Can digital communication technology reduce health system personnel time? An evaluation of personnel requirements and costs in a randomized controlled trial.

Use of digital communication technologies (DCT) shows promise for enhancing outcomes and efficiencies in asthma care management. However, little is known about the impact of DCT interventions on healthcare personnel requirements and costs, thus making it difficult for providers and health systems to understand the value of these interventions. This study evaluated the differences in healthcare personnel requirements and costs between usual asthma care (UC) and a DCT intervention (Breathewell) aimed at maintaining guidelines-based asthma care while reducing health care staffing requirements. We used data from a pragmatic, randomized controlled trial conducted in a large integrated health system involving 14,978 patients diagnosed with asthma. To evaluate differences in staffing requirements and cost between Breathewell and UC needed to deliver guideline-based care we used electronic health record (EHR) events, provider time tracking surveys, and invoicing. Differences in cost were reported at the patient and health system level. The Breathewell intervention significantly reduced personnel requirements with a larger percentage of participants requiring no personnel time (45% vs. 5%, p < .001) and smaller percentage of participants requiring follow-up outreach (44% vs. 68%, p < .001). Extrapolated to the total health system, cost for the Breathewell intervention was $16,278 less than usual care. The intervention became cost savings at a sample size of at least 957 patients diagnosed with asthma. At the population level, using DCT to compliment current asthma care practice presents an opportunity to reduce healthcare personnel requirements while maintaining population-based asthma control measures.

Human resources for health interventions in high- and middle-income countries: findings of an evidence review.

Many high- and middle-income countries face challenges in developing and maintaining a health workforce which can address changing population health needs. They have experimented with interventions which overlap with but have differences to those documented in low- and middle-income countries, where many of the recent literature reviews were undertaken. The aim of this paper is to fill that gap. It examines published and grey evidence on interventions to train, recruit, retain, distribute, and manage an effective health workforce, focusing on physicians, nurses, and allied health professionals in high- and middle-income countries. A search of databases, websites, and relevant references was carried out in March 2019. One hundred thirty-one reports or papers were selected for extraction, using a template which followed a health labor market structure. Many studies were cross-cutting; however, the largest number of country studies was focused on Canada, Australia, and the United States of America. The studies were relatively balanced across occupational groups. The largest number focused on availability, followed by performance and then distribution. Study numbers peaked in 2013-2016. A range of study types was included, with a high number of descriptive studies. Some topics were more deeply documented than others-there is, for example, a large number of studies on human resources for health (HRH) planning, educational interventions, and policies to reduce in-migration, but much less on topics such as HRH financing and task shifting. It is also evident that some policy actions may address more than one area of challenge, but equally that some policy actions may have conflicting results for different challenges. Although some of the interventions have been more used and documented in relation to specific cadres, many of the lessons appear to apply across them, with tailoring required to reflect individuals' characteristics, such as age, location, and preferences. Useful lessons can be learned from these higher-income settings for low- and middle-income settings. Much of the literature is descriptive, rather than evaluative, reflecting the organic way in which many HRH reforms are introduced. A more rigorous approach to testing HRH interventions is recommended to improve the evidence in this area of health systems strengthening.

A multi-agent system for distributed multi-project scheduling with two-stage decomposition.

A two-stage decomposition approach based on a novel multi-agent system (MAS) is proposed for the distributed resource constrained multi-project scheduling problem (DRCMPSP). In stage one, from the point of view of each local project manager, a forward-backward hybrid genetic algorithm (FBHGA) is developed to generate an initial local schedule with the objective of minimizing individual project makespan. In stage two, from the global perspective of project management office, a sequential game-based negotiation mechanism is employed to eliminate global resource conflicts with the objective of minimizing total tardiness cost (TTC). The proposed approach is tested on 140 benchmark problem instances. According to the computational results, high-quality local project schedules can be obtained by FBHGA in stage one. Furthermore, it is observed that our method is capable of dealing with various complex multi-project instances under different degrees of resource conflicts in reasonable CPU running time. Compared to the existing decentralized methods for DRCMPSP, the proposed approach with sequential game-based negotiation mechanism shows the superiority in producing multi-project schedules with lower TTC, especially for large-size and strong conflicting instances.

Fundamentos de la gestión del Capital Humano en entidades hospitalarias / Fundamentals of human capital management in hospital entities

Introducción: La gestión del capital humano es un proceso orientado a manejar un recurso crítico de las organizaciones altamente vinculado con su capacidad de innovación y mejora continua, para la obtención de los objetivos institucionales; el cual asume las particularidades del sector específico como es la salud pública, cuya actividad administrativa debe contribuir a satisfacer las crecientes necesidades sociales con altos niveles de calidad y satisfacción en los servicios que se brindan. Objetivo: Determinar algunos principios del proceso de gestión del capital humano en las instituciones hospitalarias, en relación a las actividades tradicionales que se desarrollan dentro de este subsistema. Métodos: Se utilizó la revisión bibliográfica. Resultados: La investigación entregó las tareas que se deben realizar para la gestión del capital humano y las consideraciones para la puesta en marcha de estas. Conclusiones: Los resultados presentan particularidades y desafíos en el contexto actual(AU)

Introduction: The management of human capital is a process aimed at managing a critical resource of organizations highly linked to their capacity for innovation and continuous improvement, for the achievement of institutional objectives; which assumes the particularities of the specific sector such as public health, whose administrative activity must contribute to meet the growing social needs with high levels of quality and satisfaction in the services provided. Objective: The objective of the article is to determine some principles of the human capital management process in the hospital institutions, in relation to the traditional activities that are developed within this subsystem. Methods: Bibliographic review was used. Results: The research delivered the tasks that must be performed for the management of human capital and the considerations for the implementation of these. Conclusions: The results present particularities and challenges in the current context(AU)

La gestión de recursos humanos y la construcción de subjetividades en las nuevas condiciones de la economía / Human Resources Management and the Construction of Subjectivities in the New Economy Conditions

Resumen Este documento analiza la Teoría del capital humano y sus consecuencias en la gestión humana, donde cobran relevancia los planteamientos de Foucault y sus análisis de las formas de gobernar a sujetos y poblaciones, que interesan al estudio de las organizaciones. La presente revisión surge de la preocupación por discursos convertidos en mandatos en el mundo empresarial que plantean retos y objetivos a las empresas y las áreas de gestión humana, sin que se visibilicen los aportes críticos surgidos en el ámbito académico que establecen los riesgos de seguir trabajando desde miradas reduccionistas y pragmáticas, donde los sujetos son asumidos como absolutos responsables de sus éxitos, en un ámbito donde pareciera innecesaria la construcción de sentidos de comunidad.

Abstract The present document analyzes the theory of human capital and its consequences in the human management, where Foucault's approaches are relevant and his analysis of forms of governing resulting in new studies of organizations. The inspiration for this article came from the concern that the elevated discussions of chain of command in the business world would incorrectly identify the challenges and objectives for the businesses and for the areas of human management, without considering the suggestions from the academic world that establishes the risks of working only from the pragmatic point of view. From this point, the subjects are assumed as absolute responsibilities of their successes, where in the business world it appears unnecessary to create a sense of community.

A Systematic Review of the Benefits of Hiring People with Disabilities.

Purpose We reviewed literature on the benefits of hiring people with disabilities. Increasing attention is being paid to the role of people with disabilities in the workplace. Although most research focuses on employers' concerns, many companies are now beginning to share their successes. However, there is no synthesis of the peer-reviewed literature on the benefits of hiring people with disabilities. Methods Our team conducted a systematic review, completing comprehensive searches of seven databases from 1997 to May 2017. We selected articles for inclusion that were peer-reviewed publications, had a sample involving people with disabilities, conducted an empirical study with at least one outcome focusing on the benefits of hiring people with disabilities, and focused on competitive employment. Two reviewers independently applied the inclusion criteria, extracted the data, and rated the study quality. Results Of the 6176 studies identified in our search, 39 articles met our inclusion criteria. Findings show that benefits of hiring people with disabilities included improvements in profitability (e.g., profits and cost-effectiveness, turnover and retention, reliability and punctuality, employee loyalty, company image), competitive advantage (e.g., diverse customers, customer loyalty and satisfaction, innovation, productivity, work ethic, safety), inclusive work culture, and ability awareness. Secondary benefits for people with disabilities included improved quality of life and income, enhanced self-confidence, expanded social network, and a sense of community. Conclusions There are several benefits to hiring people with disabilities. Further research is needed to explore how benefits may vary by type of disability, industry, and job type.

Examining the Gap: Compensation Disparities between Male and Female Physician Assistants.

BACKGROUND: Compensation disparities between men and women have been problematic for decades, and there is considerable evidence that the gap cannot be entirely explained by nongender factors. The current study examined the compensation gap in the physician assistant (PA) profession. METHODS: Compensation data from 2014 was collected by the American Academy of PAs in 2015. Practice variables, including experience, specialty, and hours worked, were controlled for in an ordinary least-squares sequential regression model to examine whether there remained a disparity in total compensation. In addition, the absolute disparity in compensation was compared with historical data collected by American Academy of PAs over the previous 1.5 decades. RESULTS: Without controlling for practice variables, a total compensation disparity of $16,052 existed between men and women in the PA profession. Even after PA practice variables were controlled for, a total compensation disparity of $9,695 remained between men and women (95% confidence interval, $8,438-$10,952). A 17-year trend indicates the absolute disparity between men and women has not lessened, although the disparity as a percent of male compensation has decreased in recent years. CONCLUSIONS: There remain challenges to ensuring pay equality in the PA profession. Even when compensation-relevant factors such as experience, hours worked, specialty, postgraduate training, region, and call are controlled for, there is still a substantial gender disparity in PA compensation. Remedies that may address this pay inequality include raising awareness of compensation disparities, teaching effective negotiation skills, assisting employers as they develop equitable compensation plans, having less reliance on past salary in position negotiation, and professional associations advocating for policies that support equal wages and opportunities, regardless of personal characteristics.

Policy of Labor Management and Health Education: a ProgeSUS experience. / Política de Gestão do Trabalho e Educação em Saúde: a experiência do ProgeSUS.

AIM: To evaluate the stage of labor management and education policies in municipal and state health secretariats (SMS and SES, respectively), having as reference the adherence to a qualification and structuring program of work management and education in the Unified Health System. METHOD: A descriptive and quantitative study, developed with 519 representatives from the Human Resources (HR) area of SMS and SES, through a survey composed of 56 questions, via a computer-assisted telephone interview in 2012. Responses were processed in a computerized database and the data treated by descriptive statistics. RESULTS: Changes in professional qualification, the establishment of job and salary plans and negotiation processes were identified; on the other hand, there was no progress related to the financial and budgetary autonomy of the area of work management and health education. CONCLUSION: It is observed progress in the incorporation of innovations in the management in SES and SMS from the process of training of managers and financial induction. It is necessary to monitor and periodically evaluate the operationalization of labor and education policies aimed at strengthening them, correcting directions and implementing innovative actions.

Good practice for one-to-one care.

Sam Foster, Chief Nurse at Heart of England NHS Foundation Trust, reflects on the patient and carer experience of one-to-one care.

Work Activities and Compensation of Male and Female Cardiologists.

BACKGROUND: Much remains unknown about experiences, including working activities and pay, of women in cardiology, which is a predominantly male specialty. OBJECTIVES: The goal of this study was to describe the working activities and pay of female cardiologists compared with their male colleagues and to determine whether sex differences in compensation exist after accounting for differences in work activities and other characteristics. METHODS: The personal, job, and practice characteristics of a national sample of practicing cardiologists were described according to sex. We applied the Peters-Belson technique and multivariate regression analysis to evaluate whether gender differences in compensation existed after accounting for differences in other measured characteristics. The study used 2013 data reported by practice administrators to MedAxiom, a subscription-based service provider to cardiology practices. Data regarding cardiologists from 161 U.S. practices were included, and the study sample included 2,679 subjects (229 women and 2,450 men). RESULTS: Women were more likely to be specialized in general/noninvasive cardiology (53.1% vs. 28.2%), and a lower proportion (11.4% vs. 39.3%) reported an interventional subspecialty compared with men. Job characteristics that differed according to sex included the proportion working full-time (79.9% vs. 90.9%; p < 0.001), the mean number of half-days worked (387 vs. 406 days; p = 0.001), and mean work relative value units generated (7,404 vs. 9,497; p < 0.001) for women and men, respectively. Peters-Belson analysis revealed that based on measured job and productivity characteristics, the women in this sample would have been expected to have a mean salary that was $31,749 (95% confidence interval: $16,303 to $48,028) higher than that actually observed. Multivariate analysis confirmed the direction and magnitude of the independent association between sex and salary. CONCLUSIONS: Men and women practicing cardiology in this national sample had different job activities and salaries. Substantial sex-based salary differences existed even after adjusting for measures of personal, job, and practice characteristics.

Dust Off the Historical Approach to Total Compensation.

Employers have been afforded new opportunities with the enactment of the Affordable Care Act (ACA). ACA creates a unique opportunity for employers to take a fresh, strategically based total compensation approach to planning. The concept of a total compensation framework is not new; however, a new way to achieve this approach is now possible. Employers need to create their own level playing field, and a total compensation approach is the optimal solution. This article discusses how employers that consider a framework driven toward total compensation accomplish many key objectives.

Hospitals must stop being 'ripped off' by staff agencies - NHS chief.

Hospitals should cap their spending on agency staff, including nurses, says the chief executive of NHS England.