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This study examines cesarean section (C‐section) deliveries in Ghana from 2008 to 2017 in 10 regions, distinguishing between scheduled and emergency procedures. Scheduled C‐sections target specific maternal conditions, such as advanced age, multiparity, and medical history, while emergency C‐sections address acute fetal distress, preeclampsia, bleeding, and other urgent situations. The analysis reveals various regional patterns, with the Brong‐Ahafo Region showing a potential deceleration after 2017 and the Upper West Region indicating a possible acceleration. The high number of C‐sections in Greater Accra and Ashanti may be related to population density and health facilities. The study proposes empirical models, including linear, quadratic, and exponential components, emphasizing quasilinearity. The exponential model suggests transient and permanent phases of cesarean frequency, with the latter dominated by quasilinearity. Optimal parameter values are determined, which highlights the stability of the model. However, caution is advised when projecting too far into the future due to the inevitable slowing of observed trends. The findings offer insights for healthcare planning, resource allocation, and policymaking, emphasizing the need for region‐specific approaches and ongoing monitoring of cesarean dynamics to inform nuanced interventions. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the effect of spatial adjacencies on nurses' walking patterns and the subsequent impact on staff satisfaction with perceived accessibility and adjacency-related issues. Background: Recognizing the crucial importance of spatial adjacencies in healthcare facilities is essential, as they significantly affect staff morale, fatigue management, operational efficiency, error reduction, and overall patient care excellence, highlighting the need for objective assessments to evaluate the impact of facility layout and space configuration on workflow patterns and staff satisfaction in patient care units. Methods: Integrating on-site observations with survey data, we explored how spatial adjacencies affect staff walking behavior and satisfaction in two med-surgical unit floors. Results: The findings highlighted a significant frequency of movements between nurse stations, patient rooms, and medication areas. Regression analysis identified several contributing factors to staff satisfaction, including the proximity of supplies, team visibility, ease of access across departments, and the location of equipment rooms. Specifically, satisfaction with the proximity of supplies was positively associated with increased provider satisfaction with workflow, quality of care, and workplace. Additionally, valuable feedback from staff revealed concerns regarding break room placement, medication area functionality, and disparities in the availability of supplies. Conclusion: This study highlighted the critical need for carefully planned spatial adjacency strategies to enhance workflow efficiency and raise clinical staff satisfaction within healthcare facilities. The actionable insights gleaned from this research offer valuable direction to architects, healthcare administrators, and design professionals, enabling the creation of environments that positively resonate with healthcare providers and improve healthcare operations. [ABSTRACT FROM AUTHOR]

Healthcare human resource planning is one of the biggest challenges facing the healthcare systems in many countries. Inadequate decisions in human resource planning can lead to an insufficient number of healthcare professionals then healthcare inequalities. One of the components of resource planning in the healthcare system is long-term data monitoring and the identification of potential trends. Since 1990, the number of physicians in Lithuania has decreased by 15.3% (−2266), but the decrease in the population has led to a 13.61% increase in the number of physicians per 10,000 inhabitants (5.32). During the analyzed period, the largest decrease in the number of physicians workforce by specialty was the number of medical physicians (−73.08%), epidemiology and hygiene (−69.30%), children's diseases (−49.08%), the most increased number was of family/general practitioners (GPs), geneticists, physical medicine, and rehabilitation specialists. Since 1992, the number of visits to physicians in Lithuania, which has been decreasing for a long time, began increasing, and in 2022 (9.3 visits) it has almost reached the number of visits (9.5) per capita as in 1991. The aim of this research was to collect long-term data from various databases, summarize them, and identify possible trends and the reasons for data changes. The study analyzed data from the Lithuanian healthcare system from the Declaration of Independence of Lithuania to the last 30 years. The data includes or affects the indicators of the healthcare system, changes in population and doctors, the number of visits to doctors, the number of medical students and residents, and data determining inequalities in the healthcare system. Long-term data analysis is useful for developing a model of healthcare human resource planning and for planning healthcare resources. [ABSTRACT FROM AUTHOR]

Abstract Background Gravity models are often hard to apply in practice due to their data-hungry nature. Standard implementations of gravity models require that data on each variable is available for each supply node. Since these model types are often applied in a competitive context, data availability of specific variables is commonly limited to a subset of supply nodes. Methods This paper introduces a methodology that accommodates the use of variables for which data availability is incomplete, developed for a health care context, but more broadly applicable. The study uses simulated data to evaluate the performance of the proposed methodology in comparison with a conventional approach of dropping variables from the model. Results It is shown that the proposed methodology is able to improve overall model accuracy compared to dropping variables from the model, and that model accuracy is considerably improved within the subset of supply nodes for which data is available, even when that availability is sparse. Conclusion The proposed methodology is a viable approach to improve the performance of gravity models in a competitive health care context, where data availability is limited, and especially where a the supply nodes with complete data are most relevant for the practitioner.

Objective: Contemporary medical education lacks a strong focus on health economics which guides major decisions in private and public health services. We briefly outline the rationale, guiding principles, main analytic methods, and a suggested framework for health economics education in psychiatry. Conclusions: Health economics aims to improve the efficiency of healthcare. Some analytic methods can be harnessed by psychiatrists to better plan clinical care. Health economic methods will also assist psychiatrists in translating their expertise and clinical priorities more effectively to policy-makers, governments, and private insurers motivated by economic reasoning. [ABSTRACT FROM AUTHOR]

Growing healthcare costs have been accompanied by increased policymakers' interest in the efficiency of healthcare systems. Network formation by hospitals as a vehicle for consolidation and achieving economies of scale has emerged as an important topic of conversation among academics and practitioners. Within networks, consolidation of particular specialties or entire campuses is expected and encouraged to take place. This paper describes the main findings of an effort to build gravity-type models to describe patient choices in inpatient and daycare hospital facilities. It analyzes the distance decay effects as a function of car travel times and great-circle distance, and it offers a method for inclusion of university hospitals. Additionally, it reviews the impact of driving and transit accessibility on hospital attraction and reviews the differences in distance decay for patient age groups and hospitalization types. In the described application, the best models achieve a Mean Absolute Percentage Error of around 10% in non-metropolitan areas, and 14.5% across different region types. Results in metropolitan areas suggest that latent factors unrelated to proximity and size have a significant role in determining hospital choices. Furthermore, the effects of relative driving and transit accessibility are found to be small or non-existent. [ABSTRACT FROM AUTHOR]

Background: Gravity models are often hard to apply in practice due to their data-hungry nature. Standard implementations of gravity models require that data on each variable is available for each supply node. Since these model types are often applied in a competitive context, data availability of specific variables is commonly limited to a subset of supply nodes. Methods: This paper introduces a methodology that accommodates the use of variables for which data availability is incomplete, developed for a health care context, but more broadly applicable. The study uses simulated data to evaluate the performance of the proposed methodology in comparison with a conventional approach of dropping variables from the model. Results: It is shown that the proposed methodology is able to improve overall model accuracy compared to dropping variables from the model, and that model accuracy is considerably improved within the subset of supply nodes for which data is available, even when that availability is sparse. Conclusion: The proposed methodology is a viable approach to improve the performance of gravity models in a competitive health care context, where data availability is limited, and especially where a the supply nodes with complete data are most relevant for the practitioner. [ABSTRACT FROM AUTHOR]

Healthcare human resource planning is one of the biggest challenges facing the healthcare systems in many countries. Inadequate decisions in human resource planning can lead to an insufficient number of healthcare professionals then healthcare inequalities. One of the components of resource planning in the healthcare system is long-term data monitoring and the identification of potential trends. Since 1990, the number of physicians in Lithuania has decreased by 15.3% (−2266), but the decrease in the population has led to a 13.61% increase in the number of physicians per 10,000 inhabitants (5.32). During the analyzed period, the largest decrease in the number of physicians workforce by specialty was the number of medical physicians (−73.08%), epidemiology and hygiene (−69.30%), children’s diseases (−49.08%), the most increased number was of family/general practitioners (GPs), geneticists, physical medicine, and rehabilitation specialists. Since 1992, the number of visits to physicians in Lithuania, which has been decreasing for a long time, began increasing, and in 2022 (9.3 visits) it has almost reached the number of visits (9.5) per capita as in 1991. The aim of this research was to collect long-term data from various databases, summarize them, and identify possible trends and the reasons for data changes. The study analyzed data from the Lithuanian healthcare system from the Declaration of Independence of Lithuania to the last 30 years. The data includes or affects the indicators of the healthcare system, changes in population and doctors, the number of visits to doctors, the number of medical students and residents, and data determining inequalities in the healthcare system. Long-term data analysis is useful for developing a model of healthcare human resource planning and for planning healthcare resources.

The aim of this article is to highlight the significance of actively involving young children in their own healthcare and paediatric healthcare planning. Based on a study conducted in a hospital setting, which revealed a lack of personalized care and inadequate understanding among younger children, this article discusses the potential benefits of empowering young patients. The theoretical framework explores various dimensions, including child-centred care, communication strategies, child development, and the impact of involving children in decision-making processes. By fostering children’s participation and creating a safe environment, healthcare professionals can enhance the overall quality of care and promote positive health outcomes for young patients.

Background/aim: A home-based care educational programme for family caregivers of activity-limited older people was developed and implemented to provide caregiver education and to teach basic caregiving techniques. The purpose of the home-based care educational programme was to improve the caregivers' knowledge, skills and attitudes necessary to perform the caregiving tasks with reduced physical strain., Methods: The educational programme model comprises the knowledge and skills necessary to carry out the caretaking responsibilities of older people, especially those with limited activities. It was conducted as an interventional study recruiting two groups (n=72) as intervention (n=36) and control group (n=36), and the knowledge of the caregivers was evaluated. The teaching sessions were planned considering the adult educational learning theories and guided by a developed educational handbook., Results: The pre and post mean±SD knowledge scores of the intervention group (43.78±12.41; 89.78±5.61) showed a significant difference (p<0.001), whereas the pre and post knowledge mean±SD scores of the control group (50.69±17.90; 51.43±17.79) showed no significant improvement (p>0.05). The difference between the pre-test and post-test between the two groups was significant (p<0.0001)., Conclusions: At the end of the educational programme, participants valued the opportunity that they received, and the assessment of knowledge before and after the programme showed an improvement in caregivers' knowledge. The study suggests conducting home-based or community-based health education programmes for caregivers of older people with limited activities, with the involvement of responsible healthcare professionals and leaders., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background/aim: The opioid crisis presents a complex and widespread health challenge for communities, necessitating a deeper exploration beyond simple solutions. To address this crisis, it is crucial to identify and disseminate best practices. In this study, we focused on positive deviance narratives from Columbus, Ohio, a community deeply affected by the opioid crisis., Methods: Employing an appreciative inquiry framework, we conducted purposive sampling to interview 47 frontline professionals and individuals grappling with opioid use disorder (OUD)., Results: Our research revealed several key insights, highlighting successful themes through positive narratives. First, perceiving OUD as a chronic disease emerged as a critical perspective, acknowledging the long-term nature of the condition and the need for sustained care. Second, re-humanising and de-stigmatising opioid users played a vital role in facilitating their recovery and reintegration into society. Embracing inclusive care delivery was another important aspect, ensuring that individuals from diverse backgrounds receive equitable access to effective treatment. Moreover, re-energising professionals to combat burnout proved essential, emphasising the importance of supporting and motivating healthcare providers in their efforts. Finally, fostering cross-institutional relationship building and collaboration emerged as a significant factor, as it encouraged a coordinated approach to addressing the crisis. Designing adaptive organisational structures also played a crucial role, enabling healthcare institutions to respond effectively to evolving challenges., Conclusions: Using a positive deviance approach to a challenging public health crisis like OUD can help us discover new and innovative care management approaches for community wide interventions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The potential for addressing healthcare inequalities in prescribed specialised services has historically been overlooked. There is evidence that prescribed specialised services can exacerbate inequalities even though they are often accessed at the end of complex pathways and by relatively small numbers of people. Leadership is required to facilitate a systematic approach to identifying and addressing inequalities in this area., Methods: A rapid literature review of articles from 2015 onwards and engagement with stakeholders was used to inform the development of a framework that both supports the identification of health inequalities within specialised services and provides recommendations for how to address them., Results: The framework aligns with existing national approaches in England to addressing health inequalities in other healthcare settings. It is prepopulated with features of services that may create inequalities and recommended ways of addressing them and can be readily adapted to suit population specific needs., Conclusion: The potential for addressing health inequalities should be considered at all points along a healthcare pathway. Local service leaders need to be empowered and encouraged to identify and deliver on opportunities for change to continually improve patient access, experience and outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

The ever-increasing number of hospital Emergency Department (ED) visits pose a challenge to the effective running of health systems in many countries globally and multiple strategies have been adopted over the years to tackle the plight. According to a systematic review of the available literature, of the numerous models of healthcare systems used to address the issue in western countries, the FSED Model has the greatest potential for reducing hospital ED overcrowding as it can reduce the additional load by diverting minor cases, freeing up space for more urgent cases. The aim of the study is to shed light on the Free Standing Emergency Department (FSED) model and compare it with the traditional Hospital Based Emergency Department (HBED) in international contexts. In this study, 23 papers have been collected in a literature review and the main features have been highlighted; 12 case studies have been analyzed from a layout point of view and data have been collected in terms of surfaces, functions, and flow patterns. The percentages of floor areas devoted to each function have been compared to define evolution strategies in the development of emergency healthcare models and analyses. The use of FSED models is an interesting way to face the overcrowding problem and a specific range for functional area layout has been identified. Further studies on its application in different contexts are encouraged. [ABSTRACT FROM AUTHOR]

This paper examines the substantial spike in fatalities that occurred in El Paso, Texas in late 2020 due to an unprecedented surge in COVID-19 infection. It also considers various explanations for the fatality surge, and the fatality management issues observed during the event. The paper suggests what lessons can be learned from this event, in particular those preventable causes that could be avoided in a future outbreak. The paper also examines the gaps in existing mass fatality management processes as they apply to planning for pandemics and mass fatality crisis standards of care. [ABSTRACT FROM AUTHOR]

Objective To determine the pattern of various skin disorders in Paediatric patients of Faisalabad for improving health care planning and management. Methods Patients of both genders and ages up to 14 years, presenting to the Outpatient Department of Paediatric Dermatology Children hospital / Institute of Child Health, Faisalabad over a period of one year, were included in this cross-sectional study. Their detailed history and cutaneous examination were carried out. Skin biopsies and relevant investigations were performed, where indicated, for the confirmation of diagnoses. Results A total of 24,342 children presented to the Dermatology Department. Out of those, 11,245 (46%) patients were females and 13,097 (54%) were males. Mean age noted was 6.2 ± 5.3 years. Total number of dermatoses observed was 183. Out of them, 16 dermatoses were most commonly seen and involved 89.31% of patients. Papular urticaria was the commonest disorder seen in 26.21% cases, followed by Scabies (18.29%), Folliculitis (9.1%), Impetigo (7.56%) and Atopic eczema (6.07%). Rest of the dermatoses were divided into Miscellaneous (8.23%) and Rare dermatoses (2.52%). Conclusion Dermatological disorders of paediatric patients have been overlooked for long. Better management and timely prevention of these diseases can greatly reduce burden on health care system and population at large. [ABSTRACT FROM AUTHOR]

Background: Health care planning in low-and-medium-income countries can be intellectually demanding. However, users’ centric planning approach is intuitively promising to enhance utilization, resource allocation, and strengthening of the health system. Objective: This study examines the relative importance of health status and access on intention to use the health services and the mediating role of prior experience and perceived quality of care on utilization intention. Methods: This study was a cross-sectional survey method in a suburban location in Nigeria with administration of a questionnaire on a random sample of voluntary and non-remunerated participants. The study utilized structural equation model that encompasses the relationship between these variables based on survey data from five hundred and nineteen (519) respondents. Results: The study found that access was a stronger determinant of intention to use health services than self-rated health status; in addition, negative prior experiences in the health system was found to be a disincentive to intentions to use health services. Conclusions: It seems of benefit to initiate and encourage programs that seek to improve the health care professionals’ competence in management of individual-health facilities contact experience and strengthen the bond between perceived health status and responsive attitude to use health services. Health facilities planning approach need to consider the location models that facilitate physical access and seek to deconstruct administrative barriers to obtaining care

Objectives: This study explores the evolving position of the health system chief information officer (CIO) by identifying new core roles for success., Methods: An advisory board of industry executives and system leaders guided the study. Purposeful sampling was used to invite chief executive officer and CIOs from 65 not-for-profit US health systems to participate. Interviews were conducted with 51 executives from 33 different systems, using a comprehensive interview topic guide. Interview transcripts were analysed using NVivo software, focusing on themes related to the evolving role of the health system CIO., Results: Analyses revealed three main themes, with the CIO as (1) enabler of strategic change and transformation, (2) strategic developer of technology and leadership talent and (3) driver of organisational culture., Discussion: The role of CIO has undergone transformation from technology and information system management to strategic leadership within the broader health system context. It highlights the importance of comprehensive business knowledge for CIOs and the need for other C-suite executives to have a deeper understanding of information and technology., Conclusion: As healthcare continues to evolve, the role of the CIO is expected to expand further, requiring a blend of technical and strategic business skills. This evolution presents opportunities for health systems to enhance their leadership development programmes, preparing leaders for the complexities of the contemporary health system sector., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Pandemic preparedness refers to being ready for, responding to and recovering from public health crises, and is integral for health security. Hospital leadership is a critical building block of an effective healthcare system, providing policy, accountability and stewardship in a health crisis., Objectives and Methods: We aimed to describe the leadership and governance structures put in place at the Aga Khan University Hospital, Nairobi, a private not-for-profit tertiary healthcare facility, following the COVID-19 pandemic. We reviewed over 200 hospital documents archived in the COVID-19 repository including those received from the Kenya Ministry of Health, emails, memos, bulletins, meeting minutes, protocols, brochures and flyers. We evaluated and described pandemic preparedness at the hospital under four main themes: (a) leadership, governance and incident management structures; (b) coordination and partnerships; (c) communication strategies; and (d) framework to resolve ethical dilemmas., Results: The hospital expeditiously established three emergency governance structures, namely a task force, an operations team and an implementation team, to direct and implement evidence-based preparedness strategies. Leveraging on partners, the hospital ensured that risk analyses and decisions made: (1) were based on evidence and in line with the national and global guidelines, (2) were supported by community leaders and (3) expedite financing for urgent hospital activities. Communication strategies were put in place to ensure harmonised COVID-19 messaging to the hospital staff, patients, visitors and the public to minimise misinformation or disinformation. An ethical framework was also established to build trust and transparency among the hospital leadership, staff and patients., Conclusion: The establishment of a hospital leadership structure is crucial for efficient and effective implementation of pandemic preparedness and response strategies which are evidence based, well resourced and ethical. The role of leadership discussed is applicable to healthcare facilities across low and middle-income countries to develop contextualised pandemic preparedness plans., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The Kingdom of Saudi Arabia's (KSA) Ministry of Health's (MOH) healthcare transformation strategy aims to improve the quality of life of Saudi citizens in line with the 'Vision 2030 ' strategic objectives. The MOH is reforming the way healthcare will be managed in the future and is in the process of transferring healthcare service delivery responsibilities to clusters with ratified boards, while also moving the MOH from a provision of service model to a regulatory one. Several early pathfinding clusters were initiated in the eastern central and western regions. To ensure northern and southern regions were not left behind, the early innovation, while awaiting cluster nomination status, the northern and southern business units of Health Holding Company implemented the accelerated transformation programme (ATP). The ATP's remit was to develop capabilities and stimulate local engagement and ownership in the healthcare transformation process. This paper summarises the process of healthcare transformation undertaken in the northern and southern regions of KSA to date. It reviews the success in engaging with local healthcare professional communities in a standardised way and the learning from previous clusters, and elaborates on emerging implementation issues and how we may overcome them and introduce the lessons learnt from this journey., Competing Interests: Competing interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Healthcare systems plan their activities to achieve efficiency and effectiveness, without addressing environmental and social sustainability. This paper describes a new approach adopted in Italy to plan and deliver health prevention services in an inner area of the Tuscany region (in Italy) to guarantee proximity of care and environmental and social sustainability. The project examines the design and delivery of cancer screening programmes using a mobile screening unit to maximise social benefits while minimising environmental waste. A cost analysis was developed to estimate the difference in CO 2 equivalent emissions, travel costs, and productivity losses, comparing the current screening programmes against the introduction of a comprehensive full-service mobile screening unit. The results indicate that the new service model reduces direct non-medical costs incurred by the population and improves environmental sustainability. This alternative can reduce, annually, over 95,000 euros in terms of travel costs and productivity losses, as well as 35 tons of CO 2 -equivalent travel emissions for a population of 59,000 inhabitants in a mountainous area with around 6000 people involved in the screening programme. The study supports the need to adopt a new planning methodology that considers environmental, social, and financial sustainability jointly in the provision of public health services in rural areas., Competing Interests: Declarations of competing interest None, (Copyright © 2024. Published by Elsevier B.V.)

Spatial density measures are an important tool for future healthcare planning, particularly in Northeast Thailand where the ageing population has rapidly increased for a decade. The objective of this study was to determine the relationship of geographic and elderly population density in Chiang Yuen district, Mahasarakham province, to ascertain suitable areas for elderly healthcare centres. The data of the elderly located in the villages were collected by the Global Position System (GPS) using Kernel density method to employ the analysis of population density, and GIS for healthcare mapping, and Analytical Hierarchy Process (AHP) as multiple criteria decision-making tools. Factors were determined by using the overlay analysis method, where social, physical and economic factors were variables of interest that were used for the analysis of suitable areas for Elderly Healthcare Centres. The results revealed that the spatial density of the elderly population could be divided into four levels: Low density for the agriculture areas, medium density for agricultural areas including small villages. High density for the areas near communities and public area services and highest density for the centre of towns. The most suitable area was an area with many elderly inhabitants in the community, near transportation routes including main highways leading to other areas. In conclusion, the results confirmed that the density of elderly and proximity to both local stores and transport would make the lower part of Chiang Yuen Sub-district a suitable area to establish a healthcare centre for the elderly, therefore, the authorities and stakeholders should recognise this in planning. [ABSTRACT FROM AUTHOR]

Objectives: Coronavirus disease 2019 has put unprecedented pressure on healthcare systems worldwide, leading to a reduction of the available healthcare capacity. Our objective was to develop a decision model to estimate the impact of postponing semielective surgical procedures on health, to support prioritization of care from a utilitarian perspective.Methods: A cohort state-transition model was developed and applied to 43 semielective nonpediatric surgical procedures commonly performed in academic hospitals. Scenarios of delaying surgery from 2 weeks were compared with delaying up to 1 year and no surgery at all. Model parameters were based on registries, scientific literature, and the World Health Organization Global Burden of Disease study. For each surgical procedure, the model estimated the average expected disability-adjusted life-years (DALYs) per month of delay.Results: Given the best available evidence, the 2 surgical procedures associated with most DALYs owing to delay were bypass surgery for Fontaine III/IV peripheral arterial disease (0.23 DALY/month, 95% confidence interval [CI]: 0.13-0.36) and transaortic valve implantation (0.15 DALY/month, 95% CI: 0.09-0.24). The 2 surgical procedures with the least DALYs were placing a shunt for dialysis (0.01, 95% CI: 0.005-0.01) and thyroid carcinoma resection (0.01, 95% CI: 0.01-0.02).Conclusion: Expected health loss owing to surgical delay can be objectively calculated with our decision model based on best available evidence, which can guide prioritization of surgical procedures to minimize population health loss in times of scarcity. The model results should be placed in the context of different ethical perspectives and combined with capacity management tools to facilitate large-scale implementation. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present study was to investigate how the initial phase of the COVID‐19 pandemic affected the hospital stroke management and research in Norway. Materials and methods: All neurological departments with a Stroke Unit in Norway (n = 17) were invited to participate in a questionnaire survey. The study focused on the first lockdown period, and all questions were thus answered in regard to the period between 12 March and 15 April 2020. Results: The responder rate was 94% (16/17). Eighty‐one % (13/16) reported that the pandemic affected their department, and 63% (10/16) changed their stroke care pathways. The number of new acute admissions in terms of both strokes and stroke mimics decreased at all 16 departments. Fewer patients received thrombolysis and endovascular treatment, and multidisciplinary stroke rehabilitation services were less available. The mandatory 3 months of follow‐up of stroke patients was postponed at 73% of the hospitals. All departments conducting stroke research reported a stop in ongoing projects. Conclusion: In Norway, hospital‐based stroke care and research were impacted during the initial phase of the COVID‐19 pandemic, with likely repercussions for patient care and outcomes. In the future, stroke departments will require contingency plans in order to protect the entire stroke treatment chain. [ABSTRACT FROM AUTHOR]

This paper examines the effect of Healthcare Management (HCM) on the satisfaction and loyalty of physicians from hospitals in Bangladesh. Five hundred physicians from both private and public hospitals were sampled, and 175 questionnaires were returned, giving a response rate of 35 per cent. Data collected was analyzed using descriptive statistics and structural equation modelling (SEM). Findings revealed that there are significant positive relationships between healthcare controlling, healthcare leading, healthcare organizing, healthcare staffing, and physicians' satisfaction in Bangladesh while healthcare planning is not supported. Results also show that 30.5 per cent variations in physicians' loyalty are explained by physicians' satisfaction. Practically, the findings of this study serve as inputs for policymakers in formulating policies to improve healthcare management practices as well as the entire health sector in Bangladesh. [ABSTRACT FROM AUTHOR]

The ever-increasing number of hospital Emergency Department (ED) visits pose a challenge to the effective running of health systems in many countries globally and multiple strategies have been adopted over the years to tackle the plight. According to a systematic review of the available literature, of the numerous models of healthcare systems used to address the issue in western countries, the FSED Model has the greatest potential for reducing hospital ED overcrowding as it can reduce the additional load by diverting minor cases, freeing up space for more urgent cases. The aim of the study is to shed light on the Free Standing Emergency Department (FSED) model and compare it with the traditional Hospital Based Emergency Department (HBED) in international contexts. In this study, 23 papers have been collected in a literature review and the main features have been highlighted; 12 case studies have been analyzed from a layout point of view and data have been collected in terms of surfaces, functions, and flow patterns. The percentages of floor areas devoted to each function have been compared to define evolution strategies in the development of emergency healthcare models and analyses. The use of FSED models is an interesting way to face the overcrowding problem and a specific range for functional area layout has been identified. Further studies on its application in different contexts are encouraged.

Competing Interests: Competing interests: None declared.

Aim: The identification and development of managerial talents for nursing manager succession in the future should be a concern for organisations, as the concept of succession planning has not been seriously addressed in nursing. This study aimed to explore managers' perceptions of the concept of succession planning in nursing management., Design: This qualitative study used a conventional content analysis approach., Methods: Participants included 15 nursing managers, who were purposively selected based on predetermined inclusion and exclusion criteria. After obtaining ethical approval, data were collected through semistructured interviews. MAXQDA software was used for data management, and data analysis was performed using the seven-stage method by Graneheim and Lundman. The credibility and dependability of the data were assessed using Guba and Lincoln's criteria., Results: The main categories identified in this study were barriers to succession planning, facilitators, succession planning requirements, contextualisation, succession planning cycle, the dynamism of the successor organisation and consequences of lack of succession planning. Based on the findings of this study, it is recommended that organisations plan and adopt policies to develop qualified personnel management in nursing organisations and appoint these individuals to critical managerial positions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: This study examines the social and cultural life of food innovations to inform food design thinking. The authors explore this through wellness regulating functional foods, foods scientifically modified for health benefits based on medical and nutritional claims, as a materialisation of food innovation in the marketplace., Design/methodology/approach: Drawing on affordance theory, where affordance relations enable potential for consumer food well-being regulation, the authors gathered in-depth interview data from diverse consumer groups across three illustrative exemplar functional foods., Findings: The research reveals how consumers engage in meaningful actions with functional foods in the experiences of their everyday lives. Four analytical themes emerge for consumer wellness regulation through functional foods: morality judgements, emotional consequences, social embedding and historicality., Originality: Analytical themes emerging from the findings are conceptualised as MESH, a useful acronym for the social and cultural life of food innovations within the design thinking arena. The MESH framework includes dichotomous cultural affordances that overlap and entangle different cultural themes weaving together consumers' perceived possibilities for food well-being regulation. These cultural affordances reveal distinct paths that link consumer experiences and food design thinking., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: There are concerns that public anxiety around COVID‐19 discourages patients from seeking medical help. The aim of this study was to see how lockdown due to the pandemic affected the number of admissions of acute stroke. Methods: All patients discharged from Akershus University Hospital with a diagnosis of transient ischemic attack (TIA) or acute stroke were identified by hospital chart review. January 3 to March 12 was defined as before, and March 13 to April 30 as during lockdown. Results: There were 21.8 admissions/week before and 15.0 admissions/week during the lockdown (P <.01). Patients had on average higher NIHSS during the lockdown than before (5.9 vs. 4.2, P =.041). In the multivariable logistic regression model for ischemic stroke (adjusted for sex, age, living alone and NIHSS ≤ 5), there was an increased OR of 2.05 (95% CI 1.10‐3.83, P =.024) for not reaching hospital within 4.5 hours during the lockdown as compared to the period before the lockdown. Conclusion: There was a significant reduction in number of admissions for stroke and TIAs during the lockdown due to the COVID‐19 pandemic in Norway. [ABSTRACT FROM AUTHOR]

Abstract Background Recently, patient engagement has been identified as a promising strategy for supporting healthcare planning. However, the context and structure of universalistic, “one-size-fits-all” approaches often used for patient engagement may not enable diverse patients to participate in decision-making about programs intended to meet their needs. Specifically, standard patient engagement approaches are gender-blind and might not facilitate the engagement of those marginalized by, for example, substance use, low income, experiences of violence, homelessness, and/or mental health challenges—highly gendered health and social experiences. The project’s purpose was to develop a heuristic model to assist planners to engage patients who are not traditionally included in healthcare planning. Methods Using a qualitative research approach, we reviewed literature and conducted interviews with patients and healthcare planners regarding engaging marginalized populations in health services planning. From these inputs, we created a model and planning manual to assist healthcare planners to engage marginalized patients in health services planning, which we piloted in two clinical programs undergoing health services design. The findings from the pilots were used to refine the model. Results The analysis of the interviews and literature identified power and gender as barriers to participation, and generated suggestions to support diverse populations both to attend patient engagement events and to participate meaningfully. Engaging marginalized populations cannot be reduced to a single defined process, but instead needs to be understood as an iterative process of fitting engagement methods to a particular situation. Underlying this process are principles for meaningfully engaging marginalized people in healthcare planning. Conclusion A one-size-fits-all approach to patient engagement is not appropriate given patients’ diverse barriers to meaningful participation in healthcare planning. Instead, planners need a repertoire of skills and strategies to align the purpose of engagement with the capacities and needs of patient participants. Just as services need to meet diverse patients’ needs, so too must patient engagement experiences.

Throughout South Asia a proliferation of cities and middle-sized towns is occurring. While larger cities tend to receive greater attention in terms national level investments, opportunities for healthy urban development abound in smaller cities, and at a moment where positive trajectories can be established. In Bangladesh, municipalities are growing in size and tripled in number especially district capitals. However, little is known about the configuration of health services to hold these systems accountable to public health goals of equity, quality, and affordability. This descriptive quantitative study uses data from a GIS-based census and survey of health facilities to identify gaps and inequities in services that need to be addressed. Findings reveal a massive private sector and a worrisome lack of primary and some critical care services. The study also reveals the value of engaging municipal-level decision makers in mapping activities and analyses to enable responsive and efficient healthcare planning. [ABSTRACT FROM AUTHOR]

In this paper, a problem arising in the planning of specialized diagnostic services in a segmented public healthcare system is addressed. The problem consists of deciding which hospitals will provide the service and their capacity levels, the allocation of demand in each institution, and the reallocation of uncovered demand to other institutions or private providers, while minimizing the total equivalent annual cost of investment and operating cost required to satisfy all the demand. An associated mixed-integer linear programming model can be solved by conventional branch and bound for relatively small instances; however, for larger instances the problem becomes intractable. To effectively address larger instances, a hybrid metaheuristic framework combining iterated greedy (IGA) and variable neighborhood descent (VND) components for this problem is proposed. Two greedy construction heuristics are developed, one starting with an infeasible solution and iteratively adding capacity and the other starting with a feasible, but expensive, solution and iteratively decrease capacity. The iterated greedy algorithm includes destruction and reconstruction procedures. Four different neighborhood structures are designed and tested within a VND procedure. In addition, the computation of local search components benefit from an intelligent exploitation of problem structure since, when the first-level location variables (hospital location and capacity) are fixed, the remaining subproblem can be solved efficiently as it is very close to a transshipment problem. All components and different strategies were empirically assessed both individually and within the IGA-VND framework. The resulting metaheuristic is able to obtain near optimal solutions, within 3% of optimality, when tested over a data base of 60- to 300-hospital instances. [ABSTRACT FROM AUTHOR]

Abstract Background Researchers, healthcare planners, and policymakers convey a sense of urgency in using eMental healthcare technologies to improve pediatric mental healthcare availability and access. Yet, different stakeholders may focus on different aspects of implementation. We conducted a systematic review to identify implementation foci in research studies and government/organizational documents for eMental healthcare technologies for pediatric mental healthcare. Methods A search of eleven electronic databases and grey literature was conducted. We included research studies and documents from organization and government websites if the focus included eMental healthcare technology for children/adolescents (0–18 years), and implementation was studied and reported (research studies) or goals/recommendations regarding implementation were made (documents). We assessed study quality using the Mixed Methods Appraisal Tool and document quality using the Appraisal of Guidelines for Research & Evaluation II. Implementation information was grouped according to Proctor and colleagues’ implementation outcomes—acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability—and grouped separately for studies and documents. Results Twenty research studies and nine government/organizational documents met eligibility criteria. These articles represented implementation of eMental healthcare technologies in the USA (14 studies), United Kingdom (2 documents, 3 studies), Canada (2 documents, 1 study), Australia (4 documents, 1 study), New Zealand (1 study), and the Netherlands (1 document). The quality of research studies was excellent (n = 11), good (n = 6), and poor (n = 1). These eMental health studies focused on the acceptability (70%, n = 14) and appropriateness (50%, n = 10) of eMental healthcare technologies to users and mental healthcare professionals. The quality of government and organizational documents was high (n = 2), medium (n = 6), and low (n = 1). These documents focused on cost (100%, n = 9), penetration (89%, n = 8), feasibility (78%, n = 7), and sustainability (67%, n = 6) of implementing eMental healthcare technology. Conclusion To date, research studies have largely focused on acceptability and appropriateness, while government/organizational documents state goals and recommendations regarding costs, feasibility, and sustainability of eMental healthcare technologies. These differences suggest that the research evidence available for pediatric eMental healthcare technologies does not reflect the focus of governments and organizations. Partnerships between researchers, healthcare planners, and policymakers may help to align implementation research with policy development, decision-making, and funding foci.

Background: Trauma continues to be a common cause of mortality in Singapore. By understanding the epidemiology of Traumatic Brain Injury (TBI), healthcare professionals can be better equipped to tackle the increasing socioeconomic burden of disease, adopting better strategies in healthcare planning.Methodology: A retrospective review of 367 patients admitted with TBI to a tertiary medical institution from January to December 2014 was performed, studying demographic profiles, injury details and outcomes of these patients. Data was retrieved from the National Trauma Registry and the institution's database.Results: Two hundred thirty-four of the 367 patients included in this study fell into two age groups-−19 to 40 years and ≥65 years. 58% of the TBI population were aged >60. Predominant mechanism of injuries in these groups were road traffic accidents and unwitnessed falls respectively. 39% of the Elderly group were on antiplatelet/anticoagulant agents (p < 0.001). While aggressive surgical intervention was more common in younger patients (p < 0.001), the elderly group had significantly longer lengths of hospital stay (p < 0.001). Though Glasgow Outcome Scale (GOS) scores at discharge were not significantly different between the two groups, elderly patients showed greater percentages of post-injury improvement subsequently.Conclusion: The demographics of TBI patients appears to have shifted toward an older population as compared to a decade ago, with an increased incidence of falls, highlighting a huge healthcare concern. We hope that this study will drive further nationwide studies in future, looking at the incidence and prevalence of TBI, and with the focus on tackling preventable causes of TBI.

Mass care on an epic scale -- we thought we had seen it all during Hurricanes Katrina, Rita, Ike and then Sandy. However, catastrophic scales reached a new level during Hurricane Harvey. How did the response and recovery to Harvey differ from previous hurricane events and what lessons were (and were not) learned? This paper examines the impact on the delivery of medical care to the vulnerable populations in Harvey's path. [ABSTRACT FROM AUTHOR]

Introduction: For the past 2400 years, the spatial relationship between health and location has been a concern for researchers. Studies have been conducted for decades to understand such a relationship, which has led to the identification of a number of healthcare planning issues. Geographic Information Systems (GIS) technology has contributed to addressing such issues by applying analytical approaches at the level of epidemiological surveillance and evaluating the spatial inequality of access to healthcare. Consequently, the importance of reviewing healthcare planning issues and recognition of the role of GIS are integral to relevant studies. Such research will contribute to increasing the understanding of how to apply analytical approaches for dealing with healthcare planning issues using GIS. Methods: This paper aims to provide an examination of healthcare planning issues and focuses on reviewing the potential of GIS in dealing with such issues by applying analytical approaches. The method of a typical literature review was used through collecting data from various studies selected based on temporal and descriptive considerations. Results: Researchers have focused on developing and applying analytical approaches using GIS to support two important aspects of healthcare planning: first, epidemic surveillance and modeling, despite a lack of health information and its management, and, second, evaluating the spatial inequality of access to healthcare in order to determine the optimum distribution of health resources. Conclusion: GIS is an effective tool to support spatial decision-making in public health through applying the evolving analytical approaches to dealing with healthcare planning issues. This requires a literature review before preparing relevant studies, particularly because of the continuous development of GIS technologies.

Competing Interests: Competing interests: None declared.

Basu and Pak (2014) argue that need-based workforce planning models would not maximize social welfare, and use of need-based models would result in inefficiency. They propose that planning be based on service utilization to incorporate preferences or other socioeconomic factors. We show that the analysis is based on inappropriate considerations of the nature of healthcare demand, a misrepresentation of need-based approaches and misunderstanding publicly funded healthcare system objectives. We explain how current levels of utilization emerge from workload and income interests of providers that underlie utilization-based models and are incompatible with public goals of maximizing health gains. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

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Competing Interests: Competing interests: KA, PL and AH are associated with the Faculty of Medical Leadership and Management which provides leadership development.

Doing More with Less: A Client-Centred Approach to Healthcare Logistics in a Nursing Home Setting Dutch nursing homes are currently confronted with two seemingly incompatible goals: a more client-centred approach and the necessity to reduce costs at the same time. It is becoming increasingly apparent that healthcare logistics can contribute to providing high-quality care and support at a reasonable cost. Moreover, care and support which takes the client’s preferences as starting point. A literature study revealed that there is very little in terms of a framework for healthcare logistics that embodies both aspects. Therefore, the authors developed a conceptual framework that meets both requirements. Existing insights on client-centredness and healthcare logistics were used to develop the framework, which offers a structure for both future research and practice in healthcare logistics in nursing home care. This paper reveals that further empirical research is needed to better understand how variability, volume and predictability are interrelated and how they influence the plannability of healthcare activities in terms of what, when, where and by whom. Meer met minder doen: een cliëntgerichte benadering van zorglogistiek in een verpleeg- en/of verzorgingshuissetting Nederlandse verpleeg- en verzorgingshuizen zien zich geconfronteerd met twee schijnbaar tegengestelde opdrachten: het vergroten van de invloed van de cliënt op de zorgverlening en zorglevering, ook wel vraagsturing genoemd en het reduceren van de kosten. Steeds duidelijker wordt dat zorglogistiek een belangrijke bijdrage kan leveren aan het betaalbaar houden van een kwalitatief goede zorg- en hulpverlening. Zorg- en hulpverlening die bovendien de wensen van cliënten als vertrekpunt kiest. Uit literatuuronderzoek blijkt dat er geen zorglogistiek denkraam voor een verpleeg- of verzorgingshuissetting bestaat waarmee beide opdrachten gelijktijdig kunnen worden beschouwd. Deze constatering is voor de auteurs aanleiding geweest om een denkraam of model te ontwikkelen dat wel aan deze eis voldoet. Daarbij is gebruik gemaakt van bestaande inzichten over vraagsturing en (zorg)logistiek. Het gepresenteerde model biedt aanknopingspunten voor toekomstig onderzoek en praktijkbeslissingen op het gebied van zorglogistiek in een verpleeg- en/ of verzorgingshuissetting. Deze paper laat zien dat toekomstig onderzoek nodig is om meer inzicht te krijgen in hoe variabiliteit, volume en voorspelbaarheid onderling samenhangen en de mate van planbaarheid van zorgactiviteiten in termen van wat, wanneer, waar en door wie.

From the Bhore Committee Report of 1946 to the present Universal Health Coverage (UHC) 2011, nothing much has changed in terms of health status in India. The overall health status continues to be dismal and disappointing. One factor that is mainly responsible for this state of affairs is that healthcare has not been realized as a right. If healthcare becomes a right, the state will become responsible and accountable to the people, for enhancing their health. If people are invoked into a sense of belonging to the health system and made to look at healthcare as their right, there is a strong possibility of a positive change in the overall health status of the people. The article looks at healthcare from the rights perspective and explores the methods in which it can be translated into reality. It tries to look at the moral basis of the right to healthcare. For healthcare to be achieved as a right, the state can no longer be a mute spectator of the predominant market forces dictating the healthcare delivery system. The article argues that translation of healthcare as a right is only possible if the state takes full responsibility to improve the health status of the people.

Abstract Current trends in population ageing show that, in the near future, while more people will live longer, more will also die at any one time. Health systems, as well as individual practitioners, are only just becoming aware of the extent of this problem. Health systems will have to rapidly change practice to manage the number of people dying in the coming years, many with complex multimorbid conditions. The changes involved should include a personal recognition by all health professionals of their role in caring for the dying, and healthcare education must include end-of-life care management as part of the core curriculum. Further, health systems must improve integration between primary care and specialist clinicians to ensure the burden is shared efficiently across the system. Finally, it should be recognised that end-of-life care is not terminal care, but should be anticipated months or sometimes years ahead through advance care planning for known future complications by the patient’s clinical team, as well as by patients and their main carers, to manage crises as they ariserather than react to them once they arise. Please see related article: https://bmcmedicine.biomedcentral.com/articles/ 10.1186/s12916-017-0860-2 .

Competing Interests: Competing interests: None declared.

Background: The aim was to determine how the learning about protective factors from previous pandemics was implemented and the impact of this on nurses' experience., Methods: Secondary data analysis of semistructured interview transcripts exploring the barriers and facilitators to changes implemented to support the surge of COVID-19 related admissions in wave 1 of the pandemic. Participants represented three-levels of leadership: whole hospital (n=17), division (n=7), ward/department-level (n=8) and individual nurses (n=16). Interviews were analysed using framework analysis., Results: Key changes that were implemented in wave 1 reported at whole hospital level included: a new acute staffing level, redeploying nurses, increasing the visibility of nursing leadership, new staff well-being initiatives, new roles created to support families and various training initiatives. Two main themes emerged from the interviews at division, ward/department and individual nurse level: impact of leadership and impact on the delivery of nursing care., Conclusions: Leadership through a crisis is essential for the protective effect of nurses' emotional well-being. While nursing leadership was made more visible during wave 1 of the pandemic and processes were in place to increase communication, system-level challenges resulting in negative experiences existed. By identifying these challenges, it has been possible to overcome them during wave 2 by employing different leadership styles to support nurse's well-being. Challenges and distress that nurses experience when making moral decisions requires support beyond the pandemic for nurse's well-being. Learning from the pandemic about the impact of leadership in a crisis is important to facilitate recovery and lessen the impact in further outbreaks., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)