BMJ Leader最新文献

Background: Healthcare organisations face widespread challenges in optimising their safety culture, especially amid conflicting stakeholder needs, staffing shortages and increasing acuity of patients. McMaster University Children's Hospital Neonatal Intensive Care Unit developed a safety culture programme that prioritises the needs of patients, hospital staff and learners altogether.

Methods: The safety culture programme and activities revolve around six primary drivers: psychological safety, provider well-being, equity, diversity and inclusion, teamwork and communication, organisational learning and leadership. We describe how these drivers influence safety culture, the ongoing activities being implemented, stakeholder feedback and contextual factors. We evaluated the maturity of our safety culture using the Manchester Patient Safety Framework (MaPSaF) questionnaire.

Results: MaPSaF assessments were conducted three times over 4 years. Most domains of safety culture in MaPSaF maintained their position despite COVID-19 while some indicators declined or have been maintained.

Conclusions: We provide a framework for implementing a safety culture programme that addresses the needs of diverse stakeholders. Transformation of the safety culture takes time and the failure to improve the patient safety measures over the period may be attributed to rapidly increasing workload and worsening patient acuity. These challenges underscore the imperative of balancing transactional and transformational projects to preserve a safety culture.

Introduction: Strong hospital leadership is critical to navigating the challenges of the Canadian healthcare system. Currently, physicians and nurses tend to be selected to fulfil hospital executive roles. To date, we found only limited research exploring who else could or should be in these roles, or how more diverse groups of professionals navigate the journey into these roles. We sought to interview leaders from multiple professional backgrounds to understand how their career journey led them to their executive role.

Methods: We purposively sampled Canadian hospital executives with diverse professional and educational backgrounds. Through semistructured interviews, we explored their individual leadership journeys, and their experiences working with others along the way. Our team worked together to analyse data using a phenomenographic approach.

Results: Fourteen executive-level leaders from diverse professional backgrounds were interviewed. Overall, we noted three main trajectories for people to become hospital leaders: the achievement journey, the unexpected journey and the practical journey. These journeys corresponded to three main identities the champion leader, the discovered leader and the pragmatic leader, respectively. We found that some individuals had multiple trajectories and identities.

Conclusions: Improved diversity in executive hospital leadership may support transformational change in healthcare; however, this promise may not be automatically realised. Critical reflection on current hiring processes, career development and mentorship is warranted to support those with diverse and distinct backgrounds to enter and thrive in these roles.

There is increasing recognition in the field of health and social care research that community-engaged methods should include patients and the public throughout the research process. Therefore, individuals from all backgrounds should be involved in the research. We explored the public and patient engagement experience in research and how researchers and community groups can work together to make the research process more inclusive and sustainable. We carried out a rapid review and we present three themes from our results as a narrative summary. We found that partnerships and peer support was important for individuals, and it helped them to understand their role and the expectations of stakeholders. Also, using inclusive environments for diverse communities to participate helped individuals to access research training in their communities enabling them to co-create and co-design with facilitators and their community together. Trust was an important factor for diverse community participation in research and was linked to past experiences of taking part in research. We also found that partnerships, innovative methods of information sharing and context of the individual were important facilitators of inclusion. Analysis also indicated that the design of the studies and recruitment approaches such as using flyers, word of mouth, attending health fairs and partnering with nonprofit community, led to an increase in diverse population partcipation in research.

Objective: Examine relationships between religiosity, workplace discrimination, religious accommodation and related professional and psychological outcomes among UK Muslim physicians.

Methods: In 2021, a national survey of British Islamic Medical Association members was conducted. Statistical analyses explored associations between participant religiosity, sociodemographic characteristics and the specified outcome measures.

Results: Out of 104 participants with a mean age of 39, the majority were male (56%), Asian (81%), adult immigrants to the UK (56%) and wore a beard or a hijāb (73%). Workplace experiences revealed that 40% experienced discrimination primarily based on religious identity, with 44% facing regular discrimination since medical school. Notably, 38% reported current workplace discrimination, 15% encountered patient refusals based on religion and 56% felt heightened scrutiny due to religious identity. Most struggled with prayer at work (69%), and 28% felt inadequately accommodated. In multivariate models, religiosity was associated with experiencing discrimination from patients and struggle with prayer accommodation at work but increased the odds of perceiving religious identity to be accommodated at work. Notably, participants wearing hijāb or a beard reported higher job satisfaction and lower odds of burn-out and depression. Increasing participant age lowered the odds of burn-out but increased the odds of religious discrimination at the current workplace and over one's career, as well as being passed over for professional advancement.

Conclusion: These findings underscore the urgent need for the National Health Service to address religious discrimination in the workplace by implementing policies that accommodate the workplace needs of Muslim physicians.

Background: Despite efforts to advance equity, diversity and inclusion, women face gender-based barriers in research, including in neurology. Compared with men, women are less likely to hold leadership positions and be senior authors. Gender disparities in grant funding within neurology have yet to be investigated. We examine gender disparities in Canadian Institutes of Health Research (CIHR) funding for Canadian neurology divisions and departments.

Methods: Data on CIHR grant recipients and metrics (grant contribution, duration and quantity) within Canadian neurology divisions and departments between 2008 and 2022 were acquired from the CIHR Funding Decisions Database. Gender identity was determined by a validated application programming interface. Gender-based differences in CIHR grant contribution amount, duration and prevalence within neurology were calculated. Subgroup analysis was conducted for Canadian-licensed neurologists and Project Grant awards.

Results: 1604 grants were awarded to Canadian neurology divisions and departments between 2008 and 2022. Compared with men, women received less funding (p<0.0001), shorter grant durations (p<0.0001) and fewer grants (41.5%) annually. Women comprised the minority of recipients (45.5%) and were less likely to be awarded grants (p<0.001) annually relative to men. Differences were consistent in subgroup analyses, except for equal grant durations observed across genders in Project Grant awards.

Conclusion: We report gender disparities in CIHR grant funding to Canadian neurology divisions and departments. Women receive lower contribution amounts, shorter grant durations and fewer grants than men. Future recommendations include addressing gender differences and continuing to evaluate CIHR funding to provide equal opportunities for women in research and funding.

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: Women often face the challenge of balancing professional growth with societal expectations around family and household responsibilities. Conversely, men encounter limitations due to restrictive paternity leave policies, often receiving undue praise for basic parenting duties. Through the lens of the Chief Pharmaceutical Officer's clinical fellows 2023/24, we explore the question: 'Can you have it all?'

Methods: We explore stereotypical gender norms alongside the challenges and expectations faced by individuals of all genders on their leadership journeys. Through personal reflections, literature review and informal conversations with senior leaders, we explore how societal expectations and gendered norms shape the professional and personal lives of women in leadership roles.

Results: Commitment to reflection provides opportunities to pause and assess our journeys. Peer support networks are invaluable for professional development, helping to break down barriers and hierarchies. Coaching and mentoring offer significant support and guidance to aspiring leaders from underrepresented backgrounds providing new perspectives.

Conclusion: Balancing leadership and family responsibilities is challenging but achievable with the right support systems and a shift in workplace culture. However, we recognise, through all of this, self-care and prioritisation of mental well-being must be at the forefront to sustain a healthy balance. As clinical fellows, we have had the unique opportunity to share the complexities faced in the workplace. Through collective effort, we aim to foster environments that empower individuals on their leadership journeys, illustrating that, with the right support and conditions, it is possible to truly 'have it all'.

Background: Paediatric professional scarcity and uneven distribution is acute in underdeveloped regions, exacerbated by COVID-19's workload surge and burnout, highlighting the need for strengthened prevention and response measures.

Aim: Propose an effective talent management model to address the challenge of paediatric medical personnel shortage and lack of management experience in Underdeveloped cities of developing countries.

Methods: A crisis management plan has been implemented in a paediatric hospital in Henan, China, with a talent framework to ensure a skilled, stable workforce.

Results: An advanced talent management system is vital to address paediatric talent scarcity. Leveraging the national Children's Regional Medical Center, fostering international cooperation, sharing knowledge and harnessing regional policies are key to effective paediatric talent management through leveraging, promotion, and driving initiatives.

Conclusions: Efficient talent management methods have a significant positive impact on addressing the paediatric talent crisis, enabling departments and institutions to effectively manage medical talent through scientific strategies, ultimately contributing to the alleviation of medical resource deficiencies.