Patient Safety Perception Within Hospitals: An Examination of Job Type, Handoffs and Information Exchange, and Hospital Management Support.

OBJECTIVES: The study has 3 aims: (1) to assess to what extent a person's job role relates to their evaluation of patient safety in the hospital setting; 2) to identify the relationship from hospital management aspects, including level of organizational learning-continuous improvement, level of management support, and level of leader support to patient safety perception in the hospital setting; and 3) to examine the relationship between the rating of the ease of information exchange and clinical handoffs and perceived patient safety in the hospital setting. METHODS: This study used a publicly available, deidentified cross-sectional data set from the 2021 Agency for Healthcare Research and Quality's Survey on Patient Safety Culture Hospital Survey 2.0. Welch's analysis of variance and multiple linear regression were used to examine each factor's impact on patient safety rating. RESULTS: Supervisors had a higher ( P < 0.001) patient safety perception than people in other job types, whereas nurses had a lower ( P < 0.001) patient safety perception than other job types. Level of organizational learning-continuous improvement ( P < 0.001), level of hospital management ( P < 0.001), level of leader support ( P < 0.001), and ease of handoffs and information exchange ( P < 0.001) were positively related to perceived patient safety. CONCLUSIONS: This study highlights the importance of identifying the unique issues affecting nurses and supervisors, different from other job types, that may explain their lower patient safety ratings. Findings from this study suggest that it is critical for organizations to focus on initiatives and policies that promote leadership, management, ease in information exchange and handoffs, and continuous learning.

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)

Навчання для менеджерів середньої ланки: модуль 8. Забезпечення епідеміологічного нагляду

Цей новий цикл модулів з навчання імунізації для менеджерів середньої ланки замінюєверсію, опубліковану в 1991 році. Оскільки з того часу в галузі імунізації відбулось чимало змін, ці модулі були розроблені, щоб надати менеджерам з питань імунізації актуальну технічну інформацію та пояснити, як розпізнавати управлінські та технічні проблеми і вживати коригувальних заходів, а також як найкраще використовувати ресурси.

Навчання для менеджерів середньої ланки: модуль 7. Дослідження охоплення розширеної програми імунізації

Цей новий цикл модулів з навчання імунізації для менеджерів середньої ланки замінюєверсію, опубліковану в 1991 році. Оскільки з того часу в галузі імунізації відбулось чимало змін, ці модулі були розроблені, щоб надати менеджерам з питань імунізації актуальну технічну інформацію та пояснити, як розпізнавати управлінські та технічні проблеми і вживати коригувальних заходів, а також як найкраще використовувати ресурси.

Навчання для менедже- рів середньої ланки: модуль 6. Cкладання комплексного річного національного плану імунізації та бюджету

Цей новий цикл модулів з навчання імунізації для менеджерів середньої ланки замінюєверсію, опубліковану в 1991 році. Оскільки з того часу в галузі імунізації відбулось чимало змін, ці модулі були розроблені, щоб надати менеджерам з питань імунізації актуальну технічну інформацію та пояснити, як розпізнавати управлінські та технічні проблеми і вживати коригувальних заходів, а також як найкраще використовувати ресурси.

Навчання для менеджерів середньої ланки: модуль 5. Моніторинг системи імунізації

Цей новий цикл модулів з навчання імунізації для менеджерів середньої ланки замінюєверсію, опубліковану в 1991 році. Оскільки з того часу в галузі імунізації відбулось чимало змін, ці модулі були розроблені, щоб надати менеджерам з питань імунізації актуальну технічну інформацію та пояснити, як розпізнавати управлінські та технічні проблеми і вживати коригувальних заходів, а також як найкраще використовувати ресурси.

Навчання для менеджерів середньої ланки: модуль 4. Кураторська підтримка.

Цей новий цикл модулів з навчання імунізації для менеджерів середньої ланки замінюєверсію, опубліковану в 1991 році. Оскільки з того часу в галузі імунізації відбулось чимало змін, ці модулі були розроблені, щоб надати менеджерам з питань імунізації актуальну технічну інформацію та пояснити, як розпізнавати управлінські та технічні проблеми і вживати коригувальних заходів, а також як найкраще використовувати ресурси.

Навчання для менеджерів середньої ланки: модуль 3. Безпека імунізації.

Цей новий цикл модулів з навчання імунізації для менеджерів середньої ланки замінюєверсію, опубліковану в 1991 році. Оскільки з того часу в галузі імунізації відбулось чимало змін, ці модулі були розроблені, щоб надати менеджерам з питань імунізації актуальну технічну інформацію та пояснити, як розпізнавати управлінські та технічні проблеми і вживати коригувальних заходів, а також як найкраще використовувати ресурси.

Навчання для менеджерів середньої ланки: модуль 2. Співпраця із громадами.

Цей новий цикл модулів з навчання імунізації для менеджерів середньої ланки замінюєверсію, опубліковану в 1991 році. Оскільки з того часу в галузі імунізації відбулось чимало змін, ці модулі були розроблені, щоб надати менеджерам з питань імунізації актуальну технічну інформацію та пояснити, як розпізнавати управлінські та технічні пробле-ми і вживати коригувальних заходів, а також як найкраще використовувати ресурси.

Навчання для менеджерів середньої ланки: модуль 1. Управління холодовим ланцюгом, вакцинами та обладнанням для безпечного виконання ін’єкцій.

Цей новий цикл модулів з навчання імунізації для менеджерів середньої ланки замінюєверсію, опубліковану в 1991 році. Оскільки з того часу в галузі імунізації відбулось чимало змін, ці модулі були розроблені, щоб надати менеджерам з питань імунізації актуальну технічну інформацію та пояснити, як розпізнавати управлінські та технічні пробле-ми і вживати коригувальних заходів, а також як найкраще використовувати ресурси

Dealing with pluralism: the managerial work of CEOs in Italian public healthcare organizations.

BACKGROUND: Healthcare organizations are extremely complex. The work of their CEOs is particularly demanding, especially in the public sector, though little is known about how the managerial work of a healthcare organization CEO unfolds. Drawing from scholarship on managerial work and management in pluralistic organizations, we sought to answer the questions: What is the content of managerial work of CEOs in public healthcare in Italy? How do healthcare CEOs perform their managerial work in complex interactions with multiple stakeholders? METHODS: For this study we adopted a multi-method approach in which we conducted a survey to investigate CEO behaviors, tracked CEO working time for 4 weeks, and conducted semi-structured interviews with senior CEOs. RESULTS: CEOs in public healthcare devote most of their time to interaction, which half of which is perceived as being occupied with apparently mundane problems. Nonetheless, devoting time to such activities is functional to a CEO's goals because change in pluralistic contexts can be achieved only if the CEO can handle the organization's complexity. CEOs do this by engaging in routines and conversations with professionals, creating consensus, and establishing networks with external stakeholders. CONCLUSIONS: CEOs are called to reduce fragmentation and foster cooperation across disciplines and professional groups, with the overarching aim to achieve integrated care. Using an analytical approach we were able to take into account the context and the relational dimension of the managerial work of healthcare CEOs and the specificities of this role. TRIAL REGISTRATION: This article does not report the results of a healthcare intervention on human participants, and the material used in the research did not require ethical approval according to Italian law.

'It was hell in the community': a qualitative study of maternal and child health care during health care worker strikes in Kenya.

BACKGROUND: Health care workers in Kenya have launched major strikes in the public health sector in the past decade but the impact of strikes on health systems is under-explored. We conducted a qualitative study to investigate maternal and child health care and services during nationwide strikes by health care workers in 2017 from the perspective of pregnant women, community health volunteers (CHVs), and health facility managers. METHODS: We conducted in-depth interviews and focus group discussions (FGDs) with three populations: women who were pregnant in 2017, CHVs, and health facility managers. Women who were pregnant in 2017 were part of a previous study. All participants were recruited using convenience sampling from a single County in western Kenya. Interviews and FGDs were conducted in English or Kiswahili using semi-structured guides that probed women's pregnancy experiences and maternal and child health services in 2017. Interviews and FGDs were audio-recorded, translated, and transcribed. Content analysis followed a thematic framework approach using deductive and inductive approaches. RESULTS: Forty-three women and 22 CHVs participated in 4 FGDs and 3 FGDs, respectively, and 8 health facility managers participated in interviews. CHVs and health facility managers were majority female (80%). Participants reported that strikes by health care workers significantly impacted the availability and quality of maternal and child health services in 2017 and had indirect economic effects due to households paying for services in the private sector. Participants felt it was the poor, particularly poor women, who were most affected since they were more likely to rely on public services, while CHVs highlighted their own poor working conditions in response to strikes by physicians and nurses. Strikes strained relationships and trust between communities and the health system that were identified as essential to maternal and child health care. CONCLUSION: We found that the impacts of strikes by health care workers in 2017 extended beyond negative health and economic effects and exacerbated fundamental inequities in the health system. While this study was conducted in one County, our findings suggest several potential avenues for strengthening maternal and child health care in Kenya that were highlighted by nationwide strikes in 2017.

Payer perceptions of the use of real-world evidence in oncology-based decision making.

BACKGROUND: Randomized controlled trials (RCTs), the gold standard of safety and efficacy evidence, are conducted in select patients that may not mirror real-world populations. As a result, healthcare decision makers may have limited information when making formulary decisions, especially in oncology, given accelerated regulatory approvals and niche patient populations. Real-world evidence (RWE) studies may help address these knowledge gaps and help inform oncology formulary decision making. OBJECTIVE: To assess US payer perceptions regarding the use and relevance of RWE in informing oncology formulary decisionmaking. METHODS: A national survey containing single-answer, multiple-answer, and free-response questions evaluated 4 key areas: (1) the value of RWE, (2) barriers to RWE, (3) sources of RWE, and (4) use of RWE in outcomes-based contracting. The survey was distributed to 221 US payers through the Academy of Managed Care Pharmacy (AMCP) Market Insights program in February 2020. Ten additional respondents were invited to discuss the survey results. The survey results were presented primarily as frequencies of responses and were evaluated by the respondent's plan size, type, and geography (regional vs national). Differences in responses for categorical data were compared using a Pearson Chi-Square or a Fisher's Exact test. Two-tailed values are reported and a level of ≤ 0.05 was used to indicate statistical significance. RESULTS: The national survey had a 45.9% response rate, with 106 payers responding. Most were from managed care organizations (MCOs; 47.5%) and pharmacy benefit managers (PBMs; 37.4%), with 54.5% from large plans (≥ 1 million lives) and 45.5% from small plans (< 1 million lives). Respondents were largely pharmacists (89.9%), with 55.6% overall indicating their job was a pharmacy administrator. Most (84.9%) used RWE to inform formulary decisions in oncology to support comparative effectiveness in the absence of head-to-head clinical trials (4.1 on a scale of 1 = Not At All Useful to 5 = Extremely Useful) and validation of National Comprehensive Cancer Network (NCCN) recommendations (4.0). Almost half (41.5%) used RWE results to inform off-label usage decisions. Payers valued RWE pre-launch to inform formulary and contracting decisions and desired real-world comparative effectiveness data post-launch to validate coverage decisions. However, the majority of payers (54.7%) did not conduct their own real-world studies. Commonly considered RWE sources included claims data (79.2%), medical records (68.9%), prospective cohort studies (60.4%), patient registries (36.8%), and patient outcome surveys (33.0%). Barriers to conducting internal RWE studies included the lack of resources and personnel, analytic capabilities, appropriate in-house data, and perceived value in conducting analyses. Payers expressed interest in using outcomes-based contracting in oncology; few have direct experience, and operationalizing through value measurement is challenging. CONCLUSIONS: RWE providing comparative treatment data, validation of NCCN treatment recommendations, and information on off-label usage are appreciated pre launch with post launch validation. DISCLOSURES: Pfizer provided funding for this research, and employees of Pfizer led the development of the survey and contributed to the manuscript as authors. Arondekar and Niyazov are employees of Pfizer; Oderda, Biskupiak, and Brixner are managers of Millcreek Outcomes Group and were paid as consultants on this project. Burgoyne was a consultant for Pfizer on this project. Malone was paid by Millcreek Outcomes as a consultant on this project.

Systematic review of experiences and perceptions of key actors and organisations at multiple levels within health systems internationally in responding to COVID-19.

BACKGROUND: COVID-19 has presented challenges to healthcare systems and healthcare professionals internationally. After one year of the pandemic, the initial evidence on health system responses begins to consolidate, and there is a need to identify and synthesise experiences of responding to COVID-19 among healthcare professionals and other health system stakeholders. This systematic review of primary qualitative studies depicts the experiences and perceptions of organisations and actors at multiple levels of health systems internationally in responding to COVID-19. METHODS: Six main databases of biomedical information, public health and health administration research were searched over the period October 1, 2019, to October 21, 2020. Information extracted from included studies was analysed thematically. RESULTS: Thirty-four studies were eligible for data extraction. Nine of those studies, of lower methodological quality, were removed from the thematic analysis of study results. Considering the professional level experiences, predominant themes of the studies consisted of the new roles and responsibilities of healthcare workers, burnout and distress, recognition of ´unseen´ healthcare workers, and positive changes and emergent solutions amid the crisis. Organisational level findings of the studies included provision of psychological support, COVID-19 as "catalyst" for change, and exercise of more "open" leadership by managers and health authorities. Continuous training, regulation of working conditions, providing supportive resources, coordinating a diversity of actors, and reviewing and updating regulations were roles identified  at the local health system level. CONCLUSIONS: The experiences of frontline healthcare workers have been the focus of attention of the majority of primary qualitative studies as of October 2020. However, organisational and wider system level studies indicate that some responses to COVID-19 have been characterised by increased emphasis on coordination activities by local health system actors, making service adaptations at pace, and reliance on expanded roles of front-line workers. The need for theory-informed qualitative studies was identified at the organisational level. TRIAL REGISTRATION: CRD42020202875.

Applied systems thinking: The impact of system optimization strategies on financial and quality performance in a team-based simulation.

At its core, this research was undertaken to explore the extent to which system optimization leadership strategies such as innovation, collaboration, and data-driven decision-making affect financial and quality performance in organizations. A quasi-experimental pretest-posttest research design was used to examine the increase or decrease in system performance as a result of treatment in the form of a systems thinking workshop and strategy discussion. The application of three-core system strategies lead to significant gains in financial performance across all teams, and an increase in quality performance in all but one team. In addition to an increase in performance, this research also revealed the tendency of social systems to reflexively sub-optimize their performance and at times lose focus on higher order system goals. Helpful recommendations for leadership practice and future research are presented with a view to helping optimize whole systems and not solely their parts.