Tag: healthcare workers

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The High Cost of Having Too Few Pharmacists in SA

On By ModernMedia
Photo by National Cancer Institute on Unsplash

By Chris Bateman

It’s acknowledged in key policy documents, well known at the coalface and much ventilated in the media: South Africa’s public healthcare system has too few healthcare workers, especially medical doctors, certain specialists, and theatre nurses. Less recognised however is the shortage of public sector pharmacists. We lift the lid on this until now largely hidden problem – and its impact.

There are too few public sector pharmacy posts across South Africa to deliver a comprehensive service, with no clear staffing norms, and an uneven distribution of pharmacists, especially in rural districts. This contributes in part to medicine stockouts and the emergence of deadly hospital-acquired drug-resistant infections.

This is according to Dr Andy Gray, a senior lecturer in the Division of Pharmacology at the University of KwaZulu-Natal’s School of Health Sciences and co-head of the World Health Organization Collaborating Centre for Pharmaceutical Policy and Evidence Based Practice. His views are echoed by at least two other key local stakeholder organisations.

Flagging the alarming rise in resistance to antimicrobials – an urgent global public health threat – driven by the misuse of antibiotics in hospitals and ambulatory care, Gray told Spotlight that there are not enough pharmacists to intervene if they see inappropriate use of medicines.

“This just continues without any effort to fix it. Inadequately trained and understaffed prescribers are working under immense stress, so they are prone to use the wrong medicines at the wrong time with the wrong doses,” he said. “There are also very few microbiologists and certainly not enough pharmacists at the bedside. They’re not doing what’s necessary to ensure the proper use of medicines – for example, better control over antimicrobials.”

The excessive dependence on antibiotics has resulted in the emergence of antibiotic-resistant bacteria, commonly known as superbugs. This is called bacterial resistance or antibiotic resistance. Some bacteria are now resistant to even the most powerful antibiotics available.

South Africa has been ranked 67th out of 204 countries for deaths – adjusted by age per 100 000 people – linked to antimicrobial resistance. It has been estimated that around 9 500 deaths in the country in 2019 were directly caused by antimicrobial resistance, while 39 000 deaths were possibly related to resistant infections.

The National Department of Health warned in a background document that rising antimicrobial resistance and the slow-down of new antibiotics could make it impossible to treat common infections effectively. This could also lead to an increase in the cost of healthcare because of the need for more expensive 2nd or 3rd line antimicrobial agents, as well as a reduced quality of life.

Low numbers

Gray said that while not matching the paucity of public sector doctors and nurses, pharmacists stand at 24% of the staffing levels calculated as necessary to deliver a comprehensive service.

“We need just over 50 pharmacists per 100 000 uninsured population as a target, but we’re sitting at around 12,” he said.

Gray said the SA Pharmacy Council (SAPC) has no data on the total number of pharmacists actually working in the country, or the number working in particular settings. A SAPC spokesperson said they had only provincial statistics, but could not track pharmacist movements.

“You can’t use their database to find out how many pharmacists are working where. The Health Systems Trust SA Health Review Indicator chapter has figures of public sector pharmacists per province and per 100 000 uninsured population,” Gray pointed out.

As at February 2024, there were 16 856 pharmacists registered in South Africa, (working and not working), excluding the 971 community service pharmacists.

The 5 958 pharmacists employed in the public sector represents the full complement of funded posts, but it is well below the number needed – and varies dramatically between provinces. While almost all funded posts are filled, Gray said the number of posts is less than needed to deliver a comprehensive, quality service.

Taken across South Africa’s population of around 62 million, there are around 28 registered pharmacists (working or not working), per 100 000 people (insured and uninsured). According to data from 2016, the mean global ratio stands at 73 per 100 000.

“We’re better than many other African countries, but that’s cold comfort,” said Gray.

Increases spread unevenly

There are some positives. The number of pharmacists in the public sector has grown since 2009, rising from five to 12 per 100 000 uninsured people by 2023. However, the ratio varies markedly by district – for example: from 15 in the best-served Western Cape district to a mere three in the poorest served Northern Cape district.

Gray said the more rural districts suffer the most when it comes to understaffing of pharmacists and this contributes to medicine stockouts. While the causes of medicine stockouts are complex, one of the major contributors is the refusal of suppliers to deliver any more stock until accounts are paid.

Understaffing of pharmacists often results in nurses managing patients without any pharmaceutical oversight, Pharmaceutical Society of South Africa Executive Director, Refiloe Mogale, told Spotlight. She associates such task-shifting with medicine misuse and inappropriate prescribing, noting that while it’s a vital strategy in budget-tight environments, medication errors are on the rise. This, she argues, could be solved by ensuring appropriate pharmaceutical personnel are placed to support primary healthcare facilities – such as pharmacist assistants.

“A Primary Care Drug Therapy (PCDT) trained pharmacist can diagnose, treat, and dispense medications. So, this is not as much about task-shifting as about the pharmacist providing comprehensive care. These PCDT pharmacists can do family planning, screening for diabetes, hypertension, and other clinical tasks that take the burden off doctors. We need more of them,” she said.

‘No clear staffing norm’

Addressing the human resources quandary, Gray said the core problem had always been that the number of pharmacist posts per hospital or clinic were not evenly distributed. “There’s been no clear staffing norm. The old ‘homeland’ hospitals are likely to be under resourced with pharmacists and pharmacists’ assistants. Posts are poorly distributed and by global standards, we’re nowhere near where we should be,” he said.

The National Department of Health’s most senior pharmacy official Khadija Jamaloodien agreed that pharmacy posts should be distributed better. But she said work protocols dictate that state pharmacists must visit each clinic in their district at least once per month. She said there are 3 000 primary healthcare facilities in the country and 6 000 (albeit maldistributed) public sector pharmacists.

Nhlanhla Mafarafara, President of the SA Association of Hospital and Institutional Pharmacists, told Spotlight too many of the almost 6 000 pharmacists in the public sector are doing stock management, dispensing, administration and management work in hospitals and pharmaceutical depots. He says the numbers do not necessarily reflect pharmacists in clinical or patient facing areas.

“The reality is that pharmacists are restricted to trying to get drug stock in and out,” Gray observed.

However, the lack of pharmacists and pharmacist assistants at clinics and hospitals means timely and/or knowledgeable ordering often results in shortages of essential medicines, something all experts interviewed for this article agreed on.

Mafarafara said that by defining what services a pharmacist should render and what’s needed to enable a quality service, more realistic staffing numbers could be reached. Pharmacies are central points in all hospitals, with closure for even an hour crippling a hospital. Thus, adequate staffing is critical to ensure uninterrupted access to good quality pharmaceutical care.

South Africa, Mafarafara added, was far behind many other countries in the effective use of pharmacists’ clinical expertise in leading evidence-based care in hospitals. “I’d even go so far as to say doctors should be stopped from dispensing in favour of pharmacists to improve quality of patient care,” he said.

‘If you don’t have a pharmacist, nothing gets done properly’

Jamaloodien said the cost of having too few pharmacists is more far-reaching than just antimicrobial resistance. “You can have stock outs because there’s nobody to manage the supply chain. In my experience, if you don’t have a pharmacist, nothing gets done properly,” she said.

Her solutions? Compliance with the “comprehensive and robust” evidence-based standard treatment guidelines, access to an updated and well-maintained cell phone-based application that gives everybody access to the latest information and medicine changes – and more attendance by all healthcare professionals of webinars held after every medicine’s committee meeting, plus clinicians regularly reading drug update bulletins to keep up with new medicines.

Republished from Spotlight under a Creative Commons licence.

Read the original article

Categories : General Interest Medical IndustryTags :

Essenwood Residential Home – A Case Study in Elevated Care Through Staffing Partnership

On By ModernMedia

Essenwood Residential Home, a haven for senior women since the 1850s in Durban, South Africa, provides exceptional care for its residents. However, managing the complexities of HR for a growing number of caregivers became a burden, taking away time and resources from core resident care duties. This is where Allmed, a specialist medical personnel solutions provider, stepped in to make a significant difference.

A long history of caring
Founded by the Durban Benevolent Society to provide care for elderly women, it initially resided on Victoria Street and in 1921, the home relocated to its current location on Essenwood Road, a larger and more suitable site. The Greenacre family played a pivotal role in this development, with Walter Greenacre donating the land and a bequest from his father, Sir Benjamin Greenacre, facilitating the construction.

Over the years, Essenwood has continuously evolved to meet the needs of its residents. It acquired autonomy in 1950 and established a dedicated assisted living wing in 1970. Most recently, in 2015, the home underwent extensive renovations to ensure it remained a safe and comfortable haven for its residents. Currently, Essenwood is home to 85 residents, with the capacity to care for 110.

The challenge of HR burdens stifling quality care
Essenwood, like many care facilities, struggled with the time-consuming tasks of HR management. Nursing Services Manager, Colleen Dempers, found herself spending a considerable amount of time on tasks like rostering, replacements for absent staff, and disciplinary issues. This detracted from the home’s primary focus – ensuring the well-being and individual care of residents.

“We found that we were spending so much time on HR issues that it became a huge distraction, Dempers explains. “It detracted us from additional time on HR issues that could be better spent on quality of care. This is what led us to Allmed for a solution.”

Allmed to the rescue with a partnership for success
Building on their established trust with Allmed, a partnership that began in 2016, Essenwood Residential Home made a strategic move to elevate resident care. Allmed was already providing relief support for registered nurses and enrolled nurses, offering a flexible solution for fluctuating staffing needs. The governing board made the tactical decision to entrust Allmed with their entire caregiving staff, ensuring continuity and quality.

“Our core function is resident care,” clarifies Chad Saus, Essenwood Residential Home’s General Manager. “We need to provide individual attention, activities, and a stimulating environment. By outsourcing HR, IR and payroll for 56 caregivers, along with the flexibility of additional resources when needed, Allmed frees us to focus on what truly matters – our residents.”

Streamlining operations for quality care with the Allmed advantage
The partnership with Allmed has yielded multiple benefits for Essenwood:

  • Reduced HR burden: Allmed took over recruitment, payroll, and disciplinary processes for caregivers, freeing up Essenwood’s staff to focus on resident care and quality of service.
  • Enhanced responsiveness: Allmed provided prompt and efficient support, addressing Essenwood’s concerns quickly and professionally. Whether it was staffing issues, training needs, or resident care challenges, Allmed offered round-the-clock support, solutions, and a “can-do” attitude.
  • Improved caregiver fit: Allmed understood Essenwood’s care philosophy and resident needs. The caregivers placed by Allmed at Essenwood integrated seamlessly into the environment, providing the high-quality care residents deserve.
  • Leadership that listens: Essenwood valued Allmed’s commitment to open communication. Any concerns raised by Essenwood were addressed promptly and collaboratively.

The impact: residents feel the difference
The positive ripple effects of the Essenwood-Allmed partnership are evident in the high standard of care received by residents. With a dedicated and well-matched caregiving staff, Essenwood can cater to individual needs and provide a more enriching environment for its residents.

A model partnership for senior care
The Essenwood Residential Home exemplifies the success achievable through a well-structured healthcare staffing partnership. By outsourcing HR and leveraging a qualified care staffing agency, Essenwood has demonstrably improved the quality of care for its residents. This model can serve as an inspiration for senior care facilities seeking to elevate their services and prioritise resident well-being.

Categories : Expert Opinion HospitalsTags :

Opinion piece: Specialist TES Providers Optimising Healthcare Operations – a Prescription for Patient Care Success

On By ModernMedia

By Sandra Sampson, Director at Allmed

The healthcare sector in South Africa is beset with numerous challenges, ranging from high turnover rates to skilled staffing shortages and complex regulations in addition to stressful working environments, and communication barriers. Despite these formidable obstacles, patients have the right to expect top-tier care from their medical facilities. Here, specialised Temporary Employment Services (TES) providers can become indispensable partners, adeptly assisting medical facilities to navigate these challenges in their quest to ensure a seamless continuum of care.

Streamlining healthcare staffing to counter shortages

Specialist TES providers offer a multifaceted remedy to the relentless staffing challenges in healthcare. Capable of promptly supplying temporary staff to bridge immediate gaps, TES providers ensure that all resources have already been rigorously screened, recruiting qualified professionals to function as a buffer against high turnover and staffing scarcities. Through tailored training, specialist providers ensure that their temporary staff placements align seamlessly with organisational expectations to consistently uphold care standards. Furthermore, specialist TES providers alleviate the burden of complex healthcare regulations on management and staff by taking on the responsibility of handling the entire employment relationship, from end to end, including managing human resources and labour relations components, as well as payroll. This provides significant relief for healthcare facilities giving them the staffing resources that they need, without the additional administrative complexities involved with recruiting, on-boarding and managing such resources.

Addressing skills gaps to raise the bar on healthcare resources

Maintaining consistent levels of patient care without compromising quality is challenging in the face of staffing shortages and high turnover rates. With so many specialised healthcare staff, including ICU personnel, leaving for better opportunities abroad due to financial considerations, such an exodus necessitates urgent strategies to retain and fill gaps within healthcare facilities. Specialist TES providers are already playing a critical role in addressing these concerns by focusing on nurse competencies and facilitating targeted courses to upskill their resources. These courses address critical gaps in patient safety and empower nurses to provide better care. Through the development of these essential courses, such as ECG interpretation and cannulation, TES providers are taking significant steps to ensure nurses possess the necessary skills and knowledge. This proactive approach not only enhances patient care at a facility level, but also contributes to nurse competence and job satisfaction, ultimately benefiting the healthcare ecosystem.

The strategic advantages of enhancing workforce dynamics

In addition to operational bolstering and sector-specific upskilling, specialist healthcare TES providers present strategic benefits for healthcare facilities. Access to a diverse, extensive talent pool makes it simpler for medical organisations to find the ideal fit for each role, effectively mitigating the risk of hiring mismatches usually associated with permanent placements. Medical facilities also benefit from the cost-effectiveness of the TES operating model, which aligns with the dynamic nature of healthcare to optimise resource allocation. This is particularly important in hospitals where patient occupancy levels fluctuate daily. Many healthcare organisations now operate with a 50/50 ratio of permanent placements and temporary resources, which gives them the flexibility to accommodate the ever-shifting demands of patient care staffing, while safeguarding the delivery of quality care. By efficiently managing both permanent and agency staff, TES providers optimise recruitment efforts and ensure that the right candidates are placed in suitable roles, benefiting the healthcare organisation’s operations and patient care. TES providers uphold patient confidentiality and provide comprehensive training, ensuring staff are cognisant of privacy protocols and handle sensitive information appropriately.

Boosting patient care excellence: the vital role of specialist TES providers

In an era where healthcare value is intricately tied to workforce excellence, TES providers play a pivotal role in elevating the sector by helping medical facilities conquer their industry-specific challenges, enabling the fundamental mission of enhancing patient well-being. Ultimately, Specialist TES providers represent a crucial element in the healthcare sector’s quest for excellence, as their strategic approach to staffing not only addresses immediate needs but also upholds patient care standards, while easing administrative burdens, and enhancing workforce competencies. As such, collaboration with specialist TES providers is a progressive strategy that medical organisations should prioritise to effectively navigate the intricate challenges of the healthcare landscape today while significantly enhancing patient care outcomes.

Categories : Healthcare Politics and Regulations HospitalsTags :

Concerns Raised at Public Health Conference over Freezing of Healthcare Worker Posts

On By ModernMedia

By Luvuyo Mehlwana for Spotlight

Photo by Hush Naidoo Jade Photography on Unsplash

The National Treasury’s Cost Containment Letter sent to government departments instructing, among others, the freezing of posts was one of the big themes underlying talks about building South Africa’s healthcare worker capacity during the Public Health Association of South Africa’s (PHASA) conference held recently in Gqeberha.

With Finance Minister Enoch Godongwana expected to deliver the medium-term budget policy statement on 1 November, the freezing of posts will further hamstrung already strained health services, some presenters at the conference warned.

An oversight visit to TB hospitals by members of the provincial legislature (MPLs) in the Eastern Cape in the first week of September (5 to 8 September) showed just how bad the staff shortages are. The only remaining hospital in Nelson Mandela Bay dedicated to TB services, Jose Pearson Hospital in Bethelsdorp, has had staff vacancies hovering around 20% since 2019. The hospital provides dedicated TB services to the western part of the province. MPLs heard that in some other hospitals, vacancy rates are even higher, and non-filling of critical posts in some cases results in further medico-legal claims against the department, as the current staff buckles under massive patient loads.

Last year, in response to a parliamentary question, figures the health department released showed that there were 3 892 vacant healthcare worker posts in the province. In the nursing categories, there was a vacancy rate of 15.3%. For paramedics (EMS) the vacancy rate was 10.7%, medical practitioners 8.4%, and pharmacists 13.7%. By June this year, in another response relating to specialist nurses, the vacancy rate in the province had dropped to 13%.

Dr Prudence Ditlopo Senior Researcher at the University of the Witwatersrand, was presenting her research on the impact of nurse workloads and professional support on healthcare outcomes at the PHASA conference. Ditlopo said nurses already have a huge workload and issues around budget cuts impact morale. “I am sure they are asking themselves what will happen to [them] when we [they’re] already understaffed.

“This is not the first time that this monotonous cycle has been happening. Yes, we understand the economic side of it, but at the very same time, what does it say about the well-being of the nurse practice environment, the patients, and the quality of patient care? If nurses see that they are overwhelmed by the workload, they will make sure to find ways that will enable them to cope.

“Enable them to cope” means nurses will find a way that works for them. If what works for them is only seeing ten patients per day, they will do that and they will be gatekeepers for other patients who are coming to the facility. That alone will influence the quality and standard of care in primary care in South Africa,” said Ditlopo.

‘Will create more problems’

Dr Busisiwe Matiwane of the University of The Witwatersrand’s School of Public Health also weighed in on the implications of the Treasury letter.

“In the current system, health professionals have to work for the government to fulfil their community service obligations. However, it can be challenging for them to be assigned to specific hospitals when it is time for their community service. Additionally, with the government announcing a freeze on posts, many individuals who are not government-funded may be compelled to seek employment outside of the government after completing their community service,” Matiwane told delegates.

“If these posts are indeed frozen, does that mean that the government will also halt the placement of individuals who are required to complete community service? The current structure dictates that if you fail to fulfil your community service, you will not be recognised by the statutory bodies as an independent practitioner.

“The implication of this proposal by the government will create more problems, as we already face the challenge of health professionals’ placement or their community services,” she said. “The main concern is whether the posts will be frozen and what will be done. I think this concern has raised questions for many people, who wonder what it means if they are unable to complete their community service or the internship. Does it mean they cannot work?” she asked.

‘protect what is already there’

Speaking on the sidelines of the three-day conference, director of the Rural Health Advocacy Project, Russell Rensburg, said the wage agreement on a 4.5% increase for the public sector had Treasury’s back against the wall since that was not budgeted for in their February budget.

“Treasury is playing hardball and the provinces must decide what they need. The national government must also decide what they need. If they follow through on this, they won’t be able to sustain the public health system. There is concern that doctors will leave as part of cost containment measures, and you can’t run a healthcare system without healthcare workers. But we will only know the true position of the Treasury when they publish the medium-term budget policy statement,” said Rensburg.

“I believe at the moment they are just testing the market. They are saying we must have one thing, but we can’t have both, so that is the game they are playing. Our position is clear on this issue. Before any salary cuts or job freezes, we need to protect what is already there. We need to retain this year’s cohort of community service doctors, pharmacists, and nurses because these people helped us during COVID-19. Some were interns during COVID-19 and they are the core that can build the health service in the post-COVID-19 era. So, the immediate priority is to retain those posts because we don’t know if there will still be community service going forward,” said Rensburg.

‘working with what we have’

Several speakers and presenters at the PHASA conference raised concerns about the existing scarcity of healthcare workers and urged the Department of Health to take action. The experts, academics, researchers, students, non-governmental organisations, and civil society members all agree that healthcare is a fundamental human right, but that right won’t be fulfilled without healthcare workers, as there cannot be health services without workers. The government’s key policy document on human resources for health warned as far back as 2020 that the country is facing a critical shortage of healthcare workers.

Dr Krish Vallabhjee, former Chief Director of Strategy and Health Support in the Western Cape Health Department, believes that management must use whatever resources are available to achieve good results.

Vallabhjee said, “Budget cuts are a reality, so whatever we talk about here and in many of these conference sessions, we can’t be talking about wanting more and more. We need to work with what we have. How can we repurpose the people we have? Can’t we use them more effectively to achieve the same effect?” he asked.

“Managers need to work with their staff instead of just sitting in some corner and making budget cut decisions. Managers need to engage with staff to address the problem of not having enough budget. How do we work together? What are our priorities? As managers, we must listen to what people are saying on the ground. What are the doctors, nurses, and local managers saying? We must be united. [It should not be a thing that one hospital, clinic, and the district [are] fighting for their own piece. We are one department and we have this problem of a budget. How do we unite and do the best we can?”

Government will clarify

In a cabinet statement issued on 14 September, Minister in the Presidency, Khumbudzo Ntshavheni said that Finance Minister Enoch Godongwana would clarify the cost-containment letter issued on August 31.

“Cabinet appreciates the current fiscal constraints which are not unique to South Africa but have resulted in budget shortfall. Cabinet has iterated that measures to address the budget shortfall must not impact negatively on service delivery. The Minister of Finance will shortly issue guidelines clarifying the unintended misunderstanding arising from the Cost Containment Letter issued on 31 August 2023. In addition, as part of the in-year performance review of progress in implementation priorities agreed to with Ministers, the President, and Deputy President will meet with individual Ministers to ensure that fiscal management does not derail the agreed to priorities.”

Source: Spotlight

Categories : HospitalsTags :

Don’t Teach us Resilience – Fix the Problem, Doctors and Nurses Say

On By ModernMedia
Source: Pixabay CC0

A unique collaborative study on hospital clinician wellbeing by teams at 60 of the best US hospitals, was published in JAMA Health Forum. The study found that physicians and nurses, even at hospitals known to be good places to work, experienced adverse outcomes during the pandemic and want hospital management to make significant improvements in their work environments and in patient safety.

The solutions to high hospital clinician burnout and turnover, they say, are not resilience training for clinicians to better cope with adverse working conditions but organisational improvements that provide safe workloads and better work-life balance.

Researchers sought information in 2021 from 21 050 physicians and registered nurses practicing in 60 Magnet recognised hospitals in 22 states. Forty-seven percent of nurses and 32% of physicians experienced high burnout. Twenty-three percent of physicians and 40% of nurses said they would leave their jobs if possible. Less than 10% of physicians and nurses reported experiencing joy in their work.

Many clinicians are downright hostile to programmes – like resilience training – that are designed to adapt them to poor work conditions; clinicians want the working conditions improved.

Linda H Aiken, PhD, study lead author

Not having enough nurses to care for patients, having little control over workloads, lack of confidence in management to resolve problems in patient care, and concerns about patient safety were all associated with higher burnout, job dissatisfaction, and intent to leave among both nurses and physicians.

Lead author Linda H Aiken, PhD, at the University of Pennsylvania said, “Physicians and nurses largely agree about what hospital management could do to address their burnout, job dissatisfaction, and plans to leave their current jobs; they want improved staffing, modern working conditions in which they can spend more time in direct patient care, greater control over their workloads and work schedules, and a higher priority on patient safety.”

Eighty-seven percent of nurses and 45% of physicians said improving nurse staffing was very important to their own mental health and wellbeing. Other high priorities for clinicians were health breaks without interruption and reduced time spent on documentation. Aiken added, “Many clinicians are downright hostile to programmes – like resilience training – that are designed to adapt them to poor work conditions; clinicians want the working conditions improved.”

Clinicians are concerned about quality and safety of care. Half of physicians and nurses lack confidence that their patients can safely manage their care after discharge highlighting the need for improvement in discharge planning. Patient safety remains a concern with 26% of nurses and 12% of physicians giving their own hospitals an unfavorable patient safety grade. Thirty-nine percent of nurses and 33% of physicians feel mistakes are held against them contrary to recommendations of the National Academy of Medicine to search for and correct system deficiencies that cause most medical errors.

The study was carried out by Penn Nursing’s Center for Health Outcomes and Policy Research in collaboration with the US Clinician Wellbeing Study Consortium composed of 60 Magnet Hospitals. The study took place in 2021 during the COVID pandemic, a time when all US hospitals were severely challenged. Previous research shows that clinicians in hospitals with better work environments prior to the pandemic had better outcomes during the pandemic. The Consortium committed to this study to learn from their experiences during the pandemic how to sustain and further improve their favourable work environments to better withstand external threats and to rebound rapidly.

Source: University of Pennsylvania School of Nursing

Categories : HospitalsTags :

To Improve, Doctors Don’t Mind Comparisons with Peers

On By ModernMedia
Photo by RDNE Stock project

Showing people how their behaviour compares to their peers is a commonly used method to improve behaviour. But after the burnouts of the pandemic, it wasn’t clear whether this was still a good idea for highly stressed healthcare workers.

Recent research published in JAMA Network Open throws new light onto the relationship between peer comparison and job satisfaction among clinicians, challenging prior findings that such feedback increases job dissatisfaction and burnout.  

Researchers found that behavioural interventions aimed at improving performance can be designed to protect clinician job satisfaction and improve quality of care. To avoid negative impact, the research team discovered it is important for clinicians to have control over the behaviour being evaluated or encouraged, such as ordering tests or whether to prescribe medication.

“Our research demonstrates that peer comparison aimed at improving performance can be designed in a manner that safeguards clinician job satisfaction,” said lead author Dr Jason Doctor at the University of Southern California. “Prior findings to the contrary don’t appear tied to peer comparison, but rather clinicians being measured for things they don’t have full control over.”

The Importance of Methodology in Peer Comparison

Performance feedback using peer comparison is a widely used approach in healthcare to change behaviour. Study authors emphasize the importance of methodology when conducting peer comparison intervention. They note the present study gave clinicians full agency over the outcome, kept performance private, did not restrict the number of top performers, and was successful in improving clinician behaviour without lowering job satisfaction.

Doctor and his team assessed data from their previously published research that assessed the impact of three interventions – Suggested Alternatives, Accountable Justification, and Peer Comparison – to reduce inappropriate antibiotic prescribing. In this study, they focused on on peer comparison, where clinicians received an email informing them of their ranking, from highest to lowest, for inappropriate prescriptions compared to their peers.

The findings contribute to the ongoing dialogue surrounding healthcare quality improvement and clinician well-being.

“By better understanding behavioural interventions and developing more effective strategies, healthcare organisations can foster a sense of ownership and agency, leading to improved job satisfaction and decreased burnout rates,” said Doctor.

Source: University of Southern California

Categories : HospitalsTags :

Patient Safety Incidents Doubled for Docs Suffering from Burnout

On By ModernMedia
Photo by Mulyadi on Unsplash

Doctors experiencing burnout are twice as likely to be involved in patient safety incidents and four times more likely to be dissatisfied with their job, suggests research published today in The BMJ.

The scale of burnout amongst clinicians and the serious impact it can have on patient safety and staff turnover has been revealed in the largest and most comprehensive systematic review and analysis of studies on the subject to date.

Evidence is showing that burnout is is reaching global epidemic levels among physicians. Representatives have warned that spare capacity in the field of medicine is nearing what they call crisis point.

Burnout is defined as emotional exhaustion, cynicism and detachment from the job, and a feeling of reduced personal accomplishment. In the UK, a third of trainee doctors report that they experience burnout to a high or very high degree, while in the US, four in 10 physicians report at least one symptom of burnout. And in a recent review of low and middle income countries the overall single-point prevalence of burnout ranged from 2.5% to 87.9% among 43 studies.

Yet there is a lack of evidence about the association of burnout with a physician’s career engagement and how that potentially impacts on the quality of patient care.

To address this, a team of researchers based in the UK and Greece set out to examine the association of burnout with the career engagement of physicians and the quality of patient care globally.

To do this, they selected and analysed the results of 170 observational studies on the subject involving nearly 240 000 physicians.

Their analysis showed that physicians with burnout were up to four times more likely to be dissatisfied with their job and more than three times as likely to have thoughts or intentions to leave their job (turnover) or to regret their career choice.

Equally worrying was the finding that physicians with burnout were twice as likely to be involved in patient safety incidents and show low professionalism, and over twice as likely to receive low satisfaction ratings from patients.

The analysis also found that burnout and poorer job satisfaction was greatest in hospital settings, physicians aged 31–50 years, and those working in emergency medicine and intensive care, while burnout was lowest in general practitioners.

The association with burnout and patient safety incidents was strongest among physicians aged 20–30 years and emergency medicine workers.

The study authors acknowledge some limitations in their research including the fact that precise definitions of terms, such as patient safety, professionalism, and job satisfaction, varied between the studies analysed so may have led to some overestimation of their association with burnout.

The assessment methods varied widely between the 170 studies, and the design of the original studies imposed limits on their ability to establish causal links between physician burnout and patient care or career engagement.

Nevertheless, the authors concluded: “Burnout is a strong predictor for career disengagement in physicians as well as for patient care. Moving forward, investment strategies to monitor and improve physician burnout are needed as a means of retaining the healthcare workforce and improving the quality of patient care.”

“Healthcare organisations should invest more time and effort in implementing evidence-based strategies to mitigate physician burnout across specialties, and particularly in emergency medicine and for physicians in training or residency,” they added.

This research adds to growing evidence that the poor mental health of healthcare providers jeopardises the quality and the safety of patient care, says Matthias Weigl, Professor of Patient Safety at Bonn University, in a linked editorial.

“The pervasive nature of physician burnout indicates a defective work system caused by deep societal problems and structural problems across the sector,” Prof Weigl warned. 

“Urgent action is imperative for the safety of physicians, patients, and health systems, including interventions that are evidence based and system oriented, to design working environments that promote staff engagement and prevent burnout,” he concluded.

Source: The British Medical Journal

Categories : Mental HealthTags :

Forced Retirement a Major Factor in Physician Suicides

On By ModernMedia
Phot by Mulyadi on Unsplash

Forced retirement is a major factor when it comes to physician suicides, according to a study by Dr Kristin Kim and colleagues. Physicians also neglect to discuss physical health concerns as work stressors, the authors noted, but these are still detrimental to wellbeing – especially when it renders physicians unable to work.

The study was published in the journal Suicide and Life-Threatening Behavior.

“Medicine must dispel the myth of never-ill physicians who place the needs of their patients before their own to the detriment of their own health.”

Kim et al., 2022

While physicians are known to be more likely than non-physicians to experience work-related stressors prior to suicide, the specific nature of these stressors was not known. The present study therefore aimed to better characterise job-related problems prior to physician suicide.

Using a mixed methods approach, researchers combined thematic analysis and natural language processing to develop themes representing death investigation narratives of 200 physician suicides with implicated job problems in the National Violent Death Reporting System database between 2003 and 2018.

The thematic analysis identified six overarching themes: incapacity to work due to deterioration of physical health, substance use jeopardising employment, interaction between mental health and work-related issues, relationship conflict affecting work, legal problems leading to work-related stress, and increased financial stress. Natural language processing analysis confirmed five of these themes and elucidated important subthemes.

Clinicians often neglect physical health when identifying work stressors, but poor physical health affects work performance and increases work stress, the authors said, noting that legal and psychological supports, particularly during malpractice investigations and “fit for duty” evaluations, are sorely needed.

“Medicine must dispel the myth of never-ill physicians who place the needs of their patients before their own to the detriment of their own health,” the researchers wrote.

First author Kristen Kim, MD, told Medpage Today that she hopes that this research will help physicians “give ourselves permission to attend to those needs … to prevent the dire consequences that we may see.”

The findings highlight the importance of bolstering systemic support for physicians experiencing job problems associated with their physical and mental health, substance use, relationships, legal matters, and finances in suicide prevention efforts.

Categories : HospitalsTags :

A Check-up on Western Cape Healthcare

On By ModernMedia
Image by Hush Naidoo from Unsplash
Image by Hush Naidoo from Unsplash

A report by IOL revealed mixed reviews by experts and patients for the Western Cape’s healthcare system, which, while providing mostly excellent service in certain hospitals, is seen to be especially lacking in rural areas, infrastructure and handling of patients.

Award-winning service

Along with receiving the highest marks for efficiency, Western Cape healthcare has earned recognition such as through the Batho Pele Excellence Awards, with a silver medal going to Dr Barry Smith who worked in frontline COVID hospitals in Cape Town, where as medical manager he organised efforts to deal with devastating COVID waves.

A total of R29.4 billion has been allocated to the province’s 2022–2023 budget to deal with a serious backlog of unmet TB, HIV and other medical care put off during the COVID waves, along with a new surge in mental health issues.

A critical view

The ANC’s Rachel Windvogel said that while Western Cape is said have the country’s ‘most efficient’ health-care system, it is deteriorating and “nearing collapse”.

Dilapidated infrastructure in hospitals such as Groote Schuur and Tygerberg Hospitals is a challenged, with “sections that are cordoned off and not functioning.”

The knock-on service pressure across all district hospitals has resulted in patients having to sleep in chairs or on the floor.

Windvogel said that the Khayelitsha District Hospital is a prime example, with R150 million allocated for upgrades by the hospital but with no provincial government funding forthcoming.

She said that the provincial government’s boasts about a leading healthcare system does not match the situation. This can be seen in rural communities where people wait days for an ambulance transfer to city hospitals, she said, and doctors only visiting rural clinics to issue prescriptions without examining patients.

From the wards

Speaking to IOL, on the condition of anonymity, a nurse with over 15 years of experience currently working at a local government hospital said that while they try their best to deliver a service to residents, the sector has so much lacking.

The quality of new nurses has been steadily declining, she said. “As nurses, we are inundated with work but we manage, however, as an experienced nurse seeing how the ‘latest intakes’ have no feeling towards patients is sad.”

There have been deaths from “incorrect triages” as well as problems with nurses not knowing how to speak to the community, resulting in “pissing off the very community we took an oath to serve,” she said.

While she believes nursing is her calling, she is considering moving over to the private sector, driven by a high workload, crime, poor pay and lack of experienced assistance.

A patient’s experience

Candice van der Rheede, director of the Western Cape Missing Persons Unit (WCMPU) has been through a string of hospitals since 2020 following a collapsed lung, and her experiences reflected problems with staffing and gender segregation.

She first stayed at Mitchells Plain District Hospital, and her ward was “spotless” with security “always there”. “If help was needed and you buzzed for help, nurses came immediately,” she told IOL.

The thoracic ward at Groote Schuur Hospital was also praiseworthy – except that her ward was in the middle of the men’s section.

“One night I woke up and saw one of the men standing and watching us ladies with no nurses on the inside,” Van der Rheede said.

However, entering the ICU ward after theatre, her experience took a turn for the worse, being roughly handled when check for bed sores, despite her having a large surgical wound.

In November, Van der Rheede had to overnight in the trauma section at Tygerberg Hospital due to a check-up. While she was generally satisified with the hospital and its staff, there was a major sticking point for her – in the trauma section, “we were men and women sleeping in one room which I had a big problem with. Using one toilet. I could not sleep that night.”

While she has her reservations about the state of hospitals in the province, Van der Rheede told IOL she commended the Mitchells Plain District Hospital for its impeccable service, and the Symphony Clinic in Delft which she currently attends is of the highest standard of service and cleanliness.

Source: IOL

Categories : Healthcare Politics and Regulations HospitalsTags : 1 Comment

Exodus of Healthcare Professionals as NHI Introduction Nears

On By ModernMedia
Stethoscope
Photo by Hush Naidoo on Unsplash

The prospect of an exodus of doctors and other key healthcare personnel from South Africa ahead of the planned introduction of the National Health Insurance (NHI) scheme has prompted concern among healthcare stakeholders.

In addition to the loss of skilled healthcare professionals, there is also a growing concern that the country could lose valuable training skills as professionals look to leave.

Thirteen years on from its inception, the NHI continues to suffer from the same criticisms. A May 2021 research paper [PDF} found that South Africa’s per capita spending on public healthcare was higher than even wealthier developing countries, yet it ranked near the bottom for measures of healthcare outcomes.

An informal poll on the QuickNews website in March showed that 81% of respondents had at least considered emigrating due to the planned introduction of NHI.

Professional associations are also warning of an exodus with the start of NHI. The South African Medical Association (SAMA) has said that its members cannot support the NHI in its current form.

This stems from a deep-rooted lack of confidence in the capacity of government and its financial ability to ensure the service is successful, the association said. Other concerns that members have raised include only providing emergency treatment to refugees and illegal immigrants, as well as their children.

SAMA conducted a survey which showed that up to 38% of its members plan to emigrate from South Africa due to the planned introduction of the NHI.

6% of members said that they plan to emigrate for other reasons, while 17% of doctors said that they were unsure about leaving the country. Many doctors have said that the aim should rather be to get the public sector to a state where it can appeal to private sector patients.

They added that there should be engagement with private doctors to provide additional services funded by the state. The group also called for a proper pilot of the proposed systems and payment mechanisms.

The Department of Health noted these concerns in a parliamentary briefing this week, noting that skilled personnel will be needed for the NHI to work. It added that this was not limited to healthcare professionals, but that general skilled human resources will be central to the health system going forward.

It added that the complex interactions between training, registration compliance and employment can all be greatly improved.

“This is a big ship that will need to be turned, but the framework is in place,” said acting director-general of health Dr Nicholas Crisp. “We have heard the threats that there will be an exodus of personnel if the NHI is implemented and a brain drain.”

The department is actively responding to this, he said, with a framework in place to ensure the country retains the necessary skills. A ‘Human Resources for Health strategy’ before was already under development before the start of the COVID pandemic, he added.

This framework sets out a multi-work implementation plan, but it requires money and investment in the health workforce to ensure the country is ready for universal health coverage, Dr Crisp said.

“Every health professional has a place in the National Health Insurance – whether you choose to work in the public portion of the delivery system or the private portion of that delivery system.

“We do not think there needs to be a threat on anybody, or their viability, or their role to be played.”

Source: BusinessTech