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The purpose of this paper is to increase knowledge of the role organizational factors have in how health personnel make efficiency-thoroughness trade-offs, and how these trade-offs potentially affect clinical quality dimensions.

The paper is a thematic synthesis of the literature concerning health personnel working in clinical, somatic healthcare services, organizational factors and clinical quality.

Identified organizational factors imposing trade-offs were high workload, time limits, inappropriate staffing and limited resources. The trade-offs done by health personnel were often trade-offs weighing thoroughness (e.g. providing extra handovers or working additional hours) in an environment weighing efficiency (e.g. ward routines of having one single handover and work-hour regulations limiting physicians' work hours). In this context, the health personnel functioned as regulators, balancing efficiency and thoroughness and ensuring patient safety and patient centeredness. However, sometimes organizational factors limited health personnel's flexibility in weighing these aspects, leading to breached medication rules, skipped opportunities for safety debriefings and patients being excluded from medication reviews.

Balancing resources and healthcare demands while maintaining healthcare quality is a large part of health personnel's daily work, and organizational factors are suspected to affect this balancing act. Yet, there is limited research on this subject. With the expected aging of the population and the subsequent pressure on healthcare services' resources, the balancing between efficiency and thoroughness will become crucial in handling increased healthcare demands, while maintaining high-quality care.

This study investigates the effect of user fees on access and waiting time in Nigeria. For access, the effect of user fees on both preventive and curative care; and the effect of user fees on waiting time at public healthcare facilities were examined. User fees are vital for the fiscal sustainability of healthcare provision for most African economies. Its imposition could debar healthcare access by the poor while its removal can reduce quality of care and induce longer waiting time.

The wave 3 of the Nigerian General Household Survey (2015/16) data was used for users of public health facilities. Access to healthcare was modelled using utilization data in a logistic regression model while waiting time was through the Negative Binomial Regression Model (NBRM).

The analyses showed significant effects of user fees on access to both preventive and curative care and on time spent waiting to make use of healthcare services. Individuals were able to access healthcare services regardless of amounts paid. Also, there was a non-negative effect of user fee imposition on waiting time.

Nigeria should improve healthcare facilities to address the enormous demand for healthcare services when designing policy for health sector.

This paper shows that even with the imposition of user fees, healthcare facilities could still not cater for the rising healthcare needs of the populace but cautioned that its abolition may not be a preferred option.

This literature review aims to assess the current research on healthcare job availability and skilled professionals. The objective of this research is to identify challenges caused by the imbalance between healthcare service demand and qualified professionals and propose potential solutions and future research directions.

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was employed as the guiding framework for conducting this review. A qualitative research design analyzed 38 peer-reviewed, evidence-based research works from 50 journal publications. Inclusion criteria focused on empirical studies, observational research and comprehensive reviews published within the last ten years. Thematic and discourse analysis categorized themes and factors explored in selected publications.

The findings highlight significant challenges in the healthcare sector regarding job availability and skilled professionals. Developed countries face understaffed healthcare facilities, resulting in increased workloads and compromised care. Developing countries experience high rates of unemployment among healthcare graduates due to limited resources and mentorship.

Improving educational infrastructure, expanding training opportunities and increasing healthcare investments are crucial for nurturing a skilled workforce. Implementing effective retention policies, fostering international collaborations and addressing socioeconomic determinants can create a sustainable job market.

The healthcare sector faces critical challenges in balancing job availability and skilled professionals. Strategic solutions are proposed to create a sustainable and equitable healthcare workforce. By implementing recommendations and conducting further research, access to quality healthcare and global public health outcomes can be improved.

This survey explores the application of real options theory to the field of health economics. The integration of options theory offers a valuable framework to address these challenges, providing insights into healthcare investments, policy analysis and patient care pathways.

This research employs the real options theory, a financial concept, to delve into health economics challenges. Through a systematic approach, three distinct models rooted in this theory are crafted and analyzed. Firstly, the study examines the value of investing in emerging health technology, factoring in future advantages, associated costs and unpredictability. The second model is patient-centric, evaluating the choice between immediate treatment switch and waiting for more clarity, while also weighing the associated risks. Lastly, the research assesses pandemic-related government policies, emphasizing the importance of delaying decisions in the face of uncertainties, thereby promoting data-driven policymaking.

Three different real options models are presented in this study to illustrate their applicability and value in aiding decision-makers. (1) The first evaluates investments in new technology, analyzing future benefits, discount rates and benefit volatility to determine investment value. (2) In the second model, a patient has the option of switching treatments now or waiting for more information before optimally switching treatments. However, waiting has its risks, such as disease progression. By modeling the potential benefits and risks of both options, and factoring in the time value, this model aids doctors and patients in making informed decisions based on a quantified assessment of potential outcomes. (3) The third model concerns pandemic policy: governments can end or prolong lockdowns. While awaiting more data on the virus might lead to economic and societal strain, the model emphasizes the economic value of deferring decisions under uncertainty.

This research provides a quantified perspective on various decisions in healthcare, from investments in new technology to treatment choices for patients to government decisions regarding pandemics. By applying real options theory, stakeholders can make more evidence-driven decisions.

Decisions about patient care pathways and pandemic policies have direct societal implications. For instance, choices regarding the prolongation or ending of lockdowns can lead to economic and societal strain.

The originality of this study lies in its application of real options theory, a concept from finance, to the realm of health economics, offering novel insights and analytical tools for decision-makers in the healthcare sector.

The field of implementation science has emerged as a response to the challenges experienced in translating evidence-based practice and research findings to healthcare settings. Whilst the field has grown considerably in recent years, comparatively, there is a conspicuous lack of attention paid to the work of pre-implementation, that is, how we effectively engage with organisations to support the translation of research into practice. Securing the engagement and commitment of healthcare organisations and staff is key in quality improvement and organisational research. In this paper the authors draw attention to the pre-implementation phase, that is, the development of an amenable context to support implementation research.

Drawing from examples across an interdisciplinary group of health systems researchers working across a range of healthcare organisations, the authors present a reflective narrative viewpoint. They identify the principal challenges experienced during the course of their work, describe strategies deployed to effectively mitigate these challenges and offer a series of recommendations to researchers based on their collective experiences of engaging in collaborations with healthcare organisations for research and implementation. This reflective piece will contribute to the narrative evidence base by documenting the challenges, experiences and learning emerging from the authors’ work as university researchers seeking to engage and collaborate with healthcare organisations.

The RELATE model is presented to guide researchers through six key steps and sample strategies in working to secure organisational buy-in and creating a context amenable to implementation and research. The six stages of the RELATE model are: (1) Recognising and navigating the organisation's complexity; (2) Enhancing understanding of organisational priorities and aligning intervention; (3) Leveraging common values and communicating to key individuals the value of implementation research; (4) Aligning and positioning intervention to illustrate synergies with other initiatives; (5) Building and maintaining credibility and trust in the research team; and (6) Evolving the intervention through listening and learning.

The authors hope this guidance will stimulate thinking and planning and indeed that it will encourage other research teams to reflect and share their experiences and strategies for successful engagement of organisations, thus developing a knowledge base to strengthen implementation efforts and increase efficacy in this important enterprise.

Researchers must relate to the world’s everyday reality of the healthcare managers and administrators and enable them to relate to the potential of the research world in enhancing practice if we are to succeed in bringing the evidence to practice in a timely and efficient manner. Climates receptive to implementation must be developed incrementally over time and require actors to navigate messy and potentially unfamiliar organisational contexts. In this paper, the often invisible and lamentably underreported work of how we begin to work with healthcare organisations has been addressed. The authors hope this guidance will stimulate thinking and planning and indeed that it will encourage other research teams to reflect and share their experiences and strategies for successful engagement of organisations, thus developing a knowledge base to strengthen implementation efforts and increase efficacy in this important enterprise.

Using financial incentives has been criticised for putting too much focus on things that can be measured. Value-based reimbursement may better align professional values with financial incentives. However, professional values may differ between actor groups. In this article, the authors identify institutional logics within healthcare-providing organisations. Further, the authors analyse how the centrality and compatibility of the identified logics affect the institutionalisation of external demands.

41 semi-structured interviews were conducted with representatives from healthcare providers within spine surgery in Sweden, where a value-based reimbursement programme was introduced. Data were analysed using thematic content analysis with an abductive approach, and a conceptual framework based on neo-institutional theory.

After the introduction of the value-based reimbursement programme, the centrality and compatibility of the institutional logics within healthcare-providing organisations changed. The logic of spine surgeons was dominating whereas physiotherapists struggled to motivate a higher cost for high quality physiotherapy. The institutional logic of nurses was aligned with spine surgeons, however as a peripheral logic facilitating spine surgery. To attain holistic and interdisciplinary healthcare, dominating institutional logics within healthcare-providing organisations need to allow peripheral institutional logics to attain a higher centrality for higher compatibility. Thus, allowing other occupations to take responsibility for quality and attain the feeling of professional pride.

Interviewing spine surgeons, physiotherapists, nurses, managers and administrators allows us to deepen the understanding of micro-level behaviour as a reaction (or lack thereof) to macro-level decisions.

Healthcare systems are under pressure to improve their performance, while at the same time facing severe resource constraints, particularly workforce shortages. By applying resource-dependency-theory (RDT), we explore how healthcare organizations in different settings perceive pressure arising from uncertain access to resources and examine organizational strategies they deploy to secure resources.

A cross-sectional survey of key decision-makers in different healthcare settings in the metropolitan area of Cologne, Germany, on perceptions of pressure arising from the environment and respective strategies was conducted. For comparisons between settings radar charts, Kruskal–Wallis test and Fisher–Yates test were applied. Additionally, correlation analyses were conducted.

A sample of n = 237(13%) key informants participated and reported high pressure caused by bureaucracy, time constraints and recruiting qualified staff. Hospitals, inpatient and outpatient nursing care organizations felt most pressurized. As suggested by RDT, organizations in highly pressurized settings deployed the most vociferous strategies to secure resources, particularly in relation to personnel development.

This study is one of the few studies that focuses on the environment's impact on healthcare organizations across a variety of settings. RDT is a helpful theoretical foundation for understanding the environment's impact on organizational strategies. The substantial variations found between healthcare settings indicate that those settings potentially require specific strategies when seeking to address scarce resources and high demands. The results draw attention to the high level of pressure on healthcare organizations which presumably is passed down to managers, healthcare professionals, patients and relatives.

This study aims to explore the downstream pharmaceutical supply chain (PSC) and provides insight to the delivery process of medicines and associated operational inefficiencies.

An exploratory, qualitative approach was adopted to examine PSC inefficiency within two European contexts, namely, the UK and Greece. Data was gathered through interviews and a thematic analysis conducted to analyse the data and identify challenges faced by both supply chains(SCs).

The medicines delivery system needs to be enhanced in terms of quality, visibility, speed and cost to perform effectively. The findings demonstrated that although the healthcare SCs in the two European contexts have different operational structures, the results are in concordance with each other. Financial, communication, waste and complexity issues were the major concerns.

To the knowledge this is the first study to examine aspects of the medicines SC via a cross-case analysis in the UK and Greece and extends the body of knowledge. A broader sample of responses is warranted to further validate these findings.

The study outputs can inform pharmacies’ strategic to instigate targeted improvement interventions. The implications of which may be extrapolated further to other European healthcare organisations.

This research contributes to the academic literature by adding further theoretical insights to SC strategy development, especially those that have been characterised as highly complex. The study identifies four key areas of intervention needed within this SC (in both countries) to promote higher level efficiencies and effectiveness.