Frontiers in health services最新文献

{"title":"Posttraumatic stress in young children at risk for maltreatment: a causal data science analysis.","authors":"Glenn N Saxe, Leah J Morales, Sisi Ma, Mehmet Urgurbil, Constantin Aliferis","doi":"10.3389/frhs.2026.1784459","DOIUrl":"https://doi.org/10.3389/frhs.2026.1784459","url":null,"abstract":"<p><strong>Introduction: </strong>This article features the application of Causal Data Science (CDS) methods to determine the mechanism for Posttraumatic Stress (PTS) in young, maltreated children, in order to advance knowledge for prevention. Advances in prevention require research that identifies causal factors, but the scientific literature that would inform the identification of causes are almost exclusively based on the application of correlational methods to observational data. Causal inferences from such research will frequently be in error. We conducted the present study to explore the application of CDS methods as an alternative-or a supplement-to experimental methods, which can rarely be applied in human research on causal factors for PTS.</p><p><strong>Methods: </strong>A data processing pipeline that integrates state-of-the-art CDS algorithms was applied to an existing observational, longitudinal data set collected by the Consortium for Longitudinal Studies in Child Abuse and Neglect (LONGSCAN). This data set contains a sample of 1,354 children who were identified in infancy to early childhood as being maltreated or at risk.</p><p><strong>Results: </strong>A causal network model of 251 variables (nodes) and 818 bivariate relations (edges) was discovered, revealing four direct causes (Emotional Maltreatment at age 0-4, Physical Assault at age 8, Feeling of Safety at age 8, and Witnessing Violence at age 8) and two direct effects (Negative Self-Image and Severe Assault from a Non-Caregiver at age 8) of PTS at age 8, within a network containing a broad diversity of causal pathways.</p><p><strong>Discussion: </strong>These results indicate that CDS methods show promise for research on the complex etiology of PTS in young, maltreated children.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1784459"},"PeriodicalIF":2.7,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduction of simultaneous ordering rate of high sensitivity C-reactive protein and erythrocyte sedimentation rate in a veteran affairs healthcare system.","authors":"Luke Valencia","doi":"10.3389/frhs.2025.1729117","DOIUrl":"https://doi.org/10.3389/frhs.2025.1729117","url":null,"abstract":"<p><p>It is widely recognized that the ESR (Erythrocyte Sedimentation Rate) and hs-CRP (C-Reactive Protein) are comparable inflammatory markers. In this reported veteran population, there is a significant correlation between the two assays. The simultaneous ordering of ESR and hs-CRP for evaluation of acute inflammation is unnecessary and wasteful. Various hospitals have implemented processes to reduce co-ordering habits through best practice advisories (BPAs) and/or educational interventions. In this retrospective study spanning twelve months, the Northern California Veteran Affairs Hospital System had a co-ordering rate of approximately 72% (number of hs-CRP orders with a co-ordered ESR compared to the total number of hs-CRP orders). After implementing a best practice ordering advisory and providing education to the clinical teams, there was a significant decrease in co-ordering of the assays (-34%, <i>p</i>-value = 0.00036). There was also a significant decrease in standalone ESR ordering and standalone hs-CRP ordering (<i>p</i>-value = 0.0003 and 0.0042, respectively). Departments receiving both interventions, an ordering advisory and education, had the largest decrease in co-ordering habits, the largest decrease seen being more than 56%. Proper implementation of ordering advisories paired with education results in better test utilization and lower co-ordering rates.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1729117"},"PeriodicalIF":2.7,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13144006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trust and trade: patient perspectives on the ethics of real-world data monetisation.","authors":"Alexandros Sagkriotis","doi":"10.3389/frhs.2026.1771744","DOIUrl":"https://doi.org/10.3389/frhs.2026.1771744","url":null,"abstract":"<p><p>Real-world data (RWD) and real-world evidence (RWE) are increasingly used to inform regulatory decisions, health technology assessment, and health system planning. However, patients whose data underpin these activities often experience limited transparency or benefit when their information is monetised. While regulatory and HTA frameworks emphasise methodological rigor and analytical transparency, they provide limited guidance on fairness, reciprocity, and legitimacy from a patient perspective. This Policy Brief examines this governance gap and argues that evidence integrity must extend beyond technical standards to include ethical stewardship and public trust. Drawing on policy contexts from UK, EU, and North America, it proposes five pragmatic safeguards to strengthen transparency, accountability, and patient-centred governance in secondary data use, supporting the sustainability and legitimacy of RWE infrastructures as data initiatives expand.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1771744"},"PeriodicalIF":2.7,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13132845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital competence in health and nursing education: a cross-national comparison between samples from Germany and India using the DigKomp 2.2 questionnaire.","authors":"Tom Schaal, Tim Tischendorf, Harshad Hend","doi":"10.3389/frhs.2026.1801330","DOIUrl":"https://doi.org/10.3389/frhs.2026.1801330","url":null,"abstract":"<p><strong>Introduction: </strong>The digital transformation in healthcare requires future professionals to have solid digital skills. Despite the global relevance of digital skills, little is known about how these skills differ in countries with different healthcare and education systems. This study compares the self-assessed digital skills of two institutional samples of healthcare and nursing students in Germany and India using the DigKomp 2.2 questionnaire and examines the correlation between perceived competence and the strategies reported for searching for information.</p><p><strong>Methods: </strong>An online cross-sectional survey was conducted in April and May 2025 among 49 students in Germany and 256 students in India. Digital competences were assessed using the DigKomp 2.2 questionnaire, which covers all five dimensions of the DigComp framework. An open-ended question was used to record the students' strategies for searching for reliable information on the internet. The quantitative data were analyzed using the Kolmogorov-Smirnov test, the Levene test, and the t-test for two independent samples.</p><p><strong>Results: </strong>Both cohorts showed acceptable to high internal consistency across all DigKomp 2.2 dimensions. Students in the German cohort reported higher competencies in data processing and evaluation and communication/collaboration, while students from the Indian cohort scored higher in digital content creation, security and problem solving. The exploratory bivariate analysis between the Indian and German samples revealed significant differences in 7 out of 15 items, specifically within the dimensions of digital content creation (3/3 items), Security (2/3 items), data processing & evaluation (1/3 items), and problem solving (1/4 items), whereas no significant differences were found in communication/cooperation (0/2 items). Qualitative responses revealed structured and academically oriented search strategies among German cohort. Indian responses showed greater heterogeneity.</p><p><strong>Discussion: </strong>Digital competence development varies substantially between the two institutional samples, reflecting differences in educational structures, access to digital technologies and national digitalization trajectories. While German students demonstrate strong academically grounded competencies, Indian students exhibit strengths in practical and applied digital competence. These findings underscore the need for context-sensitive digital education strategies that combine structured research competencies with practical digital literacy to prepare students for increasingly digitalized healthcare environments in both countries.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1801330"},"PeriodicalIF":2.7,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13132836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-based framework for organisational best practice recommendations in healthcare governance.","authors":"Davide Di Fusco, Serena Lavorgna, Barbara Rossi, Matteo Marconi, Claudia Marchetta, Gabriella Facchinetti, Marco Bressi, Filippo Lauria, Romano Arcieri, Velia Bruno","doi":"10.3389/frhs.2026.1803273","DOIUrl":"https://doi.org/10.3389/frhs.2026.1803273","url":null,"abstract":"<p><p>Clinical governance requires the integration of evidence not only on clinical interventions but also on organisational processes that shape health services delivery and directly influence quality, efficiency, and patient safety. Despite the widespread availability of evidence-based clinical guidelines, healthcare systems often lack standardised methods to translate evidence into effective organisational models. To address this gap, the Italian National Centre for Clinical Governance (CNCG) at the Italian National Institute of Health (ISS) developed a structured methodological framework for Organisational Clinical Best Practice Recommendations (O-BPCA), aimed at strengthening evidence-based governance and organisational performance within healthcare services. The O-BPCA framework was developed through a structured, multi-step process encompassing governance principles, methodological standards, and operational phases, culminating in institutional validation through external review, public consultation, and formal approval by the ISS. The methodological manual defines transparent procedures for evidence synthesis, consensus building, and the formulation of measurable organisational recommendations applicable across health service settings. The framework has been operationalised within the CNCG through the identification of two priority macro-areas for organisational innovation, surgical and territorial care, and the establishment of dedicated Thematic Operational Groups (GOTs) responsible for developing and validating O-BPCA recommendations in selected priority domains. Early implementation has highlighted the framework's feasibility, scalability, and potential to support coordinated organisational improvement within the Italian National Health Service. The O-BPCA framework represents an innovative policy and methodological tool for healthcare governance, bridging clinical evidence and organisational implementation within health services. By promoting standardisation, transparency, and accountability in organisational decision-making, the framework supports sustainable improvements in service delivery and performance. Its structured and replicable approach makes it transferable beyond the Italian National Health Service and adaptable to other health systems seeking to strengthen evidence-based organisational governance.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1803273"},"PeriodicalIF":2.7,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic literature review and narrative synthesis of the use of natural language processing to triage outpatient referrals.","authors":"Angela Lim Fung, Mohamed Abdalla, Yu Blanche Cheng, Manar Elsayed, Dagmara Chojecki, Joseph Ross Mitchell, Carrie Ye","doi":"10.3389/frhs.2026.1797583","DOIUrl":"https://doi.org/10.3389/frhs.2026.1797583","url":null,"abstract":"<p><strong>Background: </strong>Natural Language Processing (NLP) models show promise in enhancing interpretation and triage of outpatient referrals across diverse specialties.</p><p><strong>Objective: </strong>To conduct a systematic literature review and narrative synthesis of recent studies that utilized NLP-based models for triage-related tasks such as urgency prioritization, referral classification, and justification review.</p><p><strong>Methods: </strong>Medline, Embase, Web of Science, and CINAHL databases were searched for articles published up to February 17 2024, limiting searches to the last 5 years prior to the search. All citations were imported into Covidence for duplicate removal and screening. We included studies that utilized NLP techniques to triage outpatient referrals to a specialist (medical or surgical), and included comparison to human triage. Abstracts and full texts were each screened independently by two reviewers. Data from each study were extracted independently by two reviewers using a standardized extraction form, including fields such as study design, dataset size, specialty, models tested, and outcomes reported. Results were synthesized narratively, organized by key themes focused on data, model and clinical applicability. Quality and risk of bias assessment was performed using the PROBAST-AI and Technology Readiness scales.</p><p><strong>Results: </strong>A total of 4,225 titles and abstracts were reviewed resulting in 26 full-text reviews. A total of 10 studies were used for data extraction and synthesis. These studies spanned a wide range of medical specialties including surgery, medical specialties, and radiology. Tasks included predicting condition and priority level. Most domains were assessed as low or uncertain risk of bias. Outcome measures varied across studies, but overall, 7 studies reported high levels of accuracy compared to manual workflows. We summarized key differences in dataset preprocessing and augmentation, triage model, and feasibility and clinical applicability.</p><p><strong>Conclusion: </strong>NLP shows promise in augmenting human triage of outpatient referrals to specialty care. To realize the full potential of NLP for triage, future work should prioritize standardized reporting and prospective validation to support safe and effective integration into healthcare systems.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1797583"},"PeriodicalIF":2.7,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rule-based clinical decision support system for automated assessment of left ventricular diastolic function during stress echocardiography.","authors":"Gulnora Rozikhodjaeva, Omonulla Juraev, H-Christian Brauweiler, Tom Schaal","doi":"10.3389/frhs.2026.1690832","DOIUrl":"https://doi.org/10.3389/frhs.2026.1690832","url":null,"abstract":"<p><strong>Background: </strong>Heart failure with preserved ejection fraction (HFpEF) remains challenging to diagnose due to the complexity of diastolic function assessment during stress echocardiography, where multiple hemodynamic parameters must be evaluated under time pressure. Explainable artificial intelligence, specifically rule-based Clinical Decision Support Systems (CDSS), offers promising improvements in reproducibility and interpretability.</p><p><strong>Methods: </strong>A rule-based CDSS was developed and clinically validated to automate left ventricular diastolic function assessment during semi-supine bicycle stress echocardiography. A prospective cohort of 134 patients (mean age 61.3 ± 8.7 years) with exertional dyspnea and preserved left ventricular ejection fraction (LVEF >50%) was enrolled, excluding individuals with significant valvular pathologies, arrhythmias, or unstable ischemia. Echocardiographic and Doppler data were collected using Toshiba Aplio500 and Esaote MyLabSIGMA systems. The algorithm incorporated manual input of measurements, computed derived indices (e.g., diastolic reserve index, myocardial stiffness, vascular resistance), and applied rule-based logic in accordance with ASE/EACVI (2016/2022) guidelines and the ESC HFpEF consensus.</p><p><strong>Results: </strong>The CDSS generated diagnostic conclusions within 3 min per case, matching expert assessments in 93% of cases and correctly identifying stress-induced diastolic dysfunction in 85%. It demonstrated high diagnostic agreement (ICC > 0.94) and discrimination (AUC = 0.92). Rule-based outputs, such as \"Impaired diastolic reserve\" or \"Right ventricular dysfunction under load,\" were based on combinations of parameters (e.g., E/e' > 15, Δe' ≤ 0, TAPSE < 17 mm, PCWR > 12 mmHg).</p><p><strong>Conclusion: </strong>The explainable, guideline-compliant CDSS enables real-time, transparent analysis of diastolic function, supporting improved diagnostic consistency and augmented physician decision-making in cardiovascular care.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1690832"},"PeriodicalIF":2.7,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do nurse performance appraisals reflect caring behaviors? Evidence from an Indonesian hospital.","authors":"Kuntarti Kuntarti, Irfan Rahmayanto","doi":"10.3389/frhs.2026.1773688","DOIUrl":"https://doi.org/10.3389/frhs.2026.1773688","url":null,"abstract":"<p><strong>Introduction: </strong>Nurses' caring behavior is central to the quality and humanistic orientation of nursing services. However, many hospital performance appraisals remain task-oriented and may insufficiently reflect caring competencies essential to patient-centered care. This study examined the association between nurses' caring behavior and Individual Performance Index (IPI) scores and identified caring dimensions requiring improvement.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among 228 nurses in a public hospital in Jakarta, Indonesia, recruited through simple random sampling. Caring behavior was measured using the Caring Behavior Inventory (CBI-42), and IPI was self-entered by nurses based on their most recent official monthly appraisal report. Spearman's rank correlation was used (two-tailed, α = 0.05).</p><p><strong>Results: </strong>No significant association was found between overall caring behavior and IPI scores (<i>r</i> = 0.027; <i>p</i> = 0.680), although both measures were generally high (median CBI = 3.50 [2.00-4.00]; median IPI = 1.00 [0.80-1.10]). Positive connectedness (3.44) and attentiveness to others' experiences (3.50) were comparatively lower than the other caring dimensions.</p><p><strong>Discussion: </strong>Current appraisal systems may not adequately capture caring competencies. Integrating explicit caring indicators into nurse performance evaluation may strengthen workforce development and support patient-centered health systems.</p><p><strong>Conclusion: </strong>Nurse performance appraisal scores were not significantly associated with caring behavior, suggesting that existing appraisal systems may not adequately reflect caring competencies in nursing practice. Incorporating explicit caring-related indicators into performance evaluation may improve the alignment between assessed performance and the humanistic goals of nursing care.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1773688"},"PeriodicalIF":2.7,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Value-based outsourcing is associated with better environmental and economic sustainability metrics while maintaining patient safety: a comparative analysis of electricity use, water use, and prescription costs in public hospitals of Madrid (Spain).","authors":"Marta Del Olmo Rodríguez, Bernadette Pfang, Ángel Blanco Rubio, David Romera, Ruben Horcajo, Javier Becares, Javier Arcos, Juan Antonio Álvaro de la Parra, Jorge Short Apellaniz","doi":"10.3389/frhs.2026.1762450","DOIUrl":"https://doi.org/10.3389/frhs.2026.1762450","url":null,"abstract":"<p><strong>Background: </strong>Healthcare systems face growing pressure to maintain high-quality care while improving environmental and economic sustainability. Hospitals are resource-intensive institutions, contributing substantially to energy and water consumption, pharmaceutical expenditure, and healthcare-related greenhouse gas emissions. Value-based healthcare models, including value-based outsourcing of publicly funded hospitals to private networks, have shown promise in improving quality and efficiency. However, their impact on sustainability outcomes remains underexplored. This study compared environmental and economic sustainability indicators between value-based outsourced and publicly managed hospitals.</p><p><strong>Methods: </strong>We conducted a cross-sectional comparative study using five years of administrative data (2019-2023) from 26 public hospitals in the Madrid Regional Healthcare Service, Spain. Four hospitals were managed by a value-based private network, and 22 were publicly managed. Outcomes included electricity consumption (kWh/m² per hospital stay), water consumption (m³ per hospital stay), and mean unit cost of specialist-prescribed medications. Analyses were stratified by hospital complexity (low, medium, high) and adjusted for case-mix complexity and year of construction. Patient safety indicators (medical and surgical complications and hospital-acquired infections) were also compared. Statistical analyses used chi-squared, Student's <i>t</i>-test, or Mann-Whitney <i>U</i> tests, with <i>p</i> < 0.05 considered significant.</p><p><strong>Results: </strong>Outsourced hospitals treated patients with significantly higher overall case-mix complexity than publicly managed hospitals. Overall electricity consumption was lower in outsourced hospitals (0.009 vs. 0.011 kWh/m² per hospital stay; <i>p</i> = 0.039), leading to estimated cost savings of 1,648,305 € and an approximate reduction in greenhouse gas emissions of 8,672 CO2 metric tons during the study period, as was water consumption (0.65 vs. 0.81 m³ per hospital stay; <i>p</i> < 0.001). The mean unit cost per medication was also lower in outsourced hospitals (€21.45 vs. €22.92; <i>p</i> = 0.026), with significant differences primarily in medium-complexity hospitals. Outsourced hospitals demonstrated slightly but significantly lower rates of inpatient complications and hospital-acquired infections.</p><p><strong>Conclusions: </strong>Value-based outsourcing in Madrid's public hospitals was associated with improved environmental and economic sustainability, alongside favorable patient safety outcomes, despite higher case-mix complexity. These findings support incorporating sustainability indicators into performance-based healthcare models and suggest value-based outsourcing as a potential strategy to advance sustainable healthcare delivery.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1762450"},"PeriodicalIF":2.7,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How leaders in mental health services shape workforce training outcomes: goals, actions, and mechanisms of change.","authors":"Emma Högberg Ragnarsson, Terese Stenfors, Lise Bergman Nordgren, Clara Hellner, Tobias Lundgren, Sara Ingvarsson","doi":"10.3389/frhs.2026.1784462","DOIUrl":"https://doi.org/10.3389/frhs.2026.1784462","url":null,"abstract":"<p><strong>Objective: </strong>Workforce training is a widely used implementation strategy to improve care within mental health services, yet evidence for sustained changes in clinical practice remains inconsistent. Managerial actions are likely critical for translating training into practice, but little is known about how leaders conceptualize training objectives or which mechanisms of change they rely on. This study examined which outcomes mental health managers value from clinical staff training and the strategies they use to support effectiveness.</p><p><strong>Method: </strong>In-depth interviews were performed with 14 managers from eight Swedish regions, and data were analyzed using two forms of qualitative content analysis: Training objectives were inductively coded into categories, while reported strategies were deductively organized using an operant learning framework to identify behavior-change mechanisms.</p><p><strong>Results: </strong>Managers described training as serving multiple purposes organized in two overarching aims: <i>Care Delivery Goals</i>, including clinical impact and service provision, and <i>Work Environment Goals</i>, encompassing staff wellbeing and connectedness among colleagues. Reported strategies aligned with the four predefined categories-Antecedents, Monitoring, Consequences, and Processes & Resources-and one additional category developed during coding: Preparatory strategies. Across strategies, mechanisms essential for sustaining new skills, such as task clarification, outcome monitoring, and performance-contingent feedback, were inconsistently applied.</p><p><strong>Conclusions: </strong>This study demonstrates that leaders attribute a wider range of purposes to workforce training than is typically assumed in training and implementation research, encompassing not only clinical or competence-related outcomes but also central work environment and organizational goals. An operant analysis of their strategies clarifies the change mechanisms managers rely on and highlights the importance of intentional, strategic-level actions-including preparatory strategies that shape who is trained, in what, and why. Furthermore, the findings inform practical recommendations that emphasize linking training initiatives to organizational priorities and systematically employing strategies such as monitoring, feedback, and task clarification. Integrating these elements can strengthen the design, implementation, and long-term impact of staff training, ultimately supporting better patient outcomes, improved staff wellbeing, and more effective use of limited resources.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1784462"},"PeriodicalIF":2.7,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13111377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}