Implementing IHI Joy in Work Framework to Decrease Turnover Among Unit Leaders

Problem: A medical center in an integrated health care system in Northern California has experienced high turnover for unit level leaders employed in an acute care setting. The role of unit level leaders (managers, assistant managers, and supervisors) in this organization is complex, often stressful, and includes 24/7 accountability. These leaders must simultaneously deliver on organizational goals, patient safety, quality, budgets, and staff satisfaction (Loveridge, 2017). Increasing resilience can help these leaders cope with stress and find joy in their work, making them less likely to leave their leadership positions (Hudgins, 2016). Context: According to Loveridge, the turnover rates of nurse managers in the U.S. in 2010 was 8.3%, higher than that of senior leaders, chief nurse executives, and vice presidents (2017). The cost to replace a nurse manager can be as much as 75%-125% of their salary (Loveridge, 2017). Sources of fatigue for nurse managers that are related to high turnover have been identified as 24-hour accountability to an organization, visibility and responsiveness to staff, and interruptions in day-to-day operations. (Steege, Pinekenstein, Arsenault Knudsen, Rainbow, 2017). Intervention: The intervention for this Doctor of Nursing Practice (DNP) project included the introduction and implementation of the Institute for Healthcare Improvement (IHI) framework for improving joy in work. This consisted of a 12-week education program offered by the IHI, called “Finding and Creating Joy in Work” which included biweekly video lectures and was facilitated in a peer group practice setting for unit level leaders. The focus of the program was to use the framework to help discover and improve the conditions that contribute to joy in the workplace. Measures: The efficacy of the intervention was measured using two tools, the Conner-Davidson Resilience Scale and the Anticipated Turnover Scale. Both were given to participants prior to the intervention, and then again following program end date. The goal was to see whether there was an increase in resilience scores and a decrease in the anticipated turnover scores for unit level leaders. During the 3-month intervention, participants were also encouraged to identify and implement quality or staff engagement/improvements projects. Results: There was an 18% decrease in the mean anticipated turnover scores following the program. This suggests that providing tools to help unit level leaders measure and track joy in their departments, could help reduce turnover. There was no measurable difference between mean pre and post-intervention resilience scores for unit level leaders who completed the IHI program. Conclusions: Education in performance improvement methodologies using the IHI framework for improving joy in work, may keep unit level leaders in their roles longer. A longer term project needs to be conducted to determine if the IHI framework can increase resilience among unit level leaders. Also, a project that includes staff at all levels within an organization would be important in testing this framework

Materializing a Mad Aesthetic Through the Making of Politicized Fibre Art

The field of Disability Studies not only acknowledges the value of creative production, it also turns to it as a way to craft knowledge. However, this project asserts that it is not enough for the field to support and promote Deaf, mad, and disabled artists by documenting and analyzing our practices through qualitative and/or quantitative research. Calling into question the focus that Disability Studies puts on access and inclusion, this studio-based project interrupts this discourse with the methodological approach of research-creation and the theoretical frameworks of Mad Studies and Critical Craft Praxis. My creative work intervenes in the text, positioning the knowledge created as knowledge in making based in the provocation of change and movement. Instead of looking inward at my own experiences, as mediated through my identity, I make to look outward. I turn to craft, specifically fibre-based practices like quilting and nature-based dyeing, as a way to make sense of the world around me. Craft is what makes me feel things. It forces me to see big pictures, look outside of myself, get raw, question my long-held beliefs, be uncomfortable, desire to do better in this world. Craft can be that space where we come together, commune with each other, hold one another, see the beauty and the ugly together, and struggle through the really tough shit. Key themes that have emerged from this performative research include the significance of commodifying identity as a process of depoliticizing creative work, the transformative possibilities of disrupting simplified notions of community, the role of the audience in the creative process, the role of nature in the vulnerability of craft as object and anti-colonial praxis, and the ability for quilts to be sculptural and layered with meaning. In my final reflection I feel as though I have ended with more questions than concluding statements. And yet with more questions than answers, this dissertation has accomplished what it set out to do: use Mad Studies and Critical Craft Praxis as a way to create ruptures, open up space for exploration, engage with ideas, and create new lines of inquiry

Constructing One Another: Philodemus and Paul on Interdependence in Moral Formation

In this thesis, I argue that one gains fresh perspective on Paul’s understanding of believers’ interdependence in ‘constructing’ each other in 1 Corinthians by comparison with Philodemus’ vision for interdependence in reciprocal ‘therapy’. Pauline construction and Philodemean therapy are analogous instances of interdependent moral formation, both in concept and practice. Beyond previous comparisons, however, such a pairing is only fruitful if it is methodologically reoriented to both similarities and differences. This reorientation requires expanding the comparison to include additional dimensions of both figures’ perspectives, namely, their socio-economic locations (including their views of economic interdependence) and their theologies. In the first half (chs. two to four), I examine Philodemus’ socio-economic location and theology in the course of describing interdependence in reciprocal moral therapy via frank criticism among friends (drawing from his treatise On Frank Criticism). In the second half (chs. five to seven), I examine Paul’s socio-economic location and theology in the course of describing interdependence in reciprocal construction among believers in 1 Cor 8n10 and 12n14. In the final chapter (ch. 8), I bring Paul and Philodemus into comparative perspective. I argue that, alongside their similarities (esp. in the practices of reciprocal formation), the two have qualitatively different understandings of moral formation and moral interdependence among community members. For Philodemus, one grows out of one’s need to receive formation from others into moral self-sufficiency. This trajectory correlates with the assumed economic self-sufficiency of Epicurean friends, and the moral self-sufficiency of the gods, which Epicureans can reach by means of perfected human character. For Paul, however, believers constantly depend on one another for moral formation, as they also do for economic support in their poverty. Paul cannot champion Philodemus’ moral self-sufficiency, because the moral life of a believer is one of interactive relationship with God, who continually reveals himself through other believers for their formation, yet always transcends all human moral character

Metaphysical Organs from Leibniz to Marx

Metaphysical Organs from Leibniz to Marx Leif Weatherby Catriona MacLeod, supervisor This dissertation locates and treats the Early German Romantic project of finding or creating an organ for metaphysics. The Romantics derived their sense of Organ from a spectrum of meanings and etymological developments of the Greek organon, instrument. Simultaneously physiological and metaphysical, what I call Romantic organology was meant to bridge the critical gap between thought and being, and to provide a transition from the speculative to the political. What resulted was a kind of technological imagination forming a major moment in modern metaphysics. The term Organ had conceptual and metaphorical origins in German in the late 18th century--in biology, but also in the works of Leibniz, Kant, and Herder, it was always present but never semantically fixed. Indeed, its modern meaning ( functional part of a living being ) was established in the German public sphere only in the 1790s. Aristotelian scholasticism had long described logic a set of tools for philosophy, an organon. The organon\u27s etymological sibling, the organ, had a primarily physiological heritage ( sense-organ, internal organ ). Intentionally conflating the medical and logical notions, the Romantics imagined their literary-philosophical efforts as the construction of an ideal yet concrete tool. This project has until now been missing from the intellectual historiography of the period (and especially from the important works of Hans Blumenberg and Michel Foucault). Hölderlin, Schelling, and Novalis shared the project of determining what sort of knowledge can count as metaphysical in a world filled with antinomies created by the political and technological upheavals of the 18th century. A new metaphysics, they reasoned, would need a determinate means, and they exploited the term Organ\u27s newness and attendant ambiguity to underpin their aesthetic and philosophical pretensions. Hölderlin used it to found a metaphysics of tragedy; Schelling to bridge gaps between epistemology, natural science, and theology; and Novalis to lend weight to his universal encyclopedia. Goethe and Marx, I argue, both inherited this project indirectly, revising the Romantic project for their own metaphysical and political programs. Organology is at the basis of a surprising metaphysical legacy of Romanticism, which the dissertation reconstructs both systematically and contextually

The Public Trust Doctrine in Washington

This Article addresses questions of resource allocation and property rights, first, by presenting a brief description of the historical and legal foundation of coastal resource allocation in the United States: the “public trust doctrine.” Second, a survey of the Washington experience demonstrates, surprisingly, that a state whose 2,337 miles of marine coastline approximately equals the length of the entire remaining coastline of the contiguous western United States, has managed to establish a viable and responsive regulatory regime governing coastal resource use with scarcely a mention in its laws of the “public trust doctrine.

Maturation of auditory temporal integration and inhibition assessed with event-related potentials (ERPs)

Background: We examined development of auditory temporal integration and inhibition by assessing electrophysiological responses to tone pairs separated by interstimulus intervals (ISIs) of 25, 50, 100, 200, 400, and 800 ms in 28 children aged 7 to 9 years, and 15 adults.Results: In adults a distinct neural response was elicited to tones presented at ISIs of 25 ms or longer, whereas in children this was only seen in response to tones presented at ISIs above 100 ms. In adults, late N1 amplitude was larger for the second tone of the tone pair when separated by ISIs as short as 100 ms, consistent with the perceptual integration of successive stimuli within the temporal window of integration. In contrast, children showed enhanced negativity only when tone pairs were separated by ISIs of 200 ms. In children, the amplitude of the P1 component was attenuated at ISIs below 200 ms, consistent with a refractory process.Conclusions: These results indicate that adults integrate sequential auditory information into smaller temporal segments than children. These results suggest that there are marked maturational changes from childhood to adulthood in the perceptual processes underpinning the grouping of incoming auditory sensory information, and that electrophysiological measures provide a sensitive, non-invasive method allowing further examination of these changes

The outcomes of educational welfare officer contact in England

The key purpose of educational welfare officers in England is to support students and parents to maximise educational opportunities for young people. However more is known about their role in relation to school attendance than in relation to pupils’ educational outcomes. Using the Longitudinal Survey of Young People in England (LSYPE), this paper investigates the characteristics of teenagers who received educational welfare contact because of their behaviour between 2004 and 2006. With observational data it is often difficult to isolate respondents exposed to a particular intervention or ‘treatment’, because of non-random allocation. We address this using inverse-probability-weighted regression adjustment (IPWRA) to estimate more accurately the effect of educational welfare contact on outcomes of educational achievement and aspiration. Our findings indicate that young people who had educational welfare contact because of their behaviour were less likely to apply to university, less confident in university acceptance if they applied and had lower odds of achieving five General Certificate of Secondary Education at grades A*–C, the government benchmark for education achievement at age 16. We discuss the limitations we face and implications of these findings for future research

ESCRT-III-associated proteins and spastin inhibit protrudin-dependent polarised membrane traffic

Funder: National Institute for Health Research; doi: http://dx.doi.org/10.13039/501100000272Funder: Gates Cambridge Trust; doi: http://dx.doi.org/10.13039/501100005370Abstract: Mutations in the gene encoding the microtubule severing ATPase spastin are the most frequent cause of hereditary spastic paraplegia, a genetic condition characterised by length-dependent axonal degeneration. Here, we show that HeLa cells lacking spastin and embryonic fibroblasts from a spastin knock-in mouse model become highly polarised and develop cellular protrusions. In HeLa cells, this phenotype was rescued by wild-type spastin, but not by forms unable to sever microtubules or interact with endosomal ESCRT-III proteins. Cells lacking the spastin-interacting ESCRT-III-associated proteins IST1 or CHMP1B also developed protrusions. The protrusion phenotype required protrudin, a RAB-interacting protein that interacts with spastin and localises to ER–endosome contact sites, where it promotes KIF5-dependent endosomal motility to protrusions. Consistent with this, the protrusion phenotype in cells lacking spastin also required KIF5. Lack or mutation of spastin resulted in functional consequences for receptor traffic of a pathway implicated in HSP, as Bone Morphogenetic Protein receptor distribution became polarised. Our results, therefore, identify a novel role for ESCRT-III proteins and spastin in regulating polarised membrane traffic

Spastin MIT Domain Disease-Associated Mutations Disrupt Lysosomal Function.

The hereditary spastic paraplegias (HSPs) are genetic motor neuron diseases characterized by progressive degeneration of corticospinal tract axons. Mutations in SPAST, encoding the microtubule-severing ATPase spastin, are the most common causes of HSP. The broad SPAST mutational spectrum indicates a haploinsufficiency pathogenic mechanism in most cases. Most missense mutations cluster in the ATPase domain, where they disrupt the protein's ability to sever microtubules. However, several putative missense mutations in the protein's microtubule interacting and trafficking (MIT) domain have also been described, but the pathogenicity of these mutations has not been verified with functional studies. Spastin promotes endosomal tubule fission, and defects in this lead to lysosomal enzyme mistrafficking and downstream lysosomal abnormalities. We investigated the function of three disease-associated spastin MIT mutants and found that none was able to promote normal endosomal tubule fission, lysosomal enzyme receptor trafficking, or lysosomal morphology. One of the mutations affected recruitment of spastin to endosomes, a property that requires the canonical function of the MIT domain in binding endosomal sorting complex required for transport (ESCRT)-III proteins. However, the other mutants did not affect spastin's endosomal recruitment, raising the possibility of pathologically important non-canonical roles for the MIT domain. In conclusion, we demonstrate that spastin MIT mutants cause functional abnormalities related to the pathogenesis of HSP. These mutations do not directly affect spastin's microtubule-severing capacity, and so we identify a new molecular pathological mechanism by which spastin mutations may cause disease