Journal of Healthcare Leadership最新文献

Background: The form of leadership that can positively influence nursing care performance and patient outcomes remains a crucial subject in the healthcare sector.

Aim: This study examines the effect of leadership style at different managerial levels on nursing care performance and patient outcomes.

Methods: A retrospective cohort study was conducted in a public hospital, focusing on two primary settings: the general ward and the critical care unit. The study sample included 60 nurses and 300 patients. The leadership style is a predictor of this study and was measured using a cross-sectional survey of Jordanian nurses using the Multifactor Leadership Questionnaire (MLQ). Nursing care performance and patient outcomes were measured by surveying patients, observing practice, and reviewing health records. The analysis involved descriptive statistics, chi-square tests, odds ratios, and multivariate regression analysis.

Results: The study found that transformational leadership was predominant in the general ward, while transactional leadership was more common in the critical care unit. Leadership styles significantly influence clinical nursing performance. Nurses under transformational leaders were more likely to follow generic policies like patient surveillance but less consistent with specific care standards. Nurses under transactional leaders were linked to higher adherence to standardized care protocols like fall risk assessment and medication rights. Patient outcomes were similar between units, except for higher readmission rates under transactional leadership.

Conclusion: The study's findings underscore the complexities of nurse leadership styles and clinical nursing performance. Nurse manager should adapt their leadership style to the particular setting and a one-size-fits-all approach to leadership may not be effective in healthcare.

Background: In many Indian states, public health programs are led by clinicians without formal training in leadership and management, limiting their effectiveness. To tackle this, Uttar Pradesh's Department of Medical, Health, and Family Welfare initiated a Public Health Management and Leadership (PHML) training program for the Level 4 (mid-career) medical officers. This program aims to enhance the leadership and management skills necessary for these officers to support them transitioning to administrative roles.

Methods: The training focused on essential competencies such as leadership, communication, team building, fiscal management, and public health problem-solving. It included in-person sessions and mentored practicum, utilizing experiential learning and problem-solving group projects. Kirkpatrick's model was used to evaluate participants' reactions, learning outcomes, and behavior change. Feedback was analyzed using descriptive statistics across 12 training domains, while pre- and post-training test scores were compared using paired t-tests in Stata 18 to measure learning improvements. Participant interviews provided additional insights.

Results: Participants reported high satisfaction with the learning environment and methods but faced challenges in applying management concepts, citing limited contextual input and faculty interaction. Learning outcomes showed moderate improvement, with average test scores rising from 53.3 to 59.6 (p = 0.003). They successfully applied a structured problem-solving framework in practicum projects and created action plans for public health challenges. Participants recommended adding topics on financing, procurement, human resources, and hospital management to support them in performing their core functions. Barriers to applying learned concepts included human resource constraints, limited autonomy, gender stereotypes, and lack of recognition.

Conclusion: Emphasizing leadership competencies, experiential learning, and mentored practicum holds promise. However, customizing the curriculum to UP's specific context, ensuring sufficient training time, focusing on core management functions, and addressing organizational barriers are vital. Integrating these recommendations into blended training that enhances core managerial skills and leadership development can strengthen workforce capabilities.

Introduction: Although the importance of leader-member relationships in teamwork is acknowledged in literature, a deeper understanding of this relationship is lacking, especially in rural areas. The impact of leader-member relationships on team outcomes is especially important in rural Chinese hospitals as improving teamwork forms a national health reform priority in these hospitals. This study investigates how leader-member relationships (ie leader-member perceived similarity and power distance orientation) influence team outcomes (ie perceived quality of care and job satisfaction) via speaking up and silence.

Methods: An online questionnaire was completed by 1017 team members (ie doctors, nurses and other healthcare professionals) of 300 teams in four rural Chinese hospitals in October 2022. The questionnaire measured leader-member perceived similarity, power distance orientation, speaking up, silence, perceived quality of care, job satisfaction and control variables. Multilevel mediation analysis was conducted to test the hypotheses.

Results: Leader-member perceived similarity and power distance orientation are positively related to speaking up (β=0.61, p<0.01; β=0.17, p<0.01 respectively) and to silence (β=0.41, p<0.01; β=0.63, p<0.01 respectively). Speaking up is positively related to the perceived quality of care (β=0.24, p<0.01; β=0.46, p<0.01) and job satisfaction (β=0.30, p<0.01; β=0.54, p<0.01), while the impact of silence is not significant. Finally, speaking up mediates the associations of both leader-member perceived similarity and power distance orientation with perceived quality of care (β=0.15, p<0.01; β=0.08, p<0.01 respectively) and job satisfaction (β=0.30, p<0.01; β=0.54, p<0.01 respectively).

Conclusion: Speaking up, rather than silence, contributes to team functioning by mediating the impact of leader-member relationships to team outcomes. Hospital management may therefore seek to stimulate speaking up by focussing on leader-member relationships: increasing leader-member similarity and promoting members' power distance orientation. However, any unintended effect of increased silence through these leader-member relationships is an important area of future research, which can adopt multidimensional models of speaking up and silence.

Healthcare leaders are responsible for creating an environment where their staff can maintain their resilience and well-being. However, there is a crisis of burnout among healthcare workers. The resulting increased turnover, diminished morale and performance, safety risks, and decreased worker engagement produces a vicious cycle of burnout. A strategic intervention is needed that focuses on worker wellbeing. This paper describes how the Johns Hopkins Resilience In Stressful Events (RISE) peer support program has helped healthcare leaders support their workers and strengthen the resilience of their organization. It explains the crucial role that leaders play in the success of the program. RISE peer was established at Johns Hopkins Hospital in 2011 to provide timely peer support for stressful patient and work-related situations. RISE helps break the cycle of healthcare worker burnout by providing peer support for stresses at work 24 hours a day, 7 days a week. This program structure also supports leaders by sharing the responsibility of emotional support and by providing them with new skills to do their job in a way that generates personal and professional satisfaction. The program has been implemented globally in over 140 healthcare organizations. Leaders are essential to integrate support and serve as role models. Institutions that successfully launch peer support programs engage leaders to participate in program design, participate in the program themselves, and adapt the program to meet the needs of their staff and organization. Peer support programs broaden the base of support for all healthcare workers by providing an employee-focused resource. Implementation of a RISE support model demonstrates an institution's commitment to the overall health of the people it employs. Operational integration of the model conveys a positive impact on resilience at all levels of the organization, especially in institutions that broadly engage organizational leaders.

Digital technologies are now integral to daily life. However, their applications for the health of populations remain largely untapped. Increasing cancer incidence, and it being the leading cause of death in every country in the world, justifies the need for increasing healthcare. Digital health technology is a promising field. Digital health means different things to different people. Thus, the need for a concrete, distinctive, comprehensive action plan. Conceptual frameworks represent ways of thinking about a problem and how complex things work. We elaborate on the latest evidence with examples for the role of Digital Health Technology (DHT) as a comprehensive multi-faceted 'Conceptual Framework -5Ps' comprising: (i) DHT for Proper assessment: right from history taking to digital biopsies. (ii) DHT for Pertinent treatment: including genomic data analysis for precision treatment. Artificial Intelligence-based digital pathology approaches are practical and are increasingly improving selective cancer treatments. Digital self-management interventions improve symptom outcomes in adult cancer patients. Digital health can help cancer patients gain more autonomy, self-acceptance, and personal growth. (iii) DHT for Progress monitoring: comprehensively and remotely. The concept "hospital at home" feasible with DHT. (iv) DHT for Prevention applications: reaching all rewardingly. (v) DHT for Professional standards: education excellence. Proficiency is desirable when using DHTs fast-advancing applications. Doctors may not have the information they need to use a given DHT. General Medical Council, UK, and Medical Council India have been proactive in technology training. Regulations & ethics rigour are required energetically. All new technologies must meet the same bar for clinical evidence as other clinical interventions. Digital Health Academy is required to meet the highest standards, energizing and ensuring excellence. In the current state of healthcare and growing demands, good developments in DHT seem the solution. A conceptual framework is a good start for generous success. We hope our work progresses mindsets, practices, and policies majorly.

Background: Gender inequity persists in high-level leadership within academic medicine. Understanding the perspectives of early career women faculty could clarify how to recruit and support women who pursue high-level leadership. This study explored the specific priorities and concerns that may influence the recruitment of women leaders in the future.

Methods: Twenty-five assistant professors (mean: 1.8 years at rank) completed the Early Career Women's Leadership Program and participated in semi-structured, in-depth interviews in 2023. Data were analyzed using an iterative, thematic constant comparison process informed by constructivist grounded theory.

Results: The authors identified four themes. In theme one, participants described the importance of being seen and valued as a whole person, with consideration of their personal and professional lives. They sought mentorship and leadership positions that supported their work-life integration. In theme two, women balanced an interplay between the individual and the collective when considering themselves as future leaders. From the individual perspective, participants prioritized personal values like humility and compassion when discussing preferred leadership styles. From the collective perspective, they prioritized inclusivity and teamwork. Theme three showed discomfort with the unknown with a desire to fully understand a leadership position and its impact on personal and professional life. Participants wondered about having the authority and resources to realistically make meaningful change and whether they could adequately prepare to lead. The fourth theme was representation mattered. Participants valued having women leaders who have experienced similar challenges as themselves. These leaders inspired participants to believe that they could also achieve and succeed in high-level leadership.

Conclusion: Early career women balanced numerous factors when considering whether to pursue high-level leadership in academic medicine. Understanding women's priorities and concerns can enable institutions to prepare women faculty to lead and ultimately recruit and retain them in high-level leadership.

Telehealth services have potential to enhance access to quality healthcare, reduce costs, and increase satisfaction for both patients and providers. As a disruptive healthcare innovation, telehealth disorders old systems and creates a new hybrid model of care that delivers significant value to stakeholders. However, the failure rate of innovation implementation in healthcare ranges from 30% to 90%, depending on the complexity involved. While researchers have conducted extensive studies on the barriers and facilitators to widespread innovation implementation, the root causes of innovation implementation failure in health services (eg, telehealth implementation failure) are not fully understood. The Consolidated Framework for Implementation Research (CFIR) introduced in 2009 has become increasingly popular as a framework for informing successful innovation implementation in health services. The CFIR identifies barriers and facilitators to innovation implementation across five domains of implementation-the innovation, individual, inner, outer, and process domains. However, it lacks a mechanism to capture the complex social challenges (tensions) underlying the barriers and facilitators that affect implementation success or failure. The Tensions framework supplies a foundation beyond barriers and facilitators to provide a dynamic understanding of the role of social conflicts impacting the implementation process. This paper presents a novel conceptual model, Tensions in Innovation Implementation Processes (TIIPs), which integrates tensions and management strategies within the CFIR framework. A key contribution of TIIPS is its ability to visualize the social conflicts within and across implementation domains, offering a clearer understanding of the challenges and opportunities involved in innovation implementation. We apply TIIPs to telehealth implementation, drawing implications for practice, policy, and research to enable successful telehealth implementation in healthcare organizations. This approach advances existing frameworks, aligning with the systems thinking essential for today's healthcare leadership.

Purpose: The widespread adoption of telemedicine tools poses new and little-known challenges for healthcare professionals, who are required to adapt their knowledge, skills, and work practices to this innovative scenario. Understanding healthcare professionals' expectations and concerns about adopting telemedicine can facilitate its effective integration. Therefore, drawing upon the Value Co-Creation in Healthcare model, the current study aims to investigate pediatricians' expectations regarding antecedents, outcomes, and management activities relevant to the implementation of a telehomecare service.

Methods: Interviews invitations were sent to all pediatricians (n=13) involved in a pilot study using the TytoCare device, a telehomecare tool that enables remote medical examinations, at an Italian pediatric hospital. All invited pediatricians agreed to participate. The semi-structured interviews, each lasting approximately 30 to 45 minutes, were conducted remotely via Microsoft Teams prior to the use of the TytoCare device. All interviews were recorded and transcribed verbatim. The content was subsequently analyzed through thematic analysis using MAXQDA software.

Results: Five overarching thematic areas emerged from the interviews: factors influencing the adoption of the telehomecare device, advantages of its use, impacts on work practices, changes in the patient-professional relationship, and management activities. While concerns exist about the adequacy of telehomecare compared to in-person visits, the device offers potential benefits, such as improving the hospital experience for children by shortening hospital stays. However, it may lead to an increased workload and necessitate stronger trust and communication in remote care. Successful integration requires dedicated support staff, regulatory adjustments, and effective leadership, with active involvement of healthcare professionals in decision-making.

Conclusion: By shedding light on healthcare professionals' expectations about telehomecare device, this study provides useful insights to healthcare leaders to tailor interventions to accompany technology within care practices to valorize its benefits and promote value co-creation processes.

Introduction: Professionalism among healthcare professionals is often defined in terms such as altruism, humanism, and excellence. The integration of such professionalism ideals to healthcare professionals' practice poses a challenge to medical tutors. We examined the assessment of professionalism among physicians and nurses by their peers and evaluated the significance of each professional role component within each sector. We also performed a cross-sector assessment whereby physicians assessed nurses' professionalism and vice versa.

Methods: A survey among physicians, interns, and nurses. The participants were asked to rate the extent that each of the 12 characteristics contributes to physicians' and nurses' professionalism of on a scale of 1 (does not contribute at all) to 10 (highly contributes). Each participant rated the contribution of each component to the professionalism of their own occupation (direct scoring) and to the professionalism of the other occupation (cross scoring).

Results: In total, 300 healthcare professionals (mean age 36.6, 46% males) responded to the survey. The most highly contributing characteristics to physicians' professionalism were knowledge, responsibility, decision-making and leadership, clustered as "strategic judgment". The most highly contributing characteristics to nurses' professionalism were responsibility, personal attention, empathy, and skills, clustered as "bedside approach" and "performance abilities". Cross-assessment among professionals was different: Nurses assigned higher ratings in general, interns assigned higher ratings to physicians' characteristics, whereas physicians assigned lower ratings to professionalism characteristics, and especially to those of nurses. Nurses emphasized patient centeredness and communication skills more than physicians. Nurses and interns appreciated teamwork compared to physicians. Major differences in how physicians and nurses perceive professionalism revealed physicians' emphasis on "strategic judgment" while nurses emphasis on "bedside approach".

Conclusion: Physicians and nurses hold differing viewpoints on many topics, including the objectives of their mission, expected performance, and activity types. Medical professionals can assess their colleagues and partners, recognizing both strengths and weaknesses in themselves and others.

Introduction: Healthcare is experiencing a global period of profound transformation, and digital health shows the promise of dispensing innovative and contemporary service models. However, changes are required to improve the capabilities of health managers in driving successful digital transformation.

Objective: This paper aims to explore the organizational barriers that health service managers have encountered when realizing the benefits of a digitally transforming environment. This is part of a larger research study exploring digital competencies for health service managers, with the findings from focus group discussions providing a baseline from which to address the organizational improvements and changes in system capabilities required to assist in realizing the benefits of digital health transformation.

Methods: The study is qualitative in nature. It employs focus group discussions to gain an in-depth understanding of the experiences and views of health service managers and identify the benefits and barriers that managers have experienced in introducing digital health in their workplace.

Results: Barriers encountered in realizing digital health benefits in the workplace were evidenced across five major themes: (1) change resistance and usage, (2) trust and uniformity, (3) resourcing and procurement, (4) digital literacy, and (5) siloed systems.

Discussion: Findings from this study demonstrate that in driving the realization of digital health transformation benefits, health service managers need organizational and system-wide efforts to support managing in the digital health context. The key identified barriers experienced by health service managers include facing human and technical challenges with system adoption and the governance of data-driven decision-making in the digital context.

Conclusion: The importance of digital transformation in healthcare is evident and will increasingly become a necessity for organizational survival and success. This study adds important insights into the organizational barriers that health service managers have encountered when realizing the benefits resulting from digital transformation. Addressing these barriers requires macro-, meso- and micro-level system investments. These benefits are enhanced by enabling factors critical for digital health adoption that have been described in key categories involving health system related: (1) policy and system, (2) organizational structure and processes, and human resource management, and (3) people factors. The importance of ensuring the organizational factors driving the realization of benefits in a digitally transforming environment is also addressed and capitalized upon for health service managers.