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Given that the workforce constitutes a principal resource of primary care, appraisal of models of care requires thorough investigation of the health workforce in all Models of Child Health Appraised (MOCHA) countries. This chapter explores this in terms of workforce composition, remuneration, qualifications and training in relation to the needs of children and young people. We have focused on two principal disciplines of primary care; medicine and nursing, with a specific focus on training and skills to care for children in primary care, particularly those with complex care needs, adolescents and vulnerable groups. We found significant disparities in workforce provision and remuneration, in training curricula and in resultant skills of physicians and nurses in European Union and European Economic Area Countries. A lack of overarching standards and recognition of some of the specific needs of children reflected in training of physicians and nurses may lead to suboptimal care for children. There are, of course, many other professions that also contribute to primary care services for children, some of which are discussed in Chapter 15, but we have not had resources to study these to the same detail.

In the US, a growing number of organizations and industries are seeking to affirm their commitment to and efforts around diversity, equity, and inclusion (DEI) as recent events have increased attention to social inequities. As health care organizations are considering new ways to incorporate DEI initiatives within their workforce, the anticipated result of these efforts is a reduction in health inequities that have plagued our country for centuries. Unfortunately, there are few frameworks to guide these efforts because few successfully link organizational DEI initiatives with health equity outcomes. The purpose of this chapter is to review existing scholarship and evidence using an organizational lens to examine how health care organizations can advance DEI initiatives in the pursuit of reducing or eliminating health inequities. First, this chapter defines important terms of DEI and health equity in health care. Next, we describe the methods for our narrative review. We propose a model for understanding health care organizational activity and its impact on health inequities based in organizational learning that includes four interrelated parts: intention, action, outcomes, and learning. We summarize the existing scholarship in each of these areas and provide recommendations for enhancing future research. Across the body of knowledge in these areas, disciplinary and other silos may be the biggest barrier to knowledge creation and knowledge transfer. Moving forward, scholars and practitioners should seek to collaborate further in their respective efforts to achieve health equity by creating formalized initiatives with linkages between practice and research communities.

The received wisdom underlying many guides to ethical research is that information is private, and research is consequently seen as a trespass on the private sphere. Privacy demands control; control requires consent; consent protects privacy. This is not wrong in every case, but it is over-generalised. The distorted perspective leads to some striking misinterpretations of the rights of research participants, and the duties of researchers. Privacy is not the same thing as data protection; consent is not adequate as a defence of privacy; seeking consent is not always required or appropriate. Beyond that, the misinterpretation can lead to conduct which is unethical, limiting the scope of research activity, obstructing the flow of information in a free society, and failing to recognise what researchers’ real duties are.

‘Dual use research’ is research with results that can potentially cause harm as well as benefits. Harm can be to people, animals or the environment. For most research, harms can be difficult to predict and quantify, so in this sense almost all research could be seen as having dual use potential. This chapter will present a framework for reviewing dual use research by justifying why the responsibility for approving and conducting research does not sit with Research Ethics Committees (RECs) alone. By mapping out the wider research landscape, it will be argued that both responsibility and accountability for dual use research sits on the shoulders of broader governance structures that reflect the philosophical and political aspirations of society as a whole. RECs are certainly still important for identifying potential ‘dual use research of concern’, and perhaps teasing out some of the details that may be hidden within research plans or projects, but in a well-functioning system should never be the sole gate keepers that determine which research should, and should not, be allowed to proceed.

The Models of Child Health Appraised (MOCHA) project identified the different models of primary care that exist for children, examined the particular attributes that might be different from those directed at adults and considered how these models might be appraised. The project took the multiple and interrelated dimensions of primary care and simplified them into a conceptual framework for appraisal. A general description of the models in existence in all 30 countries of the EU and EEA countries, focusing on lead practitioner, financial and regulatory and service provision classifications, was created. We then used the WHO ‘building blocks’ for high-performing health systems as a starting point for identifying a good system for children. The building blocks encompass safe and good quality services from an educated and empowered workforce, providing good data systems, access to all necessary medical products, prevention and treatments, and a service that is adequately financed and well led. An extensive search of the literature failed to identify a suitable appraisal framework for MOCHA, because none of the frameworks focused on child primary care in its own right. This led the research team to devise an alternative conceptualisation, at the heart of which is the core theme of child centricity and ecology, and the need to focus on delivery to the child through the life course. The MOCHA model also focuses on the primary care team and the societal and environmental context of the primary care system.

The aim of this chapter is to describe a four-type model of organisational structures and to discuss two cases, Embrapa and the Brazilian Agricultural Research Corporation, as well as additional cases at SAM-Research and the centre for shared medical support services established at the University of Bologna.

These cases should help readers understand the importance of designing distinctive, tailored-made support services while keeping these structures flexible for further adaptation under unforeseen changes.

The chapter concludes by stressing the role of institutions to steadily invest in the design of these tailored support structures and in personalised training for their support staff.

The purpose of this paper is to introduce and discuss potential applications of emerging Building Information Model (BIM) and related technologies as applied to healthcare facilities. The paper presents example of applications of digital tools enabled by BIM that support more integrated outcomes for complex healthcare projects.

Paper formulation by a transdisciplinary author group with ideas and approaches developed through discussions and writing to explore future research directions. Initial ideas are supplemented by a literature review with examples introduced where relevant.

BIM as a front-end construction engineering tool is quite mature. Application of BIM and related tools to support complex healthcare at the precinct scale, for facilities management (FM), including improved user experience (UX) has been limited but shows great promise to support complex healthcare projects.

The research presented is limited and exploratory as it represents the first step by this group to investigate an integrated approach to digital healthcare design and FM.

The paper introduces the considerable benefits of BIM models, and related tools for FM and/or UX (both staff and patients) to save time, money and improves efficiency and accuracy in healthcare facilities.

The transdisciplinary author group brought broad perspectives to the potential benefits of combining accurate data-rich legacy building models with other digital tools for increased integration and co-ordination at all life stages of a healthcare precinct.

There is more to primary care than solely medical and nursing services. Models of Child Health Appraised (MOCHA) explored the role of the professions of pharmacy, dental health and social care as examples of affiliate contributors to primary care in providing health advice and treatment to children and young people. Pharmacies are much used, but their value as a resource for children seems to be insufficiently recognised in most European Union (EU) and European Economic Area (EEA) countries. Advice from a pharmacist is invaluable, particularly because many medicines for children are only available off-label, or not available in the correct dose, access to a pharmacist for simple queries around certain health issues is often easier and quicker than access to a primary care physician or nursing service. Preventive dentistry is available throughout the EU and EEA, but there are few targeted incentives to ensure all children receive the service, and accessibility to dental treatment is variable, particularly for disabled children or those with specific health needs. Social care services are an essential part of health care for many extremely vulnerable children, for example those with complex care needs. Mapping social care services and the interaction with health services is challenging due to their fragmented provision and the variability of access across the EU and EEA. A lack of coherent structure of the health and social care interface requires parents or other family members to navigate complex systems with little assistance. The needs of pharmacy, dentistry and social care are varied and interwoven with needs from each other and from the healthcare system. Yet, because this inter-connectivity is not sufficiently recognised in the EU and EEA countries, there is a need for improvement of coordination and with the need for these services to focus more fully on children and young people.