Leadership

Ward rounds are an essential activity occurring in hospital settings. Despite their fundamental role in guiding patient care, they have no standardised approach. Implementation of structured interventions during ward rounds was shown to improve outcomes such as efficiency, documentation and communication. Whether these improvements have an impact on clinical outcomes is unclear. Our systematic review assessed whether structured interventions to guide ward rounds affect patient outcomes.

A systematic search was carried out in May 2023 on Embase, Medline, CINAHL, ERIC, Web of Science Core Collection, the Cochrane Library (Wiley) and Google Scholar, and a backward and forward citation search in January 2024. We included peer-reviewed, original studies assessing the use of structured interventions during bedside ward rounds (BWRs) on clinical outcomes. All inpatient hospital settings where BWRs are performed were included. We excluded papers looking at board, teaching or medication rounds.

Our search strategy yielded 29 studies. Two were randomised controlled trials (RCTs) and 27 were quasi-experimental interventional studies. The majority (79%) were conducted in intensive care units. The main clinical outcomes reported were mortality, infectious complications, length of stay (LOS) and duration of mechanical ventilation (DoMV). Mortality, LOS and rates of urinary tract and central-line associated bloodstream infections did not seem to be affected, positively or negatively, by interventions structuring BWRs, while evidence was conflicting regarding their effects on rates of ventilator-associated pneumonia and DoMV, with a signal towards improved outcomes. Studies were generally of low-to-moderate quality.

The impact of structured interventions during BWRs on clinical outcomes remains inconclusive. Higher quality research focusing on multicentric RCTs or on prospective pre–post trials with concurrent cohorts, matched for key characteristics, is needed.

CRD42023412637.

Hospital incident reporting and patient concerns systems are widely used to detect and respond to patient harm. Despite increasing recognition of the link between equity and safety, equity remains poorly integrated into the design and function of these systems. Consequently, these systems risk obscuring or reproducing inequities rather than revealing and attending to them.

To examine how issues of equity are currently considered in research about hospital incident reporting and patient concerns systems and identify opportunities to more systematically include equity in how patient safety is addressed.

A critical interpretive synthesis was conducted to develop a theoretical understanding of the topic through inductive analysis and interpretation. The databases CINAHL, EMBASE, MEDLINE and PsycINFO were searched from database inception to 6 February 2024. Select social science, patient safety and health services literature supported the interpretive process.

After screening 6508 abstracts and conducting hand searches, we included 30 articles in our review. Our analysis identified four equity-related themes. The first theme describes how knowledge injustices in ‘what counts as a safety event or contributor’ shape what patient issues are recognised, recorded and addressed. The second theme examines how individual bias and systemic discrimination affect which safety events and concerns get reported. The third theme explores both opportunities and limitations of stratifying data to uncover equity-related patterns of harm. The fourth theme presents alternate frameworks, including restorative and human rights approaches, as ways to address inequities and humanise harm.

The findings provide direction for changes within incident reporting and patient concerns practices (eg, expanding definitions of harms; creating accessible and culturally safe patient concerns systems). They also affirm the opportunity to learn from, and build on, initiatives such as taking a restorative approach that moves beyond a customer service and risk management framing.

The aim of this article is to provide an estimate of the proportion of the general public reporting healthcare-related harm in Great Britain, its location, impact, responses post-harm and desired reactions from healthcare providers.

We used a cross-sectional survey, using quota sampling.

This research was conducted in Great Britain.

The survey had 10 064 participants (weighted analysis).

In our survey 9.7% participants reported harm caused by the National Health Service (NHS) in the last 3 years through treatment or care (6.2%) or the lack of access to care (3.5%). The main location where the harm first occurred was hospitals. A total of 37.6% of participants reported a moderate impact and 44.8% a severe impact of harm. The most common response to harm was to share their experience with others (67.1%). Almost 60% sought professional advice and support, with 11.6% contacting the Patient Advice and Liaison Service (PALS). Only 17% submitted a formal complaint, and 2.1% made a claim for financial compensation. People wanted treatment or care to redress the harm (44.4%) and an explanation (34.8%). Two-thirds of those making a complaint felt it was not handled well and approximately half were satisfied with PALS. Experiences and responses differed according to sex and age (eg, women reported more harm). People with long-term illness or disability, those in lower social grades, and people in other disadvantaged groups reported higher rates and more severe impact of harm.

We found that 9.7% of the British general population reported harm by the NHS, a higher rate than reported in two previous surveys. Our study used a broader and more inclusive definition of harm and was conducted during the COVID-19 pandemic, making comparison to previous surveys challenging. People responded to harm in different ways, such as sharing experiences with others and seeking professional advice and support. Mostly, people who were harmed wanted help to redress the harm or to gain access to the care needed. Low satisfaction with PALS and complaints services may reflect that these services do not always deliver the required support. There is a need to better understand the patient perspective following harm and for further consideration of what a person-centred approach to resolution and recovery might look like.

Evaluation of neck trauma is a common reason for emergency department (ED) visits. There are several validated clinical decision rules, such as the National Emergency X-Radiography Utilization Study (NEXUS) Cervical Spine (C-spine) Rule, that can be used to risk stratify these patients and identify low-risk patients who do not require CT imaging. Overutilisation of CT imaging exposes patients to unnecessary radiation, impairs hospital throughput and increases healthcare costs. Various audit-and-feedback strategies have been described in other settings, but it is not known whether these strategies are effective for reducing imaging overutilisation in the ED. Additionally, the effectiveness of face-to-face feedback strategies as compared with digital feedback strategies for addressing this problem has not been previously evaluated. The aim of this study was to compare audit-and-feedback strategies to reduce CT overutilisation in the ED.

This was a prospective randomised controlled trial, in which emergency medicine clinicians were randomised into three arms to receive digital feedback, hybrid face-to-face/digital feedback or no feedback. Each clinician received three rounds of feedback on patient encounters in which they ordered a CT of the C-spine. Patient encounters were retrospectively reviewed to determine each clinician’s overutilisation rate, defined as the percentage of patients who underwent CT of the C-spine despite being classified as low risk by NEXUS criteria.

A total of 78 emergency medicine clinicians were randomised into three arms. Baseline overutilisation rates for each group were 46%–47% of CT of the C-spine studies. After three rounds of audit-and-feedback strategy, the clinicians in the digital feedback group had an overutilisation rate of 33%, compared with 44% in the control group (p=0.020). The hybrid feedback group had an overutilisation rate of 36% (p=0.055 vs control; p=0.577 vs digital feedback). Over the study period, the digital group saw a reduction of 1.26 CT of the C-spine studies per provider per month (p=0.049), and the hybrid feedback group saw a reduction of 1.43 CTs per provider per month (p=0.044).

A digital audit-and-feedback strategy is effective for reducing overutilisation of CT imaging of the C-spine in the ED, while the effectiveness of a hybrid strategy requires further investigation.

In the intensive care unit (ICU), antibiotics are often given longer than recommended in guidelines. A better understanding of the factors influencing antibiotic therapy duration is needed to develop improvement strategies to effectively address these drivers of excessive duration. This study aimed to explore the determinants of adherence to recommended antibiotic therapy durations among healthcare professionals involved in antibiotic decision-making within the ICU, focusing on multidisciplinary meetings (MDMs).

Semistructured interviews were held with healthcare professionals involved in antibiotic decision-making during MDMs in four Dutch ICUs. Participants included intensivists, clinical microbiologists and ICU residents. Transcripts were analysed using deductive and inductive content analysis methods.

A total of 20 participants were interviewed. The interviews revealed that decision-making regarding antibiotic therapy duration is a complex process, primarily centred around professional interactions during MDMs and involving a broad range of determinants. These determinants were categorised into the following four steps: (1) the introduction of duration as a topic for discussion in the MDM (eg, lack of priority to discuss antibiotic therapy duration); (2) the discussion of antibiotic therapy duration itself (eg, lack of core members during MDM); (3) the establishment of a concrete decision (eg, lack of documentation of the decisions made); (4) the execution of the decision (eg, forgetting to stop antibiotics).

Our study identified numerous factors that influence decisions about the duration of antibiotic therapy during MDMs in the ICU. By describing these factors throughout the decision-making process, we provided valuable insights into barriers that commonly arise in specific steps, highlighting critical areas for improvement. Daily MDMs were deemed essential for informed decision-making regarding antibiotic therapy duration by the interviewees. Strategies to improve appropriate duration in the ICU should prioritise strengthening interdisciplinary communication between healthcare professionals and adding structure to these meetings.

Physician burn-out was associated negatively with physicians’ health, patient outcomes and healthcare system performance. Reducing physician burn-out may potentially benefit physicians and patients, improve healthcare performance and reduce societal healthcare costs.

The purpose of this study was to clarify the relationship between transformational and servant leadership behaviours and physician burn-out.

A cross-sectional, non-experimental quantitative correlation study was conducted using scores on the Maslach Burnout Inventory, Global Transformational Leadership Scale and Servant Leadership Behaviour Scale–6-item Short Form. The data were obtained by an online survey of physicians working at a metropolitan hospital in Australia.

82 physicians participated in the study. The result showed significant correlations between transformational and servant leadership and lower physician burn-out, particularly in supporting fellow physicians’ personal accomplishments, a burn-out construct (Pearson r=0.42 and 0.32, respectively). Among the constructs of transformational leadership, leaders who are clear about their values and demonstrate them in their actions correlate strongly with the constructs of burn-out. In servant leadership behaviours, helping subordinates generate meaning out of everyday work was the most influential factor in fellow physicians’ burn-out. The finding may be related to the effects of observing the positive values and actions of their supervisor and the physicians’ own understanding of the value of their work.

A positive role model and the meaning of everyday work could be protective against physician burn-out. Positive role modelling and mentorship may be relevant in physician supervisor training. Encouraging physicians to discover meaning from their everyday work may help to promote physician well-being.

The environmental impact of inhalers, particularly pressurised metered dose inhalers with high global warming potential, poses significant challenges in the context of planetary health. Although dry powder inhalers (DPIs) offer a more sustainable alternative, entrenched prescribing practices prevail. This systematic review evaluates patient and physician perspectives on inhaler environmental impacts and examines barriers and opportunities for leadership in adopting sustainable practices.

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive literature search was performed from inception to 12 June 2024, across Medline via EBSCO, EMBASE via Elsevier and Web of Science. Four studies were included, surveying 433 participants. Data extraction and risk-of-bias assessment were conducted using a standardised form and the Newcastle-Ottawa Scale.

Findings indicate that while both patients and providers express environmental concerns, limited awareness and entrenched clinical practices hamper the transition to DPIs. Leadership insights reveal that a fragmented sense of responsibility, insufficient training and low confidence in discussing environmental impacts are significant barriers. However, targeted education and interprofessional collaboration have been shown to increase the willingness to adopt sustainable inhaler practices.

The results underscore the need for leadership in healthcare to champion sustainable prescribing. Empowering clinicians through education, clear clinical guidelines and eco-ethical leadership initiatives is essential. Health leaders have the opportunity to transform practice by integrating environmental considerations into routine care, ultimately advancing planetary health.

CRD42024552555

Effective healthcare leadership has been linked to improved individual and organisational outcomes globally. However, evaluations of healthcare leadership development programmes have often been of low quality. This study investigates the evaluation and decision-making needs of stakeholders for the Oxford Emerging Leaders Programme and aims to redesign its evaluation approach.

Drawing from Michael Quinn Patton’s utilisation-focused evaluation approach, semistructured interviews were conducted with 12 key programme stakeholders. Interviews were thematically analysed to identify key areas for useful and impactful evaluation.

Three main themes were identified: impact on patients, impact on healthcare organisations and individual outcomes. Individual outcomes were further divided into skills and qualities. Stakeholders emphasised the importance of measuring improvements in organisational culture, as well as from the perspectives of patients and individual leaders. The need for a multifaceted and longitudinal evaluation approach was highlighted.

The study underscores the importance of aligning evaluation methods with stakeholder needs. Tailoring evaluations to specific programme aims and incorporating both qualitative and quantitative measures can enhance their utility. These insights contribute to the broader literature on healthcare leadership development and programme evaluation.

Effective management and leadership are needed for the successful running and improvement of National Health Service (NHS) organisations and enhance the ability of these organisations to improve. However, NHS managers are often undervalued, and there are serious shortfalls in management capacity. We hosted a workshop with a diverse audience of health professionals, to explore this issue in depth.

The workshop took place at the annual Faculty of Medical Leadership & Management conference 2024 with five panellists and roughly 40 delegates, lasting for over 90 minutes. It consisted of individual presentations, panel discussions, questions and answers and online polling and commentary. The results were analysed using thematic analysis.

We identified four themes. The first included an overall lack of management capacity in the NHS, with fewer managers compared with other sectors and countries. Difficulties in interprofessional relationships was a second theme, for example, the lack of understanding or appreciation for the management role. Significant variation in development, training and career opportunities was the third theme. Discussions on potential regulation for NHS managers was the final theme.

The workshop report identified important challenges affecting managers and leaders in the NHS. Addressing these will be crucial to sustaining and improving high-quality care.

Excellence in healthcare delivery is dependent on individuals working together on a team.

We sought to enhance team performance by partnering with human resources (HR) to identify opportunities unrecognised by unit leadership.

100 individuals representing a cross-section of the multidisciplinary team participated in an interview focused on teamwork conducted by an HR representative. Action plans were then developed and implemented. Press Ganey Survey results for the question, "Staff worked together to care for you/your baby?" were tracked to assess patient perception of teamwork.

Between 2022 and 2024, we observed improvement in the per cent of patients who assigned the highest rating of teamwork, culminating in 100% of patients reporting the highest score in the final quarter.

The model of HR facilitated discussions with work unit team members identified barriers to optimal teamwork, led to the implementation of action plans and resulted in an improvement in our teamwork rating by patients.

Residency training and parenthood are conflicting pursuits for many residents, as both often occur during similar years of life. Online policy about paid parental leave for residents is important for not only mitigating this dilemma, but also ensuring that the associated health benefits can be fully capitalised on.

Investigate the extent of advertised paid parental leave for anaesthesiology residencies in the USA and to explore whether this had an association with the gender of the department chair for these programmes. Analysis of Canadian anaesthesiology residencies was performed to assess whether a nation with federally protected paid parental leave yielded disparate rates of advertised paid parental leave.

All accredited US anaesthesiology residency programme websites were reviewed to determine the gender of the department chair and the existence of advertised paid parental leave for residents. ² analysis was used to determine if there was a statistically significant association between the gender of anaesthesiology residency department chairs and paid parental leave advertised. Rates of advertised paid parental leave were compared with those seen in Canadian anaesthesiology residencies.

US anaesthesiology residency department chairs were 84% (137/164) men. Of the men-led programmes, 42% (58/137) advertised paid parental leave, while 70% (19/27) of women-led programmes advertised such benefits (p<0.05). Overall, 47% of (77/164) of US anaesthesiology residencies advertised paid parental leave, while 76% (13/17) of Canadian anaesthesiology residencies advertised paid parental leave (p<0.05).

In the USA, anaesthesiology residencies with department chairs held by women had a higher rate of advertised paid parental leave. Such findings call attention to the potential downstream effects of lacking diversity in leadership within medicine. When compared with the USA, Canada was found to have higher rates of advertised paid parental leave across their anaesthesiology residencies, potentially highlighting the impact of federal legislature on medical residents.

Clinicians involved in errors leading to preventable patient harm often receive inadequate organisational support. Limited research examines this issue from an organisational perspective. This study aims to elucidate and evaluate healthcare leaders’ (HLs’) perspectives on medical errors and caregiver support.

A convenience sample of 81 HLs participated in this study that included the Medical Error Attitude Scale (MEAS) and questions about caregiver support synthesised from evidence-based resources.

Most participants were from acute care settings (83.1%) and were chief executives (69.3%). MEAS scores were high, indicating enlightened attitudes about medical errors. Over one-third (38.8%) could not confirm their organisation had a caregiver support programme (CSP). Fewer than 50% of HLs from organisations with a CSP expressed certainty about its effectiveness and utilisation. Still, most were confident about its value to the organisation (84.3%) and return on investment (82.2%). Some participants (33.3%) indicated healthcare organisations may have conflicts of interest interfering with optimal caregiver support.

HLs have enlightened views about medical errors, yet organisational caregiver support after errors is often suboptimal. Existing CSPs may lack important structural elements such as executive buy-in and tiers of support. Organisations can improve caregiver support by developing comprehensive approaches to patient safety, utilising tools such as the Agency for Healthcare Research and Quality’s CANDOR process or the National Health Services’ National Patient Safety Strategy documents.

The What Matters to Staff programme was designed at the Royal Free Hospital to address a key priority of improving workforce well-being. The initial aim was to set up a programme that responded to what mattered to staff and could be spread to 70 teams across the hospital within 2 years.

The programme was developed by adding a set of simple, yet important steps around the ‘what matters to you’ conversation from the Joy in Work Framework. The programme enrolled its first teams in January 2022 and has since spread widely to over 90 areas and has involved approximately 3000 staff.

There have been significant improvements in staff experience, staff engagement and workforce metrics since the programme began and it is now embedded as business as usual within each division. It was easily scalable on minimal resources due to its standardised and systematic approach and because the programme was seen to drive positive and impactful change.

Over the past 2 years, the programme has given staff the opportunity to have their voice heard and has supported leaders to ask, listen and do what matters most for their teams. This has led to improved workforce metrics and the programme being widely scaled and spread.