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Rayner S, Richards H, Lee GB, Lee E, Rixon A. Navigating competing tensions: A qualitative study of experiences and perceptions of leadership among emergency medicine doctors. Emerg Med Australas 2024. [PMID: 38987986 DOI: 10.1111/1742-6723.14466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 06/19/2024] [Accepted: 06/25/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES Emergency medicine (EM) doctors are often required to manage a diverse set of complex challenges; navigating direct patient care, systemic issues and inter-professional interactions. Leadership is well recognised as crucial in optimising both the delivery and the quality of patient care. There is a clear need to gain greater understanding of the reality of EM leadership through exploring doctors' experience and perception of leadership in EM, yet there is a paucity of research focusing on this area. The objective of the present study was to explore the research question: 'What are the experiences and perceptions of leadership by EM doctors?' METHODS This single-site qualitative study was undertaken using semi-structured in-depth individual interviews to collect data. Interviews were audio recorded, transcribed and de-identified. Reflexive thematic analysis was performed by the research team with the aid of DelveTool software. RESULTS Our sample included nine participants incorporating consultants and registrars. Three major themes were identified: (i) situational tensions, (ii) relational tensions and (iii) leadership style tensions. Each of these was further explored with subthemes discussed separately. CONCLUSIONS Leadership within the ED is complex and multifaceted, with doctors required to navigate many competing tensions. The present study highlighted key areas for future leadership development, including situational awareness, emotional intelligence and a fluid approach to leadership styles. The present study provides an important step towards enhancing the development of targeted leadership training for EM doctors.
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Affiliation(s)
- Suzanne Rayner
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Hayden Richards
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Georgie B Lee
- School of Medicine, IMPACT, Institute for Innovation in Physical and Mental Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia
- Western Australia Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Elleanor Lee
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Andrew Rixon
- Department of Business Strategy and Innovation, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia
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Wolff JC, Maron M, Chou T, Hood E, Sodano S, Cheek S, Thompson E, Donise K, Katz E, Mannix M. Experiences of Child and Adolescent Psychiatric Patients Boarding in the Emergency Department from Staff Perspectives: Patient Journey Mapping. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:417-426. [PMID: 36609956 PMCID: PMC9822692 DOI: 10.1007/s10488-022-01249-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/09/2023]
Abstract
Over the past decade, healthcare providers nationwide have contended with a growing boarding crisis as pediatric patients await psychiatric treatment in emergency departments (EDs). COVID-19 has exacerbated this urgent youth mental health crisis, driving EDs to act as crisis units. Journey mapping is a robust methodology with which to examine strengths and challenges in patient care workflows such as boarding and emergency psychiatric care. Psychiatric, emergency medicine, and hospitalist providers serving patients boarding at a northeastern children's hospital participated in semi-structured qualitative interviews. Investigators conducted directed content analysis with an inductive approach to identify facilitators, barriers, and persistent needs of boarding patients, which were summarized in a patient journey map. Findings were presented to participants for feedback and further refinement. Quantitative data showed a three-fold increase in the number of patients who boarded over the past three years and a 60% increase in the average time spent boarding in the ED. Emergent qualitative data indicated three stages in the boarding process: Initial Evaluation, Admitted to Board, and Discharge. Data highlighted positive and negative factors affecting patient safety, availability of beds in pediatric hospital and psychiatric inpatient settings, high patient-provider ratios that limited staffing support, and roadblocks in care coordination and disposition planning. Patient journey mapping provided insight into providers' experiences serving patients boarding for psychiatric reasons. Findings described bright points and pain points at each stage of the boarding process with implications for psychiatric care and systemic changes to reduce boarding volume and length of stay.
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Affiliation(s)
- Jennifer C. Wolff
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 1 Hoppin St., Suite 203, Providence, RI 02903 USA
- Present Address: Rhode Island Hospital, Providence, RI USA
| | | | - Tommy Chou
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 1 Hoppin St., Suite 203, Providence, RI 02903 USA
- Present Address: Rhode Island Hospital, Providence, RI USA
| | - Erik Hood
- Bradley Hospital, East Providence, RI USA
| | | | - Shayna Cheek
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 1 Hoppin St., Suite 203, Providence, RI 02903 USA
- Present Address: Rhode Island Hospital, Providence, RI USA
| | - Elizabeth Thompson
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 1 Hoppin St., Suite 203, Providence, RI 02903 USA
- Present Address: Rhode Island Hospital, Providence, RI USA
| | - Kathleen Donise
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 1 Hoppin St., Suite 203, Providence, RI 02903 USA
| | - Emily Katz
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 1 Hoppin St., Suite 203, Providence, RI 02903 USA
| | - Margaret Mannix
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 1 Hoppin St., Suite 203, Providence, RI 02903 USA
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Lyons O, George R, Galante JR, Mafi A, Fordwoh T, Frich J, Geerts JM. Evidence-based medical leadership development: a systematic review. BMJ LEADER 2021; 5:206-213. [PMID: 37850339 DOI: 10.1136/leader-2020-000360] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/16/2020] [Accepted: 09/28/2020] [Indexed: 11/04/2022]
Abstract
Health systems invest significant resources in leadership development for physicians and other health professionals. Competent leadership is considered vital for maintaining and improving quality and patient safety. We carried out this systematic review to synthesise new empirical evidence regarding medical leadership development programme factors which are associated with outcomes at the clinical and organisational levels. Using Ovid MEDLINE, we conducted a database search using both free text and Medical Subject Headings. We then conducted an extensive hand-search of references and of citations in known healthcare leadership development reviews. We applied the Medical Education Research Study Quality Indicator (MERSQI) and the Joanna Briggs Institute (JBI) Critical Appraisal Tool to determine study reliability, and synthesised results using a meta-aggregation approach. 117 studies were included in this systematic review. 28 studies met criteria for higher reliability studies. The median critical appraisal score according to the MERSQI was 8.5/18 and the median critical appraisal score according to the JBI was 3/10. There were recurring causes of low study quality scores related to study design, data analysis and reporting. There was considerable heterogeneity in intervention design and evaluation design. Programmes with internal or mixed faculty were significantly more likely to report organisational outcomes than programmes with external faculty only (p=0.049). Project work and mentoring increased the likelihood of organisational outcomes. No leadership development content area was particularly associated with organisational outcomes. In leadership development programmes in healthcare, external faculty should be used to supplement in-house faculty and not be a replacement for in-house expertise. To facilitate organisational outcomes, interventions should include project work and mentoring. Educational methods appear to be more important for organisational outcomes than specific curriculum content. Improving evaluation design will allow educators and evaluators to more effectively understand factors which are reliably associated with organisational outcomes of leadership development.
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Affiliation(s)
- Oscar Lyons
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Joao R Galante
- Department of Medical Education, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Cardiology Department, Buckinghamshire Healthcare NHS Trust, Amersham, UK
| | - Alexander Mafi
- University of Oxford Medical School, University of Oxford, Oxford, UK
| | - Thomas Fordwoh
- University of Oxford Medical School, University of Oxford, Oxford, UK
| | - Jan Frich
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Jaason Matthew Geerts
- Research and Leadership Development, Canadian College of Health Leaders, Ottawa, Ontario, Canada
- The Business School (formerly Cass), University of London, London, UK
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Mandell MS, Huang J, Zhao J. Enhanced recovery after surgery and practical application to liver transplantation. Best Pract Res Clin Anaesthesiol 2020; 34:119-127. [PMID: 32334782 DOI: 10.1016/j.bpa.2020.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 12/13/2022]
Abstract
There is a growing support for the use of protocols that incorporate multiple steps aimed at reducing the time patients require to regain health. A recurring limitation is the variable outcomes of these protocols with more or less success at the sites at which they are instituted. This review examines the essential building blocks needed to launch a successful ERAS protocol. It addresses why there are differences in outcome measures between centers such as the length of stay and the cost of care even if the protocols and patient populations are similar.
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Affiliation(s)
- M Susan Mandell
- Department of Anesthesiology, University of Colorado, CO, USA
| | - Jiapeng Huang
- Department of Anesthesiology, University of Louisville, Louisville, KY, USA
| | - Jing Zhao
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, China.
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Rixon A, Wilson S, Hussain S, Terziovski M, Judkins S, White P. Leadership challenges of directors of emergency medicine: An Australasian Delphi study. Emerg Med Australas 2019; 32:258-266. [DOI: 10.1111/1742-6723.13402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/11/2019] [Accepted: 09/14/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Andrew Rixon
- Department of Business Technology and EntrepreneurshipSwinburne University of Technology Melbourne Victoria Australia
| | - Samuel Wilson
- Department of Management and MarketingSwinburne University of Technology Melbourne Victoria Australia
| | - Sairah Hussain
- Department of Business Technology and EntrepreneurshipSwinburne University of Technology Melbourne Victoria Australia
| | - Mile Terziovski
- Department of Business Technology and EntrepreneurshipSwinburne University of Technology Melbourne Victoria Australia
| | - Simon Judkins
- Australasian College for Emergency Medicine Melbourne Victoria Australia
| | - Peter White
- Australasian College for Emergency Medicine Melbourne Victoria Australia
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Husebø SE, Olsen ØE. Actual clinical leadership: a shadowing study of charge nurses and doctors on-call in the emergency department. Scand J Trauma Resusc Emerg Med 2019; 27:2. [PMID: 30621752 PMCID: PMC6323734 DOI: 10.1186/s13049-018-0581-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/27/2018] [Indexed: 11/17/2022] Open
Abstract
Background The provision of safe, high quality healthcare in the Emergency Department (ED) requires frontline healthcare personnel with sufficient competence in clinical leadership. However, healthcare education curriculum infrequently features learning about clinical leadership, and there is an absence of experienced doctors and nurses as role models in EDs for younger and less experienced doctors and nurses. The purpose of this study was to explore the activities performed by clinical leaders and to identify similarities and differences between the activities performed by charge nurses and those performed by doctors on-call in the Emergency Department after completion of a Clinical Leadership course. Methods A qualitative exploratory design was chosen. Nine clinical leaders in the ED were shadowed. The data were analyzed using a thematic analysis. Results The analysis revealed seven themes: receiving an overview of the team and patients and planning the shift; ensuring resources; monitoring and ensuring appropriate patient flow; monitoring and securing information flow; securing patient care and treatment; securing and assuring the quality of diagnosis and treatment of patient; and securing the prioritization of patients. The last two themes were exclusive to doctors on-call, while the theme “securing patient care and treatment” was exclusive to charge nurses. Conclusions Charge nurses and doctors on-call perform multitasking and complement each other as clinical leaders in the ED. The findings in this study provide new insights into how clinical leadership is performed by charge nurses and doctors on-call in the ED, but also the similarities and differences that exist in clinical leadership performance between the two professions. Clinical leadership is necessary to the provision of safe, high quality care and treatment for patients with acute health needs, as well as the coordination of healthcare services in the ED. More evaluation studies of this Clinical Leadership course would be valuable.
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Affiliation(s)
- Sissel Eikeland Husebø
- Department of Quality and Health Technology, Faculty of Health Science, University of Stavanger, 4036, Stavanger, Norway. .,Department of Surgery, Stavanger University Hospital, Stavanger, Norway.
| | - Øystein Evjen Olsen
- Department of Research, Development and Education, Stavanger University Hospital, Stavanger, Norway.,Global Health Priorities Research Group, Center for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Nieuwboer MS, van der Sande R, van der Marck MA, Olde Rikkert MGM, Perry M. Clinical leadership and integrated primary care: A systematic literature review. Eur J Gen Pract 2019; 25:7-18. [PMID: 30474447 PMCID: PMC6394325 DOI: 10.1080/13814788.2018.1515907] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 07/18/2018] [Accepted: 08/15/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Leaders are needed to address healthcare changes essential for implementation of integrated primary care. What kind of leadership this needs, which professionals should fulfil this role and how these leaders can be supported remains unclear. OBJECTIVES To review the literature on the effectiveness of programmes to support leadership, the relationship between clinical leadership and integrated primary care, and important leadership skills for integrated primary care practice. METHODS We systematically searched PubMed, CINAHL, Embase, PsycINFO until June 2018 for empirical studies situated in an integrated primarycare setting, regarding clinical leadership, leadership skills, support programmes and integrated-care models. Two researchers independently selected relevant studies and critically appraised studies on methodological quality, summarized data and mapped qualitative data on leadership skills. RESULTS Of the 3207 articles identified, 56 were selected based on abstract and title, from which 20 met the inclusion criteria. Selected papers were of mediocre quality. Two non-controlled studies suggested that leadership support programmes helped prepare and guide leaders and positively contributed to implementation of integrated primary care. There was little support that leaders positively influence implementation of integrated care. Leaders' relational and organizational skills as well as process-management and change-management skills were considered important to improve care integration. Physicians seemed to be the most adequate leaders. CONCLUSION Good quality research on clinical leadership in integrated primary care is scarce. More profound knowledge is needed about leadership skills, required for integrated-care implementation, and leadership support aimed at developing these skills.
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Affiliation(s)
- Minke S. Nieuwboer
- Department of Geriatric Medicine, Radboud University Medical Center, Radboud UMC Alzheimer Centre, Nijmegen, The Netherlands
| | - Rob van der Sande
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Faculty of Health, Behaviour and Society, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Marjolein A. van der Marck
- Department of Geriatric Medicine, Radboud University Medical Center, Radboud UMC Alzheimer Centre, Nijmegen, The Netherlands
- Radboud University Medical Center, Department of Geriatric Medicine, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marcel G. M. Olde Rikkert
- Department of Geriatric Medicine, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
- Radboud University Medical Center, Department of Geriatric Medicine, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marieke Perry
- Department of Geriatric Medicine, Radboud University Medical Center, Radboud UMC Alzheimer Centre, Nijmegen, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Ballangrud R, Husebø SE, Hall-Lord ML. Cross-cultural validation and psychometric testing of the Norwegian version of the TeamSTEPPS® teamwork perceptions questionnaire. BMC Health Serv Res 2017; 17:799. [PMID: 29197381 PMCID: PMC5712180 DOI: 10.1186/s12913-017-2733-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/15/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Teamwork is an integrated part of today's specialized and complex healthcare and essential to patient safety, and is considered as a core competency to improve twenty-first century healthcare. Teamwork measurements and evaluations show promising results to promote good team performance, and are recommended for identifying areas for improvement. The validated TeamSTEPPS® Teamwork Perception Questionnaire (T-TPQ) was found suitable for cross-cultural validation and testing in a Norwegian context. T-TPQ is a self-report survey that examines five dimensions of perception of teamwork within healthcare settings. The aim of the study was to translate and cross-validate the T-TPQ into Norwegian, and test the questionnaire for psychometric properties among healthcare personnel. METHODS The T-TPQ was translated and adapted to a Norwegian context according to a model of a back-translation process. A total of 247 healthcare personnel representing different professionals and hospital settings responded to the questionnaire. A confirmatory factor analysis was carried out to test the factor structure. Cronbach's alpha was used to establish internal consistency, and an Intraclass Correlation Coefficient was used to assess the test - retest reliability. RESULT A confirmatory factor analysis showed an acceptable fitting model (χ2 (df) 969.46 (546), p < 0.001, Root Mean Square Error of Approximation (RMSEA) = 0.056, Tucker-Lewis Index (TLI) = 0.88, Comparative fit index (CFI) = 0.89, which indicates that each set of the items that was supposed to accompany each teamwork dimension clearly represents that specific construct. The Cronbach's alpha demonstrated acceptable values on the five subscales (0.786-0.844), and test-retest showed a reliability parameter, with Intraclass Correlation Coefficient scores from 0.672 to 0.852. CONCLUSION The Norwegian version of T-TPQ was considered to be acceptable regarding the validity and reliability for measuring Norwegian individual healthcare personnel's perception of group level teamwork within their unit. However, it needs to be further tested, preferably in a larger sample and in different clinical settings.
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Affiliation(s)
- Randi Ballangrud
- Department of Health Science Gjøvik, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Teknologivn. 22, 2815, Gjøvik, Norway.
| | - Sissel Eikeland Husebø
- Faculty of Health Sciences, University of Stavanger, Kjell Arholms hus, Kjell Arholms gate 43, 4021, Stavanger, Norway.,Department of Surgery, Stavanger University Hospital, Gerd Ragna Bloch Thorsens street 8, 4011, Stavanger, Norway
| | - Marie Louise Hall-Lord
- Department of Health Science Gjøvik, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Teknologivn. 22, 2815, Gjøvik, Norway.,Department of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
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