BACKGROUND:Leadership styles and conflict management strategies are key factors in improving organizational performance and enhancing the quality of healthcare services. Given the complexity of hospital systems, understanding the interaction between leadership styles and conflict management is of particular importance for hospital managers. This study aimed to examine the relationship between leadership styles based on the DISC model and conflict management strategies among senior, middle, and operational managers in hospitals. METHODS:This descriptive-analytical cross-sectional study was conducted in 2025 among a sample of 248 senior, middle, and operational hospital managers in western Iran. Data were collected using the standardized DISC personality assessment and the Thomas-Kilmann Conflict Mode Instrument (TKI). Data analysis was performed using independent t-tests, ANOVA, Pearson correlation, and multiple regression in SPSS version 26 with a significance level of 0.05. RESULTS:The highest mean scores for conflict management strategies were observed in the areas of accommodation (18.69) and avoidance (17.95). Among leadership styles, conscientious (15.27) and steadiness (14.84) were the most prevalent. Significant differences were found between management levels in conflict management strategies; senior managers showed a greater tendency toward collaboration, while middle managers more frequently adopted avoidance. Correlation analysis revealed that the dominant style was positively associated with collaboration, and the conscientious style was positively associated with avoidance. CONCLUSION:The findings indicate that leadership styles based on the DISC model are significantly associated with conflict management strategies. Developing targeted training programs to strengthen collaboration and compromise strategies, along with integrating the DISC model into leadership development initiatives, may improve performance and enhance the quality of hospital services.
BACKGROUND:Biomedical waste management (BWM) is an essential element of health safety and environmental protection. Government of Nepal introduced the Health care waste management guideline-2014; however, its implementation remains inconsistent. OBJECTIVE:To assess knowledge of BWM and practices of Personal protection measures and waste filled containers management in hospitals of Kaski district, Nepal. METHODS:A cross-sectional study was conducted among 252 Health professionals (HP) and Waste Handlers (WH) of 14 selected hospitals of Kaski, Nepal. Participants were selected using stratified sampling. Data were collected through interview and analyzed using IBM-SPSS 22. Descriptive statistics were applied. RESULTS:Knowledge and practices were categorized based on Blooms Taxonomic classification. Only 2.2% of HP and 2% of WH had good knowledge of BWM. Majority (61.3%) of HP and WH (59.0%) had moderate knowledge while over one-third (HP-36.3% and WH-39%) had poor knowledge. Similarly, 5.3% HP and 19.2% WH had good practices; 72.7% of HP and 68.3% WH had moderate practices; and 22% HP and 12.5% WH had poor practices regarding BWM. CONCLUSION:HP and WH have considerably poor knowledge on different dimensions of BWM. Meanwhile, there was better waste management practices with WH having better practices than HP. There needs continuous knowledge enhancement, practice monitoring and motivational interventions for safety.
Predictive modeling of healthcare needs to strike a balance between performance and interpretability-especially when used to guide decisions regarding resource allocation and patient risk. Here is a full machine learning workflow for predicting 30-day hospital readmission among diabetic patients based on the Diabetes 130-US Hospitals data. Following aggressive preprocessing, feature engineering, and deduplication, five classifiers were considered (logistic regression, decision trees, and ensemble learners such as Random Forest, XGBoost, and LightGBM). Although ensemble approaches had high accuracy (LightGBM: 91.4%), they had low recall because of readmission label imbalance (8.6%). To close the gap between performance and clinical confidence, we incorporated explainable AI (XAI) tools-SHAP for global and local model attributions, and LIME for case-by-case interpretability. SHAP explanations consistently pointed to length of stay, age, discharge disposition, and metabolic control (A1C values, glucose levels) as top drivers. LIME explanations served to distinguish true positives from missed cases and detected signal dilution in some medication or diagnostic patterns. In addition, we characterized high-risk patients based on SHAP-derived scores, demonstrating that they exhibited increased prior utilization, abnormal labs, and complicated discharge plans. Our framework illustrates how EHR-based classifiers enhanced with transparent XAI outputs can facilitate actionable, auditable, and clinically meaningful forecasting in the hospital environment. We publish reproducible pipelines and provide directions for next steps such as external validation and model threshold optimization for deployment-readiness.
Cervical cancer is the second most common cancer among Indian women, yet HPV vaccine coverage remains below 1% due to high cost, limited awareness, cultural barriers, and weak healthcare provider (HCP) endorsement. This pre-experimental study among 286 HCPs at a tertiary center in North India evaluated the effectiveness of an HPV Vaccine Awareness Intervention (HVAI), which included expert-led seminars and month-long digital follow-up. Knowledge and attitudes improved significantly post-intervention (p < 0.001); however, while 77.2% expressed willingness to be vaccinated, only 9.9% received the vaccine. These findings highlight a knowledge-practice gap, emphasizing the need for integrated awareness and accessible, on-site vaccination services.
The aim of this study was to examine the effect of nurses' moral sensitivity on their disaster response self-efficacy. The study was conducted with 273 nurses between August and November 2023. Data was collected using the Descriptive Information Form, Moral Sensitivity Questionnaire (MSQ) and Disaster Response Self-Efficacy Scale (DRSES). A weak but statistically significant negative correlation was found between MSQ scores and disaster response self-efficacy, indicating that higher moral sensitivity was associated with higher self-efficacy (r = -0.153, p = 0.011). Regression analysis indicated that moral sensitivity significantly predicted disaster response self-efficacy (β = -0.153, p < 0 .05). Ethical sensitivity of nurses was effective on their disaster response self-efficacy.
BACKGROUND:Medication safety is the most important priority in patient safety and medication errors especially endanger patients' safety. The purpose of this study was to investigate the relationship between medication safety and work dynamics with medication error rates in cardiac care units. METHOD:This study was a descriptive correlational study. In this study 120 nurses were available in terms of medication safety using of Singapore medication safety tools of the Ministry of Health, Salyer work dynamics and Wakefield medication error. Data were analyzed and analyzed using SPSS 16 software. RESULTS:Results showed no significant relationship between medication safety and medication error (p = 0.221), and no significant relationship was found between work dynamics and medication error (p = 0.136). This lack of association with regard to confounding variables remained significant, but between nursing experience (r = 0.225), work in cardiac care (r = 0.222), and nurses' age (r = 0.222). CONCLUSION:Although medication safety and work dynamics in cardiac care units cannot prevent medication errors, however, the presence of experienced individuals leads to increased medication safety in these units and prevents medication error.
BACKGROUND:Job satisfaction is a key issue for healthcare professionals and employees who are satisfied with their jobs feel that their job gives them some positive features. The main purpose of this study is to assess the level of Midwives' job satisfaction in Low and Middle-income countries. METHODS:The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines carried out this systematic review and meta-analysis. An observational studies reporting job satisfaction among midwives in low and middle-income countries were considered. A comprehensive literature search was carried out using selected databases. The extracted quantitative data were analyzed using STATA version 17. Heterogeneity among the included studies was assessed through the I2 test statistics. Finally, a random-effects meta-analysis model was computed to estimate the pooled level of job satisfaction among midwives, publication bias was assessed using a funnel plot and Egger's regression test, and sensitivity analysis was conducted to evaluate the stability of the overall effects in the presence of outliers. RESULTS:About 1760 articles were retrieved from the seven electronic databases, and only fifteen were included in the quantitative analysis. This systematic review and meta-analysis identified that midwives in low and middle-income countries were satisfied with 61.0% (95% CI: 51.3, 70.7). CONCLUSIONS:The overall pooled level of midwives' job satisfaction in low and middle-income countries was low. This systematic review and meta-analysis result is an important source for healthcare systems and managers to take action on why midwives had less satisfaction level toward their job.
This quality improvement research project aimed to improve the quality of the acute emergency management system of the ward settings in the accident and orthopedic department of the National Hospital Sri Lanka through the establishment of a medical emergency team. This is an interventional project to implement a medical emergency team to improve the in-ward emergency management system. Paired sample t-tests were used to determine whether the pre-post differences were statistically significant. The monitoring, guideline availability, communication, and training components and prompt response have been significantly improved. However, there were no significant improvement in infrastructure development. The overall total score increased from 32.36 ± 5.23 at the baseline to 38.36 ± 5.16 after the intervention, reflecting a general enhancement in nurses' perceptions of the emergency management system.
A study was conducted to assess seroprevalence against varicella zoster virus(VZV) and rubella virus among health care workers providing care to antenatal patients and newborn babies. A cross-sectional study enrolled healthcare workers(HCWs) working in the departments of Obstetrics and Gynecology and Pediatrics, collecting sociodemographic details along with a request for 3 mL blood samples. Serum titers of IgG antibodies against VZV and rubella were measured by ELISA(Enzyme-Linked Immunosorbent Assay). Two-hundred HCW participants were enrolled in the study. The average age of the study participants was 31.25 ± 8 years. Among 200 HCW participants 163(81.5%) were positive, 28(14%) negative, and 01(0.5%) participant had a borderline status for VZV. Similarly, 179(89.5%) were positive, 19(9.5%) negative, and 02(1%) participants were of borderline status for Rubella. Study observed a statistically significant impact of past active VZV infection, as indicated by 92.1% antibody positivity among HCWs(p = 0.000012). However, serological status against VZV and rubella were not observed to be associated with age(p = 0.18 and 0.28), gender(p = 0.75 & 0.28), profession type(p = 0.39 and 0.74), professional experience in years(p = 0.43 and 0.9), marital status(p = 0.09 and 0.6), parity(p = 0.25 and 0.9), vaccination in the past(p = 0.12), awareness about Infection during pregnancy(0.5 and 0.57) respectively. Present study offered free vaccination to seronegative healthcare workers(HCWs) and also collected information on the reasons for their refusal to get vaccinated. Pre-employment vaccination and infection history are essential to prevent complications for oneself and to contain the spread of VZV and rubella infections in hospitals that provide care to pregnant women and their newborns.
OBJECTIVE:This study examines the strategic levers that support profitability of hospitals the growing fields of medical tourism focussing on competitiveness factors and their possible interactions to achieve and sustain favorable financial performance. MATERIALS AND METHODS:Grounded on Resource-Based View theory, this study surveyed 300 stakeholders of medical tourism, and utilized SmartPLS structural equation modeling to analyze ten factors on hospital profitability along with the mediating mechanisms. RESULTS:Hospital profitability variation explained by the model 86.2% Refined Delivery was the predominant strategy (t = 37.83, p < 0.001), and included service standardization, quality accreditation, and patient experience management. Brand & Marketing played the role of a secondary lever with indirect results. The two mediating pathways were largely influenced by clinical expertise, cost competitiveness, human resource development, and socio-political stability. CONCLUSION:Hospital profitability in medical tourism will be due to purposeful bundling, not random advantages Builders should emphasize integrated service delivery capabilities while striking the right brand positioning to match operational excellence. This tactical arrangement strategy helps hospitals transform basic resources into long-lasting competitive advantages and improved profit margins in international markets for healthcare.
INTRODUCTION:Vitamin K antagonists (VKAs) are recommended to prevent thrombotic events, particularly in atrial fibrillation and after prosthetic valve replacement. Given that the therapeutic range of oral anticoagulants is narrow, therapy can be challenging. Dosing is also affected by certain factors that may increase the risk of bleeding. Knowledge gaps in oral anticoagulation therapy are linked to reduced effectiveness and safety of treatment. However, limited data are available on this issue in the urban and rural settings of southern Karnataka, India. Hence, the present study aims to measure knowledge about oral anticoagulation therapy and investigate the factors affecting knowledge among these patients. METHODS:A cross-sectional survey design was used. Three hundred twenty patients who were receiving VKAs participated in this study. Data were collected using the anticoagulation knowledge questionnaire. RESULTS:Most of the patients had poor knowledge about oral anticoagulation therapy. They had the highest level of knowledge about laboratory monitoring. Knowledge about diet and drug interactions and adverse drug reactions was significantly lower. Medication management knowledge was found to be moderate. There was a significant association between knowledge and age, education level, place of residence, prior informative sessions about therapy, and duration of use. Significantly, higher education levels, attending prior informative sessions, and longer treatment periods were linked to better knowledge. There was no association between occupation and knowledge. CONCLUSION:The results emphasize the need for targeted education on oral anticoagulation, with knowledge assessment as the first step to guide interventions that prevent complications and improve quality of life.
Many hospitals operate on thin financial margins. Minor changes in market conditions, government regulations, or insurance reimbursement often place hospitals in a precarious financial position. One strategy to ensure sustained financial viability is to adapt the mix of services offered to patients. Hospitals offering services for which insurers reimburse more generously garner additional revenue to cover expenses and/or generate profit. Certain types of specialty inpatient services have been alleged to potentially generate greater reimbursement. This study empirically assesses whether general, acute care hospitals respond to external forces by increasing their reliance on revenues derived from specialty care services. Tobit analysis is applied to data drawn from the American Hospital Association Annual Survey of Hospitals to assess whether hospitals with specific market, operating, institutional characteristics, or past financial conditions display a significantly greater proportion of total (gross) revenues derived from inpatient psychiatric and inpatient rehabilitation care services. The results suggest that a hospital's profit/tax status, past financial positions, past operating conditions, and geographic location all significantly impact a hospital's reliance on inpatient psychiatric and rehabilitation services.
BACKGROUND:Evidence has shown that breast cancer self-management support from mobile apps can improve the quality of life of patients. While many breast cancer mobile applications exist, few applications have documented the process of developing an easy-to-use application from a patient's point of view. OBJECTIVES:To develop a mobile application that is user-centered, context-specific and to evaluate its clinical effectiveness on quality of life and management of health problems of breast cancer survivors. METHODS:The proposed research will be conducted in two phases; the first phase (Phase 1a) will be focused on the development of mobile app content. The pilot phase (Phase 1b), where a prototype of the application will be designed, and its usability will be evaluated. Finally, in the second phase (Phase 2), the clinical effectiveness of a mobile app in breast cancer survivors. CONCLUSION:The findings of this proposed trial may provide a platform for telerehabilitation for breast cancer survivors in resource-limited settings. Furthermore, the findings of this study may pave the way for innovative approaches to healthcare delivery in India and other comparable contexts.
Aim: In this study we develop and standardize an instrument to measure hospital quality from the perspective of attendants in district hospitals of an Indian Union Territory. We also measure the hospital quality across dimensions and the overall service quality. Subject and Methods: We used performance only model with attendant as a proxy respondent to measure the hospital service quality. Multistage purposive sampling technique was used to select the sample hospitals and sample respondents. Results: The results revealed that hospital service quality in district hospitals of UT of J and K, India, consists of seven dimensions. It was also found that the perceived hospital quality is moderate with an overall score of 3.26 on a five-point scale and needs significant improvement. Conclusion: The study concludes that the service quality in district hospitals of UT of J and K, India is relatively poor and needs immediate attention.
Healthcare quality is affected by inefficient resource allocation, including the mismatch between trained professionals and available jobs. This study estimates the need for replacement doctors due to retirement in Alicante from 2025 to 2032. Medical graduates in the Valencian Community increased by 172 between 2015/2016 and 2020/2021, with 75 additional places in a new medical school. Projections indicate a surplus of up to 100 doctors annually. Without creating new specialist positions aligned with population growth, the number of trained doctors will exceed available jobs, risking unemployment and job insecurity in the public healthcare system.
In Canada, hospitalized patients aged 65 and older with dementia as a primary diagnosis often face delayed discharges due to limited access to long-term care (LTC) facilities and homecare services. This study compares patients aged 65 and older with dementia as the primary diagnosis to those with 16 broad categories of other primary diagnoses-excluding dementia-related conditions where applicable-across three key outcomes: (1) the likelihood of experiencing a delayed discharge, (2) the length of delay among those who experienced one, and (3) among delayed discharge patients, the likelihood of being discharged to one of three destinations-homecare, long-term care with 24-h nurse care (LTC-24), or other post-acute residential care (PARC), including rehabilitation, complex continuing care, group living, or supportive housing. Using 2023-24 data from the Discharge Abstract Database (DAD), this study applies logistic, negative binomial, and multinomial logit models. After adjusting for other factors, patients with primary diagnoses other than dementia were about 35% to 95% less likely to experience a delayed discharge, and when delays occurred, their expected duration was roughly 32% to 65% shorter. All estimates were statistically significant at the 1% level. Among patients who experienced delays, those with other primary diagnoses were also less likely to be discharged to homecare, PARC, or LTC-24 rather than home. These findings highlight the urgent need to expand access to specialized, affordable post-discharge care for patients with dementia, as their complex needs strain hospital capacity.
BACKGROUND:Remote patient monitoring (RPM) involves the digital transmission and follow-up of health data. While its implementation has impacted healthcare professionals (HCPs), real-word evidence remains limited. We provide insights on the experiences, barriers and challenges faced by HCPs using RPM for chronic heart failure (CHF) management in a multisite hospital setting. METHODS:A descriptive pilot study was conducted from October 31, 2022 to April 11, 2023 in three hospitals in Nouvelle Aquitaine, France. Patients with CHF were manually enrolled in a web-based RPM platform (Satelia® Cardio). HCPs were invited to participate in semi-structured interviews to describe their experiences and perceptions of RPM implementation. RESULTS:A total of 379 patients were enrolled to use RPM, most were male (61.5%) with a mean age of 75.2 years. Three HCPs (one cardiologist and two ambulatory care nurses) were interviewed. Key challenges identified were limited human resources, difficulty managing alerts due to scheduling constraints and the transition from traditional care models. The need to recruit and train dedicated RPM-specialised nurses was emphasized to support the growing volume of patients, particularly following the COVID-19 pandemic. Initial resistance encountered from hospital administration was reported, largely due to concerns about changing established care practices. CONCLUSIONS:Our findings offer practical first insights into the implementation of RPM for CHF. RPM was generally well accepted by HCPs in a multisite hospital setting. Addressing staffing needs and investing in training could be essential for scaling up RPM as reimbursement becomes integrated into the French healthcare system.
Rapid advancements in science and technology have led to intense yet often hidden competition across various fields. Innovations in the technologies used within healthcare services both influence and are influenced by the nursing profession and its practices. These technological developments help create new roles, support nurses in fulfilling their responsibilities, and enable the delivery of more efficient and safer patient care. To meet the demands of the future, nurses must adapt to emerging technologies and provide evidence-based care using these innovations. For instance, future gerontological nurses may act as care supervisors, overseeing robots tasked with monitoring vital signs, checking blood glucose levels, detecting pressure ulcers, or assessing fall risks. While technological advancements may reduce the demand for nursing labor, they also offer protective benefits. During the COVID-19 pandemic, the use of humanoid robots helped minimize the exposure of healthcare workers, including nurses, to the virus-thus reducing physical contact while maintaining essential care. In Wuhan, where the outbreak was first reported, robots were employed to perform tasks traditionally carried out by healthcare professionals, such as taking oral swabs, conducting basic diagnostics (e.g., using ultrasound or stethoscopes), cleaning and disinfecting patients, administering medications, delivering meals, and monitoring vital signs and body temperature. Despite a potential decrease in the number of nurses required for routine procedures, the demand for professional nurses to manage complex tasks and provide emotional care will increase. Therefore, this study aims not only to inform readers about the impact of technology on nursing practice and the profession but also to support future research in this area. To adequately prepare the nurses of tomorrow, it is essential for nurse educators, administrators, and students both undergraduate and graduate to embrace technology and actively work to expand their knowledge. Enhancing technological literacy is critical to ensuring competent and future-ready nursing professionals.
Hospital accreditation serves as a systematic approach to improving the quality of healthcare services and ensuring patient safety. The success of such programs depends heavily on the awareness, attitude, and perception of healthcare providers, particularly nurses. This study, conducted in 2024 at Imam Khomeini Educational-Therapeutic Hospital in Khalkhal, assessed these factors among 156 nurses using a self-administered questionnaire. The results revealed that the mean scores for knowledge, attitude, and perception were 25.66 (SD = 8.38), 26.23 (SD = 8.91), and 31.58 (SD = 9.53), respectively. Most participants were female (73.7%), held a bachelor's degree (98.1%), and were aged between 30 and 40 years. Knowledge levels varied significantly with age and education, with nurses aged 40-50 and those with postgraduate qualifications demonstrating higher scores. Attitudes toward accreditation were more positive among male nurses, those aged 30-40, and those with less than five years of experience. Interestingly, perception scores were highest among nurses with more than ten years of work experience. These findings suggest that while general awareness of accreditation was moderate, attitudes and perceptions were relatively favorable, particularly among specific demographic subgroups. Given that the effectiveness of accreditation relies on informed and engaged nursing staff, these variations highlight the need for targeted interventions, such as continuous education and motivational programs, to improve knowledge levels and sustain positive attitudes across all groups. Strengthening these areas is essential for the successful implementation of accreditation standards and for driving continuous quality improvement in hospital care.
BACKGROUND:Efficient wastewater management is crucial for hospitals, where water demand is high and sustainability is essential. This study aims to estimate the daily clean water requirement and determine the optimal sewage treatment plant (STP) capacity for a secondary care hospital. The objective was to assess water reuse potential and the compliance of treated wastewater with pollution control standards. METHODOLOGY:A descriptive observational study was conducted over six months in a secondary care teaching hospital. Primary data were collected on occupancy rates and water use, while secondary data were obtained from national building codes and BIS norms to guide tank capacity planning. Physical characteristics of treated water were monitored to assess plant performance. RESULTS:For 95 functional beds in this hospital, 200 daily outpatients visiting, and 200 staff working, a water requirement of ∼80 KLD was projected. An STP of equivalent capacity was constructed. Post-treatment, 49% of the water was reused for flushing and gardening, while the remaining 51% was supplied to nearby agricultural fields. Treated water met pollution control standards for reuse. CONCLUSION:Proper estimation of hospital water needs and tank capacity at the planning stage enables long-term water sustainability and cost efficiency. Reusing treated water reduces operational costs and contributes to SDG 6 goals for clean water and sanitation in healthcare settings.
