Adopting standardized cancer patient pathways as a policy at different organizational levels in the Swedish Health System.

BACKGROUND: Standardized cancer patient pathways as a new policy has been adopted in healthcare to improve the quality of cancer care. Within the health systems, actors at different levels manage the adoption of new policies to develop healthcare. The various actors on different levels play an important role and influence the policy adoption process. Thus, knowledge about how these actors use strategies when adopting cancer patient pathways as a policy in the health system becomes central. METHOD: The study's aim was to explore how actors at different organizational levels in the health system adopted cancer patient pathways. Our overarching case was the Swedish health system at the national, regional, and local levels. Constructivist Grounded Theory Method was used to collect and analyze qualitative interviews with persons working in organizations directly involved in adopting cancer patient pathways at each level. Twelve individual and nine group interviews were conducted including 53 participants. RESULTS: Organizational actors at three different levels used distinct strategies during the adoption of cancer patient pathways: acting as-missionaries, fixers, and doers. Acting as missionaries consisted of preaching the idea of cancer patient pathways and framing it with a common purpose to agree upon. Acting as fixers entailed creating a space to put cancer patient pathways into practice and overcome challenges to this. Acting as doers comprised balancing breadth and speed in healthcare provision with not being involved in the development of cancer patient pathways for the local context. These strategies were not developed in isolation from the other organizational levels but rather, each level interacted with one another. CONCLUSIONS: When adopting new policies, it is important to be aware of the different strategies and actors at various organizational levels in health systems. Even when actors on different levels developed separate strategies, if these contribute to fulfilling the four domains of inter-organizational collaboration, they can work well together to adopt new policies. Our study highlighted that the application of two domains was lacking, which meant that local actors were not sufficiently involved in collaboration, thus constricting the local use and optimization of cancer patient pathways in practice.

Policy for Equity: Associations Between Community Mental Health Agency Policies and Clinicians' Cultural Competence.

Systemic reform is needed to address racism as a root cause of mental health inequities, such as understanding how community mental health (CMH) agencies' practices and policies may impact care provided to racially minoritized populations. This study described and examined associations between CMH clinicians' multicultural knowledge and awareness and agency practices and policies to improve care for Clients of Color. CMH clinicians (N = 119) across Washington State reported on their multicultural competence and agencies' practices and policies in an online survey. Multicultural competence was assessed with the Multicultural Counseling Knowledge and Awareness Scale (MCKAS), which assesses respondents' knowledge of multicultural counseling frameworks and awareness of multicultural counseling issues. Agency policies were examined with an adapted version of the Multiculturally Competent Service System (MCSS) Assessment Guide, which asked respondents to endorse the degree to which their agencies had taken specific steps to better serve racially and ethnically minoritized populations across 11 domains, including policies, linguistic diversity in services, and quality monitoring and improvement. Multicultural knowledge and awareness were generally high across the sample. Clinicians commonly endorsed that their agencies had mission statements that were committed to cultural competence. Endorsement of concrete steps to improve services for non-English speaking clients was associated with greater multicultural knowledge and awareness, and practices to monitor and improve care provided to Clients of Color were associated with lower scores. Addressing mental health inequities requires multifaceted solutions. Results highlight the potential of examining agency practices and policies as one solution to improve care for Clients of Color.

Patient and citizen participation at the organizational level in health technology assessment: an exploratory study in five jurisdictions.

OBJECTIVE: While patient participation in individual health technology assessments (HTAs) has been frequently described in the literature, patient and citizen participation at the organizational level is less described and may be less understood and practiced in HTA bodies. We aimed to better understand its use by describing current practice. METHOD: To elicit descriptive case studies and insights we conducted semi-structured interviews and open-ended questionnaires with HTA body staff and patients and citizens participating at the organizational level in Belgium, France, Quebec, Scotland, and Wales. RESULTS: We identified examples of organizational participation in managerial aspects: governance, defining patient involvement processes, evaluation processes and methods, and capacity building. Mechanisms included consultation, collaboration, and membership of standing (permanent) groups. These were sometimes combined. Participants were usually from umbrella patient organizations and patient associations, as well as individual patients and citizens. DISCUSSION: Although the concept, participation at the organizational level, is not well-established, we observed a trend toward growth in each jurisdiction. Some goals were shared for this participation, but HTA bodies focused more on instrumental goals, especially improving participation in HTAs, while patients and citizens were more likely to offer democratic and developmental goals beyond improving participation processes. CONCLUSION: Our findings provide rationales for organizational-level participation from the perspectives of HTA bodies and patients. The case studies provide insights into how to involve participants and who may be seen as legitimate participants. These findings may be useful to HTA bodies, the patient sector, and communities when devising an organizational-level participation framework.

Coping in times of disruption and deprivation-Experiences of family members during COVID-19 patients' critical illness: A qualitative study.

AIM: To explore the experiences and needs of family members during the course of COVID-19 critical illness from onset to rehabilitation. DESIGN: An exploratory qualitative study. METHODS: Twelve family members of surviving critically ill COVID-19 patients and restricted from visiting the patients, were interviewed digitally. Reflexive thematic analysis was used. RESULTS: Three themes were generated from the data; 'Experiencing a double burden', 'Becoming an insignificant other' and 'Regaining significance'. Family members were often ill themselves, which represented an extra burden when the patient deteriorated. From admission, the family members became bystanders, deprived of most contact with the patients, as communication and information from the intensive care unit appeared unstructured and haphazard. However, when patients were discharged, great responsibility was placed on the family members.

Trajetória e participação política da enfermagem em Santa Catarina no período 1972-2018 / Trajectory and political participation of nursing in Santa Catarina in the period 1972-2018 / Trayectoria y participación política de la enfermería em Santa Catarina em el período 1972-2018

Objetivo: conhecer a participação política dos profissionais da enfermagem enquanto reflexo de suas entidades representativas. Métodos: pesquisa qualitativa de abordagem histórico-social. Dentro do recorte histórico de 1972 a 2018, entre março e setembro de 2019, entrevistaram-se 5 ex-presidentes das Associação Brasileira de Enfermagem - Seção Santa Catarina e do Conselho Regional de Enfermagem de Santa Catarina. A compreensão dos dados se deu por meio da análise de conteúdo de Bardin e interpretação através do marco conceitual de Denise Elvira Pires de Pires. Resultados: percebe-se uma significativa mudança de quadro da participação política da enfermagem através das décadas. Desde a criação da ABEn-SC a enfermagem transita de um corpo forte e unido para uma trajetória e participação em subsequente desarticulação. Conclusão: A desmobilização de uma categoria é multifatorial. Reflexo da desarticulação das entidades representativas da profissão, raízes histórico-culturais de sua fundação e do imaginário individual e social de uma profissão. (AU)

Objective: To Know the political participation of nursing professionals as a reflection of their representative entities. Methods: qualitative research of a historical-social nature in the history of 1975 to 2018, between March and September 2019. Interviewed 5 former presidents of the Brazilian Nursing Association - Santa Catarina Section and the Regional Nursing Council of Santa Catarina. The understanding of the data took place through the analysis of Bardin's content and interpretation through the conceptual framework of Denise Elvira Pires de Pires, profession, discipline and work. Results: there is a significant change in the framework of political participation in nursing over the decades. With a fragile articulation between the entities representing the category. Conclusion: The demobilization of the professional category is multifactorial. Reflection of the disarticulation of the entities representing the profession, the historical and cultural roots of its foundation and the individual and social imagery of the profession. (AU)

Objetivo: conocer la participación política de los profesionales de enfermería como reflejo de sus entidades representativas. Métodos: investigación cualitativa de carácter histórico-social en la historia de 1975 a 2018, entre marzo y septiembre de 2019. Se entrevistó a 5 ex presidentes de la Asociación Brasileña de Enfermería - Sección Santa Catarina y el Consejo Regional de Enfermería de Santa Catarina. La comprensión de los datos se llevó a cabo a través del análisis del contenido y la interpretación de Bardin a través del marco conceptual de Denise Elvira Pires de Pires, profesión, disciplina y trabajo. Resultados: hay un cambio significativo en el marco de participación política en enfermería a lo largo de las décadas. Con una articulación frágil entre las entidades que representan la categoría. Conclusión: La desmovilización de la categoría profesional es multifactorial. Reflejo de la desarticulación de los entes representativos de la profesión, las raíces históricas y culturales de su fundación y el imaginario individual y social de la profesión. (AU)

Caring for Those Who Take Care of Others: Developing Systemic and Sustainable Mental Health Support for the Diverse Healthcare Workforce in the United Kingdom.

Pressures such as high workload, stretched resources, and financial stress are resulting in healthcare workers experiencing high rates of mental health conditions, high suicide rates, high rates of staff absences from work, and high vacancy rates for certain healthcare professions. All of these factors point to the fact that a systematic and sustainable approach to mental health support at different levels and in different ways is more important than ever. In response, we present a holistic analysis of the mental health and wellbeing needs of healthcare workers across the United Kingdom healthcare ecosystem. We recommend that healthcare organisations should consider the specific circumstances of these staff and develop strategies to counter the negative impact of these factors and help safeguard the mental health of their staff.

Drug Testing Practices and Policies of Labor and Delivery Units Across the Southeastern United States.

OBJECTIVE: To describe drug testing practices used in labor and delivery units in seven southeastern U.S. states (Alabama, Georgia, Florida, Mississippi, North Carolina, South Carolina, and Tennessee), determine what risk factors prompt drug testing, and determine whether selective policies or factors that prompt testing differ based on hospital characteristics (type, size, or predominant payer source). DESIGN: Cross-sectional descriptive design. SETTING: Labor and delivery units in seven southeastern U.S. states. PARTICIPANTS: Nurse administrators of labor and delivery units (N = 49) who responded for their units. METHODS: We used a purposive sampling technique to construct a database of hospitals with obstetric services and e-mail addresses for nurse administrators. We created a 35-item survey to collect hospital characteristics and drug testing policy information. We distributed the survey to 291 nurse administrators. RESULTS: We received 49 responses (response rate = 16.8%). Respondents reported that 63% (31/49) of hospitals were not-for-profit, 87% (40/46) had Medicaid as the predominant payer source, 80% (37/46) had a formal perinatal drug testing policy, and 61% (30/49) used selective drug testing protocols. Current or past history of substance use was reported as the risk factor that most often prompted drug testing. We did not find any differences in hospital characteristics (type, size, or predominant payer source) that prompted testing. CONCLUSION: Most respondents reported that their labor and delivery units had a written drug testing policy and often used selective drug testing protocols. Drug testing protocols did not differ based on hospital type, size, or predominant payer source. Nurses have a role in implementing a best practice with unit-based drug testing.

"We Aren't Meant to Go Through the Hardest Parts of Our Lives Alone": Family Experience With Restricted PICU Presence During the COVID-19 Pandemic.

CONTEXT: PICUs across Canada restricted family presence (RFP) in response to the COVID-19 pandemic from allowing two or more family members to often only one family member at the bedside. The objective of this study was to describe the experiences and impact of RFP on families of critically ill children to inform future policy and practice. HYPOTHESIS: RFP policies negatively impacted families of PICU patients and caused moral distress. METHODS AND MODELS: National, cross-sectional, online, self-administered survey. Family members of children admitted to a Canadian PICU between March 2020 and February 2021 were invited to complete the survey. RFP-attributable distress was measured with a modified distress thermometer (0-10). Closed-ended questions were reported with descriptive statistics and multivariable linear regression assessed factors associated with RFP-attributable distress. Open-ended questions were analyzed using inductive content analysis. RESULTS: Of 250 respondents who experienced RFP, 124 (49.6%) were restricted to one family member at the bedside. The median amount of distress that families attributed to RFP policies was 6 (range: 0-10). Families described isolation, removal of supports, and perception of trauma related to RFP. Most families (183, 73.2%) felt that policies were enforced in a way that made them feel valued by PICU clinicians, which was associated with less RFP-attributable distress. Differential impact was seen where families with lower household income indicated higher RFP-attributable distress score (2.35; 95% CI, 0.53-4.17; p = 0.03). Most respondents suggested that future policies should allow at least two family members at the bedside. INTERPRETATIONS AND CONCLUSIONS: Families of children admitted to PICUs during the COVID-19 pandemic described increased distress, trauma, and removal of supports due to RFP policies. Vulnerable families showed an increased odds of higher distress. Healthcare professionals played an important role in mitigating distress. Allowance of at least two family members at the bedside should be considered for future policy.

Organizational politics and professional struggles in nursing / Políticas organizacionales y luchas profesionales en enfermería / Política organizacional e lutas profissionais na enfermagem

ABSTRACT Objective: to analyze the professional struggles between nursing organizational entities, in Rio de Janeiro, during the Regional Nursing Council's electoral process (1990-1993 administration). Method: historical study. We used journalistic articles, normative documents, legislation and semi-structured interviews with five nursing professionals who participated in this process. Interpretation of findings was supported by Bourdieu's concepts of habitus, field, capital, and symbolic power. Results: Electoral Code changes of the aforementioned council, under the influence of administration (1987-1990), candidate for re-election, influenced the disclosure and eligibility criteria, making it difficult for broad participation, especially of Associação Brasileira de Enfermagem Rio de Janeiro Section. Final considerations: nursing, in this period, generated a field of disputes related to positions of power and gender, which was evidenced in the electoral process studied, which highlighted using limiting strategies by a group, making it difficult for the entire category to participate.

RESUMEN Objetivo: analizar las luchas profesionales entre las organizaciones de enfermería de Río de Janeiro, durante el proceso electoral del Consejo Regional de Enfermería (gestión 1990-1993). Método: estudio histórico. Se utilizaron artículos periodísticos, documentos normativos, legislación y entrevistas semiestructuradas con cinco profesionales de enfermería que participaron de este proceso. La interpretación de los hallazgos se apoyó en los conceptos de habitus, campo, capital, y poder simbólico de Bourdieu. Resultados: cambios en el Código Electoral del mencionado consejo, bajo la influencia de la gestión (1987-1990), candidato a la reelección, influyeron en los criterios de divulgación y elegibilidad, dificultando la amplia participación, especialmente de la Associação Brasileira de Enfermagem Sección Río de Janeiro. Consideraciones finales: la enfermería, en este período, generó un campo de disputas relacionadas con posiciones de poder y de género, lo que se evidenció en el proceso electoral estudiado, que destacó el uso de estrategias limitantes por parte de un grupo, dificultando la participación del conjunto la categoría.

RESUMO Objetivo: analisar as lutas profissionais entre entidades organizativas da enfermagem, no Rio de Janeiro, durante o processo eleitoral do Conselho Regional de Enfermagem (gestão 1990-1993). Método: estudo histórico. Utilizamos matérias jornalísticas, documentos normativos, legislações e entrevistas semiestruturadas com cinco profissionais de enfermagem que participaram desse processo. A interpretação dos achados foi apoiada pelos conceitos de habitus, campo, capital, e poder simbólico de Bourdieu. Resultados: as alterações no Código Eleitoral do citado conselho, sob influência da gestão (1987-1990), candidata à reeleição, influenciaram na divulgação e nos critérios de elegibilidade, dificultando a ampla participação, especialmente, da Associação Brasileira de Enfermagem Seção Rio de Janeiro. Considerações finais: a enfermagem, nesse período, gerou um campo de disputas relacionadas às posições de poder e de gênero, o que se evidenciou no processo eleitoral estudado, que ressaltou o uso de estratégias limitantes por parte de um grupo, dificultando a participação de toda a categoria.

Addressing and Dismantling the Legacy of Race and Racism in Academic Medicine: A Socioecological Framework.

Over the past several years, in both clinical and academic medicine, there seems to be a growing consensus that racial/ethnic health inequities result from social, economic and political determinants of health rather than from nonexistent biological markers of race. Simply put, racism is the root cause of inequity, not race. Yet, methods of teaching and practicing medicine have not kept pace with this truth, and many learners and practitioners continue to extrapolate a biological underpinning for race. To achieve systemic change that moves us toward racially/ethnically equitable health outcomes, it is imperative that medical academia implement policies that explicitly hold us accountable to maintain a clear understanding of race as a socio-political construct so that we can conduct research, disseminate scholarly work, teach, and practice clinically with more clarity about race and racism. This short commentary proposes the use of a socioecological framework to help individuals, leadership teams, and institutions consider the implementation of various strategies for interpersonal, community-level, and broad institutional policy changes. This proposed model includes examples of how to address race and racism in academic medicine across different spheres, but also draws attention to the complex interplay across these levels. The model is not intended to be prescriptive, but rather encourages adaptation according to existing institutional differences. This model can be used as a tool to refresh how academic medicine addresses race and, more importantly, normalizes conversations about racism and equity across all framework levels.

The influences of corporate policies for COVID-19 on work stress and anxiety among healthcare employees.

BACKGROUND: During the coronavirus disease (COVID-19) pandemic, if it is considered that educated manpower is the most valuable resource of countries, it can be thought that various policies should be developed both at the macro- and micro-levels to minimize the loss of healthcare employees. OBJECTIVE: This study aims to determine the effects of the corporate policies for COVID-19 on the work stress and anxiety of healthcare employees. METHOD: The sample of the study consists of 136 of 265 healthcare employees in Sakarya Provincial Health Directorate Emergency Health Services in Turkey. The average age of the participants was 34.43 years, and the average duration of professional experience was 12.12 years. Approximately 61% of the participants are male and 51% have a bachelor's degree or higher level. A questionnaire form was used in the study as the data collection tool consisting of socio-demographic characteristics, institutional policies on COVID-19, work stress, and the Status Anxiety Scale. Process Macro Model 4, descriptive statistics and correlation analysis were used for the data analysis. RESULTS: According to the results of the study, the corporate policies for COVID-19 perception of participants were above average (3.30±0.82) while work stress (2.99±0.88) and anxiety (2.65±0.56) were below average. The corporate policies for COVID-19 perception of participants reduced their work stress (ß= - 0.430) and anxiety (ß= - 0.361). Additionally, anxiety played a mediating role in the effect of the corporate policies for COVID-19 perception on work stress, and it further raised the impact of corporate policies for COVID-19 perception on the work stress reduction (ß= - 0.169). CONCLUSIONS: During the COVID-19 pandemic, health managers should determine and control the anxiety and stress levels of the health employees on their staff and take a number of steps to reduce their anxiety and stress.

The imperative to address institutional racism in nursing practice.

Racism has been a part of nursing since its inception and has influenced its models, practices, selection of ascribed leaders, and problem framing. Reducing health disparities by effectively addressing how racism influences institutional practices is both necessary and relevant to the discipline of nursing. Using concepts from systems theory and business operations management this paper provides an important perspective for the discipline to begin to effectively address institutional racism and build nursing knowledge.

Unlimited Paid Time Off Policies: Unlocking the Best and Unleashing the Beast.

Unlimited paid time off policies are currently fashionable and widely discussed by HR professionals around the globe. While on the one hand, paid time off is considered a key benefit by employees and unlimited paid time off policies (UPTO) are seen as a major perk which may help in recruiting and retaining talented employees, on the other hand, early adopters reported that employees took less time off than previously, presumably leading to higher burnout rates. In this conceptual review, we discuss the theoretical and empirical evidence regarding the potential effects of UPTO on leave utilization, well-being and performance outcomes. We start out by defining UPTO and placing it in a historical and international perspective. Next, we discuss the key role of leave utilization in translating UPTO into concrete actions. The core of our article constitutes the description of the effects of UPTO and the two pathways through which these effects are assumed to unfold: autonomy need satisfaction and detrimental social processes. We moreover discuss the boundary conditions which facilitate or inhibit the successful utilization of UPTO on individual, team, and organizational level. In reviewing the literature from different fields and integrating existing theories, we arrive at a conceptual model and five propositions, which can guide future research on UPTO. We conclude with a discussion of the theoretical and societal implications of UPTO.

Origem, trajetória e atuação política conjunta das entidades médicas nacionais brasileiras de 1999 a 2015 / Origin, trajectory and joint political action of Brazilian national medical entities from 1999 to 2015

Resumo O artigo aborda a atuação política conjunta de entidades médicas nacionais brasileiras de 1999 a 2015, destacando elementos de sua origem, trajetória e configuração institucional. Foram analisados temas, bandeiras de luta, posicionamentos e estratégias na agenda dessas organizações. O estudo envolveu revisão bibliográfica e análise documental, ancoradas no institucionalismo histórico. Os resultados indicam processos de surgimento inter-relacionados, mais evidentes entre a Associação Médica Brasileira e o Conselho Federal de Medicina, repercutindo nas trajetórias e configurações institucionais. Observaram-se conexões entre aspectos históricos, institucionais e a atuação política das entidades. A ênfase na unidade representativa contribuiu para a conformação de uma agenda conjunta influenciada pela parceria entre as entidades, com incorporação posterior da Federação Nacional dos Médicos. Sua atuação foi voltada para o Legislativo, e simultaneamente para os setores público e privado de saúde, com crescimento de posicionamentos contrários às políticas de saúde do governo federal. A ação política se desenvolveu sem alterações de arranjo representativo trino, composto por conselho, associação e sindicato, favorecendo a definição de acordos em espaços intermediários de representação. A agenda corporativa dúbia e a defesa do exercício liberal influenciam a atuação contraditória das entidades médicas brasileiras, com desdobramentos no apoio político e incorporação desses profissionais ao SUS.

Abstract The article addresses the joint political action of Brazilian national medical entities from 1999 to 2015, highlighting elements of their origin, trajectory and institutional configuration. Themes, flags of struggle, positions and strategies in the agenda of these organizations were analyzed. The study involved bibliographic review and documentary analysis, anchored in historical institutionalism. The results indicate interrelated processes of creation, more evident between the Brazilian Medical Association and the Federal Council of Medicine, reflecting on the trajectories and institutional configurations. There were connections between historical and institutional aspects and the political action. The emphasis on the representative unit contributed to a joint agenda influenced by the partnership between the entities, with subsequent incorporation of the National Federation of Physicians. Its performance was focused on the Legislature, and simultaneously to the public and private health sectors, with growth of positions contrary to the federal health policies. The political action developed without changes of trine representative arrangement, composed of council, association and union, favoring the definition of agreements in intermediate spaces. The dubious corporate agenda and the defense of the liberal practice influence the contradictory performance of Brazilian medical entities, with consequences in political support and incorporation of these professionals to the SUS.

Navigating and Leveraging Social Media.

Social media has made a noteworthy impact in health care both in public health efforts as well as transforming how physicians connect and exchange ideas. Learning how to navigate and leverage social media across multiple platforms is becoming increasingly difficult with more platforms and features constantly being introduced. Different physicians working in the same field will have different purposes behind getting on social media, but each physician plays a different role within this social media ecosystem. This article aims to identify the common benefits of health care social media use as well as navigate the unfortunate pitfalls of social media use.

Advance Care Planning During the COVID-19 Pandemic.

Advance care planning (ACP) is especially important during the COVID-19 pandemic. Previously identified barriers to ACP include lack of time during patient visits, billing, clinician and patient discomfort and lack of resources, and difficulties with documenting and accessing ACP documents. Here we describe new challenges and new opportunities for ACP that have arisen from the COVID-19 pandemic, both due to the complexities of the illness and expedited changes in some of the stagnancies in the health care system. The shared risk for COVID-19 that all people face brings urgency to institutional policy changes to ACP form completion. However, research should assess acceptability and effectiveness of these strategies.

Changing Pharmaceutical Industry Interaction in US Family Medicine Residencies: A CERA Study.

BACKGROUND: Pharmaceutical interaction in US residencies is common. This study explores the extent and type of learner interactions in US family medicine residencies with the pharmaceutical industry and compares interactions from 2008, 2013, and 2019. METHODS: We surveyed program directors of 628 family medicine residencies with 8 questions using the 2019 Council of Academic Family Medicine Educational Research Alliance Survey and compared the responses to 2008 and 2013 results. RESULTS: The survey response rate was 39%; 81% of responding residencies did not allow food or gifts, 86% did not allow drug samples, 84% did not allow industry to interact with medical students or residents, and 81% did not allow industry-sponsored residency activities. These numbers were statistically significantly higher than both 2008 and 2013. In 2019, 151 responding programs (64%) were pharma-free, that is, they answered "No" to all 4 questions about interactions. Pharma-free residencies were increased in 2019 compared with 26% in 2008% and 49% in 2013. University-based family medicine programs were more likely to be pharma-free. Only 21% of responding programs had a formal curriculum that explores the interaction between physicians and the pharmaceutical industry. Factors cited for decreasing interaction included: institutional policy, ethical concerns, faculty input, and local response to national legislation. CONCLUSIONS: Interaction between trainees in US family medicine residencies and the pharmaceutical industry continued to decrease. A changing national legislative landscape combined with institutional policies and concerns about industry influence on prescribing habits may be important factors driving the limiting of interactions.

Improving inclusion and integration of immigrants through a voluntary workplace charter.

SETTING: The communities of Banff, Canmore, Lake Louise, and Kananaskis are home to some of Alberta's most popular tourist attractions. In recent years, the area has seen a significant increase in foreign-born residents. The Bow Valley Immigration Partnership (BVIP) brings together immigrants and stakeholders from multiple sectors to identify and implement strategies to promote integration. INTERVENTION: In collaboration with community service agencies and local employers, we developed the Bow Valley Workplace Inclusion Charter (WIC), a set of voluntarily adopted policies designed to increase inclusive practices in the workplace and promote integration of newcomers into the community. We then recruited and supported several employers in the area to make and implement specific commitments related to improving social determinants of health such as working conditions, social inclusion, education, and social support networks for immigrant workers. OUTCOMES: Eight Bow Valley employers, providing work for 38% of workers in the area, were enrolled in the pilot program. Mid-course evaluation identified facilitators and barriers to implementation of the WIC. At the conclusion of the pilot period, we evaluated the commitments implemented by each signatory to the WIC. Six of 8 employers fulfilled at least 5 commitments as articulated in the WIC, and 4 employers fulfilled 10 or more commitments. IMPLICATIONS: The WIC is a novel way of partnering with employers, community service agencies and immigrant workers to create inclusive workplace practices and improve integration of immigrants into the community. The WIC also has the potential to be adapted to address the needs of other equity-seeking groups who bring diversity to the workplace.

RéSUMé: LIEU: On trouve dans les petites villes de Banff, Canmore, Lake Louise et Kananaskis certains des attraits touristiques les plus populaires de l'Alberta. Ces dernières années, le nombre de résidents nés à l'étranger a sensiblement augmenté dans la région. L'association Bow Valley Immigration Partnership (BVIP) réunit des immigrants et des acteurs de nombreux secteurs afin de trouver et d'appliquer des stratégies pour favoriser l'intégration des nouveaux arrivants. INTERVENTION: En collaboration avec des organismes de services communautaires et des employeurs locaux, nous avons créé une charte d'intégration en milieu de travail, la Bow Valley Workplace Inclusion Charter : un ensemble de politiques adoptées volontairement pour faire augmenter les pratiques rassembleuses sur le lieu de travail et favoriser ainsi l'intégration des nouveaux arrivants dans la communauté. Nous avons ensuite recruté plusieurs employeurs de la région et nous les avons aidés à prendre et à concrétiser des engagements spécifiques pour améliorer les déterminants sociaux de la santé, comme les conditions de travail, l'inclusion sociale, l'éducation et les réseaux de soutien social des travailleurs immigrants. RéSULTATS: Huit employeurs de la vallée de Bow, qui emploient 38 % des travailleurs de la région, se sont inscrits au programme pilote. L'évaluation à mi-parcours a fait ressortir les éléments qui favorisent ou qui entravent l'application de la Charte. À la fin de la période d'essai, nous avons évalué la concrétisation des engagements pris par chaque signataire. Six des huit employeurs ont respecté au moins cinq engagements énoncés dans la Charte, et quatre sur huit en ont respecté dix ou plus. CONSéQUENCES: La Charte est un nouveau moyen de créer des partenariats avec des employeurs, des organismes de services communautaires et des travailleurs immigrants pour créer des pratiques rassembleuses en milieu de travail et améliorer l'intégration des immigrants dans la communauté. On peut aussi l'adapter aux besoins d'autres groupes en quête d'équité qui apportent de la diversité sur le lieu de travail.

Developing Statewide Violence Prevention Programs in Health Care: An Exemplar From Massachusetts.

Workplace violence is on the rise in health care. This problem contributes to medical errors, ineffective delivery of care, conflict and stress among health professionals, and demoralizing and unsafe work conditions. There is no specific federal statute that requires workplace violence protections, but several states have enacted legislation or regulations to protect health care workers. To address this problem in their state, the Massachusetts Health & Hospital Association developed an action plan to increase communication, policy development, and strategic protocols to decrease workplace violence. The purpose of this article is to report on the quality and safety improvement work that has been done statewide by the Massachusetts Health & Hospital Association and to provide a roadmap for other organizations and systems at the local, regional, or state level to replicate the improvement process.

A Study to Understand the Impact of Bereavement Grief on the Workplace.

Although most employees and business owners or operators will likely experience the death of one or more loved ones over their work lives, attention has not focused on how bereavement grief impacts the workplace. A study was conducted for foundational information. Data on the annual incidence of bereavement leaves and related matters were collected from a relatively representative sample of small, medium, and large Canadian organizations. Two of every three organizations had 1+ employees take a bereavement leave last year, with 3.2% of all employees taking a bereavement leave consisting of 2.5 days on average and often with additional travel and accommodation days. The findings suggest that more should be done by organizations to prepare for bereavement leaves and assisted work returns. This preparation is essential for the tsunami of bereavement grief in the years ahead as deaths increase rapidly in number with population aging.