9.L. Workshop: A motivated, healthy and high-performing workforce: Innovation in health workforce research in Europe

Abstract Background Hospitals and their health care staff were severely impacted by the Covid-19 pandemic. Many health professionals faced high levels of stress and burn-out due to unfavorable work environments, limited staffing and highly pressured workloads. Yet, even prior to the pandemic, health professionals in many countries faced challenging work environments with often limited resources and support. At the same time, the roles of health professionals are changing across Europe, with new roles, task-shifting and sharing happening in teams, also driven by the Covid-19 pandemic. From a health system and management perspective, recruitment and retention is critical to ensure that there is a sufficient and well-educated health workforce capable to perform high-quality care. Multiple innovations have been implemented across Europe, these will be presented and discussed with a view towards evaluating complex interventions, sustaining innovations, ensuring the scalability and transferability of proven interventions for the benefit of health professionals and wider society. Objectives This workshop will address innovative strategies at the micro (team level), meso (healthcare setting) and macro level (policy) to ensure that health professionals are motivated, perform high-quality care in teams and are sufficiently supported by enabling work environments and recruitment and retention policies. Innovations to improve work environments, task-shifting as well as recruitment and retention will be discussed, based on the findings from four EU-funded research projects: Magnet4Europe, H-Work, TASHI and METEOR. The format is a ‘round table’ with 5 panel discussants. The Magnet4Europe project focuses on the reorganization of hospital work environments for nurses and physicians in hospitals in five European countries. Innovative elements include a system-, inter-professional, organization-wide change management, structural empowerment of clinical staff and one-on-one twinning of European hospitals with U.S. twinning partners. Innovations in the EU projects The H- WORK project aims to design, implement and validate psychosocial interventions to promote mental health and well-being in SMEs and the public sector. Innovative elements are the evaluation of interventions at multiple levels (individual, team, manager and organisational level) and the development of the H-Work innovation platform with toolkits, policy briefs and novel digital solutions. The TaSHI project provides a novel and up-to-date knowledge on task shifting and transferability of good practices in implementation. Through a cross-national and -sectoral perspective, the focus is on task shifting as an innovation towards more effective organisation of care and workforce, to improve efficient and sustainable systems. METEOR aims to enhance scientific knowledge on the predictors of job retention for healthcare workers and develops evidence-based policy recommendations through stakeholder engagement and co-creation workshops. Key messages • Innovations to improve work environments include system-wide, integrated approaches spanning individual, team, management and organisational levels. • Elements of effective implementation of innovations are effective leadership at highest level, empowerment, evidence-informed action and tailored strategies on recruitment and retention of staff. Speakers/Panellists Walter Sermeus KU Leuven, Leuven, Belgium Ronald Batenburg NIVEL, Utrecht, Netherlands Lode Godderis KULeuven - IDEWE, Leuven, Belgium Rudolf Kubik Qedgroup, Prague, Czechia Claudia Maier Department of Healthcare Management, Technische Universität Berlin, Berlin, Germany


Background:
There is a consensus on the need to transform the built, economic and socio-cultural environments to promote healthy eating (HE) and physical activity (PA). Yet, limited capacity and the biomedicalisation of public health are often blamed for steering investments towards individual risk factors. In France, local health contracts (LHCs) agreed between a regional health agency (RHA) and a local government could improve health promotion strategies. We examined how LHCs take into account the environmental determinants of HE and PA.

Methods:
Using the CLoterreS national census, we analysed a stratified random sample of 53 LHCs with a view to identify if actions target individual (knowledge, skills, etc.) or environmental (interpersonal, organisational, community or political) determinants. To this end, we developed an instrument drawing from different typologies of action and consensus documents to assess the integration of the socioecological approach in programmes. We ran a series of interviews with RHA staff (n = 39) and local actors (n = 23) to put into context our results.

Results:
Out of 53 LHCs, 42 included at least one action on HE or PA. For these topics, there was a higher proportion of actions targeting individuals (83% and 76% per contract, respectively) than environments (51% and 58%). For the latter, actions on interpersonal determinants (e.g. family) were the most common. However, we also found instances of actions on more distal ones (e.g. to improve nutrition standards in school canteens and walkability). Contextual factors such as local priorities, past experience with health promotion and the involvement of local actors in needs assessment and action planning may influence such orientations.

Conclusions:
LHCs constitute a promising avenue to address the environmental determinants of health-related behaviours. A key feature of this instrument is its capacity to develop intersectoral strategies. Further research will show if LHCs deliver on their action plan. Background: Hospitals and their health care staff were severely impacted by the Covid-19 pandemic. Many health professionals faced high levels of stress and burn-out due to unfavorable work environments, limited staffing and highly pressured workloads. Yet, even prior to the pandemic, health professionals in many countries faced challenging work environments with often limited resources and support. At the same time, the roles of health professionals are changing across Europe, with new roles, task-shifting and sharing happening in teams, also driven by the Covid-19 pandemic. From a health system and management perspective, recruitment and retention is critical to ensure that there is a sufficient and well-educated health workforce capable to perform high-quality care. Multiple innovations have been implemented across Europe, these will be presented and discussed with a view towards evaluating complex interventions, sustaining innovations, ensuring the scalability and transferability of proven interventions for the benefit of health professionals and wider society.
Objectives: This workshop will address innovative strategies at the micro (team level), meso (healthcare setting) and macro level (policy) to ensure that health professionals are motivated, perform high-quality care in teams and are sufficiently supported by enabling work environments and recruitment and retention policies. Innovations to improve work environments, task-shifting as well as recruitment and retention will be discussed, based on the findings from four EU-funded research projects: Magnet4Europe, H-Work, TASHI and METEOR. The format is a 'round table' with 5 panel discussants. The Magnet4Europe project focuses on the reorganization of hospital work environments for nurses and physicians in hospitals in five European countries. Innovative elements include a system-, inter-professional, organization-wide change management, structural empowerment of clinical staff and one-on-one twinning of European hospitals with U.S. twinning partners.

Innovations in the EU projects:
The H-WORK project aims to design, implement and validate psychosocial interventions to promote mental health and wellbeing in SMEs and the public sector. Innovative elements are the evaluation of interventions at multiple levels (individual, team, manager and organisational level) and the development of the H-Work innovation platform with toolkits, policy briefs and novel digital solutions. The TaSHI project provides a novel and up-to-date knowledge on task shifting and transferability of good practices in implementation. Through a cross-national and -sectoral perspective, the focus is on task shifting as an innovation towards more effective organisation of care and workforce, to improve efficient and sustainable systems. METEOR aims to enhance scientific knowledge on the predictors of job retention for healthcare workers and develops Background:

Control of multiresistant bacteria (MRB) outbreaks in the Intensive Care Unit (ICU) is a challenge of Public Health.
There is strong evidence that surfaces, and sinks are reservoirs of MRB. In 2020, because of isolation of Klebsiella type IMP, OXA-48 and VIM in moist reservoirs in ICU of Clinico San Cecilio Hospital and another carbapenemase-producing Enterobacteriaceae (CPE) outbreak, it arises our aim, which is to highlight the relevance of periodic control of humid reservoirs and surfaces in ICU to prevent MRB transmission.

Methods:
Retrospective, descriptive study from March to June 2021. Due to a rise of cases of a CPE outbreak in our ICU in Granada, samples of surfaces and taps of different boxes were taken, after discharging patients and their corresponding terminal cleaning, whether they were CPE-colonised patient or not.

Results:
Samples of 20 boxes were taken (N = 325). CPE OXA-48 was isolated in 7,38% of the samples which correspond to 40% of the boxes, most of them Enterobacter cloacae. 25% of the positive samples isolated two types of resistance, OXA-48, and VIM. 79,2% of the positive samples were found in March. The rest of them in April and May, after establishing control measures in surfaces. CPE was isolated in blood pressure monitor, pulse oximeter, electrocardiogram and stethoscope from 6 boxes. 3 CPE humid reservoirs were found in the tap and drain sinks of 2 boxes, one of them with CPE colonised patient.

Conclusions:
We have observed the existence of carbapenem-resistant plasmids in surfaces and the persistence of humid reservoirs in our ICU, despite of establishing control measures of an outbreak. In conjunction with classical monitoring measures such as observation and training of hand hygiene, we recommend the use of disposable materials, systematic disinfection of reservoirs, appropriate use of gloves, chlorination of sinks and the goal of an ICU without water should be fundamental elements in the prevention of MRB transmission. Background: Antibiotics (AB) are essential to modern day medicine as prophylaxis and therapy. Yet, unnecessary use has various negative effects on individual and global health, such as antimicrobial resistance (AMR) and contribution to high greenhouse gas (GHG) emissions of the healthcare sector. This systematic review provides an overview of unnecessary AB use in European hospitals in order to present possible ways forward.

Methods:
The systematic review followed PRISMA guidelines, included as databases were: Embase, ProQuest Environmental Science Collection, PubMed, ScienceDirect, Scopus and Web of Science. Studies conducted among adult in-patients in EU/ EEA countries were included if they provided assessment methodology, included a clear standard of measurement and chart reviews were used as evaluation basis.

Results:
Fifty-six included studies were categorised into the following three groups: (1) Studies using an established evaluation method; 20 studies belong to this group, 18 used the same, established approach. Eleven of these studies performed an observational audit, while the interventions in the remaining studies were of educational or advisory nature. Unnecessary AB use ranged from 1.5% to 51% of all observed prescriptions. Outcomes of interventions showed great variation of effects on unnecessary use (-34.7% -+11.6).
(2) Studies using a newly developed, clearly stated evaluation method (4 studies); (3) Studies which conform with established evaluation methods but the processes were not specified (32 studies). Results are subject to further analysis.