BMJ Leader最新文献

Introduction: Preventing patient harm is a core ethical responsibility in healthcare. While support for patients and families after adverse events has improved, formal support for clinicians involved in serious medical errors, referred to in the USA as 'caregivers' remains inconsistent. This study reports the qualitative findings from a mixed-methods US study exploring healthcare leaders' perspectives on medical errors and caregiver support. The quantitative phase (n=81) found that only 64% of organisations had a caregiver-support programme and over one-third of leaders could not confirm such support existed. These results informed 19 in-depth interviews analysed thematically to identify perceived barriers and enablers to support.

Methods: Healthcare leaders who participated in the quantitative phase were recruited for semistructured interviews. Transcripts were coded independently by multiple researchers and synthesised through iterative consensus using thematic analysis.

Results: Five themes emerged: (1) impact of leadership, (2) embedded in the culture, (3) supportive response, (4) utilisation of existing infrastructure and (5) self-imposed barriers. Leadership engagement, organisational culture and stigma were central in shaping caregiver recovery after medical error.

Conclusion: Findings highlight the need for a 'compassionate just culture', defined here as an organisational approach that integrates accountability, empathy and restorative practices to support all parties after harm events. Quantitative and qualitative insights underscore the urgent need for trauma-responsive, co-designed caregiver support systems that address both individual and structural contributors to distress. Healthcare leaders play a pivotal role in ensuring compassionate, non-punitive support following medical errors. Strengthening these systems can enhance workforce well-being, organisational trust and patient safety.

Background: Coaching is increasingly used to benefit doctors' professional development. This scoping review summarises the current state of the evidence relating to workplace leadership coaching for qualified doctors.

Methods: A rapid scoping review was conducted, informed by Joanna Briggs' Institute guidelines, with protocol designed a priori. Medline, Embase and APA PsycInfo were searched for relevant articles. Search results were screened for inclusion in duplicate. Data were synthesised descriptively and thematically, mapping the existing research and identifying knowledge gaps.

Results: A total of 5307 articles were screened, and 94 met the inclusion criteria. 15 (16%) articles were classified under 'leadership training needs assessments', 15 (16%) under 'evaluations of leadership development interventions with coaching', 18 (19%) under 'evaluations of leadership coaching interventions', 1 (1%) specifically evaluated a team leader coaching training programme, 37 (40%) were commentaries, 1 (1%) was a research protocol and 7 (7%) were reviews.The studies were positive about the role of coaching in medical leadership development and as a skill for doctors to develop. The use of the term 'coaching' was often conflated with the term 'mentoring'. Most intervention articles mentioned coaches' qualifications or training. Only three used coaches with internationally recognised accreditation qualifications, and the majority used 'faculty coaches'.

Conclusion: Most of the coaching components of leadership interventions, reviews and commentaries included in our review were considered successful. Coaching appears to be increasingly requested as an intervention for leadership development and identified as a training need for medical leaders.

Background: While leadership effectiveness has been linked to occupational well-being among healthcare workers (HCWs), the relationship of specific leadership behaviours with mental health outcomes such as depression and anxiety remains less clear. To address this gap, we investigated associations between perceived effective leadership behaviours and symptoms of depression and anxiety in a large cohort of faculty and staff employed within an urban healthcare system.

Methods: Anonymous online surveys were distributed to medical faculty and staff at a large urban healthcare system in New York City. The surveys included demographic questions, the Mayo Leadership Index to measure perceived leadership effectiveness and validated mental health assessments (Patient Health Questionnaire-2 (PHQ-2), Generalised Anxiety Disorder-2 (GAD-2)). Multinomial logistic regression was used to examine associations between leadership effectiveness (standardised as a z-score) and mental health outcomes.

Results: Survey response rates were 26.1% (1482/5684) for staff and 43.5% (1635/3761) for faculty. The final sample with completed data included 2335 participants (62% above the age of 40, 45% White, 65% female; 46% staff and 54% faculty, including physicians/providers and researchers). Each SD increase in leadership index score was associated with 31% lower odds of anxiety (p<0.001), and 47% lower odds of comorbid depression and anxiety (p<0.001).

Conclusion: These findings underscore the potential role of leadership effectiveness in the mental health of HCWs. Organisational strategies that strengthen leadership effectiveness may be critical components of broad efforts to enhance well-being and promote mental health in the healthcare workforce.

Background: While physicians are crucial to rural or remote healthcare systems, they are rarely trained as effective leaders, particularly in low-income and middle-income countries context. We conducted a 2-day workshop using the LEADS framework to assess whether rural or remote primary care physicians in Aceh, Indonesia, benefited from the leadership development programme and how their professional behaviour changed 6 months post-workshop.

Methods: We applied a mixed-methods study. 10 rural and remote primary care physicians who attended the 2-day workshop were interviewed using a self-reported questionnaire (Kirkpatrick level 3A). We also applied Kirkpatrick level 3B evaluation using qualitative reports from 10 of our workshop participants' colleagues and a quantitative survey from 50 colleagues in primary care, including superiors, peers and paramedics, with a 13-item questionnaire on a 5-point Likert scale. The interview transcriptions were analysed thematically, while the survey questionnaire results were analysed descriptively.

Results: After the workshop, participants self-reported improvements in three areas: (1) communication, (2) solving collaboration and (3) patient and community engagement. Through their colleagues' reports, participants improved in three areas: (1) communication, (2) leading figure and (3) inclusivity. Although the data suggested had benefits on the participants' professional behaviour needed in the workplace, further research is needed to support this.

Conclusions: Given the reported positive impact of the workshop on the participants' professional behaviour, leadership development programmes need to be an integral part of rural and remote healthcare delivery workforce development. Such programmes may be crucial for cultivating physician leaders who are adaptable to diverse contexts.

Background: Mattering, defined as making a difference and feeling significant to others, is endorsed by the US Surgeon General as an essential component of a healthy work environment. This concept is particularly relevant for healthcare leaders whose workforce face challenges such as burnout and turnover due to the demanding nature of the healthcare work environments. Research on mattering within the context of work environments can provide valuable insights into how mattering can be understood in relation to employees' work experiences.

Objectives: This scoping review aims to explore the concept of mattering within the work environment to identify key concepts and relationships between mattering and work-related factors.

Methods: A comprehensive search was conducted across PubMed, ERIC, CINAHL, EMBASE, Business Source Complete and PsycINFO for peer-reviewed studies that investigated mattering at work.

Results: The review included 33 articles covering a diverse range of work environments in seven different countries. Employees' perceptions of mattering at work were influenced by their role and status, interpersonal relationships, peer and organisational support and societal impact. Several studies reported significant relationships between mattering and employee well-being, job satisfaction and organisational culture.

Conclusion: Employees' perceptions of their significance and the importance of their work are shaped by interpersonal, societal and organisational interactions. To foster healthy work environments, healthcare leaders can examine these interactions and prioritise employee mattering. Future research should build on these findings by exploring mattering within the healthcare work environment, measuring healthcare worker mattering and developing interventions to enhance mattering and well-being.

Introduction: Despite growing attention to diversity in academic medicine, gender and racial disparities persist in medical school leadership. This study examined how advanced academic qualifications, such as graduate degrees and additional certifications, intersect with these disparities in Canadian medical school leadership positions.

Methods: We conducted a cross-sectional analysis across 17 accredited Canadian medical schools, categorising faculty by qualifications, medical school leadership roles and academic rank. Data sources included institutional faculty directories, LinkedIn and Scopus. Race and gender were inferred using NamSor. We used the χ² tests and effect size reporting for analyses.

Results: Across qualification levels, gender and racial disparities in leadership and academic rank remained evident. Men and White faculty were disproportionately represented in senior roles, particularly among MDs who also held additional graduate degrees such as a master's or PhD, where disparities were most pronounced. In contrast, women and racialised faculty were more frequently found in mid-level or junior roles, even when holding multiple advanced degrees. These findings indicate that additional credentials alone do not mitigate inequities in academic advancement.

Conclusion: Our findings suggest that while advanced qualifications may enhance access to leadership roles, they do not close gender and racial gaps. These persistent disparities highlight the need for systemic reforms and targeted policies to ensure equitable leadership opportunities in academic medicine.

Introduction: Achieving gender equity in medicine remains elusive. We evaluated the gender distribution within executive roles of North American radiation oncology societies and assessed the relationship between gender, committee rank, academic rank and research productivity.

Methods: 205 committee members were identified from four radiation oncology society webpages. Members were categorised into leadership positions and academic ranks. For each, the Hirsch index (h-index), m-index, publications, citations and years of research were extracted from the Scopus database. This study complies with Sex and Gender Equity in Research (SAGER) guidelines for observational studies.

Results: Radiation oncology committees were comprised of significantly more men (72.7%, p<0.0001). Within these committees, men significantly outnumbered women in leadership positions, holding 73.5% of positions (p<0.0001). This trend extended to academic ranks and research productivity, with men occupying 72.7% of positions (p<0.001) and having greater mean (±SE of the mean) research productivity with more publications (171.1±12.9 vs 97.3±18.7, p<0.0001), citations (7785±785.1 vs 44061±1168, p=0.0002), h-index (36.17±2.2 vs 22.9±3.6, p=0.0002) and years of research (29.8±1.2 vs 16.7±1.7, p<0.0001). The m-index showed no significant gender difference among men and women (1.2±0.06 vs 1.2±0.09, p>0.05).

Conclusion: While men occupy more leadership roles and show higher research productivity as measured by the h-index, accounting for years of active research with the m-index showed no significant difference between genders. This underscores the need for targeted strategies such as mentorship programmes and gender-equity policies to promote greater representation of women in the discipline.

Background: Despite the widespread availability of many vaccines and health providers' favourable attitudes towards vaccines, suboptimal immunisation rates persist worldwide. This study investigates the impact of presumptive (opt-out) communication training and social norms-based messaging on healthcare providers' self-reported vaccination recommendation behaviour.

Design: Two cross-cultural, preregistered, longitudinal randomised controlled trials were conducted involving 413 physicians and healthcare providers in the USA and Brazil. The study design was a 2 (presumptive communication training vs control information) × 2 (high social proof vs control information) experimental design. Participants were surveyed at baseline, 30, 60 and 90 days to assess changes in self-reported vaccination recommendation behaviour.

Results: Physicians and healthcare providers who received presumptive communication training reported a significant increase in use of presumptive language in their vaccination recommendations 90 days post-training, by 59.5% (=24.1 pp) in the USA and 25.3% (=16.2 pp) in Brazil. Additionally, social norms-based messaging led to a significant increase in perceived patient trust among providers in Brazil at 60-day and 90-day follow-ups.

Limitations: The study relied on voluntary participation as well as self-report data, which may be influenced by social desirability bias and/or demand effects.

Conclusions: Online, presumptive (opt-out) communication training for physicians and healthcare providers can substantially boost the self-reported use of presumptive language when communicating with patients about vaccination.

Implications: The research presents a novel approach to combining presumptive communication training and social norms-based messaging to close the gap between healthcare provider intentions and actual vaccination recommendation behaviour. This shows how health systems researchers and clinical leaders can draw on insights from behavioural science to help clinicians communicate more effectively with patients.