Do standards of care and early outcomes of periprosthetic fractures change during the COVID-19 pandemic? A multicentre study.

BACKGROUND: Periprosthetic fractures (PPFs) are a growing matter for orthopaedic surgeons, and patients with PPFs may represent a frail target in the case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The purpose of this study is to investigate whether hospital reorganisations during the most severe phase of the SARS-CoV-2 pandemic affected standards of care and early outcomes of patients treated for PPFs in Northern Italy. MATERIALS AND METHODS: Data were retrieved from a multicentre retrospective orthopaedics and traumatology database, including 14 hospitals. The following parameters were studied: demographics, results of nasopharyngeal swabs, prevalence of coronavirus disease 2019 (COVID-19), comorbidities, general health status (EQ-5D-5L Score), frailty (Clinical Frailty Scale, CFS), pain (visual analogue scale, VAS), anaesthesiologic risk (American Society of Anaesthesiology Score, ASA Score), classification (unified classification system, UCS), type of operation and anaesthesia, in-hospital and early complications (Clavien-Dindo Classification, CDC), and length of stay (LOS). Data were analysed by means of descriptive statistics. Out of 1390 patients treated for any reason, 38 PPFs were included. RESULTS: Median age was 81 years (range 70-96 years). Twenty-three patients (60.5%) were swabbed on admission, and two of them (5.3%) tested positive; in three patients (7.9%), the diagnosis of COVID-19 was established on a clinical and radiological basis. Two more patients tested positive post-operatively, and one of them died due to COVID-19. Thirty-three patients (86.8%) presented a proximal femoral PPF. Median ASA Score was 3 (range, 1-4), median VAS score on admission was 3 (range, 0-6), median CFS was 4 (range, 1-8), median EQ-5D-5L Score was 3 in each one of the categories (range, 1-5). Twenty-three patients (60.5%) developed post-operative complications, and median CDC grade was 3 (range, 1-5). The median LOS was 12.8 days (range 2-36 days), and 21 patients (55.3%) were discharged home. CONCLUSIONS: The incidence of PPFs did not seem to change during the lockdown. Patients were mainly elderly with comorbidities, and complications were frequently recorded post-operatively. Despite the difficult period for the healthcare system, hospitals were able to provide effective conventional surgical treatments for PPFs, which were not negatively influenced by the reorganisation. Continued efforts are required to optimise the treatment of these frail patients in the period of the pandemic, minimising the risk of contamination, and to limit the incidence of PPFs in the future. LEVEL OF EVIDENCE: IV.

Reestructuración del funcionamiento de la Unidad de Hospitalización a Domicilio del Hospital Universitario Germans Trias I Pujol para el manejo de pacientes COVID y no COVID ingresados durante la pandemia del COVID-19 en España / Restructuring the Operation of the Home Care Unit of the Germans Trias I Pujol University Hospital for the management of patients COVID and no COVID Admitted during the COVID-19 Pandemic in Spain

INTRODUCCIÓN: La Unidad de Hospitalización a Domicilio del Hospital Universitari Germans Trias I Pujol, ante la grave situación sanitaria generada por el COVID-19 optó por varias estrategias para la atención de los pacientes ingresados con o sin diagnóstico de COVID optimizando los recursos de atención sanitaria. MÉTODO: Estudio descriptivo sobre la reorganización de la Unidad de Hospitalización a Domicilio (UHAD) durante la pandemia del COVID-19 en el período comprendido entre el 14 de Marzo y 31 de Mayo del 2020. Una ampliación del número de camas virtuales, así como de los turnos e incorporación de personal sanitario (médico/enfermeros) fue necesario, activándose paralelamente 2 plataformas de telemedicina para monitorización y contacto con los pacientes (COVIDApp para los pacientes COVID y Revita para los pacientes no COVID). RESULTADOS: Un total de 781 pacientes referidos del área de hospitalización, urgencias y atención primaria fueron incluidos, 584 (74,8%) ingresados con diagnóstico de COVID-19 (por PCR = polymerase chain reaction) y 197 (25,2%) pacientes ingresados por otras patologías (no-COVID) provenientes de la zona Metropolitana Nord de Barcelona y Maresme. Un 24,6% de los pacientes no-COVID y un 2,5% de los pacientes COVID eran pacientes crónicos complejos. El porcentaje de reingreso hospitalario fue mayor en los pacientes no-COVID (11.6%) que en los pacientes COVID (4,28%). El porcentaje de altas de la UHAD aumentó hasta un 35,34%. Ambas plataformas permitieron realizar seguimiento estrecho de los pacientes. CONCLUSIONES: La pandemia del COVID-19 ha remarcado la necesidad de optimizar y reestructurar los recursos del sistema sanitario, siendo las plataformas de Telemedicina COVIDApp y Revita de ayuda como herramientas innovadoras

INTRODUCTION: The COVID-19 pandemic made that the Home Care Unit of the Germans Trias I Pujol University Hospital implement strategies for the management of patients admitted with or without COVID-19, optimizing health care resources. METHOD: A descriptive study of patients with and without COVID-19 was conducted between March 14th and May 31th, 2020. An increase in the number of virtual beds, as well as extension of working hour and incorporation of personnel health (doctor/nurses) was necessary, activating 2 telemedicine platforms for monitoring of patients (COVIDApp for COVID patients and Revita for non-COVID patients). RESULTS: A total of 781 patients referred from the hospitalization, emergency and primary care were included, 584 (74.8%) admitted with a diagnosis of COVID-19 (by PCR) and 197 (25.2%) patients admitted by other pathologies (non-COVID) from the Nord Metropolitan area of Barcelona and Maresme. 24.6% of non-COVID patients and 2.5% of COVID patients were complex chronic patients. The percentage of hospital readmission was higher in non-COVID patients (11.6%) than in COVID patients (4.28%). The percentage of discharges from the UHAD increased to 35.34%. Both platforms allowed for close monitoring of patients. CONCLUSIONS: The COVID-19 pandemic has highlighted the need to optimize and restructure the resources of the health system, with the Telemedicine platforms COVIDApp and Revita as innovative tools

Restructuring service at a mastology outpatient clinic during the COVID-19 pandemic.

OBJECTIVE: to report the experience of a health team in restructuring service at a mastology outpatient clinic. METHODS: an experience report in a public university service mastology outpatient in Ceará between March and April 2020. Service in this outpatient clinic is exclusively for women and who have breast changes for surgical treatments ranging from nodulectomies to mastectomies with oncoplastic. RESULTS: increased COVID-19 cases brought the need to restructure healthcare services. The following steps were followed: identification of scheduled patients, reading of clinical developments in electronic medical records, individual assessment to define whether or not appointment would remain, telephone contact to inform about unscheduling. Among the 555 consultations scheduled for March and April 2020, 316 (56.9%) were maintained. FINAL CONSIDERATIONS: restructuring consultations at a mastology outpatient clinic optimized the waiting time for consultations and avoided crowds at service, providing patient safety.

The initial experience and response of vascular surgeons in Michigan during the COVID-19 pandemic.

BACKGROUND/OBJECTIVE: The unprecedented pandemic spread of the novel coronavirus has severely impacted the delivery of healthcare services in the United States and around the world, and has exposed a variety of inefficiencies in healthcare infrastructure. Some states have been disproportionately affected such as New York and Michigan. In fact, Detroit and its surrounding areas have been named as the initial Midwest epicenter where over 106,000 cases have been confirmed in April 2020. METHOD, RESULTS AND CONCLUSIONS: Facilities in Southeast Michigan have served as the frontline of the pandemic in the Midwest and in order to cope with the surge, rapid, and in some cases, complete restructuring of care was mandatory to effect change and attempt to deal with the emerging crisis. We describe the initial experience and response of 4 large vascular surgery health systems in Michigan to COVID-19.

Cirugia biliar en época de pandemia Experiencia del Hospital de Clínicas "Pte. Nicolás Avellaneda" - (Tucumán-Argentina). / BILIARY SURGERY IN A TIME OF PANDEMIC AT THE CLINICAL HOSPITAL "Pte. NICOLAS AVELLANEDA" TUCUMAN, ARGENTINA

Antecedentes: La rápida diseminación mundial de la enfermedad COVID-19 llevó a declarar la Emergencia Sanitaria, en Argentina se decretó el Aislamiento Social Preventivo y Obligatorio el 20 de Marzo, siguiendo con estos lineamientos Tucumán tuvo que adaptarse reestructurando su Sistema Provincial de Salud, quedando el Hospital de Clínicas Pte. Nicolás Avellaneda, como único hospital polivalente para patologías prevalentes. Objetivo: Mostrar el manejo quirúrgico integral mininvasivo de la patología biliar (laparoscópico, endoscópico, percutáneo y combinado), con plena vigencia de la CMA en este momento de Pandemia, durante el periodo del 20 de Marzo al 29 de Mayo del 2020. Material y métodos: Estudio descriptivo, prospectivo de corte transversal, de la patología quirúrgica biliar a quienes se le realizó Cribado Epidemiológico, exámenes preoperatorios, de ser necesaria una Tomografía Computada de Tórax; con Consentimiento Informado. Resultados: En el periodo estudiado, en el contexto de la pandemia se realizaron 51 intervenciones de la vía biliar; las vías de abordaje de elección fueron de cuatros tipos, según el orden de frecuencia: laparoscópico 65%, combinado 25%, endoscópico 8% y percutáneo 2%, con la modalidad de CMA (Cirugía Mayor Ambulatoria) se realizó 20% y 80% con internación hospitalaria, de los cuales tuvieron un promedio de un día y medio de estadía postoperatorio. Conclusión: La aparición de la Pandemia nos dió la oportunidad de incorporar nuevas técnicas mininvasivas y fortalecer la CMA. Para poder realizar esta labor, es necesario priorizar la seguridad en el entorno de trabajo y la atención de los pacientes.

Health Emergency, in Argentina Preventive and Mandatory Social Isolation was decreed on March 20, following these guidelines Tucumán had to restructure its Provincial Health System, leaving the Hospital Clinicas Pte. Nicolás Avellaneda, as the only multipurpose hospital for prevalent pathologies. Objective: To show the comprehensive minimally invasive surgical management of biliary pathology (laparoscopic, endoscopic, percutaneous, and combined), with full effect of the CMA at this time of the Pandemic, during the period from March 20 to May 29, 2020. Material and Methods: Descriptive, prospective, cross-sectional study of biliary surgical pathology for those who underwent Epidemiological Screening, preoperative examinations, if necessary, a Computed Tomography of the Thorax; with Informed Consent. Results: In the period studied, 51 bile duct problems were performed in the context of the pandemic; the approach routes of choice were of four types, according to the order of frequency: laparoscopic 65%, combined 25%, endoscopic 8% and percutaneous 2%, with the flexibility of CMA (Major Ambulatory Surgery) performed 20% and 80% with hospitalization, of which they had an average of one and a half days of postoperative stay. Conclusion: The appearance of the Pandemic gave us the opportunity to incorporate new minimally invasive techniques and strengthen the CMA. In order to carry out this work, it is necessary to prioritize safety in the work environment and patient care

Restructuring ENT out-patient services during the coronavirus disease 2019 pandemic - an iterative approach.

BACKGROUND: Coronavirus disease 2019 has demanded enormous adjustments to National Health Service provisions. Non-urgent out-patient work was initially postponed or performed virtually, but is now being re-established. In ENT surgery, aerosol-generating procedures pose a particular challenge in out-patient settings. OBJECTIVE: A rapid restructuring of ENT out-patient services is required, to safely accommodate aerosol-generating procedures and increase in-person attendances, whilst coronavirus disease 2019 persists. METHODS: Data were collected prospectively over four consecutive cycles. Two surveys were conducted. Results were analysed and disseminated, with recommendations for service restructuring implemented at cycle end-points. RESULTS: Out-patient activity increased four-fold, associated with a significant rise in aerosol-generating procedures during the study period. Mean aerosol-generating procedure duration dropped weekly, implying a learning curve. Service restructuring occurred at cycle end-points. CONCLUSION: Iterative data gathering, results analysis and outcome dissemination enabled a swift, data-driven approach to the restructuring of ENT out-patient services. Patient and staff safety was ensured, whilst out-patient capacity was optimised.

Reorganizing a Medicine Residency Program in Response to the COVID-19 Pandemic in New York.

The COVID-19 pandemic has been particularly severe in New York City, resulting in a rapid influx of patients into New York-Presbyterian Hospital/Columbia University Irving Medical Center. The challenges precipitated by this pandemic have required urgent changes to existing models of care. Internal medicine residents are at the forefront of caring for patients with COVID-19, including the critically ill. This article describes the exigent restructuring of the New York-Presbyterian Hospital/Columbia University Internal Medicine Residency Program. Patient care and educational models were fundamentally reconceptualized, which required a transition away from traditional hierarchical team structures and a significant expansion in the program's capacity and flexibility to care for large numbers of patients with disproportionately high levels of critical illness. These changes were made while the residency program maintained the priorities of patient care and safety, resident safety and well-being, open communication, and education. The process of adapting the residency program to the demands of the pandemic was iterative given the unprecedented nature of this crisis. The goal of this article is to share the experiences and lessons learned from this crisis, communicate the solutions that were designed, and inform others who may be facing the prospect of creating similar disaster response measures.

Restructuring Electrophysiology During the COVID-19 Pandemic: A Practical Guide From a New York City Hospital Network.

The coronavirus disease 2019 crisis is a global pandemic of a novel infectious disease with far-ranging public health implications. With regard to cardiac electrophysiology (EP) services, we discuss the "real-world" challenges and solutions that have been essential for efficient and successful (1) ramping down of standard clinical practice patterns and (2) pivoting of workflow processes to meet the demands of this pandemic. The aims of these recommendations are to outline: (1) essential practical steps to approaching procedures, as well as outpatient and inpatient care of EP patients, with relevant examples, (2) successful strategies to minimize exposure risk to patients and clinical staff while also balancing resource utilization, (3) challenges related to redeployment and restructuring of clinical and support staff, and (4) considerations regarding continued collaboration with clinical and administrative colleagues to implement these changes. While process changes will vary across practices and hospital systems, we believe that these experiences from 4 different EP sections in a large New York City hospital network currently based in the global epicenter of the coronavirus disease 2019 pandemic will prove useful for other EP practices adapting their own practices in preparation for local surges.

Impacto de la pandemia SARS-CoV-2 en el inicio de las prescripciones / Impact of the SARS-CoV-2 pandemic on the start of prescriptions

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Consecuencias de la pandemia COVID-19 en la unidad de patología mamaria en un hospital de segundo nivel. Nuestra experiencia / Effects of the COVID-19 pandemic in the breast surgery unit of a second-level hospital. Our experience

INTRODUCCIÓN: La pandemia por COVID-19 ha modificado nuestra actividad asistencial habitual en los últimos meses. Debido al colapso hospitalario se han suspendido consultas, pruebas diagnósticas e intervenciones quirúrgicas, con el objetivo también de reducir la exposición de pacientes al SARS-CoV-2 en el medio hospitalario. Sin embargo, esto ha provocado un retraso en la atención de otros problemas sanitarios. MATERIAL Y MÉTODOS: Analizamos y comparamos los datos de la Unidad de Mama en un hospital de segundo nivel, en cuanto a la actividad del Programa de Diagnóstico Precoz de Cáncer de Mama (PDPCM), los diagnósticos de cáncer realizados, así como las pacientes intervenidas durante los meses de marzo a mayo de 2020, con respecto al mismo período del año anterior. RESULTADOS: El número de pacientes atendidas en el PDPCM en los meses de marzo a mayo de 2020 se ha reducido en un 91,7%, y las pacientes atendidas en el Servicio de Radiodiagnóstico del hospital en un 54,2%. La actividad quirúrgica también se ha visto mermada en un 57,69% con respecto al mismo periodo del año anterior. CONCLUSIONES: La disminución de la actividad del PDPCM y Radiología conllevan a un retraso diagnóstico que concluirá con un aumento de lista de espera y demora en el tratamiento, lo que posiblemente derive en un diagnóstico en estadios más avanzados de la enfermedad

INTRODUCTION: The COVID-19 pandemic has changed routine clinical activity in the last few months. Because our hospital was overwhelmed and to prevent patient exposure to SARS-CoV-2 in the hospital setting, consultations, diagnostic tests, and surgical interventions have been postponed. However, this has provoked a delay in the care of other health problems. MATERIAL AND METHODS: We analysed and compared the data from the breast unit of a second-level hospital in terms of the activity of the Early Breast Cancer Detection Programme (EBCDP), the cancer diagnoses made, and the patients undergoing surgery from March to May, 2020, compared with the same period in the previous year. RESULTS: The number of patients attended in the EBCDP in March and May decreased by 91.7% and those attended in the Radiodiagnostics Service of the hospital fell by 54.2%. Surgical activity also decreased by 57.69% compared with the same period in 2019. CONCLUSIONS: The decrease in the activity of the EBCDP and Radiology Service have led to a diagnostic delay which will, in turn, increase waiting lists and delay treatment. These factors will possibly lead to tumours being diagnosed in more advanced stages

La necesidad de contar con sistemas resilientes: A propósito de la creación de una unidad de gestión clínica para la reorganización de un hospital de tercer nivel durante una emergencia sanitaria / The need for resilient structures: on the creation of a clinic management unit for the reorganization of a tertiary hospital during a health emergency

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Centro de material e esterilização: reconfiguração da assistência indireta de enfermagem em um hospital geral (2002 a 2007) / Material and sterilization center: reconfiguration of indirect nursing care in a general hospital

O serviço de esterilização de materiais hospitalares no Brasil foi realizado historicamente no mesmo espaço social do centro cirúrgico. Porém, os avanços tecnológicos dos instrumentais e a crescente complexidade dos procedimentos cirúrgicos implicaram na evolução das técnicas de esterilização dos materiais, o que culminou na centralização do Centro de Material e Esterilização (CME) e na concomitante reconfiguração da assistência indireta de enfermagem. Esta pesquisa tem como objeto de estudo a reconfiguração da assistência indireta de enfermagem durante a centralização do setor de esterilização no Hospital Santa Teresa (HST), um hospital geral da rede privada do município de Petrópolis, Região Serrana do Estado do Rio de Janeiro. Objetivos: descrever as circunstâncias que determinaram a centralização do CME no HST; analisar as estratégias empreendidas pela equipe de enfermagem que participou da centralização do CME para a reconfiguração da assistência indireta de enfermagem; Discutir os ganhos simbólicos com a centralização do CME para a assistência indireta da enfermagem, para o HST e para a sociedade. Metodologia: estudo histórico-social, de abordagem qualitativa, na perspectiva da História do Tempo Presente. As fontes históricas foram: primárias escritas: atas de reunião, Procedimento Operacional Padrão (POP) e material de treinamento da equipe de enfermagem; primárias orais: depoimentos temáticos com a participação de oito profissionais; secundárias: livros, dissertações, teses e artigos científicos. Os resultados desse estudo evidenciaram que, antes da centralização do CME, os profissionais de enfermagem dividiam suas práticas entre os cuidados diretos e indiretos no setor de esterilização conjugado ao centro cirúrgico, evidenciando a não exclusividade, sobrecarga de trabalho e prevalência dos cuidados diretos sobre os indiretos. Havia pouca valorização/visibilidade do serviço de esterilização, o qual era considerado desqualificatório para os profissionais que o exerciam. Não havia rotina para dimensionamento de pessoal e eram realizadas práticas que comprometiam o controle efetivo de infecção hospitalar. A partir do cumpra-se legislativo que determinava a centralização do serviço de esterilização, teve início o processo de centralização do serviço de esterilização, que passou a contar com rotinas previstas para o CME a ser centralizado, redimensionamento de pessoal com escalas e a reconfiguração da assistência indireta, que se tornou exclusiva, mais sistematizada e com mais controle sobre os processos de trabalho. Novos profissionais foram contratados para atuar na esterilização e os envolvidos passaram a adquirir novos capitais científicos por meio de educação continuada especialização, treinamento, educação permanente e/ou capacitação. Novas tecnologias foram agregadas ao serviço, inclusive após a efetiva centralização do CME. Conclui-se que as estratégias adotadas pela equipe de enfermagem para reconfigurar a assistência indireta resultaram em ganhos simbólicos para a enfermagem com redução do estresse laboral, maior satisfação no trabalho, autonomia, reconhecimento e valorização profissional; para o HST, que passou a dispor de maior eficácia no controle de infecções hospitalares e gestão financeira relacionada aos insumos mais eficiente; e para a sociedade, que se beneficiou com serviços mais qualificados e seguros prestados pelo hospital.

The hospital materials sterilization service in Brazil was carried out historically in the same social space of the surgical center. However, the technological advances of the instruments and the increasing complexity of the surgical procedures implied in the evolution of the techniques of material sterilization, which culminated in the centralization of the Central Sterile Services Department (CSSD) and the concomitant reconfiguration of the indirect nursing care. This study object is the reconfiguration of indirect nursing care during the centralization of the sterilization sector in Hospital Santa Teresa (HST), a private general hospital of the municipality of Petrópolis, Mountain Region of the State of Rio de Janeiro. Objectives: to describe the circumstances that led to the centralization of the CSSD in HST; to analyze the strategies implemented by the nursing team that participated in the centralization of the CSSD for the reconfiguration of the indirect nursing care; discuss the symbolic gains with the centralization of the CSSD for the indirect assistance of nursing, the HST and the society. Methodology: historical-social study, qualitative approach, from the perspective of the History of Present Time. The historical sources were: written primaries: meeting minutes, Standard Operating Procedure (SOP) and training material of the nursing team; oral primary: thematic statements with the participation of eight professionals; books, dissertations, thesis and scientific articles. The results of this study showed that, prior to the centralization of CSSD, nursing professionals divided their practices between direct and indirect care in the sterilization sector combined with the surgical center, evidencing non-exclusivity, work overload and prevalence of direct care over the indirect. There was little appreciation / visibility of the sterilization service, which was considered disqualifying for the professionals who carried it out. There was no routine for staff sizing and practices performed undermined the effective control of hospital infection. From the legislative resolution that established the centralization of the sterilization service, the process of centralization of this sector began, with routines planned for the CSSD, staff rescaling with scales and the reconfiguration of the indirect assistance, which has become exclusive, more systematized and with more control over work processes. New professionals were hired to perform sterilization, and those involved began to acquire new scientific capital through specialization, training, permanent education and / or training. New technologies were added to the service, even after the effective centralization of the CME. It was concluded that the strategies adopted by the nursing team to reconfigure indirect care resulted in symbolic gains for nursing with reduction of work stress, greater job satisfaction, autonomy, recognition and professional valorization; for HST, which has become more effective in the control of hospital infections and more efficient in financial management of inputs; and to society, which has benefited from more qualified and safe services provided by the hospital.

[Conceptual and Cognitive Restructuring?] / Konzeptionelle und kognitive Umstrukturierung?

Objective: In the treatment of patients with alcohol dependence it is next to physical detoxification under protected conditions to promoting abstinence motivation. Further the need of crisis interventions is derived from the clinical practise. To be able to become fairer to all groups of treatment as well as the different demands, the addiction admission station was restructured. Methods: Pre-post-evaluation. Results: It was found that the door was closed up significantly less often after the restructuring. In the residence time structure an increase appeared in the descriptive values with the more than 7-day stays. Conclusions: It is to be able to hold successfully the optional closed door highly significantly more often open.

Advances in health promotion in Asia-Pacific: promoting health through hospitals.

Since 1990, the WHO Health Promoting Hospital (HPH) movement has tried to facilitate and support hospitals to assume a core responsibility in health promotion. The Taiwan HPH Network was established in December 2006, and became the largest HPH network in the world in 2013. Compared to Europe where the HPH has been more established, the pace of HPH development has been much more rapid. This rapid development provides an inspiring example for research and health promotion practice. Systematic data and empirical information have been collected about HPH in Taiwan, allowing for research to be published about the achievements of the HPH movement. This paper provides an overview of the existing literature on current progress of the HPH project according to the four main perspectives of the WHO-HPH movement: promoting the health of patients, promoting the health of staff, changing the organization to a health-promoting setting, and promoting the health of the community in the catchment area of the hospital. The assessment can serve as a stepping stone in understanding current HPH development in Taiwan and as a reference for future research.

[Do Learning Effects Lead to Path Dependencies in Hospitals? Study of the Effects on Reorganisation Processes]. / Führen Lerneffekte zu Pfadabhängigkeiten in Krankenhäusern? Untersuchung zu Auswirkungen auf Reorganisationsprozesse.

Based on the observations concerning the economic situation, a fundamental restructuring of hospital organisations is repeatedly called for in the literature. Strengthening the process orientation by "raising" the grade of efficiency is frequently argued as an organisational measure. This work theoretically investigates where the obstacles to organisational change in hospitals can lie using the path dependency theory. Specifically, socio-professional influences on the learning behaviour of hospital staff will be discussed. Influences that affect inter-professional cooperation in hospitals are identified.

Building Resilience and Organizational Readiness During Healthcare Facility Redevelopment Transitions: Is It Possible to Thrive?

OBJECTIVE: Hospital redevelopment constitutes a revolutionary change that can face strong resistance from employees. Few studies have examined how employee readiness for change relates to adjustment outcomes typically captured in post-occupancy evaluation (POE). The relationship between organizational readiness and employee adjustment is examined in the context of a POE conducted during a hospital redevelopment. BACKGROUND: Our study focuses on the redevelopment of a complex continuing care and rehabilitation hospital that underwent complete physical redevelopment and major shifts in operational and organizational processes. METHODS: Using a pretest-posttest quasi-experimental research design, staff organizational readiness was assessed using surveys at four time periods: 6 months prior to the move (n = 125), 2 months prior to the move (n = 84), 3 months after the move (n = 187), and 6 months after the move (n = 194). Measures included organizational readiness, workplace satisfaction, psychological factors (well-being and optimism), and sociodemographic information. RESULTS: Findings suggest readiness changes from pre- to post-move, with notable drops just prior (2 months) and just post (3 months) hospital move. Employees demonstrated significant increases in workplace satisfaction and interprofessional relationships from 6 months prior to the move to 6 months after. Results suggest that higher readiness is related to improved employee adjustment. CONCLUSIONS: A supportive change environment was found to encourage positive employee outcomes in the face of revolutionary change. It is recommended that change management activities be tailored not only to employee need but also to the timing of the change process.

Management practices to support donor transition: lessons from Avahan, the India AIDS Initiative.

BACKGROUND: During 2009-2012, Avahan, a large donor funded HIV/AIDS prevention program in India was transferred from donor support and operation to government. This transition of approximately 200 targeted interventions (TIs), occurred in three tranches in 2009, 2011 and 2012. This paper reports on the management practices pursued in support of a smooth transition of the program, and addresses the extent to which standard change management practices were employed, and were useful in supporting transition. RESULTS: We conducted structured surveys of a sample of 80 TIs from the 2011 and 2012 rounds of transition. One survey was administered directly before transition and the second survey 12 month after transition. These surveys assessed readiness for transition and practices post-transition. We also conducted 15 case studies of transitioning TIs from all three rounds, and re-visited 4 of these 1-3 years later. RESULTS: Considerable evolution in the nature of relationships between key actors was observed between transition rounds, moving from considerable mistrust and lack of collaboration in 2009 toward a shared vision of transition and mutually respectful relationships between Avahan and government in later transition rounds. Management practices also evolved with the gradual development of clear implementation plans, establishment of the post of "transition manager" at state and national levels, identified budgets to support transition, and a common minimum programme for transition. Staff engagement was important, and was carried out relatively effectively in later rounds. While the change management literature suggests short-term wins are important, this did not appear to be the case for Avahan, instead a difficult first round of transition seemed to signal the seriousness of intentions regarding transition. CONCLUSIONS: In the Avahan case a number of management practices supported a smooth transition these included: an extended and sequenced time frame for transition; co-ownership and planning of transition by both donor and government; detailed transition planning and close attention to program alignment, capacity development and communication; engagement of staff in the transition process; engagement of multiple stakeholders post transition to promote program accountability and provide financial support; signaling by actors in charge of transition that they were committed to specified time frames.