BMJ Leader最新文献

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.

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.

Purpose: While there are studies on this topic, there may be a relative scarcity of research focusing on specific regions, such as Jordan. So, this study aims to gather insights from healthcare providers in Jordan concerning the advantages of integrating artificial intelligence (AI) into practices, their perspectives on AI applications in healthcare, and their views on the future role of AI in replacing key tasks within health services.

Method: An online questionnaire was used to collect data on demographics, attitudes towards using AI for tasks and opinions on the benefits of AI adoption among healthcare professionals. For healthcare professionals with restricted internet access or older people, soft copies of the questionnaire were provided to them, and then their responses were collected. A one way analysis of variance (ANOVA) was used to determine the associations between the determinants and the outcomes. Any test with a p value ≤0.05 was considered significant.

Results: A total of 612 healthcare professionals participated in the survey, with females comprising a majority of respondents (52.8%). The majority of respondents showed optimism about AI's potential to improve and revolutionise the field, although there were concerns about AI replacing human roles. Generally, physical therapists, medical researchers and pharmacists displayed openness to incorporating AI into their work routines. Younger individuals aged <40 seemed accepting of AI in the domain. A significant portion of participants believed that AI could negatively impact job opportunities.

Conclusion: To conclude, the results of this study suggest that healthcare professionals, in Jordan, hold receptive views on incorporating AI in the medical field, similar to their counterparts in developed nations. However, there is a concern about the implications of AI on job stability and potential replacements.

A doctor's ability to demonstrate compassion and empathy-the essence of bedside manners-remains as crucial today as ever. Yet modern medical training does not prepare doctors to meet the social and emotional demands of a rapidly changing clinical environment. Prompted by Debrett's reframing of 'modern manners', the authors explore how social protocols for manners apply in the healthcare setting. They identify three key areas where better etiquette could make a tangible difference for patients and carers: digital communication, day-to-day interactions on wards, authentically apologising. They note that graduating healthcare professionals often lack structured guidance on sustaining face-to-face empathy in an increasingly digital world. Similarly, small acts of politeness and genuine acknowledgement of a patient's reality during day-to-day interaction (such as timely updates or warm personal greetings) can significantly defuse anxiety. They also point out that a well-placed, heartfelt apology can restore trust when things go wrong, a skill rarely discussed in formal training. The authors argue that embedding these simple, modern manners into everyday practice is not just an optional extra; it is a vital professional competency. By explicitly teaching and modelling interpersonal skills alongside clinical or technical training, they suggest medical educators can better equip the next generation to address patients' emotional needs and enhance the overall care experience.

Background: Medical errors, while prominent in healthcare as one of the leading causes of mortality, remain a relatively unexplored area in veterinary medicine. The nature and frequency of such errors in this field are rarely reported or discussed, presenting a significant gap in understanding and improvement of veterinary practices. It is in this context that the importance of leadership styles emerge. Humble leadership involves acknowledging one's own limitations, actively seeking feedback and learning from it, and appreciating others' strengths and contributions. Such a leadership style has been linked to increased openness and error disclosure in various fields - a crucial step in mitigating medical errors.

Purpose: This study investigates the association between humble leadership and error disclosure in veterinary medicine, with a particular focus on the mediating role of psychological safety and safety climate.

Methods: A total of 669 responses were collected from veterinary staff across Australia to analyse the impact of leadership style on error disclosure. Model 4 of Hayes' PROCESS macro in SPSS was employed to analyse the effect of humble leadership on staff's attitudes towards error disclosure and the mediating effects of psychological safety and safety climate.

Results: Humble leadership had a positive influence on psychological safety (β 0.66, p<0.001) and safety climate (β 0.48, p<0.001). Furthermore, both psychological safety and safety climate significantly impacted staff's attitudes towards error disclosure (β 0.07, p<0.001; β 0.22, p<0.001, respectively). The study showed that humble leadership did not influence staff's attitudes towards error disclosure directly. Rather, the influence of humble leadership appears to be channelled through its positive effects on psychological safety and the safety climate.

Conclusion: Humble leadership fosters a safe environment and encourages a mindset of psychological safety among staff, which in turn leads to more positive attitudes towards error disclosure.