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Lai YL, Chen WY, Lee SS, Liaw YP. On the Association Between Demographic Structural Change and the Effectiveness of Nurse Staffing Policy for Inpatient Care: Evidence from Taiwan. Risk Manag Healthc Policy 2024; 17:1725-1743. [PMID: 38953037 PMCID: PMC11215666 DOI: 10.2147/rmhp.s468178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 06/14/2024] [Indexed: 07/03/2024] Open
Abstract
Purpose This study investigates the influence of demographic changes on the effectiveness of hospital nurse staffing policy, measured by the cumulative response of inpatient care quality to adjustments in hospital nurse staffing levels in Taiwan. Methods The research design utilized in this study aligns with the observational time-series methodology, and a total of 99 monthly time-series observations were collected from multiple databases administered by the Taiwan government over the period from January 2015 to March 2023. Specifically, the time-varying parameter vector autoregressive and autoregressive distributed lag models were employed to investigate the association between age distribution and nurse staffing policy effectiveness. Results The time-varying impulse responses of the unplanned 14-day readmission rate after discharge to changes in nurse staffing levels indicate a positive association between patient-to-nurse ratios and unplanned 14-day readmission rates across various types of hospitals. Nevertheless, the effectiveness of hospitals' nurse staffing policy is observed to diminish with population aging, particularly evident in medical centers and regional hospitals. Conclusion Policymakers should establish lower mandated patient-to-nurse ratios, grounded in practical nurse workforce planning, to address the needs of an aging society and enhance inpatient care quality through improved nurse staffing in hospitals.
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Affiliation(s)
- Yi-Ling Lai
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, 402367, Taiwan
- Community Health Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, 427213, Taiwan
| | - Wen-Yi Chen
- Department of Senior Citizen Service Management, National Taichung University of Science and Technology, Taichung, 403301, Taiwan
| | - Shiuan-Shinn Lee
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, 402367, Taiwan
| | - Yung-Po Liaw
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, 402367, Taiwan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, 402367, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, 402367, Taiwan
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Farsaci L, Fleming P, Almirall-Sanchez A, O'Donoghue C, Thomas S. Understanding the legacies of shocks on health system performance: Exploring Ireland's management of recent crises and its implications for policy. Health Policy 2024; 143:105063. [PMID: 38583364 DOI: 10.1016/j.healthpol.2024.105063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/26/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
This paper contrasts the Irish experience of the 2008 economic crisis and the Covid-19 pandemic, and the health system responses to these shocks, from the perspective of health system leaders working across both time periods. Based on semi-structured interviews with seven senior national and international officials, the research presented here forms the qualitative component of RESTORE, a five-year research project examining health system resilience and reform, funded through the Health Research Board's Research Leader Award in Ireland. Findings indicate that the financial crisis deeply impacted the Irish health system in relation to infrastructure and capacity, service delivery and workforce. Due to these legacy issues, Ireland's health system was in a relatively weak position when faced with the Covid-19 pandemic but the system proved adaptive and innovative during this time. Furthermore, the pandemic proved to be a catalyst for positive change, providing opportunities for long-term reform, alongside an immediate response to the crisis. This was facilitated by increased funding, a devolution in decision-making structures and a political commitment to the health system. Exploring lessons from the Irish response to these crises provides a case study for developing appropriate policy responses around financing and resource allocation, fostering support for healthcare among political leaders and policy makers, and preparing for future shocks. Furthermore, examining these experiences facilitates understanding around the impact of each crisis on the health system, exploring options for addressing legacy issues and considering practical steps to improve health system performance.
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Affiliation(s)
- Liz Farsaci
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland.
| | - Padraic Fleming
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland
| | - Arianna Almirall-Sanchez
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland
| | - Catherine O'Donoghue
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland
| | - Steve Thomas
- Edward Kennedy Professor of Health Policy and Management, School of Medicine, Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland
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Hayes C, Fitzgerald C, O'Shaughnessy Í, Condon B, Leahy A, O'Connor M, Manning M, Griffin A, Glynn L, Robinson K, Galvin R. Exploring stakeholders' experiences of comprehensive geriatric assessment in the community and out-patient settings: a qualitative evidence synthesis. BMC PRIMARY CARE 2023; 24:274. [PMID: 38093176 PMCID: PMC10717956 DOI: 10.1186/s12875-023-02222-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Comprehensive Geriatric Assessment (CGA) is a multidimensional interdisciplinary process that addresses an older adult's biopsychosocial capabilities to create an integrated and co-ordinated plan of care. While quantitative evidence that demonstrates the positive impacts of CGA on clinical and process outcomes has been synthesised, to date qualitative research reporting how older adults and service providers experience CGA has not been synthesised. This study aimed to systematically review and synthesise qualitative studies reporting community-dwelling older adults', caregivers' and healthcare professionals' (HCP) experiences of CGA in the primary care and out-patient (OPD) setting. METHOD We systematically searched five electronic databases including MEDLINE, CINAHL, PsycINFO, PsycARTICLES and Social Sciences Full Text targeting qualitative or mixed methods studies that reported qualitative findings on older adults', caregivers' and HCPs' experiences of CGA in primary care or out-patient settings. There were no language or date restrictions applied to the search. The protocol was registered with the PROSPERO database (Registration: CRD42021283167). The methodological quality of the included studies was appraised using the Critical Appraisal Skills Programme checklist for qualitative research. Results were synthesised according to Noblit and Hare's seven-step approach to meta-ethnography, which involves an iterative and inductive process of data synthesis. RESULTS Fourteen studies were included where CGA was completed in the home, general practice, out-patient setting in acute hospitals and in hybrid models across the community and hospital-based OPD settings. Synthesis generated four key themes: (1) CGA is experienced as a holistic process, (2) The home environment enhances CGA, (3) CGA in the community is enabled by a collaborative approach to care, and (4) Divergent experiences of the meaningful involvement of older adults, caregivers and family in the CGA process. CONCLUSION Findings demonstrate that CGA in a home-based or OPD setting allows for a holistic and integrated approach to care for community-dwelling older adults while increasing patient satisfaction and accessibility of healthcare. Healthcare professionals in the community should ensure meaningful involvement of older adults and their families or caregivers in the CGA process. Further robustly designed and well reported trials of different models of community-based CGA informed by the findings of this synthesis are warranted.
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Affiliation(s)
- Christina Hayes
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Christine Fitzgerald
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Íde O'Shaughnessy
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Brian Condon
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Aoife Leahy
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Margaret O'Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, Ireland
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Molly Manning
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anne Griffin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Liam Glynn
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- HRB Primary Care Clinical Trials Network Ireland, Discipline of General Practice, School of Medicine, HRB Primary Care Clinical Trials Network Ireland, National University of Ireland Galway, Galway, Ireland
| | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Overton C, Emerson T, A Evans R, Armstrong N. Responsive and resilient healthcare? 'Moments of Resilience' in post-hospitalisation services for COVID-19. BMC Health Serv Res 2023; 23:720. [PMID: 37400780 DOI: 10.1186/s12913-023-09645-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/04/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND COVID-19 caused disruption to healthcare services globally, resulting in high numbers of hospital admissions and with those discharged often requiring ongoing support. Within the UK, post-discharge services typically developed organically and were shaped over time by local need, funding, and government guidance. Drawing on the Moments of Resilience framework, we explore the development of follow-up services for hospitalised patients by considering the links between resilience at different system levels over time. This study contributes to the resilient healthcare literature by providing empirical evidence of how diverse stakeholders developed and adapted services for patients following hospitalisation with COVID-19 and how action taken at one system level influenced another. METHODS Qualitative research comprising comparative case studies based on interviews. Across three purposively selected case studies (two in England, one in Wales) a total of 33 semi-structured interviews were conducted with clinical staff, managers and commissioners who had been involved in developing and/or implementing post-hospitalisation follow-up services. The interviews were audio-recorded and professionally transcribed. Analysis was conducted with the aid of NVivo 12. RESULTS Case studies demonstrated three distinct examples of how healthcare organisations developed and adapted their post-discharge care provision for patients, post-hospitalisation with COVID-19. Initially, the moral distress of witnessing the impact of COVID-19 on patients who were being discharged coupled with local demand gave clinical staff the impetus to take action. Clinical staff and managers worked closely to plan and deliver organisations' responses. Funding availability and other contextual factors influenced situated and immediate responses and structural adaptations to the post-hospitalisation services. As the pandemic evolved, NHS England and the Welsh government provided funding and guidance for systemic adaptations to post-COVID assessment clinics. Over time, adaptations made at the situated, structural, and systemic levels influenced the resilience and sustainability of services. CONCLUSIONS This paper addresses understudied, yet inherently important, aspects of resilience in healthcare by exploring when and where resilience occurs across the healthcare system and how action taken at one system level influenced another. Comparison across the case studies showed that organisations responded in similar and different ways and on varying timescales to a disruption and national level strategies.
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Affiliation(s)
- Charlotte Overton
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Tristan Emerson
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Rachael A Evans
- Leicester NIHR Biomedical Research Centre - Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Natalie Armstrong
- Department of Population Health Sciences, University of Leicester, Leicester, UK.
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O'Donnell S, Quigley E, Hayden J, Adamis D, Gavin B, McNicholas F. Work-related experiences of consultant psychiatrists during the COVID-19 response: qualitative analysis. BJPsych Open 2023; 9:e49. [PMID: 36876639 PMCID: PMC10044173 DOI: 10.1192/bjo.2023.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Research has begun to draw attention to the challenges mental health professionals faced in delivering services during the COVID-19 pandemic response. However, few studies have examined the specific experiences of consultant psychiatrists. AIMS To examine the work-related experiences and psychosocial needs of consultant psychiatrists situated in the Republic of Ireland arising from the COVID-19 response. METHOD We interviewed 18 consultant psychiatrists and analysed data using inductive thematic analysis. RESULTS Work-related experience of participants was characterised by increased workload associated with assumption of guardianship of physical and mental health of vulnerable patients. Unintended consequences of public health restrictions increased case complexity, limited availability of alternative supports and hindered the practice of psychiatry, including inhibiting peer support systems for psychiatrists. Participants perceived available psychological supports as generally unsuitable for their needs given their specialty. Long-standing under-resourcing, mistrust in management and high levels of burnout exacerbated the psychological burden of the COVID-19 response. CONCLUSIONS The challenges of leading mental health services were evident in the increased complexity involved in caring for vulnerable patients during the pandemic, contributing to uncertainty, loss of control and moral distress among participants. These dynamics worked synergistically with pre-existing system-level failures, eroding capacity to mount an effective response. The longer-term psychological well-being of consultant psychiatrists - as well as the pandemic preparedness of healthcare systems - is contingent on implementation of policies addressing long-standing under-investment in the services vulnerable populations rely on, not least community mental health services.
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Affiliation(s)
- Shane O'Donnell
- Department of Child and Adolescent Psychiatry, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Etain Quigley
- School of Law and Criminology, Maynooth University, Maynooth, Ireland
| | - John Hayden
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Dimitrios Adamis
- Health Service Executive, Sligo Mental Health Service, Sligo, Ireland
| | - Blánaid Gavin
- Department of Child and Adolescent Psychiatry, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Fiona McNicholas
- Department of Child and Adolescent Psychiatry, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland; Children's Health Ireland, Crumlin, Dublin, Ireland; and Lucena Clinic, Rathgar, Dublin, Ireland
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Parker S, Mac Conghail L, Siersbaek R, Burke S. How to not revert to type: Complexity-informed learnings from the pandemic response for health system reform and universal access to integrated care. Front Public Health 2023; 11:1088728. [PMID: 36908402 PMCID: PMC9996344 DOI: 10.3389/fpubh.2023.1088728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. Background COVID-19 has highlighted existing health inequalities and health system deficiencies both in Ireland and internationally; however, understanding of the critical opportunities for health system change that have arisen during the pandemic is still emerging and largely descriptive. This research is situated in the Irish health reform context of Sláintecare, the reform programme which aims to deliver universal healthcare by strengthening public health, primary and community healthcare functions as well as tackling system and societal health inequities. Aims and objectives This study set out to advance understanding of how and to what extent COVID-19 has highlighted opportunities for change that enabled better access to universal, integrated care in Ireland, with a view to informing universal health system reform and implementation. Methods The study, which is qualitative, was underpinned by a co-production approach with Irish health system leadership. Semi-structured interviews were conducted with sixteen health system professionals (including managers and frontline workers) from a range of responses to explore their experiences and interpretations of social processes of change that enabled (or hindered) better access to universal integrated care during the pandemic. A complexity-informed approach was mobilized to theorize the processes that impacted on access to universal, integrated care in Ireland in the COVID-19 context. Findings A range of circumstances, strategies and mechanisms that created favorable system conditions in which new integrated care trajectories emerged during the crisis. Three key learnings from the pandemic response are presented: (1) nurturing whole-system thinking through a clear, common goal and shared information base; (2) harnessing, sharing and supporting innovation; and (3) prioritizing trust and relationship-building in a social, human-centered health system. Policy and practice implications for health reform are discussed.
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Affiliation(s)
- Sarah Parker
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Michaels I, Pirani S, Fleming M, Arana MM, D’Angelo E, Dyer-Drobnack C, DiManno M, Ravenhall S, Gloria CT. Enumeration of the Public Health Workforce in New York State: Workforce Changes in the Wake of COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13592. [PMID: 36294169 PMCID: PMC9602598 DOI: 10.3390/ijerph192013592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
The governmental public health workforce in the United States has faced staffing shortages for over a decade that have been exacerbated by the COVID-19 pandemic. To assess this critical issue, the Region 2 Public Health Training Center collaborated with the New York State Association of County Health Officials to enumerate the city and county public health workforce in New York State. The organizations used an online survey to: (1) count employees and full-time equivalent (FTEs) staff in local health departments in 2021; (2) assess workforce trends since the COVID-19 pandemic; and, (3) identify challenges local health departments encounter in recruiting and retaining qualified public health workers. To assess trends, findings were compared with secondary data from 2019. Despite playing a central role in COVID-19 mitigation, local health departments experienced no overall increase in staffing in 2021 compared to 2019, with many health departments experiencing large increases in vacant positions. Recruitment challenges include noncompetitive salaries, difficulties finding qualified candidates, and lengthy hiring processes. This study complements accumulating evidence indicating that long-term investment in local public health infrastructure is needed to bolster the workforce and ensure that communities are protected from current and future health threats.
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Affiliation(s)
- Isaac Michaels
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, NY 12144, USA
| | - Sylvia Pirani
- Region 2 Public Health Training Center (PHTC), New York, NY 10032, USA
| | - Molly Fleming
- Region 2 Public Health Training Center (PHTC), New York, NY 10032, USA
- New York State Association of County Health Officials (NYSACHO), Albany, NY 12110, USA
| | - Mayela M. Arana
- Region 2 Public Health Training Center (PHTC), New York, NY 10032, USA
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY 10032, USA
| | - Emily D’Angelo
- Region 2 Public Health Training Center (PHTC), New York, NY 10032, USA
- New York State Association of County Health Officials (NYSACHO), Albany, NY 12110, USA
| | - Cristina Dyer-Drobnack
- Region 2 Public Health Training Center (PHTC), New York, NY 10032, USA
- New York State Association of County Health Officials (NYSACHO), Albany, NY 12110, USA
| | - Margaret DiManno
- Region 2 Public Health Training Center (PHTC), New York, NY 10032, USA
- New York State Association of County Health Officials (NYSACHO), Albany, NY 12110, USA
| | - Sarah Ravenhall
- Region 2 Public Health Training Center (PHTC), New York, NY 10032, USA
- New York State Association of County Health Officials (NYSACHO), Albany, NY 12110, USA
| | - Christian T. Gloria
- Region 2 Public Health Training Center (PHTC), New York, NY 10032, USA
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY 10032, USA
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