Divided Parties, Strong Leaders

Your Medical Director Can Lead the QI Team

ObjectivesThis article aims to answer the question of who favors strong political leadership, with a few checks on its power.MethodsFirst, we specify a formal model to generate testable hypotheses on the relationship between income and attitudes toward strong political leadership support. Then, we test these claims using a rich survey of individual attitudes across countries from 1999 to 2004.ResultsWe present evidence indicating that the support for such strong leadership is inversely related to individual income, even after controlling for additional characteristics, such as education. Individual attitudes toward strong leadership are also inversely related to country‐level indicators such as income inequality, level of GDP per capita, and institutional characteristics.ConclusionWe rationalize these findings by suggesting that a strong leader, sometimes with little legislative oversight, nevertheless benefits from public support in expectation that his policies would provide protection from the expropriation by powerful elites.

I argue that the respective understanding of value discriminates between two forms of ‘strong university leadership’: one that is incompatible with academic freedom, one that is compatible with, if not necessary for it. The structural evolution of modern science implies that present-day sciences understand their path of knowledge creation in terms of the enhancement of measurable functional control over effects with regard to problems of life. Consequently, measures, parameters, quanta – in short: values – are a condition of ‘scientific progress’. If we understand academic freedom as the openness to a fundamental transformation of knowledge, in the domain of value-driven science, the scope of freedom is therefore structurally narrow. However, a particularly pernicious threat to academic freedom arises when scientific practice is controlled by a-scientific values. Once a-scientific metrics gain the upper hand over scientific values, academic freedom is out of play. University leaders who cannot discriminate between scientific ‘thinking in values’ and a-scientific ‘evaluating’, will likely adhere to the latter. ‘Strong university leadership’ will then merely consist of the authority to exercise an indiscriminate, arbitrary prerogative in deciding the ‘what’ and ‘who’ of scientific research and education. The effects on academic freedom of such ‘strong leadership’ can only be detrimental.

We examined whether perceived national status threat—i.e., perceiving that one’s country’s status on the international scene is in decline—predicts increased desire for a strong conservative or progressive leader through greater national nostalgia and collective angst. A pilot study on strong leaders’ speeches from the 2017 French presidential election campaign first revealed that both conservative and progressive strong leaders use the status threat narrative, albeit in another form. In four quantitative surveys conducted across France, Malaysia and Chile, we then found that national status threat predicted increased desire for both conservative and progressive strong leaders. In France and Chile, but not Malaysia, the underlying path was contingent on the type of leader, such that nostalgia predicted increased desire for a conservative but not a progressive strong leader. Although correlational, our data suggest that decline narratives might provide a fertile ground for the desire for diverse forms of strong leadership.

Implementing the Illness Management and Recovery Program in Community Mental Health Settings: Facilitators and Barriers

In the modern world, educational transformation is crucial because it can have a significant impact on the success of students, instructors, and institutions. A successful society is built on a strong foundation, therefore improving education is crucial for a more promising and just future. This change calls for leaders who are effective in their positions and have the ability to unite a broad range of stakeholders around a shared objective-improving education. Any successful firm needs strong leadership. It serves as the catalyst for decision-making, bringing people together, and motivating them. Strong and unifying leadership is necessary to reach the maximum level of success. Any educational revolution must have strong leadership to succeed. Leaders must be able to develop a vision and plan that takes into account the particular requirements of each stakeholder group while simultaneously establishing a common course for the group's efforts. Leaders must also have the required abilities to convey and carry out the vision. To effect the necessary changes, leaders must be willing to take chances and make tough choices. In order to ensure that all stakeholders' demands are met and their voices are heard, this process requires strong and uniting leadership. Furthermore, it is crucial for stakeholders to work together in multi-level mentorship collaborations since this can help to guarantee that the transformation process is successful and that everyone is on the same page. Finally, additional actions can assist to guarantee that the transformation process is successful and that everyone is on the same page. These actions include making sure the process is transparent and including all stakeholders in the decision-making process.

Pesantren modern Shabilla Batam, Indonesia combines two different models of educational institutions, Pesantren combines Junior High School under the Ministry of Education with pesantren which is under the Ministry of Religious Affairs. This approach is supported by strong pesantren leadership. This study aims to examine the impact of personal conception in the formation of strong leadership to lead modern pesantren. The research method used is qualitative with a case study model. The research was conducted at Pesantren Modern Shabilla Batam with the subjects of the study being foundation leaders, pesantren caregivers, junior high school principals and teacher councils with a total number of participants of ten. The selection of participants was carried out by purposive method with the help of a key person. The data collection techniques used are interviews, observations and studies. The data obtained were analyzed using the Creswell (2015) approach model. The results showed a relationship between personal concepts and strong leadership. For this reason, it is recommended that research be carried out on many similar subjects to get a more complete picture.

To better understand facilitators and barriers to implementation of quality improvement (QI) efforts, this study examined 2 evidence-based interventions, video laryngoscopy (VL)-assisted coaching, and apneic oxygenation (AO). One focus group with frontline clinicians was held at each of the 10 participating pediatric intensive care units. Qualitative analysis identified common and unique themes. Intervention fidelity was monitored with a priori defined success as >50% VL-assisted coaching or >80% AO use for 3 consecutive months. Eighty percent of intensive care units with VL-assisted coaching and 20% with AO met this criteria during the study period. Common facilitator themes were adequate device accessibility, having a QI culture, and strong leadership. Common barrier themes included poor device accessibility and perception of delay in care. A consistently identified theme in the successful sites was strong QI leadership, while unsuccessful sites consistently identified insufficient education. These facilitators and barriers should be proactively addressed during dissemination of these interventions.

IntroductionAfghanistan has faced health consequences of war including those due to displacement of populations, breakdown of health and social services, and increased risks of disease transmission for over three decades. Yet it was able to restructure its National Tuberculosis Control Programme (NTP), integrate tuberculosis treatment into primary health care and achieve most of its targets by the year 2011. What were the processes that enabled the programme to achieve its targets? More importantly, what were the underpinning factors that made this success possible? We addressed these important questions through a case study.Case descriptionWe adopted a processes and outcomes framework for this study, which began with examining the change in key programme indicators, followed by backwards tracing of the processes and underlying factors, responsible for this change. Methods included review of the published and grey literature along with in-depth interviews of 15 key informants involved with the care of tuberculosis patients in Afghanistan.Discussion and evaluationTB incidence and mortality per 100,000 decreased from 325 and 92 to 189 and 39 respectively, while case notification and treatment success improved during the decade under study. Efficient programme structures were enabled through high political commitment from the Government, strong leadership from the programme, effective partnership and coordination among stakeholders, and adequate technical and financial support from the development partners.ConclusionsThe NTP Afghanistan is an example that public health programmes can be effectively implemented in fragile states. High political commitment and strong local leadership are essential factors for such programmes. To ensure long-term effectiveness of the NTP, the international support should be withdrawn in a phased manner, coupled with a sequential increase in resources allocated to the NTP by the Government of Afghanistan.

Strong leadership in public sector innovation can empower governments to address community challenges in new ways in light of the challenges posed by the global coronavirus pandemic. Coronavirus management policy, pandemic responses, needs, and options are reflected in various Asian countries in respective published literature, but a summarized synthesis is not available. Using a systematic review approach (PRISMA), this study has analyzed the role of leadership in public sector innovation in COVID-19 management and synthesized 23 articles from 23 different Asian countries. In the light of available data, public sector innovation (PSI) and the role played by the leadership of each country' have been found to be largely inter-dependent. The current review provides a cross-section of the ongoing nature of the pandemic, as management responses and trend data in the countries are still emerging or evolving. Additionally, our study contributes a current state report regarding the barriers facing the leadership of Asian countries in mitigating the global pandemic through PSI. Our study found that a strong political leadership presence combined with a technocratic approach and a highly-skilled public sector workforce, could lead to more tremendous success in managing the outbreak. Furthermore, religious leadership was also found to have a potentially significant role in COVID-19 management strategies.

In many parts of the world, education change might have the right goals--better outcomes for students, including students from groups that had previously lagged behind average achievement levels. But many of these efforts have used wrongheaded approaches or failed to pay enough attention to what we are learning about effective large-scale change. In particular, many strategies place too much emphasis on test results as the main way to drive improvement. In contrast, Ontario's education change strategy embodies vital principles, grounded in research, that are associated with meaningful and sustainable change. Changes are respectful of professional knowledge and practice, and their main elements are coherent and aligned at the provincial, district, and school levels. Key partners--the provincial Ministry of Education, school boards, schools, and provincial and local organizations of teachers, principals, and others--work together. Change strategies are comprehensive and emphasize building capacity for improvement through professional learning, strong leadership, necessary resources, and effective engagement of parents and the broader community. Great emphasis is placed on public communication so that people know what is happening and support the schools. Most of all, there has been a relentless focus over several years on the same basic strategy. We believe this is an example of large-scale change that is effective and sustainable. Ontario has about 2 million children in its public education system. The provincial government provides essentially 100% of the funds for all four sets of locally elected school boards, reflecting Canada's constitutional requirement for public support of minority-language and Catholic schools. School boards (the equivalent of a school district in the U.S.) range in size from a few hundred students to about 250,000 in the Toronto District School Board. The province has nearly 5,000 schools extending across 400,000 square miles--the size of the eight southeastern states put together. The average elementary school has about 350 students; the average secondary school, fewer than 1,000. Ontario also has a very diverse enrollment, with 27% of the population born outside of Canada and 20% visible minorities. Ontario's 120,000 or so teachers and most of its support staff are unionized. There is a mandatory provincial curriculum. Thus, education in Ontario has all the challenges one might anticipate--large urban areas and very remote rural areas, significant urban and rural poverty levels, high levels of population diversity, areas with sharply dropping enrollment and others with rapid growth. During the 1990s, Ontario education was troubled. The province had significant labor disruption, lots of public dissatisfaction, increasing private school enrollment, and poor morale leading to high teacher turnover. However, in 2003, a new government was elected with the renewal of public education as one of its highest priorities. A premier with a deep commitment to education and talented ministers brought strong political leadership to bear. The Ontario education strategy that began in 2003 has two main components: * A commitment to improve elementary school literacy and numeracy outcomes, and * A commitment to increase high school graduation rates. These priorities were chosen because public confidence in and support for education depend on demonstrated achievement of good outcomes for students. These core goals are supported by a large-scale strategy based substantially on Michael Fullan's work. (1) The core strategies are also complemented by a range of other initiatives. Some of these initiatives, such as strengthening school leadership or renewing curricula, are necessary to support the key goals. Of particular importance was a commitment to reduce class sizes in the primary grades. Other initiatives, including provincial support for negotiating four-year collective agreements with all Ontario teachers in 2005, were necessary so that all parties could focus on improving student outcomes instead of being distracted by labor issues. …

Improving health outcomes for Indigenous people by strengthening the cultural safety of care is a vital challenge for the health sector, both in Australia and internationally. Although Indigenous people have long requested to have Indigenous practitioners involved in their health care, many health services report difficulties with recruiting and retaining Indigenous staff. This article describes Indigenous workforce policies and strategies from two Australian health services, as well as cancer-service specific strategies. Services were identified as part of a national study designed to identify and assess innovative services for Indigenous cancer patients and their families. In-depth interviews were conducted in a small number of identified services. The interviews from two services, which stood out as particularly high performing, were analysed through the lens of Indigenous health workforce. Twenty-four hospital staff (Indigenous and non-Indigenous), five Indigenous people with cancer and three family members shared their views and experiences. Eight themes were identified from the way that the two services supported their Indigenous workforce: strong executive leadership, a proactive employment strategy, the Indigenous Health Unit, the Indigenous Liaison Officer, multidisciplinary team inclusion, professional development, work environment and a culture of respect. Participants reported two positive outcomes resulting from the active implementation of the eight workforce themes: 'Improved Indigenous patient outcomes' and 'Improved staff outcomes'. These two cancer services and their affiliated hospitals show how positive patient outcomes and a strong Indigenous health workforce can be achieved when a health service has strong leadership, commits to an inclusive and enabling culture, facilitates two-way learning and develops specific support structures appropriate for Indigenous staff. It is hoped that the strategies captured in this study will be used by health services and cancer services to inform their own policies and programs to support building their Indigenous workforce.

The worldwide burden of mental illness is increasing. Strong leadership is increasingly emerging as a core component of good mental health nursing. The aim of this article is to demonstrate the ways in which nurses can provide strong and consistent leadership in a values-based practice environment that embodies respect for individuals' dignity and self-determination within a community residential mental health service, which provides a structural foundation for effective action. This is accomplished through the presentation of two vignettes, which highlight how the seemingly impossible becomes possible when an economic paradigm such as agency theory is exchanged for a sociological and psychological paradigm found in leadership as stewardship at the point of service. It is through stronger nursing leadership in mental health that stigma and discrimination can be reduced and better access to treatments and services can be gained by those with mental illness. Nurse leadership in mental health services is not new, but it is still relatively uncommon to see residential services for "high needs" individuals being led by nurses. How nurses meet the challenges faced by mental health services are often at the heart of effective leadership skills and strategies.

Objective. In recent years, New Mexico has prioritized integrated treatment for cooccurring mental health and substance use disorders within its public behavioral health system. This report describes factors likely to be important when implementing evidence-based practices (EBPs) in community agencies. Methods. Our mixed-method research design consisted of observations, semistructured interviews, and surveys undertaken with employees at 14 agencies at baseline and after 18 months. We developed four-agency typologies based on iterative coding and analysis of observations and interviews. We then examined survey data from employees at the four exemplar agencies to validate qualitative findings. Results. Financial resources and strong leadership impacted agency capacity to train providers and implement EBPs. Quantitative analysis of service provider survey responses from these agencies (N = 38) supported qualitative findings and demonstrated significant mean score differences in leadership, organizational climate, and attitudes toward EBPs in anticipated directions. Conclusion. The availability of strong leadership and financial resources were key components to initial implementation success in this study of community agencies in New Mexico. Reliance only on external funding poses risks for sustainment when demoralizing work climates precipitate employee turnover. Strong agency leadership does not always compensate for deficient financial resources in vulnerable communities.

The era of globalization signifies an increase in competition in the global market, with large organizations facing pressure to continuously adapt to rapid and complex changes in the global business environment. Information technology plays a pivotal role in business transformation in the digital era. The development of new technologies and changes in IT infrastructure affect how organizations operate and compete in the global market. The aim of this research is to investigate the influence of change management strategies on the readiness of large organizations in the globalization era. The primary focus of this research is to understand the roles played by four key factors: leadership, communication, information technology, and employee participation in addressing business dynamics in the globalization era. This research method involves a literature review with a qualitative approach and descriptive analysis. The literature review was conducted by gathering, reviewing, and synthesizing relevant scholarly articles found through searches on Google Scholar within the timeframe of 2001-2024. The study results indicate that in the ever-changing and evolving era of globalization, large organizations must be prepared to adapt quickly to remain relevant and competitive. The implementation of change management strategies is crucial in ensuring organizational readiness to face modern business dynamics. The influence of these strategies is highly significant and involves various factors such as leadership, communication, information technology, and employee participation. Strong leadership, effective communication, leveraging advanced information technology, and high employee participation are essential elements of these strategies. Therefore, one of the recommendations that can be drawn from this research is that organizations should focus on developing strong and visionary leadership to inspire and guide the organization through the change process.