The sociology of healthcare professions: the case of the professionalization of psychology in Spain

The Impact of Patient Suicide on the Professional Reactions and Practices of Mental Health Caregivers and Social Workers

Review question/objective This systematic review seeks to identify and explore the experiences of health and aged care professionals including health managers in the utilization of distributed leadership modelling. It also seeks to identify and explore their experiences in creating the conditions that enable or impede distributed leadership. Background Distributed leadership is a broad concept in which the role of formal leaders is less about "leading from the front", but rather more focused on enabling others to lead. A general principle outlined by key theorists is that distributed leadership empowers individuals to contribute ideas and expand on knowledge within groups and throughout an organization.1,2,3,4 Research into leadership in health and aged care is particularly relevant as there is an urgent need for change and reform which is being driven by pressures related to an aging population, changing care/service modelling, and increased funding requirements.5,6 Dickson and Tholl succinctly describe the leadership challenge for health care as a need "to convert a fragmented set of activities into a well-functioning whole".5(p7) As an example of the implications of fragmentation, the examination of healthcare organizations has underlined system failures which are attributed to poor responses to early cues of potential or actual client harm. One solution is for healthcare professionals to build competence in quality and safety research for the provision of evidence-based early detection systems.8 Leadership is recognized as a crucial element in uniting divergences towards a common goal.8 The lessons learned and principles arising from Greenfield and colleagues' experiences in providing distributed leadership to mobilize capacity for quality and safety research have been positive.8 However, what is required for the wider international healthcare community is a collation of how these researchers reached this positive outcome and enabled the process of distributed leadership. It is not completely understood as to how this success compares to that of other healthcare researchers or where similarities or differences exist within the application of distributed leadership modelling.8 The theory underpinning distributed leadership has been growing since it was first discussed in leadership literature in the late 1990s.1 Distributed leadership is distinctly different from other more traditional types of leadership theory as it is concerned with actions of a group rather than individual traits of leaders.1,2,4,5,10 There has been some research into the application of distributed leadership in practice in the education sector, a sector that is also recognized as being largely fragmented.4 This research has shown the effects of a more holistic approach on engaging members of a school or university, creating a positive impact on the quality of teaching and learning.2,4,9 There are still calls for further research into the application of distributed leadership practice in education.2,4,9,10 The research literature on distributed leadership in health and aged care indicates that distributed leadership could have positive impacts on the quality and safety in healthcare.3,5,8 However there are very limited empirical research studies to inform understanding in how to utilize the distributed leadership theory in practice in health and aged care.9,10 This limited research in the application of distributed leadership theory in health and aged care means there is uncertainty around the processes through which health and aged care organizations can promote, apply and embrace distributed leadership.3,9,11 Considerable time, effort and resources are required to build relationships between stakeholders in order to promote understanding of different needs and interests. A clear cost effective evidence-based approach is yet to be realized. Distributed leadership appears as a key determinant in achieving positive healthcare outcomes, particularly when engaging with complex adaptive systems.10,11 The majority of the literature on distributed leadership has focused on why it is required in healthcare and the definitions and history behind its evolution. The need for distributed leadership is therefore well documented. A significant gap does exist, however, in the collated evidence of approaches which are transferrable to other collaborative healthcare contexts.12 Searching for evidence has identified some qualitative studies on distributed leadership in health and aged care; no systematic reviews investigating the experiences of health and aged care providers utilization of distributed leadership have been identified nor those on the conditions that enable or impede distributed leadership. Initial searching in the JBI Database of Systematic Reviews and Implementation Reports, the York University Database and the Cochrane Library revealed that while there is growing literature on distributed leadership in healthcare, but relatively few of this literature focus on the specific issue of utilization of distributed leadership. There are however published qualitative studies which describe outcomes of distributed leadership.12,13,14 An example found was a qualitative longitudinal case study undertaken by Chreim et al.13 which aimed to fill a gap in the research evidence by exploring and understanding the process through which distributed leadership develops. Through extensive interviews and observations, the researchers documented changes in leadership and the roles of different agents. In their findings, the researchers recommended that further exploration is needed for outlining the processes that can facilitate effective distributed leadership modelling. This systematic review therefore aims to uncover and collate similar qualitative findings from other research that outline perceptions pertaining to distributed leadership utilization. It is in this context that the proposed review would provide value in bringing together meaningful perceptions of health and aged care professionals in guiding future utilization of distributed leadership in health and aged care. This will provide insights into and directions for others considering utilization of distributed leadership leading to the creation of conditions to enact distributed leadership within the context of health and aged care. Inclusion criteria Types of participants This review will consider any healthcare professionals, health service planners and or managers who have experienced utilization of distributed leadership. To be included, participants must have been actively engaged in distributed leadership. The review will include healthcare professionals including health managers who have been working in the acute, aged care and/or community sectors. Exclusion criteria will include participants who have not actively engaged in distributed leadership and hence have not provided insight into the utilization of distributed leadership. Phenomena of interest This review will consider studies that investigate the experiences of health and aged care professionals, including health managers, who have utilized distributed leadership modelling in the health and aged care sector. The review will also consider the barriers and facilitators to utilization of distributed leadership. Research studies that have investigated leadership broadly and not distributed leadership specifically will also be excluded. Context An international perspective will be considered regardless of relationship, age, sex, ethnic origin and socioeconomic status. A comprehensive coverage of all representations in health and aged care is required to distinguish between differences in experience and support systems as per the varied contexts of health and aged care professionals, i.e. relationships, age, ethnic origin/language, sex and socio-economic status, and workplace. There will be no limitations to country of residence. Types of studies This review will consider for inclusion all qualitative studies published in English that have examined the phenomena of interest including, but not limited to, research designs such as phenomenology, grounded theory, ethnography, action research and feminist research. Search strategy The search strategy aims to find both published and unpublished studies. A three-step search strategy will be utilized in this review. An initial limited search of the CINAHL will be undertaken. Subsequent searches of E-Journals, Health Source Academic Edition and the Psychology and Behavioral Science Collection will then be undertaken, followed by an analysis of the text words contained in the title and abstract and of the index terms used to describe the article. A second search using all identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference lists of all identified reports and articles will be searched for additional studies. Studies published in English will be considered for inclusion in this review. International studies published between 2000 and 2015 will be considered for inclusion in this review. These years were chosen because publications related to distributed leadership in healthcare began to appear in the literature during this time period. The databases to be searched include: CINAHL E-Journals Health Source Nurse Academic Edition Pubmed PsychInfo Psychology and Behavioural Science Collection. Hand searching will not be conducted. Initial keywords to be used will be: distributed leadership, aged care, health, shared leadership, collaborative leadership, strategies, designing, planning, building, utilization. Assessment of methodological quality Papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer. Data extraction Data will be extracted from papers included in the review using the standardized data extraction tool from JBI-QARI (Appendix II). The data extracted will include specific details about the phenomena of interest, populations, study methods and outcomes of significance to the review question and specific objectives. Data synthesis Qualitative research findings will, where possible, be pooled using JBI-QARI. This will involve the aggregation or synthesis of findings to generate a set of statements that represent that aggregation, through assembling the findings rated according to their quality, and categorizing these findings on the basis of similarity in meaning. These categories are then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesized findings that can be used as a basis for evidence-based practice. Where textual pooling is not possible the findings will be presented in narrative form. Conflicts of interest The authors have no conflicts of interest to declare. Acknowledgments The authors would like to thank the support provided by the Department of Health and Ageing as part of ACH Group and University of Southern Queensland Teaching, Research Aged Care (TRACS) projects.

In times of converging and diversifying audiovisual (AV) industries, digitising health sector and the increasing phenomenon of cross-sectoral innovation, the question arises about the state of affairs between the health and AV sectors. The chapter aims to explore what the main modes of cross-sectoral cooperation between the health and AV sectors are and what supports and hinders the emergence of a related cross-innovation system. The chapter introduces two case studies carried out in Estonia and the wider Aarhus region (Midtjylland) in Denmark. At each site representatives of the main stakeholders of both sectors were interviewed – policy makers, entrepreneurs, educators and professionals. The results demonstrate the crucial role of path-dependencies – in terms of both hindering and enabling cross-sectoral dialogues – and also the importance of effective coordination in supporting cross-innovation. Keywords Cross-sectoral dialogues Path-dependence Health sector Audiovisual media industries Cross-innovation Innovation systems Citation Tafel-Viia, K. (2019), "Health and Audiovisual Sector: A Meso-analysis of How Systemic Coordination of Sectoral Cooperation Leads to Convergence", Ibrus, I. (Ed.) Emergence of Cross-innovation Systems, Emerald Publishing Limited, Bingley, pp. 121-144. https://doi.org/10.1108/978-1-78769-977-920191015 Publisher: Emerald Publishing Limited Copyright © 2019, Külliki Tafel-Viia. Published by Emerald Publishing Limited License This chapter is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this chapter (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode Introduction In this chapter, we introduce developments in the field of cross-sectoral dialogues between the health and audiovisual (AV) media sectors. We use Estonia and the Aarhus region in Denmark (Midtjylland) as case studies. We chose these cases as our observations identified that amongst the six countries we studied at the initial phase of the study, the manifestations of these sectors’ convergence in these two countries was most visible and/or offered the most interesting initiatives to explore. In Aarhus, we observed the emergence of new convergent enterprises, and in Estonia, the overall systemic development of information and communication technology (ICT) infrastructures and e-governance systems offered a promising starting-point for cross-innovations. The empirical study consisted of 36 interviews with sectoral entrepreneurs, professionals and policy makers of both countries. We start the chapter with an overview of the sectors’ development stage where we outline the main changes that influence the sectors’ current and future development and their overall readiness to adapt to these changes. Thereafter, we describe the current institutional landscape that supports the sectors’ cooperation. In the second part, we continue with the sectors’ general openness to cooperation and describe the common modes and peculiarities of cross-sectoral dialogues. The chapter ends with challenges for policy makers by outlining the main shortcomings that policy could address to better support cross-boundary innovation between the health and AV media sectors. The Changing Face of the AV Media and Health Sectors AV Media Sector The interviews revealed the changing nature of the AV sector – this applies to both Estonia and the Aarhus region. In Aarhus, the AV content and services sector has a rather strong position (2nd place in Denmark after Copenhagen) with a large-scale concentration of AV industries, which are divided into four main categories: films and animation, video games, television production and production of commercials. In Estonia, the main hub of the AV sector is the capital Tallinn. Estonian interviewees were troubled in defining the scope and borders of the AV sector, which demonstrates that sectoral identities remain an important issue. Different opinions existed in terms of what to consider as part of the AV sector and what not, including whether video games are part of the larger AV sector and what fractions of the IT sector should be included. These discussions reflect well both the overall mediatisation trend and convergent processes (discussed in Chapter 1) which have given to the increase in the AV modes used in different sectors and to the borders between different media and creative sectors becoming blurred. Estonian and Danish interviewees acknowledged that the AV sector is growing and expanding. Growth is particularly noticeable in certain subfields of the AV sector, for example, animation, games, etc., which have gone through a tremendous change from a marginalised sector to a globally ascendant industry. However, micro and small-sized companies (one man to 20–25 employees) still dominate in this sector. The growth of this sector is also reflected in its internationalisation. In particular, the Danish interviewees stated that the sector has heavily internationalised during the last decade. On the one hand, there are increasing numbers of expatriates working in AV companies and, on the other hand, the majority of local companies have ties with big international corporations. The growth of the sector also means that the amount of AV content is increasing. The interviewees (in particular, the representatives of the AV sector) highlighted the belief that the importance of AV content and tools will continue to grow – thus, the interviewees pointed to the mediatisation trend. The other important key characteristic of the AV sector is, paradoxically, its both converging and diversifying nature – the multi-directionality of convergence, that Ibrus discusses in Chapter 1; the borders between different sub-sectors are blurring and the intra-sectoral convergence of the AV sector can be observed; the amount of different kinds of cross-, trans- etc. type of content is increasing, the channels and formats have changed, the business models have altered (e.g. emergence of VOD providers as crucial players in the industry), technologies are used more mixedly, the audiences are changing and attracting their attention is becoming more challenging. In addition, the AV sector is also converging with other fields. The importance of augmented reality (AR) and virtual reality (VR) is expected to increase. The interviewees emphasised that the technology is still rather immature; there are plenty of unused opportunities and less successful solutions. However, quite unanimously, the interviewees argued that the technology will become cheaper and more user-friendly. VR and AR were also seen as engaging technologies that will blur the borders between different AV subfields. As the head of a Danish AV incubator described: VR and AR call for people from both worlds […] we work with these new technologies in an engaging way. That’s why we work with the term ‘digital experiences’ instead of ‘films’ or ‘games’ or ‘audio’. As flexibility and fast learning ability were seen as main keywords to adapt to the changes in the future, we may argue that social capacities were considered important in coping with (technological) changes. In the light of those changes, the orientation towards constant product and service innovation was also rather obvious. The interviewees highlighted the fact that innovation process is a daily practice. One Estonian AV company CEO discussed that almost everything they do is experimental. He considered this a challenge, because trying out new things is always money- and time-consuming. Although the interviews pointed to innovation examples across the sector (across companies of different development stages), still, in case of Estonia, we can see that innovativeness, especially innovating in new convergent areas, is more common among younger companies. More traditional and long-term AV companies, including production companies, are somewhat more reserved when it comes to innovation in terms of entering new fields. The matured content production companies also did not consider themselves to be innovative. An owner of a company producing films and commercials explained: ‘the answer to that, how we feel, we do not feel that we are innovative […] the [audio-visual] sector is not innovative’. Several Estonian AV sector interviewees argued that innovativeness (in Estonia) is first and foremost associated with the ICT sector and with the start-up world. Quoting the owner of an Estonian AV company: At the moment in Estonia, there is a hype that all IT and start-ups are innovative and awesome […] How are feature films related to innovation? If you don’t come up with a new ID card or Skype, then you are just doing your movies […] despite the fact that, in my opinion, it is innovative to create a world-class film and bring out a new story and thought. These attitudes reflect that AV media companies, especially those working on film production, often find it difficult to think beyond their traditional practices. The novelty they work towards is usually their next film, but not a new type of cooperation or cross-innovation initiative outside the AV sector. Awareness of development opportunities that cooperation with other sectors would offer is low. Estonian public sector and sectoral umbrella organisations’ representatives also stated that the older companies are in something of a comfort zone and do not see the ultimate need for innovation. As the representative from the Estonian Ministry of Culture remarked: ‘the situation [is] not bad enough that something new should be developed’. The situation is somewhat different with broadcasting companies. The focus on cross-media output was obvious in the case of large Danish broadcasters. To quote the programme manager of a Danish TV production company: They’re also looking for unique formats, unique content, produced straight for the big internationals – Facebook, YouTube, stuff like that, but also for their own digital platforms. Two of the major broadcasters in Denmark have their own digital platforms, where they put all the flow TV, but they want unique content there as well. They want new ideas and the stuff that’s produced directly for their own platforms as well. The public media and broadcasting sector has also become more interactive in Estonia; producing content for different platforms has become an everyday practice. The Health Sector The health sector in Estonia and the Aarhus/Midtjylland region is predominantly public. The share of private sector involvement in the health sector is growing, particularly in Denmark. Differently from the AV sector, which was seen as rather progressive, the health sector was often described as old-fashioned and slow to respond to changes. However, the interviewees stressed that a certain shift has already occurred and the health sector is becoming more open, including in terms of its readiness to cooperate with other sectors. The topic that the interviewees very often addressed was the need to change current medicine education. The interviewees emphasised the need to make it more interdisciplinary and facilitate the connections between students of different fields already during the studies that would facilitate their cooperation in the future. As to the trends, both Danish and Estonian interviewees highlighted several changes that significantly influence the sector’s future development, including those that may also facilitate the emergence of cross-innovations between the health and AV sectors. One of them is the overall change towards a user-centred approach in health care: to put the patient at the centre of the health care system and increase the responsibility of the user for his/her health. Several interviewees also talked about the need to refocus the patient–doctor relationship. The doctor needs to ask the patient what she/he needs (not to define patient’s needs by him-/herself). This in turn presumes that the patient should be ready to take active position about her/his health behavior, including to answer about his/her needs, goals in life, etc. Related to that, the interviewees referred to the necessity for new types of personal assistants and new types of ‘help-desks’ that will change the communication between the patient and the doctor. The CEO and founder of Danish AV + health company remarked: the trend is maybe that […] actually resonates with people. So building feelings into the product, building personality, building character into the product […]. We don’t have an avatar that speaks to you, but we do have character. The trend that is already happening in the health sector is the strategic refocusing towards rehabilitation and prevention. As most of the cooperation with the AV sector predominantly happens in this field of the health sector then this can be seen as a good precondition for cross-innovations to emerge. Another trend that is expected to positively influence cooperation between the AV media and health sectors lies in the generational shift. Future patients are also expected to be more prone for gamified solutions. The changing technology was also seen as the main trend influencing the sector’s development. The driver is the sensed feeling that as technologies evolve one needs to keep up to stay relevant in the marketplace. But the new technologies were also seen as offering opportunities for solutions that were not possible before. Especially, health sector representatives emphasised that the sector’s innovativeness lies primarily in the usage of new cutting-edge technology and related infrastructure. Technology-centeredness in innovation (or technological innovation) was explicitly brought out by Estonian interviewees, but it was highlighted also in Aarhus. As part of technological change, the interviewees also discussed more personalised patient information systems and software developments. Cooperation with the technology-intense AV sector would amplify the technological shaping of the health sector. Health sector representatives also expressed the expectation that the world would become more diverse when the sectors’ borders become more blurred and the mixture of different competences, including social and technological competences, are highly valued. Institutional Landscape for Cross-sectoral Dialogues The current supportive institutional attitudes towards cooperation between the health and AV sectors in Aarhus and Estonia reflect several understandings in contemporary innovation theories. On the one hand, we can notice developments expressed in contemporary cluster-development theories that focus on cross-sectoral cooperation and social and interaction processes that support it (Granovetter, 1985; Harrison, 1992). On the other hand, for policy developers also, the stream of innovation studies that focus on space and proximity issues has been relevant as they attempt to understand how innovations emerge and develop in particular places (e.g. Asheim, 2012; Florida, 1995; Hassink & Klaerding, 2012; Healy & Morgan, 2012). As demonstrated below, the institutional landscape supporting the sectors’ cross-innovation in both studied cases is not limited to the narrow models of ‘innovation system’ (Edquist, 1997; Nelson, 1993), but also encompasses actors other than research institutions and firms. However, it is interesting to point out that research institutions may not be part of the landscape when it comes to the Estonian case. We shall now describe the institutional landscape of cooperation in more detail, starting with Aarhus. As to Aarhus, the key players of the supportive institutional landscape are: (a) higher education institutions (HEIs) as regional sectoral hubs, (b) private sector organisations and community-based initiatives specially targeted to foster intersectoral cooperation and (c) public sector measures that facilitate cooperation and partnerships. HEIs have had a special role to play in supporting the clustering of the AV sector and being the central hub that attracts different actors into the region. Quoting the interviewee from one Danish production company: Because we have the school in Viborg, the animation school, and they have this environment around school with the companies […]. People graduating from schools, […] some people coming back to Viborg starting [their own business]. Because it’s very convenient to be very close to truly educated animators and have access to them. The main ways that private sector organisations and community-based initiatives support the sectors’ cooperation are via creation of physical environments that include (a) labs, incubators, etc., and (b) the organisation of events that aim to bring actors physically close and support face-to-face meetings of different actors. One example here is Interactive Denmark, which is a non-profit organisation. Its mission is to accelerate, coordinate and support the development of the Danish game and interactive cluster by focusing (among others) on the interaction between what they call Digital Visual Industry (DVI) and health. 1 The other example relevant to highlight is the Filmby Aarhus Incubator located in Aarhus, which is a new incubator for start-up companies working within DVI and is aimed at matching them with companies from other sectors and public organisations that have specific challenges for which they need digital visual solutions. The importance of these kinds of initiatives and physical environments, in particular, were highly emphasised both by companies and policy and sector representatives. Quoting the CEO and founder of the Danish AV + health company: We are there [in IdeaLab] because we want to be a part of something bigger. There’s several considerations in it. One is like it’s awesome to go to work and there’s more people than us. So it is nice to have a lot of people to talk to, but it’s also a part of our identity that we are at a place with people who build digital experiences. So that works really well, just the story about it. […] And then we use people sometimes – […] [when] we are testing the product. We have a few conversations with some of the game developers about technical stuff or sometimes they look at it and comment on what we’re doing. So, basically, it’s really, really good to have this option of talking to other people about what we do. In Aarhus, the AV sector is the active player in pursuing cross-sectoral cooperation; AV sector organisations build the partnerships and find ways to facilitate cooperation with other sectors, including the health sector. One of the latest examples is the creation of the Vision Denmark alliance, 2 which has been established by seven AV sector organisations and actors, and is to support the growth of digital visual Quoting the representative of a Danish AV sector umbrella Vision Denmark […] the aim of this is to focus on how we can develop the between the sectors. We call them the Digital Visual […] both […] their but also with other industries – for […] software for or VR for in other sectors. Danish interviews highlighted several relevant innovation support but also targeted sectoral including AV from which the companies can for One of the central health sector initiatives is the Innovation which was in in to from and companies in the Denmark region as part of the business development private sector for example, the and the have had a special role to play in supporting cooperation between the health and AV sectors, as they support different cooperation it comes to support for the health and AV sectors’ the general is that, to Aarhus, the support is more and the main is the public sector. of Estonia is the policy focus on support measures and of private sector The main actors in the cooperation are: public sector) sectoral cluster organisations and public sector measures that facilitate cooperation and partnerships. As to the clustering the is put on the AV sector. Estonia supports creative industries development the development of different and in the AV sector that to the sector in include an incubator for AV sector start-ups in and an often highlighted as a good example that cooperation between the AV and technology fields. As to the health sector, a new has been – an innovation – to better and support innovative solutions in the health sector. In to Denmark, in Estonia the active who cooperation with other sectors are health sector the Health by public Estonia has also a support for creative industries cooperation which aims at supporting the growth of to other sectors through the development of business and by building on the specific and from the creative that this has not on there has not been enough initiatives to make use of the The fact that institutions do not play an important role in the cooperation landscape to argue that this could be one of the why cooperation between the health and AV sectors has rather in to and and as discussed in Chapter systems play a crucial role in the of innovation systems and are among the first of intersectoral to that, to to the in the institutional landscape is important from the point of we may that the of actors in the institutional landscape has been the hindering of sectors’ cooperation in Estonia and will also slow changes in the future. In addition, when about public sector we may argue that, despite the creative policy in Estonia for more than the of its policy has including to to other industries and and growth in them. We may argue that the development of cross-sectoral that are associated with creative industries policy by & have not become common practice. and of Cross-sectoral Dialogues This the different modes of dialogues and cooperation between the health and AV media sectors. We start with the sectors’ general openness towards cooperation and describe the main challenges that cross-sectoral which also the peculiarities of sectoral innovation practices. for and Sectoral In contemporary innovation innovation is as an interactive process and interactive learning (Edquist, 1997; is considered an important for innovation. study, highlighted certain of sectors’ capacities and readiness to At first the results of the study that, in both sectors are to cooperation with other sectors. The of cooperation both In particular, Danish AV and health sector companies that, as a are to them to cooperation. One Danish production company representative remarked: actually like of the it’s the people come to However, in the case of Estonia, the question about cooperation with other sectors to AV companies or related sector organisations and public sector representatives usually to an answer about cooperation with other creative industries sectors. The answer was for that films and games need and actors. after did a about cooperation with other sectors creative is, to consider these kinds of cooperation was somewhat with The for cooperation are very both in Estonia and in the Aarhus it is a of certain type of some cross-sectoral for with technology is term the work on innovative out new from other sectors. The study also demonstrated that the of cooperation is by the stage of development of the companies. are more active in looking for cooperation and trying it out in convergent and than more matured companies. As described by an interviewee a start-up working on a VR in we have to make some on the just the to see they have some in This especially applies to companies that are active in convergent fields and that still have to their and find their place in the The in convergent health gamified also create the need for new type of interdisciplinary and new type of cooperation Quoting the CEO of a Danish VR company that for the health care don’t really have a in related But in each that we there’s a very big on a […] it was an in the case of a it was a […] and in the case of these it was some people that care of the at the […] As to the health sector, the interviewees about its – the of very strong of the sector as described in Chapter The results of the interviews that the health sector to have its own & that do not sectoral and that be by from other sectors. The interviewees expressed rather explicitly that it is to to do you do not have connections within the health sector. The is by the fact that different do not understand each other As described by a Danish health sector organisation have to be very in how you to close to especially the Because you don’t their you don’t what understand what you Estonian interviewees that – those who do not have or in the health sector – have to the health sector to new solutions. The crucial that the sectors’ cooperation is a with a health sector in the development Quoting an Estonian health sector umbrella organisation innovation a technology an then and in the of sector. But an is in cooperation with health sector, then you don’t need the works […] it is that one of the for health sector start-ups is whether a health sector is or not in your have to be a they may also be a or in field […] as it is […] a not from we may that the health and AV sectors have to become important to each they still have to as the two sectors have not The study results also demonstrate that dialogues across sectoral are as the sectors are still learning to each their needs and practices. that, we may the for cross-innovations is This from by Ibrus in Chapter that the more the – as the health sector and AV are – the the innovation may be when these up in a of Cross-sectoral Dialogues The study results demonstrate that between the AV and health sectors do not the of

In this paper, an overview of the evolution and current situation of professional psychology in Spain is offered. From a historical viewpoint, since the seventies, the profession of psychologist in Spain has advanced significantly in both quality and quantity. There are many different reasons for this development, although in this paper, we highlight two: the introduction of the Psychology Degree and the development of a professional identity due to the influence of an organization such as the "Colegio Oficial de Psicólogos" [COP--Official College of Psychologists, also denominated The Spanish Psychological Association]. Our description of the current situation is based on the analysis of the results of 6,765 surveys out of the approximately 28,000 that were sent to members of the professional College. In general, these results reveal a profession predominantly practiced by young women (mean age 36 years), working preferably in the clinical area, whose theoretical orientation is mainly behavioral, located for the most part in urban areas, and chiefly working in private practice. The main current professional psychology fields in our country will be analyzed in detail, according to the following criteria: type of center where the professional works, intervention areas, and training required for professional practice. Some final reflections about the defense of our profession are commented upon, proposing training and accreditation strategies as the best way to face increasing problems about the entry of unqualified people into the profession.

Cybersecurity vulnerabilities of cardiac implantable electronic devices: Communication strategies for clinicians—Proceedings of the Heart Rhythm Society's Leadership Summit

Information is a key issue for people who use health services and their families and friends. In the UK, this was raised consistently by those involved in a national ‘listening exercise’, in 2005.1 The resulting White Paper Our Health, Our Care Our Say2 reinforced much of the government information strategy published in the previous year.3 The Brain and Spine Foundation is a UK-based charity that aims to improve the quality of life for people with neurological conditions (http://www.brainandspine.org.uk). The organization was awarded a grant by the Department of Health to produce a toolkit to help health and social care professionals providing information to people affected by neurological conditions. The project forms part of the implementation of The National Service Framework (NSF) for Long-term Conditions, published last year.4 The toolkit is being developed in association with the Neurological Alliance (http://www.neural.org.uk) and the Long-term Medical Conditions Alliance (LMCA; http://www.LMCA.org.uk). A series of small discussion groups were held last year throughout England and Wales to explore: (i) current obstacles in the provision of and access to information, (ii) how a toolkit might be used and (iii) to refine the toolkit's content and shape. Discussions were held with groups of people affected by neurological conditions, with voluntary sector organizations concerned with neurological conditions and with mixed groups of health and social care professionals from a variety of settings. In addition, a questionnaire survey of health and social care professionals was conducted. Care for people with neurological conditions in the UK has been very patchy. While there are some world-class centres of expertise, there are also areas of the country where there is little specialist provision.5 Traditionally, for people with neurological conditions, the majority of input has been provided by specialists (e.g. neurologists and rehabilitation consultants). However, because of shortages in these workforces, and the long-term nature of many of the conditions, people have often been left without specialist support. Access to information has become a major issue for these people who may have little contact with health and social care professionals after initial diagnosis of their condition. This is consistently reported both by individuals affected by neurological conditions as well as organizations representing them.5 A key issue explored in developing the toolkit relates to why people do not get the information they want, despite much information apparently being available, and from a proliferation of sources. Two explanations were found. First, information provided by health professionals does not always match with the information sought after by people with neurological, and other long-term conditions. Secondly, people often want very local information, whereas what is generally available is not specific to their geographical location or situation. These issues are explored further below. Another issue that became evident was that health and social care professionals did not always recognize their role in relation to providing information to people with whom they came into contact. There is a need to encourage health-care professionals to view every consultation as an opportunity to assess information needs and ensure that these are met directly or by referral to a dependable alternative source. The toolkit will, therefore, aim to signpost to sources of information on the issues of concern to people with neurological conditions. It was found that there are four key areas consistently identified by people affected by neurological conditions where they want more information. Interestingly, the groups of health and social care professionals consulted also identified these issues as a problem area for information giving. The lack of information related to benefits, employment and finance was an issue raised repeatedly by people with neurological conditions when they discussed information. When asked what information requests they found difficult to address, health professionals also identified information about benefits. This is not a new issue and surveys from the neurological charities have been reporting this for years.6 It is possible that the reason this issue has not been addressed is that health professionals do not see such issues as within their remit. These ‘social care issues’ are often seen as being the province of those working outside health-care settings. There may be a tendency to see people with a diagnosis of a long-term condition as having a continuum of needs; starting with medical needs, and medical information needs, at the diagnostic phase and progressing to ‘social’ needs later on as someone adapts to their illness or disability, and particularly if it progresses/degenerates. However, when people with neurological conditions talk about their information needs, it is clear that some of their first concerns on diagnosis are their employment and financial status –Should I go back to work tomorrow? What should I tell my employer? If I leave work how will I support myself and my family? What support will my partner get if they need to look after me? Should I move house? The health professional is more likely at this time to be focused on providing information about possible treatment options or a drug regime. Concerns about sex and relationship issues were often raised (even in focus groups where people who did not know each other). People had found information on sources of support very hard to access. Health and social care professionals were similarly at a loss to know where to go for such information. There seemed to be a tendency to hope the questions were not asked and very few health-care professionals said that they would ever raise the issue as they would not know how to deal with this or whom to refer to. This is a significant quality of life issue for people affected by many neurological, and other long-term conditions, including cancer. There is a need to address it and ensure that health and social care professionals are signposted to sources of information and advice. Complementary therapies have played a large part in the management of neurological conditions, partly because of the fact that there are often very few surgical or drug treatments available. Many health professionals find it difficult to provide information about treatments that they feel do not have a robust evidence base and that have not been traditionally available in the National Health Service (NHS). While for some conditions this is changing, it is likely that people with a life-long illness for which there is no cure will continue to seek both ‘wonder cures’ and palliative treatments. Using the toolkit health professionals will be able to signpost people to information about various complementary therapies and information about which therapies people with a similar condition have found helpful. This kind of information is often available through local and national voluntary sector organizations. Providing a diagnosis and prognosis is clearly within the domain of health-care professionals, yet all agree it is a difficult area to address. People affected by neurological conditions often report that they do not get adequate information about what to expect. Again this possibly stems from the fact that there was, and still is for many, very little that can be offered in the way of treatment and cure. Neurological conditions can also be very unpredictable. If health-care professionals view their domain as providing information about treatment options and medicines there may well be limited information they can give. There are, however, as outlined above, a range of other information needs that people with neurological conditions have at diagnosis. If these needs are addressed it is likely both that people would feel more able to manage their condition and also report that their information needs had been met. The information people often valued the most, and which they found hard to access, was about local services and sources of support. For example, people talked about finding someone who could help them fill in their benefit form, the local rehabilitation service that accepted self-referrals, the MS support group that met two streets away, yet had taken 18 months to discover. Addressing local information presents a challenge for a toolkit that has been designed for health and social care professionals across England and which will necessarily be focused at a countrywide level. As noted above, however, this is a crucial finding of the work conducted with people affected by neurological conditions. Those working on the Better Information3 strategy also identified the need for local information and the Department of Health has recently announced their intention to pilot a local integrated approach to information in order that local health and social care organizations jointly maintain an accessible database of all services and support groups in their local area.2 The project will provide a template for local information in the toolkit outlining what information should be available, based on issues that people affected by neurological conditions have raised as information needs, and indicating possible local sources of information and support locally. The ground work will necessarily be conducted at a local level, but it is hoped by providing a template and sources list we will avert excessive duplication of effort, whilst ensuring that the content of local directories and databases are focused on the needs of people affected by neurological conditions. In addition, it will be very important to ensure local voluntary organizations supporting and representing people with neurological conditions are involved in commissioning local information databases. This will be essential; to ensure firstly that the resource is focused on local needs; secondly, that the very valuable services and support provided by voluntary sector groups are included and thirdly, because of the local knowledge they have about sources of health and social care support in its widest sense. Often, during the discussions with people affected by neurological conditions, they talked about eventually tracking down the information, or service or person, through contact with a local support group or voluntary organization. For example, if you wanted to know who could help you fill out a benefit form, how to get a wheelchair, where to get hydrotherapy, who to talk to about a relationship problem the local branch of the Parkinson's Disease Society or MS Society would be a very good starting point. At national level, voluntary sector organizations produce the information often reported to be the most useful by people affected by neurological conditions. Most include in their information portfolios fact sheets and booklets about the issues raised above (complementary therapies, sex and relationships, prognosis, benefits) and about many other aspects of living with a neurological condition. There is reluctance, however, amongst health and social care professionals to provide information about these organizations to people affected by neurological conditions. A survey by the Motor Neurone Disease Association7 in 2002 found that 44% of people diagnosed with motor neurone disease that year had not been told of the Association or given contact details. In the discussions to develop the toolkit people often reported stumbling on a local or national voluntary organization ‘by accident’. The toolkit will need to make it easier for health professionals to signpost to these sources of information and support. Health professionals may feel better assured about directing people to voluntary sector sources of information if they could guarantee the quality. The Department of Health have also recently announced the intention to develop an Information Accreditation Scheme (IAS).3 It will be very important that voluntary sector providers of information are enabled to participate in this scheme in order that they can continue to disseminate the information that people affected by neurological, and other long-term conditions find so useful. A pilot version of the toolkit is currently being produced. This will be a signposting tool with generic checklists and templates. It is anticipated there will be a launch towards the end of 2006. Nikki Joule is an independent health policy consultant and Project Officer at the Brain and Spine Foundation (http://www.brainandspine.org.uk). She is also on the Steering Group of the Patient Information Forum (http://www.pifonline.org.uk).

Standards for Child and Adolescent Immunization Practices

Dementia care: Research and clinical innovation.

Confidential health care for adolescents: position paper of the Society for Adolescent Medicine

Confidential health care for adolescents: position paper of the Society for Adolescent Medicine

Introduction: Preparing current and future health care providers to work in integrated care models requires interprofessional learning about working in teams across health sectors and integrated care concepts/principles. Evidence indicates that Interprofessional education (IPE) is essential for training health and social care providers and building workforce capacity for new models of integrated care. Yet how we are preparing current and future health care professionals (HCPs) to work in these models of care is unclear. Therefore, we sought to understand how IPE is implemented in existing hospital-to- home integrated care. We report key informants’ descriptions of IPE in training existing HCPs to work in hospital-to-home integrated care programs in Ontario Canada. Method: Utilizing a qualitative descriptive approach, interviews were conducted with 15 leaders of hospital-to-home integrated care programs across the province. Interviews were audio-recorded and transcribed verbatim. Data analysis employed a thematic analysis approach. Findings were interpreted through the lens of an interprofessional learning continuum model (Institute of Medicine, 2015) and competencies for integrated care (Langins and Borgermans, 2015). Findings: Formal and informal IPE through staff orientation and team processes within the integrated care programs can support competency development (e.g., role clarity, communication, and teamwork) for interprofessional practice within hospital-to-home integrated care programs. Key informants acknowledged the importance of cross sector IPE to understand patient care trajectories and provider roles more fully. Conclusions: The findings provide examples of the need for both formal and informal IPE in these hospital-to-home integrated care programs. Interprofessional teamwork, learning together, and having no room for silos reinforced the importance of continuing interprofessional learning for existing HCPs in the context of hospital-to-home integrated care programs. IPE in integrated care programs is required to meet the changing needs of patient populations, shifting roles of health care providers, and evolving health care systems. Implications for Education and Practice: This work has direct implications for preparing current and future health care professionals to work in new models of integrated care such as hospital-to-home programs where collaborative approaches are critical to support safe, quality patient care within and across health and social care sectors. Education content should include concepts and principles related to IPE, collaborative teamwork, and fundamentals of integrated care. Training should begin in formal academic programs and continue in practice settings. Student placements for health professionals should be considered as a mechanism to develop knowledge and competencies for integrated care. Cross-sector training can help health and social care providers understand the focus of the integrated care program (e.g., patient pathways, referrals) and the roles and responsibilities of various team members. Next steps: We are currently engaging academic and practice leaders to explore the feasibility of creating new nursing student placement opportunities within hospital to home integrated care programs with the aim of building knowledge and competencies for integrated care.

Advancing leadership in medical radiation sciences: Incorporating systematic leadership education in pre-registration curricula

Recent research suggests that the notion of boundary work can improve our understanding of interprofessional tension and collaboration in health care, yet hospital social workers (HSWs) have not received sufficient attention in this area. Using boundary work as a theoretical framework, this article investigates HSWs’ boundary work in interactions with other health care professionals in paediatric acute wards. The data were based on in-depth interviews with nineteen HSWs at hospitals in Norway about their experiences with interprofessional collaboration. Based on their situated narratives, abductive analysis was performed, using the conceptually distinct but inter-related forms of competitive and collaborative boundary work that are grounded in Abbott’s framework of jurisdiction. The findings demonstrate how HSWs construct, defend and extend boundaries to create distinctions between themselves and others, and how they sometimes adapt and downplay boundaries in order to achieve common goals and perform their work. As a facilitator of this process, the HSW might be viewed as a boundary subject. This, in turn, can result in optional and intentional ways for HSWs to carry out boundary work. There is reason to believe that, the less specific educational requirements and role guidelines, the more important these mechanisms become.

REVIEW QUESTION / OBJECTIVE This systematic review seeks to identify and explore the experiences of health and aged care professionals including health managers in the utilization of distributed leadership modelling. It also seeks to identify and explore their experiences in creating the conditions that enable or impede distributed leadership. INCLUSION CRITERIA Types of participants This review will consider any healthcare professionals, health service planners and or managers who have experienced utilization of distributed leadership. To be included, participants must have been actively engaged in distributed leadership. The review will include healthcare professionals including health managers who have been working in the acute, aged care and/or community sectors. Exclusion criteria will include participants who have not actively engaged in distributed leadership and hence have not provided insight into the utilization of distributed leadership. Phenomena of interest This review will consider studies that investigate the experiences of health and aged care professionals, including health managers, who have utilized distributed leadership modelling in the health and aged care sector. The review will also consider the barriers and facilitators to utilization of distributed leadership. Research studies that have investigated leadership broadly and not distributed leadership specifically will also be excluded. Context An international perspective will be considered regardless of relationship, age, sex, ethnic origin and socioeconomic status. A comprehensive coverage of all representations in health and aged care is required to distinguish between differences in experience and support systems as per the varied contexts of health and aged care professionals, i.e. TRUNCATED AT 250 WORDS

Harmonizing legal and ethical standards for interactions between health care providers and industry