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The purpose of the study was to construct a Leadership Mindset Scale (LMS) and to assess its reliability and construct validity. Participants were 100 employees in a variety of leadership and non-leadership positions at various organizations in three states. An item and factor analysis on the 13 LMS items led to a scale with 11 items (Cronbach α = .80). A Principal Axis Factor analysis with Promax rotation suggested three factors: Leadership Mindset Teachability (LMS-T), a belief in leadership teachability; Leadership Mindset Improvability (LMS-I), a belief in leadership improvability over time; and Leadership Mindset Predictability (LMS-P), a belief that leadership cannot be predicted at an early age. Convergent validity of LMS-Total and Teachability was evidenced by significant correlations with the implicit theories of intelligence and anxiety scales, and developmental leadership and transactional leadership scales. Divergent validity was evidenced by a non-significant correlation with social desirability. The results suggest that the LMS measures a construct different from those of other leadership scales used in the study. The LMS can be helpful in leadership training programs to promote a growth mindset about the trainability of leadership skills.

There are longstanding concerns about the sustainability of the US health care system. Payment reform has been seen over the last decade as a key strategy to reorienting the US health care system around value. Alternative payment models (APMs) that seek to accomplish this goal have become increasingly prevalent in the US, yet there is a perception that physicians are resistant to their use and that organizations have been slow to adopt such models. The reasons for the limited effectiveness of APM programs are multifactorial and include aspects related to the design and implementation of these programs and lack of alignment and coordination across different payers and health care sectors. Most importantly, however, is that the current organizational structures in US health care serve to dampen the direct impact of these incentives, often because health care delivery organizations face conflicting incentives themselves. Organizations filter and refine the incentives from multiple external payment contracts and develop internal incentive systems that best reflect the amalgamation of the incentives embedded across their contracts, and thus the fragmented nature of the US health care system serves to undermine efforts to transform care under value-based contracts. In addition to organizations having conflicting incentives, there also are fundamental problems with the design and implementation of APMs that hinder their acceptance among physicians and the organizations in which they work. Moreover, much remains to be learned about how organizations can best adapt to succeed under these models, and how organizational culture can be leveraged to transform care.

This paper examines whether participation in quality early child education (ECE) lessens special education needs and insulates children against requiring costly, intensive supports. Sixty years of longitudinal data coupled with new research in the United Kingdom and Canada were examined to demonstrate how quality ECE reduces special education needs and mitigates the intensity of later supports for children with special education needs. Research demonstrates that quality ECE strengthens children's language, literacy/numeracy, behavioural regulation, and enhances high-school completion. International longitudinal studies confirm that two years of quality ECE lowers special education placement by 40–60% for children with cognitive risk factors and 10–30% for social/behavioural risk factors. Explicit social-emotional learning outcomes also need to be embedded into ECE curricular frameworks, as maladaptive behaviours, once entrenched, are more difficult (and costly) to remediate. Children who do not have the benefit of attending quality ECE in the earliest years are more likely to encounter learning difficulties in school, in turn impacting the well-being and prosperity of their families and societies.

Purpose: To demonstrate how an online coaching intervention can support well-being management (mental health and mood) of medical students, by increasing psychological awareness, emotional management, and healthy/positive action repertoires.

Design/methodology/approach: A two-group randomized control trial design using a waitlist as a control was used with a sample of 176 medical students. Half were randomly assigned the 5P© coaching intervention and the remaining half assigned to the waitlist group, scheduled to receive the intervention after the initial treatment group completed the intervention. Participant baseline data on stress, anxiety, depression, positive and negative affect, and psychological capital were obtained prior to commencing the study, after completion of the first treatment group, and again postintervention of the waitlisted group, and then at the end of the year.

Findings: Coaching the students to reflect on their emotions and make solution-focused choices to manage known stresses of medical education was shown to decrease medical student stress, anxiety, and depression, thereby increasing the mental health profiles of medical students.

Research limitations/implications: The findings suggest that an online coaching tool that increases psychological awareness and positive action can have a positive effect on mental health and mood of medical students.

Practical implications: The framework developed and tested in this study is a useful tool for medical schools to assist medical students in managing their well-being, thereby decreasing the incidence and prevalence of mental illness in medical students. The implications of this research are significant in that positively affecting the psychological well-being of medical students could have a significant effect not only on each medical student but also on every patient that they treat, and society as a whole. Better mental health in medical students has the potential to decrease dropout rates, increase empathy and professionalism, and allow for better patient care.

Originality/value: This study contributes to the literature on online coaching for improved psychological well-being and emotional regulation, mental health, and medical students. It is one of the first studies using a coaching protocol to make a positive change to the known stress, anxiety, and depression experienced by medical students worldwide.

Purpose: While COVID-19 has upended lives, it has also catalyzed innovation with potential to advance health delivery. Yet, we know little about how the delivery system, and primary care in particular, has responded and how this has impacted vulnerable patients. We aimed to understand the impact of COVID-19 on primary care practice sites and their vulnerable patients and to identify explanations for variation. Approach: We developed and administered a survey to practice managers and physician leaders from 173 primary care practice sites, October-November 2020. We report and graphically depict results from univariate analysis and examine potential explanations for variation in practices' process innovations in response to COVID-19 by assessing bivariate relationships between seven dependent variables and four independent variables. Findings: Among 96 (55.5%) respondents, primary care practice sites on average took more safety (8.5 of 12) than financial (2.5 of 17) precautions in response to COVID-19. Practice sites varied in their efforts to protect patients with vulnerabilities, providing care initially postponed, and experience with virtual visits. Financial risk, practice size, practitioner age, and emergency preparedness explained variation in primary care practices' process innovations. Many practice sites plan to sustain virtual visits, dependent mostly on patient and provider preference and continued reimbursement. Value: While findings indicate rapid and substantial innovation, conditions must enable primary care practice sites to build on and sustain innovations, to support care for vulnerable populations, including those with multiple chronic conditions and socio-economic barriers to health, and to prepare primary care for future emergencies.

The adoption of electronic health records (EHRs) and digitization of health data over the past decade is ushering in the next generation of digital health tools that leverage artificial intelligence (AI) to improve varied aspects of health system performance. The decade ahead is therefore shaping up to be one in which digital health becomes even more at the forefront of health care delivery – demanding the time, attention, and resources of health care leaders and frontline staff, and becoming inextricably linked with all dimensions of health care delivery. In this chapter, we look back and look ahead. There are substantive lessons learned from the first era of large-scale adoption of enterprise EHRs and ongoing challenges that organizations are wrestling with – particularly related to the tension between standardization and flexibility/customization of EHR systems and the processes they support. Managing this tension during efforts to implement and optimize enterprise systems is perhaps the core challenge of the past decade, and one that has impeded consistent realization of value from initial EHR investments. We describe these challenges, how they manifest, and organizational strategies to address them, with a specific focus on alignment with broader value-based care transformation. We then look ahead to the AI wave – the massive number of applications of AI to health care delivery, the expected benefits, the risks and challenges, and approaches that health systems can consider to realize the benefits while avoiding the risks.

This paper examines medical managers' beliefs about the impact reduced‐hour career paths for physicians has on organizational effectiveness. The findings of this exploratory inductive study of 17 medical managers at nine medical organizations in the Boston area suggest that managers believe the benefits of reduced‐hour physicians (RHPs) far outweigh the disadvantages. However, many of their reasons appear to be exploitative of RHPs. In particular, managers believe that employing RHPs results in increased managerial control and that RHPs should: work more than they are compensated for; do a disproportionate share of the undesirable work; and remain extra flexible and available to the organization. An interpretation of the findings based on psychological contract theory is offered, and may help to illuminate other results reported in the literature, including some controversial findings that reduced‐hour workers tend to have poor health outcomes.

Organizational change is a key mechanism to ensure the sustainability of healthcare systems. However, healthcare organizations are persistently difficult to change, and literature is riddled with examples of failed change endeavors. In this chapter, we attempt to unravel the underlying causes for failed organizational change. We distinguish three types of change with different levels of depth that require different change approaches. Transformations are the deepest forms of change where beliefs and principles need to be modified to successfully influence routines. Renewals are deep forms of change where principles need to be modified to successfully influence routines. Improvements are shallow forms of change where only modifications at the level of routines are needed. Using deoxyribonucleic acid (DNA) as our metaphor, we propose a theory of “organizational DNA” to understand organizations and these three types of organizational changes. We posit that organizations are made up of a double helix consisting of a so-called “social string,” which contains the “soft” interaction or communication among the organization's members, and a so-called “technical string,” which contains “hard” organizational aspects such as structure and technology. Ladders of organizational nucleotides (i.e., Routines, Principles, and Beliefs) connect this double helix in various combinations. Together, the double helix and accompanying nucleotides make up the DNA of an organization. Without knowledge of the architecture of organizational DNA and whether a change addresses beliefs, principles, and/or routines, we believe that organizational change is constrained and based on luck rather than change management expertise. Following this metaphor, we show that organizational change fails when it attempts to change one part of the DNA (e.g., routines) in a way that renders it incompatible with the connecting components (e.g., principles and beliefs). We discuss how the theory can be applied in practice using an exemplar case.

Little attention has been given to the mental and physical health impacts of COVID-19 on the academic public health workforce. Academic public health is an important support mechanism for public health practice, providing expertise and workforce training, conducting research, disseminating evidence-based scientific information to both public health and lay audiences, and serving as a supplementary workforce when additional resources are needed. These roles become more important during a public health emergency, particularly during a prolonged public health crisis like the COVID-19 pandemic. As a result of the COVID-19 response, the roles of academic public health have expanded to include developing and implementing contact tracing, surveillance, testing, and vaccination programs for universities and their surrounding communities, all while continuing to prepare students and support the public health practice workforce in their ongoing efforts. As in other responder groups, this has resulted in significant mental health effects and burnout among public health academicians. The authors suggest important steps that can be taken to improve the resilience of the academic public health workforce and to support their contributions during prolonged public health emergencies.

The primary aim of this chapter is to explore stigmatization, stress, and coping among adolescent mothers and to identify positive coping mechanisms that not only resist stigmatization but also generate positive affect.

Fifty-two pregnant and parenting adolescents in an urban county in the Midwestern United States were recruited to participate. A journaling tool was developed and used to allow participants to express their thoughts and concerns in a real-time, reflexive manner. Data were coded at different “nodes” or themes. Concepts, such as stigma, stress, strength, and empowerment were operationalized into key words and “themes” based on previous published literature. Key phrases were used to code the journaling data.

Adolescent mothers used positive reappraisal of life circumstances to create a positive self-image and resist the stress of stigma and parenting. Overcoming stereotypes and success in parenting were reappraised as “strength,” which allowed the young women to feel empowered in their caregiving role.

The chapter also contributes to the sociological literature on positive coping responses to stigma and stress. Indeed, very few studies have employed the sociological imagination of pregnant and parenting adolescents by describing not only their lives but also seeking their understanding and explaining their lives sociologically. This chapter also has direct implications for several health care providers, including nurses and social workers. For example, nurses and social workers are a vital part of the healthcare team for pregnant and parenting adolescents, and they often serve as the link between the adolescent, her family and significant others, and healthcare and social service agencies.

This chapter described the mechanisms that adolescent mothers use to cope with stress with a focus on how caregiving generates positive affect through the voices of these young mothers themselves. This chapter contributed to the sociological literature on stress and coping. In particular, our findings were also in line with the work of sociologist Antonovsky’s Sense of Coherence concept. SOC is a global measure that indicates the availability of, and willingness to use, adaptive coping resources as a key variable in maintaining health.