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In this age of financial restraint and increasing demands on behalf of consumers, quality is becoming an essential component of any product or service. While this study focuses on aspects of quality within the private rehabilitation segment of the health care industry, there are lessons that may be applied to the field of education. As expectations change and teachers become increasingly accountable for their students' education, issues of quality and cost effectiveness will come to light. Ideally, quality assurance represents a belief that a product or service can exist that satisfies the needs and expectations of both the consumer and producer or the service provider. Traditionally, quality assurance programs in the health care industry focused either on cost containment or risk management. The practitioners' perspective regarding quality is often overlooked. This study identifies benchmarks of quality based on the health care practitioner's perspective. Through the administration of a survey, the researcher identified four categories of benchmarks that were common to physical therapists, occupational therapists, and speech pathologists. These professional groups identified benchmarks that focused on education, communication, attitude, and the success of the therapeutic intervention. This study has potential for the field of education. Like the health care industry, the field of education is also evolving. As people become increasingly concerned about the quality of their children's education and how best their educational dollars are spent, the demands for quality assurance within education will increase.

While operating in Canada during the COVID-19 pandemic, child care professionals (CCPs) implemented and enforced COVID-induced public health practices and protocols (PHPPs), some of which have resulted in new challenges and risks to CCP’s health and safety. However, the experiences of CCPs have been underreported in Canada despite the sector's large footprint in the Canadian economy and the reality that many other essential service sectors rely on child care to function. This research seeks to understand which COVID-induced public health practices and protocols were present in Canadian child care programs, how these PHPPs were perceived by CCPs, and the factors that contributed to impacts that were experienced by CCPs. The data came from a national, web-based survey (English/French), that yielded 1610 responses primarily from CCPs working at licenced child care programs within the Canadian Child Care Federation’s email database and social media pages between June – August 2021. During the COVID-19 pandemic, CPPs implemented and enforced PHPPs and some PHPPs may have resulted in new challenges and risks to CCP’s health and safety. Fomite-based PHPPs, including surface cleaning (99.7%), handwashing with soap (97.4%), and using sanitizer (96.0%), were more commonly reported than airborne-based PHPPs such as masking (93.0%), opening windows (55.9%), using an HVAC system (19.8%). A quarter of CCPs reported using devices that Health Canada either did not recommend or were not widely approved for use against COVID-19. CCPs reported challenges with PHPP implementation, notably not feeling well equipped or trained to use disinfecting and sanitizing products (74.8%), experiencing physical difficulties (74.3%), not having sufficient funds (65.2%), the need for more staff to make working during the pandemic easier (62.9%) and need better guidance from public health officials (61.5%). CCPs were more concerned about a child in their care catching COVID-19 (87.2%) than they were for personally catching the virus (75.6%). Roughly 90% of CCPs experienced stress and other mental health challenges (SMC) and 26.6% reported being less interested in continuing to work in the sector. Four logistic regression models were constructed to determine the factors associated with CCPs’ concerns with personally contracting COVID-19, a child in their care personally contracting COVID-19, as well as factors associated with increased SMC and finally factors associated with less interest in continuing to work in the sector. Independent variables related to demographic characteristics of CCPs and child care programs, PHPPs challenges, and other outcomes from survey questions were identified through bivariate analysis and subsequently entered into a series of multivariate logistical regression models using a backward stepwise algorithm. Several variables were significant in each model and only the most significant are reported here. CCPs were roughly 10 times more likely to report concern over contracting COVID-19 if they perceived the virus as a serious health threat (OR 9.9, 95% CI 6.1-16.0) and were approximately twice as likely to report concern if they reported insufficient funds for PHPP implementation (OR 1.8, 95% CI 1.4-2.4) (R2 =0.212). Similarly, the most significant factor associated with CCPs’ concern for children contracting COVID-19 was if the CCP perceived the virus as a serious health threat (OR 6.3, 95% CI 3.7-10.8) (R2 =0.141). The two independent variables significantly affecting SMC (R2 = .163) were having a pre-existing health condition (OR 2.4, 95% CI 1.6-3.6) and the need for additional staff (OR 2.2, 95% CI 1.5-3.3). Finally, CCPs were over seven times more likely to report being less interested in working in the child care sector if they had experienced SMC (OR 7.4, 95% CI 3.2 12.0) and were almost twice as likely to report being less interested if they reported being not well training and equipped to use disinfecting and sanitizing products as to not pose a risk to human health (OR 1.9, 95% CI 1.3-2.2) (R2 = .148). The findings underscore the multifaceted challenges CCPs faced and the paramount importance of workplace preparedness, contributing to a knowledge gap in current literature, particularly within a Canadian context. This study suggests that by addressing the dissemination of information (including guidance and training), CCPs will experience less SMC and be more likely to be interested in continuing to work in the sector. Moreover, investing in support (e.g., mental health support, financial compensation, more staff) for CCPs who have experienced SMC will improve not only the health of the professional but also the sustainability of the sector.

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