Organizations perform better and have less employee turnover when the latter voice their suggestions and concerns. This study explores how organizational silence factors affect organizational commitment and job satisfaction. Given the limited related empirical evidence, this study investigated a randomly selected sample of 205 participants currently employed in a Greek public organization. To collect data, a structured questionnaire was used and multiple linear regression analysis was implemented to test hypotheses. Results showed the existence of the silence climate that leaded to employees’ silence behavior and negatively affected all dimensions of organizational commitment and job satisfaction. This study may help public entities’ management, especially in cases of countries with bureaucratic inefficiencies in the public administration, in order to successfully implement structural changes enhancing communication channels reducing thus silence and increase employee commitment and satisfaction.

Objectives: To assess the perceptions of patients with rheumatic diseases about the doctor-patient relationship and the impact on their treatment and their quality of life. Methods: A quantitative study collecting data from patients with rheumatic diseases using the following tools: (a) the Doctor-Patient Relationship Assessment Questionnaire-16 (DoPRAQ-16), assessed the quality of doctor-patient relationship, (b) the Short Form 36 (SF-36) assessed the quality of life of patients, and (c) the Health Assessment Questionnaire (HAQ), assessed the functional ability of patients. From the statistical analysis, it appears that there is no linear correlation between the DoPRAQ-16 scales and the dimensions of the SF-36 Health Survey, except for the scale of negative emotions and the dimension of Physical Functioning. The nonparametric Kruskal-Wallis H test was performed to investigate the existence of statistically significant differences between the categories of duration of the relationship with the doctor to Physical Functioning, Physical Role, Emotional Role, and Social Functioning. The test was significant (p<0.05) for the dimensions of Body Role and Social Functioning. Conclusions: Patients with long term relationship with the doctor have better health quality in the dimension of Physical Role and Social Functioning compared to people whose relationship with the doctor lasts fewer years.

Objectives:To assess the perceptions of patients with rheumatic diseases about the doctor-patient relationship and the impact on their treatment and their quality of life. Methods:A quantitative study collecting data from patients with rheumatic diseases using the following tools: (a) the Doctor-Patient Relationship Assessment Questionnaire-16 (DoPRAQ-16), assessed the quality of doctor-patient relationship, (b) the Short Form 36 (SF-36) assessed the quality of life of patients, and (c) the Health Assessment Questionnaire (HAQ), assessed the functional ability of patients. From the statistical analysis, it appears that there is no linear correlation between the DoPRAQ-16 scales and the dimensions of the SF-36 Health Survey, except for the scale of negative emotions and the dimension of Physical Functioning. The nonparametric Kruskal-Wallis H test was performed to investigate the existence of statistically significant differences between the categories of duration of the relationship with the doctor to Physical Functioning, Physical Role, Emotional Role, and Social Functioning. The test was significant (p<0.05) for the dimensions of Body Role and Social Functioning. Conclusions:Patients with long term relationship with the doctor have better health quality in the dimension of Physical Role and Social Functioning compared to people whose relationship with the doctor lasts fewer years.

The aim of this study is to look into the reliability and validity of the multidimensional Allen and Meyer’s (1990) organizational commitment (OC) scale in a financial organization belonging to the public sector in Greece, as well as the relationship between the factors of the questionnaire. Using stratified random sampling, 205 employees were selected to participate in the survey, currently working in the aforementioned organization. The necessary ethical issues of participation in the research were observed. The reliability of the questionnaire was examined using Cronbach’s alpha coefficient, while the validity was checked using factor analysis. Correlations were investigated using Spearman’s coefficient. Results confirmed that affective, continuance and normative dimensions of commitment were statistically reliable and valid while measuring the levels of Greece’s public sector OC with a statistically significant positive correlation between them. The findings are consistent with the results of previous studies that Allen and Meyer’s (1990) OC scale is the most reliable, validated, well-established and widely used instrument which provides a true picture of the relationship between various dimensions and sub-dimensions of commitment (Khajuria & Khan, 2022).

The World Health Organization has documented the impact that a balanced diet has on disease prevention. Overconsumption of meat can lead to obesity, arteriosclerosis, thrombosis, type 2 diabetes and many life-threatening diseases. A new group of proteins has currently emerged in the scientific community of alternative nutrition called "alternative proteins". Several interventions have been introduced by a large number of healthcare providers in order to promote and enhance people's dietary habits. Two of the most prevalent models of health-related behaviour modification are the transtheoretical-stages of change-model (TM) and motivational interviewing (MI). The purpose of this study is to research and examine how the ΤΜ and MI could be effectively implemented in the diet of health professionals through alterations of eating habits. The population of the study is to comprise health professionals from «AΤΤΙΚOΝ» University General Hospital, Athens, Greece. The sample of participants is to be selected by the professional environment of the researcher. Participants, through random selection, are to be divided into two groups: the control group, consisting of 50 individuals, and the intervention group, consisting of 50 individuals. The duration of the study is to be from November 2022 to November 2024. The present study is concerned with productive mixed-quantitative and qualitative-evolutionary research along with the application testing of both the ΤΜ and the MI. It is to be conducted specifically on health professionals via self-administered questionnaires and semi-structured interviews.

(1) Background: The aim of this study was to identify predictors of the unmet healthcare needs during the financial and recent health crisis in Greece. (2) Methods: Time series analysis was performed for the years 2008 through 2022 using the Eurostat database. The dependent variable was the percentage of people who reported unmet need for medical care. Demographic, socioeconomic, and health data, as well as health expenditures, were used as independent variables. Correlation analysis and simple linear regression models were conducted to analyze the results. (3) Results: Unmet health needs in Greece increased from the start of the crisis until 2016, as a gradual de-escalation of the crisis was observed. However, in 2019 the country recorded the second highest level of unmet needs for medical care before the health crisis. Limitations in usual activities, reporting bad/very bad health status, being unemployed, and having low income increased the likelihood of unmet needs. Health expenditures (public or private) were also significant determinants of unmet healthcare needs. (4) Conclusions: The increased unmet health needs widen inequalities in health and healthcare access. Therefore, health policies should eliminate barriers which restrict the access to health and enhance healthcare services, developing conditions for citizens' well-being.

This study examines the attitudes of healthcare organizations and employees in the Greek Healthcare System towards climate change and the influence of management in promoting environmentally friendly practices. A questionnaire was sent electronically to the 7 Health Districts of Greece and private sector healthcare workers associated with the researchers, while the sample consisted of service (administration, nursing, technical, and medical). The main findings indicate that public sector health organizations are lacking in motivating employees to adopt "green" actions during their work. Communication and information dissemination from administration to healthcare professionals were identified as significant challenges, resulting in participants being unsure of how to respond, in contrast to the private sector which showed slightly more positive results. Moreover, the study highlights a positive association between education level and voluntary green behaviors of employees. This research emphasizes the urgency to confront climate change in conjunction with the principles of Organizational Behavior within the Greek Healthcare System.

(1) Background: Relational Leadership Theory (RLT) has been gaining rising attention for the past 20 years with studies investigating multiple implications and practices of relationships within organizations. Yet, less attention has been given in healthcare settings. By virtue of the emerging need to move beyond exploring the quality of relationships and to move towards the exploitation of relational dynamics that influence leadership development in healthcare organizations, this study explores both the dyad relationships and the context in which those occur. With recent attention directed to the implementation of human-centered practices and the creation of effective networks to bring desired results, RLT is called on to advance this agenda within healthcare organizations. (2) Material and Methods: Research articles that examined leadership theories over the past thirty years were selected from computerized databases and manual searches. (3) Results: It is argued that the way and context in which relationships are formed between leaders and members is a social process that, in turn, shapes the effectiveness of the management of those organizations. Leadership is not rank—it is the relationship with the relational dynamics that play in the same context, creating evolutionary organizational processes. (4) Conclusions: This paper challenges leadership theory one step further. Exploring an organization through relational leadership theory is much like wearing the lens of ‘cause and effect’ in leadership behavioral studies. Therefore, this study contributes to this direction with a robust co-examination of relational dynamics that take place in the healthcare sector, showcasing a broader framework in which relational leadership is germinated and influences its outcomes.

(1) Background: The main purpose of this study was to evaluate the health services' internal quality level in Greek public hospitals and to investigate whether there is a relation between internal quality and health care professionals' job satisfaction. (2) Material and Methods: A cross-sectional study was conducted in six public hospitals (four general and two specialized hospitals). The following tools were used to collect data: (a) the SERVQUAL questionnaire, which is designed to measure service quality through five dimensions, and (b) the Job Satisfaction Survey (JSS) questionnaire, which is designed to measure employees' job satisfaction. Convenience sampling was used as a sampling technique. (3) Results: The level of internal quality service was found to be low as regards the dimensions of: reliability, assurance, responsiveness, and empathy, while the "tangibles" dimension was the only one which was assessed as having a satisfactory internal quality level. Τhe results also revealed a positive correlation between the job satisfaction subscales and the quality dimensions. Regarding demographic characteristics and their effect on employees' perceptions of internal quality dimensions, the study found that the gender and the educational factor had no effect while younger employees have a more positive perception of the quality of responsiveness dimension in the health organizations where they work. In terms of profession, administrative staff had a lower perception of the quality of tangibles dimension than doctors and nurses. Concerning years of experience, the results indicated that employees with more previous working experience had a worse perception of the quality of reliability, responsiveness, and assurance dimensions. (4) Conclusions: According to the results, establishing a sense of trust and understanding between management and health professionals through effective communication, transparent evaluation, and reward is critical to developing, enhancing, and promoting an internal quality culture in a hospital setting.

Writing a well-structured research protocol is a critical component of any research activity. It is a demanding task that requires rigor and strenuous effort especially for the novice researchers in all disciplines. The aims of the present paper are a) to demonstrate the key steps required towriting a protocol for a qualitative research study b) to assist nurses and other health professionals in effectively developing protocols on qualitative research. For this purpose, an example qualitative research protocol was used entitled “Investigating nurses’ views on care of mentally ill patients with skin injuries”. This protocol was chosen because it provides a reasonable model of proposing a qualitative research design within the field of nursing. Results of this process led to the development of a 10 key-step guide to writing a protocol for a qualitative research study. A thorough analysis of how each step of the protocol must be undertaken and accomplished is presented and supported by the relevant literature. This paper provides an informative guide for novice researchers and/or nurse students, on how to develop successful protocols on qualitative research studies that guide research and decision making in naturalistic settings.

BACKGROUND:Mental health illness is not considered as a private matter, as it affects not only the mental patient's life and those who are considered his/her immediate family, but also the society as a whole. The involuntary examination and/or hospitalization in the field of mental health as the basic first-line therapeutic solution in Greece, calls for an immediate intervention, which is supposed to counterbalance the need for therapy and patient's rights of personal freedom and safety.DESIGN AND METHODS:A research using questionnaire was realized, consisting of 100 hospitalized patients in psychiatric clinics (50 voluntarily and 50 involuntarily hospitalized) at the Psychiatric Hospital of Attica. The sampling scheme was the stratified sampling and the level of statistical significance was set to α=0.05.RESULTS:The results have shown that involuntarily and voluntarily hospitalized mental patients did not differ significantly with almost the entirety of the questionnaire; however, the involuntary patients were significantly more satisfied with the conditions of hospitalization as well as assessing the overall quality of the services provided during their hospitalization.CONCLUSIONS:For mentally ill patients, greater importance and stronger correlation with gratification, does not constitute the admission procedure to the psychiatric clinic but the development of effective communication and therapeutic relationship with the staff, full knowledge and update about patient's health condition, medication, participation in therapeutic planning and hospitalization in a regime of autonomy and respect for their rights.

(1) Background: Health care service quality has been equated with preparedness to provide, accessibility, suitability, adequacy, friendliness and ongoing support and has been connected to service excellence. The main aim of this study was to investigate patients’ perceptions and expectations regarding the quality of health services. (2) Materials and Methods: A cross-sectional analysis was carried out in 5 public general hospitals and convenience sampling was used as the sampling technique. Questionnaires were distributed to inpatients and outpatients and 700 valid questionnaires were returned. The SERVQUAL questionnaire was used for data collection in this survey. (3) Results: Overall, in this study, it became apparent that patients’ expectations as regarding the quality of the provided services were not met. All of the five quality dimensions had a negative gap between patients’ expectations and perceptions. (4) Conclusions: The findings suggested that hospital managers and health care professionals should be interested about patient expectations and subsequently they should search out ways and means to meet them. Open communication with patients, individualized attention, as well as responsiveness to their requirements, polite behavior, trustful atmosphere across the hospital and better physical facilities are the key elements that determine the patient’s judgment about quality.

Aim: This paper presents evidence on the impact of leadership development programmes on developing key competencies of clinical leaders in the European Health Sector.Methods: An International Leadership Development Programme has been used as a pilot to assess effectiveness on skills development and leadership styles.A longitudinal pre and post-test design was used, with a sample of clinical professionals attending the programme within three years.A control group provided a method of isolating the impact of the programme.Results: We found that participation in health leadership programmes has a positive impact on health professionals' leadership potential; leadership styles and talent management.However, leadership qualities are also influenced by other factors such as national and organisational culture, structure and team dynamics.Conclusion: The European cases presented in this paper reveal that the higher the contribution of clinicians in management roles, governance, and administration is, the more efficient and productive their healthcare systems become.

Introduction: Nursing activities score scales are valuable instruments for assessing the quality of nursing care provided in critically ill patients and easy to use in validating nurse staffing. The aim of this study was the assessment of nursing workload (NW) as a predictive factor of mortality by using the nursing activities score (NAS) scale. Materials and Methods: In this cross-sectional study of 91 days during 2019, convenience sampling was employed to recruit 82 registered nurses (RN) from three intensive care units (ICUs) of two public hospitals with 41 beds in total. Data were collected using the NAS scale, the researcher’s observation, the information given by the staff, and the nursing care reports. Descriptive and inductive statistics were used with significance level α = 0.05. The Statistical Package for Social Sciences (SPSS 25.0) was used for analyzing the data. Results: Females were the majority of the sample (84.1%), with a mean age of 38.9 (7.7) years, 87.8% had a nursing degree from a technological educational institute (T.E.I), the average working experience was 14 (8.1) years and the ICU experience was 12.9 (8.5) years. There were 3764 daily records of NAS with an average of 54.81 (2.34) and total NAS of 756.51 (150.27). The NW of the first day’s admission in the ICU was 65.15 (13.05), NW was 13.15 h/day and the NW of patients who died was 57.37 (4.06). The optimal nurse/patient ratio (NPR) was 1:1.82, while the existing NPR was 1:2.86. The mortality rate was 28.7%. Conclusion: Although the study results did not demonstrate a significant correlation between NW and mortality, the NW in ICU appeared to be relatively higher for patients who died than for those who survived. This result may serve as an indication for a positive correlation between these two variables. In addition, NW was found to be moderate, while one ICU nurse can take care of more than one patient.

(1) Background: Health professionals' knowledge, beliefs and perceptions concerning radiation protection may affect their behaviour during surgery and consequently influence the quality of health services. This study highlights the health professionals' average knowledge level and captures the beliefs, perceptions, and behaviours in a large public Greek hospital. (2) Materials and Methods: A cross-sectional study was carried out, including health professionals working in operating rooms. One hundred thirty-two staff members participated by responding to an original questionnaire. The sample consisted of nurses, radiographers and medical doctors of various specialties involved daily in surgical procedures where ionizing radiation is required. The survey was conducted from March to June 2021, and the response rate was 97%. (3) Results: The level of overall knowledge of health professionals regarding radiation protection safety was not satisfactory. Females and employees with a lower level of education had more misconceptions about radiation and radiation protection. Employees of younger ages and with less previous experience were more likely to have negative emotions towards radiation exposure. Finally, employees with fewer children tended to express physical complaints caused by their negative emotions due to radiation exposure. (4) Conclusions: Health professionals' lack of basic and specialized knowledge concerning radiation protection safety had a negative impact on the provision of health services. The continuing training of the staff seemed to be the only solution to reverse this trend. The training should highlight how radiation exposure can be minimized, safeguarding health professionals' trust and sense of security by significantly improving their working environment.

(1) Background: A learning organizational culture is crucial to the safety of patients and the quality of public health care. The aim of this study was to assess the learning organizational culture and capacity of Greek public hospitals. (2) Materials and Methods: A cross-sectional analysis was carried out in six public general hospitals and stratified sampling was used as the sampling technique. A total of 480 questionnaires were distributed to health care professionals and 380 valid questionnaires were returned (78% response rate). The comprehensive form of the Dimensions of Learning Organization Questionnaire (DLOQ), which was adapted and translated into Greek, was used for data collection in this survey. (3) Results: The level of learning organizational culture and capacity in the health units are very low. All seven dimensions of the learning organizational instrument are lower than the theoretically neutral median (3.0). Health care employees believe that the hospital's existing culture and management practices do not foster and contribute to continuing learning, which is the fundamental aspect of self-development, department development and performance improvement. (4) Conclusions: Greek public hospitals need to adopt different types of leadership practices and culture in order to be able to facilitate organizational learning. Organizational learning (OL) is based on collaborative working, a culture that encompasses learning as participation in the organizational work practice. This transformation of culture should take place at all levels of learning to enhance results.

In the past few years sustainable development has been in the center of attention among organizations around the world. The literature focuses mostly on the industry sector for its negative impact on the environment. However, a cautious study reveals that the healthcare sector similarly contributes to the climate change with a negative effect. The purpose of this study aims to analyze the ways (actions and plans) in which sustainable development is incorporated between a Greek and a Swedish healthcare facility. Relevant global literature and data were utilized together with the environmental reports of the two hospitals. In addition, a combined survey (interviews and quantitative research) was completed at the Greek facility to draw conclusions on the personnel’s knowledge and habits regarding sustainable development. The results highlighted the necessity to achieve sustainable development and the manner in which it has to be integrated into healthcare. Furthermore, the differences in actions that follow both the Greek and the Swedish hospital are pointed out, as well as similarities, with solutions adapted to the reality of its country individually. The outcome highlighted the significance of accomplishing sustainability in healthcare as well as in any other organization. Additionally, there are a lot of opportunities for improvement towards this goal. Solutions to various issues and possible ways of improvement are proposed, while the need for a new research at Greek national level is highlighted, so that sustainability actions can be adjusted to the Greek reality in the healthcare field.

At a time when rates, employment demands, insecurity and stress are on the rapidly increasing, exhaustion and stress are becoming an everyday reality for more and more professionals, with detrimental effects on their health, family and professional relationships.The aim of the study is to evaluate statistically significant differences of professionals between general and mental health hospitals.A questionnaire survey was carried out on 128 employees in general health units and 99 employees in mental health units, in Athens, Greece.The results showed statistically significant differences in the variable of personal achievement to a significant level.Employees in mental health units provide a higher average value for this variable than employees in general hospitals.The variable of personal achievement demonstrated statistically significant differences between employees of different age groups, marital status and educational level.Older employees, married employees and lower-level educated employees have been identified to have a higher mean value as a variable of personal achievement.Statistically significant differences were observed in relation to emotional exhaustion factor among employees of different specializations.Nurses, and subsequently physicians, report higher mean values for emotional exhaustion than managers and paramedical employees who report lower mean values for this variable.Enhancing awareness of the phenomenon of occupational burn-out can lead to development of effective intervention measures aimed at improving the well-being of medical and nursing staff, assuring the best possible outcome with the least possible medical risk and optimizing maximum possible health risk of patients.

This paper investigates the Education for Sustainable Development in international and Greek Universities.It further aims to investigate how Greek students comprehend the Sustainable Development (SD) issues and Corporate Social Responsibility (CSR) and support, as future managers, its added value concerning the environmental, social and corporate governance management in the Greek Business Community.For this purpose, a literature review and a field research among Greek Higher Educational Institutions (HEIs) students has been conducted.The field research and other relevant researches conclude that the Greek HEIs have followed the international trends and started implementing CSR and Sustainable Development courses in their curriculum.Furthermore, they state that SD and CSR courses are very important for the shaping of a business ethics management, an environmentally friendly behavior and promote the stakeholders interests.Moreover, the field researches find there are strong parallels between the CSR orientation of Greek students and students and managers in other countries.For this reason, Greek Companies could play a significant role at this point, by allowing students to participate in their CSR initiatives.For Greek Higher Educational Institutions (HEIs) and students the SD and CSR, is more than just another scientific subject, as it is a way of completely altering existing way of business management, decision making and market behavior.Therefore, Greek Higher Educational Institutions and students argue that Sustainable Development and How to cite this paper:

Recently, the design and development of a modern health policy in the field of regenerative medicine leads to the formation of a new and integrated cognitive field, which requires systematic research and study in order to produce innovative answers and best practices. Advanced therapy medicinal products (ATMPs) is a new product category, which is at the heart of concern since it has to deal with diseases in which traditional medicine has proven to be ineffective so far. The aim of this review is to provide evidence for the state of the art ATMPs and their modern applications in the field of regenerative medicine. The ATMPs are characterized by a great heterogeneity and variation in methods of isolation, which cover the entire spectrum from a single intravenous injection to a surgical placement. Clinical development of ATMP encounters specific challenges due to the nature of the product and the limited availability of non-clinical data. The gold standard of a controlled, randomized, clinical trial may not be feasible or ethically justified for all indications, particularly in life-threatening diseases, where there is no satisfactory standard of care. Therefore, the European Commission (EC) took initiatives in order to set standards and operating rules concerning authorization and supervision of ATMPs and on pharmacovigilance in relation to them. The European Union (EU) Regulation 1394/2007 provides the possibility of exceptions. In particular, the "hospital exemption" allows for the administration of an ATMP without a license on certain conditions. Although the Regulation 1394/2007 has led to the commercial exploitation of ATMPs, the reality today, 11 years after its first implementation, is completely different. While the Committee for Advanced Therapies (CAT) has already registered 285 products as ATMPs, only 10 licenses were granted which only remained six (the rest related to products withdrawn). The key players in the development and delivery of ATMPs still remain the academic/research centers and small and medium-sized enterprises; while the involvement of pharmaceutical companies is focusing on recent developments in the treatment of oncological incidents with in vitro modified cytotoxic T lymphocytes, and chimeric antigen receptor (CAR)-T cells.