BMJ Leader最新文献

{"title":"What can healthcare organisations do to improve medical engagement? A systematic review.","authors":"Jen Perry","doi":"10.1136/leader-2023-000963","DOIUrl":"https://doi.org/10.1136/leader-2023-000963","url":null,"abstract":"<p><strong>Background: </strong>Medical engagement is linked to improved outcomes for staff and patients including a reduction in staff turnover. There are significant problems with recruitment and retention of doctors globally, it is, therefore, important to try to increase medical engagement within healthcare organisations. This systematic review aimed to review evidence from 2018 to 2023 from peer-reviewed journals on interventions to improve medical engagement and from this generate practical recommendations for healthcare organisations.</p><p><strong>Method: </strong>A search strategy was developed and used across six databases alongside citation searching. Articles were screened to check whether they met the study criteria and were then critically appraised. The interventions were extracted and a thematic analysis, using an inductive approach, was undertaken.</p><p><strong>Results: </strong>15 articles were found to have met the criteria, however, the studies were generally found to be of low-quality research evidence. The interventions from the articles were grouped into nine themes covering topics such as 'Improvements to working conditions', 'Increasing support to doctors' and 'Rewards/incentives/recognition'.</p><p><strong>Conclusion: </strong>The review generated a wide range of interventions which could be used to improve medical engagement, however, critical appraisal revealed that they were of low-quality evidence, so their effectiveness should be interpreted with some caution. The majority of the interventions were transferable to healthcare settings, with some limitations depending on the country. Several HR models were described as options for implementing these interventions within healthcare organisations. Further high-quality research is needed in this area.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019043","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":"Ivory tower in MD/PhD programmes: sticky floor, broken ladder and glass ceiling.","authors":"Achint Lail, Jeffrey Ding, Brayden K Leyva, Sabeena Jalal, Sunny Nakae, Saleh Fares, Faisal Khosa","doi":"10.1136/leader-2024-001003","DOIUrl":"https://doi.org/10.1136/leader-2024-001003","url":null,"abstract":"<p><strong>Objective: </strong>Achieving gender equity in academic medicine is not only a matter of social justice but also necessary in promoting an innovative and productive academic community. The purpose of this study was to assess gender distribution in dual MD/PhD academic programme faculty members across North America.</p><p><strong>Methods: </strong>Academic metrics were analysed to quantify the relative career success of academic faculty members in MD/PhD programmes. Measured parameters included academic and leadership ranks along with nominal research factors such as peer-reviewed research publications, H-index, citation number and years of active research.</p><p><strong>Results: </strong>Χ² analysis revealed a statistically significant (p<0.0001, χ²=114.5) difference in the gender distribution of faculty and leadership across North American MD/PhD programmes. Men held 74.2% of full professor positions, 64% of associate professor positions, 59.4% of assistant professor positions and 62.8% of lecturer positions. Moreover, men occupied a larger share of faculty leadership roles with a statistically significant disparity across all ranks (p<0.001, χ²=20.4). A higher proportion of men held positions as department chairs (79.6%), vice chairs (69.1%) and programme leads (69.4%).</p><p><strong>Conclusion: </strong>Gender disparity was prevalent in the MD/PhD programmes throughout North America with women achieving a lower degree of professional stature than men. Ultimately, steps must be taken to support women faculty to afford them better opportunities for academic and professional advancement.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894523","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":"Role of emotions in change and change management in an emergency department: a qualitative study.","authors":"Savithiri Ratnapalan, Daniel Lang, Katharine Janzen, Linda Muzzin","doi":"10.1136/leader-2024-001074","DOIUrl":"https://doi.org/10.1136/leader-2024-001074","url":null,"abstract":"<p><strong>Background: </strong>Changes in emergency departments are frequently implemented to improve efficiency and reduce costs. However, staff acceptance and adoption are crucial for the intended success of changes.</p><p><strong>Objectives: </strong>This study explored staff perceptions of factors influencing the implementation of changes and any common themes linking changes and factors influencing changes in an emergency department at a university teaching hospital in the UK.</p><p><strong>Methods: </strong>We used constructivist grounded theory methodology to perform a secondary analysis of 41 interview transcripts of physicians, nurses, support workers and managers involved in paediatric emergency care.</p><p><strong>Results: </strong>Participants identified leadership, communication and education as factors impacting change management. They described many emotions associated with changes and with communication, leadership and education or the lack of any of them during changes. Both positive and negative emotions sometimes coexisted at individual, team or organisational levels. Negative emotions were due to real-life challenges and concern over compromised patient care. Professional values dictated the actions or inactions that transpired either because of these emotions or despite these emotions in health professionals.</p><p><strong>Conclusions: </strong>Emotions to change should be acknowledged and addressed by credible leadership clear communication and education to improve the change process, its success and ultimately, patient care.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876231","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":"Evolving role of the health system CIO: perspectives from 33 health systems.","authors":"Dae Hyun Kim, Christy Lemak, Douglas Jones, Dalton Pena","doi":"10.1136/leader-2023-000969","DOIUrl":"https://doi.org/10.1136/leader-2023-000969","url":null,"abstract":"<p><strong>Objectives: </strong>This study explores the evolving position of the health system chief information officer (CIO) by identifying new core roles for success.</p><p><strong>Methods: </strong>An advisory board of industry executives and system leaders guided the study. Purposeful sampling was used to invite chief executive officer and CIOs from 65 not-for-profit US health systems to participate. Interviews were conducted with 51 executives from 33 different systems, using a comprehensive interview topic guide. Interview transcripts were analysed using NVivo software, focusing on themes related to the evolving role of the health system CIO.</p><p><strong>Results: </strong>Analyses revealed three main themes, with the CIO as (1) enabler of strategic change and transformation, (2) strategic developer of technology and leadership talent and (3) driver of organisational culture.</p><p><strong>Discussion: </strong>The role of CIO has undergone transformation from technology and information system management to strategic leadership within the broader health system context. It highlights the importance of comprehensive business knowledge for CIOs and the need for other C-suite executives to have a deeper understanding of information and technology.</p><p><strong>Conclusion: </strong>As healthcare continues to evolve, the role of the CIO is expected to expand further, requiring a blend of technical and strategic business skills. This evolution presents opportunities for health systems to enhance their leadership development programmes, preparing leaders for the complexities of the contemporary health system sector.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876247","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":"Without medical education, a learning healthcare system cannot learn.","authors":"Michael A Barone, Carol Carraccio, Alison Lentz, Robert Englander","doi":"10.1136/leader-2023-000746","DOIUrl":"https://doi.org/10.1136/leader-2023-000746","url":null,"abstract":"","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724575","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":"Digital innovative healthcare during a pandemic and beyond: a showcase of the large-scale and integrated Saudi smart national health command centre.","authors":"Muaddi F Alharbi, Mohammmed Senitan, Dalia Mominkhan, Sidney Smith, Maram ALOtaibi, Michal Siwek, Tim Ohanlon, Fahad Alqablan, Sarah Alqahtani, Mohammed K Alabdulaali","doi":"10.1136/leader-2023-000890","DOIUrl":"https://doi.org/10.1136/leader-2023-000890","url":null,"abstract":"<p><strong>Introduction: </strong>The increasing frequency of pandemics, demand for healthcare and costs of healthcare services require efficient health systems with integrated care via a command centre that ensures a centralised and coordinated approach to exercise effective leadership.</p><p><strong>Description: </strong>We present a case study using the conceptual framework of Franklin to describe the novel system-based engineering approach of the Saudi National Health Command Centre (NHCC) including its features and outcomes measured.</p><p><strong>Discussion: </strong>The NHCC is structured into four departments and four zones with real-time data integration and visualisation on 88 dashboards. To empower leadership, it harnesses artificial intelligence affordances such as machine learning algorithms to enhance functionality, decision-making processes and overall performance. This allows for the rapid assessment of available resources and to monitor healthcare system efficiency at diverse levels of clinical and system indicators. Enhanced proactive capacity management has contributed to reducing lengths of stay, average supply chain lead time and surgery waiting list; early bending of the COVID-19 curve resulting in a low mortality rate; increasing bed capacity; deploying medical staff and mechanical ventilators rapidly; rolling out the COVID-19 vaccination programme and improving patient satisfaction.</p><p><strong>Conclusion: </strong>Integrating a healthcare system with a command centre provides healthcare leaders with the necessary infrastructure to create synergy between people, processes and technologies. This substantially improves both patient and service outcomes. It also allows for immediate care coordination and resource allocations and safeguards ease of access to care.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724574","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":"Evaluation of the first 5 years of the Next Generation GP leadership programme: balancing autonomy and accountability.","authors":"Steve Gulati, Judith A Smith","doi":"10.1136/leader-2024-000985","DOIUrl":"https://doi.org/10.1136/leader-2024-000985","url":null,"abstract":"<p><strong>Background: </strong>In 2017, a group of trainee general practitioners (GPs) came together to design and deliver a six-session leadership development programme for their peer trainee and early career GPs: the Next Generation GP programme. Over 2500 GPs took part in Next Generation GP between 2017 and 2022.</p><p><strong>Aim: </strong>To evaluate the origins and development of the Next Generation GP programme, its early impact on individuals and general practice, and what it reveals about GPs' needs for career and leadership development at a time of major workforce and demand pressures.</p><p><strong>Methods: </strong>A rapid review of evidence on general practice workforce and career trends informed the design of qualitative research interviews (n=28) with a purposive sample of programme participants, primary care leaders and educational experts. This was supplemented by analysis of secondary data from participant evaluations of programme workshops.</p><p><strong>Results: </strong>Many programme participants reported: improved competence in leadership skills, increased understanding of the health system, having new support networks and more energy for their GP role. Respondents pointed out the strengths of the programme, also highlighting ways in which it could be adapted to enable a transition to a more sustainable position within broader clinical and leadership career development.</p><p><strong>Conclusions: </strong>Next Generation GP has to date largely fulfilled its programme objectives. It now needs more tangible, longer-term objectives against which to assess outcomes. This evaluation has contributed to evidence about primary care leadership needing more policy attention, for the balance of autonomy and accountability within GP leadership needs careful and sustained support.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617303","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":"Building towards organisational resilience and complexity leadership: a case study of impacts and changes in a Dutch blood establishment during COVID-19","authors":"Praiseldy K Langi Sasongko, Mart Janssen, Martine de Bruijne","doi":"10.1136/leader-2024-001008","DOIUrl":"https://doi.org/10.1136/leader-2024-001008","url":null,"abstract":"Objectives This study examined how one large blood-related establishment coped and adapted during the first 1.5 years of the pandemic by evaluating the impacts and changes on its resources, communication, collaborations, and monitoring and feedback. Furthermore, we explored whether elements of complexity leadership emerged during this time. Design Duchek’s organisational resilience framework was primarily used. We followed a three-step sequential approach: (1) a document analysis of over 150 intranet, internet and internal reports; (2) 31 semistructured interviews with employees and (3) four feedback sessions. Setting Sanquin is known as the Dutch national blood bank and a large multidivisional expertise organisation in the Netherlands. Results Sanquin coped well. Respondents accepted the crisis and catalysed many collaborations to implement solutions, which were communicated to the public. There were many positive aspects related to internal collaborations, yet challenges remained related to its historical siloed structure and culture. Sanquin adapted partially. Many respondents experienced the organisation becoming more connected and flexible during the pandemic. However, Sanquin was not permanently changed due to significant leadership changes and organisational restructuring occurring simultaneously. Respondents reflected on lessons learnt, including the need for continual collaboration and improvements in Sanquin’s culture. An important driver in the successful coping was management’s enabling attitude and the adaptations occurring within and through the collaborative groups. Conclusions Sanquin improved its organisational resilience by exhibiting elements of adaptive spaces, enabling leadership and (temporary) emergence from complexity leadership. This illuminates how the organisation could continue benefiting from complexity leadership for non-crises and for future uncertainties. No data are available. The qualitative data are not publicly available due to the identifying nature of the transcripts and lack of consent from participants to publicly share this data.","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":"27 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141588659","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":"Cultivating the next generation of healthcare leaders: reflections from an established healthcare leader.","authors":"Rakhshan Kamran, Andrea S Doria","doi":"10.1136/leader-2024-001037","DOIUrl":"https://doi.org/10.1136/leader-2024-001037","url":null,"abstract":"<p><strong>Background: </strong>Dr Andrea Doria is Professor and Vice-Chair of Radiology (Clinical Practice Improvement) at the University of Toronto, Research Director, Senior Scientist and Imaging Lead of Personalised Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada. Over the past few decades, Dr Doria has established a track record of healthcare leadership. Based on Dr Doria's extensive leadership experience, she believes it is essential for established healthcare leaders to be involved in cultivating emerging healthcare leaders.</p><p><strong>Methods: </strong>An interview was conducted with Dr Doria to learn about key lessons she believes are essential for healthcare leaders to help develop the next generation. Dr Doria reflected on her leadership style and experiences, sharing what has worked to improve the effectiveness of her teams.</p><p><strong>Results: </strong>Key messages were reflected upon, including practical ways for senior leaders to support the next generation; leadership insights gained from the pandemic; the importance of building diversity in teams and nurturing leaders from underrepresented minorities; challenges to be aware of for the future of healthcare leadership; finding inspiration from team members and essential traits for healthcare leaders.</p><p><strong>Conclusion: </strong>Through cultivating the next generation of healthcare leaders, established leaders can be involved in establishing a brighter future for healthcare. This article describes reflections and practical takeaways that can help established leaders support emerging leaders and build their leadership skills.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591635","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 development programmes in healthcare research: a systematic review, meta-analysis and meta-aggregation","authors":"Harry Kingsley-Smith, Christian E Farrier, Daniel Foran, Koot Kotze, Kamal Mahtani, Sarah Short, Anna Mae Scott, Oscar Lyons","doi":"10.1136/leader-2024-000976","DOIUrl":"https://doi.org/10.1136/leader-2024-000976","url":null,"abstract":"Background Academic institutions benefit from researchers adopting leadership positions and, subsequently, leadership development programmes are of increasing importance. Despite this, no evaluation of the evidence basis for leadership development programmes for healthcare researchers has been conducted. In this study, the authors reviewed leadership development programmes for healthcare researchers and aimed to identify their impact and the factors which influenced this impact. Methods The authors searched MEDLINE, EMBASE, CINAHL and PsycINFO between January 2000 and January 2023 for evaluations of leadership development programmes with healthcare researchers. The authors synthesised results through exploratory meta-analysis and meta-aggregation and used the Medical Education Research Study Quality Instrument (MERSQI) and Joanna Briggs Institute (JBI) Checklist for Qualitative Studies to identify higher-reliability studies. Results 48 studies met inclusion criteria, of which approximately half (22) met the criteria for higher reliability. The median critical appraisal score was 10.5/18 for the MERSQI and 3.5/10 for the JBI. Common causes of low study quality appraisal related to study design, data analysis and reporting. Evaluations principally consisted of questionnaires measuring self-assessed outcomes. Interventions were primarily focused on junior academics. Overall, 163/168 categorised programme outcomes were positive. Coaching, experiential learning/project work and mentoring were associated with increased organisational outcomes. Conclusion Educational methods appeared to be more important for organisational outcomes than specific educational content. To facilitate organisational outcomes, educational methods should include coaching, project work and mentoring. Programmes delivered by external faculty were less likely to be associated with organisational outcomes than those with internal or mixed faculty, but this needs further investigation. Finally, improving evaluation design will allow educators and evaluators to more effectively understand factors which are reliably associated with organisational outcomes of leadership development. Data are available on reasonable request.","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":"36 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141587226","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}