Workplace Harassment, Cyber Incivility, and Climate in Academic Medicine.

Importance: The culture of academic medicine may foster mistreatment that disproportionately affects individuals who have been marginalized within a given society (minoritized groups) and compromises workforce vitality. Existing research has been limited by a lack of comprehensive, validated measures, low response rates, and narrow samples as well as comparisons limited to the binary gender categories of male or female assigned at birth (cisgender). Objective: To evaluate academic medical culture, faculty mental health, and their relationship. Design, Setting, and Participants: A total of 830 faculty members in the US received National Institutes of Health career development awards from 2006-2009, remained in academia, and responded to a 2021 survey that had a response rate of 64%. Experiences were compared by gender, race and ethnicity (using the categories of Asian, underrepresented in medicine [defined as race and ethnicity other than Asian or non-Hispanic White], and White), and lesbian, gay, bisexual, transgender, queer (LGBTQ+) status. Multivariable models were used to explore associations between experiences of culture (climate, sexual harassment, and cyber incivility) with mental health. Exposures: Minoritized identity based on gender, race and ethnicity, and LGBTQ+ status. Main Outcomes and Measures: Three aspects of culture were measured as the primary outcomes: organizational climate, sexual harassment, and cyber incivility using previously developed instruments. The 5-item Mental Health Inventory (scored from 0 to 100 points with higher values indicating better mental health) was used to evaluate the secondary outcome of mental health. Results: Of the 830 faculty members, there were 422 men, 385 women, 2 in nonbinary gender category, and 21 who did not identify gender; there were 169 Asian respondents, 66 respondents underrepresented in medicine, 572 White respondents, and 23 respondents who did not report their race and ethnicity; and there were 774 respondents who identified as cisgender and heterosexual, 31 as having LGBTQ+ status, and 25 who did not identify status. Women rated general climate (5-point scale) more negatively than men (mean, 3.68 [95% CI, 3.59-3.77] vs 3.96 [95% CI, 3.88-4.04], respectively, P < .001). Diversity climate ratings differed significantly by gender (mean, 3.72 [95% CI, 3.64-3.80] for women vs 4.16 [95% CI, 4.09-4.23] for men, P < .001) and by race and ethnicity (mean, 4.0 [95% CI, 3.88-4.12] for Asian respondents, 3.71 [95% CI, 3.50-3.92] for respondents underrepresented in medicine, and 3.96 [95% CI, 3.90-4.02] for White respondents, P = .04). Women were more likely than men to report experiencing gender harassment (sexist remarks and crude behaviors) (71.9% [95% CI, 67.1%-76.4%] vs 44.9% [95% CI, 40.1%-49.8%], respectively, P < .001). Respondents with LGBTQ+ status were more likely to report experiencing sexual harassment than cisgender and heterosexual respondents when using social media professionally (13.3% [95% CI, 1.7%-40.5%] vs 2.5% [95% CI, 1.2%-4.6%], respectively, P = .01). Each of the 3 aspects of culture and gender were significantly associated with the secondary outcome of mental health in the multivariable analysis. Conclusions and Relevance: High rates of sexual harassment, cyber incivility, and negative organizational climate exist in academic medicine, disproportionately affecting minoritized groups and affecting mental health. Ongoing efforts to transform culture are necessary.

Reasonable Accommodation and Disparate Impact: Clean Shave Policy Discrimination in Today's Workplace.

This article examines Bey v. City of New York - a recent Second Circuit case where four Black firefights suffering from Pseudofolliculitis Barbae (a skin condition causing irritation when shaving which mostly affects Black men) challenged the New York City Fire Department's Clean Shave Policy - with an intersectional approach utilizing legal theories of racial, disability, and religious discrimination.

Human Centered Decision-Making for COVID-19 Testing Center Location Selection: Tamil Nadu-A Case Study.

This paper proposes a blend of three techniques to select COVID-19 testing centers. The objective of the paper is to identify a suitable location to establish new COVID-19 testing centers. Establishment of the testing center in the needy locations will be beneficial to both public and government officials. Selection of the wrong location may lead to lose both health and wealth. In this paper, location selection is modelled as a decision-making problem. The paper uses fuzzy analytic hierarchy process (AHP) technique to generate the criteria weights, monkey search algorithm to optimize the weights, and Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) method to rank the different locations. To illustrate the applicability of the proposed technique, a state named Tamil Nadu, located in India, is taken for a case study. The proposed structured algorithmic steps were applied for the input data obtained from the government of India website, and the results were analyzed and validated using the government of India website. The ranks assigned by the proposed technique to different locations are in aligning with the number of patients and death rate.

Effect of lean manufacturing tools on sustainability: the case of Mexican maquiladoras.

The Mexican maquiladora industry is applying Lean Manufacturing Tools (LMT) in its production lines; however, few studies have investigated its relationship with sustainability (social, economic, and environmental). This paper presents a second-order structural equation model (SEM) relating 8 LMT integrated into three independent latent variables: continuous improvement (Kaizen and Gemba), supporting tools (Andon, visual management, and Poka-yoke), and machinery and equipment (total productive maintenance, overall equipment effectiveness, and Jidoka) that are related to social, economic, and environmental sustainability as dependent variables. The model is validated with information obtained from 249 companies using partial least squares. Findings show that the application of LMT in the Mexican maquiladora industry avoids the generation of waste and reprocessing. Likewise, the improvement of production processes reduces the waste emitted into the environment and reduces energy consumption. Also, when companies have environmental programs, the work environment is safe, and labor relations are improved, increasing morale and the commitment to work for the company, gaining economic and ecological benefits.

The Role of Participation in and Effectiveness of Shared Governance Councils in the Nurses' Perception of a Professional Practice Work Environment.

OBJECTIVES: The aims of this study were to identify the differences in nurses' perceptions of their professional practice work environment (PPWE) related to their participation in shared governance (SG) councils and to examine the perception of effectiveness of SG councils among nurses who participate in them. BACKGROUND: Research suggests that adopting SG in nursing can lead to significant, positive outcomes, such as patient and nurse satisfaction and enhanced nurse empowerment, engagement, and a PPWE. METHODS: The study used a cross-sectional design in a Magnet®-designated urban Jordanian cancer care hospital. A convenience sample of 580 direct care nurses was used. The data were collected using self-administered questionnaires, the Council Health (CH) instrument, and the Professional Practice Work Environment Inventory (PPWEI). RESULTS: Results demonstrated a significant difference in the total score of PPWE between the SG council members (4.85) and nonmembers (4.68) (t = 2.906, P = 0.004). The results also indicated small to strong correlations of the total overall council health mean and all domain means of council effectiveness with total overall PPWEI mean and all domain means of PPWE (P < 0.05) among nurses who participated in SG councils. CONCLUSION: Findings support involving more staff in SG councils and that enhancing the SG councils' effectiveness positively affects the PPWE.

Organizational Impact on Healthcare Workers' Moral Injury During COVID-19: A Mixed-Methods Analysis.

OBJECTIVE: The aim of this study was to explore relationships between organizational factors and moral injury among healthcare workers and the impact of perceptions of their leaders and organizations during COVID-19. BACKGROUND: COVID-19 placed healthcare workers at risk for moral injury, which often involves feeling betrayed by people with authority and can impact workplace culture. METHODS: Secondary data from a Web-based survey of mid-Atlantic healthcare workers were analyzed using mixed methods. Data were synthesized using the Reina Trust & Betrayal Model. RESULTS: Fifty-five percent (n = 328/595) of respondents wrote comments. Forty-one percent (n = 134/328) of commenters had moral injury scores of 36 or higher. Three themes emerged: organizational infrastructure, support from leaders, and palliative care involvement. Respondents outlined organizational remedies, which were organized into 5 domains. CONCLUSIONS: Findings suggest healthcare workers feel trust was breached by their organizations' leaders during COVID-19. Further study is needed to understand intersections between organizational factors and moral injury to enhance trust within healthcare organizations.

Association between perceived organizational support and COVID-19 vaccination intention: A cross-sectional study.

OBJECTIVES: We examined the association between perceived organizational support (POS) and COVID-19 vaccination intention as well as the influence of the implementation of workplace infection prevention measures. METHODS: We analyzed data from an Internet survey of workers aged 20-65 years conducted in December 2020, during a period of widespread COVID-19 infection in Japan. RESULTS: Of the 23 846 participants in this survey, 1958 (8%) reported very high POS. In the group with very high POS, 836 (43%) workers wanted the COVID-19 vaccination; in contrast 1382 (36%) workers in the group with very low POS wanted the vaccination. POS was associated with COVID-19 vaccination intention (odds ratio [OR] = 1.11). The OR decreased after additional adjustment for the number of workplace infection control measures (OR = 1.06). In the analysis with POS as a categorical variable, very high POS was associated with COVID-19 vaccination intention (reference: very low POS) (OR = 1.34). The OR decreased after additional adjustment for the number of workplace infection control measures (OR = 1.17). High POS was associated with COVID-19 vaccination intention (OR = 1.17) but not with vaccination intention after additional adjustment for the number of workplace infection control measures (OR = 1.05). CONCLUSIONS: High POS during the COVID-19 pandemic increased employees' vaccination intention. The relationship between POS and vaccination intention was strongly influenced by implementation of workplace infection prevention measures. Implementing appropriate workplace infection prevention measures in the event of an emerging infectious disease outbreak may influence the vaccination behavior of employees, which may contribute to the acquisition of herd immunity in the community.

CE: Nurses Are More Exhausted Than Ever: What Should We Do About It?

ABSTRACT: For nurses, the challenges posed by demanding work environments and schedules often lead to fatigue, and this can be exacerbated during crises like the COVID-19 pandemic. In this article, the authors discuss causes and challenges of nurse fatigue and consider several evidence-based strategies and solutions for individual nurses and organizations. Barriers to implementation, including a negative workplace culture and inadequate staffing, are also described, and several resources are presented.

Hospital medicine team perception of diversity and inclusion at work.

BACKGROUND: : Diversity and Inclusion concepts are crucial in healthcare as the patient population we encounter as hospitalist medicine team is diverse. A diverse and inclusive environment for healthcare employees can lead to improved job satisfaction and high-quality medical care of patients. However, hospitalist perspectives on diversity and inclusion in their work environment are not well studied and noted in literature. Understanding hospitalist perspectives of diversity and inclusion is important in promoting organizational culture. METHODS: We conducted an online survey of a large hospitalist group at Mayo Clinic, Rochester, from October-December 2019, as part of Hospital Internal Medicine (HIM) Diversity Council (HIM-DC) inception, to understand the perceptions of its staff about diversity and inclusion at work and facilitate the next best steps for the team. The responses to the survey questions were graded on a likert scale. Descriptive statistics were used to analyze and interpret the data. RESULTS: : Of the 135 team members, 78 responded (58%). Of the respondents, more than 80% never witnessed or experienced discrimination from a colleague, while more than 50% did witness or experience discrimination from a patient/visitor. More than 70% did not report this discrimination. Nearly 90% felt that it was an inclusive environment at work, across different personal attributes. Most of the respondents requested additional cultural education and social events. CONCLUSION: Unfortunately, a higher percentage of discrimination is perceived from patients/visitors. This highlights the need for institutional policies about visitor conduct. A high proportion of HIM staff felt inclusive at workplace. Committees such as HIM-DC can augment cultural education and social events to improve team's perception.

Indoor lighting design for healthier workplaces: natural and electric light assessment for suitable circadian stimulus.

Light, especially daylight, plays a critical role in human health as the main timer for circadian rhythms. Indoor environments usually lack the correct exposure to daylight and are highly dependent on electric lighting, disrupting the circadian rhythm and compromising the health of occupants. The methodology proposed assesses the combination of natural and electric lighting on circadian rhythms for operational environments. The case study chosen examines a 24/7 laboratory area representing an open-plan shift-work area. Several electric lighting scenarios under different sky conditions have been assessed, considering a variable window size and resulting in a spectrum which establishes the indoor circadian regulation performance according to the amount of light perceived. A set of configurations is presented to determine optimal electric lighting configuration based on natural light conditions in order to ensure a suitable circadian stimulus and the electric lighting flux threshold for different scenarios, benefiting occupants' health while also ensuring energy conservation.

Improving health care from the bottom up: Factors for the successful implementation of kaizen in acute care hospitals.

BACKGROUND: Kaizen-a management technique increasingly employed in health care-enables employees, regardless of their hierarchy level, to contribute to the improvement of their organization. The approach puts special emphasis on frontline employees because it represents one of their main opportunities to participate directly in decision making. In this study, we aimed to (1) understand the experiences of nurses in two hospitals that had recently implemented kaizen, and (2) identify factors affecting the implementation of the technique. METHODS: By means of purposeful sampling, we selected 30 nurses from different units in two private acute care hospitals in Switzerland in May 2018. We used the Organizational Transformation Model to conduct semi-structured interviews and perform qualitative content analysis. Lastly, originating from Herzberg's motivation theory, we suggest two types of factor influencing the implementation of kaizen-hygiene factors that may prevent nurses from getting demotivated, and motivational factors that may boost their motivation. RESULTS: Nurses generally experienced kaizen as a positive practice that enabled them to discuss work-related activities in a more comprehensive manner. In some cases, however, a lack of visible improvement in the workplace lowered nurses' motivation to make suggestions. Nurses' attitudes towards kaizen differed across both hospitals depending on the available managerial support, resources such as infrastructure and staffing levels. CONCLUSIONS: From our findings, we derived several coping strategies to help health practitioners implement kaizen for the benefit of their organization and employees: Strong managerial support, appropriate use of kaizen tools, and a greater sense of team cohesion, among other factors, can influence how effectively hospital teams implement kaizen. To reap the benefits of kaizen, hospital managers should promote the exchange of opinions across hierarchy levels, allocate the necessary resources in terms of personnel and infrastructure, and show nurses how the technique can help them improve their workplace.

Work Redesign for the 21st Century: Promising Strategies for Enhancing Worker Well-Being.

Work is a key social determinant of population health and well-being. Yet, efforts to improve worker well-being in the United States are often focused on changing individual health behaviors via employer wellness programs. The COVID-19 health crisis has brought into sharp relief some of the limitations of current approaches, revealing structural conditions that heighten the vulnerability of workers and their families to physical and psychosocial stressors. To address these gaps, we build on existing frameworks and work redesign research to propose a model of work redesign updated for the 21st century that identifies strategies to reshape work conditions that are a root cause of stress-related health problems. These strategies include increasing worker schedule control and voice, moderating job demands, and providing training and employer support aimed at enhancing social relations at work. We conclude that work redesign offers new and viable directions for improving worker well-being and that guidance from federal and state governments could encourage the adoption and effective implementation of such initiatives. (Am J Public Health. 2021;111(10):1787-1795. https://doi.org/10.2105/AJPH.2021.306283).

Health and safety risk perceptions and needs of app-based drivers during COVID-19.

BACKGROUND: App-based drivers face work disruptions and infection risk during a pandemic due to the nature of their work, interactions with the public, and lack of workplace protections. Limited occupational health research has focused on their experiences. METHODS: We surveyed 100 app-based drivers in Seattle, WA to assess risk perceptions, supports, and controls received from the company that employs them, sources of trust, stress, job satisfaction, COVID-19 infection status, and how the pandemic had changed their work hours. Data were summarized descriptively and with simple regression models. We complemented this with qualitative interviews to better understand controls and policies enacted during COVID-19, and barriers and facilitators to their implementation. RESULTS: Drivers expressed very high levels of concern for exposure and infection (86%-97% were "very concerned" for all scenarios). Only 31% of drivers reported receiving an appropriate mask from the company for which they drive. Stress (assessed via PSS-4) was significantly higher in drivers who reported having had COVID-19, and also significantly higher in respondents with lower reported job satisfaction. Informants frequently identified supports such as unemployment benefits and peer outreach among the driver community as ways to ensure that drivers could access available benefits during COVID-19. CONCLUSIONS: App-based drivers received few protections from the company that employed them, and had high fear of exposure and infection at work. There is increased need for health-supportive policies and protections for app-based drivers. The most effective occupational and public health regulations would cover employees who may not have a traditional employer-employee relationship.

Application of ISO/IEC Guide 51 to COVID-19 infection control for the occupational safety.

COVID-19 is around the world. We attempt to apply three-step method in ISO/IEC Guide 51: 2014 to COVID-19 infection control in the workplace. The results show that the COVID-19 infection control measures include the eradication of the virus, the destruction of infectivity, the detoxification and weakening and the elimination of opportunities for infection as "Inherently Safe Design Measures", the avoidance of contact as "Safeguarding and Complementary Protective Measures" and the reduction of contact and the avoidance of seriousness as "Information for Use". Among these specific measures, the New Normal, especially in the manufacturing industries, would be "telecommuting" and "unmanned workplaces", which are part of the elimination of opportunities for infection, and "changes in flow lines" and "changes in airflow", which are part of the avoidance of contact. Where "telecommuting" and "unmanned workplaces" are feasible, they should be implemented as much as possible, and where they are not, attempts should be made to minimize human-to-human contact by "changes in flow lines". In addition, in the area of "changes in airflow", there are high expectations for future research on how to establish a ventilation design for COVID-19, in which but also the source would be workers themselves, not only combustible gases and toxic gases.

Menopausal symptoms and work: a narrative review of women's experiences in casual, informal, or precarious jobs.

Governments, employers, and trade unions are increasingly developing "menopause at work" policies for female staff. Many of the world's most marginalised women work, however, in more informal or insecure jobs, beyond the scope of such employment protections. This narrative review focuses upon the health impact of such casual work upon menopausal women, and specifically upon the menopausal symptoms they experience. Casual work, even in less-then-ideal conditions, is not inherently detrimental to the wellbeing of menopausal women; for many, work helps manage the social and emotional challenges of the menopause transition. Whereas women in higher status work tend to regard vasomotor symptoms as their main physical symptom, women in casual work report musculoskeletal pain as more problematic. Menopausal women in casual work describe high levels of anxiety, though tend to attribute this not to their work as much as their broader life stresses of lifelong poverty and ill-health, increasing caring responsibilities, and the intersectionally gendered ageism of the social gaze. Health and wellbeing at menopause is determined less by current working conditions than by the early life experiences (adverse childhood experiences, poor educational opportunities) predisposing women to poverty and casual work in adulthood. Approaches to supporting menopausal women in casual work must therefore also address the lifelong structural and systemic inequalities such women will have faced. In the era of COVID-19, with its devastating economic, social and health effects upon women and vulnerable groups, menopausal women in casual work are likely to face increased marginalisation and stress. Further research is need.

Ecological factors affecting Infant at Work policies and programs in university settings.

OBJECTIVES: This study identifies the ecological (ie, policy, environment, intrapersonal, and interpersonal) factors affecting the implementation of an Infant at Work program in a university setting. METHODS: Data were collected among faculty, staff, and graduate students at a large Midwestern university from February to July 2020 via focus group (FG) discussions with university employees (n = 22) and semistructured interviews with university administrators (n = 10). We used techniques from expanded grounded theory, allowing for a constant comparative approach to data contextualization and theme identification. RESULTS: Three themes emerged from the FG data: (i) program and policy scope, (ii) employee and employer benefits, and (iii) workplace concerns. Onsite daycares, flexible schedules and participation, and expanded childcare options were some of the programs and policies employees desired. However, barriers to implementing these types of programs include cost, safety, and structure of the work environment. CONCLUSIONS: Findings offer practical recommendations and strategies to improve work/life balance among parents transitioning back to work in a university environment. Findings also provide insight into the feasibility of family-friendly workplace policies and environments. Additionally, findings provide a framework for other organizations to implement similar Infant at Work programs to improve employee work/life balance.