BMJ Leader最新文献

Background: Major global trends are reshaping health services delivery, and preparing current and future healthcare leaders requires an understanding of these trends. A well-designed leadership competency model can provide guidance for individuals, as well as for system-level leadership development and integration programmes.

Objective: To describe the process of updating the International Hospital Federation's (IHF) Global Healthcare Management Competency Directory.

Methods: Revisions were informed by a recent foresight study of major trends in health services delivery, and an evidence-informed framework of leadership competencies. The original framework competencies were reviewed by 45 subject-matter experts from 30 countries and regions, who provided feedback through electronic surveys and online interviews. We incorporated this iterative feedback to revise the framework design, competencies within the framework and their associated behavioural descriptions.

Results: A total of 45 subject-matter experts from 30 countries and regions participated in 1 or more phases of the survey process. The resulting leadership competency model includes 32 competencies organised into a framework of 6 domains: values, self-development, execution, relations, context management and transformation.

Conclusion: The updated IHF Leadership Model provides a robust, evidence-based and up-to-date resource for assessing and developing future-ready healthcare leaders.

Introduction: 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.

Description: 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.

Discussion: 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.

Conclusion: 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.

Background: The COVID-19 pandemic presented unprecedented challenges for leaders in healthcare requiring decision-making and crisis response that can often be tricky without the right level of trust. Trust is fostered and facilitated with emotional intelligence (EI); thus, a critical examination of medical leaders' reflections was essential to understand how leaders perceived their leadership responses during the initial response to COVID-19. This exploratory study used an EI lens to investigate leaders' perceptions of their decision-making during COVID-19.

Methods: A purposeful sample of seven leaders in medicine who experienced leading during COVID were invited to participate in semi-structured interviews.

Results: Four themes around leadership response during the uncertain times of the COVID-19 were identified. The themes included communication, interprofessional collaboration including decision-making and strategic planning, internal and external awareness, and finally, trust and psychological safety.

Conclusions: Incorporating EI competencies into crisis leadership education for healthcare professionals could enhance medical leaders' preparedness to adapt, collaborate and communicate effectively in a crisis.

Background: Like other fields in medicine, medical education relies on collaboration and cooperation between countries and regions of the world, although no single institution or position unifies the global medical education community in the way that the WHO does in public health, for example. Recent research in medical education has drawn attention to many injustices that exist in the field, where power and influence is held in relatively few Global North countries, although most practice happens in Global South countries.

Methods: In this article, we examine three positions that hold global prominence in medical education, including the presidents of the World Federation for Medical Education and the Association for Medical Education in Europe, and winners of the Karolinska Institutet Prize for Research in Medical Education.

Findings: We highlight that these positions have problematic histories and have perpetuated the current power disparities in the field. We argue that an alternative model for global leadership is required that should be determined democratically by those involved in medical education all around the world. Such a model should prioritise diversity and inclusivity, empowering leaders from countries who have previously been peripheral to the decision-making platforms in the field.

Conclusion: Given the shortcomings of existing leadership positions and organisations, we suggest that a new institution is required to realise this new vision, and that the principles that govern it should be determined through debate and democracy, with a focus on inviting those voices that have not previously been heard in global medical education circles.

Background: Effective healthcare leadership has been linked to improved individual and organisational outcomes globally. However, evaluations of healthcare leadership development programmes have often been of low quality. This study investigates the evaluation and decision-making needs of stakeholders for the Oxford Emerging Leaders Programme and aims to redesign its evaluation approach.

Methods: Drawing from Michael Quinn Patton's utilisation-focused evaluation approach, semistructured interviews were conducted with 12 key programme stakeholders. Interviews were thematically analysed to identify key areas for useful and impactful evaluation.

Results: Three main themes were identified: impact on patients, impact on healthcare organisations and individual outcomes. Individual outcomes were further divided into skills and qualities. Stakeholders emphasised the importance of measuring improvements in organisational culture, as well as from the perspectives of patients and individual leaders. The need for a multifaceted and longitudinal evaluation approach was highlighted.

Conclusions: The study underscores the importance of aligning evaluation methods with stakeholder needs. Tailoring evaluations to specific programme aims and incorporating both qualitative and quantitative measures can enhance their utility. These insights contribute to the broader literature on healthcare leadership development and programme evaluation.

Background: Healthcare leadership and management impacts every patient journey and every staff experience. Good leadership results in positive outcomes. Kindness is an understudied and underused leadership strategy. The research questions addressed in this study are the following: (1) Does kindness in healthcare leadership and management currently meet the criteria of a mature concept?; (2) Using concept analysis methodology, can we develop our understanding of kindness within this context?

Methods: A systematic search of the peer-reviewed literature was conducted to inform a concept evaluation, followed by a concept analysis. Search terms consisted of 'leader*' or 'manage*' and 'kindness'; databases searched comprised MEDLINE, HMIC, SPP, APA PsycInfo and CINAHL. Data extraction and thematic analysis of the data were performed manually according to concept analysis principles.

Results: The 10 papers included from the search suggested that within healthcare leadership and management, kindness is an 'emerging' rather than a 'mature' concept. Concept analysis demonstrated a cluster of recurring attributes, allowing a theoretical definition to be put forth.

Conclusions: Despite being a commonly used lay term, kindness in the context of healthcare leadership and management is not yet a mature concept. Work developing this concept is needed to validate the proposed theoretical definition. Observational studies and systematic review of the grey literature are recommended.

Purpose: To examine the consequences of broader spans of control for well-being outcomes among frontline managers.

Method: Healthcare managers were surveyed in collaboration with the Central Denmark Region. The response rate was 74.5%. Using regression analysis, we investigate how span of control is associated with outcomes related to well-being understood as perceived stress, burnout, job satisfaction, satisfaction with the work environment, intention to quit their current job and work-life balance.

Findings: Span of control may be an important factor in establishing well-being among frontline managers in the Danish hospital sector on several parameters. Span of control is associated the strongest with work-life balance and intention to quit, least but significantly with perceived stress and not significantly with burnout.

Practical implications: We recommend that healthcare organisations consider whether it could be more optimal to reduce the span of control for some managers. Furthermore, we recommend that future studies pay attention to span of control and provide stronger causal evidence about its impact on healthcare workers.