A multi-stakeholder perspective on sustainable healthcare: From 2030 onwards

Developing the green operating room: exploring barriers and opportunities to reducing operating room waste

The Australian health care system contributes 7% of the national greenhouse gas emission footprint and generates massive waste streams annually. Operating rooms are a particular hotspot, generating at least 20% of the total hospital waste. A systematic search of several global academic databases was conducted in mid-2022 (articles from 1992 to 2022) for peer-reviewed research relevant to waste management in the operating rooms. We then used thematic analysis to enumerate and characterise the strategies and barriers to sustainable waste management in the operating room. The waste reduction strategies focused on avoidance of high carbon products; correct waste segregation and reduced overage; reusing, reprocessing, and repurposing devices; and improved recycling. The first barrier identified was a constrained interpretation of the concept of "first do not harm", ingrained in surgeons' practices, in prioritising single-use surgical products. The second barrier was ineffective or insufficient waste education. The third barrier was the immediate cost of implementing waste management compared with the long term realisation of environmental and economic benefits. The last barrier to implementing institutional practice change was the lack of policies and regulations at the local hospital, federal and international levels. We also evaluated the knowledge gaps in current surgical waste research, including lack of benchmarking data and standardised regulations concerning reusable or reprocessed devices, as well as the methods used to promote pro-sustainability behavioural change.

Barriers and facilitators to technology acceptance of socially assistive robots in older adults - A qualitative study based on the capability, opportunity, and motivation behavior model (COM-B) and stakeholder perspectives

This study aimed to identify barriers and facilitators to older adults' acceptance of socially assistive robots from a stakeholder perspective. We enlisted 36 distinct stakeholders, including older adult, nurses, retirement home managers, and employees from robotics companies. Data collection was conducted through semi-structured interviews. The research findings were mapped onto the Capability, Opportunity, Motivation-Behavior (COM-B) model. We obtained a total of 14 facilitators and barriers. (1) Capability: High technological familiarity (Facilitator); insufficient technical experience and low level of education (Barriers). (2) Motivation: Strong interest in new things, perceived convenience usefulness, and emotional support (Facilitators); concerns about technical reliability, perceived lack of ease of use, inability to establish emotional connection, and low level of need (Barriers). (3) Opportunity: Insufficient policy support and economic capacity, robotics technical problems (Barriers). Collaborative efforts among stakeholders are vital for fostering an environment conducive to socially assistive robot adoption, maximizing its potential to improve older adults' well-being.

Cardiovascular Imaging, Climate Change, and Environmental Sustainability

Environmental exposures including poor air quality and extreme temperatures are exacerbated by climate change and are associated with adverse cardiovascular outcomes. Concomitantly, the delivery of health care generates substantial atmospheric greenhouse gas (GHG) emissions contributing to the climate crisis. Therefore, cardiac imaging teams must be aware not only of the adverse cardiovascular health effects of climate change, but also the downstream environmental ramifications of cardiovascular imaging. The purpose of this review is to highlight the impact of climate change on cardiovascular health, discuss the environmental impact of cardiovascular imaging, and describe opportunities to improve environmental sustainability of cardiac MRI, cardiac CT, echocardiography, cardiac nuclear imaging, and invasive cardiovascular imaging. Overarching strategies to improve environmental sustainability in cardiovascular imaging include prioritizing imaging tests with lower GHG emissions when more than one test is appropriate, reducing low-value imaging, and turning equipment off when not in use. Modality-specific opportunities include focused MRI protocols and low-field-strength applications, iodine contrast media recycling programs in cardiac CT, judicious use of US-enhancing agents in echocardiography, improved radiopharmaceutical procurement and waste management in nuclear cardiology, and use of reusable supplies in interventional suites. Finally, future directions and research are highlighted, including life cycle assessments over the lifespan of cardiac imaging equipment and the impact of artificial intelligence tools. Keywords: Heart, Safety, Sustainability, Cardiovascular Imaging Supplemental material is available for this article. © RSNA, 2024.

A context-driven approach through stakeholder engagement to introduce a digital emergency obstetric and newborn care register into routine obstetric health care services in Bangladesh

Background

Emergency obstetric and newborn care (EmONC) in Bangladesh focusses on maternal health, whereby it addresses childbirth and postpartum complications to ensure women's health and well-being. It was transitioned to a digital platform to overcome challenges with the paper-based EmONC register and we conducted implementation research to assess the outcome. Here we outline the stakeholder engagement process integral to the implementation research process.

Methods

We adopted a four-step stakeholder engagement model based on the identification, sensitisation, involvement, and engagement of stakeholders. The approach was informed by previous experience, desk reviews, and expert consultations to ensure comprehensive engagement with stakeholders at multiple levels. Led by the Maternal Health Programme of the Government of Bangladesh, we involved high-power and high-interest stakeholders in developing a joint action plan for digitisation of the paper-based EmONC register. Finally, we demonstrated this digital EmONC register in real-life settings to stakeholders at different levels.

Results

The successful demonstration process fostered government ownership and collaboration with multiple stakeholders, while laying the foundation for scalability and sustainability. Nevertheless, our experience highlighted that the stakeholder engagement process is context-driven, time-consuming, resource-intensive, iterative, and dynamic, and it requires involving stakeholders with varied expertise. Effective strategic planning, facilitation, and the allocation of sufficient time and resources are essential components for successful stakeholder engagement.

Conclusions

Our experience demonstrates the potential of adopting the 'identification, sensitisation, involvement, and engagement' stakeholder engagement model. Success in implementing this model in diverse settings depends on leveraging knowledge gained during implementation, maintaining robust communication with stakeholders, and harnessing the patience and determination of the facilitating organisation.

Planetary Health and Radiology: Why We Should Care and What We Can Do

Climate change adversely affects the well-being of humans and the entire planet. A planetary health framework recognizes that sustaining a healthy planet is essential to achieving individual, community, and global health. Radiology contributes to the climate crisis by generating greenhouse gas (GHG) emissions during the production and use of medical imaging equipment and supplies. To promote planetary health, strategies that mitigate and adapt to climate change in radiology are needed. Mitigation strategies to reduce GHG emissions include switching to renewable energy sources, refurbishing rather than replacing imaging scanners, and powering down unused scanners. Radiology departments must also build resiliency to the now unavoidable impacts of the climate crisis. Adaptation strategies include education, upgrading building infrastructure, and developing departmental sustainability dashboards to track progress in achieving sustainability goals. Shifting practices to catalyze these necessary changes in radiology requires a coordinated approach. This includes partnering with key stakeholders, providing effective communication, and prioritizing high-impact interventions. This article reviews the intersection of planetary health and radiology. Its goals are to emphasize why we should care about sustainability, showcase actions we can take to mitigate our impact, and prepare us to adapt to the effects of climate change. © RSNA, 2024 Supplemental material is available for this article. See also the article by Ibrahim et al in this issue. See also the article by Lenkinski and Rofsky in this issue.

Health Care Professionals' Perspectives Before and After Use of eDialogue for Team-Based Digital Communication Across Settings: Qualitative Study

BACKGROUND

Orthopedic surgical treatment is a transversal task that requires the active involvement of patients, relatives, and health care professionals (HCPs) across various settings. However, after hospital discharge, communication is challenged and undertaken primarily by phone. New digital communication solutions have the potential to create a space for seamless and patient-centered dialogue across discipline and sector boundaries. When evaluating new communication solutions, knowledge about HCPs' needs and perspectives of use must be explored, as it is they who are responsible for implementing changes in practice.

OBJECTIVE

This study aimed to (1) investigate HCPs' perceptions of current communication pathways (phase 1) and (2) explore their experiences of using a simple messenger-like solution (eDialogue) for team-based digital communication across settings (phase 2).

METHODS

We used a triangulation of qualitative data collection techniques, including document analysis, observations, focus groups, and individual interviews of HCPs before (n=28) and after (n=12) their use of eDialogue. Data collection and analysis were inspired by the Consolidated Framework for Implementation Research (CFIR) to specifically understand facilitators and barriers to implementation as perceived by HCPs.

RESULTS

HCPs perceive current communication pathways as insufficient for both patients and themselves. Phone calls are disruptive, and there is a lack of direct communication modalities when communication crosses sector boundaries. HCPs experienced the use of eDialogue as a quick and easy way for timely interdisciplinary interaction with patients and other HCPs across settings; however, concerns were raised about time consumption.

CONCLUSIONS

eDialogue can provide needed support for interdisciplinary and cross-sectoral patient-centered communication. However, future studies of this solution should address its impact and the use of resources.

Navigating Challenges in Biomedical Waste Management in India: A Narrative Review

Biomedical waste management (BMWM) in India poses significant challenges that demand thorough examination and strategic interventions. As the country's healthcare sector expands rapidly, proper management of biomedical waste becomes increasingly critical to safeguarding public health and environmental integrity. Biomedical waste, encompassing industrial waste, hospital waste, and waste from other healthcare facilities, poses a heightened risk of infection and injury compared to any other form of waste. A lack of understanding regarding safe medical waste disposal practices can be hazardous to one's health as well as the environment. To improve waste management practices in the country, we can suggest effective strategies and recommendations by developing a deeper understanding of the current situation. To manage medical waste effectively, healthcare professionals must be knowledgeable about and have experience with this process. This evaluation study provides a comprehensive overview of current BMWM methods in India, shedding light on the benefits, drawbacks, challenges, and areas for improvement in the healthcare waste management system. Several important facets of BMWM were highlighted by the literature research, including waste segregation, treatment techniques, and disposal options, as well as compliance and regulatory frameworks.

Beyond Healing: Embracing the Triple Bottom Line Approach in Post-pandemic Healthcare

A triple bottom line (TBL) encompasses economic, social, and environmental dimensions, which provides a strategy for transforming contemporary healthcare systems. This study contextualized current TBL developments in healthcare under the spotlight of COVID-19 pandemic-related challenges and opportunities. The paper has five sections, including an introductory section that outlines the TBL concept and its relevance to healthcare. Following this, we provide an overview of the three pillars of the TBL, including its economic, social, and environmental dimensions as they relate to healthcare. This section also includes several case studies to illustrate TBL-based practices in diverse healthcare settings, focusing on how these were implemented and the outcomes and barriers to adopting such practices. In addition to showcasing current TBL practices, we review three significant challenges to TBL and highlight potential areas for future research, such as innovative practices, educational reform, and the need for the development of robust TBL metrics. The overarching conclusion is that the TBL provides a profound approach to conceptualizing contemporary healthcare to meet the urgent requirements for a more resilient, equitable, and environmentally responsible healthcare system.

Journey from an Enabler to a Strategic Leader: Integration of the Medical Affairs Function in ESG Initiatives and Values

Like most private enterprises, the pharmaceutical industry has deeply rooted environmental, social, and governance (ESG) matters that challenge its long-term sustainability. Overcoming these external challenges requires collaborative and proactive steps as well as procedures guiding the adoption of ESG principles by all internal stakeholders. Environmental challenges such as climate change, and in addition the changes in society, have resulted in the need for governance addressing and coordinating efforts. The core function of medical affairs (MA) is connecting with stakeholders within a company and also between the company and external stakeholders. In this article, we describe the involvement of MA in several aspects of ESG, as a contributor, partner, and implementer. MA has a significant opportunity to emerge as a leading function involved in ESG strategies and their tactical implementation. Although the involvement of MA in the environment pillar of ESG is less, the function can implement changes relating to the conduct of meetings, clinical studies, and the digitalization of medical education via virtual platforms. Due to its patient centricity, MA is tasked to address social determinants of health to improve patients' outcomes. As a linking function within a company and with its external stakeholders, MA can provide proactive input in policy generation and enable effective governance by adherence to standards of accountability, ethics, and compliance, as well as transparency. Championing ESG is a collective responsibility that transcends any single department. It mandates a company-wide commitment. MA represents an essential pivot point in catalyzing the integration of ESG principles within industry, contributing to a healthcare ecosystem that is not merely more sustainable and ethical but also more conducive to patient health and public well-being.

Building an action plan to tackle palliative care inequality through multi-stakeholder platforms

Background

To achieve universal care and overcome existing barriers, the most effective strategy is to devise an action plan that incorporates palliative care into primary health care (PHC), as recommended by the World Health Organization's (WHO) Astana Declaration. In Colombia, a country with an upper-middle-income status, about 128,000 individuals experience severe health-related suffering (SHS) that necessitates palliative care. Although the country's healthcare system has made steady strides in the integration and development of palliative care, there is still no national plan in place for palliative care.

Objective

Build up Colombia's palliative care plan through stakeholder consensus.

Method

Based on the participatory action research method and the multi-stakeholder platforms model, this study convened 142 stakeholders from different levels of the health system (patient representatives, journalists, health professionals, government entities, insurance companies, universities, and drug regulatory authorities).

Results

The national plan aims to achieve its objectives through a series of strategic actions. These include integrating and diversifying palliative care services, improving access to opioids, increasing palliative care education, promoting community-based palliative care programs, securing funding, and implementing a regulatory framework for palliative care by public policymakers.

Conclusions

The national palliative care is an alliance that aims to reduce palliative care inequity in Colombia by 2026 by empowering stakeholders nationwide to collaborate around specific goals and objectives.

Preventing and developmental factors of sustainability in healthcare organisations from the perspective of decision makers: an exploratory factor analysis

BACKGROUND

UN Sustainable Development Goals are part of the political agenda of most developed countries. Being a developing country, Albania has only recently adhered to this trend. Prior research at national level has sporadically focused on environmental sustainability, neglecting a holistic view of the phenomenon. To fill this gap, this study aims to explore preventing and developmental factors of sustainability in healthcare organisations from the perspective of decision makers by relying to a Triple Bottom Line approach.

METHODS

Data were collected through a questionnaire administered to healthcare facilities and analysed through the Exploratory Factor Analysis. Findings revealed that the factors influencing the sustainability of the national healthcare system were five: Barriers of Organisational Sustainability; Stakeholders Pressure (regarding sustainable issues); Awareness (knowledge and measures taken for sustainability); Institutional Engagement; and Personal Interest and Involvement. The underlying factors included 19 items suitable for this sample, representing 64.371% of the total variance.

RESULTS

The findings show the existence of 4 factors: Barriers of Organisational Sustainability, Stakeholders Pressure regarding Sustainable issues, Awareness/knowledge and measures taken for sustainability, Personal Interest and Involvement.

CONCLUSIONS

It is evident that national health organisations should continuously improve its strategies to be consistent with the sustainable development goals of international organisations, so that their initiatives could reflect the integration of sustainability approaches at the organisational level.

Comprehensive assessment of physical activity policies and initiatives in Saudi Arabia 2016-2022

Objective

This study aimed to review health-enhancing physical activity (HEPA) policies and initiatives introduced in Saudi Arabia (SA) since 2016 and identify the gaps in their design and implementation.

Methods

A combination of methods was used, including semi-structured interviews with key informants from relevant entities (such as those from the ministries of health, education, sports, tourism, and other regulatory bodies) and a review of policy/initiative documents provided by them. Stakeholder mapping led by local experts and snowball sampling supported the identification of key informants. Three existing frameworks-the World Health Organization's HEPA Policy Audit Tool, the Global Observatory for Physical Activity (PA) Policy Inventory, and the European Monitoring Framework for PA Indicators-were used to develop data collection instruments.

Results

The review identified 44 policies/initiatives from different sectors. The Saudi Sports for All Federation is the leader in PA promotion and community sports development. However, there is a lack of multisectoral agenda and governance structures for PA promotion. The overlap between initiatives by different key informants results in duplication of efforts, including initiatives to promote PA among the general public led by competitive professional sports and community-based sports.

Conclusion

The study findings indicate that several policies/initiatives have been implemented in SA since 2016. However, there is a need to focus on the challenges or barriers that affect the sustainability of policies/initiatives. A system-based approach can help build on sectoral synergies, thereby accelerating progress in engaging the Saudi population with PA.

Investigating the Connections Between Delivery of Care, Reablement, Workload, and Organizational Factors in Home Care Services: Mixed Methods Study

BACKGROUND

Home care is facing increasing demand due to an aging population. Several challenges have been identified in the provision of home care, such as the need for support and tailoring support to individual needs. Goal-oriented interventions, such as reablement, may provide a solution to some of these challenges. The reablement approach targets adaptation to disease and relearning of everyday life skills and has been found to improve health-related quality of life while reducing service use.

OBJECTIVE

The objective of this study is to characterize home care system variables (elements) and their relationships (connections) relevant to home care staff workload, home care user needs and satisfaction, and the reablement approach. This is to examine the effects of improvement and interventions, such as the person-centered reablement approach, on the delivery of home care services, workload, work-related stress, home care user experience, and other organizational factors. The main focus was on Swedish home care and tax-funded universal welfare systems.

METHODS

The study used a mixed methods approach where a causal loop diagram was developed grounded in participatory methods with academic health care science research experts in nursing, occupational therapy, aging, and the reablement approach. The approach was supplemented with theoretical models and the scientific literature. The developed model was verified by the same group of experts and empirical evidence. Finally, the model was analyzed qualitatively and through simulation methods.

RESULTS

The final causal loop diagram included elements and connections across the categories: stress, home care staff, home care user, organization, social support network of the home care user, and societal level. The model was able to qualitatively describe observed intervention outcomes from the literature. The analysis suggested elements to target for improvement and the potential impact of relevant studied interventions. For example, the elements "workload" and "distress" were important determinants of home care staff health, provision, and quality of care.

CONCLUSIONS

The developed model may be of value for informing hypothesis formulation, study design, and discourse within the context of improvement in home care. Further work will include a broader group of stakeholders to reduce the risk of bias. Translation into a quantitative model will be explored.

The step in time study: A feasibility study of a mobile app for measuring walking ability after massage treatment in patients with osteoarthritis

Background

Massage therapy is a popular intervention for those suffering osteoarthritis, however, there is a paucity of evidence to support its effectiveness in osteoarthritis. A simple measure that could potentially assess the benefits of massage treatment is walking speed which is a predictor of mobility and survival length, particularly in ageing populations. The primary aim of the study was to assess the feasibility of using a phone app to measure walking ability in people with osteoarthritis.

Methods

This feasibility study used a prospective, observational design to collect data from massage practitioners and their clients over a 5-week period. Feasibility outcomes included practitioner and client recruitment and protocol compliance. The app MapMyWalk was used to record average speed for each walk. Pre-study surveys and post-study focus groups were conducted. Clients received massage therapy in a massage clinic and were instructed to walk in their own local community for 10 min every other day. Focus group data were analysed thematically. Qualitative data from clients’ pain and mobility diaries were reported descriptively. Average walking speeds were graphed for each participant in relation to massage treatments.

Results

Fifty-three practitioners expressed interest in the study, 13 completed the training, with 11 successfully recruiting 26 clients, 22 of whom completed the study. 90% of practitioners collected all required data. A strong motivation for participating practitioners was to contribute to evidence for massage therapy. Client compliance with using the app was high, but low for completing pain and mobility diaries. Average speed remained unchanged for 15 (68%) clients and decreased for seven (32%). Maximum speed increased for 11 (50%) clients, decreased for nine (41%) and remained unchanged for two (9%). However, data retrieved from the app were unreliable for walking speed.

Conclusions

This study demonstrated that it is feasible to recruit massage practitioners and their clients for a study involving mobile/wearable technology to measure changes in walking speed following massage therapy. The results support the development of a larger randomised clinical trial using purpose-built mobile/wearable technology to measure the medium and long-term effects of massage therapy on people with osteoarthritis.

A methodology for using a multilevel perspective framework to analyze complex systems

Misalignment between the different levels of complex societal systems (e.g. socio-technical, socio-ecological) are often a barrier to transitioning these systems toward more sustainable behavior. One way to understand alignment is through the Multilevel Perspective Theory of sustainable transitions in sociotechnical systems (MLP) which posits that when a regime (the current “ways of doing” something) exhibits behavior that negatively impacts its surrounding economic, social and environmental landscape, that landscape will exert pressure on the regime to change. This in turn opens the window of opportunity for niche developments such as novel technology adoption or policy changes. Therefore, understanding the relationships between the landscape, the regime and emerging niches can help align these different levels of perspective to facilitate a successful transition toward more sustainable practices. This paper describes a methodology for mapping complex systems such as agricultural systems based on MLP theory, and incorporates a fourth “user” level (e.g. the farm) into this multilevel framework (MLP+ F). The methodology is illustrated with a case study example of North Carolina’s lagoon and sprayfield swine waste management regime. By integrating well-established techniques for data collection and analysis, the case study engages a diverse panel of local experts through a modified Delphi approach to identify the relevant concepts and their cause-effect relationships for the current regime. These concepts and relationships are then categorized and organized into a multilevel, multi-perspective conceptual model using fuzzy cognitive maps. The conceptual model identifies how stakeholder groups align in their perception of the system, and provides a foundation for future qualitative, semi-quantitative, and visual analyses of the system and how it can be changed through alternative scenarios. Although this methodology was initially developed for agricultural applications, it has potential for application to other complex societal issues where understanding stakeholder alignment and the potential for sustainability transitions through change are needed.

Developmental disabilities in Africa: A scientometric review

BACKGROUND

Developmental disabilities are disproportionately more investigated in higher-income countries. However, global prevalence of developmental disabilities indicate that a large proportion of individuals with disabilities reside in low- and middle-income nations.

AIMS

The present work therefore aims to conduct a scientometric review to survey available literature on developmental disabilities in low- and middle-income countries belonging to the continent of Africa.

METHODS AND PROCEDURES

A literature search was conducted on Scopus, where a total of 1720 relevant publications (and an accompanying 66 thousand references) were found, representing research conducted between 1950 to 2022. Then, document co-citation analysis was performed to chart significant co-citation relationships between relevant articles and their cited references.

OUTCOMES AND RESULTS

The generated network based on document co-citation analysis revealed a total of 14 distinct thematic research clusters and 12 significant documents that have been frequently cited in the literature on developmental disabilities in Africa.

CONCLUSIONS AND IMPLICATIONS

The scientometric review revealed a trend of broadening research towards systems of care, away from a medical model of disease. It is projected that future research will continue to capitalise on inter-disciplinary strengths to arrive at a more nuanced understanding of developmental disability from all levels - individuals, families, to communities.

Can circular healthcare economy be achieved through implementation of sustainable healthcare supply chain practices? Empirical evidence from Indian healthcare sector

Purpose

Idea of circular economy defies the classical “make-use-dispose” approach of linear economic model. In the context of health-care industry, it relies heavily on the supply chain practices implemented by industry stakeholders. The purpose of this study is to explore such relationships, study their structure and put it across for attaining sustainability at large.

Design/methodology/approach

This study is an empirical research conducted on 145 health-care firms. The collected data is analysed to develop structural and measurement model. The five constructed hypotheses are examined and tested through structural equation modelling.

Findings

The study illustrates the latent relationships that exist among the stakeholders involvement, sustainable supply chain practices, sustainable performance and circular economy for health-care industry. It is found that the adoption of sustainable supply chain practices improves health-care performance, which, in turn, have positive influence on circular economy.

Research limitations/implications

The structural and measurement model is developed in the context of circular health-care economy. It can be validated or improvised by conducting similar research in other industry using different methods. This research work fulfils the long existing gap in research by offering a linkage between various constructs to achieve health-care circular economy. Based on the research results, future researchers can build theories of circular economy and sustainability for health-care industry.

Originality/value

The study attempts to study the supply chain ways to achieve circular economy for Indian health-care sector. It considered latent relationships among the set of constructs, which are needed for theory building at later stage.

Effect of physical activity interventions on quality of life in older adults: A protocol for systematic review and meta-analysis

INTRODUCTION

Quality of life (QoL) has been acknowledged as a fundamental concept in the field of health and is favorably improved by physical activity (PA). This systematic review aims to assess the benefits and harms of different types of PA to improve health-related QoL in both community-dwelling and diseased older adults to provide a recommendation for the minimum amount of PA needed to obtain measurable QoL benefits.

METHODS AND ANALYSIS

We will search MEDLINE, Cochrane Central Register of Controlled Trials, CINHAL, Epistemonikos, Web of Science and gray literature. Randomized controlled trials enrolling healthy or diseased older adults aged > 65 years, providing any kind of physical activity intervention and having quality of life as an outcome will be included. There will be no language restriction. Two independent reviewers will screen the papers, and a third reviewer will resolve the conflicts. The quality of the included studies will be assessed through the Risk of Bias 2.0 tool. Finally, data will be extracted to create proper meta-analyses of comparisons between the different kinds of physical activity interventions or to control groups.

ETHICS AND DISSEMINATION

This review does not require approval from the Ethics Committee. The results will be disseminated in peer-reviewed journals and at international conferences; moreover, the findings will be shared on social media using an accessible language.

Specific Needs of Patients and Staff Reflected in the Design of an Orthopaedic and Rehabilitation Hospital-Design Recommendations Based on a Case Study (Poland)

This article presents results of the research conducted with the use of participatory methods by the Faculty of Architecture, Poznan University of Technology on architectural design of healthcare facilities. The studies concerned the needs of patients and hospital staff in an orthopaedic and rehabilitation hospital. Preferences and expectations of all the users of healthcare facilities should be considered as early as at the stage of planning and designing. The hospital profile and the type of its users predetermine the architectural design in the area of the building functions, its internal circulation and interior design. Participation of the user in the process of compiling design recommendations is a chance for a designer to confront the original assumptions with expectations and to adjust relevant solutions to factual needs of the users. This study, undertaken in a regional setting, provided an in-depth exploration of staff's experiences of hospital space to indicate possible spatial improvements.

METHODS

The research was conducted on the basis of a case study of a renowned regional orthopaedic and rehabilitation hospital in Poznan, Poland. Rapid assessment methods and questions were examined to describe current approaches and synthesize results. Semi-structured interviews and thematic analysis identified staff and patient's experiences.

RESULT

Participation of hospital staff and patients resulted in design recommendations of high utility value. It was found that the two groups to a certain extent proposed similar recommendations; however, certain proposals submitted by the two groups were totally opposite.

CONCLUSION

the research highlighted the importance of the active research methodology that engages the researcher/expert in the action and critical reflection process. Such a methodology can successfully underlie the formulation of accurate recommendations.

National IoMT platform strategy portfolio decision model under the COVID-19 environment: based on the financial and non-financial value view

The Internet of Medical Things (IoMT) is an emerging technology in the healthcare revolution which provides real-time healthcare information communication and reasonable medical resource allocation. The COVID-19 pandemic has had a significant effect on people's lives and has affected healthcare capacities. It is important for integrated IoMT platform development to overcome the global pandemic challenges. This study proposed the national IoMT platform strategy portfolio decision-making model from the non-financial (technology, organization, environment) and financial perspectives. As a solution to the decision problem, initially, the decision-making trial and evaluation laboratory (DEMATEL) technology were employed to capture the cause-effect relationship based on the perspectives and criteria obtained from the insight of an expert team. The analytic network process (ANP) and pairwise comparisons were then used to determine the weights for the strategy. Simultaneously, this study incorporated IoMT platform resource limitations into the zero-one goal programming (ZOGP) method to obtain an optimal portfolio selection for IoMT platform strategy planning. The results showed that the integrated MCDM method produced reasonable results for selecting the most appropriate IoMT platform strategy portfolio when considering resource constraints such as system installation costs, consultant fees, infrastructure costs, reduction of medical staff demand, and improvement rates for diagnosis efficiency. The decision-making model of the IoMT platform in this study was conclusive and significantly compelling to aid government decision makers in concentrating their efforts on planning IoMT strategies in response to various pandemic and medical resource allocations.

South African Healthcare Professionals' Knowledge, Attitudes, and Practices Regarding Environmental Sustainability in Healthcare: A Mixed-Methods Study

Climate change, biodiversity loss and large-scale environmental degradation are widely recognized as the biggest health threats of the 21st century, with the African continent already amongst the most severely affected and vulnerable to their further progression. The healthcare system's contribution to climate change and environmental degradation requires healthcare professionals to address environmental issues urgently. However, the foundation for context-relevant interventions across research, practice, and education is not readily available. Therefore, we conducted a convergent mixed-methods study to investigate South African healthcare professionals' knowledge, attitudes, practices, and barriers to environmental sustainability. Healthcare professionals participated in a cross-sectional questionnaire (n = 100) and in-depth semi-structured focus group discussions (n = 18). Data were analyzed using descriptive statistics and thematic analysis, respectively, and integrated to provide holistic findings. Our results confirm overwhelmingly positive attitudes and a high degree of interest in education, implementation, and taking on more corresponding responsibility, but a lack of substantial knowledge of the subject matter, and only tentative implementation of practices. Identified barriers include a lack of knowledge, resources, and policies. Further research, education, and policy development on overcoming these barriers is required. This will facilitate harnessing the extant enthusiasm and advance environmental sustainability in South Africa's healthcare practice.

Practises, Drivers and Barriers of an Emerging Regenerative Higher Education in The Netherlands—A Podcast-Based Inquiry

Universities have the potential, and the responsibility, to take on more ecological and relational approaches to facilitating learning-based change in times of interconnected socioecological crises. Signs for a transition towards these more regenerative approaches of higher education (RHE) that include more place-based, ecological, and relational, ways of educating can already be found in niches across Europe (see for example the proliferation of education-based living labs, field labs, challenge labs). In this paper, the results of a podcast-based inquiry into the design practises and barriers to enacting such forms of RHE are shown. This study revealed seven educational practises that occurred across the innovation niches. It is important to note that these practises are enacted in different ways, or are locally nested in unique expressions; for example, while the ‘practise’ of cultivating personal transformations was represented across the included cases, the way these transformations were cultivated were unique expressions of each context. These RHE-design practises are derived from twenty-seven narrative-based podcasts as interviews recorded in the April through June 2021 period. The resulting podcast (The Regenerative Education Podcast) was published on all major streaming platforms in October 2021 and included 21 participants active in Dutch universities, 1 in Sweden, 1 in Germany, 1 in France, and 3 primarily online. Each episode engages with a leading practitioner, professor, teacher, and/or activist that is trying to connect their educational practice to making the world a more equitable, sustainable, and regenerative place. The episodes ranged from 30 to 70 min in total length and included both English (14) and Dutch (12) interviews. These episodes were analysed through transition mapping a method based on story analysis and transition design. The results include seven design practises such as cultivating personal transformations, nurturing ecosystems of support, and tackling relevant and urgent transition challenges, as well as a preliminary design tool that educational teams can use together with students and local agents in (re)designing their own RHE to connect their educational praxis with transition challenges.

How can the healthcare system deliver sustainable performance? A scoping review

BACKGROUND

Increasing health costs, demand and patient multimorbidity challenge the sustainability of healthcare systems. These challenges persist and have been amplified by the global pandemic.

OBJECTIVES

We aimed to develop an understanding of how the sustainable performance of healthcare systems (SPHS) has been conceptualised, defined and measured.

DESIGN

Scoping review of peer-reviewed articles and editorials published from database inception to February 2021.

DATA SOURCES

PubMed and Ovid Medline, and snowballing techniques.

ELIGIBILITY CRITERIA

We included articles that discussed key focus concepts of SPHS: (1) definitions, (2) measurement, (3) identified challenges, (4) identified solutions for improvement and (5) scaling successful solutions to maintain SPHS.

DATA EXTRACTION AND SYNTHESIS

After title/abstract screening, full-text articles were reviewed, and relevant information extracted and synthesised under the five focus concepts.

RESULTS

Of 142 included articles, 38 (27%) provided a definition of SPHS. Definitions were based mainly on financial sustainability, however, SPHS was also more broadly conceptualised and included acceptability to patients and workforce, resilience through adaptation, and rapid absorption of evidence and innovations. Measures of SPHS were also predominantly financial, but recent articles proposed composite measures that accounted for financial, social and health outcomes. Challenges to achieving SPHS included the increasingly complex patient populations, limited integration because of entrenched fragmented systems and siloed professional groups, and the ongoing translational gaps in evidence-to-practice and policy-to-practice. Improvement strategies for SPHS included developing appropriate workplace cultures, direct community and consumer involvement, and adoption of evidence-based practice and technologies. There was also a strong identified need for long-term monitoring and evaluations to support adaptation of healthcare systems and to anticipate changing needs where possible.

CONCLUSIONS

To implement lasting change and to respond to new challenges, we need context-relevant definitions and frameworks, and robust, flexible, and feasible measures to support the long-term sustainability and performance of healthcare systems.

Analyzing the Stressors for Frontline Soldiers Fighting Against Coronavirus Disease 2019 Pandemic

This study aimed to analyze stressors to which medical staff is vulnerable due to the coronavirus disease 2019 (COVID-19) pandemic. It also imposes a hierarchy on complex relations among stressors for excavating underlying structure and builds a model of interrelationships contrasting reality. The design of this study comprises a literature survey, data collection from primary sources, and analysis. Stressors have been explored from within current published/unpublished literature and validated by experts through approval vote. Data were collected from the focus group (panel of experts), and interpretive structural modeling (ISM) was used as the research methodology. Findings of ISM are avowed through “cross-impact matrix multiplication applied to classification” (MICMAC) analysis. As a result of the literature survey, a list of stressors was generated, and a total of 19 stressors qualified as representative of the phenomenon. The results of ISM show that two stressors (i.e., “unavailability of proper personal protective equipment (PPE)” and “lack of proper communication”) emerged as the most critical stressors since they occupy the bottom of the model, whereas, four stressors (i.e., “anxious about isolation/quarantine,” “subject to violent crimes,” “feeling frustrated and powerless,” and “exhausting shifts/hours without clear end”) are relatively less critical since they occupy the top of the model. The rest of the stressors occupy the middle of the model and therefore, have moderate-severe effects on frontline soldiers. The results of MICMAC show that the stressor “subject to violent crimes” is classified in the dependent cluster and the remaining fall in the linkage cluster but no stressor falls in independent and autonomous. Overall results indicate that all stressors are relevant to the phenomenon under this study, but they are currently not settled. This study is invaluable for policymakers, frontline soldiers, researchers, the international community, and society since it provides a lot of new information that is helpful in refining strategies and combating influential stressors.

The FutureS of healthcare

This editorial for the special issue of FutureS is not intended to provide a comprehensive, analytical overview of the future of health care; rather, it collects the perspectives on which scholars have focused most. There is a danger that what we report will quickly become obsolete for numerous reasons; think of the speed of current technological progress or the fact that the Covid-19 pandemic could further stress health care systems around the world. However, we would like to outline some of the current topics explored in the literature and focus on the scenarios envisioned by practitioners. We write this piece being interested in the innovative impulses of all the actors belonging to the "renewed" health care ecosystem, aware of the fact that there are significant differences between the countries of the North and South of the world and, consequently, between their health care systems. What we can say with certainty is that the healthcare and life sciences are the protagonists of an unparalleled revolution. The aging population and changing needs, the increasingly common occurrence of chronic disorders, and digitization are some of the challenges facing the sector. The technological change of the fourth industrial revolution is disruptive and changes the logic of the market, not only that of healthcare but also that of adjacent markets. Because of the intensity with which insiders have to face these new trends, the topic has been the focus of interest of scholars and practitioners in recent years. The big players in consulting, as well as the scholars, have deepened the issues of healthcare of the future, focusing on what will be the major challenges in 10 years and imagining potential scenarios that will reconfigure the way health care is delivered and used. In the next 10 years, there will be profound demographic changes and the healthcare system will necessarily have to reconfigure the supply of the necessary services and the methods of delivery (KPMG, 2018). Due to the aging of the population, there has already been a dramatic increase in chronic and degenerative diseases requiring complex treatment in recent years. In addition, the Covid-19 pandemic that has been sweeping the world since 2019 has strained global health systems, revealed already existing weaknesses, even in the most advanced countries, and is representing an important moment of reflection for all policymakers. The whole world is questioning what will need to be done to foster greater effectiveness of national systems as well as better capacity to cope with shocks of such magnitude. In this document we explore what practitioners and scholars consider the main future challenges and the major changes that need to be made in the healthcare sector in order to embrace a new paradigm of care, based on the centrality of the patient, on prevention and not on cure, on technologies at the side of humans.

Lessons post-COVID from national and international approaches to safety and quality in healthcare

The COVID-19 pandemic has been a challenge as well as an opportunity for healthcare. The pandemic has exposed the inherent weaknesses in health systems globally while, at the same time, revealing strengths on which post-pandemic health systems can be built. We propose lessons on improving quality and safety post-pandemic from a global perspective based on recent policy publications and our global experience. Nine possible lessons are discussed. These lessons can ensure that healthcare does not return to the old normal, but rather builds on what we have learnt as we deliver on the Sustainable Development Goals and universal health coverage. Quality and safety are an essential component of healthcare strategy. Post-pandemic systems require a transparent compassionate culture, with integration of care at its core. The workforce must be trained in the skills to improve care, and patient and healthcare worker protection (both physically and psychologically) needs to be a given. Any development of systems will best be co-produced with the people who receive and deliver care in an equal partnership. Finally, the new systems need to be conscious of emerging threats (such as the challenge of climate change), building sustainable health systems that also address the structural inequities that currently exist.

Differential diffusion of pharmaceutical innovations in a mixed market middle - income economy

Background

Policymakers are faced with the challenge of balancing patient’s access for effective and affordable medicines to sustain the rising healthcare costs. In a mixed healthcare market such as Malaysia, coverage decisions of new medicines are different: public funded health system has a formulary listing process whereas for private sector, which is a market-based economy, depends on patient’s willingness to pay and insurance coverage. There is little overlap between public and private healthcare service delivery with access to new innovative medicines, as differentiated by sources of funding. The objectives of this study were to examine the diffusion of New Chemical Entities (NCEs) into the public and private healthcare market between 2010 and 2014, and determine the factors explaining the diffusion.

Methods

We matched medicines from the product registration database by medicine formulation to medicines in IQVIA National Pharmaceutical Audit database for each year. The price per Defined Daily Dose (DDD), market concentration and generic utilization share variables were calculated. A panel fixed effect model was performed to measure diffusion of NCEs for each year and test possible determinants of diffusion of NCEs for overall market and sector specifics.

Results

The utilization of NCEs was larger in the private sector compared to the public sector but the speed of diffusion over time was higher in the public sector. Price per DDD was negatively associated with diffusion of NCEs, while generic utilization share was significantly regressive in the public sector. Market concentration was negatively associated with utilization of NCEs, however result tends to be mixed according to sector and Anatomical Therapeutic Chemical (ATC) category.

Conclusions

Understanding key aspects of sectoral variation in diffusion of NCEs are crucial to reduce the differences of access to new medicines within a country and ensure resources are used on cost effective treatments.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06786-6.

Assessing the Impact of Green Hiring on Sustainable Performance: Mediating Role of Green Performance Management and Compensation

The global need to preserve ecology has propelled the green movement across the globe. An emerging managerial challenge for all organizations is to protect natural resources by reducing their negative impact on the environment and increase sustainable performance. Greening is the need of the age to conserve natural resources. This study investigates the impact of green human resource management practice—i.e., green hiring—on the sustainable performance of public and private healthcare organizations. A quantitative research approach was used for data collection. Scale survey of 160 responses was gathered from public and private healthcare organizations. Partial least square–structural equation modeling was used for data analysis. The study results suggest that green recruitment has a positive and significant impact on environmental performance, economic performance, and social performance. Path coefficients test also revealed that green performance management and compensation significantly mediate the relationship between green hiring and sustainable performance of public and private healthcare organizations. This study is helpful for organizations in adapting GHRM practices that will benefit the organizations in all ways. This study also provides a better understanding to policymakers on how to promote GHRM practices and increase sustainability in organizations.

Knowledge, Attitude, and Practice (KAP) toward the Novel Coronavirus (COVID-19) Pandemic in a Saudi Population-Based Survey

BACKGROUND

The Coronavirus Disease 2019 (COVID-19) outbreak has affected all regions and countries with varying impacts based on infection rates and the associated fatalities. This study aimed to assess knowledge, attitude, and practices (KAP) toward the COVID-19 pandemic among Saudi Arabians.

METHODS

The study utilized a cross-sectional research design. Web-based questionnaires' link was sent via emails and social media and sample was 5483 respondents. Purposive sampling ensured only those participants that met the inclusion criteria. Validity and reliability were checked.

RESULTS

Most respondents, 67.9%, were aged between 18 and 35 years and highest level of education university. The findings based on the study objectives indicated a high level of knowledge about COVID-19, which indicated early detection can improve treatment by 4701 (85.7%), the disease can be treated at home 84.6%, the disease can be prevented and avoided when precautions are taken 96.8%. Moreover, 37.2% of the respondents still used herbal products to prevent and treat the disease, and 72.1% indicating immediate visit the physician when there are symptoms.

CONCLUSION

Promoting public knowledge about COVID-19 by the Ministry of Health is paramount in defeating this disease. Providing more education and awareness for public to comply with WHO's recommendation is recommended.

The Implications of Zinc Therapy in Combating the COVID-19 Global Pandemic

The global pandemic from COVID-19 infection has generated significant public health concerns, both health-wise and economically. There is no specific pharmacological antiviral therapeutic option to date available for COVID-19 management. Also, there is an urgent need to discover effective medicines, prevention, and control methods because of the harsh death toll from this novel coronavirus infection. Acute respiratory tract infections, significantly lower respiratory tract infections, and pneumonia are the primary cause of millions of deaths worldwide. The role of micronutrients, including trace elements, boosted the human immune system and was well established. Several vitamins such as vitamin A, B6, B12, C, D, E, and folate; microelement including zinc, iron, selenium, magnesium, and copper; omega-3 fatty acids as eicosapentaenoic acid and docosahexaenoic acid plays essential physiological roles in promoting the immune system. Furthermore, zinc is an indispensable microelement essential for a thorough enzymatic physiological process. It also helps regulate gene-transcription such as DNA replication, RNA transcription, cell division, and cell activation in the human biological system. Subsequently, zinc, together with natural scavenger cells and neutrophils, are also involved in developing cells responsible for regulating nonspecific immunity. The modern food habit often promotes zinc deficiency; as such, quite a few COVID-19 patients presented to hospitals were frequently diagnosed as zinc deficient. Earlier studies documented that zinc deficiency predisposes patients to a viral infection such as herpes simplex, common cold, hepatitis C, severe acute respiratory syndrome coronavirus (SARS-CoV-1), the human immunodeficiency virus (HIV) because of reducing antiviral immunity. This manuscript aimed to discuss the various roles played by zinc in the management of COVID-19 infection.