How do policy levers shape the quality of a national health system?

Poor quality of care may have a detrimental effect on access and take-up and can become a serious barrier to the universality of health services. This consideration is of particular interest in view of the fact that health systems in many countries must address a growing public-sector deficit and respond to increasing pressures due to COVID-19 and aging population, among other factors. In line with a rapidly emerging literature, we focus on patient satisfaction as a proxy for quality of health care. Drawing on rich longitudinal and cross-sectional data for Spain and multilevel estimation techniques, we show that in addition to individual level differences, policy levers (such as public health spending and the patient-doctor ratio, in particular) exert a considerable influence on the quality of a health care system. Our results suggest that policymakers seeking to enhance the quality of care should be cautious when compromising the level of health resources, and in particular, health personnel, as a response to economic downturns in a sector that traditionally had insufficient human resources in many countries, which have become even more evident in the light of the current health crisis. Additionally, we provide evidence that the increasing reliance on the private health sector may be indicative of inefficiencies in the public system and/or the existence of features of private insurance which are deemed important by patients.     

Non-government organization study awards: enhancing successful completion of social work qualification

ABSTRACT

The current study used a sequential, exploratory mixed-method design to explore how a social work study scholarship implemented in Aotearoa New Zealand impacted on recipients’ qualification completion and their professional and practice competence. Phase one involved 13 individual interviews with past award recipients which described how the study award impacted on their qualification completion. Thematic analysis was used to extract themes. These themes were examined in the second phase through a quantitative battery completed by 107 past recipients to examine their professional and practice competence. The findings from interviews showed the award enabled recipients to complete their studies and improve their social work practice without causing undue stress or financial pressure on the recipient and their family. Quantitative analysis corroborated and extended these findings to demonstrate that the award contributed to lifting the level of social work knowledge, competence, and skills in the recipients. Accompanying the successful qualification completion, these qualified social workers were equipped with essential skills, promoting social work values and competence to contribute and safeguard the benefit of children, families, and communities. The awards offered a ‘wrap around’ support and was not limited by age or ethnicity but provided a support system to achieve qualification completion.     

Variability in Cross‐Domain Risk Perception among Smallholder Farmers in Mali by Gender and Other Demographic and Attitudinal Characteristics

Previous research has shown that men and women, on average, have different risk attitudes and may therefore see different value propositions in response to new opportunities. We use data from smallholder farm households in Mali to test whether risk perceptions differ by gender and across domains. We model this potential association across six risks (work injury, extreme weather, community relationships, debt, lack of buyers, and conflict) while controlling for demographic and attitudinal characteristics. Factor analysis highlights extreme weather and conflict as eliciting the most distinct patterns of participant response. Regression analysis for Mali as a whole reveals an association between gender and risk perception, with women expressing more concern except in the extreme weather domain; however, the association with gender is largely absent when models control for geographic region. We also find lower risk perception associated with an individualistic and/or fatalistic worldview, a risk‐tolerant outlook, and optimism about the future, while education, better health, a social orientation, self‐efficacy, and access to information are generally associated with more frequent worry—with some inconsistency. Income, wealth, and time poverty exhibit complex associations with perception of risk. Understanding whether and how men's and women's risk preferences differ, and identifying other dominant predictors such as geographic region and worldview, could help development organizations to shape risk mitigation interventions to increase the likelihood of adoption, and to avoid inadvertently making certain subpopulations worse off by increasing the potential for negative outcomes.     

‘One MBA?’ How context impacts the development of post-MBA career outcomes

Using survey data from alumni of one of the UK's earliest and largest MBA programmes we explore how career capital, career outcomes and career satisfaction are impacted by learner context. We adopt comparative capitalisms theory to investigate whether graduates from a standardised programme marketed as ‘One MBA’ report broadly similar career outcomes irrespective of their work and study location. We find that despite the rhetoric around globalisation in management education there are differences that fit the theories of comparative capitalisms literature; thus supporting the view that, despite the global nature of MBA branding, context still plays a role in shaping learning and career outcomes as evidenced by differences reported here. Significant findings are reported in terms of the reported development of career capital ‘knowing how’; career satisfaction and perceived organisational support, however differences in terms of the achievement of objective career success (promotion and career mobility) were less pronounced.     

特色小镇建设中失地农民的权益保障问题探讨

特色小镇建设过程中出现的失地农民群体面临着权益保障困难、社会排斥及社会阶层分化等问题。通过凸显特色产业，区别对待不同类型特色小镇发展，注重旅游特色商品开发、发展休闲农业和完善社会保障等方式，可以提升失地农民的再就业，缓解失地带来的社会不稳定因素。     

Quality management as a tool for job satisfaction improvement in low-level technology organizations: the case of Ethiopia

Human resources are an important determinant of operational performances as it is crucial for quality improvement. Research suggests that issues related to quality of work life of employees are often overlooked in low technology level organizations in the developing countries. This article aims to investigate the relationship between quality management (QM) practices and job satisfaction (JS) in relation with the Ethiopian manufacturing organizations. Data were collected using a structured survey questionnaire and face-to-face interviews of shop-floor workers. Exploratory and confirmatory factor analysis was used to validate the survey instrument and structural equation modelling was used for the analysis. The findings provide evidence that top management commitment, participation of employees and continuous improvement are significantly and positively associated with JS. However, customer focus has insignificant relationship and surprisingly, teamwork showed unexpected negative relationship with JS. The study provides important insights into the true worth of QM implementation in which it enforces the belief that its practices are the decisive factor in enhancing workplace satisfaction of employees.     

Leader-employee congruence of expected contributions in the employee-organization relationship

Employees' expected contributions can be incongruent with those of their leader. We examine the congruence effect of leaders' and employees' expected contributions on job satisfaction. Results of cross-level polynomial regressions on 947 employees and 224 leaders support the congruence effect. When expected contributions are congruent, employees are more satisfied with their job. Our findings suggest that employees enjoy high challenges, as long as these challenges are in harmony with the expected contributions of their leaders. Employees are less satisfied with their jobs both when their expected contributions were higher than their leaders' and when their expected contributions were lower than those of their leaders. Beyond the relevance of having high expected contributions, the findings highlight the crucial role played by the congruence of expected contributions of leaders and employees.     

南京中山植物园游憩功能满意度评价研究

随着植物园"旅游经济"的发展,植物园在承担植物科学研究及科普功能的同时,也成为公众日常休闲的重要绿地。本文选取南京中山植物园作为研究对象,建立评价体系并运用模糊综合评价法对游客满意度进行研究,探寻影响植物园游憩功能的显著因子,为未来植物园规划设计提供参考。结果表明:游客对南京中山植物园的游憩功能达到基本满意水平。其中,植物物种多样性、景区分布、建筑景观、声景观的满意度较高,滨水景观的满意度评价值较低。通过Pearson相关系数发现植物色彩丰富度、科普场所、科普内容是影响游客满意度的显著因子。运用IPA图对16项评价因子进行重要度-满意度分析,并对各象限内的因子提出改进方向。最后基于游憩功能满意度评价结果,提出改进策略:加大对植物园休息设施、卫生设施、娱乐设施和商业服务设施的投入;更新科普方式,增添特色游憩主题园区;完善现有道路体系,增强对北部专类园的可达性;增加色叶植物的种类、提高色彩丰富度等。以期为中山植物园游憩功能的优化及其他植物园的规划设计提供借鉴。     

Variables related to maternal satisfaction with intrapartum care in Northern Italy

BackgroundThe experience of labour and birth is complex, multidimensional and subjective and has the potential to affect the women and their families physically and emotionally. However, there is a lack of research around maternal satisfaction in Italy.AimTo evaluate mothers’ satisfaction with their childbirth experience in relation to socio-demographic characteristics, obstetric history and intrapartum care variables.MethodsA cross-sectional study involving 277 women who had given birth in a low risk maternity unit in Northern Italy was undertaken. Satisfaction with birth was measured using the Italian version of the Birth Satisfaction Scale-Revised (I-BSS-R). The scale comprises three Sub-Scales: quality of care provided, personal attributes of women and stress experienced during childbirth.FindingsNo socio-demographic variables were related to maternal satisfaction. Multiparous women had a higher satisfaction score (p = 0.020; CI:0.23;2.75). Antenatal class attendance was negatively associated with maternal satisfaction (p = 0.038; CI:−2.58; −0.07). Intrapartum variables that significantly reduced maternal satisfaction were: epidural usage (p = 0.000; CI:−4.66; −2.07), active phase >12 h (p = 0.000; CI:−6.01; −2.63), oxytocin administration (p = 0.000; CI:−5.08; −2.29) and vacuum assisted birth (p = 0.001; CI:−6.50; −1.58). Women with an intact perineum were more likely to be satisfied (p = 0.008; CI:−4.60; −0.69).DiscussionIn accordance with other research, we showed that intrapartum interventions are negatively associated with maternal outcomes and therefore also with maternal satisfaction with birth. The sub-scale that measured Quality of Care provided scored higher than the other two Sub-Scales.ConclusionFurther studies on maternal satisfaction in Italy should be conducted, using the I-BSS-R with the aim to compare outcomes and understand what matters to women during childbirth.     

Factors associated with a positive childbirth experience in Brazilian women: A cross-sectional study

BackgroundHaving a positive childbirth experience is an increasingly valued outcome. Few studies evaluated the women’s satisfaction with childbirth through face-to-face interviews out of the health service environment. The objective of this study was to identify factors associated with a higher level of satisfaction with the childbirth experience among Brazilian women.MethodsThis cross-sectional study involved 287 women giving birth in two hospitals in southern Brazil. Women who gave birth to healthy newborns at term were randomly selected. Face-to-face interviews were conducted 31–37 days after delivery, at the mothers’ homes, using a structured questionnaire. Satisfaction with the childbirth experience was measured using a Likert-type scale ranging from very satisfied to very dissatisfied. Prevalence ratios (PR) were estimated using Poisson regression with robust variance.ResultsFollowing hierarchical multivariate analysis, the following factors remained associated with a higher level of satisfaction with the childbirth experience: being satisfied with antenatal care (PR = 1.30; 95% confidence interval [95%CI] = 1.06−1.59), understanding the information provided by health professionals during labor and delivery (PR = 1.40; 95%CI = 1.01−1.95), not having reported disrespect and abuse (PR = 1.53; 95%CI = 1.01−2.31), and having had the baby put to the breast within the first hour of life (PR = 1.63; 95%CI = 1.26−2.11). No association was observed with type of delivery or hospital status (public or private).ConclusionsA higher level of satisfaction with the childbirth experience is related to satisfactory antenatal care, a non-abusive, respectful, and informative environment during childbirth, and to the opportunity to breastfeed the baby within the first hour of life. In clinical practice, greater attention to these basic principles of care during pregnancy and delivery could provide more positive experiences during birth.