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.

"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.

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.

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.

Organizational politics and professional struggles in nursing

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.

Paid Leave and Access to Telework as Work Attendance Determinants during Acute Respiratory Illness, United States, 2017-2018

We assessed determinants of work attendance during the first 3 days after onset of acute respiratory illness (ARI) among workers 19-64 years of age who had medically attended ARI or influenza during the 2017-2018 influenza season. The total number of days worked included days worked at the usual workplace and days teleworked. Access to paid leave was associated with fewer days worked overall and at the usual workplace during illness. Participants who indicated that employees were discouraged from coming to work with influenza-like symptoms were less likely to attend their usual workplace. Compared with workers without a telework option, those with telework access worked more days during illness overall, but there was no difference in days worked at the usual workplace. Both paid leave benefits and business practices that actively encourage employees to stay home while sick are necessary to reduce the transmission of ARI and influenza in workplaces.

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.

Developing an agency's position with respect to patient involvement in health technology assessment: the importance of the organizational culture

OBJECTIVES

The objective of this study was to map the PI culture at KCE in the context of the development of organization-wide supported position statements about PI.

METHODS

A nominal group technique was used to measure the PI culture at KCE. Arguments for and against PI and conditions for PI in different phases of the HTA process were collected. A literature review and interviews fed the draft position statements, for which support was assessed by means of a two-round Delphi process.

RESULTS

Arguments in favor of PI in HTA related to the relevance of the scope, expertise with data collection, bringing in fresh ideas for study design, access to survey participants, validation of data analyses, adherence to recommendations. Disadvantages and risks included the lack of scientific knowledge of involved patients, resources requirements, conflicts of interest, and heterogeneity within patient populations. Conditions for meaningful PI referred to measures mitigating the identified disadvantages. Eighteen position statements supported by KCE could be formulated.

CONCLUSION

The KCE culture seems predominantly positive toward PI, although attitudes vary between HTA researchers. KCE recognizes the potential value of PI in HTA, but considers the level of involvement to be contingent on the topic and phase in the HTA process.

Causal Effect of Honorary Titles on Physicians' Service Volumes in Online Health Communities: Retrospective Study

Background

An OHC online health community (OHC) is an interactive platform for virtual communication between patients and physicians. Patients can typically search, seek, and share their experience and rate physicians, who may be involved in giving advice. Some OHC providers provide incentives in form of honorary titles to encourage the web-based involvement of physicians, but it is unclear whether the award of honorary titles has an impact on their consultation volume in an OHC.

Objective

This study is designed to identify the differential treatment effect of the incentive policy on the service volumes for the subgroups of treatment and control in an OHC. This study aims to answer the following questions: Does an honorary title for physicians impact their service volumes in an OHC? During the period of discontinuity, can we identify the sharp effect of the incentive award on the outcomes of physicians’ service volumes?

Methods

We acquired the targeted samples based on treatment, namely, physicians with an honorary title or not and outcomes measured before and after the award of the 2 subgroups. A regression discontinuity design was applied to investigate the impact of the honorary titles incentive as a treatment in an OHC. There was a sharply discontinuous effect of treatment on physicians’ online health service performance. The experimental data set consisted of 346 physicians in the treatment group (with honorary titles). Applying the propensity score matching method, the same size of physicians (n=346) was matched and selected as the control group.

Results

A sharp discontinuity was found at the time of the physician receiving the honorary title. The results showed that the parametric estimates of the coefficient were significantly positively (P<.001) associated with monthly home page views. The jump in the monthly volumes of home page views was much sharper than that of the monthly consultations.

Conclusions

The changes in the volumes of monthly consultations and home page views reflect the differential treatment effect of honorary titles on physicians’ service volumes. The effect of the incentive policy with honorary titles is objectively estimated from both the perspective of online and offline medical services in an OHC. Being named with honorary titles significantly multiplied monthly home page views, yet it did not significantly impact monthly consultations. This may be because consultation capacity is limited by the physician's schedule for consultations.

Patient safety management systems, activities and work environments related to hospital-level patient safety culture: A cross-sectional study

Improvement in patient safety culture requires constant attention. This study aimed to identify hospital-level elements related to patient safety culture, such as patient safety management systems, activities and work environments.Two questionnaire surveys were administered to hospitals in Japan in 2015 and 2016. The first survey aimed to determine which hospitals would allow their staff to respond to a questionnaire survey. The second survey aimed to measure the patient safety culture in those hospitals. Patient safety culture was assessed using the Hospital Survey on Patient Safety Culture (HSOPS). The relationship of hospital-level patient safety culture with the aforementioned elements in each hospital was analyzed.The response rate to the first survey was 22% (721/3270), and 40 eligible hospitals were selected from the respondents. The second survey was administered to healthcare workers in those 40 hospitals, and the response rate was 94% (3768/4000). The proportion of respondents who had 7 or more days off each month was related to the scores of 7 composites and the Patient Safety Grade of HSOPS. Both the presence of a mission statement describing patient safety and the proportion of respondents who participated in in-house patient safety workshops at least twice annually were related to the scores of 5 composites and the Patient Safety Grade of HSOPS.Our study suggests that the number of days off each month, the presence of a hospital patient safety mission statement, and the participation rate in in-house patient safety workshops might be key factors in creating a good patient safety culture within each hospital.

Adoption, Sustainability, and Dissemination of Chronic Disease Prevention Policies in Community-Based Organizations

Introduction. Despite increasing interest in structural (policy, systems, and environmental) changes to improve health, little attention has focused on the adoption, implementation, sustainability, and potential for dissemination of these changes among local community-based organizations. Method. A mixed methods approach was used for this process evaluation. Representatives of nine community-based organizations were surveyed using closed-ended questions and in-depth qualitative interviews to describe 32 policy changes. Diffusion of Innovation theory was used to inform the development of survey questions and the interview guide. Results. Policies adopted by local community-based organizations concerned types of food/beverages provided to staff/clients, methods to encourage physical activity, breastfeeding support, and tobacco control. The majority of the policies were either fully (66%) or partially (31%) implemented 1 year after their initial adoption. In general, participants somewhat/strongly agreed that policies had characteristics that predict sustainability/diffusion (relative advantage, compatibility, complexity, trialability, observability). In-depth interview responses described a generally smooth process for policy adoption and high levels of optimism for continued sustainability but revealed few efforts to disseminate the policies beyond the original organization. Conclusions. Structural changes in community-based organizations are a valuable tool for encouraging healthy changes in communities and have great potential to be adopted, sustained, and diffused.

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.

Job autonomy, perceptions of organizational policy, and the safety performance of nurses

AIMS

This study aimed to identify the relationship between nurses' job autonomy, perceptions of organizational policy, and safety performance by identifying the safety performance predictors of nurses working in acute health care settings in South Korea.

METHODS

Using data from a structured questionnaire, this cross-sectional descriptive study assessed the relationship between nurses' job autonomy, perceptions of organizational policy, and safety performance. In 2016, of the 290 nurses from nine acute care hospitals in South Korea invited to participate in the survey, 254 successfully did. Using cross-sectional data, characteristics of hospitals and nurses were analysed with t tests, one-way analyses of variance, Pearson correlations, and regression models.

RESULTS

On a scale of one to five, the mean job autonomy was 3.37, mean perceptions of organizational policy was 3.09, and mean safety performance was 3.75. Statistically significant positive correlations were found among job autonomy, perceptions of organizational policy, and safety performance. Multiple regression results found 44% of the variation in safety performance explained by job autonomy, length of employment, and perceptions of organizational policy.

CONCLUSION

Job autonomy and perceptions of organizational policy were positively related to safety performance. Hospital executives and nurse managers should work to enhance job autonomy and positive perceptions of organizational policy, to contribute to improving patient safety.

Lessons learned for reducing the negative impact of adverse events on patients, health professionals and healthcare organizations

Purpose

To summarize the knowledge about the aftermath of adverse events (AEs) and develop a recommendation set to reduce their negative impact in patients, health professionals and organizations in contexts where there is no previous experiences and apology laws are not present.

Data sources

Review studies published between 2000 and 2015, institutional websites and experts' opinions on patient safety.

Study selection

Studies published and websites on open disclosure, and the second and third victims' phenomenon. Four Focus Groups participating 27 healthcare professionals.

Data extraction

Study characteristic and outcome data were abstracted by two authors and reviewed by the research team.

Results of data synthesis

Fourteen publications and 16 websites were reviewed. The recommendations were structured around eight areas: (i) safety and organizational policies, (ii) patient care, (iii) proactive approach to preventing reoccurrence, (iv) supporting the clinician and healthcare team, (v) activation of resources to provide an appropriate response, (vi) informing patients and/or family members, (vii) incidents' analysis and (viii) protecting the reputation of health professionals and the organization.

Conclusion

Recommendations preventing aftermath of AEs have been identified. These have been designed for the hospital and the primary care settings; to cope with patient's emotions and for tacking the impact of AE in the second victim's colleagues. Its systematic use should help for the establishment of organizational action plans after an AE.

Safe Sleep Practices of Kansas Birthing Hospitals

BACKGROUND

Sleep-related death is tied with congenital anomalies as the leading cause of infant mortality in Kansas, and external risk factors are present in 83% of these deaths. Hospitals can impact caregiver intentions to follow risk-reduction strategies. This project assessed the current practices and policies of Kansas hospitals with regard to safe sleep.

METHODS

A cross-sectional survey of existing safe sleep practices and policies in Kansas hospitals was performed. Hospitals were categorized based on reported delivery volume and data were compared across hospital sizes.

RESULTS

Thirty-one of 73 (42%) contacted hospitals responded. Individual survey respondents represented various hospital departments including newborn/well-baby (68%), neonatal intensive care unit (3%) and other non-nursery departments or administration (29%). Fifty-eight percent of respondents reported staff were trained on infant safe sleep; 44% of these held trainings annually. High volume hospitals tended to have more annual training than low or mid volume birth hospitals. Thirty-nine percent reported a safe sleep policy, though most of these (67%) reported never auditing compliance. The top barrier to safe sleep education, regardless of delivery volume, was conflicting patient and family member beliefs.

CONCLUSIONS

Hospital promotion of infant safe sleep is being conducted in Kansas to varying degrees. High and mid volume birth hospitals may need to work more on formal auditing of safe sleep practices, while low volume hospitals may need more staff training. Low volume hospitals also may benefit from access to additional caregiver education materials. Finally, it is important to note hospitals should not be solely responsible for safe sleep education.

The Experience With Smoke-Free Policies in Affordable Multiunit Housing in North Carolina: A Statewide Survey

PURPOSE

Previous surveys of housing operators have identified concerns about enforcement, legal issues, and loss of market share as the main barriers to implementing smoke-free policies in multiunit housing. The purpose of this study was to examine enforcement practices as well as economic and legal outcomes in smoke-free affordable multiunit housing.

DESIGN

Cross-sectional.

SETTING

Affordable multiunit housing in North Carolina.

SUBJECTS

Affordable multiunit housing properties (n = 1063, 57% response rate).

MEASURES

Property representatives completed a written survey with questions regarding the existence of smoke-free policies, smoke-free policy implementation and enforcement practices, and smoking-related costs.

ANALYSIS

Descriptive statistics, χ(2) goodness-of-fit test, and t-test.

RESULTS

A total of 16.5% of properties had policies that prohibited smoking in all residential units. Half (49.8%) of smoke-free properties reported no violations to their policies in the past 12 months. Legal actions to enforce policies were rarely needed and were successful when they did occur. Compared to smoking-allowed properties, smoke-free properties did not experience a loss of market share in terms of occupancy rate (t = .09; p = .93) or residents moving away (χ(2) =. 5; p = .48).

CONCLUSION

Housing operators' concerns about enforcement, legal issues, and loss of market share associated with smoke-free policies are largely unfounded among affordable housing properties in North Carolina. Public health professionals should use messaging strategies that refute these concerns to encourage more properties to adopt smoke-free policies.

Looking through the Glass Ceiling: A Qualitative Study of STEM Women's Career Narratives

Although efforts have been directed toward the advancement of women in science, technology, engineering, and mathematics (STEM) positions, little research has directly examined women’s perspectives and bottom-up strategies for advancing in male-stereotyped disciplines. The present study utilized Photovoice, a Participatory Action Research method, to identify themes that underlie women’s experiences in traditionally male-dominated fields. Photovoice enables participants to convey unique aspects of their experiences via photographs and their in-depth knowledge of a community through personal narrative. Forty-six STEM women graduate students and postdoctoral fellows completed a Photovoice activity in small groups. They presented photographs that described their experiences pursuing leadership positions in STEM fields. Three types of narratives were discovered and classified: career strategies, barriers to achievement, and buffering strategies or methods for managing barriers. Participants described three common types of career strategies and motivational factors, including professional development, collaboration, and social impact. Moreover, the lack of rewards for these workplace activities was seen as limiting professional effectiveness. In terms of barriers to achievement, women indicated they were not recognized as authority figures and often worked to build legitimacy by fostering positive relationships. Women were vigilant to other people’s perspectives, which was costly in terms of time and energy. To manage role expectations, including those related to gender, participants engaged in numerous role transitions throughout their day to accommodate workplace demands. To buffer barriers to achievement, participants found resiliency in feelings of accomplishment and recognition. Social support, particularly from mentors, helped participants cope with negative experiences and to envision their future within the field. Work-life balance also helped participants find meaning in their work and have a sense of control over their lives. Overall, common workplace challenges included a lack of social capital and limited degrees of freedom. Implications for organizational policy and future research are discussed.

A Longitudinal Study of the Predictors of Perceived Procedural Justice in Australian University Staff

Purpose: This study examined the factors that predict employees' perceptions of procedural justice in university settings. The paper also reviews the ethical aspects of justice and psychological contracts within employment relationships.

Design/Methodology/Approach: The study examined the predictors of perceived procedural justice in a two-wave longitudinal sample of 945 employees from 13 universities by applying the Job Demands-Resources theoretical model of stress. The proposed predictors were classified into two categories: Job demands of work pressure and work-home conflict; and job resources of job security, autonomy, trust in senior management, and trust in supervisor. The predictor model also examined job satisfaction and affective organizational commitment, demographic (age, gender, tenure, role) and individual characteristics (negative affectivity, job involvement) as well as Time 1 (T1) perceptions of procedural justice to ensure that tests were rigorous.

Findings: A series of hierarchical multiple regression analyses found that job satisfaction at T1 was the strongest predictor of perceived procedural justice at Time 2. Employees' trust in senior management, and their length of tenure also positively predicted justice perceptions. There were also differences between academic and non-academic staff groups, as non-academic employees' level of job satisfaction, trust in senior management, and their length of organizational tenure predicted procedural justice perceptions, whereas for academics, only job satisfaction predicted perceived justice. For the “all staff” category, job satisfaction was a dominant and enduring predictor of justice, and employees' trust in senior management also predicted justice.

Research limitations/implications: Results highlight the importance of workplace factors in enhancing fair procedures to encourage reciprocity from employees. As perceived procedural justice is also conceptually linked to the psychological contract between employees-employers, it is possible that employees' levels of job satisfaction and perceptions of trust in senior management, relative to other work attitudinal outcomes, may be more effective for improving the broader working environment, and promoting staff morale.

Originality/value: This study adds to research on applied business ethics as it focuses on the ethical aspects of perceived procedural justice and highlights the importance of workplace factors in enhancing fair procedures in organizational policy to encourage reciprocity and promote healthy organizational environments.

A review of best work-absence management and return-to-work practices for workers with musculoskeletal or common mental disorders

BACKGROUND

Workplace absenteeism is still a curse for developed countries, and more systematic practices need to be adopted to address this issue.

OBJECTIVE

To review the literature on best practices for managing work absences related to musculoskeletal or common mental disorders.

METHODS

A review was conducted by performing a search in bibliographic databases and on work-disability research institute websites. Recommendations regarding work-absence management and return-to-work practices were extracted from all the retained documents and organized within a chronological framework.

RESULTS

In total, 17 documents were analyzed, leading to identification of common work-absence management and return-to-work practices, the importance of a worker support approach, and recommended roles and responsibilities for stakeholders. These practices were then integrated into a six-step process: (1) time off and recovery period; (2) initial contact with the worker; (3) evaluation of the worker and his job tasks; (4) development of a return-to-work plan with accommodations; (5) work resumption, and (6) follow-up of the return-to-work process.

CONCLUSIONS

Based on this review, we constructed a comprehensive work-absence management and return-to-work process designed to assist organizations. Our results indicate that such a process must be included within a broader policy of health promotion and job retention. Adaptations will be required for implementation in the workplace.

One-by-One or All-at-Once? Self-Reporting Policies and Dishonesty

Organizational monitoring relies frequently on self-reports (e.g., work hours, progress reports, travel expenses). A "one-by-one" policy requires employees to submit a series of reports (e.g., daily or itemized reports). An "all-at-once" policy requires an overall report (e.g., an annual or an overview report). Both policies use people's self-reports to determine their pay, and both allow people to inflate their reports to get higher incentives, that is, to cheat. Objectively, people can cheat to the same extent under both reporting policies. However, the two policies differ in that the segmented one-by-one policy signals closer monitoring than the all-at-once policy. We suggest here that lie aversion may have a paradoxical effect on closer monitoring and lead people to cheat more. Specifically, reporting a series of segmented units of performance (allowing small lies) should lead to more cheating than a one-shot report of overall performance (that require one larger lie). Two surveys indicated that while people perceive the all-at-once policy as more trusting, they still expected people would be equally likely to cheat in both policies. An experiment tested the effects of the two reporting policies on cheating. The findings showed that contrary to the participants' intuition, but in line with research on lie aversion, the one-by-one policy resulted in more cheating than the all-at-once policy. Implications for future research and organization policy are discussed.

Creating a safe place for pediatric care: A no hit zone

OBJECTIVES

Our goal was to create and implement a program, Kosair Children's Hospital's No Hit Zone, which trains health care workers in de-escalation techniques to address parental disruptive behaviors and physical discipline of children commonly encountered in the hospital environment.

METHODS

The Child Abuse Task Force, a multidisciplinary group, along with key hospital administrators developed specific content for the policy, as well as marketing and educational materials. The No Hit Zone policy designates Kosair Children's Hospital as "an environment in which no adult shall hit a child, no adult shall hit another adult, no child shall hit an adult, and no child shall hit another child. When hitting is observed, it is everyone's responsibility to interrupt the behavior as well as communicate system policy to those present."

RESULTS

Via a multidisciplinary, collaborative approach, the No Hit Zone was successfully implemented at Kosair Children's Hospital in 2012. Cost was nominal, and the support of key hospital administrators was critical to the program's success. Education of health professionals on de-escalation techniques and intervention with families at the early signs of parental stress occurred via live sessions and online training via case-based scenarios.

CONCLUSIONS

The No Hit Zone is an important program used to provide a safe and caring environment for all families and staff of Kosair Children's Hospital. Demand for the program continues, demonstrated by the establishment of No Hit Zones at other local hospitals and multiple outpatient clinics. This article offers information for other organizations planning to conduct similar initiatives.

Soliciting stakeholders' views on the organization of child and adolescent mental health services: a system in trouble

BACKGROUND

Despite a high prevalence of mental health problems among children and adolescents Belgium, like many other Western countries, does not have a clear strategy for the organization of child and adolescent mental healthcare services (CAMHS).

METHODS

This paper describes stakeholders' views on the organization of CAMHS based on a qualitative study. Ten in-depth interviews with high profile stakeholders were complemented by roundtable discussions (n = 30).

RESULTS

This diagnostic analysis illustrated that the system is in serious trouble characterized by fragmentation and compartmentalization.

CONCLUSION

The findings create a sense of urgency that should be used to initiate a system reform of the Belgian CAMHS system.

Disability management: organizational diversity and Dutch employment policy

INTRODUCTION

While Human Resource Managers (HRM) and line managers could play a significant role in the prevention of job-related problems and in promotion of early job-continuation, it is not clear wether the chronically ill workers are recognized as a group. Unlike some other groups, distinguished by gender, age or ethnicity, those with chronic illness are less distinct and may not be included in diversity management programs. The aim of this research is to address theory and evidence in literature about the topic, as well as to inquire whether chronic illness of the employees is 'visible' in practice.

METHODS

For desk research, we used a systematic search strategy involving medical, statistical, management, and social science databases (Web of Science, MedLine, Pub Med, Psych Info, etc.). Research results are based on case studies conducted with the managers and HRM of government and commercial organizations between March 2007 and October 2008 and between October 2008 and April 2009. These case studies were based on open interviews and focus group sessions (for human resource departments) which were consequently analyzed using thematical analysis. For group sessions, we used concept mapping to collect information from two groups of HRM professionals and managers. Secondary analysis included thematic and content analysis of 'best practice' organizations carried out by the Dutch organization Gatekeeper.

CONCLUSIONS

We have discovered that the chronically ill employees are largely invisible to HRM practitioners, line managers who do not always have the right instruments for implementation of the European or national frameworks. Most practitioners are unaware of the impact of chronic illness in their organizations and in employees work life.

A framework for the organization and delivery of systemic treatment

Background

Increasing systemic treatment and shortages of oncology professionals in Canada require innovative approaches to the safe and effective delivery of intravenous (IV) cancer treatment. We conducted a systematic review of the clinical and scientific literature, and an environmental scan of models in Canada, the United Kingdom, Australia, and New Zealand. We then developed a framework for the organization and delivery of IV systemic treatment.

Methods

The systematic review covered the medline, embase, cinahl, and HealthStar databases. The environmental scan retrieved published and unpublished sources, coupled with a free key word search using the Google search engine. The Systemic Treatment Working Group reviewed the evidence and developed a draft framework using evidence-based analysis, existing recommendations from various jurisdictions, and expert opinion based on experience and consensus. The draft was assessed by Ontario stakeholders and reviewed and approved by Cancer Care Ontario.

Results

The poor quantity and quality of the evidence necessitated a consensus-derived model. That model comprises four levels of care determined by a regional systemic treatment program and three integrated structures (integrated cancer programs, affiliate institutions, and satellite institutions), each with a defined scope of practice and a specific organizational framework.

Interpretation

New models of care are urgently required beyond large centres, particularly in geographically remote or rural areas. Despite limited applicable evidence, the development and successful implementation of this framework is intended to create sustainable, accessible, quality care and to measurably improve patient outcomes.

Security, privacy, and confidentiality issues on the Internet

We introduce the issues around protecting information about patients and related data sent via the Internet. We begin by reviewing three concepts necessary to any discussion about data security in a healthcare environment: privacy, confidentiality, and consent. We are giving some advice on how to protect local data. Authentication and privacy of e-mail via encryption is offered by Pretty Good Privacy (PGP) and Secure Multipurpose Internet Mail Extensions (S/MIME). The de facto Internet standard for encrypting Web-based information interchanges is Secure Sockets Layer (SSL), more recently known as Transport Layer Security or TLS. There is a public key infrastructure process to 'sign' a message whereby the private key of an individual can be used to 'hash' the message. This can then be verified against the sender's public key. This ensures the data's authenticity and origin without conferring privacy, and is called a 'digital signature'. The best protection against viruses is not opening e-mails from unknown sources or those containing unusual message headers.