The last resort: reducing avoidable employee harm by improving the application of the disciplinary policy and process.

Introduction: There is growing evidence within the healthcare sector that employee investigations can harm individuals involved in the process, an organization's culture and the delivery of its services. Methods: This paper details an intervention developed by an NHS Wales organization to reduce the number of its employee investigations through an organization-wide focus that promoted a 'last resort' approach and introduced the concept of 'avoidable employee harm'. A range of associated improvement initiatives were developed to support behavior change among those responsible for determining whether an employee investigation should be initiated. Results: Over a 13-month period, organizational records showed an annual reduction of 71% in investigation cases post-intervention, resulting in an estimated 3,308 sickness days averted annually and total estimated annual savings of £738,133 (based on direct savings and costs averted). This indicates that the organization has started to embrace the "last resort" approach to using employee investigations to address work place issues. The programme was supported with training for those responsible for commissioning and leading the organization's employee investigations. Analysis of survey data from those who attended training workshops to support the programme indicated that participants showed an increased awareness of the employee investigation process post-workshop and an understanding of the concept of avoidable employee harm. Discussion: The programme is congruent with the Healthy Healthcare concept, as the study illustrates how its practices and processes have a beneficial impact on staff, as well as potentially on patients. This study highlights wider issues for consideration, including the: (1) the role of Human Resources (HR), (2) taking a multi-disciplinary approach, (3) culture and practice, (4) the responsibility of the wider HR profession.

Public management approaches to an aging workforce: organizational strategies for strategies for adaptability and efficiency.

This study investigates the impact of psychological age climate on the motivation of aged workers in China and explores the mediating mechanisms at play. Two proposed chains of mediation capture the potential mechanisms underlying this process. The first chain involves the task and knowledge characteristics of work design, specifically autonomy arrangements and skill-based job demands, as mediators. The second chain focuses on the social and physical/contextual aspects of work design, including social support and ergonomic working conditions. The study sample consisted of 1,094 Chinese employees aged between 50 and 70 years (M = 55.66, SD = 4.274). Our findings reveal that a positive psychological age climate-organizational norms and practices that value and support older workers-significantly boosts their motivation to continue working. This enhancement in motivation is mediated by increased job autonomy and robust social support within the workplace, confirming that these elements are crucial for translating a positive age climate into tangible outcomes. Contrary to existing literature, our research does not support the mediating role of job design tailored to aged workers' skills and ergonomic working conditions. This indicates that in the cultural and organizational context of China, where collective values and respect for elder wisdom predominate, autonomy and social support directly influence workers' motivation more profoundly than ergonomic and job design considerations. The study underscores the importance of creating inclusive organizational cultures and implementing targeted support strategies to retain and engage aged workers effectively. It suggests that public policymakers and organizational leaders should focus on fostering positive psychological age climates and providing necessary autonomy and social resources to meet the unique needs of an aging workforce, thereby enhancing both individual and organizational outcomes in a globally aging society.

Revisiting organizational culture in healthcare: Heterogeneity as a resource.

Aligning culture to be similar across work units is a common organizational tactic, but its appropriateness for the multidisciplinary context of healthcare is far from certain. Variation in perceptions of culture across large health systems may serve a functional purpose in delivering high quality care and ameliorating job stress; however, past research in healthcare has focused on culture as the average set of values and norms (i.e., cultural content) rather than on (dis)agreement about values and norms among organizational members (i.e., cultural structure). This survey-based study examines both cultural content (averages among individuals) and structure (distances between individuals) in departments of a large U.S. healthcare organization (total sample = 26,314 workers, response rate = 84%). We used linear models to associate four commonly used culture measures with outcome measures (perceived care quality, intent to stay, and manageable job stress). We found substantial heterogeneity in perceptions for multiple culture types. We found curvilinear relationships between heterogeneity for all culture types and outcomes, suggesting that heterogeneity promotes positive outcomes up to a certain point after which the positive effect declines. For research, our findings point to the importance of studying culture in healthcare with greater focus on heterogeneity; for practice, this study highlights how culturally-focused efforts to improve care quality and worker experience in healthcare should be more precise about balancing cultural alignment and heterogeneity.

Preparing for Value: Evaluating Organizational Culture in Health Care Transformation.

The health care industry is experiencing a transformative shift from traditional fee-for-service models to value-based care (VBC), emphasizing improved patient outcomes, enhanced quality, and reduced costs. While Centers for Medicare & Medicaid Services Innovation Center models focus on financial and quality outcomes, a critical opportunity for reform lies in organizational culture. VBC signifies a cultural and systemic evolution aligned with the quintuple aim of enhancing equitable patient outcomes, improving quality, reducing costs, and prioritizing provider well-being. Cultural impacts play a pivotal role in this transformation.

Siloed mentality, health system suboptimization and the healthcare symphony: a Canadian perspective.

Measuring and optimizing a health system is challenging when patient care is split between many independent organizations. For example, patients receive care from their primary care provider, outpatient specialist clinics, hospitals, private providers and, in some instances, family members. These silos are maintained through different funding sources (or lack of funding) which incentivize siloed service delivery. A shift towards prioritizing patient outcomes and keeping the patient at the centre of care is emerging. However, competing philosophies on patient needs, how health is defined and how health is produced and funded is creating and engraining silos in the delivery of health services. Healthcare and health outcomes are produced through a series of activities conducted by diverse teams of health professionals working in concert. Health professionals are continually learning from each patient interaction; however, silos are barriers to information exchange, collaborative evidence generation and health system improvement. This paper presents a systems view of healthcare and provides a systems lens to approach current challenges in health systems. The first part of the paper provides a background on the current state and challenges to healthcare in Canada. The second part presents potential reasons for continued health system underperformance. The paper concludes with a system perspective for addressing these challenges.

Informal institutions and corporate innovation: A Perspective from Red Culture.

Since the 20th century, Red Culture has served as a significant informal institution guiding revolutionary trajectory and developmental course. However, integrating Red Culture into contemporary corporate management and leveraging its constructive influence within today's market-driven economy necessitates comprehensive exploration and thoughtful consideration. This study aims to explore the potential influence of Red Culture on contemporary innovation. Empirical findings reveal substantial and affirmative effects of Red Culture on corporate innovation. Specifically, a heightened Red Culture ambiance correlates with a marked increase in both innovation input and output within corporate. Further investigation underscores Red Culture's pivotal governance role in mitigating strategic manipulation of innovation and research and development practices, especially within the overarching framework of innovation-driven strategies. Moreover, Red Culture synergizes with formal innovation incentive mechanisms, jointly fostering corporate innovation. This study provides micro-level empirical evidence that elucidates the impact of Red Culture on corporate innovation. Additionally, it furnishes valuable policy insights for the practical implementation and enhancement of pertinent Red Culture initiative.

The dynamic feasibility of resisting (R), accepting (A), or directing (D) ecological change.

Ecological transformations are occurring as a result of climate change, challenging traditional approaches to land management decision-making. The resist-accept-direct (RAD) framework helps managers consider how to respond to this challenge. We examined how the feasibility of the choices to resist, accept, and direct shifts in complex and dynamic ways through time. We considered 4 distinct types of social feasibility: regulatory, financial, public, and organizational. Our commentary is grounded in literature review and the examples that exist but necessarily has speculative elements because empirical evidence on this newly emerging management strategy is scarce. We expect that resist strategies will become less feasible over time as managers encounter situations where resisting is ecologically, by regulation, financially, or publicly not feasible. Similarly, we expect that as regulatory frameworks increasingly permit their use, if costs decrease, and if the public accepts them, managers will increasingly view accept and direct strategies as more viable options than they do at present. Exploring multiple types of feasibility over time allows consideration of both social and ecological trajectories of change in tandem. Our theorizing suggested that deepening the time horizon of decision-making allows one to think carefully about when one should adopt different approaches and how to combine them over time.

La viabilidad dinámica de resistir (R), aceptar (A) o dirigir (D) el cambio ecológico Resumen Las transformaciones ecológicas ocurren por el cambio climático, lo que representa un reto para los enfoques tradicionales para decidir en torno a la gestión de tierras. El marco resistir­aceptar­dirigir (RAD) ayuda a los gestores a considerar cómo responder a este reto. Analizamos cómo la viabilidad de las opciones para resistir, aceptar y dirigir cambia de manera compleja y dinámica con el tiempo. Consideramos cuatro tipos distintos de viabilidad: regulatoria, económica, pública y de organización. Nuestro comentario está basado en la revisión bibliográfica y los ejemplos que existen, pero por necesidad tiene elementos especulativos ya que la evidencia empírica sobre esta estrategia emergente de gestión es escasa. Esperamos que las estrategias de resistir se vuelvan menos viables con el tiempo conforme los gestores encuentren situaciones en las que resistir no es viable de forma ecológica, económica, pública o por regulación. Al igual esperamos que cada vez más los marcos regulatorios permitan su uso, si el costo disminuye, y si el público los acepta, los gestores verán cada vez más viables las estrategias de aceptar y dirigir que las que utilizan actualmente. La exploración de varios tipos de viabilidad a lo largo del tiempo permite considerar las trayectorias sociales y ecológicas del cambio en conjunto. Nuestra teoría sugiere que profundizar en el horizonte temporal de las decisiones permite que se analice con cuidado sobre cuando se deben adoptar enfoques diferentes y cómo combinarlos con el tiempo.

Unveiling the Heartbeat of Healing: Exploring Organizational Culture in a Tertiary Hospital's Emergency Medicine Department and Its Influence on Employee Behavior and Well-Being.

This study examined the organizational culture of an emergency medicine department (EMD) in a tertiary hospital in Karnataka, India, using a prospective cross-sectional design from January to February 2024. It aimed to identify the predominant and supporting organizational cultures within the EMD and their influence on employee behavior and well-being, including job satisfaction, burnout, stress levels, and coping strategies. A total of 82 participants, including physicians, emergency medical technicians, and nurses, completed the Organizational Culture Assessment Instrument (OCAI) and a self-designed questionnaire. Ethical clearance was obtained (IEC2-656). Clan culture emerged as the dominant culture (73.17%), emphasizing collaboration and adaptability, correlated with lower stress levels and high job satisfaction (90.78%). Emotional exhaustion was the most common burnout symptom (53.66%). The coping strategies varied, with employees in Clan cultures seeking social support, while those in Hierarchy cultures sought guidance from superiors. This study highlighted the significant role of organization culture in employee well-being and EMD effectiveness, influenced by social values like respect for authority. The limitations included single-setting analysis, an uneven subgroup representation, and a lack of qualitative insights. Future research should involve multiple hospitals and qualitative methods for a comprehensive understanding.

Understanding Rewarding and Challenging Nursing Experiences During the Pandemic in Five Countries: Toward Strengthening the Workforce.

INTRODUCTION: Nurses are now more likely to leave their current role in direct patient care than they were before the COVID-19 pandemic. Country culture and the organization of health care systems drive nurses' decisions to leave or stay in the profession. METHODS: In a fall 2020 survey of nurse professional quality of life, a content analysis of responses to the open-ended question, "What has been challenging or rewarding during this pandemic experience?" was performed. Results were organized within Hofstede's Cultural Dimensions Theory. RESULTS: Six hundred and fifty-six nurses across five countries responded to the question; 526 comments were analyzed. Most (53.6%) respondents were staff bedside nurses. Themes, such as Distress and Fatigue and Building and Experiencing Social Capital were found and understood to reflect cultural values and dimensions such as Uncertainty Avoidance and Power Distance. DISCUSSION: Recommendations include strengthening culturally tailored leadership knowledge to inform and facilitate countries' nurse retention.

Toward a sustainability performance management framework.

Although the United Nations (UN) has continued to introduce the Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs) to address global sustainability, the world is becoming less sustainable. This is not surprising since our knowledge about effective sustainability performance management is scanty. The present study attempts to develop a sustainability performance management framework to deal effectively with the prevailing sustainability problems. It starts by introducing the "wicked" nature of sustainability problems, followed by a research methodology to build the sustainability performance management framework. The review suggests that the framework's components are related to the organizational culture of sustainability, the sustainability strategy employed by the firm, the corporate sustainability practices implemented, and the resulting outputs and outcomes in terms of sustainability performance. The connections between these elements are fundamentally critical, along with a feedback loop to address the dynamic, wicked sustainability problems. Finally, a Sustainability Performance Management framework and its associated propositions are derived, followed by future research directions and practical implications.

Patient Safety Culture from a Nursing Perspective in a Chilean Hospital.

Patient safety culture is relevant both in the delivery of care and in the training of nursing staff, its purpose being to prevent and reduce risks associated with health care. This research aims to evaluate patient safety culture from the perspective of the nursing teams in a highly complex public hospital in the city of Valparaíso, Chile. A cross-sectional study with a quantitative approach applying descriptive, bivariate, and inferential statistical analysis was conducted on 259 nurses and nursing assistants from 13 adult medical-surgical units of the Carlos Van Buren hospital. The participants were obtained through a non-probabilistic convenience sample, answering the hospital survey on Patient Safety Culture version 2.0 (HSOPS 2.0), adapted to the Chilean population. The best-evaluated dimension was communication and receptivity; the worst was the support administrators provide for patient safety. This study identified the weaknesses and strengths of the hospital, the most worrying weakness being the shortage of human capital, material, and financial resources necessary to improve patient safety. This study was not registered.

Organizational culture and turnover intention among primary care providers: a multilevel study in four large cities in China.

BACKGROUND: Primary health care plays an important role in providing populations with access to health care. However, it is currently facing unprecedented workforce shortages and high turnover worldwide. OBJECTIVE: This study examined the relationship between organizational culture and turnover intention among primary care providers in China. METHODS: A cross-sectional survey was administered in four large cities in China, Tianjin, Jinan, Shanghai, and Shenzhen, comprising 38 community health centers and 399 primary care providers. Organizational culture was measured using the Competing Value Framework model, which is divided into four culture types: group, development, hierarchy, and rational culture. Turnover intention was measured using one item assessing participants' intention to leave their current position in the following year. We compared the turnover intention among different organizational culture types using a Chi-square test, while the hierarchical logistic regression was used to examine the relationship between organizational culture and turnover intention. RESULTS: The study found that 32% of primary care providers indicated an intention to leave. Primary care providers working in a hierarchical culture reported higher turnover intention (43.18%) compared with those in other cultures (p < 0.05). Hierarchical culture was a predictor of turnover intention (OR = 3.453, p < 0.001), whereas rational culture had a negative effect on turnover intention (OR = 0.319, p < 0.05). CONCLUSIONS: Our findings inform organizational management strategies to retain a healthy workforce in primary health care.

Main findings: This study found that primary care physicians and nurses working in a hierarchical culture are more likely to report the intention to leave compared to other culture types, while those working in a rational culture are significantly less likely to report the intention to leave.Added knowledge: The dominant organizational culture identified in community health centers across eastern China is group culture, and organizational culture is a significant predictor of the turnover intention of primary care providers.Global health impact for policy and action: Future primary care reform should focus on managerial interventions in their efforts to retain health workers and, in particular, develop and implement strategies to cultivate and moderate rational culture.

Mapping Strategies for Strengthening Safety Culture: A Scoping Review.

BACKGROUND: Twenty years after the "To Err Is Human" report, one in ten patients still suffer harm in hospitals in high-income countries, highlighting the need to strengthen the culture of safety in healthcare. This scoping review aims to map patient safety culture strengthening strategies described in the literature. METHOD: This scoping review follows the JBI methodology. It adhered to all scoping review checklist items (PRISMA-ScR) with searches in the Lilacs, MedLine, IBECS, and PubMed databases and on the official websites of Brazilian and North American patient safety organizations. The research took place during the year 2023. RESULTS: In total, 58 studies comprising 52 articles and 6 documents from health organizations were included. Various strategies were identified and grouped into seven categories based on similarity, highlighting the need for a comprehensive organizational approach to improve patient care. The most described strategies were communication (69%), followed by teamwork (58.6%) and active leadership (56.9%). CONCLUSION: The identified strategies can promote the development of a culture in which an organization can achieve patient safety, involving practices and attitudes that reduce risks and errors in healthcare. However, the identification of strategies is limited because it is restricted to certain databases and websites of international organizations and does not cover a broader spectrum of sources. Furthermore, the effectiveness of these strategies in improving patient safety culture has not yet been evaluated.

Cultura de segurança em unidades de terapia intensiva na perspectiva da equipe multiprofissional: Estudo multicêntrico / Cultura de seguridad en unidades de terapia intensiva en la perspectiva del equipo multiprofesional: Estudio multicéntrico / Safety Culture in intensive care units from multiprofessional team perspective: A multicenter study

Resumo Introdução: A Cultura de Segurança do Paciente é considerada um importante componente estrutural dos serviços, que favorece a implantação de práticas seguras e a diminuição da ocorrência de eventos adversos. Objetivo: Identificar os fatores associados à cultura de segurança do paciente nas unidades de terapia intensiva adulto em hospitais de grande porte da região Sudeste do Brasil. Método: Estudo transversal do tipo survey e multicêntrico. Participaram 168 profissionais de saúde de quatro unidades (A, B, C e D) de terapia intensiva adulto. Foi utilizado o questionário "Hospital Survey on Patient Safety Culture". Considerou-se como variável dependente o nível de cultura de segurança do paciente e variáveis independentes aspectos sociodemográficos e laborais. Foram usadas estatísticas descritivas e para a análise dos fatores associados foi elaborado um modelo de regressão logística múltipla. Resultados: Identificou-se associação entre tipo de hospital com onze dimensões da cultura de segurança, quanto à função a categoria profissional médico, técnico de enfermagem e enfermeiro foram relacionadas com três dimensões; o gênero com duas dimensões e tempo de atuação no setor com uma dimensão. Conclusão: Evidenciou-se que o tipo de hospital, categoria profissional, tempo de atuação no setor e gênero foram associados às dimensões de cultura de segurança do paciente.

Resumen Introducción: La cultura de seguridad del paciente se considera un componente estructural importante de los servicios, que favorece la aplicación de prácticas seguras y la reducción de la aparición de acontecimientos adversos. Objetivo: Identificar los factores asociados a la cultura de seguridad del paciente en unidades de terapia intensiva adulto en hospitales de la región Sudeste del Brasil. Metodología: Estudio transversal de tipo encuesta y multicéntrico. Participaron 168 profesionales de salud de cuatro unidades (A, B, C y D) de terapia intensiva adulto. Se utilizó el cuestionario "Hospital Survey on Patient Safety Culture". Se consideró como variable dependiente el nivel de cultura de seguridad del paciente y variables independientes los aspectos sociodemográficos y laborales. Fueron usadas estadísticas descriptivas y, para analizar los factores asociados, fue elaborado un modelo de regresión logística múltiple. Resultados: Se identificó asociación entre tipo de hospital con once dimensiones de cultura de seguridad del paciente. En relación a la función, personal médico, técnicos de enfermería y personal de enfermería fueron asociados con tres dimensiones, el género con dos dimensiones y tiempo de actuación con una dimensión en el modelo de regresión. Conclusión: Se evidenció que el tipo de hospital, función, tiempo de actuación en el sector y género fueron asociados a las dimensiones de la cultura de seguridad del paciente.

Abstract Introduction: Patient safety culture is considered an important structural component of the services, which promotes the implementation of safe practices and the reduction of adverse events. Objective: To identify the factors associated with patient safety culture in adult intensive care units in large hospitals in Belo Horizonte. Method: Cross-sectional survey and multicenter study. A total of 168 health professionals from four units (A, B, C and D) of adult intensive care participated. The questionnaire "Hospital Survey on Patient Safety Culture" was used. The patient's level of safety culture was considered as a dependent variable, and sociodemographic and labor aspects were the independent variables. Descriptive statistics were used and a multiple logistic regression model was developed to analyze the associated factors. Results: An association was identified between the type of hospital and eleven dimensions of the safety culture. In terms of function, the doctors, nursing technicians, and nurse were related to three dimensions; gender with two dimensions, and time working in the sector with one dimension. Conclusion: It was evidenced that the type of hospital, function, time working in the sector, and gender were associated with the dimensions of patient safety culture.

Before and during COVID-19: the roles of transformational leadership, organizational culture and work-life balance in healthcare.

PURPOSE: This research aims to investigate the role of transformational leadership and organizational culture - encompassing Clan, Adhocracy, Hierarchical and Market Cultures - in the context of work-life balance for healthcare workers. It aims to present a comparison of observations made pre and mid-pandemic. DESIGN/METHODOLOGY/APPROACH: A structured questionnaire was utilized to collect data from a varied sample of 355 employees (258 before and 97 during the pandemic) representing multiple sectors and positions within a hospital. The interpretation of the data was accomplished using Partial Least Squares Structural Equation Modeling (PLS-SEM). FINDINGS: Findings reveal that prior to the pandemic, transformational leadership significantly influenced all forms of organizational culture perceptions, with a strong influence on Clan Culture. Clan Culture displayed a consistent positive correlation with WLB both before and during the pandemic. During the pandemic, Market Culture exhibited a negative effect on WLB and Adhocracy Culture demonstrated a positive effect, impacts which were absent before the pandemic. Transformational leadership had a positive impact on WLB before the pandemic, but no discernible effect during the pandemic was observed. ORIGINALITY/VALUE: The results indicate that the dynamics between transformational leadership, organizational culture and work-life balance are susceptible to alterations in the face of external crisis events. This study offers a unique exploration of these dynamics in the healthcare sector during the ongoing global pandemic.

Associations between patient safety culture and workplace safety culture in hospital settings.

BACKGROUND: Strong cultures of workplace safety and patient safety are both critical for advancing safety in healthcare and eliminating harm to both the healthcare workforce and patients. However, there is currently minimal published empirical evidence about the relationship between the perceptions of providers and staff on workplace safety culture and patient safety culture. METHODS: This study examined cross-sectional relationships between the core Surveys on Patient Safety Culture™ (SOPS®) Hospital Survey 2.0 patient safety culture measures and supplemental workplace safety culture measures. We used data from a pilot test in 2021 of the Workplace Safety Supplemental Item Set, which consisted of 6,684 respondents from 28 hospitals in 16 states. We performed multiple regressions to examine the relationships between the 11 patient safety culture measures and the 10 workplace safety culture measures. RESULTS: Sixty-nine (69) of 110 associations were statistically significant (mean standardized ß = 0.5; 0.58 < standardized ß < 0.95). The largest number of associations for the workplace safety culture measures with the patient safety culture measures were: (1) overall support from hospital leaders to ensure workplace safety; (2) being able to report workplace safety problems without negative consequences; and, (3) overall rating on workplace safety. The two associations with the strongest magnitude were between the overall rating on workplace safety and hospital management support for patient safety (standardized ß = 0.95) and hospital management support for workplace safety and hospital management support for patient safety (standardized ß = 0.93). CONCLUSIONS: Study results provide evidence that workplace safety culture and patient safety culture are fundamentally linked and both are vital to a strong and healthy culture of safety.

Rethinking organizational culture in intersectoral coordination: the perspective of boundary work.

PURPOSE: The purpose of this paper is to rethink the concept of organizational culture as something that emerges bottom-up by using the sociological concepts of boundary object and boundary work as an analytical lens and to show how this approach can help understand and facilitate intersectoral coordination. DESIGN/METHODOLOGY/APPROACH: We used observations and qualitative interviews to develop "deep" knowledge about processes of intersectoral coordination. The study draws on a conceptual framework of "boundary work" and "boundary objects" to show how a bottom-up perspective on organizational culture can produce better understanding of and pave the way for intersectoral coordination. We use a case of health professionals engaged in two Danish intersectoral programs developing and providing health promotion services for women with gestational diabetes mellitus (GDM). FINDINGS: The study showed how boundary work revolves around negotiations on how to define, understand and act on the diagnosis of GDM. This diagnosis has the characteristics of a "boundary object", being more loosely structured in general terms, but strongly structured in local settings. Boundary objects help connect different professionals and facilitate coordination. The analysis showed how the introduction of time and the concept of "lifelong health promotion" helped to transgress existing organizational and professional boundaries. RESEARCH LIMITATIONS/IMPLICATIONS: The findings contribute to the literature on organizational culture and intersectoral coordination. We highlight the benefits of a practice-oriented, bottom-up perspective for a better understanding of how shared meaning is produced in cross professional coordination and collaboration. While the theoretical implications will be general applicable when studying organizational culture, the implications for practice are sensitive to context and the processes we have described as the outcomes of boundary work are generated from cases that were most likely to provide deep insight into our research topic. PRACTICAL IMPLICATIONS: For practice this can build bridges between organizational and professional boundaries. ORIGINALITY/VALUE: The findings contribute to the literature on organizational culture and intersectoral coordination. We highlight the benefits of a practice-oriented, bottom-up perspective for a better understanding of how shared meaning is produced in cross professional coordination. This may build bridges between organizational and professional boundaries in practice settings.

Impact of Relational Coordination on Job Satisfaction and Willingness to Stay: A Cross-Sectional Survey of Healthcare Professionals in South Tyrol, Italy.

Job satisfaction and willingness to stay are critical for workforce stability in a challenging healthcare environment. This study examined how relational coordination, a key factor in teamwork and communication, influences outcomes among healthcare professionals in a bilingual, culturally mixed region of Italy. This cross-sectional survey included general practitioners, hospital physicians, nurses, and administrators from the South Tyrol Health Service, using the 'Relational Coordination Survey' and additional measures of job satisfaction and willingness to stay. The analytical methods used included descriptive statistics, correlations, and regression analyses. This study applied path analysis, including mediation and moderation techniques, to investigate the roles of relational coordination and job satisfaction in influencing the willingness to stay. It employs Conditional Process Analysis with the PROCESS macro in SPSS, focusing on models for moderated mediation analysis. The results indicated a critical influence of relational coordination on both job satisfaction and willingness to stay among the 525 healthcare professionals. Job satisfaction varied by health district and years of service, with midcareer professionals being the least satisfied. The findings highlight the central role of relational coordination in job satisfaction and willingness to stay and confirm that low job satisfaction increases turnover intentions. Relational coordination directly enhanced job satisfaction and willingness to stay, while also serving as a mediating factor that amplifies the impact of job satisfaction on retention intentions. This study reinforces the need for strong teamwork and communication to stabilize the healthcare workforce. Targeted interventions aimed at improving relational coordination could significantly enhance job satisfaction and retention among healthcare professionals, particularly in culturally diverse settings such as South Tyrol.

Primary Care Practice Characteristics Associated With Medical Assistant Staffing Ratios.

This study characterized adult primary care medical assistant (MA) staffing. National Survey of Healthcare Organizations and Systems (n = 1,252) data were analyzed to examine primary care practice characteristics associated with MA per primary care clinician (PCC) staffing ratios. In 2021, few practices (11.4%) had ratios of 2 or more MAs per PCCs. Compared with system-owned practices, independent (odds ratio [OR] = 1.76, P <0.05) and medical group-owned (OR = 2.09, P <0.05) practices were more likely to have ratios of 2 or more MAs per PCCs, as were practices with organizational cultures oriented to innovation (P <0.05). Most primary care practices do not have adequate MA staffing.

Pediatric nurses' fatigue descriptions in occupational injury reports: A descriptive qualitative study1.

Background: Despite the high risks associated with occupational fatigue in healthcare, few organizations require nurses to screen and report fatigue symptoms. As a result, little is known about if and how nurses would report fatigue while on the job. Objective: To determine if hospital-based pediatric nurses reported fatigue as part of an active injury reporting method. Methods: This secondary analysis of qualitative data used a descriptive design with content analysis. Data from the parent study were collected at a U.S. pediatric hospital where nurses verbally reported on-shift injuries or near misses and pre- and post-shift health status via a digital voice recorder. Researchers used content analysis to independently code data for nurses' references to fatigue. Codes were then analyzed for patterns and themes. Results: Approximately 30% (n = 104) of participants reported fatigue-related content. Emergent themes were Work Stressors, Individual Risk Factors, Fatigue Descriptors, Adverse Outcomes from Fatigue, Fatigue Buffers, Descriptors for Buffered Fatigue, and Favorable Outcomes from Buffered Fatigue. Fatigue descriptions align with prior literature, demonstrating the accuracy of the voice recorder data collection method. In addition, nurses expressed uncertainty about the appropriateness of reporting fatigue symptoms. Conclusion: Findings from this study support pediatric nurses will report fatigue, when provided an opportunity. Additional efforts are needed to better understand effective ways to improve fatigue reporting among nurses, including harnessing current technology for real-time reporting and how to change the culture around fatigue reporting.