Inpatient midwifery staffing levels and postpartum readmissions: a retrospective multicentre longitudinal study

BACKGROUND

Preventing readmission to hospital after giving birth is a key priority, as rates have been rising along with associated costs. There are many contributing factors to readmission, and some are thought to be preventable. Nurse and midwife understaffing has been linked to deficits in care quality. This study explores the relationship between staffing levels and readmission rates in maternity settings.

METHODS

We conducted a retrospective longitudinal study using routinely collected individual patient data in three maternity services in England from 2015 to 2020. Data on admissions, discharges and case-mix were extracted from hospital administration systems. Staffing and workload were calculated in Hours Per Patient day per shift in the first two 12-hour shifts of the index (birth) admission. Postpartum readmissions and staffing exposures for all birthing admissions were entered into a hierarchical multivariable logistic regression model to estimate the odds of readmission when staffing was below the mean level for the maternity service.

RESULTS

64 250 maternal admissions resulted in birth and 2903 mothers were readmitted within 30 days of discharge (4.5%). Absolute levels of staffing ranged between 2.3 and 4.1 individuals per midwife in the three services. Below average midwifery staffing was associated with higher rates of postpartum readmissions within 7 days of discharge (adjusted OR (aOR) 1.108, 95% CI 1.003 to 1.223). The effect was smaller and not statistically significant for readmissions within 30 days of discharge (aOR 1.080, 95% CI 0.994 to 1.174). Below average maternity assistant staffing was associated with lower rates of postpartum readmissions (7 days, aOR 0.957, 95% CI 0.867 to 1.057; 30 days aOR 0.965, 95% CI 0.887 to 1.049, both not statistically significant).

CONCLUSION

We found evidence that lower than expected midwifery staffing levels is associated with more postpartum readmissions. The nature of the relationship requires further investigation including examining potential mediating factors and reasons for readmission in maternity populations.

Development and applications of the Anaesthetists' Non-Technical Skills behavioural marker system: a systematic review

OBJECTIVES

To comprehensively synthesise evidence regarding the validity and reliability of the Anaesthetists' Non-Technical Skills (ANTS) behavioural marker system and its application as a tool for the training and assessment of non-technical skills to improve patient safety.

DESIGN

Systematic review.

DATA SOURCES

We employed a citation search strategy. The Scopus and Web of Science databases were searched for articles published from 2002 to May 2022.

ELIGIBILITY CRITERIA

English-language publications that applied the ANTS system in a meaningful way, including its use to guide data collection, analysis and reporting.

DATA EXTRACTION AND SYNTHESIS

Study screening, data extraction and quality assessment were performed by two independent reviewers. We appraised the quality of included studies using the Joanna Briggs Institute Critical Appraisal Checklists. A framework analysis approach was used to summarise and synthesise the included articles.

RESULTS

54 studies were identified. The ANTS system was applied across a wide variety of study objectives, settings and units of analysis. The methods used in these studies varied and included quantitative (n=42), mixed (n=8) and qualitative (n=4) approaches. Most studies (n=47) used the ANTS system to guide data collection. The most commonly reported reliability statistic was inter-rater reliability (n=35). Validity evidence was reported in 51 (94%) studies. The qualitative application outcomes of the ANTS system provided a reference for the analysis and generation of new theories across disciplines.

CONCLUSION

Our results suggest that the ANTS system has been used in a wide range of studies. It is an effective tool for assessing non-technical skills. Investigating the methods by which the ANTS system can be evaluated and implemented for training within clinical environments is anticipated to significantly enhance ongoing enhancements in staff performance and patient safety.

PROSPERO REGISTRATION NUMBER

CRD42022297773.

Evaluating human resources management literacy: A performance analysis of ChatGPT and bard

This study presents a comprehensive analysis comparing the literacy levels of two Generative Artificial Intelligence (GAI) tools, ChatGPT and Bard, using a dataset of 134 questions from the Human Resources (HR) domain. The generated responses are evaluated for accuracy, relevance, and clarity. We find that ChatGPT outperforms Bard in overall accuracy (84.3% vs. 82.8%). This difference in performance suggests that ChatGPT could serve as a robotic advisor in transactional HR roles. In contrast, Bard may possess additional safeguards against misuse in the HR function, making it less capable of generating responses to certain types of questions. Statistical tests reveal that although the two systems differ in their mean accuracy, relevance, and clarity of the responses, the observed differences are not always statistically significant, implying that both tools may be more complementary than competitive. The Pearson correlation coefficients further support this by showing weak to non-existent relationships in performance metrics between the two tools. Confirmation queries don't improve ChatGPT or Bard's response accuracy. The study thus contributes to emerging research on the utility of GAI tools in Human Resources Management and suggests that involving certified HR professionals in the design phase could enhance underlying language model performance.

Women in Health and their Economic, Equity and Livelihood statuses during Emergency Preparedness and Response (WHEELER) protocol: a mixed methods study in Kenya

INTRODUCTION

Kenya reported its first COVID-19 case on 13 March 2020. Pandemic-driven health system changes followed and unforeseen societal, economic and health effects reported. This protocol aims to describe the methods used to identify the gender equality and health equity gaps and possible disproportional health and socioeconomic impacts experienced by paid and unpaid (community health volunteer) female healthcare providers in Kilifi and Mombasa Counties, Kenya during the COVID-19 pandemic.

METHODS AND ANALYSIS

Participatory mixed methods framed by gender analysis and human-centred design will be used. Research implementation will follow four of the five phases of the human-centred design approach. Community research advisory groups and local advisory boards will be established to ensure integration and the sustainability of participatory research design.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Institutional Scientific and Ethics Review Committee at the Aga Khan University and the University of Manitoba.This study will generate evidence on root cultural, structural, socioeconomic and political factors that perpetuate gender inequities and female disadvantage in the paid and unpaid health sectors. It will also identify evidence-based policy options for future safeguarding of the unpaid and paid female health workforce during emergency preparedness, response and recovery periods.

Implementing adaptive e-learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains

INTRODUCTION

To improve healthcare provider knowledge of Tanzanian newborn care guidelines, we developed adaptive Essential and Sick Newborn Care (aESNC), an adaptive e-learning environment. The objectives of this study were to (1) assess implementation success with use of in-person support and nudging strategy and (2) describe baseline provider knowledge and metacognition.

METHODS

6-month observational study at one zonal hospital and three health centres in Mwanza, Tanzania. To assess implementation success, we used the Reach, Efficacy, Adoption, Implementation and Maintenance framework and to describe baseline provider knowledge and metacognition we used Howell's conscious-competence model. Additionally, we explored provider characteristics associated with initial learning completion or persistent activity.

RESULTS

aESNC reached 85% (195/231) of providers: 75 medical, 53 nursing and 21 clinical officers; 110 (56%) were at the zonal hospital and 85 (44%) at health centres. Median clinical experience was 4 years (IQR 1-9) and 45 (23%) had previous in-service training for both newborn essential and sick newborn care. Efficacy was 42% (SD ±17%). Providers averaged 78% (SD ±31%) completion of initial learning and 7% (SD ±11%) of refresher assignments. 130 (67%) providers had ≥1 episode of inactivity >30 day, no episodes were due to lack of internet access. Baseline conscious-competence was 53% (IQR: 38%-63%), unconscious-incompetence 32% (IQR: 23%-42%), conscious-incompetence 7% (IQR: 2%-15%), and unconscious-competence 2% (IQR: 0%-3%). Higher baseline conscious-competence (OR 31.6 (95% CI 5.8 to 183.5)) and being a nursing officer (aOR: 5.6 (95% CI 1.8 to 18.1)), compared with medical officer, were associated with initial learning completion or persistent activity.

CONCLUSION

aESNC reach was high in a population of frontline providers across diverse levels of care in Tanzania. Use of in-person support and nudging increased reach, initial learning and refresher assignment completion, but refresher assignment completion remains low. Providers were often unaware of knowledge gaps, and lower baseline knowledge may decrease initial learning completion or activity. Further study to identify barriers to adaptive e-learning normalisation is needed.

The hidden linkage of corporate efficiency and green innovation with human resource management practices: a newly perspective from China

It is disappointing that despite having access to human resources at very little cost, rising countries' administrations are so ineffective. It is often believed that an organization's unheralded employees hold the keys to its success or failure. A person's mood and demeanor may be influenced by a variety of factors. Human resource management (HRM) methods have been created and used by scientists all over the globe in an effort to maximize the potential of their most important asset. Eco-friendly inventions are crucial to the survival of humanity and the prosperity of enterprises throughout the world. Therefore, the purpose of this research is to look at how green innovation affects both the environment and businesses. Green process metrics and green product metrics, for example, may have an impact on green innovation, which is why these metrics are important to track. The second primary goal of this research is to learn how the commitment and HR practices of top management shape the link between green innovation and economic and environmental success. A self-reported poll was taken by 370 employees in China's manufacturing industry. A partial least square structural equation modelling was used to examine the data collected between April 2021 and February 2022. This research employed confirmatory component analysis, a standard technique of structural equation modelling (SEM) for examining both overt and covert variables and indicators, to assess the reflecting indicators measurement model. The findings suggest that HRM has an effect on green innovation that is both positive and statistically significant. The environment and the economy benefit greatly from green innovations. Relationships between HRM and green innovation have no unfavorable implications on business results or the environment. However, human resource management has the potential to boost organizations' prosocial impact. In a three-way interaction (moderated moderation) model, organizational success is found to have a significant role, whereas environmental and organizational success play just a little one. To improve economic and environmental outcomes across all sectors, this study adds to the existing body of knowledge and argues for the wider implementation of green innovation practices. Human resource managers play a crucial role in developing a company's culture and values. The findings suggest that with leadership's blessing, green technologies may spread across a company.

Utilizing green financing in developing green HRM resources for carbon neutrality: presenting multidimensional perspectives of China

This study examines how green finance may encourage the development of green human resource management (HRM) solutions to help China achieve carbon neutrality. For an empirical estimate, the Chinese data is subjected to DEA analysis, Tobit regression, and a sensitivity analysis model. The findings highlight the significance of green finance in the creation of green HRM solutions that aid firms in enhancing their environmental performance, boosting employee happiness, and getting them closer to their carbon neutrality goals. With the use of tools like green bonds and sustainable investment funds, businesses may raise capital for sustainability projects and encourage the adoption of environmentally responsible HRM practices. Moreover, the study results discussed the need to incorporate environmental sustainability considerations into HRM plans, enabling organizations to cultivate a sustainable culture and engage employees in supporting carbon neutrality through green practices in talent acquisition, training and development, performance management, and employee engagement. Incorporating environmental sustainability into HRM processes, boosting stakeholder involvement, and looking into new funding methods are all points emphasized in the study, which aims to enhance the uptake of green HRM initiatives.

Exploring the motivation of self-directed learning of hospital pharmacists: a multicentre qualitative study

OBJECTIVE

Self-directed learning (SDL) has been embraced by the medical community as a core professional competency, with motivation considered a crucial component of SDL. However, little is known about how hospital pharmacists perceive motivation in SDL in the workplace. This study aimed to examine the intrinsic and external motivation of hospital pharmacists in SDL.

DESIGN

This study employed a multicentre qualitative design, which lasted 13 months from May 2020 to June 2021. The interviews were audiorecorded, transcribed verbatim and analysed in NVivo V.12.0. Thematic analysis method was used to analyse the data.

SETTING

The study took place in nine public hospitals located in urban areas of Henan Province.

PARTICIPANTS

Sixteen hospital pharmacists were enrolled from the pharmacy departments of the sample hospitals, using a purposive sampling method.

RESULTS

Sixteen one-on-one semistructured interviews were conducted, identifying intrinsic and extrinsic motivation in SDL for hospital pharmacists in the workplace. Intrinsic motivation includes curiosity and interest, achievement, self-efficacy and personal growth. Extrinsic motivation includes a more comprehensive set of elements, such as interpersonal motivations, work-related motivations and career-related motivations.

CONCLUSIONS

Personal interests, the influence of surrounding individuals (directly or indirectly), work-related requirements and pressures, and professional development requirements and pressures are the main intrinsic or extrinsic motivations for SDL among hospital pharmacists in China. Future research may focus on these aspects to enhance the SDL competence of hospital pharmacists and other medical personnel.

"To tell you the truth I'm tired": a qualitative exploration of the experiences of ethnically diverse NHS staff

OBJECTIVES

The aim of this paper was to explore the experiences and support needs of ethnically diverse healthcare staff and how they were affected by the COVID-19 pandemic.

DESIGN

A qualitative study using focus groups conducted remotely on Microsoft Teams.

SETTING

The study took place across 10 National Health Service Trusts in England; 5 were Acute Hospitals Trusts and 5 were Community and Mental Health Trusts.

PARTICIPANTS

55 participants across 16 focus groups took part in the study. Participants were all healthcare staff members from ethnically diverse backgrounds.

RESULTS

Seven themes were generated which highlighted issues of negative experiences of discrimination at work, particularly during the COVID-19 pandemic, including participants often finding line managers unsupportive, appearing to lack care and compassion, and not understanding ethnic diversity issues. Participants identified many reasons for finding it difficult to speak up when faced with such experiences, such as feeling unsafe to do so, or feeling too exhausted to keep speaking up. Other staff had more positive experiences and described supportive interventions, and despite workplace difficulties, many participants discussed remaining motivated to work in the National Health Service.

CONCLUSIONS

Negative day-to-day experiences of ethnically diverse healthcare staff, and the difficulty of speaking up about these align with other, international literature on this topic. Progress in the area of staff equality is vital if healthcare organisations are to continue to provide high-quality patient care and retain skilled, compassionate staff who value their place of work. Recent literature suggests that many initiatives to reduce inequalities have not been successful, and there is a call for fundamental, cultural-level change. Future research is needed to understand how best to implement these organisational-level changes and to evaluate their effectiveness.

Cultivating sustainable environmental performance: The role of green talent management, transformational leadership, and employee engagement with green initiatives

BACKGROUND

The success of organizations' sustainable performance mainly depends on their human resource capital and for this organizations now need to focus on green human capital development programs including green talent management (GTM). GTM entails attracting, nurturing, and retaining those people who can promote the green initiatives of the organization.

OBJECTIVE

This paper aims to investigate the impact of GTM, transformational leadership, and employee engagement on the sustainable environmental performance of organizations.

METHODS

The data were collected from both academic and administrative employees in five Omani higher education institutions (HEIs). In total 367 questionnaires were collected using drop-off and pickup methods.

RESULTS

The results of the study showed that green hard and green soft talent management (TM) and employee engagement with green initiatives are significant predictors of the sustainable environmental performance of HEIs. Moreover, transformational leadership can moderate the influence of green soft TM on employee engagement with green initiatives by strengthening the relationship.

CONCLUSIONS

For sustainable performance and development, organizations especially HEIs need to actively assume their social responsibilities and implement sustainable environmental management. The present study provides meaningful implications for practitioners, educational policymakers, and leaders to promote GTM and employee engagement for sustainable environmental performance. Supporting green skill development, engaging employees with green initiatives, and promoting staff with green skills can help organizations particularly HEIs to increase their sustainable environmental performance and gain a competitive advantage.

Examining the extent, forms and factors influencing multiple job holding among medical doctors, professional nurses and rehabilitation therapists in two South African provinces: a cross-sectional study

OBJECTIVE

Multiple job holding (MJH), or working in more than one paid job simultaneously, is a common characteristic of health labour markets. The study examined the extent (prevalence), forms and factors influencing MJH among public sector medical doctors, professional nurses and rehabilitation therapists in two South African provinces.

DESIGN

A cross-sectional, analytical study.

SETTING

29 public sector hospitals in the Gauteng and Mpumalanga provinces of South Africa.

PARTICIPANTS

Full-time public sector medical doctors, professional nurses and rehabilitation therapists.

RESULTS

We obtained an overall response rate of 84.3%, with 486 medical doctors, 571 professional nurses and 340 rehabilitation therapists completing the survey. The mean age was 39.9±9.7 years for medical doctors, 43.7±10.4 years for professional nurses and 32.3±8.7 years for rehabilitation therapists. In the preceding 12 months, the prevalence of MJH was 33.7% (95% CI 25.8% to 42.6%) among medical doctors, 8.6% (95% CI 6.3% to 11.7%) among professional nurses and 38.7% (95% CI 31.5% to 46.5%) among rehabilitation therapists. Medical doctors worked a median of 20 (10-40) hours per month in their additional jobs, professional nurses worked 24 (12-34) hours per month and rehabilitation therapists worked 16 (8-28) hours per month. Private practice was the most prevalent form of MJH among medical doctors and rehabilitation therapists, compared with nursing agencies for professional nurses. MJH was significantly more likely among medical specialists (OR 4.3, p<0.001), married professional nurses (OR 2.4, p=0.022) and male rehabilitation therapists (OR 2.4, p=0.005).

CONCLUSION

The high prevalence of MJH could adversely affect the care of public sector patients. The study findings should inform the review and revision of existing MJH policies.

Emotional intelligence in military medical officers in the Defence Medical Services

BACKGROUND

Emotional intelligence (EI) is a concept describing an individual's ability to understand, process and act accordingly on others' and one's own emotions. It is a desirable quality for people working in teams and is beneficial to the individual in many ways. It is increasingly recognised that understanding and developing EI are important to working in the healthcare environment. It becomes especially pertinent in the deployed Defence Medical Services (DMS), where clinicians often fulfil a significant leadership role in a small team.

METHODS

This study was performed with the aim of exploring the role of EI in military doctors in the UK DMS. EI was measured in a cohort of 64 military doctors by way of a validated self-assessment questionnaire. Results were tested for differences in EI between different services and career stages.

RESULTS

The survey had an 83% return rate. There was roughly equal distribution between service, career groups and ages across the study population. There were more men than women. The population showed consistently high EI scores compared with control data. There were no statistical differences in EI scores between services or genders. Foundation doctors showed the highest EI scores and consultants the lowest (6.05 vs 5.3).

CONCLUSION

It was demonstrated that military doctors have consistently high EI score, especially at the most junior level. This suggests that traits deemed desirable by the single service selection processes also pertain to high EI without it being specifically measured for. The dangers of having too high EI and the benefits of having a range of EI within a team were discussed. There were limitations of being unable to obtain qualitative data and not including primary healthcare staff. Several recommendations were set out as to how the DMS may use or further investigate EI with regard to training and recruitment.

Financial fragility, human resource management, and transition to renewable energy in Asian economies: a comparative analysis

The main hurdle in deploying renewable energy projects is the high initial cost, making it difficult for businesses and individuals to afford it. The fragility of the financial sector and human resource management further slows the pace of renewable energy demand. Therefore, we aim to investigate the impact of financial fragility and human resource management on renewable energy consumption over time horizon 1997-2020. To that end, the analysis employed the ARDL-PMG model. For Asia as a whole and all other sub-regions, including South East Asia, East Asia, South Asia, and Western Asia, the estimates for bank non-performing loans are notably negative. In general, these findings imply that a rise in financial fragility significantly reduces renewable energy consumption in the long run. In the short run, the estimates attached to both bank non-performing loans and bank costs are negatively significant in Asia and sub-regions of Western Asia only. The results for the human resources show that it exerts a significant and positive influence on renewable energy demand in Asia as a whole, South Asia, East Asia, and Western Asia. The estimates attached to human resources are statistically insignificant in all models in the short run. In the end, some important public strategies and their implementations have been discussed.

Examining the health and functioning status of medical laboratory professionals in Ontario, Canada: an exploratory study during the COVID-19 pandemic

OBJECTIVES

This study aims to explore the overall and specific aspects of the functioning of medical laboratory professionals (MLPs) in Ontario, Canada during the COVID-19 pandemic.

DESIGN

A cross-sectional analysis where a questionnaire was used to assess the mental status of MLPs.

SETTING

An online questionnaire administered in Ontario, Canada.

PARTICIPANTS

632 MLPs (medical laboratory technologists, technicians and assistants) were included.

MAIN OUTCOME MEASURES

We employed the WHO Disability Assessment Schedule V.2.0 (WHODAS V.2.0) Questionnaire to assess functioning/disability and Copenhagen Psychosocial Questionnaire, third edition for psychosocial workplace factors. Multiple regression analysis examined the relationship between overall and specific domain functioning scores and psychosocial workplace factors.

RESULTS

Of the total 632 participants, the majority were female gender and Caucasian. It was found that health (β=2.25, p<0.001, CI: 1.77 to 2.73), management of environmental conditions (β=0.65, p<0.001, CI: 0.33 to 0.98), fear of unemployment (β=-0.72, p<0.001, CI: -1.09 to -0.35) and frequency of stress (β=-1.86, p<0.001, CI: -2.33 to -1.40), in addition to bullying exposure (β=0.56, p<0.01, CI: 0.15 to 0.98) and threats of violence exposure (β=0.90, p<0.01, CI: 0.25 to 1.54), significantly decreased functioning overall and within the specific WHODAS V.2.0 functioning domains.

CONCLUSION

This study provides preliminary evidence of the overall and specific aspects of functioning among the MLPs during the COVID-19 pandemic. Besides, these findings can support and guide the improvement of workplace practices and policies among MLPs in the future.

[Training concept for personnel in a university outpatient clinic: development and evaluation of a structured introductory training concept]

BACKGROUND

The training of new employees is crucial for effective interaction and commitment to the company.

OBJECTIVE

Development and evaluation of a structured induction into the process flows of a university outpatient clinic.

MATERIAL AND METHODS

We developed and tested a two-stage model for getting to know staff, premises, nursing and medical process flows, and learning examination techniques: Participants went through all stages of an outpatient clinic visit as fictitious patients and subsequently evaluated learning success by self-assessment of general (process-related) and specific (examination-related) competencies in writing and in a feedback interview.

RESULTS

In this study, 11 residents, 8 operating room nursing staff, and 6 students underwent the training program. The self-assessed level of competence before and after the run-through as well as the extent of the increase in competence varied depending on the stage and professional group. Residents and students experienced a specific increase in general competences (both 98%; nursing personnel 64%). Specific competence gains for residents were particularly evident in becoming familiar with important process-related interfaces between the occupational groups, in software and examination techniques, and in improved orientation in the outpatient clinic (competence gain at 83% of stages). Operating room nursing staff benefited most from improved communication with staff.

CONCLUSION

An increase in general competence can be achieved by a structured training with little time expenditure for different professional groups and facilitates, especially the start for new residents. For maximum specific competence gain, an outpatient clinic run tailored to the employee's field of activity seems desirable.

Diffusion of environmental technology innovation through the lens of banking sector performance and human resource management: an influential step towards environmental sustainability

Environmental technology innovations are widely recognized as the most suitable option to achieve sustainable and green development. Since banks and other financial institutions offer essential funding for investments in environmental technology projects, the banking sector and human resources are essential to developing and promoting environmental technology innovation. This study aims to investigate the impact of banking sector performance and human resources on environmental technology innovation in China, utilizing the ARDL method. The research focuses on the period spanning from 1996 to 2021. The outcomes of the ARDL model approve that short- and long-term banking sector performances positively impact environmental technology innovation in China. Among the four proxies for the banking sector's performance, market capitalization, bank deposits, and bank Z-score are substantially and favorably associated with long-term environmental technology innovation in China. However, only the banking sector's performance fosters environmental technology innovation in the short term; all other measures of banking sector performance are insignificant. Human resource positively impacts green innovation in China in the long run. Furthermore, China's long-term GDP growth and environmental pressures support environmental technology innovation. Therefore, policymakers should provide specific incentives to encourage human resource management and financial institutions that lead to the advancement of environmental technology innovation.

Exploring reasons behind UK doctors leaving the medical profession: a series of qualitative interviews with former UK doctors

BACKGROUND

The retention of doctors is an important issue for the National Health Service; yet evidence suggests that the proportion of doctors wanting to leave UK medicine is increasing. Some of these doctors chose to continue their medical careers in other countries, however, some decided to leave the profession entirely.

OBJECTIVES

This was the first study to interview a cohort of UK doctors who have left the medical profession to embark on alternative careers. Participants were asked about the reasoning behind their decision to leave medicine.

DESIGN

Qualitative study using one-to-one, semi-structured virtual interviews.

PARTICIPANTS

17 participants, recruited via purposive sampling.

SETTING

Zoom interviews with 17 former UK doctors who had left medicine to pursue alternative careers were conducted between February and July 2021.

FINDINGS

Data were analysed using thematic analysis and the theory of work adjustment was applied to findings. The most frequently discussed reasons for leaving were associated with factors preventing participants from providing a desired level of patient care, work-life balance, a lack of support, a lack of control over working lives and the pull of alternative careers. While reasons for leaving varied between participants, all participants reported greater satisfaction in their new careers.

CONCLUSION

New careers were able to address many of the issues that caused participants to leave UK medicine. Consequently, it is important that some of the key issues raised in this study are addressed to retain more doctors in the UK medical workforce.

Impact of medical students' socioeconomic backgrounds on medical school application, admission and migration in Japan: a web-based survey

OBJECTIVES

The aim of this study was to clarify and compare the socioeconomic backgrounds of medical students with those of other health professions and non-health faculty students in an era of increasing inequity in Japanese society.

DESIGN

This was a quantitative nationwide study. Data were collected by a cross-sectional web-based anonymous questionnaire.

SETTING

Data from years 3 and 4 medical, health professions and non-health faculty students across Japan were collected in 2021.

PARTICIPANTS

Participants were 1991 students from medical schools, 224 from dental, 419 from pharmacy, 326 from nursing, 144 from other health professions and 207 from non-health faculties.

RESULTS

The proportion of high-income families (>18 million yen: ca. US$140 000) among medical students was 25.6%, higher than that of pharmacy (8.7%) and nursing students (4.1%) (p<0.01). One-third of medical students had a physician parent, more common than in non-medical students (p<0.01). Students who only applied to public medical schools and a regional quota 'Chiiki-waku' students with scholarship had lower family income and physician parents compared with those who applied to private medical schools (p<0.01), but they still had higher physician parents compared with non-medical students (p<0.01). Logistic regression revealed that having a physician parent (p<0.01), aspiring to the present profession during elementary school (p<0.01) and private upper secondary school graduation (p<0.01) predicted the likelihood of studying medicine. There were regional differences of backgrounds among medical students, and 80% of medical students with urban backgrounds intended to work in urban localities after graduation.

CONCLUSIONS

This study provides evidence that medical students in Japan hail from urban and higher income classes and physicians' families. This finding has implications for the health workforce maldistribution in Japan. Widening the diversity of medical students is essential for solving physician workforce issues and meeting broad healthcare needs.

Roles of doctor-patient relationship perception and job satisfaction in the impact of workplace violence on medical professionals' turnover intentions in the early phase of COVID-19: a cross-sectional study in China

OBJECTIVE

This study aimed to explore the role of the doctor-patient relationship (DPR) perception from the perspective of medical professionals in the association between workplace violence (WPV), job satisfaction and turnover intention in the early stages of the COVID-19 pandemic based on the affective events theory (AET).

DESIGN

A cross-sectional study.

SETTING

Nine medical institutions in Beijing were enrolled in this study.

PARTICIPANTS

In total, 792 medical professionals participated in the study, excluding administrators and logisticians.

RESULTS

The structural equation model was well adapted (comparative fit index (CFI) = 0.933; root mean square error of approximation (RMSEA) = 0.060). DPR mediated the association between WPV and job satisfaction, with an indirect effect of 0.247 (p<0.001). DPR perception mediated the effect of WPV on turnover intention, with an indirect effect of 0.090 (p<0.001). It also played a chain-mediating role in job satisfaction between WPV and turnover intention, with a mediation value of 0.117 (p<0.001), accounting for 53.42% of the total effect.

CONCLUSIONS

This study developed a stable model using AET. DPR perception plays an important role in the relationship between WPV and job satisfaction and turnover intention, suggesting the key impact of emotional factors. This has strong practical implications for maintaining the stability of medical teams. Therefore, medical institutions should improve the level of DPR perception from the perspective of medical professionals to effectively prevent mental health problems following WPV.

Are green HRM Practices enough to build successful green ventures interlinked with innovation and knowledge-sharing behavior? Case of China

Green practices are now treated as an essential component of organizational element and firms are now exploring ways to incorporate new growth strategies that ensure environmentally friendly methods. The present study focuses on manufacturing industry in China and identify that green HRM practices influence eco-innovation and organization's knowledge-sharing culture. The study also aims to identify whether eco-innovation and knowledge-sharing culture help to build successful green venture and provide indirect path to green HRM and green ventures. An adopted survey was used to collect data from manufacturing employees and SPSS-AMOS is employed to assess the model reliability and proposed hypotheses. Study outcomes reveal that green HRM practices increase knowledge-sharing behavior and promote green innovation. Findings also expose that eco-innovation and knowledge-sharing behavior are potential mediator, hence provide an indirect path between green HRM practices and green ventures. Results confirm that essentiality of green HRM in order to promote knowledge-sharing behavior among employees through which environmental commitment can be fulfilled by organizations, further leading to successful green venture.

Recruiting and retaining bachelor qualified nurses in German hospitals (BSN4Hospital): protocol of a mixed-methods design

INTRODUCTION

Many countries in Europe are facing a shortage of nurses and seek effective recruitment and retention strategies. The nursing workforce is increasingly diverse in its educational background, ranging from 3-year vocational training (diploma) to bachelor and master educated nurses. This study analyses recruitment and retention strategies for academically educated nurses (minimum bachelor), including intention to leave, job satisfaction and work engagement compared with diploma nurses in innovative German hospitals; it explores recruitment and retention challenges and opportunities, and identifies lessons on recruitment and retention taking an international perspective.

METHODS AND ANALYSIS

The study will apply a convergent mixed-methods design, including qualitative and quantitative methods. The qualitative study will include semistructured interviews among hospital managers, nurses, students and stakeholders in Germany. In addition, expert interviews will be conducted internationally in countries with a higher proportion of bachelor/master nurses in hospitals. The quantitative, cross-sectional study will consist of a survey among professional nurses (bachelor/master, diploma nurses) in German hospitals. Study settings are hospitals with a higher-than-average proportion of bachelor nurses or relevant recruitment, work environment or retention strategies in place. Analyses will be conducted in several phases, first in parallel, then combined via triangulation: the parallel analysis technique will analyse the qualitative and quantitative data separately via content analyses (interviews) and descriptive, bivariate and multivariate analyses (survey). Subsequently, data sources will be collectively analysed via a triangulation matrix focusing on developing thematic exploratory clusters at three systemic levels: microlevel, mesolevel and macrolevel. The analyses will be relevant for generating lessons for clinical nursing, management and policy in Germany and internationally.

ETHICS AND DISSEMINATION

Ethics approval was obtained by the Charité Ethics Committee.Several dissemination channels will be used, including publications and presentations, for the scientific community, nursing management, clinical nurses and the wider public in Germany and internationally.

What happened to health labour markets during COVID-19? Insights from the analysis of cross-sectional survey data on the perceptions of medical doctors in Brazil

OBJECTIVES

To examine physicians' perceptions of changing employment opportunities in Brazil, and gain an insight into labour markets in low/middle-income countries (LMICs) during the pandemic.

STUDY DESIGN

Descriptive and inferential analysis of a quantitative dataset from a representative cross-sectional survey of physicians of two Brazilian states.

SETTINGS

São Paulo and Maranhão states in Brazil.

PARTICIPANTS

Representative sample of 1183 physicians.

OUTCOME MEASURES

We estimated prevalence and 95% CIs for physicians' perceptions of changes in demand and supply of doctors, as well as changes in prices of medical services for facilities of practice in the two states, stratified by public, private and dual-practice physicians.

RESULTS

Most doctors reported increased job opportunities in the public sector (54.9%, 95% CI 52.0% to 57.7%), particularly in Maranhão state (65.0%, 95% CI 60.9% to 68.9%). For the private sector, increased opportunities were reported only in large private hospitals (46.7%, 95% CI 43.9% to 49.6%) but not in smaller clinics. We recorded perceptions of slight increases in availability of doctors in Maranhão, particularly in the public sector (51.4%, 95% CI 43.2% to 59.5%). Younger doctors recounted increased vacancies in the public sector (64%, 95% CI 58.1% to 68.1%), older doctors only in walk-in clinics in Maranhão (47.5%, 95% CI 39.9% to 55.1%). Those working directly with patients with COVID-19 saw opportunities in public hospitals (65%, 95% CI 62.3% to 68.4%) and in large private ones (55%, 95% CI 51.8% to 59.1%).

CONCLUSIONS

Our findings hint that health labour markets in LMICs may not necessarily shrink during epidemics, and that impacts will depend on the balance of public and private services in national health systems.

Assessment of hypertension service availability in some primary health centres in Nigeria: a mixed-methods study

OBJECTIVE

Strengthening primary health centre (PHC) systems is a potentially effective strategy to reduce the burden of non-communicable diseases in Nigeria, a low/middle-income country with limited resources. The aim of this study was to assess hypertension service availability in some PHCs in Nigeria and seek recommendations that could facilitate improved services from PHC workers.

DESIGN

Explanatory sequential mixed-methods study.

SETTINGS

PHCs in the six geopolitical zones and Federal Capital City of Nigeria.

PARTICIPANTS

Eighteen PHC workers and 305 PHC facilities.

METHOD

Hypertension service availability and readiness were assessed in PHCs across Nigeria using a pro forma adapted from the WHO Service Readiness and Assessment tool. Eighteen workers in the PHCs were subsequently interviewed for in-depth exploration of hypertension service availability and readiness.

FINDINGS

Among the 305 health facilities assessed, 96 (31.5%) were in urban, 94 (30.8%) in semiurban and 115 (37.7%) in rural local government areas. Majority of the health facilities (43.0%) were manned by community extension workers. Only 1.6% and 19.7% of the health facilities had physicians and pharmacy technicians, respectively. About 22.3% of the providers had training in hypertension in the last 1 year. All the PHCs lacked adequate supply of essential antihypertensive medications. The identified deficiencies were less common in the urban PHCs compared with others. Qualitative analysis showed that the personnel, essential facilities and medicines required to provide hypertension services in the PHCs were inadequate. Suggested recommendations to successfully provide these services were provision of performance-based incentives; adequate staffing and training; supportive supervision of staff; provision of adequate equipment and essential medicines for hypertension management; provision of conducive environment for clients; and community engagement and participation.

CONCLUSION

Majority of the PHCs are currently not adequately equipped to provide hypertension services. Addressing identified gaps and using suggestions provided will guarantee successful provision of effective services.

Systematic review of the relationship between burn-out and spiritual health in doctors

OBJECTIVE

To investigate the relationship between burn-out and spiritual health among medical doctors.

DESIGN

Systematic literature review and narrative synthesis of cross-sectional studies.

SETTING

Any setting, worldwide.

DATA SOURCES

Five databases were searched from inception to March 2022, including Medline, Embase, PsycINFO, Scopus and Web of Science.

ELIGIBILITY CRITERIA

Any study design that involved medical doctors (and other healthcare staff if assessed alongside medical doctors), that measured (in any way) both burn-out (or similar) and spiritual health (or similar) medical doctors.

DATA EXTRACTION AND SYNTHESIS

All records were double screened. Data extraction was performed by one reviewer and a proportion (10%) checked by a second reviewer. Quality was assessed using the Appraisal of Cross-sectional Studies tool. Due to the heterogeneity of the included studies, a narrative review was undertaken without a meta-analysis.

RESULTS

Searches yielded 1049 studies. 40 studies met eligibility criteria and were included in this review. Low reported levels of spirituality were associated with high burn-out scores and vice versa. Religion was not significantly associated with lower levels of burn-out. Few studies reported statistically significant findings, few used validated spiritual scores and most were vulnerable to sampling bias.

CONCLUSIONS

Published research suggests that burn-out is linked to spiritual health in medical doctors but not to religion. Robust research is needed to confirm these findings and develop effective interventions.

PROSPERO REGISTRATION NUMBER

CRD42020200145.

Psychological capital and perceived supervisor social support as mediating roles between role stress and work engagement among Chinese clinical nursing teachers: a cross-sectional study

OBJECTIVE

This study aimed to investigate the work engagement of clinical nursing teachers and examine whether psychological capital and perceived supervisor social support mediates the association between role stress and work engagement among clinical nursing teachers.

DESIGN

A cross-sectional study design was used.

SETTING

This study was conducted in five tertiary hospitals affiliated with medical universities in Shandong Province, China.

PARTICIPANTS

A total of 412 clinical nursing teachers were recruited out of which 406 completed the questionnaires effectively.

METHODS

Questionnaires were administered offline and the items consisted of social demographic characteristics, scale related to role stress, psychological capital, perceived supervisor social support and work engagement. T-tests, one-way analysis of variance and Pearson's correlation analysis were conducted using SPSS, and mediation analysis was performed using structural equation modelling.

RESULTS

The work engagement scores of clinical nursing teachers were high, with an average score of 4.76±0.69. Structural equation modelling showed a good fit of the data to the hypothesised model. Role stress did not directly affect work engagement (β=0.057, p>0.001). However, a strong indirect effect of role stress on work engagement (β=-0.373, p<0.001) mediated by psychological capital and perceived supervisor social support was observed, with path coefficient of -0.319 (p<0.01) and -0.054 (p<0.01), respectively. The model explains 57% of the variance in work engagement.

CONCLUSION

Psychological capital and perceived supervisor social support fully mediated the relationship between role stress and work engagement among clinical nursing teachers. Thus, to promote the work engagement of clinical nursing teachers, their psychological capital needs to be improved. Furthermore, superiors should provide more support, particularly to clinical nursing teachers experiencing high role stress.

Using the integration of human resource management strategies at district level to improve workforce performance: analysis of workplan designs in three African countries

BACKGROUND

There is a worldwide shortage of health workers against WHO recommended staffing levels to achieve Universal Health Coverage. To improve the performance of the existing health workforce a set of integrated human resources (HR) strategies are needed to address the root causes of these shortages. The PERFORM2Scale project uses an action research approach to support district level management teams to develop appropriate workplans to address service delivery and workforce-related problems using a set of integrated human resources strategies. This paper provides evidence of the feasibility of supporting managers at district level to design appropriate integrated workplans to address these problems.

METHODS

The study used content analysis of documents including problem trees and 43 workplans developed by 28 district health management teams (DHMT) across three countries between 2018 and 2021 to identify how appropriate basic planning principles and the use of integrated human resource and health systems strategies were used in the design of the workplans developed. Four categories of HR strategies were used for the analysis (availability, direction, competencies, rewards and sanctions) and the relationship between HR and wider health systems strategies was also examined.

RESULTS

About half (49%) of the DHMTs selected service-delivery problems while others selected workforce performance (46%) or general management (5%) problems, yet all workplans addressed health workforce-related causes through integrated workplans. Most DHMTs used a combination of strategies for improving direction and competencies. The use of strategies to improve availability and the use of rewards and sanctions was more common amongst DHMTs in Ghana; this may be related to availability of decision-space in these areas. Other planning considerations such as link between problem and strategy, inclusion of gender and use of indicators were evident in the design of the workplans.

CONCLUSIONS

The study has demonstrated that, with appropriate support using an action research approach, DHMTs are able to design workplans which include integrated HR strategies. This process will help districts to address workforce and other service delivery problems as well as improving 'health workforce literacy' of DHMT members which will benefit the country more broadly if and when any of the team members is promoted.

Measuring and improving performance of clinicians: an application of patient-based records

BACKGOUND

Efforts to measure performance and identify its driving factors among clinicians are needed for building a high-quality clinician workforce. The availability of data is the most challenging thing. This paper presented a summary performance measure for clinicians and its application on examining factors that influence performance using routine patient-based records.

METHODS

Perfomance indicators and difficulty score were extracted from electronic medical records (EMRs). Difficulty adjustment and standardized processing were used to obtain indicators which were comparable between specialties. Principal component analysis (PCA) was used to estimate the summary performance measure. The performance measure was then used to examine the influence of person-job fit and burnout through a mediator effect model and cluster analysis.

RESULTS

A valid sample of 404 clinicians were included in this study, and 244 of them had valid response in the questionnaire. PCA explained 79.37% of the total variance presented by the four adjusted performance indicators. Non-performance attributes and performance driving factors help distinguish different clusters of clinicians. Burnout mediates the relationship between person-job fit and performance in a specific group of clinicians (β = 0.120, p = 0.008).

CONCLUSIONS

We demonstrated the analytical steps to estimate clinicians' performance and its practical application using EMRs. Our findings provide insight into personnel classified management. Such practice can be applied in countries where electronic medical record systems are relatively less developed to continuously improve the application of performance management.

Capacity building of district health management teams in the era of provincial health administration reform in the Democratic Republic of Congo: a realist evaluation protocol

INTRODUCTION

In 2006, the Congolese Ministry of Health developed a health system strengthening strategy focusing on health district development. This strategy called for reforming the provincial health administration in order to better support the health district development through leadership and management capacity building of district health management teams. The implementation is currently underway, yet, more evidence on how, for whom and under what conditions this capacity building works is needed. The proposed research aims to address this gap using a realist evaluation approach.

METHODS AND ANALYSIS

We will follow the cycle of the realist evaluation. First, we will elicit the initial programme theory through a scoping review (completed in December 2022, using MEDLINE, Health Systems Evidence, Wiley Online Library, Cochrane Library, Google Scholar and grey literature), a review of health policy documents (completed in March 2023), and interviews with key stakeholders (by June 2023). Second, we will empirically test the initial programme theory using a multiple-embedded case study design in two provincial health administrations and four health districts (by March 2024). Data will be collected through document reviews, in-depth interviews, non-participant observations, a questionnaire, routine data from the health information management system and a context mapping tool. We will analyse data using the Intervention-Context-Actor-Mechanism-Outcome configuration heuristic. Last, we will refine the initial programme theory based on the results of the empirical studies and develop recommendations for policymakers (by June 2024).

ETHICS AND DISSEMINATION

The Institutional Review Board of the Institute of Tropical Medicine and the Medical Ethics Committee of the University of Lubumbashi approved this study. We will also seek approvals from provincial-level and district-level health authorities before data collection in their jurisdictions. We will disseminate the study findings through the publication of articles in peer-reviewed academic journals, policy briefs for national policymakers and presentations at national and international conferences.

The role of mean item ratings, topic distance, direct leadership, and voice climate in action planning after employee surveys

This study contributes to the literature on employee surveys as a tool for organizational development and, specifically, the post-survey action planning process by examining key variables that affect this process. Using data from one large company in Germany, this study investigates team-level action planning in three consecutive years of 5,875 organizational units [OUs] in 2016, 5,673 OUs in 2017, and 5,707 OUs in 2018. Ratings per item on the employee survey and topic distance, which refers to the extent to which a survey topic can be addressed within the boundaries of the OU, predicted choice of topics for action planning. Furthermore, direct leadership and voice climate did not predict whether OUs conducted action planning. However, consistent with hypotheses, results showed that direct leadership and voice climate were associated with significantly less action planning in comparison to other topics of the employee survey. Direct leaders and OU members that experience shortcomings in direct leadership or voice climate need to improve on these topics. However, at the same time, these deficits could hinder leaders and members in planning actions in general and for these specific topics, as they represent important requirements for conducting effective action planning in the first place. This creates an organizational paradox. Based on the findings, it is recommend that organizations take topic distance into account when designing questionnaires that entail action planning expectations and consider offering additional resources and support to OUs and direct leaders to enable effective action planning.

Regional disparity in the provision of rehabilitation services using the open data from the Japanese national claims database: an ecological study

OBJECTIVES

There are few reports on regional differences in the supply/utilisation balance and provision of rehabilitation services. This study analysed those regional differences in Japan to help policymakers provide more uniform and efficient rehabilitation services and optimally allocate related resources.

DESIGN

An ecological study.

SETTING

47 prefectures and 9 regions in Japan in 2017.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary measures were 'supply/utilisation (S/U) ratio', calculated by dividing rehabilitation supply converted to service units, by rehabilitation utilisation and 'utilisation/expected utilisation (U/EU) ratio', calculated by dividing utilisation by EU. The EU was defined as utilisation expected from the demography in each area. Data required to calculate these indicators were collected from open sources such as the National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data Japan.

RESULTS

The S/U ratios were higher in Shikoku, Kyusyu, Tohoku and Hokuriku regions, and lower in Kanto and Tokai regions. The number of rehabilitation providers per population was higher mostly in the western part of Japan and lower mostly in the eastern part. The U/EU ratios were also higher mostly in the western part, and lower mostly in the eastern part such as Tohoku and Hokuriku regions. The same trend was seen for cerebrovascular disease and musculoskeletal disorder rehabilitation, which accounted for approximately 84% of rehabilitation services. For disuse syndrome rehabilitation, such a trend did not exist, and the U/EU ratio differed by prefectures.

CONCLUSIONS

The large surplus in rehabilitation supply in the western part was attributed to the greater number of providers, while the smaller surplus in Kanto and Tokai regions was due to the smaller amount of supply. The number of rehabilitation services used was lesser in the eastern part such as Tohoku and Hokuriku regions, indicating regional differences in the provision of rehabilitation services.

Perceived organisational support and work engagement among health sector workers during the COVID-19 pandemic: a multicentre, time-lagged, cross-sectional study among clinical hospital staff in Pakistan

OBJECTIVE

Workplace engagement is associated with several significant positive organisational outcomes. The COVID-19 pandemic has emphasised the importance of workplace engagement, particularly for front-line healthcare workers. Drawing on the conservation of resources theory, this study examines the impact of personal and job resources in a workplace that help in resource conservation for work engagement. In view of the high burnout rates reported among health professionals during the COVID-19 pandemic, this study aims to investigate the impact of perceived organisational support (POS) on work engagement through the mediating effect of well-being and the moderating role of employees' resilience.

DESIGN

Time-lagged, cross-sectional, split questionnaire-based survey study.

SETTING

Data were gathered from 68 hospitals in Pakistan, of which 45 were public and 23 were private hospitals.

PARTICIPANTS AND ANALYSIS

Simple random sampling techniques were used and data were collected from 345 healthcare professionals (ie, doctors, nurses and allied health professionals) using split questionnaires, in two waves with a 3-week interval, with a response rate of 80%. For analysis of data, the study used the PROCESS macro by Hayes.

RESULTS

Engagement at work was positively correlated with POS, well-being and resilience. POS significantly predicted work engagement through well-being (β=0.06, SE=0.02, 95% bias-corrected CI 0.021, 0.10). Further analysis of the strong effect of resilience on subjective well-being shows the significant value of the mediated moderation index (β=0.06, SE=0.02, 95% bias-corrected CI 0.03, 0.11).

CONCLUSION

The findings suggest that well-being may be an important pathway through which healthcare workers' POS may influence work engagement, particularly when their resilience capability is high. To maintain engagement at the workplace, hospital administrators should consider strengthening organisational and individual resources that build a supportive environment to meet the demands of challenging times.

Use of locum doctors in NHS trusts in England: analysis of routinely collected workforce data 2019-2021

OBJECTIVES

Temporary doctors, known as locum doctors, play an important role in the delivery of care in the National Health Service (NHS); however, little is known about the extent of locum use in NHS trusts. This study aimed to quantify and describe locum use for all NHS trusts in England in 2019-2021.

SETTING

Descriptive analyses of data on locum shifts from all NHS trusts in England in 2019-2021. Weekly data were available for the number of shifts filled by agency and bank staff and the number of shifts requested by each trust. Negative binomial models were used to investigate the association between the proportion of medical staffing provided by locums and NHS trust characteristics.

RESULTS

In 2019, on average 4.4% of total medical staffing was provided by locums, but this varied substantially across trusts (25th-75th centile=2.2%-6.2%). Over time, on average two-thirds of locum shifts were filled by locum agencies and a third by trusts' staff banks. On average, 11.3% of shifts requested were left unfilled. In 2019-2021, the mean number of weekly shifts per trust increased by 19% (175.2-208.6) and the mean number of weekly unfilled shifts per trust increased by 54% (32.7 to 50.4). Trusts rated by the Care Quality Commission (CQC) as inadequate or requiring improvement (incidence rate ratio=1.495; 95% CI 1.191 to 1.877), and smaller trusts had a higher use of locums. Large variability was observed across regions for use of locums, proportion of shifts filled by locum agencies and unfilled shifts.

CONCLUSIONS

There were large variations in the demand for and use of locum doctors in NHS trusts. Trusts with poor CQC ratings and smaller trusts appear to use locum doctors more intensively compared with other trust types. Unfilled shifts were at a 3-year high at the end of 2021 suggesting increased demand which may result from growing workforce shortages in NHS trusts.

Turnover intention among healthcare workers in Ethiopia: a systematic review and meta-analysis

OBJECTIVE

To determine the pooled prevalence of turnover intention among healthcare workers in Ethiopia.

DESIGN

A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline.

DATA SOURCES

Electronic databases of Science Direct, Medline, African Journals Online, Excerpta Medica Database, Scopus and Google Scholar were searched to identify studies published in the English language before 31 December, 2021.

ELIGIBILITY CRITERIA

Studies were included with following criteria: (1) studies conducted or published until 31 December 2021; (2) observational studies; (3) Studies conducted on healthcare workers; (4) reporting turnover intention; (v) studies conducted in Ethiopia and (vi) tudies published in the English language were included.

DATA EXTRACTION AND SYNTHESIS

Three independent reviewers screened all the papers for eligibility criteria. Data were extracted by two independent investigators using a standardised data extraction format. Random effects model meta-analysis using STATA V.14.0 statistical software was conducted to estimate the pooled prevalence of turnover intention with 95% CI. Funnel plot and Forest plot were used to check publication bias and heterogeneity between studies, respectively. Leave-one-out sensitivity analysis was done.

PRIMARY OUTCOME

Prevalence of turnover intention.

RESULT

A total of 29 cross-sectional studies with 9422 participants met the inclusion criteria. The estimated pooled prevalence of turnover intention among healthcare workers in Ethiopia was 58.09% (95% CI 54.24 to 61.93; p value <0.001, I²=93.5%).

CONCLUSION

The finding of this systematic review and meta-analysis showed high prevalence of turnover intention among healthcare workers in Ethiopia. The Government and policy makers should come up with different mechanisms including a wide variety of healthcare workers retention strategies in order to reduce turnover intention of healthcare workers and retain them.

Realist synthesis of factors affecting retention of staff in UK adult mental health services

OBJECTIVES

The shortage of healthcare staff is a global problem. UK mental health services have, on average, a higher turnover of staff than the NHS. Factors affecting retention of this staff group need to be explored in more depth to understand what is working for whom, for what reasons and in what circumstances. This review aims to conduct a realist synthesis to explore evidence from published studies, together with stakeholder involvement to develop programme theories that hypothesise how and why retention occurs in the mental health workforce and identify additional evidence to explore and test these theories thereby highlighting any persistent gaps in understanding. This paper develops programme theories that hypothesise why retention occurs and in what context and tests these theories thereby highlighting any persistent gaps in understanding.

METHODS

Realist synthesis was used to develop programme theories for factors affecting retention of UK mental health staff. This involved: (1) stakeholder consultation and literature scoping to develop initial programme theories; (2) structured searches across six databases to identify 85 included relevant literature relating to the programme theories; and (3) analysis and synthesis to build and refine a final programme theory and logic model.

RESULTS

Phase I combined findings from 32 stakeholders and 24 publications to develop six initial programme theories. Phases II and III identified and synthesised evidence from 88 publications into three overarching programme theories stemming from organisational culture: interconnectedness of workload and quality of care, investment in staff support and development and involvement of staff and service users in policies and practice.

CONCLUSIONS

Organisational culture was found to have a key underpinning effect on retention of mental health staff. This can be modified but staff need to be well supported and feel involved to derive satisfaction from their roles. Manageable workloads and being able to deliver good quality care were also key.

Impact of pausing elective hip and knee replacement surgery during winter 2017 on subsequent service provision at a major NHS Trust: a descriptive observational study using interrupted time series

OBJECTIVES

To explore the impact of a temporary cancellation of elective surgery in winter 2017 on trends in primary hip and knee replacement at a major National Health Service (NHS) Trust, and whether lessons can be learnt about efficient surgery provision.

DESIGN AND SETTING

Observational descriptive study using interrupted time series analysis of hospital records to explore trends in primary hip and knee replacement surgery at a major NHS Trust, as well as patient characteristics, 2016-2019.

INTERVENTION

A temporary cancellation of elective services for 2 months in winter 2017.

OUTCOMES

NHS-funded hospital admissions for primary hip or knee replacement, length of stay and bed occupancy. Additionally, we explored the ratio of elective to emergency admissions at the Trust as a measure of elective capacity, and the ratio of public to private provision of NHS-funded hip and knee surgery.

RESULTS

After winter 2017, there was a sustained reduction in the number of knee replacements, a decrease in the proportion of most deprived people having knee replacements and an increase in average age for knee replacement and comorbidity for both types of surgery. The ratio of public to private provision dropped after winter 2017, and elective capacity generally has reduced over time. There was clear seasonality in provision of elective surgery, with less complex patients admitted during winter.

CONCLUSIONS

Declining elective capacity and seasonality has a marked effect on the provision of joint replacement, despite efficiency improvements in hospital treatment. The Trust has outsourced less complex patients to independent providers, and/or treated them during winter when capacity is most limited. There is a need to explore whether these are strategies that could be used explicitly to maximise the use of limited elective capacity, provide benefit to patients and value for money for taxpayers.

'I never leave my house without praying': a qualitative exploration of the psychospiritual experiences of ethnically diverse healthcare staff during the COVID-19 pandemic

OBJECTIVES

The study aimed to understand the psychospiritual experiences and support needs of ethnically diverse healthcare staff during the COVID-19 pandemic.

DESIGN

A qualitative study using focus groups conducted remotely on Microsoft Teams.

SETTING

The study took place across 10 National Health Service Trusts in England: 5 were Acute Hospital Trusts and 5 were Community and Mental Health Trusts.

PARTICIPANTS

Fifty-five participants were recruited to the study across 16 focus group meetings. Participants were all National Health Service staff from ethnically diverse backgrounds.

RESULTS

Psychospiritual concerns were central to participants' understanding of themselves and their work in the National Health Service. Participants felt there was limited recognition of spirituality within the health service. They described close links between their spirituality and their ethnicities and felt that the psychospiritual support offered within the healthcare setting was not reflective of diverse ethnic and spiritual needs. Improved psychospiritual care was viewed as an opportunity to connect more deeply with other colleagues, rather than using the more individualistic interventions on offer. Participants requested greater compassion and care from leadership teams. Participants described both positive and negative changes in their spirituality as a result of the COVID-19 pandemic.

CONCLUSIONS

Culturally sensitive psychospiritual support is a key aspect of healthcare staff's well-being, despite identified gaps in this area. Aside from affecting physical, psychological, social and financial aspects of healthcare staff's lives, the pandemic has also had a significant impact on the ways that people experience spirituality.

Availability of rehabilitation services for communication disorders in Sri Lanka: a cross-sectional survey

OBJECTIVES

To describe the rehabilitation services available for communication disorders in Sri Lanka and to estimate the adequacy of the services in provinces and districts of the country.

SETTING

The study considered government and private institutions, which provide rehabilitation services for communication disorders in Sri Lanka.

PARTICIPANTS

Institutions providing services of speech-language pathologists, audiologists and audiology technicians in Sri Lanka.

PRIMARY AND SECONDARY OUTCOME MEASURES

We investigated the number of government hospitals and private institutions, which provide speech-language pathology and audiology services in Sri Lanka as the primary outcome measure. A number of speech-language pathologists, audiologists and audiology technicians working in the institutions were obtained from records and institution-based inquiries to identify the adequacy of the services in the country as the secondary outcome measure.

RESULTS

Of the 647 government hospitals that provide free healthcare services in the country, 45 and 33 hospitals had speech and language therapy and audiology units, respectively. Government hospitals do not have audiologists but only have audiology technicians. The number of speech and language therapists and audiology technicians in the government sector per 100 000 population in the country was 0.44 and 0.18, respectively. There were wide variations in specialist to population ratio between districts. 77 private centres provide speech therapy services in 15 out of the 25 districts; 36 private centres provide audiological evaluations in 9 districts.

CONCLUSIONS

The number of specialist speech and language therapists and audiologists is not sufficient to provide adequate rehabilitation services for communications disorder for the Sri Lankan population. Not recruiting audiologists to the government sector affects the management of hearing impairment in the affected.

Soft skills in personnel training: Report of publications in scopus, topics explored and future research agenda

Recent research has documented the interest of organizations in training their staff in soft skills, but few studies have been found. Therefore, the objective of this research was to analyze 753 publications in the Scopus database related to soft skills in staff training during the period 1999-2021. These documents were analyzed to identify the main information, the most explored areas, and a future research agenda; all under a bibliometric and bibliographic approach with the help of RStudio and VOSviewer software. The results showed that the keywords with the most co-occurrence were personnel training (n = 110) and soft skills (n = 79). The year with the most documents was 2021 (n = 121). The country with the most publications was the United Kingdom (n = 199). Medicine is the subject area with the most documents (n = 278) and the Article is the type of document with the most studies (n = 566). Eleven areas of further exploration were identified: "Soft skills in software engineering at the higher education level", "Soft skills and communication", "Soft skills and engineering education", "Soft skills in virtual environments", "Soft skills in machine learning", "Serious games in teaching soft skills", "Soft skills for problem-based learning", "Soft skills for project management", "Soft skills and technical skills", "Project-based learning for the assessment of soft skills" and "Soft leadership skills". Five potential areas for future research were derived: soft skills in collaborative work (CSCL), soft skills in computer-aided collaborative work (CSCW), facial expressions as a mirror of soft skills, soft skills for employability and Professional Development Plan (PDP) to assess soft skills. In conclusion, this Review type document on soft skills in personnel training helped to identify the most studied topics during the evaluated period, as well as to identify the little explored topics for future research.

Global overview of pharmacy support personnel training programmes: a scoping review protocol

INTRODUCTION

A global variation in the pharmacy support personnel training programmes has been observed. The objective of this scoping review is to map out global evidence available on the pharmacy support personnel training programme characteristics, and interface between knowledge, practice and regulatory requirements.

METHODS AND ANALYSIS

The scoping review will be undertaken by two independent reviewers. Peer-reviewed journal articles of any study design and grey literature will be included with no publication time limit. All literature published in English focusing on pharmacy support personnel training programmes, entry-level certification requirements, ongoing professional development and apprenticeship will be included. We will search MEDLINE (EBSCOhost), PubMed, CINAHL (EBSCOhost), Web of Science, Academic Search Complete, (EBSCOhost) and Dissertation and Thesis (ProQuest), ProQuest Dissertation and Thesis Global and Google Scholar, and reference list of all included studies. We will also search grey literature from websites of international professional regulatory bodies and associations. All studies that meet the inclusion criteria will be imported into a reference management package (EndNote V.20) that facilitates study selection, screening and de-duplication. Data will be extracted by two independent reviewers using a jointly developed and piloted data charting form. Data items will include skills, knowledge, competencies, admission criteria, content, duration, qualification options, accreditation status, delivery models and approaches. Data extracted from the included studies will be collated, and quantitative results presented using descriptive statistics such as percentages, tables, charts and flow diagrams as appropriate. A narrative account of findings from the literature will be presented following qualitative content analysis of the extracted information using NVivo V.12. Quality appraisal of included studies will not be assessed as the purpose of the scoping review is to give a descriptive global overview of the pharmacy support personnel training programmes, and evidence will also be sourced from grey literature.

ETHICS AND DISSEMINATION

No ethical approval is needed for this study as it does not include animals or human participants. The study findings will be disseminated electronically and in print with presentations done at relevant platforms, that is, in peer-reviewed journals, in print and in conferences.

REGISTRATION

Open Science Framework (ofs.i0/r2cdn; registration DOI: https://doi.org/10.17605/OSF.IO/F95MH; internet archive link: https://archive.org/details/osf-registrations-f95mh-v1; registration type: OSF-Standard Pre-Data Collection Registration).

Mental health of healthcare professionals during the ongoing COVID-19 pandemic: a comparative investigation from the first and second pandemic years

Healthcare staff have been facing particular mental health challenges during the COVID-19-pandemic. Building on a first study at the beginning of the pandemic in March 2020, we aimed to investigate among healthcare professionals in Germany and Austria (1) how mental health may have changed in professionals over the course of the ongoing pandemic, (2) whether there are differences between different professional groups regarding mental health, (3) which stress factors may explain these mental health outcomes and (4) whether help-seeking behaviour is related to caretaker self-image or team climate. Between March and June 2021, N=639 healthcare professionals completed an online survey including the ICD-10 Symptom Rating checklist, event-sampling questions on pandemic-related stressors and self-formulated questions on help-seeking behaviour and team climate. Findings were analysed using t-tests, regressions and comparisons to a sample of healthcare professionals assessed in 2020 as well as to norm samples. Results show that mental health symptoms, particularly for depression and anxiety, persist among healthcare staff in the second pandemic year, that symptom prevalence rates are higher among nursing staff compared with physicians and paramedics and that team climate is associated with mental health outcomes. Implications of these findings in relation to the persisting pandemic and its aftermath are discussed.

Eliciting primary healthcare physicians' preferences for job characteristics in rural China: a discrete choice experiment

INTRODUCTION

The outflow and scarcity of physicians in rural areas can adversely affect universal health coverage and population health outcomes, which are critical concerns in China. This study explored primary healthcare physicians' job preferences using a discrete choice experiment to identify appropriate incentives for retention.

METHODS

Eight job characteristics were identified through a literature review and qualitative studies as the attributes relevant to designing the discrete choice experiment, with levels varying between two hypothetical jobs. The data were analysed using conditional logit model, mixed logit model and latent class model.

RESULTS

A total of 1781 licensed physicians (including licensed assistant physicians) from township health centres in rural areas were surveyed. Policy simulation suggested that they were sensitive to both monetary and non-monetary policy incentives. As for non-monetary job characteristics, a highly intense doctor-patient relationship, bianzhi (the number of personnel allocated to each employer by the government) and educational opportunities were highly valued by the respondents. The latent class model could identify distinct groups with different job preferences according to their memberships.

CONCLUSION

Urban jobs were much preferred to rural ones. However, policy incentives can lend themselves to effective retention strategies. It is also important to tailor policy incentives to different subgroups.

Identifying strategic human resource management ability in the clinical departments of public hospitals in China: a modified Delphi study

OBJECTIVES

Chinese public hospitals are managed like a bureaucracy, which is divided into two levels of hospital and departmental management. Improving strategic human resource management ability (SHRMA) within clinical departments can improve department performance and service quality, which is an important way for public hospitals to obtain an advantage in a diversified competitive medical market. However, there is a lack of specialised evaluation tools for SHRMA in clinical departments to support this effort. Therefore, this study aims to develop an index for evaluating the SHRMA of clinical departments in public hospitals.

STUDY DESIGN AND SETTING

The Delphi technique was carried out with 22 experts, and an evaluation index of the SHRMA in the clinical departments of public hospitals was constructed. The weight of each indicator was calculated by the intuitive fuzzy analytic hierarchy process.

RESULTS

The SHRMA index constructed in this study for the clinical departments in public hospitals includes 5 first-level indicators, 13 second-level indicators and 36 third-level indicators. The first-level indicators are distributed in weight among human resource maintenance (0.204), human resource planning (0.201), human resource development (0.200), human resource stimulation (0.198) and human resource absorption (0.198). The top three weighted indicators on the second level are job analysis and position evaluation (0.105), career management (0.103) and salary incentivisation (0.100).

CONCLUSIONS

The index constructed in this study is scientific and feasible and is expected to provide an effective tool for the quantitative evaluation of SHRMA in the clinical departments of public hospitals in China.

Differential attainment in specialty training recruitment in the UK: an observational analysis of the impact of psychometric testing assessment in Public Health postgraduate selection

OBJECTIVES

To determine how current psychometric testing approaches used in selection of postgraduate training in UK Public Health are associated with socioeconomic and sociocultural background of applicants (including ethnicity).

DESIGN

Observational study using contemporaneous data collected during recruitment and psychometric test scores.

SETTING

Assessment centre of UK national Public Health recruitment for postgraduate Public Health training. The assessment centre element of selection comprises three psychometric assessments: Rust Advanced Numerical Reasoning, Watson-Glaser Critical Thinking Assessment II and Public Health situational judgement test.

PARTICIPANTS

629 applicants completed the assessment centre in 2021. 219 (34.8%) were UK medical graduates, 73 (116%) were international medical graduates and 337 (53.6%) were from backgrounds other than medicine.

MAIN OUTCOME MEASURE

Multivariable-adjusted progression statistics in the form of adjusted OR (aOR), accounting for age, sex, ethnicity, professional background and surrogate measures of familial socioeconomic and sociocultural status.

RESULTS

357 (56.8%) candidates passed all three psychometric tests. Candidate characteristics negatively associated with progression were black ethnicity (aOR 0.19, 0.08 to 0.44), Asian ethnicity (aOR 0.35, 0.16 to 0.71) and coming from a non-UK medical graduate background (aOR 0.05, 0.03 to 0.12); similar differential attainment was observed in each of the psychometric tests. Even within the UK-trained medical cohort, candidates from white British backgrounds were more likely to progress than those from ethnic minorities (89.2% vs 75.0%, p=0.003).

CONCLUSION

Although perceived to mitigate the risks of conscious and unconscious bias in selection to medical postgraduate training, these psychometric tests demonstrate unexplained variation that suggests differential attainment. Other specialties should enhance their data collection to evaluate the impact of differential attainment on current selection processes and take forward opportunities to mitigate differential attainment where possible.

Gender integration and female participation in scientific and health research in Zambia: a descriptive cross-sectional study protocol

INTRODUCTION

Despite the Zambian government making progress on prioritising gender mainstreaming, female participation in science, technology and innovation in academia, research and development is still low. This study aims to determine the integration of gender dimensions and the factors that influence female participation in science and health research in Zambia.

METHODS AND ANALYSIS

We propose a descriptive cross-sectional study design employing in-depth interviews (IDIs) and survey as data collection techniques. Twenty schools offering science-based programmes will be purposively selected from University of Zambia (UNZA), Copperbelt University, Mulungushi University and Kwame Nkrumah University. In addition, two research institutions, Tropical Disease Research Centre and Mount Makulu Agricultural Research Station, will be included. Survey respondents will include a random sample of 1389 academic and research staff from the selected schools. A total of 30 IDIs will be conducted with staff and heads of selected schools and research institutions. Data collection will be conducted over a 12-month period. Before commencement of data collection, in-depth literature search and record review on gender dimensions in science and health research will be conducted to gain insight into the subject matter and inform research instrument design. Survey data and IDIs will be collected using a structured paper-based questionnaire and semistructured interview guide, respectively. Descriptive statistics will be computed to summarise respondents' characteristics. Bivariate analysis (χ² test and independent t-test) and multivariate regression analysis will be conducted to test the association and identify factors influencing female participation in science and health research (adjusted ORs, p<0.05). An inductive approach will be used to analyse qualitative data using NVivo. Survey and IDI will be corroborated.

ETHICS AND DISSEMINATION

This study involves human participants and was approved by UNZA Biomedical Research Ethics Committee (UNZABREC; UNZA BREC 1674-2022). Participants gave informed consent to participate in the study before taking part. Study findings will be disseminated through a written report, stakeholder meetings and publication in a peer-reviewed international journal.

Scoping review protocol examining charge nurse skills: requirement for the development of training

INTRODUCTION

The charge nurse (CN) holds a position in clinical-administrative management and is essential for improving the quality and safety of care in healthcare institutions. The position requires five essential skills: leadership; interpersonal communication; clinical-administrative caring; problem solving; and knowledge and understanding of the work environment. The scientific literature has not widely examined the importance of providing these skills as part of initial training, nor when CNs begin their duties. This study aims to fill this gap through an exhaustive review of the literature with the aim of developing standardised training for the CN when they start in their position.

METHODS AND ANALYSIS

A scoping review using the Joanna Briggs Institute framework will be conducted. The CINAHL, MEDLINE, Science Direct and Cairn, databases as well as grey literature from ProQuest dissertations and thesis global database, Google Scholar and the website of the Order of Nurses of Quebec will be queried using keywords. Relevant literature in French and English, published between 2000 and 2022 will be retained. The CN is the target population. Outcomes address at least one of the five CN skills, describe how they are operationalised and what their impact is on the organisation of work and quality of care. This analysis will identify essential and relevant elements for the development of standardised, up-to-date and appropriate training for the position of CN.

ETHICS AND DISSEMINATION

Ethical approval is not required, as data does not include individual patient data. The results will be published in peer-reviewed journals, presented at conferences and presented to nursing managers and directors.

SCOPING REVIEW REGISTRATION

Research Registry ID: researchregistry7030.

Associations between lean maturity in primary care and musculoskeletal complaints among staff: a longitudinal study

OBJECTIVE

This study had two aims: (1) to determine the prevalence of musculoskeletal complaints among staff in primary care and (2) to determine to what extent lean maturity of the primary care unit can predict musculoskeletal complaints 1 year later.

DESIGN

Descriptive, correlational and longitudinal design.

SETTING

Primary care units in mid-Sweden.

PARTICIPANTS

In 2015, staff members responded to a web survey addressing lean maturity and musculoskeletal complaints. The survey was completed by 481 staff members (response rate 46%) at 48 units; 260 staff members at 46 units also completed the survey in 2016.

OUTCOME MEASURES

Associations with musculoskeletal complaints were determined both for lean maturity in total and for four Lean domains entered separately in a multivariate model, that is, philosophy, processes, people and partners, and problem solving.

RESULTS

The shoulders (12-month prevalence: 58%), neck (54%) and low back (50%) were the most common sites of 12-month retrospective musculoskeletal complaints at baseline. Shoulders, neck and low back also showed the most complaints for the preceding 7 days (37%, 33% and 25%, respectively). The prevalence of complaints was similar at the 1-year follow-up. Total lean maturity in 2015 was not associated with musculoskeletal complaints, neither cross-sectionally nor 1 year later, for shoulders (1 year β: -0.002, 95% CI -0.03 to 0.02), neck (β: 0.006, 95% CI -0.01 to 0.03), low back (β: 0.004, 95% CI -0.02 to 0.03) and upper back (β: 0.002, 95% CI -0.02 to 0.02).

CONCLUSION

The prevalence of musculoskeletal complaints among primary care staff was high and did not change within a year. The extent of lean maturity at the care unit was not associated with complaints among staff, neither in cross-sectional analyses nor in a 1-year predictive analysis.

Determining the key performance indicators of human resource management of military hospital managers; a TOPSIS study

BACKGROUND

Proper human resource management in military health centers leads to long-term development and improved health-care quality. As a result, the purpose of this research is to identify the key performance indicators of human resource management for military hospital managers, and the unique indicators of military hospitals were obtained.

METHODS

This cross-sectional study was performed by the TOPSIS method in the fall of 2021. This study used a checklist consisting of 20 performance indicators of human resource management, which were scored by 20 senior military hospital managers based on two criteria: "importance" and "measurability in military hospitals". The Shannon entropy method was used to weight the indicators, and the BT-TOPSIS Solver software was used to analyze and prioritize them.

RESULTS

Among the 20 indicators in human resource management, the staff satisfaction index in military hospitals, the competitiveness rate of salaries in military hospitals relative to the national sector, the number of permanent staff in military hospitals, and the percentage of contract labor costs in military hospitals have the highest coefficient, respectively.

CONCLUSIONS

The importance of human resource management and organizational performance is due to their influence on each other. As a result, human resource management should pay special attention to the professional and personal development of human resources, as this has an impact on the performance of the organization in the long run. In light of the sensitive nature of human resource management and its crucial role in achieving any organization's strategic goals, selecting appropriate indicators is essential. The Department of Military Health requires indicators unique to the military sector to assess the human resource management of the military hospital, since according to the existing circumstances, the indicators of the military sector and those of the civilian sector are different.

Proactive career management for female health professionals: a scoping review protocol

INTRODUCTION

Many women in frontline healthcare positions face work demands that are incompatible with their needs and aspirations, resulting in poorer work satisfaction and engagement, and greater probability of leaving their jobs. Proactive career management is associated with elevated well-being and career success but may not be accessible to female health professionals who encounter social, cultural and structural barriers. The complex and diverse nature of proactive career management and absence of a comprehensive review on the topic necessitates a synthesis of extant literature. This study aims to identify (i) proactive career management behaviours and activities among female health professionals and (ii) outcomes of proactive career management initiatives. This study will contribute to a larger study on encouraging proactive career management behaviours among Singapore female health professionals.

METHODS AND ANALYSES

Scoping review is used as our method of evidence synthesis to provide a comprehensive overview of all available constructs and markers of interest. This study started in January 2022. Original research, reviews, short reports, letters, methodologies and case studies relevant to our objectives will be examined with guidance from Arksey and O'Malley's framework. The literature contained in scientific databases and grey literature sources will be thoroughly searched. Two independent reviewers will screen citations for eligibility and extract data from the included articles. Extracted data will be narratively synthesised by two independent reviewers using Braun and Clarke's six steps of thematic analysis. We will observe the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews standards in reporting the results. An advisory panel will provide insights on the applicability of the results to negate confirmation bias.

ETHICS AND DISSEMINATION

Ethics clearance is not required. Dissemination plans include peer-reviewed journal publication and conference presentations.

REGISTRATION DETAILS

This review was registered on open science framework (Registration DOI: https://doi.org/10.17605/OSF.IO/2SY8V).

A mixed-methods evaluation of unconscious racial bias training for NHS senior practitioners to improve the experiences of racially minoritised students

OBJECTIVE

The degree awarding gap indicates that racially minoritised higher education students receive lower degree classifications relative to their white peers. While the reasons for this are complex, research suggests that educator and practitioner attitudes and behaviour towards racially minoritised students are a significant contributing factor. This preregistered study evaluates the effectiveness of unconscious racial bias training (URBT) to enhance National Health Service senior practitioner's recognition of how racial inequalities negatively impact racially minoritised students.

DESIGN

A mixed-methods study with a pretest and post-test design was conducted in the higher education and healthcare practice environment.

METHODS

Forty-nine NHS senior practitioners completed a 4-hour URBT workshop with activities focusing on activating stereotypes, exploring differences between unconscious and implicit bias, discussing the development of bias, and reflecting on student experiences of prejudice, harassment and discrimination. They completed pre- and post- quantitative measures that assessed the effectiveness of URBT and changes in racial competency, awareness and perceptions of unconscious racial bias. Qualitative measures explored the usefulness and perceived applications of URBT, and a 1-month follow-up assessed further how it had been applied within practice.

RESULTS

Participants reported positive evaluations of URBT, higher perceived racial competency, awareness and perceptions of racial bias (ps<0.001, dz>0.35). After 1 month, key themes from qualitative responses suggested that participants had increased self-awareness and were exploring how to set up mentoring and working groups, change recruitment and progression processes, and diversify the taught curriculum.

CONCLUSIONS

URBT may be one effective strategy to enhance awareness and encourage reflections of racial bias. We discuss how reducing racial inequalities requires a multifaceted approach that affords upfront conversations about systemic racism, implements effective initiatives, policies and procedures, and engages in continuous evaluation.

Remote work and the COVID-19 pandemic: An artificial intelligence-based topic modeling and a future agenda

As remote work has become more common than ever throughout the COVID-19 pandemic, it has drawn special attention from scholars. However, the outcome has been significantly sporadic and fragmented. In our systematic review, we use artificial intelligence-based machine learning tools to examine the relevant extant literature in terms of its dominant topics, diversity, and dynamics. Our results identify-eight research themes: (1) Effect on employees at a personal level, (2) Effect on employees' careers, (3) Family life and gender roles, (4) Health, well-being, and safety, (5) Labor market dynamics, (6) Economic implications, (7) Remote work management, (8) Organizational remote work strategies. With further content analysis, we structure the sporadic research into three overarching categories. Finally, for each category, we offer a detailed agenda for further research.