What are the motivating and hindering factors for health professionals to undertake new roles in hospitals? : A study among physicians, nurses and managers looking at Breast Cancer and Acute Myocardial Infarction care in nine countries

We thank all those who supported and guided this work both within the MUNROS research project team and external partners and advisory board members. In particular, we acknowledge and highly appreciate the valuable support provided by Christine Bond, and Robert Elliott, the MUNROS Co-Principal Investigators. We acknowledge group authorship of the MUNROS collaboration group and thank all MUNROS researchers and project partners for their constructive collaboration during the research. Funding This work was supported by the European Union under the European Community’s Seventh Framework Programme (FP7 HEALTH-2012-INNOVATION-1) [grant agreement number HEALTH-F3-2012-305467EC, 2012].Peer reviewedPostprin

New professional roles and patient satisfaction : evidence from a European survey along three clinical pathways

Project is funded by the European Commission, Grant Agreement no: 305467.Peer reviewedPostprin

Autoimmunity and immunodeficiency associated with monoallelic LIG4 mutations via haploinsufficiency

BACKGROUND: Biallelic mutations in LIG4 encoding DNA-ligase 4 cause a rare immunodeficiency syndrome manifesting as infant-onset life-threatening and/or opportunistic infections, skeletal malformations, radiosensitivity and neoplasia. LIG4 is pivotal during DNA repair and during V(D)J recombination as it performs the final DNA-break sealing step. OBJECTIVE: We explored whether monoallelic LIG4 missense mutations may underlie immunodeficiency and autoimmunity with autosomal dominant inheritance. METHODS: Extensive flow-cytometric immune-phenotyping was performed. Rare variants of immune system genes were analyzed by whole exome sequencing. DNA repair functionality and T cell-intrinsic DNA damage tolerance was tested with an ensemble of in vitro and in silico tools. Antigen-receptor diversity and autoimmune features were characterized by high-throughput sequencing and autoantibody arrays. Reconstitution of wild-type vs. mutant LIG4 were performed in LIG4 knock-out Jurkat T cells and DNA damage tolerance was subsequently assessed. RESULTS: A novel heterozygous LIG4 loss-of-function mutation (p.R580Q), associated with a dominantly inherited familial immune-dysregulation consisting of autoimmune cytopenias, and in the index patient with lymphoproliferation, agammaglobulinemia and adaptive immune cell infiltration into nonlymphoid organs. Immunophenotyping revealed reduced naïve CD4$^{+}$ T cells and low TCR-Vα7.2$^{+}$ T cells, while T/B-cell receptor repertoires showed only mild alterations. Cohort screening identified two other non-related patients with the monoallelic LIG4 mutation p.A842D recapitulating clinical and immune-phenotypic dysregulations observed in the index family and displaying T cell-intrinsic DNA damage intolerance. Reconstitution experiments and molecular dynamics simulations categorize both missense mutations as loss-of-function and haploinsufficient. CONCLUSION: We provide evidence that certain monoallelic LIG4 mutations may cause human immune dysregulation via haploinsufficiency

Čínské chování v Mezinárodní organizaci práce - status quo nebo revizionistický aktér?

What is Chinese behaviour like in the International Labour Organization (ILO) - is China a Status Quo or a Revisionist Actor? Despite the prominence of the issue of China's rise in international relations studies, little research has been published on China's behaviour in international organizations in other realms than the economic. This thesis, therefore, seeks the answer to the posed question. Chinese statements are examined concerning forced and child labour, as well as other distinct themes, their structure and a potential underlying strategy. The findings are retrieved from an analysis of Chinese statements in sittings of ILO organs and checked against information provided in ILO reports to detect discrepancies. A major finding is that the overall behaviour of China in the ILO can categorized as reform-minded status quo, even though there are some factors which could be interpreted as revisionist tendencies. Due to this categorization, a continued peaceful rise of China is considered to be possible.Katedra mezinárodních vztahůDepartment of International RelationsFaculty of Social SciencesFakulta sociálních vě

Chinese Behaviour in the International Labour Organization- status quo or revisionist actor?

What is Chinese behaviour like in the International Labour Organization (ILO) - is China a Status Quo or a Revisionist Actor? Despite the prominence of the issue of China's rise in international relations studies, little research has been published on China's behaviour in international organizations in other realms than the economic. This thesis, therefore, seeks the answer to the posed question. Chinese statements are examined concerning forced and child labour, as well as other distinct themes, their structure and a potential underlying strategy. The findings are retrieved from an analysis of Chinese statements in sittings of ILO organs and checked against information provided in ILO reports to detect discrepancies. A major finding is that the overall behaviour of China in the ILO can categorized as reform-minded status quo, even though there are some factors which could be interpreted as revisionist tendencies. Due to this categorization, a continued peaceful rise of China is considered to be possible

Germany's health workforce responses to Covid‐19

Köppen J, Hartl K, Maier CB. Health workforce response to Covid‐19: What pandemic preparedness planning and action at the federal and state levels in Germany? The International Journal of Health Planning and Management. 2021;36(S1):71-91.Introduction: The Covid‐19 pandemichas required countries to prepare their health workforce for a rapid increase of patients. This research aims to analyse the planning and health workforce policies in Germany, a country with a largely decentralised workforce governance mechanism. Methods: Systematic search between 18 and 31 May 2020 at federal and 16 states on health workforceaction andplanning (websitesof ministriesof health, public healthauthorities),including pandemicpreparednessplans andpolicies. The search followed World Health Organisation(WHO) Europe's health workforceguidance on Covid‐19. Content analysis was performed,informed by the themes of WHO. Results: The pandemic preparedness plans consisted of no or limited informationon how to expand and prepare the health workforce during pandemics. The 16 states varied considerably regarding implementing strategies to expand health workforce capacities. Only one state adopted apolicyontask‐shifting despite a federal law on task‐shifting during pandemics. Conclusions: Planning on the health workforce, its capacity and skill‐mix during pandemics was limited in the pandemic

Task shifting between physicians and nurses in acute care hospitals: cross-sectional study in nine countries

Maier CB, Köppen J, Busse R. Task shifting between physicians and nurses in acute care hospitals: cross-sectional study in nine countries. Human Resources for Health. 2018;16(1): 24.Background: Countries vary in the extent to which reforms have been implemented expanding nurses’ Scopes-of- Practice (SoP). There is limited cross-country research if and how reforms affect clinical practice, particularly in hospitals. This study analyses health professionals’ perceptions of role change and of task shifting between the medical and nursing professions in nine European countries. Methods: Cross-sectional design with surveys completed by 1716 health professionals treating patients with breast cancer (BC) and acute myocardial infarction (AMI) in 161 hospitals across nine countries. Descriptive and bivariate analysis on self-reported staff role changes and levels of independence (with/without physician oversight) by two country groups, with major SoP reforms implemented between 2010 and 2015 (Netherlands, England, Scotland) and without (Czech Republic, Germany, Italy, Norway, Poland, Turkey). Participation in ‘medical tasks’ was identified using two methods, a data-driven and a conceptual approach. Individual task-related analyses were performed for the medical and nursing professions, and Advanced Practice Nurses/Specialist Nurses (APN/SN). Results: Health professionals from the Netherlands, England and Scotland more frequently reported changes to staff roles over this time period vs. the other six countries (BC 74.0% vs. 38.7%, p < .001; AMI 61.7% vs. 37.3%, p < .001), and higher independence in new roles (BC 58.6% vs. 24.0%, p < .001; AMI 48.9% vs. 29.2%, p < .001). A higher proportion of nurses and APN/SN from these three countries reported to undertake tasks related to BC diagnosis, therapy, prescribing of medicines and information to patients compared to the six countries. Similar cross-country differences existed for AMI on prescribing medications and follow-up care. Tasks related to diagnosis and therapy, however, remained largely within the medical profession’s domain. Most tasks were reported to be performed by both professions rather than carried out by one profession only. Conclusions: Higher levels of changes to staff roles and task shifting were reported in the Netherlands, England and Scotland, suggesting that professional boundaries have shifted, for instance on chemotherapy or prescribing medicines. For most tasks, however, a partial instead of full task shifting is practice

Integrating the Population Perspective into Health System Performance Assessment (IPHA): Study Protocol for a Cross-Sectional Study in Germany Linking Survey and Claims Data of Statutorily and Privately Insured

Background: Health system performance assessment (HSPA) is a major tool for evidence-based governance in health systems and patient/population-orientation is increasingly considered as an important aspect. The IPHA study aims (1) to undertake a comprehensive performance assessment of the German health system from a population perspective based on the intermediate and final dimensions defined by the World Health Organization (WHO) and (2) to identify differences in HSPA between (a) common user characteristics and (b) user types, which differ in their interactions and patterns of action within the health system.Methods and Analysis: A cross-sectional survey was conducted between October and December 2018 with statutorily and privately health insured to assess the German health system from a population perspective related to the past 12 months. The random sample consists of 32 000 persons insured by AOK Nordost and 20 000 persons insured by Debeka. Data from the survey will subsequently be linked with health insurance claims data at the individual level for each respondent who has given consent for data linkage. Claims data covers the time period January 1, 2017 to June 30, 2018. The combination of the 2 data sources allows to identify associations between insured patient characteristics and differences in the assessment of health system performance. The survey consists of 71 items measuring all final and intermediate health system goals defined by the WHO and user characteristics like health literacy, self-efficacy, the attention an individual pays to his or her health or disease, the personal network, autonomy, compliance and sociodemographics. The claims data contains information on morbidity, care delivery, service utilization, (co)payments and sociodemography.Discussion: The study represents a promising attempt to perform a holistic HSPA using a population perspective. For this purpose, a questionnaire was designed that contains both validated and new items in order to collect data on all relevant health system dimensions. In particular, linking survey data on HSPA with claims data is of high potential for assessing and analysing determinants of health system performance from the population perspective

Skill-mix, Rationierung und Qualität in der Pflege: Forschungsstand international und Situation in Deutschland mit Schwerpunkt Onkologie

Maier CB, Köppen J, Nägele M, Strohbücker B. Skill-mix, Rationierung und Qualität in der Pflege: Forschungsstand international und Situation in Deutschland mit Schwerpunkt Onkologie . Pflege &amp; Gesellschaft . 2019;(5):312-330

Transformational nurse leadership attributes in German hospitals pursuing organization-wide change via Magnet® or Pathway® principles: results from a qualitative study

Abstract Background Budget constraints, staff shortages and high workloads pose challenges for German hospitals. Magnet® and Pathway® are concepts for implementing organization-wide change and redesigning work environments. There is limited research on the key elements that characterize nurse leaders driving the implementation of Magnet®/Pathway® principles outside the U.S. We explored the key attributes of nurse leaders driving organization-wide change through Magnet®/Pathway® principles in German hospitals. Methods Using a qualitative study design, semi-structured interviews (n = 18) were conducted with nurse leaders, managers, and clinicians, in five German hospitals known as having started implementing Magnet® or Pathway® principles. The interviews were recorded and transcribed verbatim. Data were analyzed in Atlas.ti using content analysis. For the analysis, a category system was created using a deductive-inductive approach. Results Five leadership attributes and eleven sub-attributes were identified as main themes and sub-themes: Visionary leaders who possess and communicate a strong vision and serve as role models to inspire change. Strategic leaders who focus on strategic planning and securing top management support. Supportive leaders who empower, emphasizing employee motivation, individualized support, and team collaboration. Stamina highlights courage, assertiveness, and resilience in the face of challenges. Finally, agility which addresses a leader’s presence, accessibility, and rapid responsiveness, fostering adaptability. Conclusions The study demonstrates leadership attributes explicitly focusing on instigating and driving organization-wide change through Magnet®/Pathway® principles in five German hospitals. The findings suggest a need for comprehensive preparation and ongoing development of nurse leaders aimed at establishing and sustaining a positive hospital work environment