Perceived violence climate: A new construct and its relationship to workplace physical violence and verbal aggression,and their potential consequences

Abstract

Workplace accidents and violence are both potential sources of employee injuries that have been dealt with in entirely separate literatures. In this study we adapted the concept of safety climate from the accident/injury literature to violence in developing the concept of perceived violence climate. A scale was developed to assess perceived violence climate, including items about management attention, concern, and policies designed to keep employees safe from violence. Data were collected from a sample of 198 nurses from a US Hospital. Perceived violence climate was found to correlate significantly with both physical violence and verbal aggression experienced by the nurses, injury from violence, and perceptions of workplace danger. Furthermore, regression analyses showed that climate explained additional variance in psychological strain and perceptions of danger over experienced violence. These results have implications for interventions aimed at producing a good perceived violence climate in order to reduce the incidence of violence and aggression within an organization.     

A Universal Appointment Rule in the Presence of No‐Shows and Walk‐Ins

This study introduces a universal “Dome” appointment rule that can be parameterized through a planning constant for different clinics characterized by the environmental factors—no‐shows, walk‐ins, number of appointments per session, variability of service times, and cost of doctor's time to patients’ time. Simulation and nonlinear regression are used to derive an equation to predict the planning constant as a function of the environmental factors. We also introduce an adjustment procedure for appointment systems to explicitly minimize the disruptive effects of no‐shows and walk‐ins. The procedure adjusts the mean and standard deviation of service times based on the expected probabilities of no‐shows and walk‐ins for a given target number of patients to be served, and it is thus relevant for any appointment rule that uses the mean and standard deviation of service times to construct an appointment schedule. The results show that our Dome rule with the adjustment procedure performs better than the traditional rules in the literature, with a lower total system cost calculated as a weighted sum of patients’ waiting time, doctor's idle time, and doctor's overtime. An open‐source decision‐support tool is also provided so that healthcare managers can easily develop appointment schedules for their clinical environment.     

Transferring HIV/AIDS Related Healthcare from Non‐governmental Organizations to the Public Healthcare System in South Africa: Opportunities and Challenges

Almost two decades after the transition to a post‐apartheid regime, South Africa is still high‐ranking in the incidence of chronic diseases like tuberculosis, HIV/AIDS, diabetes and hypertension. This article explores the transition from HIV/AIDS related healthcare offered by internationally supported non‐governmental organizations (NGOs) in rural areas to the inclusion of this healthcare into the public healthcare system. This transition is part of a wider process that represents the exact reverse of healthcare reforms in Western industrialized countries. Instead of a transition from public healthcare to privatized or marketized healthcare, the transition in South Africa is from partly private healthcare to a public healthcare system in which the private commercial health sector as well as all services provided by NGOs will be integrated. In that process, many obstacles obscure intended outcomes, such as equal access to healthcare. Some obstacles are evident in the case studies of two internationally supported NGOs in the field of HIV/AIDS healthcare. We will conclude that governance structures of public and private NGO‐based healthcare are often difficult to integrate; implementation timelines and priorities do not always coincide; and the public healthcare system is still too weak to deliver good quality healthcare in rural areas without continued NGO support.     

Stratification of randomization is not required for a pre‐specified subgroup analysis

Published literature and regulatory agency guidance documents provide conflicting recommendations as to whether a pre‐specified subgroup analysis also requires for its validity that the study employ randomization that is stratified on subgroup membership. This is an important issue, as subgroup analyses are often required to demonstrate efficacy in the development of drugs with a companion diagnostic. Here, it is shown, for typical randomization methods, that the fraction of patients in the subgroup given experimental treatment matches, on average, the target fraction in the entire study. Also, mean covariate values are balanced, on average, between treatment arms in the subgroup, and it is argued that the variance in covariate imbalance between treatment arms in the subgroup is at worst only slightly increased versus a subgroup‐stratified randomization method. Finally, in an analysis of variance setting, a least‐squares treatment effect estimator within the subgroup is shown to be unbiased whether or not the randomization is stratified on subgroup membership. Thus, a requirement that a study be stratified on subgroup membership would place an artificial roadblock to innovation and the goals of personalized healthcare. Copyright © 2012 John Wiley & Sons, Ltd.     

环境污染、经济增长与医疗卫生服务对公共健康的影响分析——基于中国省际面板数据的研究

环境污染与经济增长对居民的公共健康水平有重要影响,但基于面板数据对此问题分区域的研究较少。本文在Grossman健康生产函数的基础上加入环境污染等多重因素,使用中国30个省市区1997年到2010年的面板数据,建立个体固定效应模型,将我国划分为东部、中部和西部三个区域,实证分析了环境污染、经济增长与医疗卫生服务对不同区域居民公共健康的影响及其差异。研究发现:环境污染、经济增长、医疗卫生服务与居民公共健康存在长期均衡的协整关系,经济增长与全国、东部和中部的公共健康关系呈现倒U型的特征;具体而言:东部区域,曲线已达到拐点,中部区域,当人均GDP为3311元时,曲线达到拐点;全国以及东、中、西部区域,工业烟尘排放量与人口死亡率呈正向关关系,工业二氧化硫排放量与人口死亡率只在中部地区显著正相关;全国、东部和中部区域人均医生数与人口死亡率呈显著负相关,西部地区未呈现这一特性;人均医疗保健支出与人口死亡率在中部地区显著负相关,医疗卫生服务可有效减少环境污染对居民的健康威胁。因此,制定差别化的环境污染、经济增长与医疗服务政策等有利于提升全国以及东中西部居民的公共健康水平。     

Electronic Psychosocial Assessment Tool: Concept Development and Identification of Barriers to Successful Implementation

Information Communication Technologies (ICT) have resulted in positive outcomes in a range of clinical studies, however, most have not had widespread subsequent uptake, partly because they were not developed with all stakeholder requirements in mind. In the current study, we engaged stakeholders in the concept development stage of a project to transform a psychosocial assessment into an ICT-enabled format. By engaging the stakeholders in this early process we were able to identify a range of software functionalities that are likely to improve the applicability for users, as well as identify possible barriers to implementation.     

Lean healthcare: review,classification and analysis of literature

This study presents a literature review of 107 papers on lean healthcare to evaluate its evolution by updating previous literature reviews and to propose a classification and analysis of the papers reviewed. The literature classification was performed based on six parameters: research method, country, healthcare area, implementation, lean tools and methods and results. From the analysis performed, this paper presents a quantitative analysis of the state of the art concerning lean healthcare and indicates current research trends, based on the stage of evolution of the area, that may guide further studies on the subject. An example is lean healthcare expansion to other countries, such as Brazil and the Netherlands. Another aspect is the application of lean healthcare in hospital as a whole, not limited to a specific setting. Finally, a few studies detail the lean implementation process and use infrequently applied tools, present the barriers and main critical factors found in the lean implementation.     

A Hybrid Methodology for Modeling Risk of Adverse Events in Complex Health‐Care Settings

In spite of increased attention to quality and efforts to provide safe medical care, adverse events (AEs) are still frequent in clinical practice. Reports from various sources indicate that a substantial number of hospitalized patients suffer treatment‐caused injuries while in the hospital. While risk cannot be entirely eliminated from health‐care activities, an important goal is to develop effective and durable mitigation strategies to render the system “safer.” In order to do this, though, we must develop models that comprehensively and realistically characterize the risk. In the health‐care domain, this can be extremely challenging due to the wide variability in the way that health‐care processes and interventions are executed and also due to the dynamic nature of risk in this particular domain. In this study, we have developed a generic methodology for evaluating dynamic changes in AE risk in acute care hospitals as a function of organizational and nonorganizational factors, using a combination of modeling formalisms. First, a system dynamics (SD) framework is used to demonstrate how organizational‐level and policy‐level contributions to risk evolve over time, and how policies and decisions may affect the general system‐level contribution to AE risk. It also captures the feedback of organizational factors and decisions over time and the nonlinearities in these feedback effects. SD is a popular approach to understanding the behavior of complex social and economic systems. It is a simulation‐based, differential equation modeling tool that is widely used in situations where the formal model is complex and an analytical solution is very difficult to obtain. Second, a Bayesian belief network (BBN) framework is used to represent patient‐level factors and also physician‐level decisions and factors in the management of an individual patient, which contribute to the risk of hospital‐acquired AE. BBNs are networks of probabilities that can capture probabilistic relations between variables and contain historical information about their relationship, and are powerful tools for modeling causes and effects in many domains. The model is intended to support hospital decisions with regard to staffing, length of stay, and investments in safety, which evolve dynamically over time. The methodology has been applied in modeling the two types of common AEs: pressure ulcers and vascular‐catheter‐associated infection, and the models have been validated with eight years of clinical data and use of expert opinion.     

The Elderly Mentally Retarded

No abstract available for this article.     

新医改后中国个人现金卫生支出的趋势分析

基于新医改中政府做出的投入承诺以及近十年的卫生总费用和相关经济数据,分析估算了2009—2012年中国个人现金卫生支出占卫生总费用的比例以及个人现金卫生支出占家庭可支配收入的比例的发展趋势。结果表明：短期内降低趋势比较明显,但要保证长期的降低趋势,不仅需要政府的持续投入,还需要社会支出的同期大力支持及尽快地完善收入分配制度。