Professional learning, organisational change and clinical leadership development outcomes

Navigating between two figured worlds: A constructivist grounded theory study on residents' workplace experiences with health care management tasks

INTRODUCTION

Medical residents may be required to handle health care management (HCM) tasks alongside their clinical duties, despite not having received training to perform them. However, little research has been done on how medical residents acquire HCM skills at the workplace and how these experiences impact their learning.

METHODS

We completed a qualitative research study using the Constructivist Grounded Theory approach inform by the Figured World theory. To gather data, we held focus groups and conducted semi-structured interviews with 22 medical residents from various disciplines and learning levels at Pontificia Universidad Javeriana. We utilised iterative data collection and analysis, constant comparison methods and theoretical sampling to construct our findings.

RESULTS

We constructed two different worlds to represent how residents acquire HCM skills: the non-managing physician and the physician-as-manager. The former was characterised by a discourse that underplayed the role of the HCM tasks as part of residents' training, was full of negative interactions with the health care team and limited residents' agency. In the latter, residents collaborated and learned from health care team members, had supervisors who modelled how to incorporate HCM tasks into daily activities and expanded residents' agency. Residents developed their professional identity according to the world they were introduced into.

DISCUSSION

Educational leaders must understand that the non-managing physician figured world gives residents a feeling of uprooting and discomfort when carrying out this type of tasks. To transform this world into the physician-as-manager, it is necessary to reconfigure some workplace hierarchies, consolidate interprofessional collaborations and change the discourse perpetuated by influential role models. Supervisors must also strengthen their knowledge of HCM and improve its integration into clinical practice. Any effort to train residents on HCM competencies could be lost if the workplace underscores their value in patient care.

An "integration" of professional identity formation among rural physicians experiencing an interplay between their professional and personal identities

The present understanding of professional identity formation is problematic since it underrepresents minority physicians and potentially excludes their professional identity formation experiences. Rural physicians are expected to have similar underrepresented aspects as minority physicians because of their specific sociocultural contexts and consequent private-professional intersection, which lead to ethical complexities. Therefore, to bridge this research gap, we interviewed 12 early- to mid-career Japanese physicians working in rural areas and explored their experiences. Through a narrative analysis guided by Figured Worlds theory, we analysed the data by focusing on the vocabulary, expressions, and metaphors participants used to describe their experiences. A central theme emerged concerning how the rural physicians configurated their personal versus professional participation in their local communities. Further, their identity narratives varied regarding how they constructed their identities, rural communities, and relationships as well as their identity formation ideals and strategies to achieve them. Informed by 'Big Questions' concerning worldview framework, we delineated four identity narratives as prototypes to describe how they participated in their communities. These identity narratives provide a preliminary understanding of how diverse identity formation is for rural physicians. In addition, our findings exposed the current professional identity formation framework as potentially biased towards single forms of participation in monolithic communities, overlooking complicated forms of participation in multiple communities. We argue that applying frameworks and concepts to capture these multiple forms of participation as well as revisiting the 'discourse of integration' are necessary steps to overcome the limitation of the current understanding of professional identity formation.

Exploring the Peer Leadership Network of Rehabilitation Healthcare Professionals Following Leader Development Training

Purpose

The researcher aimed to identify how rehabilitation professionals engage in their peer leadership network during the first year following leader development training for the purpose of understanding the networking experiences, development of the peer leadership network, and expansion of collective leadership in an organization.

Methodology

A sequential exploratory mixed method design including Q-Methodology and focus group interviews identified the experiences of 11 rehabilitation professionals in an urban rehabilitation hospital during the first year following leader development training.

Findings

Three themes were identified. These include: (a) an opportunity to connect, (b) a community of leaders, and (c) a healthy peer leadership network emerged from the data analysis. These results indicated that shared experiences and opportunities to connect in a robust peer leadership network can influence the growth of all leaders independent of their current leadership or networking competency. The opportunity to connect for shared discussions in a healthy peer leadership network can accentuate the learning following leader development curriculum as individual leaders develop leadership and as collectives advance organizational outcomes.

Practical Implications

Healthcare organizations should facilitate connections in a healthy leadership network to develop individual and collective leadership in an organization.

An antidote to what's ailing healthcare workers: a new (old) way of relational leadership

PURPOSE

The purpose of the study's mixed-methods evaluation was to examine the ways in which a relational leadership development intervention enhanced participants' abilities to apply relationship-oriented skills on their teams.

DESIGN/METHODOLOGY/APPROACH

The authors evaluated five program cohorts from 2018-2021, involving 127 interprofessional participants. The study's convergent mixed-method approach analyzed post-course surveys for descriptive statistics and interpreted six-month post-course interviews using qualitative conventional content analysis.

FINDINGS

All intervention features were rated as at least moderately impactful by at least 83% of participants. The sense of community, as well as psychological safety and trust created, were rated as impactful features of the course by at least 94% of participants. At six months post-intervention, participants identified benefits of greater self-awareness, deeper understanding of others and increased confidence in supporting others, building relationships and making positive changes on their teams.

ORIGINALITY/VALUE

Relational leadership interventions may support participant skills for building connections, supporting others and optimizing teamwork. The high rate of skill application at six months post-course suggests that relational leadership development can be effective and sustainable in healthcare. As the COVID-19 pandemic and systemic crises continue to impact the psychological well-being of healthcare colleagues, relational leadership holds promise to address employee burnout, turnover and isolation on interprofessional care teams.

Multidimensional analysis of job advertisements for medical record information managers

Objective

The rapid growth of the medical industry has resulted in a tremendous increase in medical record data, which can be utilized for hospital management, aiding in diagnosis and treatment, medical research, and other purposes. For data management and analysis, medical institutions require more qualified medical record information managers. In light of this, we conducted an analysis of the qualifications, abilities, and job emphasis of medical record information managers in order to propose training recommendations.

Materials and methods

From online job posting sites, a sample of 241 job advertisements for medical record information management positions posted by Chinese healthcare institutions were collected. We conducted word frequency and keyword co-occurrence analysis to uncover overall demands at the macro level, and job analysis to investigate job-specific disparities at the micro level. Based on content analysis and job analysis, a competency framework was designed for medical record information managers.

Results

The most frequent keywords were "code," "job experience," and "coding certification," according to the word frequency analysis. The competency framework for managers of medical record information is comprised of seven domains: essential knowledge, medical knowledge, computer expertise, problem-solving skills, leadership, innovation, and attitude and literacy. One of the fundamental skills required of medical record information managers is coordination and communication. Similarly, knowledge and skill requirements emphasize theoretical knowledge, managerial techniques, performance enhancement, and innovation development.

Conclusion

According to organization type and job differences, the most crucial feature of the job duties of medical record information managers is cross-fertilization. The findings can be utilized by various healthcare organizations for strategic talent planning, by the field of education for medical record information managers for qualification and education emphasis adjustment, and by job seekers to enhance their grasp of the profession and self-evaluation.

Towards the idea of 'clinical capital': A longitudinal study exploring nurses' dispositions and workplace manifestations in an Australian intensive care unit

OBJECTIVE

To explore the concept of 'capital' through the study of successive interventions and outcomes (patient and staff) in a quaternity intensive care unit (ICU) across a 5-year time frame.

DESIGN

A longitudinal intrinsic single site, a survey study was designed. The concept of 'capital' was explored through an adopted interpretive approach that involved understanding meanings from different sources, for example, discussions at compassion cafés, follow-up from staff-initiated activities, informal responses to organizational imperatives external to the unit (i.e. staff reductions and resource constraints), alongside empirical data about workplace climate and patient incidents.

SETTING

A single ICU employing approximately 220 registered nurses at a quaternary hospital in Queensland, Australia.

PARTICIPANTS

All nurses employed in the ICU at the time of compassion cafes participated in providing feedback to inform successive activities. All nurses in the unit had equal opportunity to complete surveys, participate in subsequent unit-based sessions, take-up options; and all nurses had a responsibility to complete incident data.

RESULTS

Survey and incident data from 2015 to 2019 identify the complexity of workplace environments. Between 35% and 45% of nurses consistently completed the survey. Activities based on staff requests initially improved incident data but did not impact the work environment; negative perceptions of the work environment at the endpoint (2019) were associated with external factors.

CONCLUSION

Quality care environments are labile; sensitive to both unit activity and external organization directives (namely staff reductions). Quality care can be sustained in adverse situations with increased nurse engagement in patient care dynamics in the short term.

IMPACT

This study articulates a previously unidentified concept, 'clinical capital'. Activities facilitating nurse engagement in broad care dynamics gave rise to a more robust climate than just focusing on social and psychological well-being activities for nurses. Participation in issues of concern about patient care can promote resilience to short term fluctuations.

A Theory-Led Evaluation of a Scalable Intervention to Promote Evidence-Based, Research-Informed Practice in Schools to Address Attainment Gaps

Evidence-based practice is a salient solution that has been presented to address the persistent educational attainment gap linked to economic disadvantage. However, most schools do not engage with research, and we know little about facilitating school-led research use at scale. Linking different approaches to studying educational effectiveness, equity and change, and drawing on cultural-historical activity theory, this study develops intermediate theory about the mechanisms influencing institutions’ success in using research. In the context of the Opportunity Area Programme, supporting place-based interventions in the UK’s most socio-economically disadvantaged regions, we conducted a theory-led evaluation of the Evidence-Based Practice Fund (EBPF), aimed at supporting school-led research engagement to improve learning outcomes. We analysed the documentation of 83 EBPF projects, 8 focus groups, and a school survey. We demonstrate that enabling schools to address locally identified needs motivates research engagement but formulating these as stimulus for change requires scaffolding. Schools were keen but needed re-translation to use research to address those challenges. Low-key school-to-school support was found adequate. Leadership support and collaboration were significant but require relational expertise and professional learning to be effective. This study demonstrates that the use of research by schools at scale is possible and can transform a school’s agency in developing their own practice to improve equity.

'This trainee makes me feel angry': It's time to validate the reality and role of trainer emotions

Discussing the 'failiure to fail' phenomenon, the authors call for a system‐wide culture shift to better articulate failures as learning opportunities in healthcare.