BMJ Leader最新文献

{"title":"Emergency Medical Commander: a multimethod case study applying the lens of Path-Goal leadership theory.","authors":"Adelaide Joan Fairweather Michael, Rachael Smithson","doi":"10.1136/leader-2024-001189","DOIUrl":"https://doi.org/10.1136/leader-2024-001189","url":null,"abstract":"<p><strong>Background and aim: </strong>In 2020, the Gold Coast University Hospital emergency department (ED) established a Medical Commander role; a medical leadership position with a focus on optimising patient flow. The objective of this study was to understand how the role executes leadership tasks to promote patient flow and its impact on staff working in and with the ED.</p><p><strong>Methods: </strong>A multimethod case study approach combined data from documents, observations staff interviews and surveys across a breadth of stakeholders. Data were deductively themed and triangulated through the analytical framework of Path-Goal leadership theory to provide a comprehensive analysis of the Medical Commander role functions and impact.</p><p><strong>Results: </strong>The Medical Commander role dynamically exhibits a combination of directive, supportive and participative leadership behaviours to enact and deliver patient flow leadership across a breadth of stakeholders. Path-Goal theory illuminates the environmental and personnel characteristics that have contributed to the role's perceived successes in patient flow and employee motivation. In addition, the application of this theory identifies several crucial enablers, including role characteristics (ie, clinical and service seniority, division-wide oversight and absence of clinical load) that support the dynamic use of leadership behaviours observed in this study and their effect on staff morale and patient flow.</p><p><strong>Conclusions: </strong>As rising demand and complexity increase the risks associated with delays to patient care coordination and flow, the senior-level oversight and enabling leadership behaviours provided by the Medical Commander role represent a viable and effective intervention to manage these gaps.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance-related pay for NHS consultants: exploring views and perceived impacts in one NHS Trust in England.","authors":"Mark Exworthy, Julia Gauly, Jo Parsons, Katlyn Green, Nick Murphy","doi":"10.1136/leader-2024-001000","DOIUrl":"https://doi.org/10.1136/leader-2024-001000","url":null,"abstract":"<p><strong>Background/aim: </strong>To investigate senior doctors' (consultants) views about local clinical excellence awards (CEAs; a form of performance-related pay (PRP)) in theory and in practice.</p><p><strong>Methods: </strong>Online survey of consultants in one National Health Service Trust in England which had implemented new variations to local CEAs. 31% response rate, comprising 250-500 applicants and non-applicants. Descriptive statistics were conducted with quantitative data and content analysis with qualitative data.</p><p><strong>Results: </strong>Most consultants (57%) were supportive of CEAs in theory and in practice. A minority was not supportive (21%). This was justified by not applying (due to opposition, limited time to apply or being apathetic about them); 22% were neutral. About one-third (32%) of respondents had not applied for local CEAs in 2022, mainly because they thought they would be unsuccessful (30%). Two-thirds (67%) of respondents felt that CEAs provided recognition for their work, with female respondents and those working less than full-time expressing most recognition. Respondents were not supportive of the idea that CEAs should be paid fully for those working less than full-time (45% disagreed, 35% agreed, 21% neutral).</p><p><strong>Conclusions: </strong>The exploratory study found mixed support for CEAs. Engagement with CEAs was complicated by pension and tax issues, claims of limited time to apply, and equity concerns about current and previous applications. However, CEAs offered some consultants some recognition for their work. These findings are more nuanced than existing evidence and elaborate extant theoretical perspectives of PRP in relation to doctors.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leadership knowledge and behaviours: outcomes of a full-day leadership workshop focusing on personal growth in foundation doctors.","authors":"Claudia Juliette Jansen van Vuuren, Sharlini Sathananthan, Dina Hamalis, James Fenwick, Martin Patrick Griffiths, Ankur Thapar, Shiva Dindyal","doi":"10.1136/leader-2024-001062","DOIUrl":"https://doi.org/10.1136/leader-2024-001062","url":null,"abstract":"<p><strong>Background: </strong>Effective clinical leadership is required at every level, including in Foundation doctors. Most leadership programmes neglect self-awareness and personal growth aspects of leadership training. We modified the Basildon Leadership Hub to focus on these aspects and evaluated the new programme.</p><p><strong>Methods: </strong>Large group sessions were led by speakers with varied leadership roles, interspersed by breakout sessions incorporating experiential and reflective learning. Attendees answered anonymous surveys before, immediately after, and 2 months after the workshop, with 5-point Likert-scale responses (1=strongly disagree to 5=strongly agree) designed around reaction, knowledge and behaviour levels of evaluation. We assessed differences in median responses using the Mann-Whitney U test with Bonferroni-Holm correction.</p><p><strong>Results: </strong>The full-day workshop was attended by 27 trainees, 93% of whom considered it enjoyable and relevant. Attendees agreed more strongly to the statements 'I am a leader' and 'I know how I can demonstrate and develop my own leadership knowledge, skills and behaviours' in postcourse versus precourse surveys (p<0.001). The follow-up survey had a poor response rate of 26% with non-significant differences.</p><p><strong>Conclusion: </strong>A full-day leadership workshop for Foundation doctors focusing on personal growth resulted in improvement in self-assessed precourse and postcourse knowledge and attitudes; however, poor follow-up response rate limited demonstration of sustained outcomes or changes in behaviour.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diversity in leadership: analysing representation in global committees on climate and health.","authors":"Manish Barik, Kent Buse, Soumyadeep Bhaumik","doi":"10.1136/leader-2024-001146","DOIUrl":"https://doi.org/10.1136/leader-2024-001146","url":null,"abstract":"<p><strong>Background: </strong>Climate change is the greatest threat to global health. There are several working groups at the intersection of climate and health, which provide leadership in global governance around the issue-but their diversity has not been previously analysed.</p><p><strong>Objective and methods: </strong>We analysed 13 active committees, comprising 226 members. Committee members were analysed in terms of World Bank country income status, political grouping (G7 membership), climate vulnerability (being from Small Island Developing States (SIDS) and top 10 in the Global Climate Risk Index, 2021) and gender.</p><p><strong>Results: </strong>We found that 72.1% of the committee members are from high-income countries (HICs), 57.0% are from G7 nations, 2.2% are from SIDS nations, 5.3% are from the top 10 most vulnerable climate vulnerable countries and 45.6% are female. Only three committees exhibit a balanced representation in terms of country income status. Nine committees have more than half of their members from G7 countries. 10 committees do not have representation from SIDS, and 7 lack members from the 10 most climate-vulnerable countries. Eight committees have good gender representation. Most chairs and co-chairs (only six committees reported them) are from HICs (83.3%), with good gender representation. Half of these chairs and co-chairs are from G7 nations, 16.7% are from SIDS and none are from the 10 most climate vulnerable nations.</p><p><strong>Conclusions: </strong>We call on committees to develop policies that are grounded in intersectionality to improve diversity among their members, including for Indigenous/Adivasi people (which we did not analyse) to improve global governance of climate and health.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing nursing and allied health professional leaders: the wider impact of a professional development initiative on leadership.","authors":"Gemma Phillips, Claire Armitage, Katherine Hawker, Kelly Barber, Deanne Rennie, Lizelle Bernhardt","doi":"10.1136/leader-2024-001111","DOIUrl":"https://doi.org/10.1136/leader-2024-001111","url":null,"abstract":"<p><strong>Background: </strong>Effective leadership is necessary across healthcare systems to ensure person-centred safe and effective care delivered by a workforce that is empowered to flourish. Similarly, research is essential to underpin evidence-based clinical practice to optimise the quality of care provided. It is important to develop the capacity and capability of the healthcare workforce to become effective clinical and research leaders; however, there are challenges. The creation of fellowship programmes such as the Director of Nursing and Allied Health Professions (AHPs) Fellowship was inspired by this need to support the skill development of these clinicians.</p><p><strong>Aims: </strong>To report the experiences of nurses, midwives and AHPs (NMAHPs) completing the Director of Nursing and AHP Fellowship programme; a 1-year development programme focussing on leadership, research and quality improvement. To describe the broader impact of the fellowship on NMAHP leadership. To consider the implications of the fellowship on the fellows and the wider organisation and healthcare system.</p><p><strong>Methods: </strong>The evaluation consisted of surveys and focus groups with fellows and mentors supporting them. These included clinical mentors, academic mentors, quality improvement advisors and improvement partners.</p><p><strong>Findings: </strong>The following four themes were identified from the survey and focus group data: leadership development, networking and relationships, collaborative working and communication.Fellows' development within the programme translated into multiple clinicians securing new job roles in clinical leadership positions, and key learning has been incorporated into future iterations of the programme.</p><p><strong>Conclusion: </strong>High-quality patient care relies on the support of research and implementation of evidence-based practice. Investment in the leadership of clinicians is key to promoting a culture of high-quality patient care and evidence-based practice. The Director of Nursing and AHP fellowship contributes to the development of nurses and AHPs implementing national priorities optimising patient care.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives on leadership for medical educators: a qualitative study of leadership qualities identified by US medical school deans.","authors":"Michael J Orrick, Steven Durning, Joshua Hartzell, Anita Samuel","doi":"10.1136/leader-2024-001145","DOIUrl":"https://doi.org/10.1136/leader-2024-001145","url":null,"abstract":"<p><strong>Introduction: </strong>Leaders in medical education face unique challenges and carry the immense responsibility of training the next generation of healthcare professionals. Highly effective leaders are critical in medical education, and degree programmes in health professions education aim to produce these needed academic leaders. This study aims to identify the leadership qualities deemed important by established leaders in medical education to guide the development of health professions education leadership curricula.</p><p><strong>Methods: </strong>From September 2023 to March 2024, the authors conducted semistructured interviews with 23 US medical school deans or recommended members of their staff (eg, Associate Dean for Medical Education) regarding the leadership qualities they deemed important for leading in medical education. The authors then applied reflexive thematic analysis to the interview transcripts to identify themes representing leadership qualities.</p><p><strong>Results: </strong>Transcript analysis demonstrated 12 themes that represent leadership qualities thought to be essential in medical education. These themes included a leader who is driven by values, humble, resilient, emotionally intelligent, puts people first, fosters psychological safety, is collaborative, communicates effectively, makes decisions, acts strategically, drives innovation and is adaptable.</p><p><strong>Conclusion: </strong>This study identified twelve key leadership qualities that US medical school deans perceive as essential for leadership in medical education. These qualities can be organised into personal, interpersonal and system-level qualities, but they are interconnected in practice with qualities being relevant on multiple levels. These findings align with several healthcare leadership models but emphasise resilience and adaptability more distinctly, highlighting unique challenges in medical education. These insights could help refine existing leadership theories and frameworks within the context of medical education and enhance leadership development programmes in medical education and potentially related fields.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Huddles for unprofessional behaviours in the healthcare setting that may require immediate investigation, inquiry or intervention.","authors":"Cynthia A Baldwin, Thomas F Catron, Gerald B Hickson, Scott Aberson, Rebecca M Anderson, Sandy Bledsoe, Michael Brodman, Jeremy Cauwels, Roger Dmochowski, Thomas Hemmen, Brian Hoenerman, Rochelle Johnson, Sonam Kapoor, Daniel Lee, Dustin Lillie, Kristen Mekeel, Steven Meranze, Diane Moate, William Perry, Shira L Robbins, Thomas J Savides, Brijen J Shah, Kimberly Thillman, Craig Uthe, Christian Tomaszewski, Britney Wade, Lynn Webb, William O Cooper","doi":"10.1136/leader-2024-001134","DOIUrl":"https://doi.org/10.1136/leader-2024-001134","url":null,"abstract":"<p><strong>Background: </strong>Some unprofessional behaviours, including allegations of discrimination, hostile work environment, violent behaviour, sexual boundary violations, potentially impaired clinicians, professional integrity and retaliation, require healthcare organisations to have a timely and reliable process to guide investigation, inquiry and/or interventions. Failure to have a consistent approach creates extraordinary risk for organisations, their team members and their patients.</p><p><strong>Methods: </strong>Descriptive study of five health systems that participate in a national professionalism collaborative through the Vanderbilt Health Center for Patient and Professional Advocacy (CPPA) and implemented a huddle process to guide the initial disposition of event reports describing unprofessional behaviours that might warrant investigation, inquiry or intervention. Each site applied lessons learnt over the study period to refine the huddle participants, the process for the huddle and the tracking of information based on their experience.</p><p><strong>Results: </strong>During the study, the participating sites held 219 huddles, which represented <1% of reports processed by CPPA during the study period. The most common type of reports resulting in a huddle included allegations of discrimination (30% of huddles) or hostile work environment (29%). Other common reasons for huddles included violent or aggressive behaviour (15%) or potential sexual boundary violations (13%). Additional reasons for huddles included concerns for an impaired clinician (3%), integrity (2%) or retaliation against a reporter for a previous electronic safety event report (2%).</p><p><strong>Conclusions: </strong>Implementing a huddle to review and guide next steps for reports including allegations of serious behaviours provided the healthcare organisations a process to reduce the variability of response to such reports and fostered increased communication and trust among organisational key stakeholders.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community, courage, culture and care: a qualitative study exploring the experiences of planetary health leadership in the UK health context.","authors":"Rammina Yassaie, Carrie Stephenson","doi":"10.1136/leader-2024-001171","DOIUrl":"https://doi.org/10.1136/leader-2024-001171","url":null,"abstract":"<p><strong>Background: </strong>Planetary health and the delivery of planetary healthcare are growing concerns for health and health institutions globally. While the leadership required to navigate this evolving arena is an area of increasing study, little research exists exploring the experience and perceptions of leaders in this field.</p><p><strong>Aim: </strong>This study aimed to explore the experiences and perceptions of leaders working towards planetary health in the UK health context, with a view to making recommendations on leadership and leadership development in this field.</p><p><strong>Methods: </strong>A qualitative study with 25 participants with experience of planetary health and/or planetary healthcare leadership. Virtual semistructured interviews were used for data collection and thematically analysed.</p><p><strong>Results: </strong>Six themes were identified: creating community; managing the scale of the challenge; morality; creating consensus; shaping culture and identity (as leader and/or as activist).</p><p><strong>Conclusions: </strong>This study highlights the relational, collaborative and moral aspects of leadership as central to the experience of planetary health leadership, offering recommendations for leadership educators to strengthen leadership development in this field. It also identified the critical need for the well-being needs of leaders navigating this emotive and uncharted territory to be appreciated and responded to, along with the importance of legitimising and professionalising action and leadership in this field.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attention-based view of leadership.","authors":"Amit Nigam, Zuhur Balayah","doi":"10.1136/leader-2024-001156","DOIUrl":"https://doi.org/10.1136/leader-2024-001156","url":null,"abstract":"<p><strong>Background: </strong>Healthcare leaders' attention is stretched in healthcare organisations due to the large number of issues that they must respond to. Effectively attending to legitimate attentional demands, which involves deprioritising less important demands, is a defining feature of competent leadership.</p><p><strong>Method: </strong>This piece summarises key findings from research in the attention-based view, integrating its key findings with insights from conversations with healthcare leaders in executive education settings.</p><p><strong>Findings: </strong>The attention-based view develops three premises that explain how organisations structure and channel attention in ways that shape what organisations do: (1) given the scarcity of attention, where leaders focus their attention shapes what they do, (2) people's attention is situated (eg, in the work they do and the meetings they attend) and (3) organisations structure roles and communication channels in ways that shape who pays attention to what. Five lessons drawn from these premises are that leaders should: create an architecture that will address critical issues; be mindful of attentional networks; cultivate opportunities for voice; create attentional capacity and embrace creating attentional coherence as perhaps the core task of leadership.</p><p><strong>Conclusion: </strong>Given the diverse issues, people and demands that characterise contemporary healthcare organisations, effectively focusing attention on what matters is essential if organisations are to function well. A critical task for leaders is to prioritise for themselves and for everyone in their organisation the key issues that should be fundamental to, and hence merit attention from, everyone.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resident doctors: return of the lost tribe.","authors":"Waqas Akhtar, Vivek Trivedi","doi":"10.1136/leader-2025-001229","DOIUrl":"https://doi.org/10.1136/leader-2025-001229","url":null,"abstract":"","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}