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Gao Y, Zhu J, Hu L, Chen C. Is there any difference in organizational commitment between general hospitals and specialized hospitals? Empirical evidence from public hospitals in Beijing, China. BMC Health Serv Res 2023; 23:1397. [PMID: 38087250 PMCID: PMC10717447 DOI: 10.1186/s12913-023-10362-5] [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: 06/18/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE The purpose of the study on the one hand is to see different hospital organization commitment have difference, including the overall score and various dimensions, on the other hand, due to the different hospital type, its function orientation is different, the factors of the doctor organization commitment may also exist differences, so the study of another purpose is to determine for different types of hospital doctor organization commitment the focus and key groups, provide reference for the doctor incentive strategy. METHODS A total of 292 doctors in four large public hospitals in Beijing were investigated. Physicians' perceived organizational commitment was investigated using self-made electronic questionnaires. Data were analyzed by factor analysis, descriptive statistics, t-test, ANOVA, and multiple linear regression. RESULTS In the large public hospital doctor perception of the hospital commitment status, Specialized hospitals had higher overall commitment behavior scores, it is 3.47 ± 0.86; General hospital commitment behavior scored low at 3.39 ± 0.91. In the regression results, department category, working years, administrative position, and entry mode are the influencing factors of the organizational commitment of doctors in general hospitals, while in specialized hospitals, in addition to whether to hold an administrative position, entry mode, and working hours, the influencing factors also include gender, professional title and overseas learning background. CONCLUSION There are differences in the perceived organizational commitment by doctors in different types of public hospitals, and different factors influencing their organizational commitment.Hospital type directly influences physicians' organizational commitment and plays a moderating role in influencing other factors. A possible solution is general hospital specialization, encouraging general hospitals to develop the dominant discipline. These findings can help healthcare service hospital executives or government policymakers understand the impact of hospital specialization strategies and develop more efficient medical staff incentive systems.
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Affiliation(s)
- Yirui Gao
- Department of Health Policy and Management, School of Public Health, Capital Medical University, Beijing, China
| | - Junli Zhu
- Department of Health Policy and Management, School of Public Health, Capital Medical University, Beijing, China.
| | - Lujia Hu
- Department of Health Policy and Management, School of Public Health, Capital Medical University, Beijing, China
| | - Chen Chen
- Department of Health Policy and Management, School of Public Health, Capital Medical University, Beijing, China
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Syltern J, Ursin L, Solberg B, Støen R. Postponed Withholding: Balanced Decision-Making at the Margins of Viability. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:15-26. [PMID: 33998962 DOI: 10.1080/15265161.2021.1925777] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Advances in neonatology have led to improved survival for periviable infants. Immaturity still carries a high risk of short- and long-term harms, and uncertainty turns provision of life support into an ethical dilemma. Shared decision-making with parents has gained ground. However, the need to start immediate life support and the ensuing difficulty of withdrawing treatment stands in tension with the possibility of a fair decision-making process. Both the parental "instinct of saving" and "withdrawal resistance" involved can preclude shared decision-making. To help health care personnel and empower parents, we propose a novel approach labeled "postponed withholding." In the absence of a prenatal advance directive, life support is started at birth, followed by planned redirection to palliative care after one week, unless parents, after a thorough counseling process, actively ask for continued life support. Despite the emotional challenges, this approach can facilitate ethically balanced decision-making processes in the gray zone.
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Affiliation(s)
- Janicke Syltern
- Norwegian University of Science and Technology
- St Olavs Hospital University Hospital in Trondheim
| | - Lars Ursin
- The Norwegian University of Science and Technology
| | | | - Ragnhild Støen
- Norwegian University of Science and Technology
- St Olavs Hospital University Hospital in Trondheim
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Huang H, Toh RQE, Chiang CLL, Thenpandiyan AA, Vig PS, Lee RWL, Chiam M, Lee ASI, Baral VR, Krishna LKR. Impact of Dying Neonates on Doctors' and Nurses' Personhood: A Systematic Scoping Review. J Pain Symptom Manage 2022; 63:e59-e74. [PMID: 34271142 DOI: 10.1016/j.jpainsymman.2021.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 11/23/2022]
Abstract
CONTEXT Caring for dying neonates is distressing for healthcare professionals (HCP)s. Yet, the extent of these effects is poorly understood, compromising support of HCPs. To better understand and support HCPs, a systematic scoping review (SSR) of prevailing data is proposed. OBJECTIVES In mapping prevailing data on the impact of caring for dying neonates on HCPs, an SSR proffers new insights on changes to their beliefs, values, coping, actions, relationships and self-concepts of personhood. METHODS Krishna's Systematic Evidenced Based Approach (SEBA) supports a robust, reproducible review whilst its constructivist approach and relativist lens effectively contends with diverse data sources, facilitating a holistic study. RESULTS A total of 9826 abstracts were reviewed and 69 articles were included. Thematic and content analysis were used simultanously. The four categories drawn from the Ring Theory of Personhood (RToP) complements the four themes identified: Emotional and Physical Difficulties, Coping Mechanisms, Conflict and Recommendations. CONCLUSION In highlighting significant longitudinal effects upon all aspects of their lives, this SSR in SEBA reveals a critical need for timely, appropriate and personalized support. We recommend adapting the RToP as an assessment tool to identify and evaluate the needs of these HCPs. It may also be used to structure a holistic support mechanism. Future studies are required to validate its use and appraise other aspects of support available for HCPs.
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Affiliation(s)
- Huixin Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Division of Supportive and Palliative Care, National Cancer Center Singapore, Singapore, Singapore
| | - Rachelle Qi En Toh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Division of Supportive and Palliative Care, National Cancer Center Singapore, Singapore, Singapore
| | - Christine Li Ling Chiang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Division of Supportive and Palliative Care, National Cancer Center Singapore, Singapore, Singapore
| | - Ashiley Annushri Thenpandiyan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Division of Supportive and Palliative Care, National Cancer Center Singapore, Singapore, Singapore
| | - Prachi Simran Vig
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Division of Supportive and Palliative Care, National Cancer Center Singapore, Singapore, Singapore
| | - Randal Wei Liang Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Division of Supportive and Palliative Care, National Cancer Center Singapore, Singapore, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Center Singapore, Singapore, Singapore
| | - Alexia Sze Inn Lee
- Division of Cancer Education, National Cancer Center Singapore, Singapore, Singapore
| | - Vijayendra Ranjan Baral
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Division of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Division of Supportive and Palliative Care, National Cancer Center Singapore, Singapore, Singapore; Division of Cancer Education, National Cancer Center Singapore, Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore; Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Center, University of Liverpool, Cancer Research Center, University of Liverpool, Liverpool, United Kingdom; Center of Biomedical Ethics, National University of Singapore, Singapore, Singapore; PalC, The Palliative Care Center for Excellence in Research and Education, Singapore, Singapore.
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