Departmental Leadership Research Articles

"Showing up to the conversation": Qualitative reflections from a diversity, equity, and inclusion book club with emergency medicine leadership.

Diversity, equity, and inclusion (DEI) in health care fosters many positive outcomes including improved patient care. DEI initiatives are often created by or require buy-in from departmental leaders with low DEI literacy. Book clubs are one way to develop DEI literacy. The purpose of this paper is to describe how leaders in the department of emergency medicine (DEM) process the information gained from reading a DEI book through discussion in a book club setting and explore how participation enhances their DEI literacy and fosters self-reflection. This was a qualitative exploratory study based on a constructivist approach. Data were analyzed by four researchers using inductive thematic analysis techniques. Sixty-eight leaders within the DEM participated in 11 book clubs. Nine themes were identified (examination of privilege, initial reaction to discussion about racism, discomfort, worry, self-reflection, release, role recognition, readiness, and education). After prompted examination of their own privilege participants moved through a model of perceived readiness to act. Participants started with feeling paralyzed by the work's enormity or becoming defensive. They then moved toward discomfort with discussions of racism and systemic racism and progressed to discussions around worrying that they were contributing to noninclusive environments. After a period of self-reflection, participants tended to release their paralysis, push aside their defensiveness, accept the role of discomfort, and express the importance of education on these issues. Participants then recognized their role in creating inclusive environments and started discussing what they can do about it, which, for many, was to show up to the conversation. An underlying driver of movement through this model was the education that was provided through the book. By addressing privilege and systemic inequities through the reflective practice and dialogue of a book club, participants demonstrated a growing commitment and perceived readiness to advancing inclusive practices within medicine.

Promoting and supporting leadership in hematology departments

Promoting and supporting leadership in hematology departments

Investigating Factors that Predict Japanese Science Teachers’ Job Satisfaction: Evidence from TIMSS 2019

Trends in International Mathematics and Science Study (TIMSS) 2019 data revealed that Grade 8 science teachers in several Asian countries (Chinese Taipei, Hong Kong SAR, Japan, and South Korea) reported lower job satisfaction levels than the international average. For example, while Japanese Grade 8 students ranked among the highest in science achievement on the TIMSS 2019, their science teachers reported the lowest job satisfaction composite scale score compared to the other 63 participating countries. Using teacher questionnaire data from TIMSS 2019, we utilized correlation analysis and multiple linear regression to uncover the answers to this research question: Which factors contribute to Japanese Grade 8 science teachers’ job satisfaction? The results from the analysis indicate that working in a safe and orderly school environment was the strongest predictor of Japanese Grade 8 science teacher job satisfaction. The number of working hours, amount of perceived pressure exerted by their students’ parents, participation in professional development focused on science curriculum, and adopting a constructivist orientation to science teaching were the other significant factors that predicted job satisfaction. Findings from this study have implications for Japanese educational policy stakeholders, school administrators, mentor teachers, science department leadership, and those invested in science teachers’ professional development.

Implementing an early-life nutrition intervention through primary healthcare: staff perspectives

BackgroundNutrition interventions targeting early childhood can be cost-effective and may provide lifelong, intergenerational benefits. From October 2022 to April 2023 the Nutrition Now (NN) e-learning resource was implemented within Early Childhood Education and Care centres and the Maternal and Child Healthcare Centre (MCHC) in a southern Norwegian municipality. As part of the NN project, the present study aims to explore the MCHC staff’s experiences with implementing the NN resource, to gain insights into measures important to scale up digital early-life nutrition interventions.MethodsThree group interviews were conducted among public health nurses and midwives alongside one individual interview with the department leader of a MCHC in May 2023. An inductive thematic analysis, as described by Braun and Clarke, was conducted to generate the key themes and subthemes regarding the implementation process of NN within the MCHC.ResultsThree main themes were generated: [1] Important resource but not always utilized; [2] Parents are interested but had issues with access; and [3] Staff and stakeholder buy-in and commitment needed from the start. Overall, the staff viewed the NN resource as a potential tool for promoting diet-related topics and believed it could support the guidance they were already providing parents. However, few staff members fully familiarized themselves with the resource. While staff perceived parents as positive when informed about NN, they believed issues such as access challenges, competing platforms, and time constraints reduced parental engagement. Lastly, staff suggested improvements for NN’s implementation, including enhanced training, better planning, assigning champions, and lowering the threshold for access.ConclusionThe findings of this study suggest that the real-world implementation of digital evidence-based health behaviour interventions is feasible but would be enhanced by employing strategies focusing on engagement and utilization.Trial registrationThe main study is registered in the ISRCTN registry with ID ISRCTN10694967, https://doi.org/10.1186/ISRCTN10694967. (Registration date: 19-06-2022).

Assessing Academic Preferential Hiring Practices in Highly Ranked Otolaryngology Departments.

Objective: To assess whether preferential hiring practices, particularly self-hiring, are present in academic otolaryngology departments. Setting: A list of academic Otolaryngology-Head and Neck Surgery (O-HNS) departments ranked #1-40 was generated from the Doximity 2021 rankings. The educational background and training information of clinical faculty members and departmental leadership was extracted from each department's online directories. Methods: Descriptive statistics were used to examine inter/intradepartmental relationships and affiliations of included clinical faculty and departmental leadership based on current employment and medical training sites. A "prior affiliation ratio" was calculated to assess the degree of self-hiring and account for multiple possible prior affiliations (medical school, residency, and fellowship) by dividing all prior self-hired affiliations of faculty by the total number of faculty at each department. Results: A total of 1344 clinical faculty were identified, and 596 (44.35%) had at least 1 prior affiliation with their department. The overall prior affiliation ratio was 0.6, and 7 departments had a value >0.8, with the highest being 1.27 (>1.0 indicating multiple prior affiliations per individual such as both residency and fellowship). A network map of departments #1-10 showed heavy intradepartmental faculty recruitment with 24% of faculty having completed a #1-10 residency, 24% a #11-20 residency, 13% a #21-30 residency, and 11% a #31-40 residency. Totaling this data, 76% of faculty at departments ranked #1-10 had completed training at a program ranked #1-40. Furthermore, our data shows high rates of self-hiring among departmental leadership, (40% of Departmental Chairs and 62.5% of Program Directors) though rates are not significantly higher than self-hiring among faculty overall. Conclusion: The top 40 ranked O-HNS departments have high rates of self-hiring, relying on prestige of training programs and prior affiliation in hiring decisions. The effect on departmental productivity and training is unclear.

Digitalization capability and digital product and service innovation performance: empirical evidence from China

PurposeDigital product and service innovations (DPSI) has attracted widespread attention from both management scholars and practitioners. Previous studies have documented that information technology (IT) capability and digital orientation positively influence DPSI performance. However, the question of whether and how digitalization capability can facilitate DPSI performance remains unresolved. This paper fills these gaps by investigating the mediating role of improvisation capability and the moderating role of technological turbulence.Design/methodology/approachThis study used two-wave data from 240 matched digital transformation department leaders and senior managers from Chinese firms and examined the hypotheses deploying hierarchical regression and bootstrapping.FindingsOur analyses reveal positive, significant links between digitalization capability and improvisation capability and between improvisation capability and DPSI performance. The findings further show that the effect of digitalization capability on DPSI performance is partially mediated by improvisation capability and that technological turbulence strengthens the indirect relationship between digitalization capability and DPSI performance through improvisation capability.Originality/valueIntegrating resource-based view, this research provides evidence that the extent to which improvisation capability mediates the relationship between digitalization capability and DPSI performance depends on technological turbulence. It provides a new direction for digitalization capability and DPSI performance.

Using National Public Health Accreditation to Explore Quality Improvement and Performance Management in Small Local Health Departments

Context: This article focuses on 4 small local health departments (LHDs) that were in the process of seeking Public Health Accreditation Board (PHAB) reaccreditation or Pathways Recognition using PHAB Standards & Measures Version 2022. Objective: The objective of this study was to explore the experiences of 4 small LHDs related to Quality Improvement (QI) and Performance Management (PM) in their pursuit of PHAB reaccreditation or Pathways Recognition. Design: A team of researchers conducted 22 qualitative interviews with health department leaders and staff. Findings relative to QI/PM represent an embedded case study since they were part of a larger investigation. Setting: The research team conducted interviews remotely with health departments located in the West and Midwest. Participants: Participants included adults at least 18 years old and employed in 1 of 4 health departments. Main Outcome Measures: Emergent themes from this qualitative investigation included using QI/PM tracking systems, building staff buy-in for QI/PM, integrating QI/PM into daily work, and advice for other health departments regarding QI/PM. Results: Participants suggested that tracking systems helped them manage QI/PM processes. Staff buy-in for QI/PM was strengthened by building a sense of ownership of the process and connecting improvement processes to outcomes. Health departments integrated QI/PM into daily work by leadership modeling and communicating expectations. Advice for other health departments included finding a QI system that was easy to follow and recognizing the role of QI/PM in improving performance to better support the wellbeing of the community. Conclusions: QI/PM are important tools for health department effectiveness. Participants affirmed that the primary purposes of QI/PM are to enhance internal processes and improve community health outcomes. Study findings demonstrate how 4 small health departments integrated QI/PM into their public health practice.

Fostering Organizational Excellence through Inclusive Leadership: Practical Guide for Radiology Leaders.

Inclusive leadership styles value team members, invite diverse perspectives, and recognize and support the contributions of employees. The authors provide guidance to radiology leaders interested in developing inclusive leadership skills and competencies to improve workforce recruitment and retention and unlock the potential of a rapidly diversifying health care workforce. As health care organizations look to attract the best and brightest talent, they will be increasingly recruiting millennial and Generation Z employees, who belong to the most diverse generations in American history. Additionally, radiology departments currently face critical workforce shortages in radiologists, radiology technicians, staff, and advanced practice providers. In the context of these shortages, the costs of employee turnover have emphasized the need for radiology leaders to develop leadership behaviors that promote recruitment and retention. Radiology department leaders who perceive and treat valued employees as replaceable commodities will be forced to deal with the extremely high costs associated with recruitment and training, decreased morale, and increased burnout. The authors review inclusive versus exclusive leadership styles, describe key attributes and skills of inclusive leaders, provide radiology leaders with concrete methods to make their organizations more inclusive, and outline key steps in change management. By adopting and implementing inclusive leadership strategies, radiology groups can position themselves to succeed in rapidly diversifying health care environments. ©RSNA, 2024 See the invited commentary by Siewert in this issue.

Real-Time Workload Assessment to Enhance Performance.

Workforce shortages, increasing costs, decreased reimbursement, and focus on quality outcomes are crucial issues for health care leaders. To remain competitive, profitable, and productive, health care organizations need to provide structure, a safe working environment, and an acceptable leader workload to guarantee effective leader performance. Poorly designed work environments and interfaces can increase workload resulting in decreased performance and satisfaction. Excessive workload has led to reduced job satisfaction, productivity, and resilience. Due to leadership turnover and vacancy rates, leader workload was perceived to be unreasonable in the respiratory therapy (RT) department of an academic medical institution in central North Carolina. The aim of this quality initiative was to explore the workload of health care leaders in the RT department to identify the factors that influenced workload as well as implement strategies to decrease perceived workload. A workload assessment was performed, which identified inefficiencies and opportunities to partner with ancillary departments to align the workload with appropriate clinical teams. The redistribution of workload provided alignment, top of scope practice, and improved satisfaction among the RT department leaders. This article identifies the strategies utilized which can be translated to other institutions.

Assessing Radiology and Radiation Therapy Needs for Cancer Care in Low-and-Middle-Income Countries: Insight From a Global Survey of Departmental and Institutional Leaders

BackgroundThe global cancer burden and mortality rates are increasing, with significant disparities in access to care in low-and-middle-income countries (LMICs). This study aims to identify radiology and radiotherapy needs in LMICs from the perspective of departmental and institutional leaders. MethodsA survey was developed and conducted by the American Association of Physicists in Medicine (AAPM) Global Needs Assessment Committee (GNAC) and the AAPM International Council. The survey, organized into five sections (Introduction, Infrastructure Needs, Education Needs, Research Needs, and General Information), was open to respondents from March 1 to August 16, 2022. FindingsA total of 175 responses were received from six global regions: Africa (31.4%), Americas (17.7%), Eastern Mediterranean (14.3%), Europe (9.1%), South-East Asia (23.4%) and Western Pacific (4.0%). The greatest reported need was for new or updated equipment, particularly PET/CT imaging technology. There was also a high demand for clinical and equipment training. Approximately 25% of institutions reported a lack of radiology-based cancer screening programs due to high healthcare costs and a shortage of specialized equipment. Many institutions that expressed interest in research face funding and grant challenges. InterpretationThe findings highlight critical areas where organizations can support LMICs in enhancing radiology and radiotherapy services to mitigate the growing cancer burden.

Building Community and Developing Professionally through FUN Final Friday Sessions.

FUN Final Fridays (FFFs) are a professional development effort resulting from a pandemic-inspired virtual pedagogical meeting. Over the past three academic years, Faculty for Undergraduate Neuroscience (FUN) has hosted FFFs as monthly professional development sessions. These sessions offer a mechanism to address current issues in higher education with emphasis on topics relevant to neuroscience educators. Broadly, topics covered in FFF sessions fall under three areas: a faculty focus that addresses issues of wellness and professional opportunity; a diversity, equity, inclusion, and belonging focus that addresses how to advocate for justice through education; and a pedagogical focus that address classroom strategies and issues that affect student learning. We share here our experiences and lessons learned regarding selecting topics, identifying facilitators, navigating timing across a semester, and engaging participants with a goal of providing a framework for successful professional development so that other institutional and departmental leaders can contribute meaningfully to the growth and development of their colleagues.

“Does an Additional Advanced Degree Influence Career Trajectory as a Shoulder and Elbow Surgeon?”

BackgroundAs orthopedic surgery becomes increasingly competitive, orthopedic surgeons are now pursuing advanced degrees more frequently to enhance their resumes or gain additional expertise. The specific impact of this additional training and education on a surgeon’s career trajectory is not well defined. The purpose of this study was to understand the impact of an advanced degree on the academic career of orthopedic shoulder and elbow surgeons. MethodsOrthopedic shoulder and elbow fellowship-trained surgeons were identified using the directory listed on the American Shoulder and Elbow Surgeons website. Demographics, education, and current professional roles were obtained. Research productivity was obtained using SCOPUS and Google Scholar. Advanced degrees were defined as those additional to the primary medical degree (Doctor of Medicine [MD] or Doctor of Osteopathic Medicine [DO]). Outcome measures collected included timing of advanced degree obtainment, current academic and leadership roles, leadership on journal editorial boards, and research productivity. Statistical analysis was performed using the chi-square test and Mann-Whitney U test to determine the association of advanced degrees on outcome measures. ResultsIn total, 893 orthopedic shoulder and elbow surgeons were identified, of whom 129 had advanced degrees. Most common advanced degrees included Master of Science (MS/MSc; 43%), Master of Business Administration (MBA; 23%), and Doctor of Philosophy (PhD; 13%). The most common period of degree obtainment was before medical school (35%) with the least common times being after medical school/before residency (0.9%) and between residency and fellowship training (0.9%). Surgeons who held advanced degrees demonstrated greater research productivity, with a higher h-index (p < 0.001), a greater number of citations (p < 0.001), and more publications (p < 0.001). Of the 523 shoulder and elbow surgeons who worked at an academic institution, those holding advanced degrees were more likely to serve as orthopedic department chair (p < 0.001) and serve an editorial board position (< 0.001). ConclusionThis study found that having an advanced degree as an orthopedic shoulder and elbow surgeon was linked to higher research impact and productivity and an increased likelihood of becoming a department chair and holding an editorial position. These significant findings can help future trainees and department leadership in understanding the importance and impact of additional training on career trajectories for academic faculty.

Understanding uptake of information about innovations among emergency department clinicians during the COVID-19 pandemic.

Early in the COVID-19 pandemic, little was known about managing sick patients, but emergency department (ED) clinicians had to decide which treatments and care processes to adopt. Our objective was to describe how ED clinicians learned about innovations and how they assessed them for credibility during the pandemic. We purposively sampled clinicians from hospital-based EDs to conduct focus groups with ED clinicians and staff. We used both inductive and deductive approaches to conduct thematic analysis of transcripts. We conducted focus groups with clinicians from eight EDs across the United States. We found that ED clinicians in our sample relied on friends and colleagues or departmental and institutional leadership for information on innovations. They used social media sources when they came from credible accounts but did not directly seek information from professional societies. Clinicians reported a range of challenges to obtain credible information during the pandemic, including a fractured and changing information environment, policies misaligned across clinical sites or that conflicted with clinical knowledge, high patient volume, fear of harming patients, and untimely information. Facilitators included access to experienced and trusted colleagues and leaders and practicing at multiple EDs. Participants cited anecdotal evidence, institutional practice, and word-of-mouth-rather than peer-reviewed evidence and professional society communications-as their primary sources of information about care innovations during the early phases of the pandemic. These results underscore the importance of developing trusted local mechanisms and wider networks to identify and vet information for frontline clinicians during rapidly emerging public health emergencies.

Demographic and Academic Characteristics of Orthopaedic Shoulder and Elbow Division Chiefs in the United States

Division Chiefs (DCs) and department leadership play an integral role within the service, and in the department as a whole. The goal of this study was to assess the demographics and academic characteristics of the leadership in orthopedic shoulder and elbow services across academic centers in the United States and comment on the diversity within these leadership positions. Academic medical centers were identified using the FRIEDA database. DCs were identified using the hospitals' respective websites where data such as sex, race/ethnicity, academic rank, fellowship institution, and time since graduating fellowship. Scopus database was used to determine individual h-indices. Of 198 academic programs identified, 49 were found to have a DC of the orthopedic shoulder and elbow division. An additional 26 programs were noted to have a shoulder and elbow division, but were not found to have a DC of the division. These DCs were mostly White (n=43, 87.8%), with only 6 identified DCs with a different ethnicity. Forty-five of the DCs (91.8%) were male and 4 were female (8.2%). The average time out of fellowship was 20.7 years and the average h-index was 18.9. More than 20% of the DCs trained at Columbia's Neer shoulder and elbow Fellowship. Six DCs were current or past president of ASES and 5 DCs completed the ASES traveling fellowship. There is a paucity of available research on demographic and leadership characteristics in academic orthopedic shoulder and elbow. Shoulder and elbow DC had average h-index of 18.9 and 20% trained at one fellowship. There also opportunities for increased gender/racial/ethnic diversity among the leadership of shoulder and elbow divisions.

From mandate to co-create: leading the development of inclusive performance evaluation criteria

PurposeAnnual performance evaluations of faculty are a routine, yet essential, task in higher education. Creating (or revising) performance criteria presents an opportunity for leaders to work with their teams to co-create evaluation metrics that broaden participation and minimise inequity. The purpose of this study was to support organisational leaders in developing equitable performance criteria.Design/methodology/approachWe adopted the “dual-agenda” dialogues training that draws on concepts of collective self-efficacy and intersectionality for department leaders to co-create annual review criteria with their faculty members at one university. We used qualitative and quantitative data to assess the training and conducted an equity audit of the resulting annual review criteria.FindingsSurvey results from faculty members and departmental leaders (n = 166) demonstrated general satisfaction with the process used to create new criteria, perceptions that their criteria were inclusive and optimism about future reviews. Those with greater familiarity with the dialogues process had more positive perceptions of the inclusivity of their department’s criteria and more positive expectations of future reviews. The examination of eight indicators of equity illustrated that the resultant criteria were transparent and holistic.Originality/valueThis study builds on the relatively little research on faculty members’ annual performance evaluations, focussing on inclusive dialogues that centre equity and diversity. Results highlight the value of providing department leaders with evidence-based tools to foster system-level change through equitable evaluation policies. A toolkit is available for adaptation of the “dual-agenda” leadership training to both co-create annual review criteria and improve equity and inclusion.

Unveiling the Invisible: Challenges Faced by Arab Women International Medical Graduates in U.S. Academia.

The Arab experience is understudied because Arabs are categorized as White on the U.S. Census, leading to diminished documentation of their personal experiences. There is also little understanding of the Arab experience and its intersectionality with gender, being an international medical graduate (IMG), and working in academia. The authors studied the experience of Arab women IMGs working in the U.S. academic system. This qualitative study used interpretative phenomenological analysis to analyze in-depth interview data from 20 first-generation U.S. immigrant Arab women who were IMGs. Interpretative phenomenological analysis involved data familiarization, immersion, and coding. Codes were grouped into potential themes on the participants' experience. The authors explored connections between the themes and engaged in reflexive practice through memo writing and team meetings. The study was performed from November 2022 to May 2023. The experiences of the 20 first-generation U.S. immigrant Arab women IMGs were as diverse as the Arab identity itself but congruent with some documented IMG experiences. Political turmoil, desire for new opportunities, and career goals were all reasons that led them to emigrate, but cultural differences, isolation from their home countries, and missing family were central to their experiences. Muslim women wearing the hijab or those with heavy accents faced more microaggressions and xenophobia in academic clinical settings. Those in environments that embraced their differences and supported them described less discrimination. They all, however, felt that they benefited from training in the United States. However, they noted room for improving cultural humility in residencies and the need for a more inclusive workplace. This study highlights the visible and invisible challenges that affect Arab women IMGs' experience in the United States. Program directors and department leaders should try to learn about the backgrounds of IMGs and current geopolitical events that might affect IMGs and extend support.

Evidence of Horizontal Violence in Healthcare Settings: A Narrative Review.

In the professional realm, the healthcare sector stands out as one of the most susceptible to violence. One notable manifestation of this is violence among colleagues, commonly referred to as horizontal violence, which has garnered significant attention in recent times. To delve deeper into this phenomenon across various categories of healthcare professionals, a comprehensive search was conducted on PubMed, Scopus, and CINAHL, resulting in the inclusion of 13 articles. The findings of this narrative review illuminate how horizontal violence can manifest in both physical and psychological forms and how it often becomes normalized among the healthcare professionals who endure it. Particularly vulnerable to such occurrences are recent graduates and those with limited professional experience. Furthermore, it has been observed that horizontal violence has detrimental effects on the well-being of those subjected to it, as well as on the quality of patient care delivered. Considering preventive measures, numerous studies emphasize the pivotal role of effective departmental leadership in fostering a harmonious work environment. Despite the largely underreported nature of this phenomenon, the conclusions drawn in this study advocate for a deeper exploration of the dynamics surrounding horizontal violence, with the goal of devising targeted strategies to mitigate its occurrence.

Sustaining Active Learning in Undergraduate Precalculus: Results and Challenges of a Course Redesign

Addressed toward course coordinators and departmental leaders interested in redesigning undergraduate mathematics courses with a focus on active learning, this report provides an update on progress in redesigning the Precalculus course offered by the Department of Mathematics at the University of Maryland, College Park, following initial indicators of success. We begin by discussing our team’s challenges due to the COVID-19 pandemic and our attempts to navigate these challenges. We then provide results related to student achievement, self-efficacy, and STEM intentions, in addition to addressing the remaining goals of the redesign.

Supporting Care Transformation Through a Comprehensive Graduate Medical Education Curricular Program in a Department of Internal Medicine.

The imperative to train physicians in skills required to lead care transformation is increasingly recognized, yet few Graduate Medical Education (GME) programs exist to meet this need. Describe the development, outcomes, and lessons learned from a novel GME care transformation curricular program. Department of Internal Medicine (IM) at Dell Medical School at The University of Texas, Austin. Between 2020 and 2023, 33 IM residents and fellows completed training with participation in the Care Transformation program. Department leadership developed a comprehensive educational and experiential program that included (1) Dell Medical School-wide Distinction in Care Transformation curriculum; (2) Primary Care Residency track with care transformation projects; (3) participation in the national Veterans Affairs Chief Resident in Quality and Safety program; and (4) Hospital Medicine Fellowship in Quality and Safety. Each trainee led a care transformation project spanning a variety of topics and settings. Graduates who responded to a follow-up survey (22 of 33 graduates) reported they used skills learned through the program in their current roles and these experiences better prepared them for fellowship and/or faculty positions. The Care Transformation program provides real-world experiences and skillsets that are increasingly valuable in modern healthcare delivery.

Development and implementation of an injury and illness surveillance system for team USA

BackgroundThe purpose of this report is to provide insight and details regarding the development and implementation of an injury and illness surveillance (IIS) system for the United States Olympic and Paralympic Committee (USOPC).MethodsThe development and deployment of the IIS employed a multiphase approach. First, researchers determined variables to include in the IIS using the recommendations from the 2020 IOC consensus statement for reporting sport epidemiological data. Second, the hosting and deployment platforms were comprehensively evaluated for their suitability, ease of use, flexibility, and backend data structure (for both capture and aggregation). Third, focus groups consisting of the Sports Medicine department leadership and clinicians piloted the IIS system and revisions were made based on their feedback. Pilot testing of the IIS and follow-up focus groups were then conducted among all departmental clinicians to solicit additional feedback and drive further revisions. Finally, the IIS system was piloted among providers working during the 2023 Pan American and Parapan American Games to refine the system for future Games. After reviewing all potential software platform options (electronic medical record [EMR] system, athlete management systems, secure data collection platforms), Qualtrics (Qualtrics, Provo, UT, USA) was selected to host the IIS system. This choice was made due to the inability of the EMR and athlete-management systems to make frequent updates, modify existing questions, and provide the necessary form logic for the variety of scenarios in which the IIS system would be deployed. Feedback from the department’s leadership and clinicians resulted in a number of changes, most notably being the ability to enter multiple diagnoses for a single injury event. Additionally, clinician feedback resulted in the creation of additional diagnostic codes not currently present in the OSIICS v14.0 diagnostic coding system, adding “non-sport” as an additional variable for injury setting, and developing a system for reporting return-to-sport date for time-loss injuries.DiscussionA multi-stage process of extensive planning, stakeholder feedback, and ongoing updates is required in order to successfully develop and implement an IIS system within a National Olympic and Paralynpic Committee. This process can be used to inform the development and implementation of IIS systems in other sporting organizations.