Association of off-the-job training with work performance and work–family conflict among physicians: a cross-sectional study in China

ObjectivesTo determine whether experiences of off-the-job training in domestic (DT) and overseas study (OS) settings are associated with work performance and work–family conflict in physicians.Design, setting and participantsWe conducted a national cross-sectional survey in 77 public hospitals across seven provinces in China between July 2014 and April 2015. Participants were 3182 physicians.ExposureParticipants were categorised into four groups: none, DT only, OS only and DT and OS.Primary outcome measuresWork performance was assessed by work engagement, career attrition and patient-centred care. Work–family conflict was assessed by affecting care for family, feeling guilty towards family and receiving complaints from family.ResultsA total of 25.89% participants had experienced DT only, 8.71% OS only and 8.47% DT and OS. After adjustment for potential confounders, participants who had experiences of DT and OS compared with those with no training were more likely to report positive work performance (pride in work: OR=2.11, 95% CI: 1.43 to 3.10; enjoyment of work: OR=1.67, 95% CI: 1.11 to 2.51; turnover intention: OR=0.54, 95% CI: 0.38 to 0.77; early retirement: OR=0.63, 95% CI: 0.45 to 0.89; and exhaustion: OR=0.66, 95% CI: 0.45 to 0.98) and less work–family conflicts (feeling guilty towards family: OR=0.51, 95% CI: 0.35 to 0.74; and complaints from family: OR=0.66, 95% CI: 0.47 to 0.91). We found no obvious association between DT/OS experience with patient-centred care.ConclusionsPhysicians with DT and OS experiences are more likely to have better work performance and less work–family conflict than those without such experience. Physicians face increasing pressure to pursue continuing education and experience associated distress. Therefore, hospitals and government policy-makers should promote DT and OS.

Applying the Nursing Ecosystem Concept to Developing Strategic Innovation and Entrepreneurial Leadership for Valued Patient Care

Research confirms entrepreneurial leadership encourages entrepreneurial behaviour and an entrepreneurial culture supports the development of ‘entrepreneurial mindset’. Nurses implementing and optimizing information technology need to work with numerous stakeholders that collectively make up their ecosystem. Indeed, nurses with an entrepreneurial mindset increase their ability to sense opportunities and mobilize the resources and knowledge required to seek’ informatics’ opportunities to deliver patient centred care across the whole ecosystem.

A nurse-led conceptual model to inform patient-centred, type 2 diabetes mellitus management in public clinical settings

Background Globally, there is an increased need to provide patient-centred care for people diagnosed with type 2 diabetes mellitus. In Nigeria, a poorly financed health system has worsened the difficulties associated with managing type 2 diabetes mellitus in clinical settings, causing a detrimental effect on patient-centred care. Aims We aimed to develop a conceptual model to promote patient-centred type 2 diabetes mellitus care in clinical settings. We explored nurses’ contextual perceptions of clinical practices and operations in light of type 2 diabetes mellitus management across public hospitals in Lagos, Nigeria. Identifying a nurse-led intervention is critical to care optimisation for people diagnosed with type 2 diabetes mellitus. Methods We adopted a qualitative approach. Using the constant comparison method and semi-structured questions and interviewed practice nurses, with over one year’s experience and who were working in public hospitals across Lagos, Nigeria. The framework method was used to analyse the data obtained. Results Nurses provided insight into four areas of patient-centred type 2 diabetes mellitus management in clinical settings: empowering collaboration; empowering flexibility; empowering approach; and empowering practice. Nurses discussed an empowering pathway through which health settings could provide patient-centred care to individuals diagnosed with type 2 diabetes mellitus. The pathway entailed the integration of macro, meso and micro levels for patient management. Nurses’ accounts have informed the development of a conceptual model for the optimisation of patient care. Conclusions The model developed from this research sits within the patient-centred care model of healthcare delivery. The research sits within the patient-centred care model of healthcare delivery. inform patient-centred care, not only in countries with poorly financed healthcare systems, but in developed countries with comparatively better healthcare.

Preferences for healthcare services among hypertension patients in China: a discrete choice experiment

ObjectivesOur study aimed to support evidence-informed policy-making on patient-centred care by investigating preferences for healthcare services among hypertension patients.DesignWe identified six attributes of healthcare services for a discrete choice experiment (DCE), and applied Bayesian-efficient design with blocking techniques to generate choice sets. After conducting the DCE, we used a mixed logit regression model to investigate patients’ preferences for each attribute and analysed the heterogeneities in preferences. Estimates of willingness to pay were derived from regression coefficients.SettingThe DCE was conducted in Jiangsu province and Shanghai municipality in China.ParticipantsPatients aged 18 years or older with a history of hypertension for at least 2 years and who took medications regularly were recruited.ResultsPatients highly valued healthcare services that produced good treatment effects (β=4.502, p<0.001), followed by travel time to healthcare facilities within 1 hour (β=1.285, p<0.001), and the effective physician–patient communication (β=0.771, p<0.001). Continuity of care and minimal waiting time were also positive predictors (p<0.001). However, the out-of-pocket cost was a negative predictor of patients’ choice (β=−0.168, p<0.001). Older adults, patients with good health-related quality of life, had comorbidities, and who were likely to visit secondary and tertiary hospitals cared more about favourable effects (p<0.05). Patients were willing to pay ¥2489 (95% CI ¥2013 to ¥2965) as long as the clinical benefits gained were substantial.ConclusionsOur findings highlight the importance of effective, convenient, efficient, coordinated and patient-centred care for chronic diseases like hypertension. Policy-makers and healthcare providers are suggested to work on aligning the service provision with patients’ preferences.

Patient Centredness, Values, Equity and Sustainability: Professional, Organizational and Institutional Implications

The concept of “patient centredness”, or “patient-centred care”, has been studied so far as an umbrella term including a variety of declinations, perspectives, and concrete care practices [...]