Hospital Support Services Research Articles

Driving sustainable healthcare service management in the hospital sector

Sustainability in service management is a crucial issue in today's competitive business environment. Previous researchers have conducted studies on healthcare sustainability from various areas, but none has been conducted on the assessment of driving factors to sustainable service management in the hospital sector. This study fills this research gap by identifying and assessing the driving factors behind sustainable service management in the hospital sector from an emerging economy context. The study does so by utilizing integrated qualitative and quantitative research methods. Primarily, the study performed a Delphi study to identify the most relevant driving factors and then utilized the integrated grey-based decision-making trial and evaluation laboratory (DEMATEL) model to aid the evaluation within the Bangladesh hospital sector. The study identified eleven factors as the causal and nine factors as effect group factors. Furthermore, the factor “Engaging experienced doctors in top management (D20)” was identified as the most prominent driving factor for sustainable hospital service management. The driving factor “Implementation of public health policies (D18)” was identified as the topmost causal factor, and “Proper maintenance and monitoring of hospital support services (D9)” identified as the most influenced/impacted effect group driving factor. The study's findings have significant policy implications for service operations and managers in the hospital sectors. The service managers should give special attention to the causal group driving factors and invest heavily in them as that will help to improve the effect group factors within the system.

Evaluation, Remedy of Waste, Lean Hospital Method, Process of Inpatient Pharmacy Services in Hospital

Each installation in the hospital must continue to evaluate, improvement, and develop, including the pharmacy installation. Pharmacy installations as one of the medical support services in hospitals are required to improve the quality of their services on an ongoing basis. This study aims to see, the root of the problem, and provide evaluation and improvement for the reading of critical waste in the inpatient pharmacy service process of Kabupaten Karanganyar Hospital.
 This study uses a non-experimental research design and was descriptive qualitative in nature. Data techniques in qualitative and quantitative research. The value of patient data was obtained from distributing questionnaires. The pharmaceutical service process was obtained from observation and document review, then mapping in the form of value stream mapping. The determination of waste was obtained from distributing questionnaires and in-depth interviews with the 5 why method.
 The results of the reasearch show critical waste on inpatient service in pharmacy installation is waste defect and waste waiting. The root cause of critical waste is the prescription of drugs by doctors outside the formulary and the root cause of waiting for waste is a prescription from the hospital admission at the same time. The proposed improvement for the cause of critical waste is Monitoring and evaluating the implementation of the formularium on an going basis, provide special software to enter patient data, and implement the use of electronic prescribing to shorten the service process time.

Clinical and behavioral factors associated with undernutrition among highly active antiretroviral therapy users in Southwest Ethiopia.

Globally, about 1.9 billion adults are overweight or obese, while 462 million are underweight. These are primarily found in countries with low and middle incomes, such as Ethiopia. Undernutrition is a frequent health problem among people living with HIV/AIDS; however, no large-scale research, including several health facilities, has been conducted in Ethiopia. Thus, this study aimed to assess the nutritional status and nutrition-related factors among highly active antiretroviral therapy (HAART) users in public hospitals in Southwest Ethiopia. A cross-sectional facility study design was conducted in all public hospitals in Southwest Ethiopia from January to March 2021. A systematic sampling technique was used to select the study participants. The collected data were entered into EpiData 3.1 and then exported to SPSS version 24 for statistical analysis. Binary logistic regression analysis was done to identify the factors associated with the outcome variable. The level of significance was declared at a P-value of <0.05, with their corresponding 95% confidence level. A total of 402 HAART users have participated with a 100% response rate. The proportion of undernutrition (BMI <18.5 kg/m2) and patients with overweight or obesity (BMI ≥25 kg/m2) were 29.3% [95% CI: (24.6-33.5)] and 10% [95% CI: (6.6-12.9)], respectively. Out of undernutrition patients, severe undernutrition (BMI <16 kg/m2) accounted for 5.6%. Factors, such as food insecurity [AOR: 3.21, 95% CI: (1.76-5.91)], history of diarrhea [AOR: 2.86, 95% CI: (1.96-6.78)], CD4 cell count ≤ [AOR: 4.72, 95% CI: (2.14-12.13)], and substance user [AOR: 4.12, 95% CI: (2.31-7.30)], were the independent factors of undernutrition. This study found that the prevalence of undernutrition was high compared with other settings. The government should also pay due attention to improving the treatment of HIV/AIDS by offering nutritional support services in hospitals. Moreover, policymakers and healthcare professionals consider the effects of these factors on nutrition while providing ART services.

Key determinants of building maintenance in hospitals: the perspective of maintenance personnel

PurposeThe maintenance of hospital buildings is often acknowledged as challenging tasks yet inevitable to ensure effective delivery of health-care functions. This study aims to investigate the rationale behind the execution of maintenance which provides essential input for better prioritization of maintenance tasks.Design/methodology/approachThis study evaluated the determinants of building maintenance of public hospitals in Malaysia from the perspectives of key personnel appointed to monitor, supervise and inspect the activities of the privatised support services in public hospitals. A total of 66 questionnaire survey responses were analysed.FindingsFindings revealed that the maintenance practices in public hospitals are user-centric with high emphasis on user’s expectations and complaints. Comparatively, vandalism and improper use of facilities were less of concerns.Originality/valueThis paper reveals the key determinants that influence decision-making in building maintenance of the Malaysian public hospitals from the perspective of maintenance personnel. It adds value to the under-researched topic of privatised hospital support services, which is currently outsourced to five concession companies nationwide.

Breastfeeding and Child Development

We show that children who are born at or just before the weekend are less likely to be breastfed, owing to poorer breastfeeding support services in hospitals at weekends. We use this variation to estimate the effect of breastfeeding on children's development in the first seven years of life, for a sample of births of low-educated mothers. We find large effects of breastfeeding on children's cognitive development but no effects on health or noncognitive development during the period of childhood we consider. Regarding mechanisms, we study how breastfeeding affects parental investments and the quality of the mother-child relationship. (JEL I12, I14, I18, J13, J16, J24)

National Survey of Sibling Support Services in Children's Hospitals (GP708)

National Survey of Sibling Support Services in Children's Hospitals (GP708)

Assessment of Services at Tertiary Care Hospital Located in Central India, using ‘Kayakalp Initiative Tool’

Background: Kayakalp is an innovative initiatory started by the Health and Family Welfare Ministry through Swachh Bharat Abhiyan campaign on 15th May 2015. These instructions concentrate on advancement of desirable schemes for housekeeping facilities, pest control procedure, water sanitation, appointment &amp; tutoring of manpower, advancement and accomplishment of appropriate cleansing procedure in terms of protocols / Standard Operating Procedures (SOPs), powerful management and inspection by the employees and inherent Machinery in the treaties linked with an organizational framework which places a bonus on excellent cleaning services and sanitary facilities. This study aims to describe the experiences and knowledge based on assessment of Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha District using this tool.&#x0D; Objectives: To assess and document hospital upkeep, Sanitation, Hygiene Practices, Hygiene Promotion and to study Handling of Biomedical Waste, Infection Control and Hospital Support Services.&#x0D; Methodology: This cross sectional hospital based study that will be conducted at Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha District.&#x0D; Apart from observation of various practices and Processes, the participants to be interviewed will be Nursing staff in-charge in different wards along with Biomedical engineers, Administrative officers and beneficiary patients. For Quantitative data collection, a kayakalp checklist will be used. Data will be collected through observation, staff interview, record keeping, and patient interview forms as per Kayakalp Initiative Tool.&#x0D; Results: This study would help to understand current hospital sanitation procedures, hospital hygiene, infection prevention, general maintenance, waste management, and support services, etc. and will help to improve services based on findings of the study so as to improve satisfaction of population catered by hospital and provide an ideal working environment for all stakeholders.&#x0D; Conclusion: This work will assist in improving hospital/facility management and will aid in improvement of sanitation and hygiene practices, it will also improve overall satisfaction of all stakeholders after due implementation of changes suggested at the end of study.

The Mental Health of Pregnant Women During COVID-19

Dear Editor,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global health emergency since the end of 2019.1 It has been the cause of more than 2.06 million deaths around the world until now.2,3 As you know, this pandemic has caused many problems and has had damaging effects on various aspects of people’s lives. One of the essential issues to pay special attention to is women’s mental health during pregnancy. In this letter, we would like to explain the immediate need to focus on the psychological impact of the SARS-Cov-2 during pregnancy.Several reports have shown that the rate of psychopathology (anxiety, depression, etc.) in pregnancy has increased significantly during pandemics. This increasing rate was related to fear of infection with the virus, reduce support services in hospitals and operating rooms, inadequate prenatal care, and social isolation from support networks.4Mortazavi and colleagues published an article regarding pregnant women’s well-being and worry during the COVID-19 pandemic.5 The results of their study showed that the COVID-19 pandemic has had a harmful effect on pregnant women in terms of mental health. A little percentage of pregnant women have severe coronavirus infection, but this pandemic has psychological consequences for the neonate and the mother.Perinatal support is a service for any woman with mental health problems, who are planning a pregnancy, are pregnant, or have a baby up to one year of age. There has been a significant decrease in prenatal care around the world, which could lead to increased rates of psychopathology problems which is in turn a risk factor for poor postpartum health and postnatal depression. Since the start of the pandemic, for the protection of pregnant women and their children, only one person is allowed to enter the delivery room and unnecessary visits are unacceptable.Perinatal support leads to reduced pain during delivery, increases psychological health, and satisfaction during pregnancy, so it seems that these policies have some harmful effects, and they will show themselves in the near future.Moreover, during the pandemic, violence against women has increased as a result of economic stress and financial instability. Domestic violence is closely related to psychopathology, especially increased rates of depression, anxiety, and suicide. During pregnancy, mental health disorders can have very serious consequences for both the mother and baby. For instance, increased perinatal psychopathology can result in the usage of drugs, alcohol, and future suicide. In addition, when the mother has stress, many problems can restrict fetal growth, lead to premature birth, and induce low birthweight.According to all the explanations above, future research should aim to recognize women who are exposed to domestic violence, as well as the psychological effects of the pandemic on pregnant women and their children. To solve these problems, careful planning and management is needed and if not addressed, it can lead to irreversible outcomes in the future.In order to have a healthy society in future, we also suggest that after the end of this pandemic we need to set up a screening and control program for women who have given birth during this pandemic to monitor and manage possible consequences.

Environmental responsibility in nursing in hospitals: A modified Delphi study of nurses' views.

To identify nurses' views on environmentally responsible clinical practices, and to examine their consensus regarding the stakeholders and their roles and tools needed to promote, and enable, environmental responsibility in clinical practice. Using materials and energy in hospitals has a negative impact on the environment and people's environmental health. Research on decreasing this burden in clinical practice is sparse. A modified Delphi method with two rounds. Data were collected from 35 nursing staff in five Finnish university hospitals in 2019. The first-round data were collected with semi-structured interviews in small groups and subjected to content analysis. The second-round data were collected with an Internet-based questionnaire from 27 of those participants and statistically analysed. The CREDES checklist was used. According to nurses, environmentally responsible clinical practices focus on effective material and energy use. Material use focused on sustainable and cooperative purchasing, considerate use of products and minimising waste and idle electricity and reducing water and transport use. The tools needed to promote, and enable, environmental responsibility in clinical practice were staff inducements and training and certain resources and guidance. All the hospital health and support service staff needed to commit to collaboration. It is important to address stakeholders' roles in environmental responsibility in hospitals. Environmental aims should be firm and visible, and nurses should have the relevant competencies. They also need sufficient time to develop environmental initiatives and proper facilities to carry out their work with a minimal environmental burden. Providing staff feedback and rewards for their environmental efforts is beneficial for engagement. This study will help nurses to identify their needs and opportunities to realise and develop environmental responsibility in their practice. It can also inform hospital leaders to develop corporate environmental responsibility, including in-service training.

Outnumbered yet needed: The Lung Cancer Nurse Specialist.

Outnumbered yet needed: The Lung Cancer Nurse Specialist.

Life after sepsis: an international survey of survivors to understand the post-sepsis syndrome.

In this study, we aim to describe the post-sepsis syndrome from the perspective of the sepsis survivors. The study is a prospective, observational online international survey. Sepsis survivors enrolled via social media from 13 September 2014 to 13 September 2016. None. Physiologic, physical and psychological function post-sepsis; and patient satisfaction with sepsis-centered care. 1731 completed surveys from 41 countries were analyzed, with 79.9% female respondents, age 47.6 ± 14.4 years. The majority of respondents (47.8%) had sepsis within the last year. Survivors reported an increase in sensory, integumentary, digestive, breathing, chest pain, kidney and musculoskeletal problems after sepsis (all P-value <0.0001). Physical functions such as daily chores, running errands, spelling, reading and reduced libido posed increased difficulty (all P-value <0.0001). Within 7 days prior to completing the survey, the survivors reported varying degrees of anxiety, depression, fatigue and sleep disturbance. Sepsis survivors reported dissatisfaction with a number of hospital support services, with up to 29.3% of respondents stating no social services support was provided for their condition. Sepsis survivors suffer from a myriad of physiologic, physical and psychological challenges. Survivors overall reveal dissatisfaction with sepsis-related care, suggesting areas for improvement both in-hospital and post-discharge.

Process Model for the Food Service in Swiss Hospitals

ABSTRACT Background Since the introduction of Swiss Diagnosis Related Groups in 2012, a Swiss hospital's core business requires Facility Management that provides more transparent, effective and efficient services. In that respect, the new remuneration system has caused a growing interest in processes. Food provision is of high importance since it is one of the costliest support services and is a critical image factor of a hospital. Purpose The purpose of this research was to analyse the food service processes in Facility Management in hospitals through the lenses of social, economic and ecological sustainability as well as hygiene and safety, and to identify which issues arise from each viewpoint for the respective sub-processes. Methodology A two-fold qualitative case study design was applied, based on the reference model theory Process Model for Non-Medical Support Services in Hospitals. First, based on focus groups, the process model was developed. Second, the model was validated by input from interviews with Facility Management professionals. Results Each sub-process requires the consideration of individual factors from the perspectives of sustainability, hygiene and safety. Similarly, various overarching factors were identified, such as the production method that impact not only a single sub-process, but also play a role in the whole catering process. Additionally, it became evident that food provision in hospitals is particularly affected by the conflicting priorities of cost-effectiveness and sustainability. Conclusion The outcome of this work is a model that allows a holistic process analysis of catering activities in hospitals since it takes into account social, economic and ecological sustainability, as well as both hygiene and safety aspects for the individual sub-processes. This research gives guidance to facility managers who strive for process optimisation to guarantee efficient and effective food provision in hospitals. Unique Value to the Body of Facility Management Knowledge This work applies established catering sub-processes in hospitals to the context of sustainability, hygiene and safety. The proposed model caters to the increasing interest in processes in healthcare in Switzerland and can presumably be applied to hospitals of other countries.

Palyatif bakım servisinde yatan akciğer kanserli hastaların narkotik analjezik kullanımı

Introduction: Greater than half of cancer patients suffer from the pain, which is the one of the major problems that disrupt the quality of life at, any time during the disease. Pain should be decreased as soon as possible and the maintenance treatment should be planned in these groups of patients. The World Health Organization (WHO) suggests the use of a three-step analgesic ladder approach including non-opioid, weak opioid and strong opioids according to the severity of the pain. However, the pain palliation can’t be accomplished in more than 80% of patients because of the wrong thoughts of health professionals, patients and patients’ relatives about narcotic analgesics. Methods: In this study 72 lung cancer patients, hospitalized between 29 July 2013 to 31 December 2015 at Izmir Katip Celebi University Ataturk Education and Research Hospital Palliative Care and Support Service were assessed retrospectively about pain palliation. Results: Patients mean ages 61.2 ± 8.2 and 77.8% (56) were male, and 22.2% (16) were female. Patients applied with different complaints such as Inability to feed, pain, general condition disorders, shortness of breath and nausea and 27.8% (20) of patients had only admitted with pain. The median duration of hospital stay was 7 (2-45) days, which is the 18.1% of patients were not given any analgesics. 49.2% (29) of patients have second line treatment, 50.8% (30) had received third line treatment. Hospitalization indication and discharge status of the patients was statistically significant association between analgesic use (p = 0.002; p = 0.03). Conclusion: Cancer pain is the most common symptom affecting the quality of life negatively. Pain management should be well known by clinicians. Success in the treatment of pain patients linked to multidisciplinary approach include the whole psychological and social environment will be possible with the treatment applied by step approach.

Hospital support services and the impacts of outsourcing on occupational health and safety.

Outsourcing labor is linked to negative impacts on occupational health and safety (OHS). In British Columbia, Canada, provincial health care service providers outsource support services such as cleaners and food service workers (CFSWs) to external contractors. This study investigates the impact of outsourcing on the occupational health safety of hospital CFSWs through a mixed methods approach. Worker's compensation data for hospital CFSWs were analyzed by negative binomial and multiple linear regressions supplemented by iterative thematic analysis of telephone interviews of the same job groups. Non-significant decreases in injury rates and days lost per injury were observed in outsourced CFSWs post outsourcing. Significant decreases (P<0.05) were observed in average costs per injury for cleaners post outsourcing. Outsourced workers interviewed implied instances of underreporting workplace injuries. This mixed methods study describes the impact of outsourcing on OHS of healthcare workers in British Columbia. Results will be helpful for policy-makers and workplace regulators to assess program effectiveness for outsourced workers.

Zuberi, D.Cleaning Up: How Hospital Outsourcing is Hurting Workers and Endangering Patients. Ithaca: Cornell University Press. 2013. ix + 182pp $59.95 (hbk) $19.95 (pbk) ISBN 978–0‐80147896–3

This is one of the first books to examine the impact of the shift towards outsourcing in the healthcare industry. Zuberi's principal focus is on two key casualties of the process in which hospital support service responsibilities are handed over to private companies: patient safety and social equality. While this empirically informed book makes for a quick and easy read, it is both informative and thought-provoking. Zuberi's book provides a wealth of evidence that the outsourcing of hospital jobs has resulted in deteriorating working conditions and that, in turn, such conditions are the cause of an increase in hospital acquired infections. This book starts by describing the prevalent and persistent nature of hospital acquired infections and the importance of hospital cleanliness in tackling them. Zuberi then emphasises the role that hospital support workers – housekeepers and dietary aides – play in maintaining hospital cleanliness. Here, Zuberi outlines his own research, the outsourced hospital support workers study, on which he draws throughout the book. While Zuberi's study involved interviews with 96 hospital workers in Vancouver, he also draws upon broader empirical evidence in order to demonstrate the applicability of his study to both Europe and the USA. Zuberi catalogues the effect that outsourcing, often coupled with the drive to cut costs, has had upon hospital support jobs; including understaffing, increased physical demands on staff, lack of training, reduced wages and so on. Notably, Zuberi makes clear that the harmful consequences of these changes are predominantly felt by the most economically vulnerable members of the workforce who are unable to seek alternative employment. In doing so, he underlines the crucial role which workplace reforms must play in both promoting socioeconomic equality and improving patient care. Zuberi's meticulous exploration of his participants' accounts provides robust empirical evidence for his argument. While the outsourcing of hospital support services may initially reduce public expenditure, the profit-oriented measures that private contractors put in place come at a steep price. Practices which raise profits – reducing staffing, restricting supplies and eliminating supervisory positions – lead to overworked and undervalued housekeeping staff who find it impossible to keep hospitals clean enough to prevent the spread of infections. It is by faithfully presenting the voices of his participants that Zuberi brings home what is at stake here: hospital outsourcing is subjecting workers to stress and exhaustion, compromising hospital cleanliness and, in turn, putting lives at risk – and it is doing so in plain view. The emotive, yet comprehensive, way in which Zuberi makes these claims leaves one with the hope that Cleaning Up will fall into the laps of those responsible for the shift toward privatisation. For all its merits, Zuberi's book is not without flaws. The analysis would benefit from moving beyond his discussion of the impact that poor hygiene practices, resulting from the driving down of costs, have upon the prevalence of hospital acquired infections. Some mention of the broader ethical and emotional implications of such practices upon patients, for example, might have strengthened and added depth to Zuberi's argument. One could contend that it is not only patients' physical health that is devalued and placed at risk when the need to drive down costs is placed above their need for care. Focusing on dietary aides and housekeepers is perhaps what leads Zuberi to leave out a discussion of broader patient needs – dignity, respect, privacy – which are perhaps forfeited alongside good hygiene practices when vital aspects of patient care are privatised. In short, Zuberi's book will be of interest to both academics and practitioners concerned with patient care and medical labour conditions. While the book provides a wealth of empirical evidence, it stops short of offering a wealth of original thought on the moral or ethical implications of the outsourcing of hospital work. Despite its limitations, however, the book is undoubtedly a valuable addition to the literature on the quality of care in hospitals and its links to the privatisation and outsourcing of healthcare services.

The significance of services in a psychiatric hospital for family members of persons with mental illness.

Hospitalization of persons with mental illness may cause their family members to experience multiple stressors that stem from the hospitalization as well as from the duties of helping him or her. However, providing support services in psychiatric hospitals for family members has received only limited attention. To change this situation, mental health professionals in a psychiatric hospital in Israel developed an innovative family-centered practice model, the Family Members' Support and Consultation (FMSC) service center. We examined the significance to family members of the services they received from the FMSC service center in a study that included 20 caregivers. Ten participated in 2 focus groups of 5 participants each; 10 were interviewed personally. We implemented a thematic analysis to analyze the data. According to the participants, the staff of the FMSC service center provided support services that helped them cope with the stressors and difficulties they experienced within the context of the psychiatric hospital. The participants emphasized the significance of the immediacy and accessibility of support provided, as well as the positive effects of systemic interventions aimed at changing the relationships between family members and systems in the psychiatric hospital. Our findings show the importance of integrating a service that focuses on the needs of family members of persons with mental illness within a psychiatric hospital.

Learning employee-driven innovating

Purpose– The purpose of this paper is to introduce a workshop process to enhance the learning of employee-driven innovating (LEDI) and to evaluate in multiple ways the practical effects of the LEDI process, which aimed to enhance the employee-driven innovation practices at workplace level in a public organisation. Although front-line employees are increasingly encouraged to participate in innovation, organisations lack multi-level knowledge on the practices, outcomes and effects of participation.Design/methodology/approach– A six-month development process (LEDI) was conducted to empower front-line hospital support service workers to learn to innovate and to apply this in the services they provide. The process consisted of different themes: future visions, current services, creating new services and evaluations of ideas and innovation embryos. The multi-method evaluation of the process included pre-evaluation of the generated innovation ideas, a developmental evaluation of the selected innovation embryos, a follow-up evaluation of the innovation ideas and an evaluation of the organisational level effect via a quantitative survey.Findings– The intervention process had positive effects on employee participation and learning to innovate. The conclusion of the four evaluations is that the LEDI process developed a new kind of agency among employees and enabled significant improvements to services. The evaluation of the organisation-level effect revealed that the process had also improved the views regarding preconditions for development.Originality/value– The intervention method is a practical application of employee-driven innovation conception that is validated as practical and effective at workplace level. The process is a viable method for enhancing workers’ innovation-related learning in service organisations. The novelty of the method is based on the multi-disciplinary combination of approaches that consist of theories of practice-based innovation, expansive learning and emphatic human-centred service design.

Execution of Computerized Management Systems in Facility Maintenance Services of Government Hospitals

Maintenance management of a hospital is the most important element in determining the ability of a hospital to provide its services successfully. On 28th October 1996, the Ministry of Health (MOH) privatized five Hospital Support Services (HSS), one of them being Facility and Engineering Maintenance Services (FEMS). Currently, the Ministry has granted concessions for the privatized services to three contractors where they have established and are maintaining their own basic Management Information System (MIS) to manage the entire project and track the work performed for all of their services. These MISs consist of a variety of modules which help maintenance strategies adopted in a building run smoothly. The purpose of this paper is to study the utilization of computerized management system modules in the MISs of those three HSS providers and to investigate problems that have occurred during the utilization of these systems. This study was conducted in the form of case studies at three different hospitals that subscribed to three different concession companies. Targeting maintenance staff and users of computerized management systems, 60 sets of questionnaires were distributed and interview sessions were conducted. This study will also highlight the challenges of using computerized management systems and propose suitable recommendations to improve the utilization of such systems.

Safety leadership: extending workplace safety climate best practices across health care workforces.

Hospitals within the United States consistently have injury rates that are over twice the national employee injury rate. Hospital safety studies typically investigate care providers rather than support service employees. Compounding the lack of evidence for this understudied population is the scant evidence that is available to examine the relationship of support service employees'perceptions of safety and work-related injuries. To examine this phenomenon, the purpose of this study was to investigate support service employees' perceptions of safety leadership and social support as well as the relationship of safety perception to levels of reported injuries. A nonexperimental survey was conducted with the data collected from hospital support service employees (n = 1,272) and examined. (1) relationships between safety leadership (supervisor and organization) and individual and unit safety perceptions; (2) the moderating effect of social support (supervisor and coworker) on individual and unit safety perceptions; and (3) the relationship of safety perception to reported injury rates. The survey items in this study were based on the items from the AHRQ Patient Safety Culture Survey and the U.S. National Health Care Surveys. Safety leadership (supervisor and organization) was found to be positively related to individual safety perceptions and unit safety grade as was supervisor and coworker support. Coworker support was found to positively moderate the following relationships: supervisor safety leadership and safety perceptions, supervisor safety leadership and unit safety grade, and senior management safety leadership and safety perceptions. Positive employee safety perceptions were found to have a significant relationship with lower reported injury rates. These findings suggest that safety leadership from supervisors and senior management as well as coworker support has positive implications for support service employees' perceptions of safety, which, in turn, are negatively related to lower odds of reporting injuries.

The Development of the Emergency Medicine Milestones

The Accreditation Council for Graduate Medical Education (ACGME) has outlined its "Next Accreditation System" (NAS) that will focus on resident and residency outcome measurements. Emergency medicine (EM) is one of seven specialties that will implement the NAS beginning July 2013. All other specialties will follow in July 2014. A key component of the NAS is the development of assessable milestones, which are explicit accomplishments or behaviors that occur during the process of residency education. Milestones describe competencies more specifically and identify specialty-specific knowledge, skills, attitudes, and behaviors (KSABs) that can be used as outcome measures within the general competencies. The ACGME and the American Board of Emergency Medicine (ABEM) convened an EM milestone working group to develop the EM milestones. This article describes the development, use within the NAS, and challenges of the EM milestones.