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We argue that concentration of power in religious hospitals threatens disestablishment values. When hospitals deny care for religious reasons, they dominate patients’ bodies and convictions. Health law should — and to some extent already does — constrain such religious domination.
This Element examines the problem of hospital noise, a problem that has repeatedly been discovered anew, with each new era bringing its own efforts to control and abate unwanted sound in healthcare settings. Why, then, has hospital noise never been resolved? This question is at the heart of Making Noise in the Modern Hospital, which brings together histories of the senses, space, technology, society, medicine and architecture to understand the changing cacophony of the late twentieth-century British hospital. This Element is fundamentally interdisciplinary – despite being historical, it comes up to the present day and brings in scholarship on space, place, atmosphere and the senses that will have relevance to scholars working outside of historical research. The intersection between medical and sensory histories also puts interdisciplinary research at the Element's core.
When hospitals are damaged or destroyed in armed conflict, the loss is far greater than the physical structures: safe spaces are lost, health outcomes worsen and trust in health institutions is undermined. Despite the legal protections afforded to medical units under international humanitarian law (IHL), attacks on hospitals are a recurring problem in armed conflict. In 2019, the Safeguarding Health in Conflict Coalition documented more than 1,203 incidents of violence against medical facilities, transports, personnel and patients in twenty countries. This article examines investigations of four post-Second World War incidents of attacks on hospitals in armed conflicts in Vietnam, Bosnia and Herzegovina, Palestine and Afghanistan, the role public advocacy campaigns played in bringing about these investigations, and how national and international authorities can work together to promote greater accountability for violations of IHL.
This chapter completes the description of the delivery system, focusing on three fundamental categories of providers: hospitals, doctors and nurses. For each of these three categories, recent data regarding the density of these providers with respect to the resident population are reported. These data are provided for the twenty-seven OECD countries analyzed in this book. A particular focus is reserved for the mechanism through which hospital facilities and physicians are remunerated.
Chapter Six, ‘On the Wards’, shifts to hospitals. Hospitals were sites of colonial entanglement in the ‘in-between’ zones bestriding active combat and civilian life. Despite the apparent limitations of the space, where men were rendered immobile by the injury or illness, hospitals facilitated encounters, particularly between patients and nurses. For nurses in these spaces, new responsibilities were expected, as chaperones of racial, national and sexual boundaries. Using not only the men’s letters and diaries but those of the women who nursed them – from Britain and the dominions – the politics of caring for colonial troops, white and of colour, are examined. Complex responses to nursing by both the men and the women surpassed existing maternal motifs of caregiving. The threat of racial mixing placed new limits on ‘care’ but there were complicated individual reactions to the new and intimate contact between white women and men of colour: neglect, anxiety, apathy, curiosity and even desire.
uses the biopolitical and socio-environmental perspectives on health constructed in the previous chapters to reinterpret municipal responses to plague. This chapter argues that when Netherlandish cities took action against epidemic spread, they applied pre-existing health policies. It challenges two scholarly biases, namely of crisis and of government. First, actions to prevent spread of the plague are often interpreted as radical innovations, yet many subjects targeted in plague ordinances were usual suspects and recurring problems; already regulated outside the context of plague because they were perceived as posing a (combined) threat to physical and moral communal well-being. Cities employed various strategies, from quarantine and street sanitation to spiritual measures and culling dogs. Secondly, there is a clear need to move beyond a top-down perspective and complicate the playing field of daily dealings with an epidemic through networks of plague care, which are discussed here by focusing on the role of hospitals, medical officials and confraternal caregivers, especially the Cellites.
Secondary and tertiary care (STC) evolved to progressively improve access and quality of care. For various phases of development, the chapter analyses the dynamic interactions of various components of the health system such as human resources, financing, information, medical products and technology and their influence on STC, and the influence of wider factors such as political, socio-economic, demographic and population behaviour. Challenges include the provision of affordable, integrated, seamless care from primary to tertiary levels. Outcomes are discussed in terms of access, utilisation, client satisfaction and quality of care. The analysis includes the dynamics inherent in the dichotomy between the public and private sectors in financing and provision of STC services. Systems thinking illustrates the challenges in the dichotomous public-private system that is subject on the one hand to increasing specialisation and compartmentalisation in medical care and on the other hand to the need for integrated care for the individual patient.
The Victorian period was the most formative era for professional nursing and for cultural concepts of the nurse. The most prominent representative figures of nursing from the period were the disreputable Sairey Gamp – the infamous character from Charles Dickens’s Martin Chuzzlewitt – and the very real and very proper Florence Nightingale. The Victorian cultural perception of nursing was more complex than these polar opposites might suggest, however. The influences that cumulatively fashioned the popular figure of the nurse were legion and contradictory, ranging from camp follower to proselytising nun to heroic martyr.
The evolution of nursing practice from menial to professional work was widely examined and debated in the media and through fictional representations of nurses. As these treatments reveal, there was marked cultural ambiguity about the entrance of refined women into nursing, which, even in its most professional form, entailed a level of intimacy with both male and female bodies and bodily fluids that was disturbing to Victorian sensibilities. What emerges in both the media and fiction is a curious and very Victorian fixation on sexuality that was explicitly or implicitly directed at the women who practised nursing.
Public service innovation, defined as the adoption of new technology and methods of service delivery, is at the heart of public management research. Scholars have long studied public and private sector innovation as distinctive phenomena, arguing that private sector innovation aims to increase firms' competitive advantage, while public sector innovation purports to improve governance and performance. The public-private dichotomy overlooks the complex way how organizations interact with each other for service delivery. Public services are increasingly delivered through the web of collaborative networks, in which organizations compete and cooperate simultaneously. This Element explores how coopetition, namely the simultaneous presence of competition and collaboration, shapes innovation in the health care sector. Analyzing panel data of 4,000+ American hospitals from 2008 to 2017, this Element finds evidence that coopetition catalyzes the technology and service process innovation and offers practical implications on managing innovation in competitive environments.
The current study was conducted to assess disaster preparedness of hospitals in the Eastern region of Saudi Arabia.
Methods:
A descriptive cross-sectional study of all hospitals in the Eastern Region of KSA was conducted between July 2017 and July 2018. The included hospitals were selected using convenience sampling. The questionnaire was distributed together with an official letter providing information about the aim and objectives of the study as well as ethical issues guiding their participation in the exercise.
Results:
All the included hospitals had a disaster plan that was completely accessible by all staff members. About 70% of the included hospitals established an educational program on disaster preparedness once per year. Assessment of hospital disaster preparedness was conducted using disaster drills in 62 (n= 98%) of the hospitals. However, only 9.5% of the hospitals had post-disaster recovery assistance programs like counseling and support services.
Conclusion:
Most hospitals involved in this study had sufficient resources for disaster management; however, the overall effectiveness of hospitals’ disaster preparedness was slight to moderate. Some recommendations to improve hospitals’ disaster preparedness should be proposed, including improved staff training and testing, better communications and safety procedures, and adoption of a holistic approach for disaster management.
Health care organizations have been challenged by the coronavirus disease 2019 (COVID-19) pandemic for some time, while in January 2020, it was not immediately suspected that it would take such a global expansion. In the past, other studies have already pointed out that health care systems, and more specifically hospitals, can be a so-called “soft target” for terrorist attacks. This report has now examined whether this is also the case in the context of the COVID-19 pandemic.
During the lockdown, hospitals turned out to be the only remaining soft targets for attacks, given that the other classic targets were closed during the lockdown. On the other hand, other important factors have limited the risk of such attacks in hospitals. The main delaying and relative risk-reducing factors were the access control on temperature and wearing a mask, no visits allowed, limited consultations, and investigations.
But even then, health care systems and hospitals were prone to (cyber)terrorism, as shown by other COVID-19-related institutions, such as pharmaceuticals involved in developing vaccines and health care facilities involved in swab testing and contact tracing. Counter-terrorism medicine (CTM) and social behavioral science can reduce the likelihood and impact of terrorism, but cannot prevent (state-driven) cyberterrorism and actions of lone wolves and extremist factions.
This chapter documents and identifies the presence of several kinds of European medical practitioners in West-Central Africa. It shows that African healers were not the only ones whose practice could come under the scrutiny of ecclesiastical or secular authorities. The legitimacy of white healers was similarly discussed from time to time. In Luanda, ailing patients could theoretically go to a number of Portuguese practitioners, but in reality the number of physicians and surgeons was limited and concentrated on treating the colonial elites and soldiers serving in the military. A fair number of Africans were trained as and served as barbers in Angola and Kongo, pointing to the transfer of European medical technology to Africans. Medical pluralism reflected mostly local African practices and values, but global influences were also present in the form of the charitable brotherhoods, which ran hospitals in Luanda, Benguela and Massangano. It is also evident in the arrival of quina bark from Brazil as early as the 1720s.
To describe the establishment of, and assess the implementation of, a hospital-based health technology assessment (HTA) program in a comprehensive cancer center in Jordan.
Methods
This is a cross-sectional assessment study of the HTA program from 2008 to 2018. We used an indicator-based assessment that included structural, process, and outcome indicators. Structural indicators measured the program's enablers. Process indicators measured activities and outputs, whereas outcome indicators measured the program impact. A data collection form was prepared to collect data related to each indicator.
Results
The program met its core structural and process indicators. The Center for Drug Policy and Technology Assessment was established as an organizational entity to conduct assessments. A functional decision-making entity is available. There are competent pharmacists to conduct assessments, including economic evaluation and decision analytical modeling. There is a structured capacity building program that has been implemented within the last 5 years. Specific submission, assessment, and appraisal processes were established and implemented. Reference methodological guidelines for efficacy, safety, and cost-effectiveness assessments were developed and used by assessors. Thirty-one HTA reports were produced from 2012 to 2018 with a 100 percent utilization rate. Twenty-three medications were listed under restriction, and eight were rejected. The prices of twenty-one medications out of the twenty-three listed medications were reduced based on the HTA assessment results.
Conclusion
The HTA program at the King Hussein Cancer Center (KHCC) in Jordan is functional, is effective with a high utilization rate of produced assessments, and is having a positive impact on price reductions.
To investigate the association between newly developed type 2 diabetes (T2D) and incident psychopharmacological treatment and psychiatric hospital contact. Via Danish registers, we identified all 56 640 individuals from the Central and Northern Denmark Regions with newly developed T2D (defined by the first HbA1c measurement ≥6.5%) in 2000–2016 as well as 315 694 age- and sex-matched controls (without T2D). Those having received psychopharmacological treatment or having had a psychiatric hospital contact in the 5 years prior to the onset of T2D were not included. For this cohort, we first assessed the 2-year incidence of psychopharmacological treatment and psychiatric hospital contact. Secondly, via Cox regression, we compared the incidence of psychopharmacological treatment/psychiatric hospital contact among individuals with T2D to propensity score-matched controls – taking a wide range of potential confounders into account. Finally, via Cox proportional hazards regression, we assessed which baseline (T2D onset) characteristics were associated with subsequent psychopharmacological treatment and psychiatric hospital contact. A total of 8.3% of the individuals with T2D initiated psychopharmacological treatment compared to 4.6% of the age- and sex-matched controls. Individuals with T2D were at increased risk of initiating psychopharmacological treatment compared to the propensity score-matched controls (HR = 1.51, 95% CI = 1.43–1.59), whereas their risk of psychiatric hospital contact was not increased to the same extent (HR = 1.14, 95% CI = 0.98–1.32). Older age, somatic comorbidity, and being divorced/widowed were associated with both psychopharmacological treatment and psychiatric hospital contact following T2D. Individuals with T2D are at elevated risk of requiring psychopharmacological treatment.
High rates of mortality and morbidity result from disasters of all types, including armed conflicts. Overwhelming numbers of casualties with a myriad of illnesses and patterns of injuries are common in armed conflicts, leading to unpredictable workloads for hospital health care providers (HCPs). Identifying domains of hospital HCPs’ core competency for armed conflicts is essential to inform standards of care, educational requirements, and to facilitate the translation of knowledge into safe and quality care.
Objective:
The objective of this study is to identify the common domains of core competencies among HCPs working in hospitals in armed conflict areas.
Methods:
A scoping review was conducted using the Joanna Briggs Institute framework. The review considered primary research and peer-reviewed literature from the following databases: Ovid Medline, Ovid EmCare, Embase, and CINAHL, as well as the reference lists of articles identified for full-text review. Eligibility criteria were outlined a priori to guide the literature selection.
Results:
Four articles met the inclusion criteria. The studies were conducted in different countries and were published from 2011 through 2017. The methods included three surveys and one Delphi study.
Conclusion:
This review maps the scope of knowledge, skills, and attitudes required by HCPs who are practicing in hospitals in areas of major armed conflict. Incorporation of identified core competency domains can improve the future planning, education, and training, and may enhance the HCPs’ response in armed conflicts.
Chapter six investigates the economic bases of Jeddah, trade and pilgrimage. A brief overview of major trends in trade and transport is followed by a more detailed discussion of the merchants of Jeddah and their internal organisation. The political role of the merchants and their relation to the respective ruling powers forms another topic. The chapter then turns to the pilgrimage, starting by investigating the pilgrims’ guides and the way in which they organised reception, accommodation and transport for pilgrims. Given the attempts of Western powers to limit what were perceived health and political threats emanating from the pilgrimage, the ways in which such organisation played out locally through the consulates is touched upon, notably in as far it affected local water and health provision. Finally, the chapter turns to the Bedouin, a population usually residing outside of the city walls but indispensable to trade and pilgrimage and constituting a vital link between the city, its suburbs and surroundings.
Discusses the use of the gramophone for both educational and recreational purposes, showing how this developing technology was used on the fighting fronts in the maintenance of servicemen’s morale, as well as for medicinal and therapeutic uses in hospitals and convalescent homes.
Provides an overview of the ways in which music was used in medical settings during the war. It will outline how the British Red Cross, which was tasked by the War Office to coordinate the organisation and supply of British hospitals, ensured that provision was made for live and recorded music in the majority of their facilities. This chapter will also consider how the medical profession came to recognise that music was an aid to servicemen’s recovery and convalescence. The experiences of civilian entertainers in military medical settings will also be examined.
Societies invest substantial amounts of resources on disaster preparedness of hospitals. However, the concept is not clearly defined nor operationalized in the international literature.
Aim:
This review aims to systematically assess definitions and operationalizations of disaster preparedness in hospitals, and to develop an all-encompassing model, incorporating different perspectives on the subject.
Methods:
A systematic search was conducted in five databases: Scopus, PubMed, Web of Science, Disaster Information Management Research Centre, and SafetyLit. Peer-reviewed articles containing definitions and operationalizations of disaster preparedness in hospitals were included. Articles published in languages other than English, or without available full-text, were excluded, as were articles on prehospital care. The findings from literature were used to build a model for hospital disaster preparedness.
Results:
In the included publications, 13 unique definitions of disaster preparedness in hospitals and 22 different operationalizations of the concept were found. Although the definitions differed in emphasis and width, they also reflected similar elements. Based on an analysis of the operationalizations, nine different components could be identified that generally were not studied in relation to each other. Moreover, publications primarily focused on structure and process aspects of disaster preparedness. The aim of preparedness was described in seven articles.
Discussion/Conclusion:
This review points at an absence of consensus on the definition and operationalization of disaster preparedness in hospitals. By combining elements of definitions and components operationalized, disaster preparedness could be conceptualized in a more comprehensive and complete way than before. The model presented can guide future disaster preparedness activities and research.