BMJ Leader最新文献

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.

Background: Leadership education is increasingly recognised as essential for preparing healthcare students to navigate complexity and drive change. Yet practice-based learning (placements) focusing on leadership in the Allied Health Professions remains underexplored and is often perceived as less relevant than those in clinical settings. This article presents a reflective account from a mature physiotherapy student from a minoritised ethnic background, whose cultural upbringing initially positioned education and leadership as inaccessible.

Method: The student undertook a 6-week leadership-focused placement during her second year of study. Entering with apprehension and uncertainty about its value, she engaged in structured activities, including weekly presentations designed to reflect on learning from the previous weeks and to discuss progress on the placement's central project.

Results: Drawing on personal experiences of navigating cultural and gender norms, the placement provided opportunities for significant personal and professional growth, including increased confidence, resilience and development of transferable skills in communication, digital literacy and teamworking. It enabled the student to challenge internalised limitations shaped by cultural expectations and recognise leadership as an integral aspect of physiotherapy practice. The impact of this leadership journey was demonstrated through a university leadership award and the opportunity to influence others via a national online presentation for the Chartered Society of Physiotherapy.

Conclusion: This article illustrates how leadership-focused placements can be transformative by fostering inclusion, self-belief and professional adaptability. These placements align with workforce transformation goals and highlight the need to embed leadership as a core component of healthcare education.

Background: Transitioning into a new chief executive role within a large national health and social care provider prompted a period of systematic observation and deliberate reflection. Drawing on Schön's concept of the reflective practitioner, I kept a journal during my first months to capture critical moments that tested my assumptions and revealed how organisational culture shapes leadership behaviour.

Reflection: This autoethnographic account integrates observation, intentional listening and reflective journaling to explore how leadership meaning is constructed in everyday practice. Six anonymised vignettes are presented, spanning board discussions, governance meetings and frontline encounters. Each vignette illustrates tensions such as silence vs intervention, urgency vs empathy and authority vs collaboration, analysed through frameworks including adaptive, situational and collective leadership, as well as psychological safety, motivation and organisational culture.

Conclusion: The reflections show that leadership is not confined to formal authority but emerges in presence, tone and everyday interactions. They demonstrate how listening, humility and adaptive behaviour foster psychological safety and collective leadership. While situated in health and social care, the insights are transferable to leaders at all levels and across sectors facing complexity and uncertainty.

Introduction: In their 2024 editorial, Yassaie and Garman called on health professionals to be planetary health leaders. Responding to their call for articles, this submission reflects my COVID-19 'planetary health' epiphany during the Australian lockdowns while curating sustainable healthcare and climate change education submissions. COLLECTIVE COVID-19 LEARNINGS: As a global collective, we could have learnt much from the pandemic. Despite our broken relationship with Nature, during lockdown, most of us spent considerable time in Nature. This should have heightened our awareness of our interdependence with our natural environment. The United Nations has asked us to Make Peace with Nature and be the #GenerationRestoration in the 2021-2030 Decade of Restoration. A PERSONAL COVID-19 EPIPHANY: My COVID-19 epiphany happened while curating sustainable healthcare education articles for a medical education journal. An article reflecting Indigenous perspectives introduced me to Natural and First Laws. My newfound awareness of Indigenous communities' deep spiritual connection to and stewardship of Country or Land changed the lens with which Planetary Health was integrated across our curriculum.

Advancing planetary health: This 'epiphany' also led to advocacy for advancing planetary stewardship in health professions education, such as the development of a Consensus Statement on Planetary Health and Education for Sustainable Healthcare, and contributing to the revision of the Australian Medical Council's Accreditation Standards.

Restoration of the planet: Individually and collectively, as health professionals and health professions educators and as #GenerationRestoration, current and yet unborn generations of all 'beings' are relying on us to be inclusive eco-ethical leaders and planetary stewards.

Objective: The aim of this review article is to comprehensively examine and analyse the studies and research conducted in the field of succession planning in nursing management.

Introduction: Succession planning, through the identification and appointment of qualified managers to key leadership positions, helps improve the quality of nursing services.

Methods: The present study is a scoping review that was conducted using Arksey and O'Malley's framework. We used English-language databases such as Web of Science, PubMed, Scopus, ProQuest and the Google Scholar search engine. Additionally, for searching Persian-language sources, databases such as the Islamic World Science Citation Center, the Jihad University Journals Bank, Iran-Doc, Elm-Net and the Ministry of Health's of Iran Theses System were employed.

Results: 30 documents were selected based on the evaluation for data extraction, aligning with the objectives of the study. The results of the data analysis identified six main categories related to succession planning: barriers, facilitators, requirements, contextualisation, cyclical succession planning and potential succession planner organisation.

Conclusion: Based on the importance of succession planning in nursing management, we recommend using the study's findings to plan and carry out thorough and practical research, formulate guidelines and managerial policies, define hospital goals and missions, and shape the organisational vision.

Objectives: This study examines the relationship between the diversification and complexity of ward operations (DCWO) during the COVID-19 pandemic and incident occurrence. Our hospital faced significant changes in ward management during the pandemic. Typically, each ward accommodates two to four clinical departments, with department assignments remaining relatively fixed. However, to free up beds for patients with COVID-19, the number of general wards was reduced, forcing a more fluid allocation of patients across various departments. This shift resulted in a more complex and diverse departmental mix within each ward, complicating ward operations.

Methods: This study retrospectively examined patients admitted to a university hospital in Japan from 1 April 2020 to 31 March 2022. We analysed incident occurrences by ward (including all inpatients within the target ward) and assessed the relationship between nurse-related incidents and DCWO.

Results: We selected records for 7030 ward days from 21 559 patients admitted (10 336 in 2020 and 11 233 in 2021). No significant difference in average age was observed between fiscal year (FY) 2020 and FY 2021 (62.5±16.6 years vs 62.3±16.8 years, respectively; p=0.69). However, the average length of stay differed (13.6±23.9 days vs 12.9±17.5 days, respectively; p<0.01). Logistic regression analysis revealed an OR for DCWO of 1.008 (95% CI 1.002 to 1.015; p=0.007), indicating that an increase in DCWO was associated with the occurrence of mild incidents (where treatment was not necessary). Multiple regression analyses also revealed the association between DCWO and drug-related incidents (p=0.011) and mild incidents (treatment was not necessary; p=0.010).

Conclusions: Changes in departmental configurations during the COVID-19 pandemic influenced patients' conditions and the frequency of mild incidents, highlighting the importance of patient safety considerations in hospital ward operations.

Aims: To identify the range of internal specialist management expertise providers in the NHS and explore their blending with external organisations to address complex organisational challenges.

Methods: Ongoing quantitative and qualitative research (e.g. interviews) and a national networking event and workshop organised by the University of Bristol with NHS partners.

Findings: There is a diverse NHS ecosystem of what we term internal consultancies where strategic benefits can result from combining their contextual insight with the specialist skills of external providers. Effective blending can build sustainable management capacity, deliver better value and reduce over-reliance on external consultants.

Conclusion: There is a need for coordinated action across policy, procurement and workforce development to support a network of internal consultancy/expertise and its periodic blending with other partners, including external organisations.