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Background: Chief Executive Officer's (CEO) are integral leaders of health care organisation. Over the last two decades in United States (US) hospitals, it has been noted that CEO turnover rates are increasing, and it was reported that the CEO turnover rates have augmented from 14% in 2008 to 18% in 2017 in the private sector. In Australia, it was discovered that during two years, 41 executives had 18 distinct positions. It has been highlighted that the increasing CEO turnover is a major issue for Australian and international health care organisations. Some of the negative consequences of CEO turnover include organisational instability, high financial costs, loss of human capital and adverse effects on staff morale and patient care. Objective: Our scoping review aimed to map and summarise the evidence associated with CEO turnovers in both health and non-health setting, and answer the following questions: 1. What are the reasons for CEO departure?, 2. What are the strategies to minimise CEO turnover? Results: A protocol explaining the objectives, inclusion criteria and methods for this scoping review were specified in advance and published. This scoping review included 17 studies (13 health and 4 non-health setting) published over a 31-year period that investigated and described the increasing CEO turnover rates. All 17 studies identified causes of CEO turnover along with certain studies identifying facilitators of CEO retention. We classified CEO's departure reasons into three major themes: organizational, performance, and personal. Organisational factors include CEO departures due to issues within the organisation, performance factors include issues with CEO's work and personal factors captures personal reasons for CEO's leaving their job. Conclusion: CEOs are under immense pressure to deliver good results and drive growth while satisfying the interests of internal and external stakeholders. There are various reasons for CEO's departure however the most common factor identified is organisational. Contribution of paper statement: What is already known Causes and consequences of CEO turnover in both health and non-health settings. What this paper adds Three main factors associated with CEO turnover such as organisational, performance and personal factors. [ABSTRACT FROM AUTHOR]

Background: Germany has the highest per capita health care spending among EU member states, but its hospitals face pressure to generate profits independently due to the government's withdrawal of investment cost coverage. The diagnosis related groups (DRG) payment system was implemented to address the cost issue, challenging hospital physicians to provide services within predefined prices and an economic target corridor to reduce costs. This study examines the extent of cost awareness among medical personnel in German hospitals and its influencing factors. Methods: We developed an online survey in which participants across all specialties in hospitals estimated the prices in euros of four common interventions and answered questions about their human capital and perceived stress on the workplace. As a measure of cost awareness, we used the probability of estimating the prices correctly within a reasonable margin. We employed logit logistic regression estimators to identify influencing factors in a sample of 86 participants. Results: The results revealed that most of the respondents were unaware of the costs of common interventions. General human capital, acquired through prior education, and job-specific human capital had no influence on cost awareness, whereas domain-specific human capital, that is, gaining economic knowledge based on self-interest, had a positive nonlinear effect on cost awareness. Furthermore, an increased stress level negatively influenced cost awareness. Conclusions: This paper is the first of its kind for the German health care sector that contributes responses to the question whether health care professionals in German hospitals have cost awareness and if not, what reasons lie behind this lack of knowledge. Our findings show that the cost awareness desired by the introduction of the DRG system has yet to be achieved by medical personnel. [ABSTRACT FROM AUTHOR]

Background: While there is an extensive literature on Health System (HS) strengthening and on the performance of specific HSs, there are few exhaustive syntheses of the challenges HSs are facing worldwide. This paper reports the findings of a scoping review aiming to classify the challenges of HSs investigated in the scientific literature. Specifically, it determines the kind of research conducted on HS challenges, where it was performed, in which health sectors and on which populations. It also identifies the types of challenge described the most and how they varied across countries.Methods: We searched 8 databases to identify scientific papers published in English, French and Italian between January 2000 and April 2016 that addressed HS needs and challenges. The challenges reported in the articles were classified using van Olmen et al.'s dynamic HS framework. Countries were classified using the Human Development Index (HDI). Our analyses relied on descriptive statistics and qualitative content analysis.Results: 292 articles were included in our scoping review. 33.6% of these articles were empirical studies and 60.1% were specific to countries falling within the very high HDI category, in particular the United States. The most frequently researched sectors were mental health (41%), infectious diseases (12%) and primary care (11%). The most frequently studied target populations included elderly people (23%), people living in remote or poor areas (21%), visible or ethnic minorities (15%), and children and adolescents (15%). The most frequently reported challenges related to human resources (22%), leadership and governance (21%) and health service delivery (24%). While health service delivery challenges were more often examined in countries within the very high HDI category, human resources challenges attracted more attention within the low HDI category.Conclusions: This scoping review provides a quantitative description of the available evidence on HS challenges and a qualitative exploration of the dynamic relationships that HS components entertain. While health services research is increasingly concerned about the way HSs can adopt innovations, little is known about the system-level challenges that innovations should address in the first place. Within this perspective, four key lessons are drawn as well as three knowledge gaps. [ABSTRACT FROM AUTHOR]

Background: The objectives of the study reported in this paper were: (a) to score the coverage of core NCD population-based interventions and individual services in Mauritius; (b) to analyse and score the presence of 15 common health system challenges that impede delivery of core NCD interventions and services in Mauritius; and (c) to provide policy recommendations for Mauritius to address health system barriers to delivery of NCD interventions and services.Methods: The Mauritius country assessment applied the guidelines developed by the World Health Organization Regional Office for Europe for systematically scoring coverage of NCD interventions and assessing health system challenges for improving NCD outcomes. The assessment used qualitative research design approach.Results: Of the 24 core population-based interventions for addressing key NCD risk factors, 16.7% were rated extensive, 37.5% moderate and 45.8% limited. Three (20%), 8 (53%) and 4 (27%) of the 15 individual/personal CVD, diabetes and cancer services were rated extensive, moderate and limited respectively. The top five health system challenges hampering scale-up of coverage of population-based NCD interventions in Mauritius were inadequate interagency cooperation; limited application of explicit priority setting approaches; inadequate change management; sub-optimal distribution and mix human resources; insufficient population empowerment; and insufficient political commitment. The top five challenges had average scores of between 3.1 (interagency cooperation) and 2.4 (distribution and mix of human resources). The top five health system challenges constraining expansion in coverage of individual NCD services were limited integration of evidence into practice; limited use of explicit priority-setting approaches; inadequate application of information and technology solutions; insufficient population empowerment; and sub-optimal distribution and mix of human resources. The top five challenges for individual interventions had mean scores varying between 2.6 (integration of evidence into practice) and 1.7 (distribution and mix of human resources).Conclusions: Mauritius needs to increase its domestic general government investments into the national health system and requisite multi-sectoral action to address the priority health system challenges with a view of bridging the existing gaps in coverage of NCD population-based interventions and individual services. [ABSTRACT FROM AUTHOR]

Concern among the public and policymakers about current and future major staff shortages is increasing. Strengthening Human Resource (HR) practices and adopting HR technologies such as Human Resource Information Systems (HRIS), that can collect, store and report workforce data are often described as a potential solution to this problem. Indeed, examples from other industries show that HRIS can help to launch or manage, as well as provide ongoing insights concerning the whole career cycle of an employee. However, few of the existing studies that discuss technology or its impacts on the future of work have focused on health organizations, and those that do have not received sufficient attention in health literature. Furthermore, such contributions as there have been have either prioritized a particular type of technology or focused mainly on the effect of automation on health professionals' work. They have thus overlooked the full range of possible uses of these technologies and, specifically, have neglected the topic of HR for Health (HRH) management in health organizations. The primary aim of this paper is to address this lacuna, with specific reference to the existing categorization of HR technological disruptions. To conclude, health organizations and the health and HR professionals who work within them need to use HRIS responsibly, finding a balance between the drive for innovation, productivity and efficiency and respect for all potential legal, ethical and compliance issues, as well as taking account of the importance of HRH wellbeing and satisfaction. [ABSTRACT FROM AUTHOR]

Background: An effective referral system is essential for a high-quality health system that provides safe surgical care while optimizing patient outcomes and ensuring efficiency. The role of referral systems in countries with under-resourced health systems is poorly understood. The aim of this study was to examine the rates, preventability, reasons and patterns of outward referrals of surgical patients across three levels of the healthcare system in Northern Tanzania.Methods: Referrals from surgical and obstetric wards were assessed at 20 health facilities in five rural regions prospectively over 3 months. Trained physician data collectors used data collection forms to capture referral details daily from hospital referral letters and through discussions with clinicians and nurses. Referrals were deemed preventable if the presenting condition was one that should be managed at the referring facility level per the national surgical, obstetric and anaesthesia plan but was referred.Results: Seven hundred forty-three total outward referrals were recorded during the study period. The referral rate was highest at regional hospitals (2.9%), followed by district hospitals (1.9%) and health centers (1.5%). About 35% of all referrals were preventable, with the highest rate from regional hospitals (70%). The most common reasons for referrals were staff-related (76%), followed by equipment (55%) and drugs or supplies (21%). Patient preference accounted for 1% of referrals. Three quarters of referrals (77%) were to the zonal hospital, followed by the regional hospitals (17%) and district hospitals (12%). The most common reason for referral to zonal (84%) and regional level (66%) hospitals was need for specialist care while the most common reason for referral to district level hospitals was non-functional imaging diagnostic equipment (28%).Conclusions: Improving the referral system in Tanzania, in order to improve quality and efficiency of patient care, will require significant investments in human resources and equipment to meet the recommended standards at each level of care. Specifically, improving access to specialists at regional referral and district hospitals is likely to reduce the number of preventable referrals to higher level hospitals, thereby reducing overcrowding at higher-level hospitals and improving the efficiency of the health system. [ABSTRACT FROM AUTHOR]

Background: eHealth programmes in African countries face fierce competition for scarce resources. Such initiatives should not proceed without adequate appraisal of their probable impacts, thereby acknowledging their opportunity costs and the need for appraisals to promote optimal use of available resources. However, since there is no broadly accepted eHealth impact appraisal framework available to provide guidance, and local expertise is limited, African health ministries have difficulty completing such appraisals. The Five Case Model, used in several countries outside Africa, has the potential to function as a decision-making tool in African eHealth environments and serve as a key component of an eHealth impact model for Africa.Methods: This study identifies internationally recognised metrics and readily accessible data sources to assess the applicability of the model's five cases to African countries.Results: Ten metrics are identified that align with the Five Case Model's five cases, including nine component metrics and one summary metric that aggregates the nine. The metrics cover the eHealth environment, human capital and governance, technology development, and finance and economics. Fifty-four African countries are scored for each metric. Visualisation of the metric scores using spider charts reveals profiles of the countries' relative performance and provides an eHealth Investment Readiness Assessment Tool.Conclusion: The utility of these comparisons to strengthen eHealth investment planning suggests that the five cases are applicable to African countries' eHealth investment decisions. The potential for the Five Case Model to have a role in an eHealth impact appraisal framework for Africa should be validated through field testing. [ABSTRACT FROM AUTHOR]

Background: The relationship between healthcare system inputs (e.g., human resources and infrastructure) and mortality has been extensively studied. However, the association between healthcare system inputs and patient-reported outcomes remains unclear. Hence, we explored the predictive value of human resources and infrastructures of the countries' healthcare system on patient-reported outcomes in adults with congenital heart disease.Methods: This cross-sectional study included 3588 patients with congenital heart disease (median age = 31y; IQR = 16.0; 52% women; 26% simple, 49% moderate, and 25% complex defects) from 15 countries. The following patient-reported outcomes were measured: perceived physical and mental health, psychological distress, health behaviors, and quality of life. The assessed inputs of the healthcare system were: (i) human resources (i.e., density of physicians and nurses, both per 1000 people) and (ii) infrastructure (i.e., density of hospital beds per 10,000 people). Univariable, multivariable, and sensitivity analyses using general linear mixed models were conducted, adjusting for patient-specific variables and unmeasured country differences.Results: Sensitivity analyses showed that higher density of physicians was significantly associated with better self-reported physical and mental health, less psychological distress, and better quality of life. A greater number of nurses was significantly associated with better self-reported physical health, less psychological distress, and less risky health behavior. No associations between a higher density of hospital beds and patient-reported outcomes were observed.Conclusions: This explorative study suggests that density of human resources for health, measured on country level, are associated with patient-reported outcomes in adults with congenital heart disease. More research needs to be conducted before firm conclusions about the relationships observed can be drawn.Trial Registration: ClinicalTrials.gov: NCT02150603. Registered 30 May 2014. [ABSTRACT FROM AUTHOR]

Background: In order to develop a context appropriate in mental health system, there is a need to document relevant existing resources and practices with a view of identifying existing gaps, challenges and opportunities at baseline for purposes of future monitoring and evaluation of emerging systems. The World Health Organization Assessments Instrument for Mental Health Systems (WHO-AIMS) was developed as a suitable tool for this purpose. Our overall objective of this study, around which research questions and specific aims were formulated, was to establish a baseline on mental health system as at the time of the study, at Makueni County in Kenya, using the WHO-AIMS.Methods: To achieve our overall objective, answer our research questions and achieve specific aims, we conducted a mixed methods approach in which we did an audit of DHIS records and county official records, and conducted qualitative interviews with the various officers to establish the fidelity of the data according to their views. The records data was processed via the prescribed WHO-Aims 2.2 excel spreadsheet while the qualitative data was analyzed thematically. This was guided by the six domains stipulated in the WHO AIMS.Results: We found that at the time point of the study, there were no operational governance, policy or administrative structures specific to mental health, despite recognition by the County Government of the importance of mental health. The identified interviewees and policy makers were cooperative and participatory in identifying the gaps, barriers and potential solutions to those barriers. The main barriers and gaps were human and financial resources and low prioritization of mental health in comparison to physical conditions. The solutions lay in bridging of the gaps and addressing the barriers.Conclusion: There is a need to address the identified gaps and barriers and follow up on solutions suggested at the time of the study, if a functional mental health system is to be achieved at Makueni County. [ABSTRACT FROM AUTHOR]

Background: In order to achieve the Millennium Development Goals (MDG) 4 and 5, the Chinese Government has invested greatly in improving maternal and child health (MCH) with impressive results. However, one of the most important barriers for further improvement is the uneven distribution of MCH human resources. There is little information about the distribution, quantity and capacity of the Chinese MCH human resources and we sought to investigate this.Methods: Cities at prefectural level were selected by random cluster sampling. All medical and health institutions providing MCH-related services in the sampled areas were investigated using a structured questionnaire. The data were weighted based on the proportion of the sampled districts/cities. Amount, proportions and numbers per 10,000 population of MCH human resources were estimated in order to reveal the quantity of the Chinese MCH human resources. The capacity of MCH human resources was evaluated by analyzing data on the education level and professional skills of the staff.Results: There were 77,248 MCH workers in China in 2010. In general, 67.6% and 71.9% of the women's and children's health care professionals had an associate degree or higher, whereas around 30% had only high-school or lower degrees. More than 40% of the women's health workers were capable of providing skilled birth attendance, but these proportions varied between different institutions and locations.Conclusions: Evidence from this study highlights that Chinese MCH human resources are not in shortage in the national level. However, the quantity and capacity of MCH human resources are not evenly distributed among different institutions and locations. Finally there is a need in the improvement of the MCH services by improving the quality of MCH human resources. [ABSTRACT FROM AUTHOR]

Background: Requesting blood prior to a surgical procedure for perioperative transfusion is a common practice in surgical patients. More unit of blood is requested than used by anticipating the patient will be transfused to provide a safety margin in an event of unexpected haemorrhage. Over requesting with minimal utilization results in significant wastage of blood, reagents and human resource. This study was conducted to assess blood utilization practice of the largest tertiary hospital in Ethiopia.Methods: A cross-sectional prospective study method was used. Data was collected using a Proforma questionnaire by perusal of each individual patient's records from December 1, 2017 to February 28, 2018.patient age, sex, department requesting the blood, level of operating surgeon, hemodynamic status, number of unit requested, number of unit crossed matched and number of unit transfused were collected. Efficiency of blood utilization was calculated with three indices: Crossmatch to transfusion ratio, transfusion probability, and transfusion index indices.Results: Blood was requested for 406 patients and a total of 898 units were crossmatched for this patients. Overall Crossmatch to transfusion ration, transfusion probability and transfusion index were 7.6, 15.3% and 0.29 respectively. Results showed insignificant blood usage. Among different departments and units, better blood utilization was seen in neurosurgical unit with C/T ratio, TP and TI of 4.9, 24.4 and 0.6% respectively, while worst indices were from obstetrics unit with C/T ratio, TP and TI of 31.0, 6.5% and 0.06.Conclusion: Using all the three parameters for evaluation of efficiency of blood utilization, the practice in our hospital shows ineffective blood utilization in elective surgical procedure. Blood requesting physician should order the minimum blood anticipated to be used as much as possible. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) has the potential to ease the human resources crisis in healthcare by facilitating diagnostics, decision-making, big data analytics and administration, among others. For this we must first tackle the technological, ethical and legal obstacles.The human resource crisis is widening worldwide, and it is obvious that it is not possible to provide care without workforce. How can disruptive technologies in healthcare help solve the variety of human resource problems? Will technology empower physicians or replace them? How can the medical curriculum, including post-graduate education prepare professionals for the meaningful use of technology? These questions have been growing for decades, and the promise of disruptive technologies filling them is imminent with digital health becoming widespread. Authors of this essay argue that AI might not only fill the human resources gap, but also raises ethical questions we need to deal with today.While there are even more questions to address, our stand is that AI is not meant to replace caregivers, but those who use AI will probably replace those who don't. And it is possible to prepare for that. [ABSTRACT FROM AUTHOR]

Background: Retention of Human Resources for Health (HRH), particularly doctors at district level is a big challenge facing the decentralized health systems in poorly resourced countries. Tanzania, with 75% of its population in rural areas, has only 26% of doctors serving in rural areas. We aimed to analyze the experiences regarding the retention of doctors at district level in Tanzania from doctors' and district health managers' perspectives.Methods: A qualitative study was carried out in three districts from June to September 2013. We reviewed selected HRH documents and then conducted 15 key informant interviews with members of the District Health Management teams and medical doctors working at the district hospitals. In addition, we conducted three focus group discussions with Council Health Management Team members in the three districts. Incentive package plans, HRH establishment, and health sector development plans from the three districts were reviewed. Data analysis was performed using qualitative content analysis.Results: None of the districts in this study has the number of doctors recommended. Retention of doctors in the districts faced the following challenges: unfavourable working conditions including poor working environment, lack of assurance of career progression, and a non-uniform financial incentive system across districts; unsupportive environment in the community, characterized by: difficulty in securing houses for rent, lack of opportunities to earn extra income, lack of appreciation from the community and poor social services. Health managers across districts endeavour to retain their doctors through different retention strategies, including: career development plans, minimum financial incentive packages and avenues for private practices in the district hospitals. However, managers face constrained financial resources, with many competing priorities at district level.Conclusions: Retention of doctors at district level faces numerous challenges. Assurance of career growth, provision of uniform minimum financial incentives and ensuring availability of good social services and economic opportunities within the community are among important retention strategies. [ABSTRACT FROM AUTHOR]