Facility Directors Research Articles

Analysis of Managers' Cognitive Models (ORAC Classification) and its Impact on the Effectiveness of Implementation of Management Decision Support Systems: The Case of the Healthcare Sector

Purpose: The aim of the article is to show the importance of reasoning (cognitive models) and experience of managers as a key success factor in implementation of management information systems (MIS). An important goal of the article is also to identify information needed and the importance of information and management decision support systems in healthcare which is one of the important sectors of the economy. Design/Methodology/Approach: The article is based on secondary and primary research. The literature in the area of decision support systems in management and factors that influence the success of implementing these systems were analysed. Quantitative and qualitative research was carried out on the information systems of health care facilities and information needs of decision makers. The conclusions of the research were based on the following research, in-depth group interviews (FGI), individual in-depth interviews (IDI) with directors of medical facilities (27), interviews with facility employees (PAPI), interviews with patients (PAPI), Delphi study using the CAWI technique. Findings: There is a great need to implement decision support systems due to the growing amount of information available to managers and the need to process it quickly. Practical Implications: The article presents a unique approach showing how the cognitive systems of managers and their way of reasoning influence the type and specifics of management decision support systems. Originality/value: The article presents a unique approach showing how the cognitive systems of managers and their way of reasoning influence the type and specificity of management decision support systems.

Child Gauge 2019: Child and Adolescent Health - Leave no one behind

This 14th issue of the South African Child Gauge is a comprehensive review of the current situation for children and adolescents in South Africa. This issue is divided into three parts, and makes a powerful case for investing in child health - by highlighting recent legislative developments affecting children, examining the importance of early childhood for life-long health trajectories in an 11 chapter series, and lastly by providing informative and detailed statistics on child health, demographics, nutrition, housing, education and access to basic services in an 8 chapter series. The chapters are written by South African academic experts from various universities, in collaboration with directors of research units and facilities, directors of NGOs, medical and allied medical professionals, as well as staff from UNICEF, SAMRC, and other agencies. This review thus provides a multi-faceted approach to understanding where we stand in terms of child health, where to target interventions, and how to prioritise policy making in order to implement sustainable change in this critical, and vulnerable population. The theme of this issue is “Leave no one behind” – a clear message that in order to effect the greatest change in our country, investment must be made to protect ALL children, and to allow the next generation of South Africans to not only survive, but also to thrive. The science clearly shows that if we want to prevent the intergenerational cycles of poverty and violence that are pervasive in our country – focus on the first 1000 days of a child’s life (pregnancy and the first two years of life) as well as on adolescence (and thus the preconception period) is key. These two periods of life are sensitive to change, and are thus critical for future health returns. Health promotion in these period of life is essential for improving later life cognitive development, for prevention of non-communicable diseases, and for halting the rising obesity epidemic we are facing. All chapters are well written and up to date, but Part 3: Children Count, is particularly intriguing and useful as a go-to guide on children statistics in South Africa. This section provides in-depth, and well summarised data on the demography of South African children, income, poverty and social grants, child health, nutrition, and children’s access to education, basic services and housing. This rich data source, in combination with the science provided in part two into the importance of this period of life, will be useful for researchers, policy makers, agencies and health care professionals alike. Ultimately, given that South Africa has committed to the 2030 SDGs, particularly improving maternal and child health and reducing childhood mortality, this Child Gauge is a valuable tool for monitoring progress, and also for identifying key target areas for improvement. As Nelson Mandela knew and proclaimed nearly 40 years ago, “There can be no keener revelation of a society's soul than the way in which it treats its children”. The importance of children for the future of our country cannot be understated – let us learn from our mistakes and shortcomings that have been so clearly laid out in this issue, and from those that came before; and start providing our children with a country that they can be proud of. Dr Alessandra Prioreschi, PhD, MSc, BSc(Hons)

Merging Implementation Practice and Science to Scale Up Promising Practices: The Veterans Health Administration (VHA) Diffusion of Excellence (DoE) Program

The Veterans Health Administration (VHA) Diffusion of Excellence (DoE) program developed and manages a framework for identification, replication, and diffusion of promising practices throughout the nation's largest integrated health care system. DoE identifies promising practices through a "Shark Tank" competition with winning bidders receiving external implementation facilitation. DoE further supports diffusion of successful practices across the VHA. This article presents results of a mixed methods implementation evaluation of DoE, focusing on program reach, program participation and decisions to adopt innovative practices, implementation processes, and practice sustainment. Data sources include practice adoption metrics, focus groups with bidders (two focus groups), observations of DoE events (seven events), surveys of stakeholders (five separate surveys), and semistructured interviews of facility directors, practice developers, implementation teams, and facilitators (133 participants). In the first four Shark Tank cohorts (2016-2018), 1,676 practices were submitted; 47 were designated Gold Status Practices (practices with facilitated implementation). Motivation for participation varied. Generally, staff led projects targeting problems they felt passionate about, facility directors focused on big-picture quality metrics and getting middle manager support, and frontline staff displayed variable motivation to implement new projects. Approximately half of facilitated implementation efforts were successful; barriers included insufficient infrastructure, staff, and resources. At the facility level, 73.3% of facilities originating or receiving facilitated implementation support have maintained the practice. VHA-wide, 834 decisions to adopt these practices were made. DoE has resulted in the identification of many candidate practices, promoted adoption of promising practices by facility directors, and supported practice implementation and diffusion across the VHA.

Identifying, Replicating, and Spreading Health care Innovations across a Nation‐Wide Health care System: VHA Diffusion of Excellence

Research ObjectiveLarge health care systems and organizations face the challenge of identifying, replicating, and spreading evidence‐based innovation across health care system locations. The Diffusion of Excellence (DoE) program aims to incentivize implementing and spreading innovations across the nationwide Veterans Health Administration (VHA). VHA frontline staff submit successfully implemented innovations/practices to a “Shark Tank” competition, in which VHA facility directors place bids to support further implementation. DoE designates the best submission as Gold Status Practices (GSPs), and “winning” bidders receive 6‐months of external facilitation to implement their GSP. DoE then provides national support for diffusing successful GSPs across the VHA. We present results from a mixed‐methods evaluation focused on motivations for program participation, adopting innovations, predictors of implementation, and innovation maintenance/sustainability.Study DesignThe evaluation utilizes the Consolidated Framework for Implementation Research (CFIR). Data sources include: (a) metrics on innovation adoptions linked to VHA facility characteristics; (b) tracking of project specific metrics for practices receiving intensive support for national spread (e.g., potential costs averted, individuals served); (c) 2 focus groups with bidders; (d) observations of 7 DoE events; (e) 143 participants in semi‐structured interview of facility leaders, innovation developers, teams implementing Shark Tank innovations, and implementation facilitators; and (f) 4 surveys of DoE stakeholders. Results are summarized based on the RE‐AIM (Reach‐Effectiveness‐Adoption‐Implementation‐Maintenance) evaluation framework.Population StudiedInnovations aimed at 146 VHA facilities/individual health care systems.Principal FindingsREACH—In the first four Shark Tank rounds, 1676 promising innovations/practices were submitted, with 47 designated as GSPs. EFFECTIVENESS—The impact of specific practices varied. However, impacts have been associated with greater use of evidence‐based services and improved administrative functioning. ADOPTION—Motivations for participating in the DoE process varied among individuals with key roles. Innovations frequently arose from “passion” projects to address identified issues. VA facility/medical center leaders often focus on “big picture” quality metrics and getting middle manager support. Front‐line staff varied in their motivation to implement new projects, potentially leading to a mismatch in stakeholder motivation. IMPLEMENTATION success—approximately half of facilitated‐implementation efforts were fully successful. CFIR themes of Engaging Key Stakeholders and Available Resources received ratings that varied based on level of successful implementation (i.e., fully, partially, or not successful). While sites reported some degree of concern with External Policies and Incentives (e.g., challenges quickly hiring staff), all tried to overcome these challenges with the assistance of External Change Agents (e.g., facilitators and practice developers). MAINTENANCE—At the facility‐level, 74% of facilities originating or receiving facilitated‐implementation support have maintained the practice, including facilities that may have taken longer than 6 months for initial implementation. VHA‐wide, 834 decisions to adopt GSPs have been documented.ConclusionsDoE’s innovative Shark Tank approach identified a large number of candidate practices, successfully promoted adoption of promising practices by facility directors, and supported practice implementation and diffusion across VHA.Implications for Policy or PracticeAs health systems grow in size and complexity, they face additional challenges in identifying, prioritizing, replicating, and spreading best practices. DoE offers a potential model for other health systems and can be a key strategy to move toward being a learning health system.Primary Funding SourceDepartment of Veterans Affairs.

A Week of Coronavirus in a Community Clinic

A Week of Coronavirus in a Community Clinic

Critical success factors for campus interaction spaces and services – a systematic literature review

PurposeThe purpose of this paper is to create an overview of current literature and identify gaps in what is known about stimulating interaction through spaces and services provided on university campuses.Design/methodology/approachThe authors used the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement methodology for systematic literature review. In total, 3,616 articles were screened, 31 articles were included. Facility Directors from 13 Dutch Universities were asked to define the search terms related to services.FindingsSpaces and services were mostly studied separately. The majority of papers (18/31) were based on perceptions (surveys or interviews). The following critical success factors were identified in the literature: geographic proximity, cognitive proximity, scale, transitional spaces, comfort and experience, shared facilities and events, local buzz and networks. These factors are interrelated. The authors present a new relational model, from spaces and services, through interaction to innovation, visualising how the identified papers are related.Research limitations/implicationsThe scope of possible findings may have been narrowed because prior relevant studies were rather limited and as a consequence of the search strategy designed to limit the number of unrelated hits. Some knowledge gaps may not have been identified, as only a few mainstream concepts related to the critical success factors were used for comparison. Nevertheless, the literature review provides a reliable overview of current academic knowledge regarding critical success factors for spaces and services that stimulate interaction on campuses.Originality/valueThis paper offers a novel perspective by emphasising the relational chain from interaction to innovation, visualising the large diversity in research fields and summarising the critical success factors in the literature.

Interdisciplinary Education: The Advanced Science Research Center.

Interdisciplinary Education: The Advanced Science Research Center.

A MAGIC GATHERING: PILOTING AN AUGMENTED REALITY ENGINE TO PROMOTE MENTAL HEALTH AND WELL-BEING

Augmented reality (AR), superimposing digital assets onto the real-world (i.e., holograms)—offers a paradigm shift in delivering immersive interventions for aging adults. Reminiscence and life review are robust intervention techniques that have decades of empirical support to boost mood and meaning in older adults. In this presentation, we demonstrate the applied research and technology development process to create an AR reminiscence and life review engine for aging adults and their caretakers. We conducted 25 needs assessment interviews with community-dwelling older adults, and assisted living facility directors, nurses, and residents. Initial analyses revealed the need for: (1) finding scalable and cost-effective solutions to alleviate time burden for caregivers; (2) increasing variety of activities that do not need much instruction; (3) producing activities that grab and maintain attention; and, (4) generating more personalized activities that do not divert too much time from caretakers. We integrated the findings to develop a working prototype AR engine called “Project Phonado.” From preliminary user testing, Project Phonado aids in boosting mental health and meaning in aging adults—at least temporarily (immediate and one day follow-up). We will show clips of some pilot user testing of the engine and discuss the next evaluation and development steps.

Attitudes of Residential Care Facility Directors Towards the Need for Professional Accreditation and Licensing of Caregivers

Attitudes of Residential Care Facility Directors Towards the Need for Professional Accreditation and Licensing of Caregivers

Career Advancement: Microscopy Technician to Core Facility Director

Career Advancement: Microscopy Technician to Core Facility Director

‘ It is a question of determination’: a case study of monitoring and evaluation of integrated family planning services in urban areas of Togo

Background: Integrating family planning into postabortion and postpartum services can increase contraceptive use and decrease maternal and child death; however, little information exists on the monitoring and evaluation of such programs. This article draws on research completed by the EngenderHealth’s AgirPF project in three urban areas of Togo on the extent to which monitoring and evaluation systems of health services, which operated within the AgirPF project area in Togo, captured integrated family planning services. Methods: This mixed methods case study used 25 health facility assessments with health service record review in hospitals, large community clinics, a dispensary, and private clinics and 41 key informant interviews with health faculty, individuals working at reproductive health organizations, individuals involved in reproductive health policy and politics, health care workers, and health facility directors. Results: The study found the reporting system for health care was labor intensive and involved multiple steps for health care workers. The system lacked a standardized method to record family planning services as part of other health care at the patient level, yet the Ministry of Health required integrated family planning services to be reported on district and partner organization reporting forms. Key informants suggested improving the system by using computer-based monitoring, streamlining the reporting process to include all necessary information at the patient level, and standardizing what information is needed for the Ministry of Health and partner organizations. Conclusion: Future research should focus on assessing the best methods for recording integrated health services and task shifting of reporting. Recommendations for future policy and programming include consolidating data for reproductive health indicators, ensuring type of information needed is captured at all levels, and reducing provider workload for reporting.

Quality of malaria services offered in public health facilities in three provinces of Mozambique: a cross-sectional study

BackgroundFever associated with malaria is the leading cause of health care-seeking in Mozambique, yet there is limited evidence on the quality of malaria case management. This study evaluated the quality of malaria service provision offered in public health facilities in Mozambique.MethodsA cross-sectional assessment was conducted in April–May 2018 in three provinces of Mozambique: Maputo Province (low malaria burden), Cabo Delgado (high), and Zambézia (high). The study included all secondary and tertiary facilities and a random sample of primary facilities in each province. Data collection included exit interviews and re-examinations of 20 randomly selected outpatient service patients, interviews with up to five health care providers and the health facility director, a stockroom inventory and routine data abstraction.ResultsA total of 319 health care providers and 1840 patients from 117 health facilities were included. Of these, 1325 patients (72%) had suspected malaria (fever/history of fever) and 550 (30%) had febrile, confirmed malaria with the highest burden in Cabo Delgado (43%), followed by Zambézia (34%) and Maputo Province (2%). Appropriate management of malaria cases, defined as testing malaria suspects and treating confirmed cases with the correct dose of anti-malarial, was highest in Zambézia and Cabo Delgado where 52% (95% CI 42–62) and 49% (42–57) of febrile malaria cases were appropriately managed, respectively. Only 14% (5–34) of febrile cases in Maputo Province were appropriately managed. The biggest gap in the malaria case management pathway was failure to test febrile patients, with only 46% of patients with this indication tested for malaria in Maputo Province. Additionally, anti-malarial treatment of patients with a negative malaria test result was common, ranging from 8% (2–23) in Maputo Province to 22% (14–32) of patients with a negative test in Zambézia. Only 58–62% of patients prescribed an anti-malarial correctly recited dosing instructions. Provider training and malaria knowledge was low outside of Zambézia and supervision rates were low in all provinces. Factors associated with correct case management varied by province and included patient age, facility type, treatment and testing availability, supervision, and training.ConclusionThese findings underscore the need to strengthen provider testing of all patients with fever, provider adherence to negative test results, and effective counselling of patients across epidemiological settings in Mozambique.

' It is a question of determination': a case study of monitoring and evaluation of integrated family planning services in urban areas of Togo.

Background: Integrating family planning into postabortion and postpartum services can increase contraceptive use and decrease maternal and child death; however, little information exists on the monitoring and evaluation of such programs. This article draws on research completed by the EngenderHealth's AgirPF project in three urban areas of Togo on the extent to which monitoring and evaluation systems of health services, which operated within the AgirPF project area in Togo, captured integrated family planning services. Methods: This mixed methods case study used 25 health facility assessments with health service record review in hospitals, large community clinics, a dispensary, and private clinics and 41 key informant interviews with health faculty, individuals working at reproductive health organizations, individuals involved in reproductive health policy and politics, health care workers, and health facility directors. Results: The study found the reporting system for health care was labor intensive and involved multiple steps for health care workers. The system lacked a standardized method to record family planning services as part of other health care at the patient level, yet the Ministry of Health required integrated family planning services to be reported on district and partner organization reporting forms. Key informants suggested improving the system by using computer-based monitoring, streamlining the reporting process to include all necessary information at the patient level, and standardizing what information is needed for the Ministry of Health and partner organizations. Conclusion: Future research should focus on assessing the best methods for recording integrated health services and task shifting of reporting. Recommendations for future policy and programming include consolidating data for reproductive health indicators, ensuring type of information needed is captured at all levels, and reducing provider workload for reporting.

HPC chart completeness-an internal audit

Background & Aim According to FACT standards, the cell processing facility should perform internal audits on a regular basis. In CTMF, HPC chart completeness is defined as one of the yearly key audit topics. This study is an example of the HPC chart completeness internal audit, in which selected parameters of the HPC chart were audited and analyzed, to indicate trend and help process improvement. Methods, Results & Conclusion Methods The HPC cryopreservation processes occurred in CTMF from 06/01/2018 to 07/15/2018. Total 5 autologous patients chart, 11 processes were audited. Goal: Compliance 95% at the time of audit, 100% after corrections made. Auditor is the laboratory supervisor, who has the knowledge of the processes, and did not participate in the processes being audited, and therefore independent. Results 1. 59 missing / incomplete entries identified at the time of audit, total 604 pages, 2543 entries audited, approximately 97.7% compliance (entries completed out of all audited entries). After correction, 100% compliance. 2. Incomplete Entry Analysis-per Incomplete Type: (1) Sampling Record and Coulter/Flow print-out contributed to a big portion (20%) of all incomplete entries. Major examples are Sampling and Testing Record cover sheet) missing review, or not initialed and dated. (2) Batch Record: label control took up 1/7 of all entries missed in the batch record. All 18 “Batch Record, Others” missing items were from the last day of patient “D”’s last day of the 4-day collection. (3) 45% (5 out of 11) CryoMed print-out did not have initial and / or date. (4) Chain of Custody, Storage Record, Release Criteria were other weak areas affecting the completion rate. See Figure 1. 3. Incomplete Entry Analysis-per timing Min number of collection/process was 1, max 4. 3 patients had 2 days collections. The 4-day collection had the highest incomplete entries per processing day (7.3). Out of the 59 incomplete entries, 43 (73%) were from Processing Days, 16 (27%) were from After Processing Days (post thaw, infusion). 4. Incomplete Entry Analysis-per staff, Incomplete Rate. Figure 2. 5. Incomplete Entry Analysis-as Performer/as Reviewer. Out of the 59 incomplete entries, 47 (80%) were from performers, 12 (20%) were from reviewers. 6. Incomplete Entry Analysis-per staff as Paperwork Manager. Figure 3. Conclusion Audit result is acceptable. Recommendation is to enhance good documentation practice, enhance Paperwork Magager and facility director review in a timely fashion, especially for multiple days collections.

Examining the Beliefs of Skilled Nursing Facility Directors of Nursing Regarding BSN Completion and the Impact of Nurse Leader Education on Patient Outcomes.

Research suggests that acute care patients cared for by baccalaureate-educated nurses have better outcomes. Directors of nursing (DONs) in skilled nursing facilities (SNFs) have lower rates of baccalaureate attainment than acute care nurses for unclear reasons. To understand the interest in advancing education, researchers surveyed SNF DONs in Connecticut to examine their beliefs about academic advancement and the impact of DON education on resident outcomes. Nearly 70% of participants with diplomas and associate degrees lacked interest in degree advancement and did not believe a baccalaureate degree is necessary for DONs or that DON level of education impacts resident outcomes. Alternatives to degree completion may include interventions to provide SNF DONs with skills for improving resident outcomes.

Strategic partnerships enhance resources for care of rural-dwelling older adults

Purpose The purpose of this paper is to disseminate a new model that addresses the urgent social challenge of providing adequate long-term care in rural circumstances through innovative use of existing resources, and to suggest future research. Design/methodology/approach This paper is exploratory in and is based upon the analysis of qualitative observations (interviews and site visits) framed in the financial and operational records of the facility studied, macro- and micro-level demographics, and the scholarly and practice literatures. Findings Significant cost savings upon implementation, improvements in quality of care and both worker and client satisfaction were observed. Research limitations/implications The model has been in operation only one year; the trend has been positive, however, more research is needed to identify its stability and develop a more refined description of its components: while essential features of this innovative model can be applied in any residential long-term care situation, replicating its success is obviously linked with the skill and authority of the director. Evaluation research is currently in progress. Practical implications The paper suggests budget-neutral solutions to persistent challenges of caring for older adults in rural circumstances. Social implications Quality and financing of long-term residential care for elders is insufficient and worsening. This model addresses problems central to financing and quality of care by connecting existing resources in new ways. It does not require additional funding or changes in qualifications required for jobs. Originality/value The model is the original creation of a residential long-term care facility director working with a network of partnerships that he discovered and developed: partnerships include a broad range of organizations in the public and non-profit sectors, and the state university.

Communicator or Shill?

Communicator or Shill?

부산 아시아드주경기장 문제점 분석을 통한 활성화 방안 모색

The purpose of this study is to analyze factors hindering the development of track and field events and devise plans to vitalize the Busan Asiad Main Stadium. By making plans to vitalize the operation of the main stadium and operate it efficiently, this research aims to develop track and field events and contribute to suggesting directions for the current athletics in Busan and strategies for its development. This study will analyze problems in the Busan Asiad Main Stadium which is the only official track-and-field stadium in Busan. In terms of facilities, the Busan Asiad Main Stadium is the only official track-and-field stadium in Busan. Regarding the subjects of this study, this author selected the track-and-field expert group involved in Busan track and field events in 2016 as its population. Among the kinds of non-probability sampling, purposive sampling was employed. The participants are total 12, three professors of athletics, three facility committee members and directors of the Korea Athletics Federation, three heads and persons in charge of the Busan Sports Facility Maintenance Office, and three track-and-field instructions having 20 years of experience. The study tool used in this paper is a Delphi open-ended questionnaire. The aspects of facilities in the Busan Asiad Main Stadium were divided into three areas: publicness, fairness, and efficiency. After classifying the contents about problems and solutions drawn by the expert group regarding the data of three areas collected in the 1st survey by different items, frequency analysis was done. Concerning the data collected in the 2nd survey about the degree of hopes and possibility of changes, the linear formulation of 〈Table 3〉, 〈Table 4〉, and 〈Table 5〉 was applied, and division was made by percentage. Conclusions and results from the discussion were arranged by importance regardless of the ranks related to the degree of hopes or possibility of changes drawn by the researcher and expert group about publicness, fairness, and efficiency.

Rigor and reproducibility in rodent behavioral research.

Behavioral neuroscience research incorporates the identical high level of meticulous methodologies and exacting attention to detail as all other scientific disciplines. To achieve maximal rigor and reproducibility of findings, well-trained investigators employ a variety of established best practices. Here we explicate some of the requirements for rigorous experimental design and accurate data analysis in conducting mouse and rat behavioral tests. Novel object recognition is used as an example of a cognitive assay which has been conducted successfully with a range of methods, all based on common principles of appropriate procedures, controls, and statistics. Directors of Rodent Core facilities within Intellectual and Developmental Disabilities Research Centers contribute key aspects of their own novel object recognition protocols, offering insights into essential similarities and less-critical differences. Literature cited in this review article will lead the interested reader to source papers that provide step-by-step protocols which illustrate optimized methods for many standard rodent behavioral assays. Adhering to best practices in behavioral neuroscience will enhance the value of animal models for the multiple goals of understanding biological mechanisms, evaluating consequences of genetic mutations, and discovering efficacious therapeutics.

Employment Barriers into US Healthcare Management Industry for New Facilities Management College Graduates

ABSTRACT Purpose The purpose of this research is to better understand employment barriers into the healthcare facilities management (FM) industry for new FM college graduates. Design/methodology/approach A national survey was distributed to healthcare FM managers and directors to collect information on individual demographics, hiring practices, and opinions of FM college graduates. Designated survey respondents were also contacted for phone interviews. Findings Results indicate that strong homogeneousness demographics, backgrounds, and paths of entry among existing healthcare FM professionals has created an industry bias against candidates attempting to enter healthcare FM from non-traditional sources. The healthcare FM industry's principal source for new talent comes from building trade succession within healthcare organizations. However, continuing to rely on building tradespersons as the main path of entry into the healthcare FM industry may prove problematic. Most existing healthcare facility managers and directors will be retiring within 10 years, yet it is taking more than 17 years of full-time work experience to prepare building tradespersons to assume these roles. Younger professionals are more commonly entering the healthcare FM through the path of higher education. Although few new college graduates enter the healthcare FM industry, they are experiencing similar promotion timeframes compared to other candidate with many years of full-time work experience. Unfamiliarity with FM academic programs, work experience requirements, limited entry-level jobs within small organizations, and low pay also present challenges for new FM college graduates attempting to enter the healthcare FM industry. Originality/value This paper is valuable in establishing major barriers of entering the healthcare FM industry for new FM college graduates. Findings may facilitate development of interventions by healthcare organizations and universities to further open FM academic programs as a sustainable source of new talent to help address healthcare FM attrition.