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Tung J, Nahid M, Rajan M, Bogdewic S, Mancuso CA. Putting Traits Associated with Effective Medical Leadership into Action: Support for a Faculty Development Strategy. J Clin Psychol Med Settings 2024:10.1007/s10880-024-10031-7. [PMID: 39143441 DOI: 10.1007/s10880-024-10031-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 08/16/2024]
Abstract
Leadership development is essential to the well-being of medical organizations, but leadership concepts do not easily translate into skills or actions. The Mayo Leadership Behavior Index© (Leader Index), a validated instrument describing eight leadership traits associated with constituent well-being, can serve as a guide. The authors analyzed narratives from a qualitative study of senior medical leaders describing successful leadership behaviors to see how the tenets of the Leader Index can be applied. Current/emeritus chairs of major academic departments/divisions from a single institution were asked to describe anecdotes of actions used by leaders in actual settings. Narratives from interviews were analyzed for behaviors that map to the eight traits in the Leader Index. Eleven senior leaders volunteered multiple scenarios of effective and ineffective leadership with illustrative examples. The behaviors they identified mapped to all eight traits of the Leader Index, specifically career conversations, empowerment to do the job, encouragement of ideas, treatment with respect and dignity, provision of job performance feedback and coaching, recognition of well-done work, information about organizational changes, and development of talents and skills. These findings provide faculty development experts and psychologists tangible behaviors and actions they can teach to enhance leadership skills.
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Affiliation(s)
- Judy Tung
- Department of Medicine, Weill Cornell Medicine, 505 East 70th Street New York, New York, NY, 10021, USA.
| | - Musarrat Nahid
- Department of Medicine, Weill Cornell Medicine, 505 East 70th Street New York, New York, NY, 10021, USA
| | - Mangala Rajan
- Department of Medicine, Weill Cornell Medicine, 505 East 70th Street New York, New York, NY, 10021, USA
| | - Stephen Bogdewic
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Carol A Mancuso
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
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Bernard KS, Bostain N. The opportunity to lead facilitates PA professional well-being. JAAPA 2024; 37:1-10. [PMID: 38747902 DOI: 10.1097/01.jaa.0000000000000022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
OBJECTIVE Physician associates/assistants (PAs) with mature careers represent an important leadership resource for healthcare employers. This study sought to determine whether PA leadership task responsibility interacted with experience level to predict professional well-being. METHODS This quantitative study used an archival dataset from a national sample of PAs. The Professional Fulfillment Index was used to measure well-being and career length was used to represent experience level. PA leadership task responsibility was calculated as an aggregate score. Bivariate linear regression with mediation analysis was conducted to determine the relationship between variables. RESULTS An increase in PA experience level predicted higher professional fulfillment and lower burnout, and aggregate leadership task score partially mediated this relationship. CONCLUSIONS Granting leadership task responsibility compatible with experience level may enhance PA professional fulfillment, mitigate burnout, and increase PA usefulness for healthcare employers.
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Affiliation(s)
- Kari Sue Bernard
- Kari Sue Bernard is associate director of research and capstone in the Doctor of Medical Science program at A.T. Still University's Arizona School of Health Sciences in Mesa, Ariz., and practices in psychiatry at Orion Behavioral Health Network in Eagle River, Alaska. Nancy Bostain is an adjunct faculty member at Walden University in Minneapolis, Minn. Dr. Bernard discloses that she owns and operates Bernard Wellness Initiative, LLC, a professional well-being business that provides continuing medical education, coaching, and workplace assessments to healthcare providers and organizations. The authors have disclosed no other potential conflicts of interest, financial or otherwise
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Weisbaum E, Chadi N, Young LT. Improving physician wellness through the Applied Mindfulness Program for Medical Personnel: findings from a prospective qualitative study. CMAJ Open 2023; 11:E1083-E1092. [PMID: 37989514 PMCID: PMC10681671 DOI: 10.9778/cmajo.20220252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Physicians play a critical role across health care delivery systems, yet their own well-being is often overlooked; mindfulness has been widely recommended as a promising modality to support physician wellness. We sought to explore how physicians experience and engage with a 5-week applied mindfulness program and how they perceive its impact on their personal well-being in the context of their daily lives. METHOD We delivered the Applied Mindfulness Program for Medical Personnel (AMP-MP) at a tertiary care hospital in downtown Toronto, Canada. This prospective qualitative study consists of a thematic analysis of post-program interviews with physicians, from across different specialties, who participated in the AMP-MP. The program includes 2-hour sessions, delivered once a week over 5 weeks, and is based on the teachings of Thích Nhất Hạnh. RESULTS We interviewed 28 physicians after they completed the AMP-MP. Our data show that a 5-week training was sufficient for physicians to develop a foundational level of mindfulness that integrated into their daily life. Two themes were identified: mindfulness encourages behavioural and cognitive changes that facilitate well-being, and mindfulness improves communication with patients and colleagues. INTERPRETATION Our results show applied mindfulness to be well received by physicians as an effective modality to increase their perceived sense of wellness and enhance communication with their patients and colleagues. Further research is necessary to better understand the individual and systemic implications of mindfulness training, and how this modality can complement other efforts being made to address and maintain physician wellness.
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Affiliation(s)
- Elli Weisbaum
- Buddhism, Psychology and Mental Health, New College, Faculty of Arts and Sciences and the Department of Psychiatry, Temerty Faculty of Medicine, cross-appointment to the Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto (Weisbaum), Toronto, Ont.; Division of Adolescent Medicine, Department of Pediatrics (Chadi), Université de Montréal, Montréal, Que.; Departments of Psychiatry, and Pharmacology and Toxicology, and Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto and Campbell Family Research Institute, Centre for Addiction and Mental Health (Young), Toronto, Ont.
| | - Nicholas Chadi
- Buddhism, Psychology and Mental Health, New College, Faculty of Arts and Sciences and the Department of Psychiatry, Temerty Faculty of Medicine, cross-appointment to the Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto (Weisbaum), Toronto, Ont.; Division of Adolescent Medicine, Department of Pediatrics (Chadi), Université de Montréal, Montréal, Que.; Departments of Psychiatry, and Pharmacology and Toxicology, and Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto and Campbell Family Research Institute, Centre for Addiction and Mental Health (Young), Toronto, Ont
| | - L Trevor Young
- Buddhism, Psychology and Mental Health, New College, Faculty of Arts and Sciences and the Department of Psychiatry, Temerty Faculty of Medicine, cross-appointment to the Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto (Weisbaum), Toronto, Ont.; Division of Adolescent Medicine, Department of Pediatrics (Chadi), Université de Montréal, Montréal, Que.; Departments of Psychiatry, and Pharmacology and Toxicology, and Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto and Campbell Family Research Institute, Centre for Addiction and Mental Health (Young), Toronto, Ont
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Debets M, Jansen I, Lombarts K, Kuijer-Siebelink W, Kruijthof K, Steinert Y, Daams J, Silkens M. Linking leadership development programs for physicians with organization-level outcomes: a realist review. BMC Health Serv Res 2023; 23:783. [PMID: 37480101 PMCID: PMC10362722 DOI: 10.1186/s12913-023-09811-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Hospitals invest in Leadership Development Programs (LDPs) for physicians, assuming they benefit the organization's performance. Researchers have listed the advantages of LDPs, but knowledge of how and why organization-level outcomes are achieved is missing. OBJECTIVE To investigate how, why and under which circumstances LDPs for physicians can impact organization-level outcomes. METHODS We conducted a realist review, following the RAMESES guidelines. Scientific articles and grey literature published between January 2010 and March 2021 evaluating a leadership intervention for physicians in the hospital setting were considered for inclusion. The following databases were searched: Medline, PsycInfo, ERIC, Web of Science, and Academic Search Premier. Based on the included documents, we developed a LDP middle-range program theory (MRPT) consisting of Context-Mechanism-Outcome configurations (CMOs) describing how specific contexts (C) trigger certain mechanisms (M) to generate organization-level outcomes (O). RESULTS In total, 3904 titles and abstracts and, subsequently, 100 full-text documents were inspected; 38 documents with LDPs from multiple countries informed our MRPT. The MRPT includes five CMOs that describe how LDPs can impact the organization-level outcomes categories 'culture', 'quality improvement', and 'the leadership pipeline': 'Acquiring self-insight and people skills (CMO1)', 'Intentionally building professional networks (CMO2)', 'Supporting quality improvement projects (CMO3)', 'Tailored LDP content prepares physicians (CMO4)', and 'Valuing physician leaders and organizational commitment (CMO5)'. Culture was the outcome of CMO1 and CMO2, quality improvement of CMO2 and CMO3, and the leadership pipeline of CMO2, CMO4, and CMO5. These CMOs operated within an overarching context, the leadership ecosystem, that determined realizing and sustaining organization-level outcomes. CONCLUSIONS LDPs benefit organization-level outcomes through multiple mechanisms. Creating the contexts to trigger these mechanisms depends on the resources invested in LDPs and adequately supporting physicians. LDP providers can use the presented MRPT to guide the development of LDPs when aiming for specific organization-level outcomes.
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Affiliation(s)
- Maarten Debets
- Amsterdam UMC, Medical Psychology, Univ of Amsterdam, Amsterdam Public Health, AMC, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
| | - Iris Jansen
- Amsterdam UMC, Medical Psychology, Univ of Amsterdam, Amsterdam Public Health, AMC, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands
| | - Kiki Lombarts
- Amsterdam UMC, Medical Psychology, Univ of Amsterdam, Amsterdam Public Health, AMC, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands
| | - Wietske Kuijer-Siebelink
- School of Education, Research On Responsive Vocational and Professional Education, HAN University of Applied Sciences, Nijmegen, Netherlands
- Research On Learning and Education, Radboud University Medical Centre, Radboudumc Health Academy, Nijmegen, Netherlands
| | - Karen Kruijthof
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, De Boelelaan 1117, Amsterdam, Netherlands
| | - Yvonne Steinert
- Faculty of Medicine and Health Sciences, Institute of Health Sciences Education, McGill University, Montreal, Canada
| | - Joost Daams
- Medical Library, Amsterdam University Medical Centers, Amsterdam, Noord-Holland, Netherlands
| | - Milou Silkens
- Department of Health Services Research & Management, City University of London, London, UK
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, Netherlands
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Lexa FJ, Parikh JR. Leadership: Causing and Curing Burnout in Radiology. J Am Coll Radiol 2023; 20:500-502. [PMID: 36914082 PMCID: PMC10149620 DOI: 10.1016/j.jacr.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/15/2023]
Abstract
Burnout in US radiology has reached crisis proportions. Leaders play critical roles in both causing and preventing burnout. This article will review the current state of the crisis and how leaders can work to stop causing burnout as well as developing proactive strategies for preventing and mitigating burnout.
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Affiliation(s)
- Frank J Lexa
- Professor and Vice Chair of Faculty Affairs, Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsyvania; and UPMC International Vice President, the American College of Radiology Chief Medical Officer, The Radiology Leadership Institute of the ACR.
| | - Jay R Parikh
- Professor and Division Wellness Lead, Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Radike M, Zuromskis T. Lithuanian physicians practising abroad: Reasons to leave and conditions to return to Lithuania. A survey. Health Policy 2023; 128:75-83. [PMID: 36435631 DOI: 10.1016/j.healthpol.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 10/10/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Abstract
This study aimed to assess the factors of emigration and return among Lithuanian doctors practicing abroad. A call for participation in an online survey was distributed via social media. Questions covered demographics, reasons to emigrate and factors that would favor returning to practice in Lithuania. Survey data were analysed with appropriate statistical methods. Out of 465 respondents, the majority (453/465, 97.4%) work in Europe. The majority (334/465, 71.8%) were women, and 304/465 (65.4%) were trainees (residents). The top three factors to emigrate from and come back to Lithuania were: economic reasons, perceived corruption and the work environment. Most respondents listed more than two factors to emigrate and return (>70% in each category). Out of all respondents, 230 (49.5%) reported an attractive net monthly salary for a full-time post in Lithuania to be >3500 EUR; 173/465 (37.2%) respondents declared intention of not returning to practice in Lithuania. There were statistically significant gender- and training level-related differences in emigration factors. In conclusion, doctors' reasons for leaving and returning to practice in Lithuania are multifactorial, with economic and non-economic circumstances prompting them to choose to work in another country.
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Affiliation(s)
- Monika Radike
- Radiology Department, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, United Kingdom; Cardiovascular Research Center-ICCC, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain.
| | - Tadas Zuromskis
- Department of Neurology, Great Western Hospitals NHS Foundation Trust, Marlborough Rd, Swindon, SN3 6BB, United Kingdom.
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Wang X, Zhu Y, Wang F, Liang Y. Association of organizational and patient behaviors with physician well-being: A national survey in China. PLoS One 2022; 17:e0268274. [PMID: 35639674 PMCID: PMC9154115 DOI: 10.1371/journal.pone.0268274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/26/2022] [Indexed: 11/19/2022] Open
Abstract
This study aims to investigate the association of organizational and patient behaviors (reflecting the internal and external environment of hospital, respectively) with physician well-being. A national cross-sectional survey was conducted in 77 hospitals across seven provinces in China between July 2014 and April 2015. Physician well-being was assessed with job satisfaction, career regret and happiness. Organizational behaviors were assessed with organizational fairness, leadership attention and team interaction; patient behaviors were assessed with patient trust and unreasonable requests from patients. Of a study sample of 3,159 physicians, 1,788 were men (56.6%) and 1,371 were women (43.4%). Overall, positive organizational and patient behaviors reported by physicians were relatively low. Negative organizational behaviors and patient behaviors including lower organizational fairness, lower leadership attention, lower team interaction and lower patient trust were associated with lower job satisfaction and lower life satisfaction, and higher career regret. The association between organizational behaviors and physician well-being exhibited some gender differences, while no clear gender difference was found for the relationship between patient behaviors and physician well-being. Given the importance of physician well-being for the healthcare system, interventions for improving internal and external hospital environments (e.g., organizational fairness, leadership attention, team interaction and patient trust) may benefit physician well-being.
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Affiliation(s)
- Xiaoyu Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yimei Zhu
- School of Media, Communication and Sociology, University of Leicester, Leicester, United Kingdom
| | - Fang Wang
- Department of Epidemiology and Health Statistics, School of Health, Wuhan University, Wuhan, China
| | - Yuan Liang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail: ,
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Santhosh L, Abdoler E, O'Brien BC, Schwartz B. How do internal medicine subspecialty societies support clinician-educator careers? A qualitative exploratory study. BMC MEDICAL EDUCATION 2022; 22:222. [PMID: 35361197 PMCID: PMC8973507 DOI: 10.1186/s12909-022-03287-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Internal Medicine (IM) subspecialty professional societies can provide valuable community, recognition, resources, and leadership opportunities that promote career success. Historically, this support focused on clinical and research dimensions of academic careers, but educational dimensions have gained more attention recently. This study explores how IM subspecialty professional societies support their clinician-educator members. METHODS Using a qualitative study with two phases, the authors collected information from each IM subspecialty society's website about support for medical education. Using information from the first phase, we developed an interview guide for subspecialty society leaders. We used inductive thematic analysis to analyze interview transcripts. RESULTS Website analysis identified various mechanisms used by several IM subspecialty societies to promote medical education. These included websites focused on medical education, dedicated medical education poster/abstract sessions at annual meetings, and strategies to promote networking among clinician-educators. Interviews with eight subspecialty society leaders about the professional societies' roles with respect to medical education yielded four main themes: [1] varying conceptions of "medical education" in relation to the society [2] strategies to advance medical education at the society level [3] barriers to recognizing medical education [4] benefits of clinician-educators to the societies. Integrating these themes, we describe recommended strategies for professional societies to better serve clinician-educators. CONCLUSIONS We explore how IM subspecialty societies attend to a growing constituency of clinician-educators, with increasing recognition and support of the career path but persistent barriers to its formalization. These conversations shed light on opportunities for professional subspecialty societies to better serve the needs of their clinician-educator members while also enabling these members to make positive contributions in return.
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Affiliation(s)
- Lekshmi Santhosh
- Department of Medicine, University of California-San Francisco, CA, San Francisco, USA.
| | - Emily Abdoler
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Bridget C O'Brien
- Department of Medicine, University of California-San Francisco, CA, San Francisco, USA
| | - Brian Schwartz
- Department of Medicine, University of California-San Francisco, CA, San Francisco, USA
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Weisbaum E, Chadi N. Applied Mindfulness for Physician Wellbeing: A Prospective Qualitative Study Protocol. Front Public Health 2022; 10:807792. [PMID: 35223736 PMCID: PMC8873143 DOI: 10.3389/fpubh.2022.807792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/20/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Physician burnout has significant adverse impacts on the wellbeing of individual physicians, and by extension the healthcare delivery systems of which they are part. Mindfulness is consistently cited as a pragmatic approach to effectively address burnout and enhance physician wellbeing. However, very few empirical studies have been published on Mindfulness Based Interventions (MBIs) for physicians. Moreover, the majority of these studies have been quantitative, leaving a gap in understanding the practical application of mindfulness in the context of physicians' daily lives. OBJECTIVES This paper outlines the rationale, development and design of a novel prospective qualitative study examining the acceptability, feasibility, and pragmatic application of a mindfulness intervention for physician wellness. METHODS The study will be conducted in three groups of at least 8 practicing physicians from a broad range of medical specialties at a tertiary care hospital in a large urban center in Eastern Canada. The intervention will consist of an innovative program based on the teachings of internationally renowned scholar and Zen Master Thích Nhãt Hạnh. It will include 5 weekly 2-h mindfulness sessions delivered by two health providers trained in mindfulness and in the teachings of Thich Nhat Hanh. The primary outcome measure will be an in-depth Thematic Analysis of post-program semi-structured interviews. Field data will also be collected through participant observation. The study will be theoretically grounded within the interpretive paradigm utilizing "the Mechanisms of Mindfulness Theory". An external advisory committee formed by four senior members of Thích Nhãt Hạnh's community will provide guidance across all phases of the study. DISCUSSION Our innovative approach provides a new framework to further understand the mechanisms by which mindfulness interventions can impact physician wellbeing, and by extension their patients, colleagues, and broader healthcare systems. Through a clear articulation of the rigorous application of accepted procedures and standards used in our protocol, this paper seeks to provide a roadmap for other researchers who wish to develop further studies in this area. Lessons learned in the preparation and conduction of this study can be applied to other healthcare contexts including non-physician health provider wellbeing, clinical care, and population-level mental health.
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Affiliation(s)
- Elli Weisbaum
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Buddhism, Psychology and Mental Health Program, New College, Faculty of Arts and Sciences, University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Nicholas Chadi
- Department of Pediatrics, University of Montreal, Montreal, QC, Canada
- Division of Adolescent Medicine, Sainte-Justine University Hospital Centre, Montreal, QC, Canada
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Mai DH, Newton H, Farrell PR, Mullan P, Kapoor R. Implementation of a Clinical Leadership Curriculum for Pediatric Residents. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2022; 9:23821205221096354. [PMID: 35509681 PMCID: PMC9058360 DOI: 10.1177/23821205221096354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Clinical leadership is an essential skill for physicians, empowering them to lead and coordinate teams, communicate clearly under various conditions, model positive behaviors, display emotional intelligence, and ultimately improve patient care outcomes. However, there are currently no standardized residency curricula or competency-based assessments for clinical leadership, as residents often assimilate leadership skills through trial-and-error or observation of their clinical faculty. By utilizing a comprehensive needs assessment and synthesizing evidence-based practices, we developed and implemented a longitudinal and skills-based clinical leadership curriculum for pediatric residents. METHODS We modeled our clinical leadership curriculum after Kern's 6-step approach to curricular development and the Accreditation Council for Graduate Medical Education competency requirements for professionalism. We identified topics based on a resident needs assessment and synthesized evidence from published practices. The curriculum was implemented through both monthly facilitated group sessions and independent learning modules. RESULTS 44 postgraduate year-2 (PGY-2) and PGY-3 pediatric residents participated in at least one monthly session of the clinical leadership curriculum. 27 (61%) completed the survey to evaluate the efficacy of the curriculum. Of the respondents, 23 (85%) residents found the leadership sessions useful, 4 (15%) were neutral, and none (0%) rated the sessions as not useful. 26 (96%) residents reported that the sessions should be continued. CONCLUSION The clinical leadership curriculum has been received favorably by senior pediatric residents at our institution. Our next steps are to pilot the curriculum within residency programs of different specialties at our own institution as well as with pediatric residencies at other institutions.
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Affiliation(s)
- Daniel H. Mai
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Heather Newton
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Peter R. Farrell
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA
- Children’s Hospital of The King’s Daughters, Norfolk, VA, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s Hospital, Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Paul Mullan
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA
- Children’s Hospital of The King’s Daughters, Norfolk, VA, USA
| | - Rupa Kapoor
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA
- Children’s Hospital of The King’s Daughters, Norfolk, VA, USA
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Biquet JM, Schopper D, Sprumont D, Michel P. A Call for the Application of Patient Safety Culture in Medical Humanitarian Action: A Literature Review. J Patient Saf 2021; 17:e1732-e1737. [PMID: 32175966 DOI: 10.1097/pts.0000000000000638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of the study were to assess lessons learned on patient safety in Organization for Economic Cooperation and Development (OECD) countries and to assess whether they are applied or can be applied to the humanitarian medicine. METHODS This is (a) a 2013-2018 rapid literature review of reviews and systematic reviews articles (PubMed database) on "patient safety" and "medical error" to look for lessons learned regarding patient safety in OECD countries and (b) a rapid literature review (PubMed and Embase databases) on "humanitarian medicine" and "patient safety," from their creation to 2018, to find any articles related to patient safety in humanitarian medicine. In both reviews were excluded articles specifically related to one device, disease, or medical act. These reviews were complemented by a Google search. RESULTS Of the 245 references retrieved, 104 met the inclusion criteria. Of 308 references, 39 respected the inclusion criteria. In OECD countries, patient safety comprises correlated measures taken at three levels. The micro level focuses on individual staff involved in healthcare provision or management; the meso level focuses on medical institutions; the macro level focuses on national healthcare systems. Only one reference mentioned the implementation of a medical error reporting and analysis system in medical humanitarian organization. CONCLUSIONS The adoption of strategies and a culture of safety will need to be adapted to address the variety of intervention contexts and to respond first to the fears and expectations of humanitarian staff. Medical humanitarian organizations, in the absence of an overarching authority for the sector, have a major responsibility in the development of a general patient safety policy applicable in all their operations.
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Affiliation(s)
| | | | - Dominique Sprumont
- Institute of Health Law, University of Neuchâtel, Neuchâtel, Switzerland
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Barr TL, Nathenson SL. A Holistic Transcendental Leadership Model for Enhancing Innovation, Creativity and Well-Being in Health Care. J Holist Nurs 2021; 40:157-168. [PMID: 34213955 DOI: 10.1177/08980101211024799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Burnout in health care employees and leaders is at an all-time high. Strategies to address burnout can fall short of addressing the broad range of underlying causes, including both organizational culture and personal factors. The National Academies of Medicine has set forth recommendations to address health care burnout from a leadership-based systems level that focuses on the whole employee, body, mind, and spirit. Across generations and societies, there is a growing trend toward spirituality and meaning as a critical component of both personal life and work. Among the working-age millennials, values of purpose and greater societal good take precedent and impact work choices and behaviors. Spiritually based values such as a sense of purpose, the transcendence of the self and ego, and the acknowledgment of something greater than our collective selves, are present in both popular culture and research on transcendental models of leadership. This article presents a model of holistic transcendental leadership that can be leveraged in the health care workplace to enhance innovation and creativity, while placing a novel emphasis on the physical, emotional, and spiritual well-being at the individual, group, and organizational level.
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Affiliation(s)
- Taura L Barr
- 2647The Ohio State University College of Nursing
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Torres-Landa S, Wairiri L, Cochran A, Brasel KJ. Evaluation of leadership curricula in general surgery residency programs. Am J Surg 2021; 222:916-921. [PMID: 34116793 DOI: 10.1016/j.amjsurg.2021.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/07/2021] [Accepted: 05/25/2021] [Indexed: 11/25/2022]
Abstract
The rapid and dynamic surgical environment requires leaders that can help guide their teams to desired outcomes while delivering patient-centered care. The need for early implementation of leadership curricula has been identified; however, most available leadership curricula are tailored for faculty and not embedded within surgery training. The ideal intervention(s) to close this gap while addressing the unique challenges of the demanding surgical training are yet to be identified. This manuscript reviews the current status of residency leadership programs and the relationship of leadership to other essential aspects for optimal training of future surgeon leaders. The use of best practice medical education frameworks is key to help guide effective and sustainable evidence-based leadership curricula. The collaboration, standardization, and publication of leadership curricula for surgery residents can serve as prototypes to address specific needs at different training institutions with the aim of equipping surgeons with the necessary leadership tools for their success.
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Affiliation(s)
- Samuel Torres-Landa
- Division of Trauma, Critical Care, Acute Care Surgery, and General Surgery, Department of Surgery, Oregon Health and Science University, 3181, SW Sam Jackson Park Rd, Portland, OR, United States.
| | - Loise Wairiri
- Department of Radiation Medicine, Oregon Health and Science University, 3181, SW Sam Jackson Park Rd, Portland, OR, United States.
| | | | - Karen J Brasel
- Division of Trauma, Critical Care, Acute Care Surgery, and General Surgery, Department of Surgery, Oregon Health and Science University, 3181, SW Sam Jackson Park Rd, Portland, OR, United States.
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Mai DH, Newton H, Farrell PR, Mullan P, Kapoor R. Assessment of Clinical Leadership Training Needs in Senior Pediatric Residents. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2021; 8:2382120520988593. [PMID: 33532596 PMCID: PMC7841860 DOI: 10.1177/2382120520988593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/14/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Although clinical leadership in physicians is associated with improved healthcare, leadership training is rarely integrated into residency training. Our objective was to perform a comprehensive needs assessment of our pediatric residents' existing leadership experiences and knowledge and to identify training gaps within our program. METHODS First, we held focus groups with senior pediatric residents to understand their clinical leadership experiences and identify training needs. Notes were transcribed and independently coded by 2 researchers, with thematic saturation achieved. Next, we focused each session on 1 leadership content area identified from the aforementioned themes to better understand the specific training needs for each topic. RESULTS Four major themes were identified: (1) Effective and timely communication with supervisors, learners, ancillary staff, and patients is indispensable in promoting safe patient care, avoiding conflict, and preventing misunderstanding. (2) Training in teaching methods is desired, especially gaining the skills needed to teach various levels of learners, in different settings and under time constraints. (3) Time management, availability of resources, and team logistics were often learned through trial-and-error. (4) Self-care, self-acceptance, emotional regulation, and peer debriefing are relied upon to manage negative emotions; rarely are resilience and wellness strategies employed in "real-time." CONCLUSION Senior residents currently face gaps in clinical leadership training and may benefit from additional instruction in content areas related to these 4 themes. Our next steps are to utilize the identified themes to develop a longitudinal and skills-based clinical leadership curriculum to address the gap in graduate medical education.
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Affiliation(s)
- Daniel H Mai
- School of Medicine, Eastern Virginia Medical School, Norfolk, USA
| | - Heather Newton
- School of Medicine, Eastern Virginia Medical School, Norfolk, USA
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, USA
| | - Peter R Farrell
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, USA
- Children’s Hospital of The King’s Daughters, Norfolk, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
| | - Paul Mullan
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, USA
- Children’s Hospital of The King’s Daughters, Norfolk, USA
| | - Rupa Kapoor
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, USA
- Children’s Hospital of The King’s Daughters, Norfolk, USA
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Diaz Baez Y, Chodakowski JD, Mycyk MB, Kontrick AV. Resident physician perception on how food choice affects wellness and professional development. Am J Emerg Med 2020; 45:602-603. [PMID: 33341324 DOI: 10.1016/j.ajem.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Yudith Diaz Baez
- Department of Emergency Medicine, Cook County Health, Chicago, IL, United States of America.
| | - Jason D Chodakowski
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Mark B Mycyk
- Department of Emergency Medicine, Cook County Health, Chicago, IL, United States of America.
| | - Amy V Kontrick
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
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Saxena A, Meschino D, Hazelton L, Chan MK, Benrimoh DA, Matlow A, Dath D, Busari J. Power and physician leadership. BMJ LEADER 2019. [DOI: 10.1136/leader-2019-000139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Power and leadership are intimately related. While physician leadership is widely discussed in healthcare, power has received less attention. Formal organisational leadership by physicians is increasingly common even though the evidence for the effectiveness of physician leadership is still evolving. There is an expectation of leadership by all physicians for resource stewardship. The impact of power on interprofessional education and practice needs further study. Power also shapes the profession’s attempts to address physician and learner well-being with its implications for patient care. Unfortunately, the profession is not exempt from inappropriate use of power. These observations led the authors to explore the concept and impact of power in physician leadership. Drawing from a range of conceptualisations including structuralist (French and Raven), feminist (Allen) and poststructuralist (Foucault) conceptualisations of power, we explore how power is acquired and exercised in healthcare systems and enacted in leadership praxis by individual physician leaders (PL). Judicious use of power will benefit from consideration and application of a range of concepts including liminality, power mediation, power distance, inter-related use of power bases, intergroup and shared leadership, inclusive leadership, empowerment, transformational leadership and discourse for meaning-making. Avoiding abuse of power requires moral courage, and those who seek to become accountable leaders may benefit from adaptive reflection. Reframing ‘followers’ as ‘constituents or citizens’ is one way to interrupt discourses and narratives that reinforce traditional power imbalances. Applying these concepts can enhance creativity, cocreation and citizenship-strengthening commitment to improved healthcare. PLs can contribute greatly in this regard to further transform healthcare.
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Slater PJ, Edwards RM. Needs analysis and development of a staff well-being program in a pediatric oncology, hematology, and palliative care services group. J Healthc Leadersh 2018; 10:55-65. [PMID: 30532608 PMCID: PMC6241859 DOI: 10.2147/jhl.s172665] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Around 170 multidisciplinary staff of the Oncology Services Group at Queensland Children's Hospital, Brisbane, care for children with oncology, hematology, and palliative care needs from throughout Queensland and northern New South Wales. A series of challenges impacted staff resilience and retention, and strategies were needed to improve staff well-being and enable them to flourish despite the inherent work stressors. METHODS A needs analysis was conducted using themes from Discovery Interviews with 51 staff, surveys related to "The Work Stressors Scale - Pediatric Oncology" and "The Work Rewards Scale - Pediatric Oncology" completed by 59 staff, and an organizational staff survey responded to by 51 staff. RESULTS The needs analysis informed the development of a customized Oncology Staff Well-being Program with a range of strategies aligned to a PERMA framework for flourishing (positive emotion, engagement, relationships, meaning, and accomplishment). Positive emotion areas included education on topics such as well-being, resilience, responding to escalating behaviors, grief and loss, and self-care. Staff attended the available mindfulness sessions, debriefing and counselors on site, developed self-care plans, and followed a well-being Facebook Group. Engagement was supported through exploring character strengths, improving communication, supporting innovation, and addressing frustrations and safety concerns. Relationships within the team were addressed through team building and social events. Meaning of the work was emphasized through sharing family updates and end of treatment celebrations. Accomplishments of staff were acknowledged in newsletters and meetings. CONCLUSION The needs analysis drove a multifaceted approach to staff well-being with the development of strategies which aligned to a framework that would empower staff to flourish at work. Implementation and evaluation are ongoing and will be reported in a subsequent paper.
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Affiliation(s)
- Penelope J Slater
- Oncology Services Group, Queensland Children's Hospital, South Brisbane, QLD, Australia,
| | - Rachel M Edwards
- Nursing Learning and Workforce Development, Queensland Children's Hospital, South Brisbane, QLD, Australia
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Hasbrouck MA, Waddimba AC. The work-related stressors and coping strategies of group-employed rural health care practitioners: A qualitative study. Am J Ind Med 2017; 60:867-878. [PMID: 28833294 DOI: 10.1002/ajim.22753] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Escalating demands on practitioners, stagnating/dwindling resources, and diminishing autonomy have heightened patient-care work-related stress. Using qualitative content/thematic analysis of responses to open-ended survey questions, plus spontaneous comments, we sought to identify rural clinicians' subjective perceptions of their workplace stressors and typical adaptive/coping strategies. METHODS Within a hybrid inductive-deductive approach, we framed empirical themes (derived by consensus, corroborated with text segments, and extant literature) into theory-based coding templates by which we analyzed the data. RESULTS Of 308 (65.1% of) recipients completing questionnaires, 290 (94%) answered open-ended questions and/or provided comments. Categorizing stressors by socio-ecology, they cited four themes: Organizational, practitioner/staff-related, patient-related, and third party-induced stressors. Organizational stressors were referenced most conspicuously. How respondents described their coping fitted the Stress, Appraisal and Coping. [Lazarus and Folkman (1984): New York, NY: Springer Publishing Company, Inc] model. Emotion-focused were referenced more than problem-focused approaches. Themes scarcely differed by demographics, except for marital status. CONCLUSIONS Findings highlight needs for resilience coaching, rekindling work meaningfulness, mentorship in work-home balance/limit-setting, supportive peer networks, and deeper teamwork.
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Affiliation(s)
| | - Anthony C. Waddimba
- Parkland Health and Hospital System; Center for Clinical Innovation; Dallas Texas
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