Enhancing Healthcare Accountability for Administrators: Fostering Transparency for Patient Safety and Quality Enhancement.

Transparency in healthcare organizations is essential for creating a culture of patient-centered care where patients are respected, informed, and actively engaged in their health and well-being. Organizational transparency is a crucial element in healthcare, enhancing patient safety and quality improvement. Transparency involves open communication about healthcare organizations' performance, outcomes, and processes, leading to improved accountability, trust, and patient engagement. Transparent organizations prioritize patient-centered care, involving patients in decision-making and fostering shared mental models between healthcare providers and patients. Psychological safety is vital for organizational transparency. Patient safety reporting systems play a key role in transparency, allowing anonymous reporting of safety concerns and incidents. These systems facilitate early risk identification, continuous improvement, and compliance with regulatory requirements. Transparency in reporting encourages a culture of openness, learning from near misses, and addressing systemic issues and human errors. It aligns with ethical principles, potentially mitigating legal challenges. This review synthesizes key themes, including the importance of patient-centered care, the role of psychological safety in fostering transparency, and the effectiveness of patient safety reporting systems.

Why do acute healthcare staff behave unprofessionally towards each other and how can these behaviours be reduced? A realist review.

Background: Unprofessional behaviour in healthcare systems can negatively impact staff well-being, patient safety and organisational costs. Unprofessional behaviour encompasses a range of behaviours, including incivility, microaggressions, harassment and bullying. Despite efforts to combat unprofessional behaviour in healthcare settings, it remains prevalent. Interventions to reduce unprofessional behaviour in health care have been conducted - but how and why they may work is unclear. Given the complexity of the issue, a realist review methodology is an ideal approach to examining unprofessional behaviour in healthcare systems. Aim: To improve context-specific understanding of how, why and in what circumstances unprofessional behaviours between staff in acute healthcare settings occur and evidence of strategies implemented to mitigate, manage and prevent them. Methods: Realist synthesis methodology consistent with realist and meta-narrative evidence syntheses: evolving standards reporting guidelines. Data sources: Literature sources for building initial theories were identified from the original proposal and from informal searches of various websites. For theory refinement, we conducted systematic and purposive searches for peer-reviewed literature on databases such as EMBASE, Cumulative Index to Nursing and Allied Health Literature and MEDLINE databases as well as for grey literature. Searches were conducted iteratively from November 2021 to December 2022. Results: Initial theory-building drew on 38 sources. Searches resulted in 2878 titles and abstracts. In total, 148 sources were included in the review. Terminology and definitions used for unprofessional behaviours were inconsistent. This may present issues for policy and practice when trying to identify and address unprofessional behaviour. Contributors of unprofessional behaviour can be categorised into four areas: (1) workplace disempowerment, (2) organisational uncertainty, confusion and stress, (3) (lack of) social cohesion and (4) enablement of harmful cultures that tolerate unprofessional behaviours. Those at most risk of experiencing unprofessional behaviour are staff from a minoritised background. We identified 42 interventions in the literature to address unprofessional behaviour. These spanned five types: (1) single session (i.e. one-off), (2) multiple sessions, (3) single or multiple sessions combined with other actions (e.g. training session plus a code of conduct), (4) professional accountability and reporting interventions and (5) structured culture-change interventions. We identified 42 reports of interventions, with none conducted in the United Kingdom. Of these, 29 interventions were evaluated, with the majority (n = 23) reporting some measure of effectiveness. Interventions drew on 13 types of behaviour-change strategy designed to, for example: change social norms, improve awareness of unprofessional behaviour, or redesign the workplace. Interventions were impacted by 12 key dynamics, including focusing on individuals, lack of trust in management and non-existent logic models. Conclusions: Workplace disempowerment and organisational barriers are primary contributors to unprofessional behaviour. However, interventions predominantly focus on individual education or training without addressing systemic, organisational issues. Effectiveness of interventions to improve staff well-being or patient safety is uncertain. We provide 12 key dynamics and 15 implementation principles to guide organisations. Future work: Interventions need to: (1) be tested in a United Kingdom context, (2) draw on behavioural science principles and (3) target systemic, organisational issues. Limitations: This review focuses on interpersonal staff-to-staff unprofessional behaviour, in acute healthcare settings only and does not include non-intervention literature outside the United Kingdom or outside of health care. Study registration: This study was prospectively registered on PROSPERO CRD42021255490. The record is available from: www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255490. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR131606) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 25. See the NIHR Funding and Awards website for further award information.

For this study, we asked: how, why and in what situations can unprofessional behaviour between healthcare staff working in acute care (usually hospitals) be reduced, managed and prevented? We wanted to research how people understand unprofessional behaviour, explore the circumstances leading to unprofessional behaviour and understand how existing approaches to addressing unprofessional behaviour worked (or did not work) across staff groups and acute healthcare organisations. We used a literature review method called a 'realist review', which differs from other review methods. A realist review focuses on understanding not only if interventions work but how and why they work, and for whom. This allowed us to analyse a wider range of relevant international literature ­ not only academic papers. We found 148 sources, which were relevant either because they described unprofessional behaviour or because they provided information on how to address unprofessional behaviour. Definitions of unprofessional behaviour varied, making it difficult to settle on one description. For example, unprofessional behaviour may involve incivility, bullying, harassment and/or microaggressions. We examined what might contribute to unprofessional behaviour and identified factors including uncertainty in the working environment. We found no United Kingdom-based interventions and only one from the United States of America that sought to reduce unprofessional behaviour towards minority groups. Strategies often tried to encourage staff to speak up, provide ways to report unprofessional behaviour or set social standards of behaviour. We also identified factors that may make it challenging for organisations to successfully select, implement and evaluate an intervention to address unprofessional behaviour. We recommend a system-wide approach to addressing unprofessional behaviour, including assessing the context and then implementing multiple approaches over a long time (rather than just once), because they are likely to have greater impact on changing culture. We are producing an implementation guide to support this process. Interventions need to enhance staff ability to feel safe at work, work effectively and support those more likely to experience unprofessional behaviour.

Evolution of the roles of family physicians through collaboration with rehabilitation therapists in rural community hospitals: a grounded theory approach.

BACKGROUND: The role of rural family physicians continues to evolve to accommodate the comprehensive care needs of aging societies. For older individuals in rural areas, rehabilitation is vital to ensure that they can continue to perform activities of daily living. In this population, a smooth discharge following periods of hospitalization is essential and requires management of multimorbidity, and rehabilitation therapists may require support from family physicians to achieve optimal outcomes. Therefore, this study aimed to investigate changes in the roles of rural family physicians in patient rehabilitation. METHODS: An ethnographic analysis was conducted with rural family physicians and rehabilitation therapists at a rural Japanese hospital. A constructivist grounded theory approach was applied as a qualitative research method. Data were collected from the participants via field notes and semi-structured interviews. RESULTS: Using a grounded theory approach, the following three themes were developed regarding the establishment of effective interprofessional collaboration between family physicians and therapists in the rehabilitation of older patients in rural communities: 1) establishment of mutual understanding and the perception of psychological safety; 2) improvement of relationships between healthcare professionals and their patients; and 3) creation of new roles in rural family medicine to meet evolving needs. CONCLUSION: Ensuring continual dialogue between family medicine and rehabilitation departments helped to establish understanding, enhance knowledge, and heighten mutual respect among healthcare workers, making the work more enjoyable. Continuous collaboration between departments also improved relationships between professionals and their patients, establishing trust in collaborative treatment paradigms and supporting patient-centered approaches to family medicine. Within this framework, understanding the capabilities of family physicians can lead to the establishment of new roles for them in rural hospitals. Family medicine plays a vital role in geriatric care in community hospitals, especially in rural primary care settings. The role of family medicine in hospitals should be investigated in other settings to improve geriatric care and promote mutual learning and improvement among healthcare professionals.

The last resort: reducing avoidable employee harm by improving the application of the disciplinary policy and process.

Introduction: There is growing evidence within the healthcare sector that employee investigations can harm individuals involved in the process, an organization's culture and the delivery of its services. Methods: This paper details an intervention developed by an NHS Wales organization to reduce the number of its employee investigations through an organization-wide focus that promoted a 'last resort' approach and introduced the concept of 'avoidable employee harm'. A range of associated improvement initiatives were developed to support behavior change among those responsible for determining whether an employee investigation should be initiated. Results: Over a 13-month period, organizational records showed an annual reduction of 71% in investigation cases post-intervention, resulting in an estimated 3,308 sickness days averted annually and total estimated annual savings of £738,133 (based on direct savings and costs averted). This indicates that the organization has started to embrace the "last resort" approach to using employee investigations to address work place issues. The programme was supported with training for those responsible for commissioning and leading the organization's employee investigations. Analysis of survey data from those who attended training workshops to support the programme indicated that participants showed an increased awareness of the employee investigation process post-workshop and an understanding of the concept of avoidable employee harm. Discussion: The programme is congruent with the Healthy Healthcare concept, as the study illustrates how its practices and processes have a beneficial impact on staff, as well as potentially on patients. This study highlights wider issues for consideration, including the: (1) the role of Human Resources (HR), (2) taking a multi-disciplinary approach, (3) culture and practice, (4) the responsibility of the wider HR profession.

Medical Professionals' Responses to a Patient Safety Incident in Healthcare.

Objectives: Patient safety incidents (PSIs) are common in healthcare. Open communication facilitated by psychological safety in healthcare could contribute to the prevention of PSIs and enhance patient safety. The aim of the study was to explore medical professionals' responses to a PSI in relation to psychological safety in Slovak healthcare. Methods: Sixteen individual semi-structured interviews with Slovak medical professionals were performed. Obtained qualitative data were transcribed verbatim and analysed using the conventional content analysis method and the consensual qualitative research method. Results: We identified eight responses to a PSI from medical professionals themselves as well as their colleagues, many of which were active and with regard to ensuring patient safety (e.g., notification), but some of them were passive and ultimately threatening patients' safety (e.g., silence). Five superiors' responses to the PSI were identified, both positive (e.g., supportive) and negative (e.g., exaggerated, sharp). Conclusion: Medical professionals' responses to a PSI are diverse, indicating a potential for enhancing psychological safety in healthcare.

Linking ethical leadership to nurses' internal whistleblowing through psychological safety.

Background: Cultivating internal whistleblowing among nurses is of paramount importance to nurse leaders. Yet, the literature on how nurse leaders can foster this phenomenon among nurses is limited. Additionally, the underlying mechanisms linking leadership behaviors to internal whistleblowing intentions remain underexplored.Aim: This study aimed to examine how ethical leadership is linked to internal whistleblowing intentions among nurses through the mediating effect of psychological safety.Research design: A multicenter cross-sectional research design was used for this study.Participants and research context: This study involved 201 nurses working in three tertiary governmental hospitals across three cities in Egypt. Data were collected between October and December 2023, using an introductory information form, the Ethical Leadership Scale, the Psychological Safety Scale, and the Internal Whistleblowing Intentions Scale. Structural equation modeling was used to evaluate study hypotheses.Ethical consideration: Research Ethics Committee of Faculty of Nursing, Port Said University, Egypt approved the study (reference number: NUR (6/8/2023)(28)), and each participant signed the informed consent form before participation in the study.Results: Ethical leadership was positively linked to nurses' psychological safety and internal whistleblowing intentions. Psychological safety mediated the link between ethical leadership and nurses' internal whistleblowing intentions.Conclusion: Our study suggests that nurse leaders can foster nurses' intentions to blow the whistle internally by adopting ethical leadership behaviors and enhancing psychological safety among nurses.

Psychological Safety: Creating a Transformative Culture in a Faculty Group Peer-Mentoring Intervention.

We investigated psychological safety (PS) in a randomized controlled study of a group peer mentoring intervention. Forty mid-career academic medicine research faculty participated in the year-long C-Change Mentoring & Leadership Institute, completing a survey after the first session and post-intervention. Qualitative data included ethnographic observations, interviews, and participant writings. A codebook thematic analysis used PS as one sensitizing concept. PS mean scores increased from 5.6 at baseline to 6.1 (range 1-7) post-intervention (t=3.03, p=.005, mean difference=0.48, 95% CI=0.33, 0.81). In qualitative analysis, PS resulted from intervention structure, storytelling/listening curriculum, and skilled facilitation, fostering norms that enabled sharing, repaired trust, and nurtured belonging. PS enabled faculty to be authentic, vulnerable, and responsive, and to develop social bonds within a peer community.

The Pediatric Heart Center Melting Pot: Sharing Recipes for Success: Proceedings from the 8th World Congress of Pediatric Cardiology and Cardiac Surgery.

The challenges of present-day healthcare are urgent; there is a shortage of clinicians, patient care is increasingly complex, resources are limited, clinician turnover seems ever-increasing, and the expectations of providers and patients are monumental. To transform problems into innovative opportunities, diverse perspectives and a sense of possibility are needed. The following is a collaborative manuscript authored by the speakers of the 8th World Congress of Pediatric Cardiology and Cardiac Surgery session, "Teamwork, Culture Change, and Strategy." Although this panel was diverse in the clinical roles, nationalities, and genders represented, several consistent themes emerged which are explored in this work.

The Art of Speaking Up: Supporting a Culture of Safety in the OR.

Considering the high-risk, stressful, and fast-paced nature of the perioperative environment and vulnerability of surgical patients, the quest for maintaining a safety culture in the OR is ongoing. Speaking up-an interaction between perioperative team members to address a concern-requires team member empowerment to advocate for patient safety when needed. Hierarchical gradients, lack of psychological safety, incivility, and a nonsupportive organizational culture can impede speaking-up behaviors. Strategies to improve speaking up include using multimethod education initiatives, enhancing psychological safety, and managing conflict. Perioperative nurses can experience barriers to speaking up, such as lack of team familiarity, normalization of deviance, and differing perceptions among team members. The logistics of whole-team training initiatives can be challenging; however, such initiatives can help participants improve their understanding of the perspectives and communication goals of all involved personnel. Perioperative nurses and leaders should collaborate to promote speaking up for safety when warranted.

A structural equation model of the impacts of nurses' psychological safety and psychological contract breach.

AIM: To investigate the effects of psychological contract breach and psychological safety on health and well-being outcomes among nurses. DESIGN: A cross-sectional study. METHODS: Data were gathered from members of the Finnish social and healthcare workers' trade union (n = 4575) in February 2023. This study focused on data from 3260 nurses. Structural equation modelling was employed to firstly explain burnout and work engagement and subsequently health and well-being outcomes in relation to perceived psychological contract breach and psychological safety. RESULTS: Younger male nurses, those with lower-level university degrees, and nurses employed in public hospitals reported experiencing more psychological contract breaches. Conversely, older nurses and those working in private organizations perceived a higher level of psychological safety. Psychological contract breaches were associated with increased burnout and reduced work engagement, while psychological safety contributed to lower burnout and higher work engagement. Moreover, burnout was linked to health problems and diminished mental well-being, whereas increased work engagement led to fewer health problems and improved mental well-being. The final model demonstrated excellent fit. CONCLUSION: Breaches in the psychological contract, followed by distrust, and anger significantly burden nurses, detrimentally affecting their well-being at work. Psychologically safe working environments, consequently, improve nurses' well-being at work and should be promoted within work teams. IMPLICATIONS FOR THE PROFESSION: Nursing managers could receive training to understand the consequences of, and practices for supporting, a beneficial psychological work climate. IMPACT: The study examined psychological burden and resource factors at work, finding that psychological contract breaches increased burden and led to negative well-being outcomes. In contrast, psychological safety emerged as a positive resource for health and well-being. These results offer benefits for nurses, managers and organizations. REPORTING METHOD: The study was reported following the Strengthening of the reporting of observational studies in epidemiology guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

'Safer, Not Safe': Service Users' Experiences of Psychological Safety in Inpatient Mental Health Wards in the United Kingdom.

Research on patient safety in mental health settings is limited compared to physical healthcare settings. Recent qualitative studies have highlighted that patient safety is more than just physical safety but includes psychological safety. Traditionally, psychological safety has been defined as the belief that it is safe to take interpersonal risks, such as speaking up, without a fear of negative consequences. However, to date, it is not clear what constitutes psychological safety for service users of inpatient mental health settings. To understand this, we conducted 12 interviews with former inpatient mental health service users. Interviews were analysed with Reflexive Thematic Analysis, and five themes were developed. All themes had subthemes. Overall, we found that participants were more readily able to draw on situations where they felt psychologically unsafe, rather than safe. Psychological safety in service users was influenced by (1) healthcare staff attitudes and behaviours towards them, (2) their relationships with other service users, (3) whether they felt they had any control over their environment and medical decision-making regarding their care, (4) their experiences of physically safety, feeling listened to and believed and (5) access to meaningful occupation on the wards. These findings suggest that changes are needed to enhance inpatient mental health service users' general experiences of psychological safety. Further research will need to (1) further develop understanding of the concept of psychological safety for service users and (2) identify interventions, and such interventions should be co-designed with service users.

Psychological safety is associated with better work environment and lower levels of clinician burnout.

Burnout is attributed to negative work environments and threatens patient and clinician safety. Psychological safety is the perception that the work environment is safe for interpersonal risk-taking and may offer insight into the relationship between the work environment and burnout. In this cross-sectional analysis of survey data from 621 nurse practitioners in California, we found that one-third (34%) experienced high burnout. Four factors in the work environment were negatively associated with burnout and positively associated with psychological safety. Significant mediation effects of psychological safety were observed on the relationships between each work environment factor and both emotional exhaustion and depersonalization. The largest mediation effects were observed on the total effects of Nurse Practitioner-Physician Relations and Practice Visibility on Emotional Exhaustion (37% and 32%, respectively) and Independent Practice and Support and NP-Administration Relations on Depersonalization (32% and 29%, respectively). We found, overall, that psychological safety decreased the strength of the negative relationship between work environment and burnout. We argue that research, practice, and policy efforts to mitigate burnout and improve the work environment should consider psychological safety as a metric for system-level well-being.

Professional Integrity and Ethical Considerations in Simulation.

As healthcare providers, ethical decisions are woven into the fabric of our profession from bedside care to the use of simulation as an educational pedagogy. Simulation as a method for healthcare education began in response to ethical dilemmas in clinical practice. Educators require an interactive approach to education that will keep patients, learners, and faculty psychologically safe, decrease errors in clinical practice, and engage participants, all of which are inherent in simulation-based experiences. Professional integrity and morality are infused throughout simulation design: prebriefing, facilitation, debriefing, and evaluation.

Creating an Effective Simulation Environment.

Simulation is a teaching and learning strategy that is used commonly in healthcare education in academia and practice settings. Nurses at the bedside may recall times in their formal education where simulation was used as a form of clinical learning or evaluation of their performance. It is possible that with the rise of nurse residency programs and in situ simulation that bedside nurses are experiencing simulation regularly within the workplace as a means of professional development. This article will set the stage for educators to develop high-quality simulation experiences.

Setting Learners up for Simulation and Clinical Success: Achieving Psychological Safety.

Simulation is an effective method for learning and demonstrating competency in the clinical setting. Like protocols used by nurses in the practice setting, simulation educators have standards of best practice to guide their use of simulation for teaching and learning. By using the Healthcare Simulation Standard of Best Practice: Prebriefing, the simulation educators and nurse preceptors can create safe learning and working environments. Incorporating a standard prebriefing method and plan that carries throughout the clinical environment may be one way to decrease stress and anxiety of the nursing team and promote a psychologically safe working environment.

Improving departmental psychological safety through a medical school-wide initiative.

BACKGROUND: Psychological safety is a team-based phenomenon whereby group members are empowered to ask questions, take appropriate risks, admit mistakes, propose novel ideas, and candidly voice concerns. Growing research supports the benefits of psychological safety in healthcare and education for patient safety, learning, and innovation. However, there is a paucity of research on how to create psychological safety, especially within academic medicine. To meet this need, the present study describes and evaluates a multi-year, medical school-wide psychological safety initiative. METHODS: We created, implemented, and assessed a multi-pronged psychological safety initiative including educational training sessions, departmental champions, videos, infographics, and targeted training for medical school leaders. Employees' perceptions of psychological safety at both the departmental and institutional levels were assessed annually. The impact of educational training sessions was quantified by post-session surveys. RESULTS: Deidentified employee surveys revealed a statistically significant increase in departmental psychological safety between the first and second annual surveys. Perceived psychological safety remained lower at the institution-wide level than at the departmental level. No significant differences in psychological safety were observed based on gender, position, or employment length. Post-educational training session surveys showed that the sessions significantly increased knowledge of the topic as well as motivation to create a culture of psychological safety within the medical school. CONCLUSIONS: This study establishes an evidence-based method for increasing psychological safety within medical school departments and serves as a template for other health professions schools seeking to promote psychological safety. Training leadership, faculty, and staff is an important first step towards creating a culture of psychological safety for everyone, including trainees.

Antecedents and Consequences of Violence in Homeless Shelters: Perspectives and Experiences of Service Users and Shelter Staff.

Violence is a critical issue in homeless shelters that affects service users and staff, yet there is limited evidence on how shelter-based violence occurs. The objective of this qualitative study was to investigate the antecedents and consequences of shelter-based violence from the perspectives of service users and staff. Purposive sampling was used to recruit individuals experiencing homelessness and shelter staff in a large metropolitan city in Ontario, Canada. Data from in-depth interviews with 56 individuals experiencing homelessness and 30 shelter staff were analyzed. Findings showed that shelter-based violence toward service users and staff was perceived to manifest in response to three interacting factors: (a) burden of homelessness and shelter living, (b) individual histories and marginalization, and (c) interpersonal conflict. These antecedents had a hierarchical structure in that each subsequent factor exacerbated the risk of previous ones and culminated with the most proximal factor for violence. There were three primary outcomes of shelter-based violence reported by service users and staff: (a) health and environmental harms, (b), procedural enforcement, and (c) avoidant behaviors. Avoidance was often a subsequent impact following health harms, as was procedural enforcement to a lesser extent. Overall, the study findings demonstrate that shelter-based violence is a complex and dynamic problem that is perceived to be the result of interacting structural, environmental, programmatic, interpersonal, and individual factors, with similar consequences for service users and staff. Implications for preventing violence through shelter design and service delivery are discussed.

Speaking Up About Patient Safety, Withholding Voice and Safety Climate in Clinical Settings: a Cross-Sectional Study Among Ibero-American Healthcare Students.

Objectives: To explore speaking up behaviours, barriers to openly expressing patient safety concerns, and perceived psychological safety climate in the clinical setting in which healthcare trainees from Ibero-America were receiving their practical training. Methods: Cross-sectional survey of healthcare trainees from Colombia, Mexico, and Spain (N = 1,152). Before the field study, the Speaking Up About Patient Safety Questionnaire (SUPS-Q) was translated into Spanish and assessed for face validity. A confirmatory factor analysis was conducted to establish the construct validity of the instrument, and the reliability was assessed. The SUPS-Q was used to evaluate voice behaviours and the perceived psychological safety climate among Ibero-American trainees. Descriptive and frequency analyses, tests for contrasting means and proportions, and logistic regression analyses were performed. Results: Seven hundred and seventy-one trainees had experience in clinical settings. In the previous month, 88.3% had experienced patient safety concerns, and 68.9% had prevented a colleague from making an error. More than a third had remained silent in a risky situation. Perceiving concerns, being male or nursing student, and higher scores on the encouraging environment scale were associated with speaking up. Conclusion: Patient safety concerns were frequent among Ibero-American healthcare trainees and often silenced by personal and cultural barriers. Training in speaking up and fostering safe interprofessional spaces is crucial.

Establishing inclusion safety in pharmacy education: Wielding psychological safety as a tool to address student burnout.

INTRODUCTION: Burnout is a common issue that impacts students across professional programs, where symptoms such as loneliness and isolation lead to a decrease in student and faculty success. The primary tactic utilized to combat burnout in pharmacists has been an emphasis on wellbeing strategies. COMMENTARY: Psychological safety is an important cultural dynamic that allows individuals to feel included, supported, and heard. This is particularly important as developing a professional setting of inclusivity and safety is associated with reducing the impact of psychosocial stressors on an individual outside of their professional setting. However, psychological safety has not yet been explored as a means to combat burnout in pharmacy education. IMPLICATIONS: Making space for inclusion, learning, contribution, and challenge in pharmacy education curriculums is necessary to create psychologically safe learning environments, which thereby increases feelings of belonging and community among students and faculty and subsequently reduces feelings of isolation and burnout. A commitment from administrators, faculty, and preceptors is necessary to encourage egalitarian dialogue and imagine a more dynamic, collegial relationship among students and faculty. Ultimately, this commitment communicates to students that they are valued as human beings, respected as individuals, and empowered as future healthcare providers well before they are asked to rise to the role of pharmacist.

Shifting institutional culture to develop climate solutions with Open Science.

To address our climate emergency, "we must rapidly, radically reshape society"-Johnson & Wilkinson, All We Can Save. In science, reshaping requires formidable technical (cloud, coding, reproducibility) and cultural shifts (mindsets, hybrid collaboration, inclusion). We are a group of cross-government and academic scientists that are exploring better ways of working and not being too entrenched in our bureaucracies to do better science, support colleagues, and change the culture at our organizations. We share much-needed success stories and action for what we can all do to reshape science as part of the Open Science movement and 2023 Year of Open Science.