Quality and Safety in Healthcare, Part LXX: Qualifications and Leadership of the Chief Medical Officer.

ABSTRACT: The chief medical officer ideally has a degree in business, hospital administration, or related subjects and has also pursued training in leadership. This is very important to be able to read and interpret financial documents, understand the language of hospital executives, and be able to advise the administrators and physicians on many projects. The chief medical officer must be trusted by both the C-suite executives and the medical staff and be able to communicate effectively and diplomatically with both. In order to optimize value, it is important to engage the medical staff and to align the goals of not only the executives and doctors, but also of the patients and their families.

[How did the private labs fit onto COVID-19 crisis?] / Comment les laboratoires de biologie médicale privés français se sont adaptés à la crise de la COVID-19 ?

Confronted with the COVID-19 crisis, healthcare professionals have had to tackle an epidemic crisis of a huge magnitude for which they were not prepared. Medical laboratories have been on the front line, from collecting samples to performing the analysis required to diagnose this new pathology. Responding to the needs and to the urgency of the situation, the authorities relied on the network of private laboratories. In France, private laboratory medicine represents 70% of overall activity, and with a network of more than 4,000 local laboratories, private laboratory medicine has been the cornerstone of the « screen-trace-isolate ¼ strategy. This article gives feedback from private laboratory medicine professionals, directly involved in the reorganization carried out at the pre-analytical, analytical and post-analytical stages, during the crisis from March to October 2020.

[Psychological interventions in hospital during the first-wave of CoViD-19: an overview of the experiences of the Units of Clinical Psychology in Lombardy, Italy.] / Interventi psicologici in ospedale ai tempi della CoViD-19: una panoramica delle realtà proposte dalle Unità Operative di Psicologia (UOPSI) della Lombardia.

The current CoViD-19 pandemic threatens both physical and psychological well-being. According to the bio-psycho-social model, Units of Clinical Psychology of the Hospitals in Lombardy (Italy) reacted to this risk, offering diversified interventions, described in the present contribution. The medical staff operated on the front line during the emergency: psychologists addressed their needs through individual clinical work, sessions of decompression and debriefing. At the same time, Units of Clinical Psychology supported the hospitalized positive patients by conducting psychological consultations, either on the ward or through devices. Moreover, some hospitals activated helplines to address the needs of the population and family members, who were particularly vulnerable during the relative's illness and after the mourning.

Determinants of improved data consistency across routine immunization data tools for health facilities in Kano State, Nigeria.

INTRODUCTION: in this study, determinants of improved data consistency for routine immunization information at health facilities was measured to identify associated factors. METHODS: between June and August 2015, 1055 HFs were visited across 44 Local Government Areas in Kano state. We assessed data consistency, frequency of supportive supervision visits, availability of trained staff and attendance to monthly LGA RI review meetings. We compared RI monthly summary forms (MSF) versus national health management information system summary form (NHMIS) and vaccine management form 1a (VM1a) versus HF vaccine utilization summary monthly summary (HFVUM) for consistency. Data consistency at HF was determined at <+10% between number of children reportedly immunized, and doses of vaccine opened using 3 antigens (BCG, Penta and Measles). Levels of discrepancy <10% were considered as good data consistency. Bivariate and multivariate analysis used to determine association. RESULTS: data Consistency was observed in 195 (18.5%) HFs between (MSF vs NHMIS) and 90 (8.5%) HFs between (VM1a vs HFVUM). Consistency between MSF vs NHMIS was associated with receiving one or more SS visits in the previous month (p=0.001), data collection tools availability (p=0.001), recent attendance to monthly LGA RI review meeting and availability of trained staff. Data consistency between VM1a form and the HF VU summary was associated with a recent documented SS visit (p=0.05) and availability of trained staff (p=0.05). CONCLUSION: low level of data consistency was observed in Kano. Enhanced SS visits and availability of trained staff are associated with improved data quality.

[The interplay between isolation and precariousness, and hospitalization duration in French Guiana]. / Calcul de l'IP-DMS en Guyane : prendre en compte le poids réel de la précarité et de l'isolement.

BACKGROUND: French Guiana faces singular health challenges: poverty, isolation, structural lag, difficulties in attracting health professionals. Hospital stays exceed the recommended durations. The present study aimed to model the impact of precariousness and geographic isolation on the hospital duration performance indicator and to recalculate the indicator after incrementing severity by 1 unit when patients were socially precarious. METHODS: Cayenne hospital data for 2017 were used to model the hospital duration performance indicator (IP-DMS) using quantile regression to study the impact of geographic and social explanatory variables. This indicator was computed hypothesizing a 1 unit increment of severity for precarious patients and by excluding patients from isolated regions. RESULTS: Most excess hospitalization days were linked to precariousness: the sojourns of precarious patients represented 47% of activity but generated 71% of excess days in hospital. Quantile regression models showed that after adjustment for potential confounders, patients from western French Guiana and Eastern French Guiana, precarious patients and the interactions terms between residence location and precariousness were significantly associated with IP-DMS increases. Recalculating the IP-DMSafter exclusion of patients from the interior and after increasing severity by 1 notch if the patient was precarious led to IP-DMS levels close to 1. CONCLUSION: The results show the nonlinear relationship between the IP-DMS and geographical isolation, poverty, and their interaction. These contextual variables must be taken into account when choosing the target IP-DMS value for French Guiana, which conditions funding and number of hospital beds allowed in a context of rapid demographic growth.

Physician engagement: the Vancouver Medical Staff Association engagement charter.

Engagement of physicians with their healthcare community or institution should be a central issue in healthcare because it can be translated into improved patient care, enhanced well-being for physicians as well as safer, more effective and less costly healthcare. To accomplish the mission/goal of meaningful physician engagement, we set about to establish a 'charter' for physician engagement. We defined our concept of meaningful physician engagement and customised the engagement spectrum construct for physician relationship with their healthcare community or institution. While recognising the importance of physician leaders within the hierarchical system for efficacy of organisational management, relying only on physicians in formal executive positions is insufficient for developing physician engagement. There is a need for widespread physician engagement across the organisation. The objective is both an improvement in patient care and in physician well-being.

[COP21 - Organization and activity of a medical cover under "pressure"]. / COP21 ­ Organisation et bilan d'une médicalisation sous haute tension.

INTRODUCTION: The United Nations Climate Conference (COP21) gathered in France for delegations from all around the world, with 20,000 delegates from 195 countries every day, including 150 heads of states during the first 48hours. A specific medical cover was organized in a particular "post-attacks" context and with harsh constraints due to delimitation of an inner zone under the sole UN authority ("blue zone"). OBJECTIVE: To evaluate medical means involved and medical activity. METHODS: Medical cover was managed by SAMU 93 in collaboration with zonal SAMU and regional health agency for the entire site including the "blue zone". End-points: engaged workforce, number of visits, including transfers and medicalized transfers. RESULTS: In "France zone" (operational headquarters): an emergency physician dispatcher and an assistant for 20 days. In "blue zone": 20 rescuers, mobile intensive care unit H24 and two emergency physicians (consultations) 12/24hours for 16 days. A total of 47 doctors, 25 nurses, 25 paramedics and 20 assistants participated in the medical service. This corresponded to three emergency physician full medical time equivalents (FMTE) for 16 days. Consultations performed: 1238 or 97/day resulting in 34 (3%) transfers including seven medicalized. Patients were 706 (57%) men and 495 (43%) women, with mean age of 43±1 years. Trauma patients were most numerous (20%). CONCLUSION: Medical means involved were consistent for 16 days. The medical activity was sustained, but medicalized transfer rarely required.

Step by step guide to do a systematic review and meta-analysis for medical professionals.

INTRODUCTION: Systematic review and meta-analysis are statistical tools used to review researches performed on a same topic. They extract the collective effect of the studies performed on the topic of interest after statistically analysing the data of all the studies included. AIMS AND OBJECTIVES: Systematic reviews and meta-analysis are getting more and more popular in the medical field. Statistics is never the strong aspect of medical professionals, and facing a large number of statistical tests and values could be quite confusing for them. The aim of this article is to simplify these two very important research modalities for medical professionals. CONCLUSION: This article will provide a step-to-step guide for the medical colleagues to perform a meta-analysis if they are interested.

Condiciones de trabajo en consultorios adyacentes a farmacias privadas en Ciudad de México: perspectiva del personal médico / Working conditions in outpatient clinics adjacent to private pharmacies in Mexico City: perspective of physicians

Objetivo: Analizar, desde la perspectiva del personal médico, las condiciones laborales de los consultorios adyacentes a farmacias privadas (CAF), así como sus elementos organizativos. Método: Estudio cualitativo exploratorio consistente en entrevistas semiestructuradas a 32 médicos/as de los CAF en Ciudad de México. Se utilizó la técnica de análisis de contenido dirigido basado en códigos previamente construidos y emergentes, relacionados con la experiencia vivida de los sujetos en su campo laboral. Resultados: El personal médico percibió que trabajar en los CAF no cumple con sus expectativas profesionales por la baja remuneración, la informalidad en la contratación y la ausencia de garantías laborales establecidas en la ley. Esto les impide disfrutar de los beneficios asociados con el empleo formal y sustenta el deseo de laborar en los CAF solo de manera temporal. Consideraron que los incentivos económicos por número de consultas, procedimientos y ventas alcanzadas por la farmacia les permiten aumentar su ingreso sin influir en su conducta prescriptiva. Señalaron que los sistemas de supervisión y presión en los CAF buscan afectar su autonomía para activar la venta de medicamentos en la farmacia. Conclusiones: El personal médico que labora en CAF enfrenta una difícil situación laboral. Los elementos gerenciales usados para inducir la prescripción y activar las ventas de las farmacias conforman un entorno laboral que genera retos en materia de regulación, y subraya la necesidad de monitorear la calidad de los servicios brindados en estos consultorios y los posibles riesgos a los usuarios (AU)

Objective: To analyse the working conditions of physicians in outpatient clinics adjacent to pharmacies (CAFs) and their organizational elements from their own perspective. Methods: We carried out an exploratory qualitative study. Semi-structured interviews were conducted with 32 CAF physicians in Mexico City. A directed content analysis technique was used based on previously built and emerging codes which were related to the experience of the subjects in their work. Results: Respondents perceive that work in CAFs does not meet professional expectations due to low pay, informality in the recruitment process and the absence of minimum labour guarantees. This prevents them from enjoying the benefits associated with formal employment, and sustains their desire to work in CAF only temporarily. They believe that economic incentives related to number of consultations, procedures and sales attained by the pharmacy allow them to increase their income without influencing their prescriptive behaviour. They express that the monitoring systems and pressure exerted on CAFs seek to affect their autonomy, pushing them to enhance the sales of medicines in the pharmacy. Conclusions: Physicians working in CAFs face a difficult employment situation. The managerial elements used to induce prescription and enhance pharmacy sales create a work environment that generates challenges for regulation and underlines the need to monitor the services provided at these clinics and the possible risk for users (AU)

Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: protocol for a realist evaluation case study.

INTRODUCTION: In developed countries, substituting physicians with nurse practitioners, physician assistants and nurses (physician substitution) occurs in nursing homes as an answer to the challenges related to the ageing population and the shortage of staff, as well as to guarantee the quality of nursing home care. However, there is great diversity in how physician substitution in nursing homes is modelled and it is unknown how it can best contribute to the quality of healthcare. This study aims to gain insight into how physician substitution is modelled and whether it contributes to perceived quality of healthcare. Second, this study aims to provide insight into the elements of physician substitution that contribute to quality of healthcare. METHODS AND ANALYSIS: This study will use a multiple-case study design that draws upon realist evaluation principles. The realist evaluation is based on four concepts for explaining and understanding interventions: context, mechanism, outcome and context-mechanism-outcome configuration. The following steps will be taken: (1) developing a theory, (2) conducting seven case studies, (3) analysing outcome patterns after each case and a cross-case analysis at the end and (4) revising the initial theory. ETHICS AND DISSEMINATION: The research ethics committee of the region Arnhem Nijmegen in the Netherlands concluded that this study does not fall within the scope of the Dutch Medical Research Involving Human Subjects Act (WMO) (registration number 2015/1914). Before the start of the study, the Board of Directors of the nursing home organisations will be informed verbally and by letter and will also be asked for informed consent. In addition, all participants will be informed verbally and by letter and will be asked for informed consent. Findings will be disseminated by publication in a peer-reviewed journal, international and national conferences, national professional associations and policy partners in national government.

End of life care for people with dementia: The views of health professionals, social care service managers and frontline staff on key requirements for good practice.

BACKGROUND: Evidence consistently shows that people with advanced dementia experience suboptimal end of life care compared to those with cancer; with increased hospitalisation, inadequate pain control and fewer palliative care interventions. Understanding the views of those service managers and frontline staff who organise and provide care is crucial in order to develop better end of life care for people with dementia. METHODS AND FINDINGS: Qualitative interviews and focus groups were conducted from 2013 to 2015 with 33 service managers and 54 staff involved in frontline care, including doctors, nurses, nursing and care home managers, service development leads, senior managers/directors, care assistants and senior care assistants/team leads. All were audio recorded and transcribed verbatim. Participants represented a diverse range of service types and occupation. Transcripts were subject to coding and thematic analysis in data meetings. Analysis of the data led to the development of seven key themes: Recognising end of life (EOL) and tools to support end of life care (EOLC), Communicating with families about EOL, Collaborative working, Continuity of care, Ensuring comfort at EOL, Supporting families, Developing and supporting staff. Each is discussed in detail and comprise individual and collective views on approaches to good end of life care for people with dementia. CONCLUSIONS: The significant challenges of providing good end of life care for people with dementia requires that different forms of expertise should be recognised and used; including the skills and knowledge of care assistants. Successfully engaging with people with dementia and family members and helping them to recognise the dying trajectory requires a supportive integration of emotional and technical expertise. The study strengthens the existing evidence base in this area and will be used with a related set of studies (on the views of other stakeholders and observations and interviews conducted in four services) to develop an evidence-based intervention.

How to set up a robotic-assisted laparoscopic surgery center and training of staff.

The use of computers to assist surgeons in the operating room has been an inevitable evolution in the modern practice of surgery. Robotic-assisted surgery has been evolving now for over two decades and has finally matured into a technology that has caused a monumental shift in the way gynecologic surgeries are performed. Prior to robotics, the only minimally invasive options for most Gynecologic (GYN) procedures including hysterectomies were either vaginal or laparoscopic approaches. However, even with over 100 years of vaginal surgery experience and more than 20 years of laparoscopic advancements, most gynecologic surgeries in the United States were still performed through an open incision. However, this changed in 2005 when the FDA approved the da Vinci Surgical Robotic Systemtm for use in gynecologic surgery. Over the last decade, the trend for gynecologic surgeries has now dramatically shifted to less open and more minimally invasive procedures. Robotic-assisted surgeries now include not only hysterectomy but also most all other commonly performed gynecologic procedures including myomectomies, pelvic support procedures, and reproductive surgeries. This success, however, has not been without controversies, particularly around costs and complications. The evolution of computers to assist surgeons and make minimally invasive procedures more common is clearly a trend that is not going away. It is now incumbent on surgeons, hospitals, and medical societies to determine the most cost-efficient and productive use for this technology. This process is best accomplished by developing a Robotics Program in each hospital that utilizes robotic surgery.

Involvement Drivers: A Study of Nurses and Physicians in Improvement Work.

This article reports on the involvement of nurses and physicians in improvement work, with a special focus on the drivers. The purpose was to describe how the nurse and physician groups understand involvement drivers for improvement work and to explain the differences in how they understand involvement. The study was conducted at 2 Swedish hospitals, and a total of 20 nurses and 10 physicians were interviewed. The theoretical framework, developed by an interpretative approach, identifies and describes a number of involvement drivers. On clustering the drivers into larger involvement factors, the study shows clear differences and profiles in terms of the 2 groups' perception and understanding of the involvement-drivers. Each group's profile was then analyzed on the basis of concept of professional culture.

Two Models of Integrating Buprenorphine Treatment and Medical Staff within Formerly "Drug-Free" Outpatient Programs.

"Drug-free" outpatient programs deliver treatment to the largest number of patients of all treatment modalities in the U.S., providing a significant opportunity to expand access to medication treatments for substance use disorders. This analysis examined staff perceptions of organizational dynamics associated with the delivery of buprenorphine maintenance within three formerly "drug-free" outpatient treatment programs. Semi-structured interviews (N = 15) were conducted with counseling and medical staff, and respondents were predominantly African American (n = 11) and female (n = 12). Themes and concepts related to medical staff integration emerged through an inductive and iterative coding process using Atlas.ti qualitative analysis software. Two treatment clinics incorporated buprenorphine maintenance into their programs using a co-located model of care. Their staff generally reported greater intra-organizational discord regarding the best ways to combine medication and counseling compared to the clinic using an integrated model of care. Co-located program staff reported less communication between medical and clinical staff, which contributed to some uncertainty about proper dosing and concerns about the potential for medication diversion. Clinics that shift from "drug-free" to incorporating buprenorphine maintenance should consider which model of care they wish to adapt and how to train staff and structure staff communication.

Compliance with standard precautions: Results of a French national audit.

BACKGROUND: Standard precautions (SPs) aim to reduce the risk of cross-transmission of microorganisms. The objectives of the present study were to assess institutional policies for SPs promotion, available resources for SPs implementation, and education of health care workers (HCWs) and their compliance with SPs. METHODS: A multisite mixed-methods audit was conducted in 2011. Self-assessment questionnaires were administered at institution, ward, and HCW levels in French health care facilities (HCFs). Results were given as percentage of objectives achieved (POA) or percentage of "never or sometimes," "often," and "always" responses for each question. RESULTS: A total of 1599 HCFs participated, including 14,968 wards and 203,840 HCWs. At an institutional level, the POA was 88%, covering SPs promotion (91%), procedures (99%), and SPs evaluation (63%). At the ward level, the POA was 94%, covering procedures (95%) and resources (93%). HCWs reported the best compliance for changing gloves between patients (94.5% "always"), and the worst compliance for the use of gloves for intramuscular injection and the use of eye protection in cases of blood exposure risk (34.5% and 24.4% of "always," respectively). CONCLUSIONS: A literature review found no other study of SPs that included such a large study group. These results led to SPs promotion actions at local and regional levels. Reinforcement of SPs observance will be prioritized in the next national program from the French Ministry of Health.