Frontline Leaders Research Articles

Enabling efficient patient discharge with a mindset, toolset, and skillset framework.

33 Background: Timely access to care for patients coming through the emergency center can be achieved by efficiently discharging patients. When continued bed growth is not sustainable, improvements in team-based approaches to discharges are necessary and require a multi-pronged approach. Our institution embarked on a process improvement effort anchored on completing 1 out of 2 patients discharged by 12PM. We hypothesize that a discharge before noon will assist with getting our next patient to a bed by 2PM. We conducted a pilot on our Stem Cell Transplant units to test and enable our case for change allowing for scale and spread to other units. Methods: Our multi-pronged framework was focused on mindset, toolset, and skillset. As our first step, executive leadership set direction to achieve a shift in mindset by socializing the case for change using a hospital throughput framework including a 9-12-2 branding. A discharge launchpad [toolset] was established to define expectations of discharge tasks including accountability within a 2-day window of medical readiness for discharge. This served as the tool aligning various teams to a date for task completion. Lastly, we evaluated skillset and defined best practices for the unit RN role and APP, along with others, which included empowering various roles to discharge patients. Results: For discharges during the baseline period of 12/1/2022 - 11/30/2023 from the Stem Cell Transplant service, the percent of discharge orders in by 9AM was 10.3% and discharges completed by 12PM was 12.2%. The pilot period month of April 2024 resulted in a month close performance of 52.5% for orders in by 9AM and 55.4% of patients discharged by 12PM. The average time spent by Stem Cell patients boarding in our emergency center during the baseline period was 6 hours and 34 minutes with a reduction to 2 hours and 23 minutes in April 2024. There were no Stem Cell beds added during the pilot period compared to baseline. The period of 12/1/2023 – 3/31/2024 was excluded to limit any improving data from the Hawthorne effect since throughput socialization began during those months. Conclusions: We met the goal within one month with plans underway to assess sustainability for implementation readiness for scale and spread to other units. Early efforts made to scale this model within the institution confirm the multi-pronged model approach is necessary. Additionally, we believe that a frontline leadership model would contribute best to implementation success. Missing any component of the multi-pronged approach or team member, such as the APP role without the RN role, will not yield the ultimate result of discharging patients by noon. This change requires a coordinated, team-based approach. The new institutional governance structure for hospital throughput, including academic and operational departments, and a logistics center in the future may contribute to building trust in leadership’s commitment to improving patient care.

Frontline Leadership: Nurses in Special Pathogens Preparedness and Response.

Frontline Leadership: Nurses in Special Pathogens Preparedness and Response.

Virtual hospital care development and deployment:Arapid qualitative study of frontline clinicians and leaders.

Virtual hospitalist programs are rapidly growing in popularity due to worsening clinician shortages and increased pressure for flexible work options. These programs also have the potential to establish sustainable staffing models across multiple hospitals optimizing cost. We aimed to explore the current state of virtual hospitalist services at various health systems, challenges and opportunities that exist in providing virtual care, and future opportunities for these types of services. To identify perspectives on design and implementation of virtual hospitalist programs from academic hospitalist leaders. We conducted focus groups with United States academic hospitalist leaders. Semistructured interviews explored experiences with virtual hospitalist programs. Using rapid qualitative methods including templated summaries and matrix analysis, focus group recordings were analyzed to identify key themes. We conducted four focus groups with 13 participants representing nine hospital systems across six geographic regions and range of experience with virtual hospital medicine care. Thematic analysis identified three themes: (1) a broad spectrum of virtual care delivery; (2) adoption and acceptance of virtual care models followed the stages of diffusion of innovation; and (3) sustainability and scalability of programs were affected by unclear finances. Hospitalist leader perspectives revealed complex factors influencing virtual care adoption and implementation. Addressing concerns about care quality, financing, and training may accelerate adoption. Further research should clarify the best practices for sustainable models optimized for access, hospitalist experience, patient safety, and financial viability.

Front-line lean leader capacities, practices and effects on implementing tools: a survey of leaders in industrial companies

PurposeFront-line lean leadership is critical for implementing and sustaining lean production systems (LPS). The purpose of this paper is to analyze the relationships between front-line lean leader (FLL) capacities (cognitive, social, motivational, knowledge and experience), lean leader practices (developing people and supporting daily kaizen) and the degree of implementation of lean tools (pull system, involvement of employees and process control) in manufacturing companies.Design/methodology/approachA survey was conducted with FLLs from large Brazilian manufacturing companies. The survey collected 103 responses, 99 of which were validated. Data were analyzed using partial least squares structural equation modeling.FindingsThere was a positive, significant and direct relationship between FLL capacities, leadership practices and a degree of implementation of LPS tools on the shop floor. The validated model is a reference base for planning FLL capacities and practices that result in more effectively implementing LPS on the shop floor.Practical implicationsThe findings provide managers with a new perspective on the importance of the development and training of FLLs focusing on leadership capacities. As decisions about developing lean capabilities impact the application of Lean leadership practices and the use of lean tools, they are also related to day-to-day lean activities and improved operational results. Additionally, the proposed model can be used by managers as a basis to diagnose, develop and select lean leaders.Originality/valueThis study seeks to fill a theoretical gap of knowledge on front-line lean leadership as it jointly addresses and empirically analyzes the existing relationships between lean leadership capacities, encompassing the perspective of psychology, lean practices and tools on the shop floor.

Comrades in Arms? Rebel Leadership Roles and Coups in Rebel Regimes

Abstract Why do some winning rebel groups build loyal postwar militaries, while others do not? Surprisingly, though victorious rebel political and military elites cooperate successfully to seize sovereign power, they often struggle to share it. In roughly one-third of rebel regimes, military elites attempt to depose their leaders through military coups. I contend that postwar coup risk is primarily shaped by the wartime roles of rebel leaders. Rebel leaders that occupy a frontline role—exposing themselves to the hazards of the conflict theater—establish regimes less likely to suffer postwar coups. Frontline leaders win greater prestige and stronger legitimacy among military audiences. Further, frontline leaders’ greater proximity to their military commanders allows them to develop institutional structures that more effectively reduce military autonomy. However, remote leaders, who are absent from the conflict theater, exercise weaker postwar control over the armed forces, resulting in greater coup risk. I find support for this theory using original cross-national data on all rebel regimes and the wartime roles of victorious rebel leaders between 1945 and 2010. A controlled case comparison of civil–military relations in two rebel regimes—Guinea-Bissau and Uganda—further illustrates the mechanisms tying wartime roles to postwar coups.

The Role of First-Line Managers in a Pandemic in Reducing the Spread of Infections and Promoting the Health and Well-Being of Rohingya Refugees

ABSTRACT Humanitarian organizations in Bangladesh introduced emergency services to protect Rohingya refugees from COVID-19. This article aims to explore the roles front-line leaders from those organizations played in reducing the spread of the infection and protecting the refugees. By using in-depth interviews with 42 first-line managers (FLMs), it explores the innovative actions and strategies adopted by these managers to implement COVID-19-related programs and services. Initiatives such as training and engaging Rohingya volunteers and developing services promptly in order to raise awareness and manage testing, treatment, and psychosocial interventions contributed significantly to pandemic management in Rohingya refugee camps.

Implementing Clinical Guidelines for the Treatment of Psychosis: The Frontline Leaders' Point of View. A Qualitative Study.

Despite the large amount of leadership and implementation theories and recommendations, healthcare services continue to struggle with efficiently incorporating new knowledge. The questioning of conventional leadership approaches in healthcare organizations prompted us to investigate how frontline leaders comprehend their own implementation intentions and actions, and how these intentions and actions may impact the implementation of clinical guidelines in mental healthcare in Norway. Employing a theory-driven qualitative design, we conducted nine semi-structured interviews with frontline leaders who had recently led implementation of clinical guidelines for the treatment of psychosis in mental health. We employed Systematic Text Condensation, informed by Normalization Process Theory, to structure and analyze the data and used fidelity scales to measure the degree of implementation and distinguish between leaders' levels of success in implementation. Frontline leaders in units that achieved high success in implementation described their intentions and actions differently, from those with less success. The former group's actions aligned more closely with the constructs of the Normalization Process Theory compared to the latter group when describing their actions. Frontline leaders leading units with a high degree of implementation success describe relation-orientation, trust, and providing adaptive space for staff members to take initiative. In contrast, those leading units with less implementation success describe more control and guidance of co-operators and place more emphasize on information and knowledge. Differences in how frontline leaders describe their actions and intentions to achieve clinical guideline implementation suggest that the leadership approach of these frontline leaders is an important factor to consider when planning and conducting implementation. To better understand the implementation process, it is important to pay attention to how frontline leaders customize their leadership approaches to the dynamics of complex organizations, and how they interact with their team and superiors.

INTERPROFESSIONAL CO-LEARNING AT MULTIPLE LEVELS OF LTSS: PRO-HOME PROGRAMS AND RESEARCH

Abstract Promoting Seniors’ Health with Home Care Aides (Pro-Home), a randomized controlled trial (RCT) of a gentle physical activity program delivered by home care aides (HCAs) for their older clients in English or Spanish, provided unprecedented opportunities for collaboration and co-learning across multiple disciplines and professions (public health, health services research, sociology, medicine, physical/occupational therapy, kinesiology, social work, psychology, economics, medicine, nursing; frontline care workers, leaders and staff members of state and home care agencies, , social service agencies, researchers, undergraduate and graduate students). The turbulent long-term services and supports (LTSS) environment, which culminated in the COVID-19 pandemic, provided the study participants (HCAs and their older clients), multiple levels of LTSS stakeholders and the research team with rapidly evolving new contexts for the RCT. This paper presents how the Pro-Home project developed into a learning organization where individuals and organizations learn from each other to pivot at every new turn in the environment, focusing on the development of a novel interactive training for HCAs in-person or remotely. The initial training activities were conducted in-person. After adapting the material for remote delivery, we provided the latter sessions via phone with digital and physical tools. For each training session, we assessed outcome quality using an exit survey and other methods capturing HCAs’ program delivery. The presentation concludes with implications for research and practice in LTSS.

The COVID-19 Pandemic Challenged Nurse Managers’ Daily Leadership Work: A Qualitative Study

Aim. To explore and describe nurse managers’ experiences of how the COVID-19 pandemic affected their leadership work. Background. As frontline leaders in healthcare, the work of nurse managers was dominated by the global COVID-19 pandemic in recent years. Method. Semistructured interviews were carried out during autumn 2021 at a Finnish university hospital. Twelve nurse managers participated in video call interviews, and the data were analysed by inductive content analysis. Results. Four main categories of COVID-19 effect on the nurse managers’ leadership work were identified: increased work requirements; changes in work content; crisis communication; and human resources. The main categories included a total of 14 subcategories. Conclusion. The complexity and range of nurse managers’ leadership work during the pandemic were emphasized. Nurse managers performed several important tasks that ensured ongoing delivery of healthcare services. Flexibility, ability to solve problems, capacity to tolerate uncertainty, pressure and rapidly evolving situations, excellent crisis communicational skills, and an ability to address the diverse needs of their staff were key competencies that nurse managers relied on during this period. Implications for Nursing Management. Nurse managers’ experiences of COVID-19 can inform practice, policies, nursing, and nursing leadership education in relation to future crises.

Enabling Teams to Implement Innovative Personalized Activation in a Public Sector Context: Why and How Frontline Leadership Matters

This article investigates the strategies used by frontline supervisors to lead teams in the implementation of innovative activation services and the ways in which these strategies are perceived by the frontline workers they lead. Empirical data are collected from team observations and in-depth interviews with frontline supervisors and workers known as employment specialists in a public sector context, i.e., in the Norwegian Labour and Welfare Administration (NAV). In this context,a large-scale programme known as Extended Follow-Up was implemented beginning in 2017 with the aim of improving activation services for persons with complex support needs. We identified two leadership strategies: a) a team-focused strategy based on interdependence, in which frontline workers were encouraged to shape and adapt the activation services to each jobseeker, and b) a rule-focused strategy based on constant monitoring of frontline workers to secure their adherence to predefined tools and aims. The former strategy promoted team cohesion and provided the necessary psychological safety to implement the personalized activation service,while the latter strategy limited the frontline workers’ creativity and room to manoeuvre. Our findings reveal that integrative leadership approaches that combine autonomy with support present greater prospects for successful innovation implementation in a public sector context.

A Dynamic Staffing & Scheduling Solution: The Build and Implementation of a Logistics Engine to Optimize Nurse Schedules and Rosters

The use of electronic scheduling and staffing tools should be standard practice in health care. Gone are the days of paper scheduling, replaced with mobile apps and sleek desktop applications. The frontline clinician has access to scheduling, paid time off (PTO), trades, and timecard management in the palm of their hand. Ease of use and work flexibility are top of mind for many frontline clinicians and leaders. Yet even with the newest technology and sleekest design, there continues to be a gap in functionality and practice: predictive scheduling. The tools facilitate the management of actions such as balancing a schedule, automating trades, simple approval of time off, and clean record keeping, but have limited decision support functionality to accurately predict how many nurses should be scheduled to match projected demand, or how many nurses should be hired to meet the schedules modeled to match that projected demand. Therefore, nurse managers and leaders spend hours trying to figure out how many nurses are needed on a schedule that would require as little rebalancing as possible for the actual shift in hopes of limiting the chance of cancelations or needing to expensively recruit for unfilled shifts with incentive pay or overtime. The need for decision support tools for predictive scheduling is paramount and critical for effective labor management. To overcome the gap in technology and capability, St. Luke’s Health System designed, built, and implemented their own logistics engine to move from reactive nurse staffing to proactive nurse scheduling, reaping the rewards of managerial time saved, controlled labor cost, a more predictable roster, and a more satisfied nursing workforce.

To err is human: A healthcare organization blueprint towards safety and reliability.

392 Background: In 2019, a comprehensive cancer center was audited by a regulatory agency that identified opportunities to improve the safe delivery of healthcare. Even though the organization has been engaged in multiple continuous improvement initiatives, we found that to run a complex enterprise efficiently, we needed to break silos, learn from the frontline, and educate and train leaders in a psychologically safe environment. The overarching goal is to improve our culture of safety by developing a safety-focused workforce, improving robust processes around high-harm events, increasing transparency/feedback regarding safety events, and advancing the institution towards a High Reliability Organization (HRO)1 with zero preventable patient harm. Methods: Key interventions implemented: 1. Revamped our Root Cause Analysis; 2. Developed a Quality Assurance Performance Improvement (QAPI)2 council with leadership from the enterprise and representatives of the Patient Family Advisory Program, patients of the organization; 3. Implemented a Tiered Readiness Briefing (TRB) 7 days a week; 4. Selection of Serious Safety Event Rate (SSER)3 as the organization's measurement of patient safety and made it transparent; 5. Implementation of a mandatory training program in HRO skills and tools necessary to change behaviour. Training of leadership first goal was to get their buy-in so that the rest of the workforce would comply with the training; 6. Created Priority Focus Areas (PFA) initiatives supported by QAPI, the board, and leadership- providing resources to improve widespread, problem-prone, high-risk issues. Also, a system of accountability. Results: From June 2020 to April 2023- 59% reduction on SSER and sustained rate <0.9; 96% of leaders and 86% of medical faculty trained in HRO; 100% of “Start the Clock” issues identified in TRB are acted on within 24 hrs.; PFA success: the creation of the Blood Shortage Safety Decision Matrix- resulted in no surgery cancellation due to blood shortage. Conclusions: Rigorously implementing HRO principles in a comprehensive and complex cancer center resulted in improved process outcomes and patient safety outcomes that significantly reduced serious safety events.

Representing Gandhi: A Study of Mahatma Gandhi as a Character in Selected Novels from Colonial and Post-Colonial Times

The 1930s saw the rise of Mahatma Gandhi as the frontline leader of India’s struggle against the British imperialists, and it was also a decade when the Indian novel in English came of age, with the publication of Mulk Raj Anand’s Untouchable, R.K. Narayan’s Swami and Friends and Raja Rao’s Kanthapura within a few years of each other. The English novel in India grew as a consequence of the English education introduced by the British, and it was used as a weapon against the imperialists by a bunch of young men who were primarily educated abroad, with an aim to use a universal language that addressed all Indians all over the world. Gandhi, unsurprisingly, became a great source of inspiration for these writers. Gandhi has been a subject of literature and other forms of art to this day, but the portrayal of the ‘Great-soul’ (as Tagore called Gandhi) has gone through a change since the pre-independence days. This essay analyses the change in the portrayal of Gandhi by close-reading four novels, Untouchable (1935) and Kanthapura (1938) from the colonised period, and Waiting for the Mahatma (1955) and Dhorai Charit Manas (1950) from the post-independence era. The essay shows how the portrayal of Gandhi and Gandhism went through a change in the novels from the colonial period to post-colonial times, as the reverence and deification of Gandhi that was so prevalent in the novels of the colonial time gave way to a more humane portrayal of the most influential leader of India’s freedom struggle.

Stairway to heaven or a placebo: the impact of lean leadership, through job demands, on hospital workers’ engagement and performance

PurposeThis study aims to examine to what extent the relationships between hospital workers’ perceptions of lean leadership behaviour, their engagement and the hospital unit’s perceived performance are mediated by job demands.Design/methodology/approachThe data (n = 1,624) come from a lean implementation study in a Dutch hospital and are analysed using structural equation modelling in Mplus (v8.4).FindingsThe results confirm that lean leadership behaviour is related to employee engagement and hospital unit performance as perceived by employees, and these relationships are partially mediated through job demands. More specifically, the authors found that the type of job demand explains the direction of mediation effects. On the one hand, so-called challenging demands positively mediate the relationships between lean leadership behaviour and its outcomes. Conversely, hindering demands negatively mediates the relationship between lean leadership behaviour and perceived unit performance.Practical implicationsThe authors recommend hospital organisations and human resources managers start by helping hospital leaders understand the underlying mechanisms that explain the effects of leadership on employees’ perceptions and, second, support their frontline leaders by providing training, coaching and feedback on how to influence job demands in a way that creates an optimal work environment for hospital employees.Originality/valueThe authors contribute to the literature by building upon insights from the job demands-resources model to explain the effects of lean leadership behaviour and by investigating the relevance of lean leadership in a hospital context, given the phenomenon’s strong roots in manufacturing.

Evaluation of a charge nurse leadership development program.

Evaluation of a charge nurse leadership development program.

Book Review: Practical Innovation in Government: How Front-Line Leaders Are Transforming Public-Sector Organizations

Book Review: Practical Innovation in Government: How Front-Line Leaders Are Transforming Public-Sector Organizations

In this June issue

In line with several other journals we co-publish the Australian Commission on Safety and Quality in Health Care Low Back Pain Clinical Care Standard. It describes the early clinical management of people who present with a new acute episode of low back pain. The background to how the standard was developed and finalised are described in an introductory editorial. Coronial findings and royal commissions have repeatedly identified deficiencies in the emergency health care provided to prisoners in Australia. These deficiencies are operational, clinical and stigmatic and not limited to a single prison or jurisdiction. Applying a health quality of care framework focused on prevention and chronic health management appropriate assessment and escalation when urgent medical assistance is requested, and a structured audit framework could avoid future preventable deaths in prisons. We publish an editorial on this topic to accompany the paper written by a team from Victoria and Queensland. A group from the neurosurgery department of the Royal Brisbane and Women's Hospital report that the availability of cranial access equipment outside Queensland tertiary centres is limited. Inter-hospital transfers are likely to persist in Queensland and so improving access to cranial access equipment in hospitals where it is currently lacking is highly warranted. They surveyed senior theatre nurse or surgical service directors from rural and regional Queensland hospitals located outside the local catchment of a tertiary centre and had a CT scanner. Questions regarded availability, location and storage conditions of mechanical cranial access kits, as well as last usage, and associated patient outcomes. Life-threatening thoracic trauma requires emergency pleural decompression, and thoracostomy and chest drain insertion are core trauma procedures. Reliably determining a safe site for pleural decompression in children is challenging, even for experienced clinicians. A team from Melbourne report that the Mid-Arm-Point (MAP) technique, a procedural aid for use with injured adults, is also a safe site for pleural decompression in children <4 years and with a very minor modification is safe in children ≥4 years. An excellent study from Queensland describes the demographics, presentation characteristics, clinical features and cardiac outcomes for Aboriginal and Torres Strait Islander patients who present to a regional cardiac referral centre ED with suspected acute coronary syndrome (ACS). The authors conclude this cohort with suspected ACS have a high burden of traditional cardiac risk factors, regardless of whether they are eventually diagnosed with ACS. These patients may benefit from assessment for coronary artery disease regardless of age at presentation. In a nice paper, James Mallows explores the concept of collegiality, something considered to be any extra-role behaviour that is discretionary, not recognised by a formal reward system and that promotes the effective functioning of the organisation. There are few studies examining collegiality in the medical profession and none looking at collegiality among emergency physicians (EPs). He explores the perceptions of different ED health care professionals on the meaning of collegiality among EPs, the benefits of collegiality and behaviours they identify as indicative of collegiality. He identifies distinct themes and behaviours indicative of collegiality among EPs. Promoting these behaviours could improve staff well-being, ED efficiency, patient safety and productivity. Continuing with the previous theme, team culture underpins team performance. Psychological safety is a critical component of team culture for high performing teams. A group from the Gold Coast Hospital decided to explore this further. They conclude that familiarity of team members and leaders is critical to the development of psychological safety within the ED. Fostering familiarity should be a focus for frontline leadership each shift and a priority in broader departmental decisions for those seeking to enhance the psychological safety of their teams. The focus in this issue is on the anaesthetic component of the Fellowship training programme.

The rise and fall of emotional intelligence in police risk assessments of domestic abuse

The policing of domestic abuse is a significant and problematic element of the frontline officer’s everyday business. Finding ways through which we can improve officers’ interactions with female victims has been none more pressing than in the post covid period, as the increase in domestic abuse continues to rise. This paper is based upon research of frontline officers as leaders in the practice of policing domestic abuse across four police areas and their perspective of emotional intelligence in risk assessing domestic incidents. What it revealed is two-fold; firstly, the considerable decline in its use with those officers who have attended multiple incidents of domestic abuse and how this decline has a negative impact on a victim’s long-term protection. Secondly, the motivation to find ways in which emotional intelligence can be reinvigorated and developed as a frontline leadership skill.

Embracing relational competencies in applying the LEADS framework for health-care leaders in transformational change and the COVID-19 pandemic

PurposeThe purpose of this paper is to assess the extent to which the LEADS Framework guided health-care leaders through organizational change and the COVID-19 pandemic in a western Canadian province.Design/methodology/approachA qualitative exploratory inquiry assessed the extent to which health leaders applied competencies that aligned with the LEADS Framework. A purposeful sample of 22 health-care leaders participated in the study representing senior, mid-level and front-line health-care leaders in various health-care organizations to ensure diverse representation of leader competencies. The authors conducted semi-structured interviews to collect the data and used Braun and Clarke’s (2006) six-phase approach to guide data analysis.FindingsThe analysis suggests that health-care leaders found Engaging with Others and Developing Coalitions were the most critical themes of the LEADS Framework for change management and for navigating the COVID-19 pandemic. Findings reveal that during transformational change and a crisis context, leaders embrace relational approaches to adapt and improve performance in dynamic organizations.Practical implicationsThese findings have implications for a relational approach to improve teamwork and decrease emotional strain; a focus on mobilizing and sharing power with nurses; and educational programs to advance relational and self-management skills, shared leadership, communication, change management, human resource and talent development as critical learning components for current and future health-care leaders.Originality/valueThe LEADS Framework is used to examine how health-care leaders responded to transformational change in the organization while situated in a pandemic context.

Official Information on Twitter during the Pandemic in Spain

This article shows the use of Twitter that the main official spokespersons of the Spanish government made during the first weeks of the pandemic, with the aim of analyzing how government health campaigns were managed during the exceptional period of the state of alarm to deal with the COVID-19 pandemic and whether the instructions in terms of institutional management of communication to combat the infodemic set by the World Health Organization (WHO) were followed. This research considers the diffusion of official information in different phases of the first three months of the government’s action (102 days) from the outbreak of COVID-19 in Spain (March 2020) and how it developed its approach to crisis communication using the Twitter accounts of the President of the Spanish government (@sanchezcastejon), front-line leaders and the Ministry of Health (@sanidadgob), the main public institution responsible for health crisis management with the hashtags #EsteVirusLoParamosUnidos and #COVID-19. The results of a sample of 750 tweets reveal how the official sources used a model of online communication with a particular emphasis on informative and motivational tweets from leaders aimed at audiences (media and the general public). At the same time, there is also an instructive function about the pandemic towards audiences (general public and companies), with the Ministry and health authorities playing a key, proactive role in an attempt to achieve informative transparency to mitigate the pandemic and infodemic.