Addressing the challenge of an aging population, retirement financial strategies are crucial, affecting not only the quality of life but also the economic security of middle-aged and elderly individuals. This study utilizes data from the 2020 China Health and Retirement Longitudinal Study (CHARLS) to explore the impact of children’s structure on the retirement financial intentions of the middle-aged and elderly. It reveals that the number and quality of children, including their education level and economic status, significantly influence the acceptance and preferences for retirement financial instruments among the middle-aged and elderly. Therefore, it is imperative for researchers to consider the retirement financial intentions of this demographic and develop more personalized and flexible retirement financial policies. Additionally, enhancing retirement financial education can improve the elderly’s understanding of financial products, ensuring their economic security and achieving a comfortable and secure old age.

Objectives: The ever-growing demands on care systems have increased the reliance on Home Care Support Worker’s (HCSW’s) which has seen a shift to provision of care to community based and close to home care provision. Currently there is no clear outline of a career pathway nor career development for HCSW’s, and this lack of associated framework which recognises CPD for career progression is impacting on recruiting and retaining HCSW’s within the care sector. The aim of this scoping review is to explore the international evidence to identify the potential costs/outcomes of the development of a career pathway for HCSW, and the economic benefits connected with continual professional development (CPD). The rational for taking this approach is that the evidence to date is limited, regarding the effectiveness of systems or frameworks for a career pathway for HCSW’s and value for money. Methods: A scoping review was conducted of peer-reviewed international literature using structured searches of electronic databases (Web of Science, PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, Social Care Online, and Social Sciences Citation Index) and grey literature (Sept-Nov 2023) using key economic terms and methodologies to capture economic evidence and connected costs with HCSW career development and CPD activities. Results: Article screening of titles, abstracts and full texts was conducted by two independent reviewers (EM, ML) to minimise bias and ensure rigour along with applying a GRADE approach for literature quality. The search strategy identified peer reviewed literature which included economic issues associated with CPD and HCSW career development. Following, 17 papers were critically appraised and during the process of data extraction four key themes emerged: (1) Cost-benefits of employment and training (2) Organisational economic perspectives (3) Service economic perspectives and (4) Sector economic perspectives. Discussion: The inclusion of economic evidence within this scoping review identified that there is very limited evidence associated with economic evaluation approaches to estimate the costs and benefits of CPD and development of a career pathway for HCSW. The scoping review did identify the gaps in the evidence on the assessments of systems or frameworks for HCSW’s career pathways development and CPD opportunities. Recommendations are that future research examining this topic should include Cost Benefit Analysis (CBA) to build evidence to support CPD activity and a career pathway development for HCSWs.

Measuring the efficiency of health services using Data Envelopment Analysis is a customary practice nowadays. In addition, some of the studies use analytical techniques to discover the variables that explain the efficiency level of such services. Nevertheless, efficiency analyses have seldom resulted in proposals to design organizational health care structures that provide adequate management for improving efficiency. Thus, to address the lack of use of Data Envelopment Analysis results in practice, this paper provides a general methodology based on the idea that measuring the efficiency of healthcare services must be complemented with their redesign to obtain potential efficiency improvements. This redesign includes healthcare processes or clinical flows, analytical techniques to advise such processes -e.g., OR/MS and AI models-, information technology for their support, and new management structures to facilitate the implementation and operation of the redesigns. Such methodology was applied to a large hospital specialized in cancer to illustrate its use and the results that can be achieved. They show that the potential cost savings of the proposed design are about US$ 1.0 million yearly. To generate such savings, the author designed new medical and management practices with the hospital personnel participation. The implementation of the practices and their continuous evaluation and innovation was possible by the new organizational structure designed for such purpose. This work shows the importance of integration methodologies to generate better-founded designs and facilitate their implementation. This integration is lacking in health-service design research, particularly in connection with architecture, processes, and organizational structure; this paper shows that this is a promising line of application. Highlights DEA analysis determines efficiency of health services and ways to improve it Scarce research on how to use DEA results to improve health processes exists A DEA-based methodology to design health and supporting flows is presented The methodology is applied to the design of the flows of a cancer hospital

Background: Indigenous Peoples continue to face colonisation and oppressive policies that intentionally disrupt their ways of life and wellbeing. The increased experience of disease for Indigenous Peoples, due to colonial processes, is confounded by immense difficulties accessing culturally secure healthcare. The experience of pain for Indigenous Peoples within this unjust socio-political context encompasses physical, emotional, spiritual, and mental pain. Objective: This systematic review aims to explore factors related to the experience of pain for Indigenous Peoples globally. Search Strategy: Four databases: PubMed, EMBASE, Scopus, and Web of Science were searched utilising a pre-established search strategy to identify qualitative papers that focused on experiences and understandings of pain among global Indigenous Communities. Data extraction and synthesis: Two independent reviewers performed title, abstract and full text screening, which resulted in the inclusion of 26 papers. Data extraction and synthesis was done in two stages which involved grouping illustrations from papers into categories, and then into five overarching synthesised findings. Main results: The synthesised findings aligned with social ecological theories and included: intrapersonal, interpersonal, institutional and cultural levels. For Indigenous Peoples, pain is situated within a complex network of social, historical, and political determinants of health. Discussion: The creation of a judgment-free space, accessibility of traditional healing practices and a greater inclusion of family and Community throughout treatment processes were identified as facilitators to care for Indigenous Peoples experiencing pain. Conclusion: By ascertaining and prioritising patient desires throughout the pain management experiences, practitioners can actualise self-determination of patient wellbeing and ensure provision of culturally respectful and comprehensive care.

Labor actions by healthcare workers are increasing in frequency and quantity, particularly throughout the United States. Regardless of their cause and size, these strikes have the potential to disrupt normal hospital operations and could impact patient access to care, quality of care, and costs. Strikes resemble other large-scale incidents like natural disasters, pandemics, or terrorist attacks in that they shrink a hospital’s capacity to care for patients, force hospitals to pursue logistically complicated actions like finding replacement providers, and impact nearby facilities due to the offloading of patients. In contrast to these incidents, however, strikes are unique because they often come with months of advanced notice, they reduce capacity by precise amounts with predictable provider losses, they occur over defined periods of time, and they do not necessarily increase the demand for patient care. To maximize efficiency and minimize disruption in response to strikes, hospitals must properly plan ahead and successfully execute their plans. Drawing on the recent planning and response to a resident physician strike at a New York hospital, this paper recounts the experience while describing six core strategies and a planning template that other hospitals can use to prepare for and respond to healthcare provider strikes. These strategies include strike aversion, increasing coverage, decreasing demand, internal and external messaging, creating external partnerships, and demobilization. When properly planned for using Appendix A: Strike Planning Template, strike consequences can be mitigated to ensure that patient care and hospital operations can continue with minimal impact to access, quality, or cost.

Background: Healthcare managers and administrators increasingly need to develop systems, structures, and operations capable of improving the patient experience performance of their organizations or service delivery units. Aim: To systematically review the effectiveness of organizational and service management interventions on standardized patient experience measure scores. Methods: Six scientific databases, specialty journals, and snowballing were used to identify English-language, peer-reviewed, contemporary studies (2015-2023) that examined the impact of service management or organizational interventions on the patient experience as a primary outcome. The studies needed to include inferential statistics on standardized, patient-reported experience measures. Two independent reviewers performed the eligibility decisions and risk-of-bias appraisals. Results: Nine papers were finally included. Three papers were on discrete, service-level interventions, including two randomized controlled trials (RCTs) and one pre-post study; one RCT achieved significant improvements by delaying the timing of bedside rounding versus maintaining the early morning schedule. One non-randomized controlled study and two pre-post studies addressed organization-wide approaches. Among those, one pre-post study achieved significant improvements by having site managers meet regularly with an organizational oversight committee to compare the units’ patient-experience performance and setting improvement expectations. Finally, three observational, multi-site comparative studies were included. These addressed self-reported improvement approaches, implementation of a nursing excellence certification program, and implementation of Patient Experience Offices. The latter was significantly associated with improved patient experience performance. Conclusion: Selected discrete service-level interventions and organizational approaches can lead to better patient experience outcomes, even though the evidence from the pre-post and observational studies should be interpreted with caution.

Background: Health planning is essential for effective public health interventions and optimal resource utilisation. The Portuguese General Directorate of Health has a long history of developing health plans and programmes, for communicable and noncommunicable diseases, and their determinants. This study aimed to review the current 24 programmes and assess the adequacy of their structure and content. Methods: A document analysis was conducted using a programme assessment matrix developed by the research group. Two independent researchers evaluated each programme, scoring items as ”absent,” ”present,” or ”not applicable.” A quantitative analysis was employed to analyse compliance scores between priority and non-priority programmes and across the year of publication. Results: Of the 24 existing programmes, 16 complied with at least 75% of the predefined items. Priority programmes had an 83% global compliance score, surpassing non-priority programmes (with 33% of compliance). While the healthy eating programme achieved 100% compliance, the programme on sexual and reproductive scored the lowest (19%). The item least commonly present was “updated time scope”, in only 21% of the programmes. Most recently published programmes were more likely to have a higher compliance score (Β = 0.76, 95% CI: [0.46, 1.05]). Not all programmes were publicly available in the same digital location. Conclusions: There was heterogeneity in the 24 health promotion programmes in terms of structure, content, timeliness, and accessibility. A standardised structure could enhance their quality and ease their interpretation and dissemination.

A document by Elif Güzide Emirza. Click on the document to view its contents.

Background: Numerous national-based indicators aid in designing population-centered chronic disease surveillance. However, there is little consensus on the key indicators and goals for developing a chronic disease surveillance analysis system. Objective: This study aimed to develop evidence-based indicators to measure and improve the health outcomes of chronic disease surveillance systems in Korea. Methods: A scoping review was focused on peer-reviewed literature from 2012 to 2022 using PubMed, Medline, Embase, PsychINFO, CINHAL, Wiley Online, Scopus, and Cochrane Library. Three reviewers evaluated and selected the articles in accordance with comprehensive inclusion and exclusion criteria. Data were synthesized using median descriptive analysis, prioritization, and agreement. There was a consensus meeting to discuss the recommendations, and the findings were analyzed thematically and descriptively. Results: Forty-eight articles were finalized and most of them were published in 2019 (18.8%). The studies on chronic disease-based surveillance systems and related data sources were conducted primarily in Canada (58.3%). The findings were prioritized by prevalence rate, risk factors, data linkage, complex disease, and updated indicators in a current system. The key themes of focus were mortality, survival management, diagnosis, treatment, and healthcare systems. Conclusion: Our preliminary measurement methods need validation through follow-up projects. Chronic disease surveillance will improve public health resource allocation and monitoring in real time. Public health and healthcare systems could be enhanced through timely assessments of population health at the local and regional levels. In Korea, experts will validate the chronic disease-based surveillance system’s development.

Introduction: Reflection and learning about the use of virtual care in healthcare delivery has become a central goal for health systems internationally. Insights drawn in the aftermath of the COVID-19 pandemic have led to vast changes to embed virtual care in health care delivery. This study explored the methodologies used to manage change that encompasses virtual care and factors contributing to success. Methods: A systematic review and narrative synthesis was undertaken. Eligible articles were those reporting structured change management processes in the context of virtual care published between 1 st January 2019 –31 st December 2023, identified by searching four electronic databases (Scopus, MedLine, PsycInfo and Business Source Premier). Data were extracted and synthesised from the eligible studies. Results: A total of 17 articles were included; studies focused on changes occurring within hospital settings and in community health centres, often within a single organisational unit, institution, or hospital network. Studies described using various methodologies for managing change during the introduction of large digital systems, embedding new digital tools, the introduction of new technologies and workflow or process design changes resulting from virtual care. Discussion: Structured change methodologies were often integrated in a strategic change framework with process improvement methods utilised to support the change process. Managing change relating to the technology with attention to the clinical and people aspects of change was considered a key gap and challenge in the context of virtual care change. Change leadership and the integration of technical and clinical teams were identified as key enablers.

Abstract Background: Research facilitation (RF) positions are a developing workforce in health services. The aim of this review was to explore literature on the role and impact of these positions. Methods: A scoping review was conducted using three inclusion criteria. 1. Population: Articles about RF positions; 2. Concept: Articles that describe the roles and duties of RF positions, and/or report how their impact is evaluated; 3. Context: RF positions employed by, or have a significant role within, health services. Medline, EMBASE and CINAHL electronic databases were searched in June 2022 for records from 2000-present. Full text articles published in English were included. Data were extracted regarding the structure, responsibilities, and evaluation of RF positions. Results : Eighteen articles were included, representing 86 RF positions. Most positions were orientated to support nursing or allied health research. Position titles and structure varied widely. Whilst key responsibilities were highly heterogeneous, almost all included providing direct support to health service staff to engage in research, and many included facilitating research education. A range of measures were used to evaluate RF positions, with traditional academic outputs such as publications and grants most frequent. Quantitative evidence of the impact of RF positions was weak, though positive. Qualitative evaluations revealed the important role of RF positions in research capacity and evidence-based practice. Conclusion: RF positions provided a wide variety of supports to clinicians and health services. While there is some positive evidence of the value of RF positions, further research is needed on their structure and outcomes.

Background: Linguistic concordance between healthcare providers and patients is critical for ensuring quality healthcare. Professional interpretation can be expensive and challenging to access. This scoping review aimed to explore the evidence on the role and education of medical students as interpreters in caring for patients with limited language proficiency (LLP), and to determine the benefits and risks associated with this practice. Methods: A scoping review using the Joanna Briggs Institute methodology was conducted. Six literature databases were searched systematically between 1946 – 02 Aug 2023. All publications discussing the use of medical students as interpreters in healthcare settings were included. Retained documents were analyzed using Covidence, with coding by two raters and regular team discussions. A thematic analysis framework was used. Results: Thirteen articles met the eligibility criteria. Multilingual medical students are frequently asked to interpret in healthcare settings. This was found to be advantageous in reducing communication barriers, improving care quality, and contributing to students’ clinical experience. Concerns were raised regarding the lack of knowledge on the professional obligations of interpreters. Interpretation training programs for medical students have been implemented at selective healthcare centres and demonstrated successful results in providing care to LLP patients. Conclusions: Medical students play an important role in addressing language barriers in healthcare institutions when serving LLP patients, by combining their unique position in the healthcare team with their medical, linguistic, and cultural competency skills. Academic institutions stand to benefit from offering interpretation training programs and integrating medical students as a resource towards delivering language-concordant care.

Organizational transformation is a multifaceted process that involves altering an organization's structure, culture, processes, systems, and strategies to better adapt to internal and external changes. This transformative process is characterized by interprofessional interactions that aim to foster collective dynamics. The likelihood of organizational transformation failure is considerable, especially in pluralistic organizations. Our study's research question centered on the interactional mechanisms that come into play in the dynamics of organizational transformations within hospitals during a health crisis, treating the crisis as a valuable learning opportunity. Following a six-month period of observation, 28 semi-structured interviews were conducted between September 2021 and December 2022 with various professionals from different hierarchical levels and professional categories in two French hospitals. The research emphasizes the mechanisms that facilitate the development of a social structure and social systems in pluralistic organizations and govern individual and collective actions that regulate the process of organizational transformation.

Background: Low contraceptive prevalence rates among women of reproductive age in low-income countries, including Nigeria, continue to impede efforts to improve women’s reproductive health through family planning services. This qualitative study examines the barriers to accessing family planning clinics. Methods: In-depth interviews with 30 women aged 15 to 49 were conducted at a secondary and a tertiary health facility, Lagos. Results: The research identifies two key themes: the impact of geographic proximity and the challenges faced at the clinic in accessing family planning services.” Women living far from clinics face transportation barriers. Long waiting times, stigma and privacy are issues identified, particularly in government clinics. Despite challenges, respondents praised nurses and expressed satisfaction with services. Conclusions: The study offers contemporary insights into the specific challenges faced by women in Lagos State, aiming to inform targeted interventions and policy recommendations. The study, however, suggests that even with the removal of proximity barriers, stigma remains a limiting factor for interventions, adding a novel perspective to the discourse on reproductive health in low-income settings. Addressing these barriers in a holistic manner is vital for empowering women to make informed reproductive choices, ultimately improving maternal and child health outcomes.

Pairing assistance (PA) of health professionals between county hospitals and township health centers is one of the key components of the reform of medical alliances in China to strengthen the development of health workforce in primary health care (PHC). This study aims to examine the effect of PA on healthcare utilization for patients with chronic diseases in rural areas. Two waves of National Health Services Survey (2013 and 2018) were used. A total of 13893 and 22725 rural residents with chronic diseases were included in the 2013 and 2018 waves, respectively. Multiple logistic regressions were used to examine the associations between PA and outpatient and inpatient service utilization in PHC. Chow test was used to examine the difference between PA in two models. Among rural patients with chronic diseases, two-week outpatient visits increased from 22.69% to 27.54%, and annual hospitalization admission increased from 20.72% in 2013 to 25.44%. PA was associated with a significant decrease in outpatient visits (p<0.001) in 2018 after controlling for individual and county characteristics. Patients in PA counties were 1.45 times (95% CI 1.10-1.90) more likely to use PHC outpatient care in 2013, but the difference disappeared in 2018 (OR=0.85, 95% CI 0.71-1.01). PA did not reverse the downward trend in the share of PHC outpatient visits. PA under medical alliances in China provides a potential model for building integrated people-centered health systems for other low- and middle-income countries.

The objective of this study was to explore the dynamics of efficiency and productivity of Greek public hospitals during the crisis, as well as to review the effect of implemented policies on hospital efficiency before and the implementation of the claw-back for hospital pharmaceutical expenditure. We implemented Data Envelopment Analysis and decomposed the Malmquist productivity index (MPI) to investigate the fluctuations of the Greek public hospital productivity frontier and therefore their technical efficiency between 2009 and 2019. The MPI components allowed us to capture the frontier shift, as well as pure efficiency changes and scale efficiency changes. Through the period 2009-2019 hospital inputs were reduced drastically. Doctors were reduced by 54% while beds were reduced by 15%. Hospital expenditure was decreasing between 2009 and 2015 but increased by 23% since due to fixed hospital budgets and the “claw-back”. Moreover, output seems to have increased. Patient discharges increased by 14% while diagnostic procedures were reduced by 10% between 2009 and 2016 but have been continuously rising since. Nonetheless, under variable returns to scale (VRS) average hospital efficiency was stable (~75%) for most of the period under study while declining since 2016. Policymakers in Greece have always chosen to implement cost- or input-oriented policies, instead of opting to improve outputs and quality of services. Our analysis indicated that fixed-budget-oriented reforms have impacted hospital efficiency negatively by creating a counterincentive to adopting best practices and improving hospital efficiency. Highlights Technical Efficiency under CRS was stable in Greece (0.70) over the period 2012-2016, and declined to 0.51 in 2019. Hospital Fixed Budget reforms had a negative impact on hospital efficiency. During the economic crisis 2009-2019 hospital inputs were reduced drastically Memorandum Policies introduced by Troika focused exclusively in reducing cost and not improving efficiency.

With the development of medical treatment partnership and “internet + medical service” in China, this study proposes a remote patient perceived value satisfaction model (RPPVSM) with online medical service for specialties from the perspective of patient perceived value. Taking Shanghai Pulmonary Hospital Specialist Alliance (SPHSA) as the research subject, RPPVSM was constructed based on ACSI and TAM. Structural Equation Modeling (SEM) was modified to have a better degree of fitness and validation outcomes of the hypothesis as follows: Perceived ease of use has a significantly positive impact on perceived value with coefficient being 0.248; perceived usefulness has a significantly positive impact on the satisfaction with coefficient being 0.577; perceived value has a significantly positive impact on satisfaction with coefficient being 0.163. Perceived synergy has a significantly positive impact on perceived value with coefficient of 0.547; perceived ease of use will have a significantly positive impact on satisfaction through the perceived value variable with coefficient of mediation being 0.094; perceived synergy has a significant impact on satisfaction through perceived value with mediation coefficient being 0.196. The results suggest that the inclusion of the patient’s perception value index in the medical information platform is conducive to the construction of RPPVSM.

Abstract Objective This study aims to explore the spatiotemporal disparities in the equalization of basic medical and health services in China, in order to provide reference and guidance for promoting the equalization process of basic medical and health services and ensuring the fair enjoyment of citizens’ right to life and health. Methods Based on the theory of Structure-Process-Outcome(SPO), a comprehensive evaluation index system of equalization level was constructed with 22 core indicators of basic medical and health services, from the three dimensions of medical and health investment, health service utilization, and medical service effectiveness. The Generalized Principal Component Analysis (GPCA) model was used to calculate the equalization level of basic medical and health services in 31 provinces, municipalities, and autonomous regions from 2011 to 2021. Furthermore, the kernel density estimation and Moran’s I model was employed to analyze the correlation and disparity at the spatial level. Results 1. From a national perspective, the level of equalization of basic medical and health services in China has significantly improved from 2011 to 2021. The mean score of national equalization level increased from -0.605 to 0.174, with an increase of 128.75%.