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In order to meet the large gap between the number of people in Ghana experiencing a mental health condition and those receiving treatment, there is a great need for more psychiatrists in this country, particularly those with training in psychiatric subspecialties, to meet evolving needs. The Ghana Global Health Workforce Programme was designed to enhance psychiatric training in Ghana, by strengthening the capacity of general psychiatrists in specific subspecialties. The programme received positive feedback from both the psychiatric trainees and supervisors who attended, and was expanded into other low- and middle-income settings.
Successful completion of industry-sponsored clinical trials requires effective collaboration between sponsors and clinical research sites recruiting patients. As pharmaceutical companies specialize in more therapy areas, complexity and volume of clinical trials increases, with study sites facing growing operational and logistical challenges. These may be administrative, financial, technological, or workforce-related and can prevent sites from meeting trial obligations, inhibiting long-term site sustainability. Here we outline a suggested framework (with metrics) designed to address three key pillars: site infrastructure, workforce, and the establishment of a ‘trial funnel’ to maintain sufficient trial volume. We review key site-level challenges and barriers to success in clinical trial conduct and argue that issues could be mitigated by sponsors investing programmatically in their site partnerships, including investing in research-naïve sites. Long-term programmatic planning and investment has the potential to deliver greater efficiency and sustainability in trial delivery; site investment upfront would increase working capital for the site, maximizing commitment and security on both sides. This, however, requires safeguarding through the implementation of targets and metrics of success. Many of the challenges faced in modern clinical research can be mitigated by new and longer-term thinking, concerning the working relationship and methods adopted between sponsors and research sites.
Attrition of experienced clinical research coordinators (CRCs) remains one of the most significant challenges to clinical and translational research. While multiple factors contribute to CRC retention, adequate compensation remains one of the most important. This manuscript describes a novel methodology for applying Joint Task Force (JTF) clinical research competencies as a guiding framework for salary adjustments via a pilot program for clinical research staff. This methodology can be adapted to a variety of institutional settings, especially in environments where opportunities for salary advancement are constrained by labor contracts. At UC Davis, CRC salary advancements are defined by contractual agreements with the Union of the Professional and Technical Employees, Research Support Professionals Unit (UPTE RX). While the union contract allows for periodic, across-the-board (all UPTE RX members) salary increases, it does not include clear provisions for merit-or competency-based increases. The CRC Equity Pathway is the first institutional compensation strategy that ties salary advancement to CRC competency, taking a significant step toward eliminating historical salary inequities. The pilot program described in this manuscript demonstrated that the CRC Equity Pathway is a viable mechanism for standardizing job descriptions around the JTF competencies, and for informing corresponding salary adjustments.
This chapter describes the Mental Health Gap Action Programme (mhGAP) and the mhGAP-Intervention Guide (mhGAP-IG) developed by the World Health Organization (WHO), aimed at scaling up suicide prevention and management services to bridge unmet need.The mhGAP-IG is an evidence-based tool for mental disorders with structured and operationalised guidelines for clinical decision-making targeting non-specialist community and primary care workers in low and middle-income countries (LMICs).
Over the last decade in the UK the number of medically trained addiction specialists has halved, to record low numbers. Despite acknowledgment of this crisis by the UK Government in its recently published 10-Year Strategic Plan for the Addiction and Recovery Workforce, psychiatric training remains the only available route to gain specialist medical accreditation in the treatment of addiction disorders. This article asks if it is time for the UK to embrace the creation of a new physician-led addiction medicine specialty akin to models developed in Australia and other peer countries.
To explore factors shaping social prescribing (SP) link workers (LWs) experiences of their job, and how they influence decisions about whether or not to leave it.
Background:
LWs support healthcare delivery by listening to patients’ non-medical concerns and social or relational difficulties, connecting them to ‘community assets’ (groups, organizations, charities) when relevant to help. LWs try to assist people with often complex emotional and/or social issues. This can affect how they feel in their job.
Methods:
As part of a mixed methods project on LW retention, a qualitative study was conducted. It involved 20 LWs, purposively selected from respondents to a questionnaire; variation in the sample was sought in terms of self-efficacy in the role, length of time in it, intention to leave or not, employing organization, where they worked in the UK and gender. Semi-structured interviews, conducted via Microsoft Teams, were audio-recorded and transcribed verbatim. Prior to interviews, we asked participants to take photographs of: a typical part of their working day; something that gave them confidence in their role; an unexpected part of their role. These photographs were discussed at the start of the interview. Thematic analysis was used to interpret data (the computer programme NVIVO supported this); this involved coding and clustering codes to develop analytical themes.
Findings:
We produced four themes from the data; 1) Disconnection through place and space: straddling different organizational spheres; 2) Delivery ambiguity: vagueness around the link worker role; 3) Job misalignment and realignment: navigating identity and boundaries; 4) Clouded by instability: uncertainty around career advancement and sustainability. This led to the development of an overarching theme of LWs inhabiting a liminal space as they entered and undertook the role. Findings highlight the importance of training, supervision and other support to ensure LWs do not experience a prolonged liminal state.
To successfully recruit and retain faculty members from underrepresented backgrounds (URBs), we need to understand the factors that attract them to research careers in the first place. However, scholarship in this area has focused largely on students who are contemplating research careers rather than faculty members who are currently in such careers.
Methods:
This study explores the career motivations of early-career health researchers (faculty members and postdoctoral fellows) from URBs. It was conducted as part of a cluster randomized trial across 25 academic institutions investigating a support intervention. We conducted 1-hour semi-structured qualitative interviews with scholars from URBs in both the intervention and control arms of the trial. To our knowledge, this is the largest qualitative study of early-career faculty members from URBs to date.
Results:
Seventy-eight individuals were interviewed. Our analysis revealed six key themes pertinent to participants’ motivations to pursue research careers: (1) love of science; (2) making a larger impact; (3) happenstance and economic considerations; (4) family, community, and a path out of poverty; (5) the role of mentors and role models; and (6) support programs for scholars from URBs.
Conclusions:
Our results align with prior studies while offering new insights into the motivations of URB faculty members in research careers. These insights can and should inform the design of programs to both recruit and retain URM faculty members in research careers.
Extended reality may offer a convenient and effective method of increasing well-being within the wider healthcare workforce and particularly for those working in the mental health sector who are subject to high levels of stress because of increased workload, high levels of staff turnover and limited resources.
Aims
This scoping review aims to identify and assimilate relevant literature pertaining to the use of extended reality to improve healthcare practitioners’ well-being.
Method
Databases (MEDLINE, CINAHL, Cochrane and PubMed) and grey literature were searched for relevant articles using established methodology and reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews.
Results
A total of 280 articles were yielded by the search strategy, with 13 relevant articles selected by two independent reviewers in a blinded process. Studies demonstrated a heterogenous pool of outcome measurement modalities, intervention modalities and duration and frequency of the interventions. Of all the studies, 85% note a positive impact on healthcare practitioner well-being but studies have limited comparability because of heterogeneity. Interventions were engaging but the practicality of implementing such technologies into a finance- and time-limited healthcare environment will be a challenge.
Conclusions
Whilst extended reality is a promising well-being intervention, there is a paucity of literature relating to its effect on mental health practitioners’ well-being, and further studies in this area are required.
Consistent with many countries in the region, the Republic of Guatemala likely has a high level of mental health need. However, with high poverty rates and workforce deficits, Guatemala faces challenges in providing accessible mental healthcare across the nation. We describe examples of interventions that have been developed to reduce this mental health gap by addressing the existing barriers to accessing mental healthcare. Within this country profile, we identify further opportunities, such as future mental health legislation, to improve access to services across the human lifespan, especially for at-risk and underserved communities.
The complexities inherent in healthcare organisations highlight the multifaceted nature of their operations. Regardless of role, scale, procedural intricacies or governance structures, these organisations need to deal with the complexities of both internal dynamics and external landscapes. The diversity of stakeholders involved adds layers of challenge to effectively managing clinical and social processes, optimising outcomes, allocating resources equitably, developing and retaining a skilled workforce, making informed decisions and upholding ethical standards.
Workforce planning in the healthcare system continues to be a politically charged issue in many countries due to the continuing shortage of various health professional groups and the subsequent costs and liabilities to governments hoping to generate improvements and efficiencies. In 2016, the World Health Organization (WHO) released the Global strategy on human resources for health: Workforce 2030, whose overall goal was to improve health, social and economic development outcomes by ensuring universal availability, accessibility, acceptability, coverage and quality of the health workforce, through adequate investment to strengthen health systems and the implementation of effective policies at national, regional and global levels. The Strategy reaffirms the importance of the WHO Global Code of Practice on the International Recruitment of Health Personnel, which recommends countries, including Australia and Aotearoa New Zealand, aim for workforce self-sufficiency with regard to workforce-planning.
In a text on leadership and management in health services, human resource management requires a strategic approach. Health is dominated by a large, diverse and highly professionalised workforce. Human resource management is complex and focuses on the performance effects of human resource systems rather than individual human resource practices. The focus is on systems since employees are exposed to an interrelated set of human resource practices which, in turn, are dependent on other multiple sets of systems within the wider health service.
Women remain underrepresented in National Institutes of Health (NIH) study sections, panels of scientists who review grant applications to inform national research priorities and funding allocations. This longitudinal, retrospective study examined the representation of women on study sections before and during the COVID-19 pandemic. Overall, 16,902 reviewers served on 1,045 study sections across 2019, 2020, and 2021, of which 40.1% (n = 6,786) were women. The likelihood of reviewers being women significantly increased from 2019 to 2021, except among chairpersons. Understanding the representation of scientists influencing NIH grant decisions is important to ensuring scientific discovery that meets the nation’s pluralistic needs.
Rates of youth anxiety, depression, and self-harm have increased substantially in recent years. Expansion of clinical service capacity is constrained by workforce shortages and system fragmentation, and even substantial investment may not achieve the scale of growth required to address unmet need. Preventive strategies – such as strengthening social cohesion – are therefore essential to alleviate mounting pressures on the mental health system, yet their potential to compensate for these constraints remains unquantified.
Methods
This study employed a system dynamics model to explore the interplay between service capacity and social cohesion on youth mental health outcomes. The model was developed for a population catchment characterized by a mix of urban, suburban, and rural communities. Primary outcomes were prevalence of psychological distress and mental disorders, and incidence of mental health-related emergency department (ED) presentations among young people aged 15–24 years, projected over a 10-year time horizon. Two-way sensitivity analyses of services capacity and social cohesion were conducted.
Results
Changes to specialized mental health services capacity growth had the greatest projected impact on youth mental health outcomes. Heatmaps revealed thresholds where improvements in social cohesion could offset negative impacts of constrained service capacity. For example, if services capacity growth was sustained at only 80% of baseline, improving social cohesion could still reduce years lived with symptomatic disorder by 6.3%. To achieve a similar scale of improvement without improvements in social cohesion, the current growth rate in services capacity would need to be more than double. Combining a doubling of service capacity growth with reversing the decline in social cohesion could reduce ED presentations by 25.6% and years with symptomatic mental disorder by 19.2%. A doubling of specialized, headspace, and GP services capacity growth could prevent 24,060 years lived with symptomatic mental disorder among youth aged 15–24.
Conclusions
This study provides a quantitative framework for understanding how social cohesion improvements can help mitigate workforce constraints in mental health systems, demonstrating the value of integrating service expansion with social cohesion enhancement strategies.
The roles and responsibilities of the public health emergency preparedness (PHEP) and response workforce have changed since the last iteration of competencies developed in 2010. This project aims to identify current competencies (i.e., knowledge, skills, and abilities) for the PHEP workforce, as well as all public health staff who may contribute to a response.
Methods
Five focus groups with members of the PHEP workforce across the US focused on their experiences with workforce needs in preparedness and response activities. Focus group transcripts were thematically analyzed using qualitative methods to identify key competencies needed in the workforce.
Results
The focus groups revealed 7 domains: attitudes and motivations; collaboration; communications; data collection and analysis; preparedness and response; leadership and management; and public health foundations. Equity and social justice was identified as a cross-cutting theme across all domains.
Conclusions
Broad validation of competencies through ongoing engagement with the PHEP practice and academic communities is necessary. Competencies can be used to inform the design of PHEP educational programs and PHEP program development. Implementation of an up-to-date, validated competency model can help the workforce better prepare for and respond to disasters and emergencies.
The purpose of this research was to understand perceptions and experiences of inclusion among underrepresented early-career biomedical researchers (postdoctoral fellows and early-career faculty) enrolled in the Building Up study. Because inclusion is vital to job satisfaction and engagement, our goal was to shed light on aspects of and barriers to inclusion within the academic workforce.
Methods:
We used qualitative interviews to assess workplace experiences of 25 underrepresented postdoctoral fellows and early-career faculty including: their daily work experiences; sense of the workplace culture within the institutions; experiences with microaggressions, racism, and discrimination; and whether the diversity, equity, and inclusion (DEI) policies and practices at their institution enhanced their experiences. Using qualitative methods, we identified themes that highlighted high-level characteristics of inclusion.
Results:
Four distinct themes were identified: (1) participants appreciated the flexibility, versatility, and sense of fulfillment of their positions which enhanced feelings of inclusion; (2) greater psychological safety led to a greater sense of belonging to a research community; (3) participants had varied experiences of inclusion in the presence of microaggressions, racism, and discrimination; and (4) access to opportunities and resources increased feelings of value within the workplace.
Discussion:
Our findings provide new insight into how inclusion is experienced within the institution among underrepresented early-career biomedical researchers. This research points to specific approaches that could be used to enhance experiences of inclusion and to address barriers. More research is needed to understand how to accomplish a balance between the two, so that perceptions of inclusion outweigh negative experiences.
Community and primary health care nursing is experiencing a rapid metamorphosis as our population ages and the prevalence of chronic and complex conditions increases. To meet these changing needs, our health workforce has evolved with a range of specialised disciplines now working in diverse health settings. Throughout these changes, nursing continues to be the largest global health workforce providing the most direct client care. Historically, nurses were the original transdisciplinary health care workers, providing basic physiotherapy, occupational therapy, nutritional advice and all other care as required. As more detailed knowledge developed in an area of practice, specialised areas of care evolved, and a variety of allied health professions emerged. In turn, nursing itself became more specialised, due to developments in clinical practice, technological advances and the need for more complex care.
The Japanese mass media has been reporting a rising number of foreign workers in Japan based on data published by the Ministry of Health, Labour and Welfare. The Ministry's data, however, is neither derived from a comprehensive database of foreign workers, nor is it a credible source of information about the foreign workforce. This paper explains how the ministry arrives at its figures, why the reported rapid increase over the past decade is incorrect, and pinpoints flaws in its data collection process. Finally, we suggest a new approach for estimating the total number of foreign workers in Japan at a time when the Japanese government has proposed a significant increase in the number of foreign workers.
Converting knowledge from basic research into innovations that improve clinical care requires a specialized workforce that converts a laboratory invention into a product that can be developed and tested for clinical use. As the mandate to demonstrate more real-world impact from the national investment in research continues to grow, the demand for staff that specialize in product development and clinical trials continues to outpace supply. In this study, two academic medical institutions in the greater Houston–Galveston region termed this population the “bridge and clinical research professional” (B + CRP) workforce and assessed its turnover before and after the onset of the COVID-19 pandemic . Both institutions realized growth (1.2 vs 2.3-fold increase) in B + CRP-specific jobs from 2017 to 2022. Turnover increased 1.5–2-fold after the onset of the pandemic but unlike turnover in the larger clinical and translational research academic workforce, the instability did not resolve by 2022. These results are a baseline measurement of the instability of our regional B + CRP workforce and have informed the development of a regional alliance of universities, academic medical centers, and economic development organizations in the greater Houston–Galveston region to increase this highly specialized and skilled candidate pool.