Scenarios for Assessing Leadership Behaviors of Mid-level Managers in the Greek National Health System Through the Lens of Servant Leadership Theory: A Pilot Study in the Hospital Cluster of North Attica.

This study aimed to develop a scenario-based questionnaire for evaluating medium-level leadership behaviors within the Greek National Healthcare System (NHS), drawing upon the principles of servant leadership theory. Data for this pilot study were collected in the first quarter of 2019, using a sample of 33 (22.9% of all medium-level managerial positions) medium-level managers from the Greek NHS hospital cluster located in North Attica. To assess managerial behaviors, an ordinal scale was employed, revealing non-normal data distributions. Consequently, our analysis involved presenting descriptive statistics, utilizing non-parametric tests to explore distinctions in managerial behaviors, and conducting thematic analysis of responses to open-ended questions, with frequencies and relative frequencies of each theme meticulously recorded. Overall, our findings indicate that, in most cases, managers exhibited positive behaviors toward their employees, regardless of whether the outcomes were positive, negative, or unknown. Positive behaviors towards the administration were comparatively rare. Significant differences were observed, highlighting that managers were more inclined to exhibit positive behaviors when the outcome was known, particularly in scenarios involving employee management. Within each scenario, behavioral patterns varied, with managers demonstrating a propensity to take credit for employee success in positive outcomes but distancing themselves from negative outcomes when reporting to the administration. Furthermore, the survey responses underscored the prevalence of positive attitudes regarding accountability and stewardship, with stewardship showing a positive correlation with scenario-based behaviors. Finally, our study brought to light several challenges in the management of the Greek NHS, including the absence of comprehensive managerial evaluation, the lack of meritocracy, regulatory deficiencies, and a shortage of leadership skills among current managers. These findings emphasize the importance of scenario-based assessments for Greek hospital managers, as they can help connect managerial behaviors to stewardship, accountability, and skills, ultimately contributing to the enhancement of leadership within the Greek NHS.

The Existence-Relatedness-Growth Theory for Job Satisfaction and Motivation of Greek National Healthcare Service Employees in the Context of Severe Financial Constraints.

The hospital environment is often quite complicated due to interdisciplinary workflow procedures and multitasking staff, which are exacerbated during periods of economic crisis. This study aimed to examine the motivation and job satisfaction factors of Greek National Healthcare Service (NHS) employees in relation to the Existence-Relatedness-Growth (ERG) theory of motivation during a period of severe financial constraints. A cross-sectional study was conducted in three public hospitals in Greece from 2018 to 2019, utilizing a survey tool to measure the factors of motivation and job satisfaction among Greek NHS employees. The study also aimed to identify the most relevant motivational theory applicable to the complex Greek hospital environment. Exploratory factor analysis (EFA) was employed to extract the structural factors of the survey tool, and analysis of variance (ANOVA) was used to identify statistical differences between the means of three or more independent groups. A sample of 363 Greek NHS employees participated in this study. Statistically significant differences were detected between hospital units and job satisfaction factors, as well as between the functions of hospital clusters and job positions. Specifically, managerial staff presented higher levels of job satisfaction, while nursing staff had the lowest scores in terms of psychological contracts when compared to medical and administrative staff. This study demonstrated that job satisfaction in Greek public hospitals, in a context of severe financial constraints, was mainly driven by strong interpersonal connections and employee trust in management, despite significant cuts in salaries, staff numbers, and hospital budgets.

A 2-Year Single-Centre Audit on Antibiotic Resistance of Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae Strains from an Intensive Care Unit and Other Wards in a General Public Hospital in Greece.

Hospital-acquired infections, particularly in the critical care setting, are becoming increasingly common during the last decade, with Gram-negative bacterial infections presenting the highest incidence among them. Multi-drug-resistant (MDR) Gram-negative infections are associated with high morbidity and mortality, with significant direct and indirect costs resulting from long hospitalization due to antibiotic failure. As treatment options become limited, antimicrobial stewardship programs aim to optimize the appropriate use of currently available antimicrobial agents and decrease hospital costs. Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae are the most common resistant bacteria encountered in intensive care units (ICUs) and other wards. To establish preventive measures, it is important to know the prevalence of Gram-negative isolated bacteria and antibiotic resistance profiles in each ward separately, compared with ICUs. In our single centre study, we compared the resistance levels per antibiotic of P. aeruginosa, A. baumannii and K.pneumoniae clinical strains between the ICU and other facilities during a 2-year period in one of the largest public tertiary hospitals in Greece. The analysis revealed a statistically significant higher antibiotic resistance of the three bacteria in the ICU isolates compared with those from other wards. ICU strains of P. aeruginosa presented the highest resistance rates to gentamycin (57.97%) and cefepime (56.67%), followed by fluoroquinolones (55.11%) and carbapenems (55.02%), while a sensitivity rate of 97.41% was reported to colistin. A high resistance rate of over 80% of A. baumannii isolates to most classes of antibiotics was identified in both the ICU environment and regular wards, with the lowest resistance rates reported to colistin (53.37% in ICU versus an average value of 31.40% in the wards). Statistically significant higher levels of resistance to most antibiotics were noted in ICU isolates of K. pneumoniae compared with non-ICU isolates, with the highest difference-up to 48.86%-reported to carbapenems. The maximum overall antibiotic resistance in our ICU was reported for Acinetobacter spp. (93.00%), followed by Klebsiella spp. (72.30%) and Pseudomonas spp. (49.03%).

Using Microbiological Data Analysis to Tackle Antibiotic Resistance of Klebsiella Pneumoniae.

Optimal antibiotic use for the treatment of nosocomial infections plays a central role in the effort to control the rapidly increasing prevalence of multidrug-resistant bacteria. Antibiotic selection should be based on accurate knowledge of local susceptibility rates. Traditional methods of resistance reporting, which are in routine use by microbiology laboratories could be enhanced by using statistically significant results. We present a method of reporting based on antibiotic susceptibility data analysis which offers an accurate tool that reduces clinician uncertainty and enables optimization of the antibiotic selection process.