Search

Aims To identify the organisational changes faced by front‐line nurses working with COVID‐19 patients during the first wave and describe how they responded to these changes. Background The COVID‐19 pandemic has altered the provision of care and the management of health care around the world. Evolving information about SARS‐CoV‐2 meant that health care facilities had to be reorganised continually, causing stress and anxiety for nurses. Methods Qualitative study based on Rapid Research Evaluation and Appraisal (RREAL). The research took place in hospital and community health settings of the Spanish national health system with a purposive sampling of 23 front‐line nurses. Semi‐structured interviews were conducted between May and June 2020. The duration was 30–45 min per interview. We used the Dedoose® data analysis software to perform a thematic analysis. Results Nurses responded to organisational changes using the following strategies: improvisation, adaptation and learning. Conclusion Our rapid approach allowed us to record how nurses responded to changing organisation, information that is easily lost in a disaster such as the COVID‐19. Implications for nursing management: Knowing about their strategies can help planning for future health disasters, including subsequent waves of the COVID‐19.

Background Physician turnover is a concern in many health care systems globally. A better understanding of physicians’ reasons for leaving their job may inform organisational policies to retain key personnel. The aim of this study was to investigate hospital physicians’ intention to leave their current job, and to investigate if such intentions are associated with how physicians assess their leaders and the organisational context. Methods Data was derived from a survey of 971 physicians working in public hospitals in Norway in 2016. The data was analysed using descriptive statistics and multivariate analysis. Results We found that 21.0% of all hospital physicians expressed an intention to leave their current job for another job. An additional 20.3% of physicians had not made up their mind whether to stay or leave. Physicians’ perceptions of their leaders and the organisational context influence their intention to leave their hospital. Respondents who perceived their leaders as professional-supportive had a significantly lower probability of reporting an intention to leave their job. The analysis suggests that organisational context, such as department mergers, weigh in on physicians’ considerations about leaving their current job. Social climate and commitment are important reasons why physician stay. Conclusions A professional-supportive leadership style may have a positive influence on retention of physicians in public hospitals. Further research should investigate how retention of physicians is associated with performance related to organisational and leadership style.

OBJECTIVE: We aim to describe medical services provided by Nordic general practitioners (GPs), and to explore possible differences between the countries.DESIGN AND SETTING: We did a comparative analysis of selected data from the Nordic part of the study Quality and Costs of Primary Care in Europe (QUALICOPC).SUBJECTS: A total of 875 Nordic GPs (198 Norwegian, 80 Icelandic, 97 Swedish, 212 Danish and 288 Finnish) answered identical questionnaires regarding their practices.MAIN OUTCOME MEASURES: The GPs indicated which equipment they used in practice, which procedures that were carried out, and to what extent they were involved in treatment/follow-up of a selection of diagnoses.RESULTS: The Danish GPs performed minor surgical procedures significantly less frequent than GPs in all other countries, although they inserted IUDs significantly more often than GPs in Iceland, Sweden and Finland. Finnish GPs performed a majority of the medical procedures more frequently than GPs in the other countries. The GPs in Iceland reported involvement in a more narrow selection of conditions than the GPs in the other countries. The Finnish GPs had more advanced technical equipment than GPs in all other Nordic countries.CONCLUSIONS: GPs in all Nordic countries are well equipped and offer a wide range of medical services, yet with a substantial variation between countries. There was no clear pattern of GPs in one country doing consistently more procedures, having consistently more equipment and treating a larger diversity of medical conditions than GPs in the other countries. However, structural factors seemed to affect the services offered.

IntroductionCommunity-orientated primary care (COPC) is an approach to primary healthcare (PHC) that originated in South Africa and contributed to the formulation of the Declaration of Alma-Ata 40 years ago. Despite this, PHC remains poorly developed in sub-Saharan African countries. There has been a resurgence of interest in strengthening PHC systems in the last few years and identifying key knowledge gaps. COPC has been an effective strategy elsewhere, most notably Brazil. This scoping review investigated COPC in the sub-Saharan African context and looked for evidence of different models, effectiveness and feasibility.MethodsDatabases were systematically searched using a comprehensive search strategy to identify studies from the last 10 years. A methodological guideline for conducting scoping reviews was followed. A standardised template was used to extract data and compare study characteristics and findings. Studies were grouped into five categories: historical analysis, models, implementation, educational studies and effectiveness.ResultsA total of 1997 publications were identified and 39 included in the review. Most publications were from the last 5 years (n = 32), research (n = 27), from South Africa (n = 27), focused on implementation (n = 25) and involving case studies (n = 9), programme evaluation (n = 6) or qualitative methods (n = 10). Nine principles of COPC were identified from different models. Factors related to the implementation of COPC were identified in terms of governance, finances, community health workers, primary care facilities, community participation, health information and training. There was very little evidence of effectiveness of COPC.ConclusionsThere is a need for further research to describe models of COPC in Africa, investigate the appropriate skills mix to integrate public health and primary care in these models, evaluate the effectiveness of COPC and whether it is included in training of healthcare workers and government policy.

Objetivos: Conhecer as representações dos enfermeiros acerca das práticas administrativas de saúde atuais e perceber em que medida essas representações se aproximam dos princípios da Teoria Clássica da Administração. Enquadramento: A Teoria Clássica da Administração, desenvolvida por Henri Fayol, assentava numa visão administrativa marcada pela previsibilidade, organização, comando, coordenação, e controle. Para pôr em prática este paradigma administrativo, foram definidos catorze princípios gerais da administração. Metodologia: Estudo qualitativo de natureza descritiva e exploratória. Recolha de dados realizada através de entrevista semiestruturada, com categorias definidas a priori correspondentes aos catorze princípios gerais da administração, realizadas a oito enfermeiros, com caraterísticas profissionais heterogéneas, escolhidos por seleção racional. Resultados: As representações dos enfermeiros são consideravelmente uniformes verificando-se, contudo, algumas diferenças na comparação entre os dados obtidos a partir de enfermeiros e de chefias intermédias. Os relatos apontam para que, na atualidade, algumas dimensões dos princípios da autoridade, centralização, hierarquia e ordem estejam presentes a nível administrativo. Conclusões: As representações dos enfermeiros entrevistados revelam que estes veem a administração atual em saúde de uma forma relativamente próxima dos princípios preconizados por Fayol. Assim, estes tendem a afirmar a existência dos princípios ligados ao comando, coordenação e organização. O presente estudo evidencia que o debate com os enfermeiros, acerca da mudança da organização do trabalho em saúde, é fundamental quando está em causa o desenvolvimento de estratégias de gestão mais adequadas à organização do trabalho destes profissionais., Background: Henri Fayol’s Classical Management Theory was based on an administrative vision marked by predictability, organisation, command, coordination, and control. To implement this administrative paradigm, fourteen general principles of management were defined. Objectives: To identify nurses’ representations of the current health administrative practices and analyse the extent to which these representations are in line with the principles of the Classical Management Theory. Methodology: Qualitative descriptive exploratory study. Data were collected using semi-structured interviews, with previously defined categories corresponding to the fourteen general principles of management. These interviews were conducted to eight nurses, with heterogeneous professional features and chosen by rational selection. Results: Interviewed nurses’ representations show that for them the current health administration is relatively close to the principles advocated by Fayol. Conclusion: The present study highlights that the discussion with nurses about changing the health work organisation is major when developing the best management strategies for the organisation of these professionals’ work., Marco contextual: La Teoría Clásica de la Administración, desarrollada por Henri Fayol, se asentaba en una visión administrativa marcada por la previsibilidad, organización, mando, coordinación y control. Para poner en práctica este paradigma administrativo se definieron catorce principios generales de la administración. Objetivos: Conocer las representaciones de los enfermeros acerca de las prácticas administrativas de salud actuales y entender hasta qué punto esas representaciones se aproximan a los principios de la teoría clásica de la administración. Metodología: Investigación cualitativa, de carácter descriptivo y exploratorio. La recolección de datos se realizó a través de entrevistas semiestructuradas, con categorías previamente definidas correspondientes a los catorce principios generales de la administración, realizadas con ocho enfermeros con características profesionales heterogéneas y elegidos por elección racional. Resultados: Las representaciones de los enfermeros entrevistados revelan que estos ven la administración actual en la salud de una manera relativamente próxima a los principios de Fayol. Conclusión: El presente estudio muestra que el debate con los enfermeros sobre el cambio de la organización del trabajo en la salud es fundamental cuando está en juego el desarrollo de estrategias de gestión más adecuadas para la organización del trabajo de estos profesionales.

The management of chronic diseases is a prime challenge of most 21st century health care systems. Many Western countries have invested heavily in care plans oriented towards specific conditions and diseases, such as dementia and cancer. The major downside of this narrowly focused approach is that treatment of multimorbidity is ignored. This paper describes the development and main stance of a national position that proposes streamlined reforms of the Belgian health care system to improve care for patients with multiple chronic diseases. We used a combination of methods to develop this stance: literature review and stakeholders’ consultation. The latter identified areas for improvement: efficiency of the health care system, coordination of care, investments in human care resources, informal caregivers’ support, better accessibility, and changes in the financial payment system. The position paper list 20 recommendations that are translated into about 50 action points to reform the health care system. Chronic care tailored to the patient's needs, including implementation of multidisciplinary teamwork, new functions, task delegation in primary care, and empowerment of the patient and informal caregivers are some major areas discussed. In addition, improved support, revised payment mechanisms, and setting up a quality system, along with the tailoring of patient care, can all facilitate delivery of high quality care in patients with chronic comorbidities.