Rompendo o silêncio pelo riso: relações hospitalares e atuação dos palhaços promotores da saúde / Breaking the silence through laughter: hospital relations and the work of health-promoting clowns / Rompiendo el silencio a través de la risa: Las relaciones hospitalarias y el trabajo de los payasos promotores de salud

Justificativa: Desde o início da história, registra-se a presença da figura do palhaço na sociedade, designadamente nos cenários de saúde, onde buscavam levar a arte e a recreação ao processo de tratamento. Entretanto, no século XX, especificamente a partir dos anos 1970, surgiram propostas de trabalho para que essa relação no hospital fosse vinculada à promoção da saúde, de forma integrada e efetiva. Este projeto tem como objetivo avaliar como os palhaços de hospital interferem nas relações hospitalares. O estudo questiona: Como estabelecer relações hospitalares para ampliar a eficácia da intervenção do palhaço? De que forma as relações já existentes entre a organização de palhaços e os hospitais facilitam ou dificultam o acesso aos hospitais? Para responder a estes questionamentos foi utilizada a metodologia de pesquisa qualitativa para a produção de dados através de entrevistas semiestruturadas com integrantes de projetos de palhaços de hospital a nível internacional. Para análise dos dados, foi utilizada a técnica Análise de Conteúdo na modalidade temática de Bardin (2010). Como resultados desta pesquisa estão a compreensão de como são promovidas e mantidas as relações entre as organizações de palhaços e a administração hospitalar, de modo a assegurar a abertura, continuidade, eficácia e reconhecimento do trabalho dos palhaços nesse contexto. Além disso pontua-se a identificação, sistematização e disseminação de práticas, de modo a permitir a sua adoção por outras organizações de palhaços em escala mundial. Como conclusão, foi visualizado o potencial do palhaço de hospital no que diz respeito às relações de gênero e raciais e enquanto instrumento de enfrentamento à colonialidade, principalmente a nível nacional, com respaldo nas políticas do SUS. Mostra-se ainda primordial que o discurso para conhecimento da prática de cuidados dos palhaços promotores da saúde seja compartilhado com os gestores hospitalares, tendo como finalidade promover a qualidade das relações interinstitucionais.

Justification: Since the beginning of history, the presence of clowns in society has been recorded, particularly in healthcare settings, where they sought to bring art and recreation to the treatment process. However, in the 20th century, specifically from the 1970s onwards, proposals emerged to link this relationship in hospital to health promotion, in an integrated and effective way. This project aims to assess how hospital clowns interfere in hospital relationships. The study asks: How can hospital relationships be established to increase the effectiveness of the clown's intervention? How do existing relationships between clown organisations and hospitals facilitate or hinder access to hospitals? To answer these questions, a qualitative research methodology was used to produce data through semi-structured interviews with members of international hospital clown projects. Bardin's (2010) thematic content analysis technique was used to analyse the data. The results of this research include an understanding of how relationships between clown organisations and hospital administration are promoted and maintained in order to ensure the openness, continuity, effectiveness and recognition of clowns' work in this context. In addition, the identification, systematisation and dissemination of practices is highlighted, so that they can be adopted by other clown organisations worldwide. In conclusion, the potential of hospital clowns was visualised with regard to gender and race relations and as an instrument for confronting coloniality, especially at a national level, backed up by SUS policies. It is also essential that the discourse on the care practices of health-promoting clowns is shared with hospital managers, with the aim of promoting the quality of inter-institutional relations.

Justificación: Desde el comienzo de la historia, se ha registrado la presencia de payasos en la sociedad, en particular en el ámbito sanitario, donde buscaban aportar arte y recreación al proceso de tratamiento. Sin embargo, en el siglo XX, concretamente a partir de los años 70, surgieron propuestas para vincular esta relación en el hospital a la promoción de la salud, de forma integrada y eficaz. Este proyecto pretende evaluar cómo los payasos de hospital interfieren en las relaciones hospitalarias. El estudio se pregunta: ¿Cómo se pueden establecer relaciones hospitalarias para aumentar la eficacia de la intervención del payaso? ¿Cómo facilitan o dificultan el acceso a los hospitales las relaciones existentes entre las organizaciones de payasos y los hospitales? Para responder a estas preguntas, se utilizó una metodología de investigación cualitativa para producir datos a través de entrevistas semiestructuradas con miembros de proyectos internacionales de payasos de hospital. Para analizar los datos se utilizó la técnica de análisis de contenido temático de Bardin (2010). Los resultados de esta investigación incluyen la comprensión de cómo se promueven y mantienen las relaciones entre las organizaciones de payasos y la administración hospitalaria con el fin de garantizar la apertura, la continuidad, la eficacia y el reconocimiento del trabajo de los payasos en este contexto. Además, se destaca la identificación, sistematización y difusión de prácticas, para que puedan ser adoptadas por otras organizaciones de payasos en todo el mundo. En conclusión, se visualizó el potencial de los payasos de hospital en lo que se refiere a las relaciones de género y raza y como instrumento de enfrentamiento a la colonialidad, especialmente a nivel nacional, respaldado por las políticas del SUS. También es fundamental que el discurso sobre las prácticas asistenciales de los payasos promotores de salud sea compartido con los gestores hospitalarios, con el objetivo de promover la calidad de las relaciones interinstitucionales.

Measuring Productivity and Relative Efficiency of Public Tertiary Traditional Chinese Medicine Hospitals in Hubei, China.

Improving the productivity and relative efficiency of traditional Chinese medicine (TCM) hospitals is pivotal for hospital managers and policymakers to optimize the utilization of TCM resources in China. This study aimed to measure the productivity and relative efficiency of public tertiary TCM hospitals in Hubei Province. The input and output indicators data were extracted from the Health Commission of Hubei Province (HCHP) from 2019 to 2021. The Bootstrap-Malmquist-DEA model was employed to measure the productivity and relative efficiency of the hospitals. The statistical significance was set at P < .05. The numbers of total diagnostic patients and discharged patients declined by 23.44% and 28.34% from 2019 to 2020, and then increased by 25.76% and 20.44% respectively from 2020 to 2021. The average bias-corrected technical efficiency (TE) scores of the TCM hospitals from 2019 to 2021 were 0.8391, 0.8048, and 0.8559, indicating good efficiency. The average total factor productivity (TFP) in 2020 and 2021 decreased compared to that in 2019, with scores of 0.7479 and 0.8996, respectively. Between 2019 and 2020, the TFP changes among 19 out of 21 (90.48%) TCM hospitals and the technological changes (TC) among 20 out of 21 (95.24%) were less than 1.0000 (P < .05). The TFP changes of 17 out of 21 (80.95%) TCM hospitals and the TC of 20 out of 21 (95.24%) were less than 1.0000 (P < .05) between 2019 and 2021. COVID-19 might have constrained the provision of healthcare services by the public tertiary TCM hospitals in Hubei Province. Priority should be given to the utilization of healthcare resources, performance evaluation, information system strengthening, and internal hospital management to boost technical efficiency. TCM hospitals need to focus further on technology innovation to improve their technological progress.

Educação permanente no sistema único de saúde: concepções de profissionais da gestão e dos serviços / Continuing permanent education in the brazilian national health system: conceptions from management and care professionals / Educación continua en el sistema único de salud brasileño: concepciones de los profesionales de gestión y servicios

Este artigo pretende compreender as concepções de profissionais da gestão e dos serviços do Sistema Único de Saúde (SUS) sobre Educação Permanente em Saúde (EPS), bem como seus desafios e potencialidades. Utilizou-se de grupo focal para coleta, seguido de análise lexical do tipo classificação hierárquica descendente com auxílio do software Iramuteq. Os resultados delinearam quatro classes: a) EPS - entendimentos e expectativas; b) entraves à EPS; c) ETSUS e EPS por meio de cursos e capacitações; e d) dispositivos de EPS: potencialidades e desafios. Os participantes apontaram equívocos de entendimentos acerca da EPS ao equipará-la à Educação Continuada (EC) voltada à transferência de conteúdo, com repercussões negativas na prática de EPS. Discute-se o risco em centralizar o responsável pela concretização dessa proposta, que deveria ser coletiva e compartilhada entre diferentes atores. Reivindica-se, portanto, uma produção colaborativa, que possa circular entre os envolvidos, de modo que cada um experimente esse lugar e se aproprie da complexidade de interações propiciadas pela Educação Permanente em Saúde.(AU)

This article aims to understand the conceptions of professionals from the management and services of the Unified Health System (SUS) on Permanent Education in Health (EPS), as well as its challenges and potential. A focus group was used for data collection, followed by a lexical analysis of the descending hierarchical classification type using the Iramuteq software. The results delineated four classes: a) EPS - understandings and expectations; b) obstacles to EPS; c) ETSUS and EPS by courses and training; and d) EPS devices: potentialities and challenges. Participants pointed out misunderstandings about EPS, when equating it with Continuing Education (CE) focused on content transfer, with negative repercussions on EPS practice. The risk of centralizing the person responsible for implementing this proposal, which should be collective and shared among different actors, is discussed. Therefore, a collaborative production is claimed for, which can circulate among those involved, so that each one experiences this place and appropriates the complexity of interactions provided by Permanent Education in Health.(AU)

Este artículo tiene por objetivo comprender las concepciones de los profesionales de la gestión y servicios del Sistema Único de Salud (SUS) sobre Educación Continua en Salud (EPS), así como sus desafíos y potencialidades. Se utilizó un grupo focal para la recolección de datos, seguido por un análisis léxico del tipo clasificación jerárquica descendente con la ayuda del software Iramuteq. Los resultados delinearon cuatro clases: a) EPS: entendimientos y expectativas, b) Barreras para EPS, c) ETSUS y EPS a través de cursos y capacitación, y d) Dispositivos EPS: potencialidades y desafíos. Los participantes informaron que existen malentendidos sobre EPS al equipararla a Educación Continua, con repercusiones negativas en la práctica de EPS, orientada a la transferencia de contenidos. Se discute el riesgo de elegir a un solo organismo como responsable de implementar esta propuesta colectiva, que debería ser colectiva y compartida entre los diferentes actores. Se aboga por un liderazgo colaborativo, que pueda circular entre los involucrados, para que cada uno experimente este lugar y se apropie de la complejidad de interacciones que brinda la Educación Continua en Salud.(AU)

Impact of COVID-19 on healthcare organisation and cancer outcomes.

BACKGROUND: Changes in the management of patients with cancer and delays in treatment delivery during the COVID-19 pandemic may impact the use of hospital resources and cancer mortality. PATIENTS AND METHODS: Patient flows, patient pathways and use of hospital resources during the pandemic were simulated using a discrete event simulation model and patient-level data from a large French comprehensive cancer centre's discharge database, considering two scenarios of delays: massive return of patients from November 2020 (early-return) or March 2021 (late-return). Expected additional cancer deaths at 5 years and mortality rate were estimated using individual hazard ratios based on literature. RESULTS: The number of patients requiring hospital care during the simulation period was 13,000. In both scenarios, 6-8% of patients were estimated to present a delay of >2 months. The overall additional cancer deaths at 5 years were estimated at 88 in early-return and 145 in late-return scenario, with increased additional deaths estimated for sarcomas, gynaecological, liver, head and neck, breast cancer and acute leukaemia. This represents a relative additional cancer mortality rate at 5 years of 4.4 and 6.8% for patients expected in year 2020, 0.5 and 1.3% in 2021 and 0.5 and 0.5% in 2022 for each scenario, respectively. CONCLUSIONS: Pandemic-related diagnostic and treatment delays in patients with cancer are expected to impact patient survival. In the perspective of recurrent pandemics or alternative events requiring an intensive use of limited hospital resources, patients should be informed not to postpone care, and medical resources for patients with cancer should be sanctuarised.

Surgical Re-entry Strategy Following COVID-19 Pandemic: A Tiered and Balanced Approach.

Following the Presidential declaration of a national emergency, many health care organizations adhered to recommendations from the Centers for Medicare and Medicaid (CMS) as well as the American College of Surgeons (ACS) to postpone elective surgical cases. The transition to only emergent and essential urgent surgical cases raises the question, how and when will hospitals and surgery centers resume elective cases? As a large health care system providing multispecialty tertiary/quaternary care with across the Southeast United States, a collaborative approach to resuming elective surgery is critical. Numerous surgical societies have outlined a tiered approach to resuming elective surgery. The majority of these guidelines are suggestions which place the responsibility of making decisions about re-entry strategy on individual health care systems and practitioners, taking into account the local case burden, projected case surge, and availability of resources and personnel. This paper reviews challenges and solutions related to the resumption of elective surgeries and returning to the pre-COVID-19 surgical volume within an integrated health care system that actively manages 18 facilities, 111 operating rooms, and an annual operative volume exceeding 123,000 cases. We define the impact of COVID-19 across our surgical departments and outline the staged re-entry approach that is being taken to resume surgery within the health care system.

Identifying integration and differentiation in a Hospital's logistical system: a social network analysis of a case study.

BACKGROUND: Integration, the coordination and alignment of tasks, has been promoted widely in order to improve the performance of hospitals. Both organization theory and social network analysis offer perspectives on integration. This exploratory study research aims to understand how a hospital's logistical system works, and in particular to what extent there is integration and differentiation. More specifically, it first describes how a hospital organizes logistical processes; second, it identifies the agents and the interactions for organizing logistical processes, and, third, it establishes the extent to which tasks are segmented into subsystems, which is referred to as differentiation, and whether these tasks are coordinated and aligned, thus achieving integration. METHODS: The study is based on case study research carried out in a hospital in the Netherlands. All logistical tasks that are executed for surgery patients were studied. Using a mixed method, data were collected from the Hospital Information System (HIS), documentation, observations and interviews. These data were used to perform a social network analysis and calculate the network metrics of the hospital network. RESULTS: This paper shows that 23 tasks are executed by 635 different agents who interact through 31,499 interaction links. The social network of the hospital demonstrates both integration and differentiation. The network appears to function differently from what is assumed in literature, as the network does not reflect the formal organizational structure of the hospital, and tasks are mainly executed across functional silos. Nurses and physicians perform integrative tasks and two agents who mainly coordinate the tasks in the network, have no hierarchical position towards other agents. The HIS does not seem to fulfill the interactional needs of agents. CONCLUSIONS: This exploratory study reveals the network structure of a hospital. The cross-functional collaboration, the integration found, and position of managers, coordinators, nurses and doctors suggests a possible gap between organizational perspectives on hospitals and reality. This research sets a basis for further research that should focus on the relation between network structure and performance, on how integration is achieved and in what way organization theory concepts and social network analysis could be used in conjunction with one another.

Hospital adoption of multiple health information exchange approaches and information accessibility.

OBJECTIVE: Hospital engagement in electronic health information exchange (HIE) has increased over recent years. We aimed to 1) determine the change in adoption of 3 types of information exchange: secure messaging, provider portals, and use of an HIE; and 2) to assess if growth in each approach corresponded to increased ability to access and integrate patient information from outside providers. METHODS: Panel analysis of all nonfederal, acute care hospitals in the United States using hospital- and year-fixed effects. The sample consisted of 1917 hospitals that responded to the American Hospital Association Information Technology Supplement every year from 2014 to 2016. RESULTS: Adoption of each approach increased by 9-15 percentage points over the study period. The average number of HIE approaches used by each hospital increased from 1.0 to 1.4. Adoption of each approach was associated with increased likelihood that providers routinely had necessary outside information of 4.2-12.7 percentage points and 4.5-13.3 percentage points increase in information integration. Secure messaging was associated with the largest increase in both. Adoption of 1 approach increased the likelihood of having outside information by 10.3 percentage points, while adopting a second approach further increased the likelihood by 9.5 percentage points. Trends in number of approaches and integration were similar. DISCUSSION/CONCLUSION: No single HIE tool provided high levels of usable, integrated health information. Instead, hospitals benefited from adopting multiple tools. Policy initiatives that reduce the complexity of enabling high value HIE could result in broader adoption of HIE and use of information to inform care.

Verifying the impact of corporate governance on hospital performance on HIV and malaria control: A structural equation modelling approach.

BACKGROUND: The research aims to study the impact of corporate governance on hospital performance regarding HIV and malaria control, using the Ghana health industry as a case. The nation is making frantic effort to control HIV and malaria, since they continue to be among the deadliest diseases that attract holistic attention; hence, there is the need to put structures in place to curb the spread. METHODS: A total of 1005 precoded questionnaires were administered to 125 hospitals, for responses from staff, managers, board, and chief executive officers (CEOs). The collated data were analysed using structural equation modelling approach. RESULTS: Our research revealed that corporate governance has a positive effect on hospital performance, regarding the control of the two deadly diseases (HIV and malaria). The interventions in Ghana health delivery have brought a level of improvement in malaria control, since the disease mortality has significantly declined from 19% in 2010 to 4% in 2016. Through the implementation of systems and policies, the national HIV prevalence has admirably reduced from 2.9% in 2000 to 1.6% in 2017. CONCLUSIONS: Hospitals are therefore encouraged to continue to implement effective corporate governance mechanisms to facilitate efficient, well-organised, and prudent practices that can deliver more institutional performance in HIV and malaria control.

A longitudinal review of rural health policy in Ontario.

This article examines the Ontario Ministry of Health policy response to persistent rural health challenges over the last 5 decades. Rural health policy responses are grouped into policy "paradigms" for purposes of this high-level analysis. Key policies are assessed in terms of progress, limitations, and lessons learned for policy-makers and rural health leaders.

Decision-Making on New Non-Drug Health Technologies by Hospitals and Health Authorities in Canada.

INTRODUCTION: Unlike those for publicly funded drugs in Canada, coverage decision-making processes for non-drug health technologies (NDTs) are not well understood. OBJECTIVES: This paper aims to describe existing NDT decision-making processes in different healthcare organizations across Canada. METHODS: A self-administered survey was used to determine demographic and financial characteristics of organizations, followed by in-depth interviews with senior leadership of consenting organizations to understand the processes for making funding decisions on NDTs. RESULTS: Seventy-three and 48 organizations completed self-administered surveys and telephone interviews, respectively (with 45 participating in both ways). Fifty-five different processes were identified, the majority of which addressed capital equipment. Most involved multidisciplinary committees (with medical and non-medical representation), but the types of information used to inform deliberations varied. Across all processes, decision-making criteria included local considerations such as alignment with organizational priorities. CONCLUSIONS: NDT decision-making processes vary in complexity, depending on characteristics of the healthcare organization and context.

Hospital-Level Cardiovascular Management Practices in Kerala, India.

Background Hospital management practices are associated with cardiovascular process of care measures and patient outcomes. However, management practices related to acute cardiac care in India has not been studied. Methods and Results We measured management practices through semistructured, in-person interviews with hospital administrators, physician managers, and nurse managers in Kerala, India between October and November 2017 using the adapted World Management Survey. Trained interviewers independently scored management interview responses (range: 1-5) to capture management practices ranging from performance data tracking to setting targets. We performed univariate regression analyses to assess the relationship between hospital-level factors and management practices. Using Pearson correlation coefficients and mixed-effect logistic regression models, we explored the relationship between management practices and 30-day major adverse cardiovascular events defined as all-cause mortality, reinfarction, stroke, or major bleeding. Ninety managers from 37 hospitals participated. We found suboptimal management practices across 3 management levels (mean [SD]: 2.1 [0.5], 2.0 [0.3], and 1.9 [0.3] for hospital administrators, physician managers, and nurse managers, respectively [ P=0.08]) with lowest scores related to setting organizational targets. Hospitals with existing healthcare quality accreditation, more cardiologists, and private ownership were associated with higher management scores. In our exploratory analysis, higher physician management practice scores related to operation, performance, and target management were correlated with lower 30-day major adverse cardiovascular event. Conclusions Management practices related to acute cardiac care in participating Kerala hospitals were suboptimal but were correlated with clinical outcomes. We identified opportunities to strengthen nonclinical practices to improve patient care.

Hospital based massage therapy specific competencies.

As massage therapy experiences a resurgence of use for hospitalized patients, it is appropriate to consider the competencies needed by practitioners to practice safely and effectively in the inpatient setting. Hospitals differ vastly from other massage practice locations such as private offices, spas, and sports clubs. The variety of conditions encountered in an acute care setting require the knowledge and ability to adapt massage protocols appropriately. The Academic Collaborative for Integrative Health (ACIH) created the Hospital Based Massage Therapy (HBMT) Task Force to determine if there is a need for HBMT specific competencies and then, if needed, to develop peer reviewed competencies that hospital staff, massage therapy educators, and massage therapists all may find useful. The members of the task force identified massage therapists who worked in hospitals generally, as well as in hospitals known to have HBMT programs. A spreadsheet was created listing the individuals and a survey was distributed to those on the spreadsheet. These individuals were also asked to identify others who might be interested in participating in the project. The purpose of the survey was to assess various elements of HBMT programs such as educational/experience requirements, employment model, orientation, and supervision. 32 out of 37 hospitals (87%) completed the survey. The Task Force considered the high response rate and the extent to which respondents provided in-depth answers to the open-ended questions as evidence of the need for specific competencies for safe and effective massage therapy for hospitalized patients. In addition to the survey, the task force used a Delphi technique to engage survey participants and other experts in the field to shape the initial draft of the competencies. As these competencies are shared with hospitals, massage therapists, and massage educators, the Task Force members expect that additional development of the competencies will take place as various groups implement them.

Development and pilot of a multicriteria decision analysis (MCDA) tool for health services administrators.

INTRODUCTION: Health administration is complex and serves many masters. Value, quality, infrastructure and reimbursement are just a sample of the competing interests influencing executive decision-making. This creates a need for decision processes that are rational and holistic. METHODS: We created a multicriteria decision analysis tool to evaluate six fields of healthcare provision: return on investment, capacity, outcomes, safety, training and risk. The tool was designed for prospective use, at the beginning of each funding round for competing projects. Administrators were asked to rank their criteria in order of preference. Each field was assigned a representative weight determined from the rankings. Project data were then entered into the tool for each of the six fields. The score for each field was scaled as a proportion of the highest scoring project, then weighted by preference. We then plotted findings on a cost-effectiveness plane. The project was piloted and developed over successive uses by the hospital's executive board. RESULTS: Twelve projects competing for funding at the Royal Brisbane and Women's Hospital were scored by the tool. It created a priority ranking for each initiative based on the weights assigned to each field by the executive board. Projects were plotted on a cost-effectiveness plane with score as the x-axis and cost of implementation as the y-axis. Projects to the bottom right were considered dominant over projects above and to the left, indicating that they provided greater benefit at a lower cost. Projects below the x-axis were cost-saving and recommended provided they did not harm patients. All remaining projects above the x-axis were then recommended in order of lowest to highest cost-per-point scored. CONCLUSION: This tool provides a transparent, objective method of decision analysis using accessible software. It would serve health services delivery organisations that seek to achieve value in healthcare.

Experts' perceptions of management and leadership competence in Finnish hospitals in 2030.

PURPOSE: The purpose of this study is to elicit and analyze experts' perceptions of management and leadership competence (MLC) and likely MLC developments and requirements in hospital contexts by 2030. DESIGN/METHODOLOGY/APPROACH: A three-round, web-based Argument Delphi process was used to gather critically discussed opposing perceptions of 33 Finnish experts, which were subjected to inductive content analysis to identify themes. FINDINGS: Current deficiencies in MLC and several trends (e.g. an ongoing shift towards collaborative management) and required improvements (e.g. a need to adopt more holistic approaches) were identified. However, there were some conflicting perceptions, regarding for example the desirability of fixed-term positions for managers. RESEARCH LIMITATIONS/IMPLICATIONS: The findings provide qualitative indications of a group of Finnish experts' perceptions of MLC and requirements for its development, elicited using the Argument Delphi Method. Thus, they are subject to the usual limitations of the applied methodology and should be generalized to other contexts cautiously. PRACTICAL IMPLICATIONS: The identification of current deficiencies and future requirements for MLC may facilitate the formulation of robust approaches for improving it in hospital contexts. SOCIAL IMPLICATIONS: The findings may be useful for improving MLC in hospitals, thereby enhancing efficiency, teamwork, safety and client satisfaction in healthcare settings. ORIGINALITY/VALUE: The Argument Delphi Method has been rarely used in health management science studies and healthcare context. It is intended to develop relevant arguments and reveal reasons for differing views about focal issues, thereby providing deeper understanding of experts' perceptions of MLC and its likely development.

Integration of Primary Care with Hospital Services for Sustainable Universal Health Coverage in Singapore.

Primary care services have been developed and extended, with the support of the Singapore government, in order to address the increasing needs of the aging population and noncommunicable diseases and to achieve the goal of universal health care. Though countries across the Asia Pacific aspire to achieve universal coverage, there is no set pathway. In Singapore, various service models, quality assurance methods, and financing mechanisms have been piloted and some have been scaled up. Significant effort has also gone into building links and establishing networks between hospitals and local primary care providers, including dental and allied health professionals. Several initiatives have also been introduced to support professional development, provide financial safety nets, and integrate and resource community clinics to provide family-oriented care. Social support has also been improved for isolated elderly through formalized networks linking government agencies, health providers, and community welfare groups. Ongoing challenges include integration of private providers, maintaining affordability of out-of-pocket charges, resources to meet increasing chronic disease management needs, and achieving economies of scale to sustain universal health coverage (UHC).

Improving access to Indigenous medicine for patients in hospital-based settings: a challenge for health systems in northern Canada.

In this commentary, we argue that Indigenous patients in the Northwest Territories (NWT) have a right to access traditional medicine and related practitioners as a part of the continuum of medical care. Indigenous people make up over half of the NWT population, spread over vast geographic areas with representation from First Nations, Inuit and Métis (FNIM) people. Ensuring barrier-free access to traditional medicine and providers in a culturally respectful environment is a challenge that requires structural transformation in the territorial health system. The ongoing transmission of knowledge about Indigenous traditional medicine in Northern Canada and the collective survival of Northern peoples is a testament to the applicability of traditional medicines in a self-determined wellness system. Through a discussion of the barriers to policy development and implementation, this commentary aims to elevate Indigenous perspectives and offer recommendations for integrating traditional medicines into Northern health systems.

Museum Moving to Inpatients: Le Louvre à l'Hôpital.

Anxiety and depressive symptoms are common in hospitalized patients. Arts and cultural programs were reported to enhance their quality of life. The Le Louvre à l'hôpital study presents a new approach in which the museum moves to the hospital by displaying and discussing artworks with patients interactively. Over one year, four large statues were disposed in the hospital gardens, 30 reprints of large painting were exhibited in the hospital hall, dining rooms, and circulations areas. A total of 83 small-group guided art discussions (90 min) were organized, which 451 patients attended. The 200 small-size reproductions of paintings placed in the patients' rooms were chosen based on their individual preferences. Decreased anxiety after the art sessions was reported by 160 of 201 patients (79.6%). Out of 451 patients, 406 (90%) said the art program had met their expectations, and 372 (82.4%) wished to continue the experience with caregivers (162 paramedics trained for art activity during 66 workshops). In conclusion, moving the museum to the hospital constitutes a valuable way to provide art activities for inpatients in large numbers, which may reduce hospital-related anxiety in many instances.

A taxonomy of hospitals participating in Medicare accountable care organizations.

BACKGROUND: Medicare was an early innovator of accountable care organizations (ACOs), establishing the Medicare Shared Savings Program (MSSP) and Pioneer programs in 2012-2013. Existing research has documented that ACOs bring together an array of health providers with hospitals serving as important participants. PURPOSE: Hospitals vary markedly in their service structure and organizational capabilities, and thus, one would expect hospital ACO participants to vary in these regards. Our research identifies hospital subgroups that share certain capabilities and competencies. Such research, in conjunction with existing ACO research, provides deeper understanding of the structure and operation of these organizations. Given that Medicare was an initiator of the ACO concept, our findings provide a baseline to track the evolution of ACO hospitals over time. METHODOLOGY/APPROACH: Hierarchical clustering methods are used in separate analyses of MSSP and Pioneer ACO hospitals. Hospitals participating in ACOs with 2012-2013 start dates are identified through multiple sources. Study data come from the Centers for Medicare and Medicaid Services, American Hospital Association, and Health Information and Management Systems Society. RESULTS: Five-cluster solutions were developed separately for the MSSP and Pioneer hospital samples. Both the MSSP and Pioneer taxonomies had several clusters with high levels of health information technology capabilities. Also distinct clusters with strong physician linkages were present. We examined Pioneer ACO hospitals that subsequently left the program and found that they commonly had low levels of ambulatory care services or health information technology. CONCLUSION: Distinct subgroups of hospitals exist in both the MSSP and Pioneer programs, suggesting that individual hospitals serve different roles within an ACO. Health information technology and physician linkages appear to be particularly important features in ACO hospitals. PRACTICE IMPLICATIONS: ACOs need to consider not only geographic and service mix when selecting hospital participants but also their vertical integration features and management competencies.

The requirements of hospital-based spiritual care for cancer patients.

PURPOSE: This paper aimed to discover the requirements of hospital-based spiritual care for cancer patients. METHODS: This study was a descriptive qualitative-exploratory research, in which 25 participants were selected through purposive sampling and had semi-structured interviews. RESULT: The data analysis revealed 3 themes and 8 sub-themes including fundamental requirements (changes in the attitudes and behaviors of the healthcare team), structural requirements (inter-professional collaborations, a reference system), and functional requirements (religious-spiritual, pastoral, psycho-spiritual, and supportive-spiritual care). In this study, the received topics have been related to the spiritual care which can help improve patient care. CONCLUSION: The results were added to the repertoire of knowledge about the spiritual needs of cancer patients. The results indicated that it is essential to get acquainted with the spiritual care requirements in the hospital and enforce them through inter-professional collaboration. Accordingly, the spiritual care program should be designed, implemented, and evaluated.