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Situations of moral injury and ambiguity will always go on in healthcare: it is how we deal with them that is important. 在医疗保健中,道德伤害和模糊的情况总是会发生:重要的是我们如何处理它们。
IF 1.7 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-01 DOI: 10.1136/leader-2022-000691
Kim Nurse, Hannah Baird

The article explores the concepts of moral distress and moral injury experienced by healthcare professionals, from the perspective of two junior doctors, in the National Health Service. It highlights the daily challenges faced by doctors due to insufficient resources, staff shortages and time constraints, leading to an inability to provide the expected level of care, which if not addressed can result in long-term psychological harm and impaired functioning.

本文从国家卫生服务局的两名初级医生的角度探讨了医疗保健专业人员所经历的道德痛苦和道德伤害的概念。它强调了医生由于资源不足、人员短缺和时间限制而面临的日常挑战,导致他们无法提供预期水平的护理,如果不加以解决,可能会导致长期的心理伤害和功能受损。
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引用次数: 0
Role of hospital leadership in pandemic preparedness: experience at a tertiary hospital in Kenya during the COVID-19 pandemic. 医院领导在大流行病防备中的作用:肯尼亚一家三级医院在 COVID-19 大流行期间的经验。
IF 1.7 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-01 DOI: 10.1136/leader-2023-000833
Lucy W Mwangi, William Macharia, Benjamin W Wachira, Jemimah Kimeu, Boniface Mativa, Lukoye Atwoli

Introduction: Pandemic preparedness refers to being ready for, responding to and recovering from public health crises, and is integral for health security. Hospital leadership is a critical building block of an effective healthcare system, providing policy, accountability and stewardship in a health crisis.

Objectives and methods: We aimed to describe the leadership and governance structures put in place at the Aga Khan University Hospital, Nairobi, a private not-for-profit tertiary healthcare facility, following the COVID-19 pandemic. We reviewed over 200 hospital documents archived in the COVID-19 repository including those received from the Kenya Ministry of Health, emails, memos, bulletins, meeting minutes, protocols, brochures and flyers. We evaluated and described pandemic preparedness at the hospital under four main themes: (a) leadership, governance and incident management structures; (b) coordination and partnerships; (c) communication strategies; and (d) framework to resolve ethical dilemmas.

Results: The hospital expeditiously established three emergency governance structures, namely a task force, an operations team and an implementation team, to direct and implement evidence-based preparedness strategies. Leveraging on partners, the hospital ensured that risk analyses and decisions made: (1) were based on evidence and in line with the national and global guidelines, (2) were supported by community leaders and (3) expedite financing for urgent hospital activities. Communication strategies were put in place to ensure harmonised COVID-19 messaging to the hospital staff, patients, visitors and the public to minimise misinformation or disinformation. An ethical framework was also established to build trust and transparency among the hospital leadership, staff and patients.

Conclusion: The establishment of a hospital leadership structure is crucial for efficient and effective implementation of pandemic preparedness and response strategies which are evidence based, well resourced and ethical. The role of leadership discussed is applicable to healthcare facilities across low and middle-income countries to develop contextualised pandemic preparedness plans.

导言:大流行病防备是指做好准备,应对公共卫生危机并从中恢复,是卫生安全不可或缺的一部分。医院领导层是有效医疗保健系统的重要组成部分,在卫生危机中提供政策、问责和管理:我们旨在描述内罗毕阿迦汗大学医院(一家私立非营利性三级医疗机构)在 COVID-19 大流行后建立的领导和治理结构。我们查阅了 COVID-19 资料库中存档的 200 多份医院文件,包括从肯尼亚卫生部收到的文件、电子邮件、备忘录、公告、会议记录、协议、小册子和传单。我们按照以下四个主题对该医院的大流行病防备工作进行了评估和描述:(a) 领导、治理和事件管理结构;(b) 协调和伙伴关系;(c) 沟通策略;(d) 解决伦理困境的框架:该医院迅速建立了三个应急管理机构,即工作队、行动小组和实施小组,以指导和实施循证备灾战略。该医院借助合作伙伴的力量,确保风险分析和决策:(1) 以证据为基础,符合国家和全球指导方针;(2) 得到社区领袖的支持;(3) 加快为医院的紧急活动提供资金。制定了沟通策略,以确保向医院员工、患者、来访者和公众传达统一的 COVID-19 信息,从而最大限度地减少误导或虚假信息。此外,还建立了一个道德框架,以在医院领导层、员工和患者之间建立信任和透明度:建立医院领导结构对于高效和有效地实施以证据为基础、资源充足和符合道德规范的大流行病防备和应对战略至关重要。所讨论的领导作用适用于中低收入国家的医疗机构,以制定符合国情的大流行病防备计划。
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引用次数: 0
ChatGPT: a novel AI assistant for healthcare messaging-a commentary on its potential in addressing patient queries and reducing clinician burnout. ChatGPT:一种用于医疗保健信息的新型人工智能助手——对其在解决患者查询和减少临床医生倦怠方面的潜力的评论。
IF 1.7 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-01 DOI: 10.1136/leader-2023-000844
Benjamin Laker, Emily Currell
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引用次数: 0
Impact and effectiveness of leadership and management in academic health sciences. 学术健康科学领域领导与管理的影响和有效性。
IF 1.7 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-01 DOI: 10.1136/leader-2023-000843
Claire Donnellan
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引用次数: 0
System planning for modern-day Just Culture to mitigate worker distress and second victim response. 现代公正文化的系统规划,以减轻工人的痛苦和第二受害者的反应。
IF 1.7 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-01 DOI: 10.1136/leader-2023-000811
Joanna R Sells, Irene Cole, Charlie Dharmasukrit, Amy Brown, Christine Rovinski-Wagner, Tamara L Tasseff
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引用次数: 0
'We are in for a culture change': continuing professional development leaders' perspectives on COVID-19, burn-out and structural inequities. “我们正在进行文化变革”:延续职业发展领导者对新冠肺炎、淘汰和结构性不平等的观点。
IF 1.7 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-01 DOI: 10.1136/leader-2023-000837
Sophie Soklaridis, Rabia Zaheer, Michelle Scully, Rowen Shier, Betsy Williams, Linda Dang, Sam J Daniel, Sanjeev Sockalingam, Martin Tremblay

Introduction: The COVID-19 pandemic positioned healthcare systems in North America at the epicentre of the crisis, placing inordinate stress on clinicians. Concurrently, discussions about structural racism, social justice and health inequities permeated the field of medicine, and society more broadly. The confluence of these phenomena required rapid action from continuing professional development (CPD) leaders to respond to emerging needs and challenges.

Methods: In this qualitative study, researchers conducted 23 virtual semistructured interviews with CPD leaders in Canada and the USA. Interview audiorecordings were transcribed, deidentified and thematically analysed.

Results: This study revealed that the CPD leaders attributed the pandemic as illuminating and exacerbating problems related to clinician wellness; equity, diversity and inclusion; and health inequities already prevalent in the healthcare system and within CPD. Analysis generated two themes: (1) From heroes to humans: the shifting view of clinicians and (2) Melding of crises: an opportunity for systemic change in CPD.

Discussion: The COVID-19 pandemic increased recognition of burn-out and health inequities creating momentum in the field to prioritise and restrategise to address these converging public health crises. There is an urgent need for CPD to move beyond mere discourse on these topics towards holistic and sustainable actionable measures.

简介:新冠肺炎大流行将北美的医疗保健系统置于危机的中心,给临床医生带来了过度的压力。与此同时,关于结构性种族主义、社会正义和健康不平等的讨论渗透到了医学和更广泛的社会领域。这些现象的汇合要求持续专业发展(CPD)领导者迅速采取行动,应对新出现的需求和挑战。方法:在这项定性研究中,研究人员对加拿大和美国的CPD领导人进行了23次虚拟半结构访谈。访谈录音被转录、识别和主题分析。结果:这项研究表明,CPD领导人将疫情归因于与临床医生健康相关的问题;公平、多样性和包容性;以及医疗保健系统和CPD内部已经普遍存在的健康不平等现象。分析产生了两个主题:(1)从英雄到人类:临床医生观点的转变;(2)危机的融合:CPD系统性变革的机会。国家方案文件迫切需要超越对这些主题的单纯讨论,转而采取全面和可持续的可行措施。
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引用次数: 0
Public health leadership in the COVID-19 era: how does it fit? A scoping review. COVID-19 时代的公共卫生领导力:如何适应?范围审查。
IF 1.7 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-01 DOI: 10.1136/leader-2022-000653
Tommaso Osti, Angelica Valz Gris, Valerio Flavio Corona, Leonardo Villani, Floriana D'Ambrosio, Marta Lomazzi, Carlo Favaretti, Fidelia Cascini, Maria Rosaria Gualano, Walter Ricciardi

The COVID-19 pandemic has put a lot of pressure on all the world's health systems and public health leaders who have often found themselves unprepared to handle an emergency of this magnitude. This study aims to bring together published evidence on the qualities required to leaders to deal with a public health issue like the COVID-19 pandemic. This scoping literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. A search of relevant articles was performed in the PubMed, Scopus and Web of Science databases. A total of 2499 records were screened, and 45 articles were included, from which 93 characteristics of effective leadership were extrapolated and grouped into 6 clusters. The qualities most frequently reported in the articles were human traits and emotional intelligence (46.7%) and communication skills such as transparency and reliability (48.9%). Responsiveness and preparedness (40%), management skills (33.3%) and team working (35.6%) are considered by a significant percentage of the articles as necessary for the construction of rapid and effective measures in response to the emergency. A considerable proportion of articles also highlighted the need for leaders capable of making evidence-based decisions and driving innovation (31.1%). Although identifying leaders who possess all the skills described in this study appears complex, determining the key characteristics of effective public health leadership in a crisis, such as the COVID-19 pandemic, is useful not only in selecting future leaders but also in implementing training and education programmes for the public health workforce.

COVID-19 大流行给世界上所有的卫生系统和公共卫生领导者带来了巨大的压力,他们常常发现自己对处理如此大规模的紧急事件毫无准备。本研究旨在汇集已发表的有关领导者应对 COVID-19 大流行等公共卫生问题所需素质的证据。本范围界定文献综述是根据《系统综述和元分析首选报告项目扩展范围界定综述清单》进行的。在 PubMed、Scopus 和 Web of Science 数据库中对相关文章进行了检索。共筛选出 2499 条记录,45 篇文章被纳入其中,从中推断出有效领导力的 93 个特征,并将其分为 6 组。文章中报道最多的素质是人性特质和情商(46.7%)以及沟通技巧,如透明度和可靠性(48.9%)。相当大比例的文章认为,反应和准备能力(40%)、管理技能(33.3%)和团队合作 (35.6%)是制定快速有效的应急措施所必需的。相当大比例的文章还强调需要能够做出有依据的决策和推动创新的领导者(31.1%)。尽管确定具备本研究所述所有技能的领导者似乎很复杂,但确定在 COVID-19 大流行等危机中有效的公共卫生领导的关键特征,不仅有助于挑选未来的领导者,也有助于实施公共卫生队伍的培训和教育计划。
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引用次数: 0
Future-ready healthcare leadership: the revised International Hospital Federation competency model. 未来就绪的医疗保健领导力:国际医院联合会能力模型修订版。
IF 1.7 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-06-24 DOI: 10.1136/leader-2023-000925
Sylvia Basterrechea, Jan C Frich, Andrew N Garman

Background: Major global trends are reshaping health services delivery, and preparing current and future healthcare leaders requires an understanding of these trends. A well-designed leadership competency model can provide guidance for individuals, as well as for system-level leadership development and integration programmes.

Objective: To describe the process of updating the International Hospital Federation's (IHF) Global Healthcare Management Competency Directory.

Methods: Revisions were informed by a recent foresight study of major trends in health services delivery, and an evidence-informed framework of leadership competencies. The original framework competencies were reviewed by 45 subject-matter experts from 30 countries and regions, who provided feedback through electronic surveys and online interviews. We incorporated this iterative feedback to revise the framework design, competencies within the framework and their associated behavioural descriptions.

Results: A total of 45 subject-matter experts from 30 countries and regions participated in 1 or more phases of the survey process. The resulting leadership competency model includes 32 competencies organised into a framework of 6 domains: values, self-development, execution, relations, context management and transformation.

Conclusion: The updated IHF Leadership Model provides a robust, evidence-based and up-to-date resource for assessing and developing future-ready healthcare leaders.

背景:主要的全球趋势正在重塑医疗服务的提供,培养当前和未来的医疗保健领导者需要了解这些趋势。一个精心设计的领导能力模型可以为个人以及系统级领导力发展和整合计划提供指导:描述国际医院联合会(IHF)全球医疗保健管理能力目录的更新过程:方法:根据最近对医疗服务提供主要趋势的前瞻性研究以及以证据为依据的领导能力框架进行修订。来自 30 个国家和地区的 45 位主题专家对最初的能力框架进行了审查,并通过电子调查和在线访谈提供了反馈意见。我们采纳了这些反复反馈意见,对框架设计、框架内的能力及其相关行为描述进行了修订:共有来自 30 个国家和地区的 45 位主题专家参与了一个或多个阶段的调查过程。最终形成的领导能力模型包括 32 项能力,由 6 个领域组成:价值观、自我发展、执行力、关系、背景管理和转型:更新后的 IHF 领导力模型为评估和培养未来就绪的医疗保健领导者提供了一个强大的、以证据为基础的最新资源。
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引用次数: 0
Adaptive leadership in crisis: a healthcare system's resilience journey. 危机中的适应性领导:医疗保健系统的复原之旅。
IF 1.7 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-06-21 DOI: 10.1136/leader-2023-000958
Marie Aouad, Maya Jalbout Hastie, Vanda Yazbeck Karam

Background: Amid the complexities of a healthcare system facing economic collapse, pandemic challenges, a devastating human-made disaster, and critical staffing shortages, effective leadership becomes paramount. This article explores the adaptive leadership approach in the face of unprecedented challenges, drawing from the experiences of a healthcare system in Lebanon.

Methods: Anchored in Maslow's hierarchy of needs and guided by the adaptive leadership framework, leaders addressed challenges resulting from the economic crisis, compounded by the COVID-19 pandemic and a catastrophic explosion in Beirut, which tested the resilience of the healthcare system.

Results: Challenges ranged from resource shortages and financial strain to the critical staffing upheaval and psychological impact on healthcare workers. Prioritising physiological, safety, belongingness, self-esteem and self-actualisation needs, leaders implemented innovative strategies, including volunteer mobilisation, recruitment plans, makeshift clinics and psychological support. Transparent communication, self-esteem recognition and fostering resilience emerged as crucial components.

Conclusion: The article provides insights into the practical application of adaptive leadership and Maslow's hierarchy of needs in navigating multifaceted crises within a healthcare setting. It underscores the significance of fostering resilience, prioritising the well-being of healthcare professionals and leveraging innovative solutions to ensure the continued delivery of high-quality care amid unprecedented challenges.

背景:医疗保健系统面临着经济崩溃、大流行病挑战、毁灭性的人为灾难以及严重的人员短缺等复杂问题,在这种情况下,有效的领导力变得至关重要。本文从黎巴嫩医疗系统的经验出发,探讨了面对前所未有的挑战时的适应性领导方法:方法:以马斯洛的需求层次理论为基础,在适应性领导力框架的指导下,领导者们应对了经济危机带来的挑战,而 COVID-19 大流行病和贝鲁特的灾难性爆炸又加剧了这些挑战,对医疗保健系统的应变能力提出了考验:挑战包括资源短缺和财政紧张,以及关键的人员配置动荡和对医疗工作者的心理影响。领导者优先考虑生理、安全、归属感、自尊和自我实现需求,实施了创新战略,包括志愿者动员、招聘计划、临时诊所和心理支持。透明沟通、自尊认可和培养复原力成为关键要素:文章深入分析了适应性领导力和马斯洛需求层次理论在应对医疗环境中多方面危机时的实际应用。文章强调了培养抗压能力、优先考虑医疗保健专业人员的福祉以及利用创新解决方案确保在前所未有的挑战中继续提供高质量医疗保健服务的重要性。
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引用次数: 0
Logistics and administration-related stressors among young physicians working in the emergency medicine (EM) department and their perceived job satisfaction in EM department across hospitals of India: a nationwide multicentric digital survey. 印度各医院急诊科年轻医生的后勤和行政压力以及他们对急诊科工作的满意度:一项全国性多中心数字调查。
IF 1.7 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-06-21 DOI: 10.1136/leader-2023-000919
Murtuza Ghiya, Alok A Gangurde, Jilshy Varghese, Mohamed M A Hishaam, Balamurali Krishna, Jeffrey Pradeep Raj, Manu Mathew Lal

Objective: Emergency medicine (EM) is a growing specialty in India with the board approving training programme commencing only since 2009. This study aimed to identify the challenges faced by EM department personnel in the country and to obtain valuable insight into the concerns and problems experienced by them.

Methods: This study was a cross-sectional digital survey conducted among EM department personnel in teaching institutions across India. The study involved 170 respondents, who completed an online questionnaire that covered various aspects of their work and identified the challenges they faced. It also captured potential solutions as perceived by the respondents.

Results: A total of n=170 participants completed the survey of which N=164 fulfilled the eligibility criteria. The study revealed significant challenges faced by EM personnel in India. Administrative and clerical work consumed a considerable amount of respondents' time. Understaffing (n=144/164; 87.8%), followed by complains about delay due to hospital administrative processes and policies (n=141/164; 85.9%), and delay in interhospital transfers (n=139/164; 84.8%) were the primary concerns spelt out by the respondents. Additionally, respondents experienced interpersonal conflicts, and verbal/physical abuse and inappropriate behaviour from patients and their family members. Potential key solutions suggested were to improve resources including manpower and take steps to prevent violence against EM staff.

Conclusion: The study's results call for policy-makers and hospital administrators to address the issues faced by EM department staff. Improving EM department operations can improve patient care and staff well-being. Future research should examine challenges in non-teaching institutions and potential solutions.

目的:急诊医学(EM)在印度是一个不断发展的专科,自 2009 年才开始由委员会批准培训计划。本研究旨在确定印度急诊科人员所面临的挑战,并深入了解他们所关心的问题:本研究是一项横断面数字调查,调查对象为印度各地教学机构的电磁系人员。170 名受访者填写了一份在线问卷,内容涉及他们工作的各个方面,并确定了他们所面临的挑战。调查还收集了受访者认为潜在的解决方案:共有 170 人完成了调查,其中 164 人符合资格标准。研究揭示了印度环境管理人员面临的重大挑战。行政和文书工作耗费了受访者大量的时间。人员不足(n=144/164;87.8%),其次是抱怨医院行政程序和政策造成的延误(n=141/164;85.9%),以及医院间转院延误(n=139/164;84.8%)是受访者提出的主要问题。此外,受访者还经历了人际冲突,以及来自患者及其家属的言语/身体虐待和不当行为。建议的潜在主要解决方案是改善资源(包括人力),并采取措施防止针对急诊室工作人员的暴力行为:研究结果呼吁政策制定者和医院管理者解决急诊科员工面临的问题。改善急诊科的运作可以改善病人护理和员工福利。未来的研究应探讨非教学机构面临的挑战和潜在的解决方案。
{"title":"Logistics and administration-related stressors among young physicians working in the emergency medicine (EM) department and their perceived job satisfaction in EM department across hospitals of India: a nationwide multicentric digital survey.","authors":"Murtuza Ghiya, Alok A Gangurde, Jilshy Varghese, Mohamed M A Hishaam, Balamurali Krishna, Jeffrey Pradeep Raj, Manu Mathew Lal","doi":"10.1136/leader-2023-000919","DOIUrl":"https://doi.org/10.1136/leader-2023-000919","url":null,"abstract":"<p><strong>Objective: </strong>Emergency medicine (EM) is a growing specialty in India with the board approving training programme commencing only since 2009. This study aimed to identify the challenges faced by EM department personnel in the country and to obtain valuable insight into the concerns and problems experienced by them.</p><p><strong>Methods: </strong>This study was a cross-sectional digital survey conducted among EM department personnel in teaching institutions across India. The study involved 170 respondents, who completed an online questionnaire that covered various aspects of their work and identified the challenges they faced. It also captured potential solutions as perceived by the respondents.</p><p><strong>Results: </strong>A total of n=170 participants completed the survey of which N=164 fulfilled the eligibility criteria. The study revealed significant challenges faced by EM personnel in India. Administrative and clerical work consumed a considerable amount of respondents' time. Understaffing (n=144/164; 87.8%), followed by complains about delay due to hospital administrative processes and policies (n=141/164; 85.9%), and delay in interhospital transfers (n=139/164; 84.8%) were the primary concerns spelt out by the respondents. Additionally, respondents experienced interpersonal conflicts, and verbal/physical abuse and inappropriate behaviour from patients and their family members. Potential key solutions suggested were to improve resources including manpower and take steps to prevent violence against EM staff.</p><p><strong>Conclusion: </strong>The study's results call for policy-makers and hospital administrators to address the issues faced by EM department staff. Improving EM department operations can improve patient care and staff well-being. Future research should examine challenges in non-teaching institutions and potential solutions.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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