2026-04-02
Xiaolong Cui, Chen Liang, Shijie Jia, Ying Bi, Qing Li, Xiaomin Zhao, Min Wang, Zhongquan Tang, Ting Ou, Xinyu Dai, Jingqing Yao, Yuntao Li, Hong Ding
BackgroundCritical value management represents a core component of medical safety, yet primary healthcare institutions continue to face challenges including non-standardized processes, incomplete documentation, and insufficient IT support. Although the PDCA cycle is widely adopted as a quality management tool, most evaluations of its effectiveness rely on simple pre-post comparisons, failing to distinguish true intervention effects from underlying secular trends.MethodsWe conducted a prospective, multicenter study implementing a 24-month PDCA cycle intervention across 62 primary healthcare institutions in Jiangsu Province. Quality improvement initiatives included implementing a unified Critical Value Reporting Protocol, standardizing logbooks, and establishing monitoring mechanisms. We employed an interrupted time series model to analyze 24 months of data, assessing both immediate and sustained intervention effects.ResultsFollowing PDCA implementation, the standardized critical value management rate increased from a pre-intervention average of 93.8% to 98.9%. Interrupted time series analysis revealed a significant immediate improvement (OR = 1.721, p = 0.012) and a progressively strengthening trend effect (OR = 1.298, p < 0.001). The model demonstrated excellent fit with no residual autocorrelation, and statistical inferences based on robust standard errors proved reliable.ConclusionThe PDCA cycle effectively enhances the standardized management of critical values in primary healthcare settings. Interrupted time series analysis provides a scientific foundation for evaluating its effectiveness. This model offers substantial operational practicality and scalability, contributing to continuous improvement in healthcare quality.
DOI: 10.3389/frhs.2026.17459452026-04-02
Chidera Gabriel Obi, Faith Udochukwu Uzor
BackgroundThe attainment of Universal Health Coverage (UHC) remains difficult in most low- and middle-income countries (LMICs) due to gaps in health funding, high out-of-pocket spending and further worsening due to recent donor cuts. Existing literature predominantly focuses on traditional sources which include government budgets, donor aid, social health insurance, and household payments while the role of commercial banks as strategic health system financiers remains largely untapped beyond Corporate Social Responsibility (CSR) activities.AimThis perspective examines how commercial banks can provide innovative solutions and utilize their untapped resources to become strategic partners in health financing which can be harnessed towards attaining UHC.ApproachAnchored in Financial Intermediation Theory and the World Health Organization's health financing framework, the paper reviews evidence from peer-reviewed literature, policy documents, and illustrative country experiences.Key argumentsCommercial banks possess significant liquidity, risk-assessment capacity, and extensive networks that can be potentially leveraged through health-targeted savings and insurance products, ESG-aligned health bonds, de-risked lending to health SMEs. Structured public–private partnerships can further improve health outcomes while maintaining profitability. Empirical examples from Nigeria and other LMICs demonstrate the feasibility of these approaches.ConcernsThe involvement of commercial banks in health financing involves the risk of equity concerns (urban bias, over-indebtedness, technicality of the products and profit-equity alignment), especially in weak regulatory context while PPPs can carry political undertones with higher political risks.RecommendationsCommercial Banks and policy makers should promote health focused and inclusive products with literacy support, mobilize capital through bonds/guarantees, expand health SME credit, leverage PPPs, and monitor outcomes to mitigate risk.ConclusionsThe integration of commercial banks into UHC as strategic partners can bridge financing gaps, improve health access, and strengthen health system resilience in LMICs, provided supportive regulation, ethical frameworks, and contextual adaptation guide their engagement.
DOI: 10.3389/frhs.2026.17501562026-04-01
Yerlan Ayaganov, Gani Akhanov, Zhulduz Sadykova, Berik Isatayev, Alibek Zhanisbayev, Yerdos Algazyev, Beknur Umraliyev, Sarafaddin Mansharipov, Ray Omirzak, Ermek Dyussembekov
Background/objectivesChiasmatic–sellar region tumors represent a significant burden for specialized healthcare services due to the need for complex diagnostics, multidisciplinary management, and prolonged inpatient treatment. In the absence of population-based registries, hospital-based analyses provide important insights into the organization of care and resource utilization. This study aimed to assess the organization and key characteristics of specialized neurosurgical care for patients with chiasmatic–sellar tumors in a large metropolitan center in Kazakhstan.MethodsA retrospective hospital-based study was conducted using medical records of adult patients treated for chiasmatic–sellar region tumors in a tertiary neurosurgical center in Almaty between 2019 and 2024. Demographic characteristics, tumor structure, surgical activity dynamics, length of hospital stay, intensive care unit (ICU) utilization, perioperative complications, reoperations, and in-hospital mortality were analyzed using descriptive statistical methods.ResultsA total of 342 patients were included (mean age 49.6 ± 14.2 years; 59.9% women). Pituitary adenomas accounted for 82.2% of cases. Surgical activity varied over time, with a temporary decline followed by a compensatory increase in subsequent years. Median length of hospital stay was 16 days (IQR 14–20), and routine short-term ICU monitoring was required for the majority of patients. Postoperative complications occurred in 5.8% of cases, reoperations in 4.1%, and in-hospital mortality was 2.6%.ConclusionsThis hospital-based study highlights key organizational features and resource utilization patterns of specialized neurosurgical care for chiasmatic–sellar tumors in a metropolitan setting. These findings provide real-world evidence to support planning and optimization of centralized neurosurgical services in metropolitan health systems of middle-income countries, particularly with regard to inpatient capacity, intensive care utilization, and standardized postoperative pathways.
DOI: 10.3389/frhs.2026.18077442026-04-01
Sini Eloranta, Saara Ketola, Tuija Ikonen
IntroductionPatient safety is a fundamental component of high-quality healthcare, and integrating its principles into health professional education and continuing professional development is essential for ensuring safe care. This article describes and compares four international patient safety competency models from high-income regions (Australia, Canada, the United Kingdom, the Nordic countries), and the WHO Multi-professional Patient Safety Curriculum Guide and analyzes their similarities and differences. In this descriptive comparative review, the objective is to identify which competency domains each model emphasises, and which competencies are critical for advancing patient safety across healthcare systems.MethodsA thematic analysis of the patient safety competency models was conducted, focusing on their core competency domains and identifying the competencies most critical for advancing patient safety across healthcare systems in high-income regions.FindingsCommon competency domains include safety culture, systems thinking, teamwork, communication, risk management, human factors, and continuous learning. However, there are notable differences: for example, the Nordic framework for knowledge and skills emphasizes technology and preparedness, Australia highlights ethics, and Canada focuses on resourcing.DiscussionThe comparison of four patient safety competency models in high-income countries, and the WHO Multi-professional Patient Safety Curriculum Guide shows that they share a common set of core domains, providing a strong basis for aligning patient safety education in high-income countries. At the same time, country specific emphases highlight the need for contextual adaptation.
DOI: 10.3389/frhs.2026.17576012026-03-31
Samantha A. Meeker, Margaret Ziemann, Alys Barton
IntroductionDespite growing awareness of mental health, stress, and trauma among public safety workers (EMTs, firefighters, and emergency dispatchers), gaps remain in programs and research addressing burnout and moral injury -especially when compared to the attention given to healthcare professionals and, to some extent, police officers. The objective of this study is to systematically review the literature on the environmental, relational, and operational drivers, processes, and outcomes associated with burnout and moral injury among public safety personnel according to a national framework.MethodsA systematic search following PRISMA extension for Scoping Reviews guidelines was conducted across six databases for peer-reviewed publications from 2004 to 2024. Search terms focused on burnout, moral injury, and public safety professions. Reference lists from included studies and key journals were also hand-searched. Identified studies were uploaded to Covidence and screened by three reviewers using defined criteria.ResultsOf nearly 13,000 articles identified, 43 were included. Only three studies examined moral injury. Most studies examined individual burnout factors (e.g., age, gender), with less attention to organizational drivers. Key drivers included operational factors (e.g., occupational stress, organizational support) and non-organizational factors (e.g., traumatic events, work-family conflict). Burnout outcomes, discussed in fewer studies, primarily related to individual-level physical and mental health or job satisfaction and turnover.DiscussionUnderstanding burnout and moral injury from the perspective of public safety workers is critical to public health, given their frontline role during crises. While they safeguard the well-being of others, their own health has significant implications for downstream providers and patient outcomes. Although systems-level contributors to burnout and moral injury are increasingly acknowledged in broader healthcare, this lens is less often applied to public safety workers-especially in relation to moral injury. Addressing these issues requires a deeper understanding of their origins, particularly the organizational factors that shape how burnout and moral injury manifest in this workforce. Future research must address multi-level drivers to inform more effective and targeted interventions.
DOI: 10.3389/frhs.2026.17783142026-03-27
Luca Fimmanò, Marco Damonte Prioli, Fabrizio Figallo, Giovanni Orengo, Antonio Uccelli, Michele Messmer
IntroductionNurses are a vital component of healthcare systems, directly influencing the quality and continuity of patient care. Globally, demographic shifts have led to a rising proportion of older nurses. In Italy, this trend presents challenges, given the rapidly aging population and ongoing workforce shortages. With a retirement age of 67, many older nurses remain in physically demanding roles despite medically documented work limitations, raising concerns about workforce sustainability, safety, and long-term planning.MethodsThis study analyzed demographic trends among nurses at a major Italian public hospital. Data were extracted from the hospital's human resources system (IRIS WIN) for the period 2010–2024. A total of 2,184 nurses employed as of 31 December 2024 were stratified into four age groups (24–44, 45–54, 55–58, and 59–67 years) and mapped against clinical settings with varying levels of work intensity. Retirement eligibility was projected through 2033. Health-related absenteeism and medically documented work limitations were analyzed by age group and job intensity level.ResultsBetween 2010 and 2024, the proportion of nurses aged 24–44 declined by 36.6%, while those aged 55–58 and 59–67 increased by 222.3% and 1,914%, respectively. Projections indicate a further 91% increase in the oldest age group by 2033. In 2024, 66% of nurses aged 55–58 and 61% of those over 59 were working in high- or extremely high-intensity clinical areas. Older nurses (>55 years), representing 40% of the workforce, accounted for 54% of all health-related absenteeism, equivalent to 87 full-time nursing positions. The number of nurses with medically documented work limitations in the oldest age group is expected to double in the coming years.DiscussionThis study highlights the urgent challenges of an aging nursing workforce which are not unique to Italy's NHS, but are a global issue. A growing proportion of older nurses, many with medically documented work limitations, are working in demanding clinical environments, trends already testing healthcare systems in many countries worldwide with a potential impact on patient safety, quality of care, and workforce resilience. Urgent investment in workforce planning, age-responsive role adaptation, and transitional pathways is essential to ensure sustainable, high-quality care delivery and to safeguard workforce health.
DOI: 10.3389/frhs.2026.17787552026-03-26
Adrian Wells, Andrew Belcher, David Reeves, Patrick Doherty, Paul Wilson, Lora Capobianco
AimsAnxiety, depression, and post-traumatic stress symptoms are common in cardiac rehabilitation (CR) patients. Group metacognitive therapy (MCT) alongside CR can significantly improve such symptoms compared to usual care. We aimed to conduct the first implementation study of group-MCT in NHS CR services. The objectives were: 1. Establish sites and assess levels of adoption; 2. Revise and pilot data capture via national auditing systems to assess MCT attendance and uptake; 3. Assess site-level MCT-adherence under roll-out conditions.MethodsA mixed-methods study evaluated implementation of group-MCT in routine care in CR services. Services across England were recruited as early adopters and staff were trained. The National Audit of Cardiac Rehabilitation (NACR) database was modified to collect and assess performance of group-MCT data capture. Five implementation outcomes were assessed; uptake and adherence, data-capture and quality, patient characteristics, site-level of adoption, and treatment adherence.ResultsTwenty-six courses of group-MCT were delivered across six services, with an average of 4.3 courses per site and 131 patients receiving treatment. 82.4% of patients attended at least four sessions. Five services met all outcomes and were classed as green; one failed on one criterion and was rated amber. Data capture worked but with some minor discrepancies. Levels of intervention adherence were excellent, with high consistency across sites and time.ConclusionsWe established six sites meeting our recruitment threshold and demonstrated satisfactory data capture on MCT attendance and uptake via national auditing systems. Five out of six sites met all adoption criteria. Site level adherence and compliance was excellent at 86.7%. Wider-scale adoption could improve access to evidence-based psychological therapy and enhance outcomes across the 188 CR-services in England.
DOI: 10.3389/frhs.2026.17930552026-03-25
Michele Hardiman, Judith Watkin, Winifred O'Neill, Sinead Hanley
Electronic Health Records (EHRs) are central to healthcare transformation, promising improved access to information, decision support, and safer care delivery. It acts as a central repository of all information pertinent to a person receiving treatment and is easily accessible. This paper presents a an experiential perspective and follow up from a nursing team who led the design, development, and evaluation of a person-centred electronic nursing record within an acute hospital setting. Guided by the Person-centred Practice Framework and participatory approaches to workplace culture development, the team collaborated with informatics specialists to redesign more than 120 assessments, diagnoses, interventions and outcomes that better reflect nursing values, patient choice, and local workflows. Through continuous attention to organisational structures, facilitative processes, and emerging cultural patterns, nurses achieved greater alignment between digital documentation and the realities of bedside practice. Evaluation data demonstrated improved nurse engagement with the EHR, enhanced therapeutic relationships, reduced documentation burden, and strengthened person-centred cultures across the organisation. These findings highlight the critical role of nurses in digital transformation and the need for meaningful input into EHR content design and governance. We argue that digital nursing documentation must reflect the complexity and relational nature of nursing practice, rather than prioritising technical tasks or disease-focused content. As national and international EHR initiatives advance, nursing leadership must influence system procurement, content customisation, and ongoing evaluation to ensure that digital records uphold professional values and support compassionate, holistic, person-centred care.
DOI: 10.3389/frhs.2026.17814502026-03-25
Christina Evaldsson, Sofia Kjellström
IntroductionImprovement science emphasizes the need to understand and enhance quality in complex service systems. While the field primarily has developed within healthcare, its expansion into social care requires deeper engagement with how quality is understood and enacted in practice. This study addresses this need by exploring how child welfare professionals in Sweden understand and enact “quality” in their everyday work with implications for improvement science in complex human service systems.MethodsThe study employed a qualitative, practice-oriented, and interactive research design. The data consisted of 28 semi-structured interviews with professionals in child welfare, an analysis seminar, and documents (such as a quality management system and quality reports). An inductive content analysis was conducted, constructing themes through systematic interpretation rather than predefined frameworks.ResultsThe analysis identified two coexisting logics of quality: one emphasizing uniformity, the other emphasizing responsiveness to uniqueness. The findings show how professionals move between these logics as tensions become salient in daily practice.DiscussionBy conceptualizing quality as a paradoxical construct, the study highlights how quality in child welfare is enacted through the ongoing negotiation of multiple logics, with implication for improvement science. The findings align with previous research suggesting that sustainable improvement involves the interplay of generalizable and contextual knowledge, and that paradoxes in organizational life shape conditions for learning and improvement.ConclusionQuality in child welfare is not a fixed attribute but a negotiated phenomenon, shaped by persistent tensions between uniformity and responsiveness. Recognizing these paradoxes invites reflection on how improvement science engages with quality in complex human service systems, particularly in relation to the interplay between codified standards and professional judgment.
DOI: 10.3389/frhs.2026.17670832026-03-24
Rachele M. Hendricks-Sturrup, Fraser W. Gaspar
Global mental health needs are escalating, yet few people with mental disorders receive effective care, underscoring the need for robust real-world evidence (RWE) to guide system transformation. Real-world data (RWD)—such as electronic records, claims, patient-reported outcomes, and digital sources—can capture the complexity of mental health care delivery beyond trials but remain underused. In this mini-review, we discuss methodological and infrastructural priorities for leveraging RWD to improve mental health services research and care. We describe recent peer-reviewed studies that have used RWD to examine complex mental health care and associated outcomes, focusing on applications of artificial intelligence and machine learning (AI/ML) and on approaches that enhance validity and reproducibility. Many recent studies report the use of AI/ML to identify study populations, extract unstructured clinical information, or predict treatment patterns, while others report the use of RWD to characterize trajectories, service use, and costs. Building on these examples, we propose two urgent actions: (1) adopt relevant, reliable, and routine RWD curation, transformation, and analysis strategies—including target trial emulation for causal inference—and (2) strengthen mental health care data systems through standardization, harmonization, and interoperability. To promote transparency, we highlight protocol and reporting tools (e.g., HARPER, ATRAcTR, TARGET) and recommend registration of RWE studies. Collectively, these advances can enable high-quality, patient-centered RWE that better reflects real-world mental health care and informs more equitable, effective services.
DOI: 10.3389/frhs.2026.17775972026-03-23
Wei Wang, Sisi Li, Wenxuan Liu, Xiaoyan You, Yang Liu, Xianying Wang
ObjectiveThe escalating incidence of prostate cancer poses a significant global public health challenge. Optimal utilization of resources is crucial for the effective deployment of funds among the diverse and emerging treatment options for managing prostate cancer. This systematic review aims to offer insights and serve as a reference for pharmacoeconomic studies related to the use of degarelix and luteinizing hormone-releasing hormone (LHRH) agonists in the treatment of prostate cancer.MethodsWe conducted a comprehensive search in databases including Embase, PubMed, the Cochrane Library, CNKI, Web of Science, Scopus, and the Tufts CEA Registry to identify cost-effectiveness studies on the use of degarelix and LHRH agonists in the treatment of prostate cancer, spanning from the inception of these databases up to December 30, 2025. Two independent reviewers sequentially examined titles, abstracts, and full-text articles, applying predefined inclusion and exclusion criteria to select studies for data extraction. Any disagreements were resolved through discussion until a consensus was reached. The quality of the included studies was evaluated using the Quality of Health Economic Studies and Consolidated Health Economic Evaluation Reporting Standards. Relevant data were then summarized and comparatively analyzed, focusing on aspects such as the model framework, model parameters, and uncertainty analysis.ResultsA total of 13 studies were ultimately incorporated, with an overall high quality but significant methodological variations among them. Five studies compared degarelix with leuprorelin, goserelin, or triptorelin; four compared triptorelin to goserelin or leuprorelin; one study evaluated leuprorelin acetate in a 6-month depot formulation vs. a 3-month depot; two compared leuprorelin to goserelin and triptorelin; and one study assessed radiotherapy vs. radiotherapy plus goserelin. Eight studies employed the Markov model, with time horizons spanning from 1 year to 30 years. The majority of the studies (n = 7) conducted cost-effectiveness analyses, and most were based in developed countries (n = 7). Degarelix was deemed cost-effective in the United States, United Kingdom, and China. Additionally, 6-month depot LHRH agonists were found to be more cost-effective than their monthly or 3-monthly counterparts.ConclusionFrom a societal perspective, the evidence suggests that degarelix may be a cost-effective option for patients with prostate cancer. All assessments of LHRH agonists are of high quality. Among the three LHRH agonists evaluated, the 6-month depot formulation of triptorelin may be a cost-effective option in certain settings. In clinical practice, the evaluation of a drug should comprehensively consider its efficacy, adverse effects, cost-effectiveness, and overall patient survival. The evidence is predominantly derived from high-income countries, and thus the conclusions may have limited generalizability to low- and middle-income country settings.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/recorddashboard, PROSPERO CRD420250653923.
DOI: 10.3389/frhs.2026.16085322026-03-19
Nina Veenstra, Papillon Gustafson, Michelle Lambert, Lisa Kremer, Holly O'Loughlin, Karen Bartholomew, Peter Carswell, Mihi Ratima, Adam Fusheini, Patricia Priest, Sue Crengle
IntroductionEquitable implementation is an important dimension of effective implementation. In Aotearoa New Zealand, many health interventions with the potential to lessen health inequities for Māori fail to do so because of implementation challenges. Equity readiness can ensure organisations are both willing and able to implement or scale up health interventions in a way that doesn't result in further health disparities.MethodsAn equity readiness assessment tool, designed to be used by healthcare organisations in conjunction with an equity focussed process framwork (FrEEIA: Framework for Effective and Equitable Implementation in Aotearoa), was developed through a seven stage, mixed methods, iterative process. This tool frames equity readiness as a collective, multi-level construct. Initial stages of its development included interviews with interest holders to explore barriers and facilitators impacting the implementation of interventions to improve health equity, a reveiw of existing equity assessment and change readiness tools, and a researcher workshop to develop key domains. This was followed by the actual development/adaptation of a suitable tool with advice from interest holders who had utilised similar tools, testing and the development of additional resources that would aid its use.Results and discussionThe final version of the FrEEIA Readiness Assessment Tool is an adapted version of The Readiness Thinking Tool®, comprising 31 statements in three sections (individual readiness, intervention-specific readiness, and organisational readiness) which users rate individually and then discuss as a team, before formulating an action plan to improve equity readiness. Pilot testing highlighted the particular benefit of the tool in increasing awareness of the different dimensions of equity readiness, with the identification of strategies to address barriers to readiness more challenging due primarily to timing, team make up, and facilitation challenges. A range of supporting resources -a User Guide, Facilitator's Guide and Action Plan template- were developed to facilitate action plan development.The FrEEIA Readiness Assessment Tool is now available for use and adaptation through an interactive online interface, a format which was found to carry distinct advantages for tailoring feedback. The research team will continue to make refinements as this tool gets rolled out in a wider variety of service settings.
DOI: 10.3389/frhs.2026.17336852026-03-19
Reema Harrison, Ashfaq Chauhan, Rebecca Mitchell, Smriti Raichland, Gaston Arnolda, Jeffrey Braithwaite, Johanna I. Westbrook, Elizabeth Manias, Janani Mahadeva, Bronwyn Newman, Ramya Walsan, Kate Churruca, Sam Ricketts, Ricki Spencer, Mashreka Sarwar, Jeffrey Liang, Deborah Pallavicini, Dalal Dawood Baumgartner, Kim Bowen, Donna Gillies, Charbel Badr, Konrad Kangru, Ai-Vee Chua, Louise Hardy, Sarah Judd-Lamm, Kirsten Moore, Lily Edwards, Sanjyot Vagholkar
BackgroundManaging the burden of chronic and complex disease is a global priority for health service delivery. Initiatives that aim to improve care integration and continuity to optimise health care utilisation, efficiency and outcomes are a priority. Patient registration with a general practice or practitioner has been adopted in multiple countries to promote continuity of care. This program of work will provide novel, critical evidence of the implementation of the Australian “MyMedicare” voluntary patient registration scheme, and the associated outcomes within its first years.MethodsThree workstreams will address five research objectives. Methods comprise analyses of longitudinal observational administrative health data (Workstream 1), qualitative interviews and quantitative surveys (Workstream 2) and analysis of linked general practice and health administrative data (Workstream 3). Primary outcomes are the number and demographics of patients registered in the MyMedicare scheme, implementation outcomes including feasibility and acceptability of registering, cost to practices associated with registering patients, and early impacts in the extent to which registration is associated with changes in health service utilisation, health outcomes and continuity of care.ConclusionsBy evaluating over five years, the proposed research provides ample opportunity for people to have registered in order to assess, the process of registration, the effects of MyMedicare incentives, and the scheme's impact on continuity of care and health outcomes. The resulting evidence will contribute to national policy and international literature on the application of patient registration models to promote health service delivery and outcomes in the context of an aging population with escalating chronic and complex disease burdens.
DOI: 10.3389/frhs.2026.1746024