an adequate creation of awareness with regards to the pandemic while 25% agreed that the hospital compliance with the CDC (Center for disease control) preventive protocols/guidelines in surgical institutions were adequate.There was a statistically significant association (P = 0.019 (< 0.05); X2= 5.517) between hospital type and provision of adequate Personal protective equipment for surgical procedures. Only 19% of the government hospital employees felt that adequate amount of PPEs were provided compared to 41% of private hospital employees. The results from this study show that the hospital response to Covid-19 pandemic and awareness creation amongst surgical institutions in Southeastern Nigeria are inadequate. The government should equip the health sector by providing the necessary amenities to adequately combat the challenges of surgical practice in the Covid-19 pandemic.

Development and Preliminary Evaluation of Patient Perceptions on Safety Culture in a Hospital Setting Scale.

Majority of the existing patient safety culture tools are designed for healthcare workers. Despite the claims that this patient safety tools are patient-centered, limited attention was given to the patients' perspectives and cultural considerations in the development. Local studies are not available in extant literature that capture patient perspectives on being safe during hospitalization. The goal of the study was to develop and provide preliminary psychometric analysis on a tool that measures patients' perception of safety culture in a hospital setting. The study was a quantitative methodological study. The instrument was developed in three phases, conceptualization and item generation through literature review, clinical observation, and focus group discussion, two rounds of expert panel review, and pilot testing. The tool was tested on 122 eligible patients admitted in a tertiary hospital. Factor analysis of the items was done to determine the underlying factor under each item. Cronbach's alpha was used to test the degree of internal consistency of the scale. The Patient Perceptions on Safety Culture in Hospital Setting Scale consists of 25 items. The analysis yielded four factors explaining a total of 69.23% of the variance in the data. Items were grouped in four dimensions: Hospital workforce (4 items), Hospital Environment (5 items), Heath Management and Care Delivery (7 items), and Information Exchange (9 items). Each factor registered a Cronbach's alpha of 0.81, 0.78, 0.91, 0.94, respectively. The overall Cronbach's alpha of the scale is 0.95. The study offers preliminary evidence on the psychometric properties of a newly developed tool that measures patient perceptions on hospital safety culture. Subsequent studies on larger samples need to be conducted to determine the reliability and validity of the tool when applied to different population and contexts as well as determining valid cut-off points in scoring and interpretation.

Adapting infection prevention and control assessment tools for use in low- and middle-income countries

Background: There are many existing infection prevention and control (IPC) tools developed and validated by large organizations such as the World Health Organization (WHO) and the Centers for Disease Control and Prevention. These tools are generally created with little input from professionals working in low-income regions and are tested in high-income countries and/or high-level facilities in low- and middle-income countries (LMICs). Recent publications have highlighted both the disproportionate burden of surgical site infections (SSIs) in LMICs and the very limited data on surgical conditions and practices in these regions. There is a need and a desire for quality improvement in SSI/IPC/patient safety in low-level facilities in LMIC. Therefore, a logical starting point would be to adapt available tools for use in resource-limited facilities, with a strong focus on input and enthusiastic participation from local health-care workers and leadership. Our goal was to assess IPC capacity of facilities by analyzing health-care-associated infection (HAI) surveillance, hospital workforce and infrastructure, environmental cleaning, and surgical operative practices. Methods: We created an adapted survey using components from the WHO’s Guideline on Core Components for IPC and Essential Surgical Care Situational Analysis Tool that addressed IPC program support, HAI surveillance, surgical preparation practices, and infrastructural support. Purposive sampling was used to identify 23 health facilities across 7 counties in Kenya. We chose to use cesarean section as a bellwether procedure because it is a high-volume procedure in LMIC. Permission to conduct the survey was solicited from facility leadership prior to the beginning of the survey. Two surveyors visited each facility to complete the adapted assessment framework. Results: All facilities had an IPC program and 22 (95.6%) reported that their program was supported by facility leadership and a professional IPC team. However, only 10 (43.5%) facilities reported a specific IPC budget. Eight (34.8%) facilities had on-site and 8 (34.8%) had off-site microbiological laboratory. Twelve (52.2%) conducted HAI surveillance, and out of those that conducted HAI surveillance, 11 (91.7%) monitored specifically for SSIs. Most had adequate and reliable water (95.6%) and power (91.3%). Fifteen (65.2%) allowed bed-sharing and 6 (26.1%) placed beds in hallways or areas other than rooms. Over 75% of facilities did not follow the WHO-recommended preoperative practices on bathing, hair removal, and skin preparation. Conclusions: This survey was a time and resource-efficient way of collecting the data needed to understand the variables associated with surgery, SSI, and IPC in low-level facilities. Clear targets for surgical practice improvement were identified, and the workforce and infrastructure data will be used to design effective and sustainable solutions.

Sick Leave Determinants in the Healthcare Sector (Part I): A Review of Contextual Factors

Background: This study aims to describe contextual factors that influence and contribute to sick leave in healthcare, especially in hospital settings. This review would provide a valuable, comprehensive, and evidence-based resource for readers interested in effective human resource management and healthcare or hospital workforce planning. This review referred to studies on the determinants of absenteeism in the healthcare setting. Methods: To ensure that pertinent papers (2004 – 2022) were identified, a literature search was performed searching Google Scholar, Econ Lit, PubMed, ResearchGate, ScienceDirect, Emerald Insight, Scopus, Medline, PsychInfo, and Web of Science. All abstracts were screened to identify papers that empirically investigated contextual factors of work absence in healthcare populations. A total of 126 papers were initially identified. These were reduced to 61 papers using pre-determined inclusion and exclusion criteria. Results: Contextual factors such as nature of work, cultural expectations, economic conditions, and seasonality have moderately strong associations with absence. There is a negative relationship between high psychological demands and work-related absenteeism. The key factors associated with sickness absence in healthcare staff were long hours worked, night shifts, changing rostering patterns, work overload and stress, physically demanding roles, poor social support. Other contextual factors such as cultural norms and expectations that support poor attendance reflected strong association with absence levels. Economic conditions are negatively associated with absenteeism as a result of job security fears. Absenteeism is more pronounced during winter and school holidays. Conclusions: The review concluded that interventions such as screening the prior attendance levels of potential employees would assist greatly in terms of absenteeism rates, while monitoring current absence patterns of existing employees will negate the development of cultural norms in the workplace. Many of the contextual related variables associated with high levels of absenteeism are reducible with the development of screening and monitoring tools.

Influence of years of experience and age on hospital workforce compassion satisfaction, anxiety, depression, stress, and burnout during pandemic: Implications for retention

ABSTRACT The hospital workforce is experiencing overwork and burnout in response to COVID-19. It is imperative to identify those experiencing mental duress and determine protective factors to promote mental wellness and workforce retention. Our research aim was to identify the mental wellness and professional quality of life among hospital staff working during a global health pandemic, and to determine if age or years of experience served as protective factors. We electronically surveyed hospital staff in North Dakota during Summer 2021. Participants reported demographic data and completed clinically validated behavioral health screening tools assessing anxiety, depression, perceived stress, and work-related quality of life. The survey was administered to all 47 hospitals in North Dakota and received 771 complete responses. All hospital staff ages 18 and older were invited to participate. Age and years of experience were collected categorically in line with research on the topic. Years of experience had a significant influence (p < 0.05) on compassion satisfaction, burnout, and perceived stress. Compassion satisfaction was lowest for those who had worked 5–10 years, and then began to increase incrementally every 10 years thereafter. Hospital staff with 21–30 years of experience reported the highest mean score for both perceived stress and depression. Age had a significant influence (p < 0.05) on scores for anxiety, depression, compassion satisfaction, burnout, secondary traumatic stress, and perceived stress. Those closest to retirement (the oldest and those with the greatest years of experience) reported higher compassion satisfaction, while the youngest cohorts reported experiencing greater stress and burnout and may subsequently leave the profession. This may impact access to, and quality of, care. This study demonstrates the need to implement interventions with a focus on defending healthcare workers from the psychological effects of their caring profession.

Application of healthcare failure mode and effect analysis in controlling surgical instrument packaging defects

Surgical instrument packaging defects may affect the safety of medical care and patients and waste the hospital workforce, material resources, and financial resources. This study explored the application of healthcare failure mode and effect analysis in controlling surgical instrument packaging defects. We retrospectively evaluated the packaging process of 183,642 surgical instruments packaged in our hospital during January–June 2020 using the healthcare failure mode and effect analysis. Besides, we used a decision tree model to determine the steps requiring improvement and formulate the improvement measures. We applied the improvement measures to 190,231 surgical instrument packs packaged in our hospital during July–December 2020. Based on the healthcare failure mode and effect analysis, we compared the packaging defect rates before and after adopting the improvement measures. Of the 183,642 packs selected before adopting the improvement measures, 98 defects occurred, with a defect rate of 0.053%. However, of the 190,231 packs selected after adopting the improvement measures, 22 defects occurred, with a defect rate of 0.012%. The defect rate of surgical instrument packaging handled by the central sterile supply department staff was significantly reduced (χ2 = 50.822, P = 0.001) after adopting the improvement measures. Using the medical failure mode and effect analysis method to control the defects in surgical instrument packaging can effectively reduce the packaging defect rate, ensuring patient safety.

Personal assistants in England and the factors associated with absenteeism.

Personal assistants (PAs) have become an increasingly important element of long-term care (LTC) in England since the introduction of Direct Payments in 1996 and the Care Act 2014 legislation. The PAs, who are directly employed by social care users, can perform a number of support tasks including vital assistance in activities of daily living (ADL). Internationally these roles would be classed as domestic care work, including the employment of migrant care workers, e.g. in Germany and Austria. High turnover rates and work absenteeism in this market can cause disruption of these important daily activities, causing LTC users to potentially suffer neglect and poorer quality of life. Although there is research on turnover and absenteeism in nursing workforce in hospitals and LTC workers in nursing homes, little attention has been given to reasons for turnover of PAs and even less for absenteeism, which often precedes turnover, in a workforce of over 100,000 people in England. This research aims to fill this gap in knowledge by analyzing the reasons behind the absenteeism of PAs using quantitative methods. We used survey data of PAs in England, exploring the factors associated to one form of absenteeism—sick leave from work. After controlling for a number of factors ranging from job characteristics such as number of hours worked and type of contract, socio-economic characteristics from the PA and their employer, and supply and demand factors at local government region, the findings suggest a number of factors that significantly influenced sick leave, including distances traveled to work and number of PAs employed. Following the analysis, two people with life experience of LTC discuss the findings of the study and how they compare to their experiences of the market for PAs, providing a unique perspective from the people who could benefit the most from improving PA retention and reducing absenteeism.

Looking after our menopausal workforce: A model for NHS staff.

To determine whether a staff menopause clinic would benefit our peri/postmenopausal hospital workforce. The three menopause consultants, with OH administration assistance, set up a virtual clinic for staff members to address the unanswered need for access to good menopause care. Feedback was gathered from the attendees and the staff who ran the clinic. The clinic was an overwhelming success and has now become an established clinic at a major London teaching hospital. We hope that this model can be used in other trusts, and other companies to provide good menopause care to our senior female workforce to retain them. Acknowledgements: We would like to thank the OH staff who ensured the clinics ran so smoothly.

Addressing Shortcomings in Contingency Standards of Care

Addressing Shortcomings in Contingency Standards of Care

Declines in the utilization of hospital-based care duringCOVID-19 pandemic.

The disruptions of the coronavirus disease 2019 (COVID‐19) pandemic impacted the delivery and utilization of healthcare services with potential long‐term implications for population health and the hospital workforce. Using electronic health record data from over 700 US acute care hospitals, we documented changes in admissions to hospital service areas (inpatient, observation, emergency room [ER], and same‐day surgery) during 2019−2020 and examined whether surges of COVID‐19 hospitalizations corresponded with increased inpatient disease severity and death rate. We found that in 2020, hospitalizations declined by 50% in April, with greatest declines occurring in same‐day surgery (−73%). The youngest patients (0−17) experienced largest declines in ER, observation, and same‐day surgery admissions; inpatient admissions declined the most among the oldest patients (65+). Infectious disease admissions increased by 52%. The monthly measures of inpatient case mix index, length of stay, and non‐COVID death rate were higher in all months in 2020 compared with respective months in 2019.

Implementation of Medical Assistance in Dying as Organizational Ethics Challenge: A Method of Engagement for Building Trust, Keeping Peace and Transforming Practice.

This paper focuses on the ethics of how to approach the introduction of MAiD as an organizational ethics challenge, a focus that diverges from the traditional focus in healthcare ethics on the ethics of why MAiD is right or wrong. It describes a method co-designed and implemented by ethics and medical leadership at a tertiary hospital to develop a values-based, grassroots response to the decriminalization of assisted dying in Canada. This organizational ethics engagement method embodied core tenants that drew inspiration from a variety of sources, including poetic ones. These tenants are: make the problem bigger; focus on values; cultivate open moral spaces; and trust emergence. The paper describes how these tenants were put into practice in order to create a rigorous and sustainable MAiD program that delivers high-quality care to patients and families while honoring the moral diversity of the hospital workforce. One of the goals in sharing this method is to provide a roadmap for healthcare organizations in Canada and other jurisdictions around the world that are facing the challenge of responding to patient requests for MAiD following the decriminalization of this care option.

Improving allocative efficiency from network consolidation: a solution for the health workforce shortage

BackgroundPublic hospitals are facing a critical shortage of health workers. The area-based network consolidations could be the solution to increase the system capacity for human resources by improving local allocative efficiency.MethodsThis study develops counterfactual simulations for area-based network allocations for the health workforce in 10500 public hospitals in Thailand and examines improvements in allocative efficiency from the health workforce redistribution at different administrative levels such as sub-districts, districts, provinces, and health service areas. The workload per worker is calculated from the output measured by numbers of outpatient and inpatient cases and the input measured by numbers of health workers. Both output and input are weighted with their economic values and controlled for heterogeneity through regression analysis. Finally, this study compares the workload per worker and economic valuation of the area-based networks or ex-ante scenarios with the hospital-level or status quo scenario.ResultsNetwork consolidations of the sub-district primary-level hospitals within the same district could reduce workload per worker by seven percentage points. Another practical policy option is to consolidate similar hospital levels such as primary, first-level secondary, and mid-level secondary hospitals altogether within the same province which could result in the reduction of the workload per worker by 6–7 percentage points. The total economic value gained from consolidating similar hospital levels within the same province is about 15–18 percentage points of total labor cost in the primary hospitals.ConclusionThis study illustrates the improvement in allocative efficiency of the health workforce in public hospitals from the area-based network consolidations. The results provide an insightful example of economic gains from efficiently reallocating the medical workforce within the same local areas. Major reforms are required such that the health care delivery units can automate their resources in corresponding to the population's health needs through a strengthening gatekeeping system.

The social networks of hospital staff: A realist synthesis.

ObjectivesThe social ties people have with one another are known to influence behaviour, and how information is accessed and interpreted. It is unclear, however, how the social networks that exist in multi-professional health care workplaces might be used to improve quality in hospitals. This paper develops explanatory theory using realist synthesis to illuminate the details and significance of the social ties between health care workers. Specifically we ask: How, why, for whom, to what extent and in what context, do the social ties of staff within a hospital influence quality of service delivery, including quality improvement?MethodsFrom a total of 75 included documents identified through an extensive systematic literature search, data were extracted and analysed to identify emergent explanatory statements.ResultsThe synthesis found that within the hospital workforce, an individual’s place in the social whole can be understood across four identified domains: (1) social group, (2) hierarchy, (3) bridging distance and (4) discourse. Thirty-five context-mechanism-outcome configurations were developed across these domains.ConclusionsThe relative position of individual health care workers within the overall social network in hospitals is associated with influence and agency. As such, power to bring about change is inequitably and socially situated, and subject to specific contexts. The findings of this realist synthesis offer a lens through which to understand social ties in hospitals. The findings can help identify possible strategies for intervention to improve communication and distribution of power, for individual, team and wider multi-professional behavioural change in hospitals.