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1.
Stud Health Technol Inform ; 299: 283-286, 2022 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-36325877

RESUMO

The current Finnish public hospitals' eHealth services are organization-oriented rather than patient-oriented. Patients remain passive and use eHealth services that are designed by private or governmental organizations. Patients had little or no involvement in that process. This paper introduces a novel eHealth Services Model that can be used as a tool to capture the needs of both organizations and patients. Two eHealth services were used to verify and support the validity of the presented model. The first eHealth service features came from an existing Finnish eHealth service that was designed by a Finnish organization. The second eHealth service features have been derived from the collected patients' feedback. A survey was carried out to compare the selected two eHealth services features. The finding of this paper suggests that an eHealth service with features that capture patients' needs is favorable against the eHealth service features that came from a Finnish organization. The presented model is a long-term solution that can be utilized in designing and providing the right technologies and services that will continuously satisfy the needs of patients and organizations.


Assuntos
Telemedicina , Humanos , Inquéritos e Questionários , Modelos Organizacionais , Finlândia
2.
BMJ Open ; 12(8): e059606, 2022 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-36170225

RESUMO

INTRODUCTION: Ageing entails a variety of physiological changes that increase the risk of chronic non-communicable diseases. The prevalence of these diseases leads to an increase in the use of health services. The care models implemented by health systems should provide comprehensive long-term healthcare. We conducted this systematic review to determine whether any model of care for older persons have proven to be effective. METHODS: A systematic review of literature was carried out to identify randomised clinical trials that have assessed how effective a care model for older patients with chronic diseases. A searches electronic databases such as MEDLINE, Turning Research Into Practice Database, Cochrane Library and Cochrane Central Register of controlled Trials was conducted from January 1966 to January 2021. Two independent reviewers assessed the eligibility of the studies. Interventions were identified and classified according to the taxonomies developed by the Cochrane Effective Practice and Organisation of Care and Cochrane Consumers and Communication groups. RESULTS: Of the 4952 bibliographic references that were screened, 577 were potentially eligible and the final sample included 25 studies that evaluated healthcare models in older people with chronic diseases. In the 25 care models, the most frequently implemented interventions were educational, and those based on the provision of healthcare. Only 22% of the outcomes of interventions were identified as being effective, whereas 21% were identified as being partially effective; thus, more than 50% of the outcomes were identified as being ineffective. CONCLUSIONS: It was not possible to determine a care model as effective. The interventions implemented in the models are variable. The most effective outcomes were focused on improving the patient-healthcare professional relationship in the early stages of the intervention. The interventions addressed in the studies were similar to public health interventions as their main objectives focused on promoting health. Most studies were of low methodological quality.


Assuntos
Doença Crônica , Assistência Integral à Saúde , Modelos Organizacionais , Idoso , Doença Crônica/terapia , Assistência Integral à Saúde/organização & administração , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
3.
G Ital Nefrol ; 39(3)2022 Jun 20.
Artigo em Italiano | MEDLINE | ID: mdl-35819040

RESUMO

The prevalence of chronic kidney disease is 7.05% in Italy. The replacement dialysis treatments determine greenhouse gas emissions thus contributing to climate change, an important source of risk to global health. Furthermore, the percentage of the Italian Gross Domestic Product destined to public health expenditure has progressively contracted. The province of Belluno has an area of 3610 km2, with a population density of 56 people/km2, an old age index of 248.5, and offers 4 dialysis centers; however, several patients take up to 8 hours/week to commute to the dialysis center, with a consequent significant environmental and economic impact. We have investigated the Home Hemodialysis (H-HD) models, both as Assisted Home Hemodialysis (AH-HD), and as Not-assisted Home Hemodialysis (NH-HD), to evaluate their environmental and economic sustainability, and the actual impact due to their adoption by 5 patients. Thanks to AH-HD it is possible a reduction up to 3767 kg of CO2 per year, and an economic saving of € 32 456 per year. Utilizing a NH-HD treatment, it is possible a reduction of 5330 kg of CO2 per year, and a reduction in annual healthcare costs up to € 30 156 per year. Furthermore, the adoption of H-HD treatment for 5 patients allowed an effective reduction of 14 537 kg of CO2 emitted and a net economic saving of € 57 975. Therefore, we consider H-HD methods a valid option for patients living in areas with low population density, where transports have a significant impact, allowing a net reduction of CO2 equivalent emissions and a considerable saving of the health resources.


Assuntos
Hemodiálise no Domicílio , Falência Renal Crônica , Dióxido de Carbono , Análise Custo-Benefício , Hemodiálise no Domicílio/métodos , Humanos , Falência Renal Crônica/terapia , Modelos Organizacionais , Diálise Renal/métodos
4.
Artigo em Russo | MEDLINE | ID: mdl-35670405

RESUMO

The modern trends in health care (strategies of optimizing costs, value-oriented medical care) require systematic development of laboratory services for administrative territories. The study was carried out to provide support for decision-making by systematizing models of laboratory services on the basis of principles of systematic approach. Four basic models (centralization, outsourcing, horizontal integration, point-of-care) were analyzed. The study applied such research methods as analytical and strategic SWOT-analysis. The SWOT-analysis was implemented using list of standard characteristics for each model of laboratory service organization. Each model is distinguished by complex combination of strengths, weaknesses, lines of functioning and development. The availability of implementing particular model depends on delicate balance of opportunities and risks against the background of local characteristics of administrative subject. The dynamics of the social economic and infrastructural development of administrative subject can significantly affect effectiveness of model implementation. The objective set of characteristics was obtained for each model of laboratory service organization. Actually it is impossible to select particular model for specific administrative subject. Hence, scientific substantiation of "flexible" model is needed to implement.


Assuntos
Atenção à Saúde , Modelos Organizacionais , Serviços de Diagnóstico
5.
Front Public Health ; 10: 819096, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35651862

RESUMO

Performance of healthcare can be measured as its ability to restore and preserve health with acceptable costs for the society. Under the current prevalence of chronic disease, medical care (the major content of healthcare) underperforms in all key indicators: clinical effectiveness, benefit/risk ratio of interventions, cost/benefit ratio, and general population health. In Russia key performance indicators (KPI) of healthcare do not allow effective decision-making; a similar situation is seen worldwide: most KPIs are either focused on the process (not results) of medical care, or depend on efforts out of control of healthcare decision-makers. The key root factors limiting clinical effectiveness and cost-effectiveness of healthcare are reactive diagnosis-centered organizational model of care and the underlying biomedical paradigm, generally inadequate in chronic diseases. They make healthcare intervene too late, use less effective prevention and treatment instruments, and be in a state of resource scarcity. In Russia there is also a lack of interdisciplinary and interagency cooperation essential for health preservation and promotion. Performance of healthcare system in overcoming the chronic disease epidemic can be improved through supplementing the current 'reactive' organizational model with preventive person-centered model based on the biopsychosocial paradigm. Enabling patients for early lifestyle-based interventions, the core P4 medicine approach, should prevail in managing chronic disease. Communication and information technologies should allow fast scaling up of the best person-centered practices.


Assuntos
Atenção à Saúde , Promoção da Saúde , Doença Crônica , Análise Custo-Benefício , Humanos , Modelos Organizacionais
6.
Health Care Manage Rev ; 47(4): 272-278, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35499390

RESUMO

ASSOCIATE EDITORS NOTE: This article is an adapted version of Dr. Jacqueline Zinn's Keith G. Provan Distinguished Scholar Award plenary to the Health Care Management Division of the Academy of Management in 2020. We are excited to share it with you because it is noteworthy among scholarly career award plenaries. Specifically, the article does two big things exceptionally well: (a) provides a compelling and informative retrospective on a truly exceptional scholarly career renowned for work that consistently and deeply engages with practice, practitioners, and emerging, urgent problems in a conceptually and empirically rigorous manner and (b) inventively connects her research to the health care, managerial, and organizational challenges posed by the pandemic (and pandemics from prior eras) to provide a forward looking research agenda on organizational resilience and well-being that offers ready-made conceptual development and empirical work for the next generation.


Assuntos
Modelos Organizacionais , Pandemias , Feminino , Humanos , Estudos Retrospectivos
7.
Infant Ment Health J ; 43(4): 624-637, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35638583

RESUMO

Early relational health between caregivers and children is foundational for child health and well-being. Children and caregivers are also embedded within multiple systems and sectors, or a "child-serving ecosystem", that shapes child development. Although the COVID-19 pandemic has made this embeddedness abundantly clear, systems remain siloed and lack coordination. Fostering relational health amongst layers of this ecosystem may be a way to systematically support young children and families who are facing adversity. We integrate theory, examples, and empirical findings to develop a conceptual model informed by infant mental health and public health frameworks that illustrates how relational health across the child-serving ecosystem may promote child health and well-being at a population level. Our model articulates what relational health looks like across levels of this ecosystem from primary caregiver-child relationships, to secondary relationships between caregivers and child-serving systems, to tertiary relationships among systems that shape child outcomes directly and indirectly. We posit that positive relational health across levels is critical for promoting child health and well-being broadly. We provide examples of evidence-based approaches that address primary, secondary, and tertiary relational health, and suggest ways to promote relational health through cross-sector training and psychoeducation in the science of early development. This model conceptualizes relational health across the child-serving ecosystem and can serve as a template for promoting child health and well-being in the context of adversity.


La salud de la temprana relación entre quienes prestan cuidado y los niños es fundamental para la salud y el bienestar del niño. Los niños y quienes les cuidan forman parte de múltiples sistemas y sectores, o un "ecosistema de servicio al niño," que moldea el desarrollo del niño. Aunque la pandemia del COVID-19 ha demostrado abundante y claramente esta pertenencia, los sistemas permanecen aislados y les hace falta coordinación. Fomentar la salud de la relación entre las capas del ecosistema pudiera ser una manera de apoyar sistemáticamente a los niños pequeños y familias que se enfrentan con situaciones adversas. Presentamos un modelo conceptual con base en marcos de trabajo de la salud mental infantil y la salud pública que ilustra cómo la salud de la relación a lo largo del ecosistema de servicio al niño pudiera promover el desarrollo del niño al nivel de grupo de población. Nuestro modelo articula cómo aparece la salud de la relación a lo largo de los niveles del ecosistema desde las relaciones entre quien presta el cuidado primario y el niño, hasta las relaciones secundarias entre quienes prestan el cuidado y loa sistemas de servicio al niño, y las relaciones terciarias entre sistemas que amoldan directa e indirectamente los resultados en el niño. Una positiva salud de la relación a través de todos los niveles es esencial para promover la salud y el bienestar del niño de manera amplia. Describimos ejemplos específicos de salud de la relación primaria, secundaria y terciaria, y sugerimos maneras de promover la salud de la relación a través del entrenamiento intersectorial y la educación sicológica dentro de la ciencia del desarrollo temprano. Este modelo conceptualiza la salud de la relación a lo largo del ecosistema de servicio al niño y puede ser un esquema patrón para promover el desarrollo del niño dentro del contexto de situaciones adversas.


La Santé Relationnelle Précoce entre les personnes prenant soin des enfants et les enfants est fondamentale pour la santé de l'enfant et son bien-être. Les enfants et les personnes prenant soin d'eux sont encastrés dans de multiples systèmes et des secteurs, ou un « écosystème ¼ servant l'enfant qui forme le développement de l'enfant. Bien que la pandémie du Covid19 ait rendu cet encastrement très clair, les systèmes demeurent compartimentés et manquent de coordination. Cultiver la santé relationnelle au sein des couches de l'écosystème pourrait s'avérer être une manière de soutenir des jeunes enfants et les familles faisant face aux obstacles. Nous présentons un modèle conceptuel informé par les structures de la santé mentale du nourrisson et de la santé publique qui illustre la manière dont la santé relationnelle au travers de l'écosystème servant les enfants peut promouvoir le développement de l'enfant au niveau de la population. Notre modèle articule ce à quoi la santé relationnelle ressemble au travers des niveaux de l'écosystème, des relations entre la personne principale qui s'occupe de l'enfant et l'enfant aux relations secondaires entre les personnes prenant soin de l'enfant et les systèmes servant l'enfant, jusqu'aux relations tertiaires entres les systèmes qui donnent forme aux résultats directement et indirectement. Une santé relationnelle positive au travers de tous les niveaux est critique pour la promotion de la santé de l'enfant et de son bien-être en général. Nous décrivons des exemples spécifiques de santé relationnelle primaire, secondaire et tertiaire, et suggérons des manières de promouvoir la santé relationnelle au travers de la formation entre secteurs et de la psychoéducation dans la science du développement précoce. Ce modèle conceptualise la santé relationnelle au travers de l'écosystème servant l'enfant et peut servir de modèle pour la promotion du développement de l'enfant dans le contexte de l'adversité.


Assuntos
Desenvolvimento Infantil , Promoção da Saúde , COVID-19/epidemiologia , Cuidadores/psicologia , Pré-Escolar , Ecossistema , Promoção da Saúde/organização & administração , Humanos , Lactente , Modelos Organizacionais , Pandemias , Relações Pais-Filho
8.
Eur J Emerg Med ; 29(5): 329-340, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-35503094

RESUMO

Paediatric attendances at the emergency department (ED) are often admitted to the hospital less than 24 h to allow time for more extended evaluation. Innovative organisational models could prevent these hospital admissions without compromising safety or quality of delivered care. Therefore, this systematic review identifies evidence on organisational models at the ED with the primary aim to reduce hospital admissions among paediatric patients. Following the PRISMA guidelines, three bibliographic databases (Ovid Medline, Embase, and Cochrane Library) were searched. Studies on organisational models in Western countries, published between January 2009 and January 2021, which applied a comparative design or review and studied at least hospital admission rates, were included. Analyses were mainly descriptive because of the high heterogeneity among included publications. The primary outcome is hospital admission rates. Secondary outcomes are ED length of stay (LOS), waiting time, and patient satisfaction. Sixteen publications described several innovative organisational models ranging from the creation of dedicated units for paediatric patients, innovative staffing models to bringing paediatric critical care physicians to patients at rural EDs. However, the effect on hospital admission rates and other outcomes are inconclusive, and some organisational models may improve certain outcomes in certain settings or vice versa. It appears that a paediatric consultation liaison team has the most consistent effect on hospital admission rates and LOS of paediatric patients presenting with mental problems at the ED. Implementing new innovative organisational models at the ED for paediatric patients could be worthwhile to decrease hospital admissions. However, the existing evidence is of rather weak quality. Future service developments should, therefore, be conducted in a way that allows objective evaluation.


Assuntos
Serviço Hospitalar de Emergência , Modelos Organizacionais , Criança , Hospitalização , Hospitais , Humanos , Tempo de Internação , Admissão do Paciente
9.
Ann Ital Chir ; 93: 147-151, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35503058

RESUMO

AIM: We analysed our one-year surgical activity in a spoke 'COVID-19 free' centre during the pandemic in South Italy. MATERIAL OF STUDY: From Feb 2020 to Feb 2021 we performed 800 operations (40% in emergency and 60% of major surgery). We applied restrictive measures for the access of patients in our department from 15/2/2020 after several cases of unclear fever. Visitors were not allowed to stay in the ward. RESULTS: In the first period of lockdown, from March to June 2020, in our Region, biomolecular test was indicated only for symptomatic people. We organized the hospitalization with a sealed compartment system (that we defined "boing system") in which the patient stationed in an 'isolation room' for at least 48 hours upon the entry. From July 2020 molecular test were made to all patients before hospitalization. The boing system remains for emergency recovery. DISCUSSION: In the first phase of pandemia we chose to subject patients to serological examination based on the IgM assay to consider them negative. We organized the hospitalization with a sealed compartment system (that we defined "boing system") CONCLUSION: In the first phase of the pandemic the serological examination has shown high specificity in identifying positive patients for COVID 19. In that period we supposed that patients with negative serology could be considered non-contagious Neither patients or staff has been resulted positive to SarS CoV2 test. KEY WORDS: Covid 19, Emercency Surgery, Spoke Center, Pandemia, Serological Tests.


Assuntos
COVID-19 , Pandemias , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Humanos , Modelos Organizacionais , SARS-CoV-2
10.
Creat Nurs ; 28(2): 121-125, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35501137

RESUMO

Professional nurses utilize person-centered/patient-centered models of care to provide meaningful and effective healing or promotion of wellness. Using their skills, knowledge, and expertise, nurses are poised to lead quality improvement efforts that enhance patient outcomes, reduce inequities among populations, and contain costs. Culturally aligned organizational models are built on key concepts of cultural competency, patient- and family-centered care, and diversity, equity, inclusion, and belonging concepts. Nurses are poised to lead cultural alignment innovations across health-care professional teams, using their foundational skills to enhance quality and safety across the health-care spectrum.


Assuntos
Enfermagem , Assistência ao Paciente , Competência Cultural , Atenção à Saúde , Humanos , Modelos Organizacionais
11.
Semin Roentgenol ; 57(2): 176-180, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35523533

RESUMO

In this paper, we provide a brief overview of the history, organizational structure, and current operational state of our blended academic and community-model breast service. We review the challenges inherent to governance and management of a "matrix" organization practice model such as ours, and discuss the ways in which the leadership of our evolving blended practice are addressing those challenges collaboratively.


Assuntos
Liderança , Modelos Organizacionais , Humanos
13.
World J Emerg Surg ; 17(1): 17, 2022 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-35300731

RESUMO

BACKGROUND: The objectives of the study were to investigate the organizational characteristics of acute care facilities worldwide in preventing and managing infections in surgery; assess participants' perception regarding infection prevention and control (IPC) measures, antibiotic prescribing practices, and source control; describe awareness about the global burden of antimicrobial resistance (AMR) and IPC measures; and determine the role of the Coronavirus Disease 2019 pandemic on said awareness. METHODS: A cross-sectional web-based survey was conducted contacting 1432 health care workers (HCWs) belonging to a mailing list provided by the Global Alliance for Infections in Surgery. The self-administered questionnaire was developed by a multidisciplinary team. The survey was open from May 22, 2021, and June 22, 2021. Three reminders were sent, after 7, 14, and 21 days. RESULTS: Three hundred four respondents from 72 countries returned a questionnaire, with an overall response rate of 21.2%. Respectively, 90.4% and 68.8% of participants stated their hospital had a multidisciplinary IPC team or a multidisciplinary antimicrobial stewardship team. Local protocols for antimicrobial therapy of surgical infections and protocols for surgical antibiotic prophylaxis were present in 76.6% and 90.8% of hospitals, respectively. In 23.4% and 24.0% of hospitals no surveillance systems for surgical site infections and no monitoring systems of used antimicrobials were implemented. Patient and family involvement in IPC management was considered to be slightly or not important in their hospital by the majority of respondents (65.1%). Awareness of the global burden of AMR among HCWs was considered very important or important by 54.6% of participants. The COVID-19 pandemic was considered by 80.3% of respondents as a very important or important factor in raising HCWs awareness of the IPC programs in their hospital. Based on the survey results, the authors developed 15 statements for several questions regarding the prevention and management of infections in surgery. The statements may be the starting point for designing future evidence-based recommendations. CONCLUSION: Adequacy of prevention and management of infections in acute care facilities depends on HCWs behaviours and on the organizational characteristics of acute health care facilities to support best practices and promote behavioural change. Patient involvement in the implementation of IPC is still little considered. A debate on how operationalising a fundamental change to IPC, from being solely the HCWs responsibility to one that involves a collaborative relationship between HCWs and patients, should be opened.


Assuntos
Anti-Infecciosos , COVID-19 , Antibacterianos/uso terapêutico , Estudos Transversais , Humanos , Modelos Organizacionais , Pandemias/prevenção & controle
14.
Med Sci (Paris) ; 38(3): 288-293, 2022 Mar.
Artigo em Francês | MEDLINE | ID: mdl-35333166

RESUMO

This article describes the concept of occupational exposome in highlighting the value of the concept in understanding the complexity of workplace exposures and their determinants. An organizational approach to the occupational exposome is proposed. The organizational approach is intended, from an interdisciplinary perspective, to broaden the levels of analysis of the exposures (whether they are) of the individual to the work situation (individual or collective), the work situation in the workshop or in the service, the company and the socio-economic environment of the company, the socio-economic environment of the company to the Society as a whole. The organizational approach of the occupational exposome helps to broaden the spectrum of health risk assessment and to promote a comprehensive and integrated approach to the prevention of arduousness at work and occupational wear and tear.


Title: Un modèle organisationnel de l'exposome professionnel. Abstract: Dans cette revue, nous décrivons le concept d'exposome professionnel, en soulignant son intérêt pour appréhender la complexité des expositions en milieu de travail et saisir l'ensemble de leurs déterminants. Une approche organisationnelle de cet exposome est par ailleurs proposée. Elle vise, en lui donnant une perspective interdisciplinaire, à élargir les niveaux d'analyse des expositions, quelles qu'elles soient, de l'individu à la situation de travail, individuelle ou collective, de la situation de travail à l'atelier ou au service dans l'entreprise1 et son environnement socio-économique, et, enfin, de l'environnement socio-économique de l'entreprise à l'ensemble de la Société. Cette approche organisationnelle de l'exposome professionnel contribue également à élargir le spectre de l'évaluation des risques sanitaires et à promouvoir une approche globale et intégrée de la prévention de la pénibilité au travail et de l'usure professionnelle.


Assuntos
Expossoma , Exposição Ambiental/análise , Humanos , Modelos Organizacionais , Medição de Risco
15.
Environ Sci Pollut Res Int ; 29(26): 39622-39637, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35107730

RESUMO

The Mexican maquiladora industry is applying Lean Manufacturing Tools (LMT) in its production lines; however, few studies have investigated its relationship with sustainability (social, economic, and environmental). This paper presents a second-order structural equation model (SEM) relating 8 LMT integrated into three independent latent variables: continuous improvement (Kaizen and Gemba), supporting tools (Andon, visual management, and Poka-yoke), and machinery and equipment (total productive maintenance, overall equipment effectiveness, and Jidoka) that are related to social, economic, and environmental sustainability as dependent variables. The model is validated with information obtained from 249 companies using partial least squares. Findings show that the application of LMT in the Mexican maquiladora industry avoids the generation of waste and reprocessing. Likewise, the improvement of production processes reduces the waste emitted into the environment and reduces energy consumption. Also, when companies have environmental programs, the work environment is safe, and labor relations are improved, increasing morale and the commitment to work for the company, gaining economic and ecological benefits.


Assuntos
Comércio , Indústria Manufatureira , Desenvolvimento Sustentável , Comércio/métodos , Comércio/organização & administração , Indústrias/métodos , Internacionalidade , Indústria Manufatureira/instrumentação , Indústria Manufatureira/métodos , Indústria Manufatureira/organização & administração , México , Modelos Organizacionais , Melhoria de Qualidade , Energia Renovável , Gerenciamento de Resíduos , Local de Trabalho/organização & administração , Local de Trabalho/normas
16.
Ann Ig ; 34(6): 635-649, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35060992

RESUMO

Background: Increasing waiting times for elective surgery is a major concern for policymakers and healthcare staff in many countries, due to its effect on health, patient satisfaction and the perceived quality of health-care. Many organizational models to reduce surgical waiting times have been studied, but the international literature indicates that multidimensional interventions on different aspects of the surgical pathway can be more effective in reducing waiting times than interventions focused on optimizing a single aspect. Aim: The aim of the study is to evaluate the effectiveness of a multidimensional intervention in reducing waiting times for elective surgery. Study design: We used a pre-post approach to evaluate the effect of a multidimensional project to reduce waiting times and lists. Methods: In a district general hospital (Italy) with three elective surgery operating rooms open 6 hours/day, 5 days/week (surgery specialties: general surgery, orthopaedics, gynaecology and urology), a project for reducing surgery waiting times was implemented in October 2018. The project focused on three aspects: i) separation of the flow of day surgery from that of ordinary surgery; ii) increasing available operating time by reorganizing the staff; iii) allocation of operating sessions flexibly in proportion to the waiting list. Waiting times for surgery in the periods 1/10/2019-31/12/2019 and 1/10/2018-31/12/2018 were compared by t test. Results: Waiting times for non-high-priority cases shortened significantly for all specialities (p<0.01), ex-cept for urology. For general surgery, orthopaedics and gynaecology, mean waiting times for day surgery decreased from 198 to 100 days (-50%) and for ordinary operations from 213 to 134 days (-37%). Waiting times for high-priority cases also shortened. Conclusions: Our multidimensional project based on reorganization of staff and facilities and on improved scheduling proved effective in reducing waiting times for elective surgery.


Assuntos
Procedimentos Cirúrgicos Eletivos , Listas de Espera , Humanos , Modelos Organizacionais , Salas Cirúrgicas , Satisfação do Paciente
17.
Aust N Z J Obstet Gynaecol ; 62(3): 401-406, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35064674

RESUMO

BACKGROUND: In Australia, a significant proportion of women live rurally and deliver their babies in services supported by general practitioner obstetricians (GPOs). While GPOs are known to be an important backbone in the provision of maternity care in Australia, little attention has been paid to their models of care. AIMS: To describe the models of maternity care provided by GPOs across Western Australia. MATERIALS AND METHODS: This was a multi-phase mixed-methods cross-sectional exploratory study. We invited rural GPOs in Western Australia to complete an online survey about their models of care and a sub-group of GPOs agreed to an interview to further explore their responses. RESULTS: Thirty-five GPOs completed the survey and 12 completed an interview. We found that GPOs work in a variety of models, dependent on local community needs, resources and geography. Key attributes of GPO models are continuity of care, safety, generalism, accessibility and affordability. GPO care involves continuity of care beyond the time limits of pregnancy. CONCLUSIONS: GPOs' models of care make up an essential part of rural maternity services and have evolved to meet the needs of the communities they serve. This work informs rural generalist trainees of career pathways and policymakers about rural service provision.


Assuntos
Clínicos Gerais , Serviços de Saúde Materna , Serviços de Saúde Rural , Estudos Transversais , Feminino , Humanos , Serviços de Saúde Materna/organização & administração , Modelos Organizacionais , Gravidez , Serviços de Saúde Rural/organização & administração , Austrália Ocidental
19.
PLoS One ; 17(1): e0262394, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35073357

RESUMO

Research on the relationship between transformational leadership and safety compliance has yielded equivocal results. This study investigates how and when transformational leadership produces divergent effects on safety compliance. Using a time-lagged research design, we collect data from a sample of 309 employees in the Chinese construction industry to examine the hypothesized relationship. We find that transformational leadership positively affects safety compliance through employees' felt obligation toward their leader. However, transformational leadership also negatively impacts safety compliance through safety risk tolerance. We further show that employees' perception of the safety climate plays a contingent role in the above processes. Specifically, a high-level perceived safety climate strengthens the positive indirect effect of transformational leadership on safety compliance through felt obligation, while a low-level perceived safety climate strengthens the negative indirect effect of transformational leadership on safety compliance through safety risk tolerance. The theoretical and practical implications of the findings are also discussed.


Assuntos
Liderança , Saúde do Trabalhador , Adulto , Análise Fatorial , Feminino , Humanos , Masculino , Modelos Organizacionais , Cultura Organizacional , Inovação Organizacional , Medição de Risco
20.
Bull Cancer ; 109(1): 89-97, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34785029

RESUMO

CONTEXT: The administration of immune checkpoints inhibitors (ICIs) within hospitalization at home (HaH) organizations is an interesting alternative to conventional care. Three surveys were carried out to describe the different organizational models of French HaHs and criteria used by physicians in patient selection. METHODS: Three surveys were conducted between April 1 and August 31, 2020. The first one was addressed to all French HaHs, and the two others to public HaHs and oncologists treating patients with solid cancer in the Auvergne-Rhone-Alpes region. RESULTS: Overall, 54 French HaHs and 23 oncologists participated to the study. The health professionals involved in the patients' care were very heterogeneous, although in 92% of cases, the treatment prescription was made by the oncologist. HaH physicians were more involved in clinical assessment the day before treatment (19% vs. 0%), treatment validation (56% vs. 15%), and treatment prescription (19% vs. 0%), while nurses were better equipped (emergency kit available in 81% versus 50% of cases) when HaHs did carry out ICIs compared to when they did not. Most oncologists agreed that age, neuropsychiatric disorders, home environment, as well as treatment duration and good tolerance should be considered in patient selection. ECOG PS status and treatment response were less consensually considered. CONCLUSION: These results highlight the variability in French HaH organizations and patient selection criteria for employing ICIs at home. This study resulted in recommendations for administrating ICIs in HaH settings, which will likely be instrumental in further promoting this activity across France.


Assuntos
Serviços Hospitalares de Assistência Domiciliar/organização & administração , Inibidores de Checkpoint Imunológico/administração & dosagem , Neoplasias/terapia , Fatores Etários , França , Serviços Hospitalares de Assistência Domiciliar/estatística & dados numéricos , Hospitalização , Humanos , Transtornos Mentais , Modelos Organizacionais , Enfermeiras e Enfermeiros , Oncologistas/estatística & dados numéricos , Seleção de Pacientes , Inquéritos e Questionários/estatística & dados numéricos
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