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Like other European countries, Germany is facing regional physician shortages, which have several consequences on patient care. This study analyzes how hospitals perceive physician shortages and which strategies they adopt to address them. As a theoretical framework, the resource dependency theory is chosen.

The authors conducted 20 semi-structured expert interviews with human resource officers, human resource directors, and executive directors from hospitals in the northwest of Germany. Hospitals of different ownership types, of varying sizes and from rural and urban locations were included in the sample. The interviews were analyzed by using qualitative content analysis.

The interviewees reported that human resource departments in hospitals expand their recruiting activities and no longer rely on one single recruiting instrument. In addition, they try to adapt their retaining measures to physicians' needs and offer a broad range of employment benefits (e.g. childcare) to increase attractiveness. The study also reveals that interviewees from small and rural hospitals report more difficulties with attracting new staff and therefore focus on recruiting physicians from abroad.

Since the staffing situation in German hospitals will not change in the short term, the study provides suggestions for hospital managers and health policy decision-makers in dealing with physician shortages.

This study uses the resource dependency theory to explain hospitals' strategies for dealing with healthcare staff shortages for the first time.

The purpose of this paper is to increase the understanding of organizational challenges when decision-makers try to comply with technological developments and increasing demands for a more rational distribution of health care services. This paper explores two decision-making processes from 2007–2019 in the area of vascular surgery at a regional and a local level in Norway.

The study draws upon extensive document analyses, semi-structured interviews and field conversations. The empirical material was analyzed in several steps through an inductive approach and described and explained through a theoretical framework based on rational choice (i.e. bounded rationality), political behavior and institutionalism. These perspectives were used in a complementary way.

Both decision-making processes were resource-intensive, long-lasting and produced few organizational changes for the provision of vascular services. Stakeholders at both levels outmaneuvered the health care planners, though by different means. Regionally, the decision-making ended up in a political process, while locally the decision-making proceeded as a strategic game between different departments and professional fields.

Decision-makers need to prepare thoroughly for convincing others of the benefits of new ways of organizing clinical care. By providing meaningful opportunities for public involvement, by identifying and anticipating political agendas and by building alliances between stakeholders with divergent values and aims decision-makers may extend the realm of feasible solutions.

This paper contributes to the understanding of why decision-making processes can be particularly challenging in a field characterized by rapid technological development, new treatment options and increasing demands for more rational distribution of services.

Patient length of stay (LOS) is an important indicator of emergency department (ED) performance. Investigating factors that influence LOS could thus improve healthcare delivery and patient safety. Previous studies have focused on patient-level factors to explain LOS variation, with little research into service-related factors. This study examined the association between LOS and multi-level factors including patient-, service- and organization-level factors.

This study uses a retrospective observational design to identify a cohort of patients from arrival to discharge from ED. A year-long data regarding patients flow trhoguh ED were analyzed using analytics techniques and multi-regression models. The response variable was patient LOS, and the independent variables were patient characteristics, service-related factors and organizational variables.

The findings of this study showed that older patients, middle triage and hospitalization were all associated with longer LOS. Service-related factors such as complexity of care provided, initial ward designation and ward transfer had a significant impact as well. Finally, prolonged LOS was associated with a higher ratio of patients per medical doctor and per nurse. In contrast, a higher number of residents in the ED were associated with longer patient LOS.

Previous studies on patient LOS have focused on patient-level factors, with little research on service-related factors. This study has addressed that gap by examining the association between LOS and multi-level factors including patient-, service- and organization-level factors. Patient-level factors included demographics, acuity, arrival shift, arrival mode and discharge type. Service-level factors consisted of first ward, ward transfer and complexity of care provided. Organizational factors consisted of three ratios: patients per MD, patients per nurse and patients per resident. The results add to the current understanding of factors that increase patient LOS in EDs and contribute to the body of knowledge on ED performance, operation management and quality of care. The study also provides practical and managerial insights that could be used to improve patient flow in EDs and reduce LOS.

Despite the continuation of hospital mergers in many western countries, it is uncertain if and how hospital mergers impact the quality of care. This poses challenges for the regulation of mergers. The purpose of this paper is to understand: how regulators and hospitals frame the impact of merging on the quality and safety of care and how hospital mergers might be regulated, given their uncertain impact on quality and safety of care.

This paper studies the regulation of hospital mergers in The Netherlands. In a qualitative study design, it draws on 30 semi-structured interviews with inspectors from the Dutch Health and Youth Care Inspectorate (Inspectorate) and respondents from three hospitals that merged between 2013 and 2015. This paper draws from literature on process-based regulation to understand how regulators can monitor hospital mergers.

This paper finds that inspectors and hospital respondents frame the process of merging as potentially disruptive to daily care practices. While inspectors emphasise the dangers of merging, hospital respondents report how merging stimulated them to reflect on their care practices and how it afforded learning between hospitals. Although the Inspectorate considers mergers a risk to quality of care, their regulatory practices are hesitant.

This qualitative study sheds light on how merging might affect key hospital processes and daily care practices. It offers opportunities for the regulation of hospital mergers that acknowledges rather than aims to dispel the uncertain and potentially ambiguous impact of mergers on quality and safety of care.

Hospitals are labor intensive facilities based on highly skilled employees. A merger of hospitals is an effort to increase and rationalize this production. Decisions behind a merger are made at the top leadership level. How this might be done is demonstrated by examples from a 36 bed acute psychiatric facility. The aim of the study was to calculate the hidden costs of fragmented destruction of parts of a total hospital supply to patients after a merger. Fragmented destruction is the deliberate stopping of activities deemed not part of the core activities of the hospital without due consideration of the impact on core activities. The proposed changes to operational expenses at a single acute psychiatric hospital were materials for the study. The changes included activities as a reduction in local laboratory service, cleaning services, closure of physiotherapy unit, closing of cultural activities and reduced productivity. The selected activities are calculated as giving an imputed gain of € 630,000 as indicated by the leadership. The not calculated costs of reducing or removing the selected activities are estimated at € 1,955,640. The cost of staff disappointment after a merger is difficult to assess, but is probably higher than assumed in the present calculations.

Imputed cost containment is not attained. The calculations indicate that implemented changes may increase cost, contrary to the belief of the leadership at both the hospital level and further up in the hospital trust.

Arguments in favor of a merger have to be scrutinized thoroughly for optimistic neglect of uncalculated costs of mergers. Future hospital mergers and selected fragmentation of productive tasks at ward or hospital levels should include calculations of unavoidable costs as shown in the present paper.

Strong leadership in primary care is necessary to coordinate an effective pandemic response; however, descriptions of leadership roles for family physicians are absent from previous pandemic plans. This study aims to describe the leadership roles and functions family physicians played during the COVID-19 pandemic in Canada and identify supports and barriers to formalizing these roles in future pandemic plans.

This study conducted semi-structured qualitative interviews with family physicians across four regions in Canada as part of a multiple case study. During the interviews, participants were asked about their roles during each pandemic stage and the facilitators and barriers they experienced. Interviews were transcribed and a thematic analysis approach was used to identify recurring themes.

Sixty-eight family physicians completed interviews. Three key functions of family physician leadership during the pandemic were identified: conveying knowledge, developing and adapting protocols for primary care practices and advocacy. Each function involved curating and synthesizing information, tailoring communications based on individual needs and building upon established relationships.

Findings demonstrate the need for future pandemic plans to incorporate formal family physician leadership appointments, as well as supports such as training, communication aides and compensation to allow family physicians to enact these key roles.

The COVID-19 pandemic presents a unique opportunity to examine the leadership roles of family physicians, which have been largely overlooked in past pandemic plans. This study’s findings highlight the importance of these roles toward delivering an effective and coordinated pandemic response with uninterrupted and safe access to primary care.

The purpose of this study is to evaluate the effectiveness of an online psychological support group on patients with coronavirus disease 2019 (COVID-19) in a Thai field hospital.

A prospective controlled trial was conducted at a Thai field hospital and included patients with confirmed COVID-19 who were over the age of 18 and able to use an online communication application. Patients were free to decide whether to participate in the online group. The group provided a space for participants to communicate with each other and a mental health service team. The everyday activities were designed to enable group support via texting or livestreaming through the LINE application. Psychoeducation via video clips or articles regarding stress management were provided. Outcomes were measured by an online self-reported questionnaire based on the twenty-one-item Depression, Anxiety and Stress Scale (DASS-21) on the first and fourteenth day of admission to the field hospital.

Forty-six patients participated in this study. Forty participants completed the secondary assessment, with 21 in the intervention group and 19 in the control group. From multilevel mixed-effects regression analysis, adjusted for gender, age and education, participation in the intervention group significantly decreased total DASS scores and anxiety subdomain scores compared to those in the control group (p = 0.038 and 0.008).

The online psychological support group offered benefits for patients with COVID-19 who were isolated in the field hospital. It could be an effective alternative measure to distribute psychological care during a pandemic situation. However, a small sample size was a limitation of this study.

This paper aims to explore the responses of households in the informal economic sector to the Cameroon Government strategy against Covid-19 in Yaounde, Cameroon between March and May 2020.

Given the recency of Covid-19, the exploratory design was used to collect and analyse information for the study. Empirical data was obtained through personal observations and questionnaires, whereas grey data were sourced from official sources in government and international agencies in Yaounde. The mode of the ordinal data generated from the questionnaire was used to characterise the attitudes of respondents to quarantine measures and bar charts were used to illustrate the distribution of responses.

The government’s strategy against Covid-19 was largely ignored in Yaounde between March and May 2020 because of the influence of the predominantly informal economy on household’s ability to allocate scarce resources between the competing needs of protecting their health on the one hand, and their livelihoods on the other hand. Poor households had to walk a difficult line between shutting down their businesses to protect their health or risking Covid-19 infections to protect their livelihoods. Over 53.1% of respondents thought quarantine measures were unsuccessful as over 63% ignored them. Quarantining and Social distancing were also difficult in informal settlements because of structural congestion.

Perhaps, the greatest limitation of this study was the use of non-probability sampling. As such, sampling error could not be estimated, blurring the ability to ascertain the degree of similarity between the sample and the study population. This made sample generalisability difficult.

There are short-term and long-term policy implications of these findings. Basic comprehensive measures including food and water distribution, as well as rent holidays, must be implemented in informal neighbourhoods to ensure more successful quarantines in future pandemics. In the long run, investments in urban social housing must be carried out to reduce slums, an ever-present risk factor in the rapid propagation of infections.

The originality of this study is first, in its level of analysis which is the household. By measuring household responses to quarantine measures within defined neighbourhoods, the study deviates from most that have adopted a theoretical approach and conducted analysis at country or regional levels. Few studies have attempted to investigate the failure of quarantine measures against Covid-19 from the viewpoint of the occupational characteristics of the populations involved.

Currently, people leaving prisons face concurrent risks from the COVID-19 pandemic and the overdose public health emergency. The closure or reduction of community services people rely on after release such as treatment centres and shelters has exacerbated the risks of poor health outcomes and harms. This paper aims to learn from peer health mentors (PHM) about changes to their work during overlapping health emergencies, as well as barriers and opportunities to support people leaving prison in this context.

The Unlocking the Gates (UTG) Peer Health Mentoring Program supports people leaving prison in British Columbia during the first three days after release. The authors conducted two focus groups with PHM over video conference in May 2020. Focus groups were recorded and transcribed, and themes were iteratively developed using narrative thematic analysis.

The findings highlighted the importance of peer health mentorship for people leaving prisons. PHM discussed increased opportunities for collaboration, ways the pandemic has changed how they are able to provide support, and how PHM are able to remain responsive and flexible to meet client needs. Additionally, PHM illuminated ways that COVID-19 has exacerbated existing barriers and identified specific actions needed to support client health, including increased housing and recovery beds, and tools for social and emotional well-being.

This study contributes to our understanding of peer health mentorship during the COVID-19 pandemic from the perspective of mentors. PHM expertise can support release planning, improved health and well-being of people leaving prison and facilitate policy-supported pandemic responses.