Using technology to promote the development of health science libraries in China.

From the point of view of the development of libraries, technology has made possible the emergence and development of library automation; digital libraries; mobile libraries; and smart libraries. This article briefly describes the impact of technological developments and application in Health Science Libraries in China in relation to collections development, service provision and the role of library associations.

Using data envelopment analysis to perform benchmarking in intensive care units.

BACKGROUND: Studies using Data Envelopment Analysis to benchmark Intensive Care Units (ICUs) are scarce. Previous studies have focused on comparing efficiency using only performance metrics, without accounting for resources. Hence, we aimed to perform a benchmarking analysis of ICUs using data envelopment analysis. METHODS: We performed a retrospective analysis on observational data of patients admitted to ICUs in Brazil (ORCHESTRA Study). The outputs in our data envelopment analysis model were the performance metrics: Standardized Mortality Ratio (SMR) and Standardized Resource Use (SRU); whereas the inputs consisted of three groups of variables that represented staffing patterns, structure, and strain, thus resulting in three models. We compared efficient and non-efficient units for each model. In addition, we compared our results to the efficiency matrix method and presented targets to each non-efficient unit. RESULTS: We performed benchmarking in 93 ICUs and 129,680 patients. The median age was 64 years old, and mortality was 12%. Median SMR was 1.00 [interquartile range (IQR): 0.79-1.21] and SRU was 1.15 [IQR: 0.95-1.56]. Efficient units presented lower median physicians per bed ratio (1.44 [IQR: 1.18-1.88] vs. 1.7 [IQR: 1.36-2.00]) and nursing workload (168 hours [IQR: 168-291] vs 396 hours [IQR: 336-672]) but higher nurses per bed ratio (2.02 [1.16-2.48] vs. 1.71 [1.43-2.36]) compared to non-efficient units. Units from for-profit hospitals and specialized ICUs presented the best efficiency scores. Our results were mostly in line with the efficiency matrix method: the efficiency units in our models were mostly in the "most efficient" quadrant. CONCLUSION: Data envelopment analysis provides managers the information needed to identify not only the outcomes to be achieved but what are the levels of resources needed to provide efficient care. Different perspectives can be achieved depending on the chosen variables. Its use jointly with the efficiency matrix can provide deeper understanding of ICU performance and efficiency.

FASStR: a framework for ensuring high-quality operational metrics in health care.

OBJECTIVES: Poorly defined measurement impairs interinstitutional comparison, interpretation of results, and process improvement in health care operations. We sought to develop a unifying framework that could be used by administrators, practitioners, and investigators to help define and document operational performance measures that are comparable and reproducible. STUDY DESIGN: Retrospective analysis. METHODS: Health care operations and clinical investigators used an iterative process consisting of (1) literature review, (2) expert assessment and collaborative design, and (3) end-user feedback. We sampled the literature from the medical, health systems research, and health care operations (business and engineering) disciplines to assemble a representative sample of studies in which outpatient health care performance metrics were used to describe the primary or secondary outcome of the research. RESULTS: We identified 2 primary deficiencies in outpatient performance metric definitions: incompletion and inconsistency. From our review of performance metrics, we propose the FASStR framework for the Focus, Activity, Statistic, Scale type, and Reference dimensions of a performance metric. The FASStR framework is a method by which performance metrics can be developed and examined from a multidimensional perspective to evaluate their comprehensiveness and clarity. The framework was tested and revised in an iterative process with both practitioners and investigators. CONCLUSIONS: The FASStR framework can guide the design, development, and implementation of operational metrics in outpatient health care settings. Further, this framework can assist investigators in the evaluation of the metrics that they are using. Overall, the FASStR framework can result in clearer, more consistent use and evaluation of outpatient performance metrics.

Stop Doing Needless Things! Saving Healthcare Resources During COVID-19 and Beyond.

The COVID-19 outbreak is putting tremendous strain on the US healthcare system, with a direct impact on medical professionals, hospital systems, and physical resources. While comprehensive public health and regulatory efforts are essential to overcome this crisis, it is important to recognize this moment as an opportunity to provide more intelligent and more efficient care in spite of increasing patient volumes and fewer resources. Specifically, we must limit unnecessary and wasteful medical practices and improve the delivery of those services which enhance the quality of patient care. In doing so, we will increase availability of the critical resources required for the provision of high-quality care to those in greatest need both now and in the future.

¿Qué es una intervención sanitaria eficiente en España en 2020? / What is an efficient health intervention in Spain in 2020?

Hace más de 15 años que en Gaceta Sanitaria se publicó el artículo titulado «¿Qué es una tecnología sanitaria eficiente en España?». El creciente interés por fijar el precio de las nuevas tecnologías en función del valor que estas proporcionan a los sistemas de salud y la experiencia acumulada por los países de nuestro entorno hacen oportuno revisar qué es una intervención sanitaria eficiente en España en el año 2020. El análisis de coste-efectividad sigue siendo el método de referencia para maximizar los resultados en salud de la sociedad con los recursos disponibles. La interpretación de sus resultados requiere establecer unos valores de referencia que sirvan de guía sobre lo que constituye un valor razonable para el sistema sanitario. Los umbrales de eficiencia deben ser flexibles y dinámicos, y actualizarse periódicamente. Su aplicación debe estar basada en la gradualidad y la transparencia, considerando, además, otros factores que reflejen las preferencias sociales. Aunque la fijación de los umbrales corresponde a los decisores políticos, en España puede ser razonable utilizar unos valores de referencia como punto de partida que podrían estar comprendidos entre los 25.000 y los 60.000 euros por año de vida ajustado por calidad. No obstante, en la actualidad, más que la determinación de las cifras exactas de dicho umbral, la cuestión clave es si el Sistema Nacional de Salud está preparado y dispuesto a implantar un modelo de pago basado en el valor, que contribuya a lograr la gradualidad en las decisiones de financiación y, sobre todo, a mejorar la previsibilidad, la consistencia y la transparencia del proceso

Fifteen years ago, Gaceta Sanitaria published the article entitled "What is an efficient health technology in Spain?" The growing interest in setting the price of new technologies based on the value they provide to health systems and the experience accumulated by the countries in our environment make it opportune to review what constitutes an efficient health intervention in Spain in 2020. Cost-effectiveness analysis continues to be the reference method to maximize social health outcomes with the available resources. The interpretation of its results requires establishing reference values that serve as a guide on what constitutes a reasonable value for the health care system. Efficiency thresholds must be flexible and dynamic, and they need to be updated periodically. Its application should be based on and transparency, and consider other factors that reflect social preferences. Although setting thresholds is down to political decision-makers, in Spain it could be reasonable to use thresholds of 25,000 and 60,000 Euros per QALY. However, currently, in addition to determining exact figures for the threshold, the key question is whether the Spanish National Health System is able and willing to implement a payment model based on value, towards achieving gradual financing decisions and, above all, to improve the predictability, consistency and transparency of the process

Artificial Intelligence and Nursing: The Future Is Now.

As systems evolve over time, their natural tendency is to become increasingly more complex. Studies in the field of complex systems have generated new perspectives on the application of management strategies in health systems. Much of this research appears as a natural extension of the cross-disciplinary field of systems theory. Since writing my 1st article for Managing Organizational Complexity in 2004, much has happened to further our understanding of complexity in healthcare systems. The growth of new computational methods in the fields of data science and data analytics has allowed scientists to identify signals or patterns in large complex data sets (big data) that in the past were seemingly hidden. Rather than relying on historical statistical methods to infer outcomes, these advanced methods combined with increased computer processing power allow machines to learn the structure of data and create artificial intelligence (AI). In our ongoing efforts to find solutions for complex healthcare problems, AI is becoming more and more an accepted method. The purpose of this edition of Managing Organizational Complexity is to define AI and machine learning, discuss the recent resurgence of AI, and then provide examples of how AI can provide value to healthcare with an emphasis on nursing.

Trends in the 10-year history of the vascular integrated residency match: More work, higher cost, same result.

OBJECTIVE: The purpose of this study was to examine trends in application submission, rank lists, and applicant quality for vascular surgery integrated residency. METHODS: The National Resident Matching Program Results and Data reports and the Electronic Residency Application Service Statistics from 2007 to 2017 were compiled and mined for trends in terms of application submission and the number of applicants a program needed to rank to fill all residency positions. Applicant pool depth and percentage of programs applied to were calculated. Outcome data from the National Resident Matching Program were reviewed for 2014 and 2016 for United States Medical Licensing Examination Step scores and experiences. RESULTS: During the last 10 years, the number of vascular surgery integrated residency spots rose from 9 to 60 per year. Most programs offer one spot per year; none offer more than two. The average number of applications received by programs rose from 17 applications in 2008 to 63.8 in 2017. The average rank list depth needed by programs to fill the spots has not increased (range, 2.5-5.1; standard deviation, 0.73). The proportional depth of the applicant pool decreased from 4.6 U.S. and Canadian applicants for every one residency spot in 2008 to 1.7 applicants for every one residency spot in 2017. Applicant quality metrics were available for 2 years (2014 and 2016). Step 1 scores (237/239), Step 2 scores (250/250), research experiences (3.7/4.2), and volunteer experiences (5.9/5.5) remained nearly unchanged. The number of contiguous ranks for matched applicants remained stable (12.3/12.8). CONCLUSIONS: The current system promotes multiple inefficiencies, resulting in application glut. Fewer applicants are flooding programs with an increasing number of applications. More money is being spent on Electronic Residency Application Service applications without changes in the number needed to rank by applicants or programs to achieve a match. There is no improvement in the quality of the applicant. Should these trends continue, they represent an unsustainable model for resident selection.

Personalidade, ansiedade e vulnerabilidade ao burnout em enfermeiros: um estudo comparativo portugal/espanha / Personality, anxiety and vulnerability to burnout among nurses: a comparative study Portugal/Spain

Introduction: Nowadays nurses execute their tasks in demanding and stressful contexts, where the stress accumulates and can trigger burnout. This one seems to be the result from the combination of organizational factors with individual vulnerability, in particular predisposition for anxiety and personality traits such as neuroticism. Objectives: This study aims, by comparing nurses from Portugal/Spain, to identify burnout levels and to analyse if personality and anxiety predict burnout. Methodology: This is a quantitative, exploratory, descriptive and transversal study, using a demographic/professional characterization questionnaire, the Eysenck Personality Questionnaire, State-Trait Anxiety Inventory, and Maslach Burnout Inventory. After institutional authorizations, participated anonymously and volunteer, 337 Portuguese nurses and 309 Spanish nurses. Results: We found 55% of nurses without burnout, 35% with moderate burnout and 11% with high burnout, without differences between countries. However, the Portuguese nurses present significantly more exhaustion and less depersonalization, less anxiety trait, and more extroversion and Social Desirability, all with a moderate level. In Portugal, the age and professional experience correlate negatively with burnout, and anxiety predicts 32% of burnout. In Spain, anxiety explains 36% of burnout and personality traits only 2%. Discussion: These findings are consistent with studies in which anxiety is a vulnerability factor for burnout, but contradicted the influence of other personality traits, reinforcing the influence of organizational factors. Conclusion: The results are useful, in the field of occupational health, to develop organizational strategies that enhance individual characteristics of stress management, which, lately, have been applied using Mindfulness among nurses and nursing students

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Identifying the contribution to hospital performance among Chinese regions by an aggregate directional distance function.

In this paper, we examine efficiency and total factor productivity for hospitals operating in China between the years of 2009-2016. Given reforms in China focusing on the hospital sector, it has been demonstrated that efficiency and productivity are important in meeting the overall objective of meeting more accessibility to hospital care for the population. Measuring an aggregate directional distance function is in itself a non-parametric approach, we report on the decomposition of hospital performance and found that between 2009 and 2010, technical inefficiency (using resources inefficiently) dominated overall inefficiency but beyond 2011-2016, mix inefficiency (misallocation of resources) was higher. Furthermore, an additive total factor productivity (TFP) indicator is proposed to capture contributions of individual provincial (or group) hospital performance to the total productivity gain. We also report that mix inefficiency had growth throughout this time period indicating a catching up in the correct mix of inputs. This finding is worth following as hospital reform in China also focuses on utilizing the right labor and capital mix in producing efficient care.

How do employees adapt to organizational change? the role of meaning-making and work engagement

This multi-wave, multi-source study focuses on the benefits of work engagement for employee adaptation to organizational change. The change entailed the implementation of a flexible office design in an engineering firm, which caused radical change for employees. Building on conservation of resources (COR) theory and change transition models, we predict that work engagement trajectories during change are crucial for successful adaptation. The hypothesized process was that initial employee meaning-making will facilitate work engagement, which, in turn, predicts supervisor-rated adaptive performance (i.e. adaptive work-role performance and extra-role performance) via attitude-to-change. Attitude-to-change was modeled as reciprocally related to work engagement at different points in time. Weekly questionnaires were completed by 71 employees during the first five weeks of the change (296 observations). Latent growth trajectories using weekly engagement measures showed no overall growth, but did show significant variance around the slope of work engagement. Meaning-making and attitude-to-change at the onset were positively related to initial levels, but not to growth of work engagement. Meaning-making was indirectly related to short-term attitude-to-change via work engagement. Short-term attitude-to-change was predictive of supervisor-rated adaptive performance and long-term attitude-to-change. Finally, work engagement (slope) predicted long-term attitude-to-change and supervisor-rated extra-role performance via short-term attitude-to-change. Taken together, the study contributes to knowledge about micro-level transition processes of employee adaptation and the benefits of work engagement during change

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Does more medicine make us sicker? Ivan Illich revisited / ¿El uso de más medicina, nos vuelve más enfermos? Retorno a Ivan Illich

A proper understanding of health is a social and political challenge, the modern social medicine approach to public health and health approaches more generally tend to minimise this, making the isolated individual the primary unit of health. Ivan Illich, social critic and philosopher, was at the forefront of arguing for a collective health approach and challenging medical hegemony. His theories of institutional counter-productivity, proportionality and his critique of the medical model which he argued was entrenched within an economics of scarcity are as relevant today as they were at their height of popularity, in the 1970s. Applying his analysis to current trends in health approaches I conclude, as did he, that beyond a certain institutional scale or intensity more medicine is making us sicker. Therefore public health requires a dramatic shift away from a focus on individual deficits, lifestyle diseases, behaviour change and health promotion approaches towards genuine community building and significant political investment in the health creation of local communities. Moreover, there is need for more resolute regulation of the marketplace to prevent the health-harming behaviours of industrial and other institutional interests, including public sector and third sector organisations engaged in institutional overreach

La sanidad, propiamente entendida, es un reto social y político. La medicina social moderna apunta a la salud pública y, por lo general, los enfoques sanitarios tienden a minimizar este hecho, convirtiendo a la persona aislada en la unidad primaria de la salud. Ivan Illich, crítico social y filósofo, encabezó el debate a favor de un enfoque basado en la sanidad colectiva y la lucha contra la hegemonía médica. Sus teorías sobre contraproductividad y proporcionalidad institucional, y su crítica sobre el modelo médico, del que argumentó que estaba arraigado en una economía de escasez, son relevantes hoy en día, al igual que lo eran en la cima de su popularidad, en los años 1970. Aplicando su análisis a las tendencias actuales, yo concluyo, como hizo él, que más allá de una cierta escala o intensidad institucional, el uso de más medicina nos vuelve más enfermos. Por ello, la sanidad pública requiere un cambio drástico, alejando su objetivo de los déficits individuales, las enfermedades relacionadas con el estilo de vida, los cambios de comportamiento y la promoción de la salud, centrándose en cambio en el desarrollo comunitario genuino y la inversión política en la creación de salud en las comunidades locales. Además, existe una necesidad de regular firmemente el mercado para evitar los comportamientos nocivos para la salud provenientes de los intereses industriales y demás instituciones, incluyendo el sector público y las organizaciones del tercer sector, implicadas en las extralimitaciones institucionales

Professional self-efficacy and job satisfaction: the mediator role of work design / Autoeficacia profesional y satisfacción laboral: el rol mediador del diseño del trabajo

The purpose of this study is to investigate the mediating role of work design characteristics (task, knowledge, social, and contextual characteristics) in the relationship between professional self-efficacy and job satisfaction. Research has shown how motivational job design has positive consequences for individuals, increasing control and perception of internal forces (such as self-efficacy) and affects positively job satisfaction. However, little is known about how self-efficacy affects job satisfaction through job enrichment. In this study, 353 Chilean workers answered a self-reported survey. Regression analyses confirmed partially the hypotheses, showing a complete mediation of task and social characteristics of work design in the relationship between professional self-efficacy and job satisfaction. These results show how professionalself-efficacy relates to work design and highlight the importance of social and task characteristics to improve job satisfaction, contributing to a better understanding of how self-efficacy improves job satisfaction through work design

Un importante volumen de investigación ha mostrado cómo las características motivacionales del diseño del trabajo tienen consecuencias positivas para las personas, al aumentar la percepción de control y creencias como la autoeficacia,afectando positivamente a la satisfacción laboral. Sin embargo, se tiene poca información respecto a cómo puede la autoeficacia, a través del trabajo enriquecido, afectar la satisfacción laboral. Tomando esto en cuenta, el propósito de este estudio fue investigar el rol mediador de las características del diseño del trabajo (características de tarea, conocimiento, sociales y físicas) en la relación entre autoeficacia profesional y satisfacción laboral. Participaron 353 trabajadores chilenos voluntarios, quienes respondieron una encuesta de autoinforme. Los análisis de regresión lineal permitieron sostenerparcialmente las hipótesis de investigación. Se observó una mediación total de las características de tarea y conocimiento en la relación entre autoeficacia profesional y satisfacción laboral. Se advierte que la autoeficacia se relaciona con el diseño del trabajo y que las dimensiones social y de tarea del diseño del trabajo pueden incidir en la satisfacción laboral. A partir de esto se puede avanzar en la comprensión de cómo la autoeficacia aumenta la satisfacción laboral a través del diseño del puesto

Changing Anesthesia Block Allocations Improves Endoscopy Suite Efficiency.

Non-operating room anesthesia (NORA) has grown and continues to expand as a proportion of all anesthesia practice in the United States [1, 2]. While many management processes have been adapted for NORA from the traditional operating room, it is still unclear what scheduling paradigm will maximize efficiency of resource utilization in this arena. In this study, we investigate the impact of tactical a shift from a shared group to individual, provider-specific block allocations for available anesthesia time in an endoscopy suite for adult patients undergoing elective endoscopy procedures at an academic hospital. Using a retrospective and prospective analysis, we measured elective time-in-block; elective time out-of-block; under-utilized (opportunity and non-opportunity unused) time; over-utilized time; and case tardiness to determine operational efficiency and clinical productivity. Over the study period, the monthly caseload remained constant. Elective time in block increased by 156% (p < 0.0001) and elective time out of block decreased by 38% (p < 0.0001). Opportunity unused time decreased by 28% (p < 0.0001) and productivity increased by 51% (p < 0.0001). Neither over-utilized time nor case tardiness showed a significant change after the intervention. Despite the evidence base supporting traditional approaches to anesthesia block allocation involving group block allocation and non-sequential case scheduling, we have demonstrated an advantage to individual block allocation in a GI endoscopy setting. This sequential case scheduling highlights how tactical decisions in NORA environments may require a rethinking of many practices that anesthesiologists have brought with them from the traditional OR. Using these efficiency and productivity metrics, further adjustments to scheduling practices should be investigated, and connecting these metrics to other systems outcomes, such as financial productivity, is an important next step as NORA services expand into the future.

The productivity development of total hip arthroplasty in Sweden: a multiple registry-based longitudinal study using the Malmquist Productivity Index.

OBJECTIVE: The increasing demand for total hip arthroplasty (THA) combined with limited resources in healthcare puts pressure on decision-makers in orthopaedics to provide the procedure at minimum costs and with good outcomes while maintaining or increasing access. The objective of this study was to analyse the development in productivity between 2005 and 2012 in the provision of THA. DESIGN: The study was a multiple registry-based longitudinal study. SETTING AND PARTICIPANTS: The study was conducted among 65 orthopaedic departments providing THA in Sweden from 2005 to 2012. OUTCOME MEASURES: The development in productivity was measured by Malmquist Productivity Index by relating department level total costs of THA to the number of non-cemented, hybrid and cemented THAs. We also break down the productivity change into changes in efficiency and technology. RESULTS: Productivity increased significantly in three periods (between 1.6% and 27.0%) and declined significantly in four periods (between 0.8% and 12.1%). Technology improved significantly in three periods (between 3.2% and 16.9%) and deteriorated significantly in two periods (between 10.2% and 12.6%). Significant progress in efficiency was achieved in two periods (ranging from 2.6% to 8.7%), whereas a significant regress was attained in one period (3.9%). For the time span as a whole, an average increase in productivity of 1.4% per year was found, where changes in efficiency contributed more to the improvement (1.1%) than did technical change (0.2%). CONCLUSIONS: We found a slight improvement of productivity over time in the provision of THA, which was mainly driven by changes in efficiency. Further research is, however, needed where differences in quality of care and patient case mix between departments are taken into account.