Health and health care in Israel: an introduction.

Starting well before Independence in 1948, and over the ensuing six decades, Israel has built a robust, relatively efficient public system of health care, resulting in good health statistics throughout the life course. Because of the initiative of people living under the British Mandate for Palestine (1922-48), the development of many of today's health services predated the state's establishment by several decades. An extensive array of high-quality services and technologies is available to all residents, largely free at point of service, via the promulgation of the 1994 National Health Insurance Law. In addition to a strong medical academic culture, well equipped (albeit crowded) hospitals, and a robust primary-care infrastructure, the country has also developed some model national projects such as a programme for community quality indicators, an annual update of the national basket of services, and a strong system of research and education. Challenges include increasing privatisation of what was once largely a public system, and the underfunding in various sectors resulting in, among other challenges, relatively few acute hospital beds. Despite substantial organisational and financial investment, disparities persist based on ethnic origin or religion, other socioeconomic factors, and, regardless of the country's small size, a geographic maldistribution of resources. The Ministry of Health continues to be involved in the ownership and administration of many general hospitals and the direct payment for some health services (eg, geriatric institutional care), activities that distract it from its main task of planning for and supervising the whole health structure. Although the health-care system itself is very well integrated in relation to the country's two main ethnic groups (Israeli Arabs and Israeli Jews), we think that health in its widest sense might help provide a bridge to peace and reconciliation between the country and its neighbours.

A clinical governance framework for blood services.

BACKGROUND AND OBJECTIVES: The elements of clinical governance, which ensure excellence in clinical care, can be applied to blood services. In this survey, their application in a range of blood providers was gauged, with the aim of identifying best practice and producing a generalizable framework. MATERIALS AND METHODS: The Medical Directors of members of the Alliance of Blood Operators surveyed how different elements of clinical governance operated within their organizations and developed recommendations applicable in the blood service environment. RESULTS: The recommendations that emerged highlighted the importance of an organization's culture, with the delivery of optimal clinical governance being a corporate responsibility. Senior management must agree and promote a set of values to ensure that the system operates with the patient and donor at its heart. All staff should understand how their role fits into the 'journey to the patient', and a culture of openness promoted. Thus, reporting of errors and risks should be actively sought and praised, with penalties applied for concealment. Systems should exist to collect, analyse and escalate clinical outcomes, safety data, clinical risk assessments, incident reports and complaints to inform organizational learning. CONCLUSION: Clinical governance principles from general health care can be applied within blood services to complement good manufacturing practice. This requires leadership, accountability, an open culture and a drive for continuous improvement and excellence in clinical care.

[Petitioning for prosecution in the event of violation of the requirement to provide responsible health care]. / Påtalebegjæring ved brudd på kravet om forsvarlig helsehjelp.

BACKGROUND: The Norwegian Board of Health Supervision can petition for prosecution of health care personnel or facilities. The purpose of the survey is to find out what circumstances will prompt the Norwegian Board of Health Supervision to petition for prosecution of doctors and/or facilities for violation of the requirement of responsible conduct, how often this happens and what the outcome is. MATERIAL AND METHOD: Petitions for prosecution in the period 1 February 2002 - 31 October 2008 were reviewed. The data stem mainly from two databases containing about 11 500 cases brought before the Norwegian Board of Health Supervision. RESULTS: During the period, the Boards of Health Supervision at county level petitioned for prosecution in some 7,700 cases where doctors and/or facilities had failed to provide responsible health care. Unsound professional practice was found in about 2400 cases. The Board of Health Supervision petitioned for 19 prosecutions in 16 cases (0.7 %), in 9 of them against doctors and in 10 against facilities. Of the cases against doctors, four ended with fines, four were dismissed and in one a ruling has not yet been handed down. Eight facilities were fined, while the cases against two of them were dismissed. The number of petitions for prosecution has shown a declining tendency during the period. INTERPRETATION: The initiation of criminal proceedings against doctors and facilities is relegated by the Norwegian Board of Health Supervision to a minor position among its supervisory activities.

Underdiagnosis and undertreatment of migraine in Italy: a survey of patients attending for the first time 10 headache centres.

The aim of this study was to asses the clinical features, pattern of healthcare and drug utilization of migraine patients attending 10 Italian headache centres (HC). Migraine is underdiagnosed and undertreated everywhere throughout the world, despite its considerable burden. Migraine sufferers often deal with their problem alone using self-prescribing drugs, whereas triptans are used by a small proportion of patients. All patients attending for the first time 10 Italian HCs over a 3-month period were screened for migraine. Migraine patients underwent a structured direct interview about previous migraine diagnosis, comorbidity, headache treatments and their side-effects and healthcare utilization for migraine. Patient satisfaction with their usual therapy for the migraine attack was evaluated with the Migraine-Assessment of Current Therapy (ACT) questionnaire. The quality of life of migraine patients was assessed by mean of Short Form (SF)-12 and Migraine-Specific Quality of life (MSQ) version 2.1 questionnaires. Of the 2675 patients who attended HCs for the first time during the study period, 71% received a diagnosis of migraine and the first 953 subjects completed the study out of 1025 patients enrolled. Only 26.8% of migraine patients had a previous diagnosis of migraine; 62.4% of them visited their general practitioner (GP) in the last year, 38.2% saw a specialist for headache, 23% attended an Emergency Department and 4.5% were admitted to hospital for migraine; 82.8% of patients used non-specific drugs for migraine attacks, whereas 17.2% used triptans and only 4.8% used a preventive migraine medication. Triptans were used by 46.4% of patients with a previous diagnosis of migraine. About 80% of migraine patients took over-the-counter medications. The Migraine-ACT revealed that 60% of patients needed a change in their treatment of migraine attacks, 85% of whom took non-specific drugs. Both the MSQ version 2.1 and the SF-12 questionnaires indicated a poor quality of life of most patients. Migraine represents the prevalent headache diagnosis in Italian HCs. Migraine is still underdiagnosed in Italy and migraine patients receive a suboptimal medical approach in our country, despite the healthcare utilization of migraine subjects being noteworthy. A cooperative network involving GPs, neurologists and headache specialists is strongly desirable in order to improve long-term migraine management in Italy.

Personal protective equipment provision in prehospital care: a national survey.

BACKGROUND: Safety in prehospital practice is a paramount principle. Personal protective equipment (PPE) use is intrinsic to safe practice. There is varied guidance as to what constitutes effective PPE. No evidence is available of what current provision encompasses. METHODS: A questionnaire-based study directed to all ambulance trusts, British Association for Immediate Care (BASICS) schemes and air ambulance operations in England, Scotland and Wales. RESULTS: Total response rate was in excess of 66%. A specific protocol for PPE use was issued by 81%, 89% and 38% of ambulance trusts, air ambulance and BASICS schemes, respectively. There was a wide variation in provision of PPE both within and between different groups of providers. Fewer than 55% of providers had an evaluation system in place for reviewing PPE use. CONCLUSIONS: Many reasons account for the differences in provision. There is a clear need for a standard to be set nationally in conjunction with locally implemented evaluation and re-accreditation processes.

Does Clinical Governance influence the quality of medical records?

BACKGROUND: Clinical Governance (CG) is a validated framework for continuous quality improvement in health care settings. Quality medical records may reflect the quality of care delivered and are a viable tool to implement CG skills. AIM: Aim of this study is to investigate the correlation between the level of implementation of CG dimensions and the quality of medical records. MATERIAL AND METHODS: A cross-sectional study was carried out in an Italian Teaching Hospital. CG implementation levels were quantified through a systematic methodology (OPTIGOV©). The overall quality of medical records was measured through a revised version of a National-validated scale. A multiple linear regression model was used to test the likely influence of all the variables constituting the OPTIGOV evaluation on the quality of medical records. 47 hospital wards and 1458 medical records were assessed. RESULTS: A significant and positive association between the quality of medical records and the accountability score (ß = 0.15; p < 0.01) and the clinical audit score (b = 0.11; p = 0.02), was found. Conversely, the risk management score shown a negative and significant correlation (b = -0.17; p < 0.01). This study confirms that CG plays a central role in driving quality improvement and advocates a systematic implementation of such an approach within healthcare organizations.

Monitoring a Prison Opioid Treatment Program Over a Period of Change to Clinical Governance Arrangements, 2007-2013.

BACKGROUND AND AIMS: Opioid substitution therapy (OST) is an effective treatment for opioid dependence that is provided in many correctional settings, including New South Wales (NSW), Australia. In 2011, changes to the clinical governance of the NSW prison OST program were implemented, including a more comprehensive assessment, additional specialist nurses, and centralization of program management and planning. This study aimed to document the NSW prison OST program, and assess the impact of the enhanced clinical governance arrangements on retention in treatment until release, the provision of an OST prescription to patients at release, and presentation to a community OST clinic within 48 hours of release from custody. METHOD: Data from the NSW prison OST program were obtained for the calendar years 2007-2013. Outcomes were analyzed quarterly using log binomial segmented regression. RESULTS: 8577 people were treated with OST in NSW correctional centers, 2007-2013. Over the entire study period, patients were retained in OST until release in 82% of treatment episodes; a prescription for OST was able to be arranged prior to release in 90% of releases; and patients presented to a community clinic within 48 hours of release in 94% of releases with prescriptions. Following the introduction of the changes to clinical governance, there was a significant increasing trend in retention in OST until release, and in provision of an OST prescription at release. There was an initial increase, followed by a decreasing trend, in presentation to a community clinic within 48 hours of release. DISCUSSION: This large prison-based OST program has high rates of retention in treatment and continuity of care as patients transition from custody to the community. Strengthened clinical governance arrangements were associated with increased retention in treatment until release and increased provision of an OST prescription at release, but did not improve clinic attendance following release from custody.

From boundary concept to boundary object: the practice and politics of care pathway development.

Care pathways are multidisciplinary care management technologies which map out chronologically activities in a healthcare process. In the UK, they are advanced as a mechanism for enacting the changes called for under clinical governance. The terminological imprecision of care pathway methodology has enabled it to align clinical, management and service user interests and helps to explain the growing popularity of care pathways as quality improvement tools. Whilst it is possible to identify a 'zone of agreement' between these social worlds, there exists a fuzzy periphery characterised by conflicting agendas, which presents challenges for those charged with inscribing these interests into the pathway artefact. Drawing on a qualitative case study of a mental health safety care pathway in the UK, this paper examines the processes by which originators negotiated and settled upon a given design. The data reveal inherent tensions within pathway technology and the knowledge developers draw upon in devising strategies to overcome these challenges.

Construcción y validación del cuestionario G-Clinic para medir la satisfacción laboral en profesionales de enfermería de las unidades de gestión clínica / G-Clinic Questionnaire to assess job satisfaction in the clinical management units, Spain

Fundamentos: La satisfacción laboral de los profesionales de enfermería es un factor determinante en la calidad y adaptación organizativa de los modelos de gestión clínica en el actual contexto socioeconómico. El objetivo del estudio fue construir y validar un cuestionario para conocer el nivel de satisfacción laboral de los profesionales enfermeros en las Unidades de Gestión Clínica en el Sistema Sanitario Público Andaluz. Métodos: Estudio clinimétrico y transversal, tomando como muestra a 314 profesionales de enfermería pertenecientes a los Hospitales Universitarios Virgen del Rocío y Virgen Macarena de Sevilla. Las encuestas se realizaron en 2011, entre los meses de marzo a junio. Se utilizó como base el cuestionario Font Roja adaptado a las variables de nuestra investigación. Se realizó el análisis de correlaciones, fiabilidad, validez de constructo mediante Análisis Factorial Exploratorio (AFE) y Análisis Factorial Confirmatorio (AFC) para comprobar el modelo apriorístico. Resultados: Se construyó un cuestionario con 10 ítems, cuya consistencia interna es de 0,75 con un porcentaje explicativo de la varianza del 63,67%. El AFC corroboró 4 dimensiones (clima laboral, relaciones laborales, motivación y reconocimiento): χ2 significativo (p<,001); χ2/gl=2,013; GFI=0,958, RMR=0,055 y RMSEA=0,057; AGFI=0,927, NFI=0,878, TLI=0,902, CFI=0,933 e IFI=0,935; AIC=132,486 y EC- VI=0,423. Conclusiones: Este nuevo cuestionario (G_Clinic) mejora los valores del cuestionario Font Roja, ya que disminuye el número de ítems, mejora la fiabilidad de cada una de las dimensiones, aumenta el valor de la varianza explicada y posibilita conoce la satisfacción de los profesionales de enfermería en la gestión clínica (AU)

Background: Job satisfaction of nurses is a determinant factor in the quality and organizational adaptation of clinical management models in the current socio-economic context. The aim of this study was to construct and validate a questionnaire to measure job satisfaction of nurses in the Clinical Management Units in the Andalusian Public Health System. Methods: Clinimetric and cross-sectional study with a sample of 314 nurses of two university hospitals from Seville. Nurses were surveyed in 2011, from March to June. We used the Font Roja questionnaire adapted to our study variables. We performed analyses of correlations, reliability and construct validity, using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to test the a priori model. Results: The end questionnaire consists of 10 items, whose internal consistency was 0.75, with a percentage of variance explaining of 63.67%. CFA confirmed 4 dimensions (work environment, work relationships, motivation, and recognition): significant χ2 (p < .001); χ2/gl = 2.013; GFI= 0.958, RMR = 0.055 y RMSEA = 0.057; AGFI = 0.927, NFI = 0.878, TLI = 0.902, CFI = 0.933 e IFI = 0.935; AIC = 132.486 y ECVI = 0.423. Conclusion: This new questionnaire (G_Clinic) improves clinimetric values of the Font Roja questionnaire, because it reduces the number of items, improves the reliability of the dimensions, increases the value of variance explained, and allows knowing job satisfaction of nurses in clinical managementt (AU)

Améliorer la gouvernance pour la viabilisation du district de santé au Cameroun

Au début de la décennie 90, le Cameroun a mis en œuvre un système de santé décentralisé conformément aux cadres conceptuels du district de santé et des soins de santé primaires recommandés par le Bureau régional de l'Organisation mondiale de la Santé (AFRO). Des structures de dialogue communautaire ont été mises en place en tant qu'instances dirigeantes, dans le but d'améliorer la réceptivité aux doléances des usagers et l'équité, mais également pour favoriser la participation dans le financement et la gestion du service public de santé. Cette gouvernance participative se proposait d'améliorer la prise en compte des valeurs et préférences des acteurs de terrain (fonctionnaires, gestionnaires, soignants, communautés et patients), de les responsabiliser davantage et de renforcer le système de santé du district afin d'améliorer l'état de santé des populations. Lors de l'évaluation à mi-parcours de la Stratégie du secteur de la santé (SSS) 2001-2010, les parties prenantes ont exprimé leur insatisfaction quant à la performance du système et identifié la mauvaise gouvernance et le faible niveau de viabilisation des districts de santé comme étant les principales raisons de l'incapacité du Cameroun à atteindre les Objectifs du millénaire pour le développement (OMD) liés à la santé. Plusieurs facteurs sous-jacents ont été identifiés s'agissant de l'incapacité à mettre effectivement en œuvre la réforme de décentralisation/déconcentration dans le secteur de la santé. Aussi a-t-il été retenu que l'amélioration de la gouvernance du district de santé soit une priorité majeure de la stratégie sectorielle de santé révisée pour la période 2001- 2015. Le Secrétariat technique du Comité et de suivi pour la mise en œuvre de la SSS a demandé au Centre pour le Développement des Bonnes Pratiques en Santé (CDBPS) de synthétiser les bases factuelles relatives à la gouvernance sanitaire.