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3.
J Bone Joint Surg Am ; 102(12): 1022-1028, 2020 06 17.
Article in English | MEDLINE | ID: covidwho-1409848

ABSTRACT

BACKGROUND: Although elective surgical procedures in the United States have been suspended because of the coronavirus disease 2019 (COVID-19) pandemic, orthopaedic surgeons are being recruited to serve patients with COVID-19 in addition to providing orthopaedic acute care. Older individuals are deemed to be at higher risk for poor outcomes with COVID-19. Although previous studies have shown a high proportion of older providers nationwide across medical specialties, we are not aware of any previous study that has analyzed the age distribution among the orthopaedic workforce. Therefore, the purposes of the present study were (1) to determine the geographic distribution of U.S. orthopaedic surgeons by age, (2) to compare the distribution with other surgical specialties, and (3) to compare this distribution with the spread of COVID-19. METHODS: Demographic statistics from the most recent State Physician Workforce Data Reports published by the Association of American Medical Colleges were extracted to identify the 2018 statewide proportion of practicing orthopaedic surgeons ≥60 years of age as well as age-related demographic data for all surgical specialties. Geospatial data on the distribution of COVID-19 cases were obtained from the Environmental Systems Research Institute. State boundary files were taken from the U.S. Census Bureau. Orthopaedic workforce age data were utilized to group states into quintiles. RESULTS: States with the highest quintile of orthopaedic surgeons ≥60 years of age included states most severely affected by COVID-19: New York, New Jersey, California, and Florida. For all states, the median number of providers ≥60 years of age was 105.5 (interquartile range [IQR], 45.5 to 182.5). The median proportion of orthopaedic surgeons ≥60 years of age was higher than that of all other surgical subspecialties, apart from thoracic surgery. CONCLUSIONS: To our knowledge, the present report provides the first age-focused view of the orthopaedic workforce during the COVID-19 pandemic. States in the highest quintile of orthopaedic surgeons ≥60 years old are also among the most overwhelmed by COVID-19. As important orthopaedic acute care continues in addition to COVID-19 frontline service, special considerations may be needed for at-risk staff. Appropriate health system measures and workforce-management strategies should protect the subset of those who are most potentially vulnerable. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Orthopedic Surgeons/supply & distribution , Pneumonia, Viral/epidemiology , Age Distribution , Age Factors , COVID-19 , Geographic Mapping , Health Workforce/organization & administration , Humans , Middle Aged , Pandemics , SARS-CoV-2 , United States/epidemiology
4.
Public Health Rep ; 136(6): 658-662, 2021.
Article in English | MEDLINE | ID: covidwho-1378103

ABSTRACT

Public health in the United States has long been challenged by budget cuts and a declining workforce. The COVID-19 pandemic exposed the vulnerabilities left by years of neglecting this crucial frontline defense against emerging infectious diseases. In the early days of the pandemic, the University of Texas Medical Branch and the Galveston County Health District (GCHD) partnered to bolster Galveston County's public health response. We mobilized interprofessional teams of students and provided training to implement projects identified by GCHD as necessary for responding to the pandemic. We provided a safe outlet for students to contribute to their community by creating remote volunteer opportunities when students faced displacement from clinical rotations and in-person didactics converted to virtual formats. As students gradually returned to clinical rotations and didactic demands increased, it became necessary to expand volunteer efforts beyond what had initially been mostly hand-selected student teams. We have passed the initial emergency response phase of COVID-19 in Galveston County and are transitioning into more long-term opportunities as COVID-19 moves from pandemic to endemic. In this case study, we describe our successes and lessons learned.


Subject(s)
COVID-19/epidemiology , Public Health Administration , Students, Medical , Volunteers , Health Workforce/organization & administration , Humans , Interprofessional Relations , Pandemics , SARS-CoV-2 , Telephone , United States/epidemiology
5.
Br J Nurs ; 30(15): 941, 2021 Aug 12.
Article in English | MEDLINE | ID: covidwho-1357667

ABSTRACT

Although the latest report on workforce equality shows positive changes, some improvements are marginal and the issue must be kept high on the agenda, says Sam Foster, Chief Nurse, Oxford University Hospitals.


Subject(s)
Health Workforce , Racism , State Medicine , Health Workforce/organization & administration , Humans , Racism/prevention & control , State Medicine/organization & administration , United Kingdom
7.
Healthc Q ; 24(2): 15-26, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1323457

ABSTRACT

During the COVID-19 pandemic, the rapid surge in demand for critical supplies and public health efforts needed to guard against virus transmission have placed enormous pressure on health systems worldwide. These pressures and the uncertainty they have created have impacted the health workforce in a substantial way. This paper examines the relationship between health supply chain capacity and the impact of the COVID-19 pandemic on Canada's health workforce. The findings of this research also highlight the impact of the pandemic on health workers, specifically the relationship between the health supply chain and the autonomy of the health workforce.


Subject(s)
COVID-19/epidemiology , Equipment and Supplies/supply & distribution , Health Workforce/organization & administration , Professional Autonomy , Canada/epidemiology , Decision Making, Organizational , Fear/psychology , Health Workforce/statistics & numerical data , Humans , Personal Protective Equipment/supply & distribution , Resource Allocation/organization & administration , Uncertainty
8.
Int J Health Plann Manage ; 36(S1): 58-70, 2021 May.
Article in English | MEDLINE | ID: covidwho-1318703

ABSTRACT

While policy-makers in many jurisdictions are paying increasing attention to health workforce issues, human resources remain at best only partially aligned with population health needs. This paper explores the governance of human resources during the pandemic, looking at the Quebec health system as a revelatory case. We identify three issues related to health human resource (HHR) policies: working conditions, recognition at work and scope of practice. We empirically probe these issues based on an analysis of popular media, policy reports and participant observation by the lead authors in various forums and research projects. Using an integrated model of HHR, we identify major vulnerabilities in this domain. Persistent labour shortages, endemic deficiencies in working environments and inequity across occupational categories limit the ability to address critical HHR issues. We propose three ways to eliminate HHR vulnerabilities: reorganize work through participatory initiatives, implement joint policy making to rebalance power across the health workforce, and invest in the development of capacities at all system levels.


Subject(s)
COVID-19 , Global Health , Health Workforce/organization & administration , Humans , Organizational Case Studies , Pandemics , Quebec , SARS-CoV-2
9.
Fam Med Community Health ; 8(4)2020 09.
Article in English | MEDLINE | ID: covidwho-1316963

ABSTRACT

Despite policies for addressing shortages and maldistribution of health professionals, sub-Saharan Africa continues to experience shortages and maldistribution of skilled health professionals. Policies such as return-of-service schemes or state-funded educational initiatives do not seem to be achieving their intended objectives, potentially due to poor design, implementation; and lack of monitoring and evaluation of the strategies. A focus by global health experts on strengthening and reformulating educational initiatives offers potential for producing, retaining and recruiting health professionals.


Subject(s)
Global Health , Health Workforce , Africa South of the Sahara , Health Policy , Health Workforce/legislation & jurisprudence , Health Workforce/organization & administration , Healthcare Disparities , Humans , Models, Organizational
10.
Br J Nurs ; 30(12): 734-741, 2021 Jun 24.
Article in English | MEDLINE | ID: covidwho-1282729

ABSTRACT

BACKGROUND: Health professionals are considered a group vulnerable to developing mental health symptoms during a pandemic, with redeployment being a risk factor. However, previous literature suggests workplace communication can be a protective element. AIMS: An audit aimed to evaluate NHS research staff's experiences of redeployment in order to provide suggestions for future improvements in the process. METHODS: A questionnaire was disseminated to all staff in the clinical research directorate of an NHS trust. Responses were analysed using thematic analysis. FINDINGS: Over half the redeployed staff experienced perceived negative psychological outcomes. The main reported contributor to this was perceived lack of communication. CONCLUSION: Communication needs to be improved in future redeployments. Future research should consider a larger cohort and more input from team members who remained on the pre-COVID-19 studies in order to improve the transition back from redeployment.


Subject(s)
COVID-19 , Clinical Nursing Research , Health Workforce , Pandemics , COVID-19/epidemiology , COVID-19/nursing , Clinical Nursing Research/organization & administration , Health Workforce/organization & administration , Humans , United Kingdom/epidemiology
14.
JAMA Netw Open ; 4(3): e212382, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1141275

ABSTRACT

Importance: The 2017-2018 influenza season in the US was marked by a high severity of illness, wide geographic spread, and prolonged duration compared with recent previous seasons, resulting in increased strain throughout acute care hospital systems. Objective: To characterize self-reported experiences and views of hospital capacity managers regarding the 2017-2018 influenza season in the US. Design, Setting, and Participants: In this qualitative study, semistructured telephone interviews were conducted between April 2018 and January 2019 with a random sample of capacity management administrators responsible for throughput and hospital capacity at short-term, acute care hospitals throughout the US. Main Outcomes and Measures: Each participant's self-reported experiences and views regarding high patient volumes during the 2017-2018 influenza season, lessons learned, and the extent of hospitals' preparedness planning for future pandemic events. Interviews were recorded and transcribed and then analyzed using thematic content analysis. Outcomes included themes and subthemes. Results: A total of 53 key hospital capacity personnel at 53 hospitals throughout the US were interviewed; 39 (73.6%) were women, 48 (90.6%) had a nursing background, and 29 (54.7%) had been in the occupational role for more than 4 years. Participants' experiences were categorized into several domains: (1) perception of strain, (2) effects of influenza and influenza-like illness on staff and patient care, (3) immediate staffing and capacity responses to influenza and influenza-like illness, and (4) future staffing and capacity preparedness for influenza and influenza-like illness. Participants reported experiencing perceived strain associated with concerns about preparedness for seasonal influenza and influenza-like illness as well as concerns about staffing, patient care, and capacity, but future pandemic planning within hospitals was not reported as being a high priority. Conclusions and Relevance: The findings of this qualitative study suggest that during the 2017-2018 influenza season, there were systemic vulnerabilities as well as a lack of hospital preparedness planning for future pandemics at US hospitals. These issues should be addressed given the current coronavirus disease 2019 pandemic.


Subject(s)
Capacity Building , Change Management , Civil Defense/organization & administration , Disaster Planning/methods , Disease Outbreaks , Influenza, Human , COVID-19/epidemiology , COVID-19/prevention & control , Capacity Building/methods , Capacity Building/organization & administration , Disease Outbreaks/prevention & control , Disease Outbreaks/statistics & numerical data , Health Workforce/organization & administration , Humans , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Influenza, Human/therapy , Personnel Management/methods , Qualitative Research , SARS-CoV-2 , Seasons , Severity of Illness Index , United States/epidemiology
15.
J Nurs Adm ; 51(4): 177-178, 2021 Apr 01.
Article in English | MEDLINE | ID: covidwho-1140038

ABSTRACT

The COVID-19 pandemic exhausted the nursing workforce, casting doubt that future supply will meet demand. To preserve their workforces, nursing leaders are offering emotional support to the frontline. Although these efforts are essential, leaders are overlooking an untapped opportunity to safeguard staffing levels: creating a more flexible nursing workforce. In this article, the authors discuss flexible nurse staffing and suggest 4 key opportunities for improvement.


Subject(s)
COVID-19/nursing , Nursing Staff/supply & distribution , Personnel Staffing and Scheduling/organization & administration , Health Workforce/organization & administration , Humans
16.
Int J Health Plann Manage ; 36(S1): 71-91, 2021 May.
Article in English | MEDLINE | ID: covidwho-1139246

ABSTRACT

INTRODUCTION: The Covid-19 pandemic has required countries to prepare their health workforce for a rapid increase of patients. This research aims to analyse the planning and health workforce policies in Germany, a country with a largely decentralised workforce governance mechanism. METHODS: Systematic search between 18 and 31 May 2020 at federal and 16 states on health workforce action and planning (websites of ministries of health, public health authorities), including pandemic preparedness plans and policies. The search followed World Health Organisation (WHO) Europe's health workforce guidance on Covid-19. Content analysis was performed, informed by the themes of WHO. RESULTS: The pandemic preparedness plans consisted of no or limited information on how to expand and prepare the health workforce during pandemics. The 16 states varied considerably regarding implementing strategies to expand health workforce capacities. Only one state adopted a policy on task-shifting despite a federal law on task-shifting during pandemics. CONCLUSIONS: Planning on the health workforce, its capacity and skill-mix during pandemics was limited in the pandemic response plans. Actions during the peak of the pandemic varied considerably across states, were implemented ad hoc and with limited planning. Future action should focus on integrated planning and evaluation of workforce policies.


Subject(s)
COVID-19 , Health Policy , Health Workforce/organization & administration , Databases, Factual , Germany , Humans , Pandemics , Public Health , SARS-CoV-2 , World Health Organization
18.
GMS J Med Educ ; 38(1): Doc23, 2021.
Article in English | MEDLINE | ID: covidwho-1110242

ABSTRACT

The COVID-19 pandemic has led to a short-term sharp increase in the demand for auxiliary staff in emergency rooms and intensive care units. Against this background student tutors of the Medical Faculty Erlangen have developed a training concept. The aim was to familiarize students in the clinical section quickly and effectively with skills that are particularly important in a clinical assignment as (student) assistant in the care of corona patients (e.g.: personal protective equipment, intubation assistance, arterial blood collection, assessment of blood gas values and ventilation parameters). In a blended learning concept, learning materials were prepared in advance and then implemented and deepened in a presence phase. The selection of learning materials and the low supervision ratio (1:2) made it possible to realize an internally differentiated approach. The offer met with great interest among students of all clinical semesters and was evaluated very positively. The skills learned can be applied widely even independently of a pandemic.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Education, Medical/organization & administration , Health Workforce/organization & administration , Students, Medical , Blood Specimen Collection/standards , Humans , Intubation, Intratracheal/methods , Pandemics , Personal Protective Equipment/supply & distribution , SARS-CoV-2
19.
Prev Med ; 146: 106464, 2021 05.
Article in English | MEDLINE | ID: covidwho-1096270

ABSTRACT

The COVID-19 pandemic has resulted in substantial morbidity and mortality and challenged public health agencies and healthcare systems worldwide. In the U.S., physical distancing orders and other restrictions have had severe economic and societal consequences. Populations already vulnerable in the United States have experienced worse COVID-19 health outcomes. The World Health Organization has made recommendations to engage at risk populations and communicate accurate information about risk and prevention; to conduct contract tracing; and to support those affected by COVID-19. This Commentary highlights the ways in which an existing and cost-effective, but underutilized workforce, community health workers and non-clinical patient navigators, should be deployed to address the COVID-19 pandemic. Community health workers and non-clinical patient navigators have skills in community engagement and health communication and are able to gain the trust of vulnerable communities. Furthermore, many community health workers and non-clinical patient navigators have skills in assisting community members with meeting basic needs and with navigating public health and healthcare systems. Members of this workforce are more than prepared to conduct contact tracing. State, local, tribal, and territorial public health agencies and healthcare systems should be collaborating with national, state, and local organizations that represent and employ CHWs/non-clinical patient navigators to determine how to better mobilize this workforce to address the COVID-19 pandemic. Furthermore, Congress, the Centers for Medicare & Medicaid Services (CMS), and individual states need to adopt policies to sustainably fund their critically needed services in the long term.


Subject(s)
COVID-19/therapy , Community Health Workers/organization & administration , Health Workforce/organization & administration , Patient Navigation/organization & administration , COVID-19/diagnosis , COVID-19/epidemiology , Humans
20.
Ann Surg ; 272(6): e311-e315, 2020 12.
Article in English | MEDLINE | ID: covidwho-1081376

ABSTRACT

OBJECTIVE: The aim of this study was to define whether rapidly reallocating health care workers not experienced with PP for performing PP in ICU is feasible and safe. SUMMARY BACKGROUND DATA: In the setting of severe acute respiratory distress syndrome (ARDS), the use of prone and supine positioning procedures (PP) has been associated with improved oxygenation resulting in decreased mortality. Nevertheless, applying PP is time consuming for ICU staffs that are at risk of mental of physical exhaustion, especially with the constant surge of admitted COVID-19 patients with severe ARDS. METHODS: This prospective cohort study conducted at a single regional university hospital between March 27 and April 15, 2020. Among 117 patients admitted to ICU, 67 patients (57.3%) presented with proven SARS-CoV-2 infection with severe ARDS requiring PP. After accelerated simulation training, 109 volunteers including surgeons, physicians, nurses and physiotherapists, multiple dedicated teams performed daily multiple PP following a systematic checklist. Patient demographics and PP data were collected. Patient safety and health care workers safety were assessed. RESULTS: Among 117 patients admitted to ICU, 67 patients (57.3%) required PP. Overall, 53 (79%) were male, with a median age of 68.5 years and median body mass index of 29.3 kg/m. A total of 384 PP were performed. Overall, complication occurred in 34 PP (8.8%) and led to PP cancelation in 4 patients (1%). Regarding health care workers safety, four health care workers presented with potential COVID-19 related symptoms and none was positive. CONCLUSIONS: To overcome the surge of critically ill COVID-19 patients, reallocating health care workers to targeted medical tasks beyond their respective expertise such as PP was safe.


Subject(s)
COVID-19/complications , Health Workforce/organization & administration , Patient Positioning/methods , Prone Position , SARS-CoV-2 , Severe Acute Respiratory Syndrome/therapy , Severe Acute Respiratory Syndrome/virology , Surgical Procedures, Operative , Aged , COVID-19/epidemiology , Checklist , Disease Outbreaks , Female , Humans , Male , Middle Aged , Prospective Studies , Resource Allocation/methods , Resource Allocation/organization & administration
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