OBJECTIVE: To investigate how Chief Medical Officers experience their role in the municipalities´ work with making the public health overview documents, demanded by the Norwegian Public Health Act from 2012.
METHODS: A qualitative study with semi-structured focus group interviews with 21 Chief Medical Officers from 20 different municipalities in Norway. The interviews were conducted in 2017. The data were analyzed thematically.
RESULTS: The Chief Medical Officers were mainly positive to participating in making public health overview documents. They took on roles as leaders of the work, medical advisors, data collectors towards local GPs and listening post to other sectors. Organizational factors like too small positions and a lack of tradition to involve the CMO in public health work were experienced as barriers to their involvement. The collaboration with the public health coordinators was said to be rewarding, and the intersectoral process involved employees from other sectors in a new way in public health. Although there were some positive experiences, several CMOs considered the use and impact of the public health overview document as limited.
CONCLUSIONS: There was a large variation in the amount and the type of involvement the Chief Medical Officers had in making the public health overview documents in Norwegian municipalities. More research is needed to understand if this has any consequences for the quality of public health work in the municipalities and whether it is a sign of a changing role of the Chief Medical Officers.

Emergency departments (EDs) are the primary source of health care for many patients diagnosed with sexually transmitted infections (STIs). Expedited partner therapy (EPT), treating the partner of patients with STIs, is an evidence-based practice for patients who might not otherwise seek care. Little is known about the use of EPT in the ED. In a national survey, we describe ED medical directors\' knowledge, attitudes, and practices of EPT.
A cross-sectional survey of medical directors from academic EDs was conducted from July to September 2020 using the Academy of Academic Administrators of Emergency Medicine Benchmarking Group. Primary outcomes were EPT awareness, support, and use. The survey also examined barriers and facilitators.
Forty-eight of 70 medical directors (69%) responded. Seventy-three percent were aware of EPT, but fewer knew how to prescribe it (38%), and only 19% of EDs had implemented EPT. Seventy-nine percent supported EPT and were more likely to if they were aware of EPT (89% vs. 54%; P = 0.01). Of nonimplementers, 41% thought EPT was feasible, and 56% thought departmental support would be likely. Emergency department directors were most concerned about legal liability, but a large proportion (44%) viewed preventing sequelae of untreated STIs as \"extremely important.\"
Emergency department medical directors expressed strong support for EPT and reasonable levels of feasibility for implementation but low utilization. Our findings highlight the need to identify mechanisms for EPT implementation in EDs.

This study aimed to describe emergency medical services (EMS) managers\' and medical directors\' perceptions of collaborating with patients concerning patient safety issues in the EMS.
The study used a descriptive qualitative approach. Five focus groups and two individuals were interviewed using a semi-structured guide with open-ended questions. The data were analysed using reflexive thematic analysis. Consolidated criteria for Reporting Qualitative research was used to guide the reporting of this study.
EMS organisations from Finland\'s five healthcare districts.
EMS medical directors (n=5) and EMS managers (n=14). Purposive sampling was used.
Two main themes, \'Patient safety considered an organisational responsibility\' and \'EMS patients\' opportunities and obstacles to speaking up\', were generated from the data. Under the main theme, \'Patient safety considered an organisational responsibility\', were three subthemes: patient safety considered part of the quality in EMS, system-level models for handling and observing patient safety in EMS, and management\'s ability to find a balance when using patients\' feedback for patient safety development. Under the other main theme were four subthemes: \'social and feedback skills of EMS personnel and management\', \'managements\' assumptions of patients\' reasons for not speaking up\', \'EMS organisations\' different but unsystematic ways of collecting feedback\' and \'management\'s openness to develop patient participation\'.
The nature of the EMS organisations and EMS assignments could affect a patient\'s participation in developing patient safety in EMS. However, EMS managers and medical directors are receptive to collaborating with patients concerning patient safety issues if they have sufficient resources and a coherent way to collect patient safety concerns. The management is open to collaborating with patients, but there is a need to develop a systematic method with enough resources to facilitate the management\'s collaborating with patients.

During the coronavirus disease 2019 (COVID-19) crisis, Canada\'s provincial chief medical officers of health (CMOHs) have provided regular updates on the pandemic response. We sought to examine whether their messaging varied over time and whether it varied across jurisdictions.
We conducted a qualitative study of news releases from Canadian provincial government websites during the initial phases of the COVID-19 outbreak between Jan. 21 and Mar. 31, 2020. We performed content analysis using a predefined data extraction framework to derive themes.
We identified 290 news releases. Four broad thematic categories emerged: describing the government\'s preparedness and capacity building, issuing recommendations and mandates, expressing reassurance and encouraging the public, and promoting public responsibility. Most of the news releases were prescriptive, conveying recommendations and mandates to slow transmission. Cross-jurisdictional variations in messaging reflected local realities, such as evidence of community transmission. Messaging also reflected changing information about the pandemic over time, shifting from a tone of reassurance early on, to a sudden emphasis on social distancing measures, to a concern with public responsibility to slow transmission.
Messaging across jurisdictions was generally consistent, and variations in the tone and timing of CMOH messaging aligned with different and changing realities across contexts. These findings indicate that when evaluating CMOHs\' statements, it is critical to consider the context of the information they possess, the epidemiologic circumstances in their jurisdiction and the way the province has structured the CMOH role.

To manage increasing demand for emergency and unscheduled care NHS England policy has promoted services in which patients presenting to Emergency Departments (EDs) with non-urgent problems are directed to general practitioners (GPs) and other primary care clinicians working within or alongside emergency departments. However, the ways that hospitals have implemented primary care services in EDs are varied. The aim of this study was to describe ED clinical leads\' experiences of implementing and delivering \'primary care services\' and \'emergency medicine services\' where GPs were integrated into the ED team.
We conducted interviews with ED clinical leads in England (n = 19) and Wales (n = 2). We used framework analysis to analyse interview transcripts and explore differences across \'primary care services\', \'emergency medicine services\' and emergency departments without primary care services.
In EDs with separate primary care services, success was reported when having a distinct workforce of primary care clinicians, who improved waiting times and flow by seeing primary care-type patients in a timely way, using fewer investigations, and enabling ED doctors to focus on more acutely unwell patients. Some challenges were: trying to align their service with the policy guidance, inconsistent demand for primary care, accessible community primary care services, difficulties in recruiting GPs, lack of funding, difficulties in agreeing governance protocols and establishing effective streaming pathways. Where GPs were integrated into an ED workforce success was reported as managing the demand for both emergency and primary care and reducing admissions.
Introducing a policy advocating a preferred model of service to address primary care demand was not useful for all emergency departments. To support successful and sustainable primary care services in or alongside EDs, policy makers and commissioners should consider varied ways that GPs can be employed to manage variation in local demand and also local contextual factors such as the ability to recruit and retain GPs, sustainable funding, clear governance frameworks, training, support and guidance for all staff. Whether or not streaming to a separate primary care service is useful also depended on the level of primary care demand.

Most family medicine residency training takes place in hospitals, which is not reflective of the outpatient care practiced by most primary care clinicians. This pilot study is an initial exploration of family medicine residency directors\' opinions regarding this outpatient training gap.
The authors surveyed 11 California family medicine residency program directors in 2017-2018 about factors that influence decisions regarding allocation of residents\' inpatient and outpatient time. Nine of the 11 program directors agreed to be interviewed. We analyzed the interviews for common themes.
The participating program directors were generally satisfied with inpatient and outpatient balance in their residents\' schedules. Factors identified as promoting inpatient training included the need for resident staffing of hospital services, the educational value of inpatient rotations, and a lack of capacity in continuity clinics. From the program directors\' perspective, residency funding played no direct role in curriculum planning. Program directors also felt that the ACGME requirements prescribing 1,650 continuity clinic visits throughout residency inhibited the development of creative outpatient training opportunities.
Family medicine residency program directors participating in this exploratory study did not feel that their programs overly emphasized inpatient care and training.

Burnout is considered a public health crisis among physicians and is related to poor quality of life, increased medical errors, and lower patient satisfaction. A recent literature review and conceptual model suggest that awareness of life meaning, or meaning salience, is related to improved stress and coping, and may also reduce experience of burnout. This study examined associations among meaning salience, burnout, fatigue, and quality of life among family medicine residency program directors.
Data were collected via an online survey administered by the Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA; n=268, response rate of 45.4%) in December 2018. Program directors completed measures of meaning salience, burnout, fatigue, and quality of life. Data were analyzed using Spearman correlations and path analysis.
Program directors who reported greater experienced meaning salience also reported significantly less burnout (β=-.40, P<.001) and less fatigue (β=-.38, P<.001), which were then both significantly associated with greater quality of life (Ps<.001). Program directors who reported greater meaning salience also reported greater quality of life (β=.21, P<.001). Additionally, there were significant indirect associations between meaning salience and quality of life through less burnout and fatigue (β=.26, P<.001).
The potential for increasing physicians\' awareness of their sense of meaning as a means to prevent or decrease burnout is underresearched and warrants further study. Both preventive measures (eg, wellness curricula) and interventions with already-distressed physicians may encourage regular reflection on meaning in life, especially during busy workdays.

A survey to investigate the educational background of the Health Top Managers recently appointed by Italian Regions as CEOs (Chief Executive Officer) of Local Health Authorities (ASL) and General Hospitals was performed in April 2019, approximately one year after the entry into force of the new law for their selection (D.Lgs 171/2016). The study follows a similar one carried out by Bocconi University in 2013 and focuses on 8 Italian Regions (Piedmont, Lombardy, Liguria, Umbria, Lazio, Basilicata, Sicily, Sardinia). The study examined the CVs of the 112 recently appointed CEOs: the average age is 58.7 years, with the proportion of female surprisingly low (16%). About half of them (50.5%) have a Degree in Medicine and Surgery. Among Managers with a non-medical degree (49.5%), Law (21) and Economic sciences (21) are the most common degrees. Among medical doctors, 33 (58.9%) are specialists in Hygiene and Preventive Medicine. Overall, our data are consistent with those recorded in 2013 (except a decrease in medical graduates -18.5%) and confirm the diversified backgrounds of Health Managers. The background in Public Health, acquired from the 35 Schools of Hygiene and Preventive Medicine, remains relevant among Managers of the Italian National Health Service.

OBJECTIVE: This study determines the extent to which residents and their program directors have discordant perceptions regarding wellness, support, and treatment opportunities for trainees. In addition, the authors examined whether psychiatry residents differed in their perceptions compared with residents in other specialties.
METHODS: Residents and their program directors from each of 10 specialties were electronically surveyed after IRB approval and giving informed consent.
RESULTS: Of 42 program directors responding, over 92% indicated they provided wellness education and programming; however, a significantly lower percentage of 822 trainees were aware of this (81.2% and 74.9%, respectively). A similar disparity existed between program directors (PDs) who knew where to refer depressed residents for help (92.9%) and residents who knew where to seek help (71%). Moreover, 83.3% of program directors believed they could comfortably discuss depression with a depressed resident, but a lower percentage of their trainees (69.1%) felt their training directors would be supportive. A significantly greater percentage of program directors (40.5%) believed seeking treatment for depression might compromise medical licensure than did residents (13.0%). Psychiatry residents were significantly more aware of wellness, support, and access than were residents from other specialties.
CONCLUSIONS: The availability of wellness education, programming, program director accessibility, and knowing where to ask for help if depressed does not seem to be adequately communicated to many residents. Moreover, program directors disproportionately see depression treatment as a risk to medical licensure compared with their residents. Psychiatry residents seem to be more aware of program director support and access to care than their colleagues.

Health care delivery is moving toward a value-based environment, which calls for increased integration between physician groups and health systems. Health executives sit at a key nexus point for determining how and when physician-system integration occurs.
The objective of this study was to identify the organizational factors that health executives perceived to have made physician-system integration successful.
We used a multiple-case study research design. We conducted semistructured, qualitative interviews with 25 health executives in the roles of CEO, chief medical officer, chief financial officer and physician group chief executives from eight of Washington State\'s largest integrated delivery systems. To guide our analysis, we employed open systems theory and Porter\'s Value Chain to identify physician group and hospital factors that were integral to successful integration.
Using the executives\' perspectives, the factors grouped into three themes: (1) organizational structure-a mix of integration contracts united by common structural characteristics between physician groups and hospitals); (2) organizational culture-alignment of leadership between physician groups and hospitals; and (3) strategic resources-designated resources to establish and support care coordination activities.
Our work indicates that health systems should focus on the pathway to integration success through the alignment of structure (not just the integration contract), culture, and resources and not on an end goal of the physician employment model.
Health system executives are key drivers for when and how physician groups are integrated into health services organizations. This article provides executives with an evidence-based model to aid in formulating integration approaches that combine elements of organizational structure, organizational culture, and strategic resources.