促进和支持血液科的领导能力

IF 7.6 2区 医学 Q1 HEMATOLOGY HemaSphere Pub Date : 2024-10-17 DOI:10.1002/hem3.70028
Roch Houot, Emmanuel Gyan
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Today, the European healthcare system is in a continuous crisis, primarily due to underinvestment and workforce shortages.<span><sup>1</sup></span> In such a situation, management skills at all levels of hospital departments become critical, especially for heads of departments—a position historically driven in many countries, including France, by academic rather than managerial competencies.</p><p>Challenges with medical staff retention have also exacerbated the workload of healthcare professionals.<span><sup>2</sup></span> The shortage of healthcare workers in Europe is projected to reach 4.1 million by 2030, including 0.6 million physicians.<span><sup>3</sup></span> Workforce shortages contribute to burnout among physicians and other healthcare workers, which renders the tasks of heads of departments extremely challenging.<span><sup>4, 5</sup></span></p><p>In the past two decades, the practice of hematology has experienced accelerated advancements in diagnostics and therapeutics, with notable prolongation of patient survival, albeit at the cost of intensified medical care due to the novel time-consuming therapeutic approaches. As such, the diversity of hematologic diagnoses and specialized treatments have created an expanding curriculum with ever more limited human resources.<span><sup>2, 6</sup></span> The number of hematologic specialists and the competence of their training have become a concern in European countries.<span><sup>6</sup></span></p><p>The European Hematology Association (EHA) has created solutions for training in hematology, including the European Hematology curriculum, developed through a “bottom-up” process, which has inspired national educational initiatives.<span><sup>6</sup></span> The European Working Time Directive (EWTD), introduced in 2004, aims to reduce long working hours to enhance patient safety. In this context, the European Commission urged member states to adopt the EWTD for hospital physicians.<span><sup>2</sup></span> However, these initiatives create challenges for department heads, who must manage increased workloads with limited staffing and heightened awareness of the adverse effects of inadequate organization on workers' health.</p><p>In a recent survey conducted with 2390 university hospital faculty members in France between October and December 2021, 40% of participants had severe burnout, 14% had suicidal ideation, and 12% had job strain.<span><sup>4</sup></span> The factors associated with the unfavorable experiences included heavy work overload, work-life imbalance, and perceived lack of support from the institution.<span><sup>4, 7</sup></span> Although the impact of stressful events on the risk of burnout and suicide is undeniable, many personality traits, such as emotional stability, extraversion, and social integration, play a role.<span><sup>4</sup></span></p><p>In France, a group of heads of hematology departments from both academic and community hospitals gathered with the intuition that welcoming a community of heads of departments could provide support on an individual basis.<span><sup>8, 9</sup></span> The community sets two main objectives: (i) an individual objective to support each head of department to achieve his/her mission; (ii) a collective goal to transform the hospital system starting from the “bottom-up,” namely from the hospital departments. We will discuss the benefits of building this community of heads of hematology departments and some proposed solutions based on the evolving French experience, in the hope that this may be valuable for other medical departments and other European clinical hematology structures. A department, in this context, is a unit specialiszed in clinical hematology, sometimes within a larger division of internal medicine or medical oncology specialities.</p><p>The initiative of creating a community of heads of hematology departments emerged in response to the French hospital system crisis and the challenges faced by the heads of departments. The community identified three directions: (i) reflecting on the missions of heads of departments and creating a network for them; (ii) sharing experience based on collective intelligence and brainstorming ideas to find solutions for the difficulties that each faces; and (iii) inventing and testing new forms of organization and management.<span><sup>8, 9</sup></span> In French public hospitals, management training is sometimes offered but not mandatory for heads of departments, and most of them feel isolated from their counterparts.</p><p>A 2-day inaugural seminar was held in January 2023 in order to re-evaluate the situation of hematology departments amidst the French healthcare crisis. This seminar established the foundational “core” group of 14 heads of departments. Throughout the year 2023, this emerging community gathered virtually on a monthly basis and launched a social network, offering sustained support to peers and adherence to the mission of the community, by sharing information and ideas.<span><sup>8</sup></span></p><p>A second “expanded” seminar, held in January 2024, aimed to broaden the community by including additional heads of hematology departments.<span><sup>9</sup></span> In total, 36 departments were represented, including university hospitals (69%), general hospitals (22%), and comprehensive cancer centers (9%). During that event, 36 heads of departments participated, exchanging their thoughts and reflecting on the mission of the community. Guest speakers were invited to share their experience, as well as external specialists in methods of co-development and co-construction in different settings (Figure 1).</p><p>The seminars were successful in promoting collective intelligence, creativity, strength, and support, highlighting the importance of regularly conducting these sessions to increase closeness and collaboration among heads of departments. These seminars expanded through continuous communication among the heads of departments via teleconferences, social network groups, working groups, and social gatherings.</p><p>The inaugural seminar provided a platform for sharing management experiences among heads of departments, which, to our knowledge, is an unprecedented initiative at the specialist level in France. Different topics related to the organizational structure of the departments were tackled. The most noteworthy were: the methods adopted for involving medical and paramedical teams; cooperation and interaction between the head of department and staff managers (both paramedical and administrative); social interaction within the teams; induction and training of new employees; organization of departmental meetings; annual performance reviews; and sources of funding.<span><sup>8</sup></span></p><p>In the second seminar, each participating head of a hematology department delivered a short presentation of 180 s to share an experience that could be useful for other heads of the department. The presentations addressed four main themes: management, patient care, research, and education/development. Participants were able to appreciate the challenges faced by their peers and the proposed solutions, as well as the learning opportunities from these experiences. Overall, the second seminar's presentations highlighted the importance of addressing the following topics in future sessions: exchanging and sharing problems and success stories; mutual aid and solidarity; reassurance and motivation; conviviality and meetings; and discovering management tools.<span><sup>9</sup></span></p><p>Social support can provide encouragement, feedback, and positive reinforcement, which improves personal and professional relationships, and possibly increases stress tolerance. Indeed, a systematic review of 15 randomized clinical trials and 37 cohort studies evaluating the approaches to prevent and reduce burnout showed that social gatherings and facilitated small-group programs decreased the prevalence of burnout among physicians from 54% to 44% (<i>p</i> &lt; 0.001).<span><sup>10</sup></span> Monthly dinner meetings improved engagement, human connection in the workplace, and the perceived sense of care by the department and supportive environment.<span><sup>10</sup></span> This spontaneous bottom-up approach may facilitate the emergence of robust solutions to problems widely faced by heads of departments from the same specialty. Indeed, having a group of heads of departments of the same specialty offers several advantages: (i) dealing with the same challenges specific to the specialty; (ii) having more opportunities to meet at scientific conferences and meetings related to the specialty; and (iii) the possibility of extending these exchanges through collaborative research initiatives.</p><p>Hospital organizations have encountered several challenges due to management practices that have not fully addressed functional and structural needs. For instance, in France, appointing medical heads of departments is predominantly based on academic credentials rather than managerial training and expertise. Heads of departments are also constrained by a highly hierarchical administrative system, resulting in limited freedom to manage their teams. Limited experience or understanding of administrative responsibilities, such as budgeting, resource allocation, staff management, or strategic planning, could be an additional source of constraints related to operational efficiency and financial management. Subsequently, inadequate managerial practices may negatively impact the professional's well-being, the quality of patient care, and the effectiveness of research and education.</p><p>Given that heads of departments must lead interdisciplinary teams under budgetary constraints and practice bottom-up governance, it is crucial to offer and ensure acceptance of leadership training and professional development opportunities for those with an academic focus. The inclusion of heads of departments in the decision-making process is essential for organizational morale and performance, as they are at the forefront of hospital activity. Indeed, this approach contrasts with the current administrative organization of the hospital. The goal of the French community of heads of hematology departments is to enhance managerial skills, aiming to rebuild the healthcare system from the ground up. This initiative is in line with the French government's decision to create more autonomy in the medical departments, whereby the head of the department would be at the center of the hospital's management.<span><sup>11</sup></span> This, in turn, implies that managerially trained heads of departments are prepared to participate in the multistakeholder organization that a hospital requires, in addition to their clinical and academic responsibilities. The head of department contributes massively to the internal structure of the department and the quality of life at work of the medical team, and constitutes the reference level in terms of organiszation, relevance, quality and safety of care, local management of medical and paramedical teams, and management of fellows and healthcare students.<span><sup>12</sup></span> Our experience has demonstrated that a peer community is a powerful management support tool. It offers to its members the benefit from the collective intelligence, experience, creativity, strengths, and support of the group.</p><p>Hematology departments are experiencing staff shortages and an expanding curriculum, with the integration of promising new diagnostic and therapeutic options.<span><sup>2</sup></span> For instance, the success of targeted therapies and immunotherapies has revolutionised the treatment landscape for various hematological disorders and improved patient outcomes, including prolonged survival. Hematologists consequently face new challenges that require ongoing research, multidisciplinary collaboration, and specialized expertise to optimize patient outcomes and ensure the safe and effective use of these therapies in clinical practice. Considering the complexities of the novel treatments and the increased number of cancer survivors, physicians are experiencing increased professional burdens. Serious consequences include burnout, which may ultimately compromise patient care.<span><sup>13</sup></span> As talented physicians leave public hospitals to join alternatives that offer a better financial remuneration for better conditions, hematology departments are also suffering from staff shortages.<span><sup>2</sup></span></p><p>Initiatives to increase investment in healthcare systems or hospital budgets to retain and attract healthcare professionals are necessary to counteract the effects of increased clinical overload. Another initiative includes the delegation of time-consuming tasks to nonmedical personnel, including biomedical scientists in the laboratory and clinical nurse specialists, as observed in the National Health Service of the United Kingdom.<span><sup>2</sup></span> There is increasing acceptance and encouragement of the latter in France<span><sup>14</sup></span>; however, the medical profession needs to be an active participant in this evolution. Interventions by professional societies and communities have an impactful role in preventing and managing increased burden on an individual level. Published research has highlighted the prevalence of burnout among European oncologists, and increased awareness campaigns in national and international congresses,<span><sup>13</sup></span> and the EHA is addressing this issue amongst young hematologists.<span><sup>15</sup></span> Data on burnout prevalence among European hematologists of all ages must be collected to call for investment in measures that make hematology an attractive field for both young and senior physicians.</p><p>Healthcare authorities and hospital administrators should play a vital role in developing strategies to alleviate physician burnout in France and other European countries. However, this is far from reality. To that end, a bottom-up rebuild of the hospital system is necessary to accommodate administrative changes. Engaging in supportive networks, such as the community we are establishing, allows for shared experiences and learning opportunities. This community of heads of hematology departments serves as a powerful tool for management support. Given the individual and organizational initiatives of this kind of community, heads of other specialty departments are encouraged to actively engage in community building and contribute to the reconstruction of hospital organization, structure, and functionality from the bottom up. Likewise, such engagement with heads of departments from other European countries will certainly contribute to sharing different care and organization models that inspire each other.</p><p>The authors contributed to the writing and the editing of the article and approved its final version for submission and publication.</p><p>The authors declare no conflicts of interest.</p><p>The medical writing was funded by Kephren Publishing.</p>","PeriodicalId":12982,"journal":{"name":"HemaSphere","volume":null,"pages":null},"PeriodicalIF":7.6000,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hem3.70028","citationCount":"0","resultStr":"{\"title\":\"Promoting and supporting leadership in hematology departments\",\"authors\":\"Roch Houot,&nbsp;Emmanuel Gyan\",\"doi\":\"10.1002/hem3.70028\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>In recent years, the hospital system has faced tremendous pressure from economic and societal crises, which were further aggravated by the COVID-19 pandemic. Today, the European healthcare system is in a continuous crisis, primarily due to underinvestment and workforce shortages.<span><sup>1</sup></span> In such a situation, management skills at all levels of hospital departments become critical, especially for heads of departments—a position historically driven in many countries, including France, by academic rather than managerial competencies.</p><p>Challenges with medical staff retention have also exacerbated the workload of healthcare professionals.<span><sup>2</sup></span> The shortage of healthcare workers in Europe is projected to reach 4.1 million by 2030, including 0.6 million physicians.<span><sup>3</sup></span> Workforce shortages contribute to burnout among physicians and other healthcare workers, which renders the tasks of heads of departments extremely challenging.<span><sup>4, 5</sup></span></p><p>In the past two decades, the practice of hematology has experienced accelerated advancements in diagnostics and therapeutics, with notable prolongation of patient survival, albeit at the cost of intensified medical care due to the novel time-consuming therapeutic approaches. As such, the diversity of hematologic diagnoses and specialized treatments have created an expanding curriculum with ever more limited human resources.<span><sup>2, 6</sup></span> The number of hematologic specialists and the competence of their training have become a concern in European countries.<span><sup>6</sup></span></p><p>The European Hematology Association (EHA) has created solutions for training in hematology, including the European Hematology curriculum, developed through a “bottom-up” process, which has inspired national educational initiatives.<span><sup>6</sup></span> The European Working Time Directive (EWTD), introduced in 2004, aims to reduce long working hours to enhance patient safety. In this context, the European Commission urged member states to adopt the EWTD for hospital physicians.<span><sup>2</sup></span> However, these initiatives create challenges for department heads, who must manage increased workloads with limited staffing and heightened awareness of the adverse effects of inadequate organization on workers' health.</p><p>In a recent survey conducted with 2390 university hospital faculty members in France between October and December 2021, 40% of participants had severe burnout, 14% had suicidal ideation, and 12% had job strain.<span><sup>4</sup></span> The factors associated with the unfavorable experiences included heavy work overload, work-life imbalance, and perceived lack of support from the institution.<span><sup>4, 7</sup></span> Although the impact of stressful events on the risk of burnout and suicide is undeniable, many personality traits, such as emotional stability, extraversion, and social integration, play a role.<span><sup>4</sup></span></p><p>In France, a group of heads of hematology departments from both academic and community hospitals gathered with the intuition that welcoming a community of heads of departments could provide support on an individual basis.<span><sup>8, 9</sup></span> The community sets two main objectives: (i) an individual objective to support each head of department to achieve his/her mission; (ii) a collective goal to transform the hospital system starting from the “bottom-up,” namely from the hospital departments. We will discuss the benefits of building this community of heads of hematology departments and some proposed solutions based on the evolving French experience, in the hope that this may be valuable for other medical departments and other European clinical hematology structures. A department, in this context, is a unit specialiszed in clinical hematology, sometimes within a larger division of internal medicine or medical oncology specialities.</p><p>The initiative of creating a community of heads of hematology departments emerged in response to the French hospital system crisis and the challenges faced by the heads of departments. The community identified three directions: (i) reflecting on the missions of heads of departments and creating a network for them; (ii) sharing experience based on collective intelligence and brainstorming ideas to find solutions for the difficulties that each faces; and (iii) inventing and testing new forms of organization and management.<span><sup>8, 9</sup></span> In French public hospitals, management training is sometimes offered but not mandatory for heads of departments, and most of them feel isolated from their counterparts.</p><p>A 2-day inaugural seminar was held in January 2023 in order to re-evaluate the situation of hematology departments amidst the French healthcare crisis. This seminar established the foundational “core” group of 14 heads of departments. Throughout the year 2023, this emerging community gathered virtually on a monthly basis and launched a social network, offering sustained support to peers and adherence to the mission of the community, by sharing information and ideas.<span><sup>8</sup></span></p><p>A second “expanded” seminar, held in January 2024, aimed to broaden the community by including additional heads of hematology departments.<span><sup>9</sup></span> In total, 36 departments were represented, including university hospitals (69%), general hospitals (22%), and comprehensive cancer centers (9%). During that event, 36 heads of departments participated, exchanging their thoughts and reflecting on the mission of the community. Guest speakers were invited to share their experience, as well as external specialists in methods of co-development and co-construction in different settings (Figure 1).</p><p>The seminars were successful in promoting collective intelligence, creativity, strength, and support, highlighting the importance of regularly conducting these sessions to increase closeness and collaboration among heads of departments. These seminars expanded through continuous communication among the heads of departments via teleconferences, social network groups, working groups, and social gatherings.</p><p>The inaugural seminar provided a platform for sharing management experiences among heads of departments, which, to our knowledge, is an unprecedented initiative at the specialist level in France. Different topics related to the organizational structure of the departments were tackled. The most noteworthy were: the methods adopted for involving medical and paramedical teams; cooperation and interaction between the head of department and staff managers (both paramedical and administrative); social interaction within the teams; induction and training of new employees; organization of departmental meetings; annual performance reviews; and sources of funding.<span><sup>8</sup></span></p><p>In the second seminar, each participating head of a hematology department delivered a short presentation of 180 s to share an experience that could be useful for other heads of the department. The presentations addressed four main themes: management, patient care, research, and education/development. Participants were able to appreciate the challenges faced by their peers and the proposed solutions, as well as the learning opportunities from these experiences. Overall, the second seminar's presentations highlighted the importance of addressing the following topics in future sessions: exchanging and sharing problems and success stories; mutual aid and solidarity; reassurance and motivation; conviviality and meetings; and discovering management tools.<span><sup>9</sup></span></p><p>Social support can provide encouragement, feedback, and positive reinforcement, which improves personal and professional relationships, and possibly increases stress tolerance. Indeed, a systematic review of 15 randomized clinical trials and 37 cohort studies evaluating the approaches to prevent and reduce burnout showed that social gatherings and facilitated small-group programs decreased the prevalence of burnout among physicians from 54% to 44% (<i>p</i> &lt; 0.001).<span><sup>10</sup></span> Monthly dinner meetings improved engagement, human connection in the workplace, and the perceived sense of care by the department and supportive environment.<span><sup>10</sup></span> This spontaneous bottom-up approach may facilitate the emergence of robust solutions to problems widely faced by heads of departments from the same specialty. Indeed, having a group of heads of departments of the same specialty offers several advantages: (i) dealing with the same challenges specific to the specialty; (ii) having more opportunities to meet at scientific conferences and meetings related to the specialty; and (iii) the possibility of extending these exchanges through collaborative research initiatives.</p><p>Hospital organizations have encountered several challenges due to management practices that have not fully addressed functional and structural needs. For instance, in France, appointing medical heads of departments is predominantly based on academic credentials rather than managerial training and expertise. Heads of departments are also constrained by a highly hierarchical administrative system, resulting in limited freedom to manage their teams. Limited experience or understanding of administrative responsibilities, such as budgeting, resource allocation, staff management, or strategic planning, could be an additional source of constraints related to operational efficiency and financial management. Subsequently, inadequate managerial practices may negatively impact the professional's well-being, the quality of patient care, and the effectiveness of research and education.</p><p>Given that heads of departments must lead interdisciplinary teams under budgetary constraints and practice bottom-up governance, it is crucial to offer and ensure acceptance of leadership training and professional development opportunities for those with an academic focus. The inclusion of heads of departments in the decision-making process is essential for organizational morale and performance, as they are at the forefront of hospital activity. Indeed, this approach contrasts with the current administrative organization of the hospital. The goal of the French community of heads of hematology departments is to enhance managerial skills, aiming to rebuild the healthcare system from the ground up. This initiative is in line with the French government's decision to create more autonomy in the medical departments, whereby the head of the department would be at the center of the hospital's management.<span><sup>11</sup></span> This, in turn, implies that managerially trained heads of departments are prepared to participate in the multistakeholder organization that a hospital requires, in addition to their clinical and academic responsibilities. The head of department contributes massively to the internal structure of the department and the quality of life at work of the medical team, and constitutes the reference level in terms of organiszation, relevance, quality and safety of care, local management of medical and paramedical teams, and management of fellows and healthcare students.<span><sup>12</sup></span> Our experience has demonstrated that a peer community is a powerful management support tool. It offers to its members the benefit from the collective intelligence, experience, creativity, strengths, and support of the group.</p><p>Hematology departments are experiencing staff shortages and an expanding curriculum, with the integration of promising new diagnostic and therapeutic options.<span><sup>2</sup></span> For instance, the success of targeted therapies and immunotherapies has revolutionised the treatment landscape for various hematological disorders and improved patient outcomes, including prolonged survival. Hematologists consequently face new challenges that require ongoing research, multidisciplinary collaboration, and specialized expertise to optimize patient outcomes and ensure the safe and effective use of these therapies in clinical practice. Considering the complexities of the novel treatments and the increased number of cancer survivors, physicians are experiencing increased professional burdens. Serious consequences include burnout, which may ultimately compromise patient care.<span><sup>13</sup></span> As talented physicians leave public hospitals to join alternatives that offer a better financial remuneration for better conditions, hematology departments are also suffering from staff shortages.<span><sup>2</sup></span></p><p>Initiatives to increase investment in healthcare systems or hospital budgets to retain and attract healthcare professionals are necessary to counteract the effects of increased clinical overload. Another initiative includes the delegation of time-consuming tasks to nonmedical personnel, including biomedical scientists in the laboratory and clinical nurse specialists, as observed in the National Health Service of the United Kingdom.<span><sup>2</sup></span> There is increasing acceptance and encouragement of the latter in France<span><sup>14</sup></span>; however, the medical profession needs to be an active participant in this evolution. Interventions by professional societies and communities have an impactful role in preventing and managing increased burden on an individual level. Published research has highlighted the prevalence of burnout among European oncologists, and increased awareness campaigns in national and international congresses,<span><sup>13</sup></span> and the EHA is addressing this issue amongst young hematologists.<span><sup>15</sup></span> Data on burnout prevalence among European hematologists of all ages must be collected to call for investment in measures that make hematology an attractive field for both young and senior physicians.</p><p>Healthcare authorities and hospital administrators should play a vital role in developing strategies to alleviate physician burnout in France and other European countries. However, this is far from reality. To that end, a bottom-up rebuild of the hospital system is necessary to accommodate administrative changes. Engaging in supportive networks, such as the community we are establishing, allows for shared experiences and learning opportunities. This community of heads of hematology departments serves as a powerful tool for management support. Given the individual and organizational initiatives of this kind of community, heads of other specialty departments are encouraged to actively engage in community building and contribute to the reconstruction of hospital organization, structure, and functionality from the bottom up. Likewise, such engagement with heads of departments from other European countries will certainly contribute to sharing different care and organization models that inspire each other.</p><p>The authors contributed to the writing and the editing of the article and approved its final version for submission and publication.</p><p>The authors declare no conflicts of interest.</p><p>The medical writing was funded by Kephren Publishing.</p>\",\"PeriodicalId\":12982,\"journal\":{\"name\":\"HemaSphere\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":7.6000,\"publicationDate\":\"2024-10-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hem3.70028\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"HemaSphere\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/hem3.70028\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"HEMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"HemaSphere","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/hem3.70028","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEMATOLOGY","Score":null,"Total":0}
引用次数: 0

摘要

法国血液科主任团体的目标是提高管理技能,从根本上重建医疗系统。这一举措符合法国政府的决定,即在医疗部门建立更多的自主权,使科室主任成为医院管理的核心。11 这反过来又意味着,受过管理培训的科室主任除了承担临床和学术职责外,还要准备好参与医院所需的多方利益相关者组织。科室主任对科室的内部结构和医疗团队的工作生活质量做出了巨大贡献,并在组织、相关性、医疗质量和安全、医疗和辅助医疗团队的本地管理以及研究员和医学生的管理等方面构成了参考水平。2 例如,靶向疗法和免疫疗法的成功彻底改变了各种血液病的治疗格局,改善了患者的预后,包括延长了生存期。因此,血液病学家面临着新的挑战,需要持续研究、多学科合作和专业知识,以优化患者预后,确保在临床实践中安全有效地使用这些疗法。考虑到新型疗法的复杂性和癌症幸存者人数的增加,医生的职业负担也在加重。13 随着优秀的医生离开公立医院,加入经济待遇更好、条件更优越的其他医院,血液科也面临着人员短缺的问题。2 有必要采取措施,增加对医疗系统或医院预算的投资,以留住并吸引医疗专业人员,从而抵消临床负担过重的影响。另一项举措包括将耗时的任务委托给非医务人员,包括实验室的生物医 学科学家和临床护理专家,如英国国民健康服务所做的那样。专业协会和社区的干预措施在预防和管理个人负担加重方面发挥着重要作用。已发表的研究强调了职业倦怠在欧洲肿瘤学家中的普遍性,并在国家和国际大会上加强了宣传活动,13 欧洲血液学协会正在解决年轻血液学家中的这一问题。15 必须收集欧洲各年龄段血液学家中职业倦怠普遍性的数据,以呼吁投资采取措施,使血液学成为对年轻和资深医生都有吸引力的领域。然而,这与现实相去甚远。为此,有必要自下而上地重建医院系统,以适应行政管理的变化。参与支持性网络,如我们正在建立的社区,可以分享经验和学习机会。这个由血液科负责人组成的社区是提供管理支持的有力工具。鉴于这种社区的个人和组织主动性,我们鼓励其他专业科室的负责人积极参与社区建设,自下而上地为医院组织、结构和功能的重建做出贡献。同样,与欧洲其他国家的科室负责人进行这种交流,也必将有助于分享不同的护理和组织模式,从而相互启发。
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Promoting and supporting leadership in hematology departments

In recent years, the hospital system has faced tremendous pressure from economic and societal crises, which were further aggravated by the COVID-19 pandemic. Today, the European healthcare system is in a continuous crisis, primarily due to underinvestment and workforce shortages.1 In such a situation, management skills at all levels of hospital departments become critical, especially for heads of departments—a position historically driven in many countries, including France, by academic rather than managerial competencies.

Challenges with medical staff retention have also exacerbated the workload of healthcare professionals.2 The shortage of healthcare workers in Europe is projected to reach 4.1 million by 2030, including 0.6 million physicians.3 Workforce shortages contribute to burnout among physicians and other healthcare workers, which renders the tasks of heads of departments extremely challenging.4, 5

In the past two decades, the practice of hematology has experienced accelerated advancements in diagnostics and therapeutics, with notable prolongation of patient survival, albeit at the cost of intensified medical care due to the novel time-consuming therapeutic approaches. As such, the diversity of hematologic diagnoses and specialized treatments have created an expanding curriculum with ever more limited human resources.2, 6 The number of hematologic specialists and the competence of their training have become a concern in European countries.6

The European Hematology Association (EHA) has created solutions for training in hematology, including the European Hematology curriculum, developed through a “bottom-up” process, which has inspired national educational initiatives.6 The European Working Time Directive (EWTD), introduced in 2004, aims to reduce long working hours to enhance patient safety. In this context, the European Commission urged member states to adopt the EWTD for hospital physicians.2 However, these initiatives create challenges for department heads, who must manage increased workloads with limited staffing and heightened awareness of the adverse effects of inadequate organization on workers' health.

In a recent survey conducted with 2390 university hospital faculty members in France between October and December 2021, 40% of participants had severe burnout, 14% had suicidal ideation, and 12% had job strain.4 The factors associated with the unfavorable experiences included heavy work overload, work-life imbalance, and perceived lack of support from the institution.4, 7 Although the impact of stressful events on the risk of burnout and suicide is undeniable, many personality traits, such as emotional stability, extraversion, and social integration, play a role.4

In France, a group of heads of hematology departments from both academic and community hospitals gathered with the intuition that welcoming a community of heads of departments could provide support on an individual basis.8, 9 The community sets two main objectives: (i) an individual objective to support each head of department to achieve his/her mission; (ii) a collective goal to transform the hospital system starting from the “bottom-up,” namely from the hospital departments. We will discuss the benefits of building this community of heads of hematology departments and some proposed solutions based on the evolving French experience, in the hope that this may be valuable for other medical departments and other European clinical hematology structures. A department, in this context, is a unit specialiszed in clinical hematology, sometimes within a larger division of internal medicine or medical oncology specialities.

The initiative of creating a community of heads of hematology departments emerged in response to the French hospital system crisis and the challenges faced by the heads of departments. The community identified three directions: (i) reflecting on the missions of heads of departments and creating a network for them; (ii) sharing experience based on collective intelligence and brainstorming ideas to find solutions for the difficulties that each faces; and (iii) inventing and testing new forms of organization and management.8, 9 In French public hospitals, management training is sometimes offered but not mandatory for heads of departments, and most of them feel isolated from their counterparts.

A 2-day inaugural seminar was held in January 2023 in order to re-evaluate the situation of hematology departments amidst the French healthcare crisis. This seminar established the foundational “core” group of 14 heads of departments. Throughout the year 2023, this emerging community gathered virtually on a monthly basis and launched a social network, offering sustained support to peers and adherence to the mission of the community, by sharing information and ideas.8

A second “expanded” seminar, held in January 2024, aimed to broaden the community by including additional heads of hematology departments.9 In total, 36 departments were represented, including university hospitals (69%), general hospitals (22%), and comprehensive cancer centers (9%). During that event, 36 heads of departments participated, exchanging their thoughts and reflecting on the mission of the community. Guest speakers were invited to share their experience, as well as external specialists in methods of co-development and co-construction in different settings (Figure 1).

The seminars were successful in promoting collective intelligence, creativity, strength, and support, highlighting the importance of regularly conducting these sessions to increase closeness and collaboration among heads of departments. These seminars expanded through continuous communication among the heads of departments via teleconferences, social network groups, working groups, and social gatherings.

The inaugural seminar provided a platform for sharing management experiences among heads of departments, which, to our knowledge, is an unprecedented initiative at the specialist level in France. Different topics related to the organizational structure of the departments were tackled. The most noteworthy were: the methods adopted for involving medical and paramedical teams; cooperation and interaction between the head of department and staff managers (both paramedical and administrative); social interaction within the teams; induction and training of new employees; organization of departmental meetings; annual performance reviews; and sources of funding.8

In the second seminar, each participating head of a hematology department delivered a short presentation of 180 s to share an experience that could be useful for other heads of the department. The presentations addressed four main themes: management, patient care, research, and education/development. Participants were able to appreciate the challenges faced by their peers and the proposed solutions, as well as the learning opportunities from these experiences. Overall, the second seminar's presentations highlighted the importance of addressing the following topics in future sessions: exchanging and sharing problems and success stories; mutual aid and solidarity; reassurance and motivation; conviviality and meetings; and discovering management tools.9

Social support can provide encouragement, feedback, and positive reinforcement, which improves personal and professional relationships, and possibly increases stress tolerance. Indeed, a systematic review of 15 randomized clinical trials and 37 cohort studies evaluating the approaches to prevent and reduce burnout showed that social gatherings and facilitated small-group programs decreased the prevalence of burnout among physicians from 54% to 44% (p < 0.001).10 Monthly dinner meetings improved engagement, human connection in the workplace, and the perceived sense of care by the department and supportive environment.10 This spontaneous bottom-up approach may facilitate the emergence of robust solutions to problems widely faced by heads of departments from the same specialty. Indeed, having a group of heads of departments of the same specialty offers several advantages: (i) dealing with the same challenges specific to the specialty; (ii) having more opportunities to meet at scientific conferences and meetings related to the specialty; and (iii) the possibility of extending these exchanges through collaborative research initiatives.

Hospital organizations have encountered several challenges due to management practices that have not fully addressed functional and structural needs. For instance, in France, appointing medical heads of departments is predominantly based on academic credentials rather than managerial training and expertise. Heads of departments are also constrained by a highly hierarchical administrative system, resulting in limited freedom to manage their teams. Limited experience or understanding of administrative responsibilities, such as budgeting, resource allocation, staff management, or strategic planning, could be an additional source of constraints related to operational efficiency and financial management. Subsequently, inadequate managerial practices may negatively impact the professional's well-being, the quality of patient care, and the effectiveness of research and education.

Given that heads of departments must lead interdisciplinary teams under budgetary constraints and practice bottom-up governance, it is crucial to offer and ensure acceptance of leadership training and professional development opportunities for those with an academic focus. The inclusion of heads of departments in the decision-making process is essential for organizational morale and performance, as they are at the forefront of hospital activity. Indeed, this approach contrasts with the current administrative organization of the hospital. The goal of the French community of heads of hematology departments is to enhance managerial skills, aiming to rebuild the healthcare system from the ground up. This initiative is in line with the French government's decision to create more autonomy in the medical departments, whereby the head of the department would be at the center of the hospital's management.11 This, in turn, implies that managerially trained heads of departments are prepared to participate in the multistakeholder organization that a hospital requires, in addition to their clinical and academic responsibilities. The head of department contributes massively to the internal structure of the department and the quality of life at work of the medical team, and constitutes the reference level in terms of organiszation, relevance, quality and safety of care, local management of medical and paramedical teams, and management of fellows and healthcare students.12 Our experience has demonstrated that a peer community is a powerful management support tool. It offers to its members the benefit from the collective intelligence, experience, creativity, strengths, and support of the group.

Hematology departments are experiencing staff shortages and an expanding curriculum, with the integration of promising new diagnostic and therapeutic options.2 For instance, the success of targeted therapies and immunotherapies has revolutionised the treatment landscape for various hematological disorders and improved patient outcomes, including prolonged survival. Hematologists consequently face new challenges that require ongoing research, multidisciplinary collaboration, and specialized expertise to optimize patient outcomes and ensure the safe and effective use of these therapies in clinical practice. Considering the complexities of the novel treatments and the increased number of cancer survivors, physicians are experiencing increased professional burdens. Serious consequences include burnout, which may ultimately compromise patient care.13 As talented physicians leave public hospitals to join alternatives that offer a better financial remuneration for better conditions, hematology departments are also suffering from staff shortages.2

Initiatives to increase investment in healthcare systems or hospital budgets to retain and attract healthcare professionals are necessary to counteract the effects of increased clinical overload. Another initiative includes the delegation of time-consuming tasks to nonmedical personnel, including biomedical scientists in the laboratory and clinical nurse specialists, as observed in the National Health Service of the United Kingdom.2 There is increasing acceptance and encouragement of the latter in France14; however, the medical profession needs to be an active participant in this evolution. Interventions by professional societies and communities have an impactful role in preventing and managing increased burden on an individual level. Published research has highlighted the prevalence of burnout among European oncologists, and increased awareness campaigns in national and international congresses,13 and the EHA is addressing this issue amongst young hematologists.15 Data on burnout prevalence among European hematologists of all ages must be collected to call for investment in measures that make hematology an attractive field for both young and senior physicians.

Healthcare authorities and hospital administrators should play a vital role in developing strategies to alleviate physician burnout in France and other European countries. However, this is far from reality. To that end, a bottom-up rebuild of the hospital system is necessary to accommodate administrative changes. Engaging in supportive networks, such as the community we are establishing, allows for shared experiences and learning opportunities. This community of heads of hematology departments serves as a powerful tool for management support. Given the individual and organizational initiatives of this kind of community, heads of other specialty departments are encouraged to actively engage in community building and contribute to the reconstruction of hospital organization, structure, and functionality from the bottom up. Likewise, such engagement with heads of departments from other European countries will certainly contribute to sharing different care and organization models that inspire each other.

The authors contributed to the writing and the editing of the article and approved its final version for submission and publication.

The authors declare no conflicts of interest.

The medical writing was funded by Kephren Publishing.

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来源期刊
HemaSphere
HemaSphere Medicine-Hematology
CiteScore
6.10
自引率
4.50%
发文量
2776
审稿时长
7 weeks
期刊介绍: HemaSphere, as a publication, is dedicated to disseminating the outcomes of profoundly pertinent basic, translational, and clinical research endeavors within the field of hematology. The journal actively seeks robust studies that unveil novel discoveries with significant ramifications for hematology. In addition to original research, HemaSphere features review articles and guideline articles that furnish lucid synopses and discussions of emerging developments, along with recommendations for patient care. Positioned as the foremost resource in hematology, HemaSphere augments its offerings with specialized sections like HemaTopics and HemaPolicy. These segments engender insightful dialogues covering a spectrum of hematology-related topics, including digestible summaries of pivotal articles, updates on new therapies, deliberations on European policy matters, and other noteworthy news items within the field. Steering the course of HemaSphere are Editor in Chief Jan Cools and Deputy Editor in Chief Claire Harrison, alongside the guidance of an esteemed Editorial Board comprising international luminaries in both research and clinical realms, each representing diverse areas of hematologic expertise.
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