title: Implementing Health and Safety Policy Changes at the High School Level From a Leadership Perspective.
abstract: BACKGROUND
  Although consensus statements and recommendations from professional organizations aim to reduce the incidence of injury or sudden death in sport, nothing is mandated at the high school level. This allows states the freedom to create and implement individual policies. An example of a recommended policy is heat acclimatization. Despite its efficacy in reducing sudden death related to heat stroke, very few states follow the recommended guidelines.
  
  
  OBJECTIVE
  To retroactively examine why and how 3 states were able to facilitate the successful creation and adoption of heat-acclimatization guidelines.
  
  
  METHODS
  Qualitative study.
  
  
  METHODS
  High school athletic associations in Arkansas, Georgia, and New Jersey.
  
  
  METHODS
  Eight men and 3 women (n = 11; 6 athletic trainers; 2 members of high school athletic associations; 2 parents; 1 physician) participated. Participant recruitment ceased when data saturation was reached.
  
  
  METHODS
  All phone interviews were digitally recorded and transcribed verbatim. A grounded-theory approach guided analysis and multiple analysts and peer review were used to establish credibility.
  
  
  RESULTS
  Each state had a different catalyst to change (student-athlete death, empirical data, proactivity). Recommendations from national governing bodies guided the policy creation. Once the decision to implement change was made, the states displayed 2 similarities: shared leadership and open communication between medical professionals and members of the high school athletic association helped overcome barriers.
  
  
  CONCLUSIONS
  The initiating factor that spurred the change varied, yet shared leadership and communication fundamentally allowed for successful adoption of the policy. Our participants were influenced by the recommendations from national governing bodies, which align with the institutional change theory. As more states begin to examine and improve their health and safety policies, this information could serve as a valuable resource for athletic trainers in other states and for future health and safety initiatives.
authors.affiliation: Department of Kinesiology, Temple University, Philadelphia, PA;
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Pagnotta
authors.affiliation: Department of Kinesiology.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Mazerolle
authors.affiliation: Department of Kinesiology and Physical Education, Northern Illinois University, DeKalb.
authors.forename: William A
authors.initials: WA
authors.lastname: Pitney
authors.affiliation: §Department of Educational Leadership, University of Connecticut, Storrs;
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Burton
authors.affiliation: Department of Kinesiology.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Casa
mesh_terms: D000064:Acclimatization / Q000502:physiology; D000328:Adult; D001131:Arkansas; D056352:Athletes / Q000706:statistics & numerical data; D016022:Case-Control Studies; D005260:Female; D005845:Georgia; D006284:Health Plan Implementation; D006291:Health Policy; D018883:Heat Stroke / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007857:Leadership; D008297:Male; D009515:New Jersey; D061214:Patient Safety; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D012189:Retrospective Studies; D012572:School Health Services; D013177:Sports / Q000706:statistics & numerical data; D013334:Students / Q000706:statistics & numerical data
keywords: heat acclimatization; institutional theory; shared authority