Workplace Engagement Around Stewardship and Recyling in a Healthcare Setting

The healthcare industry is second only to the food industry in overall waste production, and there are many opportunities to mitigate the environmental impacts of waste through waste reduction and recycling programs in healthcare. Beaumont Royal Oak is a 1,000-bed hospital in Southeast Michigan that is part of an eight-hospital, non-profit health system called Beaumont Health. Beaumont Royal Oak is unique in that it has a voluntary training program that educates employees on environmental stewardship in the work place. The Green Officer program is administered by a Green Team made up of leaders in the hospital. In addition to running the Green Officer training program, the Green Team also implements other environmental stewardship initiatives at the hospital. While the Green Team had been successful in recruiting 483 employees to undergo the Green Officer certification program at Royal Oak, as of January 2015, they lacked information about whether Green Officer’s attitudes, knowledge, and behaviors differed from non-trained employees. At the same time, data on the hospital’s waste management revealed that the hospital’s recycling rate was lower than other hospitals with dedicated stewardship programs. This master’s project attempted to answer two questions: (1) how do Beaumont Royal Oak staff perceive and engage in environmental stewardship in the work place, and (2) how can Beaumont Royal Oak increase its recycling rate? To help us answer the second question, we used the Community-Based Social Marketing (CBSM) framework to give us guidance on how to address recycling in particular. The framework helped us focus on identifying barriers and benefits to recycling and engagement in environmental stewardship. We employed a wide variety of methods, including site visits, a literature review, an online survey, and employee interviews to answer our two questions. Our survey formed the crux of our data collection process and the findings from it provided the foundation for our recommendations. We used Qualtrics software to design our 10-minute, online survey which we distributed to both Green Officers and non-Green officers within the hospital. The goals of this survey instrument were two-fold: one, to gather data about environmental stewardship among employees at Beaumont Royal Oak, and two, to identify reasons why employees were not recycling at Beaumont Royal Oak. The first half of our survey measured whether there were differences between the environmental behavior and attitudes reported by Green Officers and non-Green Officers, while the second half narrowed in on recycling and measured employee knowledge and awareness of recycling procedures, self-reported recycling behaviors, and employee perceptions of barriers to recycling. We conducted our analysis based on a sample of 294 responses, composed of 116 GOs and 178 non- GOs. Based on our analysis, we saw that attitudes towards the hospital’s work in environmental stewardship were positive across all employees suggesting ample support for future stewardship programming. Green Officers, however, reported practicing environmental stewardship behaviors in the work place more often than their colleagues who are not Green Officers. This finding suggested that Green Officers are a key group to include in developing and rolling out behavior change interventions. The second portion of the survey focused on recycling, and for all items that we asked about, we found that Green Officers recycle them more frequently than employees who have not been trained. Our survey findings demonstrated that Green Officers are also more knowledgeable about what is recyclable in the hospital. However, across both groups we found that there was a lower level of knowledge about how recycling worked in the hospital. When we asked about barriers to recycling, we found that non- Green Officers reported finding recycling more difficult than Green Officers. They consider it more inconvenient, they are more confused about labels, and they do not feel it is as worthwhile as their Green Officers counterparts do. They also reported feeling less encouragement from supervisors and colleagues to recycle. The barriers identified by respondents demonstrated a need for greater communication about how the recycling program works and how the hospital is performing over time. The physical infrastructure of the recycling bins could also use greater standardization, while still keeping unique needs for different types of workspaces in mind. Based on our site visits, survey, literature review, and interviews, we created six recommendations that fit into three themes: convenience, awareness and knowledge, and motivation. These six recommendations are to increase bin availability, standardize bin appearance, inform employees how and where to recycle, tap into effective communication channels, renew commitments regularly, and to recognize recycling leaders for their efforts. A summary table of recommendations is shown in Section 7.3. After describing our recommendations, we provide guidance to Beaumont for completing the final steps of the CBSM process. This includes piloting, evaluating, and adjusting strategies, then scaling them up across the hospital. In conclusion, this project helps the Beaumont RO Green Team understand the current state of attitudes, knowledge, and engagement regarding environmental stewardship and recycling. After investing heavily in training hundreds of GOs, a feat unique in healthcare organizations across the country, there is still much more to do to help GOs succeed in helping their peers be better stewards at work. This project contributes to the small body of knowledge surrounding healthcare professionals’ opinions on environmental issues. This is an important contribution because healthcare professionals are trusted members of the community and can be strong environmental leaders with the right support and direction.Master of ScienceNatural Resources and EnvironmentUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/117634/1/Masters Project Beaumont Sustainability Final Report.pd

A study of the norcaradiene-cycloheptatriene equilibrium in a series of azulenones by NMR spectroscopy; the impact of substitution on the position of equilibrium

A systematic investigation of the influence of substitution at positions C-2 and C-3 on the azulenone skeleton, based on NMR characterisation, is discussed with particular focus on the impact of the steric and electronic characteristics of substituents on the position of the norcaradiene-cycloheptatriene (NCD-CHT) equilibrium. Variable temperature (VT) NMR studies, undertaken to enable the resolution of signals for the equilibrating valence tautomers revealed, in addition, interesting shifts in the equilibrium

Results from Ireland north and south\u27s 2016 report card on physical activity for children and youth

Background: Physical activity (PA) is a key performance indicator for policy documents in both the Republic of Ireland and Northern Ireland. Building on baseline grades set in 2014, Ireland\u27s second Report Card on Physical Activity for Children and Youth allows for continued surveillance of indicators related to PA in children and youth. Methods: Data and information were extracted and collated for 10 indicators and graded using an international standardized grading system. Results: Overall, 7 grades stayed the same, 2 increased, and 1 decreased. Grades were assigned as follows: Overall PA, D (an increase); Sedentary Behavior (TV), C-; Physical Education, D-; Active Play, Incomplete/Inconclusive (INC); Active Transportation, D; School, D (a decrease); Home (Family), INC; Community and the Built Environment, B+ (an increase); and Government, INC. Unlike 2014\u27s report card, different grades for the Republic (C-) and Northern Ireland (C+) were assigned for Organized Sport Participation. Conclusions: Although the grade for Overall PA levels increased to a D, this may reflect the increased quality and quantity of data available. The double burden of low PA and high sedentary levels are concerning and underscore the need for advocacy toward, and surveillance of, progress in achieving targets set by the new National Physical Activity Plan in the Republic and obesity and sport plans in the North

Patients’ experiences of attending emergency departments where primary care services are located: qualitative findings from patient and clinician interviews from a realist evaluation

Background: Patient experience is an important outcome and indicator of healthcare quality, and patient reported experiences are key to improving quality of care. While patient experience in emergency departments (EDs) has been reported in research, there is limited evidence about patients’ specific experiences with primary care services located in or alongside EDs. We aim to identify theories about patient experience and acceptability of being streamed to a primary care clinician in an ED. Methods: Using theories from a rapid realist review as a basis, we interviewed 24 patients and 106 staff members to generate updated theories about patient experience and acceptability of streaming to primary care services in EDs. Feedback from 56 stakeholders, including clinicians, policymakers and patient and public members, as well as observations at 13 EDs, also contributed to the development of these theories, which we present as a programme theory. Results: We found that patients had no expectations or preferences for which type of clinician they were seen by, and generally found being streamed to a primary care clinician in the ED acceptable. Clinicians and patients reported that patients generally found primary care streaming acceptable if they felt their complaint was dealt with suitably, in a timely manner, and when clinicians clearly communicated the need for investigations, and how these contributed to decision-making and treatment plans. Conclusions: From our findings, we have developed a programme theory to demonstrate that service providers can expect that patients will be generally satisfied with their experience of being streamed to, and seen by, primary care clinicians working in these services. Service providers should consider the potential advantages and disadvantages of implementing primary care services at their ED. If primary care services are implemented, clear communication is needed between staff and patients, and patient feedback should be sought

Results from Ireland North and South’s 2022 report card on physical activity for children and adolescents

BackgroundThe Ireland North and South Report Card on Physical Activity (PA) for Children and Adolescents aims to monitor progress in PA participation across a range of internationally established indicators.MethodsData were collated for 11 indicators and graded following the harmonised Active Healthy Kids Global Alliance report card process. Six representative studies (sample size range n = 898 to n = 15,557) were primarily used in the grading, with many indicators supplemented with additional studies and reports. Data collected since the implementation of COVID-19 public health measures in March 2020 were excluded.ResultsGrades were awarded as follows: ‘Overall physical activity’, C-; ‘Organised Sport and Physical Activity’, C; ‘Active Play’, INC; ‘Sedentary Behaviours’, C-; ‘Physical Fitness’, INC; ‘Family and Peers’, D+; ‘School’, C-; ‘Physical Education’, D; ‘Community and Environment’, B+ and ‘Government’, B. Separate grades were awarded for disability as follows; ‘Overall physical activity’, F; ‘Organised Sport and Physical Activity’, D; ‘Sedentary Behaviours’, C-; ‘Family and Peers’, C; ‘School’, C- and ‘Government’, B. ‘Active Play’, ‘Physical Fitness’, ‘Physical Education’ and ‘Community and Environment’ were all graded INC for disability. Since the last report card in 2016, four grades remained the same, three increased (‘Overall physical activity’, ‘School’ and ‘Physical Education’) and two (‘Family and Peers,’ and ‘Government’) were awarded grades for the first time.ConclusionGrades specific to children and adolescents with disability were generally lower for each indicator. While small improvements have been shown across a few indicators, PA levels remain low across many indicators for children and adolescents

Results from Ireland North and South’s 2022 report card on physical activity for children and adolescents

BackgroundThe Ireland North and South Report Card on Physical Activity (PA) for Children and Adolescents aims to monitor progress in PA participation across a range of internationally established indicators.MethodsData were collated for 11 indicators and graded following the harmonised Active Healthy Kids Global Alliance report card process. Six representative studies (sample size range n = 898 to n = 15,557) were primarily used in the grading, with many indicators supplemented with additional studies and reports. Data collected since the implementation of COVID-19 public health measures in March 2020 were excluded.ResultsGrades were awarded as follows: ‘Overall physical activity’, C-; ‘Organised Sport and Physical Activity’, C; ‘Active Play’, INC; ‘Sedentary Behaviours’, C-; ‘Physical Fitness’, INC; ‘Family and Peers’, D+; ‘School’, C-; ‘Physical Education’, D; ‘Community and Environment’, B+ and ‘Government’, B. Separate grades were awarded for disability as follows; ‘Overall physical activity’, F; ‘Organised Sport and Physical Activity’, D; ‘Sedentary Behaviours’, C-; ‘Family and Peers’, C; ‘School’, C- and ‘Government’, B. ‘Active Play’, ‘Physical Fitness’, ‘Physical Education’ and ‘Community and Environment’ were all graded INC for disability. Since the last report card in 2016, four grades remained the same, three increased (‘Overall physical activity’, ‘School’ and ‘Physical Education’) and two (‘Family and Peers,’ and ‘Government’) were awarded grades for the first time.ConclusionGrades specific to children and adolescents with disability were generally lower for each indicator. While small improvements have been shown across a few indicators, PA levels remain low across many indicators for children and adolescents

Identifying safe care processes when GPs work in or alongside emergency departments: realist evaluation

Background: Increasing pressure on emergency services has led to the development of different models of care delivery including GPs working in or alongside emergency departments (EDs), but with a lack of evidence for patient safety outcomes. Aim: We aimed to explore how care processes work and how patient safety incidents associated with GPs working in ED settings may be mitigated. Design and Setting: We used realist methodology with a purposive sample of 13 EDs with different GP service models. We sought to understand the relationship between contexts, mechanisms and outcomes to develop theories about how and why patient safety incidents may occur, and how safe care was perceived to be delivered. Method: We collected qualitative data (observations, semi-structured audio-recorded staff interviews and local patient safety incident reports). We coded data using ‘if, then, because’ statements to refine initial theories developed from an earlier rapid realist literature review and analysis of a sample of national patient safety incident reports. Results: We developed a programme theory to describe how safe patient care was perceived to be delivered in these service models including: an experienced streaming nurse using local guidance and early warning scores; support for GPs’ clinical decision-making with clear governance processes relevant to the intended role (traditional GP approach or emergency medicine approach); and strong clinical leadership to promote teamwork and improve communication between services. Conclusion: Our findings can be used as a focus for more in-depth human factors investigations to optimise work conditions in this complex care delivery settin

A network analysis to identify mediators of germline-driven differences in breast cancer prognosis.

Identifying the underlying genetic drivers of the heritability of breast cancer prognosis remains elusive. We adapt a network-based approach to handle underpowered complex datasets to provide new insights into the potential function of germline variants in breast cancer prognosis. This network-based analysis studies ~7.3 million variants in 84,457 breast cancer patients in relation to breast cancer survival and confirms the results on 12,381 independent patients. Aggregating the prognostic effects of genetic variants across multiple genes, we identify four gene modules associated with survival in estrogen receptor (ER)-negative and one in ER-positive disease. The modules show biological enrichment for cancer-related processes such as G-alpha signaling, circadian clock, angiogenesis, and Rho-GTPases in apoptosis