BMJ Leader最新文献

Objectives: This study explores the evolving position of the health system chief information officer (CIO) by identifying new core roles for success.

Methods: 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.

Results: 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.

Discussion: 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.

Conclusion: 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.

Background: Since the outbreak of the COVID-19 pandemic, healthcare workers (HCWs) have faced multiple difficulties in their work and personal lives. However, most of the quantitative reviews have focused on the extent of the pandemic's impact on the HCWs and have thus failed to fully capture the HCWs' experiences and the complexity of the problems they encountered. Therefore, this qualitative systematic review elucidates the HCWs' challenges brought about by the pandemic, their perceptions of the existing support and the support that require further attention.

Methods: The literature search spanned five databases: Scopus, PubMed, Web of Science, CINAHL and PsycInfo, targeting qualitative studies of HCWs' pandemic experiences from December 2019 to December 2023. These studies underwent strict quality and relevance assessment, emphasising critical appraisal and selection. Findings were unified through meta-synthesis, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study was registered in PROSPERO.

Results: This study analysed 29 qualitative studies on HCWs' experiences during the pandemic and their perceptions of support, identifying four themes of HCWs' physical and mental well-being, the impact of the pandemic on their professional and personal lives, their work environments and the support they received. These themes encompassed 8 main categories and 25 codes. The research revealed that the pandemic and work conditions negatively influenced their health, affecting their professional and personal lives. Current support has lessened the pandemic's effects on HCWs but should also address future requirements like long-term psychological support.

Conclusion: The studies identified the challenges faced by HCWs during the pandemic, and the existing support. However, due to the complex interactions between the work and environmental factors, the effectiveness of the existing support remains challenging. To improve their effectiveness, the future support should target the interactions between the HCWs and the work system.

Prospero registration number: CRD42023426238.

Background: In 2021, Dr Kalra embraced an opportunity for a leadership role at a start-up healthcare organisation in India. This gave him an opportunity to adapt his National Health Service (NHS) leadership experience to the evolving Indian private healthcare landscape. This paper shares his lived experience as a National Medical Director and delves into the experiences and leadership insights he acquired during this.

Method: This account draws on Dr Kalra's reflections and learning from his experiences, including social and professional interactions with individuals and teams, and links these experiences with leadership and management literature.

Results: Dr Kalra's transition from the public NHS to a private healthcare start-up environment in India presented challenges characterised by unfamiliarity, uncertainty and self-doubt. Manoeuvring through these challenges required forming a well-integrated team. By harnessing a mix of democratic, visionary and adaptive leadership styles, Dr Kalra developed an environment that fosters collaboration among healthcare professionals. He learnt to focus on articulating the overarching organisational vision and promoting autonomy, which led to a deeper sense of ownership and purpose among the team. Furthermore, fostering a culture of co-production enriched patients' experiences and contributed to business growth.

Conclusion: Experiencing this leadership transition highlighted and reinforced the importance of a deep understanding of the context, taking an adaptable approach to leadership and recognising and accepting one's vulnerability and fallibility. Fundamentally, Dr Kalra concluded that empowering teams and cultivating a patient-centred approach are critical for success.

Climate change driven by anthropogenic greenhouse gas (GHG) emissions represents an immediate and grave threat to human health and survival. Sea level rise, altered weather patterns and increasingly frequent and severe extreme weather events can damage health directly (eg, injury, heat stress, altered aeroallergen and particulate exposure). They also bring indirect health impacts through altered patterns of zoonotic and vectorborne diseases, disruption of food systems and downstream social consequences (economic collapse, mass migration and conflict).Healthcare providers and healthcare workers all need to take immediate action to drive and deliver reductions in GHG emissions, and to help patients in better managing the health impacts brought about by climate change. Here, we propose the '4Ps framework' (Personal, Professional, Pathway-specific and Policy) to empower and facilitate such action.

The healthcare sector has recognised its significant emissions and climate impact, and is beginning to address emission hotspots. However, implementing necessary changes while working with current stressors in the sector such as high patient volumes, limited resources, and staffing shortages, remains a challenge. PEACH Health Ontario (Partnerships for Environmental Action by Communities within Health care systems) was launched in 2021 to address this and has grown to a national scope of work with some of our initiatives. This paper outlines the 'PEACH Approach' to guide healthcare towards a net-zero future. This article describes how PEACH Health Ontario and the PEACH Approach were developed. We identify the various areas of healthcare sustainability that PEACH focuses on as well as our approach to collaboration and engagement across the sector. The PEACH Approach has led to the creation of specialty-specific green guidebooks, the Green Office Toolkit, and other knowledge mobilisation materials targeting system-wide transformation. These solutions are developed through multidisciplinary collaboration and knowledge translation, ensuring practical and evidence-based recommendations. The PEACH Approach drives a cultural shift in healthcare sustainability, creating solutions that lead to tangible outcomes. By using knowledge translation, providing practical solutions, and engaging with stakeholders, PEACH charts a course forward for both people and the planet.

Background: Healthcare education must evolve to address one of the greatest public health challenges we face in delivering care that allows future generations to meet their own healthcare needs. The integration of sustainable healthcare practices into medical education is a key step towards environmentally responsible healthcare delivery. Educational leadership plays a crucial role in transforming curricula in a way that prepares our future workforce to better understand and contribute to addressing emerging healthcare challenges.The integration of sustainable healthcare principles into primary care education requires strategic leadership to navigate institutional complexities and ensure meaningful change.

Methods: Our team at Imperial College London, comprising both faculty members and student partners, examined the undergraduate primary care curriculum, drawing on the Medical Schools Council sustainable health framework and practical case studies, with the goal of incorporating sustainable healthcare principles.

Results: In this paper, we share the process and our framework for integration of sustainable healthcare principles into our curriculum. For educators looking to embark on similar transformations, we share our reflections on the challenges, our solutions and top tips from our experience.

Conclusions: We hope our experience and reflections will give educational leaders and institutions a roadmap to prepare future doctors for the challenges of delivering environmentally sustainable healthcare.

This paper explores leadership in planetary health in an emerging grassroots organisation, Greener Practice. Greener Practice, formed in 2017, set out with the intention of creating the UK's Primary Care Sustainability hub and network. In the face of the evolving public health threat of the climate and ecological crisis, planetary health leadership has never been more necessary or urgent. There was a noticeable gap in leadership on this issue within Primary Care, with General Practice teams grossly underfunded, and climate action often seeming low on a list of burgeoning priorities. This article explores how visionary, nurturing and democratic leadership grew a grassroots movement. Through telling the story of Greener Practice's growth and development, I hope to share the lessons I have learned about our joint leadership of an emerging organisation. This paper is a reflection on my personal experience as a leader of an emerging grassroots organisation outside, but working alongside, existing healthcare organisations. I have used the narrative of Greener Practice's growth and establishment on the larger stage to illustrate my own leadership lessons that inform how we support our network's emerging leaders. This paper summarises my personal experience as I have grown and developed as a leader and approached the challenges of leading a grassroots movement. It has five sections entitled Leadership to: engage and inspire; educate and empower; grow the movement; nurture and develop new leaders; and influence systems. After each section, I have drawn out lessons learned in these areas. I conclude with further reflections on the importance of self-awareness, resonant leadership and active hope. Greener Practice aims to be a beacon of hope and inspiration, both for, and through, its leaders; visionary, nurturing and actively hopeful leadership is crucial to support emerging leaders to address the planetary health crisis.