Work situation of rheumatologists and residents in times of COVID-19

Background and objective The work situation is an important dimension of professional life and wellbeing, and a policy lever to strengthen recruitment and retention. This study aims to explore the work situation of physicians and residents in internal medical rheumatology, considering the impact of the coronavirus pandemic COVID-19. Methods A questionnaire-based online survey was conducted in early 2021 at the Hannover Medical School, supported by the German Society of Rheumatology. Target groups were all rheumatology physicians and residents in Germany. The main areas of investigation included work hours, task delegation, and collaboration; workload and mental health issues; discrimination and sexual harassment experiences; and the impact of COVID-19. Descriptive statistical analysis was performed for the standardized items and qualitative content analysis for the free-text information. Results The respondents (n = 101) expressed positive attitudes towards cooperation and task delegation to medical assistants, especially those specialized in rheumatology, while attitudes towards cooperation with GPs pointed to blockades. There was a strong mismatch between actual and desired work hours both in the group of women and in the group of men. 81% rated their workload as high or very high; every sixth rheumatologist has suffered from stress or burnout syndromes at least once in the past. Experiences of gender discrimination and sexual harassment/violence were frequently reported, mostly by women. COVID-19 was an amplifier of stress, with major stressors being digitalization and increased demand for communication and patient education. Conclusion There is an urgent need to improve the work situation of rheumatologists and reduce stress and mental health risks.

Orchestration of autonomous trusted third-party banking

Background Digital transformation is changing the structure and landscape of future banking needs with much emphasis on value creation. Autonomous banking solutions must incorporate on-the-fly processing for risky transactions to create this value. In an autonomous environment, access control with role and trust delegation has been said to be highly relevant. The aim of this research is to provide an end to end working solution that will enable autonomous transaction and task processing for banking. Method We illustrate the use case for task delegation with the aid of risk graphs, risk bands and finite state machines. This paper also highlights a step by step task delegation process using a risk ordering relation methodology that can be embedded into smart contracts. Results Task delegation with risk ordering relation is illustrated with six process owners that share immutable ledgers. Task delegation properties using Multi Agent Systems (MAS) is used to eliminate barriers for autonomous transaction processing. Secondly, the application of risk graph and risk ordering relation with reference to delegation of tasks is a novel approach that is nonexistent in RBAC. Conclusion The novelty of this study is the logic for task delegation and task policies for autonomous execution on autonomous banking platforms akin to the idea of federated ID (Liberty Alliance).

Experimental evaluation of tasking and teaming design patterns for human delegation of unmanned vehicles

This work discusses different approaches for the cooperation between humans as a supervisor and multiple unmanned vehicles (UVs). We evaluated the most promising approach experimentally with expert pilots of the German Air Force. The co-agency of humans and highly automated unmanned systems (i.e., human autonomy teaming, HAT) is described by the use of a design and description language for HAT design patterns. This design language is used to differentiate control modes for tasking, teaming, and swarming of UVs. The different control modes are then combined in a planner agent (PA) design pattern that further enables the UV guidance on scalable delegation levels from a single individual up to a team. The desired system behavior and interaction concept of the PA for these scalable delegation levels is then transferred to the domain of manned-unmanned teaming in fighter aircraft missions. To demonstrate the applicability of the system, we implemented the concept into our fast-jet simulator of the Institute of Flight Systems (IFS) and conducted an experimental campaign with expert pilots. The results of the experiment showed (1) task delegation with the PA design pattern is faster and reduces the error potential; (2) scalable delegation levels enable a pilot and situation-specific task delegation; (3) the delegation of teams is faster and reduces the error potential; however, in some situations, deeper access through the scalable delegation levels is needed; (4) the concept is intuitive and the transparency and trust in UVs and swarms were very high; and (5) the pilots could imagine operating such systems in the future. Overall speaking the presented PA design pattern is suited for the guidance of UVs and the scalable delegation levels are beneficial.

Scaling-up an integrated care for patients with non-communicable diseases: An analysis of healthcare barriers and facilitators in Slovenia and Belgium

Introduction Although the concept of integrated care for non-communicable diseases was introduced at the primary level to move from disease-centered to patient-centered care, it has only been partially implemented in European countries. The aim of this study was to identify and compare identified facilitators and barriers to scale-up this concept between Slovenia and Belgium. Methods This was a qualitative study. Fifteen focus groups and fifty-one semi-structured interviews were conducted with stakeholders at the micro, meso and macro levels. In addition, data from two previously published studies were used for the analysis. Data collection and analysis was initially conducted at country level. Finally, the data was evaluated by a cross-country team to assess similarities and differences between countries. Results Four topics were identified in the study: patient-centered care, teamwork, coordination of care and task delegation. Despite the different contexts, true teamwork and patient-centered care are limited in both countries by hierarchies and a very heavily skewed medical approach. The organization of primary healthcare in Slovenia probably facilitates the coordination of care, which is not the case in Belgium. The financing and organization of primary practices in Belgium was identified as a barrier to the implementation of task delegation between health professionals. Conclusions This study allowed formulating some important concepts for future healthcare for non-communicable diseases at the level of primary healthcare. The results could provide useful insights for other countries with similar health systems.

Involving practice nurse and other assistant clinical staff members in the management of low back pain: A qualitative interview study from Danish general practice

Objectives: Involving practice nurse and other assistant clinical staff members in providing information and education to patients with low back pain at follow-up appointments may release more time and improve care in general practice. However, this requires a shift in the division of tasks, and general practitioners’ barriers and facilitators for this are currently unknown. The objectives were to explore general practitioners’ experiences and perceptions of including assistant clinical staff members in the management of low back pain. Methods: This is a semi-structured interview study in Danish general practice. General practitioners with a variation in demographics and experience with task-delegation to clinical staff were recruited for in-depth interviews. We used a phenomenological approach to guide the data collection and the analysis in order to gain insight into the subjective experiences of the general practitioners and to understand the phenomenon of ‘delegating tasks to practice staff’ from the perspective of the general practitioners’ lifeworld. Analysis was conducted using an inductive descriptive method. The sample size was guided by information power. Results: We conducted five interviews with general practitioners. All general practitioners had experience with task delegation, but there was a variation in which tasks the general practitioners delegated and to which types of clinical staff members. The following themes were derived from the analysis: general practice organisation, delegating to clinical staff members, doctor–patient relationship, exercise instruction, clinical pathway for patients and external support. Conclusion: General practitioners consider patients with low back pain to be a heterogeneous group with a variety of treatment needs and a patient group without any predetermined content or frequency of consultations; this can be a barrier for delegating these patients to clinical staff members.

INDENTIFIKASI HIGH PERFORMANCE WORK SYSTEM

The development of the business world now requires all forms of business including cooperatives to do various ways to increase productivity and performance. One of the efforts in increasing productivity and performance is by building a high-performance work system. The purpose of this research is to find out the high performance work system in cooperatives. The number of respondents was 132 respondents with factor analysis analysis techniques. From the results of the analysis conducted found three factors as determinants of high performance work systems, namely the method of task delegation, internal planning and motivation.

Can Learning Self-Regulatory Competencies Through a Guided Intervention Improve Coaches’ Burnout Symptoms and Well-Being?

While coaches are considered at risk of experiencing burnout, there is an absence of intervention studies addressing this syndrome. The purpose of this qualitative study was to conduct a self-regulation intervention with five Canadian developmental (n = 2) and elite (n = 3) sport coaches (three men, two women) experiencing moderate to high levels of burnout and examine the perceived impact of this intervention on their self-regulation capacity and experiences of burnout and well-being. The content analysis of the coaches’ outtake interviews and five bi-weekly journals revealed that all five of them learned to self-regulate more effectively by developing various competencies (e.g., strategic planning for their well-being, self-monitoring) and strategies (e.g., task delegation, facilitative self-talk). Four of the coaches also perceived improvements in their symptoms of burnout and well-being. Sport psychology interventions individualized for coaches are a promising means for helping them manage burnout and enhance their overall functioning.