Journal of Health Organization and Management最新文献

{"title":"Dynamic adaptive decision support for strategic decision-making in healthcare organizations.","authors":"Anke Aarninkhof-Kamphuis, Hans Voordijk, Geert Dewulf","doi":"10.1108/JHOM-07-2023-0229","DOIUrl":"https://doi.org/10.1108/JHOM-07-2023-0229","url":null,"abstract":"<p><strong>Purpose: </strong>The main objective of this study was to design a dynamic adaptive decision support model for healthcare organizations facing deep uncertainties by considering promising dynamic adaptive approaches. The main argument for this is that healthcare organizations have to make strategic decisions under deep uncertainty, but lack an approach to deal with this.</p><p><strong>Design/methodology/approach: </strong>A Dynamic Adaptive Decision Support model (DADS) is designed using the Design Science Research methodology. The evaluation of an initial model leads, through two case studies on ongoing and strategic decision-making, to the final design of this needed model for healthcare organizations.</p><p><strong>Findings: </strong>The research reveals the relevance of the designed dynamic and adaptive tool to support strategic decision-making for healthcare organizations. The final design of DADS innovates Decision Making under Deep Uncertainty (DMDU) approaches in an organizational context for ongoing and strategic decision-making.</p><p><strong>Originality/value: </strong>The designed model applies the Dynamic Adaptive Policy Pathways approach in an organizational context and more specifically in health care organizations. It further integrates Corporate Real Estate Management knowledge and experience to develop a most needed tool for decision-makers in healthcare. This is the first DADS designed for an organization facing deep uncertainties in a rapidly changing healthcare environment and dealing with ongoing and strategic decision-making.</p>","PeriodicalId":47447,"journal":{"name":"Journal of Health Organization and Management","volume":"38 5","pages":"638-661"},"PeriodicalIF":1.7,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship among group learning, individuals' and groups' internalization of evidence-based practice, and nurses' sustainment of the practice: a cross-sectional study.","authors":"Keiko Ishii, Yukie Takemura, Ryohei Kida","doi":"10.1108/JHOM-04-2023-0096","DOIUrl":"https://doi.org/10.1108/JHOM-04-2023-0096","url":null,"abstract":"<p><strong>Purpose: </strong>This study, by applying the feedback process of the organizational learning model, examined the relationships among group learning, individuals' and groups' internalization of institutionalized evidence-based practice (I-EBP), and nurses' sustainment of I-EBP.</p><p><strong>Design/methodology/approach: </strong>Twelve hospitals were included in this cross-sectional study, with 1,741 nurses from 59 wards. Anonymous questionnaires were administered from October to December 2021. Participants self-reported their wards' group learning, internalization of I-EBP, sustainment of I-EBP, EBP beliefs, intra-hospital transfers, and nursing research experiences. The number of nurses and I-EBP introduction length and type of I-EBP were assessed. Internalization of I-EBP of nurses and groups was considered the mediating variable, while group learning and nurses' sustainment of I-EBP were the independent and dependent variables, respectively. Significant variables in bivariate analyses were used as control variables. Multi-level Mediation Analysis and a significance test of indirect effect using the bootstrap method were conducted.</p><p><strong>Findings: </strong>Responses from 360 nurses in 48 wards from 12 hospitals were analyzed. Groups' internalization of I-EBP significantly mediated the relationship between group learning and nurses' sustainment of I-EBP. In contrast, no significant mediating effect of nurses' internalization of I-EBP was observed.</p><p><strong>Originality/value: </strong>In the feedback process of organizational learning, group learning and its subsequent effects on individuals and groups have not been previously examined. Regardless of the nurses' degree of internalization of I-EBP, those who belong to the ward with a high degree of internalization of I-EBP are more likely to sustain it. Conducting group learning may prevent superficial practice, resulting in its sustainability.</p>","PeriodicalId":47447,"journal":{"name":"Journal of Health Organization and Management","volume":"38 5","pages":"705-723"},"PeriodicalIF":1.7,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What are the antecedents of nosiness among nurses? A qualitative study.","authors":"Mehdi Golverdi, Amir Hossein Soleimani Naeini, Mohammad Shaker Ardakani, Mohammad Sadegh Sharifirad","doi":"10.1108/JHOM-10-2023-0306","DOIUrl":"https://doi.org/10.1108/JHOM-10-2023-0306","url":null,"abstract":"<p><strong>Purpose: </strong>Nosiness is an annoying behavior at the workplace that can lead to negative consequences. It is characterized by being overly curious about other people's affairs. Specifically, this study aims to identify the factors contributing to nosiness among nurses.</p><p><strong>Design/methodology/approach: </strong>We conducted an exploratory qualitative interview study involving 38 nurses in Iran. The participants were selected by purposive sampling.</p><p><strong>Findings: </strong>We identified nine themes as the antecedents of nosiness among nurses: defamation motive, the need for certainty, the need for power, recreational motive, empathy, social comparison, the allure of the subject for the individual, having an employee-friendly workplace, and work environment and workload.</p><p><strong>Originality/value: </strong>Understanding the antecedents of nosiness can help healthcare organizations curtail this phenomenon and foster a positive work environment, particularly in nursing where empathy, compassion, and attention to detail make them susceptible to nosiness.</p>","PeriodicalId":47447,"journal":{"name":"Journal of Health Organization and Management","volume":"38 5","pages":"760-777"},"PeriodicalIF":1.7,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public-private partnerships, boundary spanners and the boundary wall in the English National Health Service.","authors":"James Duncan Alexander","doi":"10.1108/JHOM-01-2023-0002","DOIUrl":"https://doi.org/10.1108/JHOM-01-2023-0002","url":null,"abstract":"<p><strong>Purpose: </strong>The paper investigates English National Health Service (NHS) organisations partnering with private companies, a form commonly known as a Public-Private Partnership (PPP). Successive governments have promoted PPPs as a way of improving the delivery of health care, making the best of the different skills/experience which both sectors bring. However, the task of making these relationships work on the ground often falls to individual leaders/practitioners (\"boundary spanners\") whose role has been under-researched in this type of partnership.</p><p><strong>Design/methodology/approach: </strong>The paper opted for a comparative three case study approach, including 13 semi-structured interviews and questionnaires with employees representing middle and senior management involved in managing the partnerships. The data were complemented by documentary analysis, including minutes, descriptions of internal processes and press releases.</p><p><strong>Findings: </strong>The paper provides conceptual and empirical insights by creating a framework called the \"boundary wall\" that indicates the ways in which different elements of the boundaries between organisations influence the role and activities of boundary spanners (managers of the partnership).</p><p><strong>Research limitations/implications: </strong>This is an initial framework in an under-researched area, so will need further testing and application to other case study sites in future research.</p><p><strong>Practical implications: </strong>The paper includes implications for both practice and policy.</p><p><strong>Originality/value: </strong>While we know an increasing amount about the role of boundary spanners in public partnerships, the paper makes a unique contribution by exploring these concepts in the context of relationships between the public and private sectors.</p>","PeriodicalId":47447,"journal":{"name":"Journal of Health Organization and Management","volume":"38 5","pages":"662-681"},"PeriodicalIF":1.7,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The joint impact of burnout and neurotic personality on career satisfaction and intention to leave among health workers during the first 2 years of COVID-19.","authors":"Hannah Vivian Osei, Justice Arthur, Francis Aseibu, Daniel Osei-Kwame, Rita Fiakeye, Charity Abama","doi":"10.1108/JHOM-03-2023-0089","DOIUrl":"https://doi.org/10.1108/JHOM-03-2023-0089","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of the study is to examine the psychological impact of COVID-19 on health workers' career satisfaction and intention to leave the health profession, with neurotic personality type as a moderator.</p><p><strong>Design/methodology/approach: </strong>A total of 277 health workers in two public hospitals in Ghana were included in this study. Purposive and convenience sampling techniques were adopted for the study, focusing on eight departments that were involved in the management of COVID-19 cases. Validated instruments were used to measure burnout, intention to leave, neurotic personality and career satisfaction. Using AMOS and partial least squares structural equation modeling (PLS-SEM), various techniques were employed to analyze mediating and moderating mechanisms.</p><p><strong>Findings: </strong>The departments had staff sizes ranging from 19 to 40, with 67% female and 33% male, with an average age of 31. Nurses accounted for the majority of responses (67.8%), followed by physicians (13.9%), sonographers (0.9%), lab technicians (0.9%) and other respondents (16.5%). The study found that health workers' level of burnout during COVID-19 had a positive effect on their intention to leave the health profession. Career satisfaction does not mediate this relationship; however, career satisfaction negatively influences the intention to leave the health profession. A neurotic personality does not moderate this relationship.</p><p><strong>Originality/value: </strong>This study provides validation of burnout and intention to leave among health workers in Ghana during COVID-19 and supports the proposition that threats to resources (burnout) and having a resource (career satisfaction) have effects on the intention to leave one's profession.</p>","PeriodicalId":47447,"journal":{"name":"Journal of Health Organization and Management","volume":"ahead-of-print ahead-of-print","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosing patient flow issues in the emergency department: an Australasian hospital case study.","authors":"Tillmann Boehme, Brogan Rylands, Joshua Poh Fan, Sharon Williams, Eric Deakins","doi":"10.1108/JHOM-12-2022-0378","DOIUrl":"https://doi.org/10.1108/JHOM-12-2022-0378","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigates how a hospital can increase the flow of patients through its emergency department by using benchmarking and process improvement techniques borrowed from the manufacturing sector.</p><p><strong>Design/methodology/approach: </strong>An in-depth case study of an Australasian public hospital utilises rigorous, multi-method data collection procedures with systems thinking to benchmark an emergency department (ED) value stream and identify the performance inhibitors.</p><p><strong>Findings: </strong>High levels of value stream uncertainty result from inefficient processes and weak controls. Reduced patient flow arises from senior management's commitment to simplistic government targets, clinical staff that lack basic operations management skills, and fragmented information systems. High junior/senior staff ratios aggravate the lack of inter-functional integration and poor use of time and material resources, increasing the risk of a critical patient incident.</p><p><strong>Research limitations/implications: </strong>This research is limited to a single case; hence, further research should assess value stream maturity and associated performance enablers and inhibitors in other emergency departments experiencing patient flow delays.</p><p><strong>Practical implications: </strong>This study illustrates how hospital managers can use systems thinking and a context-free performance benchmarking measure to identify needed interventions and transferable best practices for achieving seamless patient flow.</p><p><strong>Originality/value: </strong>This study is the first to operationalise the theoretical concept of the seamless healthcare system to acute care as defined by Parnaby and Towill (2008). It is also the first to use the uncertainty circle model in an Australasian public healthcare setting to objectively benchmark an emergency department's value stream maturity.</p>","PeriodicalId":47447,"journal":{"name":"Journal of Health Organization and Management","volume":"ahead-of-print ahead-of-print","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141332274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organizing visions for data-centric management: how Norwegian policy documents construe the use of data in health organizations.","authors":"Mads Solberg, Ralf Kirchhoff, Jannike Dyb Oksavik, Lauri Wessel","doi":"10.1108/JHOM-12-2023-0378","DOIUrl":"https://doi.org/10.1108/JHOM-12-2023-0378","url":null,"abstract":"<p><strong>Purpose: </strong>Norway, like other welfare states, seeks to leverage data to transform its pressured public healthcare system. While managers will be central to doing so, we lack knowledge about how specifically they would do so and what constraints and expectations they operate under. Public sources, like the Norwegian policy documents investigated here, provide important backdrops against which such managerial work emerges. This article therefore aims to analyze how key Norwegian policy documents construe data use in health management.</p><p><strong>Design/methodology/approach: </strong>We analyzed five notable policy documents using a \"practice-oriented\" framework, considering these as arenas for \"organizing visions\" (OVs) about managerial use of data in healthcare organizations. This framework considers documents as not just texts that comment on a topic but as discursive tools that formulate, negotiate and shape issues of national importance, such as expectations about data use in health management.</p><p><strong>Findings: </strong>The OVs we identify anticipate a bold future for health management, where data use is supported through interconnected information systems that provide relevant information on demand. These OVs are similar to discourse on \"evidence-based management,\" but differ in important ways. Managers are consistently framed as key stakeholders that can benefit from using secondary data, but this requires better data integration across the health system. Despite forward-looking OVs, we find considerable ambiguity regarding the practical, social and epistemic dimensions of data use in health management. Our analysis calls for a reframing, by moving away from the hype of \"data-driven\" health management toward an empirically-oriented, \"data-centric\" approach that recognizes the situated and relational nature of managerial work on secondary data.</p><p><strong>Originality/value: </strong>By exploring OVs in the Norwegian health policy landscape, this study adds to our growing understanding of expectations towards healthcare managers' use of data. Given Norway's highly digitized health system, our analysis has relevance for health services in other countries.</p>","PeriodicalId":47447,"journal":{"name":"Journal of Health Organization and Management","volume":"ahead-of-print ahead-of-print","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141307109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the readiness of healthcare administration students to utilize AI for sustainable leadership: a survey study.","authors":"Mohammad Movahed, Stephanie Bilderback","doi":"10.1108/JHOM-12-2023-0385","DOIUrl":"https://doi.org/10.1108/JHOM-12-2023-0385","url":null,"abstract":"<p><strong>Purpose: </strong>This paper explores how healthcare administration students perceive the integration of Artificial Intelligence (AI) in healthcare leadership, mainly focusing on the sustainability aspects involved. It aims to identify gaps in current educational curricula and suggests enhancements to better prepare future healthcare professionals for the evolving demands of AI-driven healthcare environments.</p><p><strong>Design/methodology/approach: </strong>This study utilized a cross-sectional survey design to understand healthcare administration students' perceptions regarding integrating AI in healthcare leadership. An online questionnaire, developed from an extensive literature review covering fundamental AI knowledge and its role in sustainable leadership, was distributed to students majoring and minoring in healthcare administration. This methodological approach garnered participation from 62 students, providing insights and perspectives crucial for the study's objectives.</p><p><strong>Findings: </strong>The research revealed that while a significant majority of healthcare administration students (70%) recognize the potential of AI in fostering sustainable leadership in healthcare, only 30% feel adequately prepared to work in AI-integrated environments. Additionally, students were interested in learning more about AI applications in healthcare and the role of AI in sustainable leadership, underscoring the need for comprehensive AI-focused education in their curriculum.</p><p><strong>Research limitations/implications: </strong>The research is limited by its focus on a single academic institution, which may not fully represent the diversity of perspectives in healthcare administration.</p><p><strong>Practical implications: </strong>This study highlights the need for healthcare administration curricula to incorporate AI education, aligning theoretical knowledge with practical applications, to effectively prepare future professionals for the evolving demands of AI-integrated healthcare environments.</p><p><strong>Originality/value: </strong>This research paper presents insights into healthcare administration students' readiness and perspectives toward AI integration in healthcare leadership, filling a critical gap in understanding the educational needs in the evolving landscape of AI-driven healthcare.</p>","PeriodicalId":47447,"journal":{"name":"Journal of Health Organization and Management","volume":"ahead-of-print ahead-of-print","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141301826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is knowledge liberating? The role of knowledge behaviors and competition on the workplace happiness of healthcare professionals.","authors":"Tiago Gonçalves, Lucía Muñoz-Pascual, Carla Curado","doi":"10.1108/JHOM-12-2022-0382","DOIUrl":"https://doi.org/10.1108/JHOM-12-2022-0382","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this paper is to highlight the joint impact of competitive culture and knowledge behaviors (sharing, hoarding and hiding) on workplace happiness among healthcare professionals. It addresses a literature gap that critiques the development of happiness programs in healthcare that overlook organizational, social and economic dynamics. The study is based on the Social Exchange Theory, the Conservation of Resources Theory and the principles of Positive Psychology.</p><p><strong>Design/methodology/approach: </strong>The study analyzes a linear relationship between variables using a structural equation model and a partial least squares approach. The data are sourced from a survey of 253 healthcare professionals from Portuguese healthcare organizations.</p><p><strong>Findings: </strong>The data obtained from the model illustrate a positive correlation between competitive culture and knowledge hoarding as well as knowledge hiding. Interestingly, a competitive culture also fosters workplace happiness among healthcare professionals. The complex relationship between knowledge behaviors becomes evident since both knowledge hoarding and sharing positively affected these professionals' workplace happiness. However, no direct impact was found between knowledge hiding and workplace happiness, suggesting that it negatively mediates other variables.</p><p><strong>Originality/value: </strong>This research addresses a previously identified threefold gap. First, it delves into the pressing need to comprehend behaviors that enhance healthcare professionals' workplace satisfaction. Second, it advances studies by empirically examining the varied impacts of knowledge hiding, hoarding and sharing. Finally, it sheds light on the repercussions of knowledge behaviors within an under-explored context - healthcare organizations.</p>","PeriodicalId":47447,"journal":{"name":"Journal of Health Organization and Management","volume":"ahead-of-print ahead-of-print","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141262825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between profitability and financial factors of hospitals after a period of austerity and health care reforms: evidence from Greece.","authors":"Stelios Terzoudis, Nikolaos Kontodimopoulos, John Fanourgiakis","doi":"10.1108/JHOM-05-2023-0147","DOIUrl":"https://doi.org/10.1108/JHOM-05-2023-0147","url":null,"abstract":"<p><strong>Purpose: </strong>The reduction of government expenditure in the healthcare system, the difficulty of finding new sources of funding and the reduction in disposable income per capita are the most important problems of the healthcare system in Greece over the last decade. Therefore, studying the profitability of health structures is a crucial factor in making decisions about their solvency and corporate sustainability. The aim of this study is to investigate the effect of economic liquidity, debt and business size on profitability for the Greek general hospitals (GHs) during the period 2016-2018.</p><p><strong>Design/methodology/approach: </strong>Financial statements (balance sheets and income statements) of 84 general hospitals (GHs), 52 public and 32 private, over a three-year period (2016-2018), were analyzed. Spearman's Rs correlation was carried out on two samples.</p><p><strong>Findings: </strong>The results revealed that there is a positive relationship between the investigated determinants (liquidity, size) and profitability for both public and private GHs. It was also shown that debt has a negative effect on profitability only for private GHs.</p><p><strong>Practical implications: </strong>Increasing the turnover of private hospitals through interventions such as expanding private health insurance and adopting modern financial management techniques in public hospitals would have a positive effect both on profitability and the efficient use of limited resources.</p><p><strong>Originality/value: </strong>These results, in conjunction with the findings of the low profitability of private hospitals and the excess liquidity of public hospitals, can shape the appropriate framework to guide hospital administrators and government policymakers.</p>","PeriodicalId":47447,"journal":{"name":"Journal of Health Organization and Management","volume":"ahead-of-print ahead-of-print","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141187083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}