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This paper aims to explore users' perceptions of whether the Leadership Development Impact Assessment (LDI) Toolkit is valid, reliable, simple to use and cost-effective as a guide to its quality improvement.

The Canadian Health Leadership Network codesigned and codeveloped the LDI Toolkit as a theory-driven and evidence-informed resource that aims to assist health-care organizational development practitioners to evaluate various programs at five levels of impact: reaction, learning, application, impact and return on investment (ROI) and intangible benefits. A comparative evaluative case study was conducted using online questionnaires and semistructured telephone interviews with three health organizations where robust leadership development programs were in place. A total of seven leadership consultants and specialists participated from three Canadian provinces. Data were analyzed sequentially in two stages involving descriptive statistical analysis augmented with a qualitative content analysis of key themes.

Users perceived the toolkit as cost-effective in terms of direct costs, indirect costs and intangibles; they found it easy-to-use in terms of clarity, logic and structure, ease of navigation with a coherent layout; and they assessed the sources of the evidence-informed tools and guides as appropriate. Users rated the toolkit highly on their perceptions of its validity and reliability. The analysis also informed the refinement of the toolkit.

The refined LDI Toolkit is a comprehensive online collection of various tools to support health organizations to evaluate the leadership development investments effectively and efficiently at five impact levels including ROI.

The purpose of this paper is to present a case study of the World Health Organization’s Global Healthcare Workforce Alliance (GHWA). Based on a commissioned evaluation of GHWA, it applies network theory and key concepts from systems thinking to explore network emergence, effectiveness, and evolution to over a ten-year period. The research was designed to provide high-level strategic guidance for further evolution of global governance in human resources for health (HRH).

Methods included a review of published literature on HRH governance and current practice in the field and an in-depth case study whose main data sources were relevant GHWA background documents and key informant interviews with GHWA leaders, staff, and stakeholders. Sampling was purposive and at a senior level, focusing on board members, executive directors, funders, and academics. Data were analyzed thematically with reference to systems theory and Shiffman’s theory of network development.

Five key lessons emerged: effective management and leadership are critical; networks need to balance “tight” and “loose” approaches to their structure and processes; an active communication strategy is key to create and maintain support; the goals, priorities, and membership must be carefully focused; and the network needs to support shared measurement of progress on agreed-upon goals. Shiffman’s middle-range network theory is a useful tool when guided by the principles of complex systems that illuminate dynamic situations and shifting interests as global alliances evolve.

This study was implemented at the end of the ten-year funding cycle. A more continuous evaluation throughout the term would have provided richer understanding of issues. Experience and perspectives at the country level were not assessed.

Design and management of large, complex networks requires ongoing attention to key issues like leadership, and flexible structures and processes to accommodate the dynamic reality of these networks.

This case study builds on growing interest in the role of networks to foster large-scale change. The particular value rests on the longitudinal perspective on the evolution of a large, complex global network, and the use of theory to guide understanding.

Fostering diversity in health leadership is imperative as that not only enhances the quality of health care itself, but improves an organization's effectiveness and responsiveness to address the needs of a diverse population. Inequitable structures entrenched in health care such as sexism, racism and settler colonialism undermine efforts made by women from diverse backgrounds to obtain leadership roles. This paper identifies leading practices which support diverse health leadership.

A multi-methodological approach involving a targeted published and gray literature search undertaken through both traditional means and a systematic social media search, focused particularly on Twitter. A literature and social media extraction tool was developed to review and curate more than 800 resources. Items chosen included those which best highlighted the barriers faced by diverse women and those sharing tools of how allies can best support the diverse women.

Four core promising practices that help to disrupt the status-quo of health leadership include (1) active listening to hear and amplify voices that have been marginalized, (2) active learning to respond to translation exhaustion, (3) active observing and noticing microaggressions and their consequences and (4) active bystanding and intervention.

When implemented, these practices can help to dismantle racism, sexism, ableism and otherwise challenge the status-quo in health leadership.

This paper provides an original and value-added review of the published literature and social media analysis of heretofore disparate practices of allyship, all while amplifying the voices of health leaders from marginalized communities.

This article aims to provide an overview on key trends in public sector policy and professional development and how they intersect with gender and diversity. It seeks to explore new configurations in the relationship between gender and the professions and to develop a matrix for the collection of articles presented in this volume.

The authors link social policy and governance approaches to the study of professions, using the health professions and academics as case studies. Material from a number of studies carried out by the authors together with published secondary sources provide the basis of our analysis; this is followed by an introduction of the scope and structure of this thematic issue.

The findings underline the significance of public policy as key to better understand gender and diversity in professional groups. The outline of major trends in public sector professions brings into focus both the persistence of gender inequality and the emergence of new lines of gendered divisions in the professions.

The research presented here highlights a need for new models of public sector management and professional development that are more sensitive to equality and diversity.

This article focuses on the “making” of inequality at the interface of public policy and professional action. It introduces a context sensitive approach that moves beyond equal opportunity policies and managerial accounts and highlights new directions in research and policy.

This article aims to explore the gendered dimensions of the heterogeneous path of non‐native graduates in nursing and medicine in the Portuguese National Health Service, including institutional factors like the process of credential recognition, the professional integration and internal labour market segmentation.

Biographical interviews with nurses and physicians (23 males and 35 females) from Spain and from some Eastern European countries who migrated to work in Portugal were conducted, and additionally semi‐structured interviews with 12 institutional participants to contextualise the experiential data.

The research highlights complex intersections between gender and the resources for action. Institutional conditions, like legal frameworks and the self‐regulatory mechanisms of the professions, and individual characteristics shape successful translation of foreign credentials into a new social and cultural context. The specific configurations may create gender traps that push women into low status professional segments and also new forms of inequality in the professions.

The development of successful professional action and agency in a socio‐culturally different health care labour market can be differentiated by gender, place of graduation and citizenship status. The factors identified in this small‐scale qualitative study would need further investigation.

The findings highlight new demands for integration policies for foreign‐trained professionals, such as policies to promote equal opportunities for women and men in the workplace.

The article reinforces women as professional participants in the international migration process and examines the opportunities for successful integration.

This chapter examines the relationship between health service restructuring and the health care experiences of women from rural and remote areas of Canada. Data were collected from 34 focus groups (237 women), 15 telephone interviews and 346 responses from an online survey. Access to services, care quality and satisfaction are salient themes in these data. Problems include: travel, shortage of providers, turnover in personnel, delays associated in accessing care, lack of knowledge of women's health issues and patronizing attitudes of some health care providers. Health care service restructuring has led to deterioration in service availability and quality. Key areas for policy development need to address health care access and quality improvement issues, including increasing access to more (particularly female) providers who are sensitive to women's health issues.

This paper sets out to explore health professionals' views and experiences regarding the work culture that exists in their hospital units, and further how patients influence these experiences.

The paper employs a qualitative approach involving individual interviews with 60 health professionals in Canada employed in what is conceptualised as “open” (emergency room and maternity care) and “closed” (intensive care, head and neck surgery) units.

The paper finds that the influence of the hospital unit outweighs the influence of professional boundaries but for some groups more than for others. Health professionals in more open units tend to be less satisfied with their work, have more difficult relations with patients, and experience tensions with co‐workers and management. Those in closed units tend to be more satisfied with their work, have relatively better relations with patients and co‐workers, and tend to have more cooperative relations with management. The different structural conditions of work in open and closed units are also clearly important.

The sample for the study was self‐selected from one hospital, which may limit the generalisability of some of the findings.

The insights garnered from the study may help professionals and managers to develop unit‐specific policies to create a more positive workplace culture.

There is a growing body of research on professional culture and oganisational culture that often does not clearly delineate how the two exist concurrently. The paper explicitly investigates this issue by examining work culture across various health professional groups and also across hospital units, and further how patients figure in these experiences.

This article aims to address topical issues in the debate on gender (in)equality in higher education in Europe and beyond, and highlights future perspectives of research and practice.

It is based on a conference report of the 5th European Conference on Gender Equality in Higher Education that was hosted by Humboldt University in Berlin, Germany, 28‐31 August 2007.

Number matters (“wore women into science”), but quality matters more: more women are needed in top positions in higher education, science, technology and engineering, and more female participation in higher education decision‐making processes. It is necessary to reveal gender biases of recent strategies in higher education. Exclusion happens also among women; an intersectional approach is therefore called for, which includes primary and secondary educations as well as labour market and careers in the academe.

Equality programmes have to consider the diversity of gender in higher education and to strengthen women's lobbying in European education and science politics.

This conference brought together about 350 participants from 56 countries. Thus, it provided an excellent opportunity for knowledge exchange with European scholars and beyond, which is reported in this paper.

Purpose – This chapter critically examines the purportedly growing phenomenon of Maternal Request Caesarean Sections (MRCS) and its relative contribution to the rising caesarean section (CS) rates.

Methodology – We apply a decentred comparative methodological approach to this problem by drawing upon and comparatively examining empirical data from Canada, the US, the UK and Finland.

Findings – We find that the general argument that has emerged within the obstetric community, evidenced in particular by a recent “State of the Science” conference, is that the reduced risks and benefits of MRCS are evenly balanced, thus ethically it could be seen as a valid choice for women. This approach, taken in particular in the North American context, negates the problematic nature of accurately measuring, and therefore assessing the importance of maternal request in addressing rising CS rates. Moreover, although some of the blame for rising CS rates has focused on MRCS, we argue that it has a relatively minor influence on rising rates. We show instead how rising CS rates can more appropriately be attributed to obstetrical policies and practices.

Originality – In presenting this argument, we challenge some of the prevailing notions of consumerism in maternity care and its influence on the practice patterns of maternity care professionals.

Practical implications – Our argument also calls into question how successful efforts to address MRCS will be in reducing CS rates given its relatively minor influence.

The paper aims to argue that US colleges and universities resemble a “leaning tower” with ever expanding layers of administrators and managers who control and dominate university life. This set of institutional changes has altered the way that college administrators are recruited.

The paper uses recent developments in institutional theories of organisations to explain the changing environment facing US colleges and universities and the role that college administrators play in this environment. The paper matches data from a sample of administrative positions advertised in the 2004‐2005 Careers section of the Chronicle of Higher Education with web‐based data on incumbents subsequently hired for each position. These data are supplemented with aggregate statistics provided by the Chronicle and the American Association of University Professors (AAUP).

Results suggest that only a small number of administrative positions advertised involve academic appointments with tenure and that the educational qualifications advertised span a surprisingly wide spectrum of credentials other than academic PhD's. Ethnically underrepresented groups and women are most likely to hold jobs requiring PhD's while whites and men occupy most of the positions where qualifications are ambiguous or classic academic qualifications are not called for.

The paper is the first to discuss the growing distinctive labour market for college administrators while providing preliminary data on the diversity effects of this labour market.