Background Increasing healthcare costs need to be contained in order to maintain equality of access to care for all EU citizens. A cross‐disciplinary consortium of experts was supported by the EU FP7 research programme, to produce a roadmap on cost containment, while maintaining or improving the quality of healthcare. The roadmap comprises two drivers: person‐centred care and health promotion; five critical enablers also need to be addressed: information technology, quality measures, infrastructure, incentive systems, and contracting strategies. Method In order to develop and test the roadmap, a COST Action project was initiated: COST−CARES, with 28 participating countries. This paper provides an overview of evidence about the effects of each of the identified enablers. Intersections between the drivers and the enablers are identified as critical for the success of future cost containment, in tandem with maintained or improved quality in healthcare. This will require further exploration through testing. Conclusion Cost containment of future healthcare, with maintained or improved quality, needs to be addressed through a concerted approach of testing key factors. We propose a framework for test lab design based on these drivers and enablers in different European countries.

Aims To investigate how nursing experts and experts from other health professions understand the concept of rationing/missed/unfinished nursing care and how this is compared at a cross‐cultural level. Design The mixed methods descriptive study. Methods The semi‐structured questionnaires were sent to the sample of 45 scholars and practitioners from 26 countries. Data were collected from November 2017–February 2018. Results Assigning average cultural values to participants from each country revealed three cultural groups: high individualism‐high masculinity, high individualism‐low masculinity and low individualism‐medium masculinity. Content analysis of the findings revealed three main themes, which were identified across cultural clusters: (a) projecting blame for the phenomenon: Blaming the nurse versus blaming the system; (b) intentionality versus unintentionality; and (c) focus on nurses in comparison to focus on patients. Conclusion Consistent differences in the understanding of missed nursing care can be understood in line with the nation's standing on two main cultural values: individualism and masculinity. Impact The findings call for scholars' caution in interpreting missed nursing care from different cultures, or in comparing levels and types of missed nursing tasks across nations. The findings further indicated that mimicking interventions to limit missed nursing care from one cultural context to the other might be ineffective. Interventions to mitigate the phenomenon should be implemented thoughtfully, considering the cultural aspects.

The objective of this chapter is to provide conceptual understandings of evaluation methods for healthcare and concrete illustrations in order to take stock of the advancements and applications on the subject. The chapter is divided in four sections: the first one sets the stage at a European level by evaluating healthcare system performance; the second goes back to the fundamental principles of methods of evaluation for healthcare; the third one follows with illustrations of patient-centred and person-centred methods of evaluation; and the last part moves forward with a reflection on intangibles and a proposition for a method of observation.

Background: The literature on the functioning of public health facilities in health systems with significant arrears is limited. The growing liabilities of health facilities and the accumulating arrears have been a challenge in the Republic of Srpska. Most public primary healthcare (PHC) centres generated a gross loss in 2018. Method: Guided by the 'positive deviance' approach, we used an exploratory case study design to identify strategies used by managers to achieve financial sustainability in eight top-performing PHC centres. Qualitative data were collected through face-to-face in-depth semistructured interviews with key informants from the PHC centres that reported positive financial results in 2018. Results: Seven organisational goals, comprising 34 financial sustainability strategies, were recognised during the data analysis and were used to build an organisational-level model for a PHC centre. Conclusion: Managers concurrently used multiple strategies to ensure financial sustainability. Each centre tailored its range of strategies to the organisational context, local context, and wider environment of the health system. The strategies were conceived and implemented by managers operating at different organisational levels under the leadership of top-level managers. Managers of indebted health facilities can learn from the positively deviant peers who manage facilities that achieved satisfactory financial performance.

Sažetak: Potreba za rekreacijom kao jednim od načina održavanja psihofizičkog zdravlja i radne sposobnosti, je bitna potreba savremanog čovjeka. Značajan broj ljudi, povremeno ili stalno, koristi u te svrhe bazene. Međutim, rekreativne aktivnosti na bazenima, ali i korištenje bazena u svrhu liječenja ili oporavka, mogu da ugroze zdravlje, tako da je neophodno odgovarajuće upravljanje bazenima kako bi se taj uticaj sveo na što manju mjeru.Korisnici bazena izloženi su različitim opasnostima od kojih je rizik obolijevanja prouzrokovan mikrobiološkom kontaminacijom vode bazena najveći. Rizik bolesti ili infekcija zbog korištenja bazena povezan je, u prvom redu, sa fekalnom kontaminacijom vode zbog fecesa kupača ili fekalnom kontaminacijom vode sa kojom se puni bazen. Patogeni mikroorganizmi predstavljaju najčešći i najrašireniji zdravstveni rizik vezan za vodu kao sredinu zbog pojava infektivnih bolesti izazvanih bakterijama, virusima i parazitskim protozoama. Prećišćavanje vode smanjuje dijelom taj rizik, ali se najveća mjera sigurnosti korisnika može ostvariti tek dezinfekcijom vode u bazenu. Kulatura i samodisciplina kupača su doprinosni činioci njenoj bezbijednosti.Razmatranje problema upravljanja mikrobiološkim kvalitetom vode u bazenima, izloženo u ovom radu, bazira se najvećim dijelom na odgovarajućim Preporukama Svjetske zdravstvene organizacije (WHO, 2000).