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Yip A, Yip J, Tsui Z, Smith GD. Navigating Uncertainty with Compassion: Healthcare Assistants' Reflections on Balancing COVID-19 and Routine Care through Adversity. Healthcare (Basel) 2024; 12:1544. [PMID: 39120247 PMCID: PMC11311336 DOI: 10.3390/healthcare12151544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/30/2024] [Accepted: 08/03/2024] [Indexed: 08/10/2024] Open
Abstract
The coronavirus disease 2019 pandemic created unprecedented challenges for healthcare systems around the world. Healthcare assistants played a vital role in the provision of frontline patient care during this crisis. Despite their important contribution, there exists limited research that specifically examines the healthcare assistant's experiences and perspectives of care provision during the COVID-19 pandemic. This study explored healthcare assistants' caring experiences and perspectives on resilience and self-efficacy during the COVID-19 pandemic in Hong Kong. A qualitative descriptive study with semi-structured interviews was conducted with 25 healthcare assistants from public hospitals. Interview recordings were analyzed using thematic analysis. Five main themes emerged from the data: frontline reinforcement: supporting HCAs through resourcing and education amidst the COVID-19 crisis, confronting uncertainty: building personal fortitude in the face of the COVID-19 pandemic, fostering collective resilience through shared support, self-efficacy as a catalyst for adaptive growth, and paving the way for transformation. These findings advocate for the resilience and self-efficacy of healthcare assistants; this may potentially strengthen healthcare system preparedness for navigating unpredictable challenges in the future.
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Affiliation(s)
- Alice Yip
- S.K. Yee School of Health Sciences, Saint Francis University, Hong Kong, China; (Z.T.); (G.D.S.)
| | - Jeff Yip
- Hong Kong Institute of Paramedicine, Hong Kong, China;
| | - Zoe Tsui
- S.K. Yee School of Health Sciences, Saint Francis University, Hong Kong, China; (Z.T.); (G.D.S.)
| | - Graeme Drummond Smith
- S.K. Yee School of Health Sciences, Saint Francis University, Hong Kong, China; (Z.T.); (G.D.S.)
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Pasha AS, Niess MA, Parish DC, Henry T, Krishnamoorthi VR, Baron RB, Wan S. Complexities of Physician Workforce Projection: Call for a Unified National Healthcare Workforce Policy. J Gen Intern Med 2024:10.1007/s11606-024-08966-6. [PMID: 39075269 DOI: 10.1007/s11606-024-08966-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 07/18/2024] [Indexed: 07/31/2024]
Abstract
Ensuring an adequate supply of physicians is paramount in securing the future of healthcare. To do so, accurate physician workforce predictions are needed to inform policymakers. However, the United States lacks such predictions from reliable sources. Several non-governmental organizations have actively been involved in attempting to quantify workforce needs, but they often employ opaque methodologies and are deeply conflicted, leading to potentially unreliable or biased results. Moreover, while federal and state entities invest approximately $15 billion annually in graduate medical education (GME) payments, they have very little control over how the funding is used to shape the future physician workforce. In this article, we review physician workforce predictions from both an international and a domestic perspective and finally discuss how the creation of an apolitical, data-driven, expert-led panel at the federal level with sufficient authority to influence broader workforce policy is the optimal solution for ensuring an adequate supply of physicians for generations to come.
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Affiliation(s)
- Amirala S Pasha
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Meredith A Niess
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - David C Parish
- Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
| | - Tracey Henry
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Robert B Baron
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Shaowei Wan
- General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Reinhard L, Clarfeld L, Gobin N, Knoblauch C, Järgen P, Le Boudec J, Merker M, Rimensberger C, Roulet C, Schaub N, Töttler K, Wertli MM, Streit S. Current and future workforce of general internal medicine in Switzerland: a cross-sectional study. Swiss Med Wkly 2024; 154:3861. [PMID: 39137384 DOI: 10.57187/s.3861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024] Open
Abstract
AIM OF THIS STUDY General internal medicine is a crucial element in healthcare systems. Understanding how many people are and will be working in this field is important to maintain and improve quality for patients in healthcare systems. This can provide a basis for political decisions. METHODS We conducted a cross-sectional study to analyse the current and future workforce of generalists (general practitioners and internists in hospitals) in Switzerland. The Swiss Society of General Internal Medicine (SSGIM) distributed a survey to all members. Respondents were asked about their current average workload in 2023 and planned workload in 2033. The responses were used to calculate full-time equivalent (FTE) for the current and future workforce of generalists and to extrapolate FTE for all active SSGIM members. To model the demand by 2033, we derived different scenarios. RESULTS Of all 6,232 active SSGIM members, 2,030 (33%) participated: 46% female, 25% (largest age group) 56-65 years old, 19% still in postgraduate training. The average workload in 2023 was 78% for female and 87% for male generalists; the FTE extrapolated to all active SSGIM members in 2023 was 5,246. By 2033, 1,935 FTEs (36%) will retire, 502 FTEs (10%) will reduce their workload, 116 FTEs (2%) will increase their workload and 2,800 FTEs (53%) will remain in the workforce with the same workload as in 2023. To maintain the same workforce as in 2023, 2,321 new FTEs (44%) will be needed by 2033. To fill this gap of 232 FTE new generalists per year, we modelled different scenarios with assumptions of interest, workload, migration and dropouts. CONCLUSIONS Within only one decade, 44% of the current workforce of generalists will disappear, mainly due to retirement and decreased workload. To fill this gap, various scenarios need to be incorporated. Politicians are called upon to create the political framework to create attractive training and working conditions for generalists to address the future demand for healthcare services.
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Affiliation(s)
- Lukas Reinhard
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | | | - Niels Gobin
- Swiss Society of General Internal Medicine's Young Talent Promotion Committee
- General Internal Medicine, Hospital Center of Valais Romand (CHVR), Sion, Valais, Switzerland
| | - Christoph Knoblauch
- Swiss Society of General Internal Medicine
- Swiss Society of General Internal Medicine's Young Talent Promotion Committee
| | - Patrick Järgen
- Swiss Society of General Internal Medicine's Young Talent Promotion Committee
- Department of Internal Medicine, Cantonal Hospital Baden, Baden, Switzerland
| | - Joana Le Boudec
- Swiss Society of General Internal Medicine's Young Talent Promotion Committee
- Unisanté, Center for Primary Care and Public Health, University of Lausanne, Switzerland
| | - Meret Merker
- Swiss Society of General Internal Medicine's Young Talent Promotion Committee
- Department of Internal Medicine Cantonal Hospital Olten, Solothurner Spitäler AG, Olten, Switzerland
| | | | - Céline Roulet
- Swiss Society of General Internal Medicine's Young Talent Promotion Committee
| | - Nora Schaub
- Swiss Society of General Internal Medicine's Young Talent Promotion Committee
| | | | - Maria M Wertli
- Swiss Society of General Internal Medicine's Young Talent Promotion Committee
- Department of Internal Medicine, Cantonal Hospital Baden, Baden, Switzerland
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
- Swiss Society of General Internal Medicine's Young Talent Promotion Committee
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4
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Gurung R, Podlasek A. Urgent Direct Access to Diagnostic Services for General Practitioners: Bridging the Gap in Cancer Diagnosis. Cureus 2024; 16:e63350. [PMID: 39077251 PMCID: PMC11283923 DOI: 10.7759/cureus.63350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/31/2024] Open
Abstract
Urgent direct access to diagnostic services for general practitioners (GPs) is a new pathway to capture any cancer diagnoses that may have been missed due to vague symptom presentations. Hence, GPs should look out for the key symptoms mentioned by NHS England that should prompt urgent direct access referrals for chest X-ray (CXR), computed tomography (CT) chest, MRI brain, ultrasound (US) abdomen and pelvis, and CT abdomen and pelvis. By implementing this approach, we can significantly reduce the time to diagnosis, while minimizing the number of visits to GP and specialist appointments prior to initiating investigations. However, the use of this pathway can only improve if access to diagnostic scans is improved. This needs to be done by ensuring all GPs in the country have access to directly request MRI brains, CT chest, abdomen, and pelvis. Further research into the impact of the urgent direct access pathway as well as investigating the number of GPs without access to these vital diagnostic services is required to fully improve and measure the progress of this referral pathway.
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Affiliation(s)
- Roji Gurung
- Radiology, Nottingham University Hospital, Nottingham, GBR
| | - Anna Podlasek
- Radiological Sciences, University of Nottingham, Nottingham, GBR
- Radiology and Imaging Technology, University of Dundee, Dundee, GBR
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Goldthorpe J, Kilbee L, Pretty I, Cotterill S, Hart J, Peters S. Supporting post-pandemic recovery: a qualitative study of the capabilities, opportunities and motivations to deliver oral health behaviour change messages to parents of young children in community settings. BMC Oral Health 2024; 24:580. [PMID: 38762726 PMCID: PMC11102627 DOI: 10.1186/s12903-024-04344-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/07/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic exacerbated vulnerabilities and inequalities in children's oral health, and treatment activity virtually ceased during periods of lockdown. Primary care dentistry is still in the post-pandemic recovery phase, and it may be some years before normal service is resumed in NHS dentistry. However, opportunities to support the dental workforce through offering some preventative care in outreach settings may exist. This has the additional benefit of potentially reaching children who do not routinely see a dentist. The aim of this research was therefore to explore views around upskilling practitioners working in early years educational and care settings to support families of pre-school aged children to adopt and maintain preventative oral health behaviours. METHODS Using the Capability, Opportunity and Motivation model of behaviour (COM-B) to structure our data collection and analysis, we conducted semi-structured interviews with 16 practitioners (dental and non-dental) and analysed the data using deductive framework analysis. RESULTS The data were a good fit with the COM-B model, and further themes were developed within each construct, representing insights from the data. CONCLUSION Early years practitioners can reach vulnerable children who are not usually brought to see a dentist, and have the capability, opportunity and motivation to support the oral health behaviours of families of children in their care. Further research is needed to identify training needs (oral health and behaviour change knowledge and skills), acceptability to parents, and supporting dental practice teams to work in partnership with early years settings.
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Affiliation(s)
- Joanna Goldthorpe
- Manchester Centre for Health Psychology, Division of Health Research, University of Manchester, Manchester, UK
| | - Lauren Kilbee
- Manchester Centre for Health Psychology, Division of Health Research, University of Manchester, Manchester, UK
| | - Iain Pretty
- Division of Medical Sciences, Colgate Palmolive University of Manchester Dental Health Unit, Manchester, UK
| | - Sarah Cotterill
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jo Hart
- Division of Medical Education, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Sarah Peters
- Manchester Centre for Health Psychology, Division of Health Research, University of Manchester, Manchester, UK.
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Mloka DA, Sakita F, Minja IK, Dika H, Tarimo EAM, Sirili N, Mselle LT, Kisenge RR, Sasi P, Nsemwa L, Msanga DR, Matayan EY, Ngowi NB, Moshi MJ, Bartlett J, Macfarlane SB, Kaaya E, O’Sullivan PS. Preparing Institutions to Implement Harmonized Medicine and Nursing Curricula Through the Use of Cross-Institutional Faculty Developers. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:401-408. [PMID: 38764788 PMCID: PMC11102737 DOI: 10.2147/amep.s441090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 04/17/2024] [Indexed: 05/21/2024]
Abstract
Background Effective implementation of new curricula requires faculty to be knowledgeable about curriculum goals and have the appropriate pedagogical skills to implement the curriculum, even more so if the new curriculum is being deployed at multiple institutions. In this paper, we describe the process of creating a common faculty development program to train cross-institutional faculty developers to support the implementation of national harmonized medicine and nursing curricula. Methods A five-step approach was used, including a cross-institutional needs assessment survey for faculty development needs, the development of a generic faculty development program, the identification and training of cross-institutional faculty educators, and the implementation of cross-institutional faculty capacity-building workshops. Results A list of common cross-cutting faculty development needs for teaching and learning was identified from the needs assessment survey and used to develop an accredited, cross-institutional faculty development program for competency-based learning and assessment. A total of 24 cross-institutional faculty developers were identified and trained in 8 core learning and assessment workshops. A total of 18 cross-institutional and 71 institutional workshops were conducted, of which 1292 faculty members and 412 residents were trained, and three cross-institutional educational research projects were implemented. Conclusion The success attained in this study shows that the use of cross-institutional faculty developers is a viable model and sustainable resource that can be used to support the implementation of harmonized national curricula.
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Affiliation(s)
- Doreen Anna Mloka
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Francis Sakita
- Department of Emergency Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Irene Kida Minja
- Department of Restorative Dentistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Haruna Dika
- Department of Anatomy, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Edith A M Tarimo
- Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nathanael Sirili
- Department of Development Studies, Muhimbili University of Health and Allied Sciences, School of Public Health and Social Sciences, Dar es Salaam, Tanzania
| | - Lillian Teddy Mselle
- Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Rodrick Richard Kisenge
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Philip Sasi
- Department of Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Livuka Nsemwa
- Department of Nursing and Midwifery, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Delfina R Msanga
- Department of Pediatrics and Child Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Einoti Yohana Matayan
- Department of Ophthalmology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Mainen Julius Moshi
- Department of Biological and Preclinical Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - John Bartlett
- Department of Global Health and Medicine, Duke University, Durham, NC, USA
| | - Sarah B Macfarlane
- Department of Global Health Sciences, University of San Francisco California, San Francisco, CA, USA
| | - Ephata Kaaya
- Department of Pathology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Patricia S O’Sullivan
- Office of Research and Development in Medical Education, University of San Francisco California, San Francisco, CA, USA
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Nobes J, Leith D, Handjiev S, Dillon JF, Dow E. Intelligent Liver Function Testing (iLFT): An Intelligent Laboratory Approach to Identifying Chronic Liver Disease. Diagnostics (Basel) 2024; 14:960. [PMID: 38732374 PMCID: PMC11083526 DOI: 10.3390/diagnostics14090960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 04/29/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
The intelligent Liver Function Testing (iLFT) pathway is a novel, algorithm-based system which provides automated laboratory investigations and clinical feedback on abnormal liver function test (LFT) results from primary care. iLFT was introduced to NHS Tayside, Scotland, in August 2018 in response to vast numbers of abnormal LFTs, many of which were not appropriately investigated, coupled with rising mortality from chronic liver disease. Here, we outline the development and implementation of the iLFT pathway, considering the implications for the diagnostic laboratories, primary care services and specialist hepatology clinics. Additionally, we describe the utility, outcomes and evolution of iLFT, which was used over 11,000 times in its first three years alone. Finally, we will consider the future of iLFT and propose areas where similar 'intelligent' approaches could be used to add value to laboratory investigations.
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Affiliation(s)
- Jennifer Nobes
- Department of Blood Sciences, NHS Tayside, Ninewells Hospital, Dundee DD1 9SY, UK
- Population Health & Genomics, School of Medicine, University of Dundee, Dundee DD1 9SY, UK
| | - Damien Leith
- Department of Gastroenterology and Hepatology, NHS Tayside, Ninewells Hospital, Dundee DD1 9SY, UK
- Gut Group, School of Medicine, University of Dundee, Dundee DD1 9SY, UK
| | - Sava Handjiev
- Department of Blood Sciences, NHS Tayside, Ninewells Hospital, Dundee DD1 9SY, UK
- Gut Group, School of Medicine, University of Dundee, Dundee DD1 9SY, UK
| | - John F. Dillon
- Department of Gastroenterology and Hepatology, NHS Tayside, Ninewells Hospital, Dundee DD1 9SY, UK
- Gut Group, School of Medicine, University of Dundee, Dundee DD1 9SY, UK
| | - Ellie Dow
- Department of Blood Sciences, NHS Tayside, Ninewells Hospital, Dundee DD1 9SY, UK
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Pryde SJ, Williams O, O'Hare MP, Murdock C, Pedlow K. Exploring access to community neurorehabilitation for people with progressive neurological conditions: a qualitative study. Disabil Rehabil 2024:1-14. [PMID: 38632940 DOI: 10.1080/09638288.2024.2338198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Community neurorehabilitation enables people with progressive neurological conditions (PNCs) to manage their symptoms to live an active, fulfilling life; however, it is not accessible to all. This study explored the factors influencing access to community neurorehabilitation in Northern Ireland from the perspective of people with PNCs and their carers. METHODS Eleven people living with a PNC and three carers took part in virtual focus groups. Data was thematically analysed using the framework method. RESULTS Access to neurorehabilitation was described as a staged journey, driven by people with PNCs, and impacted by interactions with others. Four themes were identified: the person in the driving seat, describing the value of person-centred care and the need for proactivity; the traffic lights, depicting the role and influence of health care professionals (HCPs); the need for direction; and roadworks and roadblocks, identifying additional barriers to access. In addition, six fundamentals of good access were identified. CONCLUSIONS This study adds depth to our understanding of the complexity, and the roles and needs of people with PNCs and HCPs, in accessing community neurorehabilitation. Further research is needed to determine how best to empower people to access rehabilitation.
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Affiliation(s)
- Shona J Pryde
- School of Health Sciences, Ulster University, Londonderry, UK
- Physiotherapy Department, Belfast Health and Social Care Trust, Belfast, UK
| | | | | | - Carolyn Murdock
- School of Health Sciences, Ulster University, Londonderry, UK
| | - Katy Pedlow
- School of Health Sciences, Ulster University, Londonderry, UK
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Moscelli G, Nicodemo C, Sayli M, Mello M. Trends and determinants of clinical staff retention in the English NHS: a double retrospective cohort study. BMJ Open 2024; 14:e078072. [PMID: 38626968 PMCID: PMC11148701 DOI: 10.1136/bmjopen-2023-078072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 02/19/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES To investigate how demographic, contractual and organisational factors are related to the retention of hospital workers in the English NHS. The study will specifically examine the trends in age-retention profiles. DESIGN A double retrospective cross-cohort study using administrative data on senior and specialty doctors, nurses and midwives who were included in the 2009 and 2014 payrolls of all English NHS hospital Trusts. These individuals were tracked over time until 2019 to examine the associations between sociodemographic characteristics and the retention of hospital workers in each cohort. Logistic regressions were estimated at the individual worker level to analyse the data. Additionally, a multilevel panel regression was performed using linked payroll-survey data to investigate the association between hospital organisation characteristics and the retention of clinical staff. SETTING Secondary acute and mental healthcare NHS hospital Trusts in England. PARTICIPANTS 70 777 senior doctors (specialty and specialist doctors and hospital consultants) aged 30-70, and a total of 448 568 between nurses and midwives of any grade aged 20-70, employed by English NHS Trusts. PRIMARY OUTCOME MEASURES Employee retention, measured through binary indicators for stayers and NHS leavers, at 1-year and 5-year horizons. RESULTS Minority doctors had lower 1-year retention rates in acute care than white doctors, while minority nurses and midwives saw higher retention. Part-time roles decreased retention for doctors but improved it for nurses. Fixed-term contracts negatively impacted both groups' retention. Trends diverged for nurses and doctors from 2009 to 2014-nurses' retention declined while doctors' 5-year retention slightly rose. Engagement boosted retention among clinical staff under 51 years of age in acute care. For nurses over 50, addressing their feedback was positively associated with retention. CONCLUSIONS Demographic and contractual factors appear to be stronger predictors of hospital staff retention than organisational characteristics.
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Affiliation(s)
| | - Catia Nicodemo
- Oxford University, Oxford, UK
- University of Verona, Verona, Italy
| | | | - Marco Mello
- University of Surrey, Guildford, UK
- University of Aberdeen, Aberdeen, UK
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10
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Grigoroglou C, Walshe K, Kontopantelis E, Ferguson J, Stringer G, Ashcroft DM, Allen T. Comparing the clinical practice and prescribing safety of locum and permanent doctors: observational study of primary care consultations in England. BMC Med 2024; 22:126. [PMID: 38532468 DOI: 10.1186/s12916-024-03332-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/29/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Temporary doctors, known as locums, are a key component of the medical workforce in the NHS but evidence on differences in quality and safety between locum and permanent doctors is limited. We aimed to examine differences in the clinical practice, and prescribing safety for locum and permanent doctors working in primary care in England. METHODS We accessed electronic health care records (EHRs) for 3.5 million patients from the CPRD GOLD database with linkage to Hospital Episode Statistics from 1st April 2010 to 31st March 2022. We used multi-level mixed effects logistic regression to compare consultations with locum and permanent GPs for several patient outcomes including general practice revisits; prescribing of antibiotics; strong opioids; hypnotics; A&E visits; emergency hospital admissions; admissions for ambulatory care sensitive conditions; test ordering; referrals; and prescribing safety indicators while controlling for patient and practice characteristics. RESULTS Consultations with locum GPs were 22% more likely to involve a prescription for an antibiotic (OR = 1.22 (1.21 to 1.22)), 8% more likely to involve a prescription for a strong opioid (OR = 1.08 (1.06 to 1.09)), 4% more likely to be followed by an A&E visit on the same day (OR = 1.04 (1.01 to 1.08)) and 5% more likely to be followed by an A&E visit within 1 to 7 days (OR = 1.05 (1.02 to 1.08)). Consultations with a locum were 12% less likely to lead to a practice revisit within 7 days (OR = 0.88 (0.87 to 0.88)), 4% less likely to involve a prescription for a hypnotic (OR = 0.96 (0.94 to 0.98)), 15% less likely to involve a referral (OR = 0.85 (0.84 to 0.86)) and 19% less likely to involve a test (OR = 0.81 (0.80 to 0.82)). We found no evidence that emergency admissions, ACSC admissions and eight out of the eleven prescribing safety indicators were different if patients were seen by a locum or a permanent GP. CONCLUSIONS Despite existing concerns, the clinical practice and performance of locum GPs did not appear to be systematically different from that of permanent GPs. The practice and performance of both locum and permanent GPs is likely shaped by the organisational setting and systems within which they work.
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Affiliation(s)
- Christos Grigoroglou
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK.
| | - Kieran Walshe
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Jane Ferguson
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Gemma Stringer
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Thomas Allen
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
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Dixon-Woods M, Summers C, Morgan M, Patel K. The future of the NHS depends on its workforce. BMJ 2024; 384:e079474. [PMID: 38538029 DOI: 10.1136/bmj-2024-079474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Affiliation(s)
| | | | - Matt Morgan
- University Hospital of Wales and Cardiff University, Cardiff, UK
- Curtin University, Australia
- The BMJ
| | - Kiran Patel
- University Hospitals Birmingham and University of Warwick, UK
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12
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Anderson M, Gutacker N, Wimmer S, Mossialos E. Information gaps in England's independent healthcare sector. BMJ 2024; 384:e079261. [PMID: 38503446 DOI: 10.1136/bmj-2024-079261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
- Michael Anderson
- Health Organisation, Policy, Economics (HOPE), Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Nils Gutacker
- Centre for Health Economics, University of York, York, UK
| | - Sabrina Wimmer
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Elias Mossialos
- Health Organisation, Policy, Economics (HOPE), Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
- Institute of Global Health Innovation, Imperial College London, London, UK
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Shahaed H, Glazier RH, Anderson M, Barbazza E, Bos VLLC, Saunes IS, Auvinen J, Daneshvarfard M, Kiran T. Soins primaires pour tous: Le Canada peut s’inspirer de pays semblables ayant un niveau élevé de continuité relationnelle entre patientèle et centres de soins primaires. CMAJ 2024; 196:E359-E368. [PMID: 38499306 PMCID: PMC10948188 DOI: 10.1503/cmaj.221824-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Affiliation(s)
- Heba Shahaed
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande
| | - Richard H Glazier
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande
| | - Michael Anderson
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande
| | - Erica Barbazza
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande
| | - Véronique L L C Bos
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande
| | - Ingrid S Saunes
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande
| | - Juha Auvinen
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande
| | - Maryam Daneshvarfard
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande
| | - Tara Kiran
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande.
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Kuha S, Rissanen S, Harmoinen M, Vähänikkilä H, Kanste O. The association between appreciative management and work engagement among health- and social care professionals: A cross-sectional study. Scand J Caring Sci 2024; 38:210-219. [PMID: 37577811 DOI: 10.1111/scs.13202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/29/2023] [Accepted: 07/29/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The importance of work engagement has been emphasised due to the increasing demand for health- and social care and the shortage of skilled labour. Improving organisational and managerial factors is important when enhancing professionals' work engagement. The association between management and work engagement has only been established in previous studies at a general level, but the association between appreciative management and work engagement has not received equivalent research interest. AIM This study aimed to describe the association between appreciative management and work engagement among health- and social care professionals. METHODS The study used a cross-sectional survey design. The data were collected in five health and social services centres in one city in Finland from September to October 2022 using the Appreciative Management Scale 2.0 and the Utrecht Work Engagement Scale-9. A total of 182 health- and social care professionals participated. The data were analysed using correlations, linear regression analyses, independent samples t-tests and two-way analyses of variance (ANOVAs). RESULTS A moderate association was found between appreciative management and work engagement and its dimensions of vigor, dedication and absorption. Systematic management had the strongest association and equality had the weakest association with work engagement. Among the dimensions of work engagement, appreciative management had the strongest association with vigour and the weakest association with absorption. Appreciative management and work type predicted 18% of the variance in work engagement. Full-time employees reported higher levels of work engagement and all its dimensions than did part-time employees. CONCLUSION The results indicate that appreciative management and full-time work predict work engagement among health- and social care professionals. Due to this positive association, it is important to promote managers' appreciative management skills by educating them to understand how appreciative management enables and supports professionals' vigour, dedication and absorption in health- and social care.
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Affiliation(s)
- Suvi Kuha
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Sanna Rissanen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Merja Harmoinen
- Faculty of Social Sciences, Health Sciences, Nursing Science, Tampere University, Tampere, Finland
| | - Hannu Vähänikkilä
- Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Outi Kanste
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
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Cleary M, West S, Hungerford C. The Post-Graduate: How and Why to Take Mental Health Nurses to the Next Level. Issues Ment Health Nurs 2024; 45:352-355. [PMID: 37410955 DOI: 10.1080/01612840.2023.2225102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Affiliation(s)
- Michelle Cleary
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, New South Wales, Australia
| | - Sancia West
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, New South Wales, Australia
| | - Catherine Hungerford
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, New South Wales, Australia
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16
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Matthews E, Ragatha P, Smart N, Bethune R. Single-shot liposomal bupivacaine in place of rectus sheath catheters to provide non-opiate analgesia after laparotomy: a quality improvement project to reduce the need for ongoing nursing input. BMJ Open Qual 2024; 13:e002313. [PMID: 38413091 PMCID: PMC10900319 DOI: 10.1136/bmjoq-2023-002313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 01/25/2024] [Indexed: 02/29/2024] Open
Abstract
Opioid-sparing pain management is an integral component of enhanced recovery after colonic and rectal surgery. In our hospital, rectus sheath catheters (RSCs) are routinely placed during emergency laparotomy for colorectal procedures to allow a postoperative compartmental block of the surgical site with repeated doses of bupivacaine. However, RSCs require a significant amount of clinical nursing time to maintain and 'top-up'. We present a quality improvement project in which we administered single-shot liposomal bupivacaine (LB) intraoperatively as an alternative to bolus doses of conventional bupivacaine delivered through RSCs. Having thereby reduced the demands placed on nursing time through a reduction in the use of RSCs, we sought to establish whether there was any associated change in analgesic efficacy. Patient pain scores, use of patient-controlled analgesia (PCA) and length of stay following surgery were analysed before and after the introduction of LB. No disruption in these outcomes was identified using statistical process control analysis. A direct comparison of results for patients who received LB versus those who received bolus dosing of bupivacaine via RSCs found no significant differences, with a median total PCA dose of 270 mg oral morphine equivalents (OME) for patients who received LB versus 396 mg OME for patients who had RSCs (p=0.54). The median length of stay for patients who received LB was 15.5 days versus 16 days for those who had RSCs (p=0.87). We conclude that LB represents a viable alternative to boluses of conventional bupivacaine via RSCs in promoting enhanced recovery after emergency laparotomy and look to extend its use locally.
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Affiliation(s)
| | | | - Neil Smart
- Royal Devon and Exeter Hospital, Exeter, UK
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Caton E, Philippou J, Baker E, Lee G. Exploring perceptions of digital technology and digital skills among newly registered nurses and clinical managers. Nurs Manag (Harrow) 2024; 31:27-33. [PMID: 37752873 DOI: 10.7748/nm.2023.e2101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Digital technology has an increasing role in healthcare, but staff lack opportunities to develop their digital skills and there is a lack of research on education and training in digital technology for staff. AIM To explore nurses' perceptions of the use of digital technology in their practice and to identify the digital skills required by newly registered nurses to work in a digitally enabled environment. METHOD Individual semi-structured interviews were conducted on an online communication platform with nine participants - four newly registered nurses and five senior nurses working in clinical and/or management roles. Inductive thematic analysis was used to analyse the data. FINDINGS Several barriers and facilitators to the use of digital technology were identified, including around infrastructure, time, skills, training, support, leadership, familiarity and confidence. The use of digital technology may enhance care consistency and increase patient autonomy, but it may also erode nurse-patient relationships. CONCLUSION Digital technology can enhance patient care but organisational barriers, notably in relation to digital literacy training, need to be addressed for nurses to fully adopt it.
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Affiliation(s)
| | | | - Edward Baker
- King's College Hospital NHS Foundation Trust, London, England
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18
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Brown MEL, Samuriwo R, Asif A, Da Silva A, Vance G, Conn R. How to… support others in developing a career in clinical education research. CLINICAL TEACHER 2024; 21:e13666. [PMID: 37874078 DOI: 10.1111/tct.13666] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/05/2023] [Indexed: 10/25/2023]
Abstract
The Incubator for Clinical Education Research (ClinEdR) is a UK-wide network, established with support from the National Institute for Health Research, to lead initiatives to build capacity in the field. A key barrier identified by this group is that many experienced educators, clinicians, and researchers, who may be committed to supporting others, have little guidance on how best to do this. In this "How to …" paper, we draw on relevant literature and our individual and collective experiences as members of the National Institute for Health Research ClinEdR incubator to offer suggestions on how educators can support others to develop successful careers involving ClinEdR. This article offers guidance and inspiration for all professionals whose role involves research and scholarship and who encounter aspiring or developing clinical education researchers in the course of their work. It will also be of interest to researchers who are starting out and progressing in the field.
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Affiliation(s)
| | - Ray Samuriwo
- School of Nursing and Healthcare Leadership, University of Bradford, Bradford, UK
| | - Aqua Asif
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Ana Da Silva
- Medical School, Faculty of Medicine Health and Life Science, Swansea University, Swansea, UK
| | - Gill Vance
- School of Medicine, Newcastle University, Newcastle, UK
| | - Richard Conn
- School of Medicine, Ulster University, Coleraine, UK
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Affiliation(s)
- Connor S Qiu
- School of Public Health, Imperial College London, London SW7 2AZ, UK
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London SW7 2AZ, UK
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20
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Papalia F, Fung K, Chen Y, Thornton GD, Geatches N, Cousins F, Kirkham K, Westwood M. Innovative approach to medical leadership and management development: clinician secondment to a management consulting firm. BMJ LEADER 2023; 7:304-306. [PMID: 37192097 DOI: 10.1136/leader-2022-000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 04/13/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND AND AIM Opportunities to participate in leadership and management with protected time can be limited for clinical trainees. The aim of this fellowship was to gain experience of gold standard healthcare management by becoming part of multidisciplinary teams working to deliver transformational change in the National Health Service (NHS). METHODS A 6-month pilot fellowship, structured as an Out of Programme Experience was created for two registrars to be seconded to the healthcare division of Deloitte, a leading professional services firm. Competitive selection was jointly administered by the Director of Medical Education at St Bartholomew's Hospital and Deloitte. RESULTS The successful candidates worked on service-led and digital transformation projects, interfacing with senior NHS executives and directors. Trainees gained direct experience and understanding of high-level decision making in the NHS, tackling complex service delivery problems and the practical realities of delivering change within a constrained budget. One impact of this pilot has been completion of a business case to scale up the fellowship into an established programme that can allow other trainees to apply. CONCLUSION This innovative fellowship has allowed interested trainees an opportunity to broaden the relevant skills and experience in leadership and management required in specialty training curriculum with real-life application in the NHS.
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Affiliation(s)
- Francesco Papalia
- Cardiology, Barts Health NHS Trust, London, UK
- Cardiology, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
| | | | - Yang Chen
- Cardiology, Barts Health NHS Trust, London, UK
- Leadership and Training, Royal College of Physicians, London, UK
| | - George D Thornton
- Cardiology, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | | | | | | | - Mark Westwood
- Cardiology, Barts Health NHS Trust, London, UK
- Queen Mary University of London, London, UK
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Bradford N, Moore E, Taylor K, Cook O, Gent L, Beane T, Williams N, Alexander K, Pitt E, Still J, Wellard C, McErlean G, Kirk D, Monterosso L, McCarthy A, Lokmic-Tomkins Z, Balson J, Gates P. The cancer nursing workforce in Australia: a national survey exploring determinants of job satisfaction. BMC Nurs 2023; 22:461. [PMID: 38057825 DOI: 10.1186/s12912-023-01629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND To maintain and improve the quality of the cancer nursing workforce, it is crucial to understand the factors that influence retention and job satisfaction. We aimed to investigate the characteristics of cancer nurses in Australia and identify predictors of job satisfaction. METHODS We analysed data from an anonymous cross-sectional survey distributed through the Cancer Nurses Society Australia membership and social media platforms from October 2021 to February 2022. The survey was compared to national nursing registration data. Data were analysed with non-parametric tests, and a stepwise, linear regression model was developed to best predict job satisfaction. RESULTS Responses were received from 930 cancer nurses. Most respondents (85%) described themselves as experienced nurses, and more than half had post-graduate qualifications. We identified individual, organizational, and systemic factors that contribute to job satisfaction and can impact in workforce shortages. The findings include strategies to address and prioritize workforce challenges. There were 89 different titles for advanced practice nursing roles. Managing high workload was a reported challenge by 88%. Intention to stay less than 10 years was reported by nearly 60%; this was significantly correlated with job satisfaction and age. Significantly higher scores for job satisfaction were associated with those who had career progression opportunities, career development opportunities, adequate peer support and a clearly defined scope of role. Conversely, job satisfaction scores decreased the more people agreed there was a lack of leadership and they had insufficient resources to provide quality care. CONCLUSION Cancer nurses are critical to the delivery of cancer care however, the workforce faces multiple challenges. This study provides an understanding of the Australian cancer nursing workforce characteristics, their roles and activities, and highlights important considerations for retaining nurses in the profession.
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Affiliation(s)
- Natalie Bradford
- Cancer and Palliative Care Outcomes Centre and School of Nursing, Queensland University of Technology, QLD, Brisbane, QLD, Australia.
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia.
| | - Elizabeth Moore
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Karen Taylor
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- Cancer Network WA, Perth, WA, Australia
| | - Olivia Cook
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- McGrath Foundation - Level 1, 32 Walker St North Sydney, Sydney, NSW, Australia
- Monash Nursing and Midwifery, Monash University, Melbourne, VIC, Australia
| | - Lucy Gent
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- Sir Charles Gairdner Osborne Park Hospitals Health Care Group, Perth, WA, Australia
- Edith Cowan University, Perth, WA, Australia
| | - Theresa Beane
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- Hervey Bay Hospital, Queensland Health, Pialba, QLD, Australia
| | - Natalie Williams
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- King Edward Memorial Hospital, Perth, WA, Australia
| | - Kimberly Alexander
- Cancer and Palliative Care Outcomes Centre and School of Nursing, Queensland University of Technology, QLD, Brisbane, QLD, Australia
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
| | - Erin Pitt
- Cancer and Palliative Care Outcomes Centre and School of Nursing, Queensland University of Technology, QLD, Brisbane, QLD, Australia
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
| | - Jemma Still
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
| | - Cameron Wellard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Gemma McErlean
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Deborah Kirk
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- Edith Cowan University, Perth, WA, Australia
| | - Leanne Monterosso
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- Notre Dame University, Perth, WA, Australia
| | - Alexandra McCarthy
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- The University of Queensland, Brisbane, QLD, Australia
| | - Zerina Lokmic-Tomkins
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- Monash Nursing and Midwifery, Monash University, Melbourne, VIC, Australia
| | - Jessica Balson
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Priscilla Gates
- Cancer Nurses Society of Australia, Gabbadah, WA, Australia
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Deakin University, Melbourne, VIC, Australia
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Shahaed H, Glazier RH, Anderson M, Barbazza E, Bos VLLC, Saunes IS, Auvinen J, Daneshvarfard M, Kiran T. Primary care for all: lessons for Canada from peer countries with high primary care attachment. CMAJ 2023; 195:E1628-E1636. [PMID: 38049161 DOI: 10.1503/cmaj.221824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Affiliation(s)
- Heba Shahaed
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Richard H Glazier
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Michael Anderson
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Erica Barbazza
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Véronique L L C Bos
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Ingrid S Saunes
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juha Auvinen
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Maryam Daneshvarfard
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Tara Kiran
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland.
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Wu J, Xue E, Huang S, Fu Y, Chen D, Shao J, Zhang H, Tang L, Ye Z. Facilitators and Barriers of Integrated Care for Older Adults with Multimorbidity: A Descriptive Qualitative Study. Clin Interv Aging 2023; 18:1973-1983. [PMID: 38050622 PMCID: PMC10693763 DOI: 10.2147/cia.s436294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/05/2023] [Indexed: 12/06/2023] Open
Abstract
Purpose A lack of coordinated care leads to multiple adverse effects for older adults with multimorbidity, including high treatment burdens, adverse health outcomes, reduplicated healthcare service utilization, and catastrophic healthcare expenditure. To foster healthy aging, person-centered integrated care that is responsive to older adults has been proposed by the World Health Organization. The objective of this study was to identify factors that impact the successful implementation of integrated care for older adults with multimorbidity in China. Patients and Methods From July 2022 to May 2023, 33 healthcare providers and managers involved in the delivery and management of healthcare services for older adults with multimorbidity were recruited from Zhejiang Province, China using purposeful and maximum variation sampling methods. Semi-structured, face-to-face in-depth interviews were conducted by the same interviewer in the participants' native Chinese language until data saturation was reached. Inductive thematic analysis was used to analyze the data, and then, themes were mapped onto six dimensions using the Rainbow Model of Integrated Care to allow for a comprehensive view of the study's findings. Results Eleven themes were generated as facilitators and barriers to integrated care for older adults with multimorbidity in China. These themes include (1) clinical integration: patient-centered care, (2) professional integration: interdisciplinary teams and training, (3) organizational integration: resources and accessibility, (4) system integration: community and funds, incentives, and health insurance, (5) functional integration: electronic health record systems, workforce, and guidelines, and (6) normative integration: shared mission. Conclusion Guided by the Rainbow Model of Integrated Care, various factors at both micro, meso, and macro levels that impact the implementation of integrated care for older adults with multimorbidity in the Chinese context have been identified in this study. The strategies for future interventions and policies should focus on promoting facilitators and addressing barriers.
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Affiliation(s)
- Jingjie Wu
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Erxu Xue
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Siyuan Huang
- Nursing Department, the First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, People’s Republic of China
| | - Yujia Fu
- School of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Dandan Chen
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Jing Shao
- School of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Hui Zhang
- Nursing Department, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, People’s Republic of China
| | - Leiwen Tang
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Zhihong Ye
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
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24
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Srivastava D, Van Kessel R, Delgrange M, Cherla A, Sood H, Mossialos E. A Framework for Digital Health Policy: Insights from Virtual Primary Care Systems Across Five Nations. PLOS DIGITAL HEALTH 2023; 2:e0000382. [PMID: 37939131 PMCID: PMC10631700 DOI: 10.1371/journal.pdig.0000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/04/2023] [Indexed: 11/10/2023]
Abstract
Digital health technologies used in primary care, referred to as, virtual primary care, allow patients to interact with primary healthcare professionals remotely though the current iteration of virtual primary care may also come with several unintended consequences, such as accessibility barriers and cream skimming. The World Health Organization (WHO) has a well-established framework to understand the functional components of health systems. However, the existing building blocks framework does not sufficiently account for the disruptive and multi-modal impact of digital transformations. In this review, we aimed to develop the first iteration of this updated framework by reviewing the deployment of virtual primary care systems in five leading countries: Canada, Finland, Germany and Sweden and the United Kingdom (England). We found that all five countries have taken different approaches with the deployment of virtual primary care, yet seven common themes were highlighted across countries: (1) stated policy objectives, (2) regulation and governance, (3) financing and reimbursement, (4) delivery and integration, (5) workforce training and support, (6) IT systems and data sharing, and (7) the extent of patient involvement in the virtual primary care system. The conceptual framework that was derived from these findings offers a set of guiding principles that can facilitate the assessment of virtual primary care in health system settings.
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Affiliation(s)
- Divya Srivastava
- Department of Health Policy, London School of Economics and Political Science (LSE), London, United Kingdom
- LSE Health, London School of Economics and Political Science (LSE), London, United Kingdom
| | - Robin Van Kessel
- Department of Health Policy, London School of Economics and Political Science (LSE), London, United Kingdom
- LSE Health, London School of Economics and Political Science (LSE), London, United Kingdom
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Marine Delgrange
- Guy’s and St Thomas’ NHS Foundation Trust and NHS Leadership Academy, London, United Kingdom
| | - Avi Cherla
- Department of Health Policy, London School of Economics and Political Science (LSE), London, United Kingdom
| | - Harpreet Sood
- LSE Health, London School of Economics and Political Science (LSE), London, United Kingdom
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science (LSE), London, United Kingdom
- LSE Health, London School of Economics and Political Science (LSE), London, United Kingdom
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25
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Moncrieff G, Downe S, Maxwell M, Cheyne H. Mapping factors that may influence attrition and retention of midwives: a scoping review protocol. BMJ Open 2023; 13:e076686. [PMID: 37865412 PMCID: PMC10603492 DOI: 10.1136/bmjopen-2023-076686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/29/2023] [Indexed: 10/23/2023] Open
Abstract
INTRODUCTION An appropriately staffed midwifery workforce is essential for the provision of safe and high-quality maternity care. However, there is a global and national shortage of midwives. Understaffed maternity services are frequently identified as contributing to unsafe care provision and adverse outcomes for mothers and babies. While there is a need to recruit midwives through pre-registration midwifery programmes, this has significant resource implications, and is counteracted to a large extent by the high number of midwives leaving the workforce. It is increasingly recognised that there is a critical need to attend to retention in midwifery in order to develop and maintain safe staffing levels. The objective of this review is to collate and map factors that have been found to influence attrition and retention in midwifery. METHODS AND ANALYSIS Joanna Briggs Institute guidance for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be used to guide the review process and reporting of the review. CINAHL, MEDLINE, PsycINFO and Scopus databases will be searched for relevant literature from date of inception to 21 July 2023. Research from high-income countries that explores factors that influence leaving intentions for midwives will be included. Literature from low-income and middle-income countries, and studies where nursing and midwifery data cannot be disaggregated will be excluded. Two reviewers will screen 20% of retrieved citations in duplicate, the first author will screen the remaining results. Data will be extracted using a preformed data extraction tool by the first author. Findings will be presented in narrative, tabular and graphical formats. ETHICS AND DISSEMINATION The review will collate data from existing research, therefore ethics approval is not required. Findings will be published in journals, presented at conferences and will be translated into infographics and other formats for online dissemination.
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Affiliation(s)
| | - Soo Downe
- University of Central Lancashire, Preston, UK
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26
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Östergård K, Kuha S, Kanste O. Health-care leaders' and professionals' experiences and perceptions of compassionate leadership: A mixed-methods systematic review. Leadersh Health Serv (Bradf Engl) 2023; ahead-of-print:49-65. [PMID: 37823549 PMCID: PMC10868663 DOI: 10.1108/lhs-06-2023-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/24/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE The purpose of this study is to identify and synthesise the best evidence on health-care leaders' and professionals' experiences and perceptions of compassionate leadership. DESIGN/METHODOLOGY/APPROACH A mixed-methods systematic review was conducted in accordance with the Joanna Briggs Institute methodology for mixed-methods systematic reviews using a convergent integrated approach. A systematic search was done in January 2023 in PubMed, CINAHL, Scopus, Medic and MedNar databases. The results were reported based on Preferred Reporting Items for Systematic Reviews and Meta-analyses. The data was analysed using thematic analysis. FINDINGS Ten studies were included in the review (five qualitative and five quantitative). The thematic analysis identified seven analytical themes as follows: treating professionals as individuals with an empathetic and understanding approach; building a culture for open and safe communication; being there for professionals; giving all-encompassing support; showing the way as a leader and as a strong professional; building circumstances for efficient work and better well-being; and growing into a compassionate leader. PRACTICAL IMPLICATIONS Compassionate leadership can possibly address human resource-related challenges, such as health-care professionals' burnout, turnover and the lack of patient safety. It should be taken into consideration by health-care leaders, their education and health-care organisations when developing their effectiveness. ORIGINALITY/VALUE This review synthesised the knowledge of compassionate leadership in health care and its benefits by providing seven core elements of health-care leaders' and professionals' experiences and perceptions of compassionate leadership.
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Affiliation(s)
- Kevin Östergård
- Research Unit of Health Sciences and Technology, University of
Oulu, Oulu, Finland
| | - Suvi Kuha
- Research Unit of Health Sciences and Technology, University of
Oulu, Oulu, Finland and
Finnish Centre for Evidence-Based Health Care, Helsinki,
Finland
| | - Outi Kanste
- Research Unit of Health Sciences and Technology, University of
Oulu, Oulu, Finland and
Finnish Centre for Evidence-Based Health Care, Helsinki,
Finland
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27
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Flinkman M, Coco K, Rudman A, Leino-Kilpi H. Registered nurses' psychological capital: A scoping review. Int J Nurs Pract 2023; 29:e13183. [PMID: 37485748 DOI: 10.1111/ijn.13183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/28/2023] [Accepted: 06/24/2023] [Indexed: 07/25/2023]
Abstract
AIMS The aim was to examine the extent and scope of empirical research concerning registered nurses' psychological capital. BACKGROUND In a time of global nursing shortage, identifying variables that could positively contribute to the retention of the nursing workforce is essential. Prior research has shown that psychological capital correlates positively with employees' better performance and well-being. DESIGN A scoping review. DATA SOURCES A systematic literature search was conducted in the following databases: PubMed, CINAHL, PsycINFO, Web of Science and Scopus covering the period from 1 January 2005 to 7 May 2023. REVIEW METHODS The JBI methodological guidance for scoping reviews was followed. The results were summarized narratively. RESULTS A total of 111 studies reported in 114 peer-reviewed articles were included. Studies were carried out across 20 countries, with the majority from China (45), Australia (nine), Pakistan (nine), Canada (eight), South Korea (eight) and the United States (eight). A positive correlation was found between registered nurses' psychological capital and desirable work-related outcomes, such as work engagement, commitment and retention intention. CONCLUSION A comprehensive overview of research evidence suggests that psychological capital is associated with many positive work-related outcomes and might therefore be a valuable resource for reducing nurse turnover.
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Affiliation(s)
- Mervi Flinkman
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Kirsi Coco
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Ann Rudman
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- School of Health and Welfare, Department of Caring Sciences, Dalarna University, Sweden
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Weyman A, O'Hara R, Nolan P, Glendinning R, Roy D, Coster J. Determining the relative salience of recognised push variables on health professional decisions to leave the UK National Health Service (NHS) using the method of paired comparisons. BMJ Open 2023; 13:e070016. [PMID: 37699606 PMCID: PMC10514647 DOI: 10.1136/bmjopen-2022-070016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 07/10/2023] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVE The primary and secondary impacts from the COVID-19 pandemic are claimed to have had a detrimental impact on health professional retention within the UK National Health Service (NHS). This study set out to identify priorities for intervention by scaling the relative importance of widely cited push (leave) influences. DESIGN During Summer/Autumn 2021, a UK-wide opportunity sample (n=1958) of NHS health professionals completed an online paired-comparisons exercise to determine the relative salience of work-related stress, workload intensity, time pressure, staffing levels, working hours, work-homelife balance, recognition of effort and pay as reasons why health professionals leave NHS employment. SETTING The study is believed to be the first large-scale systematic assessment of factors driving staff exits from the NHS since the COVID-19 pandemic. RESULTS All professions gave primacy to work-related stress, workload intensity and staffing levels. Pay was typically located around the midpoint of the respective scales; recognition of effort and working hours were ranked lowest. However, differences were apparent in the rank order and relative weighting of push variables between health professions and care delivery functions. Ambulance paramedics present as an outlier, notably with respect to staffing level (F-stat 4.47, p=0.004) and the primacy of work-homelife balance. Relative to staffing level, other push variables exert a stronger influence on paramedics than nurses or doctors (f 4.29, p=0.006). CONCLUSION Findings are relevant to future NHS health professional retention intervention strategy. Excepting paramedics/ambulance services, rankings of leave variables across the different health professional families and organisation types exhibit strong alignment at the ordinal level. However, demographic differences in the weightings and rankings, ascribed to push factors by professional family and organisation type, suggests that, in addition to signposting universal (all-staff) priorities for intervention, bespoke solutions for different professions and functions may be needed.
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Affiliation(s)
- Andrew Weyman
- Department of Psychology, University of Bath, Bath, UK
| | - Rachel O'Hara
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Peter Nolan
- School of Management, University of Leicester, Leicester, UK
| | | | - Deborah Roy
- Department of Psychology, University of Bath, Bath, UK
| | - Joanne Coster
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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29
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Patynowska KA, McConnell T, McAtamney C, Hasson F. 'That just doesn't feel right at times' - lone working practices, support and educational needs of newly employed Healthcare Assistants providing 24/7 palliative care in the community: A qualitative interview study. Palliat Med 2023; 37:1183-1192. [PMID: 37334445 PMCID: PMC10503246 DOI: 10.1177/02692163231175990] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
BACKGROUND Healthcare assistants working in hospice at home settings have a pivotal role in supporting people dying at home and their family caregivers. Some healthcare assistants are working alone in patients' homes, which magnifies some of the issues reported for those working closely with other team members. There is a dearth of evidence in terms of education, training and support needs for healthcare assistants when working alone. AIM To explore the role of newly employed lone working healthcare assistants delivering palliative care in the community, and their support and educational needs. DESIGN Qualitative exploratory study using semi-structured interviews. SETTING/PARTICIPANTS Healthcare assistants (n = 16) employed less than 12 months by a national non-profit hospice and palliative care provider located across the UK. RESULTS Analysis of interviews identified three main themes: (1) Healthcare assistants have a unique and complex role catering for holistic needs of patients and their family caregivers in the home environment; (2) preparation for the complex role requires focus on experiential learning and specific training to support holistic care provision; (3) lone workers experience loneliness and isolation and identify peer support as a key intervention to support their wellbeing. CONCLUSIONS Given the complexities of their role within community palliative care teams, there are key learning points in relation to healthcare assistant preparation. Education and support networks should be prioritised to reduce isolation and support ongoing learning and development of newly employed healthcare assistants; all of which is vital to ensure safety and quality of care for the growing number of people they support in the community.
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Affiliation(s)
| | - Tracey McConnell
- Marie Curie Hospice Belfast, Belfast, UK
- School of Nursing and Midwifery, Queen’s University Belfast, Medical Biology Centre, Belfast, UK
| | | | - Felicity Hasson
- Institute of Nursing and Health Sciences, School of Nursing and Paramedic Sciences Ulster University, Belfast Campus, UK
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30
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Lin T, Li Y, Li Y, Guo W, Guo X, Tang C. Individual- and institution-level predictors of the turnover intention of medical staff among rural primary medical institutions in Xinjiang Production and Construction Corps, China: a cross-sectional multi-level analysis. Front Psychol 2023; 14:1112057. [PMID: 37637903 PMCID: PMC10447901 DOI: 10.3389/fpsyg.2023.1112057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
Background Primary medical staff (PMS) are the guardians of population health. However, their loss further worsens the shortage and uneven distribution of human health resources, which should be addressed immediately. This study aimed to investigate the current status of turnover intention of rural PMS in Xinjiang Production and Construction Corps (XPCC) in China and its influencing factors atthe individual and institutional levels to provide reliable baseline data for intervention strategies to protect valuable rural PMS. Methods Participants were recruited from rural public health institutions of the XPCC using a cross-sectional multistage sampling process. Data on participants' turnover intention and individual- and institution-level indicators were obtained through standardized electronic questionnaires and statistical reports of regional health administrative departments. The key factors influencing PMS turnover intention were identified us ingunivariateandmulti-level logistic regression analysis. Findings Overall, 20.5% (447/2182) of participants reported turnover intention. Univariate analysis showed that the occurrence of turnover intention was significantly influenced by marriage, education, age, year of working, monthly income, human resource management practices (HRMP), job satisfaction, per capita served population (PCSP) and number of beds (p < 0.05). Multi-level logistic regression analysis showed that bachelor's degree or above and intermediate professional title were closely related to the occurrence of turnover intention (p < 0.05), age 41-50 years old and above, high human resource management practice, and high job satisfaction effectively reduced the odds (p < 0.05). The odds of turnover intention increased by 37% (p < 0.10) for PMS in institutions with PCSP more than 250 people. In contrast, the odds of turnover intention decreased to 68% (p < 0.05) for PMS in institutions with more than 50 beds. Conclusion Government-run primary medical institutions face the risk of PMS turnover intention. From a personal perspective, the high-risk population fortheturnover intention was mainly the PMS with bachelor's degrees or above and intermediate professional titles. The low-risk population was the PMS with aged over 40 years, a higher evaluation of human resource management practice, and job satisfaction. From the perspective of primary medical institutions, larger institutions can reduce the turnover intention of individuals, whereas the size of the service population has the opposite effect.
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Affiliation(s)
- Taoyu Lin
- The People’s Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Ye Li
- School of Medicine, Shihezi University, Shihezi, Xinjiang, China
| | - Yuanyuan Li
- School of Medicine, Shihezi University, Shihezi, Xinjiang, China
| | - Wei Guo
- School of Medicine, Shihezi University, Shihezi, Xinjiang, China
| | - Xiaoying Guo
- School of Medicine, Shihezi University, Shihezi, Xinjiang, China
| | - Changmin Tang
- School of Management, Hubei University of Chinese Medicine, Wuhan, Hubei, China
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Sagan A, Thomas S, Kennedy E, Webb E, McKee M. Assessing resilience of a health system is difficult but necessary to prepare for the next crisis. BMJ 2023; 382:e073721. [PMID: 37402509 DOI: 10.1136/bmj-2022-073721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Affiliation(s)
- Anna Sagan
- European Observatory on Health Systems and Policies, London, UK
- London School of Economics and Political Science, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Steve Thomas
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Erin Webb
- European Observatory on Health Systems and Policies, London, UK
- Department of Health Care Management, Technical University of Berlin, Berlin, Germany
| | - Martin McKee
- European Observatory on Health Systems and Policies, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
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Geiger I, Schang L, Sundmacher L. Assessing needs-based supply of physicians: a criteria-led methodological review of international studies in high-resource settings. BMC Health Serv Res 2023; 23:564. [PMID: 37259109 DOI: 10.1186/s12913-023-09461-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/27/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Many health systems embrace the normative principle that the supply of health services ought to be based on the need for healthcare. However, a theoretically grounded framework to operationalize needs-based supply of healthcare remains elusive. The aim of this paper is to critically assess current methodologies that quantify needs-based supply of physicians and identify potential gaps in approaches for physician planning. To this end, we propose a set of criteria for consideration when estimating needs-based supply. METHODS We conducted searches in three electronic bibliographic databases until March 2020 supplemented by targeted manual searches on national and international websites to identify studies in high-resource settings that quantify needs-based supply of physicians. Studies that exclusively focused on forecasting methods of physician supply, on inpatient care or on healthcare professionals other than physicians were excluded. Additionally, records that were not available in English or German were excluded to avoid translation errors. The results were synthesized using a framework of study characteristics in addition to the proposed criteria for estimating needs-based physician supply. RESULTS 18 quantitative studies estimating population need for physicians were assessed against our criteria. No study met all criteria. Only six studies sought to examine the conceptual dependency between need, utilization and supply. Apart from extrapolations, simulation models were applied most frequently to estimate needs-based supply. 12 studies referred to the translation of need for services with respect to a physician's productivity, while the rest adapted existing population-provider-ratios. Prospective models for estimating future care needs were largely based on demographic predictions rather than estimated trends in morbidity and new forms of care delivery. CONCLUSIONS The methodological review shows distinct heterogeneity in the conceptual frameworks, validity of data basis and modeling approaches of current studies in high-resource settings on needs-based supply of physicians. To support future estimates of needs-based supply, this review provides a workable framework for policymakers in charge of health workforce capacity planning.
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Affiliation(s)
- Isabel Geiger
- Technical University of Munich, Munich, Germany.
- Ludwig-Maximilians-University (LMU) Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Laura Schang
- Pettenkofer School of Public Health, Munich, Germany
| | - Leonie Sundmacher
- Department of Health Economics, Technical University of Munich, Munich, Germany
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Grigoroglou C, Walshe K, Kontopantelis E, Ferguson J, Stringer G, Ashcroft D, Allen T. Use of locum doctors in NHS trusts in England: analysis of routinely collected workforce data 2019-2021. BMJ Open 2023; 13:e065803. [PMID: 37230514 DOI: 10.1136/bmjopen-2022-065803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES Temporary doctors, known as locum doctors, play an important role in the delivery of care in the National Health Service (NHS); however, little is known about the extent of locum use in NHS trusts. This study aimed to quantify and describe locum use for all NHS trusts in England in 2019-2021. SETTING Descriptive analyses of data on locum shifts from all NHS trusts in England in 2019-2021. Weekly data were available for the number of shifts filled by agency and bank staff and the number of shifts requested by each trust. Negative binomial models were used to investigate the association between the proportion of medical staffing provided by locums and NHS trust characteristics. RESULTS In 2019, on average 4.4% of total medical staffing was provided by locums, but this varied substantially across trusts (25th-75th centile=2.2%-6.2%). Over time, on average two-thirds of locum shifts were filled by locum agencies and a third by trusts' staff banks. On average, 11.3% of shifts requested were left unfilled. In 2019-2021, the mean number of weekly shifts per trust increased by 19% (175.2-208.6) and the mean number of weekly unfilled shifts per trust increased by 54% (32.7 to 50.4). Trusts rated by the Care Quality Commission (CQC) as inadequate or requiring improvement (incidence rate ratio=1.495; 95% CI 1.191 to 1.877), and smaller trusts had a higher use of locums. Large variability was observed across regions for use of locums, proportion of shifts filled by locum agencies and unfilled shifts. CONCLUSIONS There were large variations in the demand for and use of locum doctors in NHS trusts. Trusts with poor CQC ratings and smaller trusts appear to use locum doctors more intensively compared with other trust types. Unfilled shifts were at a 3-year high at the end of 2021 suggesting increased demand which may result from growing workforce shortages in NHS trusts.
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Affiliation(s)
- Christos Grigoroglou
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Kieran Walshe
- Alliance Manchester Business School, Institute for Health Policy and Organisation, The University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research, The University of Manchester, Manchester, UK
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Jane Ferguson
- Alliance Manchester Business School, Institute for Health Policy and Organisation, The University of Manchester, Manchester, UK
| | - Gemma Stringer
- Alliance Manchester Business School, Institute for Health Policy and Organisation, The University of Manchester, Manchester, UK
| | - Darren Ashcroft
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Thomas Allen
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
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Sutton C, Prowse J, McVey L, Elshehaly M, Neagu D, Montague J, Alvarado N, Tissiman C, O'Connell K, Eyers E, Faisal M, Randell R. Strategic workforce planning in health and social care - an international perspective: A scoping review. Health Policy 2023; 132:104827. [PMID: 37099856 DOI: 10.1016/j.healthpol.2023.104827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/06/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023]
Abstract
Effective strategic workforce planning for integrated and co-ordinated health and social care is essential if future services are to be resourced such that skill mix, clinical practice and productivity meet population health and social care needs in timely, safe and accessible ways globally. This review presents international literature to illustrate how strategic workforce planning in health and social care has been undertaken around the world with examples of planning frameworks, models and modelling approaches. The databases Business Source Premier, CINAHL, Embase, Health Management Information Consortium, Medline and Scopus were searched for full texts, from 2005 to 2022, detailing empirical research, models or methodologies to explain how strategic workforce planning (with at least a one-year horizon) in health and/or social care has been undertaken, yielding ultimately 101 included references. The supply/demand of a differentiated medical workforce was discussed in 25 references. Nursing and midwifery were characterised as undifferentiated labour, requiring urgent growth to meet demand. Unregistered workers were poorly represented as was the social care workforce. One reference considered planning for health and social care workers. Workforce modelling was illustrated in 66 references with predilection for quantifiable projections. Increasingly needs-based approaches were called for to better consider demography and epidemiological impacts. This review's findings advocate for whole-system needs-based approaches that consider the ecology of a co-produced health and social care workforce.
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Affiliation(s)
- Claire Sutton
- Workforce Observatory, University of Bradford, UK; Faculty of Health Studies, University of Bradford, Bradford, UK.
| | - Julie Prowse
- Workforce Observatory, University of Bradford, UK; Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Lynn McVey
- Workforce Observatory, University of Bradford, UK; Faculty of Health Studies, University of Bradford, Bradford, UK; Wolfson Centre for Applied Health Research, Bradford, UK
| | - Mai Elshehaly
- Workforce Observatory, University of Bradford, UK; Wolfson Centre for Applied Health Research, Bradford, UK; Faculty of Engineering and Informatics, University of Bradford, Bradford, UK
| | - Daniel Neagu
- Workforce Observatory, University of Bradford, UK; Faculty of Engineering and Informatics, University of Bradford, Bradford, UK
| | - Jane Montague
- Workforce Observatory, University of Bradford, UK; Faculty of Health Studies, University of Bradford, Bradford, UK; Wolfson Centre for Applied Health Research, Bradford, UK
| | - Natasha Alvarado
- Workforce Observatory, University of Bradford, UK; Faculty of Health Studies, University of Bradford, Bradford, UK; Wolfson Centre for Applied Health Research, Bradford, UK
| | | | | | - Emma Eyers
- Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Muhammad Faisal
- Workforce Observatory, University of Bradford, UK; Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Rebecca Randell
- Workforce Observatory, University of Bradford, UK; Faculty of Health Studies, University of Bradford, Bradford, UK; Wolfson Centre for Applied Health Research, Bradford, UK
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Skinner A, Occhipinti JA, Prodan A, Song YJC, Hickie IB. Bi-stability and critical transitions in mental health care systems: a model-based analysis. Int J Ment Health Syst 2023; 17:5. [PMID: 36959667 PMCID: PMC10037813 DOI: 10.1186/s13033-023-00573-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/07/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Delayed initiation and early discontinuation of treatment due to limited availability and accessibility of services may often result in people with mild or moderate mental disorders developing more severe disorders, leading to an increase in demand for specialised care that would be expected to further restrict service availability and accessibility (due to increased waiting times, higher out-of-pocket costs, etc.). METHODS We developed a simple system dynamics model of the interaction of specialised services capacity and disease progression to examine the impact of service availability and accessibility on the effectiveness and efficiency of mental health care systems. RESULTS Model analysis indicates that, under certain conditions, increasing services capacity can precipitate an abrupt, step-like transition from a state of persistently high unmet need for specialised services to an alternative, stable state in which people presenting for care receive immediate and effective treatment. This qualitative shift in services system functioning results from a 'virtuous cycle' in which increasing treatment-dependent recovery among patients with mild to moderate disorders reduces the number of severely ill patients requiring intensive and/or prolonged treatment, effectively 'releasing' services capacity that can be used to further reduce the disease progression rate. We present an empirical case study of tertiary-level child and adolescent mental health services in the Australian state of South Australia demonstrating that the conditions under which such critical transitions can occur apply in real-world services systems. CONCLUSIONS Policy and planning decisions aimed at increasing specialised services capacity have the potential to dramatically increase the effectiveness and efficiency of mental health care systems, promoting long-term sustainability and resilience in the face of future threats to population mental health (e.g., economic crises, natural disasters, global pandemics).
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Affiliation(s)
- Adam Skinner
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Computer Simulation and Advanced Research Technologies (CSART), Sydney, Australia
| | - Ante Prodan
- Computer Simulation and Advanced Research Technologies (CSART), Sydney, Australia
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Sydney, Australia
| | - Yun Ju Christine Song
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ian B Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Wood RM, Harper AL, Onen-Dumlu Z, Forte PG, Pitt M, Vasilakis C. The False Economy of Seeking to Eliminate Delayed Transfers of Care: Some Lessons from Queueing Theory. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:243-251. [PMID: 36529825 PMCID: PMC9760184 DOI: 10.1007/s40258-022-00777-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND It is a stated ambition of many healthcare systems to eliminate delayed transfers of care (DTOCs) between acute and step-down community services. OBJECTIVE This study aims to demonstrate how, counter to intuition, pursual of such a policy is likely to be uneconomical, as it would require large amounts of community capacity to accommodate even the rarest of demand peaks, leaving much capacity unused for much of the time. METHODS Some standard results from queueing theory-a mathematical discipline for considering the dynamics of queues and queueing systems-are used to provide a model of patient flow from the acute to community setting. While queueing models have a track record of application in healthcare, they have not before been used to address this question. RESULTS Results show that 'eliminating' DTOCs is a false economy: the additional community costs required are greater than the possible acute cost saving. While a substantial proportion of DTOCs can be attributed to inefficient use of resources, the remainder can be considered economically essential to ensuring cost-efficient service operation. For England's National Health Service (NHS), our modelling estimates annual cost savings of £117m if DTOCs are reduced to the 12% of current levels that can be regarded as economically essential. CONCLUSION This study discourages the use of 'zero DTOC' targets and instead supports an assessment based on the specific characteristics of the healthcare system considered.
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Affiliation(s)
- Richard M Wood
- UK National Health Service (BNSSG ICB), NHS Bristol, North Somerset and South Gloucestershire Integrated Care Board, 360 Bristol, Marlborough St, Bristol, BS1 3NX, UK.
- School of Management, University of Bath, Bath, UK.
- Health Data Research UK, South West Better Care Partnership, Bristol, UK.
| | - Alison L Harper
- Medical School, University of Exeter, Exeter, UK
- Health Data Research UK, South West Better Care Partnership, Bristol, UK
| | - Zehra Onen-Dumlu
- School of Management, University of Bath, Bath, UK
- Health Data Research UK, South West Better Care Partnership, Bristol, UK
| | - Paul G Forte
- UK National Health Service (BNSSG ICB), NHS Bristol, North Somerset and South Gloucestershire Integrated Care Board, 360 Bristol, Marlborough St, Bristol, BS1 3NX, UK
- Health Data Research UK, South West Better Care Partnership, Bristol, UK
| | - Martin Pitt
- Medical School, University of Exeter, Exeter, UK
- Health Data Research UK, South West Better Care Partnership, Bristol, UK
| | - Christos Vasilakis
- School of Management, University of Bath, Bath, UK
- Health Data Research UK, South West Better Care Partnership, Bristol, UK
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Kiran T. Garder la porte d’entrée ouverte : assurer l’accès aux soins primaires à toute la population canadienne. CMAJ 2023; 195:E251-E253. [PMID: 36781196 PMCID: PMC9928439 DOI: 10.1503/cmaj.221563-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Affiliation(s)
- Tara Kiran
- Département de médecine familiale et communautaire, Hôpital St. Michael, Réseau hospitalier Unity Health Toronto; Département de médecine familiale et communautaire, Université de Toronto; Centre MAP pour des solutions de santé urbaine, Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé ICES Central; Institut des politiques, de la gestion et de l'évaluation de la santé, Université de Toronto, Toronto, Ont.
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Waters CJ. Supporting person-centred dementia care following the COVID-19 pandemic. Nurs Stand 2023; 38:37-41. [PMID: 36317537 DOI: 10.7748/ns.2022.e11876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/07/2022]
Abstract
In recent years, nurses have experienced increased workplace pressures in part due to the coronavirus disease 2019 (COVID-19) pandemic, which exacerbated challenges in the delivery of person-centred dementia care. This article examines how people with dementia were affected by the COVID-19 pandemic, as well as exploring the ongoing effects on nurses and the care they provide for people with dementia. The author discusses the importance of dementia awareness and education for nurses that supports them to promote the needs of people with the condition. The article also outlines how nurse leaders can promote person-centred care for people with dementia through reflection and clinical supervision.
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Affiliation(s)
- Tara Kiran
- Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine, University of Toronto; MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.
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Jiang F, Liu H, Tang YL. Editorial: Mental health of healthcare professionals. Front Psychol 2022; 13:1093569. [PMID: 36571050 PMCID: PMC9780691 DOI: 10.3389/fpsyg.2022.1093569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Feng Jiang
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China,Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China,Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China,Department of Psychiatry, Anhui Psychiatric Center, Hefei, China,*Correspondence: Huanzhong Liu
| | - Yi-lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States,Substance Abuse Treatment Program, Atlanta Veterans Affairs Medical Center, Decatur, GA, United States
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Aljohani M, Donnelly M, O’Neill C. Changes in public satisfaction with GP services in Britain between 1998 and 2019: a repeated cross-sectional analysis of attitudinal data. BMC PRIMARY CARE 2022; 23:83. [PMID: 35436843 PMCID: PMC9014779 DOI: 10.1186/s12875-022-01696-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 04/05/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Between 1998 and 2019, the structure and process of general practitioner services in Britain underwent a series of reforms and experienced distinct funding environments. This paper examines changes in satisfaction with GP services over time against this backdrop.
Methods
Data were extracted from the British Social Attitudes Survey for the period 1998–2019. Logistic regression analyses investigated changes in overall satisfaction and among specific population sub-groups differentiated by socio-demographic characteristics whilst taking account of time trend and interaction effects between sub-group membership and time trend.
Results
Sustained and significant changes in satisfaction coincided closely with changes to the funding environment. Distinct patterns were evident among sub-groups. Satisfaction appeared to fall more sharply during austerity for low income groups, older people and people who had fewer formal qualifications/years in education.
Conclusion
While a series of policy initiatives were adopted over the period examined, public satisfaction seemed to move in a manner consistent with levels of government expenditure rather than exhibiting distinct breaks that coincided with policy initiatives. As services recover from the pandemic it will be necessary to invest in a significant and sustained way to rebuild public satisfaction.
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Slater T, Round J. Shielding during medical training: an exploration of effects, consequences and best practices. Future Healthc J 2022; 9:291-294. [PMID: 36561810 PMCID: PMC9761448 DOI: 10.7861/fhj.2022-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Shielding during the COVID-19 pandemic impacted postgraduate medical training, likely affecting between 7% and 14% of trainees. We examine the burden of shielding on this cohort and provide strategies for future working practices. Methods Seventeen postgraduate doctors in training took part in non-incentivised, virtual focus groups or interviews. Focus group content underwent thematic analysis. Results were validated in subsequent focused interviews. Results Shielding trainees reported guilt, limited support and occasionally stigmatisation. Rotational changes and returning to work were also difficult and led to contractual challenges. Departmental support, IT provision and proactivity were key to successful shielding. Early discussion with training bodies was deemed essential to plan objective onward progression. Conclusion As we enter an era of endemic COVID-19, adjusted working practices will continue. Embedding successful working practices for shielding at national and local levels will minimise the long-term impact on postgraduate medical training.
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Affiliation(s)
- Thomas Slater
- AHealth Education England, London, UK and fellow, London School of Paediatrics, London, UK,Address for correspondence: Dr Thomas Slater, St. George's Hospital, Blackshaw Road, London SW17 0QT, UK.
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McGuinness SL, Josphin J, Eades O, Clifford S, Fisher J, Kirkman M, Russell G, Hodgson CL, Kelsall HL, Lane R, Skouteris H, Smith KL, Leder K. Organizational responses to the COVID-19 pandemic in Victoria, Australia: A qualitative study across four healthcare settings. Front Public Health 2022; 10:965664. [PMID: 36249244 PMCID: PMC9557753 DOI: 10.3389/fpubh.2022.965664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/07/2022] [Indexed: 01/24/2023] Open
Abstract
Objective Organizational responses that support healthcare workers (HCWs) and mitigate health risks are necessary to offset the impact of the COVID-19 pandemic. We aimed to understand how HCWs and key personnel working in healthcare settings in Melbourne, Australia perceived their employing organizations' responses to the COVID-19 pandemic. Method In this qualitative study, conducted May-July 2021 as part of the longitudinal Coronavirus in Victorian Healthcare and Aged Care Workers (COVIC-HA) study, we purposively sampled and interviewed HCWs and key personnel from healthcare organizations across hospital, ambulance, aged care and primary care (general practice) settings. We also examined HCWs' free-text responses to a question about organizational resources and/or supports from the COVIC-HA Study's baseline survey. We thematically analyzed data using an iterative process. Results We analyzed data from interviews with 28 HCWs and 21 key personnel and free-text responses from 365 HCWs, yielding three major themes: navigating a changing and uncertain environment, maintaining service delivery during a pandemic, and meeting the safety and psychological needs of staff . HCWs valued organizational efforts to engage openly and honesty with staff, and proactive responses such as strategies to enhance workplace safety (e.g., personal protective equipment spotters). Suggestions for improvement identified in the themes included streamlined information processes, greater involvement of HCWs in decision-making, increased investment in staff wellbeing initiatives and sustainable approaches to strengthen the healthcare workforce. Conclusions This study provides in-depth insights into the challenges and successes of organizational responses across four healthcare settings in the uncertain environment of a pandemic. Future efforts to mitigate the impact of acute stressors on HCWs should include a strong focus on bidirectional communication, effective and realistic strategies to strengthen and sustain the healthcare workforce, and greater investment in flexible and meaningful psychological support and wellbeing initiatives for HCWs.
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Affiliation(s)
- Sarah L. McGuinness
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia,Alfred Health, Melbourne, VIC, Australia,*Correspondence: Sarah L. McGuinness
| | - Johnson Josphin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Owen Eades
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Sharon Clifford
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Maggie Kirkman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Grant Russell
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Carol L. Hodgson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia,Alfred Health, Melbourne, VIC, Australia
| | - Helen L. Kelsall
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Riki Lane
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Helen Skouteris
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Karen L. Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia,Ambulance Victoria, Melbourne, VIC, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia,Royal Melbourne Hospital, Melbourne, VIC, Australia
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Habonimana D, Leckcivilize A, Nicodemo C, English M. Addressing the need for an appropriate skilled delivery care workforce in Burundi to support Maternal and Newborn Health Service Delivery Redesign (MNH-Redesign): a sequential study protocol. Wellcome Open Res 2022; 7:196. [PMID: 36212218 PMCID: PMC9520631 DOI: 10.12688/wellcomeopenres.17937.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Despite Burundi having formed a network of 112 health facilities that provide emergency obstetric and neonatal care (EmONC), the country continues to struggle with high rates of maternal and newborn deaths. There is a dearth of empirical evidence on the capacity and performance of EmONC health facilities and on the real needs to inform proper planning and policy. Our study aims to generate evidence on the capacity and performance of EmONC health facilities in Burundi and examine how the country might develop an appropriate skilled delivery care workforce to improve maternal and newborn survival. Methods We will use a sequential design where each study phase serially inputs into the subsequent phase. Three main study phases will be carried out: i) an initial policy document review to explore global norms and local policy intentions for EmONC staffing and ii) a cross-sectional survey of all EmONC health facilities to determine what percent of facilities are functional including geographic and population coverage gaps, identify staffing gaps assessed against norms, and identify other needs for health facility strengthening. Finally, we will conduct surveys in selected schools and ministries to examine training and staffing costs to inform staffing options that might best promote service delivery with adequate budget impacts to increase efficiency. Throughout the study, we will engage stakeholders to provide input into what are reasonable staffing norms as well as feasible staffing alternatives within Burundi's budget capacity. Analytical models will be used to develop staffing proposals over a realistic policy timeline. Conclusion Evidence-based health planning improves cost-effectiveness and reduces wastage within scarce and resource-constrained contexts. This study will be the first large-scale research in Burundi that builds on stakeholder support to generate evidence on the capacity of designated EmONC health facilities including human resources diagnosis and develop staffing skill-mix tradeoffs for policy discussion.
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Affiliation(s)
- Desire Habonimana
- Centre de Recherche Universitaire en Santé (CURSA), Department of Community Medicine, Faculty of Medicine, University of Burundi, Bujumbura, 5190, Burundi
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Attakrit Leckcivilize
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Catia Nicodemo
- Centre for Health Service Economics and Organisation, Department of Economics, University of Oxford, Oxford, UK
| | - Mike English
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Wang H, English M, Chakma S, Namedre M, Hill E, Nagraj S. The roles of physician associates and advanced nurse practitioners in the National Health Service in the UK: a scoping review and narrative synthesis. HUMAN RESOURCES FOR HEALTH 2022; 20:69. [PMID: 36109746 PMCID: PMC9479410 DOI: 10.1186/s12960-022-00766-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 09/07/2022] [Indexed: 05/17/2023]
Abstract
BACKGROUND Mid-level practitioners (MLPs), including physician associates (PAs) and advanced nurse practitioners (ANPs), have emerged to address workforce shortages in the UK and perform specific roles in relation to population needs. This has resulted in new ways of working and changes to established professional hierarchies. We conducted a study to investigate the career development, competencies, effectiveness, perceptions, and regulation of PAs and ANPs, with the aim of understanding ways to effectively integrate MLPs into the NHS workforce. METHODS We conducted a systematic scoping review following PRISMA guidelines. Embase, Medline, the Cochrane database, Pubmed, and CINAHL databases were searched, using terms relating to PAs and ANPs in the UK. A total of 128 studies (60 on PAs and 68 on ANPs) were included in the final analysis. A narrative synthesis, guided by the pre-defined themes and emerging themes, was conducted to bring together the findings. RESULTS PAs are educated on a medical model with basic medical skills but lack formal professional regulation and do not have prescribing rights. ANPs are educated on a nurse model with enhanced skills that depend on roles within specific specialities, and their governance is mostly employer-led. PAs are primarily employed in secondary care. ANPs are employed widely in both primary and secondary care. No defined career progression exists for PAs. In contrast, becoming an ANP is a form of career progression within nursing. Both roles were regarded as cost-effective in comparison to doctors performing simple tasks. PAs were less understood compared to ANPs and received a mixed reception from colleagues, which sometimes undermined their professional identity, whereas ANPs were mostly welcomed by colleagues. CONCLUSIONS Potential ways to better integrate PAs and ANPs into the NHS workforce include further initiatives by regulatory bodies and the NHS to create more awareness and clearer role definitions for MLPs, outline potential for career progression, offer transparency with regard to remuneration, and introduction of prescribing rights. Future research might include more cadres of MLPs and explore the international literature.
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Affiliation(s)
- Hanyu Wang
- Nuffield Department of Medicine, Oxford Centre for Global Health Research, University of Oxford, Oxford, UK.
| | - Mike English
- Nuffield Department of Medicine, Oxford Centre for Global Health Research, University of Oxford, Oxford, UK
- KEMRI-Wellcome Trust Research Programme, KEMRI-Wellcome Trust, Nairobi, Kenya
| | - Samprita Chakma
- Nuffield Department of Medicine, Oxford Centre for Global Health Research, University of Oxford, Oxford, UK
| | | | - Elaine Hill
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Shobhana Nagraj
- Nuffield Department of Medicine, Oxford Centre for Global Health Research, University of Oxford, Oxford, UK
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Affiliation(s)
- Michael Anderson
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Alistair McGuire
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Andrew Street
- Department of Health Policy, London School of Economics and Political Science, London, UK
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Habonimana D, Leckcivilize A, Nicodemo C, English M. Addressing the need for an appropriate skilled delivery care workforce in Burundi to support Maternal and Newborn Health Service Delivery Redesign (MNH-Redesign): a sequential study protocol. Wellcome Open Res 2022; 7:196. [PMID: 36212218 PMCID: PMC9520631 DOI: 10.12688/wellcomeopenres.17937.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 02/15/2024] Open
Abstract
Background Despite Burundi having formed a network of 112 health facilities that provide emergency obstetric and neonatal care (EmONC), the country continues to struggle with high rates of maternal and newborn deaths. There is a dearth of empirical evidence on the capacity and performance of EmONC health facilities and on the real needs to inform proper planning and policy. Our study aims to generate evidence on the capacity and performance of EmONC health facilities in Burundi and examine how the country might develop an appropriate skilled delivery care workforce to improve maternal and newborn survival. Methods We will use a sequential design where each study phase serially inputs into the subsequent phase. Three main study phases will be carried out: i) an initial policy document review to explore global norms and local policy intentions for EmONC staffing and ii) a cross-sectional survey of all EmONC health facilities to determine what percent of facilities are functional including geographic and population coverage gaps, identify staffing gaps assessed against norms, and identify other needs for health facility strengthening. Finally, we will conduct surveys in schools and different ministries to examine training and staffing costs to inform staffing options that might best promote service delivery with adequate budget impacts to increase efficiency. Throughout the study, we will engage stakeholders to provide input into what is reasonable staffing norms as well as feasible staffing alternatives within Burundi's budget capacity. Analytical models will be used to develop staffing proposals over a realistic policy timeline. Conclusion Evidence-based health planning improves cost-effectiveness and reduces wastage within scarce and resource-constrained contexts. This study will be the first large-scale research in Burundi that builds on stakeholder support to generate evidence on the capacity of designated EmONC health facilities including human resources diagnosis and develop staffing skill-mix tradeoffs for policy discussion.
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Affiliation(s)
- Desire Habonimana
- Centre de Recherche Universitaire en Santé (CURSA), Department of Community Medicine, Faculty of Medicine, University of Burundi, Bujumbura, 5190, Burundi
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Attakrit Leckcivilize
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Catia Nicodemo
- Centre for Health Service Economics and Organisation, Department of Economics, University of Oxford, Oxford, UK
| | - Mike English
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Hammond J, Davies N, Morrow E, Ross F, Vandrevala T, Harris R. "Raising the curtain on the equality theatre": a study of recruitment to first healthcare job post-qualification in the UK National Health Service. HUMAN RESOURCES FOR HEALTH 2022; 20:57. [PMID: 35804352 PMCID: PMC9264517 DOI: 10.1186/s12960-022-00754-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND UK equality law and National Health Service (NHS) policy requires racial equality in job appointments and career opportunities. However, recent national workforce race equality standard (WRES) data show that nearly all NHS organisations in the UK are failing to appoint ethnically diverse candidates with equivalent training and qualifications as their white counterparts. This is problematic because workforce diversity is associated with improved patient outcomes and other benefits for staff and organisations. AIM To better understand the reasons behind underrepresentation of ethnically diverse candidates in first NHS healthcare jobs post-qualification and to identify any structural or systemic barriers to employment for such groups. METHODS The study was informed by critical theory and the authors' interdisciplinary perspectives as educators and researchers in the healthcare professions. Data collected from semi-structured face-to-face interviews with 12 nurse and physiotherapy recruiting managers from two NHS trusts in London were analysed using a healthcare workforce equity and diversity conceptual lens we developed from the literature. Using this lens, we devised questions to examine six dimensions of equity and diversity in the interview data from recruiting managers. RESULTS Recruiting managers said they valued the benefits of an ethnically diverse workforce for patients and their unit/organisation. However, their adherence to organisational policies for recruitment and selection, which emphasise objectivity and standardisation, acted as constraints to recognising ethnicity as an important issue in recruitment and workforce diversity. Some recruiting managers sense that there are barriers for ethnically diverse candidates but lacked information about workforce diversity, systems for monitoring recruitment, or ways to engage with staff or candidates to talk about these issues. Without this information there was no apparent problem or reason to try alternative approaches. CONCLUSION These accounts from 12 recruiting managers give a 'backstage' view into the reasons behind ethnic inequalities in recruitment to first healthcare job in the UK NHS. Adherence to recruitment and selection policies, which aim to support equality through standardisation and anonymisation, appear to be limiting workforce diversity and creating barriers for ethnically diverse candidates to attain the jobs that they are trained and qualified for. The Healthcare Workforce Equity + Diversity Lens we have developed can help to 'raise the curtain on the equality theatre' and inform more inclusive approaches to recruitment such as contextualised recruitment or effective allyship between employers and universities.
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Affiliation(s)
- John Hammond
- Centre for Allied Health, St George’s University of London, Cranmer Terrace, Tooting, London, SW17 0RE UK
| | - Nigel Davies
- College of Health, Medicine and Life Sciences, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH UK
| | | | - Fiona Ross
- Emerita Professor, Health and Social Care, Kingston University and St George’s University of London, Cranmer Terrace, Tooting, London, SW17 0RE UK
| | - Tushna Vandrevala
- Centre for Health and Social Care Research, Kingston University and St George’s University of London, Cranmer Terrace, Tooting, London, SW17 0RE UK
| | - Ruth Harris
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
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MacKenzie A, MacQuarrie C, Murphy M, Piers G, Philopoulos K, Carrigan S, Joice J, Kapra J, Casault CA, MacDougall J, Langley JM, Tomblin Murphy G. Operationalizing integrated needs-based workforce planning at Nova Scotia Health in response to the COVID-19 pandemic. Healthc Manage Forum 2022; 35:222-230. [PMID: 35748087 PMCID: PMC9234379 DOI: 10.1177/08404704221093982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
This paper documents Nova Scotia Health’s progress in operationalizing integrated
needs-based workforce planning as part of its ongoing response to the pandemic.
A multidisciplinary workforce planning team with representation spanning key
portfolios was created to facilitate the organization’s response to the
pandemic. Analyses applied early in Wave 3 of the pandemic showed large
projected shortages in several professions and identified which services would
likely be scarcest among the available workforce relative to patient need. Based
on these results, the workforce planning team recommended and supported
operational teams in implementing a multi-faceted set of interventions aimed at
increasing the availability of individuals with these competencies. These
interventions collectively yielded an adequate supply of additional competent
personnel to meet the needs of COVID-19 inpatients across the province through
the third wave of the pandemic. Lessons learned are proving critical to
maintaining core operations during Wave 4 of the pandemic.
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Affiliation(s)
- Adrian MacKenzie
- 432234Nova Scotia Health, Halifax, Nova Scotia, Canada.,Dalhousie University, Halifax, Nova Scotia, Canada.,WHO/PAHO Collaborating Centre on Health Workforce Planning & Research, Halifax, Nova Scotia, Canada
| | | | | | - Geoff Piers
- 432234Nova Scotia Health, Halifax, Nova Scotia, Canada
| | | | | | - Jesse Joice
- 432234Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Junaid Kapra
- 432234Nova Scotia Health, Halifax, Nova Scotia, Canada
| | | | | | - Joanne M Langley
- 432234Nova Scotia Health, Halifax, Nova Scotia, Canada.,Dalhousie University, Halifax, Nova Scotia, Canada.,IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Gail Tomblin Murphy
- 432234Nova Scotia Health, Halifax, Nova Scotia, Canada.,Dalhousie University, Halifax, Nova Scotia, Canada.,WHO/PAHO Collaborating Centre on Health Workforce Planning & Research, Halifax, Nova Scotia, Canada
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King RL, Taylor B, Laker S, Wood E, Senek M, Tod A, Ryan T, Snowden S, Robertson S. A tale of two bridges: Factors influencing career choices of trainee nursing associates in England: A longitudinal qualitative study. Nurs Open 2022; 9:2486-2494. [PMID: 35666045 PMCID: PMC9374398 DOI: 10.1002/nop2.1266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/02/2022] [Accepted: 05/16/2022] [Indexed: 11/05/2022] Open
Abstract
AIM The nursing associate role has created a new second-level nursing role and provided an alternative route into registered nursing. For some, this provides a previously inaccessible opportunity for career progression. The aim of the study was to understand the factors that influence career choices of trainee nursing associates. DESIGN A longitudinal qualitative study of trainee nursing associate motivations, experiences and career aspirations. METHODS Semi-structured interviews with trainee nursing associates from across England, UK, in February 2020 (N = 14) and March 2021 (N = 13). Diary data were also collected. Interview and diary data were analysed thematically. Reporting has followed COREQ guidelines. RESULTS Nursing associate training was viewed by some as a bridge into registered nursing. Role ambiguity led several to seek perceived security offered by the Registered Nurse profession. Those preferring to remain as nursing associates were keen to embed the bridging role between healthcare assistants and Registered Nurses, valuing a positive workplace culture.
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Affiliation(s)
- Rachel Louise King
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Bethany Taylor
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Sara Laker
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK.,Department of Undergraduate Nursing, Winona State University, Winona, Minnesota, USA
| | - Emily Wood
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Michaela Senek
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Angela Tod
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Tony Ryan
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Sally Snowden
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Steven Robertson
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
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