Setting up a Governance Framework for Secondary Use of Routine Health Data in Nursing Homes: Development Study Using Qualitative Interviews.

BACKGROUND: In the nursing home sector, reusing routinely recorded data from electronic health records (EHRs) for knowledge development and quality improvement is still in its infancy. Trust in appropriate and responsible reuse is crucial for patients and nursing homes deciding whether to share EHR data for these purposes. A data governance framework determines who may access the data, under what conditions, and for what purposes. This can help obtain that trust. Although increasing attention is being paid to data governance in the health care sector, little guidance is available on development and implementation of a data governance framework in practice. OBJECTIVE: This study aims to describe the development process of a governance framework for the "Registry Learning from Data in Nursing Homes," a national registry for EHR data on care delivered by nursing home physicians (in Dutch: specialist ouderengeneeskunde) in Dutch nursing homes-to allow data reusage for research and quality improvement of care. METHODS: Relevant stakeholders representing practices, policies, and research in the nursing home sector were identified. Semistructured interviews were conducted with 20 people from 14 stakeholder organizations. The main aim of the interviews was to explore stakeholders' perspectives regarding the Registry's aim, data access criteria, and governing bodies' tasks and composition. Interview topics and analyses were guided by 8 principles regarding governance for reusing health data, as described in the literature. Interview results, together with legal advice and consensus discussions by the Registry's consortium partners, were used to shape the rules, regulations, and governing bodies of the governance framework. RESULTS: Stakeholders valued the involvement of nursing home residents and their representatives, nursing home physicians, nursing homes' boards of directors, and scientists and saw this as a prerequisite for a trustworthy data governance framework. For the Registry, involvement of these groups can be achieved through a procedure in which residents can provide their consent or objection to the reuse of the data, transparency about the decisions made, and providing them a position in a governing body. In addition, a data request approval procedure based on predefined assessment criteria indicates that data reuse by third parties aligns with the aims of the Registry, benefits the nursing home sector, and protects the privacy of data subjects. CONCLUSIONS: The stakeholders' views, expertise, and knowledge of other frameworks and relevant legislation serve to inform the application of governance principles to the contexts of both the nursing home sector and the Netherlands. Many different stakeholders were involved in the development of the Registry Learning from Data in Nursing Homes' governance framework and will continue to be involved. Engagement of the full range of stakeholders in an early stage of governance framework development is important to generate trust in appropriate and responsible data reuse.

Cyber governance studies in ensuring cybersecurity: an overview of cybersecurity governance.

With the exponential increase of digital data in cyber environments, security measures have gained more importance. Cybersecurity threats are revealed by national and international units, and the number of these threats is increasing daily. The elimination of cybersecurity risks is possible with an effective cybersecurity strategy. Since the concept of management is not sufficient, the implementation of this strategy is possible with cyber governance, which includes all stakeholders in the management processes. This study emphasizes the importance and necessity of cyber governance in ensuring cybersecurity. The research and results for cybersecurity governance have been examined. A descriptive research model was used to this end. In terms of research philosophy, a basic research model and a documentary research model have been created with regard to the application method. The universe of the research consists of studies obtained from Web of Science, EBSCO, Scopus, Google Scholar, and TR Index. Studies from the last 5 years have been downloaded with the determined keywords. The result showed that although there are studies that produce local solutions for cybersecurity governance in different countries, a general governance framework has not been established as yet. On the contrary, there is a latent struggle to retain the management of this area, not its governance.

Regular COVID-19 Pandemic Containment in Communities: A Risk Governance Perspective.

Post COVID-19, differentiated regular management in place of strict lockdowns is more favored as a feasible option for balancing economic resumption and pandemic control. China's transition experience shows that this stage came not easily, during which regional sporadic outbreaks could re-emerge. Actually, it is an ongoing process of identifying loopholes and refining the management. Based on the IRGC risk governance framework, this article analyzes these challenges in community involvement posed by the transition. The systematic examination of the whole risk chain would be conducive to contain the virus spread, lessen the pressure of communities for the battle and enhance future responses for a possible resurgence. Unlike the emergency mode with mass mobilized, during regular control periods, community becomes the critical frontline for suppressing COVID-19 but with limited manpower and resources. Still, it can serve as a transformation platform to motivate atomized residents to take responsibility or contribute. Notably, the health governance of all people never ends. With the increased knowledge of COVID-19, the progress of pandemic control, and the needed adjustments for behavioral responses, different communities should come up with more suitable options instead of rigid management back to the old days.

A Governance Framework to Assist with the Adoption of Sensing Technologies in Construction.

Sensing technologies present great improvements in construction performance including the safety, productivity, and quality. However, the corresponding applications in real projects are far behind compared with the academically research. This research aims to discover dominate influence factors in the sensing technologies adoption and ultimately develop a governance framework facilitating adoption processes. The framework is dedicated on general sensing technologies rather than single sensor in previous framework studies. To begin with, the influence factors of sensing technologies and other similar emerging technologies are summarised through a review. Then, a mixed methods design was employed to collect quantitative data through an online survey, and qualitative data through semi-structured interviews. Findings of the quantitative method reveal that the most widely implemented sensing technologies are GPS and visual sensing technology, but they're still not adopted by all construction companies. Partial Least Squares Structural Equation Modelling reveals that supplier characteristics have the highest effect in all influence factors. Qualitative method was adopted to investigate perceptions of construction stakeholders on the major decision-making considerations in the adoption process. Ultimately, a triangulation analysis of findings from the literature review, online survey and interviews resulted in the governance framework development. The overarching contribution of this research focus on the general adoption of sensing technologies rather than the adoption of a specific sensor. Therefore, the governance framework can assist with the decision-making process of any sensing technology adoption in construction.

Risk Governance of Emerging Technologies Demonstrated in Terms of its Applicability to Nanomaterials.

Nanotechnologies have reached maturity and market penetration that require nano-specific changes in legislation and harmonization among legislation domains, such as the amendments to REACH for nanomaterials (NMs) which came into force in 2020. Thus, an assessment of the components and regulatory boundaries of NMs risk governance is timely, alongside related methods and tools, as part of the global efforts to optimise nanosafety and integrate it into product design processes, via Safe(r)-by-Design (SbD) concepts. This paper provides an overview of the state-of-the-art regarding risk governance of NMs and lays out the theoretical basis for the development and implementation of an effective, trustworthy and transparent risk governance framework for NMs. The proposed framework enables continuous integration of the evolving state of the science, leverages best practice from contiguous disciplines and facilitates responsive re-thinking of nanosafety governance to meet future needs. To achieve and operationalise such framework, a science-based Risk Governance Council (RGC) for NMs is being developed. The framework will provide a toolkit for independent NMs' risk governance and integrates needs and views of stakeholders. An extension of this framework to relevant advanced materials and emerging technologies is also envisaged, in view of future foundations of risk research in Europe and globally.

A governance model for the application of AI in health care.

As the efficacy of artificial intelligence (AI) in improving aspects of healthcare delivery is increasingly becoming evident, it becomes likely that AI will be incorporated in routine clinical care in the near future. This promise has led to growing focus and investment in AI medical applications both from governmental organizations and technological companies. However, concern has been expressed about the ethical and regulatory aspects of the application of AI in health care. These concerns include the possibility of biases, lack of transparency with certain AI algorithms, privacy concerns with the data used for training AI models, and safety and liability issues with AI application in clinical environments. While there has been extensive discussion about the ethics of AI in health care, there has been little dialogue or recommendations as to how to practically address these concerns in health care. In this article, we propose a governance model that aims to not only address the ethical and regulatory issues that arise out of the application of AI in health care, but also stimulate further discussion about governance of AI in health care.

Managing "incidental findings" in biobank research: Recommendations of the Taiwan biobank.

BACKGROUND: In this article, incidental findings (IF) refer to unforeseen findings made possible through biobanking research and advances in medical diagnostic technologies that raise issues regarding the obligation and/or responsibility of biobank-users and biobanks to return clinically significant information to participants. The World Medical Association (WMA) Declaration of Taipei (2016) highlights the possibility of encountering IF and requires that research on biospecimens address biobank feedback policies in their informed consent process, leaving open the possibility that the policy may be "no return". As clinicians and researchers begin to use these "resources", the possibility of finding clinically significant IF is becoming a reality. DISCUSSION: In line with the WMA's Declaration of Taipei, a pragmatic approach is needed to deal with the issue of returning IF in biobank governance. Indeed, the impacts and concerns associated with the return of IF differ across different stakeholder groups and jurisdictions. Therefore, the framework governing IF return needs to be custom-built, taking into account the nature of each research project and the unique features of biobanks. To this end, in addition to facilitating biobank transparency, establishing an endurable and horizontal connection among biobanks and clinical institutions under a public health system will improve efficiency and effectiveness. Hence, subject to contemporary Taiwanese ethical and/or legal regulations, this article argues for the establishment of an updated framework for imaging-related and genetic-related IF return within the Taiwan Biobank (TWB), mainly based on a limited obligation to disclose life-threatening information revealed by imaging, but not genetic, information. SUMMARY: After discussing some of the ethical, legal and social issues encountered by the TWB and accounting for the experiences of other international biobanks, we propose a systematic framework for returning IF, mainly on a "limited obligation" basis, which offers better and more comprehensive protection for biobank-participants' rights and health.

Assessment of Public Hospital Governance in Romania: Lessons From 10 Case Studies.

BACKGROUND: The Government of Romania commissioned international technical assistance to help unpacking the causes of arrears in selected public hospitals. Emphases were placed on the governance-related determinants of the hospital performance in the context of the Romanian health system. METHODS: The assessment was structured around a public hospital governance framework examining 4 dimensions: institutional arrangements, financing arrangements, accountability arrangements and correspondence between responsibility and decision-making capacity. The framework was operationalized using a 2-pronged approach: (i) a policy review of broader health system governance arrangements influencing hospital performance; and (ii) a series of 10 casestudies of public hospitals experiencing financial hardship. Data were collected during 2016-2017 through key informant interviews with central authorities and hospital management teams, exhaustive semi-structured questionnaires filled in by hospitals, as well as the review of documentary sources where feasible. RESULTS: Overall, the governance landscape of Romanian public hospitals includes a large number of seemingly modern legislative provisions and management instruments. Over the past 30 years substantial efforts have been made to put in place standardised hospital classification, hospital governance structures, management and service purchasing contracts with key performance indicators, modern reimbursement mechanisms based on diagnosis-related groups (DRGs), and regulatory requirements for accountability, including internal and external audit. Nevertheless, their application appears to have been challenging for a range of reasons, pointing to the misalignment between the responsibility and decisionmaking capacity given to hospitals in a questionably conducive context. Incoherent policy design, outdated and often disjointed regulatory frameworks, and cumbersome administrative procedures limit managerial autonomy and obstruct efficiency gains. In a context of chronic insufficient funding, misaligned incentives, and overly rigid service procurement processes, hospitals seem to struggle to adjust service baskets to the population's health needs or to overcoming financial hardship. External challenges, combined with the limited strategic, operational, and financial management capacity within hospitals, make it difficult to exhibit good financial and general performance. CONCLUSION: Existing governance arrangements for Romanian public hospitals appear conducive to poor financial performance. The suggested framework for hospital governance assessment has proved a powerful tool for identifying system and hospital-specific challenges contributing to sub-optimal hospital performance.

Need for a new workplace safety and health (WSH) strategy for the fourth Industrial Revolution.

We are on the cusp of the fourth Industrial Revolution which promises to revolutionize the way we live and work. Throughout history, as society and technology progress, so too have our workplace safety and health (WSH) strategies in regard to better knowledge and enhanced regulation. In this paper, we argue for a new WSH 4.0 strategy which requires us to adopt an adaptive and highly responsive approach to promote Total Worker Health in the face of rapid technological advancements and changes in employment relationships. To do so, we propose a multi-pronged strategy comprising (i) adaptive WSH solutions in regard to surveillance, risk assessment, and control measures leveraging on new technologies; (ii) effective multi-stakeholder dialogues for collaborative and sustainable solutions; (iii) an anticipatory WSH governance framework based upon shared values and cooperative responsibility; and (iv) professional development among WSH practitioners. This new WSH 4.0 strategy will enable WSH professionals to remain effective in this coming Industrial Revolution.

What is good governance in the context of drug policy?

The concept of governance is applied in a wide range of contexts, but this paper focuses on governance in relation to public administration, i.e. states and how they take action, and specifically governance of particular policy areas. In the current context of financial austerity and an era of globalisation, policy-makers face pressures and challenges from a growing range of interests and local, national and supranational actors. Drug policy is an example of a particularly contentious and polarised area in which governance-related challenges abound. In response to these challenges, interest has grown in developing agreed policy governance standards and processes and articulating policy-making guidelines, including the use of available evidence to inform policy-making. Attempts have been made to identify 'policy fundamentals' - factors or aspects of policy-making apparently associated with successful policy development and implementation (Hallsworth & Rutter, 2011; Laughrin, 2011) and, in the drug policy field, Hughes et al. (2010) reflecting on the co-ordination of Australian drug policy highlighted some of what they considered principles of good governance. But how useful is the concept of 'good governance'; how well can it be defined, and to what purpose? As part of a wider project considering the governance of drug policy, RAND Europe and the UK Drug Policy Commission undertook a targeted review of other research and sought expert views, from within and beyond drug policy, on principles, processes, structures and stakeholders associated with good drug policy governance. From this emerged some perceived characteristics of good governance that were then used by the UK Drug Policy Commission to assess the extent to which drug policy making in the UK fits with these perceived good governance characteristics, and to suggest possible improvements. Particular consideration was given to the range of interests at stake, the overarching aims of drug policy and the development and inclusion of an evidence base where possible. This paper draws on findings of the study to highlight challenges associated with defining good governance, provides an example of a framework for assessing drug policy governance and discusses the feasibility, transferability and potential benefits of such an undertaking.