Psychosocial factors associated with pharmacists' end-of-life medication counseling and dispensing.

OBJECTIVE: In 2015, California legalized physician-assisted suicide through passing the End of Life Option Act (ELOA). This study aimed to identify and describe the psychosocial factors associated with pharmacists' intention to counsel and dispense end-of-life medications. METHODS: Data were collected using a 51-item questionnaire that was mailed to 2,000 registered community pharmacists in California. The study collected data on TPB constructs (attitude, subjective norm [SN], and perceived behavioral control [PBC]), behavioral and control beliefs, perceived obligation, and demographic and practice characteristics. Hierarchical linear regression was used to identify the factors associated with the pharmacists' intention. RESULTS: A total of 353 responses (19.4% response rate) were received from respondents with an average age of 50.4 ± 14.8 years. Most of the respondents were women (53.1%) and religious (56.4%). Most pharmacies did not currently stock ELOA medications (n = 197, 56.1%), and most pharmacists had never been presented with an ELOA prescription in their practice (n = 319, 90.4%). The pharmacists had a positive intention (mean = 8.24 ± 4.6, range: 2-14), attitude (mean = 17.15 ± 6.9, range: 4-28), SN (mean = 1.1 ± 4.5; range: -9 to 9), and PBC (mean = 1.85 ± 3.5; range: -6 to 6) to dispense ELOA medications. Attitude (ß = 0.570, P < 0.001), SN (ß = 0.238, P < 0.001), and perceived obligation were statistically significant predictors of the pharmacists' intention to dispense ELOA medications for patients with a valid prescription but PBC (ß = 0.022, P = 0.531) was not. CONCLUSION: Interventions to promote pharmacists' counseling and dispensing of ELOA medications should focus on developing strong intention. Improving pharmacists' attitude, SN, and perceived obligation is critical to increasing their willingness to dispense ELOA medications.

The use of actor-based immersive health and safety inductions: Lessons from the Thames Tideway Tunnel megaproject.

Health and safety inductions are ubiquitous in construction but tend to be poorly designed and suffer low levels of worker engagement. In this paper we report on the evaluation of an innovative, full day, actor-based health and safety induction called EPIC, currently being used on London's Thames Tideway Tunnel megaproject. As of March 2019, more than 14,000 individuals had attended EPIC. This evaluation examines the impact of EPIC from the perspective of participants and other stakeholders, and considers the utility of actor-based immersive health and safety inductions for use more widely, in both construction and other sectors. Using a mixed-method, longitudinal approach to data collection, EPIC is evaluated against Kirkpatrick's (1959) 'four levels' framework of reactions, learning, behaviour change and results. This paper discusses factors which support and hinder actor-based inductions, and the challenges involved in assessing the impact of inductions on subsequent behaviour and health and safety outcomes.

Operationalizing lean health assets.

OBJECTIVE: To demonstrate the potential of employing unconventional facility/facilities management (FM) performance indicators in healthcare settings to enable more strategic conversations between FM and business users concerning asset performance. BACKGROUND: The theoretical background for a Lean asset approach and a high-level analysis of data from hospital trusts in England have been published elsewhere. This paper reports on the first uses of that approach in operational settings. METHOD: Observations are drawn primarily from three case studies. RESULTS: The individual studies support the premise that the conventional emphasis on cost per square meter (m(2)) as a preeminent measure of FM disguises a portfolio of too much underutilized space. They provide a means of putting a healthcare estates strategy in terms that will engage business users. CONCLUSIONS: Despite a growing interest in Lean approaches in healthcare, the philosophy has not yet been extended to the estate. This study demonstrates that alternative benchmarks are possible.