BMJ Leader最新文献

The development of high-quality clinicians takes place through immersion in clinical practice facilitated by educational supervisors with appropriate capabilities and organisational support to undertake the role. Learners give feedback on the quality of their learning experience on placement, which provides insights about the quality of clinical care received by patients.In this article, we explore the role of educational leaders in engaging with learner feedback about patient care, the challenges and tensions this generates, and the path through resolution. We use a lived example to showcase the issues raised and offer reflections on the challenges faced.

Introduction: Interprofessional leadership is essential to sustain the National Health Service (NHS) in pressured times, which should include the NHS's third largest clinical workforce in England: allied health professionals (AHPs) (AHPs as defined by NHS England: Art therapists; Dramatherapists; Music therapists; Dietitians; Occupational therapists; Operating department practitioners; Orthoptists; Osteopaths; Paramedics; Physiotherapists; Podiatrists, Prosthetists and Orthotists; Radiographers; Speech and language therapists). Therefore, a feasibility study was undertaken, to explore the views of AHPs working in early to mid-career positions, regarding the barriers and opportunities they encounter, in both leadership and career development.

Methods: Twenty-seven participants, representing 8 of the 14 AHP professions across England, were interviewed across 10 focus groups.

Results: Thematic analysis (TA) generated four themes, including the barriers and opportunities for AHP leadership development and career progression. Further TA identified three overarching themes: equitable and interprofessional leadership development; an equitable and structured AHP career pathway; and having AHP leaders at a strategical and/or very senior level. These overarching themes were subsumed under the umbrella category: equity of opportunity and voice. The AHPs, who were interviewed, reported inequitable access to both career and leadership development, compared with other professions, such as nurses, doctors and pharmacists.

Discussion: Further work is needed to ensure that interprofessional representation, within senior leadership levels, includes AHPs; which the data suggests would directly benefit all AHPs' leadership and career development. Recommendations for organisations to facilitate leadership and career development were developed from the TA and at a system-wide level. Further research would be beneficial to gather the views of the six AHP professions not interviewed in this study and from other organisations, such as independent practice. However, this feasibility study does attempt to represent the voices of AHPs, which can be lacking in both organisations and research.

Background: The potential for addressing healthcare inequalities in prescribed specialised services has historically been overlooked. There is evidence that prescribed specialised services can exacerbate inequalities even though they are often accessed at the end of complex pathways and by relatively small numbers of people. Leadership is required to facilitate a systematic approach to identifying and addressing inequalities in this area.

Methods: A rapid literature review of articles from 2015 onwards and engagement with stakeholders was used to inform the development of a framework that both supports the identification of health inequalities within specialised services and provides recommendations for how to address them.

Results: The framework aligns with existing national approaches in England to addressing health inequalities in other healthcare settings. It is prepopulated with features of services that may create inequalities and recommended ways of addressing them and can be readily adapted to suit population specific needs.

Conclusion: The potential for addressing health inequalities should be considered at all points along a healthcare pathway. Local service leaders need to be empowered and encouraged to identify and deliver on opportunities for change to continually improve patient access, experience and outcomes.

Objective: Effective clinical leadership is crucial for the delivery of high-quality medical care. However, the extent to which current leadership development effectively enhances leadership competencies for junior doctors remains uncertain.

Methods: This study aimed to investigate the utilisation of quality improvement projects (QIPs) to enhance leadership skills among junior doctors in a District General Hospital. Additionally, the feasibility of implementing a leadership programme in a smaller District General Hospital alongside didactic learning, reflection and stakeholder engagement was assessed. The Medical Leadership Competency Framework Self-Evaluation Tool was used to assess current leadership qualities and develop personal action plans.

Results: While the majority of junior doctors completed QIPs, only a few engaged in reflective practice. Moreover, limited participation in formal leadership programmes was observed.

Conclusion: The study suggests that effective interpersonal development combined with long-term leadership training can be a resource-intensive yet valuable approach to adequately prepare future leaders even within District General Hospitals. The findings highlight the need for a structured leadership curricula utilising longitudinal project-based learning.

Background/aim: In the past decades, there has been an increasing focus on defining, identifying and reducing unwarranted variation in clinical practice. There have been several attempts to monitor and reduce unwarranted variation, but the experience so far is that these initiatives have failed to reach their goals. In this article, we present the initial process of developing a safety, quality and utilisation rate dashboard ('clinical dashboard') based on a selection of data routinely reported to executive boards and top-level leaders in Norwegian specialist healthcare.

Methods: We used a modified version of Wennberg's categorisation of healthcare delivery to develop the dashboard, focusing on variation in (1) effective care and patient safety and (2) preference-sensitive and supply-sensitive care.

Results: Effective care and patient safety are monitored with outcome measures such as 30-day mortality after hospital admission and 5-year cancer survival, whereas utilisation rates for procedures selected on cost and volume are used to follow variations in preference-sensitive and supply-sensitive care.

Conclusion: We argue that selecting quality indicators of patient safety, quality and utilisation rates and presenting them in a dashboard may help executive hospital boards and top-level leaders to focus on unwarranted variation.

Background: Physician wellness remains a growing concern, not only affecting the physicians' quality of life but also the quality of care delivered. One of the core tasks of medical regulatory authorities (MRAs) is to supervise the quality and safety of care. This brief report aimed to evaluate the practices of MRAs regarding physician wellness and their views on residents as a high-risk group for decreased physician wellness.

Methods: A questionnaire was sent to MRAs worldwide, related to four topics: the identification of physician wellness as a risk factor for quality of care, data collection, interventions and the identification of residents as high risk for poor physician wellness. 26 responses were included.

Results: 23 MRAs consider poor physician wellness a risk factor for quality of care, 10 collect data and 13 have instruments to improve physician wellness. Nine MRAs identify residents as a high-risk group for poor physician wellness. Seven MRAs feel no responsibility for physician wellness.

Conclusion: Although almost all MRAs see poor physician wellness as a risk factor, actively countering this risk does not yet appear to be common practice. Given their unique position within the healthcare regulatory framework, MRAs could help improve physician wellness.

As I reflect on my leadership journey, I have learnt that when we actively seek and purposefully engage with the knowledge others bring, we express the highest levels of respect, we elevate engagement, we get smarter ourselves, and we achieve better results. I have learnt that collaboration is not just a nice concept; it is a fundamental value to all we can achieve and must commit to in healthcare. When we are willing to be vulnerable and open, to learn from others, and share our successes, not for praise, but in the interest of others achieving similar success, we are truly leading with purpose. I have learnt when we honour the human being in front of us in every moment, we build bridges, relationships, stronger capacity to communicate, better listening, we express compassion, and show dignity and respect. I have learnt that in honouring lived experience, fostering collaboration and ensuring kindness, we can create a transformational space, a community of action and purpose and that with a commitment to lived experience, collaboration and kindness, we can truly transform healthcare.

Background: Medical engagement is linked to improved outcomes for staff and patients including a reduction in staff turnover. There are significant problems with recruitment and retention of doctors globally, it is, therefore, important to try to increase medical engagement within healthcare organisations. This systematic review aimed to review evidence from 2018 to 2023 from peer-reviewed journals on interventions to improve medical engagement and from this generate practical recommendations for healthcare organisations.

Method: A search strategy was developed and used across six databases alongside citation searching. Articles were screened to check whether they met the study criteria and were then critically appraised. The interventions were extracted and a thematic analysis, using an inductive approach, was undertaken.

Results: 15 articles were found to have met the criteria, however, the studies were generally found to be of low-quality research evidence. The interventions from the articles were grouped into nine themes covering topics such as 'Improvements to working conditions', 'Increasing support to doctors' and 'Rewards/incentives/recognition'.

Conclusion: The review generated a wide range of interventions which could be used to improve medical engagement, however, critical appraisal revealed that they were of low-quality evidence, so their effectiveness should be interpreted with some caution. The majority of the interventions were transferable to healthcare settings, with some limitations depending on the country. Several HR models were described as options for implementing these interventions within healthcare organisations. Further high-quality research is needed in this area.