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Objectives: To identify the leadership styles, strengths, strategies, and key factors of PA leaders in healthcare executive, clinical, and academic settings. Methods: An exploratory, qualitative study was completed through the American Academy of Physician Associates 2023 Practice Survey to answer seven qualitative questions. Of the 1,423 PAs who responded to the survey invitation, 348 PA leaders in formal and informal roles chose to answer, for a 24.4% response rate. Results: For PA leaders' styles and strengths, collaborative and emotional intelligence emerged as themes. For key factors of PA leadership, balancing expectations and giving and receiving critical feedback emerged as themes. For skills or qualities PA leaders wish they had before starting to lead, project management skills and increased confidence emerged as themes. Conclusions: Leadership development training needs to be in the didactic and clinical curriculum of PA programs for the future of PA leadership. Leadership pathways for PA leaders in healthcare executive, clinical, and academic settings need to be created and established more widely. [ABSTRACT FROM AUTHOR]

Background: Palliative care (PC) education should be an important part of both the graduate and undergraduate nursing curriculum. Nursing's philosophy of holistic care, which aims to improve the quality of life of patients and families, aligns with the primary objective of PC, positioning nurses to take the lead in expanding and improving PC delivery to all patients with a life-threatening diagnosis. The best way to facilitate this level of care is when staff nurses and advanced practice nurses work collaboratively. Aim: To establish a new standard for nursing education that emphasises intradisciplinary care. Methods: To fill the gap in PC education for nursing students, a dedicated elective PC class was developed for undergraduate and graduate students at a large midwestern University in the United States. Findings: Through an interactive approach to learning, both groups were able to experience and more fully understand how they would work collaboratively with each other to provide high-quality PC. Conclusions: Intradisciplinary PC education is an opportunity for students to learn the precepts of PC in an environment that will mirror their post-graduation practice environment. [ABSTRACT FROM AUTHOR]

Background: The need to expand and better engage patients in primary care improvement persists. Purpose: Recognizing a continuum of forms of engagement, this study focused on identifying lessons for optimizing patient partnerships, wherein engagement is characterized by shared decision-making and practice improvement codesign. Methodology: Twenty-three semistructured interviews with providers and patients involved in improvement efforts in seven U.S. primary care practices in the Academic Innovations Collaborative (AIC). The AIC aimed to implement primary care improvement, emphasizing patient engagement in the process. Data were analyzed thematically. Results: Sites varied in their achievement of patient partnerships, encountering material, technical, and sociocultural obstacles. Time was a challenge for all sites, as was engaging a diversity of patients. Technical training on improvement processes and shared learning "on the job" were important. External, organizational, and individual-level resources helped overcome sociocultural challenges: The AIC drove provider buy-in, a team-based improvement approach helped shift relationships from providers and recipients toward teammates, and individual qualities and behaviors that flattened hierarchies and strengthened interpersonal relationships further enhanced "teamness." A key factor influencing progress toward transformative partnerships was a strong shared learning journey, characterized by frequent interactions, proximity to improvement decision-making, and learning together from the "lived experience" of practice improvement. Teams came to value not only patients' knowledge but also changes wrought by working collaboratively over time. Conclusion: Establishing practice improvement partnerships remains challenging, but partnering with patients on improvement journeys offers distinctive gains for high-quality patient-centered care. Practice Implications: Engaging diverse patient partners requires significant disruption to organizational norms and routines, and the trend toward team-based primary care offers a fertile context for patient partnerships. Material, technical, and sociocultural resources should be evaluated not only for whether they overcome specific challenges but also for how they enhance the shared learning journey. [ABSTRACT FROM AUTHOR]

Farmer adoption of practices to build soil health can be enhanced using a knowledge network supported by programs and resources that incorporate technical, social and experiential learning pathways. University Extension plays a critical role in building and supporting the knowledge network by serving as (a) a boundary organization to create space for conversations to occur, (b) network manager to facilitate learning and (c) builder of social capital to encourage trust in the network. The North Dakota State University (NDSU) Soil Health Program was used to illustrate the above approach. Between 2014 and 2016, 32 informal discussion groups, called Soil Health Café Talks, reached 156 individuals. A knowledge network of all participants was developed using NodeXL. The 10 most influential individuals in the network included two scientists, five farmers, one crop consultant and two Extension specialists. All non‐NDSU participants received an evaluation form. Respondents increased their frequency of discussing cover crops with other individuals and increased sharing equipment across farming operations (i.e., vertical tillage implements and no‐till drills). Of the topics discussed, over 25% of respondents adopted practices using cover crops (interseeding and using cover crops for weed control and adjusting rotations to incorporate cover crops) as a result of attending Café Talks. Respondents also increased their use of NDSU Soil Health online resources such as Twitter (22%), YouTube (23%) and the web page (21%) as follow‐up information to Café Talks. Network‐based approaches have proven to be successful in encouraging on‐farm adoption of soil health‐building practices. [ABSTRACT FROM AUTHOR]

Quality problem or issue: Healthcare is complex and we know that evidence takes nearly 20 years to find its way into clinical practice.Initial assessment: The slow process of translating research points to the need for effective translational research models to ensure patient care quality and safety are not compromised by such an epistemic failure.Choice of solution: Our model to achieve reasonably rapid and enduring improvements to clinical care draws on that developed and promulgated by the Institute for Healthcare Improvement in the United States of America model as well as that developed by the Johns Hopkins Quality and Safety Group known as the Translating Research into Practice implementation model.Implementation: The core principle of our hybrid model was to engage those most likely to be affected by the changes being introduced through a series of face-to-face and web-enabled meetings that act both as drivers of information but also as a means of engaging all stakeholders across the healthcare system involved in the change towards their pre-established goals.Evaluation: The model was piloted on the focused topic of the management of inadvertent perioperative hypothermia across nine hospitals within Australia (four sites in Victoria, three sites in New South Wales and two sites in Queensland). Improvement in management of hypothermia in these patients was achieved and sustained over time.Lessons learned: Our model aims to engage the hearts and minds of healthcare clinicians, and others in order to empower them to make the necessary improvements to enhance patient care quality and safety. [ABSTRACT FROM AUTHOR]

Objective: NutriBee was the first clinical nutrition intervention designed to bring the Institute of Medicine recommendations for 20 hours of experiential nutrition-themed learning to grades 4-7 into club and camp settings. We piloted NutriBee to assess acceptability and impact among early adolescents in diverse and disadvantaged communities in order to evaluate its future potential as a group medical nutrition intervention.Methods: Nine communities across Guam, Maryland, Michigan, and New Mexico representing South Pacific Island, American Indian, urban African American, recently immigrated Hispanic, and rural Caucasian ethnic groups piloted NutriBee in nonclinical settings (clubs, schools, camps). The 6 club and camp pilots administered consenting NutriBee participants a 41-question pre-post survey assessing impact on food selection and the psychosocial parameters of intentions, outcome expectations, self-efficacy, and knowledge. Process measures included dose, fidelity, and acceptability questions.Results: Pre- and postsurveys were completed by 170 of 179 (95%) consenting, eligible participants. Impact scores increased significantly (p < 0.001): Food selection behavior (+9.3%), intentions (+19.1%), outcome expectations (+15.1%), self-efficacy (+7.4%), and knowledge (+17.6%). Each pilot (n = 6) demonstrated significant (p < 0.001) impact, a mean dose delivered of 80% (16 hours) or higher, and an acceptability score of at least 74%. Girls participating in girl-only programs (n = 72) shared greater impact than girls in coed programs (n = 41; 13.6% vs. 10.4% mean score increase, p = 0.05).Conclusions: NutriBee successfully extended the impact of an IOM-aligned intervention to club and camp settings to which clinicians can refer at-risk early adolescents. [ABSTRACT FROM AUTHOR]

Significant changes in the healthcare environment have occurred that offer challenges for quality improvement and nursing education programs, and thus impact both nursing practice and education. We formed an academic-practice partnership to actively engage students enrolled in an undergraduate nursing research course in quality processes with participation in a medical center's performance improvement program. This article describes the development of the partnership; and projects, results, and implications for practice. Students worked collaboratively in groups with hospital staff performance improvement preceptors and a course faculty member. Using the Plan, Do, Check, Act (PDCA) model, students collected, analyzed, and disseminated data from existing projects, or those for which the organization had identified a need. Leaders involved in the inception of this partnership agreed that it achieved its goals of enabling the college to effectively teach recently mandated quality improvement methodologies to achieve competency and enhancing the medical center's capabilities to obtain data for quality improvement purposes. The academic-practice partnership continues to evolve, and we offer discussion about lessons learned and partnership growth. [ABSTRACT FROM AUTHOR]

This paper investigates the dynamics of the Millennial and Post-Millennial Generations, born after 1982, along with the pedagogical changes commanded by those dynamics. It describes various learning modalities that satisfy learners' expectations and adaptations necessitated by the exponential speed of technological changes impacting learners' attitudes. Relying on extensive research of earlier studies that describe changing attitudes, values, and characteristics of the Millennial Generation, this study matches those elements with pedagogical considerations. Research on use of various learning modalities, student satisfaction and learning outcomes are referenced to ascertain the most successful approaches that facilitate learning. The Millennial Generation, defined as those born between 1982 and 2002, has never known a world where information was not readily available at the click of a mouse. While the Millennial learners operate on short attention spans, demand immediate gratification, and process information in short spurts, they are also keen on multi-tasking and likely to dive into a project with fairly successful outcomes rather than spend time reading instructions. Traditional lecture formats cannot hold their attention and instructors must integrate more interactive exercises in order to achieve satisfactory learning outcomes. This paper matches innovative uses of technology, collaborative assignments and experiential exercises with important learning outcomes expected of post-secondary education that include critical thinking, problem solving and communication skills. Models demonstrated include use of contemporary news media in group and individual research assignments, with deliverables using latest technology tools, as well as game playing that serves to reinforce learned principles. Measures for outcomes assessment embedded in assignments are included in the various learning modalities described. [ABSTRACT FROM AUTHOR]

The health care quality and patient safety movement has evolved rapidly during the past 10 years largely as a result of the Institute of Medicine (IOM) report, "To Err is Human." Patient safety teams are using a collaborative model to improve patient outcomes. Diffusion of improvement-oriented innovations is a major challenge facing health care. Utilizing a tool to measure innovativeness, a 39-hospital patient safety collaborative was evaluated for their "Innovativeness Quotient." Findings showed that 75.5% of the members of the collaborative who completed the survey were innovators/early adopters compared to 16% as described for the general population. The application and implications of this project are described. [ABSTRACT FROM AUTHOR]

The article presents a study on the efficiency of YourTeamIsIn as collaborative learning and assessment tool for diverse educational disciplines in the U.S. The assessment tool is an online tool that provides multiple choice questions. The presence of the PowerPoint template allows the user to create a quiz with just few clicks.

Well known as the primary source of commissioned officers for both the Navy and Marine Corps, the United States Naval Academy (USNA) is an undergraduate educational institution with emphasis on technical education. This technical education is supplemented with design-and-build projects, hands-on demonstrations, and laboratory exercises using a wide variety of state-of-the-art test equipment. These laboratory facilities are leveraged by the civilian and military faculty to perform test and evaluation in support of cutting-edge research as well as answering operational questions from the Fleet. Of particular note are the modest costs associated with funded research at the Academy, the proximity of many other government agencies and laboratories in the Greater Washington, D.C., area, and the prior or current military experience of a significant fraction of the faculty. Described herein are several typical project efforts performed at the Naval Academy that were funded either by the Office of Naval Research, the Air Force Research Laboratory, or the Naval Research Laboratory. These examples are provided as a means to showcase the research and test capabilities that can be found at the Naval Academy. [ABSTRACT FROM AUTHOR]

The article reports on the increase of organ donation brought upon the presence of the U.S. Organ Donation Breakthrough Collaborative (ODBC). It mentions that the over 92,000 Americans are in need for organ transplants and an average of 17 of them die each day because of the lack of organs needed. The ODCB which began in 2003 at the request of the Secretary of the U.S. Department of Health and Human Services served as the answer to their problem.

In seeking to trace linkages among groups involved with environmental management in New York State's Adirondack Park, we developed a participatory exercise and employed it at a recent Adirondack research conference. Fourteen organizations took part, collectively representing 72 linkages associated with policies and programs, expertise, information dissemination, and physical facilities. The exercise revealed a dense "hub-and-spoke" pattern of interactions, with state agencies acting as the hubs. The exercise is easy to administer and can be used to provide a one-time snapshot of organizational interactions as well as serving as a basis for longitudinal research. [ABSTRACT FROM AUTHOR]

Burn-out among US physicians has been on the rise in the past few decades. Similarly, rheumatologists in the Geisinger Health System have experienced professional dissatisfaction through significant administrative burden and in-basket work. We embedded pharmacists into our rheumatology team in 2019 with the aim of reallocating medication refills to pharmacists, trained professionals in this domain, to help reduce physician workload and burn-out and increase satisfaction. Protocol-driven medication refill parameters per the American College of Rheumatology guidelines and new refill workflows for disease-modifying antirheumatic drugs (DMARDs) and non-DMARDs were created for use by our rheumatology pharmacists. Monthly data on medication refill volume and time saved for rheumatologists were collected from 1 January 2019 to 31 March 2021. Statistical analysis was completed via Shewhart p-charts. The volume of refills by rheumatologists decreased by 73% and the time saved per month for all the rheumatologists increased to 41.5 hours within 6 months. Physicians' feedback was obtained via anonymous electronic surveys preintervention and postintervention. The statistical difference between the presurveys and postsurveys was calculated via two-tailed unpaired t-testing. It demonstrated reduced burn-out and improved workplace satisfaction. This study showed that the integration of rheumatology pharmacists into our practice can help improve the work life of the rheumatologists. It is important for physicians' well-being to practice at the top of their scope and achieve work-life balance., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Collaborative nonregulatory programs can benefit the long-term sustainability of environmental resources. Such programs benefit from extensive planning and assessment relative to ecological systems as well as public participation. While many programs use adaptive management as a guiding programmatic framework, few programs successfully integrate social and human context into their adaptive management frameworks. While this adaptive governance framework can be successful, many potential challenges arise when incorporating public stakeholders into the adaptive management framework. To reduce those challenges, programs need participation from diverse stakeholder groups that represent multiple communities of interest, place, and identity. The participatory process benefits from a diverse group of stakeholders and can result in successful management of environmental resources. We highlight the participatory co-management process of three newly developing nonregulatory programs that are modeled after the United States EPA's National Estuary Program in the Perdido and Pensacola Bay systems, Choctawhatchee Bay, and the St. Andrew and St. Joseph Bay systems (Florida USA). This case study illustrates how collaborative nonregulatory programs can be implemented not only in the United States, but also in other regions of the world., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

A virtual course for the nurse educator master's program was developed and delivered collaboratively between two professors, one from the College of Health Professions (CHP) and the other from the College of Liberal Arts and Education (CLAE). The collaborative effort provided a venue for both professors to complement each other's strengths, affording students the benefit of constructivist pedagogy using content appropriate for a nurse educator program. Student discussion board communication indicated the anticipated conceptual change as a result of teaching using constructivist methodology. Qualitative data were collected and will be used to improve the course as well as develop the follow-up course. [ABSTRACT FROM AUTHOR]

We examine quality improvement (QI) collaboratives underway in 9 states participating in the Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program. A total of 147 diverse, child-serving practices were participating in the collaboratives. We conducted 256 semistructured interviews with key stakeholders from March to August 2012-2 years into the 5-year demonstration projects-and analyzed states' grant applications, operating plans, and progress reports. The collaboratives have multiple complex aims. In addition to developing patient-centered medical home (PCMH) capability, some states use collaboratives to familiarize practices with CMS's Initial Core Set of Children's Health Care Quality Measures, practice-level quality measurement, and improving QI knowledge and skills. The duration of the collaboratives is longer than other well-known collaborative models. Collaboratives also vary in their methods for targeting areas for improvement and strategies for motivating practice recruitment and engagement. States also vary with respect to the other strategies they use to support QI and PCMH development. All states supplement the collaboratives with practice facilitation; the majority utilized practice-level parent engagement, but only 4 used workforce augmentation (ie, providing care coordinators and QI specialists). Practice staff highly valued aspects of the collaboratives and supplemental strategies, including the opportunity to work with experts and other child-serving practices; states' efforts to provide stipends and align demonstration efforts with other professional requirements or programs; receipt of relevant, customized QI materials; opportunities to learn how care coordinators or QI specialists might work in their practice without the risk of hiring them; and satisfaction from learning more about quality measures, QI concepts and techniques, critical medical home components, and how to identify PCMH capacity and performance gaps. However, practice staff also reported a variety of challenges, including difficulty learning from other practices that have very different preexisting QI and PCMH capacity and patient populations, or that are working on different topic areas and measures; a sometimes overwhelming amount of materials and ideas covered during in-person meetings; difficulty keeping up with Webinars, calls, and Web sites/blogs; and trouble motivating and sharing information with other practice staff not attending collaborative activities. As the demonstration projects continue, states and the national evaluation team will learn more about how best to use collaboratives and complementary strategies to support child-serving practices in QI and PCMH development. States will also search for ways to sustain and spread these activities after the demonstration ends, if they prove effective., Competing Interests: The authors declare that they have no conflict of interest., (Copyright © 2013 Academic Pediatric Association. All rights reserved.)