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Many families in developing countries do not have access to medical doctors and instead receive health care from informal providers. Das et al. used “mystery” patients (trained actors) to test whether a 9-month training program improved the quality of care delivered by informal providers in West Bengal (see the Perspective by Powell-Jackson). The patients did not identify themselves to the providers and were not told which providers had participated in the training program. The results of this blinded assessment showed that medical doctors delivered better care than informal providers but that the training program closed much of the gap. Science , this issue p. 80 ; see also p. 34 Training helped informal providers deliver better care for angina, diarrhea, and asthma. [Also see Perspective by Powell-Jackson ] Health care providers without formal medical qualifications provide more than 70% of all primary care in rural India. Training these informal providers may be one way to improve the quality of care where few alternatives exist. We report on a randomized controlled trial assessing a program that provided 72 sessions of training over 9 months to 152 informal providers (out of 304). Using standardized patients (“mystery clients”), we assessed clinical practice for three different conditions to which both providers and trainers were blinded during the intervention, representative of the range of conditions that these providers normally diagnose and treat. Training increased correct case management by 7.9 percentage points (14.2%) but did not affect the use of unnecessary medicines and antibiotics. At a program cost of $175 per trainee, our results suggest that multitopic medical training offers an effective short-run strategy to improve health care.

This proactive guide brings the relationship between work life and mental well-being into sharp focus, surveying common challenges and outlining real-life solutions. The authors' approach posits managers as the chief mental health officers of their teams, offering both a science-based framework for taking stock of their own impact on the workplace and strategies for improvement. Areas for promoting mental wellness include reducing stress and stigma, building a safe climate for talking about mental health issues, recognizing at-risk employees, and embracing diversity and neurodiversity. Emphasizing key questions to which managers should be attuned, the book speaks to its readers--whether in corporate, nonprofit, start-up, or non-business organizations--as a friendly and trusted mentor. Featured in the coverage: ¨ Mind the mind: how am I doing, and how can I do better? ¨ Dare to care: how are my people doing, and how might I help? ¨ Building blocks for mental health: how do I manage my team? ¨ Stress about stressors: what is constantly changing in the environment? ¨ Changing my organization and beyond: how can I have a greater impact? Compassionate Management of Mental Health in the Modern Workplace holds timely relevance for managers, human resources staff, chief medical officers, development heads in professional service firms, union or employee organization leaders, legal and financial professionals, and others in leadership and coaching positions. \"Workplace mental health: Wow! A subject that frightens most managers. If they read this book, they will strengthen their own skills and transform their workplace and our society.\" Donna E. Shalala, Trustee Professor of Political Science and Health Policy, University of Miami; former U.S.^Secretary of Health and Human Services \"Mental health is an underappreciated, and oft-misunderstood challenge that is growing in the modern workplace. This book provides leaders with practical advice to address mental health challenges in their organization and improve productivity and wellbeing. This is a topic that can no longer be ignored by leaders in any field, and a book that will fundamentally change the way we think about and help improve mental health in the workplace.\" Dominic Barton, Managing Director, McKinsey & Company .

Health worker density per 1000 population in Ghana is one of the lowest in the world estimated to be 2.3, below the global average of 9.3. Low health worker motivation induced by poor working conditions partly explain this challenge. Albeit the wage bill for public sector health workers is about 90% of domestic government expenditure on health in countries such as Ghana, staff motivation and performance output remain a challenge, suggesting the need to complement financial incentives with non-financial incentives through a community-based approach. In this study, a systematic community engagement (SCE) intervention was implemented to engage community groups in healthcare quality assessment to promote mutual collaboration between clients and healthcare providers, and enhance health worker motivation levels. SCE involves structured use of existing community groups and associations to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements made and rewards given to best performing facilities for closing quality care gaps. To evaluate the effect of SCE interventions on health worker motivation and experiences with clients. The study is a cluster randomized trial involving health workers in private (n = 38) and public (n = 26) primary healthcare facilities in two administrative regions in Ghana. Out of 324 clinical and non-clinical staff randomly interviewed at baseline, 234 (72%) were successfully followed at end-line and interviewed on workplace motivation factors and personal experiences with clients. Propensity score matching and difference-in-difference estimations were used to estimate treatment effect of the interventions on staff motivation. Intrinsic (non-financial) work incentives including cordiality with clients and perceived career prospects appeared to be prime sources of motivation for health staff interviewed in intervention health facilities while financial incentives were ranked lowest. Intervention health facilities that were assessed by female community groups (Coef. = 0.2720, p = 0.0118) and informal groups with organized leadership structures like Artisans (Coef. = 0.2268, p = 0.0368) associated positively with higher intrinsic motivation levels of staff. Community-based approach to health worker motivation is a potential complementary strategy that needs policy deliberation to explore its prospects. Albeit financial incentives remain critical sources of staff motivation, innovative non-financial approaches like SCE should complement the latter.

\"The same Lean principles that are helping hospitals eliminate waste and improve efficiencies are applicable to individuals working in healthcare. This book not only provides the tools to alleviate the obvious symptoms of inefficiency but also demonstrates how to find the root causes underlying that inefficiency. It presents a practical, step-by-step approach to applying Lean principles to individuals, including real-world examples that illustrate how these principles have been applied in the healthcare industry\"-- Provided by publisher.

IntroductionPhysical activity has important benefits for the prevention and management of chronic diseases and healthy ageing. Health professionals have valuable opportunities to promote physical activity to a large group of people across the lifespan. Promotion of Physical Activity by Health Professionals is a hybrid type 1 effectiveness-implementation cluster randomised trial designed to evaluate the impact of physical activity promotion by health professionals (n=30 clusters) on physical activity participation in their patients (n=720). To inform the future implementation of this programme, we will be conducting a within-trial and modelled economic evaluation.Methods and analysisWe will conduct a cost-effectiveness and cost-utility analysis from the perspective of the healthcare, aged care and disability funder. The time horizon will be 6 months for the within-trial analysis and 2 years for the modelled analysis. Data on intervention costs will be collected using trial records. Data on healthcare utilisation will be collected using data linkage. Incremental cost-effectiveness ratios (ICERs) will be reported for physical activity and quality-adjusted life years outcomes. Bootstrapping will be used to explore uncertainty around the ICERs and estimate 95% CIs. Results will be presented on a cost-effectiveness plane. The probability that the intervention would be cost-effective at varying willingness-to-pay thresholds will be presented using a cost-effectiveness acceptability curve.Ethics and disseminationEthics approval was obtained through Sydney Local Health District (RPAH zone) Ethics Review Committee (X23-0197). The findings of this study will be disseminated through peer-reviewed journal articles and conference presentations.Trial registration numberAustralian New Zealand Clinical Trials Registry: ACTRN12623000920695.

Given the increase in financial-incentive programs nationwide, many physicians and physician groups are concerned about potential unintended consequences of providing financial incentives to improve quality of care. However, few studies examine whether actual unintended consequences result from providing financial incentives to physicians. We sought to document the extent to which the unintended consequences discussed in the literature were observable in a randomized clinical trial (RCT) of financial incentives. We conducted a qualitative observational study nested within a larger RCT of financial incentives to improve hypertension care. We conducted 30-minute telephone interviews with primary care personnel at facilities participating in the RCT housed at12 geographically dispersed Veterans Affairs Medical Centers nationwide. Participants answered questions about unintended effects, clinic team dynamics, organizational impact on care delivery, study participation. We employed a blend of inductive and deductive qualitative techniques for analysis. Sixty-five participants were recruited from RCT enrollees and personnel not enrolled in the larger RCT, plus one primary care leader per site. Emergent themes included possible patient harm, emphasis on documentation over improving care, reduced professional morale, and positive spillover. All discussions of unintended consequences involving patient harm were only concerns, not actual events. Several unintended consequences concerned ancillary initiatives for quality improvement (e.g., practice guidelines and performance measurement systems) rather than financial incentives. Many unintended consequences of financial incentives noted were either only concerns or attributable to ancillary quality-improvement initiatives. Actual unintended consequences included improved documentation of care without necessarily improving actual care, and positive unintended consequences. Clinicaltrials.gov Identifier: NCT00302718.

\"This book explains the findings of research on 100 large organizations that have tackled the problems of employee health costs and disengagement in four fresh ways\"-- Provided by publisher.

Background Disinvestment from inefficient or ineffective health services is a growing priority for health care systems. Provision of allied health services over the weekend is now commonplace despite a relative paucity of evidence supporting their provision. The relatively high cost of providing this service combined with the paucity of evidence supporting its provision makes this a potential candidate for disinvestment so that resources consumed can be used in other areas. This study aims to determine the effectiveness, cost-effectiveness and safety of the current model of weekend allied health service and a new stakeholder-driven model of weekend allied health service delivery on acute medical and surgical wards compared to having no weekend allied health service. Methods/Design Two stepped wedge, cluster randomised trials of weekend allied health services will be conducted in six acute medical/surgical wards across two public metropolitan hospitals in Melbourne (Australia). Wards have been chosen to participate by management teams at each hospital. The allied health services to be investigated will include physiotherapy, occupational therapy, speech therapy, dietetics, social work and allied health assistants. At baseline, all wards will be receiving weekend allied health services. Study 1 intervention will be the sequential disinvestment (roll-in) of the current weekend allied health service model from each participating ward in monthly intervals and study 2 will be the roll-out of a new stakeholder-driven model of weekend allied health service delivery. The order in which weekend allied health services will be rolled in and out amongst participating wards will be determined randomly. This trial will be conducted in each of the two participating hospitals at a different time interval. Primary outcomes will be length of stay, rate of unplanned hospital readmission within 28 days and rate of adverse events. Secondary outcomes will be number of complaints and compliments, staff absenteeism, and patient discharge destination, satisfaction, and functional independence at discharge. Discussion This is the world’s first application of the recently described non-inferiority (roll-in) stepped wedge trial design, and the largest investigation of the effectiveness of weekend allied health services on acute medical surgical wards to date. Trial registration Australian New Zealand Clinical Trials Registry. Registration number: ACTRN12613001231730 (first study) and ACTRN12613001361796 (second study). Was this trial prospectively registered?: Yes. Date registered: 8 November 2013 (first study), 12 December 2013 (second study). Anticipated completion: June 2015. Protocol version: 1. Role of trial sponsor: KP and DL are directly employed by one of the trial sponsors, their roles were: KP assisted with overall development of research design and assisted with overall project management; DL contributed to project management, administration and communications strategy.