Journal of Healthcare Leadership最新文献

Purpose: Healthcare is a complex, multi-layered team environment where effective change often requires reaching consensus among relatively autonomous stakeholders. Although conducting informal consensus discussions is a frequently used implementation strategy in real-world clinical settings, limited information exists about what defines consensus when using these methods. Specifying the criteria for consensus is important, as it can shape the design of consensus-building strategies. This study aimed to identify and define the key domains of consensus used in local consensus discussions to standardise healthcare practices.

Patients and methods: A qualitative study was conducted in one private hospital in Australia using a modified, grounded theory methodology. Clinical, non-clinical and leadership staff involved in developing standardised perioperative pathways using informal consensus discussions were recruited. Data were collected via semi-structured interviews and naturalistic participant observations between February 2023 and May 2024. Data collection and analysis occurred concurrently until theoretical saturation was achieved. Data were analysed using open coding with constant comparison, focussed and theoretical coding to develop theoretical concepts.

Results: Sixteen hours of observations with 31 participants and nine semi-structured interviews were conducted. Analysis identified four distinct consensus criteria: i) unanimous consensus, ii) delegated consensus, iii) assumed consensus and iv) concessional consensus. While unanimity was the preferred outcome, other consensus types emerged as viable alternatives when unanimous agreement was challenging to achieve. Each criterion had differing factors and mechanisms which influenced reaching the consensus criterion, underpinning assumptions, and considerations for practice, which formed four domains of consensus.

Conclusion: These domains provide a structured framework for classifying consensus criteria when conducting local consensus discussions in healthcare. The findings broaden our understanding of consensus in local healthcare discussions, moving beyond a singular focus on unanimity. By clearly defining consensus types, organisations can strategically select consensus methods that best support decision-making and intervention implementation.

Physician and advanced practice provider (APP) burnout is a significant issue in healthcare, exacerbated by the COVID-19 pandemic. Burnout rates remain high, with severe implications for both clinicians and patient care. This paper acknowledges the multifaceted causes of burnout, including environmental and individual factors, and evaluates the effectiveness of wellness-centered leadership as a mitigation strategy. St. Luke's Health System implemented a comprehensive wellness-centered leadership program, including training and toolkits, to improve well-being. Surveys conducted in 2022, 2023, and 2024 assessed burnout levels, feeling valued by the organization, intent to leave, and leadership alignment among physicians and APPs. Results indicated a decrease in burnout and intent to leave, alongside improved leadership alignment, and improved feeling valued by the organization. The findings suggest that wellness-centered leadership can significantly reduce burnout and enhance job satisfaction, highlighting the importance of leading with well-being in healthcare settings.

In addition to advancing biomedical research and delivering cutting-edge clinical care, academic medical centers (AMCs) are tasked with training the next generation of physicians and scientists. This training is based on a competencies model, with emphasis given to the high-level acquisition of technical clinical and research skills. While this framework is appropriate for the learning years, once researchers and clinician-scientists transition from training to fuller career responsibilities, they are in need of an expanded psychological and psychosocial toolkit for holistic success. At present, academic medicine does not sufficiently support, address, or welcome the elements of this toolkit; in the early career phase, overemphasis is placed on the expression and expansion of independent technical competencies, to the neglect of the psychosocial facets necessary for academics' successful career progression and fulfillment. Delineating the legacy of the current training model for the early career period, this paper explicates the tension that exists between the conventional markers of success and adult psychosocial needs, with special attention paid to the potential consequences of this mismatch. The paper concludes with a series of suggestions for how leaders in academic medicine may help their research and clinician-scientist faculty flourish more fully in early career.

Belonging is a human necessity, fostering psychological safety and self-actualization. The importance and benefits of belonging are well documented, and there is a growing body of research emphasizing the role belonging plays in the workplace and its effects on employees and companies alike. Due to the unique stressors and barriers present in healthcare, a lack of belonging among employees is not uncommon. This paper explores how cultivating an inclusive environment transforms healthcare delivery and highlights tangible strategies leaders in healthcare can utilize to enhance belonging for staff and ultimately the patient populations they interact with. Because belonging is multifaceted and highly individualized, effective strategies include people-centered approaches that prioritize physical and mental well-being, career-advancing initiatives, empathetic leadership and robust support systems. The importance of analyzing systems that either promote or inhibit belonging, specifically by examining existing organizational policies and practices through an equity lens, is also discussed. By prioritizing diverse perspectives and implementing tailored interventions, healthcare organizations and committed staff can create a culture where both patients and professionals feel valued, leading to enhanced well-being, improved patient outcomes, and equitable healthcare delivery.

Background: Although women provide approximately 75% of healthcare globally, they are underrepresented in healthcare leadership, surgery, and anesthesia. Patient- provider gender concordance has been shown to improve patient experience in high-income settings; however, patients in low-and middle-income countries often lack the opportunity to choose the gender of their provider and there is a paucity of literature on the importance of women healthcare providers in these settings.

Aim: To assess the experiences and provider gender preferences of patients with cleft and their caregivers before and after receiving care from an all-women surgical team in a Women in Medicine (WIM) surgical program.

Methods: This cross-sectional study is based on an anonymous survey administered to patients 15 years or older or their caregivers after receiving care from an all-women surgical team during four distinct cleft surgery programs in Morocco, Peru, Malawi, and the Philippines throughout 2022. Analysis included quantitative, descriptive statistics, chi-squared and f-tests.

Results: Before the program, 20% of participants had never received care from women physicians and only 35% preferred women as their healthcare provider. After the program, 66% preferred women as their healthcare provider (p<0.001) with the highest proportion in Morocco (90%) and lowest in Malawi and the Philippines (55%). Across all education levels, most participants preferred women after the program (64%) and 98% were satisfied or more than satisfied with the care received. The three most influential characteristics for preferring women were their understanding, patience, and communication.

Conclusion: Participation in the WIM program provided some patients with their first opportunity to experience receiving care from a woman. This exposure may influence their preference for a healthcare provider, which has been shown to enhance patient experience. Programs like this are imperative to increasing visibility of women in surgical and healthcare leadership roles, improving patient experience, and increasing access to care.

Introduction: Healthcare leaders face complex ethical challenges that can impact patient care and organizational integrity. For international healthcare management students pursuing leadership roles in Australia, these challenges are heightened by ethical, cultural, and transnational differences. This exploratory study examined the challenges faced by these students to establish foundational understanding of the competencies needed for effective ethical decision-making, cultural integration, and transnational readiness in diverse healthcare environments.

Methods: Using a composite theoretical framework incorporating Cultural Relativism, Ethical Climate Theory, Institutional Theory, and Transnationalism, a 35-item instrument was adapted from three validated sources. A cross-sectional survey of 35 international postgraduate health services management students collected quantitative and qualitative data. Quantitative data were summarized using descriptive statistics, while thematic analysis, informed by the Gioia methodology, was applied to qualitative responses.

Results: Key ethical challenges identified included healthcare inequity, resource allocation, and patient safety. Effective leadership practices emphasized fostering supportive work environments and promoting diversity. Participants demonstrated strong cultural competence, particularly in cultural awareness and cross-cultural communication, but highlighted the need for enhanced preparation in ethical decision-making and navigating transnational healthcare systems.

Conclusion: The findings underscore the importance of transnational training programs that integrate cultural orientation, healthcare-specific language support, and ethical decision-making simulations. The Ethical, Cultural, and Transnational framework developed in this study provides a practical guide for embedding these competencies into leadership curricula, equipping international students to navigate the complexities of globalized healthcare systems effectively.

Purpose: People living with dementia and their care partners identify interactions with the healthcare system as among their greatest challenges. Many hospital staff do not feel prepared to care for people living with dementia. This contributes to poor outcomes for patients living with dementia, frustration and confusion for care partners, and distress for hospital staff.

Patients and methods: An academic project team with expertise in education, geriatrics, simulation, and community engagement, who had previously developed dementia-friendly training materials for classroom and community use, designed a dementia-friendly hospital toolkit. Applying principles of user-centered design, the project team consulted with care partners of people living with dementia, hospital staff, hospital leadership, and advocates from communities disproportionately impacted by dementia to identify and address the needs of patients, care partners, hospital staff, and hospital leadership.

Results: The project team developed a dementia-friendly hospital toolkit, which includes training materials for hospital staff across roles and an organizational guide to facilitate uptake by a wide range of hospitals. In multiple rounds of pilot testing, hospital staff rated toolkit training activities highly, reporting new insights and applying the knowledge or skills gained in their professional roles. Five hospitals, ranging from large academic centers to rural critical access hospitals, used the toolkit to assess needs, develop plans, and organize training sessions for staff. All hospitals reported receiving positive feedback from staff, meeting staff learning objectives, and intending to continue using the toolkit to meet their dementia-friendly goals.

Conclusion: Following an inclusive, user-centered approach to developing dementia-friendly training materials allowed the project team to address the needs of key partners: people living with dementia, their care partners, hospital staff, and hospital leadership. Based on the positive responses from hospital pilot partners, the project team is supporting wider dissemination of the dementia-friendly hospital toolkit.

Purpose: Drawing on the conservation of resources theory, we explore how job autonomy affects resilience and emotional exhaustion through psychological self-care (PSC). In addition, we study the impact of role overload as a boundary condition which dampens the beneficial effects of job autonomy.

Methods: Cross-sectional data was collected through an online survey among Canadian health care workers (HCWs) across multiple organizations. We performed structural equation modeling (SEM) to test the proposed hypotheses (N=860).

Results: Job autonomy had a positive relationship with resilience and negative with emotional exhaustion, both through PSC. However, high role overload hinders these relationships.

Conclusion: Job autonomy combined with reasonable workload allows HCWs to invest in themselves in the form of PSC, which in turn alleviates their emotional exhaustion and fosters their resilience. Accordingly, this helps HCWs in overcoming both current and future adverse events at work. Valuing autonomy and PSC through communication and contextualized human resource management practices will help support HCWs and health care organizations in turn. Indeed, nurturing resilience and reducing emotional exhaustion will provide and protect the needed individual resources to face future disruptive events, consequently leading to strengthen health care organizations.

Purpose: Physician burnout is a global issue associated with low job satisfaction, decreased quality of patient care, reduced productivity, and early retirement from clinical practice. We sought to evaluate the impact of the leadership qualities of direct physician supervisors on the burnout and professional satisfaction of the physicians they supervise.

Methods: An online survey was distributed by Email to all staff physicians practicing at a large Canadian academic tertiary care hospital. The primary outcome was the prevalence of burnout and professional satisfaction, assessed using the 2-item Maslach Burnout Inventory and a single item 5-point Likert scale rating, respectively. The secondary outcome was the relationship between composite leadership score and burnout/satisfaction, with leadership assessed by the 12-item Mayo Clinic Participatory Management Leadership Index.

Results: Out of the 1176 physicians surveyed, 383 (32.6%) responded (51.2% male; 41.5% female). Overall, 41.7% of physicians reported at least one symptom of burnout (40.0% reported high emotional exhaustion; 15.3% reported high depersonalization). 40.1% of physicians reported being satisfied with the organization, 26.3% were neutral, and 33.6% were dissatisfied. On multivariate analysis adjusting for age, sex, duration of employment at the institution, and specialty, each one-point increase in composite leadership score was associated with a 3.1% decrease in the likelihood of burnout (p = 0.0017), and a 6.6% increase in the likelihood of satisfaction (p < 0.0001).

Conclusion: Physician burnout is prevalent and positive leadership qualities of direct supervisors decreases the likelihood of burnout in physicians and increases the likelihood of their satisfaction with the organization.

Trial registration: ClinicalTrials.gov; Identifier: NCT04896307.