Frontiers in health services最新文献

Background: Patient safety-related adverse events continue to pose a serious threat in healthcare, frequently arising from excessive job demands on frontline staff. It is particularly critical to understand how work overload affects nursing interns, a group vulnerable due to limited clinical experience.

Purpose: This study examines the relationship between work overload and patient safety behaviours among nursing interns in Nigerian public hospitals. It also investigates whether perceived supervisor and coworker support moderate that relationship, guided by the Job Demands-Resources (JD-R) model.

Methods: A cross-sectional survey was administered to nursing interns during clinical placements in government teaching hospitals located in the Southwest region of Nigeria, measuring self-reported work overload, perceived supervisor and coworker support, and medical error incidence.

Results: Higher levels of reported work overload were found to significantly predict a higher incidence of self-reported patient safety errors. However, both perceived supervisor support and coworker support significantly moderated this association, helping to buffer the negative impact of work overload on the occurrence of patient safety errors.

Conclusions: Social support from supervisors and colleagues serves as a protective resource in high-stress clinical environments. Health institutions should therefore promote supportive supervisory practices and team cohesion to mitigate patient safety-related adverse events and enhance the well-being and performance of early-career nurses.

Introduction: As in-demand, specialty service providers, neuropsychologists and dementia evaluation teams in the Veterans Health Administration often face significant patient backlogs, many of which worsened during the COVID-19 pandemic. As long waitlists can result in delayed care, effective methods for reducing waitlists are essential. The purpose of this clinical quality improvement (QI) project was to increase clinical efficiency by implementing comprehensive criteria to streamline consult management in an interdisciplinary memory disorder clinic within the Central Arkansas VA healthcare system.

Methods: This project used a combination of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and the practical, robust implementation and sustainability model (PRISM) primarily for implementation purposes. Consult management criteria were developed and chart reviews utilizing these criteria were performed on all referrals to determine if patient needs could be best addressed though the memory clinic or other departments.

Results: A total of 195 consults were reviewed between August 2023 and April 2024, with approximately 40% of referrals triaged to other services to appropriately address their needs. Increased administrative support and educating referring providers were also implemented. Consult tracking showed waitlist reduction from approximately 6 months to less than a month with consistent implementation and has been maintained at that level.

Conclusions: Overall, implementation of our team's consult management criteria greatly improved efficiency, by reducing the clinic's wait list by prioritizing patients whose needs could be best served by our clinic while providing alternative referrals for patients whose care could be better and more expediently addressed by other services.

Background: Improving patient experience is a prominent theme of the National Health Service (NHS) 10-Year Health Plan for England including the need to improve patient experience of clinical negligence claims. Understanding the factors that shape patient choices in bringing a claim for clinical negligence is an important aspect of patient experience that has the potential to provide crucial insight that could inform the future reform of the clinical negligence process in England. This scoping review aimed to identify the key concepts within the limited research exploring the factors that shape patient choices in bringing a claim for clinical negligence against the NHS in England and identify where gaps in the research may exist.

Methods: To address this knowledge gap, a methodological framework for conducting scoping reviews was applied. Search strategies were developed using selected keywords and index terms. Relevant published literature was identified by applying the search strategy to the peer-reviewed databases MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Westlaw. Reference lists of relevant publications were searched to identify relevant research and academic policy. All studies identified were charted, and the results were presented as a narrative synthesis.

Results: Two main themes were identified from the 17 included records. These themes were 'experience of harm' and 'accessibility of compensation for clinical negligence'.

Conclusion: How an NHS organisation responds to harm can shape patient choices in bringing a claim for clinical negligence. However, this scoping review identified the limited consideration given to how current law and policy, organisational cultures, social determinants of health and health inequalities may shape patient choices in bringing a claim for clinical negligence. Furthermore, this scoping review has identified that empirical research has given no consideration to the role of social media or Artificial Intelligence (AI) in shaping patient choices in bringing a claim for clinical negligence. Research considering these factors is vital to improve patient experience of the clinical negligence process in England and has the potential to play an important role in informing the future reform of the clinical negligence process in England.

Systematic review registration: https://doi.org/10.17605/OSF.I0/6BP2N.

Introduction: The prevalence of cardiovascular diseases (CVD) and CVD risk factors such as Type 2 Diabetes Mellitus (T2DM), hypertension and hypercholesterolemia has increased steadily worldwide. Population health screening is a common effort that promotes early detection, better prognosis and reduces disease burden. However, despite nationwide efforts, screening uptake for CVD risk factors in Singapore has remained moderately low (60.2%). Profiles of individuals who do not screen remain largely unknown, making them harder to reach via mainstream screening efforts. Existing literature has yet to organise factors systematically influencing CVD screening uptake, making it difficult to select a set of robust strategies to promote CVD screening uptake. This study aims to identify determinants of screening uptake for T2DM, hypertension and hypercholesterolemia in eligible adults residing in Western Singapore, and develop an implementation strategy toolkit to enhance screening uptake in this population.

Methods: Prospective, theory-informed, two-phased, multi-method study design. Phase 1: rapid umbrella review, document review and qualitative interviews (n = 20-40) to examine existing evidence about behavioural factors influencing CVD risk factors and strategies implemented to increase uptake. Phase 2: identified determinants mapped onto strategies, its feasibility and acceptability. Strategies ranked high will be specified to clarify who will implement them, what actions are required and how they will be implemented in specific settings. The strategies are organised into an actionable toolkit, where the Implementation Research Logic Model technique will be adopted to articulate the interrelationships between determinants, hypothesised causal mechanisms and strategies. Both phases will be guided by established implementation science frameworks and co-design approach.

Clinical trial registration: identifier [CRD42024566701].

Background: The goal of personalized medicine (PM) is to provide tailored diagnostics and therapies for individual patients, primarily in oncology. However, significant regional disparities exist in its implementation. The Deutsches Netzwerk für Personalisierte Medizin (DNPM; German Network for Personalized Medicine) project aims to harmonize and network the implementation of PM in Germany.

Methods: The DNPM project is evaluated as a Hybrid Type 3 implementation study using a non-randomized, modified stepped-wedge design. Twenty-one university hospital sites across Germany will transition from standard, non-harmonized care to a harmonized personalized medicine intervention at different time points, based on administrative readiness indicated by certification. The primary outcome is change in patient management due to molecular tumor board (MTB) decisions, assessed on three tiers using prospectively collected primary data entered by clinical staff: (1) number of patients with access to an MTB, (2) proportion with revised diagnostic or therapeutic recommendations, and (3) proportion with implemented changes. Therefore, the study aims to include 4,807 patients (intervention group: 3.507). A mixed-methods approach is employed to evaluate further aspects of the implementation process including patient and staff satisfaction, perceived quality of care, and the degree of harmonization and collaboration within the network. Health economic outcomes include health-related quality of life, healthcare utilization costs, and intervention-related costs.

Discussion: The study's wide range of outcome parameters and mixed-methods approach yield robust results for implementation insights. A limitation of the study design is the lack of a clear cutoff for transitioning from the control to the intervention group and the lack of randomization. Additionally, the health economic evaluation is limited by the absence of health insurance claims data, as no insurance company is involved in the project.

Trial registration: This trial is registered with the German Clinical Trials Register (DRKS) under the trial number DRKS00031622 (registration date: 23 May 2023).

[This corrects the article DOI: 10.3389/frhs.2025.1638587.].

Introduction: Inpatient falls are serious adverse events that contribute to functional decline and adverse outcomes. Overconfidence in mobility, and reluctance to seek assistance, are often difficult for staff to detect in the absence of a structured tool. The Multidimensional Falls Efficacy Scale (MdFES) was developed to assess patients' confidence across fall prevention, recovery, and self-protection domains. This pilot implementation feasibility study evaluated the early adoption of the MdFES in a community hospital, using the Proctor Implementation Outcomes framework to examine patient and nurse perspectives.

Methods: A mixed-methods pilot was conducted in Singapore community hospitals involving 90 patients and 32 nurses. Quantitative data were collected across multiple implementation outcomes-including acceptability, appropriateness, feasibility, cost, and fidelity-using structured questionnaires, with results reported as mean ± SD. Qualitative data from open-ended responses were thematically analysed to identify barriers and facilitators to MdFES implementation.

Results: Patients reported high acceptability [Acceptability of Intervention Measure (AIM)] = 17.48 ± 2.66) and appropriateness [Intervention Appropriateness Measure (IAM)] = 17.54 ± 2.75), with 80% agreeing with their MdFES results and an average completion time of 3.12 ± 2.23 min, indicating low perceived burden. In contrast, nurses reported moderate acceptability (AIM = 12.72 ± 2.11), appropriateness (IAM = 13.19 ± 3.17), and feasibility [Feasibility of Intervention Measure (FIM)] = 13.47 ± 2.66), citing language barriers, cognitive limitations, and workflow constraints as key challenges. Fidelity was affected, with frequent rewording and translation required. Qualitative themes highlighted the need for translated versions, simplified wording, and workflow integration.

Conclusion: This pilot feasibility study demonstrates that the MdFES is acceptable and meaningful to patients, while revealing modifiable feasibility challenges for nurses. These early findings provide essential insights to guide workflow adaptations, stakeholder engagement, and contextual modifications required before proceeding to a larger-scale, multi-centre implementation study.

In many rural communities, traditional and biomedical health systems operate side by side, yet the comparative roles of traditional birth attendants and community health workers in perinatal care remain poorly understood. This study examines the variations in the influence of Accredited Social Health Activists (ASHAs) and traditional birth attendants (locally known as Dais) on maternal and newborn health behaviors in rural Bihar, India. We employed a mixed-methods design. Qualitative data included 40 focus group discussions, 50 key informant interviews, and six weeks of focused ethnographic observation of both ASHAs and Dais guided by rapid ethnography principles. Quantitative data were collected through a multi-stage cluster random survey of 1,166 recent mothers and 400 ASHAs, designed to ensure representation across Bihar's major linguistic regions. Logistic regression with backward selection (validated through sensitivity analyses and alternate specifications) estimated the influence of each provider on perinatal behaviors, with multicollinearity assessed using variance inflation factors. Findings revealed distinct temporal and functional roles: ASHAs were most active during pregnancy and labor, significantly increasing the odds of antenatal visits and institutional delivery, while Dais exerted greater influence postpartum, promoting traditional practices such as newborn massage. Synergistic effects emerged in breastfeeding initiation when both providers were involved, while conflicting guidance appeared in cord care. Families often created hybrid care models that blended biomedical recommendations with ritual practices. Overall, the coexistence of ASHAs and Dais suggests complementarity rather than simple competition, though patterns varied across settings. The study focuses on behaviors rather than health outcomes, and we acknowledge that this scope, along with ethical considerations of working with overlapping provider systems, shapes interpretation. Tailored strategies that foster respectful collaboration-such as joint training and coordinated outreach-may improve the uptake and cultural acceptability of maternal and newborn health programs in rural contexts.

Introduction: Multidisciplinary school mental health (SMH) teams play a key role in delivering mental health services to children. However, poor workflow, inefficient communication, and limited resources, compromise SMH service delivery. Despite robust literature demonstrating the efficacy of team science interventions, such as the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), research on these interventions with SMH teams is limited.

Methods: We conducted qualitative interviews with SMH team members, teachers, and school administrators who had participated in a hybrid effectiveness-implementation trial of TeamSTEPPS. Participants identified barriers and facilitators to implementation of the adapted TeamSTEPPS intervention, which were then organized according to the Consolidated Framework for Implementation Research (CFIR). An Implementation Research Logic Model was developed, aligning implementation determinants with implementation strategies and proposed mechanisms by which the strategies impact outcomes.

Results: Barriers to the successful implementation of the adapted TeamSTEPPS intervention included a lack of financing and resources, the intervention not being a relative priority, mission misalignment, poor work infrastructure to support, unmotivated innovation recipients and leaders, and insufficient planning. Proposed implementation strategies included providing dynamic training for leadership and SMH team members, centralizing technical assistance, development and distribution of educational materials, and ongoing consultation about implementation supports/when challenges arose, developing local policies that support implementation, establishing mandates for change, pruning competing initiatives, and providing reminders of strategies to school personnel. Proposed implementation outcomes (e.g., acceptability, feasibility), service outcomes (e.g., Observation of use of TeamSTEPPS strategies, Perceptions of teaming, Attitudes toward teamwork), and "client outcomes" (e.g., student service use, absences, suspensions, grade promotion) were also identified.

Discussion: Lessons from the implementation process and recommendations for future directions are highlighted to inform the delivery and sustainment of team science interventions, such as TeamSTEPPS, for use with SMH teams.

Vision health is a critical yet often overlooked component of comprehensive primary care, particularly for underserved populations. Patient access to eye care services enhances workplace productivity, household income, and employment opportunities, ultimately supporting economic growth, poverty reduction, and food security. Community Health Centers (CHC) collectively serve over 32 million patients annually and are uniquely positioned to address disparities in eye care access. Yet only 26% of CHCs offer vision care services, and only 2.9% of people who access CHC services receive eye care. Addressing this gap requires a strategic, systems-level approach to implementation. This perspective proposes an integrated framework to guide the sustainable and equitable integration of eye care providers, including optometrists and ophthalmologists, into Community Health Centers (CHCs). Drawing on and uniting the Consolidated Framework for Implementation Research (CFIR), the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework, and the National Association of Community Health Centers' (NACHC) Value Transformation Framework (VTF), we outline a multi-level strategy that addresses implementation readiness, equity, and sustainability. This integrated framework is intended to inform implementation research and policy development aimed at making on-site eye care via an optometrist or ophthalmologist a mandated service in CHCs nationwide. In doing so, we offer an actionable game plan for CHC leaders, healthcare administrators, and public health advocates to expand access to comprehensive eye care in underserved communities.