Search Results (1,165)

The National Special Pathogens System (NSPS) stratifies U.S. healthcare facilities by their readiness level to care for patients with high-consequence infectious diseases (HCIDs). While NSPS Level 1 and 2 facilities possess advanced biocontainment capabilities to care for patients for the duration of their illness, most U.S. hospitals fall under a NSPS Level 3 or 4 designation, with limited resources to manage patients with a suspected or confirmed HCID. However, emerging zoonotic threats like H5N1 underscore the need to bolster HCID preparedness across all NSPS Levels. Beginning in March 2024, the U.S. H5N1 outbreak has primarily impacted wild bird flocks, poultry, and cattle, along with some human infections. The continuation of this outbreak in wild and domesticated animals increases the likelihood of further human spillover and eventual viral evolution in human hosts. At the frontlines, rural farming communities are likely to be most affected, with potential outbreaks exacerbated by a lack of accessible NSPS Level 1, 2, or 3 facilities in these regions. Thus, strengthening the HCID preparedness of local NSPS Level 4 facilities is critical to preventing transmission, minimizing societal disruption, protecting communities and the healthcare workforce, along with ensuring an equitable, coordinated response to future emerging infectious disease threats. This manuscript explores the financial, societal and health system impacts of HCID outbreaks to delineate the necessity of strengthening the preparedness of NSPS Level 4 facilities. Full article

Background: Surgical operations are an integral part of healthcare delivery and impose a substantial clinical and operational burden. Understanding how the operation- and process-management literature in healthcare reflects the intensity of surgical services and how this may affect the specialization preferences of healthcare professionals is important for strategic workforce planning. Methods: A bibliometric analysis was conducted on 272 academic publications obtained from the Web of Science Core Collection with the keywords “lean philosophy”, “health” and “process” to capture the operational and process-improvement perspective of healthcare services. In this work, the “lean philosophy” keyword was taken to denote the operation- and process-management view of healthcare services, not to reflect the whole literature on surgical intensity. This selection was performed due to the multiple reasons, with an example being that lean-related studies often discuss complexities of workflow, efficiency, organizational responsiveness, and quality optimization, which are aspects also directly linked to surgical operational intensity. The data were analyzed using the bibliometrix R package, R-4.6.0 to construct the keyword co-occurrence network. Based on this network, a cognitive map was designed to visualize the conceptual relationships among the themes. Thematic clusters based on the co-occurrence network were then evaluated and prioritized by using the Analytic Network Process (ANP). Pairwise comparison data were derived from seven experts (surgeons and healthcare managers), and the model was implemented in Super Decisions with consistency ratios below 0.10. Results: The findings of the co-occurrence analysis are five main thematic clusters with surgical intensity themes including Healthcare Services, Quality, Care, Health and Outcomes. The cognitive map shows that Healthcare Services and Quality have the most central positions and structural hubs in the literature, whereas Outcomes is a dimension of great importance in terms of performance. The ANP results show that Quality (limiting weight ≈ 0.21), General Topics (≈0.14) and Management and Leadership (≈0.13) are the most influential sub-themes with regard to surgical operational intensity and, indirectly, to specialization preferences. Conclusions: The findings reveal that quality management, organizational leadership and larger health policy concerns are closely associated with the intensity of operations of surgical services as depicted in the operation- and process-management literature. Healthcare workers might be inclined to relocate to job positions related to quality improvement and leadership in lieu of places with a high direct clinical burden. Such insights can guide the policies of strategic human resource planning and specialization balancing in healthcare systems. Full article

Science, Technology, Engineering, and Mathematics (STEM) education and workforce participation are growing increasingly important for economic and social development, yet STEM disengagement and participation challenges persist. Existing research has predominantly focused on the aspirations of young people, leaving the retrospective perspectives of STEM professionals relatively underexplored, particularly in non-metropolitan contexts. This study examines how 79 STEM professionals, educated in non-metropolitan settings, rated and described influential factors in their STEM career journeys. A predominantly female sample working in health fields was obtained through convenience and snowball sampling approaches. Using a convergent mixed-method design, participants quantitatively rated 10 STEM career influence factors and qualitatively reflected on their educational and professional pathways. Repeated-measures analyses indicated personal interest/ability was rated as the most influential factor, followed by secondary/high school education and teachers. Qualitative cluster analysis identified a bifurcated pattern in which proximal personal, social, and school-based influences contributed to STEM trajectory establishment, while broader economic and cultural influences were associated with STEM trajectory resilience and maintenance. Participants also described circumstantial impediments, alternate pathways, and real-world experiences that challenged linear pipeline assumptions about STEM careers. The findings suggest that rural STEM participation involves both the establishment and maintenance of career trajectories shaped by related, but distinct, influences. Full article

Sustaining high performance in private healthcare requires that internal organizational processes actively reinforce the values employees carry into their daily work. This study examines how organizational communication and internal branding shape employee commitment, positioning commitment as a foundational condition for sustainable organizational performance in health services. Drawing on quantitative data from 247 healthcare professionals, a structured questionnaire validated through reliability analysis and Confirmatory Factor Analysis was used to assess the direct and indirect pathways between these constructs. Multiple regression analysis confirmed that both organizational communication and internal branding are significant positive predictors of employee commitment, with communication carrying a marginally stronger direct effect. Mediation analysis further revealed that internal branding mediates the relationship between organizational communication and employee commitment, accounting for approximately 29 percent of the total effect. These findings suggest that coherent communication structures and well-anchored internal branding practices are associated with the kind of internal alignment that prior research has linked to workforce stability and service continuity, which are themselves proximal conditions for organizational sustainability. The study concludes by proposing an integrated managerial framework that brings these two strategic levers into closer coordination, while acknowledging that distal sustainability outcomes were not directly measured and should be assessed in subsequent longitudinal research. Full article

Confined space operations are characterized by environmental complexity and latent hazards, where failures in human risk perception represent a primary precursor to industrial accidents, posing a significant challenge to sustainable occupational health and safety (OHS) management. This study investigates the mechanism by which individual traits (risk propensity) influence risk perception performance through cognitive processes (inattentional blindness). Utilizing psychological scales and eye-tracking technology, we quantitatively analyzed the visual search behaviors of participants with varying risk propensities across typical confined space hazard scenarios. The results indicate that individuals with high risk propensity tend to adopt a “random-exploratory superficial scanning strategy,” characterized by significantly delayed Time to First Fixation (TFF) and lower Fixation Count (FC) within critical hazard areas compared to the low-risk propensity group. Statistical analysis reveals that inattentional blindness exerts a full mediating effect between risk propensity and risk perception performance, accounting for 72.56% of perception failures. This research confirms that an imbalance in attentional resource allocation leads to higher cognitive omission of salient hazards among high-risk propensity individuals. These findings provide a theoretical foundation for cognitive reliability assessment and the design of sustainable safety training programs in high-risk industries, ultimately contributing to the social sustainability and well-being of industrial workforces. Full article

Background: In Italy, Departments of Prevention (Dipartimenti di Prevenzione, DPs) are primary organizational units for disease prevention, health promotion, and environmental health. Constitutional decentralization (2001) generated significant regional variability. While national data exist, in-depth regional analyses are lacking. Objectives: To provide a systematic descriptive analysis of organizational structure, governance mechanisms, and workforce composition of DPs in the Triveneto area (Veneto, Friuli Venezia Giulia, Autonomous Provinces of Trento and Bolzano), contextualized within national and international frameworks. Methods: Cross-sectional descriptive study using 2022 Italian Prevention Observatory national survey data. A structured 87-item questionnaire assessed organizational structure, governance, staffing, and quality systems. Results: A total of 10 of 14 DPs participated (71.4% coverage; 5.2 million inhabitants, 87% of Triveneto population). All maintained three mandated core services (Public Health and Hygiene, Veterinary Public Health, and Occupational Health and Safety), employing medians of 35%, 23%, and 14% of staff, respectively. Management Committees were active in 80% of DPs (vs. 77.6% nationally). Quality certification (30%) and institutional accreditation (50%, Veneto only) showed inconsistent implementation. The workforce was predominantly non-executive (65% vs. 67% nationally), reflecting progressive task reallocation. Median staff density: 3235 inhabitants/staff member (vs. 2608 nationally). Conclusions: Participating DPs—predominantly from the Veneto Region—demonstrate comprehensive service coverage and established governance structures, yet face standardization challenges. Findings should be interpreted in light of Veneto overrepresentation (8/10 participating DPs). Alignment with territorial care reforms (Ministerial Decree 77/2022) and National Recovery Plan investments could enhance integration, digital infrastructure, and preparedness capacity. Full article

Child and adolescent mental health (CAMH) is a global concern that is increasingly recognized and prioritized. Worldwide, mental health conditions affect a significant number of children and adolescents; however, access to CAMH services remains limited. This study sought to explore the implementation of child and adolescent mental health services in the rural Chris Hani District of the Eastern Cape province, South Africa, from the perspectives of health professionals and teachers, focusing on strengths, weaknesses, opportunities, and threats. Using a qualitative approach, a sample of 36 participants (12 health professionals and 24 teachers) was purposively recruited. Data were collected through face-to-face, semi-structured individual interviews and focus group discussions. Thematic analysis identified several strengths, including effective screening and identification of CAMH problems, training in psychiatry and psychology, teacher support, collaboration with stakeholders, and the availability of policy and guidelines. Key weaknesses included inadequate CAMH training, a limited CAMH workforce, personal barriers, guidelines primarily oriented toward physical health, and insufficient basic infrastructure. Opportunities for improvement include enhancing the skills of the existing workforce, increasing engagement in extramural activities, and empowering parents with knowledge of available CAMH services. Identified threats included the normalization of CAMH symptoms, challenges involving parents and feeder schools, stigma, poor stakeholder collaboration, and inadequate guidelines. Overall, the analysis of strengths, weaknesses, opportunities, and threats reflects the broader challenges present in low-resource settings that hinder the implementation of CAMH services. It also highlights the need for integrative approaches to implementing CAMH services in rural contexts, while identifying opportunities to improve service delivery. Full article

Family medicine has attracted increasing policy and institutional support across the Gulf Cooperation Council (GCC) countries through health system reform, expansion of the healthcare workforce, and sustained public investment. Nevertheless, important challenges continue to affect the strength of primary healthcare systems, access to care, and the management of non-communicable diseases. The aim of the narrative review is to identify future trends, directions, perspectives, and opportunities that can strengthen implementation of family medicine across GCC countries and improve healthcare delivery. This review is based on a structured search of major databases such as PubMed, Scopus, and Google Scholar. The focus was evaluation of literature associated with family medicine and primary healthcare development in GCC countries. Regional priorities now include improving medical education and training, expanding the family medicine workforce, strengthening links with communities, promoting more equitable access to healthcare, and managing treatment costs through workforce development and digital health initiatives. Family medicine practice across the GCC is being supported increasingly by electronic health records, telemedicine, and interprofessional education. Policy directions in the region also suggest growing interest in value-based research, international collaboration, multidisciplinary care, and innovation in healthcare delivery. The future of development of family medicine in the GCC will depend on better integration of digital health, more effective use of data in planning and policy, continued investment in training, and broader adoption of patient-centred models of care. In general, strengthening family medicine through sustained investment in workforce development, primary healthcare infrastructure, research capacity, and digital health integration is essential for achieving resilient, equitable, and patient-centered healthcare systems across the GCC. Full article

Healthcare quality systems have evolved from narrow inspection and compliance mechanisms into broader, multi-level architectures that combine standards, measurement, organizational learning, patient safety, equity and patient-reported outcomes. Yet the field remains fragmented, with substantial variation in how quality is defined, measured and operationalized across countries and healthcare settings. This narrative review synthesizes major international quality systems and frameworks used in healthcare delivery, examines principal methods for evaluating and improving quality, and critically discusses organizational and policy conditions associated with successful implementation. A purposive review of the seminal conceptual literature and authoritative documents from major international organizations was undertaken to identify cross-cutting themes relevant to hospitals, ambulatory care and health systems. The review shows that influential approaches—including the World Health Organization’s quality and patient safety frameworks, Joint Commission International accreditation, NCQA/HEDIS, the EFQM model, ISO-based management systems, AHRQ quality indicators and OECD performance initiatives such as PaRIS—should be viewed as complementary rather than competing models. Their effectiveness depends less on formal adoption alone than on leadership commitment, workforce engagement, data infrastructure, patient involvement and alignment with financing and regulation. Evidence is strongest for gains in standardization, safety processes, teamwork and selected efficiency outcomes; direct causal effects on patient outcomes remain less consistent, particularly when quality systems become compliance-driven or are insufficiently adapted to local context. Future healthcare quality systems should integrate equity, digital interoperability, AI-enabled learning capabilities, patient-reported measures and continuous improvement while reducing measurement burden and indicator proliferation. Full article

Background/Objectives: Health systems in many countries are increasingly turning to task shifting, task sharing and broader skill-mix solutions to address staff shortages and unequal access to care, particularly in rural regions. This article summarizes how different healthcare systems introduce intersecting competencies through new professional roles, the expansion of the scope of existing professions, and the transfer of selected tasks between them. The aim was also to indicate which strategies may be relevant for the Polish context. Methods: A literature review was carried out using PubMed and Embase (14 February–9 March 2025). Publications from 2010 to 2024 in English or Polish were included. The study was designed as a narrative review supported by a structured literature search. Publications and policy documents relevant to skill-mix strategies were identified through a concept-driven process and incorporated into a thematic synthesis. Results: Countries that introduced new professional roles reported better access to care and more continuity for patients. Expanding the scope of nurses, physiotherapists and pharmacists often helped reduce the workload of doctors and, in some places, also supported better treatment results or smoother work in facilities. At the same time, there were clear challenges: unclear role boundaries, gaps in training, extra workload and limited organizational support. These issues were particularly visible in rural areas, where staff shortages are the most severe. Conclusions: Skill-mix strategies can support healthcare systems by improving access and the overall quality of care. However, their success depends on clear regulations, adequate preparation and acceptance among health workers. Although many solutions are promising, further research is needed to better assess their long-term effects and usefulness in medical deserts. Full article

This study investigates the emergence of psychosocial risks during the COVID-19 pandemic in the architecture, engineering, and construction (AEC) industry. It aims to enhance mental health outcomes for project professionals by identifying pandemic-related stressors, evaluating the role of organisational interventions, and developing a practical framework for psychosocial risk management. Guided by Job Demands–Resources (JDR) theory, the research involved a literature review, expert consultations, and a structured survey targeting AEC project managers. The findings reveal that COVID-19-related psychosocial risks such as work overload, isolation, job insecurity, and blurred work–life boundaries were negatively associated with mental health. Organisational interventions were positively associated with improved mental health. However, the moderating effect of organisational intervention on the relationship between psychosocial risks and mental health was not statistically significant. This study proposes a framework to guide AEC organisations in integrating proactive mental health strategies into everyday project practices. While the data are sector-specific and collected during a crisis period, the implications extend to broader project-based settings. This research offers practical insights for AEC firms, policymakers, and industry stakeholders on supporting workforce well-being through targeted interventions. It also contributes conceptually by linking pandemic-induced stressors to established theoretical models of occupational stress, highlighting the need for sector-specific strategies in promoting psychological safety in high-demand work environments. Full article

Background/Objectives: Natural disasters and climate-related emergencies increasingly disrupt maternal healthcare systems, placing growing demands on the midwifery workforce. While midwives play a critical role in maintaining continuity of care, evidence on how workforce preparedness influences service delivery remains limited. This systematic review aimed to synthesize evidence on determinants of midwives’ disaster preparedness and examine their association with continuity of maternal care. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Searches were performed in PubMed, Embase, CINAHL, Scopus, and Web of Science from inception to March 2026. Eligible studies examined midwives or midwifery-led care in natural disasters or climate-related emergencies. Data were extracted independently by two reviewers, and methodological quality appraised using the Mixed Methods Appraisal Tool (MMAT). Due to substantial methodological and clinical heterogeneity across study designs, populations, and outcomes, a meta-analysis was not feasible and findings were synthesized narratively. Results: Nine studies met the inclusion criteria, with the evidence base consisting predominantly of qualitative and cross-sectional studies, alongside one cohort study. Evidence was mainly derived from earthquake-affected settings. Preparedness was influenced by individual, professional, organizational, and psychosocial factors. Insufficient disaster-specific training, role ambiguity, and limited institutional preparedness were linked to reduced response capacity and disruptions across antenatal, intrapartum, and postnatal care. Conclusions: The evidence suggests that midwifery workforce preparedness is an important determinant of continuity of maternal care during disasters and climate-related emergencies. Strengthening disaster education, integrating midwives into emergency planning, and enhancing organizational support are essential to improve health system resilience. Further longitudinal and intervention-based research across diverse disaster contexts is needed to strengthen the evidence base. However, the findings should be interpreted cautiously due to the limited number and heterogeneity of included studies. Full article

Artificial intelligence (AI) is increasingly influencing healthcare administration and clinical informatics by supporting disease diagnosis, clinical decision-making, treatment personalization, drug discovery, remote monitoring, public health surveillance, and hospital operations. However, the successful adoption of AI in healthcare depends not only on algorithmic performance, but also on its safe integration into clinical information systems, organizational workflows, and governance structures. This article presents a narrative critical review of recent advances in AI-driven healthcare, with a focus on four major domains: AI-enabled disease diagnosis, treatment personalization and clinical decision support, drug discovery and biomedical knowledge generation, and healthcare administration. Evidence from radiology, pathology, ophthalmology, dermatology, and cardiology shows that AI systems can achieve strong diagnostic performance in selected settings, while applications in electronic health records, natural language processing, telemedicine, and predictive analytics are increasingly used to support healthcare delivery and operational decision-making. At the same time, important barriers continue to limit real-world implementation, including fragmented data infrastructures, limited interoperability, poor data quality, algorithmic bias, lack of explainability, privacy and cybersecurity risks, unclear accountability, and insufficient external validation. This review critically examines these challenges and proposes a governance-oriented roadmap for responsible AI integration in healthcare administration and clinical informatics. The proposed roadmap emphasizes data readiness, model validation, workflow integration, institutional accountability, post-deployment monitoring, and workforce readiness. The findings suggest that AI can contribute to more efficient, accessible, and patient-centered healthcare only when it is implemented within trustworthy medical informatics ecosystems supported by ethical governance, human oversight, and continuous evaluation. Full article

For almost fifty years, Crew Resource Management (CRM) has been a cornerstone of aviation safety and training. This narrative review examines the current state of CRM training and identifies key directions for future development, including the integration of artificial intelligence, increasing attention on mental health and resilience, and workforce diversity. While there is evidence of gradual evolution in CRM practices, reflected in updated regulatory frameworks, competency-based approaches, and a growing community of human factors and aviation psychology specialists, progress remains uneven across the industry. We argue that many aviation operators and training organizations still lack robust institutional mechanisms to systematically translate emerging scientific evidence into training design and delivery. As a result, advances in research on teaching and learning methods and human performance are not consistently brought forward into everyday training practices. The review concludes with a set of practical recommendations aimed at strengthening knowledge exchange between researchers and operational stakeholders, enhancing evidence-informed training, and supporting the modernization of CRM in a rapidly changing operational environment. Full article

Background/Objectives. Country-level evidence on the economic footprint of home care nursing is still scarce, particularly in systems where tariffs for community-based nursing are lacking. In Italy, recent laws have expanded home care; yet planning and funding remain constrained by the absence of robust micro-costing evidence. Objectives. To estimate the accounting cost of home care nursing visits in Italy using a bottom-up micro-costing approach and to identify the main cost drivers influencing expenditure. Methods. A multicentre, cross-sectional study was conducted. Data were collected in two phases: (1) a national survey of 3949 home care nurses from 70 Local Health Authorities (April–October 2023), describing workload, travel time, and the most frequently performed activities; and (2) a time-and-motion study of 527 consecutive home visits performed by 83 nurses in three Local Health Authorities (March 2024). Direct costs were estimated from the Italian National Health Service perspective and included nursing time, travel time and transportation, back-office activities, and materials. Personnel costs were derived from national collective labour agreements and inflation-adjusted. A base-case scenario estimated accounting costs directly measured in the study. An extended, illustrative scenario explored the economic value of nursing activities by applying existing outpatient tariffs. Deterministic and probabilistic sensitivity analyses (10,000-iteration Monte Carlo simulation) were performed. Results. The mean accounting cost of home care nursing was €27.78 per patient per day. At the provider level, the corresponding daily cost per nurse was €190.00, assuming a mean caseload of 6.84 patients per nurse per shift. In the extended scenario, the imputed economic value of nursing activities increased the estimated daily cost to €120.81 per patient and €826.32 per nurse. Sensitivity analyses identified organizational factors (particularly the number of patients per shift and the number of activities per visit) as the dominant cost drivers, while material and transportation costs had a comparatively limited impact. Conclusions. Home care nursing in Italy appears to be delivered at a relatively low accounting cost, with organizational factors playing a greater role than unit prices in determining expenditure. The absence of a dedicated reimbursement framework for nursing activities may result in a substantial under-recognition of the economic value of home-based nursing care. These findings provide preliminary evidence to support workforce planning, reimbursement policies, and the sustainable development of territorial care services. Full article