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.

Sexual Harassment at Work: Scoping Review of Reviews.

Background: This article presents a scoping review of reviews on the topic of Sexual Harassment (SH) in the workplace, a subject that has garnered significant global attention. The phenomenon of SH poses a critical challenge to equal opportunity and gender equity in the workplace. Aim: The review aims to synthesize existing research, focusing on the antecedents, consequences, and interventions related to SH. Methods: The inclusion and exclusion criteria were established based on the research question, which was adapted from the PICO strategy. A protocol was devised following the "DS-CPC" format, which encompasses considerations related to Documents, Studies, Construct, Participants, and Contexts. The search was carried utilizing several automated databases, specifically focusing on the fields of Psychology, Behavioral Sciences, and Health. Preliminary search yielded a total of 468 articles, and the review ultimately encompassed a total of 22 articles. Results: This review critically examines the complexity of SH, including the role of bystanders, the perpetuation of myths and misconceptions, and the exploitation of power imbalances by harassers. It also explores the manifestation of SH in male-dominated workplaces and the varying levels of organizational awareness and response to such incidents. The review highlights the importance of fostering an organizational culture that not only acknowledges and protects victims but also implements effective measures to penalize perpetrators. Implications: It aims to elucidate the intricacies of SH and advocate for a workplace environment characterized by respect and accountability. Through this comprehensive analysis, the article seeks to inform and guide future research, policy development, and organizational practices concerning SH.

Circular design strategies and economic sustainability of construction projects in china: the mediating role of organizational culture.

This research aims to elucidate the relationship between circular design strategies (CDS) and the economic sustainability of construction projects (ESCP), examining the mediating role of organizational culture (OC). Motivated by the imperative to develop a sustainable circular economy (CE) model in the building industry, our study focuses on a crucial dimension of CE processes. Specifically, we investigate how construction firms' organizational values shape their pursuit of desired economic outcomes within CE theory. Through a comprehensive analysis of 359 responses from a cross-sectional survey of Chinese construction firms employing Partial Least Squares-Structural Equation Modeling (PLS-SEM), our findings reveal a positive albeit weakly impactful association between CDS and ESCP. Simultaneously, OC is identified as a factor detrimental to ESCP. Notably, this study unveils the influential roles of hierarchical culture (HC) and group culture (GC) in shaping the current state of ESCP in China. Emphasizing the significance of CDS, we propose that contract administrators proactively reposition their organizations to adopt strategies conducive to achieving the necessary economic output for construction projects. The originality aspect lies in this research contributes to the existing body of knowledge by offering empirical insights into the theoretical framework, marking the first such empirical study in northern China. We conclude by critically examining research outcomes and limitations while providing insightful recommendations for future research to foster sustainable construction practices in the Chinese context.

The environmental awareness of nurses as environmentally sustainable health care leaders: a mixed method analysis.

BACKGROUND: People worldwide are concerned with the possibility of climate change, microplastics, air pollution, and extreme weather affecting human health. Countries are implementing measures to reduce environmental impacts. Nurses play a vital role, primarily through Green Teams, in the process of promoting sustainable practices and minimizing the environmental footprint of health care facilities. Despite existing knowledge on this topic, assessing nurses' environmental awareness and behavior, including the barriers they face, is crucial with regard to improving sustainable health care practices. AIM: To analyze the environmental awareness and behavior of nurses, especially nurse leaders, as members of the Green Team and to identify areas for improvement with regard to the creation of a sustainable environment. METHODS: A sequential mixed-method study was conducted to investigate Spanish nurses. The study utilized an online survey and interviews, including participant observation. An online survey was administered to collect quantitative data regarding environmental awareness and behavior. Qualitative interviews were conducted with environmental nurses in specific regions, with a focus on Andalusia, Spain. RESULTS: Most of the surveyed nurses (N = 314) exhibited moderate environmental awareness (70.4%), but their environmental behavior and activities in the workplace were limited (52.23% of participants rarely performed relevant actions, and 35.03% indicated that doing so was difficult). Nurses who exhibited higher levels of environmental awareness were more likely to engage in sustainable behaviors such as waste reduction, energy conservation, and environmentally conscious purchasing decisions (p < 0.05). Additionally, the adjusted model indicated that nurses' environmental behavior and activities in the workplace depend on the frequency of their environmental behaviors outside work as well as their sustainable knowledge (p < 0.01). The results of the qualitative study (N = 10) highlighted certain limitations in their daily practices related to environmental sustainability, including a lack of time, a lack of bins and the pandemic. Additionally, sustainable environmental behavior on the part of nursing leadership and the Green Team must be improved. CONCLUSIONS: This study revealed that most nurses have adequate knowledge, attitudes, and behaviors related to environmental sustainability both inside and outside the workplace. Limitations were associated with their knowledge and behaviors outside of work. This study also highlighted the barriers and difficulties that nurses face in their attempts to engage in adequate environmental behaviors in the workplace. Based on these findings, interventions led by nurses and the Green Team should be developed to promote sustainable behaviors among nurses and address the barriers and limitations identified in this research.

Thwarted belongingness and empathy's relation with organizational culture change.

Introduction: In response to several high-profile cases of senior leaders in the Canadian Armed Forces (CAF) being accused of various forms of sexual and professional misconduct, the organization has committed to culture change. Drawing on the group engagement model and empirical evidence, we propose that CAF members' experience of thwarted belongingness reduces their capacity to show empathy, which in turn affects their support for culture change. Method: Participants were 139 Naval and Officer Cadets from the Royal Military College of Canada who were predominantly male (61%), between 18 and 21 years old (80%), and not members of a visible minority group (68%). Data was collected via an online self-report survey assessing thwarted belongingness, empathy, and attitudes toward culture change. Results: Whether participants experienced thwarted belongingness was not directly related to their level of support for culture change. Individuals' thwarted belongingness was indirectly and negatively associated with support for culture change, through its impact on empathy. Discussion: Taken together, the results demonstrate that cadets' experience of belongingness contributed to their level of empathy, which together predicted their support for culture change initiatives. Efforts to change the culture of the CAF may need to consider improving members' levels of belongingness and, by extension, their levels of empathy. Implications for inclusion efforts are discussed.

Co-worker unprofessional behaviour and patient safety risks: an analysis of co-worker reports across eight Australian hospitals.

A key component of professional accountability programmes is online reporting tools that allow hospital staff to report co-worker unprofessional behaviour. Few studies have analysed data from these systems to further understand the nature or impact of unprofessional behaviour amongst staff. Ethos is a whole-of-hospital professional accountability programme that includes an online messaging system. Ethos has now been implemented across multiple Australian hospitals. This study examined reported unprofessional behaviour that staff indicated created a risk to patient safety. This study included 1310 Ethos submissions reporting co-worker unprofessional behaviour between 2017 and 2020 across eight Australian hospitals. Submissions that indicated the behaviour increased the risk to patient safety were identified. Descriptive summary statistics were presented for reporters and subjects of submissions about unprofessional behaviour. Logistic regression was applied to examine the association between each unprofessional behaviour (of the six most frequently reported in the Ethos submissions) and patient safety risk reported in the submissions. The descriptions in the reports were reviewed and the patient safety risks were coded using a framework aligned with the World Health Organization's International Classification for Patient Safety. Of 1310 submissions about unprofessional behaviour, 395 (30.2%) indicated that there was a risk to patient safety. Nurses made the highest number of submissions that included a patient safety risk [3.47 submissions per 100 nursing staff, 95% confidence interval (CI): 3.09-3.9] compared to other professional groups. Medical professionals had the highest rate as subjects of submissions for unprofessional behaviour with a patient safety risk (5.19 submissions per 100 medical staff, 95% CI: 4.44-6.05). 'Opinions being ignored' (odds ratio: 1.68; 95% CI: 1.23-2.22; P < .001) and 'someone withholding information which affects work performance' were behaviours strongly associated with patient safety risk in the submissions (odds ratio: 2.50; 95% CI: 1.73-3.62; P < .001) compared to submissions without a patient safety risk. The two main types of risks to patient safety described were related to clinical process/procedure and clinical administration. Commonly reported events included staff not following policy or protocol; doctors refusing to review a patient; and interruptions and inadequate information during handover. Our findings indicate that unprofessional behaviour was associated with risks to patient safety. Co-worker reports about unprofessional behaviour have significant value as they can be used by organizations to better understand how unprofessional behaviour can disrupt work practices and lead to risks to patient safety.

Shifting the Safety Culture: Evaluation of a Novel Approach to Understanding and Responding to Workplace Harassment and Violence Experienced by Homecare Workers.

BACKGROUND: Workplace violence and harassment are commonplace for healthcare workers and most incidents are unreported. Normalization of these experiences, lack of confidence in reporting systems, and fear of the consequences of reporting contribute to the invisibility of these experiences. Challenges are exacerbated in homecare settings and for precarious workforces including Personal Support Workers (PSWs). We created, piloted, and evaluated an intervention to enhance safety culture and encourage reporting of workplace violence and harassment. METHODS: A multi-stakeholder steering committee designed an intervention combining policy changes, a pre-visit screening tool, education, and brief end-of-visit reporting. This was piloted with a PSW care team which provided >55,000 client visits during the 32-week intervention. Operational metrics characterized screening, education, and reporting uptake. Pre- and post-intervention surveys characterized PSWs' experiences with workplace violence and harassment, reporting experiences, training history and intervention feedback. FINDINGS: PSWs reported increased comfort discussing workplace violence and harassment, and increased confidence managing client-to-worker incidents. The screening went smoothly with most clients in private homes. Most PSWs (75%) engaged at least once with end-of-visit reporting and nearly half submitted reports regularly. During the pilot, 21% of PSWs reported incidents and 52% of reports shared client-specific strategies for managing these situations. APPLICATION TO PRACTICE: Changes in comfort and behavior with reporting indicated a shift toward a more open culture surrounding workplace violence and harassment. Tools created for this intervention and lessons for implementation are shared for consideration by occupational health practitioners throughout the homecare sector.

Opinion Article on Empowering Nurses: The Cornerstone of Exceptional Patient Care.

The patients' journey is a complex network involving multiple layers of impactful stakeholders, among these stakeholders are nurses. Nurses' impact is critical to achieving better health outcomes and an uplifted experience, yet there are gaps in supporting nurses and empowering them to maximize their contribution to patients. Empowering nurses can take place in the form of educational support, recognition, and reducing their workload to limit their burn-out. The impact of such support to nurses would result in improved health outcomes, reduced mortality rates and an increase in patient satisfaction.

Cross-level transformation of creativity from entrepreneurs to organizations.

With the intensification of competition in the business environment, organizational creativity is increasingly becoming crucial for organizations to build competitive advantages and promote organizational development. For innovative enterprises, their entrepreneurs largely determine the development orientation of the enterprise. They are one of the most critical factors determining the level of corporate innovation, but there need to be more effective creativity transformation path to pursue innovation development. The findings in this study show that entrepreneurial individual creativity has a significant positive effect on organizational creativity, platform leadership mediates the path of creativity transformation across hierarchical levels, and organizational culture has positive moderating effect between platform leadership and organizational creativity. The study results explain the transformation mechanism of creativity from the entrepreneur's perspective, expand the potential transformation path of organizational creativity, and are instructive for enhancing organizational creativity.

Predictive modeling of burnout based on organizational culture perceptions among health systems employees: a comparative study using correlation, decision tree, and Bayesian analyses.

Burnout is a significant concern, particularly within the healthcare field, affecting both nurses and physicians. It is a common issue in health systems, which encompass a range of healthcare facilities, such as hospitals, physician practices, ambulatory sites, and administrative offices like finance. Despite this, there has not been an extensive exploration of burnout in employees working directly with patients versus those in non-patient-facing roles within these health systems. It is important to note that organizational culture plays a crucial role in influencing various aspects of employees' work-life balance and their experiences of burnout. This study adopts a cross-sectional design, involving the distribution of a 57-question Likert scale survey to employees in health systems. These employees serve in various roles, both patient-facing and non-patient-facing, within jointly owned healthcare organizations, which encompass hospitals, ambulatory sites, and administrative offices. The survey was disseminated through trade organizations and employees at the managerial level and above within these health systems. Data was collected between October 2022 and January 2023, resulting in a total of 67 responses. The study employs correlation analysis to explore the connection between organizational culture and burnout. Furthermore, a decision tree model is constructed to predict burnout scores based on survey responses, specifically the question regarding the perceived positivity of the organizational culture. The decision tree models indicate that perceiving organizational culture as positive, safety-oriented, and supportive predicts various outcomes for individuals, including job retention, positive experiences with patients, increased callousness, and stimulation while working with colleagues. Bayesian analysis, considering the small sample size, reinforces these findings and provides a different perspective, incorporating prior knowledge and credible intervals. An association test suggests a strong link between a positive organizational culture and burnout symptoms, while another test supports a connection with engagement signs. Similar to nurses and physicians, administrative health systems' personnel are susceptible to burnout. Organizational culture can affect burnout. Therefore, health systems' leaders should cultivate an organizational culture that protects against burnout.

The role of organizational culture and communication skills in predicting the quality of nursing care.

AIMS: This study aims to identify the level of nursing care quality and examine its predictors considering nurses' demographic data, organizational culture, and communication skills. BACKGROUND: Quality of care is a determinant of the sustainability of any healthcare organization. Therefore, it is imperative to understand how factors may contribute to the quality of nursing care. Limited research is available on the interaction between the concepts of quality of nursing care, communication skills, and organizational culture. METHODS: A cross-sectional multi-site correlational design was used in this study. A convenience sample of 200 nurses from four Jordanian hospitals was recruited. Data was collected using self-reported questionnaires. Descriptive statistics, Pearson correlations, and multiple regression were performed to achieve the study's aims. RESULTS: The majority of the nurses in this study were females with bachelor's degrees. Age ranged between 22 and 53 years whereas experience ranged from 1 to 30 years. Communication skills significantly predicted the quality of nursing care; however, organizational culture was not a significant predictor of the quality of nursing care. Nevertheless, Pearson r correlation results revealed a significant correlation between organizational culture and communication skills (r = 0.57, p < 0.05). CONCLUSION: Nurses and organizational managers can increase the level of quality of nursing care by investing in programs that target improving nurses' communication skills. Providing a good environment in the hospital can increase communication skills between staff members, ultimately increasing the quality of nursing care. Further studies are recommended to elaborate and further uncover concerns related to the current research.

A qualitative study on the process of dietitians working in pharmacies to practice dietary habit improvement support in their daily work

Background: Recently in Japan, there have been some cases of pharmacies staffed with dietitians in an effort to improve their health support functions. However, there have been few reports on the effects of these efforts, and it has been pointed out that dietitians may not be fully exercising their professional abilities. We conducted a before-and-after comparison study in 2022 to confirm the effectiveness of collaboration between pharmacy dietitians and pharmacists in supporting patients with type 2 diabetes. Objective: This study aimed to investigate the process by which dietitians who participated in our research project became accustomed to providing continuous dietary counseling as a matter of habit. Methods: Semi-structured interviews were conducted with three dietitians and two pharmacists. The main questions asked were about 1) the nature of their work before they began providing the interventions, 2) the aspects they paid attention to while providing the interventions, 3) what they felt they had changed during the intervention period, and4) what they considered obstacles to providing nutritional guidance in their pharmacies. Results: The responses of the participants regarding the nature of their work before they began providing interventions were mostly related to their “work as a dispensing clerk.” The dietitians also indicated their desire for more continuous dietary support. The responses of the participants regarding what they felt had changed during the intervention period included numerous references to having an “opportunity for trial and error” and obtaining the “cooperation of staff.” In the responses regarding what the participants considered obstacles, the dietitians mentioned “recognition by patients” and “an environment in which they can consult with patients.”... (AU)

If you build it, will they come? Exploring the success factors of knowledge management systems in the Malaysian public sector.

The current study investigates the factors that influence the success of knowledge management systems in the public sector. This study integrates the DeLone and McLean Model with critical organizational factors. The model has been tested on the data collected from 158 employees in the public sector in Malaysia, the study found that knowledge content quality has a higher significant impact on the use of knowledge management systems than system quality. Perceived usefulness also has a greater impact than user satisfaction in determining the system's overall success. Among the organizational factors, leadership is the most significant determinant of success. However, the culture of sharing, perceived trust, and incentives do not significantly influence the use of knowledge management systems. The findings suggest that public sector organizations should focus on both system and organizational factors to implement successful knowledge management systems.

A mixed-methods evaluation of organization and individual factors influencing provider intentions to use caregiver coaching in community-based early intervention.

BACKGROUND: Most psycho-social interventions contain multiple components. Practitioners often vary in their implementation of different intervention components. Caregiver coaching is a multicomponent intervention for young autistic children that is highly effective but poorly implemented in community-based early intervention (EI). Previous research has shown that EI providers' intentions, and the determinants of their intentions, to implement caregiver coaching vary across components. Organizational culture and climate likely influence these psychological determinants of intention by affecting beliefs that underlie attitudes, norms, and self-efficacy to implement an intervention. Research in this area is limited, which limits the development of theoretically driven, multilevel implementation strategies to support multi-component interventions. This mixed methods study evaluated the relationships among organizational leadership, culture and climate, attitudes, norms, self-efficacy, and EI providers' intentions to implement the components of caregiver coaching. METHODS: We surveyed 264 EI providers from 37 agencies regarding their intentions and determinants of intentions to use caregiver coaching. We also asked questions about the organizational culture, climate, and leadership in their agencies related to caregiver coaching. We used multilevel structural equation models to estimate associations among intentions, psychological determinants of intentions (attitudes, descriptive norms, injunctive norms, and self-efficacy), and organizational factors (implementation climate and leadership). We conducted qualitative interviews with 36 providers, stratified by strength of intentions to use coaching. We used mixed-methods analysis to gain an in-depth understanding of the organization and individual-level factors. RESULTS: The associations among intentions, psychological determinants of intentions, and organizational factors varied across core components of caregiver coaching. Qualitative interviews elucidated how providers describe the importance of each component. For example, providers' attitudes toward coaching caregivers and their perceptions of caregivers' expectations for service were particularly salient themes related to their use of caregiver coaching. CONCLUSION: Results highlight the importance of multi-level strategies that strategically target individual intervention components as well as organization-level and individual-level constructs. This approach holds promise for improving the implementation of complex, multicomponent, psychosocial interventions in community-based service systems.

How do organizational culture and leadership style affect nurse presenteeism and productivity?: A cross sectional study of Hong Kong acute public hospitals.

BACKGROUND: Presenteeism is defined as a type of work behavior in which employees are physically present at work when ill, often with reduced performance. While organizational culture and leadership style are known to impact the organizational behavior of hospital staff, as indicated by increased burnout and decreased work engagement, their impact on nurse presenteeism and productivity has not been explored. Moreover, nursing studies often neglect the importance of using multi-level analysis, adopting aggregated unit-level scores to account for collective perceptions to evaluate culture and leadership. OBJECTIVE: This study aims to evaluate the impact of unit-level organizational culture and leadership style on individual-level nurse presenteeism and productivity in acute care hospitals using multilevel analysis. DESIGN: Cross-sectional study. SETTING(S): Three major acute care public hospitals in Hong Kong, where public hospitals provide over 90 % of inpatient services. PARTICIPANTS: All full-time nurses (N = 4657) in the three study hospitals were invited to participate in this study. A total of 2339 nurses responded to the survey for a 65 % response rate. METHODS: Organizational culture and leadership style are characterized using the competing values framework and a two-factor leadership style typology, respectively. Multilevel hierarchical linear modeling was applied with unit-level clustering in each hospital. RESULTS: Hierarchical culture was the dominant culture (M = 3.64, SD = 0.74) in our nurse sample. None of the unit-level organizational culture and leadership styles were associated with nurse presenteeism, however, rational organizational culture at the unit-level was significantly associated with increased productivity (regression coefficient: 0.17, 95 % CI: 0.04-0.31). CONCLUSIONS: This study provides hospital managers with improved understanding of the differential impact of unit-level organizational culture and leadership style on nurse presenteeism and productivity. Unit-level leadership style did not have a direct impact on nurse presenteeism and productivity in this study, while the externally focused rational organizational culture increased nurse productivity. Further research is needed to understand the impacts of modifiable work factors and nurse psychosocial emotions on presenteeism and productivity.

How Can Organizations Support a Culture of Care?

Providing care is central to the operations of health care organizations. This article discusses how organizations can create a culture of care. It also identifies key elements that health care organizations can implement to build a culture that nurtures both patients and employees. Additionally, the article examines the benefits of implementing practices that demonstrate compassion toward both employees and patients. This article explores the significance of creating and supporting a culture of care for both patients and employees in health care organizations. Finally, the article identifies prevalent practices that contribute to a culture of care.

Implementing the learning health system paradigm within academic health centers.

Introduction: The learning health system (LHS) concept represents a bold innovation that combines organizational learning, strategic analysis of patient data, stakeholder engagement and the systematic translation of research into practice - all in service of improving the quality of health care delivered across the organization. This innovation has been diffused and widely adopted by healthcare organizations over the past 15 years, but academic health centers (AHCs) have been slower on the uptake. The irony is that AHCs have the resources (e.g., trained researchers, sophisticated clinical data systems, informatics infrastructure) that are necessary to do the highest-quality and most impactful LHS work. Methods: Based on a review of publications describing how AHCs have implemented LHS work, as well as the authors' direct experience promoting the adoption of the LHS paradigm at Atrium Health Wake Forest Baptist (AHWFB), we:identify a set of factors that have inhibited broader adoption of the LHS paradigm among AHCs; distinguish between the forms of LHS work that are consistent and inconsistent with the mission of AHCs; and offer recommendations for broader adoption and fuller implementation of the LHS paradigm. Results: The LHS paradigm represents an expansion of the scientific paradigm which serves as the foundation of research enterprise within AHCs. Both paradigms value rigorous studies of new treatments and practices, including pragmatic clinical trials. The LHS paradigm also places a high value on quality improvement studies, organizational learning, and the translation of research findings into improved patient care and operations within the local health system. The two paradigms differ on the origin of the research question, i.e., a pressing patient-care issue facing the health system versus the investigator's own research interests. Academic researchers have been disincentivized from pursuing at least some forms of LHS research. However, a growing number of AHCs are finding ways to integrate the LHS paradigm into their research enterprise, either by providing research faculty with institutional funding to cover their effort on studies that address the health system's priority issues, or by establishing an institute dedicated to LHS research. Conclusions: The LHS paradigm is a disruptive intervention for AHCs, one that was initially resisted but is increasingly being embraced. AHCs are developing strategies for conducting LHS research, typically in parallel to the more traditional biomedical science that is core to academic medicine. Full implementation of the LHS paradigm will require further alignment between LHS and science, including a shift in the criteria for promotion and tenure to support those researchers who choose to focus on the pressing issues facing the health system.