BMJ Leader最新文献

Background: Climate change is an escalating public health emergency, yet within the National Health Service (NHS) it remains marginal to board-level leadership and governance. Despite its direct implications for population health, service resilience and health inequalities, responsibility for climate action is often delegated away from strategic decision-making forums.

Context: This article draws on the author's experience as the NeXt Director (Non-Executive Director in Training) with a remit for future generations, including climate change and sustainability, on a newly established Integrated Care Board in England.

Approach: Using a reflective leadership lens, the article examines how climate change was reframed from a peripheral sustainability issue into a core governance and risk concern. Practical strategies included embedding climate-related threats into formal risk registers, aligning climate action with population health and inequality priorities and integrating climate considerations into existing strategic and operational levers.

Outcomes: Positioning climate risk within established governance structures shifted board-level engagement, normalised climate-informed questioning in strategic discussions and enabled early integration of climate considerations into population health, commissioning and resilience planning. These changes established climate change as a shared leadership responsibility rather than a siloed agenda.

Implications for leaders: The article argues that NHS leadership models must evolve to address long-term, systemic risks such as climate change. Boards should treat climate change as a determinant of quality, safety and equity, embedding it within risk management, strategy and accountability frameworks to ensure system preparedness in an increasingly unstable climate.

Objective: To identify contemporary leadership and governance approaches used to drive environmentally sustainable healthcare in high-income countries, such as Australia at the macro (governmental), meso (organisational) and micro (individual) levels.

Methods: A rapid scoping review of peer-reviewed and grey literature published between 1 January 2018 and 26 July 2024 was conducted based on Population Concept Context methodology. Key themes were identified using qualitative content analysis and inductive thematic analysis, and findings were presented in a multi-level, systems thinking framework.

Results: 81 articles were included. Leadership and governance approaches found to be present across all levels were collaboration, education and advocacy. In addition, at the macro and meso levels, the need for financial investment, decarbonisation roadmaps, ambitious emissions reductions targets and delivery of sustainable models of care was evident. At the micro level, healthcare providers taking on the role of sustainability champions and communicating the health risks of climate change to increase receptiveness to climate messages was important. At the macro level, there was a greater focus on policies, while the meso level focused on organisational influence to drive decarbonisation.

Conclusions: Australian and global healthcare systems alike require strong leadership and governance across multiple scales to rapidly transition to environmentally sustainable healthcare systems. To achieve this transition, key contemporary leadership and governance approaches crossing all levels from healthcare providers to healthcare organisations and governments were found to be (1) collaboration within the healthcare sector and externally, (2) education of the healthcare workforce and community about the health impacts of climate change, and (3) advocacy for transitioning to environmentally sustainable healthcare.

Background: Healthcare professionals play a vital role in addressing planetary health; however, their proenvironmental behaviour (PEB) remains underexplored, particularly in Pakistan. The study aimed to assess healthcare professionals' knowledge and attitudes regarding planetary health and the new ecological paradigm (NEP) and to determine the PEB of healthcare professionals.

Methods: The cross-sectional study was conducted in Rawalpindi and Islamabad, Pakistan, from July to November 2024. A total of 307 healthcare professionals filled out a structured questionnaire. Spearman's correlation was used to assess the relationship between knowledge of planetary health and the NEP, as well as PEB.

Results: The mean age of participants was 40±11.4 years. Regarding knowledge, 238 (77.5%) of participants agreed that environmental problems have a direct impact on human health. The majority, 283 (92.2%), expressed their concern about climate change. Most respondents recognised the limits to Earth's resources (268; 87.3%), agreed that humans are abusing the environment (260; 84.7%) and expressed concern about ecological crises (280; 91.3%). Almost 85% (261 respondents) thought that encouraging sustainable healthcare practices is necessary for both present and future generations. PEBs included frequent recycling, conserving water and educating others about environmental impacts, as mentioned by 249 (81.1%) respondents. A highly significant, positive correlation was observed between participants' endorsement of the NEP and their PEB, specifically in 'day-to-day activities' (correlation coefficient=0.47, p value<0.001), as well as between NEP and attitude (correlation coefficient=0.45, p value<0.001).

Conclusion: Knowledge about planetary health and the NEP has a positive influence on environmental attitudes and PEBs. Similarly, environmental attitudes have a positive impact on PEBs.

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: Last-minute gaps in the rota are demoralising for those still at work and reduce the standard of patient care. Agency staff are the most common solution, but at peak times, it is often impossible to find a locum at the last minute. We present a novel solution that improves conditions for doctors, patients and rota coordinators.

Methods: We implemented a standby system to prevent unfilled late notice gaps over 3 weekends. This was compared with previous weekends where cover was required. Additionally, we surveyed the junior doctors involved in the scheme.

Results: In 2022-2023, 19 had late gaps. Only five of these were successfully covered.The following year, doctors volunteered to be Guardian's Angels for 29 standby shifts. Of the 25 filled standby slots, 4 (16%) were converted to full shifts.24 junior doctors responded to an online survey, 95% felt the scheme is beneficial.

Conclusions: Staffing gaps result in poor morale, stressed staff which may lead to poor outcomes for patients. Doctors taking part in this scheme feel more valued and supported. Disadvantages of the scheme are the modest cost to the hospital (this may be offset by avoiding locum agencies with higher fees).

Introduction: Effective management and leadership are needed for the successful running and improvement of National Health Service (NHS) organisations and enhance the ability of these organisations to improve. However, NHS managers are often undervalued, and there are serious shortfalls in management capacity. We hosted a workshop with a diverse audience of health professionals, to explore this issue in depth.

Description: The workshop took place at the annual Faculty of Medical Leadership & Management conference 2024 with five panellists and roughly 40 delegates, lasting for over 90 minutes. It consisted of individual presentations, panel discussions, questions and answers and online polling and commentary. The results were analysed using thematic analysis.

Discussion: We identified four themes. The first included an overall lack of management capacity in the NHS, with fewer managers compared with other sectors and countries. Difficulties in interprofessional relationships was a second theme, for example, the lack of understanding or appreciation for the management role. Significant variation in development, training and career opportunities was the third theme. Discussions on potential regulation for NHS managers was the final theme.

Conclusion: The workshop report identified important challenges affecting managers and leaders in the NHS. Addressing these will be crucial to sustaining and improving high-quality care.

Background: The environmental impact of inhalers, particularly pressurised metered dose inhalers with high global warming potential, poses significant challenges in the context of planetary health. Although dry powder inhalers (DPIs) offer a more sustainable alternative, entrenched prescribing practices prevail. This systematic review evaluates patient and physician perspectives on inhaler environmental impacts and examines barriers and opportunities for leadership in adopting sustainable practices.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive literature search was performed from inception to 12 June 2024, across Medline via EBSCO, EMBASE via Elsevier and Web of Science. Four studies were included, surveying 433 participants. Data extraction and risk-of-bias assessment were conducted using a standardised form and the Newcastle-Ottawa Scale.

Results: Findings indicate that while both patients and providers express environmental concerns, limited awareness and entrenched clinical practices hamper the transition to DPIs. Leadership insights reveal that a fragmented sense of responsibility, insufficient training and low confidence in discussing environmental impacts are significant barriers. However, targeted education and interprofessional collaboration have been shown to increase the willingness to adopt sustainable inhaler practices.

Conclusions: The results underscore the need for leadership in healthcare to champion sustainable prescribing. Empowering clinicians through education, clear clinical guidelines and eco-ethical leadership initiatives is essential. Health leaders have the opportunity to transform practice by integrating environmental considerations into routine care, ultimately advancing planetary health.

The prospero registration number: CRD42024552555.

Sri Lanka has been going through its worst economic crisis ever since April 2022. The economic crisis had a significant impact on a tertiary care hospital in Sri Lanka (THS), and the main challenges faced included a severe shortage of medical supplies, a lack of funding, staff transportation issues due to a nationwide fuel shortage, a shortage of reagents, human resource issues due to the outmigration of hospital staff and a lack of a business continuity plan in place. This perspective article aimed to describe how the economic crisis affected a THS in Sri Lanka and how the hospital's administration overcame it by employing a leadership style similar to situational leadership. THS implemented situational leadership style, directing, coaching, supporting and delegating to effectively address the above challenges. The directing style strategies such as withholding renovation projects, purchasing drugs locally, hiring consultants, providing extra duty payments and prioritising resources were employed to guide the team through immediate challenges. The establishment of a crisis management committee served as a coaching approach. Enhancing communication among workers and implementing emotional support initiatives were key aspects of our supportive leadership, creating a positive work environment. We emphasised delegation, empowerment and teamwork, encouraging team members to take ownership of their roles and collaborate effectively. It is recommended that a business continuity plan to manage hospitals during an economic crisis be included. Medical supplies should be buffered in a larger hospital like THS for a minimum of 6 months. The government ought to enact new legislation and require applicants to sign bonds in order to retain healthcare professionals in the nation.

Background: Residency training and parenthood are conflicting pursuits for many residents, as both often occur during similar years of life. Online policy about paid parental leave for residents is important for not only mitigating this dilemma, but also ensuring that the associated health benefits can be fully capitalised on.

Purpose: Investigate the extent of advertised paid parental leave for anaesthesiology residencies in the USA and to explore whether this had an association with the gender of the department chair for these programmes. Analysis of Canadian anaesthesiology residencies was performed to assess whether a nation with federally protected paid parental leave yielded disparate rates of advertised paid parental leave.

Methods: All accredited US anaesthesiology residency programme websites were reviewed to determine the gender of the department chair and the existence of advertised paid parental leave for residents. χ² analysis was used to determine if there was a statistically significant association between the gender of anaesthesiology residency department chairs and paid parental leave advertised. Rates of advertised paid parental leave were compared with those seen in Canadian anaesthesiology residencies.

Results: US anaesthesiology residency department chairs were 84% (137/164) men. Of the men-led programmes, 42% (58/137) advertised paid parental leave, while 70% (19/27) of women-led programmes advertised such benefits (p<0.05). Overall, 47% of (77/164) of US anaesthesiology residencies advertised paid parental leave, while 76% (13/17) of Canadian anaesthesiology residencies advertised paid parental leave (p<0.05).

Conclusion: In the USA, anaesthesiology residencies with department chairs held by women had a higher rate of advertised paid parental leave. Such findings call attention to the potential downstream effects of lacking diversity in leadership within medicine. When compared with the USA, Canada was found to have higher rates of advertised paid parental leave across their anaesthesiology residencies, potentially highlighting the impact of federal legislature on medical residents.

Background: Climate change is the greatest threat to global health. There are several working groups at the intersection of climate and health, which provide leadership in global governance around the issue-but their diversity has not been previously analysed.

Objective and methods: We analysed 13 active committees, comprising 226 members. Committee members were analysed in terms of World Bank country income status, political grouping (G7 membership), climate vulnerability (being from Small Island Developing States (SIDS) and top 10 in the Global Climate Risk Index, 2021) and gender.

Results: We found that 72.1% of the committee members are from high-income countries (HICs), 57.0% are from G7 nations, 2.2% are from SIDS nations, 5.3% are from the top 10 most vulnerable climate vulnerable countries and 45.6% are female. Only three committees exhibit a balanced representation in terms of country income status. Nine committees have more than half of their members from G7 countries. 10 committees do not have representation from SIDS, and 7 lack members from the 10 most climate-vulnerable countries. Eight committees have good gender representation. Most chairs and co-chairs (only six committees reported them) are from HICs (83.3%), with good gender representation. Half of these chairs and co-chairs are from G7 nations, 16.7% are from SIDS and none are from the 10 most climate vulnerable nations.

Conclusions: We call on committees to develop policies that are grounded in intersectionality to improve diversity among their members, including for Indigenous/Adivasi people (which we did not analyse) to improve global governance of climate and health.