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Omer M, Machetanz K, Lawson McLean AC, Ahmed M, Fadlalla M, Farzullayev J, Maurer S, Alhamdan AA, Nguyen TL, Beck J, Posti JP. Challenges and aspirations of neurosurgery residents in Germany: Insights from a questionnaire-based survey. Clin Neurol Neurosurg 2024; 245:108477. [PMID: 39098248 DOI: 10.1016/j.clineuro.2024.108477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 07/21/2024] [Accepted: 07/30/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVE Neurosurgery residents in Germany face numerous challenges including receiving comprehensive surgical training with adequate learning opportunities, achieving balanced work life equilibrium, maintaining a positive work environment and navigating career prospects. The objectives of this study are to assess overall satisfaction with the training program, identify factors contributing to dissatisfaction, explore various dimensions of the training program, evaluate the psychological well-being of residents, and ascertain their preferences for future subspecialties. METHODS A questionnaire-based survey was conducted anonymously among neurosurgery residents from various training hospitals, nationwide. The survey utilized a quantitative questionnaire as data collection tool. The data collection took place from June 2021 to January 2023. RESULTS The survey encompassed 120 neurosurgery residents, with a gender distribution of 55 % male and 45 % female. The respondents were primarily from university hospitals (53 %), followed by community hospitals (38 %) and private hospitals (9 %). In terms of training program satisfaction, 37 % reported moderate satisfaction, 39 % indicated below-moderate satisfaction, and 28 % experienced above-moderate satisfaction. The predominant causes of dissatisfaction identified were insufficient surgical exposure (reported by 39 % of respondents), suboptimal educational content (38 %), and inadequate research opportunities (32 %). Additionally, 24 % of respondents highlighted psychological stress, and 36 % reported frequent experiences of burnout. A majority (63 %) indicated a workload of 60-80 h weekly. About half of the residents indicated a future specialization interest in neurosurgical oncology. CONCLUSION The results of the survey findings provide valuable insights into the challenges and aspirations of neurosurgery trainees in Germany. These results serve as a basis for improving the training system, enhancing the working environment, and guiding future planning in this field. To optimize the training of residents, it is important to address issues such as limited surgical and research opportunities and psychological well-being. The expressed interest in subspecializing offers guidance for shaping the training program's future direction.
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Affiliation(s)
- Mazin Omer
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany.
| | - Kathrin Machetanz
- Department of Neurosurgery, Tubingen University Hospital, Tubingen, Germany
| | | | - Mamoun Ahmed
- Department of Neurosurgery, Sana Kliniken Duisburg, Duisburg, Germany
| | - Mohamed Fadlalla
- Department of Neurosurgery, Sanderbuch Hospital, Sanderbuch, Germany
| | - Jeyhun Farzullayev
- Department of Neurosurgery, Gottingen University Hospital, Gottingen, Germany
| | - Stefanie Maurer
- Department of Neurosurgery, St Barbara Klinik, Hamm, Germany
| | - Akram A Alhamdan
- Department of Neurosurgery, Helios-klinik Wiesbaden, Wiesbaden, Germany
| | - Thuy Linh Nguyen
- Department of Neurosurgery, Nordstadt-Hospital Hannover, Hannover, Germany
| | - Jürgen Beck
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | - Jussi P Posti
- Department of Neurosurgery and Turku Brain Injury Center, Turku University Hospital and University of Turku, Turku, Finland
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Schnack H, Uthoff SAK, Ansmann L. The perceived impact of physician shortages on human resource strategies in German hospitals - a resource dependency perspective. J Health Organ Manag 2022; 36:196-211. [PMID: 36098505 DOI: 10.1108/jhom-05-2021-0203] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Like other European countries, Germany is facing regional physician shortages, which have several consequences on patient care. This study analyzes how hospitals perceive physician shortages and which strategies they adopt to address them. As a theoretical framework, the resource dependency theory is chosen. DESIGN/METHODOLOGY/APPROACH The authors conducted 20 semi-structured expert interviews with human resource officers, human resource directors, and executive directors from hospitals in the northwest of Germany. Hospitals of different ownership types, of varying sizes and from rural and urban locations were included in the sample. The interviews were analyzed by using qualitative content analysis. FINDINGS The interviewees reported that human resource departments in hospitals expand their recruiting activities and no longer rely on one single recruiting instrument. In addition, they try to adapt their retaining measures to physicians' needs and offer a broad range of employment benefits (e.g. childcare) to increase attractiveness. The study also reveals that interviewees from small and rural hospitals report more difficulties with attracting new staff and therefore focus on recruiting physicians from abroad. PRACTICAL IMPLICATIONS Since the staffing situation in German hospitals will not change in the short term, the study provides suggestions for hospital managers and health policy decision-makers in dealing with physician shortages. ORIGINALITY/VALUE This study uses the resource dependency theory to explain hospitals' strategies for dealing with healthcare staff shortages for the first time.
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Affiliation(s)
- Helge Schnack
- Division for Organizational Health Services Research, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Sarah Anna Katharina Uthoff
- Division for Organizational Health Services Research, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Lena Ansmann
- Division for Organizational Health Services Research, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Ansmann L, Vennedey V, Hillen HA, Stock S, Kuntz L, Pfaff H, Mannion R, Hower KI, Cologne Research And Development Network CoRe-Net Study Group CRADNCNSG. Resource dependency and strategy in healthcare organizations during a time of scarce resources: evidence from the metropolitan area of cologne. J Health Organ Manag 2021; 35:211-227. [PMID: 34245141 PMCID: PMC9136866 DOI: 10.1108/jhom-12-2020-0478] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Healthcare systems are under pressure to improve their performance, while at the same time facing severe resource constraints, particularly workforce shortages. By applying resource-dependency-theory (RDT), we explore how healthcare organizations in different settings perceive pressure arising from uncertain access to resources and examine organizational strategies they deploy to secure resources. DESIGN/METHODOLOGY/APPROACH A cross-sectional survey of key decision-makers in different healthcare settings in the metropolitan area of Cologne, Germany, on perceptions of pressure arising from the environment and respective strategies was conducted. For comparisons between settings radar charts, Kruskal-Wallis test and Fisher-Yates test were applied. Additionally, correlation analyses were conducted. FINDINGS A sample of n = 237(13%) key informants participated and reported high pressure caused by bureaucracy, time constraints and recruiting qualified staff. Hospitals, inpatient and outpatient nursing care organizations felt most pressurized. As suggested by RDT, organizations in highly pressurized settings deployed the most vociferous strategies to secure resources, particularly in relation to personnel development. ORIGINALITY/VALUE This study is one of the few studies that focuses on the environment's impact on healthcare organizations across a variety of settings. RDT is a helpful theoretical foundation for understanding the environment's impact on organizational strategies. The substantial variations found between healthcare settings indicate that those settings potentially require specific strategies when seeking to address scarce resources and high demands. The results draw attention to the high level of pressure on healthcare organizations which presumably is passed down to managers, healthcare professionals, patients and relatives.
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Affiliation(s)
- Lena Ansmann
- Department of Health Services Research, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany
| | - Vera Vennedey
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne, Cologne, Germany
| | - Hendrik Ansgar Hillen
- Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne, Cologne, Germany
| | - Ludwig Kuntz
- Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany
| | - Holger Pfaff
- Faculty of Human Sciences and Faculty of Medicine, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Kira Isabel Hower
- Faculty of Human Sciences and Faculty of Medicine, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
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Aghdassi SJS, Hansen S, Bischoff P, Behnke M, Gastmeier P. A national survey on the implementation of key infection prevention and control structures in German hospitals: results from 736 hospitals conducting the WHO Infection Prevention and Control Assessment Framework (IPCAF). Antimicrob Resist Infect Control 2019; 8:73. [PMID: 31080588 PMCID: PMC6505265 DOI: 10.1186/s13756-019-0532-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/30/2019] [Indexed: 12/18/2022] Open
Abstract
Background Healthcare-associated infections (HAI) pose a burden on healthcare providers worldwide. To prevent HAI and strengthen infection prevention and control (IPC) structures, the WHO has developed a variety of tools and guidelines. Recently, the WHO released the Infection Prevention and Control Assessment Framework (IPCAF), a questionnaire-like tool designed for assessing IPC structures at the facility level. The IPCAF reflects the eight WHO core components of IPC. Data on the implementation of IPC measures in German hospitals are scarce. Therefore, it was our objective to utilize the IPCAF in order to gather information on the current state of IPC implementation in German hospitals, as well as to promote the IPCAF to a broad audience. Methods The National Reference Center for Surveillance of Nosocomial Infections (NRZ) sent a translated version of the IPCAF to 1472 acute care hospitals in Germany. Data entry and transfer to the NRZ was done electronically between October and December 2018. The IPCAF was conceived in a way that depending on the selected answers a score was calculated, with 0 being the lowest possible and 800 the highest possible score. Depending on the overall score, the IPCAF allocated hospitals to four different “IPC levels”: inadequate, basic, intermediate, and advanced. Results A total of 736 hospitals provided a complete dataset and were included in the data analysis. The overall median score of all hospitals was 690, which corresponded to an advanced level of IPC. Only three hospitals (0.4%) fell into the category “basic”, with 111 hospitals (15.1%) being “intermediate” and 622 hospitals (84.5%) being “advanced”. In no case was the category “inadequate” allocated. More profound differences were found between the respective core components. Components on multimodal strategies and workload, staffing, ward design and bed occupancy revealed the lowest scores. Conclusions IPC key aspects in general are well established in Germany. Potentials for improvement were identified particularly with regard to workload and staffing. Insufficient implementation of multimodal strategies was found to be another relevant deficit. Our survey represents a successful attempt at promoting the IPCAF and encouraging hospitals to utilize WHO tools for self-assessment. Electronic supplementary material The online version of this article (10.1186/s13756-019-0532-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Seven Johannes Sam Aghdassi
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
| | - Sonja Hansen
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
| | - Peter Bischoff
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
| | - Michael Behnke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
| | - Petra Gastmeier
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
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Wendsche J, Hacker W, Wegge J. Understaffing and registered nurses’ turnover: The moderating role of regular rest breaks. GERMAN JOURNAL OF HUMAN RESOURCE MANAGEMENT-ZEITSCHRIFT FUR PERSONALFORSCHUNG 2017. [DOI: 10.1177/2397002216683880] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Current demographic and occupational changes call for new interventions to promote staff retention, especially in nursing where understaffing promotes turnover by increasing workload and strain. Based on previous research examining recovery at work, we investigated whether well-designed rest breaks can function as a resource that buffers adverse consequences of understaffing in nursing. We used a cross-sectional, multi-method study design and assessed understaffing of registered nurses, their regularity of rest breaks, and their annual turnover behaviour in 80 German geriatric nursing teams. As expected, understaffing positively predicted turnover only in work conditions with irregular rest breaks. Hence, implementing regularly scheduled rest breaks can be considered as an effective intervention for improving retention of nurses even in a situation of understaffing.
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Kuhlmann E, Lauxen O, Larsen C. Regional health workforce monitoring as governance innovation: a German model to coordinate sectoral demand, skill mix and mobility. HUMAN RESOURCES FOR HEALTH 2016; 14:71. [PMID: 27894307 PMCID: PMC5127055 DOI: 10.1186/s12960-016-0170-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 11/22/2016] [Indexed: 05/07/2023]
Abstract
BACKGROUND As health workforce policy is gaining momentum, data sources and monitoring systems have significantly improved in the European Union and internationally. Yet data remain poorly connected to policy-making and implementation and often do not adequately support integrated approaches. This brings the importance of governance and the need for innovation into play. CASE The present case study introduces a regional health workforce monitor in the German Federal State of Rhineland-Palatinate and seeks to explore the capacity of monitoring to innovate health workforce governance. The monitor applies an approach from the European Network on Regional Labour Market Monitoring to the health workforce. The novel aspect of this model is an integrated, procedural approach that promotes a 'learning system' of governance based on three interconnected pillars: mixed methods and bottom-up data collection, strong stakeholder involvement with complex communication tools and shared decision- and policy-making. Selected empirical examples illustrate the approach and the tools focusing on two aspects: the connection between sectoral, occupational and mobility data to analyse skill/qualification mixes and the supply-demand matches and the connection between monitoring and stakeholder-driven policy. CONCLUSION Regional health workforce monitoring can promote effective governance in high-income countries like Germany with overall high density of health workers but maldistribution of staff and skills. The regional stakeholder networks are cost-effective and easily accessible and might therefore be appealing also to low- and middle-income countries.
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Affiliation(s)
- E. Kuhlmann
- Institute for Economics, Labour and Culture, Goethe University Frankfurt, Frankfurt, Germany
- Medical Management Centre, LIME, Karolinska Institutet, Stockholm, Sweden
| | - O. Lauxen
- Institute for Economics, Labour and Culture, Goethe University Frankfurt, Frankfurt, Germany
| | - C. Larsen
- Institute for Economics, Labour and Culture, Goethe University Frankfurt, Frankfurt, Germany
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