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Something important seems to have been lost that once made adversity in the health care workplace tolerable or even enjoyable. Many of the same tasks that used to be surrounded by fun no longer have that aura. This article explores eight structural factors that collectively explain why health care managers report having much less fun at work recently. It suggests redefining what having fun at work means in the first instance and proposes a new conception focused on pursuing worthwhile health care goals. Health care managers should abandon many former notions of fun, let fun evolve from the work itself, and trust staff members to determine what they consider to be fun at work. [ABSTRACT FROM AUTHOR]

There is a growing consensus that a hybrid of two common approaches to quality improvement (QI), local participatory QI and expert QI, might be the best method for achieving quality care. Achieving such a hybrid requires that content experts establish an ongoing dialogue with both frontline staff members and managers. In this study we examined frontline staff members' and managers' preferences regarding how to conduct such a dialogue, and we provide practical suggestions for implementation. The two groups shared a number of preferences (e.g., verbal face-to-face exchanges, discussions focused on quality of care). There were also some differences. For example, although managers were interested in discussions of business aspects (e.g., costs), frontline staff members were concerned with workload issues. Finally, although informants acknowledged that engaging in a QI dialogue was time consuming, they also believed it was essential if health care organizations are to improve the quality of care they provide. [ABSTRACT FROM AUTHOR]