Patient safety topics, especially the second victim phenomenon, are neglected in undergraduate medical and nursing curricula in Europe: an online observational study.

This study aims to assess the inclusion of second victims and other patient safety issues in the curricula of undergraduate medical and nursing degrees in the countries participating in the European Researchers' Network Working on Second Victims (The ERSNT Consortium, COST Action 19,113). A review of medical and nursing school curricula in 206 universities was carried out, using their websites to search for subjects addressing "patient safety", "quality of care", "risk management", "safe practices", "interprofessional communication", "adverse events", and "second victims". There was substantial variability in the extent of training for patient safety. Forty-four out of 88 nursing schools and 74 of 118 medical schools did not include any of the patient safety topics studied. The most frequent in both nursing and medicine was "interprofessional communication", followed by "quality of care" and basic aspects on "patient safety". The second victim phenomenon was present in only one curriculum of the total sample. Our study showed that patient safety, especially the second victim phenomenon, is still neglected in medical and nursing curricula in European universities, although positive initiatives were also found. Given the frequency with which adverse events occur in health centres and the need to prepare students to deal with them adequately, additional efforts are needed to introduce patient safety elements into medical and nursing education.

A Review of the Applicability of Current Green Practices in Healthcare Facilities.

BACKGROUND: Circular economy (CE) has raised great interest as a concept and as a development model worldwide. This concept aims to provide a substitute for the linear economic model, which was based on production and consumption, continuous growth, and resources depletion. CE allows a greener economy with sustainable development and promotes more balanced societies. The healthcare sector is a major contributor to the climate crisis, with a carbon footprint representing 4.4% of global net emissions. It is thus essential to rethink the applicability of CE in healthcare. METHODS: We conducted a scoping review guided by the Arksey and O'Malley methodological framework and utilised PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist. A systematic search from MEDLINE complete, SCOPUS, and Web of Science databases published between 1992 and 2022. RESULTS: Through database searching a total of 1018 records were identified and 475 duplicates were removed. From the total search, 543 articles were screened by title/abstract according to the inclusion and exclusion criteria. After screening, 38 full-text articles were selected and assessed for eligibility. Forty-seven additional records were also identified through other sources and screened for eligibility. Other sources included: 12 articles from snowballing of previous papers; 9 articles following peer-reviewers suggestions; 19 reports from relevant organisations in CE and healthcare; two webpage, and one book. CONCLUSION: Specific areas were identified where hospitals could reduce their greenhouse gas (GHG) emissions and consequently their negative environmental impact, namely through waste management, energy, water, transportation/travel, hospital design, food optimisation, green procurement, and behaviour. Also, lack of staff awareness and knowledge of the environmental impact of healthcare, and hospitals sustainability were identified as major contributors.

PROTOCOL: Do hospital leadership styles predict patient safety indicators? A systematic review.

This is the protocol for a Campbell systematic review. The objectives are as follows: The main aim of this systematic review is to identify whether hospital leadership styles predict patient safety as measured through several indicators over time. The second aim is to assess the extent to which the prediction of hospital leadership styles on patient safety indicators varies as a function of the leader's hierarchy level in the organization.

Digital Practices by Citizens During the COVID-19 Pandemic: Findings From an International Multisite Study.

BACKGROUND: The COVID-19 pandemic brought digital practices and engagement to the forefront of society, which were based on behavioral changes associated with adhering to different government mandates. Further behavioral changes included transitioning from working in the office to working from home, with the use of various social media and communication platforms to maintain a level of social connectedness, especially given that many people who were living in different types of communities, such as rural, urban, and city spaces, were socially isolated from friends, family members, and community groups. Although there is a growing body of research exploring how technology is being used by people, there is limited information and insight about the digital practices employed across different age cohorts living in different physical spaces and residing in different countries. OBJECTIVE: This paper presents the findings from an international multisite study exploring the impact of social media and the internet on the health and well-being of individuals in different countries during the COVID-19 pandemic. METHODS: Data were collected via a series of online surveys deployed between April 4, 2020, and September 30, 2021. The age of respondents varied from 18 years to over 60 years across the 3 regions of Europe, Asia, and North America. On exploring the associations of technology use, social connectedness, and sociodemographic factors with loneliness and well-being through bivariate and multivariate analyses, significant differences were observed. RESULTS: The levels of loneliness were higher among respondents who used social media messengers or many social media apps than among those who did not use social media messengers or used ≤1 social media app. Additionally, the levels of loneliness were higher among respondents who were not members of an online community support group than among those who were members of an online community support group. Psychological well-being was significantly lower and loneliness was significantly higher among people living in small towns and rural areas than among those living in suburban and urban communities. Younger respondents (18-29 years old), single adults, unemployed individuals, and those with lower levels of education were more likely to experience loneliness. CONCLUSIONS: From an international and interdisciplinary perspective, policymakers and stakeholders should extend and explore interventions targeting loneliness experienced by single young adults and further examine how this may vary across geographies. The study findings have implications across the fields of gerontechnology, health sciences, social sciences, media communication, computers, and information technology. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.3389/fsoc.2020.574811.

Diffusion of person-centred care within 27 European countries - interviews with managers, officials, and researchers at the micro, meso, and macro levels.

PURPOSE: This study aimed to describe facilitators and barriers in terms of regulation and financing of healthcare due to the implementation and use of person-centred care (PCC). DESIGN/METHODOLOGY/APPROACH: A qualitative design was adopted, using interviews at three different levels: micro = hospital ward, meso = hospital management, and macro = national board/research. Inclusion criteria were staff working in healthcare as first line managers, hospital managers, and officials/researchers on national healthcare systems, such as Bismarck, Beveridge, and mixed/out-of-pocket models, to obtain a European perspective. FINDINGS: Countries, such as Great Britain and Scandinavia (Beveridge tax-based health systems), were inclined to implement and use person-centred care. The relative freedom of a market (Bismarck/mixed models) did not seem to nurture demand for PCC. In countries with an autocratic culture, that is, a high-power distance, such as Mediterranean countries, PCC was regarded as foreign and not applicable. Another reason for difficulties with PCC was the tendency for corruption to hinder equity and promote inertia in the healthcare system. RESEARCH LIMITATIONS/IMPLICATIONS: The sample of two to three participants divided into the micro, meso, and macro level for each included country was problematic to find due to contacts at national level, a bureaucratic way of working. Some information got caught in the system, and why data collection was inefficient and ran out of time. Therefore, a variation in participants at different levels (micro, meso, and macro) in different countries occurred. In addition, only 27 out of the 49 European countries were included, therefore, conclusions regarding healthcare system are limited. PRACTICAL IMPLICATIONS: Support at the managerial level, together with patient rights supported by European countries' laws, facilitated the diffusion of PCC. ORIGINALITY/VALUE: Fragmented health systems divided by separate policy documents or managerial roadmaps hindered local or regional policies and made it difficult to implement innovation as PCC. Therefore, support at the managerial level, together with patient rights supported by European countries' laws, facilitated the diffusion of PCC.

A systematic review of meta-research studies finds substantial methodological heterogeneity in citation analyses to monitor evidence-based research.

OBJECTIVES: This systematic review aimed to identify the characteristics and application of citation analyses in evaluating the justification, design, and placement of the research results of clinical health studies in the context of earlier similar studies. STUDY DESIGN AND SETTING: We searched MEDLINE (Ovid), Embase (Ovid), and the Cochrane Methodology Register for meta-research studies. We included meta-research studies assessing whether researchers used earlier similar studies and/or systematic reviews of such studies to inform the justification or design of a new study, whether researchers used systematic reviews to inform the interpretation of new results, and meta-research studies assessing whether redundant studies were published within a specific area. The results are presented as a narrative synthesis. RESULTS: A total of 27 studies were included. How authors of citation analyses define their outcomes appears rather arbitrary, as does how the reference of a landmark review or adherence to reporting guidelines was expected to contribute to the initiation, justification, design, or contextualization of relevant clinical trials. CONCLUSION: Continued and improved efforts to promote evidence-based research are needed, including clearly defined and justified outcomes in meta-research studies to monitor the implementation of an evidence-based approach.

Strategies for the Psychological Support of the Healthcare Workforce during the COVID-19 Pandemic: The ERNST Study.

The COVID-19 pandemic led to the implementation of interventions to provide emotional and psychological support to healthcare workers in many countries. This ecological study aims to describe the strategies implemented in different countries to support healthcare professionals during the outbreak. Data were collected through an online survey about the measures to address the impact of the pandemic on the mental health of healthcare workers. Healthcare professionals, researchers, and academics were invited to respond to the survey. Fifty-six professionals from 35 countries contributed data to this study. Ten countries (28.6%) reported that they did not launch any national interventions. Both developed and developing countries launched similar initiatives. There was no relationship between the existence of any type of initiative in a country with the incidence, lethality, and mortality rates of the country due to COVID-19, and per capita income in 2020. The 24 h hotline for psychological support was the most frequent intervention. Tools for self-rescue by using apps or websites were extensively used, too. Other common interventions were the development of action protocols, availability of regular and updated information, implantation of distance learning systems, early detection of infection programs for professionals, economic reinforcements, hiring of staff reinforcement, and modification of leave and vacation dates.

The relationship between leader support, staff influence over decision making, work pressure and patient satisfaction: a cross-sectional analysis of NHS datasets in England.

OBJECTIVE: To explore the relationships between leader support, staff influence over decisions, work pressure and patient satisfaction. DESIGN: A cross-sectional study of large National Health Service (NHS) datasets in England in 2010. SETTING AND PARTICIPANTS: 158 NHS acute hospital trusts in England (n=63 156) from all staff groups. PRIMARY AND SECONDARY OUTCOME MEASURES: Survey data measuring leader support, staff influence over decision making, staff work pressure and objective outcome data measuring patient satisfaction. RESULTS: Multilevel serial mediation analysis showed a significantly positive association between leader support and staff influence over decisions (B=0.74, SE=0.07, p<0.01). Furthermore, staff influence over decisions showed a negative association with staff work pressure (B=-0.84, SE=0.41, p<0.05) which in turn was negatively linked to patient satisfaction (B=-17.50, SE=4.34, p<0.01). Serial mediation showed a positive indirect effect of leader support on patient satisfaction via staff influence over decisions and work pressure (B=10.96, SE=5.55, p<0.05). CONCLUSIONS AND IMPLICATIONS: Our results provide evidence that leader support influences patient satisfaction through shaping staff experience, particularly staff influence over decisions and work pressure. Patients' care is dependent on the health, well-being, and effectiveness of the NHS workforce. That, in turn, is determined by the extent to which leaders are supportive in ensuring that work environments are managed in a way which protects the well-being of staff.

A review of literature on risk prediction tools for hospital readmissions in older adults.

PURPOSE: The purpose of this paper is to identify and analyse the readmission risk prediction tools reported in the literature and their benefits when it comes to healthcare organisations and management. DESIGN/METHODOLOGY/APPROACH: Readmission risk prediction is a growing topic of interest with the aim of identifying patients in particular those suffering from chronic diseases such as congestive heart failure, chronic obstructive pulmonary disease and diabetes, who are at risk of readmission. Several models have been developed with different levels of predictive ability. A structured and extensive literature search of several databases was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis strategy, and this yielded a total of 48,984 records. FINDINGS: Forty-three articles were selected for full-text and extensive review after following the screening process and according to the eligibility criteria. About 34 unique readmission risk prediction models were identified, in which their predictive ability ranged from poor to good (c statistic 0.5-0.86). Readmission rates ranged between 3.1 and 74.1% depending on the risk category. This review shows that readmission risk prediction is a complex process and is still relatively new as a concept and poorly understood. It confirms that readmission prediction models hold significant accuracy at identifying patients at higher risk for such an event within specific context. RESEARCH LIMITATIONS/IMPLICATIONS: Since most prediction models were developed for specific populations, conditions or hospital settings, the generalisability and transferability of the predictions across wider or other contexts may be difficult to achieve. Therefore, the value of prediction models remains limited to hospital management. Future research is indicated in this regard. ORIGINALITY/VALUE: This review is the first to cover readmission risk prediction tools that have been published in the literature since 2011, thereby providing an assessment of the relevance of this crucial KPI to health organisations and managers.

Defining Delayed Discharges of Inpatients and Their Impact in Acute Hospital Care: A Scoping Review.

BACKGROUND: With the ever-increasing demand on acute healthcare, the hospital discharge process and delayed discharges are considered relevant in achieving optimal performance in clinical settings. The purpose of this paper is to review the literature to identify conceptual and operational definitions of delayed discharges, identify causes and effects of delayed discharges, and also to explore the literature for interventions aimed at decreasing the impact (in terms of reducing the number/rate of delays) of delayed discharges in acute healthcare settings. METHODS: An extensive literature search yielded a total of 26 248 records. Sixty-four research articles were included in the scoping review after considering inclusion/exclusion criteria and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) search strategy. The following databases were utilized: Cochrane, EBSCO, PubMed, PubMed Central, Medline, and Web of Science. The search was carried out between January 2017 and March 2020 and covered literature ranging from 1990 to 2019. Results were reviewed by authors for duplicates and filtered using the inclusion/ exclusion criteria. Tables were created to classify the chosen articles (n = 64), allowing us to organise findings and results. RESULTS: Conceptual and operational definitions were analysed. In turn, causes and effects of delayed discharges were extracted and represented in diagrammatic format, together with specific interventions used in acute healthcare settings to lessen the effect of delayed discharges. Operational definitions of delayed discharges were found to be more difficult to establish, particularly in the light of the vast number of different scenarios and workplace interventions uncovered in the literature. The main causes of delayed discharges were faulty organisational management, inadequate discharge planning, transfer of care problems, and age. The main effects were bed-blocking, A&E (Accident & Emergency) overcrowding, and financial implications. The main interventions included 'discharge before noon' initiative, 'discharge facilitation tools,' 'discharge delay tracking' mechanisms, and the role of general practitioners and social care staff. CONCLUSION: This paper fills a gap in the fragmented literature on delayed inpatient discharges by providing a researchbased perspective on conceptual and operational definitions, causes and effects, as well as interventions to minimize their impact. The findings and definitions are intended as points of reference for future research.

Testing cost containment of future healthcare with maintained or improved quality-The COSTCARES project.

BACKGROUND: Increasing healthcare costs need to be contained in order to maintain equality of access to care for all EU citizens. A cross-disciplinary consortium of experts was supported by the EU FP7 research programme, to produce a roadmap on cost containment, while maintaining or improving the quality of healthcare. The roadmap comprises two drivers: person-centred care and health promotion; five critical enablers also need to be addressed: information technology, quality measures, infrastructure, incentive systems, and contracting strategies. METHOD: In order to develop and test the roadmap, a COST Action project was initiated: COST-CARES, with 28 participating countries. This paper provides an overview of evidence about the effects of each of the identified enablers. Intersections between the drivers and the enablers are identified as critical for the success of future cost containment, in tandem with maintained or improved quality in healthcare. This will require further exploration through testing. CONCLUSION: Cost containment of future healthcare, with maintained or improved quality, needs to be addressed through a concerted approach of testing key factors. We propose a framework for test lab design based on these drivers and enablers in different European countries.

Corporate social responsibility and internal stakeholders' health and well-being in Europe: a systematic descriptive review.

Corporate social responsibility (CSR) can contribute to the triple bottom line of economic, social and environmental performance in organizations. However, the relationship between CSR, employee health and well-being has not been frequently assessed despite an increased awareness that this relationship can contribute to sustainable workplaces. To identify studies addressing the relationship between CSR and employee health and well-being within the EuCIropean context, we conducted a systematic literature search using Web of Science and Medline. Of the 60 articles screened for inclusion, 16 were retained. The results suggest that the majority (n = 14) of the identified studies aimed to understand the impact of CSR strategies on employees' job satisfaction. None of the studies investigated the relationship between internal CSR and physical health. There was no clarity in the measurement of either internal CSR or the extent to which it affected employee outcomes. There is a need for consensus on measurement of internal CSR and of the health and well-being-related outcomes. Public health and occupational health researchers should be part of the discussion on the potential role of CSR in physical and psychological health outcomes beyond job satisfaction.

Supporting Innovative Person-Centred Care in Financially Constrained Environments: The WE CARE Exploratory Health Laboratory Evaluation Strategy.

The COST CARES project aims to support healthcare cost containment and improve healthcare quality across Europe by developing the research and development necessary for person-centred care (PCC) and health promotion. This paper presents an overview evaluation strategy for testing 'Exploratory Health Laboratories' to deliver these aims. Our strategy is theory driven and evidence based, and developed through a multi-disciplinary and European-wide team. Specifically, we define the key approach and essential criteria necessary to evaluate initial testing, and on-going large-scale implementation with a core set of accompanying methods (metrics, models, and measurements). This paper also outlines the enabling mechanisms that support the development of the "Health Labs" towards innovative models of ethically grounded and evidenced-based PCC.

Person-Centered Care From a Relational Ethics Perspective for the Delivery of High Quality and Safe Healthcare: A Scoping Review.

Background: The aim of this scoping review is to explore whether or not person-centered care (PCC), in its quest to deliver high quality and safe health care, has a relational-ethics perspective. To do so, we first need to relate the extant literature pertaining to PCC and relational ethics. To this extent, the specific features that define PCC and relational ethics were identified. PCC dimensions include: patient and provider concordance, improved health outcomes, improved patient safety, individual expectations, patients' integration within the environment, patient as a person, patient as an active part of society, dialogue and interaction, sharing experience, and documentation of patient's (person's) narrative. Relational ethics framework includes the following actions: mutual respect, engagement, embodied knowledge, environment, and uncertainty. Methods: Data were retrieved through multiple keywords search on PubMed, Medline, and Scopus. Inclusion/exclusion criteria were set, and these were based on year of publication (2008-2018), language, paper focus, research method and document types. A total of 23 articles (N = 23) were selected and reviewed. Content analysis was conducted in order to identify and compare the main features of PCC and relational ethics. Results: The most important relational ethics action referred to in conjunction with PCC features is environment (referred to as person's integration within a social environment/community). This is followed by mutual respect, engagement and embodied knowledge. These were the salient relational ethics actions both directly and indirectly linked to PCC. Uncertainty was the less recurrent relational ethical action mentioned. Conclusions: This paper revealed that while PCC features embrace most of the relational ethics approaches, these are not exploited in their entirety and therefore PCC emerges as a unique ethical stance in healthcare. PCC's ethical approach goes beyond what is explained within provider-patient relational ethics and emphasizes that the patient is an active person and a partner in care with capabilities and resources. This distinction enables us to explain the paradigm shift from "patient-centered" to "person-centered" care. The healthcare provider partnership and co-creation of the healthcare plan contributes to the delivery of high quality, safe and cost-contained healthcare.

COVID-19: Technology, Social Connections, Loneliness, and Leisure Activities: An International Study Protocol.

Drawn from the stress process model, the pandemic has imposed substantial stress to individual economic and mental well-being and has brought unprecedented disruptions to social life. In light of social distancing measures, and in particular physical distancing because of lockdown policies, the use of digital technologies has been regarded as the alternative to maintain economic and social activities. This paper aims to describe the design and implementation of an online survey created as an urgent, international response to the COVID-19 pandemic. The online survey described here responds to the need of understanding the effects of the pandemic on social interactions/relations and to provide findings on the extent to which digital technology is being utilized by citizens across different communities and countries around the world. It also aims to analyze the association of use of digital technologies with psychological well-being and levels of loneliness. The data will be based on the ongoing survey (comprised of several existing and validated instruments on digital use, psychological well-being and loneliness), open for 3 months after roll out (ends September) across 11 countries (Austria, France, Germany, India, Malta, Portugal, Romania, Spain, Turkey, and UK). Participants include residents aged 18 years and older in the countries and snowball sampling is employed via social media platforms. We anticipate that the findings of the survey will provide useful and much needed information on the prevalence of use and intensities of digital technologies among different age groups, gender, socioeconomic groups in a comparative perspective. Moreover, we expect that the future analysis of the data collected will show that different types of digital technologies and intensities of use are associated with psychological well-being and loneliness. To conclude, these findings from the study are expected to bring in our understanding the role of digital technologies in affecting individual social and emotional connections during a crisis.

The Personal and Professional Consequences of Physician Burnout: A Systematic Review of the Literature.

The well-being of the health care workforce has emerged as both a major concern and as a component of the "quadruple aim" to enable the "triple aim" of improving patient experiences, reducing costs, and improving population health. Physician burnout is problematic given its effects on physicians, patients, health care organizations, and society. Using conservation of resources theory as a frame, we conducted a systematic review of the empirical literature on the relationship of physician burnout with physician personal and professional outcomes that includes 43 articles. Nine outcomes were organized into three categories illustrating burnout as a dynamic loss spiral rather than a static end-state. Findings show that emotional exhaustion had the greatest impact with the outcomes explored, while depersonalization and lack of professional accomplishment manifested fewer associations. The results suggest that burnout is a complex, dynamic phenomenon, which unfolds over time. Future research and implications of these results are discussed.

Inclusion of Older Adults in the Research and Design of Digital Technology.

Digital technology holds a promise to improve older adults' well-being and promote ageing in place. However, there seems to be a discrepancy between digital technologies that are developed and what older adults actually want and need. Ageing is stereotypically framed as a problem needed to be fixed, and older adults are considered to be frail and incompetent. Not surprisingly, many of the technologies developed for the use of older adults focus on care. The exclusion of older adults from the research and design of digital technology is often based on such negative stereotypes. In this opinion article, we argue that the inclusion rather than exclusion of older adults in the design process and research of digital technology is essential if technology is to fulfill the promise of improving well-being. We emphasize why this is important while also providing guidelines, evidence from the literature, and examples on how to do so. We unequivocally state that designers and researchers should make every effort to ensure the involvement of older adults in the design process and research of digital technology. Based on this paper, we suggest that ageism in the design process of digital technology might play a role as a possible barrier of adopting technology.