1
|
Hendrix JM, Burgart AM, Baker EB, Wolman RL, Kras JF. Physician Unionization: Opportunities and Challenges for Anesthesiologists in the United States. Anesth Analg 2024; 139:432-438. [PMID: 38091478 PMCID: PMC11221793 DOI: 10.1213/ane.0000000000006852] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 07/05/2024]
Abstract
Physician unionization is gaining traction in the United States, with <10% of practicing physicians now members, up from historically weak support. Factors that drive interest in unions include a decreased number of independent practitioners, an increase in workloads, and the erosion of autonomy. Approximately 56% of anesthesiologists are considered employees and may be eligible for union membership. Physician unions may provide higher wages, better working conditions, and legal protection. However, they also raise concerns about patient care and professionalism. This article discusses the legal and regulatory framework governing the unionization of physicians, benefits, challenges, and potential future developments. Continued analysis and debate are necessary to determine the optimal role of physician unions in the health care industry.
Collapse
Affiliation(s)
- Joseph Maxwell Hendrix
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern, Dallas, Texas
| | - Alyssa M. Burgart
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford Center for Biomedical Ethics, Palo Alto, California
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico
| | - E. Brooke Baker
- Stanford Center for Biomedical Ethics, Stanford University, Palo Alto, California
| | - Richard L. Wolman
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Joseph F. Kras
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri
| |
Collapse
|
2
|
Craveiro I, Choudhury PK, de OLiveira APC, Pereira A, Fronteira I, Chança R, Cometto G, Poz MRD, Ferrinho P. Impacts of industrial actions, protests, strikes and lockouts by health and care workers during COVID-19 and other pandemic contexts: a systematic review. HUMAN RESOURCES FOR HEALTH 2024; 22:47. [PMID: 38956631 PMCID: PMC11221126 DOI: 10.1186/s12960-024-00923-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 05/17/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Public health emergencies of international concern (PHEICs) as the COVID-19 pandemic and others that have occurred since the early 2000s put enormous pressure on health and care systems. This is being a context for protests by health and care workers (HCWs) because of additional workload, working conditions and effects on mental and physical health. In this paper, we intended to analyze the demands of HCWs associated with industrial actions, protests, strikes and lockouts (IAPSLs) which occurred during COVID-19 pandemic and other PHEICs; to identify the impact of these grievances; and describe the relevant interventions to address these IAPSLs. METHODS We included studies published between January 2000 and March 2022 in PubMed, Embase, Scopus, BVS/LILACS, WHO's COVID-19 Research Database, ILO, OECD, HSRM, and Google Scholar for grey literature. Eligibility criteria were HCWs as participants, IAPSLs as phenomenon of interest occurring in the context of COVID-19 and other PHEICs. GRADE CERQual was used to assess risk of bias and confidence of evidence. RESULTS 1656 records were retrieved, and 91 were selected for full-text screening. We included 18 publications. A system-wide approach, rather than a limited approach to institutions on strike, makes it possible to understand the full impact of the strike on health and care services. PHEICs tend to aggravate already adverse working conditions of HCWs, acting as drivers for HCWs strikes, leading to staff shortages, and financial issues, both in the North and in the Global South, particularly evident in Asia and Africa. In addition, issues related to deficiencies in leadership and governance in heath sector and lack of medical products and technologies (e.g., lack of personal protective equipment) were the main drivers of strikes, each contributing 25% of the total drivers identified. CONCLUSIONS It is necessary to focus on the preparedness of health and care systems to respond adequately to PHEICs, and this includes being prepared for HCWs' IAPSLs, talked much in the context of COVID-19 pandemic. Evidence to assist policymakers in defining strategies to respond adequately to the health and care needs of the population during IAPSLs is crucial. The main impact of strikes is on the disruption of health care services' provision. Gender inequality being a major issue among HCWs, a proper understanding of the full impact of the strike on health and care services will only be possible if gender lens is combined with a systemic approach, rather than gender-undifferentiated approaches limited to the institutions on strike.
Collapse
Affiliation(s)
- Isabel Craveiro
- Global Health and Tropical Medicine, GHTM, LA-REAL, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, 1349-008, Lisbon, Portugal.
| | - Pradeep Kumar Choudhury
- Zakir Husain Centre for Educational Studies, School of Social Sciences, Jawaharlal Nehru University, Room No. 234, New Delhi, India
| | - Ana Paula Cavalcante de OLiveira
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524, 7º Andar, Blocos D E E, Maracanã, Rio de Janeiro, RJ, 20550-013, Brazil
| | - Alessandra Pereira
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524, 7º Andar, Blocos D E E, Maracanã, Rio de Janeiro, RJ, 20550-013, Brazil
| | - Inês Fronteira
- Global Health and Tropical Medicine, GHTM, LA-REAL, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, 1349-008, Lisbon, Portugal
- National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University of Lisbon, Avenida Padre Cruz, 1600-560, Lisbon, Portugal
| | - Raphael Chança
- Instituto Nacional de Cancer, Ministério da Saúde, Rua Marquês de Pombal, 125, Centro, Rio de Janeiro, RJ, 20230240, Brazil
| | - Giorgio Cometto
- Health Workforce Department, World Health Organization, Av. Appia 20, 1202, Geneva, Switzerland
| | - Mario Roberto Dal Poz
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524, 7º Andar, Blocos D E E, Maracanã, Rio de Janeiro, RJ, 20550-013, Brazil
| | - Paulo Ferrinho
- Global Health and Tropical Medicine, GHTM, LA-REAL, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, 1349-008, Lisbon, Portugal
| |
Collapse
|
3
|
Zeitouni F, Attaluri PK, Wirth PJ, Shaffrey EC, Rao V. State of Physician Unionization. JOURNAL OF SURGICAL EDUCATION 2024; 81:929-937. [PMID: 38749815 DOI: 10.1016/j.jsurg.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/10/2024] [Accepted: 04/03/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVES To provide an overview of the current state of physician unionization, potential factors surrounding increased unionization, and the ethical and financial issues that may arise. DESIGN Review article. SETTING Not applicable. PARTICIPANTS Not applicable. RESULTS Over the last few years, there has been a recent surge in physician unionization. Union membership among residents and fellows is also at an all-time high and continues to increase, as seven residency programs voted to unionize in 2023. The resulting threat of strikes has grown considerably over the last year as residents across 6 hospitals have threatened to strike, resulting in New York's first physician strike in over three decades. As physician practice continues to shift from private to corporate health system-based employment, more opportunities for unionization will arise. Globally, these trends have been comparable, with thousands of physicians striking across the United Kingdom, Germany, Italy, Nigeria, and New Zealand in the last year. CONCLUSION The current state of physician unionization is of increasing significance as more physicians are presented with opportunities for unionization. Physicians perceive a lack of autonomy, and the demand to deliver high level outcomes with diminishing resources is becoming an insurmountable challenge. Additionally, physician satisfaction with their workplace has decreased with increased burnout rates. Thus, it is important to understand the current state of unionization, potential reasons for unionization among physicians and residents, and its future impact on the field of medicine.
Collapse
Affiliation(s)
- Ferris Zeitouni
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Pradeep K Attaluri
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Peter J Wirth
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ellen C Shaffrey
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Venkat Rao
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| |
Collapse
|
4
|
Manguele ALJ, Sidat M, Ferrinho P, Cabral AJR, Craveiro I. Strikes of physicians and other health care workers in sub-Saharan African countries: a systematic review. Front Public Health 2024; 12:1209201. [PMID: 38873309 PMCID: PMC11169935 DOI: 10.3389/fpubh.2024.1209201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/25/2024] [Indexed: 06/15/2024] Open
Abstract
Introduction Strikes in the health sector have been of growing concern, given their disruptive nature, negatively impacting the provision of health care and jeopardizing the well-being of patients. This study aims to identify the main actors, the reasons behind industrial actions protests, strikes and lockouts (IAPSL) in sub-Saharan African countries and their impact on health care workers (specifically doctors) and health services, as well as to identify the main strategies adopted to reduce their impact on healthcare services. Methods Studies published between January 2000 and December 2021 and archived in MEDLINE, Google Scholar, Scopus, ProQuest, and Science Direct were included. Quantitative, observational (i.e., cohort, case-control, cross-sectional, and ecological) and experimental studies, as well as mixed methods, quasi-experimental, and qualitative studies were eligible. Results A total of 5521 studies were identified and after eliminating duplicates, applying the inclusion criteria, and assessing the risk of bias, a total of 11 studies were included in the review. Nurses and doctors are the actors most commonly involved in strikes. The main causes of strikes were salary claims and poor working conditions. The main strategies adopted to mitigate the strike consequences were to restrict services and prioritize emergency and chronic care, greater cooperation with the private sector and rearrange tasks of the available staff. The strikes led to a reduction in hospitalizations and in the number of women giving birth in health units, an increase in maternal and child morbidities and delays in the immunization process. Increased mortality was only reported in faith-based hospitals. Discussion This evidence can assist decision-makers in developing strategies and interventions to address IAPSL by health care workers, contributing to strengthen the health system. Strikes in the health sector disrupt healthcare services provision and compromise the well-being of patients, especially the most disadvantaged, with consequences that may be difficult to overcome ever. The potential health impacts of strikes highlights the importance of their prevention or timely resolution through regulation and negotiations to balance the rights of health care workers and the rights of patients. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=334173, identifier CRD42022334173.
Collapse
Affiliation(s)
- Alexandre Lourenço Jaime Manguele
- Instituto Superior de Ciências de Saúde, Maputo, Mozambique
- Global Health and Tropical Medicine, GHTM, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Mohsin Sidat
- Global Health and Tropical Medicine, GHTM, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, Lisboa, Portugal
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Paulo Ferrinho
- Global Health and Tropical Medicine, GHTM, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - António Jorge Rodrigues Cabral
- Global Health and Tropical Medicine, GHTM, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Isabel Craveiro
- Global Health and Tropical Medicine, GHTM, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, Lisboa, Portugal
| |
Collapse
|
5
|
Ravioli S, Jina R, Risk O, Cantle F. Impact of junior doctor strikes on patient flow in the emergency department: a cross-sectional analysis. Eur J Emerg Med 2024; 31:53-58. [PMID: 37851520 DOI: 10.1097/mej.0000000000001093] [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: 10/20/2023]
Abstract
BACKGROUND AND IMPORTANCE Healthcare worker strikes are a global phenomenon. Mortality and morbidity seem to be unaffected by doctor strikes, but there is little evidence on the impact on emergency department (ED) flow and patient characteristics. In March and April 2023, two consecutive UK junior doctor strikes occurred. OBJECTIVES This study investigated the impact of junior doctor strikes on ED patient flow. Additionally, variation in patient presentations was compared between non-strike and strike days. DESIGN, SETTING AND PARTICIPANTS This cross-sectional study was conducted at King's College Hospital ED, a university hospital in London. All ED attendances during the 72- and 96-hour strike actions were compared with the corresponding non-strike days of the previous week. OUTCOME MEASURES AND ANALYSIS National key performance indicators (KPIs) were analysed and compared between non-strike and strike days. Patients' demographics, acuity and diagnoses were compared. Outcome measures included number of 4-hour breaches, number of patients admitted or discharged and ED mortality. Staff seniority was categorised into levels for analysis. MAIN RESULTS There was increased ED patient flow during strike days with a significantly shorter total time in department in March [240 min (IQR 155-469) vs. 286 min (IQR 198.5-523.5), P < 0.001] and in April [222.5 min (IQR 147-351) vs. 251.5 min (IQR 174-443), P < 0.001]. Time to first clinician, treatment, and decision to admit were all shorter during both strike actions. Number of attendances, acuity, diagnoses, admission, discharge, and mortality rates were similar during strike and non-strike days. Staffing numbers were lower or equivalent on strike days but level of seniority was higher ( P < 0.001). CONCLUSION The improved KPIs and increased patient flow during strike days, while multifactorial, seem largely attributed to the higher number of senior staff. Patient presentations and outcomes were unaffected by junior doctor strike action.
Collapse
Affiliation(s)
- Svenja Ravioli
- Emergency Department, King's College Hospital NHS Foundation Trust
| | - Raeesa Jina
- Emergency Department, King's College Hospital NHS Foundation Trust
| | - Omar Risk
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Fleur Cantle
- Emergency Department, King's College Hospital NHS Foundation Trust
| |
Collapse
|
6
|
Jinah N, Lee KY, Zakaria NH, Zakaria N, Ismail M, Mohmad S. Contract doctors' strike in Malaysia: A content analysis of the perception of medical fraternity and stakeholders on Facebook. PLoS One 2023; 18:e0292213. [PMID: 37768943 PMCID: PMC10538735 DOI: 10.1371/journal.pone.0292213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023] Open
Abstract
Contract appointment policy for newly graduated medical officers was implemented by the Ministry of Health Malaysia in 2016 to overcome the lack of permanent posts. Contract officers faced disadvantages in terms of salary, leave provision, and career prospects. A nationwide strike, Hartal Doktor Kontrak (HDK) was organised on 26th July 2021. Besides generating widespread public attention, HDK was also closely scrutinised by the medical fraternity and stakeholders. This content analysis aimed to explore how the medical fraternity and stakeholders viewed the strike as their perception would offer vital insights into the fundamental causes and viable solutions to the contract appointment policy. A qualitative content analysis of Facebook (FB) posts on the HDK strike was conducted from 1st June 2021 until 28th February 2022. A total of 182 FB posts were retrieved from stakeholders, medical fraternity groups, and medical key opinion personnel. Inductive coding was used in the thematic analysis to identify pertinent themes. Three main themes emerged: triggering factors, reactions to the strike, and outcomes of the strike. Factors that led to the strike included unequal treatment faced by contract officers, frustration with the government's lack of long-term solutions, and aggravation by the COVID-19 pandemic. In terms of reactions, there was a mixture of supportive and opposing voices. No substantial negative impact on the healthcare service resulted from the strike. Instead, it generated widespread attention that propelled the government into implementing solutions to prevent adverse short and long-term consequences. Various suggestions were proposed, including the reform of human resource planning and undergraduate medical education. The results highlight the importance of proactive systemic measures by the government to prevent further strikes that may jeopardise healthcare provision. In summary, social media was found to influence the progress and outcome of HDK, thus demonstrating the impact of media influence on similar issues.
Collapse
Affiliation(s)
- Norehan Jinah
- Centre of Leadership and Professional Development, Institute for Health Management, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Kun Yun Lee
- Centre of Leadership and Professional Development, Institute for Health Management, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Nor Haniza Zakaria
- Centre of Leadership and Professional Development, Institute for Health Management, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Nursyahda Zakaria
- Centre of Leadership and Professional Development, Institute for Health Management, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Munirah Ismail
- Centre of Leadership and Professional Development, Institute for Health Management, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Shazwani Mohmad
- Centre of Leadership and Professional Development, Institute for Health Management, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| |
Collapse
|
7
|
Ogei E, Lewis C. Medical Training in Uganda: A Critical but Neglected Part of the Healthcare System. Cureus 2023; 15:e40044. [PMID: 37425588 PMCID: PMC10324625 DOI: 10.7759/cureus.40044] [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: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Quality healthcare is dependent upon the structure of healthcare and/or healthcare facilities in a country. In Uganda, the healthcare system has had drastic changes over the last 50 years. Medical students, interns, and medical officers play an invaluable role in the function of hospitals and the overall quality of the healthcare system of Uganda, particularly in government facilities. Demands for better working conditions and payment of arrears have forced the graduate medical students and upcoming medical interns to strike, causing disruption in the fulfillment of basic health services. In order to prioritize the care of patients in the country, there should be fair treatment of the medical workers to boost and maintain morale and ultimately lead to continued quality patient care.
Collapse
Affiliation(s)
- Esau Ogei
- Internal Medicine, St. Joseph's Hospital Kitovu, Masaka, UGA
| | - Catherine Lewis
- General Surgery, East Tennessee State University, Johnson City, USA
- General Surgery, St. Joseph's Hospital Kitovu, Masaka, UGA
| |
Collapse
|
8
|
Azilagbetor DM, Jawara M. Improving patient safety: Did we learn from the story of Jean-Pierre Adams? JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2023. [DOI: 10.1177/25160435231157235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The safety of surgery and anesthesia has seen many advances over the last several decades; however, the frequency of complications experienced by patients undergoing surgical operations remains high. Most of these complications are avoidable, with a considerable portion of surgical patient injuries originating from human factors. Telling stories and assessing what went wrong and why for lessons to be learned are proven methods used to improve patient safety in anesthesia. In this narrative, we revisited a case of an anesthesia mishap that occurred in 1982, leaving the victim in a coma for nearly four decades until his death in September 2021. The patient reported for his operation, but a number of the hospital's staff were on strike. His operation, however, went ahead and the reduction in anesthesia care team members and its consequential increase in workload resulted in a series of avoidable errors. Decades after this event, many of the issues identified still remain a challenge in anesthesia care; there are still lessons to learn. We identified and discussed three major issues of concern: the non-cancellation of his procedure amid a strike action, giving a delicate anesthetic duty to a trainee without active supervision, and poor coordination and teamwork among team members in the operating room.
Collapse
Affiliation(s)
| | - Maimuna Jawara
- Higher Institute of Health Sciences, Hassan 1st University, Settat, Morocco
| |
Collapse
|
9
|
Ssekamatte T, Mugambe RK, Nalugya A, Isunju JB, Kalibala P, Musewa A, Bikaako W, Nattimba M, Tigaiza A, Nakalembe D, Osuret J, Wafula ST, Okech S, Buregyeya E, Tsiouris F, Michaels-Strasser S, Kabasa JD, Bazeyo W. Employment status of AFROHUN-Uganda one health alumni, and facilitators and barriers to application of the one health approach: a tracer study. BMC Health Serv Res 2022; 22:1205. [PMID: 36167534 PMCID: PMC9513298 DOI: 10.1186/s12913-022-08537-7] [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: 12/09/2021] [Accepted: 09/07/2022] [Indexed: 12/05/2022] Open
Abstract
Background The One Health (OH) approach integrates multiple competencies in the prevention and control of disease outbreaks. Through a range of OH competence-based activities, the Africa One Health University Network (AFROHUN) built the capacity of selected students at Makerere University and Mbarara University of Science and Technology. This study applied the Systems Theoretical Framework (STF) of career development to establish the employment status of AFROHUN-Uganda alumni, and the facilitators and barriers to application of the OH approach in their organisations. Methods We conducted an embedded mixed-methods study among a random sample of 182 AFROHUN-Uganda alumni of the 2013–2018 cohorts. For quantitative data, descriptive statistics were computed using Stata 14.0 statistical software. A total of 12 in-depth interviews were conducted, and NVivo 12 Pro was used to organise data during thematic analysis. Results While the majority, 87.4% were or got employed after participating in the AFROHUN Uganda capacity building programme, 68.1% were employed at the time of the survey, 57.7% had worked with their current employer for at least a year, and 39% held managerial positions. The facilitators of applying the OH approach into employing organisations included being knowledgeable about OH, the presence of a multidisciplinary workforce, the nature of activities implemented, and existing partnerships and collaborations between organisations. The barriers to the application of the OH approach included limited funding, a negative attitude towards working with people from other disciplines, and limited knowledge of the One Health approach. Conclusion Notably, more than two-thirds of the OH alumni were employed, and more than a third held managerial position. While these findings portray a fairly good absorption rate of the OH alumni into the workforce, they also highlight the facilitators of application of the OH approach that need to be promoted as well as the barriers that need to be addressed if the application of the OH approach is to be improved within the workforce. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08537-7.
Collapse
Affiliation(s)
- Tonny Ssekamatte
- Department of Disease Control and Environmental Health, School of Public Health, Kampala, College of Health Sciences, Makerere University, P. O Box, 7072, Kampala, Uganda. .,Africa One Health University Network, Plot 20B Kawalya Kagwa Cl, Kololo, Kampala, Uganda.
| | - Richard K Mugambe
- Department of Disease Control and Environmental Health, School of Public Health, Kampala, College of Health Sciences, Makerere University, P. O Box, 7072, Kampala, Uganda
| | - Aisha Nalugya
- Department of Disease Control and Environmental Health, School of Public Health, Kampala, College of Health Sciences, Makerere University, P. O Box, 7072, Kampala, Uganda
| | - John Bosco Isunju
- Department of Disease Control and Environmental Health, School of Public Health, Kampala, College of Health Sciences, Makerere University, P. O Box, 7072, Kampala, Uganda.,Africa One Health University Network, Plot 20B Kawalya Kagwa Cl, Kololo, Kampala, Uganda
| | - Patrick Kalibala
- Africa One Health University Network, Plot 20B Kawalya Kagwa Cl, Kololo, Kampala, Uganda.,Makerere University College of Veterinary Medicine, Animal Resources and Biosecurity, Kampala, Uganda
| | - Angella Musewa
- Africa One Health University Network, Plot 20B Kawalya Kagwa Cl, Kololo, Kampala, Uganda.,Makerere University College of Veterinary Medicine, Animal Resources and Biosecurity, Kampala, Uganda
| | - Winnie Bikaako
- Makerere University College of Veterinary Medicine, Animal Resources and Biosecurity, Kampala, Uganda
| | - Milly Nattimba
- Makerere University College of Veterinary Medicine, Animal Resources and Biosecurity, Kampala, Uganda
| | - Arnold Tigaiza
- Department of Disease Control and Environmental Health, School of Public Health, Kampala, College of Health Sciences, Makerere University, P. O Box, 7072, Kampala, Uganda
| | - Doreen Nakalembe
- Department of Disease Control and Environmental Health, School of Public Health, Kampala, College of Health Sciences, Makerere University, P. O Box, 7072, Kampala, Uganda
| | - Jimmy Osuret
- Department of Disease Control and Environmental Health, School of Public Health, Kampala, College of Health Sciences, Makerere University, P. O Box, 7072, Kampala, Uganda.,Africa One Health University Network, Plot 20B Kawalya Kagwa Cl, Kololo, Kampala, Uganda
| | - Solomon T Wafula
- Department of Disease Control and Environmental Health, School of Public Health, Kampala, College of Health Sciences, Makerere University, P. O Box, 7072, Kampala, Uganda
| | - Samuel Okech
- Africa One Health University Network, Plot 20B Kawalya Kagwa Cl, Kololo, Kampala, Uganda.,Makerere University College of Veterinary Medicine, Animal Resources and Biosecurity, Kampala, Uganda
| | - Esther Buregyeya
- Department of Disease Control and Environmental Health, School of Public Health, Kampala, College of Health Sciences, Makerere University, P. O Box, 7072, Kampala, Uganda
| | - Fatima Tsiouris
- Columbia University, Columbia University Mailman School of Public Health, New York, NY, USA
| | | | - John David Kabasa
- Africa One Health University Network, Plot 20B Kawalya Kagwa Cl, Kololo, Kampala, Uganda.,Makerere University College of Veterinary Medicine, Animal Resources and Biosecurity, Kampala, Uganda
| | - William Bazeyo
- Department of Disease Control and Environmental Health, School of Public Health, Kampala, College of Health Sciences, Makerere University, P. O Box, 7072, Kampala, Uganda.,Africa One Health University Network, Plot 20B Kawalya Kagwa Cl, Kololo, Kampala, Uganda
| |
Collapse
|
10
|
Mohiddin A, Langat E, Orwa J, Naanyu V, Temmerman M. Exploring the impact of health worker strikes on maternal and child health in a Kenyan county. BMC Health Serv Res 2022; 22:1139. [PMID: 36085069 PMCID: PMC9461094 DOI: 10.1186/s12913-022-08493-2] [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] [Received: 01/01/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Studies of the impact of health care workers’ strikes tend to look at facility-level activity rather than populations, with evidence from low and middle-income countries relatively sparse. This study explored the effect of national strikes on maternal and child health. It looked at the impact on health system activity in both public and non-public sectors (e.g. private, faith-based), on health promotion investments like immunisation, and on disease detection like post-partum haemorrhage (PPH). A 100 day doctors’ strike started in December 2016, a 150 day nurses strike from June 2017 and then the clinical officers for 21 days that September.
Methods
Time series descriptive analysis of attendance data from the Kenyan Health Management Information System (public, non-public sector facilities). The setting was Kilifi, a coastal county in Kenya with a population of about 1.5 million.
Results
Along the care pathway from antenatal, postnatal and out-patient child health clinics, activity levels dropped markedly in the public sector with only partial compensatory increases in non-public sector activity. The number of fully immunised children fell during the nurses strike as did women seen with PPH during all strikes. These health care strikes caused significant adverse health impacts at the time and potentially inter-generationally as exemplified by the fall in antenatal haematinics supplementation and syphilis testing. Some post-strike ‘’catch-up” activity occurred, however this may have been too late in some instances.
Conclusions
Policy-makers at national and county level need to ensure population health is protected at times of strikes and ideally resolve disputes without such action. Not to do so risks major negative effects on maternal and child health. Increased use of the non-public health sector could be done by the authorities in mitigation should strikes occur again.
Collapse
|
11
|
Chima SC. Evaluating Knowledge, Practice, and Barriers to Informed Consent Among Professional and Staff Nurses in South Africa: An Empirical Study. CANADIAN JOURNAL OF BIOETHICS 2022. [DOI: 10.7202/1089785ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
12
|
Jansåker F, Holm MKA, Gradel KO, Knudsen JD, Boel JB. All-cause Mortality Due to Bacteremia during a 60-Day Non-Physician Healthcare Worker Strike. Clin Infect Dis 2021; 73:e1758-e1761. [PMID: 32918453 PMCID: PMC8852811 DOI: 10.1093/cid/ciaa1373] [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: 06/17/2020] [Accepted: 09/09/2020] [Indexed: 11/13/2022] Open
Abstract
This study explored all-cause mortality of bacteremia diagnosed during a 60-day non-physician healthcare worker strike in 2008. A significant change, with 5.0% (95% confidence interval [CI] 1.2–8.7%, P < .01) absolute risk increase, was seen in 90-day mortality during the strike (n = 598) compared with the rest of the study period 2000–2015 (n = 75 647).
Collapse
Affiliation(s)
- Filip Jansåker
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark.,Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | | | - Kim Oren Gradel
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark.,Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jenny Dahl Knudsen
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - Jonas Bredtoft Boel
- Department of Clinical Microbiology, Herlev University Hospital, Herlev, Denmark
| | | |
Collapse
|
13
|
Cho YH, Cho JW, Ryoo HW, Moon S, Kim JH, Lee SH, Jang TC, Lee DE. Impact of an emergency department resident strike during the coronavirus disease 2019 (COVID-19) pandemic in Daegu, South Korea. Yeungnam Univ J Med 2021; 39:31-38. [PMID: 34411473 PMCID: PMC8895968 DOI: 10.12701/yujm.2021.01130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/09/2021] [Indexed: 11/04/2022] Open
Abstract
Background To prepare for future work stoppages in the medical industry, this study aimed to identify the effects of healthcare worker strikes on the mortality rate of patients visiting the emergency department (ED) at six training hospitals in Daegu, Korea. Methods We used a retrospective, cross-sectional, multicenter design to analyze the medical records of patients who visited six training hospitals in Daegu (August 21-September 8, 2020). For comparison, control period 1 was set as the same period in the previous year (August 21-September 8, 2019) and control period 2 was set as July 1-19, 2020. Patient characteristics including age, sex, and time of ED visit were investigated along with mode of arrival, length of ED stay, and in-hospital mortality. The experimental and control groups were compared using t-tests, and Mann-Whitney U-test, chi-square test, and Fisher exact tests, as appropriate. Univariate logistic regression was performed to identify significant factors, followed by multivariate logistic regression analysis. Results During the study period, 31,357 patients visited the ED, of which 7,749 belonged to the experimental group. Control periods 1 and 2 included 13,100 and 10,243 patients, respectively. No significant in-hospital mortality differences were found between study periods; however, the results showed statistically significant differences in the length of ED stay. Conclusion The ED resident strike did not influence the mortality rate of patients who visited the EDs of six training hospitals in Daegu. Furthermore, the number of patients admitted and the length of ED stay decreased during the strike period.
Collapse
Affiliation(s)
- Yo Han Cho
- Department of Emergency Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jae Wan Cho
- Department of Emergency Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Wook Ryoo
- Department of Emergency Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sungbae Moon
- Department of Emergency Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jung Ho Kim
- Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Sang-Hun Lee
- Department of Emergency Medicine, Keimyung University Dongsan Medical Center, Anyang, Korea
| | - Tae Chang Jang
- Department of Emergency Medicine, Daegu Catholic University School of Medicine, Gyeongsan, Korea
| | - Dong Eun Lee
- Department of Emergency Medicine, Kyungpook National University Chilgok Hospital, Daegu, Korea
| |
Collapse
|
14
|
Affiliation(s)
- Ryan Essex
- From the University of Greenwich, London, United Kingdom
| | | |
Collapse
|
15
|
Kaguthi GK, Nduba V, Adam MB. The impact of the nurses', doctors' and clinical officer strikes on mortality in four health facilities in Kenya. BMC Health Serv Res 2020; 20:469. [PMID: 32456634 PMCID: PMC7249343 DOI: 10.1186/s12913-020-05337-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 05/18/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Health worker strikes are a significant threat to universal access to care globally and especially in sub Saharan Africa. Kenya's health sector has seen an increase in such industrial action. Globally there is limited data that has examined mortality related to such strikes in countries where emergency services were preserved. We sought to assess the mortality impact of an 100 day physician strike which was followed by 151 day nurses' strike and 20 day clinical officer strike in Kenya. METHODS Monthly mortality data was abstracted from four public hospitals, Kenyatta National Referral Hospital, AIC Kijabe Hospital, Mbagathi Hospital and Siaya Hospital between December 2016 and March 2018. Differences in mortality were assessed using t-tests and multiple linear regression adjusting for facility, numbers of patients utilizing the hospital and department. RESULTS There was a significant decline in the numbers of patients seen, comparing the non-strike and strike periods; beta (ß) coefficient - 649 (95% CI -950, - 347) p < 0.0001. The physicians' strike saw a significant decline in mortality (ß) coefficient - 19.0 (95%CI -29.2, - 8.87) p < 0.0001. Nurses and Clinical Officer strikes' did not significantly impact mortality. There was no mortality increase in the post-strike period beta (ß) coefficient 7.42 (95%CI -16.7, 1.85) p = 0.12. CONCLUSION Declines in facility-based mortality during strike months was noted when compared to a non-striking facility, where mortality increased. The decline is possibly associated with the reduced patient volumes, and a possible change in quality of care. Public health facilities are congested and over-utilized by the local population majority of whom cannot afford even low cost private care. Health worker strikes in Kenya where the public health system is the only financially accessible option for 80% of the population pose a significant threat to universal access to care. Judicious investment in the health infrastructure and staffing may decrease congestion and improve quality of care with attendant mortality decline.
Collapse
Affiliation(s)
- Grace Kiringa Kaguthi
- Centre for Respiratory Diseases Research-Kenya Medical Research Institute (KEMRI-CRDR), P.O. Box 62269-00200, Nairobi, Kenya.
| | - Videlis Nduba
- Centre for Respiratory Diseases Research-Kenya Medical Research Institute (KEMRI-CRDR), P.O. Box 62269-00200, Nairobi, Kenya
| | | |
Collapse
|
16
|
Chan HYL. Which are overriding during a pandemic: Professional healthcare duties or personal interests? Nurs Ethics 2020; 27:637-638. [PMID: 32301667 DOI: 10.1177/0969733020916668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|