Effect of energy renovation and occupants' activities on airborne particle concentrations in Swedish rental apartments.

Exposure to airborne particles causes detrimental health effects, hence their assessment in indoor environments, where people spend most of the time, is important. The influence of energy renovation and occupants' activities on airborne particle concentrations was assessed in seven occupied Swedish residences. Ultrafine particle (UFP, <100 nm) number concentrations, PM2.5 (<2.5 µm) and black carbon (BC, <900 nm) mass concentrations were simultaneously measured inside and outside before, after renovation, and during follow-up. The average indoor UFP number concentrations increased from 6200 (±4070) cm-3 before renovation to 12,700 (±6040) cm-3 during the follow up, as the number of indoor activities doubled. Indoor UFP number concentrations depended mainly on frequency and type of occupants' activities in studied residences (e.g., cooking, candle burning). The average indoor PM2.5 concentration decreased from 8.6 (±5.8) µg m-3 before renovation to 2.5 (±1.3) µg m-3 during follow up, as the activities that generated PM2.5 decreased, and infiltration of outdoor particles could have been decreased due to renovation measures. However, the indication of infiltration decrease during the follow up, assessed on the basis of indoor to outdoor ratios during non-activity times (with no influence of occupants' activities), was not observed after the renovation and should be treated with caution. In this study indoor PM2.5 and BC were influenced by activities and outdoor concentrations. Reduction of exposure to indoor UFP, might be obtained by optimization of kitchen exhaust flows. An improved design of supply air inlets in mechanical exhaust ventilation systems may reduce PM2.5 infiltration. Occupants' logbook records, needed for identification of sources contributing to particle exposure, proved useful but not always accurate compared to technical measurements of activities and UFP concentrations. Development of simple and reliable activity detection systems is needed to complement logbooks and allow accurate assessment of source contribution to particle exposure in homes and associated health effects.

Attitudes toward elderly workers and perceptions of integrated age management practices.

This qualitative study investigates attitudes toward elderly workers and their work situation in different sectors, and explores perceptions and organizational measures that can enable an extended working life. Previous age management studies indicate that there are several interconnected measures and key areas of importance, and that there is a general need for strategies to strengthen sustainable age management at the organizational level. A structured content analysis was used to analyze data from focus group interviews with informants from a variety of organizations. The study identified three themes that highlight attitudes and perceptions of integrated age management practices: (a) contemporary policies and practices in the work environment; (b) social participation and attitudes; (c) experience and mentorship. These themes can form the basis of a good approach to an integrated age management strategy. Such a strategy can be achieved through intervention studies where research on sustainable working life meets the real problems faced by employees and managers.

What do doctors mean when they talk about teamwork? Possible implications for interprofessional care.

The concept of teamwork has been associated with improved patient safety, more effective care and a better work environment. However, the academic literature on teamwork is pluralistic, and there are reports on discrepancies between theory and practice. Furthermore, healthcare professionals' direct conceptualizations of teamwork are sometimes missing in the research. In this study, we examine doctors' conceptualizations of teamwork. We also investigate what doctors think is important in order to achieve good teamwork, and how the empirical findings relate to theory. Finally, we discuss the methodological implications for future studies. The research design was explorative. The main data consisted of semi-structured interviews with twenty clinically active doctors, analyzed with conventional content analysis. Additional data sources included field observations and interviews with management staff. There was large variation in the doctors' conceptualizations of teamwork. The only characteristic they shared in common was that team members should have specific roles. This could have consequences for practice, because the rationale behind different behaviors depends on how teamwork is conceptualized. Several of the teamwork-enabling factors identified concerned non-technical skills. Future studies should put more emphasis on the practitioners' perspective in the research design, to create a more grounded foundation for both research and practice.

Effects of a multifaceted intervention QI program to improve ICU performance.

BACKGROUND: To benefit from the increasing clinical evidence, organisational changes have been among the main drivers behind the reduction of ICU mortality during the last decade. Increasing demand, costs and complexity, amplifies the need for optimisation of clinical processes and resource utilisation. Thus, multidisciplinary teamwork and critical care processes needs to be adapted to profit from increased availability of human skill and technical resources in a cost-effective manner. Inadequate clinical performance and outcome data compelled us to design a quality improvement project to address current work processes and competence utilisation. METHODS: During revision period, clinical processes, professional performance and clinical competence were targeted using "scientific production management methodology" approach. As part of the project, an intensivist training program was instituted, and full time intensivist coverage was obtained in the process of creating multi-professional teams, composed of certified intensivists, critical care nurses, assistant nurses, physiotherapists and social counsellors. The use of staff resources and clinical work-processes were optimised in accordance with the outcome of a "value stream mapping". In this process, efforts to enhance the personal dynamics and performance within the teams were paramount. Clinical and economic outcome data were analysed during a seven year follow up period. RESULTS: • Consecutive reduced overall ICU (24%) and long-term (600 days) mortality. The effect on ICU mortality was especially pronounced in the subgroup of patients > 65 years (30%) • Consecutive reduced length of stay (43%, septic patients) and time on ventilator (for septic patients and patients > 65 years of age (23 resp.52%). • Substantial increase in life years gained (13,140 life years) as well as quality-adjusted life-years (9593 QALY: s) over the study period. • High cost-effectiveness as ICU costs were  reduced while patient outcomes were improved. Disregarding the cost reduction in ICU, the intervention is highly cost effective with cost- effectiveness ratios of (75€/QALY) and (55€ / life year) CONCLUSIONS: We have shown favourable results of a QI project aiming to improve the clinical performance and quality through the development of multi-professional interaction, teamwork and systematic revisions of work processes. The economic evaluation shows that the intervention is highly cost-effective and potentially dominating.

Healthy Indoor Environments: The Need for a Holistic Approach.

Indoor environments have a large impact on health and well-being, so it is important to understand what makes them healthy and sustainable. There is substantial knowledge on individual factors and their effects, though understanding how factors interact and what role occupants play in these interactions (both causative and receptive) is lacking. We aimed to: (i) explore interactions between factors and potential risks if these are not considered from holistic perspective; and (ii) identify components needed to advance research on indoor environments. The paper is based on collaboration between researchers from disciplines covering technical, behavioural, and medical perspectives. Outcomes were identified through literature reviews, discussions and workshops with invited experts and representatives from various stakeholder groups. Four themes emerged and were discussed with an emphasis on occupant health: (a) the bio-psycho-social aspects of health; (b) interaction between occupants, buildings and indoor environment; (c) climate change and its impact on indoor environment quality, thermal comfort and health; and (d) energy efficiency measures and indoor environment. To advance the relevant research, the indoor environment must be considered a dynamic and complex system with multiple interactions. This calls for a transdisciplinary and holistic approach and effective collaboration with various stakeholders.

Driving for successful change processes in healthcare by putting staff at the wheel.

Purpose The purpose of this paper is to describe five salient factors that emerge in two successful change processes in healthcare. Organizational changes in healthcare are often characterized by problems and solutions that have been formulated by higher levels of management. This top-down management approach has not been well received by the professional community. As a result, improvement processes are frequently abandoned, resulting in disrupted and dysfunctional organizations. This paper presents two successful change processes where managerial leadership was used to coach the change processes by distributing mandates and resources. After being managerially initiated, both processes were driven by local agency, decisions, planning and engagement. Design/methodology/approach The data in the paper derive from two qualitative case studies. Data were collected through in-depth interviews, observations and document studies. The cases are presented as process descriptions covering the different phases of the change processes. The focus in the studies is on the roles and interactions of the actors involved, the type of leadership and the distribution of agency. Findings Five factors emerged as paramount to the successful change processes in the two cases: local ownership of problems; a coached process where management initiates the change process and the problem recognition, and then lets the staff define the problems, formulate solutions and drive necessary changes; distributed leadership directed at enabling and supporting the staff's intentions and long-term self-leadership; mutually formulated norms and values that serve as a unifying force for the staff; and generous time allocation and planning, which allows the process to take time, and creates room for reevaluation. The authors also noted that in both cases, reorganization into multi-professional teams lent stability and endurance to the completed changes. Originality/value The research shows how management can initiate and support successful change processes that are staff driven and characterized by local agency, decisions, planning and engagement. Empirical descriptions of successful change processes are rare, which is why the description of such processes in this research increases the value of the paper.