The effect of human resource management on performance in hospitals in Sub-Saharan Africa: a systematic literature review

Improving Hospital Efficiency and Cost Management: A Systematic Review and Meta-Analysis

Internationally, improving hospital efficiency and reducing costs in the healthcare sector is a goal that requires major effort and successful collaboration. Most hospitals have a dedicated department responsible for quality control, and this is where many of the challenges to efficiency and cost reductions arise. The purpose of this study is to review the literature on the successful improvement of hospital efficiency and cost reduction with no negative impact on the quality of patient care. For this study, we conducted a systematic review and meta-analysis. We screened the available data from 2014 to 2024 in various respected databases, including the Cumulated Index to Nursing and Allied Health Literature (CINAHL) (via EBSCO), the Cochrane Library (via Wiley), PubMed, Google Scholar, and Scopus. The selected articles (n = 7) met the criteria set by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, ensuring their quality and relevance. The study designs that were included are randomized clinical trials, systematic literature reviews, and prospective and retrospective cohort studies. The selected studies represent a wide range of programs and approaches that were adopted to address the issue of hospital efficiency and cost reduction, for example, the Plan-Do-Study-Act problem-solving model and a telemedicine program. These approaches achieved a 25%-50% reduction in costs, allowing for the reallocation of resources and, ultimately, an improvement in the quality of care (QoC). Regarding hospital efficiency, hospitals were encouraged to explore systems to support patient care that did not simply involve new equipment and would help reduce the supply shortage.  The findings of our study provide valuable insights that can act as a foundation for policymakers tasked with improving hospital efficiency and cost-effectiveness. On the one hand, this findings emphasize the importance of focusing on the provision of quality service, encouraging collaboration, and creating tailored solutions. On the other hand, this focus will help hospitals achieve systems that ensure efficiency, promote sustainable outcomes, and improve cost management in healthcare.

Human resources for health: a framework synthesis to put health workers at the centre of healthcare

BACKGROUND

Human resources are a key determinant for the quality of healthcare and health outcomes. Several human resource management approaches or practices have been proposed and implemented to better understand and address health workers' challenges with mixed results particularly in low- and middle-income countries (LMICs). The aim of this framework synthesis was to review the human resources frameworks commonly available to address human resources for health issues in LMIC.

METHODS

We searched studies in Medline, Embase, CAB Global Health, CINAHL (EBSCO) and WHO global Index Medicus up to 2021. We included studies that provided frameworks to tackle human resources for health issues, especially for LMICs. We synthesised the findings using a framework and thematic synthesis methods.

RESULTS

The search identified 8574 studies, out of which 17 were included in our analysis. The common elements of different frameworks are (in descending order of frequency): (1) functional roles of health workers; (2) health workforce performance outcomes; (3) human resource management practises and levers; (4) health system outcomes; (5) contextual/cross-cutting issues; (6) population health outcomes and (7) the humanness of health workers. All frameworks directly or indirectly considered themes around the functional roles of health workers and on the outcomes of health workforce activities, while themes concerning the humanness of health workers were least represented. We propose a synthesised Human-Centred Health Workforce Framework.

CONCLUSIONS

Several frameworks exist providing different recurring thematic areas for addressing human resources for health issues in LMIC. Frameworks have predominantly functional or instrumental dimensions and much less consideration of the humanness of health workers. The paradigms used in policy making, development and funding may compromise the effectiveness of strategies to address human resources challenges in LMIC. We propose a comprehensive human resources for health framework to address these pitfalls.

Measuring Equity of Geographical Distribution of Specialist Physicians in Iran's Health System

Background

Equitable distribution of health care sector resources is one of the most important goals of health systems in all countries. The purpose of this study is to measure equity of geographical distribution of active specialist physicians in Iran's health system.

Methods

The present study was a descriptive-cross-sectional. The statistical population included: all active specialist physicians working in the public, private, social insurance organization, military, charity, and the other health service providers in Iran in 2019. Studied demographic data were collected from Iran's national statistic center. Also, information of specialist physicians was obtained from several databases. Finally, duplicated records were removed, and the number of specialist physicians extracted. Data analysis was performed using Stata V.16 and ArcGIS 10.4 software.

Results

The results showed that the number of specialist physicians per 100,000 population who worked in Iran's health system was 46.81. The provinces of Tehran had the highest and Sistan and Baluchestan had the lowest number of specialist physicians. Also, 52.63% of active specialist physicians provide health services in four provinces, whereas these provinces are 37.13% of the country's population. Total Gini coefficient of the distribution of active physicians in Iran in 2019 was 0.23.

Conclusions

Distribution of specialist physician was different but somewhat equitable in the provinces. However, in some provinces, the ratio of specialist physicians to the population was still low. Therefore, when the number of specialist physicians increased, their distribution should be considered concurrently.

Identifying strategic human resource management ability in the clinical departments of public hospitals in China: a modified Delphi study

OBJECTIVES

Chinese public hospitals are managed like a bureaucracy, which is divided into two levels of hospital and departmental management. Improving strategic human resource management ability (SHRMA) within clinical departments can improve department performance and service quality, which is an important way for public hospitals to obtain an advantage in a diversified competitive medical market. However, there is a lack of specialised evaluation tools for SHRMA in clinical departments to support this effort. Therefore, this study aims to develop an index for evaluating the SHRMA of clinical departments in public hospitals.

STUDY DESIGN AND SETTING

The Delphi technique was carried out with 22 experts, and an evaluation index of the SHRMA in the clinical departments of public hospitals was constructed. The weight of each indicator was calculated by the intuitive fuzzy analytic hierarchy process.

RESULTS

The SHRMA index constructed in this study for the clinical departments in public hospitals includes 5 first-level indicators, 13 second-level indicators and 36 third-level indicators. The first-level indicators are distributed in weight among human resource maintenance (0.204), human resource planning (0.201), human resource development (0.200), human resource stimulation (0.198) and human resource absorption (0.198). The top three weighted indicators on the second level are job analysis and position evaluation (0.105), career management (0.103) and salary incentivisation (0.100).

CONCLUSIONS

The index constructed in this study is scientific and feasible and is expected to provide an effective tool for the quantitative evaluation of SHRMA in the clinical departments of public hospitals in China.

TRANSLATION, ADAPTATION, AND VALIDATION OF AN ARABIC VERSION OF HUMAN RESOURCE PRACTICES SCALE AMONG NURSES

Background and Purpose: Nursing human resource practices (HRP) have a unique role in healthcare organizations. Nevertheless, there is no valid and reliable Arabic tool measuring nursing HRP has been published. The present study aimed to translate, culturally adapt and validate the HRP scale into the Arabic language among nurses. Methods: A methodological study was applied in a sample of 328 nurses from 16 hospitals in Port-Said, Egypt. Results: The scale had good content and concurrent validity. Confirmatory factor analysis showed a better fit for the second-order. Cronbach's alpha was 0.95, and the intra-class correlation coefficient was 0.91 for the total scale showed good reliability. Conclusion: The scale application is recommended in clinical and research settings to assess HRP among Arabic nurses.

Nursing Workforce Retention in Rural Ghana: The Predictive Role of Satisfaction, Rural Fit, and Resilience

Introduction. High turnover of nurses in rural healthcare settings contributes to challenges in healthcare delivery. Various incentive packages have been introduced in rural healthcare settings to curb this phenomenon, but the canker still exists. The study aimed at assessing the predictive role of job satisfaction, rural fit, and resilience on nurses’ retention in rural Ghana. Materials and Methods. A multicentre cross-sectional design was adopted to collect data from 462 nurses. Analysis through descriptive statistics, one-way ANOVA, Pearson moment product correlation, and multiple regression was done. Results. There was low resilience and rural fit among nurses with higher turnover intention, which was predicted by average daily attendance (β = 0.108), rural fit (β = −0.144), resilience (β = −0.350), satisfaction with prospects (β = −0.187), and satisfaction with prospect and pay (β = −0.171) at the significance of 0.05. Conclusion. Policymakers can be assured that not just improving financial incentives to nurses, but the integration of nurses to rural settings, commensurate workload and improving pay and prospects for professional growth and resilience are needed for rural retention. Implications for nursing management, nurse managers, and policymakers have a role to develop sustainable strategies to integrate rural fit, resilience, and job satisfaction to help reduce turnover among nurses.

Patient safety and staff psychological safety: A mixed methods study on aspects of teamwork in the operating room

Objectives

To predict the amount of teamwork that takes place throughout a surgery, based on performing a preoperative safety standards (surgical safety checklist and surgical count) and to explore factors affecting patient safety and staff psychological safety during a surgery, based on interprofessional teamwork.

Methods

This mixed methods study included quantitative and qualitative analyses. Quantitative data included 2,184 direct observations of surgical cases with regard to the performance of safety standards during surgeries in 29 hospitals, analyzed using multivariate binary logistic regressions. Qualitative data were obtained from an analysis of 25 semi-structured interviews with operating room (OR) clinicians and risk managers, using an inductive thematic analysis approach.

Results

Analysis of the OR observations revealed that a lack of teamwork in the preoperative "sign-in" phase doubled the chances of there being a lack of teamwork during surgery [odds ratio = 1.972, 95% confidence interval (CI) 1.741, 2.233, p < 0.001] and during the "time-out" phase (odds ratio = 2.142, 95% CI 1.879, 2.441, p < 0.001). Consistent presence of staff during surgery significantly increased teamwork, by 21% for physicians and 24% for nurses (p < 0.05), but staff turnover significantly decreased teamwork, by 73% for physicians (p < 0.05). Interview data indicated that patient safety and staff psychological safety are related to a perception of a collaborative team role among OR staff, with mutual commitment and effective interprofessional communication.

Conclusions

Healthcare organizations should consider the key finding of this study when trying to identify factors that affect teamwork during a surgery. Effective preoperative teamwork positively affects intraoperative teamwork, as does the presence of more clinicians participating in a surgery, with no turnover. Other factors include working in a fixed, designated team, led by a surgeon, which functions with effective interprofessional communication that promotes patient safety and staff psychological safety.

Nurses' perceptions of quality of work life in private hospitals in Enugu, Nigeria: A qualitative study

Despite being essential for retaining nurses, not much is known about nurses' quality of work life (QWL) in private hospitals in sub-Saharan Africa, including Nigeria. We explored nurses' perceptions of QWL, factors influencing it, how it affects motivation, and strategies for its improvement. The study was conducted in seven private hospitals in Enugu, Nigeria. The design was qualitative, using focus group discussion (n = 7) with registered nurses (n = 66) purposively selected using maximum variation sampling and the inclusion criteria. Data were analyzed using verbatim transcription and thematic analysis. The nurses understood QWL from work-family life, work design, work context and work world perspectives. Opportunities for skill acquisition, resource availability, helpfulness from colleagues, and a hygienic work environment improved the QWL and motivation of nurses. Work-family life factors including caring obligations, night shifts, long hours, burnout, and inappropriate leave policies; work design factors including declining autonomy, inadequate staffing, and a high workload; work context factors consisting of a lack of participatory decision-making, blaming nurses for gaps, restrictive training policy, limited training opportunity, and insecurity; and work world factors related to poor remuneration, poor community view of nursing and ease of job termination undermined QWL and demotivated nurses. Strategies identified by the nurses to improve QWL included improving staffing, vacation, care coordination, supportive supervision, teamwork, promotion, participatory decision-making, training opportunities, timely hand-over of shifts, job recognition, and compensation. The quality of nursing work life in private hospitals in Enugu needs improvement. Quality improvement programs addressing the barriers to nurses' QWL are warranted.

Building leadership and managerial capacity for maternal and newborn health services

Background

Strengthening leadership and management is important for building an effective and efficient health system. This paper presents the findings from a L&M capacity building initiative which was implemented as part of a larger study aimed at improving maternal and newborn outcomes within primary health facilities in the Morogoro, Tanzania.

Methods

The initiative, involving 30 stakeholders from 20 primary health facilities, 4 council health management teams and the regional health management team in the Morogoro region, provided leadership and managerial training through two 5-day in-person workshops, onsite mentoring, and e-learning modules. The initiative was evaluated using a pre-post design. Quantitative instruments included the ‘Big Results Now’ star-rating assessments and a team-developed survey for health providers/managers. The ‘Big Results Now’ star-rating assessments, conducted in 2018 (19 facilities) and 2021 (20 facilities), measured overall facility leadership and management capability, with comparisons of star-ratings from the two time-points providing indication of improvement. The survey was used to measure 3 key leadership indicators - team climate, role clarity/conflict and job satisfaction. The survey was completed by 97 respondents at baseline and 100 at follow up. Paired t-tests were used to examine mean score differences for each indicator. Triangulated findings from focus groups with 99 health providers and health management team members provided support and context for quantitative findings.

Results

Star-ratings increased in 15 (79%) of 19 facilities, with the number of facilities achieving the target of 3 plus stars increasing from 2 (10%) in 2018 to 10 (50%) in 2021, indicating improved organizational performance. From the survey, team climate, job satisfaction and role clarity improved across the facilities over the 3 project years. Focus group discussions related this improvement to the leadership and managerial capacity-building.

Conclusion

Improved leadership and managerial capacity in the participating health facilities and enhanced communication between the health facility, council and regional health management teams created a more supportive workplace environment, leading to enhanced teamwork, job satisfaction, productivity, and improved services for mothers and newborns. Leadership and managerial training at all levels is important for ensuring efficient and effective health service provision.

Human resource management in Ethiopian public hospitals

Background

In Ethiopia, public hospitals deal with a persistent human resource crisis, even by Sub-Saharan Africa (SSA) standards. Policy and hospital reforms, however, have thus far resulted in limited progress towards addressing the strategic human resource management (SHRM) challenges Ethiopia’s public hospitals face.

Methods

To explore the contextual factors influencing these SHRM challenges of Ethiopian public hospitals, we conducted a qualitative study based on the Contextual SHRM framework of Paauwe. A total of 19 structured interviews were conducted with Chief Executive Officers (CEOs) and HR managers from a purposive sample of 15 hospitals across Ethiopia. An additional four focus groups were held with professionals and managers.

Results

The study found that hospitals compete on the supply side for scarce resources, including skilled professionals. There was little reporting on demand-side competition for health services provided, service quality, and service innovation. Governmental regulations were the main institutional mechanism in place. These regulations also emphasized human resources and were perceived to tightly regulate employee numbers, salaries, and employment arrangements at detailed levels. These regulations were perceived to restrict the autonomy of hospitals regarding SHRM. Regulation-induced differences in allowances and external employment arrangements were among the concerns that decreased motivation and job satisfaction and caused employees to leave. The mismatch between regulation and workforce demands posed challenges for leadership and caused leaders to be perceived as incompetent and unable when they could not successfully address workforce needs.

Conclusions

Bottom-up involvement in SHRM may help resolve the aforementioned persistent problems. The Ethiopian government might better loosen regulations and provide more autonomy to hospitals to develop SHRM and implement mechanisms that emphasize the quality of the health services demanded rather than the quantity of human resources supplied.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08046-7.

Authorship representation in global emergency medicine: a bibliometric analysis from 2016 to 2020

INTRODUCTION

High-income country (HIC) authors are disproportionately represented in authorship bylines compared with those affiliated with low and middle-income countries (LMICs) in global health research. An assessment of authorship representation in the global emergency medicine (GEM) literature is lacking but may inform equitable academic collaborations in this relatively new field.

METHODS

We conducted a bibliometric analysis of original research articles reporting studies conducted in LMICs from the annual GEM Literature Review from 2016 to 2020. Data extracted included study topic, journal, study country(s) and region, country income classification, author order, country(s) of authors' affiliations and funding sources. We compared the proportion of authors affiliated with each income bracket using Χ2 analysis. We conducted logistic regression to identify factors associated with first or last authorship affiliated with the study country.

RESULTS

There were 14 113 authors in 1751 articles. Nearly half (45.5%) of the articles reported work conducted in lower middle-income countries (MICs), 23.6% in upper MICs, 22.5% in low-income countries (LICs). Authors affiliated with HICs were most represented (40.7%); 26.4% were affiliated with lower MICs, 17.4% with upper MICs, 10.3% with LICs and 5.1% with mixed affiliations. Among single-country studies, those without any local authors (8.7%) were most common among those conducted in LICs (14.4%). Only 31.0% of first authors and 21.3% of last authors were affiliated with LIC study countries. Studies in upper MICs (adjusted OR (aOR) 3.6, 95% CI 2.46 to 5.26) and those funded by the study country (aOR 2.94, 95% CI 2.05 to 4.20) had greater odds of having a local first author.

CONCLUSIONS

There were significant disparities in authorship representation. Authors affiliated with HICs more commonly occupied the most prominent authorship positions. Recognising and addressing power imbalances in international, collaborative emergency medicine (EM) research is warranted. Innovative methods are needed to increase funding opportunities and other support for EM researchers in LMICs, particularly in LICs.

The impact of management practices on relative patient mortality: Evidence from public hospitals

A small, but growing, body of empirical evidence shows that the material and persistent variation in many aspects of the performance of healthcare organisations can be related to variation in their management practices. This study uses public data on hospital patient mortality outcomes, the Summary Hospital-level Mortality Indicator (SHMI) to extend this programme of research. We assemble a five-year dataset combining SHMI with potential confounding variables for all English NHS non-specialist acute hospital trusts. The large number of providers working within a common system provides a powerful environment for such investigations. We find considerable variation in SHMI between trusts and a high degree of persistence of high- or low performance. This variation is associated with a composite metric for management practices based on the NHS National Staff Survey. We then use a machine learning technique to suggest potential clusters of individual management practices related to patient mortality performance and test some of these using traditional multivariate regression. The results support the hypothesis that such clusters do matter for patient mortality, and so we conclude that any systematic effort at improving patient mortality should consider adopting an optimal cluster of management practices.

Therapeutic Drug Monitoring of Anti-infective Drugs: Implementation Strategies for 3 Different Scenarios

BACKGROUND

Therapeutic drug monitoring (TDM) supports personalized treatment. For successful implementation, TDM must have a turnaround time suited to the clinical needs of patients and their health care settings. Here, the authors share their views of how a TDM strategy can be tailored to specific settings and patient groups.

METHODS

The authors selected distinct scenarios for TDM: high-risk, complex, and/or critically ill patient population; outpatients; and settings with limited laboratory resources. In addition to the TDM scenario approach, they explored potential issues with the legal framework governing dose escalation.

RESULTS

The most important issues identified in the different scenarios are that critically ill patients require rapid turnaround time, outpatients require an easy sampling procedure for the sample matrix and sample collection times, settings with limited laboratory resources necessitate setting-specific analytic techniques, and all scenarios warrant a legal framework to capture the use of escalated dosages, ideally with the use of trackable dosing software.

CONCLUSIONS

To benefit patients, TDM strategies need to be tailored to the intended population. Strategies can be adapted for rapid turnaround time for critically ill patients, convenient sampling for outpatients, and feasibility for those in settings with limited laboratory resources.

Advances in training of the specialized human resources for health in Tanzania: the case of Muhimbili University of Health and Allied Sciences

BACKGROUND

Increasing the number of specialized human resources for health is paramount to attainment of the United Nations sustainable development goals. Higher learning institutions in low-and middle-income countries must address this necessity. Here, we describe the 5-years trends in accreditation of the clinical and non-clinical postgraduate (PG) programmes, student admission and graduation at the Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania, highlighting successes, challenges and opportunities for improvement.

METHODS

This was a retrospective longitudinal study describing trends in PG training at MUHAS between 2015 and 2016 and 2019-2020. Major interventions in the reporting period included university-wide short course training programme to faculty on curricula development and initiation of online application system. Data were collected through a review of secondary data from various university records and was analyzed descriptively. Primary outcomes were the number of accredited PG programmes, number of PG applicants as well as proportions of applicants selected, applicants registered (enrolled) and students graduated, with a focus on gender and internationalization (students who are not from Tanzania).

RESULTS

The number of PG programmes increased from 60 in 2015-2016 to 77 in 2019-2020, including programmes in rare fields such as cardiothoracic surgery, cardiothoracic anesthesia and critical care. The number of PG applications, selected applicants, registered applicants and PG students graduating at the university over the past five academic years had steadily increased by 79, 81, 50 and 79%, respectively. The average proportions of PG students who applied, were selected and registered as well as graduated at the university over the past five years by gender and internationalization has remained stably at 60% vs. 40% (male vs. female) and 90% vs. 10% (Tanzanian vs. international), respectively. In total, the university graduated 1348 specialized healthcare workers in the five years period, including 45 super-specialists in critical fields, through a steady increase from 200 graduates in 2015-2016 to 357 graduates in 2019-2020. Major challenges encountered include inadequate sponsorship, limited number of academic staff and limited physical infrastructure for teaching.

CONCLUSION

Despite challenges encountered, MUHAS has made significant advances over the past five years in training of specialized and super-specialized healthcare workforce by increasing the number of programmes, enrollment and graduates whilst maintaining a narrow gender gap and international relevance. MUHAS will continue to be the pillar in training of the specialized human resources for health and is thus poised to contribute to timely attainment of the health-related United Nations sustainable development goals in Tanzania and beyond, particularly within the Sub-Saharan Africa region.

Technological Innovation, Sustainable Green Practices and SMEs Sustainable Performance in Times of Crisis (COVID-19 pandemic)

COVID-19 restrictions significantly affected SMEs, which have faced many challenges to their sustainability within this fragile new environment. This study proposes a holistic framework of sustainable performance by interrelating factors showing robust associations to produce this effect' for achieving sustainable performance in SMEs, through integrating the Technology Organisation Environment (TOE) and Resource Based View (RBV) models, to test how sustainable green practices can process the TOE factors when affecting sustainable performance. The research focuses on SMEs with worldwide employees and involves data collected from a range of different employees belonging to four different managerial levels. The process incorporated the analysis of 669 questionnaires to test the proposed hypotheses using structural equation modeling. Findings suggest that, together, TOE factors represent crucial inputs for green practices such as green training, green performance appraisal, that, in turn, mean critical processes lead to sustainable performance (output). Additionally, the findings should also inspire SMEs to focus even more effort on internal technological and organisational factors and to encourage an eco-friendly culture that would demand stakeholders adopt a more positive environmental stance.

Health-care determinants of mortality and recovered cases from COVID-19: Do heath systems respond COVID-19 similarly?

BACKGROUND

The COVID-19 pandemic has spread rapidly across the world and has currently impacted most countries and territories globally. This study aimed to identify health-care determinants of mortality and recovery rates of COVID-19 and compare the efficiency of health systems in response to this pandemic.

MATERIALS AND METHODS

A cross-sectional study was conducted using data obtained from the World Bank database, that provides free and open access to a comprehensive set of health- and socioeconomic-related data, by September 12, 2020. An adjusted linear regression model was applied to determine predictors of mortality (per 1 million population [MP]) and recovery rates (per 1 MP) in the included countries. One-way analysis of variance was applied to assess health systems' efficiency in response to COVID-19 pandemic using mortality and recovery rate (output variables) and current health expenditure (CHE) per capita (input variable).

RESULTS

Globally, San Marino and Qatar had the highest mortality rate (1237/1 MP) and confirmed case rate (43,280/1 MP) until September 12, 2020, respectively. Iran had a higher mortality rate (273/1 MP vs. 214.5/1 MP) and lower recovery rate (4091.5/1 MP vs. 6477.2/1 MP) compared to countries with high CHE per capita. CHE per capita (standardized coefficient [SC] = 0.605, P < 0.001) and population aged 65 years and over as a percentage of total population (SC = -0.79, P < 0.001) significantly predicted recovered cases from COVID-19 in the included countries.

CONCLUSION

This study revealed that countries with higher CHE per capita and higher proportion of older adults were more likely to have a higher recovery rate than those with lower ones. Furthermore, our study indicated that health systems with higher CHE per capita statistically had a greater efficiency in response to COVID-19 compared to those with lower CHE per capita. More attention to preventive strategies, early detection, and early intervention is suggested to improve the health system efficiency in controlling COVID-19 and its related mortalities worldwide.

Personal médico como factores asociados a la eficiencia hospitalaria en Chile

Objetivo El Análisis Envolvente de Datos se ha convertido en una herramienta de gran ayuda para analizar la eficiencia en el uso de los recursos hospitalarios. El objetivo de este trabajo fue determinar la eficiencia técnica para un conjunto de hospitales de la Red del Sistema Nacional de Salud de Chile para el período 2007-2016. Método La metodología utilizada en el estudio es el análisis envolvente de datos DEA-CCR, conocido como rendimientos constantes a escala, y DEA-BCC, conocido como rendimientos variables a escala (orientación inputs). Como variables de entrada se utilizaron la cantidad de personal médico, dentistas, nutricionistas, enfermeras, kinesiólogos, matronas, técnicos, médicos y número de camas por millón de habitantes. Comovariables de salida se utilizaron los egresos hospitalarios. Resultados Del análisis de eficiencia se encontró que los hospitales que resultaron ser técnicamente eficientes en todo el período fueron de las regiones de Antofagasta (100%), Metropolitana (100%) y ÓHiggins (100%). En concreto, se puede constatar que, en su conjunto, y bajo el primero de los supuestos, los hospitales de las distintas regiones del país deberían reducir sus inputs en un 11,3% para situarse en la frontera eficiente. Si se considera el supuesto de rendimientos variables a escala, los hospitales deberían reducir sus inputs en un 5,2% para situarse en la frontera eficiente. Conclusiones Esta investigación podría contribuir a la mejora del quehacer hospitalario y a la toma de decisiones de las autoridades sanitarias en el uso de sus recursos.

Strategy and Human Resources Management in Non-Profit Organizations: Its Interaction with Open Innovation

The socioeconomic changes that many countries have been experiencing in recent decades, caused by structural factors or by specific circumstances, where the pandemic crisis of COVID-19 is only the most recent example, have posed challenges to organizations, which present themselves more and more and in various forms as threatened by the possibility of fulfilling their mission. Public and private sectors increasingly present themselves as insufficient to respond effectively to day-to-day requests. This context of instability and the resulting impacts for non-profit organizations pose serious problems to the way in which governance is exercised and served as a motivation for carrying out a study that aimed to understand the influence of strategy and human resources on the governance of these organizations. A review of the literature on the variables under study made it possible to identify the sub-dimensions associated with each one of them and the respective indicators. Thus, for a quantitative study, it was possible to apply a questionnaire to 242 Holy Houses of Mercy in Portugal to understand the direct and indirect influences of strategic management and human resources management on the governance of these institutions. The results obtained show the existence of a positive relationship between the variables under analysis, confirming that not only do these variables influence, by themselves and directly, the governance of the institutions studied, but also the strategy influences human resources policies, which in turn have implications for the way the Holy Houses of Mercy deal with aspects associated with governance. It is concluded that, in general, for these organizations to be more effective in efforts to improve their governance processes, they must focus on strategic management and human resources management instruments.

Dental caries experience and associated factors in adults: a cross-sectional community survey within Ethiopia

Background

Ethiopia is a developing sub-Saharan African country with increasing prevalence of non-communicable diseases (NCDs), including oral conditions. Oral health and dental care have been given little consideration, and there is limited information relating to population oral health and use of dental services in the country. The aim of this study was to examine the burden and associated factors of dental caries experience and investigate access to dental care amongst adults within Ethiopia.

Methods

This community-based oral health survey is a baseline study for the ASSET - Health System Strengthening in sub-Saharan Africa project undertaken in the Butajira area, south-central Ethiopia. A stratified random sample of households and individuals participated in the study. The survey instruments were mainly based on the WHO Oral Health Survey Methods manual (5^th ed.). Face-to-face interviews and clinical dental examinations were conducted. The data were analysed for descriptive statistics; and Poisson regression models were built to assess the association of dental caries and predictor variables in adults (≥18 years).

Results

Most of the study population (n = 626) were female (63.9%), married (71.4%) and Muslim (76.0%). Just over half (53.2%) lived in rural areas and many (44.4%) had no formal education. A majority (74.0%) reported never utilising dental care services, and the main reason was never experiencing any dental problem (71.3%). Sixty percent (n = 377) of the adults had experienced dental caries, 88.0% (n = 332) of whom had untreated carious teeth. Pain or discomfort was reported by 16.5, and 7.2% had one or more PUFA component. Most (59.9%) adults with dental caries experience reported tooth pain or discomfort during the last year. In the fully adjusted Poisson regression model, increasing age, dental care utilisation and Khat chewing had positive significant associations with dental caries experience, whilst education status was negatively associated (p < 0.05).

Conclusion

This study demonstrated a high burden of dental caries and considerable consequences resulting from untreated disease in this population of adults. There was evidence of social inequity, limited utilisation of dental care and oral health awareness. This highlights the need for oral health system strengthening focusing on health promotion and expanding overall access to care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10199-9.

Human Resource Management and Innovative Performance in Non-profit Hospitals: The Mediating Effect of Organizational Culture

Literature suggests that human resources of non-profit hospitals (NPHs) present features that could potentially reach any expected organizational performance even when the attention to human resource management (HRM) are often low in non-profit organizations. Nowadays ambitious organizations strive to obtain a profitable performance that is also innovate and do it through building an organizational culture (OC), while for NPHs a positive culture is given by their human resources traits. However, there is not enough literature to understand how these three variables behave together. This study aims to explain the influence of HRM on IP mediated by OC. The research model was assessed through Partial Least Squares Structural Equation Modeling (PLS-SEM). The results support all the stated hypotheses. Both, HRM and OC are moderately strong predictors of IP, and OC mediates partially and in a complementary way the relationship between HRM on IP. An importance-performance map analysis (IPMA) was performed to expand the PLS-SEM results. The OC indicators show greater importance to explain IP, consequently, they are the most relevant indicators to initiate management actions by NPHs. The influence of HRM on IP represent an opportunity for NPH as it implies an affordable investment in comparison to the cost of technological solutions for enterprises.

Perceptions and predictors of organizational justice among healthcare professionals in academic hospitals in South-Eastern Nigeria

Background

Research on organizational justice in hospitals in African countries are limited despite being important for workforce performance and hospital operational efficiency. This paper investigated perceptions and predictors of organizational justice among health professionals in academic hospitals in South-east Nigeria.

Methods

The study was conducted in two teaching hospitals in Enugu State, South-east Nigeria using mixed-methods design. Randomly sampled 360 health professionals (doctors = 105, nurses = 200 and allied health professionals, AHPs = 55) completed an organizational justice scale. Additionally, semi-structured, in-depth interview with purposively selected 18 health professionals were conducted. Univariate and bivariate statistics and multivariable linear regression were used to analyze quantitative data. Statistical significance was set at alpha 0.05 level. Qualitative data were analyzed thematically using NVivo 11 software.

Results

The findings revealed moderate to high perception of different dimensions of organizational justice. Doctors showed the highest perception, whereas AHPs had the least perception. Among doctors, age and education predicted distributive justice (adjusted R² = 22%); hospital ownership and education predicted procedural justice (adjusted R² = 17%); and hospital ownership predicted interactional justice (adjusted R² = 42%). Among nurses, age, gender and marital status predicted distributive justice (adjusted R² = 41%); hospital ownership, age and gender predicted procedural justice (adjusted R² = 28%); and hospital ownership, age, marital status and tenure predicted interactional justice (R² = 35%). Among AHPs, marital status predicted distributive justice (adjusted R² = 5%), while hospital ownership and tenure predicted interactional justice (adjusted R² = 15%). Qualitative findings indicate that nurses and AHPs perceive as unfair, differences in pay, access to hospital resources, training, work schedule, participation in decision-making and enforcement of policies between doctors and other health professionals due to medical dominance. Overall, supervisors have a culture of limited information sharing with, and disrespectful treatment of, their junior colleagues.

Conclusion

Perceptions of organizational justice range from moderate to high and predictors vary among different healthcare professionals. Addressing specific socio-demographic factors that significantly influenced perceptions of organizational justice among different categories of health professionals and departure from physician-centered culture would improve perceptions of organizational justice among health professionals in Nigeria and similar settings.

Task shifting of intraocular injections from physicians to nurses: a randomized single-masked noninferiority study

PURPOSE

To test if task shifting of intraocular injections to nurses in a real-world setting can result in similar visual function outcome with equal safety profile.

METHOD

All patients with either age-related macular degeneration, retinal vein occlusion or diabetic macular oedema remitted to intraocular injections at a tertiary ophthalmology department in Norway between March 2015 and May 2017, were asked to participate. The participants were randomized to either nurse- or physician-administered intraocular injections of anti-vascular endothelial growth factor. The primary outcome measure was change in best-corrected visual acuity from baseline to 1-year follow-up. The mean difference in the primary outcome between the groups was analysed by a noninferiority test with a margin of three letters in disfavour of the nurse group. Adverse events were recorded.

RESULTS

Three hundred and forty-two patients entered the study. Two hundred and fifty-nine completed the 1-year follow-up and were included in the study sample for the analysis of the primary outcome. Nurse-administered intraocular injections were noninferior to physician-administered injections with 0.7 and 1.6 letters gained, respectively (95% CI of the mean difference, -2.9 to 1.0; p = 0.019, one-sided t-test). Two thousand and seventy-seven injections and three ocular adverse events were recorded.

CONCLUSION

Task shifting of intraocular injections to nurses can be performed without increased risk to visual function. Such a task shift can alleviate the burden of performing intraocular injections in ophthalmology departments. To our knowledge, this is the first RCT on task shifting of a surgical procedure from physicians to nurses in a high-income country.

The inclusion of mothers in human resources for health planning

AIM

This paper examines the possibility of including families, particularly mothers, within the health workforce using the human resource for health planning model to improve newborn outcomes.

BACKGROUND

In many low- and middle-income countries, there is a critical shortage of healthcare providers which impacts care for the neonatal population. A maternal and newborn health need that is prevalent in such countries is the care available between pregnancy and the postnatal period, where significant maternal and newborn deaths occur.

SOURCES OF EVIDENCE

Using the population health need of the neonatal population in Tanzania, this paper explores the opportunity to include mothers as an additional human resource for health within the Needs-Based Health Human Resources and Health Systems Planning model.

DISCUSSION

In relation to educating and engaging family caregivers, the possible extension of the health workforce to include mothers as a response to meeting the healthcare needs of the neonatal population has yet to be explored. Through mothers and healthcare providers working together to address the population health need of essential newborn care, it offers a way forward for planning the resources needed in a health system. If utilized, mothers offer the opportunity to supplement the demand for human resources for health in the provision of newborn care, without replacing healthcare providers.

CONCLUSION

Mothers as potential members of the health workforce furthers the health system as a whole whereby population health needs are addressed and newborn mortality declines.

IMPLICATIONS FOR HEALTH POLICY

To solve the critical gap based on the supply of and demand for providers including doctors, nurses and midwives, a broader look at innovative solutions is essential.

IMPLICATIONS FOR NURSING PRACTICE

Mothers offer the opportunity to supplement the available human resources for health in the provision of newborn care, thus helping to close existing gaps.