Factors driving differences in the adoption of quality management practices among hospitals: A two-phase, sequential mixed-methods analysis.

BACKGROUND: Although all hospitals aim to deliver high-quality care, there is considerable variation in their adoption of quality management (QM) practices. Organizational and environmental factors are known to drive strategic decision-making in hospitals, but their impact on the adoption of QM practices remains unclear. PURPOSE: Our study aims to identify multiple organizational and environmental factors that explain variation in the adoption of QM practices among hospitals and to explore mechanisms underlying these relationships. METHODOLOGY: We conducted a two-phase, sequential mixed-methods study of German acute care hospitals. The quantitative phase used between-effects regressions to identify factors explaining variation in the number of QM practices adopted by hospitals from 2015 to 2019. The qualitative phase used semistructured interviews with quality managers to gain in-depth insights. RESULTS: The number of QM practices adopted by a hospital was significantly associated with factors like hospital size and the presence of an emergency department or QM steering committee. Our qualitative findings highlighted potential mechanisms such as the presence of an emergency department serving as a proxy for organizational complexity or urgency of case-mix. CONCLUSION: We provide an overview of factors driving QM adoption in hospitals, extending beyond the focus on single factors in previous research. Future studies could explore additional factors highlighted by our interviewees. PRACTICE IMPLICATIONS: Our results can inform interventions to strengthen QM in hospitals and guide future research on this topic.

Program coordinators' perspectives on implementing a transition program for newly graduated nurses: a qualitative interview study.

PURPOSE: While transition programs are widely used to facilitate newly graduated nurses transition to healthcare settings, knowledge about preconditions for implementing such programs in the hospital context is scarce. The purpose of this study was to explore program coordinators' perspectives on implementing a transition program for newly graduated nurses. DESIGN/METHODOLOGY/APPROACH: An explorative qualitative study using individual interviews. Total of 11 program coordinators at five acute care hospital administrations in a south-west region in Sweden. Data was subjected to thematic analysis, using NVivo software to promote coding. FINDINGS: The following two themes were identified from the analysis: Create a shared responsibility for introducing newly graduated nurses, and establish legitimacy of the program. The implementation process was found to be a matter of both educational content and anchoring work in the hospital organization. To clarify the what and why of implementing a transition program, where the nurses learning processes are prioritized, was foundational prerequisites for successful implementation. ORIGINALITY/VALUE: This paper illustrates that implementing transition programs in contemporary hospital care context is a valuable but complex process that involves conflicting priorities. A program that is well integrated in the organization, in which responsibilities between different levels and roles in the hospital organization, aims and expectations on the program are clarified, is important to achieve the intentions of effective transition to practice. Joint actions need to be taken by healthcare policymakers, hospitals and ward managers, and educational institutions to support the implementation of transition programs as a long-term strategy for nurses entering hospital care.

Designing Iranian hospital organizational charts: Global comparisons.

BACKGROUND: Hospitals should have effective and efficient organizational charts to face the changing healthcare environment. Thus, for this purpose, the present study seeks to compile an organizational chart for Iranian hospitals. MATERIALS AND METHODS: The present study was conducted in two phase overview and qualitative (using focus group discussion). In the overview phase, the organizational charts of hospitals were analyzed in terms of complexity (i.e., degree of horizontal and vertical separations), and the initial hospital organizational chart was developed based on the results. Subsequently, experts were interviewed in a focus group discussion to finalize and validate the initial organizational chart. RESULTS: The final organizational chart was designed to contain features such as internal divisions, specialization, reduction of organizational hierarchies, expansion of supervision scope, and moderate-sized organizational pyramid. CONCLUSION: Using designed organizational chart would eliminate the redundant managerial levels since it reduces organizational hierarchies to two levels of management, expands the supervision scopes, fosters a moderate-sized organizational pyramid, and catalyzes communications.

Ruta del Paciente en urgencias para una gestión clínica efectiva

Esta herramienta virtual permite desarrollar un proceso de autogestión y planeación de la oferta de servicios para la atención de urgencias y encontrará todas las variables que pueden llegar a modificar el resultado de la calidad de la atención.

[Application of Intelligent Logistics System Based on AGV Robot in Medical Consumables Management].

Objective: Medical consumables are expensive, with numerous specifications and large usage, and traditional manual management models have certain drawbacks. Building an intelligent logistics management system to improve management level. Methods: Using AGV robots to achieve functions such as outbound, inbound, and inventory in the primary warehouse, the original "person to goods" mode is transformed into "goods to person" mode. Results: The intelligent logistics system based on AGV robots saves manpower, costs, reduces labor intensity, improves warehouse utilization, improves work efficiency. Conclusion: Hospital is a new field of intelligent logistics development, and intelligent logistics systems based on AGV robots have achieved good application results in hospitals, and improved the level of hospital intelligent management.

Managing Surges in Demand: A Grounded Conceptual Framework of Surge Management Capability.

Surge management is important to hospital operations, yet surge literature has mostly focused on the addition of resources (e.g., 25% more beds) during events like pandemics. Such views are limiting, as meeting surge demands requires hospitals to engage in practices tailored to a surge's unique contingencies. We argue that a dynamic view of surge management should include surge management capability, which refers to how resources are deployed to respond to surge contingencies. To understand this capability, we qualitatively studied five hospital systems experiencing multiple surges due to COVID-19 between April 2020 and March 2022. We develop a framework showing that managing surges involves preserving capacity, expanding capacity, smoothing capacity demand, and enabling surge management. We contribute to surge literature by identifying practices hospitals can adopt to address surges and offering a better understanding of surge conditions (e.g., degree of novelty) that make some surge management practices more appropriate than others.

Pre-hospital tranexamic acid administration in patients with a severe hemorrhage: an evaluation after the implementation of tranexamic acid administration in the Dutch pre-hospital protocol.

PURPOSE: To evaluate the pre-hospital administration of tranexamic acid in ambulance-treated trauma patients with a severe hemorrhage after the implementation of tranexamic acid administration in the Dutch pre-hospital protocol. METHODS: All patients with a severe hemorrhage who were treated and conveyed by EMS professionals between January 2015, and December 2017, to any trauma-receiving emergency department in the eight participating trauma regions in the Netherlands, were included. A severe hemorrhage was defined as extracranial injury with > 20% body volume blood loss, an extremity amputation above the wrist or ankle, or a grade ≥ 4 visceral organ injury. The main outcome was to determine the proportion of patients with a severe hemorrhage who received pre-hospital treatment with tranexamic acid. A Generalized Linear Model (GLM) was performed to investigate the relationship between pre-hospital tranexamic acid treatment and 24 h mortality. RESULTS: A total of 477 patients had a severe hemorrhage, of whom 124 patients (26.0%) received tranexamic acid before arriving at the hospital. More than half (58.4%) of the untreated patients were suspected of a severe hemorrhage by EMS professionals. Patients treated with tranexamic acid had a significantly lower risk on 24 h mortality than untreated patients (OR 0.43 [95% CI 0.19-0.97]). CONCLUSION: Approximately a quarter of the patients with a severe hemorrhage received tranexamic acid before arriving at the hospital, while a severe hemorrhage was suspected in more than half of the non-treated patients. Severely hemorrhaging patients treated with tranexamic acid before arrival at the hospital had a lower risk to die within 24 h after injury.

Rompendo o silêncio pelo riso: relações hospitalares e atuação dos palhaços promotores da saúde / Breaking the silence through laughter: hospital relations and the work of health-promoting clowns / Rompiendo el silencio a través de la risa: Las relaciones hospitalarias y el trabajo de los payasos promotores de salud

Justificativa: Desde o início da história, registra-se a presença da figura do palhaço na sociedade, designadamente nos cenários de saúde, onde buscavam levar a arte e a recreação ao processo de tratamento. Entretanto, no século XX, especificamente a partir dos anos 1970, surgiram propostas de trabalho para que essa relação no hospital fosse vinculada à promoção da saúde, de forma integrada e efetiva. Este projeto tem como objetivo avaliar como os palhaços de hospital interferem nas relações hospitalares. O estudo questiona: Como estabelecer relações hospitalares para ampliar a eficácia da intervenção do palhaço? De que forma as relações já existentes entre a organização de palhaços e os hospitais facilitam ou dificultam o acesso aos hospitais? Para responder a estes questionamentos foi utilizada a metodologia de pesquisa qualitativa para a produção de dados através de entrevistas semiestruturadas com integrantes de projetos de palhaços de hospital a nível internacional. Para análise dos dados, foi utilizada a técnica Análise de Conteúdo na modalidade temática de Bardin (2010). Como resultados desta pesquisa estão a compreensão de como são promovidas e mantidas as relações entre as organizações de palhaços e a administração hospitalar, de modo a assegurar a abertura, continuidade, eficácia e reconhecimento do trabalho dos palhaços nesse contexto. Além disso pontua-se a identificação, sistematização e disseminação de práticas, de modo a permitir a sua adoção por outras organizações de palhaços em escala mundial. Como conclusão, foi visualizado o potencial do palhaço de hospital no que diz respeito às relações de gênero e raciais e enquanto instrumento de enfrentamento à colonialidade, principalmente a nível nacional, com respaldo nas políticas do SUS. Mostra-se ainda primordial que o discurso para conhecimento da prática de cuidados dos palhaços promotores da saúde seja compartilhado com os gestores hospitalares, tendo como finalidade promover a qualidade das relações interinstitucionais.

Justification: Since the beginning of history, the presence of clowns in society has been recorded, particularly in healthcare settings, where they sought to bring art and recreation to the treatment process. However, in the 20th century, specifically from the 1970s onwards, proposals emerged to link this relationship in hospital to health promotion, in an integrated and effective way. This project aims to assess how hospital clowns interfere in hospital relationships. The study asks: How can hospital relationships be established to increase the effectiveness of the clown's intervention? How do existing relationships between clown organisations and hospitals facilitate or hinder access to hospitals? To answer these questions, a qualitative research methodology was used to produce data through semi-structured interviews with members of international hospital clown projects. Bardin's (2010) thematic content analysis technique was used to analyse the data. The results of this research include an understanding of how relationships between clown organisations and hospital administration are promoted and maintained in order to ensure the openness, continuity, effectiveness and recognition of clowns' work in this context. In addition, the identification, systematisation and dissemination of practices is highlighted, so that they can be adopted by other clown organisations worldwide. In conclusion, the potential of hospital clowns was visualised with regard to gender and race relations and as an instrument for confronting coloniality, especially at a national level, backed up by SUS policies. It is also essential that the discourse on the care practices of health-promoting clowns is shared with hospital managers, with the aim of promoting the quality of inter-institutional relations.

Justificación: Desde el comienzo de la historia, se ha registrado la presencia de payasos en la sociedad, en particular en el ámbito sanitario, donde buscaban aportar arte y recreación al proceso de tratamiento. Sin embargo, en el siglo XX, concretamente a partir de los años 70, surgieron propuestas para vincular esta relación en el hospital a la promoción de la salud, de forma integrada y eficaz. Este proyecto pretende evaluar cómo los payasos de hospital interfieren en las relaciones hospitalarias. El estudio se pregunta: ¿Cómo se pueden establecer relaciones hospitalarias para aumentar la eficacia de la intervención del payaso? ¿Cómo facilitan o dificultan el acceso a los hospitales las relaciones existentes entre las organizaciones de payasos y los hospitales? Para responder a estas preguntas, se utilizó una metodología de investigación cualitativa para producir datos a través de entrevistas semiestructuradas con miembros de proyectos internacionales de payasos de hospital. Para analizar los datos se utilizó la técnica de análisis de contenido temático de Bardin (2010). Los resultados de esta investigación incluyen la comprensión de cómo se promueven y mantienen las relaciones entre las organizaciones de payasos y la administración hospitalaria con el fin de garantizar la apertura, la continuidad, la eficacia y el reconocimiento del trabajo de los payasos en este contexto. Además, se destaca la identificación, sistematización y difusión de prácticas, para que puedan ser adoptadas por otras organizaciones de payasos en todo el mundo. En conclusión, se visualizó el potencial de los payasos de hospital en lo que se refiere a las relaciones de género y raza y como instrumento de enfrentamiento a la colonialidad, especialmente a nivel nacional, respaldado por las políticas del SUS. También es fundamental que el discurso sobre las prácticas asistenciales de los payasos promotores de salud sea compartido con los gestores hospitalarios, con el objetivo de promover la calidad de las relaciones interinstitucionales.

Identifying and prioritizing the key performance indicators for hospital management dashboard at a national level: Viewpoint of hospital managers.

Participation of main users in identifying key performance indicators (KPIs) for management dashboards contributes to their success. The aim of this study was to identify and prioritize the KPIs of hospital management dashboards from the viewpoint of hospital managers. This study was conducted on managers of public hospitals at a national level in Iran in 2020. Data were collected using a self-administrated questionnaire. The KPIs were classified into five categories, namely financial, operational, human resources, safety and quality of care, services provided to patients. A total of 234 hospital managers participated in this study. Totally, 25 KPIs were determined for the hospital management dashboard, including the patient falls rate, waiting time for patients in the emergency department, patient satisfaction, total hospital revenue, financial balance, bed occupancy rate, patients' discharge with own agreement, average length of stay, and personnel satisfaction. For designing hospital management dashboards, the domains of services provided to patients, safety and quality of care, financial resources, human resources, and operational are important from the hospital managers' viewpoint, respectively. The results of this study can be helpful for developers of business intelligence tools, such as hospital management dashboards, to visualize the most important indicators for managers.

Implementation of the Lean Healthcare System in the Emergency Room of the Clinical Hospital of the Federal University of Uberlândia: A Case Study.

The objective of this study was to analyze the effectiveness of the implementation of the lean healthcare system at the emergency room of the Clinical Hospital of the Federal University of Uberlândia, based on a comparison of hospital indicators obtained over the three phases corresponding to the period of one year before the implementation (T1), the year during the implementation (T2) and one year after implementation (T3). The methodology applied through this study can be classified as a case study that is exploratory and descriptive and developed in stages. Based herein on the search for hospital indicators, as occurred in the implementation of a lean process at the Clinical Hospital Emergency Department, along with a description of the implemented lean system. During the collection period of data relevant to the National Emergency Department Overcrowding Score and Length of Stay Indicator, the motivation of the teams grew, but with a notable tension between municipal management and hospital management. It was found that, despite the fluctuations, the patient length of stay in the Emergency Room remained high. With the exception of the variable of female deaths before 24 h of hospitalization, all other variables showed percentage increases before and after the intervention. This study reported the difficulties encountered by HC-UFU in implementing the lean project in an emergency room, thus ensuring that other institutions that intend to implement this project do not make the same types of mistakes.

Strategic management and risk control of emergency hospital construction: SWOT and STPA framework from a systems thinking perspective.

The construction of emergency hospitals is crucial for ensuring medical service provision during disasters. Assembled buildings have emerged as the preferred choice for large-scale emergency hospitals due to their rapid construction and high quality. However, the construction of emergency hospitals involves the collaboration of multiple departments, and there is a lack of research on the management of such construction projects. Given the urgent need for emergency hospitals, analyzing potential hazards in the construction process from a systemic perspective is essential to manage their construction effectively. In this study, the SWOT and STPA methods are employed to investigate the construction management of emergency buildings, with the Wuhan Vulcan Mountain Hospital in China serving as a case study for emergency management analysis. This study can provide ideas for emergency hospital management and a basis for controlling possible emergency construction accidents.

Maturity degree assessment of hospital ward system using integrated fuzzy AHP-TOPSIS model.

BACKGROUND: The hospital ward system is the core service unit of a hospital and an important aspect of hospital management. The maturity of the hospital ward system represents the level of development and improvement in ward management and services. In order to improve the quality of hospital services, it is significant to assess the maturity of the ward system. Although various assessment methods have been proposed in existing studies, there are some issues such as a single-dimensional factor system, subjectivity in qualitative factor values, and insufficient objectivity in the evaluation methods. METHODS: Therefore, based on the data collection of the factors used in the existing literature, this study made correlation analysis, determined the similarity of factors, and established a maturity assessment factor system satisfying distinctiveness and comprehensiveness. Furthermore, an evaluation method for the weights of each factor was proposed based on the fuzzy analytic hierarchy process, while taking account of the ambiguity of expert information. In addition, through the technique for order of preference by similarity to ideal solution method, an objective evaluation method for the maturity of the hospital ward system was established. Finally, a case study involving 6 hospitals in a specific location was conducted. RESULTS: There are a total of 16 factors used to assess the maturity of the hospital ward system, among which the most important is Doctor service. The maturity degree of the 6 researched hospitals are 0.4517, 0.0035, 0.4254, 0.8681, 0.6636, 0.1586, and the maturity degree of the 6 researched hospitals are II, I, II, IV, III, I. CONCLUSION: The factor system constructed in this study effectively reflected the importance of human-related factors in the development process of ward system. The evaluation results were consistent with the actual situation, demonstrating the effectiveness of the proposed method.

Advancing Equity in U.S. Hospital Systems: Employee Understandings of Health Equity and Steps for Improvement.

GOALS: Equity in the U.S. healthcare system remains a vital goal for healthcare leaders. Although many hospitals and healthcare systems have adopted a social determinants of health approach to more equitable care, many challenges have limited the effectiveness of their efforts. In this study, we wanted to explore whether healthcare leaders and providers understand the concept of equity and can link the concepts to practical applications within healthcare systems. METHODS: We explored how hospital leadership and providers at a major public hospital in Atlanta, Georgia, understand equity topics both conceptually and at a practical implementation level. We conducted 28 focus groups for >4 months involving 233 staff members, during which participants were asked about their understanding of various equity-related terms and equity implementation within the hospital. PRINCIPAL FINDINGS: Our findings reveal that there is little consensus among staff regarding the conceptual meanings of various health equity-related terms, and only a small minority of staff can articulate a conceptual definition that reflects current research-based understandings of equity. Furthermore, there is little consensus regarding how staff believes that health equity is practically enacted through various hospital programs, even among interviewees who could correctly articulate equity topics. These findings have no association with a role in the organization or length of time employed at the hospital. PRACTICAL APPLICATIONS: These findings indicate a need for a more nuanced understanding of health equity and further clarification and education on how to implement health equity. Although understanding at the conceptual level is an important first step, conceptual knowledge alone is not enough to support health equity at either the individual staff level or the system level. Our recommendations cover strategic development; education specific to the hospital system and its unique needs; consideration of the specific roles of individuals in the organization; and the designation of diversity, equity, and inclusion staff and offices in a hospital organization.

Measuring Productivity and Relative Efficiency of Public Tertiary Traditional Chinese Medicine Hospitals in Hubei, China.

Improving the productivity and relative efficiency of traditional Chinese medicine (TCM) hospitals is pivotal for hospital managers and policymakers to optimize the utilization of TCM resources in China. This study aimed to measure the productivity and relative efficiency of public tertiary TCM hospitals in Hubei Province. The input and output indicators data were extracted from the Health Commission of Hubei Province (HCHP) from 2019 to 2021. The Bootstrap-Malmquist-DEA model was employed to measure the productivity and relative efficiency of the hospitals. The statistical significance was set at P < .05. The numbers of total diagnostic patients and discharged patients declined by 23.44% and 28.34% from 2019 to 2020, and then increased by 25.76% and 20.44% respectively from 2020 to 2021. The average bias-corrected technical efficiency (TE) scores of the TCM hospitals from 2019 to 2021 were 0.8391, 0.8048, and 0.8559, indicating good efficiency. The average total factor productivity (TFP) in 2020 and 2021 decreased compared to that in 2019, with scores of 0.7479 and 0.8996, respectively. Between 2019 and 2020, the TFP changes among 19 out of 21 (90.48%) TCM hospitals and the technological changes (TC) among 20 out of 21 (95.24%) were less than 1.0000 (P < .05). The TFP changes of 17 out of 21 (80.95%) TCM hospitals and the TC of 20 out of 21 (95.24%) were less than 1.0000 (P < .05) between 2019 and 2021. COVID-19 might have constrained the provision of healthcare services by the public tertiary TCM hospitals in Hubei Province. Priority should be given to the utilization of healthcare resources, performance evaluation, information system strengthening, and internal hospital management to boost technical efficiency. TCM hospitals need to focus further on technology innovation to improve their technological progress.

Learn from the best hospitals: a comparison of the mission, vision and values.

BACKGROUND: The hospital's mission, vision, and values are the core of the hospital's culture and the most profound expression of the hospital's culture. Although there have been many comparative studies on the mission, vision and values of organizations in the past, there have been few studies on the mission, vision and values of hospitals in the healthcare field. The purpose is to understand how the world's top hospitals develop the use of mission, vision and values in their "day-to-day management" and this may help other hospitals to develop their mission, vision and value effectively. METHODS: This paper collects and discusses the approaches of the world's top five hospitals in mission, vision and value through a qualitative analysis method. Documents for the study were collected from the publicly available information of the five hospitals, including their websites, annual reports, and relevant academic literature published in English on Google Scholar, PubMed, Medline, and Web of Science. RESULTS: These five hospitals have similarities and differences in the development of their missions, visions and values, which are worthy of study by other hospitals. The setting of a mission is a useful reflection of the hospital's focus and direction showing the social responsibility and sustainability of the hospital. The development of a vision has a guiding role in the equity and development of patients and employees and can improve the efficiency and effectiveness of hospital management and ensure the quality of services. The elaboration of values can greatly help hospitals to develop strategic plans and improve daily management. CONCLUSION: The top five hospitals in the world have several common valuable cultures in their missions, visions, and values, regardless of the properties of the hospitals or their management models. In addition, each hospital also has some enlightening descriptions that reflect their particularities.

[Information Construction of Hospital Medical Consumables Management Based on SPD Mode].

To change the traditional hospital medical supplies rough management mode, the hospitals build an information material management platform which combines suppliers and hospitals, information systems and smart devices, clinical needs and professional operations innovatively. Finally, a lean management system called SPD is formed under the guidance of supply chain integration and supported by supply chain management theory and information technology. It has realized the whole process of consumables circulation information traceability, intelligent service in the hospital, and refined management of consumption settlement. The application of SPD in hospitals effectively improves the informatization level and overall operation efficiency of medical consumables management which is an important part of hospital information construction.

Reflexões acerca do uso da metodologia lean em serviços hospitalares / Reflections on the use of lean metodhodoly in hospital services

Introdução: A metodologia Lean é contemporânea e vem sendo utilizada em ambientes hospitalares, principalmente em serviços de urgências e emergências. Objetivo: Refletir acerca da metodologia Lean na perspectiva de suas ferramentas e estratégias, desafios, limitações e potencialidades, para a atenção hospitalar. Método: Estudo reflexivo fundamentado em base teórica e científica acerca da metodologia Lean na atenção hospitalar. Resultados: São discutidas considerações sobre a utilização da metodologia Lean com enfoque na implementação, monitoramento, potencialidades e limitações das ferramentas/estratégias utilizadas. Conclusão: Conclui-se que a implementação da metodologia Lean contribui para obtenção de melhores resultados nos principais indicadores da gestão de leitos, diminuição da superlotação nos serviços e do tempo de permanência nos leitos hospitalares, fortalece a atuação da regulação de leitos que, por sua vez, contribuem para uma melhoria da qualidade da assistência e satisfação dos usuários

Introduction: The Lean methodology is contemporary and has been used in hospital environments, especially in emergency services. Objective: To reflect on the Lean methodology from the perspective of its tools and strategies, challenges, limitations and potentialities for hospital care. Method: Reflective study based on theoretical and scientific basis about the Lean methodology in hospital care. Results: Considerations are discussed about the use of the Lean methodology focusing on the implementation, monitoring, potentialities and limitations of the tools/strategies used. Conclusion: It is concluded that the implementation of the Lean methodology contributes to obtain better results in the main indicators of bed management, reduction of overcrowding in services and length of stay in hospital beds, the regulation of beds, which in turn contribute to an improvement in the quality of care and user satisfaction

Introducción: La metodología Lean es contemporánea y ha sido utilizada en ambientes hospitalarios, principalmente en servicios de urgencias y emergencias. Objetivo: Reflexionar sobre la metodología Lean desde la perspectiva de sus herramientas y estrategias, desafíos, limitaciones y potencialidades para la atención hospitalaria. Método: Estudio reflexivo basado en bases teóricas y científicas sobre la metodología Lean en la atención hospitalaria. Resultados: Se discuten consideraciones sobre el uso de la metodología Lean, con foco en la implementación, seguimiento, potencialidades y limitaciones de las herramientas/estrategias utilizadas. Conclusión: Se concluye que la implementación de la metodología Lean contribuye a obtener mejores resultados en los principales indicadores de gestión de camas, reduciendo el hacinamiento en los servicios y el tiempo de estancia en camas hospitalarias, fortaleciendo el desempeño de la regulación de camas, que a su vez contribuyen a una mejora en la calidad de la atención y la satisfacción del usuario

The Psychosocial Impact of Treating Patients with COVID-19 on Psychiatry Residents in a Community Hospital: a Qualitative Study.

OBJECTIVE: The authors explored the experiences of psychiatry residents caring for patients during the COVID-19 pandemic on a medical unit. METHODS: From June 2020 through December 2020, structured, individual interviews were conducted with psychiatry residents deployed to internal medicine wards in a community hospital to provide medical care to COVID-19 patients for greater than or equal to 1 week. Interviews were recorded, transcribed verbatim, and analyzed using thematic analytical methods. RESULTS: Psychiatry residents (n = 16) were interviewed individually for approximately 45 min each. During the interviews, many residents described emotions of fear, anxiety, uncertainty, lack of preparedness, and difficulty coping with high patient mortality rates. Many of the residents expressed concerns regarding insufficient personal protective equipment, with the subsequent worries of their own viral exposure and transmission to loved ones. Multiple residents expressed feeling ill-equipped to care for COVID-19 patients, in some cases stating that utilizing their expertise in mental health would have better addressed the mental health needs of colleagues and patients' families. Participants also described the benefits of processing emotions during supportive group sessions with their program director. CONCLUSIONS: The COVID-19 pandemic represents a public health crisis with potential negative impacts on patient care, professionalism, and physicians' well-being and safety. The psychiatry residents and fellows described the overwhelmingly negative impact on their training. The knowledge gained from this study will help establish the role of the psychiatrist not only in future crises but in healthcare as a whole.

Technology and Care Load in Future Hospitals / La tecnología y la carga de cuidado en los hospitales del futuro / A tecnologia e a carga de cuidado nos hospitais do futuro

Recent technological progress is generating important disruptions, and healthcare is no stranger to them. Nursing is subject to technology change disruptions. It is important to reflect on the advantages and disadvantages technology brings with it and the changes it generates in care processes. If technology is only used to register information, it is perceived as a load that creates anxiety in the professionals. In this article, deep questions are made about the technology acceptance challenges in the nursing care processes, its implications on nursing responsibility, and the research opportunities for adopting new care humanized models result of technological development.

Recientes avances tecnológicos están generando disrupciones importantes y el cuidado de la salud no es ajena a estos cambios. La enfermería también está sujeta a disrupciones fruto del cambio tecnológico. Es importante reflexionar sobre las ventajas y desventajas que trae consigo la tecnología y los cambios que se generan en los procesos de cuidado. Si la tecnología se usa exclusivamente para el registro de información, esta se percibe como una carga que genera ansiedad en los profesionales. En este artículo se hacen cuestionamientos profundos sobre los retos de la aceptación de la tecnología en los procesos de cuidado en enfermería, las implicaciones que tiene la tecnología en la carga de cuidado en enfermería, y las oportunidades de investigación que surgen para adoptar nuevos modelos de cuidado humanizado fruto del desarrollo tecnológico.

Recentes avanços tecnológicos estão gerando disrupções importantes e o cuidado da saúde não é alheio a essas mudanças. A enfermagem também está sujeita a disrupções fruto da mudança tecnológica. É importante refletir nesse sentido sobre as vantagens e as desvantagens que trazem consigo a tecnologia e as mudanças que são geradas nos processos de cuidado. Se a tecnologia somente se usa de maneira exclusiva para registrar informações, percebe-se como uma carga que gera ansiedade nos profissionais. Neste artigo, são feitos questionamentos profundos sobre os desafios da aceitação da tecnologia nos processos de cuidado em enfermagem, as repercussões que têm na carga de cuidado em enfermagem e as oportunidades de pesquisa que surgem para adotar novos modelos de cuidado humanizado como fruto do desenvolvimento tecnológico.