Care Leaders Research Articles

Pedagogical Leadership in Finnish Early Childhood Education and Care through the Lens of Practice Architectures

This research examines how practice architectures, i.e., cultural-discursive, material-economic, and social-political arrangements both enable and constrain the pedagogical leadership practice of early child-hood education (ECE) center directors (N = 3). The data were collected by a qualitative shadowing method and analyzed deductively using the theory of practice architectures. The findings revealed that social- political arrangements were fundamental for directing pedagogical leadership practice, affecting both material- economic and cultural-discursive arrangements. The social- political arrangements of pedagog-ical leadership were grounded in the municipality’s organizational structure; in turn, this structure organ-ized daily pedagogical leadership practices. Social-political arrangements were narrated as the directors emphasized the importance of national guidelines, legislation, and implementation of the national and local curricula. These were related to the material-economic arrangements because they required organizing time for discussion and further training of personnel. The national guidelines combined material-economic and social-political aspects as well as cultural-discursive arrangements in leadership practice, as pedagog-ical development aligned with legislation and national curriculum demands in a wide range of leadership functions in ECE centers. The essence of pedagogical leadership practice was the focal point of joint dis-cussions regarding pedagogy and the implementation of curriculum in the ECE centers. Most significantly, the quality of these discussions could enable or constrain pedagogical leadership and were influenced by cultural-discursive arrangements and leadership philosophy of the center directors alike.

Physician Specialty Differences in Unprofessional Behaviors Observed and Reported by Coworkers

Because unprofessional behaviors are associated with patient complications, malpractice claims, and well-being concerns, monitoring concerns requiring investigation and individuals identified in multiple reports may provide important opportunities for health care leaders to support all team members. To examine the distribution of physicians by specialty who demonstrate unprofessional behaviors measured through safety reports submitted by coworkers. This retrospective cohort study was conducted among physicians who practiced at the 193 hospitals in the Coworker Concern Observation Reporting System (CORS), administered by the Vanderbilt Center for Patient and Professional Advocacy. Data were collected from January 2018 to December 2022. Submitted reports concerning communication, professional responsibility, medical care, and professional integrity. Physicians' total number and categories of CORS reports. The proportion of physicians in each specialty (nonsurgeon nonproceduralists, emergency medicine physicians, nonsurgeon proceduralists, and surgeons) who received at least 1 report and who qualified for intervention were calculated; logistic regression was used to calculate the odds of any CORS report. The cohort included 35 120 physicians: 18 288 (52.1%) nonsurgeon nonproceduralists, 1876 (5.3%) emergency medicine physicians, 6743 (19.2%) nonsurgeon proceduralists, and 8213 (23.4%) surgeons. There were 3179 physicians (9.1%) with at least 1 CORS report. Nonsurgeon nonproceduralists had the lowest percentage of physicians with at least 1 report (1032 [5.6%]), followed by emergency medicine (204 [10.9%]), nonsurgeon proceduralists (809 [12.0%]), and surgeons (1134 [13.8%]). Nonsurgeon nonproceduralists were less likely to be named in a CORS report than other specialties (5.6% vs 12.8% for other specialties combined; difference in percentages, -7.1 percentage points; 95% CI, -7.7 to -6.5 percentage points; P < .001). Pediatric-focused nonsurgeon nonproceduralists (2897 physicians) were significantly less likely to be associated with a CORS report than nonpediatric nonsurgeon nonproceduralists (15 391 physicians) (105 [3.6%] vs 927 [6.0%]; difference in percentages, -2.4 percentage points, 95% CI, -3.2 to -1.6 percentage points; P < .001). Pediatric-focused emergency medicine physicians, nonsurgeon proceduralists, and surgeons had no significant differences in reporting compared with nonpediatric-focused physicians. In this cohort study, less than 10% of physicians ever received a coworker report with a concern about unprofessional behavior. Monitoring reports of unprofessional behaviors provides important opportunities for health care organizations to identify and intervene as needed to support team members.

Series on the Lancet Oncology Commission on Global Cancer Surgery: Introduction-Intent and Content.

Surgery plays a key role in the multi-disciplinary cancer care pathway. Nearly 80% of patients with solid tumors will require surgical intervention during the course of their disease. Unfortunately, the vast majority of these patients do not have access to safe, timely, high-quality, and affordable cancer surgical care. The first Lancet Oncology Commission on Global Cancer Surgery shone a light on this grave situation and outlined some strategies to address them. The second Lancet Oncology Commission on Global Cancer Surgery (TLO- II) was conceived to continue the work of its predecessor by developing a roadmap of practical solutions to propel improvements in cancer surgical care globally. The Commission was developed by involving approximately 50 cancer care leaders and experts from different parts of the world to ensure diversity of input and global applicability. The Commission identified nine solutional domains that are considered essential to deliver safe, timely, high-quality, and affordable cancer surgical care. These nine domains were further refined to develop solutions specific to each of the six World Health Organization regions. Based on the above solutions, we developed eight action items that are intended to propel improvements in cancer surgical care on the global stage. The second Lancet Oncology Commission on Global Cancer Surgery builds on the first Commission by developing a pragmatic roadmap of practical solutions that we hope will ensure access to safe, timely, high-quality, and affordable cancer surgical care for everyone regardless of their socioeconomic status or geographic location.

Engendering the Positive Image of the China Government through Flood Framing

The study investigated how the flood news in China is framed by the People’s Daily, an official newspaper of the Communist Party of China. The objectives of the study were to: (1) identify the frequency of thematic and episodic framing of flood events; (2) examine the frame dimensions used for framing flood events; and (3) determine the dominant valence of news articles on flood events. Altogether 180 articles on flood in the online People’s Daily (English edition) published from 1 January to 31 December 2023 were analysed. The results showed a dominance of the episodic frame (94.4%) compared to the thematic frame (5.6%). The main frame dimension is the attribution of responsibility but it is to highlight the capability of the government to take care of the people rather than to attribute blame for poor management. There was a dominance of positive valence (70.6%) compared to negative valence (26.1%) and neutral valence (3.3%). President Xi Jinping was portrayed as a “caring leader” and a “compassionate and hands-on leader” in dealing with the flood woes of the people.

Quality of telehealth-provided cancer care in VA.

1633 Background: As the largest integrated health care system in the United States, the Veterans Health Administration (VA) has extensive experience in utilizing telehealth-(TH) to deliver care to the 10 million enrolled Veterans, including the~50,000 patients newly diagnosed with cancer annually and ~500,000 cancer survivors. The VA National TeleOncology (NTO) service was established in 2020 to provide specialized treatment regardless of geographical location. We sought to compare quality in TH-delivered care compared to traditional (TR) in-person VA care. Methods: Using the VA EHR, we identified patients who had an ICD-10 diagnostic code for an incident malignancy from Dec 2016 to March 2021 at three medical centers providing both TR and TH care. We used EHR review to classify patients as TH users, if they received TH services at least once for their cancer care, or TR care if no telehealth was used. Using both structured EHR data and manual review by two trained abstractors, we gathered demographic, clinical, and treatment characteristics to calculate 25 Quality Oncology Practice Initiative (QOPI) measures in the domains of symptoms and toxicity management (2), end of life and palliative care (10), and core measures (13). We report QOPI measures descriptively; and used chi-squared tests with alpha = 0.05 to compare TH and TR. Results: We identified 972 patients with lymphoma, prostate, lung or colorectal cancer. 427 (44%) were TH users and 545 (56%) were TR, and they were predominately white (n=819, 84.3%) men (n=930, 95.7%). TH users had better (n=13), worse (n=9), same (n=2) and unevaluable (n=1) descriptive performance on measures. For example, TH and TR were similar in administration of appropriate antiemetic therapy for high and moderate-risk antineoplastic agents (44.8% vs 42.4%). TH performed better than TR for chemotherapy summary being completed within three months of chemotherapy ending (83.4% vs 75.6%) and for emotional well-being being assessed by the second office visit (92.3% vs 89.9%). Appropriate tobacco use cessation administration within the previous year was statistically higher in TH (85.3% vs 76.2% p=0.0021). No differences were statistically significant for any other QOPI measures. Conclusions: VA is a leader in TH cancer care because of both its volume and quality. VA-provided TH cancer care quality is similar to or better than that of TR in-person care. NTO specifically, and VA teleoncology broadly, provides another option to Veterans for cancer care.

Evaluation of a summer program for minority high school students in the clinical cancer center: The Future Gen Cancer Scholars program.

e13703 Background: Individuals from minoritized communities receive less cancer screening, have higher stage at cancer diagnosis, and experience higher death rates. Helping minority high school students find a pathway to enter college and continue with advanced education and training and become leaders in cancer treatment, research and prevention may help reduce these inequities. Many public high schools in urban centers struggle in STEM education. The Rhode Island Hospital / Legorreta Cancer Center at Brown University partnered with the Papitto Opportunity Connection in Rhode Island to create the Future Gen Cancer Scholars program. Methods: High school students were invited to apply from Providence and surrounding communities. Accepted applicants became paid hospital employees and received training in professional conduct, protected health information and other skills necessary to shadow physicians in inpatient and outpatient settings. The summer curriculum included physician shadowing, radiology, pathology, student run tumor boards, seminars and community outreach. Pre/post-surveys were collected where students rated their experiences and beliefs regarding cancer careers on a 5-point Likert scale. Open-ended questions were added to evaluate interest in pursuing a career in oncology. Results: 20 high school students participated in the program’s first cohort. 70% self-identified as Hispanic/Latinx and 30% as African American, 85% were female, 90% attended a public school. Pre- and post-surveys were completed by 17 students. The 5-point Likert scale showed improvement in an understanding of oncology careers (pre, 3.9; post, 4.5), interest in pursuing a related career (pre, 3.1; post, 3.8), and recognition of available educational resources within their communities (pre, 3.9; post 4.3). Confidence in overcoming educational access barriers slightly decreased (pre-4.1; post-3.8) due to the increased awareness of the length, cost and process of medical training. Most students described the Future Gen Program as helping them identify career goals and a path forward. Conclusions: The Future Gen program helped solidify minority high school students’ desire to become leaders in cancer care and may provide a path forward to achieve this goal. We will track students’ educational and research achievements over time to measure the program’s impact. The establishment of a successful local model can provide a framework for a nationwide program.

The role of critical care nurses in organ and tissue donation: A position statement of the Australian College of Critical Care Nurses

IntroductionAustralian organ and tissue donation rates are low compared to other countries. Acknowledging that donation practices vary across Australia, the Australian College of Critical Care Nurses supported the development of a position statement to explicate critical care nurses’ role in supporting organ and tissue donation. Several Australian peak professional organisations provide guidance to inform and support organ and tissue donation. AimThe aim of this study was to develop a position statement using contemporary Australian research evidence to build upon and complement existing guidance, focussing on the role of critical care nurses in organ and tissue donation in Australian critical care. MethodAn approach similar to a rapid review was used, providing a streamlined approach to synthesising evidence. A comprehensive search using Medical Subject Headings, keywords, and synonyms was undertaken using Medline and CINAHL Complete via EBSCOhost to identify peer-reviewed Australian research evidence about critical care nurses’ role, obligations, expectations, and scope of practice during organ and tissue donation. Narrative synthesis was used to synthesise the research evidence. FindingsThe importance of separating death from organ donation in discussions with family, the timing and the approach to organ donation conversations, and working in collaboration with the DonateLife Donation Specialist Nurses were identified. The importance of understanding family perspectives, caring for families, and collegial support for critical care clinicians were also identified. With the guidance of peak professional organisations, the research evidence was then used to develop practice recommendations for critical care units, leaders, and critical care nurses. Discussion and conclusionThe recommendations explicate the important contribution critical care nurses can make to ensuring timely, sensitive communication, providing high-quality end-of-life care, supporting families irrespective of the donation decision and supporting colleagues from the wider critical care team, thereby optimising the processes related to organ and tissue donation in Australian critical care settings.

Nursing Students' Perception of Caring for Culturally Diverse Patients: A Hermeneutic Phenomenological Study.

This study examined the phenomenon of prelicensure nursing students caring for culturally diverse patients. Individual interviews were conducted with undergraduate nursing students using a hermeneutic phenomenological approach. Qualitative research experts conducted the interviews, transcribed the data, and followed van Manen's methodology for analysis. Eleven nursing students participated in the study. Data were collected from April to August 2022. The average length of the student interviews was 32 minutes. Four themes were identified: (1) communication issues; (2) access to care; (3) nurse background; and (4) trust and respect. This study highlights the importance of caring for culturally diverse patients. Policymakers and health care leaders can use the findings to support legislative proposals for enhancing culturally diverse patient safety and health equity. Based on these findings, nurse educators and preceptors can adapt their clinical teaching approaches accordingly, and nurse managers can benefit from the results when hiring new graduate nurses. [J Nurs Educ. 2024;63(6):373-379.].

The Community as Provider: Collaboration and Community Ownership in Northern Maternity Care

Across Canada, researchers and maternity care leaders have identified a crisis in maternity care due to a shortage of skilled providers (obstetricians, family physicians, midwives). For the remote Inuit communities of Nunavut this crisis is about a lack of local maternity care and childbirth brought about by the erosion of local capacity and participation in planning and provision. These communities face difficulties recruiting, training and retaining skilled providers. They also experience a lack of consistency in providers and services within and across Aboriginal communities in Canada, and system dependence on the evacuation of women in remote communities for childbirth. System dependence on evacuation for childbirth has effectively removed childbirth from Nunavut families and communities. Across Nunavut, efforts to return childbirth to communities have been challenged by a lack of mobilization of providers and communities, concerns about safety, and relationships between communities, providers, decision-makers, and various levels of government. From November 2002 to December 2004, through a qualitative consultative methodology we examined current maternity care across ten Nunavut communities and their visions for change. We found that a return of childbirth to communities is thus, not simply about hiring more providers and developing local training. This return will require a rethinking of relationships between and collaboration among communities, providers, and levels of government to determine, plan and implement sustainable maternity care for remote, Inuit communities. While collaboration is crucial to providing sustainable maternity care in remote, Inuit settings, we argue that multidisciplinary collaboration needs to be reframed to include the community. Moreover, we find that collaboration becomes all the more complex in the context of community ownership and historical relationships between traditional and non-traditional providers.

Education and diversity in cytopathology: Past, present, and future.

Diversity, equity, and inclusion is a powerful goal which many of us strive toward in medicine, both in patient care and administrative leadership. As the world evolves, the practice of medicine must evolve with it. We are cognizant of the importance of the history of our medical specialties. If we do not acknowledge all parts of our history, we are doomed to repeat it. This special issue is unique and unlike anything that has previously been published in Diagnostic Cytopathology. This issue looks at some of the history of cytopathology. This historical review is followed by some of the present state of cytopathology. There are insights into global cytopathology. The final portion of this issue examines the critical need for cytotechnology schools in the United States. All of these areas are critical to the past, present, and future of cytopathology.

The Role of Organizational Support and Teachers' Workload to the School Head's Caring Leadership and Teachers' Well-Being

The Role of Organizational Support and Teachers' Workload to the School Head's Caring Leadership and Teachers' Well-Being

How Health Care Leaders View Disparities in Care

Interviews from NEJM Catalyst Insights Council members on how their organizations are addressing the drivers of health care disparities.

Disparities in telemedicine use among Native Hawaiian and Pacific Islander individuals insured through Medicaid.

States have implemented policy changes to increase access to telemedicine services for individuals receiving Medicaid benefits. Native Hawaiian and Pacific Islander (NHPI) individuals experienced disproportionate harms from COVID-19 and have long experienced disparities in health care access compared with other racial and ethnic groups, making the issue of telemedicine access particularly salient for NHPI individuals on Medicaid. Utilizing 100% 2020-2021 Medicaid claims, we compared trends in telemedicine use between NHPI and non-Hispanic White individuals on Medicaid in Washington State and conducted a decomposition analysis to identify drivers of underlying disparities. In both years, NHPI individuals were 38%-39% less likely to use any telemedicine than White individuals after adjusting for patient- and area-level characteristics. Decomposition analysis revealed that most of this difference was due to differential effects of characteristics, rather than group differences in characteristics. Namely, several characteristics that were associated with increased telemedicine use had more muted associations for NHPI vs White individuals, such as English as the primary spoken language and female sex. These findings suggest the presence of limited acceptability of or group-specific barriers to telemedicine for NHPI individuals, including potential discrimination in being offered telemedicine visits. These issues should be understood and mitigated through close collaboration between health care leaders and NHPI communities.

Leadership in health care: What are some novel insights?

Leadership in health care: What are some novel insights?

Barriers Facing Primary Care Leaders in Implementing Goals of Care Conversations with Seriously Ill Veterans

Barriers Facing Primary Care Leaders in Implementing Goals of Care Conversations with Seriously Ill Veterans

BOOK REVIEW: SOCIAL LEADERSHIP IN EARLY CHILDHOOD EDUCATION AND CARE: AN INTRODUCTION

Social leadership in early childhood education and care refers to the ability of educators to guide and promote positive social behaviors in young children, as well as create a supportive learning environment that fosters cooperation and empathy. It involves using a range of strategies and techniques to help children develop social skills, self-regulation, and emotional intelligence. Social leadership in early childhood education and care is an essential factor in supporting positive social and emotional development in young children in the UK. According to a study by Breslin and colleagues (2019), effective social leadership involves creating a supportive and inclusive learning environment, promoting positive social behaviors, and using evidence-based strategies to help children develop social skills and emotional intelligence. The study emphasizes the importance of social leadership in improving children’s academic and social outcomes, as well as their long-term well-being. Moreover, the research suggests that social leadership can be especially beneficial in supporting the development of children from disadvantaged backgrounds.

How registrar palliative care training affected palliative care integration in South African oncology

Background: The current state of cancer care in Africa necessitates intervention to enhance accessible cancer prevention, treatment, rehabilitation, and integrated palliative care services. Achieving integration of palliative care within oncology requires both functional and normative integration. Decisive strategies are required to address misconceptions, lack of awareness, and comprehension regarding integrated palliative care (PC) services.Aim: This research aims to describe how intermediate-level palliative training affected PC integration in Oncology at Groote Schuur Hospital in South Africa.Setting: Groote Schuur Hospital is a tertiary, quaternary academic hospital with 975 beds. The oncology unit sees approximately 2800 new patients per year and qualifies 3–4 registrars annually.Methods: This is a small qualitative study combining secondary thematic analyses of qualitative data from focus group discussions (n = 2) from a previous study, and new interviews (n = 3) and purposively sampled documents analysed through thematic analysis using NVIVO.Results: Including PC education seems to enhance patient and family-centred care, contributing to improvements in the normative aspects of integration. Nevertheless, focussing solely on training registrars has proven insufficient in achieving crucial functional aspects of integration. The misalignment between policies, guidelines, and registrar education constrains effective integration of a PC approach. Consultants’ lack of training in palliative care poses difficulties in implementing comprehensive patient care. Clinical leadership in palliative care is provided from outside the oncology department which inhibits ‘functional integration’. Addressing these shortcomings is vital to successfully integrating palliative care within cancer care settings.Conclusion: Training registrars in PC is undoubtedly necessary but insufficient. Clinical PC leadership within oncology in Africa is essential for integration.Contribution: This article highlights the importance of PC in oncology and how training contributes to its integration. Furthermore, the role of clinical PC leadership within oncology in Africa is essential to this integration and will play a vital role in improving cancer care in Africa.

Competency Based Medical Education (CBME) in India: Clinicians' Multifaceted Challenges.

In the recent past, in order to achieve our national goal of 'health for all', National Medical Commission and Government of India made competency based medical education (CBME) mandatory in all Indian medical colleges. By undergoing CBME, the Indian Medical Graduate is expected to achieve the five roles of Clinician, Communicator, Leader and Member of the health care, Professional and Lifelong learner. This article is an overview of CBME, its relevant terminologies and knowledge-gaps. The purpose is to share these changes in medical education with practicing Otolaryngologists of India. It also discusses the various challenges regarding this already- suggested implementation process for clinical academicians, which could be counterproductive to the expected national aim and goal.

Survivorship Care for People Affected by Advanced or Metastatic Cancer: MASCC-ASCO Standards and Practice Recommendations.

People with advanced or metastatic cancer and their caregivers may have different care goals and face unique challenges compared with those with early-stage disease or those nearing the end of life. These Multinational Association for Supportive Care in Cancer (MASCC)-ASCO standards and practice recommendations seek to establish consistent provision of quality survivorship care for people affected by advanced or metastatic cancer. A MASCC-ASCO expert panel was formed. Standards and recommendations relevant to the provision of quality survivorship care for people affected by advanced or metastatic cancer were developed through conducting (1) a systematic review of unmet supportive care needs; (2) a scoping review of cancer survivorship, supportive care, and palliative care frameworks and guidelines; and (3) an international modified Delphi consensus process. A systematic review involving 81 studies and a scoping review of 17 guidelines and frameworks informed the initial standards and recommendations. Subsequently, 77 experts (including eight people with lived experience) across 33 countries (33% were low- to middle-resource countries) participated in the Delphi study and achieved ≥94.8% agreement for seven standards, (1) Person-Centered Care; (2) Coordinated and Integrated Care; (3) Evidence-Based and Comprehensive Care; (4) Evaluated and Communicated Care; (5) Accessible and Equitable Care; (6) Sustainable and Resourced Care; and (7) Research and Data-Driven Care, and ≥84.2% agreement across 45 practice recommendations. Standards of survivorship care for people affected by advanced or metastatic cancer are provided. These MASCC-ASCO standards support optimization of health outcomes and care experiences by providing guidance to stakeholders (health care professionals, leaders, and administrators; governments and health ministries; policymakers; advocacy agencies; cancer survivors and caregivers). Practice recommendations may be used to facilitate future research, practice, policy, and advocacy efforts.Additional information is available at www.mascc.org, www.asco.org/standards and www.asco.org/survivorship-guidelines.

Improving healthcare delivery at a district hospital through teaching interns - A short report.

Every district in Malawi has at least two doctors managing the social and healthcare needs of the local population. The medical doctors at the district are involved in administrative work and have minimal time for clinical practice. As such in most district hospitals, clinical officers (COs) form the backbone of patient care provision. These are cadres that have a 3-year training in clinical medicine; they work side by side with medical assistants (MAs) and nurses. Apart from the Ministry of Health (MoH) workforce, the Department of Family Medicine (FM) of Kamuzu University of Health Sciences (KUHeS) has its main district site at Mangochi. Family physicians and residents from FM department assist in provision of mentorship and teaching to other cadres. Work-based learning requires various strategies and approaches. The experience reported here involves deliberate mentorship and support to enhance the learning of other cadres. Family medicine residents learn through the active participation in these sessions to become future consultants and leaders in primary health care.