BMJ Leader最新文献

Background: Physicians are planful beings, spending much time imagining and trying to design their ideal careers. Yet, despite actuarial expectations that physicians may spend almost two decades in retirement, it is paradoxical that little attention is generally given to designing an ideal retirement.

Methods: The coauthors are physicians in the latter parts of their careers who both teach leadership to physicians and have thought deeply about physician transitions, including retirement. This perspective narrative is based on their observations, actual experience of colleagues who have retired well and their review of relevant literature.

Results: Several forces restrain physicians from imagining an ideal retirement: first, as with people in general, physicians may be averse to change, and second, thinking about retirement may be framed through a deficit-based lens (eg, "I am retiring because I want to avoid some unpleasant features of my current career.") Though physicians are predisposed to deficit-based thinking by virtue of their longstanding practice of developing differential diagnoses in clinical reasoning, appreciative or asset-based thinking about retirement (eg, "I am retiring because I am attracted to activities that have not otherwise been possible in my career.") offers richer possibilities and is encouraged. A rubric for navigating retirement regards being intentional about identity, relationships and purpose in the new state. A taxonomy for types in retirement is offered, recognising that physicians may exemplify more than one type or migrate among them. Finally, several examples of successful retirement by the authors' colleagues are offered.

Conclusions: We endorse physicians' being as planful and intentional about retirement as they are about designing their careers. Our hope is that the described issues and approach enhance physicians' likelihood to achieve the fulfilment and impact in retirement that they seek.

Introduction: Conflict is an inevitable part of clinical training and often arises from differences in opinions or misunderstandings. Most studies around healthcare conflict focus on perspectives of physicians and nurses, overlooking medical students' unique perspectives. This study explores medical students' experiences with conflicts during clerkship, examining types, triggers, and conflict management styles.

Methods: An educational session introduced medical students to conflict types, conflict management modes, and triggers. A total of 167 students wrote reflections about conflicts experienced or observed during their rotations. Both quantitative and qualitative elements were analysed using thematic content analysis.

Results: Conflicts most frequently occurred during surgery (n=49, 32.9%) and internal medicine (n=41, 27.5%) rotations, often involving residents (n=110, 44.7%) and attendings (n=55, 22.4%). Task-related conflicts were most common (n=113, 53.8%), with students primarily using an avoiding (n=91, 60.3%) mode, while others were perceived as using a competing (n=122, 65.2%) mode. Most conflicts were reported as being handled poorly (n=107, 64.8%). Students described five main conflict triggers: (1) conflicts stemming from unclear expectations; (2) hostile or false communication as a conflict driver; (3) unsafe environments reinforced by hierarchy and power; (4) mistrust in team relationships and (5) resident stress impacting student experiences.

Discussion: Identifying conflict characteristics from a student perspective can guide curricular improvements to better prepare students for clerkships and professional practice. Awareness of conflict management styles, types and triggers enables proactive conflict resolution, fostering growth or constructive outcomes. Findings emphasise the importance of setting clear expectations, maintaining effective communication, building psychologically safe environments, reducing stress and establishing trust between students and residents. Based on medical students' reflections, these patterns may extend to other health professions, offering a broader relevance for training and research in conflict management across clinical settings.

Background and aim: The What Matters to Staff programme was designed at the Royal Free Hospital to address a key priority of improving workforce well-being. The initial aim was to set up a programme that responded to what mattered to staff and could be spread to 70 teams across the hospital within 2 years.

Methods: The programme was developed by adding a set of simple, yet important steps around the 'what matters to you' conversation from the Joy in Work Framework. The programme enrolled its first teams in January 2022 and has since spread widely to over 90 areas and has involved approximately 3000 staff.

Results: There have been significant improvements in staff experience, staff engagement and workforce metrics since the programme began and it is now embedded as business as usual within each division. It was easily scalable on minimal resources due to its standardised and systematic approach and because the programme was seen to drive positive and impactful change.

Conclusion: Over the past 2 years, the programme has given staff the opportunity to have their voice heard and has supported leaders to ask, listen and do what matters most for their teams. This has led to improved workforce metrics and the programme being widely scaled and spread.

Background: For growing healthcare organisations, anchored resources-assets that are not easily movable-may complicate expansion and distort workflow patterns. We examine work patterns at a radiation oncology department of a major Canadian hospital. As this department doubled its size, healthcare providers remained bound to treatment planning rooms and radiation machines at the original site. This study examines workplace communication and interactions before and after the expansion.

Methods: We conducted regression analyses using a unique dataset merging email communications, badge swipes, office locations and organisation charts for individuals that routinely use the treatment planning room (n=232). We use a difference-in-differences framework to compare individuals' behaviours before and after the expansion. Our dependent variables were how often individuals accessed the treatment planning room and email volumes between two individuals.

Findings: We find an overall decrease in the use of the treatment planning room, though the effect was larger for those that moved away from it. Further, we find an increase in email communication for dyads of individuals separated in the move, but only if they belonged to different departments.

Practical implications: Our research points to complex interdependencies among healthcare providers, shedding light on how hospital expansion may have unintended consequences. Healthcare leaders should acknowledge that interaction patterns will be affected when healthcare providers are separated from each other or from anchored resources. Shifting to remote interactions may be adequate in some instances; in others, it may negatively affect work outcomes as well as the engagement and satisfaction of providers and patients.

Background: Radical cystectomy has the potential to be a curative strategy for patients with aggressive bladder cancer. Emerging evidence over the last 20 years has shown that minimally invasive surgical approaches using robotics in performing this highly complex and morbid operation can achieve the same oncological outcomes while reducing complications for the patient.

Objective: This paper aims to present a managerial and leadership roadmap for change to robotic cystectomy for patients with advanced bladder cancer to achieve improved patient outcomes while embracing technological developments in the delivery of cancer care.

Methods: Using the Irish Health Service Executive guide for change, we propose and detail a three-stage plan (define, design and deliver) to guide the organisation from the concept of the transition to performing the first operative case.

Results: A walkthrough from identifying a vision for change for robotic cystectomy to designing a step-by-step process is discussed. By providing a template for success, this approach can be applied to any health jurisdiction worldwide and can be adapted as needed.

Conclusion: Although challenging, major change within the healthcare setting through a structured approach provides a valuable opportunity for a department to grow, develop and become a champion of patient care.

Background/aim: The physician-administrator dyads are a strategic method of collaboration in healthcare organisations. Dyad leaders are part of a multidisciplinary team that integrates their expertise to generate better patient, physician, and organisational outcomes. An assumption of team science is that diverse experts, while knowledgeable, struggle to work together to resolve problems because of their vastly different decision-making and implementation strategies. Similarly, conflicting priorities, competing pressures, and lack of clear understanding of the other member's role will result in ineffective teamwork between the dyad.

Methods: We conducted a literature review of dyad leadership in healthcare and connected these insights to the teamwork literature.

Results: We connect the challenges of dyad leadership with practical solutions that help physicians and administrators integrate their diverse expertise. To overcome these challenges, healthcare employees, teams, and organisations must implement an effective structure for diverse dyads to work together effectively. We develop a framework based on a review of the literature on dyads and describe what is needed for an effective partnership between the physician and administrator.

Conclusions: We describe the teamwork mechanisms that develop as teams use these strategies, which ultimately makes the dyads effective in the organisation. Dyad leaders who use these strategies will develop their teamwork behaviours and teamwork processes to reduce conflict and sustain the viability of their team to complete their goals, benefiting the patient, the team, and the organisation.

Aim: To examine trends in quality of work life and health outcomes of managers in nursing homes in Western Canada pre-pandemic.

Methods: A repeated cross-sectional descriptive study using data collected in 2014-2015, 2017 and 2019-2020, in the Translating Research in Elder Care Programme. Self-reported measures of demographics, physical/mental health and quality of work life (eg, job satisfaction, burnout, work engagement) were administered and completed by nursing home managers. We used two-way analysis of variance to compare scores across times, controlling for clustering effects at the nursing home level.

Results: Samples for data collection times 1, 2, 3, respectively, were 168, 193 and 199. Most nursing home managers were nurses by profession (80.63-81.82%). Job satisfaction scores were high across time (mean=4.42-4.48). The physical (mean=51.53-52.27) and mental (mean=51.66-52.13) status scores were stable over time. Workplace engagement (vigour, dedication and absorption) scores were high and stable over time in all three dimensions.

Conclusions: Nursing home managers were highly satisfied, had high levels of physical and mental health, and generally reported that their work was meaningful over time pre-COVID-19 pandemic. We provided a comparison for future research assessing the impacts of the pandemic on quality of work life and health outcomes.

Background: Retention of faculty constitutes a significant challenge for higher education institutions, especially in times of crisis. Lebanon has been experiencing economic recession since the end of its civil war in 1990 until its complete collapse in 2019. This resulted in a massive faculty exodus, escaping the daily struggle with the sinking economy.

Purpose: The purpose of this study was to empirically investigate the factors that precipitate faculty attrition and the measures that foster long-term commitment to the institution in a time of unprecedented crisis.

Methods: An online anonymous survey, using a Likert scale, gathered responses from 92 faculty members. Quantitative findings were complemented by a qualitative exploration of emergent themes in comments. A team of three certified researchers conducted the analysis. Inductive analysis identified recurring themes, with steps like intercoder reliability checks and member-checking enhancing data validity. The researchers ensured methodological rigour, subject expertise, and overall reliability and validity of the thematic analysis.

Results: A total of 78 faculty participated in the survey (84.8%), with 79.5% reporting overall satisfaction, but a varying degree of satisfaction was noted across items. Faculty satisfaction was highest in areas such as respectful interactions (91.0%), belonging to the workplace (85.9%), communication from the Dean's office (85.9%), supportive environment and medical school leadership's commitment to retaining faculty (82.1%). Financial assistance, support for research and professional assistance were identified as important retention measures. Effective, transparent communication from leadership was highlighted as a critical factor during times of crisis.

Conclusion: This study provides strategies for faculty retention in times of crisis that include ensuring timely salary payments, supporting research and professional development, fostering a positive work environment and implementing bonding programmes. Transparent communication from leadership is vital for faculty satisfaction and retention. These findings can aid medical schools and other institutions facing faculty attrition during crises.