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Research suggests that improving hospital work environments and solving the nursing shortage are critical to improving patient care. The Houston–Galveston region created an aggressive approach to this issue by forming an unusual coalition of business, university, and hospital leaders and using a quality improvement approach. Four years later, the project has achieved over 40% participation among hospitals in the 13-county region and includes 50 hospitals employing approximately 15,000 registered nurses. The data that have been collected by this collaborative to date suggests that hospitals are taking action to improve outcomes by modifying their key initiatives to address the attributed causes of poor work environments. From 2004 to 2005, executives of top performing hospitals increasingly attributed successful work environment outcomes to an emphasis on management development and executive-driven initiatives, de-emphasizing specific employee behavior, process, and outcome-based initiatives.

To consider transnational aspects linked to the social production of adoptable children in a Brazilian setting.

Looks at legislation and media reports, giving particular attention to how, during the 1990s, vigorous campaigns in favor of plenary adoption by Brazilian nationals implied the near‐total silencing of alternative forms of childcare such as foster care, and how recent circumstances are reversing this trend.

Argues that an apparently straightforward conflict between poverty‐stricken families and the state authorities that strip them of parental rights is in fact a highly political issue involving innumerous overseas as well as national influences. National childcare policies that encourage certain childcare options and eliminate others emerge as much from scandals in the media, “consumer demands” by adoptive parents, and philanthropic support as from the more apparent global trends in child welfare legislation.

The findings challenge the view that childcare is a consensual issue with all fronts working for the “child's best interest”. Rather, in this paper, the issue is revealed as a political matter of conflicting interests between unequal categories of caretakers.

This paper has direct relevance for international legislation on child adoption policy.

This paper furnishes a “view from below” on international adoption, putting in question principles that are normally accepted as obvious in international legislation on child rights.