BMJ Leader最新文献

{"title":"Curriculum mapping to audit and grow longitudinal graduate medical education leadership training.","authors":"Andrew Goodwin, Kathryn Hughes, Joshua Hartzell, William Rainey Johnson","doi":"10.1136/leader-2023-000854","DOIUrl":"https://doi.org/10.1136/leader-2023-000854","url":null,"abstract":"<p><strong>Background: </strong>Residents need and want practical leadership training, yet leadership curricula are lacking in graduate medical education (GME). We describe our process of curriculum mapping, a method for auditing a curriculum, and its role in iterative leadership curriculum development.</p><p><strong>Aims: </strong>To show how to create a curriculum map for auditing a curriculum using examples from our leadership curriculum and to demonstrate its value through case examples of leadership education integration into existing resident experiences.</p><p><strong>Methods: </strong>We selected our recent systematic review on current leadership curricula to prioritise leadership content given it was the basis for our initial curriculum. We identified existing resident experiences where training can occur. We use the selected content and training environments, layered with a modified Miller's pyramid, to construct a curriculum map.</p><p><strong>Results: </strong>Our curriculum map provides an example of curriculum auditing that reveals opportunities for leadership training that could be integrated into current residency experiences. We provide case examples of application.</p><p><strong>Discussion: </strong>Effective leadership training should address critical topics and capitalise on experiential learning opportunities that exist within residency training programmes. The training must be seamlessly integrated into the demanding obligations of GME trainees, a process that can be achieved using curriculum mapping. Curriculum mapping can provide insight into a residency programme's leadership curriculum and create a direction for future leadership curriculum development.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946268","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":"Well-being in newly qualified doctors: exploring the value of peer-led reflective sessions","authors":"Christen Van Den Berghe, Yvette Jaffe, Emily Lachmann, Zahra Ladan, Amber Buckland, Sue Laurent, Sarah Needleman, Shanthi Shanmugalingam","doi":"10.1136/leader-2023-000917","DOIUrl":"https://doi.org/10.1136/leader-2023-000917","url":null,"abstract":"Introduction Following the COVID-19 pandemic and ongoing pressures within the National Health Service, there has been an increasing concern about the well-being of junior doctors in the UK. Newly qualified doctors are particularly vulnerable due to the significant shift in responsibility they experience. Objectives To implement peer-led reflective session for foundation year 1 (FY1) (first-year postgraduation) doctors and to create a dedicated space in which doctors could share difficult or challenging experiences. Methods In 2021 and 2022, peer-led reflective sessions were held for FY1s in a district general hospital in London, England. Feedback assessing well-being, perceived levels of support, as well as session benefits and areas for improvement, was obtained throughout the year. Qualitative feedback underwent thematic analysis to understand key benefits of the sessions. Results Feedback collected at the launch of the initiative revealed that over 80% of respondents agreed or strongly agreed that their mental health and well-being had been negatively impacted by work. The majority felt additional support was needed. All attendees found reflective sessions useful. Key benefits were as follows: the provision of a safe psychological space, sharing experiences and reflecting with peers, building relationships with colleagues and the reassurance that others struggled with similar challenges. Conclusion FY1 doctors reported that starting work negatively affected their well-being and that additional support was needed. Facilitated peer-led reflective sessions were beneficial and offered a supportive environment for FY1s to share and reflect. We propose the initiative can serve members of the wider healthcare team, including doctors of different grades and nurses. Data are available upon reasonable request.","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":"89 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140883724","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":"Reorganising our heads for the care of our health.","authors":"Henry Mintzberg","doi":"10.1136/leader-2023-000912","DOIUrl":"10.1136/leader-2023-000912","url":null,"abstract":"","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139973844","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":"History and its relevance to contemporary and future leadership","authors":"Martin Bricknell","doi":"10.1136/leader-2024-000993","DOIUrl":"https://doi.org/10.1136/leader-2024-000993","url":null,"abstract":"Background/Aim This paper argues that an inquisitiveness into the history of medicine and healthcare organisation is an important characteristic of a leader seeking to understand why facts are as they are, before embarking on leading change. I had the privilege of 34 years of service in the UK Defence Medical Services, culminating in the most senior role of Surgeon General. I, and many of my military medical colleagues, are members of the Faculty of Medical Leadership and Management. Through this, I hope that we have been able to add an interesting dimension to the practice of medical leadership in UK health organisations. Methods This paper is a reflection on my personal experience suggesting that studying the history of military medicine can provide insights into the collective knowledge of previous generations, the process of organisational development during war, and the clinical and system innovations needed for the next war. Results This paper summarises my personal experience of the relevance of the history of military medicine in clinical practice and policy development within the UK Defence Medical Services. It has five sections starting with history as a trajectory of knowledge, and how this links to my personal career. I then show how history informed my leadership influence on policy and practice in four topics: the prevention of heat illness, the organisation of medical services, partnerships in military medicine, and organisational learning. The paper is framed around my personal experience over a career that spanned clinical practice, policy development, leadership on military operations, and finally senior strategic roles. Conclusion While I have placed my argument in the context of military medical leadership, I suggest that understanding history is just as important in civilian medical leadership. No data are available.","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":"17 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140568345","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":"How the ‘Health Leader-as-Coach’ benefits health leaders, their teams, peers, organisation and the system","authors":"Fiona Jane Day","doi":"10.1136/leader-2023-000870","DOIUrl":"https://doi.org/10.1136/leader-2023-000870","url":null,"abstract":"One of the main ways in which health leaders at all levels can be developed on a daily basis has been neglected by clinical leadership research, and by the research community generally, relating to the leader consciously using evidence-based coaching skills to positively impact their direct reports, team members, peers, organisations and the wider system in the context of their vocational role, as ‘Leader-as-Coach’. This paper summarises the research on the role of ‘Leader-as-Coach’, and translates the learning from this into the practice of clinical leadership development. Line managers are increasingly expected to use a coaching approach and are in an ideal position to do so. While there are many similarities with professional external coaching, the behaviours of the ‘Leader-as-Coach’ are also not identical and multiple ethical issues can arise. There is no consistent academic definition to describe the behaviours of coaching in the context of a leader’s vocational role, nor yet specific competencies for training or supervision purposes. The outcomes are summarised from the known literature in this field. Individual and system challenges are then discussed and conclusions are drawn about what this research means in practice for clinical leaders and their systems. No data are available. This is a review paper with references.","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":"1 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140567793","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":"Comparing hospital leadership and front-line workers’ perceptions of patient safety culture: an unbalanced panel study","authors":"Jayson Forbes, Alejandro Arrieta","doi":"10.1136/leader-2023-000922","DOIUrl":"https://doi.org/10.1136/leader-2023-000922","url":null,"abstract":"Background/aim This article examines the relationships between workers’ hospital leadership status, hospital front-line status and patient safety culture in hospitals throughout the USA. By identifying possible disparities in perception, targeted interventions can aim at decreasing differences between the two groups to increase the quality of healthcare. Method Data from 1 739 083 individuals, spreading across 1810 hospitals between 2008 and 2017 were collected. 115 228 (6.63%) self-identified as leaders, and 772 505 (44.42%) self-identified as front-line workers. The participants also filled in information describing their demographics in reference to the hospital, such as how long they have worked at the facility, their working unit and their occupation. Results Results showed that leaders responded more positively to items that are directly related to management, such as ‘my supervisor/manager says a good word when he/she sees a job done according to established patient safety procedures’ (0.33, p<0.01), where 0.33 signifies that leaders had an average response more positive by 0.33 compared with all other occupations on a Likert scale of 1–5. Based on multiple F-tests, all items have shown a statistical significance between leadership and front-line groups. Conclusion The findings highlight a compelling link between leadership roles and patient safety culture in hospitals, as well as between front-line worker status and patient safety culture. Moreover, a pronounced divergence in viewpoints regarding patient safety culture exists between hospital leaders and front-line staff. An in-depth investigation is necessary to comprehend the ramifications of these outcomes. Data may be obtained from a third party and are not publicly available. Deidentified participant data-Contact: SOPSResearchData@westat.com- Website: <https://www.ahrq.gov/sops/databases/research-datasets.html>- Reuse: Must send data request form to above contact. The SOPS data used in this analysis was provided by the SOPS Database. The SOPS Database is funded by the US Agency for Healthcare Research and Quality (AHRQ) and administered by Westat under Contract Number HHSP233201500026I/HHSP23337004T.","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":"49 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140567794","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":"Pilot study exploring the presence of leadership curricula in undergraduate medical education","authors":"Melanie Korndorffer, Michael A Dewsnap, Erin S Barry, Neil Grunberg, David W Musick, Joann Farrell Quinn","doi":"10.1136/leader-2023-000957","DOIUrl":"https://doi.org/10.1136/leader-2023-000957","url":null,"abstract":"Introduction The physician’s role in the healthcare delivery system extends beyond patient care to include numerous critical leadership roles in healthcare. In addition to treating patients, physicians manage multidisciplinary teams and influence policies to optimise public health. Yet, leadership education is not currently emphasised as part of undergraduate medical education. The purpose of this pilot study was to survey US allopathic medical schools about their current leadership curricula for medical students, including aspects that promote or inhibit effective curricular implementation. Methods A survey was developed and administered to representatives at US allopathic medical schools regarding the presence and nature of leadership curricula for medical students currently in place, as well as barriers to effective implementation. Results A total of 41 of 144 medical schools (28%) responded to the survey. Of the schools that responded, 25 schools reported the presence of a leadership curriculum. Primary competencies and goals were similar among these institutions, but the structure of the curriculum and how it is being implemented varied. The study did not identify consistent methods of assessing student leadership competencies. Themes of improved communication and integration within the curriculum emerged as actions promoting successful implementation. Financial restraints and buy-in among stakeholder groups (eg, faculty, staff and students) were mentioned most frequently as barriers to the effective implementation of leadership curricula. Conclusions Although leadership education within undergraduate medical education is emphasised by a variety of groups, including the Association of American Medical Colleges, medical schools do not appear to universally address this topic. The Liaison Committee on Medical Education, the primary accrediting body for medical schools, does not currently require leadership education as a core topic for accreditation. To provide effective education on leadership to medical students, administrative bodies could improve their support for this topic by considering the factors identified that both hinder and promote implementation. Data are available upon reasonable request. Survey data may be furnished upon reasonable request.","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":"33 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140567795","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":"Paradox of navigating uncertainty: ancient ‘soft stuff’ makes us tough","authors":"James K Stoller, Alan Kolp, Andy Walshe, Peter Rea","doi":"10.1136/leader-2023-000932","DOIUrl":"https://doi.org/10.1136/leader-2023-000932","url":null,"abstract":"All leaders are impacted by uncertainty and the accompanying stress. What is often missing is a framework for leaders to cope with and ideally thrive in circumstances beyond our control. Without a framework, uncertainty can cause us to become fearful, disoriented and uprooted. We cling to a life that may no longer be available, and consequently, we may struggle to adapt. The central thesis of this perspective, which is supported by time-honoured concepts from great thinkers and current empiric evidence,1 is that humans’ ability to navigate uncertainty and stress and leaders’ ability to lead through tough challenges is enhanced when their character—their identity—is anchored by what is often considered ‘soft stuff’—the seven classic virtues of trust, compassion, courage, justice, wisdom, temperance and hope. As evidence of the robustness of this thesis, these virtues have been espoused as the way to live by great thinkers over millenia—Aristotle, Plutarch, Heraclitus, Confucius, Lao Tse.1 Extending the concept that a virtue-based character is key to navigating uncertainty, we propose that our identity informs other important assets that build resilience—our purpose and our relationships. Taken together, these three elements—identity, relationships and purpose—have been espoused as tools to navigate transitions2 and help leaders lead through the inevitable uncertainty that defines the human journey. We begin by framing the current state of stress in the world—dubbed the ‘polycrisis’3—and then develop the thesis. On the one hand, it is curious to think that we need research to prove that a person, team or organisation governed by trust, compassion, courage, justice, wisdom, temperance and hope would have higher levels of engagement despite uncertainty than a dysfunctional person, team or organisation defined by distrust, callousness, cowardice and despair. On the other hand, there is ample evidence that makes the case for virtue as a resilience …","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":"103 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140568251","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":"'You just don't feel like your work goes recognised': healthcare worker experiences of tension related to public discourse around the COVID-19 pandemic.","authors":"George Thomas Timmins, Julia I Bandini, Sangeeta C Ahluwalia, Armenda Bialas, Lisa S Meredith, Courtney Gidengil","doi":"10.1136/leader-2024-000983","DOIUrl":"https://doi.org/10.1136/leader-2024-000983","url":null,"abstract":"<p><strong>Objectives: </strong>To understand the impact of public discourse and reaction around the COVID-19 pandemic on healthcare worker (HCW) experiences and well-being caring for patients with COVID-19.</p><p><strong>Methods: </strong>We conducted 60 min in-depth interviews with 11 physicians and 12 nurses who were providing care to patients with COVID-19 in acute care settings at two health systems in the Western USA. Interviews were conducted in Spring-Summer 2022 using a semi-structured interview protocol that guided respondents through different stages of the pandemic.</p><p><strong>Results: </strong>Three themes emerged from the data around providing care in the unique social context of the COVID-19 pandemic including: (1) public polarisation and disagreement with science; (2) feelings of hope and optimism during the pandemic and (3) the compounded strain of providing care within this unique social context of the pandemic.</p><p><strong>Conclusions: </strong>To prepare for future pandemics, improved public health communications and social-emotional supports for HCWs are critical to ameliorate the physical and emotional impacts related to the social context of modern US pandemic response.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140327220","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":"Vital role of clinicians in reducing the NHS carbon footprint through smarter procurement decisions.","authors":"Nada Al-Hadithy, Katie Knight, Anya Gopfert, Maria Van Hove, Xana Villa Garcia","doi":"10.1136/leader-2022-000722","DOIUrl":"10.1136/leader-2022-000722","url":null,"abstract":"<p><strong>Background: </strong>The NHS' impact on the environment is significant, accounting for 5.9% of the national carbon footprint of the UK and 20 million tonnes of carbon dioxide equivalent (Mt CO₂e) emissions a year.The procurement of goods and services is responsible for 72% of the NHS carbon footprint-equivalent to 15.2Mt CO₂e. Procurement is, therefore, a priority focus area to consider, if carbon reductions are to be made. The impact of procurement decisions extends over the 'whole life'-from identification of the need for a product or service through to the provision of the product or service and including the product's 'end of life' process (disposal).From April this year, any new procurement needs to have a 10% net zero and social value weighting. From April 2023 onward, any new procurement two times per day should incorporate carbon footprint and environmental impact.This paper aims to introduce clinicians to the concept of green procurement and illustrate the potential greenhouse gases savings possible if procurement decisions were informed by the sustainability credentials such as the carbon footprint of a product or the corporate social responsibility programme of the supplier.</p><p><strong>Methods: </strong>While seconded at the Department of Health and Social Care, the senior author on this paper collaborated with the NHS Supply Chain to pilot carbon footprinting of one clinical item. We chose to focus on the 20-gauge 'pink' cannula as a high-volume familiar article; 25 million cannulas are purchased via the NHS Supply Chain each year, of which the most commonly used size is the 20 gauge.</p><p><strong>Results: </strong>Of the seven companies approached, five sent us their CSR strategies. Four companies provided product primary data, and of these four, one provided sufficient data to carry out a carbon footprint analysis. The one set of detailed data provided was for two 20-gauge cannulas, 1 with wings and 1 without. The total carbon footprint for Cannula 1 is 33.92 g CO₂e. The total carbon footprint for Cannula 2 is 35.45 g CO₂e. This amounts to a 1.54 g CO₂e difference between the 2 cannulas.</p><p><strong>Conclusion: </strong>It is both necessary and possible for the NHS to demonstrate leadership in reducing the carbon footprint of healthcare.We have provided an overview of NHS procurement to empower clinicians to get involved with local and national decision-making. We have demonstrated the potential carbon savings that could be made through careful choice of products. We have also highlighted the risks if clinicians do not engage with green procurement.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":"43-48"},"PeriodicalIF":2.7,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9936895","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}