scholarly journals Millennials - The Missing Piece in the NHS Workforce Puzzle?

2020 ◽  
Vol 13 (1) ◽  
pp. 21-25
Author(s):  
Farica Patel ◽  
Indranil Chakravorty
Keyword(s):  
Decision Making ◽  
Working Conditions ◽  
Learned Helplessness ◽  
Trade Unions ◽  
Healthcare Services ◽  
Junior Doctors ◽  
Policy Makers ◽  
Governmental Agencies ◽  
Multiple Factors ◽  
Healthcare Workforce

UK healthcare is in the throes of a workforce crisis. There are 10,000 fewer doctors and over 50,000 fewer nurses than are required to run a safe and sustainable service. Multiple factors from removal of nursing bursaries, introduction of university fees, poor working conditions, under-resourcing of healthcare services, unmanageable workloads, learned helplessness of clinical risk and a culture of incivility or blame is driving the workforce of the future away from NHS. Several governmental agencies, arm’s length bodies and trade unions have been grappling with this challenge. A few solutions have been recommended under the new contract for junior doctors, reintroduction of support for nurses and expansion of medical school places, but some are yet to be implemented. NHS leaders continue to support blue-sky thinking in terms of workforce innovations but tend to drag their feet when it comes to adoption. This reluctance by senior clinicians, managers and policy makers may be related to a lack of understanding of the values that drive the millennial generation that most younger healthcare workforce belong to. This article will explore the challenges and solutions from a generational perspective and offer an insight to guide future decision-making.

Using threshold values for cost per quality-adjusted life-year gained in healthcare decisions

2011 ◽  
Vol 27 (1) ◽  
pp. 71-76 ◽  
Author(s):  
Irina Cleemput ◽  
Mattias Neyt ◽  
Nancy Thiry ◽  
Chris De Laet ◽  
Mark Leys
Keyword(s):  
Decision Making ◽  
Policy Making ◽  
Threshold Value ◽  
Healthcare Services ◽  
Healthcare Systems ◽  
Quality Adjusted Life Year ◽  
Decision Making Process ◽  
Threshold Values ◽  
Social Security Systems ◽  
Policy Makers

Background: In many countries, the incremental cost-effectiveness ratio (ICER) is used to assess whether an intervention is worth its costs. At the same time, policy makers often feel uncomfortable with refusing reimbursement of any intervention purely on the basis of the fact that the ICER exceeds a specific threshold value. Reluctance to define a single threshold value for the ICER seems to have been stronger in social security systems than in national healthcare services systems. This study explores how basic differences between healthcare systems impact upon the potential usefulness of an ICER threshold value.Methods: This study is a narrative review of literature about the theoretical foundations of the ICER threshold value approach and its practical relevance in different types of healthcare systems.Results: A single ICER threshold value cannot be maintained, defined, or measured and should not be used as a policy-making tool. None of the solutions presented up until now to make the ICER threshold approach a valuable policy-making tool overcome the important weaknesses of the approach.Conclusions: ICERs and ICER threshold values are insufficient for assessing interventions' value for money. Rather, they should be considered as one element in the decision-making process. Complete rationalization of the decision-making process by means of quantitative decision criteria is undesirable and not feasible. Increasing transparency in the criteria used for a decision and explicitness about the relative importance of each criterion should, therefore, be the major goal.

scholarly journals Key factors of the willingness of rural populations settling in cities (RPSC) from a Lacanian psychoanalysis theory perspective

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243775
Author(s):  
Zhiheng Yang ◽  
Nengneng Shen ◽  
Chenxi Li
Keyword(s):  
Decision Making ◽  
Urban Areas ◽  
Social Background ◽  
Healthcare Services ◽  
Rural Populations ◽  
Key Factors ◽  
Lacanian Psychoanalysis ◽  
Policy Makers ◽  
Employment Insurance ◽  
Realistic Choice

The migration of populations from rural to urban areas is a typical phenomenon of urbanization in developing countries. Based on Lacanian psychoanalysis theory, this study analyzes the decision-making mechanism of the willingness of rural populations settling in cities (RPSC), and analyzes the key factors that affect the willingness of RPSC by using the binary Logit regression method based on survey data in Changyi, China. The results show that the willingness of RPSC is a realistic choice under the joint action of the ‘mirrored’ incarnation and the ‘non-mirrored’ order. Among the factors, ‘age’, ‘ethnic groups’, ‘educational attainment’, and ‘social intercourse’, representing the ‘mirrored’ incarnation, and ‘communities’ safety gap’, ‘healthcare services policy’, ‘public housing policy’ and ‘employment insurance gap’, representing the ‘non-mirrored’ order, are significant in affecting the willingness of RPSC. These findings validate the adaptability of psychoanalysis to analyze the willingness of RPSC, and increases the understanding of individual willingness and behavioral choice in the context of a specific social background, which can provide decision-making reference for urban and rural planning and public policy makers.

Evaluations for New Healthcare Environment Commissioning and Operational Decision Making Using Simulation and Human Factors: A Case Study of an Interventional Trauma Operating Room

2021 ◽  
pp. 193758672199966
Author(s):  
Mirette Dubé ◽  
Jason Laberge ◽  
Elaine Sigalet ◽  
Jonas Shultz ◽  
Christine Vis ◽  
...  
Keyword(s):  
Decision Making ◽  
Human Factors ◽  
Operating Room ◽  
Healthcare Services ◽  
Healthcare Team ◽  
Healthcare Environment ◽  
New Process ◽  
Timely Access ◽  
Operational Decision Making

Purpose: The aim of this article is to provide a case study example of the preopening phase of an interventional trauma operating room (ITOR) using systems-focused simulation and human factor evaluations for healthcare environment commissioning. Background: Systems-focused simulation, underpinned by human factors science, is increasingly being used as a quality improvement tool to test and evaluate healthcare spaces with the stakeholders that use them. Purposeful real-to-life simulated events are rehearsed to allow healthcare teams opportunity to identify what is working well and what needs improvement within the work system such as tasks, environments, and processes that support the delivery of healthcare services. This project highlights salient evaluation objectives and methods used within the clinical commissioning phase of one of the first ITORs in Canada. Methods: A multistaged evaluation project to support clinical commissioning was facilitated engaging 24 stakeholder groups. Key evaluation objectives highlighted include the evaluation of two transport routes, switching of operating room (OR) tabletops, the use of the C-arm, and timely access to lead in the OR. Multiple evaluation methods were used including observation, debriefing, time-based metrics, distance wheel metrics, equipment adjustment counts, and other transport route considerations. Results: The evaluation resulted in several types of data that allowed for informed decision making for the most effective, efficient, and safest transport route for an exsanguinating trauma patient and healthcare team; improved efficiencies in use of the C-arm, significantly reduced the time to access lead; and uncovered a new process for switching OR tabletop due to safety threats identified.

scholarly journals Factors influencing decision making for implementing e-health in light of the COVID-19 outbreak in Gulf Cooperation Council countries

2021 ◽  
Author(s):  
Fahad M Al-Anezi
Keyword(s):  
Decision Making ◽  
United Arab Emirates ◽  
Healthcare Access ◽  
Demographic Factors ◽  
Quality Of Healthcare ◽  
Healthcare Services ◽  
Gulf Cooperation Council ◽  
Factors Influencing ◽  
Electronic Health ◽  
Novel Coronavirus

Abstract Background Electronic health (e-health) approaches such as telemedicine, mobile health, virtual healthcare and electronic health records are considered to be effective in increasing access to healthcare services, reducing operational costs and improving the quality of healthcare services during the coronavirus disease 2019 (COVID-19) outbreak, a pandemic resulting from the spread of a novel coronavirus discovered in December 2019. In this context, the aim of this study was to identify the most important factors influencing decision making on the implementation of e-health in Gulf Cooperation Council (GCC) member states (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates), which are in the process of digitizing healthcare services. Methods This study reviewed the literature to identify the important factors influencing decision making on e-health. In addition, a questionnaire-based survey was conducted in order to identify the most important criteria to be considered in decision making on e-health. The survey link was forwarded to 978 healthcare practitioners and 42 experts (purposive sampling), from which a final sample of 892 (864 practitioners and 28 experts) was achieved, reflecting a response rate of 87.45%. Results Of the 44 factors identified under seven themes (strategic, quality, management, technology, function characteristics, economic, sociocultural and demographic factors), 22 factors were identified to be the most important criteria. Conclusions Findings from this study suggest that decision making in relation to e-health is a complex process that requires consideration of various factors. It was also found that attention should be paid to sociocultural and demographic factors, which may need to be considered in increasing healthcare access during the COVID-19 outbreak.

scholarly journals Health technology assessment in sub-Saharan Africa: a descriptive analysis and narrative synthesis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Samantha Hollingworth ◽  
Ama Pokuaa Fenny ◽  
Su-Yeon Yu ◽  
Francis Ruiz ◽  
Kalipso Chalkidou
Keyword(s):  
Decision Making ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Technical Assistance ◽  
Health Technology ◽  
Sub Saharan Africa ◽  
Main Theme ◽  
Narrative Synthesis ◽  
Policy Makers ◽  
Sub Saharan

Abstract Background Countries in Sub-Saharan Africa (SSA) are moving towards universal health coverage. The process of Health Technology Assessment (HTA) can support decisions relating to benefit package design and service coverage. HTA involves institutional cooperation with agreed methods and procedural standards. We systematically reviewed the literature on policies and capacity building to support HTA institutionalisation in SSA. Methods We systematically reviewed the literature by searching major databases (PubMed, Embase, etc.) until June 2019 using terms considering three aspects: HTA; health policy, decision making; and SSA. We quantitatively extracted and descriptively analysed content and conducted a narrative synthesis eliciting themes from the selected literature, which varied in study type and apporach. Results Half of the 49 papers identified were primary research studies and mostly qualitative. Five countries were represented in six of ten studies; South Africa, Ghana, Uganda, Cameroon, and Ethiopia. Half of first authors were from SSA. Most informants were policy makers. Five themes emerged: (1) use of HTA; (2) decision-making in HTA; (3) values and criteria for setting priority areas in HTA; (4) involving stakeholders in HTA; and (5) specific examples of progress in HTA in SSA. The first one was the main theme where there was little use of evidence and research in making policy. The awareness of HTA and economic evaluation was low, with inadequate expertise and a lack of local data and tools. Conclusions Despite growing interest in HTA in SSA countries, awareness remains low and HTA-related activities are uncoordinated and often disconnected from policy. Further training and skills development are needed, firmly linked to a strategy focusing on strengthening within-country partnerships, particularly among researchers and policy makers. The international community has an important role here by supporting policy- relevant technical assistance, highlighting that sustainable financing demands evidence-based processes for effective resource allocation, and catalysing knowledge-sharing opportunities among countries facing similar challenges.

scholarly journals Research use at the Ministry of Health in Burkina Faso: the decision-makers’ perspective

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Christian Dagenais
Keyword(s):  
Decision Making ◽  
Knowledge Transfer ◽  
Burkina Faso ◽  
Informed Decision ◽  
Communication Strategy ◽  
Decision Makers ◽  
Research Use ◽  
Informed Decision Making ◽  
Ministry Of Health ◽  
Policy Makers

Abstract Background Despite the increased emphasis placed on the use of evidence for policy development, relatively few initiatives have been developed to support evidence-informed decision-making, especially in West Africa. Moreover, studies examining the conditions under which policy-makers use research-based evidence are still scarce, but they show that their attitudes and opinions about research are one of the main determinants of such use. In February 2017, Burkina Faso’s Minister of Health planned to create a unit to promote evidence-informed decision-making within the ministry. Before the unit was set up, documenting the attitudes towards research at the highest levels of his Ministry appeared profitable to the unit’s planning. Method Individual interviews were conducted by the author with 14 actors positioned to consider evidence during decision-making from the Burkina Faso’s Minister of health cabinet. An interview grid was used to explore several themes such as attitudes towards research, obstacles and facilitators to research use, example of research use in decision-making and finally, ways to increase decision-makers’ participation in knowledge transfer activities. Interviews were partially transcribed and analysed by the author. Results The results show a mixed attitude towards research and relatively little indication of research use reported by respondents. Important obstacles were identified: evidence inaccessibility, lack of implementation guidelines, absence of clear communication strategy and studies’ lack of relevance for decision-making. Many suggestions were proposed such as raising awareness, improving access and research communication and prioritizing interactions with researchers. Respondents agree with the low participation of decision-makers in knowledge transfer activities: more leadership from the senior officials was suggested and greater awareness of the importance of their presence. Conclusions The conclusion presents avenues for reflection and action to increase the potential impact of the knowledge transfer unit planned within the Ministry of Health of Burkina Faso. This innovative initiative will be impactful if the obstacles identified in this study and policy-makers’ preferences and needs are taken into account during its development and implementation.

scholarly journals Factors associated with the decision to prescribe and administer antipsychotics for older people with delirium: a qualitative descriptive study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e047247
Author(s):  
Emily J Tomlinson ◽  
Helen Rawson ◽  
Elizabeth Manias ◽  
Nicole (Nikki) M Phillips ◽  
Peteris Darzins ◽  
...  
Keyword(s):  
Decision Making ◽  
Older People ◽  
Health Professionals ◽  
Acute Care Hospital ◽  
Nursing Workload ◽  
Care Hospital ◽  
Antipsychotic Medications ◽  
Factors Associated ◽  
Multiple Factors ◽  
Qualitative Descriptive

ObjectivesTo explore factors associated with decision-making of nurses and doctors in prescribing and administering as required antipsychotic medications to older people with delirium.DesignQualitative descriptive.SettingTwo acute care hospital organisations in Melbourne, Australia.ParticipantsNurses and doctors were invited to participate. Semi-structured focus groups and individual interviews were conducted between May 2019 and March 2020. Interviews were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis.ResultsParticipants were 42 health professionals; n=25 nurses and n=17 doctors. Themes relating to decisions to use antipsychotic medication were: safety; a last resort; nursing workload; a dilemma to medicate; and anticipating worsening behaviours. Nurses and doctors described experiencing pressures when trying to manage hyperactive behaviours. Safety was a major concern leading to the decision to use antipsychotics. Antipsychotics were often used as chemical restraints to ‘sedate’ a patient with delirium because nurses ‘can’t do their job’. Results also indicated that nurses had influence over doctors’ decisions despite nurses being unaware of this influence. Health professionals’ descriptions are illustrated in a decision-making flowchart that identifies how nurses and doctors navigated decisions regarding prescription and administration of antipsychotic medications.ConclusionsThe decision to prescribe and administer antipsychotic medications for people with delirium is complex as nurses and doctors must navigate multiple factors before making the decision. Collaborative support and multidisciplinary teamwork are required by both nurses and doctors to optimally care for people with delirium. Decision-making support for nurses and doctors may also help to navigate the multiple factors that influence the decision to prescribe antipsychotics.

scholarly journals To Volunteer or Not? Perspectives towards Pre-Registered Nursing Students Volunteering Frontline during COVID-19 Pandemic to Ease Healthcare Workforce: A Qualitative Study

2021 ◽  
Vol 18 (12) ◽  
pp. 6668
Author(s):  
Betsy Seah ◽  
Ben Ho ◽  
Sok Ying Liaw ◽  
Emily Neo Kim Ang ◽  
Siew Tiang Lau
Keyword(s):  
Nursing Students ◽  
Qualitative Study ◽  
Professional Identity ◽  
Healthcare Workers ◽  
Healthcare Services ◽  
Strategic Partnerships ◽  
Healthcare Workforce ◽  
Student Volunteer ◽  
Operational Processes

COVID-19 has caused a shortage of healthcare workers and has strained healthcare systems globally. Pre-registered healthcare students with training have a duty of care and can support the healthcare workforce. This study explored factors influencing the willingness of final-year nursing students to volunteer during the COVID-19 pandemic, the role of professional identity in volunteering as healthcare workers, and strategies to improve future volunteering uptakes and processes. A qualitative study using focus-group discussions was conducted. Final-year nursing students who volunteered, students who did not volunteer, and lecturers who supervised student volunteers were recruited. Interviews were conducted online, video-recorded, and transcribed verbatim. A thematic analysis was used. The themes were “wavering thoughts on volunteering”, “bringing out ‘the nurse’ in students through volunteering” and “gearing up to volunteer”. Findings suggested the need to look beyond the simplicity of altruism to the role of professional identity, operational, and motivational factors to explain nursing students’ decision to volunteer and their volunteer behavior. Providing accommodation, monetary and academic-related incentives, supporting the transitionary phase from students to “professional volunteers”, promoting cohesive and positive staff–student volunteer relationships, and establishing a volunteer management team are strategies identified to improve volunteering uptake and operational processes. Our findings advocate strategic partnerships between hospitals/communities and academic institutions in providing various healthcare services during pandemics.

scholarly journals Integrating multiple fuzzy expert systems under restricting requirements 

2012 ◽  
Vol 52 (No. 4) ◽  
pp. 187-196
Author(s):  
S. Aly ◽  
I. Vrana
Keyword(s):  
Decision Making ◽  
Expert Systems ◽  
Business Processes ◽  
New Product ◽  
Decision Problems ◽  
Food Chains ◽  
Problem Context ◽  
Multiple Factors ◽  
Decision Consistency ◽  
Fuzzy Expert Systems

The multiple, different and specific expertises are often needed in making YES-or-NO (YES/NO) decisions for treating a variety of business, economic, and agricultural decision problems. This is due to the nature of such problems in which decisions are influenced by multiple factors, and accordingly multiple corresponding expertises are required. Fuzzy expert systems (FESs) are widely used to model expertise due to its capability to model real world values which are not always exact, but frequently vague, or uncertain. In addition, they are able to incorporate qualitative factors. The problem of integrating multiple fuzzy expert systems involves several independent and autonomous fuzzy expert systems arranged synergistically to suit a varying problem context. Every expert system participates in judging the problem based on a predefined match between problem context and the required specific expertises. In this research, multiple FESs are integrated through combining their crisp numerical outputs, which reflect the degree of bias to the Yes/No subjective answers. The reasons for independency can be related to maintainability, decision responsibility, analyzability, knowledge cohesion and modularity, context flexibility, sensitivity of aggregate knowledge, decision consistency, etc. This article presents simple algorithms to integrate multiple parallel FES under specific requirements: preserving the extreme crisp output values, providing for null or non-participating expertises, and considering decision-related expert systems, which are true requirements of a currently held project. The presented results provides a theoretical framework, which can bring advantage to decision making is many disciplines, as e.g. new product launching decision, food quality tracking, monitoring of suspicious deviation of the business processes from the standard performance, tax and customs declaration issues, control and logistic of food chains/networks, etc. 

scholarly journals Measuring the Productivity of Energy Consumption of Major Industries in China: A DEA-Based Method

2014 ◽  
Vol 2014 ◽  
pp. 1-12 ◽  
Author(s):  
Xishuang Han ◽  
Xiaolong Xue ◽  
Jiaoju Ge ◽  
Hengqin Wu ◽  
Chang Su
Keyword(s):  
Decision Making ◽  
Energy Consumption ◽  
Data Envelopment Analysis ◽  
Malmquist Productivity Index ◽  
Productivity Index ◽  
Productivity Change ◽  
Data Envelopment ◽  
Policy Makers ◽  
Time Periods ◽  
Decision Making Units

Data envelopment analysis can be applied to measure the productivity of multiple input and output decision-making units. In addition, the data envelopment analysis-based Malmquist productivity index can be used as a tool for measuring the productivity change during different time periods. In this paper, we use an input-oriented model to measure the energy consumption productivity change from 1999 to 2008 of fourteen industry sectors in China as decision-making units. The results show that there are only four sectors that experienced effective energy consumption throughout the whole reference period. It also shows that these sectors always lie on the efficiency frontier of energy consumption as benchmarks. The other ten sectors experienced inefficiency in some two-year time periods and the productivity changes were not steady. The data envelopment analysis-based Malmquist productivity index provides a good way to measure the energy consumption and can give China's policy makers the information to promote their strategy of sustainable development.

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