BACKGROUND:Paramedics must be situationally aware in order to avoid human error and protect themselves, their partner, their patient, and the public. Previous research has suggested that paramedics lack situational awareness (SA), possibly due to a lack of an organized approach, distraction, and a poor understanding of SA. There is no educational approach provided to paramedics that is known to improve their levels of SA. If such an approach were provided, it could possibly reduce human error and lead to improved outcomes.OBJECTIVE:The aim of this study is to determine whether providing paramedics with a targeted educational approach, including aspects from crew resource management (CRM) such as sterile cockpit and Endsley's model for SA, can improve overall SA during emergency calls.METHODS:A prospective, quasi-experimental before-and-after study was used, in which out-of hospital paramedics were observed during 911 emergency calls. Baseline SA was measured using the situational awareness global assessment technique (SAGAT). Paramedics were then given a targeted educational lesson focusing on elements of SA and CRM as well as a novel quick reference tool to utilize during 911 calls. Post intervention SA was then measured again, and before-and-after results were compared for difference of mean scores.RESULTS:The overall baseline SA was 62% increasing to 86% following the educational intervention. The Wilcoxon Ranked Sum was used to assess for statistically significant differences between mean SA performance in the same group of paramedics before and after the intervention. The increase in SA was found to be statistically significant where p = 0.011.CONCLUSIONS:A targeted educational approach focusing on CRM and a novel quick reference tool may increase SA levels of paramedics during 911 emergency calls. Further studies are needed with bigger cohorts. Paramedicine educational institutions and out-of-hospital agencies should consider implementing this targeted approach with their students and currently practicing providers.

Health care delivery is broken. The cost of care continues to skyrocket and the outcomes most important to patients are often a mystery. Further, care is often delivered via a fee-for-service model where surgeons are rewarded for the quantity, not the quality, of services provided. Such a health care delivery system is not sustainable and does not incentivize stakeholders to focus on the most important element of the health care delivery "puzzle": the patient. Fortunately, we are in the midst of transforming our health care delivery system, with a focus on optimizing the value of care delivery (ie, health outcomes achieved per dollar spent across a full care cycle). In hand surgery, progress has been made as part of this health system evolution. However, there remains much to accomplish. In this article, the authors review the 6 components of a strategic agenda for moving to a high-value health care delivery system for hand surgery, focusing on where we are today and where we need to go from here.

Durante casi dos decadas, los ejecutivos han estado aprendiendo a desempenarse de acuerdo a un nuevo conjunto de reglas. Las empresas deben tener la flexibilidad suficiente para responder con rapidez a los cambios competitivos y del mercado. Deben compararse incesantemente con un benchmark para lograr una mejor practica. Deben tercerizar en forma agresiva con el fin de adquirir eficiencia en diferentes ambitos. Asimismo, deben fomentar algunas competencias centrales para mantenerse a la cabeza de sus rivales. El posicionamiento –antiguamente la parte mas importante de la estrategia– ha sido descartado como demasiado estatico ara los dinamicos mercados y las cambiantes tecnologias de la actualidad. Segun el nuevo dogma, los rivales pueden copiar rapidamente cualquier posicion de mercado, por lo que la ventaja competitiva es, en el mejor de los casos, temporal. ero esas creencias son peligrosas verdades a medias y estan llevando a un numero cada vez mayor de empresas hacia una competencia mutuamente destructiva. Es cierto que algunas barreras a la competencia se estan derrumbando a medida que disminuye la regulacion y los mercados se globalizan. Tambien es cierto que las empresas han invertido bien su energia para hacerse mas ligeras y mas agiles. En muchos sectores, sin embargo, lo que algunos llaman hipercompetencia es una herida autoinfligida y no el resultado inevitable de un paradigma cambiante de la competencia.

Purpose This paper aims to review the evidence on Europe’s economic performance and on the role played by policies pursued at the European Union (EU) level, using the competitiveness framework as the conceptual lens. Design/methodology/approach Why has Europe not made more progress on upgrading its competitiveness over the past few decades, despite the many initiatives that the EU has launched? Findings It finds Europe’s sluggish performance to be driven by a failure to adjust the EU’s policy approach to fundamental changes in the competitiveness context and challenges faced by European economies. Originality/value Based on this analysis, the paper suggests a new role for the EU in supporting EU member countries and regions in achieving higher levels of competitiveness.

CONTEXT:In response to growing concerns over rising costs and major variation in quality, improving value for patients has been proposed as a fundamentally new strategy for how healthcare should be delivered, measured, and remunerated. OBJECTIVE:To systematically review the literature regarding the implementation and impact of value-based healthcare in urology. EVIDENCE ACQUISITION:A systematic review was performed to identify studies that described the implementation of one or more elements of value-based healthcare in urologic settings and in which the associated change in healthcare value had been measured. Twenty-two publications were selected for inclusion. EVIDENCE SYNTHESIS:Reorganization of urologic care around medical conditions was associated with increased use of guidelines-compliant care for men with prostate cancer, and improved outcomes for patients with lower urinary tract symptoms. Measuring outcomes for every patient was associated with improved prostate cancer outcomes, while the measurement of costs using time-driven activity-based costing was associated with reduced resource utilization in a pediatric multidisciplinary clinic. Centralization of urologic cancer care in the UK, Denmark, and Canada was associated with overall improved outcomes, although systems integration in the USA yielded mixed results among urologic cancer patients. No studies have yet examined bundled payments for episodes of care, expanding the geographic reach for centers of excellence, or building enabling information technology platforms. CONCLUSIONS:Few studies have critically assessed the actual or simulated implementation of value-based healthcare in urology, but the available literature suggests promising early results. In order to effectively redesign care, there is a need for further research to both evaluate the potential results of proposed value-based healthcare interventions and measure their effects where already implemented. PATIENT SUMMARY:While few studies have evaluated the implementation of value-based healthcare in urology, the available literature suggests promising early results.

Spine care is at the center of the national effort to reduce healthcare costs and move toward a value-based healthcare system [ [1] Porter ME What is value in health care?. N Engl J Med. 2010; 363: 2477-2481 Crossref PubMed Scopus (2822) Google Scholar , [2] Rihn JA Currier BL Phillips FM Glassman SD Albert TJ Defining the value of spine care. J Am Acad Orthop Surg. 2013; 21: 419-426 PubMed Google Scholar ]. Low back pain, most commonly arising from degenerative conditions, accounts for the most years lived with disability worldwide, while neck pain accounts for the fourth most [ [3] Murray CJ Lopez AD Measuring the global burden of disease. N Engl J Med. 2013; 369: 448-457 Crossref PubMed Scopus (1083) Google Scholar ].

The depth of the Great Recession and the current COVID-19 crisis have increased the interest in the economic resilience of regions. This paper evaluates the role of clusters in the resilience of regional industry employment to economic downturns. Regions specialized in particular clusters (groups of closely related industries operating within a region) enjoy agglomeration economies that could mitigate the effects of recessions and the resulting increase in uncertainty. However, cluster specialization could also propagate negative shocks among related industries, increasing the impact of recessions. This paper explores these issues over the period of the Great Recession. Using a recently available set of cluster definitions (Delgado, Porter, and Stern, 2016), we examine annual employment growth in region-industries (6-digit NAICS) in the United States from 2003 through 2011. Overall, we find that larger regional industries experienced lower employment growth over the full business cycle, and this convergence effect was greater during the financial crisis. However, those industries located within a stronger cluster (in terms of employment, number of businesses, the presence of buyers and suppliers, and shared labor occupations) or a broader cluster (in terms of the number of specialized industries) experienced relatively higher annual growth from 2003 to 2011, and especially during the crisis. The benefits of location in a strong cluster were greater for supply chain industries (i.e., those that sell primarily to other businesses) than for business-to-consumer industries across the whole business cycle. These findings suggest that the strength and breadth of regional clusters improve the employment resilience of the constituent industries, with inter-firm, inter-industry linkages as a relevant source of resilience in the face of uncertainty. In contrast, large regional industries located in weak clusters were highly vulnerable to the Great Recession.

From athletes like Simone Biles and Kevin Love to binge‐worthy TV series like Ted Lasso and social media campaigns, mental health awareness is at an all‐time high. Even pre‐pandemic, mental health increasingly drew attention on campus, and the recent enhanced awareness means students are more likely to recognize mental health concerns and take advantage of relevant resources and processes. Institutions are more likely to be assessing their resources, policies, and procedures related to supporting students with mental health concerns and addressing challenges that arise when students have significant mental health needs.

To make the transition to value-based health care, health care information technology systems must be transformed to enable data collection, data sharing, and usability by patients and providers.

Health care leaders need to develop a different type of care organization structure to optimize value for patients across three dimensions: location, time, and the right mix of personnel.

Situational awareness (SA) has been researched and described frequently in the literature, specifically, in high dynamic systems such as commercial aviation, air traffic control, nuclear energy, and offshore oil drilling. While paramedicine has been identified as a high dynamic system there is no known empirical data related to paramedicine and SA from a theoretical perspective. Without a theoretical framework in place for paramedicine, measurement tools, guidelines, and implications of not possessing SA will remain a challenge. The aim of this study is to review and critique what is currently known about SA, including a comparison and discussion regarding the most prominent theoretical frameworks for SA. In conclusion, it is argued that due to its success in being applied to other high dynamic systems as well as its ability to separate the process of SA from the product, Endsley's three-level framework of SA is best suited for applications in paramedicine.

SummarySince its launch in late 2015, NEJM Catalyst has showcased practical innovations in health care delivery and created a dialogue among leaders and clinicians to better solve today’s complex problems. Now we take the next step. NEJM Catalyst has evolved to become a peer-reviewed subscription journal, NEJM Catalyst Innovations in Care Delivery. Six times each year, this new digital journal will publish the most important ideas and actionable innovations for care delivery that are grounded in research, real-world experience, and value for patients.

Combining data from the social progress index and measures of economic institutions and performance, our analysis focuses on how changes in economic institutions and performance are related to subsequent changes in social progress (noneconomic dimensions of societal performance). We document a positive relationship between improved economic performance and subsequent social progress improvements, a separate impact of improved economic institutions on aspects of social progress that involve individual investment (such as education and health), and a noisy relationship between economic factors and those aspects of social progress related to issues of individual freedom and social inclusion.

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BACKGROUND:Without situational awareness (SA), it is possible that paramedics, crews, patients, and the public may be at risk for injury or medical error. At present, it appears that minimal attention has been given to SA in the setting of paramedicine. OBJECTIVE:To map the state of existing literature evaluating SA in paramedicine. METHODS:To examine the breadth of knowledge available about SA and paramedicine. Searches of five electronic databases and grey literature were conducted to identify papers published related to SA and paramedicine. A narrative approach to synthesising and mapping the literature was used. RESULTS:The concepts of paramedicine and SA yielded 1,125 results which, after screening, included 20 papers for qualitative synthesis. While the literature does show that SA can be measured in allied health simulations, this review shows that there is a very limited empirical understanding of SA and paramedicine. CONCLUSIONS:While possessing SA has been shown to reduce accidents in other industries such as aviation and off-shore drilling, SA has not been researched in depth in paramedicine. Several knowledge gaps were identified that need further research including the potential effects of possessing, or not possessing, SA in paramedicine.

Business strategy. Rivkin’s business strategy work examines the interactions across functional and product boundaries within a firm–that is, the connections that link marketing, production, logistics, finance, human resource management, and other parts of a firm. His work analyzes, first, how such interactions constrain managerial behavior and, second, how managers use cognitive devices and organizational design to cope with decisions whose ramifications span boundaries.Rivkin's scholarly work has appeared in journals such as Management Science, Organization Science, the Strategic Management Journal, the Academy of Management Journal, Administrative Science Quarterly, and Research Policy. Much of this work uses simulations of complex adaptive systems to examine the theoretical implications of cross-cutting interactions. His empirical work on the topic employs a mix of large-scale statistical studies, field research, and case studies.

BACKGROUND:Risk factors for chronic illness contribute significantly to the disease burden in South Africa. The National Department of Health (NDoH) commissioned the development of a toolkit of health promotion guidelines for use by healthcare professionals working in the primary care setting to address this burden.OBJECTIVES:To (i) demonstrate the contextualisation approach to evidence-based health promotion recommendations; and (ii) present the development process of a contextually sensitive and illustrated fit-for-purpose product.METHODS:A contextualised approach was used whereby evidence from rigorous guidelines produced elsewhere was tailored to local conditions. The scope of the toolkit included five risk factors and 22 conditions identified by the NDoH and was underpinned by the Theory of Planned Behaviour. Potential health promotion messages relevant to risks, conditions or both were formulated as population, intervention, comparison and outcome (PICO) questions. The team searched for and selected evidence for each PICO question in a stepwise hierarchical manner and categorised sources as: (i) World Health Organization (WHO) guidelines; (ii) Cochrane systematic reviews; and (iii) non-Cochrane systematic reviews. Those messages supported by source-based evidence were included in the toolkit with culturally appropriate illustrations. Regular engagement with stakeholders included an initial health department stakeholder consultation, a focus group with national programme managers on the appearance and content of a draft toolkit, and a presentation of the final draft at a forum of provincial managers. Final approval of the toolkit rested with programme representatives.RESULTS:A total of 152 PICO questions were formulated. Supporting evidence was identified from 42 current WHO guidelines and 45 Cochrane systematic reviews to answer 147 PICO questions with several guidelines relevant to more than one risk or condition. Evidence for a further five PICO questions was obtained from non-Cochrane systematic reviews. Six additional service delivery messages and four 'no harm' messages were included to align the toolkit with current national guidelines. The illustrated toolkit was well received by stakeholders nationally and provincially, with programme managers expressing a high degree of willingness to adopt a preventive approach in the primary care clinic setting.CONCLUSIONS:Use of a tailored contextualised approach to health promotion guidelines resulted in a culturally appropriate tool based on evidence gathered from rigorous sources and probably reduced development time and costs. Adherence to a robust framework to identify evidence ensured that the toolkit conforms to international guideline development standards.