Suicidal ideation, perception of personal safety, and career regret among emergency medicine residents during the COVID-19 pandemic.

Objectives: The COVID-19 pandemic was disruptive for trainees and may have affected career decisions for some learners. This study examined the impact of the pandemic on emergency medicine (EM) resident perceptions of their mental health, perceptions of personal safety, and career choice regret. Methods: This was a cross-sectional survey study administered following the 2021 American Board of Emergency Medicine In-Training Examination (ITE). Survey measures included suicidal ideation (SI), COVID concerns in terms of infection prevention and control (IPC) training, COVID risk to self and/or COVID risk to family, and COVID-related career regret. COVID concerns were compared by gender and race/ethnicity using Pearson's chi-square tests. Multivariable logistic regression models were used to test the association between SI and COVID concerns, resident characteristics, and program characteristics. Results: A total of 6980 out of 8491 EM residents (82.2%) from 244 programs completed the survey. Only 1.1% of participants reported insufficient training in COVID IPC practices. Participants were concerned about COVID risk to themselves (40.3%) and to their families (63.3%) due to their job roles. These concerns were more common among women or nonbinary (vs. men); all other races/ethnicities (vs. non-Hispanic Whites); senior residents (vs. PGY-1, PGY-2 residents); and residents who were married or in relationships (vs. single or divorced). A total of 6.1% of participants reported that COVID made them reconsider choosing EM as their career. Career regret in this cohort was higher than that in the proportion (3.2%) expressing career regret in the 2020 ITE (p < 0.001). Career regret was more common among women or nonbinary (vs. men); all other races/ethnicities (vs. non-Hispanic Whites); and senior residents (vs. PGY-1, PGY-2 residents). The overall SI rate was 2.6%, which did not differ from that of the 2020 sample of EM residents (2.5%, p = 0.88). Conclusions: Many EM residents reported concerns about COVID risks to themselves and their families. Although the rate of SI remained unchanged, more EM residents reported career regret during the COVID pandemic.

Prospective validity evidence for the abbreviated emergency medicine Copenhagen Burnout Inventory.

BACKGROUND: Prior research has provided retrospective validity evidence for an abbreviated Copenhagen Burnout Inventory (CBI) to measure burnout among emergency medicine (EM) residents. We sought to provide additional validity and reliability evidence for the two-factor, six-item abbreviated CBI. METHODS: This cross-sectional study used data from the abbreviated CBI that was administered following the 2022 American Board of Emergency Medicine In-training Examination. Confirmatory factor analysis (CFA) was performed and the prevalence of burnout among EM residents was determined. RESULTS: Of the 8918 eligible residents, 7465 (83.7%) completed the abbreviated CBI. CFA confirmed the previously developed model of two factors using six items answered with a 1- to 5-point Likert scale. The internal factor was derived from personal and work-related burnout and the external factor was related to caring for patients. The reliability was determined using Cronbach's alpha (0.87). The overall prevalence of burnout was 49.4%; the lowest prevalence was at the EM1 level (43.1%) and the highest was at the EM2 level (53.8%). CONCLUSIONS: CFA of the abbreviated CBI demonstrated good reliability and model fit. The two-factor, six-item survey instrument identified an increase in the prevalence of burnout among EM residents that coincided with working in the COVID-19 environment. The abbreviated CBI has sufficient reliability and validity evidence to encourage its broader use.

The 2023 Core Content of advanced emergency medicine ultrasonography.

In February 2023, the American Board of Emergency Medicine (ABEM) approved modifications to the Advanced Emergency Medicine Ultrasonography (AEMUS) Core Content, which defines the areas of knowledge considered essential for the practice of AEMUS. This manuscript serves as a revision of the AEMUS Core Content originally published in 2014. The revision of the Core Content for AEMUS training aims to establish standardized education and qualifications necessary for AEMUS fellowship program leadership, clinical application, administration, quality improvement, and research. The Core Content provides the organizational framework and serves as the basis for the development of content for the Focused Practice Examination (FPE) administered by ABEM. AEMUS fellowship directors may reference the Core Content when designing AEMUS fellowship curricula to help prepare graduates for the autonomous practice of AEMUS and the FPE. In this article, an updated revision of the previously published AEMUS Core Content is detailed, and the entire development of the Core Content is presented.

Comparison of performance data between emergency medicine 1-3 and 1-4 program formats.

Objective: This study compares performance data from physicians completing 3-year versus 4-year emergency medicine residency training programs. Currently, there are 2 training formats and little is known about objective performance differences. Methods: This was a retrospective cross-sectional analysis of emergency residents and physicians. Multiple analyses were conducted comparing physicians' performances, including Accreditation Council of Graduate Medical Education Milestones and American Board of Emergency Medicine In-training Examination (ITE), Qualifying Examination (QE), Oral Certification Examination (OCE), and program extensions from 3-year and 4-year residency programs. Some confounding variables were not or could not be considered, such as rationale for medical students to choose one format over another, as well as application and final match rates. Results: Milestone scores are higher for emergency medicine 3 residents in 1-3 programs (3.51) versus emergency medicine 3 residents in 1-4 programs (3.07; P < 0.001, d = 1.47) and highest for emergency medicine 4 residents (3.67). There was no significant difference in program extension rates (emergency medicine 1-3, 8.1%; emergency medicine 1-4, 9.6%; P = 0.05, ω = 0.02). ITE scores were higher for emergency medicine 1, 2, and 3 residents from 1-3 programs and emergency medicine 4 residents from 1-4 programs scored highest. Mean QE score was slightly higher for emergency 1-3 physicians (83.55 vs 83.00; P < 0.01, d = 0.10). QE pass rate was higher for emergency 1-3 physicians (93.1% vs 90.8%; P < 0.001, ω = 0.08). Mean OCE score was slightly higher for emergency 1-4 physicians (5.67 vs 5.65; P = 0.03, d = -0.07) but did not reach a priori statistical significance (α < 0.01). OCE pass rate was also slightly higher for emergency 1-4 physicians (96.9% vs 95.5%; P = 0.06, ω = -0.07) but also non-significant. Conclusions: These results suggest that although performance measures demonstrate small differences between physicians from emergency medicine 1-3 and 1-4 programs, these differences are limited in their ability to make causal claims about performance on the basis of program format alone.

Workplace Mistreatment, Career Choice Regret, and Burnout in Emergency Medicine Residency Training in the United States.

STUDY OBJECTIVE: The influence of workplace mistreatment on the well-being and career satisfaction of emergency medicine residents is unknown. This study examined the relationships between burnout, career choice regret, and workplace mistreatment in a national sample of emergency medicine residents. METHODS: This was a secondary analysis of a survey study on the prevalence of workplace mistreatment among emergency residents. Residents who reported emotional exhaustion or depersonalization at least once per week were considered to have burnout. Residents who reported dissatisfaction with their decision to become an emergency physician were considered to have career choice regret. Respondents also reported the type (discrimination, abuse, sexual harassment) and frequency of mistreatment over the academic year. Multivariable logistic regression, adjusting for program characteristics, was used to examine resident characteristics associated with burnout and career choice regret, with the frequency of mistreatment as a covariate. RESULTS: Of the 8,162 eligible residents, 7,680 (94.1 %) participated. About a third of respondents reported burnout (2,188 of 6,902, 31.7%), whereas a minority (224 of 6,923, 3.2%) reported career choice regret. Of the 7,087 responses on mistreatment frequency, 2,117 (29.9%) reported "a few times per year," and 1,296 (18.3%) reported "a few times per month or more." Compared with residents who never experienced mistreatment, residents who reported increasing frequencies of mistreatment were associated with having burnout-from mistreatment a few times per year (OR [odds ratio],1.6; 99% CI [confidence interval], 1.3 to 1.9) to a few times per month or more (OR, 3.3; 99% CI, 2.7 to 4.1). Compared with residents without burnout, residents who reported burnout were associated with having career choice regret (OR, 11.3; 99% CI, 7.0 to 18.1). After adjusting for burnout, there were no significant relationships between the frequency of mistreatment and career choice regret. CONCLUSIONS: Workplace mistreatment is associated with burnout, but not career choice regret, among emergency medicine residents. Efforts to address workplace mistreatment may improve emergency medicine residents' professional well-being.

Reliability and validity support for an abbreviated Copenhagen burnout inventory using exploratory and confirmatory factor analysis.

Objective: The Copenhagen Burnout Inventory (CBI) is an open-access, valid, and reliable instrument measuring burnout that includes 19 items distributed across the following 3 domains (factors): personal burnout, work burnout, and patient burnout. The primary objective of this study was to determine the validity and reliability of an abbreviated CBI to assess burnout in emergency medicine residents. Methods: This cross-sectional study used data from the CBI that followed the 2021 American Board of Emergency Medicine In-training Examination. Exploratory factor analysis (EFA) was followed by confirmatory factor analysis (CFA). Results: Of the 8491 eligible residents, 7225 (85.1%) completed the survey; the EFA cohort included 3613 residents and the CFA cohort included 3612 residents. EFA showed 2 eigenvalues ≥1, an internal factor and an external factor. There were 6 CBI items that contributed to the 2 factors. The first factor was related to personal burnout and work-related burnout and the second factor was related to working with patients. There were 4 CBI items that contributed to the internal factor and 2 CBI items that contributed to the external factor. Using the abbreviated CBI, the incidence of a resident having 1 or both types of burnout was 34.1%. Conclusions: This study provides validity evidence and reliability support for the use of a 6-item, 2-factor abbreviated CBI. A shorter, reliable, valid, and publicly accessible burnout inventory provides numerous advantages for burnout research in emergency medicine.

Formation of Coelomic Cavities during Abbreviated Development of the Brittle Star Ophioplocus esmarki.

AbstractIn brittle stars, the coelomic cavities that form during embryogenesis contribute to most of the internal organ systems of the juvenile. In the ancestral mode of development, the coelomic cavities begin with bilateral symmetry and play a minor role in the function of the ophiopluteus larva. However, the coelomic cavities undergo extensive changes during metamorphosis to set up the body systems of the juvenile brittle star. Many lineages of brittle stars have evolved life histories without the ophiopluteus larva. The non-feeding vitellaria larva has rapid development of juvenile structures. This work demonstrates the modifications to the origin and early development of the coelomic cavities in a vitellaria larva. Much of the archenteron forms an unpaired axocoel, hydrocoel, and somatocoel. The posterior-most portion of the archenteron forms the rudiment of the juvenile stomach. The right somatocoel and a portion of the left somatocoel form as invaginations of the lateral ectoderm. Later morphogenesis of the axocoel, the hydrocoel, and the two somatocoels is similar to what has been shown for brittle stars with an ophiopluteus larva. Confocal microscopy and three-dimensional modeling were used to show new details for the later morphogenesis of the coelomic cavities. The stone canal originates as an outgrowth of the hydrocoel between lobes 4 and 5. The hydrocoel lobes have minimal migration after they meet to complete the ring canal. The right somatocoel contributes to a component of the axial complex and perihemal system. A detailed description is given for how the left somatocoel contributes to multiple organ systems.

Prevalence of Discrimination, Abuse, and Harassment in Emergency Medicine Residency Training in the US.

Importance: The prevalence of workplace mistreatment and its association with the well-being of emergency medicine (EM) residents is unclear. More information about the sources of mistreatment might encourage residency leadership to develop and implement more effective strategies to improve professional well-being not only during residency but also throughout the physician's career. Objective: To examine the prevalence, types, and sources of perceived workplace mistreatment during training among EM residents in the US and the association between mistreatment and suicidal ideation. Design, Setting, and Participants: In this survey study conducted from February 25 to 29, 2020, all residents enrolled in EM residencies accredited by the Accreditation Council for Graduate Medical Education (ACGME) who participated in the 2020 American Board of Emergency Medicine computer-based In-training Examination were invited to participate. A multiple-choice, 35-item survey was administered after the examination asking residents to self-report the frequency, sources, and types of mistreatment experienced during residency training and whether they had suicidal thoughts. Main Outcomes and Measures: The types and frequency of workplace mistreatment and the sources of the mistreatment were identified, and rates of self-reported suicidality were obtained. Multivariable logistic regression models were used to examine resident and program characteristics associated with suicidal thoughts. Results: Of 8162 eligible EM residents, 7680 (94.1%) responded to at least 1 question on the survey; 6503 (79.7%) completed the survey in its entirety. A total of 243 ACGME-accredited residency programs participated, and 1 did not. The study cohort included 4768 male residents (62.1%), 2698 female residents (35.1%), 4919 non-Hispanic White residents (64.0%), 2620 residents from other racial/ethnic groups (Alaska Native, American Indian, Asian or Pacific Islander, African American, Mexican American, Native Hawaiian, Puerto Rican, other Hispanic, or mixed or other race) (34.1%), 483 residents who identified as lesbian, gay, bisexual, transgender, queer, or other (LGBTQ+) (6.3%), and 5951 residents who were married or in a relationship (77.5%). Of the total participants, 3463 (45.1%) reported exposure to some type of workplace mistreatment (eg, discrimination, abuse, or harassment) during the most recent academic year. A frequent source of mistreatment was identified as patients and/or patients' families; 1234 respondents (58.7%) reported gender discrimination, 867 (67.5%) racial discrimination, 282 (85.2%) physical abuse, and 723 (69.1%) sexual harassment from patients and/or family members. Suicidal thoughts occurring during the past year were reported by 178 residents (2.5%), with similar prevalence by gender (108 men [2.4%]; 59 women [2.4%]) and race/ethnicity (113 non-Hispanic White residents [2.4%]; 65 residents from other racial/ethnic groups [2.7%]). Conclusions and Relevance: In this survey study, EM residents reported that workplace mistreatment occurred frequently. The findings suggest common sources of mistreatment for which educational interventions may be developed to help ensure resident wellness and career satisfaction.

Attitudes of food consumers at universities towards recycling human urine as crop fertiliser: A multinational survey dataset.

We present here a data set generated from a multinational survey on opinions of university community members on the prospect of consuming food grown with human urine as fertiliser and about their urine recycling perceptions in general. The data set comprises answers from 3,763 university community members (students, faculty/researchers, and staff) from 20 universities in 16 countries and includes demographic variables (age bracket, gender, type of settlement of origin, academic discipline, and role in the university). Questions were designed based on Ajzen's theory of planned behaviour to elicit information about three components of behavioural intention-attitudes, subjective norms, and perceived behavioural control. Survey questions covered perceived risks and benefits (attitudes), perceptions of colleagues (injunctive social norm) and willingness to consume food grown with cow urine/faeces (descriptive social norm), and willingness to pay a price premium for food grown with human urine as fertiliser (perceived behavioural control). We also included a question about acceptable urine recycling and disposal options and assessed general environmental outlook via the 15-item revised New Ecological Paradigm (NEP) scale. Data were collected through a standardised survey instrument translated into the relevant languages and then administered via an online form. Invitations to the survey were sent by email to university mailing lists or to a systematic sample of the university directory. Only a few studies on attitudes towards using human urine as fertiliser have been conducted previously. The data described here, which we analysed in "Willingness among food consumers at universities to recycle human urine as crop fertiliser: Evidence from a multinational survey" [1], may be used to further understand potential barriers to acceptance of new sanitation systems based on wastewater source separation and urine recycling and can help inform the design of future sociological studies.

Willingness among food consumers to recycle human urine as crop fertiliser: Evidence from a multinational survey.

Source-separating sanitation systems offer the possibility of recycling nutrients present in wastewater as crop fertilisers. Thereby, they can reduce agriculture's impacts on global sources, sinks, and cycles for nitrogen and phosphorous, as well as their associated environmental costs. However, it has been broadly assumed that people would be reluctant to perform the new sanitation behaviours that are necessary for implementing such systems in practice. Yet, few studies have tried to systematically gather evidence in support of this assumption. To address this gap, we surveyed 3763 people at 20 universities in 16 countries using a standardised questionnaire. We identified and systematically assessed cross-cultural and country-level explanatory factors that were strongly associated with people's willingness to consume food grown using human urine as fertiliser. Overall, 68% of the respondents favoured recycling human urine, 59% stated a willingness to eat urine-fertilised food, and only 11% believed that urine posed health risks that could not be mitigated by treatment. Most people did not expect to pay less for urine-fertilised food, but only 15% were willing to pay a price premium. Consumer perceptions were found to differ greatly by country and the strongest predictive factors for acceptance overall were cognitive factors (perceptions of risks and benefits) and social norms. Increasing awareness and building trust among consumers about the effectiveness of new sanitation systems via cognitive and normative messaging can help increase acceptance. Based on our findings, we believe that in many countries, acceptance by food consumers will not be the major social barrier to closing the loop on human urine. That a potential market exists for urine-fertilised food, however, needs to be communicated to other stakeholders in the sanitation service chain.

Actions, indicators, and outputs in urban biodiversity plans: A multinational analysis of city practice.

Urban biodiversity offers important benefits to residents and may be crucial to reaching global biodiversity conservation targets, but little research has been conducted on how cities actually plan for biodiversity. In this study, we conducted a mixed methods content analysis of biodiversity plans by 39 cities around the world to determine whether they measured their actions, how they did so (via quantitative indicators and qualitative outputs), and what topics these actions and measures covered. We based our analytical framework on the Singapore Index on Cities' Biodiversity (also known as the City Biodiversity Index), a widely applied 23-indicator index that helps cities track their progress in biodiversity planning. The Singapore Index groups its indicators into the following three core components: native biodiversity, ecosystem services, and governance and management. For actions and measures not classifiable by the Singapore Index, we inductively derived additional categories. Across all plans, we identified 2,231 actions, 346 indicators, and 444 outputs. We found that all of the plans included actions, while 82% included measures (67% included indicators and 72% included outputs). Only 29% of actions were associated with a measure. Overall, the plans covered all of the categories in the Singapore Index, particularly within the core components of native biodiversity and governance and management, though some plans had a narrower focus. The 20 additional urban biodiversity topics that were not covered by the Singapore Index framework included socioeconomic considerations, data collection, genetic diversity, urban agriculture and forestry, green infrastructure, human-wildlife conflicts, indigenous concerns, and citizen science. Indicators were the most common measures for native biodiversity and ecosystem service topics, while outputs were the most common measures for governance and management. Our results may inform the revision and development of urban biodiversity indicators in the post-2020 framework and of other initiatives that guide cities in contributing to local and global biodiversity goals.

A National Study of Longitudinal Consistency in ACGME Milestone Ratings by Clinical Competency Committees: Exploring an Aspect of Validity in the Assessment of Residents' Competence.

PURPOSE: To investigate whether clinical competency committees (CCCs) were consistent in applying milestone ratings for first-year residents over time or whether ratings increased or decreased. METHOD: Beginning in December 2013, the Accreditation Council for Graduate Medical Education (ACGME) initiated a phased-in requirement for reporting milestones; emergency medicine (EM), diagnostic radiology (DR), and urology (UR) were among the earliest reporting specialties. The authors analyzed CCC milestone ratings of first-year residents from 2013 to 2016 from all ACGME-accredited EM, DR, and UR programs for which they had data. The number of first-year residents in these programs ranged from 2,838 to 2,928 over this time period. The program-level average milestone rating for each subcompetency was regressed onto the time of observation using a random coefficient multilevel regression model. RESULTS: National average program-level milestone ratings of first-year residents decreased significantly over the observed time period for 32 of the 56 subcompetencies examined. None of the other subcompetencies showed a significant change. National average in-training examination scores for each of the specialties remained essentially unchanged over the time period, suggesting that differences between the cohorts were not likely an explanatory factor. CONCLUSIONS: The findings indicate that CCCs tend to become more stringent or maintain consistency in their ratings of beginning residents over time. One explanation for these results is that CCCs may become increasingly comfortable in assigning lower ratings when appropriate. This finding is consistent with an increase in confidence with the milestone rating process and the quality of feedback it provides.

Global Proteomic Profiling of Salmonella Infection by a Giant Phage.

The 240-kb Salmonella phage SPN3US genome encodes 264 gene products, many of which are functionally uncharacterized. We have previously used mass spectrometry to define the proteomes of wild-type and mutant forms of the SPN3US virion. In this study, we sought to determine whether this technique was suitable for the characterization of the SPN3US proteome during liquid infection. Mass spectrometry of SPN3US-infected cells identified 232 SPN3US and 1,994 Salmonella proteins. SPN3US proteins with related functions, such as proteins with roles in DNA replication, transcription, and virion formation, were coordinately expressed in a temporal manner. Mass spectral counts showed the four most abundant SPN3US proteins to be the major capsid protein, two head ejection proteins, and the functionally unassigned protein gp22. This high abundance of gp22 in infected bacteria contrasted with its absence from mature virions, suggesting that it might be the scaffold protein, an essential head morphogenesis protein yet to be identified in giant phages. We identified homologs to SPN3US gp22 in 45 related giant phages, including ϕKZ, whose counterpart is also abundant in infected bacteria but absent in the virion. We determined the ϕKZ counterpart to be cleaved in vitro by its prohead protease, an event that has been observed to promote head maturation of some other phages. Our findings are consistent with a scaffold protein assignment for SPN3US gp22, although direct evidence is required for its confirmation. These studies demonstrate the power of mass spectral analyses for facilitating the acquisition of new knowledge into the molecular events of viral infection.IMPORTANCE "Giant" phages with genomes >200 kb are being isolated in increasing numbers from a range of environments. With hosts such as Salmonella enterica, Pseudomonas aeruginosa, and Erwinia amylovora, these phages are of interest for phage therapy of multidrug-resistant pathogens. However, our understanding of how these complex phages interact with their hosts is impeded by the proportion (∼80%) of their gene products that are functionally uncharacterized. To develop the repertoire of techniques for analysis of phages, we analyzed a liquid infection of Salmonella phage SPN3US (240-kb genome) using third-generation mass spectrometry. We observed the temporal production of phage proteins whose genes collectively represent 96% of the SPN3US genome. These findings demonstrate the sensitivity of mass spectrometry for global proteomic profiling of virus-infected cells, and the identification of a candidate for a major head morphogenesis protein will facilitate further studies into giant phage head assembly.

Straight Line Scoring by Clinical Competency Committees Using Emergency Medicine Milestones.

BACKGROUND: In 2013, milestone ratings became a reporting requirement for emergency medicine (EM) residency programs. Programs rate each resident in the fall and spring on 23 milestone subcompetencies. OBJECTIVE: This study examined the incidence of straight line scoring (SLS) for EM Milestone ratings, defined as a resident being assessed the same score across the milestone subcompetencies. METHODS: This descriptive analysis measured the frequencies of SLS for all Accreditation Council for Graduate Medical Education (ACGME)-accredited EM programs during the 2015-2016 academic year. Outcomes were the frequency of SLS in the fall and spring milestone assessments, changes in the number of SLS reports, and reporting trends. Chi-square analysis compared nominal variables. RESULTS: There were 6257 residents in the fall and 6588 in the spring. Milestone scores were reported for 6173 EM residents in the fall (99% of 6257) and spring (94% of 6588). In the fall, 93% (5753 residents) did not receive SLS ratings and 420 (7%) did, with no significant difference compared with the spring (5776 [94%] versus 397 [6%]). Subgroup analysis showed higher SLS results for residents' first ratings (183 of 2136 versus 237 of 4220, P < .0001) and for their final ratings (200 of 2019 versus 197 of 4354, P < .0001). Twenty percent of programs submitted 10% or more SLS ratings, and a small percentage submitted more than 50% of ratings as SLS. CONCLUSIONS: Most programs did not submit SLS ratings. Because of the statistical improbability of SLS, any SLS ratings reduce the validity assertions of the milestone assessments.

Whole-Genome Sequences of Salmonella enterica subsp. enterica Serovar Typhimurium Strains TT6675 and TT9097 Employed in the Isolation and Characterization of a Giant Phage Mutant Collection.

We report here the genome sequences of Salmonella enterica subsp. enterica serovar Typhimurium strains TT6675 and TT9097, which we utilize for genetic analyses of giant bacterial viruses. Our analyses identified several genetic variations between the two strains, most significantly confirming strain TT6675 as a serine suppressor and TT9097 as a nonsuppressor.

Collaborating to embrace evidence-informed management practices within Canada's health system.

In late 2005, 11 major national health organizations decided to work together to build healthier workplaces for healthcare providers. To do so, they created a pan-Canadian collaborative of 45 experts and asked them to develop an action strategy to improve healthcare workplaces. One of the first steps taken by members of the collaborative was to adopt the following shared belief statements to guide their thinking: "We believe it is unacceptable to fund, govern, manage, work in or receive care in an unhealthy health workplace," and, "A fundamental way to better healthcare is through healthier healthcare workplaces." This commentary provides an overview of the Quality Worklife-Quality Healthcare Collaborative action strategy. This strategy embraces the thinking set out by the lead papers (by Shamian and El-Jardali and by Clements, Dault and Priest) and brings to life evidence-informed management practices.

CCHSA accreditation: a change catalyst toward healthier work environments.

Canada has made significant progress in research and policy development regarding work environment issues that contribute to the quality of the work environment in health organizations. In order to successfully achieve the outcomes that healthier work environments can have on providers, patients and the system, more definitive action is required now. The Canadian Council on Health Services Accreditation (CCHSA) is a recognized catalyst of change in health organizations and systems in Canada and internationally. This paper reviews CCHSA's role in contributing to the improvement of the health of work environments in order to improve both the well-being of those working in healthcare and the quality of care being provided to their patients or clients.

Collaborating to embrace evidence-informed management practices within Canada's health system.

In late 2005, 11 major national health organizations decided to work together to build healthier workplaces for healthcare providers. To do so, they created a pan-Canadian collaborative of 45 experts and asked them to develop an action strategy to improve healthcare workplaces. One of the first steps taken by members of the collaborative was to adopt the following shared belief statements to guide their thinking: "We believe it is unacceptable to fund, govern, manage, work in or receive care in an unhealthy health workplace," and, "A fundamental way to better healthcare is through healthier healthcare workplaces. This commentary provides an overview of the Quality Worklife-Quality Healthcare Collaborative action strategy. This strategy embraces the thinking set out by the lead papers in a recent Special Issue of Healthcare Papers (www.Longwoods.com/special_issues.php) focused on developing healthy workplaces for healthcare workers, and brings to Life evidence-informed management practices.