This study examined the impact of organizational, personal, team, job demand factors and mediating effects of team and affective commitments on nurses’ work engagement. Health workers’ work engagement has positive effect on patient satisfaction; nurses constitute a major group among health workers. To find reliability of the instruments pilot study was conducted in three hospitals of Kolkata (India) in which 175 nurses participated. In the main study, 504 nurses from five hospitals in Kolkata participated. Correlation, regression analysis and Sobel test was used to find out the relationships. Perceived organizational support, leader–member exchange, team–member exchange, workplace friendship, all relate positively to work engagement. Nursing role stress negatively relates to work engagement. Team commitment positively mediates the relationship between leader–member exchange, team member exchange and workplace friendship with work engagement. Affective commitment positively mediates the relationship between perceived organizational support and core self-evaluation with work engagement and negatively mediates the relationship between nursing role stress and work engagement. Result of the study shall be helpful for health care managers to devise appropriate strategies for enhancement of work engagement of nurses.
Introduction
Work-related musculoskeletal disorders (WRMDs) represent one of the most common and important occupational health problems in the working population; they negatively impact the quality of life and are a cause for major economic burden in the form of compensation and lost wages.
Objectives
To assess the prevalence, pattern and factors associated with WRMD among housekeeping workers in a private tertiary care hospital in Bangalore.
Methodology
A cross-sectional study was conducted among housekeeping workers in a private tertiary care hospital from May to September 2014. A pre-tested semi-structured questionnaire was administered which included socio-demographic details and the standardized Nordic questionnaire (SNQ). Out of the 130 workers, we were able to contact 83 workers (as some were on long leave and some left the job).
Results
Among the 83 housekeeping workers studied, the mean age was 37.4 ± 2.42 years. Prevalence of WRMD was estimated to be 68.3 per cent and the pattern of pain was found to be high for low back and least for ankles. There was a significant association between the prevalence of pain with increased duration of work hours and years of employment.
Conclusion
This study showed a high prevalence of WRMD among housekeeping staff which is associated with long hours of work and years of work. We can aim at reducing the WRMD by giving health education about ergonomics, recommending job rotation and in severe cases even physiotherapy.
In response to a new global coalition of more than 500 leading health and development organizations worldwide, India as a country has agreed on a roadmap to progressively ensure that all people have access to the health services they need, when they need them, without fear of financial hardship.
Organizing relevant health services, pursuing only effective interventions and monitoring specific results by geographical areas, i.e., Urban Poor, Peri-urban, Un-recognized slums and so on through a better network of independent groups is the key responsibility of the health department.
To make our cities worth livable with health and productive people, we need to address the issues of urban environment first, like providing safe water, controlling air pollution, general sanitation, sewage disposal, minimizing noise pollution, providing playgrounds, walking tracks, good roads and transport for minimizing commuting pain index.
In 2011, nearly 31 per cent of Indian population lived in urban areas and this proportion was rapidly growing. In parallel, the disease epidemiology in India, as a whole, was changing, with non-communicable diseases (NCDs) contributing to nearly two-thirds of total disease burden stressing the already overburdened health systems in Indian states. Contrary to common perceptions, the health outcomes of the urban poor in India are not any better and at times worse than those of the rural population. The challenges in urban health are well known—poor infrastructure, uncoordinated and fragmented health service delivery, suboptimal financing, insufficient coordination amongst multiple agencies, migrant population, shortage of human resources, high level of inequalities and inequities, etc. In recent years, with the recognition that replication of what is being done in rural areas may not be sufficient to address challenges in urban settings, unique solutions to urban health have been identified.
This article summarizes the key health challenges and proposes a few solutions to address urban health challenges and improved health outcomes in urban agglomerations. The authors argue that progress towards universal health coverage in India would be partial unless sustained and harmonized initiatives are done to improve health situation in urban India.
Lack of hospitals and skilled healthcare providers across India is a challenge. Almost 70 per cent of the Indian population has very little access to healthcare and villagers often travel long distances even for primary healthcare. As a result, many of them go unattended because they cannot afford to reach to a healthcare centre on time on account of the cost of travel and also due to fear of losing the day’s wages. This eventually contributes to higher morbidity and mortality rates.
Government may take a long time to provide traditional healthcare infrastructure to 70 per cent of the population living in rural India, but mobile health may bridge this gap. Mobile phones, Internet and SMS facilities provide people a tremendous opportunity to connect with healthcare providers for consultation, counselling, diagnosis and other information at anytime and anywhere. This study aims to find out the potential of mHealth to improve the health conditions and spending on healthcare.
With rapid pace of urbanization, urban health has emerged as one of the most significant health themes of the decade in India. The increasing proportion of urban poor and vulnerable, with health indicators worse than their rural counterparts, face various social and financial barriers to accessing healthcare. While urban health has been emphasized over the years by various committees and five-year plans (described in detail in the article), there has been little concerted effort at the national level for providing comprehensive healthcare to the urban population, up until the launch of the National Urban Health Mission (NUHM) in 2013. As urban health infrastructure, developed under various schemes and projects in different states, is quite inconsistent across the country, covering the entire urban population with standardized services is a challenge for NUHM. Other challenges include crowding out of the urban poor from available urban facilities, multiple burden of diseases and vulnerability in urban areas and fostering coordination and convergence between various urban stakeholders including the private sector. This article describes the past and current policies on urban health, the current challenges for implementing urban health programmes in India and the way forward.
This article attempts to provide an understanding to what extent institutional change of the functional activities of microfinance influences some specific health-related outcomes for the ultra-poor people in Bangladesh. It examines impact of the ‘Challenging the Frontiers of Poverty Reduction-Targeting the Ultra Poor’ (CFPR-TUP) programme on health-related outcomes using a large balanced panel data set (2002, 2005 and 2008) from rural areas of Bangladesh. The main objective of this article is to examine both short- and long-term impacts on health-related issues of the ultra poor using both conditional and unconditional difference-in-differences (DID). In particular, this article examines the distinction between treatment and control groups in base year and the year followed up as well as the impact on coping ability. This study finds the significant impact of the programme on investment in health and awareness indicator such as usage of sanitation though we are suspicious about its sustainability. The programme therefore has sustainable impact on health investment and to some extent, on coping ability.
The demographic transition with rapid urbanisation corresponds with the challenges of urban infrastructure development. Urban health is an outcome of complex interaction of many urban factors including governance and finance. Coupled with this, climate change has overarching influence on these factors and a challenge to development, health and survival. Therefore, understanding impact of climate change with reference to urban health and development should be on high priority.
Changes in climatic patterns may alter the distribution of vector species and increase its spread in new areas. An increase in temperature and relative humidity may enlarge the transmission window. Effluent emissions to water bodies and salination of rivers through sea level rise may increase the incidence of water borne diseases. Deaths due to heat wave are reported from several parts of the country. Every city is different and success of city specific urban health programme depends on city specific planning as well as public health preparedness for climate change. Hence, study of Climate and Health brings out threshold levels of climate resilience.
Surat city experience of Urban health revealed that good governance and Finance were considered most important factors including Urban health system, community participation, Inter-sectoral convergence, disease surveillance, health information system, Public–private partnership, participation of academic institutions and cross learning. One of the major advocacy areas UHCRC is embarking in is ‘Inclusion of Climate resilience in Health and Health in Climate Resilience Planning’.
In the last 60 years since independence, India had achieved considerable improvements in the health of its population as reflected in their life expectancies which have doubled within this period. This article aims at explaining pertinent health-care issues and challenges based on some health indicators in India by using the literature review method that involved collection of material from the online sources, which included government documents, articles and publications related to healthcare, healthcare indicators, poverty, financial burden and coping strategies. To avoid premature deaths among adults, children and maternal mortalities, greater attention should be given to prevention and treatment of non-communicable diseases, and women and other social determinants of health. More attention should also be given to the reduction of births among teenage girls in order to avoid premature morbidity and mortality. To protect the vulnerable and poor, the government should provide more resources since financial burden of curative care is higher among lower income groups. However, in poorer states, the government tends to have relatively low ability to raise their own resources and the people in these states have a lower ability to pay for private insurance. Therefore, it is worthwhile and pertinent that the government initiates social insurance.
India’s urban population will be doubled from 377 million in 2011 to 915 million in 2050. Such rapid urban growth may lead to several problems by affecting the economy, environment and the society at large. These problems further affect the health vulnerability in urban areas. Thus, there exists a need for health workforce equipped with the knowledge and skills to meet the urban health challenges.
To undertake the landscaping of teaching and training of urban health as a part of health professional courses and to undertake mapping of specific training programmes related to urban health in India.
A curriculum scan of various health professional courses in India ranging from medicine, dentistry, allied health, Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH), nursing to public health was undertaken related to teaching and training of urban health. An exclusive search was also carried out for identifying urban health-specific training programmes being offered in India.
As per the curriculum scan, current health professional courses being offered in India have a very little focus on urban health. It was observed that various cross-cutting issues related to urban health are not adequately addressed in the current curricula. Also the curricula of these health professional courses have not clearly spelt out the desired urban health competencies. Few institutions in India offer short-term training programmes specific to urban health issues.
Considering the growing urban health population, it is critical that the curricula of health professional courses comprehensively incorporate adequate content regarding urban health and related issues. Curricula should be designed on the basis of clearly spelt out urban health competencies. There is a need to design specific short-term training programmes covering various aspects of urban health. Some of the institutions offering public health programmes, especially Masters in Public Health (MPH) programme, should dwell on developing urban health track as a specialization of MPH programmes.
In this study, an attempt was made to investigate the attitudes of patients towards the public healthcare system in the Kolkata Metropolitan area. The research findings suggest that poor and middle class families of the state generally avail the public healthcare facilities, due to high cost in private hospitals. The behaviour of doctors and nurses are generally cordial in the hospital and prescribed medicines are available from the hospital pharmacies. In public hospitals, nepotism and favouritism are very common. It is a very common practice in this metropolitan city, that, to get admission for treatment in the hospital, one needs a doctor’s recommendation, political link or third party’s help. The management authority is serious enough to bring about good administration and wants to keep the hospital neat and clean.
The healthcare system underwent considerable restructuring and downsizing in the early to mid-1990s as governments cut costs to reduce their budget deficits. Studies of the effects of these efforts on nursing staff and hospital functioning generally reported negative impacts. Healthcare restructuring and hospital downsizing was again being implemented as governments struggled to once again reduce deficits. The present study examines the relationship of union support during hospital restructuring initiatives with a range of individual and unit/hospital outcomes in a sample of nursing staff working in healthcare settings (hospitals) undergoing significant restructuring and downsizing. Data were collected from 289 nursing staff in California hospitals. Nurses reported a relatively large number of restructuring and downsizing initiatives during the preceding year. Levels of union support had a significant relationship with hospital functioning, but not with nursing staff work and well-being outcomes. Although union support has not shown many benefits for nursing staff during hospital restructuring and downsizing given their focus on adherence to collective agreements, nursing unions can play a larger role here. The present study adds to our understanding of the potential benefits of union support during the current hospital restructuring and downsizing, and highlights the role of union leadership and management.
HIV/AIDS is a perennial health issue in South Africa; the disease was the major cause of the 200,000 deaths in South Africa in 2013. The menace has increased with the increase in the number of people living with HIV/AIDS in South Africa, despite the rigorous preventive strategies that were adopted in the country. This article explores localism in communication as a tool of health development in promoting HIV/AIDS awareness and knowledge in Africa, with a particular reference to South Africa. This article draws attention to the various localized channels of communicating development messages in relation to their significance in facilitating HIV/AIDS awareness and knowledge.
This article presents the implementation of lean principles using action research, in a health-care environment, focused on the operating room. Lean production has been successively adopted in the services sector because its implementation improves process efficiency and resources management. Additionally, a culture of continuous improvement search is created in the organization, a culture focused on the client (patient) that creates value for the client. This implies a change of the paradigm that prevails in some countries where the doctor is viewed as the ‘client’. The action research described in this article promoted lean principles in an operating room and support warehouses. The results were as follows: stocks management improved, warehouse spaces reduced by 20 to 25 per cent, operating room areas were better organized, equipment and obsolete surgical material were eliminated, equipment management was improved and operating times were reduced. Furthermore, it was necessary to create productivity indicators for the operating room to improve visual management and train staff for adopting a lean behaviour and attitude. This action research describes a trend in health care that implies an organizational change of culture and paradigm.
The present study was a cross-sectional analytic epidemiological design to assess the frequency of observance of universal precautions in acute care wards of a large teaching hospital and to assess the epidemiological determinants of such observance. A total population of medical officers, nurses, paramedical and ancillary workers working in acute medical and surgical wards was studied using direct observations recorded on a pre-tested, structured format. The study revealed that hand washing was more frequently practiced by medical officers and ancillary staff (68–93 per cent) as compared to nurses and paramedical staff (38–58 per cent) (p < 0.01).
A significantly higher proportion of medical officers in medical wards (93 per cent) and nurses (63.3 per cent) and ancillary workers in surgical ward (89 per cent) were practicing hand washing (p < 0.01). The practice of usage of gloves was significantly more frequent among medical officers and ancillary workers (72–100 per cent), while it was quite inadequate among nurses and paramedical staff (28–36 per cent; p < 0.001). However, the use of gloves was significantly better among nurses in the surgical ward and paramedical in the medical ward (p < 0.05). A linear trend analysis of the use of protective clothing revealed that the odds of nurses adequately using the same were much lower, while those of ancillary workers were much higher as compared to medical officers, the trend being highly significant in both types of wards (p <0.001). The study reveals a definite need for stepping up educational and motivational methods for observance of universal precautions by health-care workers in large teaching hospitals. In particular, nurses and paramedical workers have been identified as high-risk groups, needing concerted efforts for observing these precautions.
Medicines are major elements of modern healthcare systems and have helped significantly to reduce the burden of deaths and diseases all over the globe. Access to these essential medicines is a major need in order to achieve ‘Good Health to All’. Traditionally, India has been a rural, agrarian economy where the majority of the population still live in villages. The main factors which affect the provision of good healthcare among the rural population are affordability, unavailability and average quality of drugs and other medical supplies. The availability and quality of medicines are substandard when compared to the urban population standards.
To promote proper utilization of medicines, there is a need for availability and affordability of quality medicines in the presence of ‘rational drug usage’ ideology among the medical professionals and health workers. They play a vital role in imparting the knowledge of drug information to the patient community which in the long run can help in achieving the goal of health to all. This paper showcases the need and emergence of a pharmaceutical supply chain mechanism in the healthcare industry and how it can prove to be the backbone of the present public healthcare system by enhancing it with information communication technology (ICT) implementation. This paper also discusses the problems and resentment faced with the initial introduction of modernized technology into the current healthcare system.
Health financing is presumed to have an immense importance in designing the delivery mechanism in health care service. Financing in public health care institutions (comprising local, state and central governments, along with autonomous public sector bodies) is not observed to be adequate in India as compared to the global standard. As a result, the participation of private health care institutions in this health care domain is urgently called for to address the gap between demand for and supply of health care services. Health financing by non-governmental organizations (NGOs) as well as the government initiatives in the form of public–private partnership (PPP) signifies an alternative delivery mechanism in meeting the demand of such services. An attempt has been made in the study to examine the interstate variation of public health care access in India by considering a comprehensive index on public health care access. In addition, the study sheds some lights on the association between the outreach of health care access and the financing of the health care infrastructure in the context of different states of India. Empirical evidence suggested that the more health care financing by the government, the greater the outreach of the public health care services of a state. Thus, a significant contribution in health financing would facilitate the access of public health care by addressing the supply-side problems of the outreach of health care services in the Indian economy.
The main objective of this study was to compare users’ perception and evaluation of both public and private healthcare services, distinguishing between primary and specialty care, with a cross-cultural approach in two Mediterranean countries: Italy and Spain.
Within an exploratory approach and following a descriptive aim, we have conducted a quantitative methodology: after a literature review about health marketing and health management, we have developed a questionnaire and collected end users’ perceptions in both countries.
Results highlight different aspects shaping the multidimensional healthcare service, such as the waiting lists, their experienced sensations, word-of-mouth (WOM) relevance and their behavioural intentions in the future
Out of the results, implications for scholars interested in the marketing of public services are proposed in terms of the idiosyncrasy of health consumer behaviour: satisfaction with and willingness to recommend a service provider (public or private) according to comparative service provision (primary or specialized care service) and geographical context (Italy and Spain). Implications for health managers highlight the relevance of time management, experiential marketing in health service provision, WOM relevance and behavioural intentions.
Substantial programmatic efforts have been undertaken to improve the access to maternal care services in the public health system of India, yet the service users are often regarded as passive recipients. Limited research is available on the preferences of service users on what they regard the greatest issues in service delivery. A hospital-based discrete choice experiment (DCE) has been conducted in the public health facilities of Tamil Nadu, a southern state of India. This study uses a sample of 261 women who came for antenatal check-ups across six different public hospitals in Tamil Nadu. The DCE technique, which is rooted in random utility theory (RUT), and conditional logit model have been used to analyze the relative importance of health service attributes. The result showed that regular ward visits by specialist doctors like obstetricians and gynaecologists (O&G) and paediatricians were the most preferred attribute of the maternal care service. Expectant mothers are willing to wait the maximum and are prepared to tolerate health service characteristics in public hospitals, such as poor patient amenities, poor staff attitude and lack of privacy maintained during physical examination, provided specialist doctors are available in the hospitals.
Inequality in the distribution of health care facilities is one of the main barriers to health care access. The purpose of this study was to assess the regional differences in health care facilities across the Kohgiluyeh and Boyer-Ahmad (KBA) province in order to reduce the gap between different regions. The study was carried out in the KBA province in the southwest of Iran. Fifteen health indices were selected based on their availability in the 2011 Statistical Centre of Iran (SCI) annual report. Data analysis was conducted through using numerical taxonomy. The findings obtained showed a huge gap between the different counties of the province. Yasouj had the highest (0.73) health indicator level, while Charam (0.982) had the lowest. Our findings can provide a big picture of the inequalities that exist in this province for policy-makers. Consequently, it enables policy-makers to make greater efforts for understanding the present conditions and moving towards a more equal distribution of health care services and facilities.
Personality characteristics have been linked to various health outcomes. Personality characteristics and rheological parameters have been found to be independent correlates of cardiovascular diseases. The present study aimed to explore the possible relationship between the two independent factors, personality characteristics (Big Five traits and Type A behaviour pattern) and rheological parameters (blood viscosity, plasma viscosity and red cell rigidity), and it was expected that the factors would be positively correlated to each other. The study was conducted on the sample of 68 healthy young adults. Personality assessments and biomedical analysis of the blood sample of participants were carried out to test the possible correlates. Descriptive statistics and Pearson correlation analysis did not show any significant relationship between the factors. The findings indicate that personality characteristics and changes in rheological factors are independent of each other, and hence rheological parameters do not explain the relationship between personality and cardiovascular disease. Limitation and implications of the study are discussed.
Service quality is considered as a key component for employer brand that is determined through customers’ satisfaction. In this context, the primary goal of the health care industry is to provide the best possible service to their patients in order to sustain in the market. An assessment will give an opportunity to find out the loopholes in the services for future rectifications and to reach the desired goal. This study is, therefore, an attempt to measure the perception of patients regarding quality of health care services in India along with a comparative study on urban and rural hospitals. Here, current status of health care service quality and preferred service dimensions of urban and rural patients in India was investigated through literature review and questionnaire survey. Data were collected from 368 patients, who were then hospitalized or already discharged. The Service Quality Measurement scale (SERVQUAL) was applied to verify the hypotheses. The findings reveal that the health care service quality was unsatisfactory and patients’ preferences of dimensions were distinct in urban and rural areas. These gaps exist due to lack of knowledge, costly modern medical substances and treatments and so on. The study has implication in maintaining standard of health care service quality, making policies and serving research purposes.
This study compared University of Missouri child and adolescent telepsychiatry services patients’ specific zip codes to child and adolescent psychiatrists’ practice locations to learn if telehealth was an appropriate option for this group of patients.
In demographically and geographically diverse state such as Missouri, patients in rural areas may have limited or no access to timely, affordable and quality care. Many large urban health-care institutions have turned to telehealth as a means of providing equal access to care for all population, no matter where they choose to live.
The management analyst system Cognos/Analyzer was used as a data source. Patient- and provider-specific zip codes were processed using GeoKettle software, and ArcGIS explorer was used for map visualization.
While patients utilizing child and adolescent telepsychiatry services come from various parts of the state, providers are mostly clustered in urban locations along the Interstate 70. This greatly limits access to specialty care for rural and other vulnerable populations. Telehealth provides adequate and timely access to child and adolescent psychiatry services for the youth that may otherwise not be able to get needed care.
Barriers such as mental health crisis and access to care for rural population have been more or less successfully addressed by telehealth for several decades now. However, the shortage of specialty physicians adds an additional layer of complexity to this issue. Health-care organizations with informatics tools such as telemedicine need to focus their efforts on maximizing usage to allow more access for the underserved population.
Emergency department (ED) overcrowding has become a common situation with significant negative effects on the quality of care. The aim of this study is to detail the flow of patients and their variability and determine the existence of stable patterns that allow better planning of resources.
We performed a retrospective descriptive observational study of emergencies attended from 2008 to 2010 in the ‘Juan Ramón Jiménez’ General Hospital (Huelva, Spain), with a sample of 343,233 visits. The time between consecutive arrivals of patients and the arrival patterns according to severity and clinical area was calculated using Microsoft Excel and Stat::Fit. Quarterly differences were determined using the Kruskal–Wallis test.
The mean value of the inter-arrival time, independent of the quarter (p < 0.05), was 2–4 minutes from 10:00
The study shows that inter-arrival times and average arrival rates of patients have a defined and reproducible pattern for each level of severity and clinical area, which forces us to rethink the fixed capacity model and oriented towards flexibility of resources to reduce the overcrowding.
Prevalence of diabetes is increasing rapidly in across the world and India is no exception. In the year 2000, the World Health Organization (WHO) estimated that India had 32 million diabetic. One of the proven strategies to improve access to healthcare, especially in the areas that are underserved or un-served through public healthcare services, is Public–Private Partnerships (PPPs).
The case study is based on the observation of the facilities and service delivery, desk review of service delivery statistics of the PHC, in-depth interviews with stakeholders.
It was observed that the Valam Primary health Centre (PHC) is an excellent example of locally-initiated, village-level PPP model to cater to rural population. It was quite evident from the available records that PHC is having adequate supply of strips and glucometer to perform the investigation to monitor the blood sugar level of diabetic or suspected cases, which was not available even in other PHCs of the same block. Round the clock availability of the diagnostic equipment reflects the commitment of the NGO for providing the optimal diabetes investigation care to the residents in and around Valam PHC level.
The Valam Diabetic Care Model is an excellent example of locally-initiated PPP model and this kind of model should be encouraged in resource constrain areas.