Physician' entrepreneurship explained: a case study of intra-organizational dynamics in Dutch hospitals and specialty clinics

Current State of Brazilian Neurosurgery: Evaluation of Burden of Care and Case Volume

BACKGROUND

Low- and middle-income countries (LMICs) bear a heavier burden of neurosurgical diseases than high-income countries. Brazil, a growing middle-income country, holds promise as a health care market. However, there exists a lack of information to characterize the state of neurosurgical practice and access to care in Brazil. This study aimed to characterize neurosurgical practice in Brazil and identify barriers to care.

METHODS

A collaborative survey was developed with Brazilian neurosurgeons and distributed by the Brazilian Society of Neurosurgery. The survey gathered demographic information, practice characteristics, case volume, referral patterns, income sources, and assessed barriers using a Likert scale. Descriptive statistics were employed for data analysis.

RESULTS

One-hundred and forty-nine neurosurgeons participated (response rate: 17.5%), representing various states in Brazil. Neurosurgeons practiced in more than 4 different hospital systems on average, with most consultations and procedures occurring in public hospitals. Common procedures included tumor surgeries, general neurosurgery, spine surgeries, trauma surgeries, and hydrocephalus management. Equipment shortage and systemic issues were identified as major barriers to care.

CONCLUSIONS

Neurosurgical practice in Brazil exhibits diverse age distribution, widespread distribution across states, and involvement in both public and private hospitals. Survey insights shed light on neurosurgical workload and neurosurgical practice characterization. Lack of equipment and inadequate postoperative resources pose significant barriers to care. The findings highlight the need for investments in equipment, critical care facilities, and improved health care system coordination to enhance access to neurosurgical care in Brazil.

Academic intrapreneurship for health care innovation: the importance of influence, perception, and time management in knowledge commercialization at a University’s Medical Centre

Academic intrapreneurship refers to the individual behaviours of scientists who depart from their customary research and education initiatives and become involved in knowledge commercialization without leaving academia. This paper aims to examine how academic intrapreneurs perceive and respond to organizational factors set by departments, faculties, schools, and university boards that influence knowledge transfer, the initiation of an internal project, and the collaboration with societal stakeholders. We employ an embedded case study approach to examine the role of perceived control and influence within the internal work environment of a knowledge commercialization process within the DiabetesStation, a healthcare innovation at the Erasmus Medical Center (MC), a university hospital in Rotterdam, the Netherlands. We used a semi-structured interview strategy and analyzed 12 individual respondent interviews. The results show that the relationship between academics and the Knowledge Commercialization Process within the DS at Erasmus MC was influenced by six factors (i.e., external collaboration, product quality, time availability, external financing, internal financing, and rewards and reinforcement). Our study highlights that the perception of- the academic intrapreneur’s control and influence seems to impact effectively transferring academic knowledge from academic institutions to the private sector for economic and societal benefit. The research results highlight three controllable areas of an academic institution’s internal work environment that can enhance the relationship between knowledge valorization and academic intrapreneurship—time availability, rewards and reinforcement, and internal financing.

The effects of austerity measures on quality of healthcare services: a national survey of physicians in the public and private sectors in Portugal

BACKGROUND

The European Union member countries reacted differently to the 2008 economic and financial crisis. However, few countries have monitored the outcomes of their policy responses, and there is therefore little evidence as to whether or not savings undermined the performance of health systems. We discuss the situation in Portugal, where a financial adjustment program was implemented between 2011 and 2014, and explore the views of health workers on the effects of austerity measures on quality of care delivery.

METHODS

A nationwide survey of physicians' experiences was conducted in 2013-2014 (n = 3442). We used a two-step model to compare public and private services and look at the possible moderating effects of the physicians' specialty and years of practice. Our data analysis included descriptive statistics, the independent t test, analysis of variance (ANOVA), multivariate logistic regression, General Linear Model Univariate Analysis, non-parametric methods (bootstrap), and post hoc probing.

RESULTS

Mainly in the public sector, the policy goal of maintaining quality of care was undermined by a lack of resources, the deterioration in medical residency conditions, and to a lesser extent, greater administrative interference in clinical decision-making. Differences in public and private services showed that the effects of the austerity measures were not the same throughout the health system. Our results also showed that physicians with similar years of practice and in the same medical specialty did not necessarily experience the same pressures.

CONCLUSIONS

The debate on the effects of austerity measures should focus more closely on health workers' concrete experiences, as they demonstrate the non-linearity between policy setting and expected outcomes. We also suggest that it is necessary to explore the interplay between lower quality and the undermining of trust relationships in health.

Job satisfaction and turnover intention among Iraqi doctors--a descriptive cross-sectional multicentre study

BACKGROUND

During the last two decades, the Iraqi human resources for health was exposed to an unprecedented turnover of trained and experienced medical professionals. This study aimed to explore prominent factors affecting turnover intentions among Iraqi doctors.

METHODS

A descriptive cross-sectional multicentre study was carried out among 576 doctors across 20 hospitals in Iraq using multistage sampling technique. Participants completed a self-administered questionnaire, which included socio-demographic information, work characteristics, the 10-item Warr-Cook-Wall job satisfaction scale, and one question on turnover intention. Descriptive and bivariate and multiple logistic regression analyses were conducted to identify significant factors affecting turnover intentions.

RESULTS

More than one half of Iraqi doctors (55.2%) were actively seeking alternative employment. Factors associated with turnover intentions among doctors were low job satisfaction score (odds ratio (OR) = 0.97; 95% confidence interval (CI): 0.95, 0.99), aged 40 years old or less (OR = 2.9; 95% CI: 1.74, 4.75), being male (OR = 4.2; 95% CI: 2.54, 7.03), being single (OR = 5.0; 95% CI: 2.61, 9.75), being threatened (OR = 3.5; 95% CI: 1.80, 6.69), internally displaced (OR = 3.1; 95% CI: 1.43, 6.57), having a perception of unsafe medical practice (OR = 4.1; 95% CI: 1.86, 9.21), working more than 40 h per week, (OR = 2.3; 95% CI: 1.27, 4.03), disagreement with the way manager handles staff (OR = 2.2; 95% CI: 1.19, 4.03), being non-specialist, (OR = 3.9, 95% CI: 2.08, 7.13), and being employed in the government sector only (OR = 2.0; 95% CI: 1.09, 3.82).

CONCLUSION

The high-turnover intention among Iraqi doctors is significantly associated with working and security conditions. An urgent and effective strategy is required to prevent doctors' exodus.