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This paper aims to evaluate the longer-term impact of the 12-month Welsh clinical leadership fellowship.

Semi-structured interviews with 10 out of 14 trainee doctors who were fellows between 2013-2016, exploring how leadership knowledge and skills were used in clinical practice, impact on patient care and influence on careers. Data, gathered in 2017 when participants had completed the fellowship between 1-3 years, were analysed thematically.

All found the fellowship rewarding. The experience was felt to advantage them in consultant interviews. They gained insight into the wider influence on organisations and the complexity of issues facing senior clinicians. Although subtle, the impact was significant, equipping fellows with negotiation skills, enabling them to better influence change. Indirect impact on clinical practice was evidenced by enhanced confidence, teamworking skills and progression of improvement projects. However, the use of skills was limited by lack of seniority within teams, demands of medical training and examinations. The negativity of others towards management and leadership was also noted by some.

Small participant numbers limit generalisability.

The fellowship is designed to equip participants with skills to lead improvements in healthcare delivery. Those more advanced in their medical training had greater opportunity and seniority to lead change and were better placed to apply the learning. This has implications for whom the training should be targeted.

A rare study exploring the longer-term impact of a leadership programme on later clinical practice, which adds to the body of knowledge of impact and efficacy of leadership training programmes in healthcare environments.

UK fellowship schemes have been set up to address low-level engagement of doctors with leadership roles. Established in 2013, the Welsh Clinical Leadership Fellowship (WCLF) programme aims to recruit aspiring future clinical leaders and equip them with knowledge and skills to lead improvements in healthcare delivery. This paper aims to evaluate the 12-month WCLF programme in its first two years of operation.

Focused on the participants (n = 8), the authors explored expectations of the programme, reactions to academic components (provided by Academi Wales) and learning from workplace projects and other opportunities. The authors adopted a qualitative approach, collecting data from four focus groups, 20 individual face-to-face or telephone interviews with fellows and project supervisors and observation of Academi Wales training days.

Although from diverse specialties and stages in training, all participants reported that the Fellowship met expectations. Fellows learned leadership theory, developing understanding of leadership and teamwork in complex organisations. Through workplace projects, they applied their knowledge, learning from both success and failure. The quality of communication with fellows distinguished the better supervisors and impacted on project success.

Small participant numbers limit generalisability. The authors did not evaluate longer-term impact.

Doctors are required to be both clinically proficient and influence service delivery and improve patient care. The WCLF programme addresses both the need for leadership theory (through the Academi Wales training) and the application of learning through the performance of leadership roles in the projects.

This work represents an evaluation of the only leadership programme in Wales, and outcomes have led to improvements.

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 describe two social simulations created to assess leadership potential and train leaders to make effective decisions in turbulent environments. One is set in the novel environment of a lunar moon colony and the other is a military combat command. The research generated from these simulations for assessing the decision effectiveness of potential leaders with different personality traits and decision styles under varying degrees of information quantity, uncertainty and complexity is summarized. Opportunities and limitations of applying current computer assisted technology to social simulations for assessing and developing leaders' decision effectiveness in turbulent environments is discussed.

College undergraduates and officer candidates in university ROTC programs made a series of decisions while being subjected to varying degrees of environmental turbulence in social simulations. The decision effectiveness of subjects with different personality characteristics under varying degrees of environmental turbulence was assessed through researcher observations, self‐reports, and peer ratings.

Social simulations are a cost effective way to assess and train leaders to make effective decisions in turbulent environments. The results of controlled experiments in social simulations have suggested that leaders with high levels of cognitive complexity and incongruity adaptation are more likely to be successful in highly turbulent environments than leaders with lower levels of incongruity adaptation ability and cognitive complexity who are more effective in more stable and structured situations.

The ease of modifying computer games renders them effective as low‐cost virtual worlds that have relevance in military leadership experimentation. However, the use of computer simulations alone fails to capture the impact that relationships and emotions have on leader decision making, highlighting the continuing need for social simulations that include these interpersonal aspects of decision making.

By participating in realistic social simulations, leaders can experiment with new decision styles without the risk of making real world mistakes that could jeopardize their own and their organization's future. The leaders who are most successful in adapting their decision style to the more complex requirements can be identified for promotion or assignment to appropriate settings.

Both military and civilian organizations are in need of cost effective way to assess and train leaders to make effective decisions in turbulent environments. Social simulations provide a unique approach to meeting these needs and can simultaneously provide a venue for research in associated areas.

This is a narrative describing events that led to four women finding their courage to save a nonprofit. Theirs was not the kind of courage that you see in movies where a hero saves the planet. Their courage was subtle, faint, and quiet. Their courage was driven by conviction and belief that someone must always do the right thing, despite the circumstance. The situation and circumstance were a local nonprofit organization being put at risk. That risk would have expanded into the community and impacted the human service work of the organization. The courage in this narrative includes whistleblowing. Whistleblowing is action that is generally considered to be most difficult, due to the potential impact on personal income and reputation. It took courage for three women, who remain anonymous to this day, to become whistleblowers. These women took a risk; they became vulnerable to fear of exposure, as they put their family incomes and personal reputations on the line. This is also the story of a novice chairwoman of a passive board of directors. She was forced to step outside her comfort zone to find and claim her courage. She was tasked with protecting the whistleblowers, addressing the issues, and resolving the problem. Yes, courage is just a seven-letter word, but when you are involved in a situation or circumstance, the weight of courage can feel monumental. The courage of four women and the seven-letter word courage saved the reputation, the service to the community, and the nonprofit organization.

The purpose of this paper is to explore perceptions of quality of life (QoL) of people with a dual diagnosis of learning disability and autism to facilitate a better understanding for clinical practice and service provision.

Mixed methods were used to gain perceptions of QoL from 20 individuals referred to their local diagnostic service. Individuals completed questionnaires and participated in in-depth interviews which were thematically analysed.

Subjective wellbeing scores were lower than those found in previous research. Social interaction was raised extensively with participants describing both positive and negative perceptions. The need for tailored social support and the value of individual control over environment were raised.

The study was small in scale and limited to subjects who had been referred for a diagnostic service. The study identified the need for further investigation, particularly in relation to the social relationships domain of QoL, and the impact of stress and anxiety.

This study demonstrated that it is possible to access views from this group and that these views are nuanced. It suggests differences between reported QoL in people with learning disabilities who are and who are not autistic. Service design and individual approaches could be improved by a better understanding of these differences.

The aim of this case study is to present one library's experiences consulting with a usability expert during the design and implementation phases of a new academic library website and the lessons learned during the process.

The library staff worked with the consultant so that he understood the work of the librarians and goals for the website. Together the consultant and library staff developed a series of tests to measure the usability of the site. The librarians implemented the tests, gradually taking the leadership role in the process.

The study confirms the value of usability testing as a tool to bring to light some of the ambiguities and complexities of a library website for users. The study demonstrates that librarians have developed an expertise and knowledge base that transfers well to the evaluation of websites and online resources. The experience of the University of Michigan AAE Library reveals that usability testing should be an ongoing exercise so that the website remains relevant to the users.

This study advises librarians of the value of testing and that, on the one hand, test results confirm what one imagines about the users' experiences, but on the other hand they reveal the unexpected strategies and understandings of the users.

This case study provides a useful example of the value of working with a usability expert, a discussion of what to expect during the process, and advice about the role of the librarian in such an endeavor.

THE CRY TODAY is for flexibility in two different senses. The readiness to acquire new skills is one. The other the resolution to accept work no matter what it is or how far away from home it happens to be.