Hospitals doi: 10.3390/hospitals3020012

Authors: Layton Vosloo

Patient-matched implants (PMIs) enable precise anatomical reconstruction but often introduce unforeseen intraoperative challenges that can provoke stress, reduce frustration tolerance, and influence surgical decision-making. Despite the growing clinical use of PMIs, the behavioural and psychological dimensions underpinning these challenging surgeries remain underexplored. This study examined the relationship between surgeon temperament, specifically frustration tolerance threshold, patience, and adherence to planned surgical workflows during PMI procedures. A qualitative thematic study was conducted over 22 months across two academic centres and 86 private surgical practices in South Africa. Data were collected through semi-structured interviews with consultant surgeons, assistant surgeons, surgical technologists, and biomedical engineers, supplemented by direct observation and detailed field notes. Inductive content analysis, thematic coding, and descriptive quantitative trends derived from Likert-style questionnaires were used to identify behavioural patterns associated with intraoperative stress and workflow deviation. Participant reports indicated that low frustration tolerance, often expressed as impatience, was perceived to be linked to increased deviations from surgical plans, including implant modification (reported in 4.6% of the 86 practices), even when design and fit were optimal. In 2.3% of the 86 practices surveyed, surgical team members reported incidents where impatience was perceived to have compromised patient safety. Stress inoculation theory and emotional intelligence frameworks offered explanatory models for the observed behaviours. Within the limits of this exploratory qualitative study, surgeon temperament—particularly mental preparedness and frustration tolerance—emerged as a recurring theme associated with intraoperative PMI workflow adherence. Whether these factors are determinants of workflow adherence whilst using high-fidelity PMIs, or merely correlated with other unmeasured variables, remains to be tested in future quantitative research.

Hospitals doi: 10.3390/hospitals3020011

Authors: Annabella Bellard Andrea Otti Enoc Carbajal Jaelyn Moore Cristian Lieneck

Rural hospitals are essential access points for healthcare delivery in the United States, yet they continue to experience disproportionate rates of closure and service disruption that threaten community health, economic stability, and equity. This rapid systematic review synthesizes recent peer-reviewed evidence examining rural hospital closures and service disruptions, with emphasis on financial, policy, workforce, and performance-related factors and their downstream impacts. Guided by PRISMA methodology, four databases were searched for U.S.-based studies published between January 2024 and June 2025. Following screening and consensus-based review, 59 articles met inclusion criteria. Across studies, financial vulnerability, characterized by revenue instability, low patient volumes, unfavorable payer mix, and reliance on non-operating revenue, emerged as a dominant precursor to closure and service reductions. Policy context, particularly Medicaid expansion status, telehealth and broadband infrastructure, and reimbursement adequacy, strongly shaped hospital sustainability. Closures and service disruptions were consistently associated with increased travel distances, reduced access to maternal, surgical, mental health, and chronic care services, higher prices at surviving hospitals, and increased strain on remaining providers. Workforce shortages further compounded these challenges. Collectively, findings demonstrate that rural hospital closures reflect interconnected structural weaknesses rather than isolated organizational failure. Coordinated policy action, targeted financial stabilization, workforce development, and technology-enabled care models are necessary to mitigate continued erosion of rural healthcare access.

Hospitals doi: 10.3390/hospitals3020010

Authors: Kangkang Tang Stella Barnass

Environmental disturbances from hospital demolition and construction can aerosolise pathogenic fungal spores, particularly those of Aspergillus species, posing a serious threat to immunocompromised patients. This paper presents a structured narrative review of representative case studies to evaluate the relationship between demolition activities and airborne Aspergillus exposure, with a focus on clinical risk and environmental monitoring. Three exemplar studies were selected to illustrate high-intensity short-duration demolition, prolonged mechanical demolition, and meteorologically integrated risk assessment. By examining these cases, this review identifies gaps in current knowledge, methodological limitations, and challenges in causal attribution. The analysis supports the development of a novel conceptual framework for assessing and managing Aspergillus-related risks during hospital redevelopment, offering a structured approach to future infection prevention and control strategies. This framework is intended as a conceptual tool to support evidence-informed decision-making while acknowledging the limitations inherent in a targeted narrative review rather than a systematic synthesis.

Hospitals doi: 10.3390/hospitals3020009

Authors: Maryam Keshtzari Bryan A. Norman

Cancer center infusion departments are often challenged with scheduling a large number of patients while having a limited number of nurses available to administer the infusions. Cancer patients have different acuity levels depending on many factors, such as treatment plans, drug side effects, and health status. Thus, several factors need to be considered when assigning patients to nurses, as unbalanced nurse-to-patient assignments affect patient flow and nurse workload. This study introduces a mixed-integer programming model for nurse–patient assignments that minimizes patient wait times while ensuring workload balance among oncology nurses, while addressing the limited attention in existing studies to jointly modeling patient acuity and nurse continuity. The model also explores the effects of maintaining nurse continuity for patients desiring the same nurse throughout their treatments. Because the mixed-integer programming model can become difficult to solve when there are many cancer patients, an alternative nurse–patient assignment heuristic is proposed and evaluated. Numerical examples based on data from a regional cancer center compare the effectiveness and performance of the exact and heuristic methods. The results show that patient wait time and workload variation among nurses increase when there is a stronger requirement to maintain nurse continuity, which could negatively affect both patient and nurse satisfaction. This study provides valuable insights into the nurse–patient assignment problem and helps cancer infusion centers determine the impacts of maintaining different levels of nurse continuity in their settings.

Hospitals doi: 10.3390/hospitals3020008

Authors: Lucky Norah Katende-Kyenda

Background: Medication nonadherence among patients with chronic diseases represents a major challenge in healthcare systems worldwide and is associated with poor clinical outcomes, increased hospitalizations, and higher healthcare costs. Patient-drug related factors such as knowledge of treatment, beliefs about medication, and the experience of side effects may significantly influence adherence behaviour. Methods: A cross-sectional quantitative study was conducted among 80 patients receiving treatment for chronic conditions at a primary healthcare facility in South Africa. Data were collected through face-to-face interviews using a standardized questionnaire that assessed demographic characteristics and patient-drug-related factors potentially associated with medication adherence. Statistical analysis was performed using IBM SPSS Version 30.0.0.0 (172). Descriptive statistics were used to summarize participant characteristics, while inferential analyses, including chi-square tests and Fisher’s exact tests, were applied to determine associations between demographic variables, patient-drug related factors, and medication nonadherence. Results: The majority of participants were female, aged between 41 and 50 years, single, unemployed, and had completed secondary education. Most participants lived in rural areas, and HIV/AIDS was the most commonly reported chronic condition. Significant associations with medication nonadherence were identified for the experience of medication side effects and inadequate knowledge about treatment. These factors demonstrated moderate effect sizes and suggest that both clinical and educational aspects of treatment may influence adherence behaviour. Conclusions: Patient-drug related factors, particularly medication side effects and insufficient knowledge regarding treatment, play a significant role in medication nonadherence among patients with chronic conditions in primary care settings. Interventions aimed at improving patient education, counselling regarding medication side effects, and strengthening patient-provider communication may help improve adherence and treatment outcomes.

Hospitals doi: 10.3390/hospitals3010007

Authors: Jayson Forbes T. Lucas Hollar Alejandro Arrieta Abraham Enyeji Dev Kantaria Rahul Mathews Sameer Siddiqui Wesley Nguyen

Background: Patient safety is evaluated using both internal assessments of safety culture and external hospital rating systems; however, the extent to which these measures capture related dimensions of patient safety remains uncertain. Methods: This study examined the association between hospital patient safety culture ratings and hospital safety grades. Using 2024 hospital-level data, patient safety culture was measured using the overall safety rating from the AHRQ Hospital Survey on patient safety culture and hospital safety grades derived from Leapfrog Safety Grades. Results: No significant association was observed between patient safety culture ratings and the likelihood of receiving higher Leapfrog Grades. Hospital bed size, however, was significantly associated with Leapfrog Grades, with larger hospitals demonstrating lower odds of receiving higher grades. Conclusions: These findings indicate that further research is needed to assess congruence between internal perceptions of patient safety culture and external hospital safety ratings. The results underscore potential measurement differences between federal survey-based assessments and private nonprofit grading methodologies and suggest caution in assuming equivalence across patient safety metrics. Further research is warranted to clarify how these tools align and to determine their respective roles in evaluating hospital patient safety.

Hospitals doi: 10.3390/hospitals3010006

Authors: Nuri Sylvia Ng Nurul Amanina Binte Hussain Maxim Mei Xin Tan Saidah Naqiyah Binte Suleiman Wong Kok Cheong Png Gek Kheng Daniel Tiang Lee Chen Ee Hong Wei Wei Hsu Pon Poh Hong Choon Oh

Preventing inpatient falls remains challenging for healthcare institutions globally, including in Singapore. Integrating technological innovations into fall prevention measures may optimize inpatient care and improve health outcomes. A multiphase study was conducted from 2019 to 2022, employing a human-centred design (HCD) approach to develop a technology-based inpatient fall prevention system (IFPS). The four phases include (1) pre-design observations and focus groups, (2) feature prioritization and wireframe development, (3) prototype testing and safety assessments, and (4) post-design staff training and feedback collection. The developed IFPS integrated artificial intelligence (AI) video analytics for bed-exit prediction with communication devices and autonomous commode delivery to facilitate ward communication and reduce staff workload. This paper describes the development process and user evaluation of the IFPS to assess its operational usability and safety. Potential users of the IFPS, such as ward nurses and patients, suggested features for the IFPS during the pre-design phase and thereafter evaluated the system through focus group discussions and/or feedback surveys. Pre-design focus group participants (n = 24) emphasized durability and user-friendliness requirements, informing system design. When evaluating the system, nurse users (n = 39) perceived the IFPS as effective in reducing falls (65%), enabling them to perform other duties (85%), and allowing them to remain with patients without searching for a commode (64%). Patient users (n = 21) found pre-recorded messages effective (91%), though communication clarity varied. Engaging healthcare workers in IFPS development offered valuable context-based insights, highlighting the importance of addressing technology acceptance factors early to promote adoption of fall prevention technologies in acute care settings.

Hospitals doi: 10.3390/hospitals3010005

Authors: Leonardo Nava-Velazquez Angélica Saraí Jiménez-Osorio Margarita Tetlalmatzi-Montiel Diego Estrada-Luna Julieta Angel-García Geu S. Mendoza-Catalán Erika Elizabeth Rodriguez-Torres

This study analyzed environmental noise levels in neonatal hospital units, including both low- and high-risk nurseries, as well as neonatal intensive care units (NICUs). Continuous 24 h measurements over ten days revealed that average sound levels significantly exceeded international recommendations. Hourly LAeq values frequently reached or surpassed 65 dB, with over 20% of daily recordings exceeding this limit, and in some instances, more than 50%. Heatmaps indicated consistent noise patterns: high-risk nurseries experienced peaks during late morning and afternoon, low-risk nurseries at night, while NICU maintained elevated levels throughout the day. The main sources of noise included alarms, medical equipment, and activity from staff or visitors. This highlights the need for hospital policies aimed at protecting the neurosensory health of neonates. These findings provide evidence-based recommendations for creating quieter environments in neonatal care.

Hospitals doi: 10.3390/hospitals3010004

Authors: Kimberly Jones-Rudolph Lorraine Brown Wilfredo Lacro Soumya Upadhyay

This study explores how hospital location (rural/non-rural) may moderate the nurse staffing ratio’s impact on three hospital-acquired infections. This study used data from 2022 to 2024 on nurse staffing and hospital characteristics from the American Hospital Association Annual Survey and data on hospital-acquired infection rates from the Medicare Care Compare dataset provided by the Centers for Medicare and Medicaid Services. After removing missing values, the final dataset included 7997 hospital-year observations across the US. Independent variables include rural hospital designation, nursing hours per patient day, and RN FTE per adjusted day. The dependent variables included infection rates of Central Line-Associated Bloodstream Infection, Catheter-Associated Urinary Tract Infection, and Methicillin-Resistant Staphylococcus aureus. Multiple regression was performed in Stata 18. Our research found that across all three infection types, an increase in nursing hours per patient day is significantly associated with a decrease in the infection rate, and that impact was not moderated by hospital rurality. Extra time spent with patients in either a rural or non-rural hospital decreased hospital-acquired infection rates. While RN FTEs were included in the model, total nursing hours per patient day emerged as the more consistent predictor of lower hospital-acquired infection rates.

Hospitals doi: 10.3390/hospitals3010003

Authors: Elissa Dabkowski Simon J. Cooper Jhodie Duncan Karen Missen

Healthcare systems operate in safety-critical environments where rapid adaptation and sustained functioning must occur simultaneously, yet existing safety frameworks tend to conceptualise agility and resilience as separate, sequential, or retrospective capabilities. This conceptual separation limits understanding of how safety is enacted during disruption, when healthcare workers and organisations must respond in real time without temporal or structural buffers. This paper introduces agilience as an emerging conceptual construct that captures the concurrent enactment of agility (rapid adaptation) and resilience (sustained functioning, recovery, and learning) under conditions of uncertainty. Drawing on safety science, resilience engineering, organisational theory, and comparative industry literature, this conceptual commentary clarifies how agilience extends existing Safety-I and Safety-II paradigms by addressing the temporal gap between prevention-focused and learning-focused approaches. Agilience is positioned as both an explanatory lens and an aspirational organisational state, highlighting the alignment required between individual adaptive capability and organisational structures to support safe, sustainable care delivery. The paper outlines the defining features, boundaries, and system conditions under which agilience becomes visible, and illustrates its relevance through healthcare examples. By articulating agilience as a distinct conceptual contribution, this work provides a foundation for future empirical investigation, measurement development, and application in healthcare safety management.

Hospitals doi: 10.3390/hospitals3010002

Authors: Samuel Petrie Mohammad Hassani David Kerr Alan Spurway Michael Hamilton Prosper Koto

Health systems face pressure to strengthen resilience against supply chain disruptions while maintaining cost-effective service delivery. This mixed-methods study describes a pilot project that integrated 3D printing services into a Canadian provincial health authority. Quantitative data were derived from internal clinical engineering work orders, where a scenario-based economic analysis compared original equipment manufacturer (OEM) procurement with modelled 3D-printed parts. Using conservative assumptions, selected non-electronic structural parts were assigned a fixed unit cost. Qualitative data were collected from two focus groups with clinical engineers and other end-users. Results from an exploratory scenario-based economic analysis suggest that substituting selected structurally simple clinical engineering parts with 3D-printed alternatives would be associated with modelled cost impacts ranging from a 67.4% net increase (OEM prices halved and 3D-printing costs doubled) to a 69.6% cost reduction (OEM prices increased by 10% and 3D-printing costs decreased by 20%). Demand changes affected absolute savings but not the percent difference (58.1% under ±50% quantity changes), and a pessimistic procurement scenario (OEM prices decreased by 30% and 3D-printing costs increased by 50%) reduced savings to 10.3%. Focus groups highlighted perceived benefits and implementation challenges associated with integrating additive manufacturing. Implementation was facilitated through an outsourcing model, which was perceived to shift certain responsibilities and risk-management functions to the vendor. Long-term adoption will require clearer communication and targeted education. This pilot study suggests that, under constrained regulatory scope and scenario-based assumptions, additive manufacturing may contribute to supply chain resilience and may be associated with modelled cost advantages for selected low-risk components.

Hospitals doi: 10.3390/hospitals3010001

Authors: Vanessa I. Klotzman Albert Kim Brian Walker Sabrina Leong Louis Ehwerhemuepha Robert B. Kelly

Effective communication in critical care units, such as the Cardiovascular Intensive Care Unit (CVICU), is vital for patient safety; however, clinical notes from multiple professionals are often lengthy and complex. This study evaluated the Mistral large language model for summarizing Cardiovascular Intensive Care Unit progress notes using the Illness severity, Patient summary, Action list, Situation awareness and contingency planning, and Synthesis by receiver (I-PASS) framework, a standardized mnemonic for patient handoffs in healthcare. A total of 385 patients were included in the cohort, and all the progress notes associated with each patient were combined into a single document and summarized by the model. The readability was assessed using multiple metrics, including Flesch Reading Ease, Flesch-Kincaid Grade Level, Gunning-Fog Index, Simple Measure of Gobbledygook Index (SMOG), Automated Readability Index, and Dale-Chall Score. The readability metrics showed that the summaries generated with the Mistral Large Language Model (LLM) were much more difficult to read than the original notes, requiring a higher reading level. In a small clinician review, junior residents rated the summaries overall more favorably than senior residents, who often identified missing clinical details. Although Mistral condensed the documentation, this reduced readability and some loss of context may limit its usefulness for clinical handoffs. As a preliminary study with a small clinician-reviewed sample, these findings are descriptive and will require validation in larger clinical settings.

Hospitals doi: 10.3390/hospitals2040029

Authors: Guosong Wu Fengjuan Yang

The increasing availability of free-text components in electronic medical records (EMRs) offers unprecedented opportunities for machine learning research, enabling improved disease phenotyping, risk prediction, and patient stratification. However, the use of narrative clinical data raises distinct ethical challenges that are not fully addressed by conventional frameworks for structured data. We conducted a narrative review synthesizing conceptual and empirical literature on ethical issues in free-text EMR research, focusing on privacy, fairness, autonomy, interpretability, and governance. We examined technical methods, including de-identification, differential privacy, bias mitigation, and explainable AI, alongside normative approaches, such as participatory design, dynamic consent models, and multi-stakeholder governance. Our analysis highlights persistent risks, including re-identification, algorithmic bias, and inequitable access, as well as limitations in current regulatory guidance across jurisdictions. We propose ethics-by-design principles that integrate ethical reflection into all stages of machine learning research, emphasize relational accountability to patients and stakeholders, and support global harmonization in governance and stewardship. Implementing these principles can enhance transparency, trust, and social value while maintaining scientific rigor. Ethical integration is therefore not optional but essential to ensure that machine learning research using free-text EMRs aligns with both clinical relevance and societal expectations.

Hospitals doi: 10.3390/hospitals2040028

Authors: Elizabeth Ziemba Irving Stackpole Millan L. Whittier Tricia J. Johnson

This Perspective presents a framework for US hospitals treating foreign patients to reconceptualize international healthcare trade by leveraging all four modes of trade in health services under the General Agreement on Trade in Services (GATS), which include information exchange (Mode 1), patient travel/medical tourism (Mode 2), commercial presence (Mode 3), and temporary movement of healthcare personnel (Mode 4). This framework illustrates how hospitals could adopt multi-modal approaches and describes the strategic implications for hospitals and their international patient programs. Historically, US hospitals have focused primarily on international patient travel (Mode 2), but this narrow approach creates vulnerability to disruption. Mode 2 exports by US hospitals have not recovered to pre-pandemic levels, making expansion into other modes essential for maintaining competitive advantages while mitigating systemic risks. Diversification into other modes, such as digital health and telemedicine (Mode 1), co-branding and managing facilities (Mode 3) and visiting professorships (Mode 4) are single-mode approaches for diversification. Multi-country clinical trials are an example of cross-border trade that addresses all four modes of GATS. Overall, this perspective provides a new framework for US providers engaged in or considering entry into international markets that does not solely rely on Mode 2 medical tourism but instead adopts a multi-modal, cross-border health service paradigm.

Hospitals doi: 10.3390/hospitals2040027

Authors: Erhauyi Meshach Aiwerioghene Vivian Chinonso Osuchukwu

Background: Artificial Intelligence (AI) holds significant potential to enhance operational efficiency and quality in healthcare. However, despite substantial investment, its widespread, sustained implementation is limited, necessitating a thorough risk assessment to overcome current adoption barriers. Methods: This scoping review, guided by the Arksey and Malley framework, systematically mapped 13 articles published between 2019 and 2024, sourced from five major databases (including CINAHL, Medline, and PubMed). A rigorous, systematic process involving independent data charting and critical appraisal, using the Critical Appraisal Skills Programme (CASP) tool, was implemented, followed by thematic synthesis to address the research questions. Results: AI demonstrates a significant positive impact on both operational efficiency (e.g., optimised resource allocation, reduced waiting times) and patient outcomes (e.g., improved patient-centred, proactive care, and identification of readmission risks). Major implementation hurdles identified include high costs, critical data security and privacy concerns, the risk of algorithmic bias, and significant staff resistance stemming from limited understanding. Conclusions: Healthcare managers must address key challenges related to cost, bias, and staff acceptance to leverage the potential of AI fully. Strategic investments, the implementation of robust data governance frameworks, and comprehensive staff training are crucial steps for mitigating risks and creating a more efficient, patient-centred, and effective healthcare system.

Hospitals doi: 10.3390/hospitals2040026

Authors: Alanoud Almarri Ziad Hunaiti Nadarajah Manivannan

Technological advancements driving smart healthcare transformation need new models and solutions for emerging technology challenges. The objective of this review paper is to introduce the concept of smart healthcare, identify its main characteristics, highlight the key drivers of its adoption (“Technological Advancements, Digital Citizen Societies, Shifting Models of Patient Care, Healthcare Workforce Shortages, Rising Costs of Healthcare Delivery, and Impacts of COVID-19”), and present the primary challenges associated with its implementation (“Reduced Human Interaction and Patient Monitoring, Data Accuracy and Reliability, Data Security and Privacy, Interoperability and System Performance, Ethical Concerns and Trust in AI, High Financial Costs”). The paper is written in simplified language to enable a wide range of healthcare stakeholders—particularly healthcare professionals with limited technical backgrounds—to develop a foundational understanding of smart healthcare. This knowledge can foster greater engagement in efforts to transform healthcare systems into smarter, more efficient models. Furthermore, the findings of this review may support future research efforts, especially those aimed at developing models or frameworks that facilitate the practical integration of smart healthcare beyond theoretical concepts, by offering a synthesized framework for SHC.

Hospitals doi: 10.3390/hospitals2040025

Authors: Ganesh-Babu Balu Subburaman Sachin Gupta Thulasiraj Ravilla Helen Mertens Carroll A. B. Webers Frits van Merode

Hospitals are complex systems that function most effectively when operations are coordinated and supported by real-time information and feedback loops. Sustained growth, quality improvement, and financial viability increasingly rely on data-based management (DBM), yet adoption and use vary widely across healthcare institutions. This study examined the enabling and hindering factors influencing DBM, with the aim of generating insights to strengthen data use and improve management of eye hospitals. A qualitative multiple case study design was employed in six purposefully selected eye hospitals in India, varying in size and baseline capacity for DBM. At each site, five to six key personnel were interviewed. Data collection involved audio-recorded interviews, transcripts, and field notes, and analysis followed a grounded theory approach using open and axial coding to identify themes, relationships, and develop a conceptual framework. Findings reaffirmed the core enablers—leadership commitment, data availability, and technology adoption. Additional drivers included operational adaptability, regulatory demands, systematic improvement practices, daily reporting, information policies, and the use of communication platforms such as WhatsApp. Key barriers were incomplete data entry, software limitations, inadequate analytical reporting, and inconsistent adherence to processes. Overall, effective DBM requires both foundational enablers and contextual drivers, while addressing barriers to institutionalizing data use and improving outcomes.

Hospitals doi: 10.3390/hospitals2030024

Authors: Elom Hillary Otchi David Greenfield

Health systems function optimally when accountability principles, legal frameworks, and governance processes are clearly defined, understood, and implemented. Together these elements set norms, standards, and systems for the practice of health professionals, facilities, products, and the provision of quality and safe care. Ghana, like other countries, has these elements in place but could be more effective. When the system fails, the consequences of a lack of accountability are widespread, significant, and impact the poor and vulnerable the hardest. Achieving accountability for the legal and social expectation of high-quality, safe healthcare is an ongoing challenge, for every country, not just Ghana. Hence, a key dual question arises: within Ghana, how can health system accountability be enhanced through examining legal frameworks and their implementation? The following six key elements are identified to promote accountability in health systems: establish and implement effective healthcare governance arrangements; capacity development, understanding, and delineation of stakeholder roles and responsibilities; appropriate financing and resourcing; establishing and maintaining effective management of required infrastructure; undertaking measurement for accountability; and focusing on people-centered care. A clear focus on these six elements enables the delivery of equitable, high-quality, safe care for the population and a better future for all.

Hospitals doi: 10.3390/hospitals2030023

Authors: Seán Paul Teeling Deborah Baldie Ailish Daly Anthony Pierce Nicola Wolfe Gillian Fagan Catherine Garry

Person-centred cultures are increasingly recognised as essential to the delivery of compassionate, safe, and effective healthcare. While Lean Six Sigma (LSS) is widely adopted as a process improvement methodology, its application is often critiqued for lacking alignment with relational or values-based care. This study aimed to test the transferability of three previously developed Programme Theories (PTs), generated through realist inquiry in a public hospital setting, within a large private acute hospital. Realist-informed adjudication workshops were conducted with interdisciplinary staff who had completed university-accredited training in LSS. Structured workbooks, visual artefacts, and thematic synthesis were used to identify how context–mechanism–outcome configurations (CMOCs) held, shifted, or evolved in the new setting. All three PTs were confirmed, with six CMOCs refined, and eight new configurations generated. Key refinements included the role of strategic intent, informal improvement communities, and intrinsic motivation. These findings suggest that values-based mechanisms underpinning person-centred LSS are not confined to public systems and may be equally active in private settings. The study confirms the explanatory strength of the original PTs while contributing new insights into their adaptability. It offers practical guidance for healthcare leaders seeking to embed person-centred improvement approaches across diverse systems, regardless of sectoral funding or governance structures.

Hospitals doi: 10.3390/hospitals2030022

Authors: Kathy Eljiz Alison Derrett David Greenfield

The challenge for healthcare policy makers, managers and practitioners is finding ways to effectively collaborate with patients and community to plan, deliver and evaluate services. The study examined how managers engage the community with the strategic redesign of health services. The study focused on four large scale redevelopment projects, valued at A$2.8B, occurring within a health district in New South Wales, Australia. The study employed a multiple qualitative methods design comprising semi-structured interviews and focus groups. Participants were professionals (n = 24) involved in the strategic planning of health facility redevelopment. Thematic analysis was used to identify, analyse and report findings. Three issues emerged as significant factors influencing engagement, including the following: establishing a new mindset to service planning and delivery; future proofing service delivery; and management of stakeholder expectations. The unique contribution of the research is the identification of three interwoven strategies with 30 actions proposed to assess, understand and respond to external factors: 1. Foster an environment that allows for flexible and adaptable thinking and discussion; 2. Develop systems, structures and processes that facilitate engagement; 3. Encourage systems thinking for effective continuous service provision and redevelopment. Large scale redevelopment projects provide a platform for the strategic redesign of health services. When doing so, engaging the community with strategic planning, implementation and evaluation of healthcare services can lead to improved care outcomes.

Hospitals doi: 10.3390/hospitals2030021

Authors: Tracia-Gay Kennedy-Dixon Mellanie Didier Fedrica Paul Andre Gordon Marvin Reid Maxine Gossell-Williams

Understanding the utilization patterns of nuclear medicine (NM) services is essential for optimizing resource allocation and service provision. This study aimed to address the regional evidence gap by reporting the demand for NM services by sex and age at a public hospital in Jamaica. This was a non-experimental, retrospective study of NM scans that were completed at the University Hospital of the West Indies from 1 June 2022 to 31 May 2024. While all scans were reported in the descriptive totals, for patients with multiple scans during the study period, only the data from the first visit was used in the inferential statistical analysis. This was performed with the IBM SPSS (version 29.0) software and involved the use of chi-square goodness of fit and multinomial logistic regression. A total of 1135 NM scans for 1098 patients were completed (37 patients had more than one scan); 596 (54.3%) were female and 502 (45.7%) were male, with the ages ranging from 3 days to 94 years old. Among the female patients, there was a greater demand in the ≥60 years age group for cardiac amyloid scans (χ2 = 6.40, p < 0.05), while females 18–59 years had a greater demand for thyroid scans (χ2 = 7.714, p < 0.05) and bone scans (χ2 = 3.904, p < 0.05). On the other hand, significantly more males in the ≥60 age group presented for cardiac amyloid (χ2 = 4.167; p < 0.05) and bone scans (χ2 = 145.79, p < 0.01). Males were significantly less likely to undergo a thyroid scan than females (p < 0.01, OR = 0.072, 95% CI: 0.021, 0.243) while individuals aged 18–59 years were more likely to undergo this scan than patients aged 60 or older (p = 0.02, OR = 3.565, 95% CI: 1.258, 10.104). Males were more likely to do a cardiac amyloid scan (p < 0.05, OR = 2.237, 95% CI: 1.023, 4.891) but less likely to undergo a cardiac rest/stress test than females (p = 0.02, OR = 0.307, 95% CI: 0.114, 0.828). Prolonged life expectancy and an aging population have the potential to impact NM utilization, thus requiring planning for infrastructure, equipment, work force, and supplies. Cancer-related and cardiovascular indications are a top priority at this facility; hence, age- and sex-specific analysis are useful in establishing models for policy makers with regard to the allocation of economic and human resources for the sustainability of this specialized service.

Hospitals doi: 10.3390/hospitals2030020

Authors: Mingchun Cai Zhengbo Yan Xiaoli Wang Bing Mao Chuan Pu

Objective: This study aimed to develop a performance evaluation index system for a district-level public hospital in Chongqing, China, based on Diagnosis-Related Groups (DRGs), to provide a benchmark for performance assessment in similar hospitals. The system was constructed using a literature analysis, the Delphi method, and the Analytic Hierarchy Process (AHP) to identify and weight relevant indicators. Results: The evaluation system consists of three primary indicators and eighteen secondary indicators. Key secondary indicators include the Case Mix Index (CMI), cost consumption index, low-risk group mortality rate, the proportion of patients with three- or four-level surgeries at discharge, and the proportion of medical service revenue to medical income. In 2020, significant improvements were observed in several indicators, such as a decrease in the low-risk group mortality rate to 0% and increases in the proportion of patients with three- or four-level surgeries and CMI by nearly 10% and 13%, respectively. Conclusions: This study successfully developed a comprehensive and scientifically sound performance evaluation index system for a district-level public hospital in Chongqing. The system has proven effective in objectively assessing inpatient medical care performance and providing valuable guidance for improving healthcare services in similar settings.

Hospitals doi: 10.3390/hospitals2030019

Authors: Plom van Rooij Annelies van der Ham Windi Winasti Hubert Berden Frits van Merode

Hospital layouts play a critical role in supporting efficient care processes, which are continually evolving. While care processes adapt over time, the spatial needs of care professionals are expected to remain relatively stable. This study proposes an evaluation framework combining cognitive mapping and space syntax analysis (SSA) to assess how hospital layouts align with these spatial needs. The framework is applied to a real-world emergency department (ED) with two distinct layout configurations. Cognitive mapping captures spatial needs from the perspective of care professionals, while SSA evaluates how the layout supports or constrains these needs. Drawing on the open building approach, we interpret layout adaptability through a layered system of primary (rigid), secondary (adaptable), and tertiary (care process) levels. Our results show that the choices in primary and secondary system designs can limit the functionality of the tertiary system. This approach supports informed decision-making by addressing multiple spatial needs simultaneously, offering insights into the coherence between spatial configuration and care delivery, and enabling quantitative comparison across different layout designs.

Hospitals doi: 10.3390/hospitals2030018

Authors: Viet Tran Lauren Thurlow Simone Page Giles Barrington

Background: The emergency department (ED) often represents the entry point to care for patients that require urgent medical attention or have no alternative for medical treatment. This has implications on scope of practice and how quality of care is measured. A diverse array of methodologies has been developed to evaluate the quality of clinical care and broadly includes quality improvement (QI), quality assurance (QA), observational research (OR) and clinical quality registries (CQRs). Considering the overlap between QI, QA, OR and CQRs, we conceptualized a modular framework for TECOR to effectively and efficiently streamline clinical quality evaluations. Streamlining is both appropriate and justified as it reduces redundancy, enhances clarity and optimizes resource utilization, thereby allowing clinicians to focus on delivering high-quality patient care without being overwhelmed by excessive data and procedural complexities. The objective of this study is to describe the process for designing a modular framework for ED CQRs using TECOR as a case study. Methods: We performed a scoping audit of all quality projects performed in our ED over a 1-year period (1 January 2021 to 31 December 2021) as well as data mapping and categorical formulation of key themes from the TECOR dataset with clinical data sources. Both these processes then informed the design of TECOR. Results: For the audit of quality projects, we identified 29 projects. The quality evaluation methodologies for these projects included 12 QI projects, 5 CQRs and 12 OR projects. Data mapping identified that clinical information was fragmented across 11 distinct data sources. Through thematic analysis during data mapping, we identified three extraction techniques: self-extractable, manual entry and on request. Conclusions: The modular framework for TECOR aims to enable an efficient streamlined approach that caters to all aspects of clinical quality evaluation to enable higher throughput of clinician-led quality evaluations and improvements. TECOR is also an essential component in the development of a learning health system to drive evidence-based practice and the subject of future research.

Hospitals doi: 10.3390/hospitals2030017

Authors: Bernal Vargas-Vargas Erick Pérez-Murillo Jaime González-Domínguez Justo García-Sanz-Calcedo

This study applies stochastic discrete event modeling to demonstrate that reducing wait times for specialized outpatient clinics in the Costa Rican public healthcare system is possible. The classification process identified four medical specialties with the longest wait times. It includes the creation of a separate queuing theory model for each specialty. The birth and death model allowed for estimating the number of arrivals and consultations in the simulation. Validation was performed by comparing the model’s input and output data with real-world statistical reports. An analysis of medical specialists revealed that approximately 22% of patients referred to secondary care did not require specialized medical consultation. Through simulation and the use of stochastic input data, patient waiting times decreased. In an optimistic scenario, waiting times decreased steadily across all specialties over 24 months. Ophthalmology and orthopedics reduced their waiting times to less than 300 days. Otorhinolaryngology decreased from 370 to 250 days, and urology showed the most significant improvement, decreasing from 350 to 100 days in the first year and remaining stable. This evidence transforms the traditional paradigm of increasing capacity as the only solution to the waiting list problem and positions improving the referral process as an alternative. To achieve these results, the study highlights the importance of implementing improved triage protocols in primary care, integrating decision-support tools for general practitioners using machine learning, for example, to reduce unnecessary referrals. Training programs and feedback mechanisms could also align referral practices with specialty criteria. While these strategies were not implemented in this study, the simulation results provide a solid basis for their design and future evaluation.

Hospitals doi: 10.3390/hospitals2030016

Authors: Hermès Karemere Samuel Lwamushi Makali Innocent Batumike Serge Kambale

This study analyzes the comparative performance of ten hospitals in the Kadutu Health Zone in the Democratic Republic of Congo using the EGIPSS model. This study was carried out at the height of the COVID-19 pandemic in August and September 2021, in a changing global context where health systems were called upon to improve their resilience capacity while maintaining high levels of performance. This is a descriptive observational study using documentary review, interviews with 85 key informants, and participatory observation at ten hospitals selected based on several criteria, including the organization of a complete complementary package of activities assigned to a hospital in the DR Congo. This study mainly reveals three facts, namely that (i) university hospitals show the best performance, (ii) adaptive capacity considerably influences the other dimensions of the EGIPSS model and the overall performance of the hospital, and (iii) to adapt, hospitals need resources and good management and governance. Adapting hospitals in the Kadutu Health Zone to the changing context requires a holistic approach that combines clinical work with research, investments in infrastructure (often dilapidated and not modern), training, technology, and governance. It also involves learning from practices implemented in more efficient hospitals.

Hospitals doi: 10.3390/hospitals2030015

Authors: Mia Werrett Joanna McIlveen Mim Fox

The majority of Australians who die each year do so in an acute hospital setting and are cared for during the end of their life by a multidisciplinary team comprising nurses, medical staff, and allied health staff. Despite the range of professional disciplines that services this patient group, the experiences of the staff providing this end-of-life care is not well understood. This study sought to explore the experiences of multidisciplinary staff providing this care at an acute hospital in Sydney, Australia and to identify the barriers that affect the end-of-life care provided. Data were collected through an online survey from a multidisciplinary sample group. A combination of statistical analysis and thematic analysis was used to analyse the data with four key themes emerging. These themes included the implications for staff working in end-of-life care, communication gaps in the acute hospital setting, recognition of the dying process, and improvement of end-of-life care through further education. This study highlighted the challenges experienced by healthcare staff in the end-of-life context, with recommendations provided for increased education and training. The need for staff to receive training with a focus on end-of-life skill development, professional confidence, and preparedness for end-of-life conversations was highlighted.

Hospitals doi: 10.3390/hospitals2030014

Authors: Alexander Micallef Sandra C. Buttigieg Gianpaolo Tomaselli Lalit Garg

Healthcare is a dynamic and ever-changing phenomenon and is subject to multiple challenges, particularly concerning sustainability and cost issues. The literature identifies bed space and problems related to the lack of hospital beds as being directly or indirectly related to both admission and discharge processes, with delays in in-patient discharges being identified as a variable of significance when it comes to a health system’s overall performance. In this respect, the aim of this research was to explore factors related to delayed discharges in an acute hospital setting in Malta, a small European member state, through the perspectives of health professionals. This study followed a qualitative approach. Semi-structured interviews (n = 8) and focus groups (n = 2) were conducted with a diverse group of experienced health professionals. Informed consent was obtained from all participants, and all data were treated with strict confidentiality throughout the study. The sample was limited to professionals working in adult, non-specialized healthcare settings. Manual thematic analysis was carried out. Codes were grouped to derive seven main themes, which were identified after carrying out the thematic analysis process on the transcripts of the interviews/focus groups. The derived themes are the following: (a) a faulty system, which is open to abuse and inefficiency, (b) procedural delays directly impacting delayed discharges, (c) long-term care/social cases as a major cause of delayed discharges, (d) the impact of external factors on delayed discharges, (e) stakeholder suggestions to management to counteract delayed discharges, (f) the impact of COVID-19 on delayed discharges, and (g) inter-professional relationships. Factors related to delayed discharges and the effects of delayed discharges on the hospital emerged from the main findings, together with specific potential interventions to minimise delays in discharge. Health professional interactions and the effects of inter-professional relationship setbacks on delayed discharges were explored, and the impact of the COVID-19 pandemic on hospital dynamics and additional delays were also addressed. This information is intended to provide hospital administrators with data-driven internal organisational evidence to guide them through changes and to inform future decisions regarding hospital performance and efficiency from a discharge delay perspective.

Hospitals doi: 10.3390/hospitals2020013

Authors: Lina Rieder Johannes Schoder

The effective and financially sustainable shift towards outpatient care in hospitals requires adjustments in infrastructure, processes, and personnel. This contribution validates and extends the existing literature by conducting expert interviews in Switzerland and Germany. Establishing transparent cost and performance data is a crucial first step. Subsequently, key organizational success factors—such as spatial and functional planning, staffing concepts, digital and AI-assisted process optimization, and collaborations—must be adapted. The findings indicate that there is no universal approach to outpatient integration. However, the adaptation of these success factors and the insights gained serve as essential milestones towards an economically viable hospital-based outpatient care model.

Hospitals doi: 10.3390/hospitals2020012

Authors: Carolina Belotti Pedroso Eugene Schneller Claudia Rebolledo Martin Beaulieu

Expensive medical devices, especially in the areas of orthopedics, and cardiology, have a significant impact on hospital costs and the delivery of high-quality services. These medical supplies are known as physician preference items (PPIs), as they act as “surrogate buyers”—impacting the selection and sourcing of products. There is a gap between the purchasing strategy and the adoption of tactical activities for these complex medical supplies. In the context of the healthcare exceptionalism thesis, this research investigates how healthcare organizations can successfully adopt suitable sourcing levers aiming to achieve different purchasing results. This research conducts a multi-case study in 15 healthcare organizations in nine countries. Three new sourcing levers specific to the healthcare sector emerged, based on the healthcare exceptionalism thesis. It was possible to identify five main sourcing levers clusters. The fit between strategy and tactical level can be allowed by the implementation of suitable sourcing levers—facilitating the achievement of the desired objectives. Healthcare procurement practitioners should assess the fit between strategy and the tactical level by employing suitable sourcing levers. Organizations wishing to move towards a value-based procurement approach should adopt a set of supporting sourcing levers to enable this transition.

Hospitals doi: 10.3390/hospitals2020011

Authors: Al-Safi Noman Abdulhakim Al-Sharjabi Sarah Noman Musheer A. Aljaberi

Background: Yemen faces significant challenges related to drug smuggling and counterfeiting, exacerbated by socio-economic hardships and a fragile healthcare and regulatory system. These conditions create an environment conducive to illicit drug trafficking. This study aims to explore the perspectives of healthcare employees working in drug-related departments in the Capital Sana’a, Yemen, focusing on the factors contributing to drug smuggling and the broader challenges within Yemen’s pharmaceutical sector. Methods: A cross-sectional study was conducted among health employees in drug-related departments in the Capital Sana’a. Data were collected through a self-administered questionnaire and analyzed using SPSS version 22.0. Descriptive and inferential statistical analyses were performed to examine group differences, including t-tests and ANOVA. A significance level of p < 0.05 was considered statistically significant. Results: The t-test indicated significant disagreement among participants (50.3%) regarding the existence of a comprehensive pharmaceutical policy (p < 0.001). High levels of agreement were observed on commonly smuggled drugs (74.7%) and the underlying reasons for drug smuggling and counterfeiting (76%, p < 0.001). A significant gender difference emerged regarding perceptions of the Supreme Board of Drugs’ role, with males scoring lower (mean = 2.86, SD = 0.81) than females (mean = 3.43, SD = 0.42, p = 0.002). However, ANOVA results showed no significant differences within or between groups based on educational qualifications, professional roles, or years of service concerning pharmaceutical policy, the Supreme Board of Drugs, registration requirements, or drug smuggling and counterfeiting (p > 0.05). Conclusions: This study highlights critical challenges in Yemen’s pharmaceutical sector, including systemic weaknesses, policy gaps, and the prevalence of drug smuggling, while emphasizing the pivotal role of health employees in addressing these issues. Strengthening their capacity through targeted interventions—such as training, awareness campaigns, robust regulatory frameworks, equitable enforcement, and enhanced stakeholder engagement—is essential. Given the cross-border nature of drug smuggling, these findings underscore the urgent need for strengthened international cooperation, harmonized regulatory policies, and intelligence-sharing mechanisms to combat illicit pharmaceutical trade. Addressing these challenges at both national and international levels is vital for ensuring drug safety, protecting public health, and mitigating the global impact of counterfeit and smuggled medicines.

Hospitals doi: 10.3390/hospitals2020010

Authors: Eleni Tsapnidou Georgios Katharakis Martha Kelesi-Stavropoulou Michael Rovithis Sofia Koukouli Evangelia Sigala Maria Moudatsou Dimitrios Papageorgiou Areti Stavropoulou

Effective nurse leadership increases nurses’ job satisfaction, performance, motivation, and empowerment. Ensuring nurses’ organizational and professional commitment is vital for addressing quality, sustainability, and cost-effectiveness challenges in a high-demanding healthcare environment. The aim of this study was to explore the impact of transformational leadership on nurses’ organizational and professional commitment. A systematic review was conducted using the Scopus, ScienceDirect, PubMed/Medline, Scilit.net, and Wiley Online Library databases. Original research studies published between 2016 and 2024 focusing exclusively on nurses’ professional and organizational commitment and transformational leadership were included. The indexing terms “nursing leadership”, “transformational leadership”, “professional/organizational commitment”, and “nursing” were used along with the Boolean operators AND, OR, and NOT. According to the findings, transformational leadership practices increase nurses’ organizational and professional commitment through vision sharing, motivation, career development, interpersonal communication, a positive working environment, and productive resources management. The healthcare policy makers should invest in organizing, supporting, and promoting relational leadership practices to retain their nursing workforce and obtain their organizational and professional commitment to ensure high care quality.

Hospitals doi: 10.3390/hospitals2020009

Authors: Anisa Utami Nebil Achour Federica Pascale

Background: The rapid expansion of telemedicine globally, especially during the COVID-19 pandemic, has been critical for maintaining the continuity of chronic care, including in low- and middle-income countries (LMICs). In the context of maintaining health services during major hazards, telemedicine offers a potential solution for reducing the impact of associated disruptions and maintaining the functionality of hospitals. This study aims to evaluate the application of telemedicine for chronic diseases in LMICs during COVID-19, with a focus on its role in enhancing health system resilience during disastrous events. Methods: A systematised review was conducted by searching PubMed, Scopus, Global Health, and Google Scholar for primary literature published between January 2020 and July 2023. English-language articles on chronic disease management were targeted; they were freely accessible and excluded abstracts, conference papers, posters, and grey literature. A multilevel evaluation framework was applied, covering access, cost, patient and health worker experiences, and the effectiveness of telemedicine interventions. Results: After screening one thousand six hundred seventy-eight records, twenty-three studies and two additional snowball-sourced papers from ten countries were included. Findings revealed that while telemedicine enhanced access to care, patient experiences, and effectiveness, cost analysis remains an understudied area. Discrepancies in perspectives were noted between patients and health workers, particularly regarding access and effectiveness. Nevertheless, the majority of studies agree on telemedicine’s positive impact on the accessibility and resilience of health systems during major emergencies, which reduces costs and improves the overall patient experience. However, concerns such as outdated regulations and policies and poor internet connectivity pose a challenge that needs to be addressed. Conclusions: This review highlights the potential of telemedicine in strengthening health system resilience, particularly in LMICs where more work is needed to update regulations and policies and to strengthen infrastructure for more affordable and uninterruptable connectivity. Further research is needed to explore the long-term sustainability of telemedicine in these contexts and to identify strategies for successful implementation across diverse public health challenges.

Hospitals doi: 10.3390/hospitals2010008

Authors: Kimberly Jones-Rudolph Wilfredo Lacro Larry Hurst Jay J. Shen

Background: With so much emphasis currently on Social Determinants of Health (SDOH), we examined the characteristics of U.S. hospitals making commitments to SDOH and engagement with community social determinant programs and activities (CSDPAs). Methods: This cross-sectional study used the 2021 American Hospital Association (AHA) Annual Survey with a total of 5992 hospitals included. The dependent variables were the community social determinants composite score, community partnership composite score, and the use of CSPDAs to assess outcomes. Results: Hospitals most influenced by payment policies and regulations were most likely to engage in CSDPAs. Hospitals with ACOs implement 3.38 more CSPDAs and hospitals participating in bundled payments are 41% more likely to address SDOH (OR = 1.41, 95% CI = [1.14, 1.75]). Hospitals in competitive markets and hospitals with ≥400 beds are positively associated with both SDOH activities and partnerships. Teaching hospitals, not-for-profit hospitals, Medicare mix, and rural hospitals, as well as market competition, were positively associated with higher levels of CSDPAs. Conclusion: Reimbursement requirements, organizational size and resources, and external pressures were shown as drivers for hospitals to implement CSDPAs.

Hospitals doi: 10.3390/hospitals2010007

Authors: Camille Suzanne Vigier-Fretey Maria Granados-Santiago Julia Raya-Benitez Jesus Zamora-Tortosa Alejandro Heredia-Ciuro Marie Carmen Valenza

Introduction: Chronic neck pain is a prevalent condition that challenges physical therapists (PTs) due to its multifactorial etiology. Differential diagnosis is crucial for identifying the underlying causes and providing appropriate interventions. However, the extent to which PTs apply and understand differential diagnostic criteria remains unclear. This study aimed to evaluate the knowledge, attitudes, and behaviors of PTs in France regarding the differential diagnosis of chronic neck pain. Materials and Methods: An online questionnaire was designed to assess PTs’ beliefs, attitudes, knowledge, and clinical application of differential diagnostic criteria in chronic neck pain. The survey was distributed nationwide and included questions regarding demographic data, theoretical knowledge, practical application, and perceived barriers. A total of 80 responses were collected and analyzed using descriptive and inferential statistics. Results: The results revealed moderate levels of theoretical knowledge among participants, with 62% correctly identifying key criteria for differential diagnosis. However, only 45% reported consistently applying these criteria in clinical practice. Common barriers included time constraints (70%), lack of access to advanced diagnostic tools (55%), and insufficient training (40%). Attitudes towards the importance of differential diagnosis were predominantly positive, with 85% recognizing its relevance for improving patient outcomes. Conclusions: This study highlights a gap between PTs’ knowledge and the practical application of differential diagnosis criteria in chronic neck pain. Addressing barriers such as training and resource availability could enhance clinical practices. Future efforts should focus on integrating these competencies into professional development programs to improve diagnostic accuracy and patient care.

Hospitals doi: 10.3390/hospitals2010006

Authors: Zifan Zhang Zhilin Liu Yutong Liu Dai Gu Chunyan Zhang Yanling Wang Ying Bian

Objective: This study investigates alarm fatigue among ICU nurses in China and its influencing factors to optimize alarm management. Methods: This study was conducted using a cross-sectional design. In May 2022, electronic questionnaires were distributed to ICU nurses in Beijing tertiary hospitals, using the Chinese version of the alarm fatigue scale and equipment alarm records. Data were analyzed using SPSS 26. Results: Results showed an average alarm fatigue score of 20.70 ± 6.54 (out of 52), indicating a moderate-to-low level. Nurses’ self-assessed health, work attitude, alarm accuracy, and frequency of simultaneous alarms significantly influenced fatigue levels (p < 0.05). Principal component analysis identified five factors, with work intensity, mental health, false alarm rate, and job responsibility being significant predictors (95% CI excluded zero). Alarm records revealed an average of 621 daily alarms in ICUs, 93.93% from monitors, with a false alarm rate of 56.36%, and only 43.64% being valid. Conclusions: This study highlights the multi-factorial nature of alarm fatigue and the need to improve alarm systems and nurse support.

Hospitals doi: 10.3390/hospitals2010005

Authors: Juan N. Walterspiel

IV line connectors often become contaminated between infusions, which leads to line infections. A flexible shield was developed to prevent this by means of passive protection. It was tested in a simulated bedside environment and protected from touch contamination as well as airborne transmission of skin bacteria to the connector hub. This flexible shield can compensate for the unavoidable human factor infection control lapses that occur during IV line handling by healthcare workers.

Hospitals doi: 10.3390/hospitals2010004

Authors: Jude Ominyi Adewale Alabi

The implementation of evidence-based practice (EBP) is crucial for improving patient outcomes and healthcare delivery, yet it faces significant challenges in acute care settings due to organisational barriers, resource limitations, and leadership complexities. This study explores how ward managers (WMs) facilitate knowledge utilisation (KU) and promote EBP adoption in these environments. A longitudinal qualitative case study was conducted over eight months in two acute care hospitals in the East Midlands, England. Data were collected through semi-structured interviews with 23 WMs, nonparticipant observations, and document analysis. Thematic analysis was used to identify key findings. Six themes emerged: navigating leadership challenges, overcoming organisational and resource barriers, sustaining EBP through learning networks, integrating technology, tailoring EBP to patient-centred care, and providing emotional support for staff. Hybrid leadership strategies, combining directive and collaborative approaches, were critical in addressing barriers, fostering engagement, and embedding EBP into workflows. Mentorship and resource management also played pivotal roles. The study highlights the need for tailored leadership strategies, innovative resource utilisation, and sustainable learning networks to overcome systemic challenges and promote EBP. These findings provide actionable insights for fostering evidence-informed care environments in resource-constrained acute care settings.

Hospitals doi: 10.3390/hospitals2010003

Authors: Subhodip Chatterjee Shubham Gupta Arnab Chanda

Slips and fall-related accidents cause a significant number of injuries in hospitals. Due to constant movement of doctors and nurses across different departments in hospitals such as OPD, trauma centres, and ICUs, there are possible interactions of their footwear with slippery floorings (e.g., wet or with soap suds), which may cause unexpected slips. To date, there is a lack of understanding on the traction of different footwear worn by hospital staff. This impedes the selection of appropriate floorings and footwear for preventing slips and falls in hospitals. In this work, the traction performances of twelve common footwear designs, worn by hospital staff, were tested on three different floorings at important locations, i.e., an outpatient department, trauma centre, and ICU entrance, at a busy public hospital. Oblique tread patterns are recommended for moderately rough floors under dry and Lizol conditions. Horizontally oriented patterns are better for smoother floors in dry conditions, while vertically oriented patterns are ideal for areas with frequent contaminant exposure. No specific recommendation can be made for soap-contaminated floors due to the contaminant’s high viscosity. The results also indicated the strong influence of flooring roughness on the measured traction, over footwear tread parameters. Also, liquid soaps were observed to significantly reduce footwear–floor traction. The findings are anticipated to be valuable to hospital management for the selection of appropriate high-traction floorings, and provide important guidelines for footwear selection, for the mitigation of slips and falls in hospitals.

Hospitals doi: 10.3390/hospitals2010002

Authors: Rainer W. G. Gruessner

Hospital and health system bankruptcies and closures continue to rise in the United States. They are troubling news not only for patients and communities but also for insurance companies. Hospital closures often lead to higher costs for insurers due to increased claim denials, delayed payments, reduced provider network and access to care, higher out-of-network costs, and a disruption of our healthcare system. These factors ultimately impact the health insurance companies’ bottom lines as well as their ability to manage patient care effectively with the risk of causing customer/patient dissatisfaction. Insurance companies can help prevent hospital closures, especially in rural areas, by implementing some of the following mechanisms: timely and adequate payments; improved patient-centric payment systems; and standby capacity payments to cover minimum fixed costs. Such early strategic investments have the potential to offset the higher costs for insurance companies associated with hospital closures and improve the sustainability of the U.S. healthcare system.

Hospitals doi: 10.3390/hospitals2010001

Authors: Emmanuel Ekundayo Sappor Rhyddhi Chakraborty

The role of clinical trials cannot be ignored due to its contribution to innovative treatment, therapies, and drug development in promoting quality service delivery. We investigated and explored the management aspect of clinical trials and its impact on healthcare service delivery within the NHS. A qualitative methodology with an interpretivism approach was adopted to collect data from nine participants using a purposive sampling method in the management of clinical trials at the NHS. A semi-structured interview with open-ended questions and probing techniques conducted via Microsoft Teams was used as a data collection tool. The collected data were thematically analysed with the support of NVivo 14 software. The staffs’ perceptions were somewhat effective and highlights required improvement for better performance regarding clinical trial management at the NHS setting. The findings represent improved patient outcomes, increasing evidence-based decision making, and the development of innovative therapies and research infrastructure could be some positive impacts of the effective management of clinical trials. However, the findings show that improvement in stakeholder collaboration and communication is vital to combat the existing challenges such as regulatory hurdles and issues in participant recruitment, retention, and communication. The findings provide practical values and insight into the staff working in the management of clinical trial processes and the audiences relevant to this field. A comprehensive understanding of the proactive measures and factors that are essential for the improvement of clinical trial management has been interpreted. In the hospital’s settings, supervision and improvement of clinical trials are necessary to promote innovative therapies, research infrastructure, and quality patient care and service delivery.

Hospitals doi: 10.3390/hospitals1020015

Authors: Francisco Epelde

Artificial intelligence (AI) has emerged as a transformative force in enhancing patient safety within hospital settings. This perspective explores the various applications of AI in improving patient outcomes, including early warning systems, predictive analytics, process automation, and personalized treatment. We also highlight the economic benefits associated with AI implementation, such as cost savings through reduced adverse events and improved operational efficiency. Moreover, the perspective addresses how AI can enhance pharmacological treatments, optimize diagnostic testing, and mitigate hospital-acquired infections. Despite the promising advancements, challenges related to data quality, ethical concerns, and clinical integration remain. Future research directions are proposed to address these challenges and harness the full potential of AI in healthcare.

Hospitals doi: 10.3390/hospitals1020014

Authors: Soumya Upadhyay Randyl A. Cochran William Opoku-Agyeman

In a dynamic healthcare industry, aligning the goals and objectives of hospitals and physicians through integration has been suggested to influence performance. Physicians’ leadership and active involvement in governance can direct resource usage, Electronic Health Record (EHR) implementation, price negotiation, better coordination, and continuity of services for patients, thus affecting performance. This study aimed to examine the relationship between physician integration and hospital performance, investigating both financial and quality outcomes. We used a longitudinal study design. Our sample was hospital-level data from 2014 to 2019, which contained 6000 U.S. hospital-year observations. The dependent variables were quality outcomes (readmission rates) and financial outcomes (total and operating margins). The independent variable explored three dimensions of integration: high, low, and overall integration. Findings showed no impact of hospital–physician integration on quality outcomes and financial performance. High-integration hospitals did not show any significant relationships with quality outcomes and financial performance compared to hospitals that did not have high integration. Hospital–physician integration may have little potential to bring clinical integration even though vertical integration is present. A commitment to improving quality as a strategic priority may be vital in impacting quality outcomes, followed by financial performance.

Hospitals doi: 10.3390/hospitals1020013

Authors: Goitseone Mogomotsi Jennifer Creese

Health systems around the world continue to experience healthcare workforce shortages, including shortages of nurses. This results in staff experiencing prolonged shifts and other stressors, which are linked to burnout, yet burned-out staff are then entrusted with the provision of patient care, despite healthcare facilities being regarded as safety-critical areas. It is assumed that the situation may have been worsened by the COVID-19 pandemic. This scoping review aims to identify the prevalence of burnout among nurses in Europe before and during the pandemic, the factors associated with this burnout, and its impact on patient safety. A literature search was conducted in the MEDLINE database; search terms included Nurse and Burnout and Patient Safety and their synonyms. The search limits used were English language, 2013 to 2023 publication years, original published research only (excluding review papers, dissertations, and unpublished reports), and studies conducted in European countries. A total of 16 papers were included for analysis: four indicated burnout levels of study participants, while 11 gave scores for individual burnout symptoms. Almost all studies indicated factors that were linked to burnout or individual dimensions of burnout. A few papers touched on the implications of these factors on patient safety. The review findings concluded that the few studies providing burnout levels on study participants could not give a clear picture of the burnout prevalence among nurses across Europe, either in general, before, or during the pandemic; therefore, this objective was not achieved and more research is required to establish this. Several factors thematically classified as sociodemographic, personal, organizational, and patient/client-related were linked to burnout. However, there were some contradictions in sociodemographic factors. Low personal accomplishment was the most common symptom of burnout before the pandemic, followed by emotional exhaustion and lastly depersonalization. Emotional exhaustion took the lead during the COVID-19 pandemic, followed by low personal accomplishment, and depersonalization remained the least common. More research is needed to establish the relationship between burnout and these factors.

Hospitals doi: 10.3390/hospitals1010012

Authors: Francisco Epelde

Welcome to Hospitals, a journal dedicated to exploring the essential pillars that drive the success and evolution of hospitals in today’s world [...]

Hospitals doi: 10.3390/hospitals1010011

Authors: Despoina Pappa Eleni Evangelou Ioannis Koutelekos Evangelos Dousis Nikoletta Margari Georgia Toulia Areti Stavropoulou Alexandra Koreli Maria Theodoratou Aggeliki Bilali Konstantina Chasaki Afroditi Zartaloudi Chrysoula Dafogianni

Background: Errors are a common occurrence in all healthcare settings, and the safety of patients is a critical concern that involves multiple factors, including the complex and demanding nature of nursing practice. Nurses, due to their continuous and direct patient care, play a pivotal role in ensuring patient safety. This cross-sectional study aimed to investigate the factors that contribute to errors from the perspectives of nurses in Greek hospitals, with a focus on understanding the challenges they face in their daily practice. Methods: Clinical nurses willingly and anonymously filled out a specific structured questionnaire, the Taxonomy of Error, Root Cause Analysis, and Practice-responsibility (TERCAP) tool that describes the conditions under which an error during clinical practice occurred. The study method included convenience sampling. After obtaining permission, questionnaires were distributed to hospital departments. To accommodate pandemic-related restrictions, an electronic version of the questionnaire was also created for distribution and collection. Analysis of data was accomplished via SPSS 26.0. Results: Five hundred and ninety-seven clinical nurses participated anonymously, reporting errors in almost seven out of ten cases, often attributing them to high workload and staff shortages. Errors were commonly reported during different shifts in this study. Factors such as assigning significant responsibilities to inexperienced staff and inadequate implementation guidelines were highlighted. Conclusions: The in-depth study of nursing errors provides a nuanced understanding of their causes by categorizing them based on various factors. It emphasizes the complexity of challenges and the need to integrate systemic, clinical, and individual factors into intervention strategies, including medication protocols, ongoing training, clear communication, administrative support, and fostering an open communication culture.

Hospitals doi: 10.3390/hospitals1010010

Authors: Mir Aftab Hussain Talpur

The population of Pakistan is increasing, with approximately 2% growth. Over the years, the country’s healthcare system has struggled to meet the needs of the population. Nevertheless, because of shortages compared to population distribution, people are facing primary healthcare challenges, specifically in rural environments. Because of the absence of standard health services, the quality of the health sector deteriorated over time. Therefore, this study aims to compute the shortage of health facilities in Badin, Pakistan, per local health standards. The information related to available health institutes was obtained from the office of the Director-General Health Office with the help of a questionnaire. The current population was determined, and the same was projected up to the year 2035 with the help of a compound interest model. The linear model was executed and found to be significant, with the values of R = 0.996, R2 = 0.991, and Sig. F-change = 0.000. The Badin sub-region needed 201 basic health units, 37 rural health centers, and 746 dispensaries. The public health institutes were found unavailable as per demographic standards. This research set a platform for local authorities to take certain actions in framing essential policies to curtail the shortage of health institutions. This study is significant, as it confers existing and futuristic health institute demands. This research can serve as a model for remote sub-regions to address primary healthcare issues, including the fight against diseases and viruses. This research may also contribute to sustainable goal number 3, i.e., Good Health and Well-being.

Hospitals doi: 10.3390/hospitals1010009

Authors: Hisayuki Miura Yuko Goto

Backgrounds: The pre-discharge conference (PDC) is crucial for ensuring care continuity based on patients’ preferences and goals. However, there is no quantitative on its effectiveness. We investigated the effectiveness of multidisciplinary PDC on the concordance rate between the preferred (PPEoLC) and actual place of end-of-life care and death. Methods: Overall, 551 older homebound patients (median age, 83.0 years; female, 49.4%; male, 50.6%) receiving continuous home medical care through clinics were enrolled in hospital ward admission from March 2011 to September 2018. Patient demographics, presence or absence of PDCs, statements from patients and their families regarding PPEoLC, and place of death of deceased patients were confirmed from the patients’ medical records, followed by concordance rate analyses between PPEoLC and place of death and a multivariate analysis of home mortality. We used the Mann–Whiney U test to assess attribute data, hypothesis testing to assess the difference in the population proportions, and binominal logistic regression analyses to evaluate the relationship between valuables. Results: In the conference group, the home mortality rate, patients’ and their families’ expression rates, and preferences for their home of PPEoLC were higher (p < 0.001) than those in the non-conference group. The place of death was significantly influenced by family preferences. Conclusions: PDC can affect the place of death of homebound patients, but family preferences rather than patient preferences influence the decision of the patient’s place of death. To better reflect the patient preferences, patient-centered decision support should be provided earlier in the disease process.

Hospitals doi: 10.3390/hospitals1010008

Authors: Eleni Tsapnidou Martha Kelesi Michael Rovithis Georgios Katharakis Georgia Gerogianni Chrysoula Dafogianni Georgia Toylia Georgia Fasoi Areti Stavropoulou

Effective nursing leadership is critical for healthcare organizations’ sustainability as nurse leaders influence many organizational aspects, including staff retention, quality of care, resource management, and development. The aim of this study is to highlight the quality achievements and benefits that transformational leadership may have for healthcare organizations. An extensive literature search has been conducted through MEDLINE and Scopus. The 6-stage framework proposed by Arksey and O’Malley was applied, guided the scoping review process. Data extracted from the included studies were systematically charted. This approach allowed for a comprehensive understanding of the advantages of transformational leadership in healthcare organizations. Of the 1245 searched articles, 26 encountered the study’s inclusion criteria. Analysis of the studies led to the formulation of two thematic categories, namely, (a) transformational leadership and human resources and (b) transformational leadership and healthcare delivery. Results indicated that transformational nursing leadership can benefit healthcare organizations in terms of effective resource management, high quality of care, and sustainability. Visionary leaders support staff retention, innovation, and research and promote organizational status and development. Through continuous support and training, transformational nurse leaders can ensure nurses’ job satisfaction and engagement, patients’ satisfaction, the best therapeutic outcomes, and high levels of organizational achievement.

Hospitals doi: 10.3390/hospitals1010007

Authors: Despoina Pappa Eleni Evangelou Ioannis Koutelekos Evangelos Dousis Georgia Toulia Areti Stavropoulou Nikoletta Margari Anna Giga Eftychia Ferentinou Konstantina Chasaki Aggeliki Bilali Afroditi Zartaloudi Chrysoula Dafogianni

Background: Adverse events are a prevalent occurrence across pediatric healthcare environments, and patient safety is intricately tied to nursing errors due to nurses’ consistent presence and interaction with patients, which surpasses that of any other healthcare professional. This research sought to explore the factors influencing errors as perceived by pediatric nurses in Greek hospital settings. Methods: Clinical pediatric nurses voluntarily and anonymously completed a specialized structured survey, utilizing the Taxonomy of Error, Root Cause Analysis, and Practice-responsibility (TERCAP) tool, which delineates the circumstances surrounding errors occurring during clinical practice. Results: Among the participants employed in the pediatric department, 80.8% (n = 84) reported experiencing an error at their workplace. Notably, in 48.7% (n = 38) of these instances, the error was attributed to themselves (personal responsibility), while in 78.9% (n = 56) of cases, it was linked to errors committed by other colleagues in the clinic. As reported by participants in pediatric departments, the primary factors contributing to potential error occurrence include the absence or inadequacy of orientation and training for new staff (43.2%), the absence of a standardized protocol for resolving disagreements (39%), insufficient ongoing training (38.3%), and breakdowns in interdisciplinary communication (21%). Conclusions: By classifying errors based on various criteria such as outcomes, processes, cognitive reasoning, ethical considerations, and importance, this study presents a holistic framework for examining pediatric nurses’ errors from diverse perspectives. Through this classification approach, the study establishes a foundation for tailored interventions targeting particular aspects of errors and their root causes in pediatric departments.

Hospitals doi: 10.3390/hospitals1010006

Authors: Abhinav R. Balu Anthony N. Baumann Grayson M. Talaski Faheem Pottayil Kempland C. Walley Albert T. Anastasio Keith D. Baldwin

Introduction: With the passage of the Physician Payment Sunshine Act, there has been increased transparency regarding the industrial financial relations that physicians have. Orthopedic surgeons have been highly studied in this domain with approximately 50% of all orthopedic surgeons engaging in industrial financial relationships. Furthermore, an increasing number of orthopedic surgeons are seeking fellowship training with pediatric fellowship programs gaining popularity in recent years. The purpose of this study is to evaluate the impact various pediatric orthopedic fellowship programs have on industry earnings and academic productivity. Methods: Pediatric orthopedic fellowship programs were identified via the Orthopedic Society of North America (POSNA) website. Information on individual fellowship programs was obtained from their respective websites. Academic productivity was measured via an aggregate of all employed physicians’ H-index at a specific fellowship as found on the Scopus website. The Open Payments Database (OPD) website was used to assess lifetime industry earnings. Other variables such as Newsweek or Doximity ranking were taken directly from relevant websites. Statistical analysis was performed using a Kruskal–Wallis test with Bonferroni correction and Mann–Whitney U-test. Results: A total of 43 pediatric orthopedic surgery fellowships in the United States were identified with a total of 392 physicians as fellowship faculty. Complete OPD and H-index information were available for 336 of those physicians (85.7%). On average, there were 7.81 ± 5.18 physicians and 1.56 ± 0.93 fellows per program. The mean combined physician H-index was 117.23 ± 122.51, and the mean combined physician lifetime supplemental earnings in dollars was $646,684.37 ± $1,159,507.17. There was no significant relationship between region of pediatric orthopedic fellowship, Newsweek ranking of affiliated hospital, Doximity ranking of affiliated hospital, presence of MBA program, type of program (public, private, mixed), and the lifetime industry earnings or academic productivity of program graduates. Conclusions: Despite the observed lack of statistical significance, there were clear trends observed with fellowship programs in the northeast and west coast regions being the highest earning and fellowship programs with top 10 Newsweek ranking of affiliated hospital having by far the greatest industry earnings. Sample size limitations likely prevented the detection of statistical significance. Future studies should examine if any relation exists when accounting for type of industry payment received and case volume per fellowship program.

Hospitals doi: 10.3390/hospitals1010005

Authors: Jesper Fabricius Anna Birthe Andersen Gitte Lindegård Munk Hanne Kaae Kristensen

Post-injury confusional state is a common phenomenon following acquired brain injury. A multi-faceted approach for decreasing confusion is recommended, but there is a paucity of research related to non-pharmacological management. The main objective was to present a conceptual model of multi-faceted approaches for confusion, and secondly to investigate the rehabilitation outcome following these approaches. The setting is a specialized ward for rehabilitation of patients with severe cognitive difficulties following acquired brain injury. The conceptual model encompasses neurobehavioral strategies, pharmacological treatment, engagement in meaningful occupations, next of kin involvement, organizational demands, the physical environment, along with differential diagnostics. Patient cases are provided to illustrate the impact of each approach. A total of 141 of 281 patients were in a confusional state at admission. At discharge, 62% had emerged from the confusional state. Patients in a confusional state due to traumatic brain injury and subarachnoid hemorrhage had clinically important differences of >22 points in the functional independence measure from admission to discharge, following rehabilitation efforts based on the conceptual model. No clinically important difference was seen in patients with non-SAH stroke and patients with other types of brain injuries. The proposed conceptual model should be further evaluated in complex intervention studies.

Hospitals doi: 10.3390/hospitals1010004

Authors: Yuko Goto Hisayuki Miura

[Background] Intermediate care is a limited-time service founded on patient-centered care (PCC) that ensures continuity and quality of care during the transition between home and acute care services, promotes recovery, and restores independence and confidence. In Japan, systematic education on intermediate care for care providers is lacking. [Method] The present study explored the relationship between a Japanese scale used to evaluate individualized discharge support skills, a Japanese version of a tool for evaluating intermediate care based on PCC, and a tool that measures the shared decision making of care providers, which is the pinnacle of PCC. [Results] Clear correlations were found between the concepts evaluated using these three tools. Some concepts were not correlated between the Japanese scale that evaluated individualized discharge support skills and intermediate care based on PCC. [Conclusions] Elucidating the perspectives that help expand discharge care to intermediate care based on PCC will contribute to future education on intermediate care for Japanese care providers and to enriching patient-centered intermediate care.

Hospitals doi: 10.3390/hospitals1010003

Authors: Jonathan Kopel

Neurology holds a unique perspective that embodies the art of capturing a patient’s story. Despite medical advancements, many neurological conditions leave patients permanently impaired. This sudden loss of independence can be demoralizing and, in most cases, directly changes a person’s identity. It is therefore a necessary part of a neurologist’s trade to know their patient’s history—their story. Their tales reveal intimate details of their personality changes, memory loss, sensory deprivation, and movement disorders. A true neurologist is a person that remains vulnerable through their willingness to take a history—the story of their patient—and remain curious, vulnerable, and compassionate through their journey to heal and comfort the patient. To understand the patient’s illness experience in neurology, the underlying themes of patient recovery (compassion, determination, and patience) are explored with regard to the neurological patient’s experience. These themes are then expanded to include the neurology patient’s mental perceptions of themselves, and their illness’ influences over their identity, recovery, and daily life. In addition to the patient’s experience, the neurologist’s awareness and emotional response to the patient’s illness experience can provide an opportunity to develop a strong therapeutic bond with their patient and improve patient outcomes. Given that their neurological impairment causes a loss of independence and control over their identity and self-worth, neurologists can incorporate the patient’s experience into their management and treatment, to better address their emotional and spiritual needs as they come to terms with their identity.

Hospitals doi: 10.3390/hospitals1010002

Authors: Marina Di Lello Finuoli

This essay focuses on so-called obstetric violence, i.e., the medical malpractice consisting of disrespect and/or abuses to the detriment of women during their labor or when they give birth, as well as during health care services concerning the sexual and reproductive sphere. The main goal is to start a debate on a topic already considered by foreign lawmakers, also for punishment purposes. After an empirical-criminological survey of the cases and the misconduct to be labelled as “obstetric violence”, this essay analyses the legal tools available in Italy. From a law reform perspective, the author reflects on the (non-criminal) strategies to prevent distortions of the doctor–patient relationship as well as on the harm to women’s self-determination and dignity, particularly in respect of the rules on informed consent.

Hospitals doi: 10.3390/hospitals1010001

Authors: Antonio Oliva Al Ozonoff Matteo Caputo Simone Grassi

“Hospitals” as a name for a journal might appear simply as an umbrella term for healthcare-relevant research [...]