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As online health communities (OHCs) continue to proliferate, narrative reviews on doctors have become a vital reference source for patients when choosing online health services. However, the potential value of subjective information reflecting patient experiences in OHCs has not been fully explored. The present study seeks to investigate the impact of narrative reviews on patients' selection of e-doctors and the extent to which such reviews are moderated by doctors' specialties. This paper collected data from 747 doctors and 105 032 reviews from WeDoctor, one of China's most popular OHCs, in 2019. We employed Latent Dirichlet Allocation topic modeling to extract 3 topics and analyzed their effects on patient e-doctor choice using a multiple regression method. Our findings indicate that Topic 1, clinical skills and effects, had a positive impact on patient choice in OHCs ( β 1  = .243, P  < .001), as did Topic 2, service attitude and trust ( β  < .05). However, the impact of Topic 3, convenience, did not show a significant effect in this study. Moreover, our results suggest that the specialty of Internal Medicine can positively moderate the relationship between Topic 1 (clinical skills and effects) and patient e-doctor choice ( 2  = .130, P  < .05). However, the impact of Topic 3, convenience, did not show a significant effect in this study. Moreover, our results suggest that the specialty of Internal Medicine can positively moderate the relationship between Topic 1 (clinical skills and effects) and patient e-doctor choice ( β 9  = .087, P  < .05). Based on the findings of this study, e-doctors are encouraged to enhance their technical competence to improve treatment effectiveness and adjust their communication methods to increase patient trust and sense of security. OHC platform managers should accurately understand the key factors that influence patient choice and take measures to improve their service quality accordingly.

Abstract Background Medical undergraduate students are often unaware of the managerial aspects of operating a healthcare facility. This leads to confusion and a sense of being lost when they assume administrative roles, highlighting the need for hospital management and leadership training. This prompted us to evaluate the needs of medical undergraduates concerning these crucial aspects. Methods An exploratory study was conducted on 240 medical undergraduate students to assess the medical undergraduates’ need to learn about hospital management and leadership training, their views about the importance and their self-perceived knowledge of the various elements of hospital management and leadership training. A meticulously validated questionnaire, comprising three essential parts, based on the Likert scale was effectively employed in the study. Part A asked students to evaluate the importance of 15 selected elements of hospital management and leadership training, ranging from not important to very important, in their role as a doctor. Part B required the students to assess their self-perceived knowledge levels on a scale from no knowledge to very adequate for the same 15 elements. Part C inquired about the students’ opinions on including these topics in their curriculum and, if so, the appropriate timing. Results Nearly 75% of the students felt that time management, stress management, and patient safety issues were very important for their role as doctor. Closely following these were communication/ public relation skills, hospital information system & record keeping, quality improvement/assurance, law, ethics & code of conduct. Only 25% of the students reported their self-perceived knowledge as very adequate for almost all the elements. For inclusion in the curriculum, the majority wanted to learn about these elements and throughout the course was the preferred timing. Conclusion The students felt that hospital management and leadership training were pivotal for their roles as doctors. They expressed a lack of sufficient knowledge in these areas and the need for these important aspects to be included in their curriculum as a longitudinal course.

In a hospital, keeping track of patients and their needs is a multi-faceted nightmare. Each department has its own intake and check-out process, and all of this information must be in one central place. That’s why there are so many hospitals that are struggling to confirm the organization of patient data. There are several of Machine Learning algorithms that can help to optimize patient flow in hospitals, provide a real-time presentation of department workflow. This editorial will examine some of the most effective ML algorithms to solve these issues. Before we dive directly into the solutions, it is important to understand how ML can help specifically in the healthcare industry. The increased adoption of ML stipulates a wide range of new technologies and applications that would transform medicine. These healthcare developments would help providers to offer care tailored to the individual needs of patients, making treatment more effective and affordable. Although the actual impact of the algorithms on healthcare is still a subject of future research, the expected outcomes are huge. Before analyzing how they work, it is important to explain the terminology. Specifically: data mining is the manner of discovering new data or knowledge from huge amounts of data. The major focus of data mining is made on unstructured data, as e.g. medical records, social media posting or images. Machine learning implies a computer program that is trained on data to find patterns and make predictions.1 There are many types of ML algorithms, but they all have three steps in common: • Training: create a model using the data. • Use the model to make predictions. • Tune the model to get the best results. Natural Language Processing (NLP) is a type of machine learning that allows computers to understand human language.2 Health care providers use NLP to meet patients’ needs, goals, and expectations. One of the many problems in hospitals is the inability to manage patient flows through various departments and check-out points. The problem is that when patients arrive at a hospital, they can be instructed to go to the Emergency Department. They can also be told to go to a different department based on the results. In spite of the fact that it is necessary for there to be a single source of information, regardless of the department, in order to ensure that both patients and staff have access to the same level of information.3 It would be ideal to have a centralized location that provides information on the department's current availability, wait times, and staff members' status. In order to enhance the efficiency of patient flow within the hospital, administrators and healthcare providers can utilize machine learning algorithms to gather information regarding patients' arrival, departure, and current condition. In addition, it is able to evaluate the condition of each individual patient and give staff with information in real time. This strategy makes it easier to control the flow of patients in an effective manner, which in turn enables staff members to concentrate on the activities that are most important to them. There are a great number of data sources that can be operated in order to collect information regarding the conditions of patients. To ensure that activities are carried out in the most effective manner possible, it is essential that staff members have instant access to these resources. Natural language processing, often known as NLP, is a method that is utilized for the retrieval of information that is very effective. Natural Language Processing (NLP) has made it possible for computers to grasp human language. This capability was first introduced in 2005. They are able to collect vital information from a patient's report and incorporate it into the centralized system in a seamless manner.4 Because of this, the system is able to collect and store information about the diagnoses, treatments, prescriptions, and other pertinent information pertaining to patients. In addition to providing patients and staff members with real-time updates on the situation, the data may be employed to provide precise estimations of the amount of time that patients will be required to wait. In addition to this, it is able to recognize and assess patterns and trends within the process of the department, thus allowing the required adjustments to be made in order to improve efficiency. After collecting data from patients, it is possible to analyses trends and patterns within the data. The investigation has the potential to improve patient care by highlighting areas for improvement. Using an acceptable sample size, it is possible to make reliable predictions about the likelihood of specific occurrences. The use of a machine learning algorithm allows for the assessment of the likelihood that persons with specified conditions will be discharged or admitted to a medical facility.5 The use of these algorithms is critical in giving invaluable assistance to workers in the performance of their everyday activities, as well as predicting and anticipating the state of patients. The rapid examination of data has various advantages, notably in terms of minimizing wait times. The provision of timely help is an important part of controlling patient flow because it has a direct impact on patient satisfaction and likely to recommend the healthcare institution. The implementation of an automated system for data collection and analysis can assist hospitals in attaining transparency. To augment transparency within the healthcare facility, administration may elect to employ machine learning algorithms to produce status dashboards.6 This type of dashboard has the capability to deliver instantaneous updates regarding the condition of facilities and departments. It can provide details such as staff availability, wait times, and the individual patient loads of each staff member. There are specific situations in which the implementation of a decentralized system is required to assure hospital-wide transparency. Particularly designed chatbots may be employed in such circumstances to collect data and provide immediate transparency. A chatbot that is purpose-built for the hospital environment can efficiently respond to fundamental inquiries, collect critical data, and improve patient transparency. By employing ML algorithms, the efficacy of patient flow can be significantly enhanced. Conflict of interest: None declared.

Rome is vulnerable to chemical, biological, radiological, nuclear, and explosive (CBRNe) attacks. The study evaluates Rome’s advanced emergency departments’ state of emergency plans for massive influx of injures (PEIMAF) plans for CBRNe attacks. We propose a chemical attack on Saint Peter’s Square during the Pope’s General Assembly and its effects. The National Stockpile Antidotes’ activation and territorial distribution timing work well for chemical attacks. We also estimated activation timing. Our data show that despite a good organization, travel times can be improved. We also believe that all major Roman hospitals must develop the PEIMAF, which should be followed by an organized training plan involving theoretical teaching and indoor and outdoor simulation to train hospital staff and evaluate PEIMAF weaknesses and vulnerabilities. The effectiveness and efficiency of first aid depend on timing, and each PEIMAF analyzed, while coherent and adequate for internal purposes, fails to integrate with the other hospitals. Integration can speed up National Stockpile Antidotes delivery and save lives. For the best CBRNe response, detailed intervention protocols must be created, updated daily, and exercised.

Context: Though many arrangements had been made during the first wave, multiple complaints were reported regarding the arrangements made for COVID patients. The control room was set up as a 24 × 7 administrative coordination center to attend to issues after the initial setup of COVID units. Aim: To identify the major problems reported to the control room during the second wave of COVID-19 and find the related cause for the same. Methods and Materials: Issues reported to the control room were recorded from April to June (2021). The control room residents were asked to allocate each problem into six categories. Next, the residents allotted a frequency score to each of the problems depending on how regularly it was reported. Secondary data from various reports were also considered. Statistical Analysis Used: Data were analyzed using MS Excel software. Results: Various administrative issues were identified to be due to issues in communication and coordination (23%), policy and procedures (22%), human resource and training (16%), administration and implementation (15%), infrastructure (14%), and HMIS and IT (10%). Conclusion: Most frequent problems reported to the control room were related to infrastructure, policy implementation, and manpower training. After the initial implementation of new processes, there was a requirement for regular follow-up and coordination. This model of setting up an administrative control room and evidence-based approach will serve as a template for public hospitals to ensure coordination of hospital operations.

Abstract Background The effect of leadership support for adherence to infection control and prevention (IPC) measures has been demonstrated. To expand this support, a target group-specific educational study for chief medical officers (CMO) was implemented and its influence on IPC indicators was investigated. Methods A controlled cohort study was conducted between 2018 and 2019. The intervention based on an initial workshop, an e-learning course, and a final meeting. Participants’ activities involving IPC management were surveyed. Consumption of alcohol hand rub (AHR) and incidence density of hospital-associated (HA) Clostridioides difficile-associated infections (CDI) were analyzed. Results Eight percent of 360 CMOs invited participated in the initial workshop; 70% of those participants registered for the online course. Overall, 43% completed the post-intervention questionnaire, in which 85% of respondents reported increased collaboration with relevant stakeholders. The pre-intervention median AHR consumption was higher in the intervention group than in the control group. Both groups showed an increase (38.6 (interquartile range (IQR) 33.6; 45.0) to 41.9 ml/patient day (PD) (IQR 35.0; 56.6) and 33.4 (IQR 28.3; 40.8) to 35.8 ml/ PD (IQR 31.6; 43.2), respectively). Pre-intervention median HA CDI cases were lower in the intervention group than in the control group. Both groups reported a decrease (0.22 (IQR 0.17; 0.33) to 0.19 cases/1000 PD (IQR 0.15; 0.26) and 0.32 (IQR 0.2; 0.48) to 0.22 cases/1000 PD (IQR 0.11; 0.33), respectively). Conclusion Multimodal IPC training of CMOs is worthwhile and can lead to changes in IPC-relevant cooperation in hospitals. IPC training of hospital management should be further intensified.

Abstract Background Septic shock is a global public health burden. In addition to the improvement of the level of individual care, the improvement of the overall hospital quality control management is also an essential key aspect of the Surviving Sepsis Campaign (SSC). Using of antibiotics is a cornerstone in the treatment of septic shock, so we conducted this study to investigate the influence of antibiotics and pathogenic bacteria on the mortality of septic shock at the level of overall hospital in China. Methods This was an observational database study in 2021 enrolled the data of 787 hospitals from 31 provinces/municipalities/autonomous regions of Mainland China collected in a survey from January 1, 2021 to December 31, 2021. Results The proportion of ICU patients with septic shock was 3.55%, while the patient mortality of septic shock was 23.08%. While carbapenem was the most preferred antibiotic medication used in 459 of the 782 hospitals, the preference for carbapenem did not show significant effect on the patient mortality in the treatment of septic shock (p-value 0.59). Compared with patients with fermenting bacteria as the most common pathogenic bacteria causing septic shock, patients with non-fermenting bacteria had a higher mortality (p-value 0.01). Conclusions Whether using carbapenem as the preferred antibiotic or not, did not show effect on the patient mortality of septic shock. Compared with patients with fermenting bacteria as the most common pathogenic bacteria, patients of septic shock with non-fermenting bacteria had a higher mortality.

Objective To verify the accuracy and cost of the value of serum sodium fluctuation in predicting adverse clinical outcomes, and to propose a warning value of serum sodium fluctuations for early warning of in-hospital death and summarize the methodology for setting warning values. Methods This investigation covered all patients admitted to Peking Union Medical College Hospital from January 1, 2014 to December 31, 2014. Patients with normal serum sodium at the time of admission and older than 18 years old were included. Patients without serum sodium retested during the hospitalization were excluded. Clinical characteristics including gender, age, primary diagnosis, and causes of death were documented and laboratory examinations were collected including all serum sodium values during hospitalization. The highest and lowest values among all measurements of serum sodium during hospitalization were identified. The difference between the highest and lowest serum sodium value was defined as the fluctuation value of serum sodium level.The area under the curve (AUC) of sodium fluctuations predicting in-hospital death was calculated. The specificities and sensitivities were calculated with the cut-off points of 10, 12, 14, 16, 18, 20, 22, and 24 mmol/L. A warning related to death in the hospital was defined as a true warning, and a warning unrelated to death in the hospital was defined as a false warning. The number of false warnings was defined as the cost of warning.The ratio of the true warnings to the total warnings was defined as the efficiency of warning. An appropriate cut-off point was selected for combined accuracy, cost, and efficiency of warning. Results In total, 33 323 hospitalization records met the inclusion criteria, of which 191 patients (0.57%) died. 148 records of death were analyzed. Among these patients, 53 died from tumor (35.6%), 52 died from infection (34.9%), 46 died from respiratory failure (30.9%), and 26 died from heart failure (17.4%), 6 died from sudden death (4.0%), 5 died from cerebral hemorrhage (3.4%), 6 died from bleeding from other parts (4.0%), and 1 died from cerebral herniation (0.7%).There were 75 patients (50.7%) experienced serum sodium fluctuations within 10 days before death. The average serum sodium fluctuation was (13.36±8.62)mmol/L, and the highest was 35 mmol/L. Serum sodium fluctuation predicted in-hospital death with an AUC of 85.2% (95% CI:81.8%-88.5%). Predicting in-hospital death with a serum sodium fluctuation greater than 20 mmol/L had a specificity of 99.0% and a sensitivity of 28.8%. If serum sodium fluctuation greater than 20 mmol/L was set as a warning value, 28.8% of hospital deaths would be identified, the number of warnings would be 397, the number of true warnings would be 55, the cost of warning would be 342, and the efficiency of warning would be 13.9%. Conclusions Serum sodium fluctuation greater than 20 mmol/L could be used as a biomarker value for early warning of in-hospital death with high accuracy and low management cost. Serum sodium fluctuations greater than 20 mmol/L is a warning value point and can be potentially used as a predicting warning to suppot the identification of critically ill patients and thus to improve the management of inpatients at high risk of death.

Highlights: • Customers expectations at Dr. Soetomo General Academic Hospital has a higher quality of service. • The handling of complaints has a low performance on the quality of services at Dr. Dr. Soetomo General Academic Hospital. • Improving service quality requires improvements in efficient complaint handling. Abstract: Service quality is essential in health institutions that can affect patient satisfaction and loyalty. The growth in the number of patients at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, triggered the diversification of services that require periodic quality control. This study aimed to investigate the performance of 31 departments/units in the hospital, the level of customer satisfaction with services provided, and factors that could influence satisfaction. A survey about service performance, perception, and expectation of services was carried out in 31 departments/units using questionnaires from August to October 2021. Convenient respondents consisted of 2121 patients and their families aged >15. Questionnaire items assessed performance, perceptions, and expectations of health services using the SERVQUAL method. Statistical Package for the Social Sciences (SPSS) software was used to perform an analysis of the results of the measurement and the difference in responses between demographic groups of respondents (p

Introduction and purpose: Job performance is the most critical organizational issue determining the survival or dissolution of an organization. Professional ethics are among the major factors promoting job performance. Since professional ethics and job performance contribute greatly to the enhancement of productivity, the present study aimed to assess the relationship between professional ethics and job performance of staff in selected hospitals of Shahid Sadoughi University of Medical Sciences in 2021. Methods: This applied research was conducted based on a descriptive cross-sectional design conducted on 180 employees of selected hospitals in 2022. The subjects were randomly selected and administered the Work Ethic Questionnaire of Gregory, C., Petty, and Job Performance Questionnaire by Patterson. Data were analyzed in SPSS software (version 16) using Kruskal-Wallis and Mann-Whitney tests. Results: The results pointed to a positive and significant relationship between professional ethics and job performance. The correlation coefficients of "interest in work', "perseverance", "healthy relationships", "collective spirit and participation in work" were reported as 0.355, 0.551, 0.483), and 0.386, respectively. Demographic variables (marriage, education, age, and professional experience) showed a significant relationship with professional ethics, and demographic variables (gender, marriage, age, and work experience) were correlated with job performance. Conclusion: As evidenced by the findings of this study, the promotion of ethics can increase employees' job performance. Since job performance directly improves organizational productivity, these two variables deserve assiduous attention.

Background: Professional Nursing Practice Model Training (Model Praktik Keperawatan Profesional; MPKP) is one of the efforts to improve the quality of service in hospitals in nursing services to minimize errors or omissions that can occur. The training carried out is expected to be able to improve the implementation of pillar IV NCDS in hospitals. Aims: This study aimed to determine the effect of MPKP training with the application of pillar IV NCDS at the General Hospital of the Evangelical Masehi Church Bolaang Mongondow Monompia Kotamobagu. Methods: This research is a quantitative research type with a pre-experimental research design one group pre-test post-test design. This research was conducted in August 2022 as many as 52 nurse respondents working at the Monompia GMIBM Hospital Kotamobagu. Results: From the survey, it shows that the intervention will increase the number of nurses implementing the Pillar IV Nursing Care Delivery System (Pillar IV NCDs) including the assessment element (from 76.9% to 90.4%), nursing diagnosis (from 36.5% to 75.0%), planning (from 51.9% to 88.5%), action or measurement (from 84.6% and 92.3%), evaluation (from 46.2% to 90.4%), and nursing care notes (78.8% and 98.1%). There are differences in the implementation of pillar IV NCDS before and after being given MPKP training (p-value:

Introduction: Healthcare reform efforts focus on patient-centered care is measured by patient satisfaction. Emergency department (ED) satisfaction ratings are often the lowest. Since ED is the first point of contact for the patient care to receive primary care, we aimed to explore patient satisfaction related to ED healthcare services at our institution. Methods: In this cross-sectional study, ED-CAHPS, a standardized validated nine-item survey questionnaire, was administered via telephonic interviews to Arabic-speaking patients who attended ED at our institution. Patient demographics, ED operation parameters, and healthcare utilization factors were evaluated as patient satisfaction predictors. Results: Out of 713 patients who were contacted 200 patients responded to the survey. In all, 70% of respondents were aged 35-64 years and 55% had secondary or higher education levels. The dimension average for the questions regarding arrival, waiting time, and urgency of treatment was 36%. Regarding satisfaction with pain management was 42%, medication information was 34% and interpreter services were only 40%. The overall dimension average for satisfaction regarding nursing care was 43%, doctor care was 36%. The overall dimension average for satisfaction regarding the discharge process was 56%. The highest scores were observed for whether the patients were asked about follow-up care (61%), whether they understood the symptoms to look for after leaving the ED (58%), and whether they received care within 30 min of arriving at the ED (56%). On the other hand, the worst scores were recorded for whether the patients were made to understand regarding the side effects of new medications (29%), whether nurses spent enough time with them (33%), and whether doctors spent enough time with them (34%). Conclusions: Based on these results, recommendations were made to improve patients' perceptions/experience in receiving the care and the overall rating. This study presents specific recommendations for maximizing patient satisfaction in primary ED settings in Saudi Arabia.

Introduction and purpose: Accreditation is a process in which a foreign institution systematically measures and evaluates the credibility of an organization in terms of process, outcome, and structural indicators. This study aimed to identify the effective challenges in the implementation of the accreditation process and achieve a comprehensive model to improve and enhance the accreditation process. Methods: This study was performed in two stages. In the first stage, a review of studies was conducted to identify the challenges affecting the implementation of hospital accreditation in Iran. In the second stage, the content validity method was used to recognize the most important challenges affecting the implementation of accreditation. Subsequently, to investigate the relationships among factors and determine the most effective and impressionable variables, quantitative interpretive structural modeling technique was used. Results: The most effective variables with a driving power of 11 and dependence power of 4 were found to be the lack of necessary infrastructure, nurses, clinical staff, and other personnel; limited resources and capital; not considering the appropriate budget for the implementation of the accreditation program; and non-compliance of some standards with national and provincial conditions. On the other hand, the least influential variables on challenges affecting the implementation of hospital accreditation with a driving power of 1 were reported to be the challenge in the degree of independence, impartiality, personal judgments, and differences of evaluatorschr('39') tastes, as well as the poor patient-medical team communication. Conclusion: It is necessary to find the main and effective factors in accreditation and establish a relationship between them to achieve the more effective implementation of accreditation. Therefore, it would be possible to provide a clear framework for determining the best policies to control and manage accreditation and ultimately prevent the waste of resources in the health sector. This research provided new insights into the challenges affecting the implementation of accreditation, which identify the priorities for action in decision-making and policy-making.

Statement of problem: Healthcare industry is struggling under an increasing pressure of constantly rising costs as the science opens new horizons in the development of new drugs and technologies making thus the task of employing resources in an effective manner more challenging than ever before. LEAN system management in hospitals can contribute to effective costs management and better results. We analyzed industrial LEAN model management and its implementation in hospitals. LEAN management has its roots in Just-In- time management implemented by the company Toyota that has provided for this company to become a fierce competitor to the United States car industry. The aim of LEAN is to eliminate waste and reduce production time. The basic principle of LEAN philosophy is to determine where the value is added in the process and where it is not. LEAN consists of several tools: five S, Kaizen events, standardized work, kanbans, spaghetti diagrams. Spaghetti diagrams are used to track the movement of employees, materials and patients. Effective implementation can reduce the time used for different needs of patients and tasks of employees, so this is an example of lost effectiveness that can be eliminated. Kaizen events include a project team selected from hospital staff, whose goal is to solve efficacy problem by defining the problem and reasonable output and then implement new ideas. An example may be a disorganized inventory of hospital pharmacy that consequently prolongs the time of drug delivery. The project team can locate the problem and suggest inventory changes. Competitive market companies must constantly innovate and implement new ideas to win a market share. Such innovations can sometimes be used in healthcare industry, and effective implementation can increase the quality of health service provided by hospitals, and also reduce never ending rising costs, a challenge that hospital management encounters.

Since an epidemic occur of Corona Virus Disease 2019(COVID-19) in December, 2019, all the dental healthcare service providers in our country have been greatly impacted. The strategy of managing the dental clinics is quite different from that of the medical healthcare clinics, and the key point of the administration of those dental healthcare providers is to focus on the management of outpatient care because they only supply just a little bit of inpatient care service but quite an large amount of outpatient care service. So we think the next step is to make plausible and effective scenarios to protect our dental healthcare staff and patients against corona virus infection during the treatments procedures after the reopening all of our dental clinics. To overcome this harsh condition, the infection prevention and control strategies adopted by the Stomatological Hospital, Southern Medical University were designed to be flexible and could be adjusted promptly according to the national and local governmental orders and latest guidelines released by the Centers for Disease Control and Prevention. All these prevention procedures and protocols were customized to fit our own situation and have been updated for several times based on the latest global pandemic reports. After going through the hardest time in the past four months, it’s considered that our COVID-19 prevention rules have been proved to be efficient and work well. Further more, it has made massive progress for the hospital in improving the capability of dealing with this state of emergency, especially by previewing and triaging patients strictly to cut off the possible coronavirus spreading from the original step, enhancing the standard precautions and those specific protocols made for minimizing the droplets, aerosol and contact transmission of COVID-19 indoors. Besides, a daily supervision system was set up as a routine job and a team of qualified infection prevention specialists were assigned to check and report every incorrect details during the whole procedure of dental practice. Meanwhile, the safety and well-being of the public and our medical workers could be also guaranteed through following those detailed prevention scenarios.

Introduction and purpose: Accreditation is a method used for the improvement of the quality of hospital services. It refers to the systematic evaluation of the health centers based on specific standards. The present study aimed to critically review the implementation of accreditation standards in hospitals. Methods: This critical review investigated all the articles that were published during 1993-2019. In order to find the sources, the authors referred to various databases, namely ISC, DOAJ, PubMed, ProQuest, Embase, Science Direct, Scopus, and Web of Science. The keywords used for the search included Mesh terms and common keywords related to the subject of the study, including challenges, barriers, hospital management, accreditation, hospital, or accreditation hospital. Finally, the full texts of 16 articles were reviewed for the purposes of the study. Results: According to the results, various issues, such as the accreditation organization independence, staff and physician participation, number, structure, and content of standards, structural and contextual problems, importance of human resources, financial and capital resources, organizational and management issues, other plans, role of evaluators and their evaluation methods, role of stakeholders, and impact of accreditation on the patients and teaching atmosphere of the hospital were executive challenges of hospital accreditation. Conclusion: In order to increase the impact of accredition and significantly address its challenges, there should be emphasis on performance indicators, preparation by training and raising awareness of the personnel, budget allocation, and development of plans on accreditation.

Background: Hospitals have constituted the limiting resource of the healthcare systems for the management of the COVID-19 pandemic. As the pandemic progressed, knowledge of the disease improved, and healthcare systems were expected to be more adapted to provide a more efficient response. The objective of this research was to compare the flow of COVID-19 patients in emergency rooms and hospital wards, between the pandemic's first and second waves at the University Hospital of Vall d’Hebron (Barcelona, Spain), and to compare the profiles, severity and mortality of COVID-19 patients between the two waves. Methods: A retrospective observational analysis of COVID-19 patients attending the hospital from February 24 to April 26, 2020 (first wave) and from July 24, 2020, to May 18, 2021 (second wave) was carried out. We analysed the data of the electronic medical records on patient demographics, comorbidity, severity, and mortality. Results: The daily number of COVID-19 patients entering the emergency rooms (ER) dropped by 65% during the second wave compared to the first wave. During the second wave, patients entering the ER were significantly younger (61 against 63 years old p

Objective (s): Public private partnership (PPP) is a good strategy to increase the capacity and efficiency of the public sector and to deliver high quality healthcare services to the community at a lower price for the government. However, there are several challenges related to PPP in Iranian health sector. Moheb-Yas hospital is one of the few hospitals built with the PPP method in Iran. The purpose of this study is to identify, explore, and explain the challenges of PPP in Moheb Yas hospital operations. Methods This case study was carried out in 2018 using semi-structured interviews, documentation, archival records, and direct observation. Twenty-four key stakeholders involved in the establishment and operations of the hospital were purposefully selected and interviewed. Content analysis was used for data analysis. Results: Moheb-Yas hospital PPP faced legal, structural, human related, cultural and managerial challenges. These challenges include vague and unclear model of partnership, political changes, insufficient supportive regulations and rules, design and built problems, limited utilization of the hospital capacity, lack of long term funding, employees’ low job security, unequal employees’ compensation, cultural differences, insufficient conflict management and resolution, management turnover and lack of participative management. Conclusion: The PPP experience in Moheb-Yas hospital was unsuccessful. Political support, stable economic condition, establishing a PPP unit, strong leadership, proper planning, trust and mutual responsibility are necessary for the success of PPP in the health sector.

Background: Hospitals are the most important element of the health system. Hospitals play a key role in providing health services and have a major impact on the health system's performance. The success of organizations depends on their managers’ performance. Organizations with qualified and experienced managers will be more successful in achieving their goals and can reach optimal efficiency. Methods: This is a phenomenological qualitative study in which content analysis was used to achieve study objectives. The study population included the hospitals managers and senior experts of the vice chancellor for treatment of a provincial department of the Ministry of Health and Medical Education in Iran. Participants were selected by purposive and heterogeneous methods and data collection continued until data saturation was achieved. Data were collected by semi-structured face-to-face interviews. Results: From our data, seven main themes were drawn, consisting of monitoring and control, planning, organizing, leadership and motivational factors, management of resources and information, communication and interdepartmental coordination and patient orientation Conclusion: Hospital managers play a key role in improving hospital function. Assessing hospital managers' performance, determining their strengths and weaknesses and taking corrective actions are beneficial to the improvement of hospitals’ performance.

BACKGROUND: Medical personnel are bound toexperience some difficulties in the course of duty and they may end up criminally or civilly liable in the performance of these responsibilities. Across the globe, many medical employees have lost their license to practice their profession after facing disciplinary committees for breach of duties. Some have been sued by patients for negligent treatment. Administratively, the hospital management boards have protected their staff against liabilities by being sued instead of the staff, paying some patients off or write off their hospital bills to compensate them for the liabilities of their medical personnel. Legally, medical personnel are also shielded from medical liabilities as long as they observe a high level of care and skills in the course of duty, otherwise, the law will remove the veil of protection and charge them as liable. METHODOLOGY: In order to achieve the objectives of this research, the doctrinal and qualitative methodology was adopted. The doctrinal approach enables the authors to explore the position of the Nigerian law to examine the liabilities of medical personal in cases of any malpractice whether intentionally or unintentionally. The qualitative approach was used to analyze the administrative protection of medical personnel by the hospital management board. CONCLUSION: The study concludes that as long as there is lack of proper supervision of medical personnel by their superior officers, no constant supply of electricity, no improved welfare package for medical personnel, lack of educational sponsorship for career advancement, deliberate observation of advanced professional ethics and honesty on the part of medical personnel, negligence in the course of treatment would not be abated in Nigerian hospitals.

OBJECTIVE: The aim of the study was to assess job satisfaction, health and psychosocial wellbeing of doctors in public hospitals in Calabar using indepth qualitative method. METHODS: Two focused group discussions were conducted among male and female resident doctors. Doctors were selected purposively giving considerations to departments, hierachy and the hospitals. Doctor selection also involved the three major public hospitals in Calabar and five different departments/specialties. A focus group discussion guide was used to direct discussion and a digital audio recorder was used to record discussion with permission from participants. A research assistant also took notes during the sessions. The discussions were transcribed from the audio recorder and compared with the notes taken. Thematic analysis was done and narratives of the discussion was reported. RESULTS: Participants expressed general satisfaction with their work. Reasons expressed for job dissatisfaction from some participants included poor salary, inadaquate tools and consumables, and dissatisfaction with level of training from consultants. Areas of the work environment in which discussants were most satisfied included opportunities for learning and career development, appreciation from patients and patients' relatives. Least satisfaction was derived from high level of mortality in a department, inadequate tools to work with, poor facilities, poor supervision, poor coworkers perception of their specialities, and inability to rest after calls. Regarding health, discussants suffered headaches, backaches, malaria, social stress from being away from family, inadequate sleep, and fear of patient assault. CONCLUSION: Hospial managment could improve doctors' job satisfaction by carrying out regular and adequate maintenance of hospital facilities and provide ergonomically suitable environment for resident doctors. Clinical team leads could also improve the opportunities for engagement with their subordinates.

Background and Objective: While efficient use of resources and cost control is the responsibility of hospital managers, it is the duty of the nurses to carry out patient care and provide high-quality services. The aim of present research was to study the perception of staff nurses and nurse managers about nursing efficiency in patient care in a trust hospital. Materials and Methods: This quantitative and explanatory research has been done on staff nurses as well as nurse managers in a 550-bedded trust hospital in rural Gujarat of India. Data collection tool was a researcher made questionnaire and the data collection method was interview schedules for staff nurse and nurse managers. The total number of staff nurse in this hospital was 450 including 50 nurse managers. Results: Staff nurses had shown dissatisfaction regarding managers' practice and stated some aspects of managers practice which needed to improve such as keeping competitive salary for staff nurse, providing counseling system to supporting nursing practice, better recognition and acknowledgement system, better job security, providing supportive managerial style, better unit size and Applying vacation system. Conclusions: There was a difference between staff nurses' perception and nurse managers' perception regarding professional characteristics for nursing profession and factors, which affect nursing efficiency in patient care (with 95% confidence interval and P < 0.05).

Background: In light of the COVID-19 pandemic and resulting demand for innovative hospital management we organized an interactive online discussion for medical students and healthcare professionals about hospital management during the crisis.Objective: The event offered an opportunity to learn from a hospital crisis management. We looked at how this new online format compares to a traditional discussion event. Methods: We used an online platform with four guests, a moderator and about 100 attendees. During the event we gathered demographic facts through an interactive questionnaire tool and an extensive evaluation afterwards.Results: The event was rated with an overall grade of 1.4 (Likert from 1 to 6, 1 best grade; SD 0.5) and participants agreed that this format should be organized again (1.2; SD 0.5). 70% of audience members preferred the online format of the event. Due to the high volume, only about 30% (total n~35) of the questions posed by the audience were addressed.Conclusion: Firstly, most participants preferred the event to be online, contrary to our expectation. Secondly, the handling of the amount of individual questions posed significant challenges.Finally, the number of attendees and questions suggested a continuing demand among students and physicians for further education regarding hospital management, especially regarding COVID-19. These findings also require a critical look at future formats and topics of podium discussions in medical education. The online format might be a good alternative to face-to-face lectures.

During the COVID-19 pandemic, many general hospitals have been transformed into designated infectious disease care facilities, where a large number of patients with COVID-19 infections have been treated and discharged. With declines in the number of hospitalizations, a major question for our healthcare systems, especially for these designated facilities, is how to safely resume hospital function after these patients have been discharged. Here, we take a designated COVID-19-care facility in Wuhan, China, as an example to share our experience in resuming hospital function while ensuring the safety of patients and medical workers. After more than 1200 patients with COVID-19 infections were discharged in late March, 2020, our hospital resumed function by setting up a three-level hospital infection management system with four grades of risk of exposure. Moreover, we also took measures to ensure the safety of medical personnel in different departments including clinics, wards, and operation rooms. After all patients with COVID-19 infections were discharged, during the five months of regular function from April to September in 2020, no positive cases have been found among more than 40,000 people in our hospital, including hospital staff and patients.

Performing accurate diagnosis using computed tomography (CT) in emergency medicine may reduce mortality rates in various diseases. In this observational, correlational and cross-sectional study, we conducted multiple regression analyses to investigate the relationship between CT utilization rates and mortality. In addition, we estimated the annual net profits from CT to show the profitability of introducing a CT system in each Japanese prefecture.

Introduction: Since hospitals provide crucial lifesaving services in societies, hospital resiliency plays an essential role in minimising the impact of disasters on the community. A resilient hospital should be able to resist, absorb, respond to, and recover from the impacts of disasters as well as continues its normal operation. Aim: This study aims to explore the main challenges for providing a resilient hospital in emergencies and disasters in context of Iran. Materials and Methods: This was a qualitative content analysis study. Interviews are in-depth and semi-structured. Each interview begins with open questions and questions become progressively narrowed based on the participants' responses. Six themes were initially formed based on analysing the primary codes. Themes were also composed of 21 categories and 20 sub-categories. Interviews were conducted with 18 experts {9 hospital managers and 3 doctors (Ph.D.) in emergency and disasters, 3 supervisors and 3 matrons} and analysed using qualitative inductive content analysis approach. Finally, an expert panel was conducted by a team of experts including 10 people {3 hospital managers and 2 doctors (Ph.D.) in emergency and disasters, and 5 supervisors}. Results: The main concepts which have been explored in the study include; lack of preparedness, continuity of essential service, non-coherent function, emotional response, developing functionality and non-resilient confrontation. Each concept includes several main categories, and main categories are also divided into several subcategories based on their field and according to their significant characteristics. Conclusion: Exploring the challenges which a hospital faces in emergencies and disasters that affect the normal operation of the hospital helps the disaster managers to improve their plans to handle the disaster situations. Findings show that the challenges of all phases of disaster management (such as prevention, preparedness, response, and recovery) must be considered by the disaster managers together. Since disaster situation is very stressful for both injured peoples and disaster management team, therefore, it is recommended that the psychological challenges of a resilient hospital after a disaster occurs are clarified.

Motive. The Covid-19 pandemic has led to the novel situation that hospitals must prioritize staff for a vaccine rollout while there is acute shortage of the vaccine. In spite of the availability of guidelines from state agencies, there is partial confusion about what an optimal rollout plan is. This study investigates effects in a hospital model under different rollout schemes. Methods. A simulation model is implemented in VBA, and is studied for parameter variation in a predefined hospital setting. The implemented code is available as open access supplement. Main results. A rollout scheme assigning vaccine doses to staff primarily by staff’s pathogen exposure maximizes the predicted open hospital capacity when compared to a rollout based on a purely hierarchical prioritization. The effect increases under resource scarcity and greater disease activity. Nursing staff benefits most from an exposure focused rollout. Conclusions. The model employs SARS-CoV-2 parameters; nonetheless, effects observable in the model are transferable to other infectious diseases. Necessary future prioritization plans need to consider pathogen characteristics and social factors.

Background: Nowadays, application of nuclear technology in different industries has largely expanded worldwide. Proportionately, the risk of nuclear incidents and the resulting injuries have, therefore, increased in recent years. Preparedness is an important part of the crisis management cycle; therefore efficient preplanning seems crucial to any crisis management plan. Equipped with facilities and experienced personnel, hospitals naturally engage with the response to disasters. The main purpose of our study was to present a practical management pattern for hospitals and medical centers in case they encounter a nuclear emergency. Materials and Methods: In this descriptive qualitative study, data were collected through experimental observations, sources like Safety manuals released by the International Atomic Energy Agency and interviews with experts to gather their ideas along with Delphi method for polling, and brainstorming. In addition, the 45 experts were interviewed on three targeted using brainstorming and Delphi method. Results: We finally proposed a management plan along with a set of practicality standards for hospitals and medical centers to optimally respond to nuclear medical emergencies when a radiation incident happens nearby. Conclusion: With respect to the great importance of preparedness against nuclear incidents adoption and regular practice of nuclear crisis management codes for hospitals and medical centers seems quite necessary.

Introduction: Surge capacity for optimization of access to hospital beds is a limiting factor in response to catastrophic events. Medical facilities, communication tools, manpower, and resource reserves exist to respond to these events. However, these factors may not be optimally functioning to generate an effective and efficient surge response. The objective was to improve the function of these factors.Methods: Regional healthcare facilities and supporting local emergency response agencies developed a coalition (the Healthcare Facilities Partnership of South Central Pennsylvania; HCFP¬SCPA) to increase regional surge capacity and emergency preparedness for healthcare facilities. The coalition focused on 6 objectives: (1) increase awareness of capabilities and assets, (2) develop and pilot test advanced planning and exercising of plans in the region, (3) augment written medical mutual aid agreements, (4) develop and strengthen partnership relationships, (5) ensure National Incident Management System compliance, and (6) develop and test a plan for effective utilization of volunteer healthcare professionals.Results: In comparison to baseline measurements, the coalition improved existing areas covered under all 6 objectives documented during a 24-month evaluation period. Enhanced communications between the hospital coalition, and real-time exercises, were used to provide evidence of improved preparedness for putative mass casualty incidents.Conclusion: The HCFP-SCPA successfully increased preparedness and surge capacity through a partnership of regional healthcare facilities and emergency response agencies.

IntroductionThe extreme variability of clinical severity in medical admitted patients is diluted in a “average” standard of care, that may be stronger than the real needs for someone, but clearly inadequate, sometimes even dangerous, for other ones, critically ill.DiscussionThe model of a differentiated intensity of hospital care can be defined as the organizational model structured to areas/sectors dedicated to patients with homogeneous needs of care. The intermediate care unit (“High dependency units”, “sub-intensive care areas” – “high care units”) are particularly suitable for patients who have a lower risk compared to patients treated in intensive care, but liable to develop complications and needing a close monitoring much more than the “standard”, “routine” care. The implementation of the a new organizational model must be careful and consider the possible enlargement errors that can be made. The analysis of the context is necessary for assess prerequisites, excluding the elements opposed to the success of the proposed model (i.e.: wards congestion and overcrowding, with a consequential with increased risk of adverse events). Before implementing and admitting patients in new “models”, we have to define the epidemiological population characteristics, their level of complexity/criticality/instability and the current assessment tools.ConclusionsAny new proposal of hospital management change has, as first obligation, to explicit the basic visions and primary goals for “the added value” resulting to the patient and the whole organization, with the evidence of an “health technology assessment” approach, for the professional hospital overall governance. But without the presumption, or worse, the apodictic assertion, to proclaim the implementation of structures with “differentiated intensity of hospital care” organizations that are not.

Background: Applying an effective management system in emergency incidents provides maximum efficiency with using minimum facilities and human resources. Hospital Emergency Incident Command System (HEICS) is one of the most reliable emergency incident command systems to make hospitals more efficient and to increase patient safety. This research was to study requirements, barriers, and strategies of HEICS in hospitals affiliated to Isfahan University of Medical Sciences (IUMS). Methods: This was a qualitative research carried out in Isfahan Province, Iran during 2008-09. The study population included senior hospital managers of IUMS and key informants in emergency incident management across Isfahan Province. Sampling method was in non-random purposeful form and snowball technique was used. The research in-strument for data collection was semi-structured interview; collected data was analyzed by Colaizzi Technique. Results: Findings of study were categorized into three general categories including requirements (organizational and sub-organizational), barriers (internal and external) of HEICS establishment, and providing short, mid and long term strategies. These categories are explained in details in the main text. Conclusions: Regarding the existing barriers in establishment of HEICS, it is recommended that responsible authori-ties in different levels of health care system prepare necessary conditions for implementing such system as soon as possible via encouraging and supporting systems. This paper may help health policy makers to get reasonable frame-work and have comprehensive view for establishing HEICS in hospitals. It is necessary to consider requirements and viewpoints of stakeholders before any health policy making or planning.

Hospital Incident Command System (HICS) has been established with the mission of prevention, response, and recovery in hazards. Regarding the key role of hospitals in medical management of events, the present study is aimed at investigating benefits, barriers, and limitations of applying HICS in hospital. Employing a review study, articles related to the aforementioned subject published from 1995 to 2016 were extracted from accredited websites and databases such as PubMed, Google Scholar, Elsevier, and SID by searching keywords such as HICS, benefits, barriers, and limitations. Then, those articles were summarized and reported. Using of HICS can cause creating preparedness in facing disasters, constructive management in strategies of controlling events, and disasters. Therefore, experiences indicate that there are some limitations in the system such as failure to assess the strength and severity of vulnerabilities of hospital, no observation of standards for disaster management in the design, constructing and equipping hospitals, and the absence of a model for evaluating the system. Accordingly, the conducted studies were investigated for probing the performance HICS. With regard to the role of health in disaster management, it requires advanced international methods in facing disasters. Using accurate models for assessing, the investigation of preparedness of hospitals in precrisis conditions based on components such as command, communications, security, safety, development of action plans, changes in staff's attitudes through effective operational training and exercises and creation of required maneuvers seems necessary.