Maya M. Jeyaraman, Sheikh Muhammad Zeeshan Qadar, Aleksandra Wierzbowski, Farnaz Farshidfar, Justin Lys, Graham Dickson, Kelly Grimes, Leah A. Phillips, Jonathan I. Mitchell, John Van Aerde, Dave Johnson, Frank Krupka, Ryan Zarychanski and Ahmed M. Abou-Setta
Strong leadership has been shown to foster change, including loyalty, improved performance and decreased error rates, but there is a dearth of evidence on effectiveness of…
Abstract
Purpose
Strong leadership has been shown to foster change, including loyalty, improved performance and decreased error rates, but there is a dearth of evidence on effectiveness of leadership development programs. To ensure a return on the huge investments made, evidence-based approaches are needed to assess the impact of leadership on health-care establishments. As a part of a pan-Canadian initiative to design an effective evaluative instrument, the purpose of this paper was to identify and summarize evidence on health-care outcomes/return on investment (ROI) indicators and metrics associated with leadership quality, leadership development programs and existing evaluative instruments.
Design/methodology/approach
The authors performed a scoping review using the Arksey and O’Malley framework, searching eight databases from 2006 through June 2016.
Findings
Of 11,868 citations screened, the authors included 223 studies reporting on health-care outcomes/ROI indicators and metrics associated with leadership quality (73 studies), leadership development programs (138 studies) and existing evaluative instruments (12 studies). The extracted ROI indicators and metrics have been summarized in detail.
Originality/value
This review provides a snapshot in time of the current evidence on ROI indicators and metrics associated with leadership. Summarized ROI indicators and metrics can be used to design an effective evaluative instrument to assess the impact of leadership on health-care organizations.
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Heather Welfare and Jonathan Mitchell
A number of initiatives within Her Majesty’s Prison Service have explored how best to support the needs of vulnerable young people. One such is the Access programme, which employs…
Abstract
A number of initiatives within Her Majesty’s Prison Service have explored how best to support the needs of vulnerable young people. One such is the Access programme, which employs a combination of simple cognitive‐behavioural techniques and physical activity to build confidence and increase levels of coping. Results from the evaluation of three Access courses facilitated at Her Majesty’s Young Offender Institute Warren Hill, a UK institution for juvenile offenders, indicate a significant reduction in reports of bullying and fear of bullying, and significantly reduced levels of self‐injury and the desire to self‐injure. Psychometric measures of hopelessness, self‐esteem, locus of control and assertiveness were administered before, immediately after and six weeks after the course. Measures of hopelessness were reduced after the course, and reduced levels were maintained six weeks post‐intervention. Locus of control and self‐esteem scores rose by the end of the course and were maintained or increased six weeks later. In general, findings were encouraging, given the level of need in this vulnerable group of young people. It is suggested that programmes such as this may provide a promising addition to strategies for dealing with problems of bullying and self‐injury in juvenile prisoners.
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John Hitchins, Jonathan Davies, Phil Rivett and Mitchell Hogg
The credit derivatives market is both fast‐growing and increasingly complex. This brings problems for banks and the infrastructure needed to support such products. There are also…
Abstract
The credit derivatives market is both fast‐growing and increasingly complex. This brings problems for banks and the infrastructure needed to support such products. There are also sophisticated questions of regulation. The authors bring a wealth of experience to bear on the topic and suggest a variety of ways in which the problems and opportunities can be dealt with satisfactorily.
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Elizabeth Hartney, Ellen Melis, Deanne Taylor, Graham Dickson, Bill Tholl, Kelly Grimes, Ming-Ka Chan, John Van Aerde and Tanya Horsley
This first phase of a three-phase action research project aims to define leadership practices that should be used during and after the pandemic to re-imagine and rebuild the…
Abstract
Purpose
This first phase of a three-phase action research project aims to define leadership practices that should be used during and after the pandemic to re-imagine and rebuild the health and social care system. Specifically, the objectives were to determine what effective leadership practices Canadian health leaders have used through the first wave of the COVID-19 pandemic, to explore how these differ from pre-crisis practices; and to identify what leadership practices might be leveraged to create the desired health and care systems of the future.
Design/methodology/approach
The authors used an action research methodology. In the first phase, reported here, the authors conducted one-on-one, virtual interviews with 18 health leaders from across Canada and across leadership roles. Data were analyzed using grounded theory methodology.
Findings
Five key practices emerged from the data, within the core dimension of disrupting entrenched structures and leadership practices. These were, namely, responding to more complex emotions in self and others. Future practice identified to create more psychologically supportive workplaces. Agile and adaptive leadership. Future practice should allow leaders to move systemic change forward more quickly. Integrating diverse perspectives, within and across organizations, leveling hierarchies through bringing together a variety of perspectives in the decision-making process and engaging people more broadly in the co-creation of strategies. Applying existing leadership capabilities and experience. Future practice should develop and expand mentorship to support early career leadership. Communication was increased to build credibility and trust in response to changing and often contradictory emerging evidence and messaging. Future practice should increase communication.
Research limitations/implications
The project was limited to health leaders in Canada and did not represent all provinces/territories. Participants were recruited through the leadership networks, while diverse, were not demographically representative. All interviews were conducted in English; in the second phase of the study, the authors will recruit a larger and more diverse sample and conduct interviews in both English and French. As the interviews took place during the early stages of the pandemic, it may be that health leaders’ views of what may be required to re-define future health systems may change as the crisis shifts over time.
Practical implications
The sponsoring organization of this research – the Canadian Health Leadership Network and each of its individual member partners – will mobilize knowledge from this research, and subsequent phases, to inform processes for leadership development and, succession planning across, the Canadian health system, particularly those attributes unique to a context of crisis management but also necessary in post-crisis recovery.
Social implications
This research has shown that there is an immediate need to develop innovative and influential leadership action – commensurate with its findings – to supporting the evolution of the Canadian health system, the emotional well-being of the health-care workforce, the mental health of the population and challenges inherent in structural inequities across health and health care that discriminate against certain populations.
Originality/value
An interdisciplinary group of health researchers and decision-makers from across Canada who came together rapidly to examine leadership practices during COVID-19’s first wave using action research study design.
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Jonathan Stern, Norman Selley, John Mitchell and Koji Morita
Abstract
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Jeffrey Braithwaite, Kristiana Ludlow, Kate Churruca, Wendy James, Jessica Herkes, Elise McPherson, Louise A. Ellis and Janet C. Long
Much work about health reform and systems improvement in healthcare looks at shortcomings and universal problems facing health systems, but rarely are accomplishments dissected…
Abstract
Purpose
Much work about health reform and systems improvement in healthcare looks at shortcomings and universal problems facing health systems, but rarely are accomplishments dissected and analyzed internationally. The purpose of this paper is to address this knowledge gap by examining the lessons learned from health system reform and improvement efforts in 60 countries.
Design/methodology/approach
In total, 60 low-, middle- and high-income countries provided a case study of successful health reform, which was gathered into a compendium as a recently published book. Here, the extensive source material was re-examined through inductive content analysis to derive broad themes of systems change internationally.
Findings
Nine themes were identified: improving policy, coverage and governance; enhancing the quality of care; keeping patients safe; regulating standards and accreditation; organizing care at the macro-level; organizing care at the meso- and micro-level; developing workforces and resources; harnessing technology and IT; and making collaboratives and partnerships work.
Practical implications
These themes provide a model of what constitutes successful systems change across a wide sample of health systems, offering a store of knowledge about how reformers and improvement initiators achieve their goals.
Originality/value
Few comparative international studies of health systems include a sufficiently wide selection of low-, middle- and high-income countries in their analysis. This paper provides a more balanced approach to consider where achievements are being made across healthcare, and what we can do to replicate and spread successful examples of systems change internationally.