A systematic approach in developing management workforce readiness for digital health transformation in healthcare

Background: The COVID-19 pandemic has sped up digital health transformation across the health sectors to enable innovative health service delivery. Such transformation relies on com-petent managers with the capacity to lead and manage. However, the health system has not adopted a holistic approach in addressing the health management workforce development needs, with many hurdles to overcome. The objectives of this paper are to present the findings of a three-step approach in understanding the current hurdles in developing a health management workforce that can enable and maximize the benefits of digital health transformation, and to explore ways of overcoming such hurdles. Methods: A three-step, systematic approach was undertaken, including an Australian dig-ital health policy documentary analysis, an Australian health service management postgraduate program analysis, and a scoping review of international literatures. Results: The main findings of the three-step approach confirmed the strategies required in developing a digitally enabled health management workforce and efforts in enabling managers in leading and managing in the digital health space. Conclusions: With the ever-changing landscape of digital health, leading and manag-ing in times of system transformation requires a holistic approach to develop the necessary health management workforce capabilities and system-wide capacity. The proposed framework, for over-all health management workforce development in the digital health era, suggests that national col-laboration is necessary to articulate a more coordinated, consistent, and coherent set of policy guide-lines and the system, policy, educational, and professional organizational enablers that drive a dig-ital health focused approach across all the healthcare sectors, in a coordinated and contextual man-ner

A Scoping Review of Forced Separation Between People and Their Companion Animals

People often form strong emotional attachments with their companion animals. When this relationship is threatened by forced separation, people may take risks to their safety and wellbeing to protect and stay with their companion animal. This scoping review maps concepts, evidence, and impacts of forced separation between people and their companion animals in the categories of domestic violence, homelessness, and natural disasters. Five relevant databases were searched: Medline Ovid, Psycinfo, Scopus, CINAHL, and EMCARE Ovid. Forty-two articles on the human–animal bond and situations of separation were included in the analysis, which revealed devastating results for companion animals, with death and loss of the animals prominent across all three categories of forced separation. Significant psychological distress and an increased risk to safety in people were found across all three categories. Risks people took to avoid forced separation included failing to evacuate to safety during natural disasters, delaying fleeing an abusive relationship, and prolonged homelessness while waiting for pet-friendly accommodation. Responsibility (who is responsible for the animal) and the cultural belief of human wellbeing as superior to that of animals emerged as major themes. This scoping review identified the extent of research evidence and gaps in the domains of domestic violence, health, homelessness, natural disasters, and animal welfare. It will assist researchers, policy makers, and service providers working in these areas in understanding the characteristics and the complexities of situations involving forced separation of people and their companion animals to optimize supports

A call for leadership and management competency development for directors of medical services—evidence from the Chinese public hospital system

Background: A competent medical leadership and management workforce is key to the effectiveness and efficiency of health service provision and to leading and managing the health system reform agenda in China. However, the traditional recruitment and promotion approach of relying on clinical performance and seniority provides limited incentive for competency development and improvement. Methods: A three-component survey including the use of a validated management competency assessment tool was conducted with Directors of Medical Services (n = 143) and Deputy Directors of Medical Services (n = 152) from three categories of hospital in Jinan, Shandong Province, China. Results: The survey identified the inadequacy of formal and informal management training received by hospital medical leaders before commencing their management positions and confirms that the low self-perceived competency level across two medical management level and three hospitals was beyond acceptable. The study also indicates that the informal and formal education provided to Chinese medical leaders have not been effective in developing the required management competencies. Conclusions: The study suggests two system level approaches (health and higher education systems) and one organization level approach to formulate overall medical leadership and management workforce development strategies to encourages continuous management competency development and self-improvement among clinical leaders in China

A proposed approach to investigate whether postgraduate health care management education in Australian universities facilitates the development of informatics competencies

Competencies have emerged as being important in healthcare. AIDH has health informatics competencies and ACHSM has health service management competencies but as health care is rapidly changing, it is important that the required competencies continue to evolve. The aim is to investigate whether postgraduate health care management education in Australian universities facilitates the development of informatics competencies. The proposed approach followed the NWCPHP ‘Steps Used to Effectively Map Preexisting Courses to Competency Sets’ to map the health informatics competency statements against the ACHSM accredited and RACMA recognised, postgraduate health care management programs offered domestically in Australia. The initial results show that only 10% of the AHICF competencies were fully addressed, 12% of the AHICF competencies were mostly addressed, 28% were partially addressed, and 50% of the AHICF competencies were not addressed at all. The proposed course competency mapping approach demonstrates that there is a need to revisit the informatics competencies taught in postgraduate health care management programs in Australia

Patient-centred care and patient autonomy: doctors' views in Chinese hospitals

Background: Patient-centred care and patient autonomy is one of the key factors to better quality of service provision, hence patient outcomes. It enables the development of patients’ trusts which is an important element to a better doctor-patient relationship. Given the increasing number of patient disputes and conflicts between patients and doctors in Chinese public hospital, it is timely to ensure patient-centred care is fully and successfully implemented. However, limited studies have examined the views and practice in different aspects of patient-centred care among doctors in the Chinese public hospitals. Methods: A quantitative approach was adopted by distributing paper-based questionnaires to doctors and patients in two hospitals (Level III and Level II) in Jinan, Shandong province, China. Results: In total, 614 doctors from the surgical and internal medicine units of the two hospitals participated in the survey yielding 90% response rates. The study confirmed the inconsistent views among doctors in terms of their perception and practice in various aspects patient-centred care and patient autonomy regardless of the hospital where they work (category II or category III), their unit speciality (surgical or non-surgical), their gender or seniority. The high proportion of doctors (more than 20%) who did not perceive the importance of patient consultation prior to determining diagnostic and treatment procedure is alarming. This in in part due to the belief held by more than half of the doctors that patients were unable to make rational decisions and their involvement in treatment planning process did not necessarily lead to better treatment outcomes. Conclusion: The study calls for the development of system level policy and organisation wide strategies in encouraging and enabling the practice of patient-centred care and patient autonomy with the purposes of improving the quality of the service provided to patients by Chinese hospitals

Doctors in Chinese public hospitals: demonstration of their professional identities

Background: An increase in the number of medical disputes and violence against doctors indicates a lack of trust in the medical profession by society in Chinese public hospitals. Empirical evidence confirms that one cause is the lack of professional identity demonstrated by doctors. Medical professionals are required to maintain high standards of competence and moral responsibility, and demonstrate qualities such as respect, compassion, integrity, responsiveness to needs, and commitment to sound ethical practice in order to maintain professional privilege. These principles and appropriate professional conduct are the foundation of the professional identity of the medical profession. Methods: A quantitative approach was adopted by distributing paper-based questionnaires to doctors and patients in two hospitals (Level III and Level II) in Jinan, Shandong province, China. Findings: In total, 614 doctors and 1184 inpatients on discharge from the surgical and internal medicine units of the two hospitals participated in the survey yielding 90% response rates. The study confirmed the variation amongst doctors in demonstrating their professionalism in terms of respecting patients’ views and preferences when determining diagnostic procedures and treatment plans, and when making ethical decisions. Although 90% patients indicated that they showed respects to doctors, close to 20% of the doctors disagreed that they received high respect from patients. About 12% of doctors prescribed unnecessary diagnostic procedures to patient for the purpose of generating profit and more than 20% of patients indicated that they gave gifts to doctors in order to receive better treatment. Conclusions: Although about 80% of doctors demonstrated certain aspects of professionalism required by practitioners, the inconsistency across the medical workforce may exacerbate tense doctor-patient relationships. A review of medical curricula and focus of the internship program is required in order to assist medical graduates with forming required professional identity in order to improve patient satisfaction and better clinical outcomes. To be effective, a more systematic approach is recommended

Leadership and management competencies for hospital managers: a systematic review and best-fit framework synthesis

Objective: Competent managers are vital to the productivity and service quality of healthcare organizations and the sustainability of the healthcare system. To improve their management competence, understanding of management competency requirements is important. The purpose of this study was to synthesize the evidence related to the leadership and management competencies in healthcare organizations through the best-fit method. Methods: A systematic review of literature published between 2000 and 2020 was performed to identify studies focusing on confirming and/or identifying the competency requirements of hospital managers. The best-fit framework synthesis method was used to map the identified competencies and associated behavioral items against the validated management competency assessment program (MCAP) management competency framework. Results: Twelve studies were identified for inclusion in the review. The mapping of the identified competencies and behavioral items generated a competency model for hospital managers that can apply for different healthcare context. The new competency model includes the following seven core leadership and management competencies: evidence-informed decision-making, operations, administration and resource management, knowledge of healthcare environment and the organization, interpersonal, communication qualities and relationship management, leading people and organisation, enabling and managing change, and professionalism. Conclusion: This review and the mapping of the competencies identified in previous studies against the validated MCAP framework has resulted in the recommendation for an extended leadership and management competency framework for health service managers. It provides guidance for the formulation of training and development directions for the health service management workforce in a different healthcare context

General wellbeing and work impacts among community pharmacists during crisis management

Background: Community pharmacists are highly accessible for advice, as most pharmacies are open long hours and no appointment is needed. Community pharmacists, as essential community health workers, play a critical role in the fight against coronavirus disease 2019 (COVID-19). This study aimed to determine the general wellbeing and work impacts of pharmacists and the factors important for adaptability and resilience during the COVID-19 pandemic. Methods: This study adopted a cross-sectional design. Community pharmacists from various professional networks in Australia were invited through emails and social media posts to complete an anonymous online survey during the second wave of the COVID-19 pandemic in Victoria, Australia. Results: Sixty-five community pharmacists completed the online survey. The respondents reported fair levels of general wellbeing during the COVID-19 pandemic, with a mean self-related health score of 33.57 (s.d. = 13.19) out of a maximal of 96, despite relatively high levels of job stress and emotional labour. Lower levels of general wellbeing were correlated with higher levels of job stress (r = 0.645, P < 0.01) and emotional labour (r = 0.513, P < 0.01), and lower levels of occupational self-efficacy (r = −0.566, P < 0.01). Leader member exchange was negatively correlated with job stress (r = −0.419, P < 0.01) and positively correlated with psychological safety (r = 0.693, P < 0.01). The linear regression models showed that female pharmacists had lower occupational self-efficacy (β = −0.286, P = 0.024), but higher psychological safety (β = 0.234, P = 0.042). Higher work ability was associated with lower job stress (β = −0.529, P < 0.001), higher occupational self-efficacy (β = 0.511, P = 0.001), and poorer self-related health (β = −0.659, P < 0.001). Conclusions: The findings highlight the importance of a supportive work environment in helping community pharmacists to feel psychologically safe and reduce stress during a crisis

Adaptation strategies in transnational education: a case study of an Australian Master of Health Administration Course offered to Chinese managers

Background: Management decisions in health influence patient care outcomes; however, health management development courses in China are rare. This study aims to document and evaluate a transnational Master of Health Administration (MHA) course launched in 2000 for the benefit of Chinese health managers. Methods: A case study of the MHA program jointly run by an Australian university and a Chinese Medical University was conducted. We reviewed the development of the MHA course through a document analysis (key events recorded in achieves, minutes, and audits) followed by reflection (by two course coordinators), extracting key themes related to adaptative strategies. We then conducted a questionnaire survey of 139 graduates seeking their views on relevance, satisfaction and challenges associated with each subject within the course, the relevance of key management skills (as determined by the Australasian College of Health Service Management competency framework), and the impact of the course on their personal career trajectories. Chi-square tests identified differences in the responses by age, gender, pre-training position, and current workplace. Results: The curriculum pedagogy followed the principles of practice-based reflective learning. Research findings and student feedback shaped the curriculum design and subject content, to enhance management practices of the students. Survey participants expressed high levels of satisfaction and confirmed the relevance of all study subjects. Two subjects, health economics and data management, were perceived as being the most challenging. Of the ten management skills we assessed, relatively low self-rated confidence was found in “strategic thinking” and “planning”. Younger and less experienced graduates were more likely to report learning challenges (p < 0.05). Frontline managers were least likely to obtain promotion by changing employers (χ2 = 6.02, p < 0.05) or being seconded to another position (χ2 = 9.41, p < 0.01). Conclusions: This case study illustrates the suitability of cross-country partnerships in health management training, which offers opportunities for managers to systematically explore and acquire a comprehensive set of management skills applicable to their career needs. Opportunities for developing training aligned to career development opportunities are critical for attracting and developing a competent and well-prepared health service management workforce in China