Comparing the Life Satisfaction of Older Immigrants and Refugees to Canadian-Born Older Adults: The Role of Immigrant Admission Classes.

OBJECTIVES: Immigrant admission classes represent different entry routes to Canada and potential divergent pathways for later-life well-being. This study examined later-life satisfaction, an important correlate of well-being, comparing levels between Canadian-born older adults with those of older immigrants and refugees by admission class and considering the role of residency time in Canada. METHODS: This study used data from the Canadian Community Health Survey (2009-2014) linked to landing records for those 55 years and older. Regression models explored the association between admission class and later-life satisfaction adjusting for covariates and stratified by residency time in Canada. RESULTS: After accounting for a range of demographic, socioeconomic, and health characteristics, economic class principal applicants and refugees had significantly lower life satisfaction than Canadian-born older adults. The negative association with life satisfaction among economic class principal applicants persisted even after accounting for residency time in Canada. CONCLUSIONS: Both admission class and length of residency in Canada are associated with levels of later-life satisfaction. Future studies should look beyond aggregated measures of immigrant status when examining determinants of well-being in later-life. CLINICAL IMPLICATIONS: Vulnerable subgroups of immigrants and refugees are at risk of experiencing lower later-life satisfaction and adverse later-life outcomes.

A framework for interprofessional team collaboration in a hospital setting: Advancing team competencies and behaviours.

Healthcare teams that practice collaboratively enhance the delivery of person-centred care and improve patient and systems outcomes. Many organizations have adopted existing interprofessional frameworks that define the competencies of individual health professionals that are required to meet practice standards and advance interprofessional goals. However, to support the collective efforts of team members to deliver optimal care within complex hospital settings, healthcare organizations may benefit from adopting team-based competencies for interprofessional collaboration. The Sunnybrook framework for interprofessional team collaboration was intentionally created as a set of collective team competencies. The framework was developed using a comprehensive literature search and consensus building by a multi-stakeholder working group and supported by a broad consultation process that included patient representation, organizational development and leadership, and human resources. The six core competencies are actionable and include associated team behaviours that can be easily referenced by teams and widely implemented across the hospital.

Building Capacity in Health Professionals to Conduct Quality Improvement: Evaluation From a Collaborative Interorganizational Program.

BACKGROUND: The Toronto Academic Health Sciences Network Health Professions Innovation Fellowship Program began in 2014 as a pilot initiative among 4 academic teaching hospitals in Toronto, Ontario. The purpose of the Program was to cultivate applied leadership, interprofessional collaboration, and quality improvement capacity among health professionals. PURPOSE: This article reports on the evaluation findings from the initial year as well as an update on current program status and sustainability. METHODS: A formative evaluation was conducted focused on the impact on clinical practice, participant skill development, participant experience, and cross-organizational partnerships. Data were collected through a focus group, interviews, and pre- and postsurveys. RESULTS: Data from the initial pilot showed increases in leadership practices, project management, and quality improvement knowledge, with changes in leadership practices being significant. Positive changes in clinical practice at both the individual and unit/team levels and capacity for building relationships were also reported. Since the pilot, more than 160 participants from 15 health professions and 9 organizations have participated. Several graduates have taken on leadership roles since their participation in the Program. CONCLUSIONS: Health care organizations wishing to advance academic practice may benefit from implementing a similar collaborative program to reap benefits beyond organizational silos.

Optimizing the role of social workers in advance care planning within an academic hospital: an educational intervention program.

Advance Care Planning (ACP) promotes communication to help patients express future health-care preferences and goals for their medical care. Social workers (SWs) are trained to facilitate complex conversations and assist in various ACP tasks across clinical settings. This three-part mixed-method interventional study implemented a comprehensive education and training program for SWs of a large academic hospital, which used pre- and post-training evaluations, chart review, and qualitative data from debrief sessions to examine ACP skills and confidence, and assess the number of ACP conversations initiated with patients. Self-reported level of preparation to facilitate ACP conversations improved significantly (n = 26; pre 36% versus post 82%; p < .05). A 4-month post-intervention chart audit showed an 8.69 fold increase in the number of initiated ACP conversations. Qualitative analysis identified key themes regarding barriers and enablers of initiating ACP conversations during standard care from the perspective of SWs.

Development of Research Core Competencies for Academic Practice Among Health Professionals: A Mixed-Methods Approach.

BACKGROUND AND OBJECTIVES: Of the 4 pillars of academic practice for nursing and allied health, research has been the least developed and no standard competency framework exists that is embedded in health professional scopes of practice. The objective of this article is to report on the preliminary development and pilot-testing of research and academic scholarship core competencies for nonphysician health professionals working within a large urban academic health sciences center. METHODS: We conducted an internal and external environmental scan and multiphase consultation process to develop research and academic core competencies for health professionals working within an interprofessional setting. RESULTS: The final framework outlines 3 levels of research proficiency (novice, proficient, and advanced) and the relevant roles, specific competencies, and observable actions and/or activities for each proficiency level. CONCLUSIONS: Organizations should consider the integration of the framework within performance management processes and the development of a road map and self-assessment survey to track progress over time and support health professionals with their academic practice goals.

Examining job tenure and lost-time claim rates in Ontario, Canada, over a 10-year period, 1999-2008.

OBJECTIVE: We sought to examine the association between job tenure and lost-time claim rates over a 10-year period in Ontario, Canada. METHODS: Data were obtained from workers' compensation records and labour force survey data from 1999 to 2008. Claim rates were calculated for gender, age, industry, occupation, year and job tenure group. A multivariate analysis and examination of effect modification were performed. Differences in injury event and source of injury were also examined by job tenure. RESULTS: Lost-time claim rates were significantly higher for workers with shorter job tenure, regardless of other factors. Claim rates for new workers differed by gender, age and industry, but remained relatively constant at an elevated rate over the observed time period. CONCLUSIONS: This study is the first to examine lost-time claim rates by job tenure over a time period during which overall claim rates generally declined. Claim rates did not show a convergence by job tenure. Findings highlight that new workers are still at elevated risk, and suggest the need for improved training, reducing exposures among new workers, promoting permanent employment, and monitoring work injury trends and risk factors.

Dedicated Research Seed Funding to Support High-Priority Clinician-Led Research: A Survey of Clinician-Researchers.

BACKGROUND AND OBJECTIVES: Developing research capacity and supporting research engagement among health professionals are essential parts of bridging the evidence-to-practice gap. The objective of this study was to describe and assess the impact of research seed funding in promoting the engagement of nursing and allied health professionals in leading practice-based research studies within a health care organization. METHODS: An impact assessment survey was administered to health professional grant recipients (n = 30) to collect self-reported observations of changes related to clinical practice, patient care, and organizational priorities as a result of the funded research projects. The electronic survey was developed in collaboration with an interprofessional advisory committee and contained 23 closed- and open-ended questions. Survey data were analyzed descriptively, and responses to open-ended survey questions were used to characterize the funded research activities and the perceived successes and challenges experienced by the research teams. RESULTS: A large proportion of health professional grant recipients reported observing impact from their research studies on clinical practice, organizational priorities, and external networks. The grant funds were used to carry out knowledge dissemination activities such as conference presentations, publications, and sharing findings at professional meetings and networks. The majority of grant expenditures were used for research personnel, and the most common challenge to conducting research was related to the need for protected research time. Most grant recipients were interested in participating in another grant-funded research project in the future. CONCLUSION: Organizational funding and support for research led by health professionals have potential impact on clinical practice, patient care, and organizational priorities. This study provides evidence to support the value of investing in continued and expanded research funding programs for health professionals.

The Role of Immigrant Admission Classes on the Health and Well-being of Immigrants and Refugees in Canada: A Scoping Review.

Many countries offer different pathways through which migrants can enter a new country. In Canada, there are three main immigrant admission classes: economic, family, and refugee. Previous research suggests that there are differences in health outcomes among various subgroups of migrants. A scoping review was conducted to characterize the role of immigrant admission classes on the health and well-being of immigrants and refugees in Canada. MEDLINE, Embase, PsycINFO, Sociological Abstracts, and EconLit databases were searched for quantitative studies published in English after 1990. The screening and selection process identified 27 relevant studies. Studies were categorized into four key reported outcomes: health care and services utilization, self-rated health and mental health, medical conditions and chronic illnesses, and social integration and satisfaction. Findings confirm that certain subgroups have worse health outcomes after arrival, particularly refugees, family class and other dependent immigrants. Health outcomes vary significantly across immigrant subgroups defined by the admission class through which they entered Canada.

Advancing Practice-Based Research among Nursing and Health Disciplines Professionals by Creating a Network of Leaders.

Representatives from various practice-based research programs have come together to establish a Canadian Practice-Based Research Network (CP-BRN). CP-BRN is a collective of healthcare leaders focused on identifying approaches and leveraging resources to support clinician-led research to advance evidence-based practice. This paper presents an overview of the development of the CP-BRN, the proceedings from the inaugural meeting of CPBRN members, and recommendations for nursing and allied health profession leaders considering establishing their own practice-based research programs. Next steps for the network are to raise awareness of its mission, expand the network membership as to grow its influence among healthcare leaders and to further advance evidence-based practice across both healthcare and academic institutions.

An evaluation of the impact for healthcare professionals after a leadership innovation fellowship program.

BACKGROUND: Leadership among healthcare professionals is required to address important healthcare challenges. The TAHSNp Health Professions Innovation Fellowship program ("Program") supports health professionals' leadership development by offering them an opportunity to lead a quality improvement project and participate in a curriculum focused on leading change. OBJECTIVE: As part of an outcome evaluation of the program, our objective was to determine the program's impact on leadership activities and roles undertaken by alumni. METHODS: A questionnaire was administered to participants who completed the program in 2019 and 2020 at 6 and 18 months post-program to assess their leadership activities, leadership roles and the program's impact. Prospectively, we conducted internal and LinkedIn searches to identify current roles and obtained personal statements from program alumni of medical imaging health professions as complementary data sources for our program evaluation. RESULTS: At 6 and 18 months post-program, 47% - 59% of alumni respondents reported participation in hospital/organization committees, mentoring fellows or students, and presenting scholarly work inside or outside their organizations (6 months: N = 25, response rate = 39.1%; 18 months: N = 17, response rate = 26.6%). Additionally, at 18 months post program, 35% - 41% of alumni reported leading a new quality improvement initiative, pursuing formal education, and having a new leadership role. Most alumni reported their leadership activities were influenced by the program, with the largest impact occurring after 18 months post-program for leading a new quality improvement initiative (100%), career plans for the next five years (94%), mentoring fellowship staff (91%), presenting at their healthcare organization (91%) and a new leadership role (90%). Alumni reported the program helped build their confidence, create networking opportunities, leadership skill-building and interest in pursuing other roles beyond their clinical role. More specifically, alumni reported that leadership skills gained from the program were used in subsequent roles and responsibilities. CONCLUSION/IMPLICATIONS: The program evaluation demonstrates engaged alumni who undertake informal and formal leadership activities and roles. Our results are illustrative of the value-add as a result of healthcare organizations' investment in developing leadership among healthcare professionals. As continued engagement and career development are known to be important for staff retention and succession planning strategies, our findings are highly relevant given the current staffing challenges in healthcare.

Assessing occupational health and safety of young workers who use youth employment centers.

BACKGROUND: Adolescents and young adults who are out of school are at elevated risk for a work injury. METHODS: To obtain more information on this "high risk" group of young workers, young people at youth employment centers across Ontario were asked through an online survey about training, unsafe work conditions, work injuries and safety knowledge. RESULTS: The 1,886 youth who completed the survey reported a medically attended work injury rate of 14.45 per 100 FTEs. Also, the most common unsafe work conditions were dust/particles, trip hazards and heavy lifting. In addition, many young workers reported using much of their income for living essentials (e.g., rent). CONCLUSIONS: Though not a representative sample, it appears that youth using employment centers experience many unsafe work conditions and work injuries. While many report safety training, the nature and effectiveness of this training remains to be determined. The large portion of young workers out of school and working for living essentials included in this sample suggest that youth employment centers should be considered in future prevention efforts targeting this vulnerable subgroup of workers.

Examining changes in reported work conditions in Quebec, Ontario and Saskatchewan between 1994 and 2003-05.

OBJECTIVES: To examine changes in work hours, work schedules, the psychosocial work environment and job satisfaction in three Canadian provinces between 1994 and 2003-05. METHODS: The study sample consisted of 46,998 respondents over four cross-sectional surveys: 1994, 2000 and 2003/05 in Quebec, Ontario and Saskatchewan. Using regression models, we examined trends in work conditions across survey cycles both unadjusted, and after adjustment for differences in age, education, gender, immigration, and method of interview. RESULTS: Crude models observed increases in rotating shifts, long work hours and job security between 1994 and 2003-05, and decreases in physical demands and job satisfaction. When models were adjusted for changes in labour market demographics and educational capacity, we further observed decreases in skill discretion, decision authority, co-worker support and in regular scheduled work across survey cycles. We also noted differences in trends for two outcomes (decision authority and co-worker support) depending on interview method. CONCLUSIONS: Employees in Quebec, Ontario and Saskatchewan were more likely to be working longer hours, at non-standard time during the week, and to be less satisfied with their jobs between 1994 and 2003/05. In addition, it appears the labour market in these provinces has not adjusted sufficiently to accommodate the increasing number of workers with high levels of education and increasing age, with declines observed in decision authority, skill discretion and co-worker support once these changes were taken into account.

Measuring the Impact of Patient Engagement From the Perspective of Health Professionals Leading Quality Improvement Projects.

INTRODUCTION: The value of engaging patients and families in health care quality improvement (QI) initiatives is to help align health care system efforts with patient priorities. Meaningful evaluation of engaging with patients and families within QI may promote future collaboration. The aim of this study was to identify the experiential impact of patient engagement from the perspective of health professionals who were leading health care QI projects. METHODS: Point-of-care health professionals who completed a fellowship capacity building program between 2014 and 2018 that provided an opportunity to learn about patient engagement concepts and to engage patients, families, and caregivers in their QI projects were invited to participate in the study. The Most Significant Change technique was used as a participatory approach to obtain qualitative evaluative data from semistructured interviews with health professional fellows. Significant change stories were curated from self-narratives grounded in the experiences of health professional fellows. RESULTS: The stories demonstrated that gaining new knowledge on concepts related to patient engagement as part of a structured curriculum is effective in both supporting engagement in practice and cultivating the importance of patient engagement among health professionals. The early and ongoing involvement of patients was a key factor in shaping the project while fostering a patient-centered focus. Seeking out the patient voice throughout the QI project led to improvements in patient care experiences. DISCUSSION: The findings of this study can inform programs seeking to promote patient engagement in health care QI. The positive changes that stem from aligning capacity building programs with patient-oriented priorities support the vision that patient engagement should be at the foundation of health care QI.

Supporting Discovery and Inquiry: A Canadian Hospital's Approach to Building Research and Innovation Capacity in Point-of-Care Health Professionals.

BACKGROUND AND OBJECTIVES: Building capacity for research and innovation among point-of-care health professionals can translate into positive outcomes from the organization, staff, and patient perspective. However, there is not a widely accepted framework in place across academic hospitals to guide this work and measure impact. This article outlines one Canadian hospital's approach and provides a blueprint with appropriate indicators as a starting point and guide for organizations looking to develop and implement a practice-based research and innovation strategy. METHODS: An adapted framework was utilized to measure and track progress toward achievement of research and innovation strategic goals. The framework outlines key domains for research and capacity development and appropriate metrics. Data are reported from a 4-year period (2014-2018). RESULTS: The evaluation of the practice-based research and innovation portfolio identified several important factors that contribute to the success of embedding this strategy across a large academic teaching institution. These include using a collaborative leadership model, leveraging linkages, partnerships, and collaborations, and recognizing the academic contributions of health professionals engaging in research and innovation. CONCLUSIONS: Engaging those who provide care directly to patients and families in research and innovation is critical to ensuring high-quality health outcomes and patient experience. Creative and innovative funding models, collaborative leadership, and partnerships with key stakeholders to support research and innovation are needed to ensure sustainability.

Translating interprofessional collaboration competencies to an international research team.

INTRODUCTION: While there has been strong emphasis on enhancing interprofessional education and interprofessional care in the published literature, there is relatively little literature focused on advancing interprofessional research. In extrapolating from the current frameworks of interprofessional collaboration (IPC), it becomes clear that the core competencies of IPC are transferable to research teams. The aim of this paper is to present our experience of an international research team framed within core competencies for IPC. METHODS: A simplified narrative inquiry approach was used to share the experience of an international research team framed within six core competencies of IPC. RESULTS AND DISCUSSION: By way of our international research collaboration, we demonstrate the translation of key core competencies for IPC. We share key learnings and mitigation strategies for the successful outcomes of the research team. CONCLUSION: To embark on a successful international research collaboration requires integrating IPC core competencies across the entire research continuum. In addition to the core competencies of collaboration, enablers to success also include digital collaborative forums, existing professional relationships and research projects that offer global meaning and value.

A survey to explore the psychological impact of the COVID-19 pandemic on radiation therapists in Norway and Canada: A tale of two countries.

INTRODUCTION: Several studies have demonstrated the psychological impact of the COVID-19 pandemic on health care providers. However, there is little known about how the COVID-19 pandemic has impacted radiation therapists (RTs) in Norway or Canada. The aim of this investigation was to study the psychological impact of working during the COVID-19 pandemic among RTs in Canada and Norway. METHODS: Online surveys were administered to a convenience sample of RTs and RT department managers. Approximately 2000 and 300 RTs were invited to participate from Canada and Norway, respectively. The RT survey collected information on demographics, work-related stressors, psychological impact, quality of life, and workplace support programmes. The RT manager survey collected information on departmental changes, patient volumes, staff shortages and redeployment, personal protective equipment, and infection control measures. Descriptive analysis, group comparisons and logistic regression were used to examine the impact of COVID-19 on RTs in the two countries, while open-ended questions were examined through thematic analysis. RESULTS: Work-related stress and anxiety were prevalent among Canadian (n = 155) and Norwegian RTs (n = 124), with Canadian RTs reporting higher levels. Fear of transmission, changes in PPE usage, and changes in staffing were reported as the most frequent work-related stressors. Themes related to working during the pandemic included: generalised anxiety; physical, emotional and cognitive symptoms of stress; and loneliness, as well as negative impact on health and quality of relationships. Survey findings from RT department managers in Canada (n = 12) and Norway (n = 13) suggest that the pandemic had an organisational impact on RT departments due to implemented infection control measures and changes in staffing. CONCLUSION: The COVID-19 pandemic has led to similar stressors amongst Canadian and Norwegian RTs but relatively higher levels of psychological impact among Canadian RTs. Findings demonstrate the importance of mental health support programmes in the workplace to mitigate the psychological impact of the COVID-19 pandemic on RTs.

Switching to Daylight Saving Time and work injuries in Ontario, Canada: 1993-2007.

OBJECTIVE: To examine whether switching to and from Daylight Saving Time (DST)-1 h shift forward in the spring and 1 h shift back in the autumn-is associated with an increase in work injuries. METHOD: Data on work-related injuries were obtained from compensation claim records from the Ontario Workplace Safety & Insurance Board for the period 1993-2007. A Poisson regression model was run separately comparing the number of no lost time claims and lost time claims during the week of DST change with the week following DST change, and the week preceding DST change. We also examined if differences in the relationship between DST and work injury claims were present across industry, age, gender and job tenure groups. RESULTS: The results of our regression model did not show an increase in the incidence of work injury claims in the days immediately following the spring shift to DST. There was a significant decrease in the number of claims on Thursday, Friday and Saturday following the spring transition to DST. However, this decline was solely due to the years when Good Friday occurred during DST week (1993, 1998 and 2004) when fewer people are at work. For the autumn transition from DST, no evidence was found that the gain of 1 h sleep results in a decrease or increase in work injury claims. CONCLUSION: Our findings show that the shift to and from DST had no detrimental effects on the incidence of claims for work injuries in Ontario, Canada.

Effectiveness of health and safety in small enterprises: a systematic review of quantitative evaluations of interventions.

INTRODUCTION: This systematic review was conducted to identify effective occupational health and safety interventions for small businesses. METHODS: The review focused on peer-reviewed intervention studies conducted in small businesses with 100 or fewer employees, that were published in English and several other languages, and that were not limited by publication date. Multidisciplinary members of the review team identified relevant articles and assessed their quality. Studies assessed as medium or high quality had data extracted, which was then synthesized. RESULTS: Five studies were deemed of medium or high quality, and proceeded to data extraction and evidence synthesis. The types of interventions identified: a combination of training and safety audits; and a combination of engineering, training, safety audits, and a motivational component, showed a limited amount of evidence in improving safety outcomes. Overall, this evidence synthesis found a moderate level of evidence for intervention effectiveness, and found no evidence that any intervention had adverse effects. CONCLUSIONS: Even though there were few studies that adequately evaluated small business intervention, several studies demonstrate that well-designed evaluations are possible with small businesses. While stronger levels of evidence are required to make recommendations, these interventions noted above were associated with positive changes in safety-related attitudes and beliefs and workplace parties should be aware of them.