The evolving landscape of healthcare necessitates a paradigm shift in professional education, blending clinical expertise with business acumen. This paper delves into the need for healthcare professionals to acquire a comprehensive understanding of both clinical intricacies and business dynamics while examining the emergence of joint degree programs aimed to equip graduates with multifaceted skills required to navigate the complexities our of modern healthcare delivery systems. Drawing from a diverse literature review, this paper highlights the pros and cons of this dual-degree education and the benefits that it brings given today\'s challenging healthcare landscape. It explores the profound impact of such programs on student outcomes, emphasizing the cultivation of leadership, financial acumen, and strategic thinking alongside clinical competencies. Moreover, it addresses concerns regarding academic rigor and the feasibility of integrating business education into an already demanding healthcare curricula. Analysis of current trends and future projections underscores the growing demand for professionals who possess hybrid skill sets. With healthcare workforce shortages and evolving industry challenges, individuals equipped with both clinical and business proficiencies are poised to lead innovation and drive organizational success.

UNASSIGNED: Various data quality issues have prevented healthcare administration data from being fully utilized when dealing with problems ranging from COVID-19 contact tracing to controlling healthcare costs.
UNASSIGNED: (i) Describe the currently adopted approaches and practices for understanding and improving the quality of healthcare administration data. (ii) Explore the challenges and opportunities to achieve continuous quality improvement for such data.
UNASSIGNED: We used a qualitative approach to obtain rich contextual data through semi-structured interviews conducted at a state health agency regarding Medicaid claims and reimbursement data. We interviewed all data stewards knowledgeable about the data quality issues experienced at the agency. The qualitative data were analyzed using the Framework method.
UNASSIGNED: Sixteen themes emerged from our analysis, collected under 4 categories: (i) Defect characteristics: Data defects showed variability, frequently remained obscure, and led to negative outcomes. Detecting and resolving them was often difficult, and the work required often exceeded the organizational boundaries. (ii) Current process and people issues: The agency adopted primarily ad-hoc, manual approaches to resolving data quality problems leading to work frustration. (iii) Challenges: Communication and lack of knowledge about legacy software systems and the data maintained in them constituted challenges, followed by different standards used by various organizations and vendors, and data verification difficulties. (iv) Opportunities: Training, tool support, and standardization of data definitions emerged as immediate opportunities to improve data quality.
UNASSIGNED: Our results can be useful to similar agencies on their journey toward becoming learning health organizations leveraging data assets effectively and efficiently.

There is a lack of understanding of how perceived racism in Veterans Healthcare Administration (VHA) healthcare providers affects the delivery of healthcare services to African American (AA) Veterans thus leading to health disparities in this population. Specifically, there is a lack of understanding of this phenomenon from the view of AA female Veterans who sought mental health care from providers within the VHA. The aim of this study was to determine if AA female Veterans have experiences of racism in their interactions with VHA mental health providers contributing to disparities. Using a phenomenological qualitative analysis approach with five AA female Veterans, the researcher was able to identify four qualitative themes: mental health service delivery, provider belief system about AA female Veterans, and the impact of microaggressions on AA female Veterans. Based on the results of this study, the following were determined: (1) there is an existence of perceived racism from VHA mental health providers to AA female Veterans, (2) we better understand AA female Veterans\' perceptions of their VHA mental health providers based on their interactions, (3) there is a shared lived experience of the phenomenon racism from VHA mental health providers, and (4) there is a failure of VHA to address the needs of AA female Veterans despite VHA policies for support.

Background Post-acute care (PAC) centers are facilities used for recuperation, rehabilitation, and symptom management in an effort to improve the long-term outcomes of patients. PAC centers include skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals. In the 1990s, Medicare payment reforms significantly increased the discharge rates to PAC centers and subsequently increased the length of stay (LOS) among these patient populations. Over the last several years, there have been national initiatives and multidisciplinary approaches to improve safe discharge rates to home. Multiple studies have shown that patients who are discharged to home have decreased rates of 30-day readmissions, reduced short-term mortality, and an improvement in their activities of daily living.  Objectives This study aimed to investigate how multidisciplinary approaches could improve a single institution\'s discharge rates to home. In doing so, we aim to lower hospital readmission rates, hospital length of stay, morbidity and mortality rates, and healthcare-associated costs. Methods A retrospective single-institution cohort study was implemented at Jersey Shore University Medical Center (JSUMC). Data from January 2015 to December 2019 served as the control period, compared to the intervention period from January 2020 to January 2024. Patients were either admitted to JSUMC teaching faculty, hospitalists, or \"others,\" which is composed of various medical and surgical subspecialists. Interventions performed to improve home discharge rates can be categorized into the following: physician education, patient education, electronic medical record (EMR) initiatives, accountability, and daily mobility initiatives. All interventions were performed equally across the three patient populations. The primary endpoint was the proportion of patients discharged to home. Results There were 190,699 patients, divided into a pre-intervention group comprising 98,885 individuals and a post-intervention group comprising 91,814 patients. Within the pre-intervention group, the faculty attended to 8,495 patients, hospitalists cared for 39,145 patients, and others managed 51,245 patients. In the post-intervention period, the faculty oversaw 8,014 patients, hospitalists attended to 35,094 patients, and others were responsible for 48,706 patients. After implementing a series of multidisciplinary interventions, there was a significant increase in the proportion of patients discharged home, rising from 74.9% to 80.2% across the entire patient population. Specifically, patients under the care of the faculty experienced a more substantial improvement, with a discharge rate increasing from 73.6% to 84.4%. Similarly, the hospitalists exhibited a rise from 69.4% to 74.3%, and the others demonstrated an increase from 79.3% to 83.7%. All observed changes yielded a p-value < 0.001. Conclusions By deploying a multifaceted strategy that emphasized physician education, patient education, EMR initiatives, accountability measures, and daily mobility, there was a statistically significant increase in the rate of patient discharges to home. These initiatives proved to be cost-effective and led to a tangible reduction in healthcare-associated costs and patient length of stay. Further studies are required to look into the effect on hospital readmission rates and morbidity and mortality rates. The comprehensive approach showcased its potential to optimize patient outcomes.

BACKGROUND: Abuse of healthcare workers (HCWs) and lack of public trust threaten the foundation of the physician-patient relationship. This growing global problem creates an even more difficult professional environment and hinders the delivery of high-quality clinical care.
OBJECTIVE: The primary aim was to determine the prevalence of violence against Trinbagonian HCWs in the public sector. Secondary objectives included determining risk factors for violence and mistrust between the public and providers.
METHODS: A cross-sectional analysis of 434 HCWs in the public sector of Trinidad and Tobago was conducted using a modified World Health Organization (WHO) data collection tool, distributed via social media and administrative emails, and snowballed for two months. Fifteen semi-structured interviews were conducted regarding trust in the healthcare system with patients selected from communities.
RESULTS: Of the 434 respondents, 45.2% experienced violence and 75.8% witnessed violence against HCWs in the past two years. Verbal abuse (41.5%) was most common. Perpetrators were patients (42.2%) and patients\' relatives (35.5%). Chi-square analysis highlighted that HCWs with the highest probability of being abused were aged 25-39 (63.8%), had two to five years of work experience (24.9%), specialized in emergency and internal medicine (48.6%), and cared for psychiatric and physically disabled patients (p-value < 0.001). HCWs believed the threat of violence negatively impacted performance (64.5%), and further action was necessary for mitigation (86.4%). Patients interviewed doubted physicians\' altruism and competence (80%) and honesty (53.3%), expressed mistrust in their physician (46.7%), and cited poor infrastructure/management (66.7%) and dissatisfaction with care (60.0%) as factors that contributed to violence.
CONCLUSIONS: Analysis revealed that violence against Trinbagonian HCWs in the public sector deteriorated patient experience and adversely affected psychological well-being, efficiency, and job satisfaction. Results suggested mistrust of HCWs by the population. Interventions should be instituted to support at-risk HCWs and educate the public to avoid recurrence.

BACKGROUND: Resilience, in the field of Resilience Engineering, has been identified as the ability to maintain the safety and the performance of healthcare systems and is aligned with the resilience potentials of anticipation, monitoring, adaptation, and learning. In early 2020, the COVID-19 pandemic challenged the resilience of US healthcare systems due to the lack of equipment, supply interruptions, and a shortage of personnel. The purpose of this qualitative research was to describe resilience in the healthcare team during the COVID-19 pandemic with the healthcare team situated as a cognizant, singular source of knowledge and defined by its collective identity, purpose, competence, and actions, versus the resilience of an individual or an organization.
METHODS: We developed a descriptive model which considered the healthcare team as a unified cognizant entity within a system designed for safe patient care. This model combined elements from the Patient Systems Engineering Initiative for Patient Safety (SEIPS) and the Advanced Team Decision Making (ADTM) models. Using a qualitative descriptive design and guided by our adapted model, we conducted individual interviews with healthcare team members across the United States. Data were analyzed using thematic analysis and extracted codes were organized within the adapted model framework.
RESULTS: Five themes were identified from the interviews with acute care professionals across the US (N = 22): teamwork in a pressure cooker, consistent with working in a high stress environment; healthcare team cohesion, applying past lessons to present challenges, congruent with transferring past skills to current situations; knowledge gaps, and altruistic behaviors, aligned with sense of duty and personal responsibility to the team. Participants\' described how their ability to adapt to their environment was negatively impacted by uncertainty, inconsistent communication of information, and emotions of anxiety, fear, frustration, and stress. Cohesion with co-workers, transferability of skills, and altruistic behavior enhanced healthcare team performance.
CONCLUSIONS: Working within the extreme unprecedented circumstances of COVID-19 affected the ability of the healthcare team to anticipate and adapt to the rapidly changing environment. Both team cohesion and altruistic behavior promoted resilience. Our research contributes to a growing understanding of the importance of resilience in the healthcare team. And provides a bridge between individual and organizational resilience.

BACKGROUND: Healthcare worker retention and burnout are confounding issues. Trust among workers and their employer, that is, organization, is an important yet underexplored concept in research.
OBJECTIVE: The aim of this qualitative study is to explore organizational actions and systems that promote or denigrate trust among registered nurses and patient care aides (aides).
METHODS: The study uses the Model of Psychological Contract as a theoretical framework. Focus groups were conducted to explore the concept of organizational trust and the consequences of broken trust.
METHODS: Registered nurses (RNs) (n=6) and aides (n=6) participated in the study. Six focus groups (three RN and three aide) were conducted, with two participants per group. Focus groups were conducted online.
METHODS: The study\'s methods were reviewed by the University of Pittsburgh Institutional Review Board.
RESULTS: Among RNs and aides, a sense of trust and feeling valued were important to their sense of relationship with their employers. Trust was breached when resources were scarce, employees did not feel validated and listened to, and problems were not addressed. RNs and aides described feeling devalued when compensation practices were unjust or inequitable, they had limited autonomy, and the employer created an organizational climate where business needs superceded human caring. Consequences of trust breach included burnout, dejection, and feelings of non-belonging.
CONCLUSIONS: Tangible organizational resources (compensation and staffing) and intangible resources (value, respect, autonomy) are important to RNs and aides alike. Inability to provide these resources diminishes trust and even causes a sense of betrayal.
CONCLUSIONS: Future research can explore the concepts of organizational justice and interventions to restore lost trust and improve healthcare worker well-being. This is one of only a few identified studies to explore organizational factors and well-being among aides and more research among this healthcare worker population is warranted.

Leadership training during residency is essential for the successful development of contemporary physicians. Creating a curriculum for healthcare leadership and administration for internal medicine residents is particularly challenging due to the heterogeneity of leadership curricula across programs, the emphasis on individual advancement rather than collective leadership, and the scarcity of published research on the topic. A healthcare administration and leadership rotation for medical residents is a valuable experience that emphasizes the importance of contextualizing education on leadership and building relationships to achieve organizational goals.

UNASSIGNED: The objective of this study was to better understand how rurality impacts the knowledge, diagnosis and management of vulvodynia by primary care providers (PCPs) practising in the geographically disparate province of Newfoundland and Labrador, Canada.
UNASSIGNED: This was a qualitative case study using questionnaires and semi-structured interviews with PCPs, compared with semi-structured focus groups and interviews with vulvodynia patients conducted in a previous study phase.
UNASSIGNED: Ten family physicians and 6 nurse practitioners participated. Over half had baseline knowledge that vulvodynia has a relatively high prevalence, but most underestimated the likelihood they would see a patient with vulvodynia in their practice. Three barriers to discussing and managing vulvodynia emerged: (1) discomfort initiating sexual/vulvar health conversations; (2) concerns about protecting patient privacy and confidentiality; and (3) time constraints and building therapeutic relationships. These issues were largely corroborated by previous findings with vulvodynia patients. Rural-informed solutions might include: (1) supporting increased education in vulvodynia and sexual health more broadly, including funding to attend continuing professional education and developing more clinical tools; (2) following practice guidelines regarding standardised initiation of sexual health conversations; (3) incentivising retention of rural providers and extending appointment times by reconsidering fee-for-service structures; and (4) researching a tailored vulvodynia toolkit and the potential advantage of mobile health units.
UNASSIGNED: Rurality exacerbates common concerns in the identification and management of vulvodynia. Acting on recommended solutions may address the impact of rurality on the provision of timely care for those experiencing vulvodynia and other sexual health concerns.
Résumé Objectif: Mieux comprendre l\'impact de la ruralité sur la connaissance, le diagnostic et la prise en charge de la vulvodynie par les prestataires de soins primaires exerçant dans la province géographiquement disparate de Terre-Neuve-et-Labrador, au Canada. Conception: Étude de cas qualitative utilisant des questionnaires et des entretiens semi-structurés avec des prestataires de soins primaires, comparés à des groupes de discussion semi-structurés et à des entretiens avec des patientes atteintes de vulvodynie menés lors d\'une phase précédente de l\'étude. Résultats: Dix médecins de famille et six infirmières praticiennes y ont participé. Plus de la moitié d\'entre eux savaient au départ que la vulvodynie a une prévalence relativement élevée, mais la plupart sous-estimaient la probabilité de voir une patiente atteinte de vulvodynie dans leur pratique. Trois obstacles à la discussion et à la prise en charge de la vulvodynie sont apparus: (1) la gêne à entamer des conversations sur la santé sexuelle/vulvaire; (2) les préoccupations relatives à la protection de la vie privée et de la confidentialité des patientes; et (3) les contraintes de temps et l\'établissement de relations thérapeutiques. Ces problèmes ont été largement corroborés par les résultats obtenus précédemment avec des patientes atteintes de vulvodynie. Les solutions adaptées au milieu rural pourraient inclure (1) soutenir une meilleure formation sur la vulvodynie et la santé sexuelle en général, notamment le financement de la formation professionnelle continue et l\'élaboration d\'outils cliniques supplémentaires; (2) suivre les directives de pratique concernant l\'amorce normalisée des conversations sur la santé sexuelle; (3) encourager la rétention des fournisseurs ruraux et prolonger les délais de rendez-vous en reconsidérant les structures de rémunération à l\'acte; et 4) faire des recherches sur une trousse d\'outils sur mesure pour la vulvodynie et sur l\'avantage potentiel des unités de santé mobiles. Conclusion: La ruralité exacerbe les problèmes courants liés à l\'identification et à la prise en charge de la vulvodynie. La mise en œuvre des solutions recommandées peut permettre de remédier à l\'impact de la ruralité sur la fourniture de soins en temps opportun aux personnes souffrant de vulvodynie et d\'autres problèmes de santé sexuelle. Mots-clés: Douleur vulvaire, dyspareunie, santé rurale, santé sexuelle, éducation sexuelle, structures tarifaires, administration des soins de santé, disparités géographiques dans les soins de santé, recherche qualitative, étude de cas qualitative.

This study quantitatively analyzed healthcare administration studies in Japan using text mining, focusing on articles published during 1994-2021 in the Journal of the Japan Society for Healthcare Administration (prior to 2008, the journal was called Hospital Administration). Both the co-occurrence network and the correspondence analysis (these are extracted words that refer to the two systems) demonstrate two major changes: (1) the introduction of the long-term care insurance system, which was enacted in 1997 and came into effect in 2000, and (2) the introduction of the late-stage medical care system for the elderly in 2008, both of which had a significant impact on the Japanese public health and welfare system. Co-occurrence network and correspondence analysis were conducted to understand changes in research interests. The analysis used two time periods following a change in the journal\'s name in 2008. To readily comprehend changing research trends, 10-year segments were considered, resulting in three time periods. The research features and trends during the aforementioned periods were examined using correspondence analysis. Configuration figures derived from this analysis plotted time transition (first dimension) against certain abstract/concrete situations (second dimension). The extracted words displayed in the configuration maps at the axes\' intersection were patient, survey, and evaluation. They revealed no distinctive features compared with other words and were commonly used in article titles within this journal during each period. The following results were obtained from the correspondence analysis: first, changes in the geriatric care system of public medical insurance and the introduction of the long-term care insurance system in 2000 were expressed in the characteristics of the extracted words; second, in the 14 years after the journal\'s name changed, published studies frequently referred to the roles of doctors, nurses, and other healthcare professionals. A chi-squared test on these extracted words and the period classification confirmed a statistically significant relationship between them.