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The response of the receiver to a voiced patient safety concern is frequently cited as a barrier to health professionals speaking up. The authors describe a novel Receiver Mindset Framework (RMF) to help health professionals understand the importance of their response when spoken up to.

The framework draws on the broader receiver-focussed literature and integrates innovative findings from a series of empirical studies. These studies examined different receiver behaviour within vignettes, retrospective descriptions of real interactions and behaviour in a simulated interaction.

The authors' findings indicated that speaking up is an intergroup interaction where social identities, context and speaker stance intersect, directly influencing both perceptions of and responses to the message. The authors' studies demonstrated that when spoken up to, health professionals poorly manage their emotions and ineffectively clarify the speaker's concerns. Currently, targeted training for receivers is overwhelmingly absent from speaking-up programmes. The receiver mindset framework provides an evidence-based, healthcare specific, receiver-focussed framework to inform programmes.

Grounded in communication accommodation theory (CAT), the resulting framework shifts speaking up training from being only speaker skill focussed, to training that recognises speaking up as a mutual negotiation between the healthcare speaker and receiver. This framework provides healthcare professionals with a novel approach to use in response to speaking up that enhances their ability to listen, understand and engage in point-of-care negotiations to ensure the physical and psychological safety of patients and staff.

The purpose of this paper is to meet Dr Joyce Shaffer, PhD, ABPP, Clinical Associate Professor at the University of Washington.

This case study is presented in two sections: a positive autoethnography written by Joyce Shaffer, followed by her answers to ten questions.

In this positive autoethnography, Shaffer shares her life story and reveals numerous mental health and positive aging recommendations and insights for us to reflect on.

This is a personal narrative, albeit from someone who has been a clinical psychologist and active in the field of aging for many decades.

A pragmatic approach to aging is recommended. According to Shaffer, “those of us who can recognize the beat of the historical drummer can harvest the best of it and learn from the rest of it.”

Positive aging has strong social implications. Shaffer considers that it is not only about maximizing our own physical, mental, emotional and social health but also about maximizing that of others, to make our world a better place for everyone.

Positive aging can be experienced despite adversity. As Shaffer says, “Adversity used for growth and healed by love is the answer.”

A novel method has been proposed to reduce the false alarm rate of arrhythmia patients regarding life-threatening conditions in the intensive care unit. In this purpose, the atrial blood pressure, photoplethysmogram (PLETH), electrocardiogram (ECG) and respiratory (RESP) signals are considered as input signals.

Three machine learning approaches feed-forward artificial neural network (ANN), ensemble learning method and k-nearest neighbors searching methods are used to detect the false alarm. The proposed method has been implemented using Arduino and MATLAB/SIMULINK for real-time ICU-arrhythmia patients' monitoring data.

The proposed method detects the false alarm with an accuracy of 99.4 per cent during asystole, 100 per cent during ventricular flutter, 98.5 per cent during ventricular tachycardia, 99.6 per cent during bradycardia and 100 per cent during tachycardia. The proposed framework is adaptive in many scenarios, easy to implement, computationally friendly and highly accurate and robust with overfitting issue.

As ECG signals consisting with PQRST wave, any deviation from the normal pattern may signify some alarming conditions. These deviations can be utilized as input to classifiers for the detection of false alarms; hence, there is no need for other feature extraction techniques. Feed-forward ANN with the Lavenberg–Marquardt algorithm has shown higher rate of convergence than other neural network algorithms which helps provide better accuracy with no overfitting.

Indoor environmental quality (IEQ) in buildings has an impact on people’s health, productivity and comfort. Maintaining the highest possible IEQ level in complex buildings, such as health care, is difficult due to economic and organizational constraints. This study aims to categorize the vicinities in a typical health-care facility in terms of importance and criticality in relation to the various IEQ factors, as well as to develop an IEQ assessment procedure.

A comprehensive literature review, established standards and structured interviews with industrial hygiene professionals in health-care settings were used in this study. To test the applicability of the developed IEQ assessment procedure, a pilot study was conducted in an existing health-care facility.

This study categorized health-care facilities into various vicinities and discovered three respondents group had varying IEQ perceptions (facility managers, environmental health specialists and nurses). According to the findings, indoor air quality is the most important and dominant factor influencing overall IEQ in health-care facilities. The trial application of the framework shows that much work is needed to improve the level of response and readiness of facility management and occupants to allow for the effective use of the developed procedure.

Previous research did not include a detailed categorization of vicinities in health-care buildings based on IEQ requirements. The findings of this study will help to close this knowledge gap and guide facility managers and operators in recognizing the relative importance of different IEQ factors, maintaining functional requirements and identifying priorities when developing maintenance and operational procedures and allocating resources.

Deficiencies or imbalances in dietary fat intake may influence on mental and neurological functions of children with autism spectrum disorders (ASD). This study aims to compare body mass index (BMI) and the amount of fatty acids intake in the autistic patients with the comparison group.

This case-control was carried out on 200 randomly selected children from 5 to 15 years old (100 autistic patients as the case group and 100 healthy children as the comparison group) in Tehran, Iran. The food frequency questionnaire (FFQ) was used to assess the intake of calorie, macronutrients and different types of dietary fatty acids including saturated fatty acids (SFA), monounsaturated fatty acids (MUFAs), poly unsaturated fatty acids (PUFAs), linoleic acid (LA), α-Linolenic acid (ALA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and trans fatty acids.

The autistic patients had higher BMI, birth weight and mother’s BMI compared to the comparison group (All p < 0.01). No significant difference was found in the amount of dietary calorie, protein, carbohydrate and total fat intake between two groups. The risk of ASD was associated with higher intake of MUFAs (OR: 3.18, CI%:1.13–4.56, p = 0.04), PUFAs (OR: 4.12, CI95%: 2.01–6.25, p < 0.01) and LA (OR: 4.76, CI95%: 1.34–14.32, p < 0.01).

The autistic children had higher BMI and higher intake of unsaturated fatty acids except for omega-3 fatty acids. Further longitudinal studies are warranted.

The objective of this study was to delineate and compare enteral nutrition (EN) practices among neonatal units across the Arabian Gulf countries.

A cross-sectional study was conducted by recruiting 255 clinicians working in neonatal units in the Arabian Gulf countries.

Out of 255 invited clinicians, 73 (29%) participated in the survey. Neonatal units used varied EN strategies, where feeding practices exhibited variability. The majority (74%) of units had a local standard feeding protocol, while 18% followed international protocols, and 8% did not adhere to a specific protocol. When maternal milk was not used, the main alternatives were preterm formula (67%) and predigested formula (14%). The age at which the first EN was commenced and the reported advancement rate showed significant variations among different units (p < 0.001). The initiation of fortification was primarily driven by reaching a specific enteral volume (commonly reported as 100 mL/kg/day) and addressing poor postnatal growth. Fortification practices did not differ significantly among professions, except for the initial fortification strength, where none of the dietitians and only 8.3% of neonatologists preferred full strength, compared to 28.6% and 21.4% of medical residents and nurses, respectively (p = 0.033).

This study marks the first exploration of EN practices in neonatal units, examining their local and cross-country variations. It provides valuable insights to guide local trials and foster global collaboration among neonatal units to establish a unified knowledge base, standardized practices and promote research and innovation, ultimately contributing to optimal feeding practices for very preterm infants.

The study aims to investigate the nurse job enjoyment and their participation in medical affairs to enchance the quality of patient care in Saudi hospitals. In addition, this study also investigates the management team's role in patient care quality through the mediating effects of nurse job enjoyment and participation in medical affairs.

The present study used a self-administered survey questionnaire to collect data from registered nurses in Saudi hospitals. In this study, 600 survey questionnaires were distributed online (Google Forms) and received 266 valid responses (44.33% response rate). In addition, SmartPLS-4.0 was applied to validate the research constructs and test the hypotheses via partial least squares structural equation modelling (PLS-SEM).

The study's findings indicate that the job enjoyment of the nurses and participation in medical affairs have positive and significant effects on the quality of patient care. In addition, the research findings also suggest that the management team of the hospitals has a significant indirect influence on the quality of patient care through the medicating effects of nurse job enjoyment and participation in medical affairs.

The findings of this study also offer various practical implications. This study showed the direct impact of the management team on job enjoyment, medical affairs and patient care quality. Therefore, hospital authorities and policymakers may emphasise clear communication, collaboration, respect and trust for the effective management team in providing higher-quality patient care. The present study suggests that hospital policymakers should strive to create a positive work environment, provide adequate resources, foster team spirit, offer incentives and allow flexible scheduling to ensure higher job enjoyment and increase nurse participation in medical affairs.

This study adds to the growing body of knowledge by investigating the effects of the management team, job enjoyment and nurses' participation in medical affairs on patient care quality. This study also enhances the theoretical depth by exploring the mediating impact of job enjoyment in predicting the relationships between the management team and the quality of care provided to patients. The present study provides guidelines for healthcare service providers or practitioners to focus on the nurses' job enjoyment and their engagement in medical activities to continuously improve the quality of patient care in the hospitals.

This research paper aims to explore how social intrapreneurs use serious games to generate social innovation. In particular, the study depicts the coproduction process between caregivers acting as intrapreneurs, patients and other stakeholders, and unveils the contributions of serious games and their key features in producing social innovation within healthcare facilities.

Through an original case study, the article analyzes a social innovation initiated by caregivers in the French care eco-system. Primary and secondary data were used to observe and examine the successful implementation of a serious game. Specifically, caregivers in hospital designed a game that helps children overcome the stress and anxiety inherent to their hospital journey.

Results unveil the role of social innovations as catalyst of social intrapreneurship and the coproduction of services. In the healthcare setting, serious games both participate in improving the stay of child in hospitals, and in facilitating the working conditions of caregivers.

This article brings together the theoretical background of social intrapreneurship, social innovation and serious games. The successful implementation of social innovation depends on the intrinsic features of social intrapreneurs, coupled with those pertaining to serious games. The positive outcome of social innovation benefits both internal and external stakeholders. Such innovation improves the end users' experience, as the latter participate in the coproduction of their own care.

Many healthcare institutions, such as hospitals, have recently implemented quality improvement initiatives such as Lean Six Sigma (LSS). However, only a few have sustained the initiatives and remained successful. One of the main reasons for the failure of LSS implementation is that managers tend to view LSS as individual projects. Managers lack a Change Management (CM) focus during the implementation. The primary purpose of this study is to document the implementation of LSS through a CM approach to improve sustainability.

Define-Measure-Analyse-Improve-Control (DMAIC) and the Awareness-Desire-Knowledge-Ability-Reinforcement (ADKAR), a popular CM approach, are combined to propose a new framework. The usefulness of the proposed framework is demonstrated using a case study in a multispeciality hospital located in southern India.

The study found that several factors are responsible for the high Length of Stay (LOS) for patients in the Emergency Department (ED). By implementing this proposed model to implement LSS and taking corrective actions, the average LOS was reduced from 267 to 158 min (a 40% reduction approximately).

The complete step-by-step approach is explained, and the LOS was considerably reduced during the pilot project. The findings will provide valuable insights for healthcare practitioners to understand the steps involved in the combined DMAIC-ADKAR model. The findings would also give healthcare practitioners the confidence to identify suitable tools and implement LSS in organisations where the practitioners work.

According to the authors' knowledge, this is the first study that synergises two models (DMAIC and ADKAR) into a single framework to implement in a hospital.

Lean Six Sigma (LSS) implementation follows a structured approach called define-measure-analyze-improve-control (DMAIC). Earlier research about its application in emergency healthcare services shows that it requires organizational transformation, which many healthcare setups find difficult. The Kotter change management model facilitates organizational transformation but has not been attempted in LSS settings till now. This study aims to integrate the LSS framework with the Kotter change management model to come up with an integrated framework that will facilitate LSS deployment in emergency health services.

Two-stage Delphi method was conducted by using a literature review. First, the success factors and barriers of LSS are investigated, especially from an emergency healthcare point of view. The features and benefits of Kotter's change management models are then reviewed. Subsequently, they are integrated to form a framework specific to LSS deployment in an emergency healthcare set-up. The elements of this framework are analyzed using expert opinion ratings. A new framework for LSS deployment in emergency healthcare has been developed, which can prevent failures due to challenges faced by organizations in overcoming resistance to changes.

The eight steps of the Kotter model such as establishing a sense of urgency, forming a powerful guiding coalition, creating a vision, communicating the vision, empowering others to act on the vision, planning for and creating short-term wins, consolidating improvements and producing still more change, institutionalizing new approaches are derived from the eight common errors that managers make while implementing change in the institution. The study integrated LSS principles and Kotter’s change management model to apply in emergency care units in order to reduce waste and raise the level of service quality provided by healthcare companies.

The present study could contribute knowledge to the literature by providing a framework to integrate lean management and Kotter's change management model for the emergency care unit of the healthcare organization. This framework guides decision-makers and organizations as proper strategies are required for applying lean management practices in any system.

The proposed framework is unique and no other study has prescribed any integrated framework for LSS implementation in emergency healthcare that overcomes resistance to change.