How Corruption Influences Population Health

The study examines the link between corruption and mortality.

The authors find that corruption is associated with higher mortality, particularly in low-income countries. Corruption is also linked with weaker fiscal capacity, reduced government funding for health care, distorted resource allocation, and patterns consistent with misallocation of public funds. Additionally, the association between corruption and mortality varies across levels of public goods provision.

The study draws on country-level data from 102 countries spanning 2008-2018. They use econometric methods, including instrumental variables and the Mundlak approach. To mitigate endogeneity concerns, they employ an instrumental variable approach based on ancestry and oral tradition, using historical cultural factors plausibly related to contemporary corruption levels.

The study expands existing research on social determinants of health by highlighting the relevance of institutional and political factors for population health. Addressing corruption could be recognized as a public health priority, given its association with health financing and population health. The Sustainable Development Goals on combating corruption and improving health are found to be complementary. 

KYRIOPOULOS, I., MINOS, D., VANDOROS, S. and MOSSIALOS, E. (2026), How Corruption Influences Population Health. Milbank Quarterly., 104: 198-219. 

Open Access Article (2026)

photo Jordi Soldevila. Iteracions de la realitat en negre

______________________________________________________________________

Corporate governance: up to date

Corporate governance is the system by which companies are directed and controlled. Boards of directors are responsible for the governance of their companies. Nonprofit governance is a political and organizational process involving multiple functions and engaging multiple stakeholders. The responsibilities of the board include setting the company’s strategic aims, providing the leadership to put them into effect, supervising the management of the business and reporting to shareholders and stakeholders on their stewardship and to ensure the mission fullfillment and overall accountability.

Having a knowledgeable and engaged board, a board that understands its fiduciary role, its managerial role and depending on the type of institution its fundraising role. is very important specially in public institutions and non for profit.

The Centre for Research in Health and Economics CRES from the Universitat Pompeu Fabra has published recently some policy papers related to  Corporate Governance. 

• Dalmau-Matarrodona, E.; "Bones pràctiques del govern de les organitzacions" Health Policy Papers Collection 2026-4_ED [Download]
• López-Casasnovas, G., Planas-Miret, I.; "La gobernanza de la colaboración público-privada en sanidad. El caso de Catalunya." Health Policy Papers Collection 2026-3_GL_IP [Download]
• Ortún, V.; "Gobierno y gestión de las organizaciones sanitarias" Health Policy Papers Collection 2026-2_VO [Download]
• López-Casasnovas, G.; "Anomalies organitzatives als consells de govern de les organitzacions públiques" Policy Papers Collection 2026-3_GL [Download]

Another interesting paper published in 2014 by Yvonne D. Harrison (University of Albany) and Vic Murray (University of Victoria): Guidelines for Improving the Effectiveness of Boards of Directors of Nonprofit Organizations

photo Jordi Soldevila. Màcula Malèvich de Sant Pau

______________________________________________________________________

Specialty choices among new generation of doctors - insights from a Polish survey study

Currently, healthcare systems around the world are facing serious labour crises, significant shortages, and unequal geographical distribution of doctors. One of the key issues in maintaining an adequate health workforce is young graduates’ choice of medical specialty. Their career choices substantially influence the future balance between different medical specialties. To better align the choices of young doctors with the needs of the healthcare system, we have to understand the differences between doctors who are already working and those who are only just starting. 

Three generations currently dominate the population of doctors in the workforce: the baby boomers (born 1945–1964), generation X (born 1965–1979), and generation Y (millennials: born 1980–1994). Each generation brings its characteristics to the medical profession. The baby boomers are known for working long hours and viewing medicine as a tireless vocation, while generations X and Y are more tech-savvy, value mobility, and prioritize work-life balance.

Doctors currently entering the healthcare labour market (generation Z) were born between the late 1990s and early 2010s. This generation, also known as‘Gen-Z’, differs significantly from older generations in many ways. Gen-Z individuals were born into a world of widespread access to information, largely due to the internet. They are proficient in using modern technologies, more focused on achieving a healthy work-life balance, and are more open to change in their lives compared to the generations of their parents and grandparentts. However, they do not accept the current state of workplace culture and working hours. They strongly desire a life-work balance, flexibility in working conditions, and collaboration in the workplace.

Although they have chosen a medical career, many young healthcare professionals report that their expectations are not being met, especially concerning non-clinical tasks, including the administrative burden. They understand that the success of future healthcare systems is closely linked to the implementation of new technologies, recognizing its potential to reduce administrative workload and work-related stress. Besides salary, autonomy, collaboration, and technology play a crucial role in selecting a workplace (hospital or practice). To attract and retain this younger generation, healthcare organisations need to focus on team collaboration, a friendly working atmosphere, and adapt their work organisation practices accordingly.

In Poland, many specialties are experiencing a ‘generation gap, which requires well-thought-out decisions to compensate for the forthcoming crisis that would become even more serious if doctors at retirement age were to stop working.

This article aimed to provide evidence on the factors that drive young doctors to choose their future specialties, presenting differences between those applying for non-surgical specialties and those applying for surgical ones.

Article: open acces and pdf

photo Jordi Soldevila. Màcules de Barcelona. Màcula simple del carrer Escorial

______________________________________________________________________

Doctors must live

Caroline Engen published in february 2025 the article: «Doctors must live»: a care ethics inquiry into physicians’ late modern suffering. Med Health Care and Philos 28, 275–290 (2025).

A good article to read (Free Acces) Article

Abstract: 

In 2023, thousands of young Norwegian physicians joined an online movement called #legermåleve (#doctorsmustlive) and shared stories of their own mental and somatic health issues, which they considered to be caused by unacceptable working conditions. 

This paper discusses this case as an extreme example of physicians’ and healthcare workers’ suffering in late modern societies, using Vosman and Niemeijer’s approach of rethinking care imaginaries by a structured process of thinking along, counter-thinking and rethinking, bringing to bear suffering as a heuristic device. 

1. Thinking along, taking the physicians’ stories and arguments literally, reveals an image of an unbearable workload. 
2. Counter-thinking resituates their suffering within the broader conditions of late modernity, suggesting that the root cause may lie not in the quantity of the workload itself but in its qualities and in its perceived threat to their integrity as caregivers through epistemic and moral injury and an inability to respond to this threat. 
3. In rethinking, the ambiguity of suffering– its dual potential as both a constraint and an opening– becomes central. 

Following the physicians’ own interpretations and the solutions emerging from this framing, both their suffering and that of their patients could paradoxically be exacerbated by further decentering physicians and reinforcing utilitarian, data-driven approaches. 

However, staying with their suffering and reinterpreting its causes opens possibilities to leverage critiques of medicalization at large and of their own suffering in particular, challenging the assumption that the weight of care must always grow heavier. 

From this reframing, I argue, it is possible to reclaim and reimagine care and the clinical space as a nexus of epistemic and moral privilege, recentering response-ability both relationally and socially.

Photo Jordi Soldevila. Els Monstres d'Ingres. III

_______________________________________________________________________

Marmot places. An initiative that must be implemented in Catalonia

"Social Injustice is killing people on a grand scale’. (M.Marmot)

Health inequalities are the systematic differences in health between social groups. Where they are judged to be avoidable differences they are inequitable, unfair. 

Putting them right is a matter of social justice. Reducing these inequities requires actions to improve the social determinants of health – the social, economic, political, physical and cultural conditions that shape our lives and our behaviours.

 
The UCL Institute of Health Equity  established in 2011 and being led by Professor Sir Michael Marmot leads and collaborates on work that addresses the social determinants of health and improves health equity. The IHE created the concept of Marmot Places. 

A Marmot Place recognises that health and health inequalities are shaped by the social determinants of health (SDH) and takes action on these social determinants at a local level. 

Sometimes called the building blocks of health, these social determinants are the conditions in which people are born, grow, live, work and age, such as education, employment and housing, and lead to wide differences in people’s health and in their life expectancy. Many places across England and Wales have become Marmot Places putting health equity at the heart of their local strategies.

Becoming a Marmot Place: 

Marmot Places develop and deliver interventions and policies to improve health equity based on eight principles:

1. Give every child the best start in life. 
2. Enable all children, young people and adults to maximise their capabilities and have control over their lives. 
3. Create fair employment and good work for all. 
4. Ensure a healthy standard of living for all. 
5. Create and develop healthy and sustainable places and communities. 
6. Strengthen the role and impact of ill health prevention. 
7. Tackle racism, discrimination and their outcomes. 
8. Pursue environmental sustainability and health equity together.

Article: Public health and health inequalities: a half century of personal involvement Michael Marmot Journal of Public Health, 2022

LSE Health's Annual Lecture:: Social justice and health equity March 2025, M.Marmot

 

Photo Jordi Soldevila. Geometries de la injustícia II

______________________________________________________________________

The generational differences: Health systems leaders need to modernize the workplace and workforce practices to reflect the values of younger health care workers.

Why new generations workers are leaving from healthcare sector?

Many younger workers cite toxic cultural dynamics, such as micromanagement, hierarchical structures, and lack of support from leadership, as significant contributors to dissatisfaction and burnout.

Younger health care workers (physicians, nurses, social care, data managers, economists, lawyers....,),  have different values than older health care workers like:

1. Work-Life Balance: Many new workers prioritize flexibility and mental health, yet the rigid schedules and high stress of healthcare roles often clash with these values.
2. Communication Challenges: New employees increasingly seek purpose-driven careers, and closing the loop on communication is crucial. Are new employees instructed on how to communicate?. The practice of medicine is based on human interaction and communication, as well as science. Balancing patient needs inside an environment of mutual respect is the goal. The deskless workforce in healthcare is high-touch, with patient and co-worker interaction at the center of service delivery. Knowing how to build trust and collaborate is key, across all generations.
3. Conflict with Traditional Structures: Many younger employees feel out of sync with the hierarchical and rigid structures common in healthcare organizations, preferring collaborative and innovative environments.

Health system leaders and administrators should consider new strategies to modernize the workplace and workforce practices to reflect the values of younger health care workers.

• Create an environment to report instances of discrimination, inequalities, and racism quickly and anonymously.
• Develop equity-centered hiring and retention practices. Including (DEI) practice: diversity, equity, and inclusion. Employees want to work at organizations that prioritize DEI practices.
• Design a healthy environment that prioritizes employee wellness. Early-career health care workers who began working during the COVID-19 pandemic endured unprecedented stress and pressure that likely influenced their outlook. Both early-career and longtime health care workers increasingly report feeling burnt out; health care leaders need to create work environments that support overall wellbeing and make workers feel heard and valued. 
• Promote empathy among the managers and leaders to understand the concerns, feelings, and thoughts of their teams.
• Provide employment opportunities for people with disabilities.
• Create a specific mentoring programms to increase awareness regarding gender, young and old, diversity, equity, and inclusion in an organization.
• Support its employees at every step in their career and promote also the accountability at every step: “Accountability breeds response-ability.”― Stephen R. Covey.

Source: 

1. Morenike Ayo-Vaughan and Laurie Zephyrin, “Young Health Care Workers See More Discrimination in the Workplace, Leading to Added Stress and Burnout,” To the Point (blog), Commonwealth Fund, May 29, 2024. Blog

2. Forbes 2024

Photo Jordi Soldevila. Seqüència Xostakòvitx. Quartet número núm  8,

 ______________________________________________________________________

Managers in health care sector

Key ideas:

• The necessary skills of healthcare managers involve planning, organizing, implementing, monitoring, and evaluation skills.
• Management skills are focused on the use of organizational resources but they also have to center on the mobilization of the members of the organization.
• The good healthcare manager provides trust and confidence to staff and appreciates staff efforts.
• Communication and critical thinking skills, relational and organizations skills for healthcare management, were seen as essential competencies for development.
• Additional skills to manage subordinates and coordinate with top-level managers is necessary: like self-awareness, change management, and conflict resolution.
• Clarity on the roles and responsibilities of existing and new professionals working in healthcare is necessary.
• Interprofessional healthcare management can resolve the issue of superiority and inferiority among healthcare professions – medicine, nursing, allied health including laboratory and pharmacy, among others. It reinforces humility and teamwork while acknowledging the importance of each profession for the improvement of health.
• If a healthcare manager knows how to lead himself, it then becomes easier for him/her to familiarize and knowing more both the members and the organization well.
• Well-managed staff can lead to well-managed patients.
• Management skills can impact positively on patients’ health outcomes.
• Healthcare management is a profession

Bayot ML, Varacallo MA. Management Skills. [Updated 2023 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. 

Article

Photo Jordi Soldevila. Màcula de la “L” de l’espai Serrahima

_______________________________________________________________________

Research on Integrated Care Systems: workforce

Integrated care systems (ICSs) were given statutory powers and new legal responsibilities for the first time in July 2022 in UK. 

These changes were intended to increase collaboration in the health and social care sector and to enable the NHS, local authorities and other partners to take collective responsibility for improving health outcomes, reducing inequalities, delivering better value for money, and driving local social and economic development. 

This research examines the development of ICSs by assessing their efforts to develop system-wide approaches to the recruitment, training and retention of staff. Workforce issues such as these are currently some of the biggest challenges facing the health and care sector, and require a co-ordinated response from multiple organisations of the kind that ICSs were designed to enable. 

Leading system-wide transformation is slow and the work is hard, but there are clear signs that progress is being made. 

The research identified six distinctive ways in which ICSs are adding value: ◦ organising around a shared purpose ◦ building system leadership ◦ encouraging system-focused behaviours ◦ scaling and spreading success ◦ using resources more effectively ◦ managing complexity. The degree which this is happening varies across systems. 

Despite signs of progress, there is a clear risk of ICSs going ‘off track’ as a result of pressures on services, intense political scrutiny, and extremely difficult economic circumstances – and the effect these conditions are having on the behaviours of leaders locally, regionally and nationally. There is widespread concern that ICSs may not achieve their full potential unless more is done to create an environment conducive to their success. 

The research suggests that success relies primarily on supporting people to think, plan and act in ‘system-focused’ ways. If this is to happen, different behaviours are needed at all levels of the system. National bodies need to create a more enabling environment and ensure that accountability and funding mechanisms support system working. Local leaders need to model system working in their relationships with partners across the system. 

There is considerable interest in how ICSs are performing and there is a danger that attention focuses on the things that are easier to measure. The research suggests that the less visible work of supporting people to work together differently is critical for success and must not be undervalued. The ability to do this well is one of the key factors that will determine whether ICSs succeed in delivering better population health and more joined-up care for people using services.

Kingsfund report ICS, 2024

Photo Jordi Soldevila. Iteració de les portes tancades

_______________________________________________________________________

València. Building Disaster Resilience: A Systems Approach to Leadership Communication

 

This commentary published by Rand  by Millard McElwee and Monika Cooper last November the 4th (2024), can serve the Spanish authorities (local, autonomous communities and national) to reflect on how to improve the communication of possible disasters such as the one that occurred in València.

Some thoughts: 

"The future of disaster resilience requires us to learn from past political failures, such as the response to Hurricane Katrina, where the lack of clear communication and cohesive narratives deepened mistrust and fragmented communities. 

The inability to align messages across federal, state, and local levels not only delayed critical aid but also exposed the consequences of failing to address social and political divides. 

To move forward, policies must integrate AI and green infrastructure with a focus on rebuilding trust through transparent, unified narratives that guide communities in understanding risks and empowering them to act. Only by bridging these divides can the resilience needed to confront future climate threats be built".

Acces to the commentary: Building disaster resilience

Photo Jordi Soldevila. Geometries de la injustícia

_______________________________________________________________________

Human resources in the National Health System. SESPAS Report 2024 (part 3)

The Spanish Society of Public Health and Health Administration publishes in Gaceta Sanitaria its biennial SESPAS 2024 Report, which shows a series of artices analysing the current situation of the National Health System in terms of Human Resources.

• Pay for performance in public directly managed healthcare centers. Part 1: General framework.  José-Ramón Repullo y JM Freire

• Pay for performance in public directly managed healthcare centers. Part 2: The Spanish National Health System.  José-Ramón Repullo y JM Freire

• Dual practice in the Spanish health system: problem or solution? Ariadna García-Prado, Paula González

• Recruitment, selection and retention of health professionals in indirect management and private management entities Olga Pané Mena y Pau Gomar Sánchez

• Health and well-being of healthcare workers: employment and working conditions beyond the pandemic Fernando G. Benavides et. al

Video: Rosa Urbanos entrevista a J.R.Repullo y J.M Freire

Video: Vicente Ortún entrevista a R.Meneu, O.Pané, P. González, P.Gomar 

Photo Jordi Soldevila. Geometries de la injustícia. Navalni

_______________________________________________________________________

Human resources in the National Health System. SESPAS Report 2024 (part 2)

The Spanish Society of Public Health and Health Administration publishes in Gaceta Sanitaria its biennial SESPAS 2024 Report, which shows a series of artices analysing the current situation of the National Health System in terms of Human Resources.

• Human resource management in health. Consensual paths forward 
• Miguel Angel Negrín, Vicente Ortún
• An overview of health workforce mobility in the European Union under the current supply challenges. Angela Blanco Moreno
• Dual practice in the Spanish health system: problem or solution? Ariadna García-Prado, Paula González
• Recruitment, selection and retention staffing policies in health services directly managed. Ricard Meneu

Photo Jordi Soldevila. Deconstruccions i iteracions de la realitat. Iteració lliure en blau

_______________________________________________________________________

Human resources in the National Health System. SESPAS Report 2024

The Spanish Society of Public Health and Health Administration publishes in Gaceta Sanitaria its biennial SESPAS 2024 Report, which shows a series of artices analysing the current situation of the National Health System in terms of Human Resources.

• Human resources in the National Health System. Medical education. Felipe Rodríguez de Castro, Teresa Carrillo Díaz, Arcadi Gual i Sala, Jordi Palés Argullós
• Experiences in human resources planning for health: The case of physicians. Data and models. Patricia Barber Pérez, Beatriz González López-Valcárcel
• What do we know and what should we know about the imbalances of doctors in Spain? Diagnosis and proposals. Beatriz González López-Valcárcel, Patricia Barber Pérez
• Shortage of nurses in Spain: from the global case to particular situation. Paola Galbany-Estragués, Pere Millán-Martínez
• The challenges of human resources governance in public healthcare. Javier Hernández Pascual

Press conference video

Photo Jordi Soldevila. Homenatge a Toni Catany. Plats vells.

_______________________________________________________________________

Teamwork in healthcare: a systematic review

Healthcare and human services increasingly rely on teams of individuals to deliver services. Implementation of evidence-based practices and other innovations in these settings requires teams to work together to change processes and behaviors. Accordingly, team functioning may be a key determinant of implementation outcomes. Understanding how team functioning influences implementation outcomes will contribute to our understanding of team-level barriers and facilitators of change.

This article is a systematic review examining associations between team functioning and implementation outcomes in healthcare and human service settings.

Affective, behavioral, and cognitive aspects of team functioning are likely to affect the ways in which teams respond to change efforts and therefore impact implementation outcomes. Better team functioning (e.g., high cohesion, effective communication) will be associated with better implementation outcomes, while problems in team functioning (e.g., poor conflict resolution, low trust) will negatively impact implementation outcomes.

Access Article

McGuier, E.A., Kolko, D.J., Klem, M.L. et al. Team functioning and implementation of innovations in healthcare and human service settings: a systematic review protocol. Syst Rev 10, 189 (2021). https://doi.org/10.1186/s13643-021-01747-w

Additional paper 

Access Article

McGuier EA, Kolko DJ, Stadnick NA, Brookman-Frazee L, Wolk CB, Yuan CT, Burke CS, Aarons GA. Advancing research on teams and team effectiveness in implementation science: An application of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Implement Res Pract. 2023 Jul 27;4:26334895231190855. doi: 10.1177/26334895231190855. PMID: 37790168; PMCID: PMC10387676.

Photo Jordi Soldevila. Estudi Geometria de la Injustícia 12

_______________________________________________________________________

Strengthening primary care in Europe: How to increase the attractiveness of primary care for medical students and primary care physicians?

The key messages of this policy brief published by the European Observatory on Health Systems and Policies are as follows:

1. The imperative of strengthening primary health care (PHC) has been widely acknowledged, yet many countries in Europe struggle with shortages and geographical maldistribution of general practitioners (GPs).
2. One of the root causes for these challenges is the perception among medical students and doctors that PHC is not an ‘attractive’ career option. In most contexts this is reinforced by substantial pay differentials and perceived low status between GPs and specialists.
3. Evidence on effective strategies to improve attractiveness of PHC is somewhat patchy, but a number of effective interventions covering medical education, working conditions, PHC models and workforce planning may nevertheless be distilled.
4. There is also some evidence on strategies that can help draw GPs to rural and remote areas. They cover various stages of professional life of a GP and usually aim to improve the work-life balance and reduce professional isolation.
5. On the whole, strengthening PHC will require a multifaceted strategy that employs a range of measures and targets not only medical students and physicians, but also nurses and other PHC professions, patients and the general public.
6. Crafting such a strategy will require a very good understanding of the local context and a much better understanding of the effectiveness of various interventions as the evidence for most of them is currently either patchy or absent.

Note that this policy brief presents the results of a literature review conducted in 2018-2019 before the COVID19 crises.

Acces: Policy brief 55 march 2023

Photo Jordi Soldevila. Refugi 3

_______________________________________________________________________

Organizational change

This research by Noora Jansson from ouluhealth scrutinizes organizational change by combining discourse and practice approaches. A case study at a public university hospital is conducted with a narrative analysis method.

The key finding of this research is that discursive practices are involved in organizational change through discourse phronesis. Discourse phronesis is a socially and contextually developed phenomenon, and hence discursive practices are particular within context. The case study revealed four particular discursive practices as examples of discourse phronesis: field practices, mandate practices, priority practices and word practices.

The results of this research advance awareness of the concealed power within discursive practices and, more importantly, invite practitioners to pursue the intellectual virtue of discourse phronesis while implementing organizational change. Discourse phronesis may be utilized as a gateway to advance change goals and to translate various discourses and actions that otherwise might remain unexplained.

Download Article full text (pdf)

This post was inspired by an article published in a newspaper by Xavier Marcet about the complexity to undergo a transition or change in an organization.

Photo Jordi Soldevila. Homenatge a Toni Catany Final

_______________________________________________________________________

Generational conflict: what works for one generation will not work for all generations

A Study of Generational Conflicts in the Workplace. Steven H. Appelbaum, Anuj Bhardwaj, Mitchell Goodyear, Ting Gong, Aravindhan Balasubramanian Sudha, and Phil Wei (2022) Concordia University, Montreal, Quebec, Canada.

Access Article (pdf)

This article reviews research around generational differences and examines the causality between these differences and conflicts usually happening at the workplace. 

The conflicts can be defined as 

• Value-based: Each generation has different views and work values that motivates them 
• Behaviour-based: 
• conflict comes from how each generation communicates. Research has shown that different generations do not communicate with each other
• conflict comes from the differences in the expectation of feedback. Gen Y requires constant feedbak on their work
• Identity-based.
• conflict arises when differences exist between the ways one generation sees their own identities and the identities of other generations
• conflict originates form the general sense of wanting to belonging to a group of by comparing themselves to other groups.

These generational differences also affect managers’ strategies when dealing with conflicts at work. Morton Deutsch’s theory of cooperation and competition is often used for organisations to understand the nature of conflicts, and the Conflict Process Model can be used to examine how conflicts can evolve. 

Studies show that once a generational conflict is identified and understood, organizations can mitigate and resolve the conflict by developing mentorship between the parties involved to embrace generational diversity. Various components of the HR activities should also be altered to adapt generational differences for an organization to attract and retain talents. However, some studies raised debate about the causality between generations and behavioural characteristics at work and argued the necessity of managing conflicts caused by generational differences, raising concerns that attributing conflicts to generational differences potentially oversimplifies the problems.

photo Jordi Soldevila. Màcules de Barcelona. Constel.lació blava

_______________________________________________________________________

Trust in public institutions and the Code of Ethics of the public service in Catalonia

The United Nations Department of Economic and Social Affairs provides thought leadership through its UN DESA Policy Briefs series, presenting timely and relevant analysis and policy guidance on global economic and social issues. Here we present the policy brief #108

Trust in public institutions: Trends and implications for economic security
The legitimacy of public institutions is crucial for building peaceful and inclusive societies.

While levels of trust in institutions vary significantly across countries, opinion surveys suggest that there has been a decline in trust in public institutions in recent decades.

Economic insecurity—which the COVID-19 crisis threatens to exacerbate—and perceptions of poor or corrupt government performance undermine the social contract and are closely linked to declines in institutional trust. Rebuilding public trust in the light of the current crisis demands services that work for everyone and jobs that provide income security, as well as more inclusive institutions.

Policy brief #108

The Code of Ethics of the Public Service of Catalonia

This code, was approved in october 2021 and constitutes a common ethical framework for all the people who work in the respective administrations and public sectors (politicians, civil servants, managers, advisers,...) as well as those who work in private organizations and entities that carry out effective public services on behalf of the administrations.

The main objective of the Code is to guide the actions of public servants from the key of values, thus strengthening the integrity of their actions and thus helping to promote the improvement of public service, the improvement of democratic quality, and the recovery of the confidence of the citizenship in its institutions.

Catalan government web: Ethics code

photo: Una habitación donde siempre llueve (Barcelona) Juan Muñoz

________________________________________________________________

Physician health management skills and patient outcomes

 

There are large, persistent differences in patient outcomes across physicians and health facilities. The root causes of these differences are not well understood. One reason could be to find if physicians’ health management styles can affect patient health outcomes and health costs.

As quality contracts become increasingly popular across various health care systems, it is important to highlight what facets of individual physicians’ health management styles have meaningful impact on health outcomes and to what extent they vary across physicians. The physician’s ability to correctly diagnose and treat common conditions is one of the central tenets of quality contracts. But the link between these skills and patient outcomes is at best tenuous. Critics have emphasized that unobserved patient-specific characteristics are important and under-researched contributors to the variability of patient health outcomes conditional on physician clinical skill.

Emilia Simeonova et al. published a working paper in 2020 in the NBER where using data on the population of statin users in Denmark between 2004 and 2008 and matching patients to their primary care physicians, they demostrated that

• The physician’s ability to facilitate adherence with prescription medications (as a proxie of physicians's health management skills) has significant positive effects on patient outcomes and health costs even after controlling for observable and unobservable patient characteristics.
• It is important to know that when we talk of physician skills is more than reflecting the clinical quality of the physician. Physician skills are related to their ability to make an adequate diagnosis and prescribe the correct treatment.
• Younger physicians have on average more adherent patients.There didn't find substantial difference in health management skills between male and female physicians after they controlled for physician age and the patient mix. 
• The interventions aiming at improving physicians’ health management skills as they relate to patient adherence with prescribed therapy will have positive impacts on patient health outcome

Access to NBER working paper (pdf)

photo: Homenatge a Ramon Llull (1976) Josep M. Subirachs ______________________________________________________________________

How to build effective teams in primary care

 

Teamworking is fundamental to the future of general practice. Practices are coming together at scale in primary care networks and new roles are being introduced, creating multidisciplinary and multi-agency teams. Making these teams function effectively is a complex task. King’s Fund published a guide with insights from research, policy analysis and leadership practice.

What are the fundamentals of effective teams?

• A small number of meaningful objectives
• Clear roles and responsibilities among team members
• Reflect on how the team is working together
• Introduce new roles into the teams
• Create a multidisciplinary team
• Ensure good communication within your teams.
• Effective information-sharing systems
• Re-design the physical space into shaered working spaces
• Clinical supervision
• Gather feedback from colleagues and patients
• Access to learning and development
• Give space for team members to talk about their experiences

Access Publication: Effective teams in General Practice (january 2020)

Merry christmas and happy new year 2021. Stay safe.

photo: Children’s Christmas play, 1958. (Nina Leen / The LIFE Picture Collection) ______________________________________________________________________

Alert: health care professionals and stress impact during the COVID-19

Healthcare professionals (HCPs) on the front lines against COVID-19 may face increased workload, and stress. Understanding HCPs’ risk for burnout is critical to supporting HCPs and maintaining the quality of healthcare during the pandemic.

Large numbers of healthcare professionals (HCPs) on the frontlines against COVID-19 face high adversity, workloads, and stress, making them vulnerable to burnout.

• Burnout: Defined as emotional exhaustion, depersonalization, and low personal achievement, is known to detract from optimal working capacities, It has been found to be driven by high job stress, high time pressure and workload, and poor organizational support.

We present a preprint article: Factors Contributing to Healthcare Professional Burnout During the COVID-19 Pandemic: A Rapid Turnaround Global Survey (2020)

Method: To assess exposure, perceptions, workload, and possible burnout of HCPs during the COVID-19 pandemic the authors conducted a cross-sectional survey.

The main outcomes and measures were HCPs’ self-assessment of burnout and other experiences and attitudes associated with working during the COVID-19 pandemic.

Results: Burnout was associated with:

• Work impacting household activities
• Feeling pushed beyond training
• Exposure to COVID-19 patients
• Making life prioritizing decisions
• Lack of adequate personal protective equipment (PPE)
• Limited organizatins support

Implications: Athough the results have multiple limitations including a non-validated questionnaire, minimal demographic data collection, and sampling method using social media the institutions should put the emphasis in support these individuals as they face enormous stress that can negatively impact their emotional and physical well-being.

Some actions that proactively instituions should do:

• Develop a resilience training: resilience refers to an individual’s ability to handle stress and recover quickly from the effects of adversity
• Cut drastically the belief of  HCP feeling that their organization doesn’t value their well-being.
• HCPs should feel secure knowing that management care about them and the management are doing as much as possible to handle with the adverse situation
  
• Support for HCPs’ families,
  
• Provide PPE,
  
• Provide mental health resources

Acces to the preprint article (pdf available)

Final article

photo: Life

______________________________________________________________________