BMJ Leader最新文献

Background: In the process of providing healthcare, our health systems significantly contribute to the climate and nature crises, which in turn threaten the health of populations under its care. The health sector has the potential to reduce its impact on planetary health while improving patient health and reducing costs. The author suggests that all healthcare workers have the opportunity to create positive change in their professional spaces by embracing grassroots leadership. The author reflects on their own journey into grassroots leadership within planetary health and outlines why it is a vital element of the healthcare sector's response to the climate and nature emergencies.

Methods: Using the framework of the National Healthcare Service Leadership Model, the author describes and reflects on a real-life example of a grassroots movement for planetary health in their profession.

Conclusion: Readers are invited to examine the opportunities in their professional spaces for positive change in the face of the climate and ecological crises.

Background and aim: In 2020, the Gold Coast University Hospital emergency department (ED) established a Medical Commander role; a medical leadership position with a focus on optimising patient flow. The objective of this study was to understand how the role executes leadership tasks to promote patient flow and its impact on staff working in and with the ED.

Methods: A multimethod case study approach combined data from documents, observations staff interviews and surveys across a breadth of stakeholders. Data were deductively themed and triangulated through the analytical framework of Path-Goal leadership theory to provide a comprehensive analysis of the Medical Commander role functions and impact.

Results: The Medical Commander role dynamically exhibits a combination of directive, supportive and participative leadership behaviours to enact and deliver patient flow leadership across a breadth of stakeholders. Path-Goal theory illuminates the environmental and personnel characteristics that have contributed to the role's perceived successes in patient flow and employee motivation. In addition, the application of this theory identifies several crucial enablers, including role characteristics (ie, clinical and service seniority, division-wide oversight and absence of clinical load) that support the dynamic use of leadership behaviours observed in this study and their effect on staff morale and patient flow.

Conclusions: As rising demand and complexity increase the risks associated with delays to patient care coordination and flow, the senior-level oversight and enabling leadership behaviours provided by the Medical Commander role represent a viable and effective intervention to manage these gaps.

Background: Some unprofessional behaviours, including allegations of discrimination, hostile work environment, violent behaviour, sexual boundary violations, potentially impaired clinicians, professional integrity and retaliation, require healthcare organisations to have a timely and reliable process to guide investigation, inquiry and/or interventions. Failure to have a consistent approach creates extraordinary risk for organisations, their team members and their patients.

Methods: Descriptive study of five health systems that participate in a national professionalism collaborative through the Vanderbilt Health Center for Patient and Professional Advocacy (CPPA) and implemented a huddle process to guide the initial disposition of event reports describing unprofessional behaviours that might warrant investigation, inquiry or intervention. Each site applied lessons learnt over the study period to refine the huddle participants, the process for the huddle and the tracking of information based on their experience.

Results: During the study, the participating sites held 219 huddles, which represented <1% of reports processed by CPPA during the study period. The most common type of reports resulting in a huddle included allegations of discrimination (30% of huddles) or hostile work environment (29%). Other common reasons for huddles included violent or aggressive behaviour (15%) or potential sexual boundary violations (13%). Additional reasons for huddles included concerns for an impaired clinician (3%), integrity (2%) or retaliation against a reporter for a previous electronic safety event report (2%).

Conclusions: Implementing a huddle to review and guide next steps for reports including allegations of serious behaviours provided the healthcare organisations a process to reduce the variability of response to such reports and fostered increased communication and trust among organisational key stakeholders.

Health professionals can play important roles in promoting planetary health, including by contributing to delivering environmentally sustainable healthcare. Interventions that promote planetary health may be more frequently and effectively implemented where leaders have knowledge, skills and values aligned with planetary health.

Aims: This study aimed to:Highlight synergies between health professionals' leadership competencies and planetary health principles.Elucidate how health professionals can meet their leadership competencies while simultaneously learning about and promoting planetary health.

Methods: Health professionals representing multiple professions engaged in discussions exploring how health leadership impacts planetary health. Discussants selected competencies from the Faculty of Medical Leadership and Management that align with the United Nations' Sustainable Development Goals and pertain to planetary health. The selected competencies were reworded to explicitly reference planetary health.

Findings: Two competencies in each of seven leadership domains were reworded to explicitly reference planetary health. Practical examples of how these competencies could be achieved while promoting planetary health were developed to guide learners, educators and those developing professional standards to incorporate a planetary health perspective.

Conclusion: A multiprofessional group identified how health leadership competencies and planetary health priorities can be addressed simultaneously in lifelong learning across all health professions, disciplines and levels of training.

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.

Objectives: This study examines the relationship between the diversification and complexity of ward operations (DCWO) during the COVID-19 pandemic and incident occurrence. Our hospital faced significant changes in ward management during the pandemic. Typically, each ward accommodates two to four clinical departments, with department assignments remaining relatively fixed. However, to free up beds for patients with COVID-19, the number of general wards was reduced, forcing a more fluid allocation of patients across various departments. This shift resulted in a more complex and diverse departmental mix within each ward, complicating ward operations.

Methods: This study retrospectively examined patients admitted to a university hospital in Japan from 1 April 2020 to 31 March 2022. We analysed incident occurrences by ward (including all inpatients within the target ward) and assessed the relationship between nurse-related incidents and DCWO.

Results: We selected records for 7030 ward days from 21 559 patients admitted (10 336 in 2020 and 11 233 in 2021). No significant difference in average age was observed between fiscal year (FY) 2020 and FY 2021 (62.5±16.6 years vs 62.3±16.8 years, respectively; p=0.69). However, the average length of stay differed (13.6±23.9 days vs 12.9±17.5 days, respectively; p<0.01). Logistic regression analysis revealed an OR for DCWO of 1.008 (95% CI 1.002 to 1.015; p=0.007), indicating that an increase in DCWO was associated with the occurrence of mild incidents (where treatment was not necessary). Multiple regression analyses also revealed the association between DCWO and drug-related incidents (p=0.011) and mild incidents (treatment was not necessary; p=0.010).

Conclusions: Changes in departmental configurations during the COVID-19 pandemic influenced patients' conditions and the frequency of mild incidents, highlighting the importance of patient safety considerations in hospital ward operations.

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.