Factors Affecting Brain Drain and a Solution to Reduce it in Iran's Health System: A Qualitative Study.

BACKGROUND: Brain drain is an issue of concern in developing countries. Many factors are involved in this issue, and their identification can be a good guide for decision-makers at different management levels. Therefore, the present study was carried out to identify the factors affecting brain drain and solutions to reduce it in Iran's health system. METHODS: The data for this qualitative study was collected in 2023 through 15 semi-structured interviews with Iranian health experts and emigrant elites. Interviews were collected both face-to-face and virtually (on Skype and Google Meet) and analyzed using the thematic content analysis method. RESULTS: Data analysis of the factors affecting brain drain in Iran's health system yielded seven main categories and 45 subcategories. The main categories were "individual factors," "economic factors," "social and cultural factors," "organizational and administrative factors," "political factors," "attraction factors for destination countries," and "attraction factors of destination countries for elites." Also, the solutions were divided into four categories of "economic," "social," "organizational and scientific," and "political" factors and 19 subcategories. CONCLUSION: Due to the increase in brain drain in recent years, it is necessary to make a serious decision in dealing with this issue. Solutions such as creating stable economic conditions, creating an atmosphere of hope, increasing respect and dignity for elite students by politicians, using the elites in macro-decisions, and creating the job rank for honorary professors can lead to reducing brain drain and decreasing the costs of the health system.

Michael is better than Mehmet: exploring the perils of algorithmic biases and selective adherence to advice from automated decision support systems in hiring.

Introduction: Artificial intelligence algorithms are increasingly adopted as decisional aides in many contexts such as human resources, often with the promise of being fast, efficient, and even capable of overcoming biases of human decision-makers. Simultaneously, this promise of objectivity and the increasing supervisory role of humans may make it more likely for existing biases in algorithms to be overlooked, as humans are prone to over-rely on such automated systems. This study therefore aims to investigate such reliance on biased algorithmic advice in a hiring context. Method: Simulating the algorithmic pre-selection of applicants we confronted participants with biased or non-biased recommendations in a 1 × 2 between-subjects online experiment (n = 260). Results: The findings suggest that the algorithmic bias went unnoticed for about 60% of the participants in the bias condition when explicitly asking for this. However, overall individuals relied less on biased algorithms making more changes to the algorithmic scores. Reduced reliance on the algorithms led to the increased noticing of the bias. The biased recommendations did not lower general attitudes toward algorithms but only evaluations for this specific hiring algorithm, while explicitly noticing the bias affected both. Individuals with a more negative attitude toward decision subjects were more likely to not notice the bias. Discussion: This study extends the literature by examining the interplay of (biased) human operators and biased algorithmic decision support systems to highlight the potential negative impacts of such automation for vulnerable and disadvantaged individuals.

Relevant factors affecting nurse staffing: a qualitative study from the perspective of nursing managers.

Objective: To understand the current situation of nursing manpower allocation, explore the factors affecting nurse staffing, improve nurse staffing level, and provide reference for better formulation of nursing human resources staffing standards. Methods: A descriptive research method was used to conduct semi-structured interviews with 14 nursing managers. The data were analyzed and refined by content analysis. The sample size was subject to content saturation. Results: Nine themes and twenty sub-themes of influencing factors for nursing staffing were identified across four levels: hospital level, department level, patient level, and nurse level. Conclusion: Hospital and department managers need to comprehensively consider the factors of affecting nurse staffing. Adopting multidimensional optimization measures, improving relevant systems, optimizing nurse structure, and establishing flexible and mobile nurse database to cope with public emergencies, so as to effectively improve nurse staffing and nursing service quality.

[Psychiatric care teams: taking care and forgetting about it]. / Les équipes de soins en psychiatrie ou prendre soin à s'en oublier.

The psychiatric care team offers comprehensive, personalized support, raising public awareness, promoting mental equilibrium and combating stigmatization. Its role includes collaboration, communication, designing adapted treatment plans and creating a climate of trust to influence the quality of care. In this way, she contributes to a more inclusive and caring society. As such, her own state of well-being deserves special attention. However, they often work in a highly degraded ecosystem that can be likened to psychiatry in a war zone.

Human resource allocation status and equity research of Centers for Disease Control and Prevention in China from 2016 to 2020.

Background: In recent years, the development of global public health has become a matter of great concern and importance for governments worldwide. China, as the largest developing country, plays a crucial role in shaping the development of the public health and its ability to respond to sudden public health emergencies through the fairness of its human resource allocation in center for disease control and prevention (CDC). Objective: This study aims to analyze the situation of health human resource allocation in the China Centers for Disease Control and Prevention (China CDCs), assess the fairness of the allocation, and provide reference for the rational allocation of human resources. Methods: We selected data from the China Health Statistics Yearbook on healthcare technical personnel, other technical personnel, managerial personnel, and workforce technical personnel of China CDCs for the period of 2016-2020. We utilized the Health Resource Density Index to evaluate the level of human resource allocation in China CDCs. Additionally, we used the Gini coefficient and Theil index to assess the fairness of human resource allocation in China CDCs from both a population and geographical perspective. Results: Firstly, the educational qualifications and professional titles of CDC staff have improved, but the workforce is aging. Secondly, HRDI development trends vary among different personnel types and regions with varying levels of economic development. Finally, the results of the Gini coefficient and Theil index indicate that population distribution fairness is better than geographical distribution fairness. Overall, the unfair population distribution is primarily due to regional disparities. Conclusion: The China CDCs should tailor different standards for the allocation of health human resources based on regional characteristics, aiming to enhance the accessibility of health human resources in various regions and achieve equitable allocation.

Evaluation of the effectiveness of a segmented alternating shift pattern based on wearable vital signs monitoring devices during COVID-19: a cross-sectional study.

AIM: To explore the feasibility and effectiveness of an alternating shift pattern in two-hour segments in the state of emergency management of public health events. METHODS: A cross-sectional research design was conducted in our study. The nursing staff working in the admission ward of suspected or confirmed patients with COVID-19 in December 2022 were selected as subjects by the whole-group sampling method. We adopted a shift pattern of alternating shifts every two-hour in the isolation wards. The vital signs parameters were captured by uniformly wearing the multi-signs sensing devices, and the questionnaires collected the symptoms. RESULTS: Sixty-seven female participants, with a mean age of 33.09 ± 5.96 years, were included in this study. Measurements of body temperature (T), blood oxygen saturation (SpO2), respiratory rate (RR), and heart rate (HR) while wearing personal protective equipment (PPE) all remained within normal limits. None of the nurses reported sweating, dizziness, blurred vision, palpitations, or dyspnea. Statistical analysis showed significant differences between the critical care group and the non-critical care group in terms of age (P = 0.041), working duration (P = 0.036), and the total number of entries into isolation areas for nursing care (rounds) (P = 0.007). However, there were no statistically significant differences in vital signs based on age, work duration, or body mass index (BMI). The data indicated a notable increase in body temperature compared to other vital sign parameters with increasing work time while wearing PPE. Body temperature approached the upper limit when working close to 2 h long. CONCLUSIONS: The alternating shift pattern in two-hour segments can effectively maintain the physical well-being of nurses wearing PPE without increasing the burden on nursing staff or the wastage of protective materials. This approach is recommended for addressing similar public health events in the future.

Applying a "medical deserts" lens to cancer care services in the North-West region of Romania from 2009 to 2022 - a mixed-methods analysis.

BACKGROUND: Medical deserts pose significant challenges to healthcare systems worldwide, leading to unmet healthcare needs and exacerbated health issues, particularly in underserved regions. METHODS: This study aims to characterise cancer care services in the North-West region of Romania through the lens of medical desertification, employing a mixed-methods approach. Quantitative analysis - descriptive statistics - of secondary data from the Activity of Healthcare Units reports from 2009 to 2022, along with qualitative data - thematic analysis - from interviews with cancer patients and healthcare professionals, were employed to uncover the current state of cancer care in Romania. RESULTS: The qualitative analysis highlighted the prevalence of medical deserts in oncology, with inadequate human resources, facility deficiencies, prolonged waiting times, high costs, and socio-cultural barriers hindering access to cancer care. Opportunities for action include revising treatment protocols, enhancing palliative care, implementing prevention strategies, promoting collaboration among healthcare professionals, and digitalising the healthcare system. However, challenges persist, including a shortage of oncology specialists, geographical disparities in cancer prevalence, and limited access to advanced treatment modalities in rural areas. CONCLUSIONS: Addressing medical deserts in cancer care requires comprehensive approaches, including strategic resource allocation, workforce development, infrastructure investments, access to innovative treatments, and digital health technologies. Collaboration among policymakers, healthcare providers, and communities is crucial to mitigating medical deserts and improving cancer outcomes. Despite limitations, this study provides valuable insights into cancer care services and underscores the need for concerted efforts to overcome medical desertification and ensure equitable access to high-quality cancer care.

Health workforce forecast in the university hospital: evidence from Lithuania.

BACKGROUND: The increasing shortage of staff in healthcare facilities worldwide calls for a human resource planning strategy in order to ensure safe, timely and patient-centred care. The purpose of this paper is to provide an analysis and supply and demand projections of nurses, midwives, and radiographers within the labor market of the largest university hospital in the Baltic States by 2030. METHODS: The staff supply was calculated on the intake and outflow of persons in the labour market annually for various factors. Projections for the demand of nurses, midwives, and radiographers took into account the different needs of the population, categorized by gender and age, for the services offered within the institution. RESULTS: The analysis highlights significant projected shortages in the supply of nurses and radiographers by 2030, while the supply of midwives is expected to meet the demand. The projected supply of nurses in 2030 will be lower than in 2021. Projected nurses demand in 2025 according medium scenario - shortage of 59 nurses, on prospective scenario - of 331 nurses. In 2030 according medium scenario - shortage of 173 nurses on prospective - of 772 nurses. The projected supply of radiographers in 2030 will be higher than in 2021. Projected radiographers demand in prospective scenario which is the most likely in 2025 - shortage of 26 and in 2030 - shortage of 52 radiographers. The projected supply of midwives in 2030 will be higher than in 2021. The variables influencing the increase in the demand for midwives did not exceed the projected supply in the institution, indicating a balanced supply-demand scenario for midwives. CONCLUSIONS: Due to the rising demand for nurse and radiographer services from the aging population, the predicted supply of nurses and radiographers will be insufficient. To ensure the projected demand for nurses in the medium and prospective scenarios, the nurses recruited each year should increase up to 38% in the medium scenario and 69% in the prospective scenario from 2022. In the prospective demand scenario, the recruitment of radiographers should increase three-fold and the recruitment of midwives should be reduced by 30%.

Burden of cardiovascular disease among the Western Pacific region and its association with human resources for health, 1990-2021: a systematic analysis of the Global Burden of Disease Study 2021.

Background: A comprehensive profile of cardiovascular disease (CVD) burden and human resources for health (HRH) distribution in the WHO Western Pacific region has yet to be presented. Studies on the relationship between HRH and CVD in this region are limited. We aimed to describe CVD trends and HRH density in the Western Pacific region and explore the association of HRH with CVD burden. Methods: Estimates of CVD deaths and disability-adjusted life years (DALYs) were obtained from the Global Burden of Disease Study (GBD) 2021, and the annual density of HRH was retrieved from GBD 2019. We presented trends in CVD burden and HRH density across 31 Western Pacific countries. Spearman rank correlation analysis and generalized linear models were used to examine associations between CVD burden and HRH density. Findings: In 2021, CVD caused six million deaths and 125 million DALYs in the Western Pacific region, accounting for 39.4% and 22.5% of all-cause deaths and DALYs. From 1990 to 2021, the number of CVD deaths and DALYs increased by 94.9% and 57.3% in this region, whereas the age-standardized rate of CVD deaths and DALYs declined in all countries. In 2021, stroke and ischemic heart disease were the leading causes in the Western Pacific region, and a 32-year increase in CVD burden was primarily driven by aortic aneurysm, lower extremity peripheral arterial disease, endocarditis, and atrial fibrillation and flutter. In 2019, there was an approximately 20-fold difference in HRH density across 31 countries from the lowest in Papua New Guinea to the highest in Australia. HRH density was negatively related to the age-standardized rate of CVD deaths (r s  = -0.74) and DALYs (r s  = -0.73), especially strong associations between CVD burden and the density of dentistry personnel, aides & emergency medical workers, and medical laboratory technicians. Interpretation: CVD remains a pressing public health issue in the Western Pacific region where noticeable shortages in health workers exist. The negative associations between CVD burden and HRH density suggest that health workers, especially dentistry personnel, aides & emergency medical staff, and medical laboratory technicians merit more investment to reduce the CVD burden. Funding: National Natural Science Foundation of China (82073573 to ZZ; 82273654 to YS).

The last resort: reducing avoidable employee harm by improving the application of the disciplinary policy and process.

Introduction: There is growing evidence within the healthcare sector that employee investigations can harm individuals involved in the process, an organization's culture and the delivery of its services. Methods: This paper details an intervention developed by an NHS Wales organization to reduce the number of its employee investigations through an organization-wide focus that promoted a 'last resort' approach and introduced the concept of 'avoidable employee harm'. A range of associated improvement initiatives were developed to support behavior change among those responsible for determining whether an employee investigation should be initiated. Results: Over a 13-month period, organizational records showed an annual reduction of 71% in investigation cases post-intervention, resulting in an estimated 3,308 sickness days averted annually and total estimated annual savings of £738,133 (based on direct savings and costs averted). This indicates that the organization has started to embrace the "last resort" approach to using employee investigations to address work place issues. The programme was supported with training for those responsible for commissioning and leading the organization's employee investigations. Analysis of survey data from those who attended training workshops to support the programme indicated that participants showed an increased awareness of the employee investigation process post-workshop and an understanding of the concept of avoidable employee harm. Discussion: The programme is congruent with the Healthy Healthcare concept, as the study illustrates how its practices and processes have a beneficial impact on staff, as well as potentially on patients. This study highlights wider issues for consideration, including the: (1) the role of Human Resources (HR), (2) taking a multi-disciplinary approach, (3) culture and practice, (4) the responsibility of the wider HR profession.