Search

BACKGROUND Specific challenges in the health care sector, such as hierarchical structures, shortages of nursing staff and high turnover of nursing staff, can be addressed by a change process of organizational culture into shared governance. Data from business organizations show that the use of digital voice channels provides employee voice. This approach makes concrete the opportunity for employees to speak up by answering surveys and making comments in an anonymous forum, which subsequently positively influences staff turnover and sick leave. Since there is no clear understanding of how a digital voice channel can be used in long-term care to address employee voice, a research gap is identified. OBJECTIVE The purpose of ADVICE—understanding employee voice behavior: experiences of long-term care with a digital voice channel—is to understand how the use of a digital voice channel performs in long-term care (nursing homes and home care facilities). The aim of the current study is to understand how the digital voice channel can support staff in making their voices heard and to see what managers need to use the voice channel to change the work environment. METHODS An embedded multiple-case study will be used to explore the experiences of two health care providers who have already implemented a digital voice channel. ADVICE is organized into two main phases: (1) a scoping review and (2) an embedded multiple-case study. For this purpose, focus group interviews with employees, discursive-dialogical interviews with managers, meeting protocols, and data from the digital voice channel will be analyzed. First, all units of analysis from every embedded unit will be separately analyzed and then comprehensively analyzed to obtain a case vignette from every embedded unit (within-analysis). In the second stage, the analyzed data from the embedded units will be compared with each other in a comparative analysis (cross-analysis). RESULTS - CONCLUSIONS The results will provide insight into how digital voice channels can be used in long-term care to address employee voice. We expect to find how the digital voice channel can empower nurses to speak up and consequently create a better work environment. Furthermore, we aimed to understand how managers deal with feedback and therefore what support they need to do so. In summary, the results may help to better understand the use of a digital voice channel in the health care sector and its transformative potential for leadership. CLINICALTRIAL

Bacterial chromosome segregation is facilitated by the ParABS system. The ParB protein binds centromere-likeparSsequences and forms nucleoprotein complexes. These nucleoprotein complexes are segregated by the dynamic ATPase ParA. In mycobacteria, ParA also interacts with the polar growth determinant DivIVA (Wag31). This interaction was earlier shown to facilitate the segregation of ParB complexes but also to affect cell extension. Here, we identify an additional partner of ParA inMycobacterium smegmatis, named PapM. UsingE. colibased analysis, we show that PapM likewise interacts with DivIVA and that the tripartite interaction of ParA-PapM-DivIVA is phosphorylation-dependent: ParA binding to DivIVA is diminished, while PapM binding is promoted upon phosphorylation of DivIVA. The presence of PapM enhances the dissociation of ParA from the DivIVA complex upon its phosphorylation. Studies ofM. smegmatismutant strains reveal that altered PapM levels influence chromosome segregation and cell length. The elimination of PapM affects ParA dynamics. Further, ParA and, to a lesser extent, PapM modulates the subcellular distribution of DivIVA. Altogether our studies show that the tripartite interplay between ParA-DivIVA and PapM controls the switch between cell division and cell elongation and in this way affects the mycobacterial cell cycle.ImportanceThe genus of Mycobacteria includes important clinical pathogens (M. tuberculosis). Bacteria of this genus share the unusual features of their cell cycle such as asymmetric polar cell elongation and long generation time. Markedly, control of the mycobacterial cell cycle still remains not fully understood. The main cell growth determinant in Mycobacteria is an essential protein DivIVA, which is also involved in cell division. DivIVA activity is controlled by phosphorylation but the mechanism and significance of this process is unknown. Here, we show how the previously established protein interaction partner of DivIVA in Mycobacteria, the segregation protein ParA, affects the DivIVA subcellular distribution. We also demonstrate the role of a newly identifiedM. smegmatisDivIVA and ParA interaction partner, a protein named PapM, and we establish how their interactions are modulated by phosphorylation. Demonstrating that the tripartite interplay affects the mycobacterial cell cycle contributes to general understanding of mycobacterial growth regulation.