Now we are 30: 10 more years of MASCC.

This paper chronicles the third decade of MASCC from 2010. There was a generational change in this decade, building on the solid foundation of the founders. It included the first female President, and a new Executive Director with a background in strategy and business development and operations as applied to healthcare. The headquarters moved from Copenhagen to Toronto. The first meeting to be held outside of Europe or North America was held in Adelaide, Australia, and the membership in the Asia Pacific region expanded. A program of international affiliates saw national supportive care organisations formally link with MASCC. In cancer supportive care, there was a raft of new toxicities to manage as immunotherapies were added to conventional cytotoxic treatment. There was also a greater emphasis on the psychosocial needs of patients and families. New MASCC groups were formed to respond to this evolution in cancer management. The MASCC journal, Supportive Care in Cancer, continued to grow in impact, and MASCC published two editions of a textbook of supportive care and survivorship. The decade ended with the challenge of the COVID-19 pandemic, but that served to highlight the importance of good supportive care to patients with cancer.

Guidelines as governance: Critical reflections from a documentary analysis of guidelines to support user involvement in research.

Although guidelines to regulate user involvement in research have been advocated and implemented for several years, literature still describes the process as challenging. In this qualitative study, we take a critical view on guidelines that are developed to regulate and govern the collaboration process of user involvement in research. We adapt a social constructivist view of guidelines and our aim is to explore how guidelines construct the perception of users and researchers and thus the process of involvement. Twenty-two guidelines published between 2006 and 2019 were analyzed iteratively. The analysis focuses on values which are emphasized in the guidelines on the distribution of entities, knowledge, and tasks between users and researchers. The analysis indicates that users and researchers are constructed differently; researchers are mainly constructed as responsible initiators and caretakers, while users are constructed as powerless and vulnerable. The guidelines portray the collaboration process as harmonious and assume a normative perspective. In doing so, challenges described in the literature related to power imbalances are not addressed. Based on these findings, we ask if these guidelines might function to maintain existing power imbalances between users and researchers.

The Journey: Nurses on Boards Coalition Preparation and Support Work Group.

Nurses have the knowledge, skills, and expertise to bring value and leadership to a myriad of boards throughout the United States, with nursing leadership critical to the transformation of complex health care systems. The 2011 Institute of Medicine Future of Nursing report calls on nurses to lead at all levels in systems as well as in board rooms. In 2014, the Nurses on Boards Coalition (NOBC) aligned its mission with this charge, creating a goal, as stated on its Web site, to "improve the health of communities and the nation through the service of nurses on boards and other bodies." A specific goal of NOBC was to have 10 000 nurses on boards by 2020. Through a partnership with the Robert Wood Johnson Foundation and the America Association of Retired Persons, NOBC worked strategically to achieve its goal. The accomplishments of one of its work groups, Preparation and Support, are highlighted.

Using Activism to Get Nurses on Boards.

Over the past 15 years, there has been a growing call for nurses to be placed on boards of hospitals and health systems. Rationale for this action includes the changing nature of health care; a greater emphasis on person and family-centered care; nurses' background and experience in health care delivery; and that boards with a more diverse composition are associated with better organizational performance. Several national organizations have come forward to support this, among them the Robert Wood Johnson Foundation, American Hospital Association, the Institute of Medicine, and several industry leaders in health care. While progress has been made, however, nurses still occupy only 4% of board seats. This article reviews some of the myths and barriers that have prevented nurses from serving on boards, as well as offering 3 major recommendations for action that reflect not only long-term efforts but also short-term activism.

Nurses on Boards: Still a Challenge for Health Care Organizations.

Multiple articles have explained the benefits of nurses as hospital board members. The Nurses on Boards Coalition has been working for several years to increase the number of nurse board members. Yet, the percentage of hospital and health care board positions filled by nurses has been decreasing. This article shares what all nurse leaders can do to increase the visibility of nurses as competent, valuable voices at the board table.

Does the Proportion of Women in Orthopaedic Leadership Roles Reflect the Gender Composition of Specialty Societies?

BACKGROUND: Increasing the number of women in surgical subspecialties has been challenging, especially in orthopaedics, in which the percentage of women has remained relatively the same for the past several decades. Certain subspecialties, such as pediatric orthopaedics, have a greater proportion of women than other orthopaedic subspecialties do. Women in leadership roles in a specialty society (for example, on the board of directors) may serve as role models and help attract women to our specialty, leading to increased diversity. As the proportion of women in a specialty society increases, the leadership (board of directors) of the society might reflect the gender composition of that society's membership. It is not known whether gender diversity in orthopaedic societies is reflected in their leadership. QUESTION/PURPOSES: (1) Does the percentage of women members in a specialty society correlate with the percentage of women on its board of directors? (2) Does having a junior position on an orthopaedics subspecialty society's board of directors correlate with an increased percentage of women on its board of directors? METHODS: We queried the executive directors of each of the 23 societies of the Board of Specialty Societies of the American Academy of Orthopaedic Surgeons to obtain the number and percentage of women members in each society, the number of women on each society's board of directors, the criteria for becoming a board member, and the presence or absence of junior board members. All 23 societies responded. We supplemented the data by reviewing these societies' bylaws. Society bylaws were studied to determine if the presence of a junior board member affected the percentage of women on its board of directors. We correlated the percentage of women in each society with the percentage of women on that society's board of directors and compared this across the studied societies. RESULTS: We found a strong correlation between the percentage of women in a society and the percentage of women on the society's board of directors (r = .2333; p = .0495). The subspecialty society with the highest percentage of women (26%), the Pediatric Orthopaedic Society of North America, did not have the highest percentage of women on its board of directors (three of 20 members were women, 15%). The subspecialty society with the highest percentage of women on its board of directors, the Orthopaedic Research Society (seven of 16 members, 44%), did not have the highest percentage of women (25%). There was no correlation between presence of a junior board member and increased percentage of women in an orthopaedic society, nor was there a correlation between the presence of a junior board member and percentage of women on the board of directors in a society. CONCLUSIONS: There is a correlation between the number of women members in an orthopaedic specialty society and the number of women on its board of directors. The correlation is not explained by the presence of a junior member position, which may be inspiring to younger women. Although a correlation exists, we could not predictably match societies with the highest percentage of women members to those with the highest percentage of women on their boards of directors, and vice versa. This study reveals the current percentage of women in orthopaedic specialty societies and the percentage of women in leadership positions. This is the first step towards diversity of gender in orthopaedics. LEVEL OF EVIDENCE: Level III, prognostic study.

Chair Versus Chairman: Does Orthopaedics Use the Gendered Term More Than Other Specialties?

BACKGROUND: Orthopaedics is the least gender-diverse medical specialty. Research suggests that the use of gendered language can contribute to workforce disparity and that gender-neutral language supports the inclusion and advancement of women, but the degree to which gender-neutral language is used by academic departments in what typically is a department's highest position (department chair) has not been characterized. QUESTIONS/PURPOSES: (1) Is the proportion of department websites that use the term chairman (as opposed to chair) greater in orthopaedics than in five other surgical and medical specialties? (2) Are departments led by chairs who are women less likely to use "chairman" than those led by men, and does this vary by specialty? METHODS: Seven hundred fourteen official websites of orthopaedic, neurosurgery, general surgery, internal medicine, pediatrics, and obstetrics and gynecology departments affiliated with 129 allopathic medical schools were screened. Any use of the term chairman on title pages, welcome messages, and faculty profile pages was identified using a Boyer-Moore string-search algorithm and terms were classified based on their location on the site. The overall use of the term chairman was compared by specialty and gender of the chair. RESULTS: Sixty percent of orthopaedic department websites (71 of 119) used the term chairman at least once, a proportion higher than that of pediatrics (36% [46 of 128]; OR 0.38; 95% CI, 0.23 to 0.63; p < 0.001), internal medicine (31% [38 of 122]; OR 0.030; 95% CI, 0.18 to 0.53; p < 0.001), and obstetrics and gynecology (29% [37 of 126]; OR 0.28; 95% CI, 0.17 to 0.48; p < 0.001), but no different than that of neurosurgery (57% [54 of 94]; OR 0.91; 95% CI, 0.52 to 1.6; p = 0.74) and general surgery (55% [69 of 125]; OR 0.83; 95% CI, 0.50 to 1.4; p = 0.48). Across disciplines, departments whose chairs were women were much less likely to use the term chairman than departments whose chairs were men (14% [17 of 122] versus 50% [297 of 592]; OR 0.16; 95% CI, 0.09 to 0.28; p < 0.001). CONCLUSIONS: The frequent use of the term chairman in orthopaedics, coupled with the preference of women to use the term chair, suggests considerable room for growth in the use of gender-equal language in orthopaedics. CLINICAL RELEVANCE: Our current efforts to increase the number of women in orthopaedics may be undermined by gendered language, which can create and reinforce gendered culture in the field. Electing to use gender-neutral leadership titles, while a relatively small step in the pursuit of a more gender-equal environment, presents an immediate and no-cost way to support a more inclusive culture and counteract unconscious gender bias. Future studies should explore the individual attitudes of chairs regarding the use of gendered titles and identify additional ways in which biases may manifest; for example, the use of gendered language in interpersonal communications and the presence of unconscious bias in leadership evaluations. Continued efforts to understand implicit bias in orthopaedics can guide actionable strategies for counteracting gendered stereotypes of the specialty, in turn aiding initiatives to recruit and promote women in the field.

The rationale for nurses on boards in the voices of nurses who serve.

BACKGROUND: Inclusion of nurses on boards (NOB) to enhance health care transformation is recommended; however, there is no research-based rationale for NOB. PURPOSE: To articulate the rationale for NOB in the voices of nurses who serve. METHODS: An explanatory sequential mixed methods design was used with priority on the quantitative strand (Delphi method). The qualitative strand was accomplished with focus groups. FINDINGS: Twenty-nine NOB participants (Delphi phase) and nine NOB participants (focus groups) agreed the rationale for NOB is embedded in specific knowledge, skills, and perspectives that nurses contribute for boardroom discussions and policymaking. This study supported anecdotal literature promoting nurses for board leadership. DISCUSSION: Nurses should be appointed to boards of directors based on their knowledge, skills, and perspectives about health care. Board leadership leverages the public's trust in nursing, advances the profession, and positions nurses to influence health care transformation. Further research is recommended.

Influencing and impacting the profession through governance opportunities.

In addition to board leadership of health care organizations and corporations, there are strategic opportunities for nurses to participate in professional association boards and commissions and expert panels. These boards have specific and unique challenges and opportunities, and it is important for nurse leaders to serve in shaping the direction of the profession. Nursing as a profession has an opening to solve many of the care delivery issues that face the country. A strategic contribution to association boards and commissions can influence the health care delivery system changes needed to improve quality of care, access to care, and reducing costs. This article describes similarities and differences of service on association boards and commissions compared with organizational and corporate boards. Through these leadership roles, the larger community can observe influential nurses in an essential role. These leadership opportunities, including membership boards, commissions, and content expert panels, call for a special understanding of those governance structures and the contributions that nurse leaders can make to impact health care. Association and membership organizations have undergone many changes in the past 10 years, and new models of governance and leadership have been called into play. There are challenges and opportunities in serving on these boards and commissions. Maximizing the leadership and governance roles of this type of service is a critical contribution that nurses can make to impact the profession of nursing and the greater health care system.

Another level of leadership: nurses on boards.

The movement to place nurses on boards of directors is growing, enriching boards with individuals possessing knowledge of clinical quality tied to care delivery models, human resource competencies and management, finance, and organizational change. Professional development educators are poised to advance a board's capacity to address complex health care problems.

On to the future.

Trustees' roles have changed greatly during the past 40 years. What can we expect in the next four decades?

Encouragement: The key to increasing the number of nurses serving on boards.

Nurses have a lot of knowledge about health and health systems but are not yet adequately represented on boards and commissions that influence health and healthcare in our country. The majority of nurses are women and the hesitancy of women to seek board and elected positions are well documented. The purpose of this statewide survey of nurses was to ascertain the political engagement of nurses and their identified barriers to service. The nurses in our sample were more politically engaged than the state as a whole and 40% reported willingness to consider or pursue a board or elected position. The primary barrier was a lack of confidence that their appointment would be supported. While there were some differences by age of the respondents, time, money, and family responsibilities were also identified as barriers to seeking board and elected positions. Our results underscore the need to socialize and encourage nurses to serve in positions that influence health and healthcare in our country.

[Medical disciplinary boards punish more often and more severely; an observational study of 10 years of medical disciplinary law]. / Medische tuchtcolleges straffen vaker en strenger.

OBJECTIVE: To examine if the medical disciplinary law in the Netherlands is becoming tougher. DESIGN: Observational study. METHOD: We read the annual reports of the Dutch Disciplinary Committees for the Healthcare Sector 2007-2017, and registered the numbers of disciplinary cases and those cases upheld, the measures imposed and the degree of consistency in the event of an appeal. Over 400 medical disciplinary cases were reviewed in more detail. Based on these cases, we determined those variables that increase or decrease the likelihood of conviction, such as the gender of the defendants, the region in which the disciplinary case was heard, and if objective norms and professional practice guidelines had been used in arriving at the verdict. RESULTS: Each year a disciplinary case is brought against an average of 0.4% of all health care providers - mainly physicians (an average of approximately 1400 disciplinary cases each year). One-third of all disciplinary cases were dealt with in court and about half of them were upheld. Over time, the number of disciplinary cases has increased (36%), as has the percentage of cases that are upheld (27%). Additionally, heavier measures were more often imposed and the degree of consistency between the initial ruling and the ruling on appeal also increased (56%). Those factors that increased the likelihood of a case being upheld were: being a physician of male gender, the disciplinary case being heard in The Hague or Eindhoven, and the non-implementation of an objective norm or professional practice guideline in arriving at the verdict. CONCLUSION: Since 2007 the Dutch medical disciplinary boards have been punishing more often and more severely. This may be because the subjective demands made on health care professionals have changed. Arriving at an opinion subjectively is not a problem when it comes to verifying compliance with standards of due care. However, if this method is used to determine the penalty, the health care system will become defensive - and this will not improve the quality of care.

Changes in the monitoring and oversight practices of not-for-profit hospital governing boards 1989-2005: evidence from three national surveys.

Despite the legal and practical importance of monitoring and oversight of management by hospital governing boards, there is little empirical evidence of how hospital boards fulfill these roles and the extent to which these practices have changed over time. We utilize data from three national surveys of hospital governance to examine how oversight and monitoring practices in public and private not-for-profit (NFP) hospital boards have changed over time. Findings suggest that board relations with CEOs in NFP hospitals display important but potentially contradictory patterns. On the one hand, NFP hospital boards appear to be exercising more stringent oversight of management and hospital performance. On the other hand, management is more actively involved with governance matters with less separation of board and management. This general pattern varies by the dimension of oversight and monitoring practice and by specific characteristics of NFP hospitals.