BMJ Leader最新文献

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.

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.

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.

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.

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.

Background: Healthcare leadership and management impacts every patient journey and every staff experience. Good leadership results in positive outcomes. Kindness is an understudied and underused leadership strategy. The research questions addressed in this study are the following: (1) Does kindness in healthcare leadership and management currently meet the criteria of a mature concept?; (2) Using concept analysis methodology, can we develop our understanding of kindness within this context?

Methods: A systematic search of the peer-reviewed literature was conducted to inform a concept evaluation, followed by a concept analysis. Search terms consisted of 'leader*' or 'manage*' and 'kindness'; databases searched comprised MEDLINE, HMIC, SPP, APA PsycInfo and CINAHL. Data extraction and thematic analysis of the data were performed manually according to concept analysis principles.

Results: The 10 papers included from the search suggested that within healthcare leadership and management, kindness is an 'emerging' rather than a 'mature' concept. Concept analysis demonstrated a cluster of recurring attributes, allowing a theoretical definition to be put forth.

Conclusions: Despite being a commonly used lay term, kindness in the context of healthcare leadership and management is not yet a mature concept. Work developing this concept is needed to validate the proposed theoretical definition. Observational studies and systematic review of the grey literature are recommended.

Introduction: Return to practice is one mechanism for recruiting and retaining allied health professionals (AHPs) within the health and care workforce in England. It is not known how this affects persons with protected characteristics.

Aim: To understand experiences of AHPs with protected characteristics of returning to the workforce through a return to practice programme.

Method: A QUAL (semistructured interviews) + qual (focus group interviews) mixed-methods study. 12 online semistructured interviews with return to practice AHPs, followed by 2 online focus groups.

Results: Our research identifies a new type of returners who have to use the return to practice programme as a vehicle to step into health and social care as they have not been able to find employment. A main driver to return to practice was financial reason.

Conclusion: To date there, is little evidence of leaders understanding the complexities of AHPs in a return to practice programme, the considerable contribution they can make to the workplace and the current inequities that exist.

Background: The COVID-19 pandemic presented unprecedented challenges for leaders in healthcare requiring decision-making and crisis response that can often be tricky without the right level of trust. Trust is fostered and facilitated with emotional intelligence (EI); thus, a critical examination of medical leaders' reflections was essential to understand how leaders perceived their leadership responses during the initial response to COVID-19. This exploratory study used an EI lens to investigate leaders' perceptions of their decision-making during COVID-19.

Methods: A purposeful sample of seven leaders in medicine who experienced leading during COVID were invited to participate in semi-structured interviews.

Results: Four themes around leadership response during the uncertain times of the COVID-19 were identified. The themes included communication, interprofessional collaboration including decision-making and strategic planning, internal and external awareness, and finally, trust and psychological safety.

Conclusions: Incorporating EI competencies into crisis leadership education for healthcare professionals could enhance medical leaders' preparedness to adapt, collaborate and communicate effectively in a crisis.

Background: Like other fields in medicine, medical education relies on collaboration and cooperation between countries and regions of the world, although no single institution or position unifies the global medical education community in the way that the WHO does in public health, for example. Recent research in medical education has drawn attention to many injustices that exist in the field, where power and influence is held in relatively few Global North countries, although most practice happens in Global South countries.

Methods: In this article, we examine three positions that hold global prominence in medical education, including the presidents of the World Federation for Medical Education and the Association for Medical Education in Europe, and winners of the Karolinska Institutet Prize for Research in Medical Education.

Findings: We highlight that these positions have problematic histories and have perpetuated the current power disparities in the field. We argue that an alternative model for global leadership is required that should be determined democratically by those involved in medical education all around the world. Such a model should prioritise diversity and inclusivity, empowering leaders from countries who have previously been peripheral to the decision-making platforms in the field.

Conclusion: Given the shortcomings of existing leadership positions and organisations, we suggest that a new institution is required to realise this new vision, and that the principles that govern it should be determined through debate and democracy, with a focus on inviting those voices that have not previously been heard in global medical education circles.