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Challenges and Opportunities in Healthcare Management

Challenges and Opportunities in Healthcare Management

Ilda, V., Patsaki, E., Kouvarakos, A., Grammatis, V., Kouroutzis, I., Apostolidi, T., Roka, V., Κοτανίδου, Α., Sarafis, P., & Μαλλιαρού, Μ. (2023)


Healthcare professionals during the pandemic in the Greek public healthcare system have experienced increased psychological distress, fear and a greater intention to quit their jobs. This study analyzes the factors of moral distress and moral resilience of healthcare professionals employed during the second wave of the pandemic. The target group was the healthcare professionals (HP = 169) who served in the Evaggelismos General Hospital Covid-clinics and -ICU for 2022 and data were collected through life protocols.

Healthcare professionals believe that when faced with moral challenges, they are able to discern them and think clearly. They are especially stressed when they care for more patients than they can safely handle when they are involved in care that causes unnecessary suffering or does not adequately relieve pain or symptoms, and when they notice that patient care is getting worse. Also stressful are the situations, leading to the creation of possible moral distress, when they witness a violation of a standard of practice or moral code. Factors that lead or may lead healthcare professionals to moral distress are nursing safety, unnecessary and deteriorating patient care, and violation of medical confidentiality, violation of standards of practice or moral codes.

The score on the MMD-HP scale indicates low-to-moderate levels of moral distress. Based on the RMRS scale the moral resilience of healthcare professionals is characterized by moderate-to-high with the highest scores per statement seen when patient care is getting worse and feel pressured to ignore situations where patients have not been given adequate information. The healthcare professionals report that they have either left or have considered leaving their position in a clinic due to moral distress, although they are not currently thinking of leaving their position. The factors that increase the frequency of moral distress and decrease their moral resilience are feeling powerless anxiety, nursing/treatment errors, aggressive treatment, caring for more patients than they can handle, substandard patient care, and hierarchical teams.

Simen, J. H. (2023)


Background: Healthcare teams possess multiple clinical capabilities to meet the demands and challenges of individual patient-centered care. Teams in healthcare have been used for centuries, but the functionality of a team largely depends on the leader facilitating. With the complexities of healthcare, single leadership models often do not apply.

This study aimed to complete a multi-method qualitative study looking at four healthcare settings to explore the applicable use of the Simen-Schreiber leadership model to best describe the needs of healthcare teams (ambulatory diabetes clinic; skilled nursing facility [SNF], acute inpatient geriatric-psychiatric unit, and outpatient high-risk geriatric clinic).

Methods: The key constructs researched in this mixed-method qualitative study were: 1) skills needed for good healthcare team participation and 2) essential outcomes needed for successful patient-centered care (e.g. communication, interpersonal engagement, and shared decision-making).  The qualitative portion of this study included three distinctive methods: 1) observation of each team functionality; 1,2 2) interview to obtain background information about each facility; and 3) Focus Group session composed of 10 questions and a duration of approximately 75 to 90 minutes. Additional methodology utilized for this study included two validated and reliable quantitative assessments: 1) a healthcare team observation tool1,2 and 2) emotional intelligence questionnaire.3

This multi-method, multi-case study design was selected to allow for triangulation of the data to support the seven constructs of the leadership model. The constructs include rotation of the leader; clinical expertise; emotional intelligence; and managerial skills, with the outcomes of communication; interpersonal engagement and share decision-making.

Results: There appears to be a slight trend of higher-functioning teams demonstrated higher emotional intelligence scores, according to the TEI-Que questionnaire and the Team Observation Tool results. From the managerial skills perspective, the Focus Groups results suggests that these skills, particularly in time management, are a target area for improvement among all four teams.  Furthermore, these findings support the need to improve training in managerial skills to prepare professionals adequately for healthcare teamwork. 

it is widely accepted that, good communication is vital within a healthcare team and is related to positive patient outcomes. Unfortunately, poor communication is seen daily in healthcare and can lead to serious health consequences for the patient and dissatisfaction with care by patients, family members, other caregivers, along with clinicians and other healthcare team members.  Lastly, there appeared to be support from this study that involvement of the patient, family and interprofessional team in the shared decision-making process is helpful for successful patient outcomes.

Conclusions: The findings of this study support the Simen-Schreiber leadership model as applicable to healthcare teams. Each healthcare professional should possess clinical expertise, high emotional intelligence and good managerial skills, to be able to best function on a healthcare team.  The Simen-Schreiber leadership model may be useful in preparing healthcare professionals for participation in teamwork, leading to more efficient and effective patient-centered care.

Emma, M., Sabrina, I., Alessandro, F., Bellopede, S., Trama, U., & Triassi, M. (2023b)


Background: Healthcare workers were at high risk of contracting COVID-19 during the pandemic due to their frontline commitment. This risk was higher than in the general population because they were exposed to the virus both at work and outside the hospital. Healthcare workers suffered from physical and psychological stress, which could lead to mental health problems.

Aims: The aim of the study was to evaluate the effectiveness of four proactive interventions implemented to protect workers’ health during the COVID-19 pandemic at the “Federico II” University Hospital in Naples, Italy. The study aimed to prevent both clinical and non-clinical risks, such as infections contagion and work-related stress.

Methods: A prospective observational study was conducted between April 9 and May 21, 2020, at the “Federico II” University Hospital. Healthcare personnel, who worked during the study period, were subject to four proactive interventions: (I) Classification based on the risk of exposure to SARS-Cov-2; (II) Healthcare surveillance: diagnostic surveillance (nasopharyngeal swabs for SARS-Cov-2, rapid antigen tests and serological for the detection of IgM/IgG antibodies against SARS-Cov-2), clinical and epidemiological surveillance (physical examination and contact tracing), individual psychological support; (III) Contacts-tracing;(IV) Constant training and information. The study analysed the number of positive swabs in healthcare workers and hospitalised patients during the same period, comparing the incidence of cases with international data. Feedback from psychologists and occupational doctors was also collected to evaluate the impact on non-clinical risks.

Results: The study found a low correlation between positive swabs in healthcare workers and patients, suggesting that the preventive measures in place were effective. Furthermore, feedback from psychologists and occupational doctors did not report an increase in stress-related sick leaves, thanks to the proactive actions.

Conclusions: The considered proactive interventions proved to be useful to protect healthcare workers during the pandemic. The study highlights the importance of a proactive approach instead of a reactive one, and the necessity to contemplate both the protection from biological risks and the psychological support.

Bukvič, V. (2023)


The author links together business analysis as a practically oriented scientific discipline and business excellence as an ideal that all well-performing organisations wish to achieve while attaining and continuously maintaining superior levels of business performance, thus fulfilling and even exceeding the expectations of their stakeholders. The aim of his research is to present a model and to expose its usefulness as an instrumental tool for operation analysis of an organisation. Thus, he leans on the European Foundation for Quality Management (EFQM) Excellence Model and uses it as an excellent tool for analysing the business of an organisation throughout all the phases defined by traditional business analysis. The scope of the author’s research is to highlight the areas across an organisation, whereat the EFQM model can serve as a very efficient approach to measuring business performance of an organisation. This includes the observation of facts and identification of problems, which can be construed as defining the organisation’s strengths and areas for improvement. This entails setting up hypotheses and testing them by applying appropriate measures. A comparative analysis is used as a main kind of study design. In addition to that, some other special methods are used, like synthesis, method of deduction, method of induction, method of elimination. After a short introduction, the author makes first a thorough literature review on business excellence in the last two decades with an emphasis on the EFQM Model. He focuses particularly on the assessment and critical attitude of individual researchers who have studied this topic. Further, the author presents the basic concepts and elements of the EFQM model of business excellence, with a particular emphasis on the RADAR matrix (Results, Approaches, Deployment, Assessment and Refinement) as a very useful instrument (management tool) for business excellence analysis. This can also be designated as the major objective of the author’s research. Further, additional objective is to show the use of the model for analysing and assessing the business excellence of organisations in the public sector, specifically in the healthcare industry (hospitals). He presents the key attributes (select healthcare aspects) that define the quality of healthcare services for its key participants, i.e., patients and the payers of these services. These attributes, namely technical performance, interpersonal relationships, amenities and access, patient preferences, efficiency and cost effectiveness, are then highlighted by select business excellence criteria, mainly referring to the stakeholders’ perception of the organisation in question and business performance indicators. The author rounds off his paper with a couple of recommendations regarding the identification of strengths and areas for continuous improvement, which he, as a leading assessor with many years’ experience, including in the healthcare industry, considers as the most important aspect of business excellence analysis.

Hwaij, R., Ghrayeb, F., Marzo, R. R., & AlRifai, A. (2022)


Healthcare workers have been working on the frontlines since the COVID-19 pandemic in 2019. In Palestine Healthcare workers have been experiencing compounded stress given their preexisting limited access and resources as imposed by the Israeli colonial system and their management of the novel coronavirus. This study aimed to investigate the impact of COVID-19 on Palestinian healthcare workers’ mental health in relationship to various demographic variables that have been found to correlate to expressed distress in previous literature. Using brief online questionnaires, 596 healthcare workers from various professions rated their experiences of depression, anxiety and risk perception. Descriptive analysis was carried out to analyze the data. Our findings indicate that the overwhelming majority of our participants were experiencing depressive and anxious symptoms, with females, physicians, and less experienced Healthcare workers showing elevated levels of symptomology. It is recommended that psychological services be offered to healthcare workers in Palestine with specific emphasis on the identified risk factors.

Peters, V. (2023)


Down syndrome is a complex congenital condition and the most prevalent genetic cause of intellectual disability in humans. Although people with Down syndrome share a typical appearance, intellectual disability, and delayed motor development, each individual with Down syndrome is unique. In addition, many individuals with Down syndrome experience various comorbidities, therefore, people with Down syndrome have complex healthcare needs. The prevalence and severity of these comorbidities varies. This makes individuals with Down syndrome a very diverse and heterogeneous patient group from an early age, despite their common genetic background (trisomy 21). Providing adequate healthcare and interventions in the early life of individuals with Down syndrome improves physical and mental development. In the Netherlands, 22 pediatric outpatient clinics organize multidisciplinary team appointments (so-called "Downteams") to address the complex healthcare needs of children with Down syndrome. In this study, we present the healthcare provided by these multidisciplinary teams in a modular way and show that this modular approach results in improved healthcare provision for children with DS.

Grammatis, V., Kouroutzis, I., Apostolidi, N., Vako, I., Apostolidi, T., Roka, V., Sarafis, P., & Μαλλιαρού, Μ. (2024)


Moral distress is the situation in which nurses know the moral principles that should guide their actions but are not allowed by the constraints of the health system. Moral sensitivity is the ability of nurses to perceive the moral dimensions of certain situations or actions. Safe care is a range of services provided to patients by nurses and consequently nurses with the aim of monitoring, promoting, maintaining or restoring the health of patients. Moral distress negatively affects safe health care, and moral sensitivity is the solution to moral distress. This study investigates the relationship between both moral distress and moral sensitivity of nurses with safe nursing care. A total of 163 nurses from a General Greek Hospital participated in the research. The protocol included the Moral Resilience (RMRS), Moral Distress (MMD-HP) and Moral Sensitivity Control (Byrd’s NEST) scales.

For the Moral Resilience scale, higher scores are recorded for the moral efficacy dimension. Moderate scores are recorded for the Moral Distress scale, so nurses are characterized by moderate moral sensitivity. None of the nurses had left or considered leaving the clinic due to moral distress, up to the time of the present study. Health professionals based on Byrd’s NEST scale are characterized by moderate moral sensitivity. The greater the integrity of the relationships, the greater the reactions to moral adversity. The greater the moral distress, or the better the perceptions of the security offered by management, the greater nurses’ personal integrity. As relational integrity or the distress decreased, moral efficacy increased. The higher the moral distress of the nurses, the greater the integrity of the relationships. Nurses who had children also felt more secure about working conditions than those who did not. The greater the dynamics of the clinic, the less reactions to moral adversity. Finally, greater moral deadlock was associated with both greater personal integrity and greater relational integrity, and less moral efficacy. Increased moral sensitivity prevents the occurrence of moral distress and has a positive effect on the provision of safe health care.

Dimitrios, M., Maria, P. L. S., & Kloutsiniotis, P. V. (2023)


Background: Leadership becomes crucial during major crises in which one could expect high levels of burnout and decrease in patient quality of care. The Covid-19 pandemic was a major healthcare crisis where healthcare professional and infrastructure had to cope with unprecedented levels of workload and stressful working conditions. Hence, empirical models for estimating the mitigating role of authentic leadership on nurses’ burnout during the pandemic can contribute to the utilization of best practices in managing effectively the scarce nursing personnel resources.

Aims: To model the influence of leadership, through measures on structural empowerment and work-life balance, on nurses’ burnout and patients’ quality of care, and to measure the nurses΄ perception of their leadership, and the opinion of the leaders regarding their role during the Covid-19 pandemic.

Methods: An institution-based cross-sectional study conducted during the third wave of the pandemic (March-July 2021). After implementing measures to enhance structural empowerment and improve work-life balance, four questionnaires referring to Authentic leadership, Structural empowerment, Work life balance, and Work Burnout were distributed to 650 nursing personnel. Moreover, 200 patients were asked to assess the received quality of care.

Results: 530 valid questionnaires included in the study. Using structural equation modeling, we estimated that authentic leadership significantly influences burnout and preserves patients’ quality of care by enhancing structural empowerment and work-life balance. In assessing attitudes, leadership was rated high, 56±5 SD (max =80) by the nursing personnel. Head nurses rated their leadership significantly higher compared to the nurses, 62,13±10 SD, (p<0,001). Structural empowerment and work-life balance measures were rated 3,55±0.6 SD, and 2,67±0,5 SD, (max =5) respectively. On the burnout subscales, emotional exhaustion and cynicism rated 3,1±0,8 and 2,3±0,7 respectively, and high in professional efficacy, 2±0,5. Patients assessed their quality-of-care 3,8±0.48 SD, (4= very good and 5=excellent).

Conclusion: Our study demonstrates that during major crises, leadership through structural empowerment measures and better work-life conditions mitigates nurses’ burnout and lead them to high levels of professional efficacy, thus preserving patients-quality of care. Moreover, team leaders in healthcare services should be modest and aware of their tendency to overestimate their leadership abilities.

Sharma, M., & Sangma, B. (2024)


Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease with varied manifestations, significantly impacting women and potentially leading to Lupus Nephritis (LN), a major cause of morbidity and mortality. The review article explores the unique challenges and opportunities in managing lupus nephritis (LN) in North Eastern India, a region characterised by diverse ethnicities, cultures, and socioeconomic challenges. With a higher than average prevalence of systemic lupus erythematosus (SLE) and lupus nephritis (LN), the region presents distinct epidemiological patterns, likely influenced by genetic, environmental, and lifestyle factors. The management and prognosis of LN are further complicated by the region’s geographical and infrastructural limitations, including access to specialised healthcare and socioeconomic barriers, which impacts the patient’s outcome. Despite the challenges, there are emerging opportunities for improvement through innovations in healthcare delivery, governmental and non-governmental initiatives aimed at enhancing healthcare access, and the adaptation of treatment guidelines to the local context. This review article underscores the importance of region-specific research and healthcare strategies to improve care and outcome for lupus nephritis (LN) patients in North Eastern India, thus contributing to the broader understanding of the disease in diverse populations and settings.

M’Koma, A. E. (2023)


Inflammatory bowel disease has an enormous impact on public health, medical systems, economies, and social conditions. Biologic therapy has ameliorated the treatment and clinical course of patients with inflammatory bowel disease. The efficacy and safety profiles of currently available therapies are still less that optimal in numerous ways, highlighting the requirement for new therapeutic targets. A bunch of new drug studies are underway in inflammatory bowel disease with promising results. This is an outlined guideline of clinical diagnosis and pharmaceutical therapy of inflammatory bowel disease. Outline delineates the overall recommendations on the modern principles of desirable practice to bolster the adoption of best implementations and exploration as well as inflammatory bowel disease patient, gastroenterologist, and other healthcare provider education. Inflammatory bowel disease encompasses Crohn’s disease and ulcerative colitis, the two unsolved medical inflammatory bowel disease-subtypes condition with no drug for cure. The signs and symptoms on first presentation relate to the anatomical localization and severity of the disease and less with the resulting diagnosis that can clinically and histologically be non-definitive to interpret and establish criteria, specifically in colonic inflammatory bowel disease when the establishment is inconclusive is classified as indeterminate colitis. Conservative pharmaceuticals and accessible avenues do not depend on the disease phenotype. The first line management is to manage symptoms and stabilize active disease; at the same time maintenance therapy is indicated. Nutrition and diet do not play a primary therapeutic role but is warranted as supportive care. There is need of special guideline that explore solution of groundwork gap in terms of access limitations to inflammatory bowel disease care, particularly in developing countries and the irregular representation of socioeconomic stratification with a strategic plan, for the unanswered questions and perspective for the future, especially during the surfaced global COVID-19 pandemic caused by coronavirus SARS-CoV2 impacting on both the patient’s psychological functioning and endoscopy services.  Establishment of a global registry system and accumulated experiences have led to consensus for inflammatory bowel disease management under the COVID-19 pandemic. Painstakingly, the pandemic has influenced medical care systems for these patients. I briefly herein viewpoint summarize among other updates the telemedicine roles during the pandemic and how operationally inflammatory bowel disease centers managed patients and ensured quality of care. In conclusion: inflammatory bowel disease has become a global emergent disease. Serious medical errors are public health problem observed in developing nations i.e., to distinguish inflammatory bowel disease and infectious and parasitic

diseases. Refractory inflammatory bowel disease is a still significant challenge in the management of patients with Crohn’s disease and ulcerative colitis. There are gaps in knowledge and future research directions on the recent newly registered pharmaceuticals. The main clinical outcomes for inflammatory bowel disease were maintained during the COVID-19 pandemic period.

Zaidi, I., Vardha, J., Khayum, A., Anjum, S., Chaudhary, S., Bakshi, A., Gill, J., & Gurav, J. (2023)


Tuberculosis (TB) along with pulmonary co-infections in patients became a grave concern to public health complicating the disease diagnosis, treatment, and prognosis. It became a challenge to healthcare professionals urging to develop new diagnostic tools and treatment regimens. This paper reviews the complex interplay and management strategies for Tuberculosis patients with co-infections. It encompasses antimicrobial therapy tailored to particular pathogens, including their susceptibility profiles to antibiotics, and understanding the potential implications of drug interactions with anti- Tuberculosis medications. In cases of co-infection between Tuberculosis and Human Immuno-Deficiency Virus (HIV), a particular focus is placed on the significance of synergistic methods and treatment duration.

Moreover, immunomodulatory drugs, immunotherapies, cellular treatments, adjunct therapies, and immunomodulatory agents that are customised to the patient’s immunological status and co-infecting pathogens emerge as a crucial component. Mitigating the transmission of pulmonary co-infections requires the implementation of infection control measures in both healthcare settings and communities. A strong barrier against the spread of tuberculosis and related illnesses is formed by administrative, engineering, and personal protective measures combined with screening, education, isolation, and contact tracking.

Prospective approaches underscore the necessity for enhanced diagnostic instruments, promoting cutting-edge technologies including molecular diagnostics, immunological tests, radiological imaging, biosensors, and point-of-care diagnostics. Comprehensive management is emphasised through multidisciplinary care comprising pulmonologists, infectious disease experts, microbiologists, and immunologists. Priorities for research include combination medications, new therapeutic approaches, personalised medicine, and developing diagnostic techniques to improve knowledge of and treatments for pulmonary co-infections.

Jerjes‐Sánchez, C., Mondragon, C., Lozano-Corres, V., Gomez-Gutierrez, R., Vargas, A., Guajardo, M. V., De La Peña Almaguer, E., Quintanilla, J., García, V., & Torre–Amione, G. (2023)


Acute heart failure (AHF), a rapid or gradual onset of symptoms and/or signs of heart failure severe enough for the patient to seek urgent medical attention, represents a significant and growing healthcare burden. With a prevalence of approximately 1%–2% of the adult population, over 5 million Americans and 15 million Europeans, with a yearly incidence of 550,000, rising ≥ 10% among the elderly. Despite therapeutic advances in chronic heart failure, the prognosis of AHF is poor, with in-hospital mortality ranging from ~2% in hypertensive AHF up to 40-60% in patients with cardiogenic shock, which is a life-threatening state characterized by tissue hypoperfusion resulting in severe multi-organ dysfunction and death. Although no current therapeutic approach has improved mortality in this patient population, incorporating standardized, multidisciplinary shock teams may change. In addition, correct and expedited identification and management of AHF can be challenging due to the heterogenicity of its clinical presentation, precipitant factors, and comorbid conditions. Thus, clinicians involved in patient care should perform a structured diagnostic work-up, starting with high clinical suspicion, followed by key diagnostic tests, including biomarkers, lung ultrasonography, and echocardiography, allowing recognition of the different clinical and hemodynamic profiles and providing guidance to perform further tests and therapeutic interventions. This review discusses the healthcare burden of acute heart failure, highlights the importance of its expedited recognition, and details a proposed diagnostic work-up and individualized management approach in the emergency department. We also perform a concise review of current international guideline recommendations. Future research directions are also provided.