Human Resources for Health最新文献

Background: While aiming to optimize patient value, the shift towards Value-Based Health Care (VBHC) in hospitals worldwide has been argued to benefit healthcare professionals as well. However, robust evidence regarding VBHC's workforce implications is lacking. This gap is problematic, as the motivation and health of healthcare professionals are central to the quality of care and crucial amidst contemporary workforce challenges. This study aims to qualitatively examine the implications of VBHC for healthcare professionals' motivation, job strain, and ongoing participation in VBHC. In addition, it explores how these outcomes are regulated at both the individual and organizational levels.

Methods: Semi-structured interviews were conducted with 26 healthcare professionals across six Dutch hospitals. Interviewees engaged in three VBHC activities: (1) value-based outpatient consultations and/or; (2) value-based quality improvement activities; as well as in; (3) VBHC implementation. Interview questions and data analysis were guided by the Job Demands-Resources model.

Results: VBHC interacts with four themes perceived to affect professional's motivation (perception of making a positive impact, enjoyability of job activities, personal development, and sense of community and support) and three themes perceived to affect job strain (workload, cognitive demands, and confidence). VBHC creates both gains (primarily increasing motivation; occasionally reducing strain) and pains (primarily increasing strain; sometimes reducing motivation). The perceived impact of VBHC depends on the fit between the individual, one's activities in VBHC, the working conditions, and the pace of VBHC implementation. An observation that warrants attention is that healthcare professionals with a 'do-er' mentality and high ambitions to optimize patient value can become demotivated to continue advancing VBHC with the same intensity, particularly due to perceived slow progress.

Conclusions: While VBHC is centered around patients, this study emphasizes that the needs, experiences and changing role identities of healthcare professionals cannot be overlooked in this transition. VBHC currently presents as a double-edged sword for healthcare professionals: resulting in both gains and pains. In the move to VBHC, it is crucial to maintain alignment between the individual, their job activities, the work environment, and the pace at which VBHC unfolds. This is essential for fostering and retaining motivated individuals, who are not only vital to the workforce but also pivotal in advancing VBHC.

Background: Quantitative methods for estimating the workload of primary healthcare (PHC) workers are essential for improving the performance of PHC institutions. However, measuring the workload of PHC workers is challenging due to the diverse and complex range of services covered by PHC. This study aims to use an equivalent value (EV)-based approach to assess the workload of PHC workers and inform policymakers about the current workload burden in Beijing, China.

Methods: The EV-based workload assessment system was designed by three main steps: identifying the list of essential PHC service items provided by PHC workers, quantifying the EV of each service item, and calculating the corresponding workload for PHC workers and community health centers (CHCs). The study included 18 CHCs, which were divided into three groups based on population density and topography: Group I (eight urban CHCs), Group II (six CHCs in semi-mountainous areas), and Group III (four CHCs in mountainous areas). Data were collected from local health information system, which automatically collected real-time service volume data for 500 PHC service items at 18 CHCs in the sample district in Beijing from 2017 to 2021.

Results: This study identified 503 essential PHC service items and defined their EVs. The theoretical full-capacity workload per PHC worker was 6024 EVs, serving as the base workload. The actual annual workload per PHC worker was 7240.0 EVs during 2017-2021. The base workload per budgeted position for the three types of CHCs was 6468.6 EVs for Group I, 5268.5 EVs for Group II, and 5038.7 EVs for Group III. Compared with the actual workload of 7702.3 EVs, 6568.3 EVs, and 5979.0 EVs in each group, respectively, all PHC workers in the sample district were overburdened during the study period.

Conclusions: The EV-based method provides a feasible solution for comprehensively assessing the workload of publicly funded PHC institutions in other regions. This study offers valuable insights to help local policymakers understand the workload burden of PHC workers, objectively evaluate their performance, and guide future health workforce planning.

Background: Primary healthcare has emerged as a powerful global concept, but little attention has been directed towards the pivotal role of the healthcare workforce and the diverse institutional setting in which they work. This study aims to bridge the gap between the primary healthcare policy and the ongoing healthcare workforce crisis debate by introducing a health system and governance approach to identify capacities that may help respond effectively to the HCWF crisis in health system contexts.

Methods: A qualitative comparative methodology was employed, and a rapid assessment of the primary healthcare workforce was conducted across nine countries: Denmark, Germany, Kazakhstan, Netherlands, Portugal, Romania, Serbia, Switzerland, and the United Kingdom/ England.

Results: Our findings reveal both convergence and pronounced diversity across the healthcare systems, with none fully aligning with the ideal attributes of primary healthcare suggested by WHO. However, across all categories, Denmark, the Netherlands, and to a lesser extent Kazakhstan, depict closer alignment to this model than the other countries. Workforce composition and skill-mix vary strongly, while disparities persist in education and data availability, particularly within Social Health Insurance systems. Policy responses and interventions span governance, organisational, and professional realms, although with weaknesses in the implementation of policies and a systematic lack of data and evaluation.

Conclusions: Aligning primary healthcare and workforce considerations within the broader health system context may help move the debate forward and build governance capacities to improve resilience in both areas.

Background: The recent announcement of the next WHO State of the World's Nursing and Midwifery Reports calls for a review of the state of nursing and midwifery worldwide. In the WHO European region, a broad set of health system reforms have been introduced in Central Asian countries (CACs), namely, the Republic of Kazakhstan, the Kyrgyz Republic, the Republic of Tajikistan, Turkmenistan and the Republic of Uzbekistan. These reforms have become the focus of a series of sub-regional policy dialogs between CACs, led by government chief nursing and midwifery officers, to accelerate the implementation of a package of policies to strengthen the capacity of nurses and midwives and build health system resilience. This study reviews the current state of nursing and midwifery capacity and documents future actions that can be taken in CACs.

Case presentation: A systematic approach was used to describe trends, capacity and gaps in CACs' education, practice, regulation, leadership, and working conditions of nurses and midwives. Currently, CACs face challenges in increasing the level, quality and evidence-base of nursing and midwifery education, require efforts to expand the role of nurses, with emphasis on PHC and particular attention is required to decent working conditions, including fair income and security in the workplace. The GCNMOs have demonstrated experience in the oversight of both workforces and require support for effective work in making policies. To build health systems resilience in CACs through nursing and midwifery, a strategic package of evidence-informed actions that addresses education, practice, regulation, leadership, and working conditions of nurses and midwives is suggested for the period up to 2030.

Conclusions: Current educational reforms and curricular development, combined with innovations in clinical practice and working environment can be pursued to foster better access to quality of care, enhance workplace satisfaction and improve recruitment and retention of nurses and midwives. However, to fully achieve this, CACs will require increased institutional capacity; strengthened data for nursing and midwifery planning in the context of health workforce policy and health priorities, and financial and non-financial investment in the nursing and midwifery workforce.

Background: Despite the rising representation of women in the physician workforce, gender-based income disparities persist. In this study, we explore the role of representation of women in the work environment in physicians' income from Medicare Part B fee-for-service payments and the income gender gap.

Methods: Our main analytic sample is a balanced panel of 371,472 physicians over 9 years, obtained from the Medicare Part B fee-for-service (FFS) Provider Utilization and Payment Data (2012-2020) from the Centers for Medicare and Medicaid Services (CMS). We use panel regressions with physician and year fixed effects to quantify how total Medicare Part B FFS payments to physicians patient volume, and per-patient payments respond to gender composition changes at the specialty and practice level, controlling for other practice characteristics. We allow the gender composition to have differential impacts on women and men by interacting it with the physician's gender. In addition, we examined the subsample of physicians who have not switched specialties or practices and explored differences in the effects by practice size.

Results: Increasing women's representation in physician work environments impacts men's and women's Medicare Part B FFS payments received differently. We find that for women physicians, a 1% increase in the share of women in the same specialty leads to 1.634% higher annual payment, 1.147% more patients, and 0.297% more per-patient payment. Conversely, these effects are reversed for men. Changes in women's share at the practice level have qualitatively similar effects. Among physicians who have not switched specialties or practices, we still find positive effects for women but no negative effects for men. Furthermore, these effects are stronger in solo or small practices than in large practices.

Conclusions: Increasing women's representation in the work environment helps increase the amount of Medicare Part B FFS payments received for women physicians but may reduce payments received for men physicians. Our findings support the efforts in increasing women's representation in the physician workforce to mitigate gender income disparities and demonstrate the nuanced differences in its impact by gender and the size of the practice to refine policy recommendations.

Background: Respiratory therapy services commenced in Saudi Arabia (SA) in the mid-1970s. Since then, respiratory therapists have become integral members of the healthcare team. However, data about the characteristics and distribution of the respiratory therapy workforce in SA are limited. Therefore, the primary objective of this investigation is to examine the characteristics and distribution of respiratory therapy practitioners in SA.

Methods: This is a cross-sectional study. Data were obtained from the Saudi Commission for Health Specialties (SCFHS) database as of January 10, 2024. This includes all registered respiratory therapy practitioners. The available data include age, gender, highest qualification, professional ranking, geographical distribution, and employment status of respiratory therapy practitioners.

Results: The SCFHS database reveals that there are 5462 respiratory therapy practitioners registered with SCFHS. Females constitute 48% of respiratory therapy practitioners, and 85% of the entire workforce is under the age of 40. A Bachelor of Science degree is the highest academic qualification for 90% of these practitioners, with 75% professionally classified as specialists. The geographical distribution of the respiratory therapy workforce is uneven, with approximately 65% located in two regions: Riyadh and the Eastern province. Employment within this field is high, with 92% of practitioners currently employed.

Conclusion: The respiratory therapy workforce is witnessing steady growth, with the majority of respiratory therapy practitioners possessing a bachelor's degree and classified as specialists professionally. Importantly, there is a clear imbalance in the distribution of these professionals across regions in SA.

Background: The 2019 coronavirus disease (COVID-19) pandemic brings critical health problems to workers in many occupations, particularly healthcare providers. The aim of the study was to examine the feasibility and effectiveness of the mindfulness-based stress reduction (MBSR) program on relieving burnout of healthcare providers during the pandemic. The roles of positive and negative emotion as well as emotion regulation strategy in the intervention effects were also investigated.

Methods: A sample of 112 healthcare providers in China were recruited and randomly assigned to the MBSR (n = 56) or the control condition (n = 56). Measures were collected at pre-intervention, mid-intervention, and post-intervention, assessing mindfulness level, emotion regulation strategy, positive and negative emotion, and burnout.

Results: The MBSR program showed acceptable feasibility. Compared to the control group, healthcare providers in the MBSR group showed significant increase in personal accomplishment and decrease in emotional exhaustion after the intervention. No significant difference was detected on the dimension of depersonalization. Results of mediation analyses implied that cognitive reappraisal and positive affect partially mediated the intervention effects on personal accomplishment.

Conclusions: The study provided preliminary evidence that the MBSR programs might be effective in reducing healthcare providers' burnout, even during the pandemic. Cognitive reappraisal and positive emotion might be important mechanisms of how the training took effect.

Background: The global nursing shortage was a well-known issue before the Covid-19 pandemic, but the Covid-19 pandemic has exacerbated the current nursing workforce shortage and reduced nursing retention. This systematic review aimed to explore factors affecting retention of nurses.

Methods: The PubMed, Web of Science, Scopus and Proquest databases were searched for relevant primary studies published on nurses retention during Covid-19 pandemic. Finally, Google Scholar was searched for retrieving more related documents that may not be indexed in other searched databases. Inclusion criteria were research articles and gray literature related to nursing retention in Covid-19 pandemic, articles published in English, access to the full-texts, and without time limitation. Both qualitative and quantitative studies focusing on factors affecting the nurses retention were included. The Joanna Briggs Institute checklists were used for assessing quality of quantitative and qualitative studies. Qualitative and thematic content analysis methods based on Braun and Clark's model were used to analyze the data.

Results: Eighteen studies were identified through a systematic search of the literature. The results showed that seven factors include personal, interpersonal, organizational, social media, educational, emotional, and protective factors are the factors affect the nurses retention.

Conclusion: The findings of this study showed that retention of nurse is complex and multi-factorial issue that factors from micro to macro-level affect it. Managers and health policy-makers based on the results obtained from this study can plan appropriate measures to increase the retention of nurses.

Background: The deteriorating psychosocial work environment among healthcare workers in Sweden, influenced by demanding working conditions and resource constraints, affects individual well-being and patient care quality. Healthcare workers, including physicians, registered nurses, and nursing assistants, often work interdependently and share workplaces, yet are three completely different professions. Nonetheless, comprehensive studies comparing their psychosocial work environments are scarce; often focusing on healthcare workers either separately or as a homogenous group, but rarely comparative.

Aim: Utilising the job demands-resources model, this study investigated variations in the psychosocial work environment among Swedish healthcare workers. We wanted to identify how the antecedents of individual well-being, in the form of demands and resources, differed between healthcare workers.

Method: Data from the 2022 Longitudinal Occupational Health Survey for Health Care in Sweden were analysed; the participants included 7589 physicians, registered nurses, and nursing assistants. The analysis involved descriptive statistics, including measures of means and analysis of covariance (ANCOVA), employing the Bonferroni correction for multiple post hoc comparisons. The ANCOVA was also stratified by working factors, including years of work experience and employment within the private/public sector.

Results: The study revealed significant variations in how healthcare workers perceive their psychosocial work environment. Physicians faced the highest level of Quantitative Demands (mean (x̄) 3.15; 95% CI 3.11-3.19), while registered nurses reported the most Emotional Demands (x̄ 3.37; 95% CI 3.32-3.41). Nursing assistants had the highest grand means for the imbalance between Efforts and Rewards (Effort Reward Imbalance) (x̄ 1.49; 95% CI 1.49-1.49) and an imbalance between Work and Private Life (Work-Life Interference) (x̄ 3.20, 95% CI 3.15-3.25), along with limited resources. The stratified analysis showed that years of experience and the sector affected healthcare workers' perceptions of their psychosocial working environment. For example, registered nurses working in the private sector reported better working conditions than registered nurses working in the public sector. The situation for nursing assistants was reversed.

Conclusion: Psychosocial work environments are experienced differently between and within healthcare professions in Sweden. This study provides crucial insights for improving workplace conditions and consequently enhancing healthcare professionals' well-being and quality of patient care.