BMJ Leader最新文献

Background: A master's programme in Health Systems Leadership and Innovation was launched in 2016 to integrate health systems science and innovation management within the medical education continuum.

Objectives: To identify faculty and staff perceptions of tailoring the programme to accommodate potential future learning needs as a continuous quality improvement initiative of the programme.

Methods: A combination of two qualitative research methodologies was used: (1) a situational analysis to explain context and (2) a collaborative autoethnographic approach to understand the evolution of the programme and future directions. Faculty and staff involved with the programme were invited to participate after obtaining institutional research ethics approval. In conducting a collaborative autoethnography, all authors are participants who narrate, analyse and theorise about their individual and or collective experiences.

Results: Nine faculty and three staff members narrated their perceptions of the programme. The situational analysis identified major internal and external actors, major processes and external actants relevant to the programme. It also outlined the multiple overlapping social arenas where the students, faculty and staff were situated through a social world map and differing positions of the authors with respect to the programme's future learners. The master narrative identified an urgent need for internal and external communications about the programme and to revisit course delivery methods. The authors were divided in their opinion as to whether the programme should continue to cater to undergraduate medical students or focus on physicians or have learners from multiple educational levels in the same class.

Conclusions: The programme needs marketing, continuous course assessments and revisions to ensure visibility and relevance. The programme offers a flexible pathway for students at different stages in the career path from novice medical students to consultant physicians, and tensions related to the level of medical education hierarchy in the class are being managed by the faculty.

The importance of physician well-being has been increasingly recognised in the last decade with an improved understanding of the prevalence and drivers of occupational and moral distress in healthcare workers. High rates of burnout have significant costs at both the individual and organisational level, with follow-on effects impacting staff turnover and patient care. Healthcare facilities have a responsibility to prioritise physician well-being and should adopt a structured and comprehensive approach to this aspect of healthcare delivery. Kindness is a significant factor impacting professional fulfilment and can reduce stress and burnout in healthcare workers. Acts of kindness and prosocial behaviours have widespread benefits, impacting the giver, receiver and even observer of the kind act. Moreover, kindness in the delivery of healthcare not only has a profound impact on patient satisfaction, but can positively influence medical outcomes. Healthcare facilities should thus cultivate kindness in the workplace as a guiding principle for all interactions and promote prosocial behaviours that improve the working environment for all staff. This paper discusses the importance of kindness in healthcare and presents a comprehensive kindness strategy implemented in our facility which encourages a fourfold approach of kindness to self, others, the community and the environment.

Background: Excellence in healthcare delivery is dependent on individuals working together on a team.

Objective: We sought to enhance team performance by partnering with human resources (HR) to identify opportunities unrecognised by unit leadership.

Methods: 100 individuals representing a cross-section of the multidisciplinary team participated in an interview focused on teamwork conducted by an HR representative. Action plans were then developed and implemented. Press Ganey Survey results for the question, "Staff worked together to care for you/your baby?" were tracked to assess patient perception of teamwork.

Results: Between 2022 and 2024, we observed improvement in the per cent of patients who assigned the highest rating of teamwork, culminating in 100% of patients reporting the highest score in the final quarter.

Conclusion: The model of HR facilitated discussions with work unit team members identified barriers to optimal teamwork, led to the implementation of action plans and resulted in an improvement in our teamwork rating by patients.

Introduction: The concept of 'medical leadership' has emerged as a critical issue in healthcare, prompting numerous countries to adopt measures toward enhancing leadership competency among physicians. This includes the development of medical leadership competency models. This scoping review aims to map and systematise the existing literature on generalised medical leadership competency models and context-specific leadership competencies for physicians, providing a comprehensive framework for future research.

Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for the scoping review framework. A comprehensive search was conducted across peer-reviewed academic databases and grey literature sources.

Results: 16 generalised medical leadership models and 13 context-specific competency studies were identified. While most models have been developed in North America and Europe, context-specific competency studies have expanded globally. Frequency analysis highlights the significant influence and application of medical leadership competency models from the UK, the USA, Canada and Switzerland.

Conclusion: A comparative analysis across countries emphasises the importance of considering contextual and cultural factors when developing and implementing medical leadership competencies. Over the last three decades, medical competency development has reflected a shift towards collective leadership within healthcare, with a focus on team-based, patient-centred approaches in the increasingly complex healthcare systems. Additionally, there is a growing need for competencies that address emerging challenges in healthcare, such as cultural sensitivity, crisis management, business skills and digital literacy.

Background and aim: The What Matters to Staff programme was designed at the Royal Free Hospital to address a key priority of improving workforce well-being. The initial aim was to set up a programme that responded to what mattered to staff and could be spread to 70 teams across the hospital within 2 years.

Methods: The programme was developed by adding a set of simple, yet important steps around the 'what matters to you' conversation from the Joy in Work Framework. The programme enrolled its first teams in January 2022 and has since spread widely to over 90 areas and has involved approximately 3000 staff.

Results: There have been significant improvements in staff experience, staff engagement and workforce metrics since the programme began and it is now embedded as business as usual within each division. It was easily scalable on minimal resources due to its standardised and systematic approach and because the programme was seen to drive positive and impactful change.

Conclusion: Over the past 2 years, the programme has given staff the opportunity to have their voice heard and has supported leaders to ask, listen and do what matters most for their teams. This has led to improved workforce metrics and the programme being widely scaled and spread.

Background: Physician burn-out was associated negatively with physicians' health, patient outcomes and healthcare system performance. Reducing physician burn-out may potentially benefit physicians and patients, improve healthcare performance and reduce societal healthcare costs.

Aim: The purpose of this study was to clarify the relationship between transformational and servant leadership behaviours and physician burn-out.

Methods: A cross-sectional, non-experimental quantitative correlation study was conducted using scores on the Maslach Burnout Inventory, Global Transformational Leadership Scale and Servant Leadership Behaviour Scale-6-item Short Form. The data were obtained by an online survey of physicians working at a metropolitan hospital in Australia.

Results: 82 physicians participated in the study. The result showed significant correlations between transformational and servant leadership and lower physician burn-out, particularly in supporting fellow physicians' personal accomplishments, a burn-out construct (Pearson r=0.42 and 0.32, respectively). Among the constructs of transformational leadership, leaders who are clear about their values and demonstrate them in their actions correlate strongly with the constructs of burn-out. In servant leadership behaviours, helping subordinates generate meaning out of everyday work was the most influential factor in fellow physicians' burn-out. The finding may be related to the effects of observing the positive values and actions of their supervisor and the physicians' own understanding of the value of their work.

Conclusions: A positive role model and the meaning of everyday work could be protective against physician burn-out. Positive role modelling and mentorship may be relevant in physician supervisor training. Encouraging physicians to discover meaning from their everyday work may help to promote physician well-being.

Introduction: Conflict is an inevitable part of clinical training and often arises from differences in opinions or misunderstandings. Most studies around healthcare conflict focus on perspectives of physicians and nurses, overlooking medical students' unique perspectives. This study explores medical students' experiences with conflicts during clerkship, examining types, triggers, and conflict management styles.

Methods: An educational session introduced medical students to conflict types, conflict management modes, and triggers. A total of 167 students wrote reflections about conflicts experienced or observed during their rotations. Both quantitative and qualitative elements were analysed using thematic content analysis.

Results: Conflicts most frequently occurred during surgery (n=49, 32.9%) and internal medicine (n=41, 27.5%) rotations, often involving residents (n=110, 44.7%) and attendings (n=55, 22.4%). Task-related conflicts were most common (n=113, 53.8%), with students primarily using an avoiding (n=91, 60.3%) mode, while others were perceived as using a competing (n=122, 65.2%) mode. Most conflicts were reported as being handled poorly (n=107, 64.8%). Students described five main conflict triggers: (1) conflicts stemming from unclear expectations; (2) hostile or false communication as a conflict driver; (3) unsafe environments reinforced by hierarchy and power; (4) mistrust in team relationships and (5) resident stress impacting student experiences.

Discussion: Identifying conflict characteristics from a student perspective can guide curricular improvements to better prepare students for clerkships and professional practice. Awareness of conflict management styles, types and triggers enables proactive conflict resolution, fostering growth or constructive outcomes. Findings emphasise the importance of setting clear expectations, maintaining effective communication, building psychologically safe environments, reducing stress and establishing trust between students and residents. Based on medical students' reflections, these patterns may extend to other health professions, offering a broader relevance for training and research in conflict management across clinical settings.

Introduction: Clinicians involved in errors leading to preventable patient harm often receive inadequate organisational support. Limited research examines this issue from an organisational perspective. This study aims to elucidate and evaluate healthcare leaders' (HLs') perspectives on medical errors and caregiver support.

Methods: A convenience sample of 81 HLs participated in this study that included the Medical Error Attitude Scale (MEAS) and questions about caregiver support synthesised from evidence-based resources.

Results: Most participants were from acute care settings (83.1%) and were chief executives (69.3%). MEAS scores were high, indicating enlightened attitudes about medical errors. Over one-third (38.8%) could not confirm their organisation had a caregiver support programme (CSP). Fewer than 50% of HLs from organisations with a CSP expressed certainty about its effectiveness and utilisation. Still, most were confident about its value to the organisation (84.3%) and return on investment (82.2%). Some participants (33.3%) indicated healthcare organisations may have conflicts of interest interfering with optimal caregiver support.

Discussion: HLs have enlightened views about medical errors, yet organisational caregiver support after errors is often suboptimal. Existing CSPs may lack important structural elements such as executive buy-in and tiers of support. Organisations can improve caregiver support by developing comprehensive approaches to patient safety, utilising tools such as the Agency for Healthcare Research and Quality's CANDOR process or the National Health Services' National Patient Safety Strategy documents.

Purpose: This study quantified the energy consumption of radiology reporting stations, identified inefficiencies and explored power management strategies to reduce energy waste and negative environmental impact.

Methods: The energy consumption of our reporting stations was monitored over 3 months in three operational states: active, standby and off modes. Three scenarios were analysed: (1) current conditions where workstations enter standby after 20 min and remain in standby overnight (baseline scenario), (2) reduced standby activation period of 5 min and (3) complete power-down of workstations overnight. The most environmentally friendly scenario was assessed both in terms of energy consumption and carbon footprint.

Results: The baseline scenario resulted in an annual energy consumption of 55 750 kWh and a carbon footprint of 75.6 tons of CO₂. Reducing the standby activation period (scenario 2) led to a minor decrease in consumption (55 349 kWh) and emissions (75.1 tons of CO₂). The most effective strategy (scenario 3) involving powering down workstations overnight reduced annual energy consumption to 37 602 kWh (by 32.5%) and lowered carbon emissions to 51.0 tons of CO₂.

Conclusion: Implementing automated power-down protocols during non-working hours can reduce the overall energy consumption and environmental impact of the department. These findings support integrating sustainable power management strategies across healthcare facilities.