Health workforce development planning in the Sultanate of Oman: a case study

Medical malpractice in Oman: A 12-year retrospective record review

BACKGROUND

There is a paucity of studies documenting medical malpractice litigation in countries of the Arabian Gulf, such as Oman.

OBJECTIVES

To describe the characteristics of malpractice claims, the outcomes decided by the medical liability committee, and predictors of medical errors.

METHODS

This is a retrospective observational study that reviewed medical malpractice cases registered in Oman over a 12-year period (2010-2021) with the medical liability committee, known as the Higher Medical Committee (HMC). Descriptive and inferential statistical techniques, including multiple logistic regression techniques, were used for data analysis.

RESULTS

Between 2010 and 2021, the HMC registered 1284 medical malpractice cases, out of which 1048 were fully investigated. The number of registered cases increased during this period. These cases included those raised by Omani nationals and expatriates, with a majority (86%) raised by Omani complainants. Two-thirds (67%) of the cases involved adult complainants aged 18-60 years. About 43% of the cases were from the urban Muscat region, and 68% were related to public hospitals. The most common specialties involved were obstetrics and gynecology (20.1%), internal medicine (19.7%), surgery (17.6%) and orthopedics (13.8%). Half (51%) of the appeals or grievances were dismissed because they were not preceded by medical negligence or malpractice. The average waiting time to initiate the investigation was 10 months. Errors were more common among non-Omani complainants and cases related to private hospitals. Significant predictors of errors included nationality (i.e. Omani vs. non-Omani), the referring institution, the medical specialty and the type of health institution involved, and the waiting time to initiate the investigation.

CONCLUSION

To date, the number of cases of medical malpractice in Oman is lower compared to international trends, although there has been an upsurge in recent years. More research using a more robust methodology is warranted to contextualise the factors that contribute to this upward trend, as well as the preponderance in urban settings and among certain demographic populations.

Role transition from education to practice and its impact on the career futures of Omani nurses

AIM

The aim of this study was to examine new Omani graduate nurses' role transition from education to practice. We also sought to describe factors that may affect the effective transition of new Omani graduates to their professional nurse role.

BACKGROUND

There is a substantial literature on the process of transition from graduation to being a professional nurse in countries across the globe; however, little is known about new Omani graduate nurses' role transition from education to practice.

DESIGN

This study had a descriptive cross-sectional design.

METHODS

Data were collected from nurses who at the time of the study had been working for at least 3 months but not longer than 2 years. Role transition was assessed with the Comfort and Confidence subscale of the Casey-Fink Graduate Nurse Experience Survey (Casey et al., 2004). The survey consists of a 24-items that are rated on a 4-point Likert scale. We conducted a multivariate regression analysis to assess the factors that influence nurses' role transition. These factors included participants' demographic information, employment orientation durations, preceptorship duration and length of time before employment.

RESULTS

The total sample consisted of 405 nurses working in 13 hospitals in Oman. Most (68.89%) had worked as a nurse for less than 6 months. The average internship and orientation durations were approximately 6 months (SD = 1.58) and 2 weeks (SD = 1.79), respectively. The number of preceptors assigned to new graduate nurses ranged from none to four. The average score on the Comfort and Confidence subscale was 2.96 (SD = 0.38). Results from the regression analysis demonstrated that age (β = 0.029, SE = 0.012, p = .021), waiting time before employment (β = -0.035, SE = 0.013, p = .007) and employment orientation duration (β = -0.007, SE = 0.003, p = .018) were statistically significant factors influencing role transition experience among newly joined nurses.

CONCLUSION

The results suggest that appropriate intervention strategies at the national level are needed to enhance the transition of nursing school graduates to their professional role. Strategies directed toward shortening the waiting time before employment and improving the internship experience are examples of priority-level tactics that can enhance Omani nursing graduates' transition to their professional role.

How to make the best use of the workload indicators of staffing needs method in determining the proportion of time spent in each of the workload components and its implication in decision making: the experience of the Sultanate of Oman

BACKGROUND

The Ministry of Health in the Sultanate of Oman decided to have better distribution of the health workforce among all health facilities through evidenced-based staffing norms. Four directorates worked together to develop the staffing norms through making use of the workload indicators of staffing needs (WISN) method. The aim of this study is to describe the process of applying the WISN method in Primary Health Care institutions and how to make the best use of method in determining the proportion of time spent in each of the workload components and its implication in decision making.

METHODS

The WISN was applied for five priority categories, namely, doctors, nurses, pharmacists, laboratory technicians, and radiology technicians at PHC institutions. The WISN ratio has been translated into workload pressure as a percentage through applying the formula [workload pressure as % (in case of shortage) = (1 - WISN ratio) × 100%]. While the proportion of time spent in each of the workload components was calculated through making use of the category allowance standard, the individual allowance standard to determine the time spent in support and additional activities. The sum is subtracted from 100% to give the time spent in the health service activities.

RESULTS

Determining the workload pressure as a percent and its interpretation is based on the fact that one cadre or as a group can bear up to 10% of extra workload. Thus, managers can undertake sensible short-term arrangements or decisions in redistributing the cadres among the health facilities on expectation of deploying more staff.

DISCUSSION

Careful and detailed analysis of the proportion of time spent in each of the workload components will allow to have better understanding of the context and dynamics of work.

CONCLUSION

Decision makers and planners can undertake rational short-term decisions in redistributing the cadres among the health facilities based on the workload pressure. In addition, they can as well as easily decide on the optimal proportions of time for each staff category, and hence choose what activities and tasks to be shifted or delegated to other staff category.

Influence of Age on 2040 Cancer Burden in the Older Population of the Gulf Cooperation Council (GCC) Countries: Public Health Implications

INTRODUCTION AND STUDY AIMS

The underlying population of global regions varies widely and is a major determinant of regional cancer differences. The aims were to: (1) estimate the cancer burden in Gulf Cooperation Council (GCC) countries in 2040 for the ≥70 population and (2) assess the public health implications for this cancer increase.

METHODS

We used Global Cancer Observatory (GLOBOCAN) estimates of cancer incidence and mortality for people aged 70 years or more in GCC countries from 2018 to 2040 from the International Agency for Research on Cancer. For population growth, we used data for the same period from the Population Division of the United Nations Department of Economic and Social Affairs. From these, we calculated the predicted increase in the number of cancer cases and cancer deaths from 2018 to 2040 and the proportion of cases/deaths represented by those aged 70+ for the 2 time periods.

FINDINGS

In the GCC countries, the predicted number of newly diagnosed cancers and cancer deaths in the older population will increase by 465% and 462% respectively due to demographic changes-greater than other countries in the World Health Organization Eastern Mediterranean Region, or in countries of similar economic development. The largest predicted increases will be for Qatar and the United Arab Emirates. Based on the predicted population age, cancer burden among older people in the GCC countries will increase by approximately 460%.

CONCLUSION

By the year 2040, the relationship between cancer and age will cause a 4- to 5-fold increase in the cancer burden in the GCC. These predictable changes will require additional planning and resources to provide appropriate healthcare.

Nurses' Knowledge, Attitudes, and Implementation of Evidence-based Practice in Oman: A Multi-institutional, Cross-sectional Study

Objectives

Little attention has been paid to the study of evidence-based practice (EBP) among nurses in Oman. Our aim was to explore knowledge, practice, and attitudes towards EBP among nurses working in Oman.

Methods

This multi-institutional cross-sectional study utilized the self-reported EBP Questionnaire with a random sample of 262 nurses working in three different health care settings in Al Dakhliyah governorate, Oman (local hospitals, primary health centers and polyclinics, and schools).

Results

A total of 202 nurses (response rate: 77.1%) completed the questionnaire. The mean age was 32.4±4.7 years. Most respondents were females (92.5%), Omani (79.1%), and holders of a diploma in nursing (73.5%) with a mean clinical experience of 10.9±4.2 years. Attitudes towards EBP showed the highest mean score of 5.5±1.2 followed by knowledge (4.9±0.8) and practice (4.7±1.2). Significant positive correlations were identified between the total years of nursing experience and knowledge (r_s = 0.145, n = 198, p = 0.041), practice (r_s = 0.172, n = 198, p = 0.015), and attitudes (r_s = 0.158, n = 197, p = 0.026) mean scores. No significant difference in EBP scores was found among the three clinical settings.

Conclusion

Although attitudes towards EBP were positive, knowledge and implementation of EBP were low. This study serves as a baseline assessment for future evaluations and provides a basis for the implementation of strategies to promote EBP utilization among nurses in three different health care settings in Oman.

The trend of feminization of doctors' workforce in Oman: is it a phenomenon that could rouse the health system?

BACKGROUND

Participation of women in the medical profession over several countries worldwide was increased over the past decades. This paper is a part of ongoing studies aiming at addressing the issue of health workforce feminization among doctors in the Sultanate of Oman as well as exploring the health system readiness in dealing with this phenomenon.

METHODS

Literature in addition to reports and records of the Ministry of Health, Oman (MoH), Sultan Qaboos University (SQU) and Oman Medical Specialty Board were reviewed regarding the gender of the doctors and the medical students.

RESULTS

Findings regarding the medical students at the SQU showed higher number of females compared to males (64% females in 2015 compared to 54% in 2009). A similar trend was observed regarding the postgraduates as 61.5% of the graduated residents doctors were females. As for active workforce, the MoH 2015 report revealed that female doctors represent 42% of the total doctors compared to 27% in 1990. It increased 4% from 1990 to 2000, doubled to 8% from 2000 to 2010. The proportion of specialized female doctors reached 31% in 2015 compared to 21% in 1990. There were also gender variations among specialities. The proportion of female general practitioners reached 50% in 2015 compared to 30% in 1990 (4% increase every 5 years).

CONCLUSIONS

The feminization phenomenon in Oman is increasing and requires more attention in order to assess the health system readiness of meeting the needs and accommodating the females as the main care providers. The trend is expected to have important consequences on future planning, given that women doctors differ from men in how they participate in the workforce. It may also potentially contribute to a shortage in supply due to difference in preferences and consequently affect the skill-mix and productivity. The cultural, social context and dimensions need to be explored and feasible options to be provided for better planning.

Health workforce metrics pre- and post-2015: a stimulus to public policy and planning

BACKGROUND

Evidence-based health workforce policies are essential to ensure the provision of high-quality health services and to support the attainment of universal health coverage (UHC). This paper describes the main characteristics of available health workforce data for 74 of the 75 countries identified under the 'Countdown to 2015' initiative as accounting for more than 95% of the world's maternal, newborn and child deaths. It also discusses best practices in the development of health workforce metrics post-2015.

METHODS

Using available health workforce data from the Global Health Workforce Statistics database from the Global Health Observatory, we generated descriptive statistics to explore the current status, recent trends in the number of skilled health professionals (SHPs: physicians, nurses, midwives) per 10 000 population, and future requirements to achieve adequate levels of health care in the 74 countries. A rapid literature review was conducted to obtain an overview of the types of methods and the types of data sources used in human resources for health (HRH) studies.

RESULTS

There are large intercountry and interregional differences in the density of SHPs to progress towards UHC in Countdown countries: a median of 10.2 per 10 000 population with range 1.6 to 142 per 10 000. Substantial efforts have been made in some countries to increase the availability of SHPs as shown by a positive average exponential growth rate (AEGR) in SHPs in 51% of Countdown countries for which there are data. Many of these countries will require large investments to achieve levels of workforce availability commensurate with UHC and the health-related sustainable development goals (SDGs). The availability, quality and comparability of global health workforce metrics remain limited. Most published workforce studies are descriptive, but more sophisticated needs-based workforce planning methods are being developed.

CONCLUSIONS

There is a need for high-quality, comprehensive, interoperable sources of HRH data to support all policies towards UHC and the health-related SDGs. The recent WHO-led initiative of supporting countries in the development of National Health Workforce Accounts is a very promising move towards purposive health workforce metrics post-2015. Such data will allow more countries to apply the latest methods for health workforce planning.

Disaster Preparedness: Need for inclusion in undergraduate nursing education

With the increasing global frequency of disasters, the call for disaster preparedness training needs to be reinforced. Nurses form the largest group of the healthcare workforce and are often on the frontline in disaster management. Therefore, nurses should be adequately equipped with the knowledge and skills to respond to disasters, starting from their pre-service training to their in-service professional training. However, the inclusion of disaster preparedness education in undergraduate nursing curricula is minimal in most countries. The purpose of this article is to highlight the current state of nursing education and training in disaster management, both generally and in Oman. The significance of disaster preparedness training and recommendations for its inclusion in nursing practice and education are also discussed.

A Call for More Diploma Nurses to Attain a Baccalaureate Degree: Advancing the nursing profession in Oman

The healthcare needs of the Omani population are evolving, particularly with regards to changes in disease complexity, advances in technology and the enhanced delivery of healthcare services. Nurses now need to adapt to a fundamental shift in the provision of patient-centred care. In line with lifelong learning goals, registered nurses in Oman at the diploma level should seek to obtain a more advanced qualification, for instance a Bachelor of Science in Nursing, to ensure they possess the requisite skills and knowledge to keep abreast of new developments in healthcare management. Challenges involved in this transition and suggestions to overcome these potential obstacles are discussed in this article in order to inform nursing education stakeholders. Recommendations to ensure the success of bridging programmes are also suggested.

Health Workforce Planning: An overview and suggested approach in Oman

In most countries, the lack of explicit health workforce planning has resulted in imbalances that threaten the capacity of healthcare systems to attain their objectives. This has directed attention towards the prospect of developing healthcare systems that are more responsive to the needs and expectations of the population by providing health planners with a systematic method to effectively manage human resources in this sector. This review analyses various approaches to health workforce planning and presents the Six-Step Methodology to Integrated Workforce Planning which highlights essential elements in workforce planning to ensure the quality of services. The purpose, scope and ownership of the approach is defined. Furthermore, developing an action plan for managing a health workforce is emphasised and a reviewing and monitoring process to guide corrective actions is suggested.

Establishing Policy Foundations and Regulatory Systems to Enhance Nursing Practice in the United Arab Emirates

In 2009, the United Arab Emirates (UAE) established a Nursing and Midwifery Council with a mandate to develop standards for the registration and regulation of nursing and midwifery and to strengthen the nursing and midwifery workforce. Priorities included workforce Emiratization and the development of regulatory standards to support advanced and speciality nursing practice and new models of care-particularly for the management of noncommunicable diseases. This article provides background, context for, and best practice inputs to the effort to provide one unified framework of nursing regulation and licensure across the whole of the UAE. This article is intended for nurse leaders, policy makers, and regulators who are reviewing or developing nursing regulatory processes and advancing nursing workforce capacity building activities; and nurse educators and nurses wishing to work in the UAE.

Attitudes of Students at Sultan Qaboos University towards the Nursing Profession

OBJECTIVES

The aim of this study was to explore the attitudes of Sultan Qaboos University (SQU) students towards the nursing profession.

METHODS

A sample of 377 students (male = 130; female = 247) were selected from different colleges of SQU, including the College of Nursing. A questionnaire was constructed and validated to assess the attitudes of SQU students towards the nursing profession.

RESULTS

Findings revealed that both male and female students in all academic years and colleges had positive attitudes toward the nursing profession. The findings also revealed that gender and academic year created no significant differences (P <0.05) among the study participants, but that the students' college affiliation did have a significant effect on their attitudes. In particular, nursing students had more positive attitudes than students of other colleges.

CONCLUSION

Findings indicated that the attitudes of SQU students towards the nursing profession were positive, especially those of the nursing students. This means that serious efforts should be made to continue to promote the nursing profession and so ensure that it remains positively regarded by all concerned.

Biomedical publications profile and trends in gulf cooperation council countries

OBJECTIVES

There is a dearth of studies examining the relationship between research output and other socio-demographic indicators in the Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). The three interrelated aims of this study were, first, to ascertain the number of biomedical publications in the GCC from 1970 to 2010; second, to establish the rate of publication according population size during the same period and, third, to gauge the relationship between the number of publications and specific socio-economic parameters.

METHODS

The Medline database was searched in October 2010 by affiliation, year and publication type from 1970 to 2010. Data obtained were normalised to the number of publications per million of the population, gross domestic product, and the number of physicians in each country.

RESULTS

The number of articles from the GCC region published over this 40 year period was 25,561. Saudi Arabia had the highest number followed by Kuwait, UAE, and then Oman. Kuwait had the highest profile of publication when normalised to population size, followed by Qatar. Oman is the lowest in this ranking. Overall, the six countries showed a rising trend in publication numbers with Oman having a significant increase from 1990 to 2005. There was a significant relationship between the number of physicians and the number of publications.

CONCLUSION

The research productivity from GGC has experienced complex and fluctuating growth in the past 40 years. Future prospects for increasing research productivity are discussed with particular reference to the situation in Oman.

Factors Affecting the Quality of Diabetic Care in Primary Care Settings in Oman: A qualitative study on patients' perspectives

OBJECTIVES

The quality of services delivered to type 2 diabetic patients in primary health care has an important impact on long-term outcomes. The aim of this study is to explore diabetic patients' views of factors affecting quality of diabetic services delivered in primary care in Oman, a developing country with a high burden of diabetes.

METHODS

Semi-structured face to face interviews were conducted with 19 type 2 diabetic patients recruited from four selected primary healthcare centres (PHCs) in Muscat region, the capital city of Oman. A framework approach was used to analyse the qualitative data.

RESULTS

PARTICIPANTS IDENTIFIED SEVERAL FACTORS WHICH COULD AFFECT THE QUALITY OF DIABETIC SERVICES PROVIDED IN PHCS: delays in the follow-up process; lack of continuity of care; diabetes educational materials unavailable in waiting areas; shortage of Omani nurses able to speak the patients' language; inadequate explanations from the attending primary care physician (PCP); under involvement of dieticians in patient management; delays in provision of laboratory results; inadequate supplies of diabetic medication between appointments, and long waits to see ophthalmologists.

CONCLUSION

Several factors were identified by diabetic patients that may influence the quality of diabetic services provided in the PHC setting in Oman. Health care professionals and decision makers in the Ministry of Health (MOH) and other health care sectors in Oman should consider patients' views and concerns in order to improve the quality of diabetic care services in primary health care.