Diversity, Inclusive Leadership, and Health Outcomes

In this time of polarization and divisiveness across increasingly diverse communities, health policy and management research offers an important insight: engaging diversity meaningfully through inclusive leadership—that embraces staff across hierarchies and engages difference perspectives so that all healthcare workers of all kinds feel they can speak up and participate—can save lives. In multiple studies of quality in cardiovascular care, top performing hospitals have been shown to exhibit the capacity to embrace staff across hierarchies and engage differences so that healthcare workers of all kinds feel they can speak up and participate meaningfully in improvement efforts. Most recently, in the two-year, longitudinal Leadership Saves Lives study of 10 hospitals, the ability to adopt a culture of improvement rather than blaming was linked to significant reductions in risk-standardized mortality rates. Moreover, the guiding coalitions (ie, quality improvement teams) in six of the 10 hospitals that were most successful were distinguished in three ways that give insight about effective modes of engaging differences: (1) including staff from difference disciplines and levels in the organizational hierarchy, (2) encouraging authentic participation by the members, and (3) using constructive patterns of managing conflict (ie, having clear role definitions, working to surface minority viewpoints, and collectively revisiting the shared goal of saving lives). Based on this literature, adequately engaging a wide range of diverse viewpoints and staff roles can have a marked impact on health outcomes. Although the studies reviewed do not examine racial/ethnic diversity per se, they do lend insight into effectively navigating environments with extensive diversity of perspectives, professional identities, and experiences. Future research may assess whether these insights have application to other forms of diversity as well. In this time of extreme polarization and division globally and locally, health policy and management research has an opportunity to share evidence that could help navigate an increasingly diverse environment, at least within the field of healthcare, towards a more inclusive, humane, and life-giving approach to our collective future

Learning to Live With Wolves: Community-based Conservation in the Blackfoot Valley of Montana

We built on the existing capacity of a nongovernmental organization called the Blackfoot Challenge to proactively address wolf (Canis lupus)-livestock conflicts in the Blackfoot Valley of Montana. Beginning in 2007, wolves started rapidly recolonizing the valley, raising concerns among livestock producers. We built on an existing program to mitigate conflicts associated with an expanding grizzly bear population and worked within the community to build a similar program to reduce wolf conflicts using an integrative, multi-method approach. Efforts to engage the community included one-on-one meetings, workshops, field tours, and regular group meetings as well as opportunities to participate in data collection and projects. Initial projects included permanent electric fencing of calving areas and livestock carcass removal to address the threat of grizzly bears and, later, wolves. Subsequently we used intensive livestock and wolf monitoring through range riders in an attempt to reduce the frequency of encounter rates among wolves and livestock. Although we cannot claim causation from our efforts, results are encouraging. Confirmed livestock losses to wolves from 2006-2015 have been 2.2 confirmed depredations per year across nearly 50 ranches on about 3,240 km2 that are annually grazed by 16,000-18,000 head of livestock. Fewer than three wolves per year have been removed (2.4 wolves per year) due to these depredations for the same period as the population increased from one confirmed pack to approximately twelve. Our collaborative approach and prior experience with grizzly bears was key in building a proactive program to help reduce conflict with wolves in a community adjusting to an increasing large carnivore presence over a short period

Blueprint for the Dissemination of Evidence-Based Practices in Health Care

Proposes strategies for better dissemination of best practices through quality improvement campaigns, including campaigns aligned with adopting organizations' goals, practical implementation tools and guides, and networks to foster learning opportunities

Evaluation of 4 Outcomes Measures in Microtia Treatment: Exposures, Infections, Aesthetics, and Psychosocial Ramifications.

BackgroundIn craniofacial microsomia, microtia and canal atresia pose formidable reconstructive challenges. We review our institutional experience in treating microtia and atresia to identify variables associated with 4 outcomes measures: complications, surgical revisions, aesthetic outcomes, and psychosocial function.MethodsCraniofacial microsomia patients treated at the University of California Los Angeles Craniofacial Clinic between 2008 and 2014 greater than 13 years of age (n = 68) were reviewed for microtia and atresia treatment and outcomes.ResultsIn total, 91.2% of patients diagnosed with craniofacial microsomia presented with microtia, affecting 75 ears. Both a male and right-sided predominance were observed. Fifty-six patients (90.3%) underwent autologous external ear reconstruction at an average age of 8.5 years. Age, type of incision, and size of cartilage framework did not predict total number of surgeries or complications. Severity of ear anomalies correlated with increased number of surgeries (P < 0.001) and decreased aesthetic outcomes (P < 0.001) but not complications. In total, 87.1% of patients with microtia had documented hearing loss, of which the majority were conductive and 18.5% were mixed sensorineural and conductive. Hearing deficits were addressed in 70.4% of patients with external hearing aids, bone anchored hearing aids, or canaloplasty. Of all variables, improvement of psychosocial function was correlated only to hearing loss treatment of any type (P = 0.01).ConclusionsOn evaluation of surgical and patient characteristics, severity of microtia predicted the total number of surgical revisions performed and aesthetic ratings. In addition, we found that the only factor that correlated with improved patient and parent-reported psychosocial outcomes was treatment of hearing loss

Managing health worker migration: A qualitative study of the Philippine response to nurse brain drain

Background: The emigration of skilled nurses from the Philippines is an ongoing phenomenon that has impacted the quality and quantity of the nursing workforce, while strengthening the domestic economy through remittances. This study examines how the development of brain drain-responsive policies is driven by the effects of nurse migration and how such efforts aim to achieve mind-shifts among nurses, governing and regulatory bodies, and public and private institutions in the Philippines and worldwide. Methods:Interviews and focus group discussions were conducted to elicit exploratory perspectives on the policy response to nurse brain drain. Interviews with key informants from the nursing, labour and immigration sectors explored key themes behind the development of policies and programmes that respond to nurse migration. Focus group discussions were held with practising nurses to understand policy recipients’ perspectives on nurse migration and policy. Results: Using the qualitative data, a thematic framework was created to conceptualize participants’ perceptions of how nurse migration has driven the policy development process. The framework demonstrates that policymakers have recognised the complexity of the brain drain phenomenon and are crafting dynamic policies and programmes that work to shift domestic and global mindsets on nurse training, employment and recruitment. Conclusions: Development of responsive policy to Filipino nurse brain drain offers a glimpse into a domestic response to an increasingly prominent global issue. As a major source of professionals migrating abroad for employment, the Philippines has formalised efforts to manage nurse migration. Accordingly, the Philippine paradigm, summarised by the thematic framework presented in this paper, may act as an example for other countries that are experiencing similar shifts in healthcare worker employment due to migration

The role of religiousness on substance-use disorder treatment outcomes: a comparison of black and white adolescents

This study compares 41 Black and 124 White adolescents at intake and discharge from a residential treatment program for substance-use disorders. Study data were obtained as part of a larger study (N = 195) that sought to assess the relationship of helping behavior and addiction recovery. This post-hoc analysis aims to identify cultural strengths that may be associated with recovery from substance-use disorders among Black adolescents. Using regression analyses and controlling for the severity of substance use and background variables that distinguish racial groups, religious practices and behaviors at intake were examined. Specifically, Black youth and White youth were compared on treatment outcomes, including alcohol or drug use during treatment, drug craving, 12-Step work, and 12-Step helping. The burden of health and socioeconomic disparities at intake did not disproportionately disfavor Black adolescents. Outcomes related to 12-Step measures were similar between Black and White youth. White adolescents reported higher craving scores at discharge, and Black adolescents were more likely to use drugs during treatment. High levels of religiousness at treatment intake were linked to greater 12-Step work and greater 12-Step helping at discharge. High levels of religiousness at intake were not related to drug use during treatment or to craving scores at discharge. The relationship between intake levels of religiousness and treatment-related outcomes did not differ by race.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437261/Accepted manuscrip

Development of a Scalable Synthesis of HP-β-CD Pluronic Polyrotaxanes

Polyrotaxanes are polymers that have macrocycles threaded onto them, analogous to beads threaded onto a string. These materials are used for a variety of different biomedical applications.1-3 The Thompson group has been developing 2-hydroxypropyl-β-cyclodextrin (HP-β-CD) polyrotaxanes as therapeutics for the treatment of Niemann-Pick Type C (NPC) disease. NPC is a debilitating genetic disorder where cholesterol accumulates in the lysosomes of cells.4 Developing a scalable process is crucial for the advancement of these materials as NPC therapeutics. The goal of this project is to optimize the only protocol for the synthesis of HP-β-CD/Pluronic polyrotaxanes in order to develop a synthetic method that can be operated on the multi-gram scale to support preclinical studies.5 Each component of the protocol was screened to determine which combination lead to the formation of polyrotaxanes with the highest yields and threading efficiencies in the shortest amount of time. Threading efficiency is a measure of how many HP-β-CD molecules are threaded onto each polymer. In addition to optimizing the current protocol, we have also explored flowing the reaction mixture through a bath sonicator and using a hydraulic press as alternative syntheses. It was found that probe sonication and bath sonication are both necessary components of the protocol. This indicates that sufficient agitation of the reaction mixture is required to promote the non-covalent threading reaction. Furthermore, bath sonication for one hour, followed by stirring for two days gave the highest threading efficiency. The results of these studies have simplified the existing protocol, but additional studies are needed to reveal whether this protocol is robust enough for efficient preparation of other HP-β-CD/Pluronic polyrotaxane derivatives

Translating Research Into Practice: Speeding the Adoption of Innovative Health Care Programs

Looks at case studies of four innovative clinical programs to determine key factors influencing the diffusion and adoption of innovations in health care

The Globular Cluster Systems around NGC 3311 and NGC 3309

We present extensive new photometry in (g',i') of the large globular cluster (GC) system around NGC 3311, the central cD galaxy in the Hydra cluster. Our GMOS data cover a 5.5' field of view and reach a limiting magnitude i' = 26, about 0.5 magnitude fainter than the turnover point of the GC luminosity function. We find that NGC 3311 has a huge population of ~16, 000 GCs, closely similar to the prototypical high specific frequency Virgo giant M87. The color-magnitude distribution shows that the metal-poor blue GC sequence and the metal-richer red sequence are both present, with nearly equal numbers of clusters. Bimodal fits to the color distributions confirm that the blue sequence shows the same trend of progressively increasing metallicity with GC mass that has previously been found in many other large galaxies; the correlation we find corresponds to a scaling of GC metallicity with mass of Z ~ M^0.6 . By contrast, the red sequence shows no change of mean metallicity with mass, but it shows an upward extension to much higher than normal luminosity into the UCD-like range, strengthening the potential connections between massive GCs and UCDs. The GC luminosity function, which we measure down to the turnover point at M_I = -8.4, also has a normal form like those in other giant ellipticals. Within the Hydra field, another giant elliptical NGC 3309 is sitting just 100" from the cD NGC 3311. We use our data to solve simultaneously for the spatial structure and total GC populations of both galaxies at once. Their specific frequencies are S_N (NGC 3311) = 12.5 +/- 1.5 and S_N (NGC 3309) = 0.6 +/-0.4. NGC 3311 is completely dominant and entirely comparable with other cD-type systems such as M87 in Virgo.Comment: 15 pages, 15 figures. Accepted to the Astrophysical Journal. Version with higher resolution figures is available at http://www.thewehners.net/astro/papers/wehner_n3311_highres.pd