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Civilian-Military Collaboration before and during COVID-19 Pandemic—A Systematic Review and a Pilot Survey among Practitioners. SUSTAINABILITY 2022. [DOI: 10.3390/su14020624] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Due to the similarity in skills and assets, Civilian-Military collaboration has emerged as one of the most reliable partnerships during the disaster and public health emergency management to address all necessary elements of surge capacity, i.e., staff, stuff, structure (space), and systems. This study aimed to evaluate this collaboration before and during the coronavirus 2019 pandemic. The outcomes of the systematic review revealed several published reports on successful civilian-military collaboration and proposed a need for further improvement. One hundred sixty-six individuals from 19 countries responded to nine questions, included in an online survey with the possibility to leave comments if necessary. The questionnaire referred to elements such as command and control, safety, communication, assessment, triage, treatment, and transport, as the crucial components of emergency management. The comprehensive examination of the survey results together with registered comments revealed a possible improvement in collaboration particularly on the strategic levels, i.e., meetings at the command-and-control level, safety, communication, and networking issues. While logistic collaboration seemed to be unchanged, the practical parts of the collaboration, i.e., clinical and non-clinical operational partnership (Triage and Treatment), mutual education, training, and operational understanding of each organization remained unchanged. In conclusion, although the current pandemic may have facilitated a more intense collaboration between civilian and military healthcare organizations, it lacks practical partnership and operative engagement, representing two crucial elements necessary for harmony and compatibility of both systems. Such collaboration may require a political will and perhaps a mutual civilian-military authority.
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Kerr R, Hendrie DV. Is capital investment in Australian hospitals effectively funding patient access to efficient public hospital care? AUST HEALTH REV 2019; 42:501-513. [PMID: 30135003 DOI: 10.1071/ah17231] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 05/07/2018] [Indexed: 11/23/2022]
Abstract
Objective
This study asks ‘Is capital investment in Australian public hospitals effectively funding patient access to efficient hospital care?’
Methods
The study drew information from semistructured interviews with senior health infrastructure officials, literature reviews and World Health Organization (WHO) reports. To identify which systems most effectively fund patient access to efficient hospitals, capital allocation systems for 17 Organisation for Economic Cooperation and Development (OECD) countries were assessed.
Results
Australian government objectives (equitable access to clinically appropriate, efficient, sustainable, innovative, patient-based) for acute health services are not directly addressed within Australian capital allocation systems for hospitals. Instead, Australia retains a prioritised hospital investment system for institutionally based asset replacement and capital planning, aligned with budgetary and political priorities. Australian systems of capital allocation for public hospitals were found not to match health system objectives for allocative, productive and dynamic efficiency. Australia scored below average in funding patient access to efficient hospitals. The OECD countries most effectively funding patient access to efficient hospital care have transitioned to diagnosis-related group (DRG) aligned capital funding. Measures of effective capital allocation for hospitals, patient access and efficiency found mixed government–private–public partnerships performed poorly with inferior access to capital than DRG-aligned systems, with the worst performing systems based on private finance.
Conclusion
Australian capital allocation systems for hospitals do not meet Australian government standards for the health system. Transition to a diagnosis-based system of capital allocation would align capital allocation with government standards and has been found to improve patient access to efficient hospital care.
What is known about the topic?
Very little is known about the effectiveness of Australian capital allocation for public hospitals. In Australia, capital is rarely discussed in the context of efficiency, although poor built capital and inappropriate technologies are acknowledged as limitations to improving efficiency. Capital allocated for public hospitals by state and territory is no longer reported by Australian Institute of Health and Welfare due to problems with data reliability. International comparative reviews of capital funding for hospitals have not included Australia. Most comparative efficiency reviews for health avoid considering capital allocation. The national review of hospitals found capital allocation information makes it difficult to determine ’if we have it right’ in terms of investment for health services. Problems with capital allocation systems for public hospitals have been identified within state-based reviews of health service delivery. The Productivity Commission was unable to identify the cost of capital used in treating patients in Australian public hospitals. Instead, building and equipment depreciation plus the user cost of capital (or the cost of using the money invested in the asset) are used to estimate the cost of capital required for patient care, despite concerns about accuracy and comparability.
What does this paper add?
This is the first study to review capital allocation systems for Australian public hospitals, to evaluate those systems against the contemporary objectives of the health systems and to assess whether prevailing Australian allocation systems deliver funds to facilitate patient access to efficient hospital care. This is the first study to evaluate Australian hospital capital allocation and efficiency. It compares the objectives of the Australian public hospitals system (for universal access to patient-centred, efficient and effective health care) against a range of capital funding mechanisms used in comparable health systems. It is also the first comparative review of international capital funding systems to include Australia.
What are the implications for practitioners?
Clinical quality and operational efficiency in hospitals require access for all patients to technologically appropriate hospitals. Funding for appropriate public hospital facilities, medical equipment and information and communications technology is not connected to activity-based funding in Australia. This study examines how capital can most effectively be allocated to provide patient access to efficient hospital care for Australian public hospitals. Capital investment for hospitals that is patient based, rather than institutionally focused, aligns with higher efficiency.
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Affiliation(s)
- Rhonda Kerr
- Centre for Population Health Research, Faculty of Health Science, Curtin University, GPO Box U1987, Perth, WA 6845, Australia. Email
| | - Delia V Hendrie
- Centre for Population Health Research, Faculty of Health Science, Curtin University, GPO Box U1987, Perth, WA 6845, Australia. Email
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Career transitions of inactive nurses: A registration database analysis (1993–2006). Int J Nurs Stud 2011; 48:184-92. [DOI: 10.1016/j.ijnurstu.2010.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 05/13/2010] [Accepted: 06/16/2010] [Indexed: 11/17/2022]
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Vickers MH. Journeys Into Grief: Exploring Redundancy for a New Understanding of Workplace Grief. JOURNAL OF LOSS & TRAUMA 2009. [DOI: 10.1080/15325020902724198] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Alameddine M, Baumann A, Laporte A, O'Brien-Pallas L, Levinton C, Onate K, Deber R. Career trajectories of nurses leaving the hospital sector in Ontario, Canada (1993-2004). J Adv Nurs 2009; 65:1044-53. [PMID: 19399977 DOI: 10.1111/j.1365-2648.2009.04965.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This paper is a report of an analysis of the career trajectories of nurses 1 year after leaving hospitals. BACKGROUND Although hospitals are traditionally the largest employers of nurses, technological advances and budgetary constraints have resulted in many countries in relative shrinkage of the hospital sector and a shift of care (and jobs) into home/community settings. It has been often assumed that nurses displaced from hospitals will move to work in the other workplaces, especially the community sector. METHOD Employment patterns were tracked by examining a longitudinal database of all 201,463 nurses registered with the College of Nurses Ontario (Canada) between 1993 and 2004. Focusing on the employment categories Active (Working in nursing), Eligible-Seeking nursing employment or Dropout from the nursing labour market, year-to-year transition matrixes were generated by sector and sub-sector of employment, nurse type, age group and work status. FINDINGS For every nurse practising nursing in any non-hospital job or in the community a year after leaving hospitals, an average of 1.3 and four nurses, respectively, dropped out of Ontario's labour market. The proportion of nurses leaving hospitals transitioning to the Dropout category ranged from 63.3% (1994-95) to 38.6% (2001-02). The proportion dropping out of Ontario's market was higher for Registered Practical Nurses (compared to Registered Nurses), increased with age and decreased with degree of casualization in nurses' jobs. CONCLUSION Downsizing hospitals without attention to the potentially negative impact on the nursing workforce can lead to retention difficulties and adversely affects the overall supply of nurses.
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Affiliation(s)
- Mohamad Alameddine
- Department of Health Management and Policy, American University of Beirut, Lebanon.
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Weller DP, Maynard A. How general practice is funded in the United Kingdom. Med J Aust 2004; 181:109-10. [PMID: 15257652 DOI: 10.5694/j.1326-5377.2004.tb06188.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2004] [Accepted: 06/03/2004] [Indexed: 11/17/2022]
Affiliation(s)
- David P Weller
- Division of Community Health Sciences, General Practice Section, University of Edinburg, Scotland EH8 9DX, UK.
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Shapiro J, Shapiro R. Towards an improved collaboration model for the national healthcare system in England and Wales: a critical and constructive approach using operational research. ACTA ACUST UNITED AC 2003. [DOI: 10.1108/09576050310483835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Dunnigan MG, Pollock AM. Downsizing of acute inpatient beds associated with private finance initiative: Scotland's case study. BMJ 2003; 326:905. [PMID: 12714469 PMCID: PMC153832 DOI: 10.1136/bmj.326.7395.905] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate whether the projected 24% reduction in acute bed numbers in Lothian hospitals, which formed part of the private finance initiative (PFI) plans for the replacement Royal Infirmary of Edinburgh, is being compensated for by improvements in efficiency and greater use of community facilities, and to ascertain whether there is an independent PFI effect by comparing clinical activity and performance in acute specialties in Lothian hospitals with other NHS hospitals in Scotland. DESIGN Comparison of projected and actual trends in acute bed capacity and inpatient and day case admissions in the first five years (1995-6 to 2000-1) of Lothian Health Board's integrated healthcare plan. Population study of trends in bed rate, hospital activity, length of stay, and throughput in Lothian hospitals compared with the rest of Scotland from 1990-1 to 2000-1. MAIN OUTCOME MEASURES Staffed bed rates, admission rates, mean lengths of stay, occupancy, and throughput in four adult acute specialty groups in 1990-1, 1995-6, and 2000-1. RESULTS By 2000-1, rates for inpatient admission in all acute, medical, surgical, and intensive therapy specialties in Lothian hospitals were respectively 20%, 6%, 28%, and 38% below those in the rest of Scotland. Day case rates in all acute and acute surgical specialties were 13% and 33% lower. The proportion of delayed discharges in staffed acute and post-acute NHS beds in Lothian hospitals exceeded the Scottish average (15% and 12% respectively; P<0.001). CONCLUSION The planning targets and increase in clinical activity in acute specialties in Lothian hospitals associated with PFI had not been achieved by 2000-1. The effect on clinical activity has been a steeper decline in the number of acute beds and rates of admission in Lothian hospitals compared with the rest of Scotland between 1995-6 and 2000-1.
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Affiliation(s)
- Matthew G Dunnigan
- University Department of Human Nutrition, Glasgow Royal Infirmary, Glasgow G31 2ER
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Affiliation(s)
- Stuart Nairn
- University of Nottingham, Derby Education Centre, Derbyshire Royal Infirmary, London Road, DE1 2QY, Derby, UK.
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Moon G, Mohan J, Twigg L, McGrath K, Pollock A. Catching waves: the historical geography of the general practice fundholding initiative in England and Wales. Soc Sci Med 2002; 55:2201-13. [PMID: 12409134 DOI: 10.1016/s0277-9536(01)00365-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
General practitioner fundholding is often represented as one of the more successful elements of the 1989/90 Conservative reforms of the UK National Health Service (NHS). Successive annual 'waves' of fundholding practices were approved from 1990 through to 1997 and, over time, the initiative came to involve some 50% of UK general practitioners. Fundholding is known to have had a strong regional geography that changed with evolving fundholding eligibility criteria. Further, there have been persistent allegations that fundholding tended to occur disproportionately in areas of higher social status. Past studies of fundholding have tended to consider single waves or the overall impact of the initiative rather than its development over time. They have also tended to work at a single geographic scale or through single-region case studies when exploring the statistical regularities underlying the uptake of fundholding. Using multilevel analysis, this paper seeks to enhance understanding of fundholding through an examination of the interaction of district health authority and practice characteristics across all implemented waves for all general medical practices in England and Wales. We conclude that wave mattered on a national scale, that deprivation was relatively unimportant and that there were certain types of area that exhibited persistent but unexpected high uptake.
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Affiliation(s)
- Graham Moon
- Institute for the Geography of Health, University of Portsmouth, Buckingham Building, Lion Terrace, Portsmouth PO1 3HE, UK.
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Pollock A. A wake up call for primary care. Br J Gen Pract 2002; 52:883-4. [PMID: 12434953 PMCID: PMC1314436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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12
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Melbye H. Community pneumonia--more help is needed to diagnose and assess severity. Br J Gen Pract 2002; 52:886-8. [PMID: 12434955 PMCID: PMC1314438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Pollock AM, Shaoul J, Vickers N. Private finance and "value for money" in NHS hospitals: a policy in search of a rationale? BMJ 2002; 324:1205-9. [PMID: 12016191 PMCID: PMC1123165 DOI: 10.1136/bmj.324.7347.1205] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Allyson M Pollock
- Health Policy and Health Services Research Unit, School of Public Policy, UCL, London WC1H 9QU.
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Dawson D. The private finance initiative: a public finance illusion? HEALTH ECONOMICS 2001; 10:479-486. [PMID: 11550289 DOI: 10.1002/hec.644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Appleby J. Will primary care trusts lead to US-style health care? BMJ (CLINICAL RESEARCH ED.) 2001; 323:281-2. [PMID: 11505934 PMCID: PMC1120891 DOI: 10.1136/bmj.323.7307.281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pollock AM, Player S, Godden S. How private finance is moving primary care into corporate ownership. BMJ (CLINICAL RESEARCH ED.) 2001; 322:960-3. [PMID: 11312229 PMCID: PMC1120133 DOI: 10.1136/bmj.322.7292.960] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- A M Pollock
- Health Policy and Health Services Research Unit, School of Public Policy, University College London, London WC1H 9QU.
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Jones J. The private finance initiative: spinning out the defence. BMJ (CLINICAL RESEARCH ED.) 2000; 320:1460-1. [PMID: 10827057 PMCID: PMC1127647 DOI: 10.1136/bmj.320.7247.1460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Price D, Green J. Capital planning and the private finance initiative: Cost minimization or health care planning? CRITICAL PUBLIC HEALTH 2000. [DOI: 10.1080/713658224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pollock AM, Dunnigan MG. Beds in the NHS. The National Bed Inquiry exposes contradictions in government policy. BMJ (CLINICAL RESEARCH ED.) 2000; 320:461-2. [PMID: 10678843 PMCID: PMC1127516 DOI: 10.1136/bmj.320.7233.461] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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McGinty F. Private finance initiative. Partnership between private and NHS is not necessarily wrong. BMJ (CLINICAL RESEARCH ED.) 2000; 320:250-1. [PMID: 10642246 PMCID: PMC1117445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Horner JS. Autonomy in the medical profession in the United Kingdom--an historical perspective. THEORETICAL MEDICINE AND BIOETHICS 2000; 21:409-423. [PMID: 11142439 DOI: 10.1023/a:1009969205289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This paper reviews the concept of professional autonomy from an historical perspective. It became formalised in the United Kingdom only after a long struggle throughout most of the nineteenth century. In its pure form professional autonomy implies unlimited powers to undertake medical investigations and to prescribe treatment, irrespective of cost. Doctors alone should determine the quality of care and the levels of remuneration to which they should be entitled. In the second half of the twentieth century a steady erosion of professional autonomy occurred in the United Kingdom. The level of remuneration has been restricted for most doctors for nearly fifty years, whilst the costs of health care have steadily reduced the doctor's ability to provide unrestricted care within the health care system. Reorganisation of the National Health Service in 1983 and 1991 has substantially eroded professional autonomy, to the point where research developments, clinical judgement and ethical standards are all now being placed at risk.
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Affiliation(s)
- J S Horner
- Centre for Professional Ethics, University of Central Lancashire, UK.
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Abstract
High up on the agenda of the World Trade Organisation (WTO) is the privatisation of education, health, welfare, social housing and transport. The WTO's aim is to extend the free market in the provision of traditional public services. Governments in Europe and the US link the expansion of trade in public services to economic success, and with the backing of powerful medico-pharmaceutical, insurance, and service corporations, the race is on to capture the share of gross domestic product that governments currently spend on public services. They will open domestic European services and domestic markets to global competition by government procurement agreements, dispute-settlement procedures, and the investment rules of global financial institutions. The UK has already set up the necessary mechanisms: the introduction of private-sector accounting rules to public services; the funding of public-sector investment via private-public partnerships or the private finance initiative; and the change to capitation funding streams, which allows the substitution of private for public funds and services. We explain the implications of these changes for European public-health-care systems and the threat they pose to universal coverage, solidarity through risk-pooling, equity, comprehensive care, and democratic accountability.
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Affiliation(s)
- D Price
- Health Policy and Health Services Research Unit, University College London, UK
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Marshall T. Policy must separate need for hospital beds from demand. BMJ (CLINICAL RESEARCH ED.) 1999; 319:855. [PMID: 10496850 PMCID: PMC1116684 DOI: 10.1136/bmj.319.7213.855a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gaffney D, Pollock AM, Price D, Shaoul J. The private finance initiative: the politics of the private finance initiative and the new NHS. BMJ (CLINICAL RESEARCH ED.) 1999; 319:249-53. [PMID: 10417094 PMCID: PMC1116335 DOI: 10.1136/bmj.319.7204.249] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- D Gaffney
- Health Policy and Health Services Research Unit, School of Public Policy, University College London, London WC1H 9EZ, UK
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Smith R. PFI: perfidious financial idiocy. A "free lunch" that could destroy the NHS. BMJ (CLINICAL RESEARCH ED.) 1999; 319:2-3. [PMID: 10390430 PMCID: PMC1116138 DOI: 10.1136/bmj.319.7201.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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