Ethics of Human Resources Management in the Cameroonian Health System, Medical Nomadism and the Ineffectiveness of the Fight against High Blood Pressure

Context/objectives: The fight against Chronic Non-Communicable Diseases (NCDs) is a long-term undertaking, which requires available, motivated and well-managed human resources (HR). The administrative management of skills on both qualitative and quantitative levels is one of the essential functions of a health system. To better implement policies of fight against High Blood Pressure (HBP) and other chronic diseases, it is important to establish strategies to retain health personnel. This loyalty requires favorable working conditions and consideration of the contribution-reward couple. Good working conditions are likely to reduce the phenomenon of medical nomadism;conversely, poor HR management can contribute to their exodus towards exotic “green pastures”, thus leading to an additional crisis in the Cameroonian health system. The fight against HBP is a complex, multifaceted and multifactorial reality that requires appropriate management model for all types of resources mainly HR. The main objective of this research is to show the impact of poor management of human resources in Cameroon health system on medical nomadism and the ineffectiveness of the fight against High Blood Pressure. Method: A cross-sectional descriptive survey among five hundred (500) health facilities in the center region of Cameroon has been conducted. A stratified probabilistic technique has been used, and the number of health facilities to be surveyed has been determined using the “sample size estimation table” of Depelteau. The physical questionnaires have been printed and then distributed to data collectors. After data collection, the latter were grouped during processing in Excel sheets. The Chi-square test was used for data with a qualitative value and that of Kolmogorov-Sminorf for data with a quantitative value to assess the normality and reliability of data. The Crochach’s Alpha reliability test allowed us to have a summary of the means and variances and then to search for intragroup correlations between variables. Descriptive analysis was possible with the XLSTAT 2016 software. Results: 43.60% of Health Facilities (HF) managers were unqualified. 82.20% of HF managers have staff in a situation of professional insecurity. They are mainly contractual (49.00), decision-making agents (24.40%), casual agents (08.80). The proportion of unstable personnel is average of 22.00% and very unstable, 12.00%.

Design and implementation of a survey of senior Canadian healthcare decision-makers: Organization-wide resource allocation processes

A three-year research project based in British Columbia, Canada, is attempting to develop a framework and tools to assist healthcare system decision-makers achieve “high performance” in resource allocation. In pursuit of this objective, a literature search was conducted and two phases of primary data collection are being undertaken: an online survey of senior healthcare decision-makers, and in-depth case studies of potential “high performing” organizations. This paper addresses the survey phase;our aim is to provide a practical example of the mechanics of survey design, of benefit to those who want to better understand our forthcoming results, but also as an aid to other researchers grappling with the hard choices and trade-offs involved in the survey development process. Survey content is described in light of the existing literature, with discussion of the choices made by the research team to decide what questions and items would be included and excluded. The target population for the survey was senior managers in Canadian regional health authorities (or the closest equivalent organizations) in each of the 10 provinces and 3 territories. The paper dis- cusses how this sample was obtained, and describes the survey implementation process.

A Method for Assessing the Fairness of Health Resource Allocation Based on Geographical Grid

The assessment of the fairness of health resource allocation is an important part of the study for the fairness of social development.The data used in most of the existing assessment methods comes from statistical yearbooks or field survey sampling.These statistics are generally based on administrative areas and are difficult to support a fine-grained evaluation model.In response to these problems,the evaluation method proposed in this paper is based on the query statistics of the geographic grid of the target area,which are more accurate and efficient.Based on the query statistics of hot words in the geographic grids,this paper adopts the maximum likelihood estimation method to estimate the population in the grid region.Then,according to the statistical yearbook data of Hunan province,the estimated number and actual number of hospitals in each grid are analyzed and compared to measure the fairness of health resource allocation in the target region.Experiments show that the geographical grid population assessment based on hot words is more accurate and close to the actual value.The estimated average error is only about 17.8 percent.This method can assess the fairness of health resource allocation in any scale,and is innovative in data acquisition and evaluation methods.

The impacts of organizational culture and neoliberal ideology on the continued existence of incivility and bullying in healthcare institutions:A discussion paper

Countless research studies have demonstrated the detrimental effects of incivility and bullying in healthcare.Despite the abundance of proposed solutions to this issue,many healthcare leaders continue to fail in mitigating the existence of such negative behaviors in the workplace.Personality attributes of perpetrators and victims have received attention,but much less research has examined the organizational and neoliberal causations of incivility and bullying in healthcare.Being the largest occupational group in the health sector,nursing professionals have the greatest influence and are crucial in ending these behaviors.This discussion paper outlines the effects of incivility and bullying in healthcare and provides a critical analysis on how organizational culture and neoliberal ideology influence the pervasiveness and persistence of these negative behaviors.The analysis reveals that organizational cultures that misuse power,disregard equality,and facilitate oppression,foster the existence of incivility and bullying in the workplace.Such cultures permit perpetrators to misuse their authority to control resource allocation,ignorance to social inequalities,and the silence of victims.Furthermore,the neoliberal concept of deregulation,austerity,and individualism further these behaviors.The neoliberal reforms have led to underfunding of anti-bullying programs and policies,use of bullying behaviours as management strategies,and victim-blaming for profit maximization.Financial cutbacks have resulted in denial and acceptance of uncivil and bullying behaviours in healthcare institutions,which endangers the rights of healthcare providers to a safe workplace environment.To curtail these negative behaviors,robust anti-bullying policies and programs must be strictly enforced and sustained in practice.Further exploration on the association of organizational culture and neoliberal principles to incivility and bullying in healthcare is greatly warranted.

The Development Opportunities and Dilemmas of Telemedicine - Base on the Perspective of Medical Resource Distribution

Objective To discuss issues related to telemedicine in the context of the“Internet plus”and the prevention of novel coronavirus in early 2020,so as to provide some reference for the rapid development of Internet plus telemedicine.Methods Literature analysis method was used to summarize the current status of telemedicine at home and abroad.Descriptive statistical analysis and comparative analysis were also conducted to analyze the data of population and health in the“China Health Statistical Yearbook”and“China Statistical Yearbook”from 2009 to 2018.Results and Conclusion The distribution of medical demand and medical resources is uneven in 31 provinces,municipalities and autonomous regions,such problems are more serious between urban and rural areas in different regions.The population’s demand for medical care and the allocation of medical resources have the characteristics of positive correlation,large urban-rural differences and regional imbalance.Confronted with the situation that the uneven distribution of medical resources provides potential development opportunities for telemedicine and the difficulties in the further development of telemedicine,the government should formulate policies to improve the publicity of telemedicine,setting up a full coverage of telemedicine service system.Besides,hospitals should ensure the information security monitoring.

Research on the Optimization of Human Resources Allocation in Public Hospitals Under the New Medical Reform

With the advancement of the new medical reform,public hospitals face numerous challenges and opportunities,making the optimization of human resource allocation a critical priority.This paper analyzes the requirements imposed by the new medical reform on human resource allocation in public hospitals,examines existing issues such as an unbalanced personnel structure,unscientific job design,and an inadequate talent mobility mechanism,and proposes corresponding optimization strategies.These strategies include improving the recruitment and selection process,scientifically planning job structures,and establishing a flexible talent mobility mechanism.The goal is to enhance the quality of medical services,improve hospital operational efficiency,and promote the sustainable development of public hospitals.

Smart Dynamic Resource Allocation Model for Patient-Driven Mobile Medical Information System Using C4.5 Algorithm

A mobile medical information system (MMIS) is an integrated application (app) of traditional hospital information systems (HIS) which comprise a picture archiving and communications system (PACS), laboratory information system (LIS), pharmaceutical management information system (PMIS), radiology information system (RIS), and nursing information system (NIS). A dynamic resource allocation table is critical for optimizing the performance to the mobile system, including the doctors, nurses, or other relevant health workers. We have designed a smart dynamic resource allocation model by using the C4.5 algorithm and cumulative distribution for optimizing the weight of resource allocated for the five major attributes in a cooperation communications system. Weka is used in this study. The class of concept is the performance of the app, optimal or suboptimal. Three generations of optimization of the weight in accordance with the optimizing rate are shown.

The Study on the Process and Impact of External-Care-Seeking Behavior in Shanghai

Objectives: To evaluate the impact of external-care-seeking, explore the framework to regulate patients’ seeking doctor behavior and to promote better medical resources allocation. Methods: Obtaining data from regular reports from public medical institutions in Shanghai, comparing patients who seek doctors from out-of-Shanghai residence and local patients with insurance in terms of the quantity of service, types of diseases, medical expenses, etc. Results: External-care-seeking has a large quantity, especially in hospitalization. In 2012, the number of discharged population from out-of-Shanghai accounted for 22.74% of the total discharged number, the proportion even higher than 30% in tertiary hospitals. Tertiary hospitals have a significant attraction effect, concentrating 59.42% of the outpatient and emergency visits and 71.82% of the amount of hospitalization, with corresponding cost of 75.86% and 82.56%. The top three divisions in tertiary hospitals for external-care-seeking were surgical, obstetrics and gynecology, internal medicine. Based on the interview, admitting out-of-shanghai patients is conducive to the improvement of the technical level of hospitals, and to the enhancement of the utilization efficiency of health resource. However, the local residents may have less accessibility of high quality of medical service. The average expense of external-care-seeking is higher than that of local patients happened in the same level of hospitals. Conclusions: External-care-seeking will have a more far-reaching impact on the health care system in Shanghai;some interventions might be necessary, such as rationally allocating medical resources based on the estimates of external-care-seeking and establishing a medical service supervision mechanism.

基于DEA-Malmquist的天津市16家保健定点医院运营效率评价

目的分析干部保健定点医院运营效率,为进一步提升保健医院综合实力提供依据。方法采用数据包络分析(data envelopment analysis,DEA)方法和动态Malmquist指数模型,获取2017—2021年16家保健医院医疗指标,计算全要素生产率指数、生产技术变动指数和技术效率指数,研究医院运营管理效率。结果2017—2021年,只有3家保健医院的全要素生产率呈上升趋势,即第6、第10和第12家医院的均值>1.000,其余医院变化均值均<1.000。全要素生产率均值为0.977,生产技术变动指数为0.983,技术效率变动指数为0.994,运营效率仍有进一步提升空间。结论医院运营效率的下降与生产技术的关系密切,天津市保健医院在2017—2021年的全要素生产率呈下降趋势,这表明生产技术变动和技术效率变动是影响运营效率的主要因素。建议采取加强技术创新投入、人才培养与引进、优化资源配置等措施提高医院运营效率。保健行政部门应做好统筹规划,保证保健医院的有序投入。

fsQCA组态视角下我国中医类医院医疗资源配置效率提升路径分析

目的 探究多重因素协同作用下我国中医类医院医疗资源配置效率提升的优化路径,为中医类医院医疗资源均衡发展提供有力支撑。方法 以数据包络分析法得到的我国31个省(区、市)中医类医院资源配置综合效率值为结果变量,借助模糊集定性比较分析方法,以人均地区生产总值、财政拨款收入占总收入比重、中医执业(助理)医师占执业(助理)医师比重、出院者平均住院日、每千人口总诊疗量、每千人口床位数作为条件变量,探究医疗资源高效配置组态路径。结果 通过对中医类医院医疗资源高效率配置的条件组态进行分析,可归纳为3条等效驱动路径,分别为综合服务能力型、中医优势型及住院驱动型。结论 我国中医类医院医疗资源配置效率整体水平有待提升,未来应努力提高医院综合服务能力和运行效率,充分发挥中医药优势,建设高质量中医人才队伍,合理缩短平均住院日,提高医院床位利用效率。

医药卫生职业教育数字化资源的开发与利用研究

通过深入分析教育信息化与数字化资源的关系,揭示了数字化资源在医药卫生职业教育中的重要作用。通过总结国际数字化资源开发与利用的经验,分析国内现状,结合医药卫生职业教育的特殊需求,提出优化策略。结果显示,数字化资源有效促进了教育资源共享、个性化学习和学生实践能力的提升。因此,构建完善的数字化资源开发体系、推广智能化服务,对于推动医药卫生职业教育的创新发展具有重要意义。

基于非整秩次秩和比法的山东省医疗卫生资源配置评价研究

目的基于非整秩次秩和比法分析2022年山东省16个地级市医疗卫生资源配置情况,为提升山东省医疗卫生资源配置水平提供参考。方法选取医疗卫生资源相关指标,利用变异系数法确定指标权重,运用非整秩次秩和比法进行评价,比较不同地级市医疗卫生资源配置差异。结果山东省16个地级市医疗卫生资源配置分为3个档次:济南市、淄博市、东营市3个地级市资源配置情况较好,为第1档;青岛市、潍坊市、威海市、济宁市、滨州市、泰安市、枣庄市、烟台市、日照市、聊城市、临沂市11个地级市资源配置情况中等,为第2档;德州市、菏泽市2个地级市资源配置情况较差,为第3档。分档结果方差分析提示各档之间存在统计学差异,分档合理。结论山东省医疗卫生资源配置低于北京、上海、浙江等经济发达地区,各地级市医疗卫生资源配置不均衡,部分地级市医疗卫生资源配置低于全国基准。建议加强区域卫生规划,均衡区域医疗卫生资源配置,加快优质资源扩容,促进医疗卫生资源与人口、经济协同发展。

优质医疗资源下沉基层现状及其对策研究

目的分析重庆市石柱县桥头镇优质医疗资源下沉基层现状及存在的问题,提出针对性的建议与对策,促进优质医疗资源下沉。方法随机抽取330名桥头镇村民开展问卷调查,选取5名桥头镇卫生院工作人员进行定性访谈,采用SPSS 26.0和MAXQDA软件对数据进行分析。结果桥头镇优质医疗资源下沉初见成效,但整体来说仍面临优质医疗资源下沉方式单一、地方财政资金投入不足、卫生院基础建设落后、人才匮乏且专科能力不强、村民就医选择行为固化等问题。结论要加大对桥头镇卫生院财政资金投入力度,强化机构人才队伍和医院信息化建设,完善下沉机制,做好村民医疗政策及健康教育宣传工作等,促进优质医疗资源下沉。

基于集聚度的北京市护理人力资源配置及公平性分析

目的分析2017年、2019年以及2021年北京市注册护士资源配置的公平性,为进一步改善护理资源配置提供参考依据。方法于2022年6月—2023年6月收集2017年、2019年以及2021年北京市及国际上相关注册护士资源数据资料,描述北京市护理队伍配置现状,运用卫生资源集聚度(health resources agglomeration degree,HRAD)分析相关数据。结果北京市注册护士数从2017年的123158名增加至2021年的141685名;2017年、2019年和2021年北京市每千常住人口注册护士数为5.67、6.10、6.47名,达到2025年国家的每千人口注册护士3.80名的要求。床护比缓慢提高,2017年为1∶1.02,2021年达到1∶1.08,医护比从2017年的1∶1.16稍微下降至2021年的1∶1.14,注册护士在卫生技术人员总数中所占比例从2017年的35.56%增至2021年的36.35%。护理资源聚集在首都功能核心区以及城市功能拓展区。结论北京市要继续培养优质护理人才,合理规划和配置优质护理资源,通过医联体及其他专科联盟等方式加大对基层和其他功能分区的扶植力度,全面提高护理管理水平,稳定护理队伍。

志愿者参与医院门诊管理与服务对提升患者就医满意度的意义

志愿者在医院门诊管理中的应用不仅提升了医疗服务的质量和效率,还能够为患者创造更加和谐、温馨的就医环境,进一步和谐医患关系,为促进医院高质量发展做出了重要贡献。文章在对患者就医满意度内涵剖析的基础上,对志愿者在医院门诊管理中的意义、志愿者在医院门诊管理中的服务方式等进行分析。在医院门诊管理要求和社会发展需求背景下,深入探讨志愿者参与医院门诊管理与服务的方式及对提升群众就医满意度的配套措施,即建立满意度调查系统、强化医院资源配置管理、改进医院门诊预约模式、推行智慧门诊模式、严格执行门诊质量管理规定。

昆明市二级妇幼保健机构发展现状与对策分析

目的探讨昆明市二级妇幼保健机构的基本情况和发展现状,为上级卫生行政部门合理地配置卫生资源及制订相关政策提供依据。方法检索2022年云南省妇幼保健机构绩效考核系统和妇幼卫生年报获取相关指标数据,调查并分析昆明市二级妇幼保健机构现状。结果昆明市二级妇幼保健机构在医疗资源配置、人才队伍、服务能力、信息化建设等方面与辖区内医疗服务机构有较大差距。结论昆明市二级妇幼保健机构需进一步明确功能定位和发展目标,合理配置医疗资源,优化人才队伍建设,完善妇幼健康服务体系,持续提升服务能力,推进信息化建设,以促进妇幼健康事业高质量发展。

依托“健康云”平台开展医养结合服务对社区慢性病老年患者生活质量和卫生资源利用情况的影响

目的:分析依托“健康云”平台开展医养结合服务对社区慢性病老年患者生活质量和卫生资源利用情况的影响。方法:选取103例社区慢性病老年患者,采用自身前后对照试验法,以2022年9月—2023年3月为对照期,按照常规诊疗流程服务,2023年4月—2024年7月依托“健康云”平台开展医养结合服务。评价干预前后患者的生活质量和卫生资源利用情况。T_(0)为对照期开始,T_(1)为对照期中点,T_(2)为对照期结束/干预期开始,T_(3)为干预期中点,T_(4)为干预期结束。结果:共有98例患者完成全部研究并纳入分析。不同时期患者生活质量比较,差异有统计学意义(P<0.05),总体呈上升趋势。对照期T_(4)各维度生活质量评分与T_(3)、T_(2)、T_(1)、T_(0)相比均上升,差异有统计学意义(P<0.05)。干预期内T_(3)—T_(4)的家庭医生签约服务次数、社区康复服务使用次数、社区健康管理服务使用次数、慢性病随访次数、健康教育参与次数均高于T_(2)—T_(3)及对照期,差异有统计学意义(P<0.01)。干预期内T_(3)—T_(4)转诊率较T_(2)—T_(3)、对照期下降,T_(2)—T_(3)的体检完成率、疫苗接种率较对照期增加,差异有统计学意义(P<0.05)。结论:“健康云”平台医养结合服务模式能够显著提高老年慢性病患者的生活质量,并优化卫生资源利用。

Medical students’ willingness to work in post-conflict areas: A qualitative study in Sri Lanka

Background: The north-east (NE) region of Sri Lanka observed a critical health workers’ shortage after the long-lasting armed conflict. This study aimed to explore medical students’ attitudes towards working in the NE and to identify factors determining such attitudes. Methods: A semi-structured, self-administered questionnaire survey was conducted in two medical schools, one in the NE and the other near the capital, in October 2004. Data were qualitatively analysed using the framework approach. Results: Three main themes were identified: 1) Professional motives and career plans;2) Students’ perceptions of the healthcare situation in the NE;and 3) Students’ choice of the NE as a future practice location. It was found that familiarity with the difficulties faced by the NE people was a major motivation for medical students to work in the NE in the future. For NE students, familiarity was linked to their sense of belonging. For non-NE students, their personal experience of the NE familiarized them with the difficult situation there, which positively influenced their willingness to work there. Demotivations to work in the NE were poor working and living conditions, fewer opportunities for postgraduate education, language differences, insecurity, and fear of an unpleasant social response from the NE communities. Conclusions: NE local medical students had a sense of belonging to the NE and compassion for the Tamil people as members of the ethnic group. They were willing to work in the NE if their concerns about difficult working and living conditions and postgraduate education could be solved. Non-NE students who were familiar with the NE situation through their personal experience also showed a willingness to work there;thus, early exposure programmes in medical education might help to increase the health workforce in the NE. It is also expected that non-NE physicians working for the NE people would facilitate reconciliation and the rebuilding of trust between two ethnic groups.

The Usage of Triage Systems in Mass Casualty Incident of Developed Countries

Victims are usually overwhelmed by local medical system in an unexpected mass casualty incident (MCI). Triage systems originate from wartime necessity to achieve the greatest efficiency to the maximum number of victims. In peacetime, the triage systems are applied to allocate constrained medical resources for the victims in MCI. There are several kinds of triage systems in different countries, such as Simple Triage and Rapid Treatment (START), Sort, Assess, Life-saving interventions, Treatment and/or Transport (SALT), Sacco Triage Method (STM), Careflight triage and Triage Sieve (TS). The START system is widely used in developed countries, especially in USA. The SALT is formulated by a work group of the Centers for Disease Control and Prevention (CDC) based on scientific data. STM is a triage algorithm designed for resource-constrained condition. Besides, the other triage systems show their power in managing the victims in MCI. However, the data of theses popular triage tools are mainly based on simulated tests, lacking of validity and reliability of triage systems. Therefore, the application, reliability, sensitivity and specificity of existing triage tools require to be validated in the real condition of MCI. Furthermore, due to the difference among triage tools used in different countries, international cooperation is demanded for a more highly organized mass-casualty medical response.

2012—2021年我国专业公共卫生机构人力资源配置状况及公平性分析

目的:分析我国专业公共卫生机构人才队伍建设情况,为加强我国公共卫生人才队伍建设提供参考。方法:基于《中国卫生健康统计年鉴》数据,采用描述性统计分析、基尼系数和卫生资源集聚度等方法,分析2012—2021年我国专业公共卫生机构人才数量、质量及不同地区人力资源配置公平性。结果:2012—2021年,全国专业公共卫生机构人员数年均增长率为4.10%,每千人口专业公共卫生机构人员数年均增长率为3.71%;2021年,我国专业公共卫生机构人力资源按人口配置的基尼系数为0.1002,按地理面积配置的基尼系数为0.6706,21个省份的卫生资源集聚度值大于1。结论:十年间我国专业公共卫生机构人力资源总量稳步增长,质量有较大提升,但与预期发展目标尚有差距,不同专业公共卫生机构人力资源发展不均衡,公共卫生人力资源配置中人口公平性优于地理公平性,且省际差异显著。