Introduction: Integrated care for families provides tailored, coordinated support across various life domains. It relies on partnerships between families, professionals, organisations, and policymakers, navigating diverse perspectives, cultures, and structures. These differences make partnerships complex and not a given. While much is known about partnerships, the dynamics between stakeholders in practice remains underexplored. Therefore, this study examines the dynamics of partnerships in the organisation and development of integrated care initiatives, identifying important aspects, facilitators and barriers. Method: This qualitative study explored partnership by following five integrated care teams over two years, through interviews (n = 54), observations of clinical case discussions (n = 40) and four learning sessions, incorporating perspectives of families, professionals, managers and local policymakers on partnership. Results: Four aspects of partnership were identified: shared vision among stakeholders; roles and responsibilities; monitoring and evaluation; and funding. Facilitators included inclusive participation, transparent communication, and flexible approaches. Barriers were conflicting interests, undefined roles and leadership, and fragmented systems that may hinder collaboration. Conclusion/Discussion: Balancing relational and organisational aspects of integrated care is complex yet essential to provide person-centred care. Continuous stakeholder involvement, along with evaluation and reflection, is crucial for fostering shared learning and ensuring the development and sustainability of partnerships within these initiatives.

This research aimed to establish whether there is consensus amongst stakeholders on how to increase agricultural understanding and awareness amongst children and young people, including consideration of stakeholder constructiveness and criticism, in order to contribute to broader understanding of why significant challenge persists in maintaining and growing a sustainable agricultural workforce in the UK. Qualitative content analysis (QCA) was used to review 25 submissions to a recent UK government inquiry on this topic. Responses were included in the analysis if they had answered the inquiry question focused on improving understanding and awareness of career opportunities in land-based sectors amongst children and young adults, and if their question response or their organisational/individual description included any of the following keywords: farm, farmer, farming, agriculture, agricultural, or agri. A high degree of consensus amongst stakeholders was observed, and responses were typically more constructive than critical, with a clear willingness to take action to tackle sector challenges. Specific themes and ideas around the need for high quality career and labour market information and support, engagement with education, collaboration, partnership and policy, and public presence and awareness were identified. There was considerable alignment between existing research, career theory, and the inquiry submissions. It is recommended that agricultural stakeholders are empowered to develop further collaborations, with appropriate government policy and financial support in place, to help them enact their shared vision of constructive change.

Addressing the Global Challenges of COPD and Asthma: A Shared Vision from the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) and the Global Initiative for Asthma (GINA).

This study contributes to ongoing reflections and debate on the legacy of the Ottawa Charter by illustrating how contemporary forms of intersectoral collaboration can be mobilized to address persistent health inequalities. Collaborations involving organizations from diverse sectors are often viewed as well-positioned to tackle complex health challenges, yet they frequently encounter political, organizational and cultural barriers that hinder their effectiveness. This paper uses a longitudinal approach to explore issues in relation to the formation and sustainability of a multi-sector collaboration in one geographic area in the UK, working under the banner of the Health Determinants Research Collaboration (HDRC)—a programme which seeks to further understand health determinants and to improve health outcomes in communities. Through qualitative interviews at two time points—12 months apart—with constituents of the collaboration, the data demonstrated a clear and shared vision for the collaboration and a neat ‘dovetailing’ of skill-sets related to community brokerage; academic rigour; and statutory legitimacy. While the collaboration under focus here was in its infancy, cultural, and practical tensions in ways of working; trust issues; pace of working; and philosophy were predicted to, and indeed did, emerge and required careful monitoring to ensure intended outcomes were not derailed.

Background and Aims: The evolution of digital technology has been continuously and rapidly advancing at an exponential rate, significantly influencing the way people live and leading to notable changes in societal lifestyles. Today, many countries around the world are leveraging digital technology to drive national development. Therefore, leaders and administrators must be capable of managing and developing ideas that benefit society and the greater good. The objectives of this research were to study and compare the levels of personnel’s opinions toward the digital leadership of school administrators under the Office of Learning Promotion, Chaiyaphum Province, classified by educational level and work experience. Additionally, the study aimed to explore guidelines for developing the digital leadership of school administrators under the Office of Learning Promotion, Chaiyaphum Province. Methodology: The sample group consisted of 217 school administrators and teachers under the Office of Learning Promotion, Chaiyaphum Province. The sample size was determined using Krejcie and Morgan's sampling table and selected through stratified random sampling. The research instruments included a 5-point Likert scale questionnaire and a semi-structured interview. The Index of Item-Objective Congruence (IOC) ranged from 0.80 to 1.00, and the reliability coefficient was 0.89. Data analysis was conducted using frequency, percentage, mean, standard deviation, t-test, F-test, and Scheffé’s method for pairwise comparison. Results: Research Findings: 1. The digital leadership of school administrators under the Office of Learning Promotion, Chaiyaphum Province, was found to be at a high level overall. 2. When categorized by educational level, the overall digital leadership of school administrators showed statistically significant differences at the 0.05 level. However, there were no significant differences in the aspects of digital vision, digital learning culture, and digital citizenship. 3. When categorized by work experience, there were no significant differences in digital leadership overall or any individual aspects. 4. Guidelines for developing digital leadership among school administrators under the Office of Learning Promotion, Chaiyaphum Province, were identified as follows: (1) Digital Vision: Administrators must adapt to change and collaborate with teachers and staff to create a shared digital vision. (2) Digital Learning Culture: There should be continuous promotion of a digital learning culture within schools and the consistent use of technology in operations. (3) Digital Communication: Administrators should utilize technology to build a positive organizational image and promote communication through digital media. (4) Digital Literacy: Administrators should lead in the integration of technology in education and support staff in their professional development related to educational technology. (5) Digital Citizenship: Administrators should possess knowledge of relevant legal aspects and promote legal understanding of technology among staff and students. Conclusion: Developing digital leadership among school administrators involves adapting to change and collaboratively creating a digital vision with teachers and staff. It promotes a digital learning culture, utilizes technology in operations, communicates through digital media, and builds a positive organizational image. Administrators should be technology leaders, support staff in their professional development, and promote understanding of technology-related laws among everyone in the educational institution.

The Creation of ICAPS 2024: The Power of Teamwork, Collaboration, and a Shared Vision in Advancing Patient Safety.

Shared Visions: Evaluating Potential in Unsettled Fields

Health system stewardship involves steering and oversight through authoritative vision-setting, effectively intervening and influencing within the health system, and placing high-value on evidence. Governments apply a multitude of strategies to assure the safety and quality of clinical care. Governments have predominately relied upon hierarchy and markets to influence health systems, but both have demonstrated limitations resulting in increased interest in networks. Clinical networks are groups that traverse institutional and professional boundaries to define and support the adoption of expectations for evidence-based care. Well-established across Australia, the unique contribution of clinical networks to stewardship and safety and quality aims has yet to be examined. A qualitative study was conducted to examine how Australian clinical networks operationalize stewardship. Methods involved interviews at the national level and comparative case study of three clinical networks within the state of Victoria. Semi-structured interviews were conducted involving government public service representatives, network managers, leads and members (n = 47). A blended deductive and inductive thematic analytical approach was applied. Findings show that the execution of safety and quality stewardship must rely on a binding structure, such as networks, to coordinate diverse actors whose behaviours and decisions ultimately affect clinical care. Networks collaborate to develop a shared vision for services, placing reliance on socially mediated influence to motivate actors to act in accordance with the vision. Yet safety and quality problems can be wicked and opaque, necessitating the use of diverse evidence types to understand problems and develop solutions that can be implemented. Networks balance evidence quality and applicability to context, elevating the importance of capability in evidence use. Empirical contributions show the necessity of networks to execute safety and quality stewardship as a shared responsibility of actors. Stewardship is not a function of governments alone. Findings show the necessity of motivation at the level of the individual to shape understanding, behaviours and quality of actor decision-making. Evidence of all types retain an instrumental role in building knowledge as a form of influence. This research argues that health system stewardship, networks and evidence use need to be considered in an interdependent way to realize safety and quality aims.

Evidence-based practice is critical to providing high-quality hospice and palliative nursing care. Professional organizations, such as the Hospice and Palliative Nurses Association (HPNA), play a critical role in shaping the future of the hospice and palliative nursing field by identifying gaps in the science and fostering collaborative research efforts to inform evidence-based practices. One such driver is the tri-annual HPNA Research Agenda, which outlines key research priorities in hospice and palliative nursing, ultimately aiming to accelerate translation of research into practice and practice improvements. In this article, 6 emerging research scholars in the field and present and former co-chairs of the HPNA Emerging Research Scholar Special Interest Group reflect on the experiences that led them to pursue research careers in hospice and palliative nursing. Through a process of collective self-assessment, these scholars articulated their shared progress toward addressing the research priorities outlined in the 2023-2026 HPNA Research Agenda as a means of generating insights to direct future research efforts in the field.

Vision Transformers (ViTs) demonstrate significant promise in medical image analysis but face two critical challenges: 1) their limited ability to capture local features in data-scarce scenarios, leading to data inefficiency, and 2) their high computational and storage demands of the full fine-tuning process in transfer learning, resulting in parameter inefficiency. To achieve efficient and accurate medical image analysis, we propose Shared Attention Vision Transformer (SAViT) that comprises three innovative modules: i) Shared Prior Attention (SPA) that enhances data efficiency by innovatively employing a visual prompt to sequentially share consistent attention weights across local image regions, thereby enabling the learning of translational invariance to capture locality; ii) MixPool that preserves global modeling ability by aggregating local features after SPA through a multi-pooling mechanism, thus effectively facilitating long-range dependency across local image regions; and iii) Low-rank Multi-head Self-Attention (Lr-MSA) that improves parameter efficiency by using low-rank weights of multi-head self-attention, hence reducing computational complexity while maintaining accuracy in medical image analysis. SAViT demonstrates strong generalization across multiple medical imaging modalities, including retinopathy, dermoscopy, and radiography. Extensive experiments are conducted. The results indicate its high data efficiency and outstanding performance in comparison with more than 20 medical-specific and ViT-based models when all of them are trained from scratch. It excels in parameter-efficient tuning by surpassing 17 models across 6 datasets in transfer learning, with only 0.17M/0.23M trainable parameters on ViT-B/SwinViT-B backbones requiring 86.60M/88.00M parameters. Source code can be found at: https://github.com/LYH-hh/SAViT.

This study assessed the leadership approaches of school administrators in rural and urban areas in Carcar City Division for the school year 2025-2026. This research employed a mixed-methods approach to achieve a thorough insight into the leadership approaches of administrators in rural and urban schools. The results revealed that the leadership approaches of school administrators, such as inspiring a shared vision, fostering a positive school culture, providing individualized support, encouraging innovation and risk-taking, and building trust and empowerment, were all rated as Strongly Agree by teachers in both rural and urban areas. The findings revealed no significant difference in the level of leadership approaches between the two contexts. However, a significant relationship was found between years of teaching experience and the administrators’ leadership approaches in both settings. Additionally, in urban schools, age was significantly related to the ability to inspire a shared vision. Contextual factors in rural and urban schools influence leadership effectiveness by shaping the challenges, resources, and community dynamics administrators face. Emerging themes included participative, collaborative, and adaptive leadership; context-responsive and relationship-centered practices; as well as challenges in operations, human resources, and relational aspects. The findings also highlighted the importance of sustained, reflective professional development tailored to local contexts. Rural and urban school leaders face distinct challenges, yet both demonstrate strong commitment to student success. Effective leadership requires adaptability, context-awareness, and tailored development to meet each school’s unique needs through a leadership development plan.

This study aimed to explore the experience of a sense of community among volunteers of Yayasan Rumpun Nurani (YRN), a faith-based social organization in Yogyakarta, Indonesia. Using a qualitative case study design, this study examines how shared Islamic values and informal community structures contribute to volunteer cohesion and organizational sustainability. Data were collected through focus group discussions, participatory observation, and document analysis of twenty active volunteers. Data analysis was conducted using Braun and Clarke's six-step thematic analysis approach. The results of the analysis resulted in eight interrelated themes: shared values and vision, belonging, peer support and emotional contagion, flexible commitment, spiritual and personal growth, conflict management, youth engagement and regeneration, and social and professional benefits. These findings suggest that spiritual values, relational dynamics, and non-hierarchical participation play a central role in fostering a sense of community in the context of grassroots communities. Theoretically, this research enriches community psychology by contextualizing the theory of sense of community in collectivist Islamic culture. Practically, the results of this study provide insights for the development of faith-based empowerment programs that strengthen social cohesion, women's participation, and cross-generational involvement in volunteer organizations.

In the light of recent initiatives to establish one shared European space and vision for citizenship education (CE), this paper addresses the long history of European CE efforts as a tectonic enterprise : one of slow and imperceptible change and preconditioned by unpredictability, complexity and contestation. By shining a critical light on the normative commonalities, tensions and contradictions underlying past and present initiatives of CE, this contribution aims to refute the commonplace assumption that more or better citizenship education can produce better citizens and a better democratic society. Rather, I argue that, – as shown by the articles in this special issue – CE unavoidably operates in the tensions and contestations between past and future, established and emerging worldviews and values. It is precisely this element of moving and struggling between past and future that holds potential for helping young people to take on their rights and responsibilities as (future) citizens and offers a lead for rethinking CE efforts in Europe as an ambitious and transformative enterprise. This, however, requires commitment to creating spaces for debates, contestations and negotiations, rather than handing down assumed shared visions and common values to young and future generations through frameworks and regulations.

BackgroundOne of the key priorities of Saudi Vision 2030 is to ensure that all Saudi citizens have access to high‐quality healthcare, but this goal is constrained by international and domestic nursing staff shortages. Nursing directors have recommended introducing a professional career path focused on developing nurses’ leadership skills. Despite recognition of nurse managers’ key role in recruiting, retaining, and engaging nurses, few studies have explored how Saudi managers acquire and deploy leadership skills. This study explores how nurse managers view and experience workplace leadership.MethodsThis ethnographic study examined nurse managers’ perceptions and experiences of leadership development in a Saudi hospital affiliated with the Ministry of Health. Qualitative data were collected during periodic visits over eight months, including workplace and continuing medical education observations, document examinations, and informal and semistructured interviews with 21 nurse managers. A framework analysis approach was used to interpret and summarize the data.FindingsThe data were organized into four major themes: imbalanced power dynamics, no shared vision, workplace rituals and behaviors, and the need for learning. The findings indicated a power imbalance, consistent with international studies. The hospital had hierarchical and transactional management structures and a culturally pervasive leadership approach framed by wasta (“middleman” or “go‐between” in Arabic). Such nepotism, normalized in Saudi business practice, is officially recognized and condemned as corrupt by state legislators. The Saudi government is rigorously combating this practice through strict regulations and enforcement. A climate encouraging adherence with the directorate’s guidelines led managers to comply, even though they employed strategies to subvert some of its authority.ConclusionWasta was used to enhance performance, obtain rewards, secure favorable work assignments, gain meritless promotions, and allocate staff arbitrarily. Paradoxically, while managers criticized the capricious use of wasta, they also employed it to secure what they believed they deserved, sometimes at the expense of their colleagues’ careers.

This study investigates how primary school leaders build high levels of faculty trust by integrating Transformational (TL), Instructional (IL) and Distributed Leadership (DL) within a highly centralised education system. Using a sequential mixed-methods multi-case design, survey data from 1320 teachers across 85 public schools identified five high-trust sites for in-depth qualitative inquiry through interviews and observations. Principals in these schools enacted context-responsive blends of leadership; articulated shared moral purpose and vision (TL), sustained instructional quality and credibility (IL) and empowered teachers through participatory decision-making (DL). Trust functioned simultaneously as a precondition and a product of these practices, reinforcing collaboration, collective efficacy and professional learning despite systemic constraints. Contextual variables – particularly governance centralisation, school size and relational culture – shaped how integration occurred. School leaders can strengthen trust by modelling fairness and transparency, engaging meaningfully with teaching and learning and sharing decision-making that recognises teacher expertise. Leadership preparation programmes should subsequently prioritise the development of these relational, instructional and collaborative competencies that enable principals to build cohesive, trust-rich school cultures within policy-driven environments. Ultimately, the study advances understanding of how integrated, trust-based leadership sustains professional cohesion and organisational resilience, offering a transferable model for leadership in both centralised and decentralised education systems.

<p>A professional learning community (PLC) is a group of educational personnel who come together to exchange knowledge, develop, and collaboratively solve problems related to improving instructional practices and school issues. The common goal is to develop students’ competencies. PLCs have the potential to transform the quality of educational results significantly. Consequently, studying the components and indicators of a PLC and conducting confirmatory factor analysis (CFA) of PLC models can help schools understand the key factors and practices that contribute to PLC success. This knowledge can be applied to develop a strong PLC within the school. The study of components and indicators of the PLC is exploratory research. The samples consisted of 1,080 administrators and heads of the subject group from 120 schools under the Secondary Educational Service Area Office, randomized by multi-stage random sampling. The research tool was a 4-level rating scale questionnaire. Research findings indicate that the CFA of PLCs aligns with empirical evidence. All components in the PLC model have significant factor loadings ranging from 0.916 to 0.945 at the 0.01 level (p<0.01). When ranked from highest to lowest, these components are: i) supportive conditions–structures; ii) shared values and vision; iii) collective learning and application; iv) Shared and supportive leadership; v) supportive conditions–relationships; and vi) shared personal practice. All of these are essential components of a PLC and serve as an important mechanism for educational personnel to work together to improve the quality of schools.</p>

Tracheostomy care spans critical care, rehabilitation, and community settings, requiring collaboration among clinicians, patients, and families. The International Council of Nurses' (ICN) 2025 definitions of nursing and a nurse provide a timely framework for advancing this continuum, emphasizing equity, health literacy, cultural safety, and shared accountability. These principles align with the mission of the Global Tracheostomy Collaborative, which promotes interprofessional teamwork, caregiver engagement, and data-driven quality improvement. Within this model, nurses serve as system integrators, working with patients and professionals in safeguarding airway management, supporting transitions, and empowering families with knowledge and confidence. Evidence demonstrates that structured protocols, discharge planning, and caregiver training reduce complications, disparities, and readmissions. Globally, nurses are also critical team members who drive innovation in resource-limited settings, adapting protocols and educational strategies to community needs. By situating tracheostomy care within the ICN framework, we highlight the central role of nurses as autonomous practitioners and collaborative partners. Specific examples illustrate this continuum. The renewed definitions reinforce that tracheostomy safety and dignity depend not on isolated tasks, but on coordinated, culturally responsive systems of care. This shared language affirms recognition of contributions of all health professional engaged in interprofessional collaboration, thereby offering a global vision for safer, more equitable outcomes across the tracheostomy journey.

Top management's green inclusive leadership and sustainable competitive advantage in manufacturing firms: The enabling role of internal CSR communication.

Health-system leaders are increasingly faced with making decisions about whether and how to use a wide range of current and emerging health-system innovations to address complex system and policy challenges. Health-system innovations can broadly include new ways of doing things at a system level, such as new approaches to govern health systems, care delivery, funding models, health policy or better ways to integrate health and social services. However, Canada has historically struggled with the adaptation and uptake of health-system innovations. This multicomponent study aimed to explore the challenges, approaches and implementation considerations for creating an integrated innovation system that enables the adaptation and uptake of health-system innovations from the perspectives of citizens and health system leaders in Canada. We synthesized the best-available evidence into an evidence brief and a subsequent plain-language version (a citizen brief) in consultation with a steering committee and key informants, including policymakers, leaders of systems, organizations and professional organizations, industry representatives, citizen leaders and researchers. These briefs informed deliberations in four citizen panels (n = 48 participants) and a national stakeholder dialogue with health-system leaders (n = 23 participants) to identify key challenges, approaches, implementation considerations and next steps that could be taken. Citizen panel participants and health-system leaders highlighted barriers such as culture and mindsets that resist health-system innovations, limited targeted funding for health-system innovations and processes that encourage sustainability, lack of mechanisms to adapt health-system innovation in local contexts and limited health human resources due to competing interests across health systems. Both groups emphasized the need for people-centred approaches to establish shared goals and vision, identify gaps and map what has worked to drive health-system innovations, set priorities and discuss how each stakeholder group can contribute to building and reviewing implementation considerations such as resources and funding related for the adaptation and uptake of health-system innovations. The findings provide insight for ongoing efforts to improve the development, implementation and evaluation efforts to enhance and harness health-system innovation to strengthen health systems in Canada. Collaboration from within and between governments and sectors will ultimately help to increase the value gained from health-system innovations.

Diversity, equity, and inclusion (DEI) have become defining priorities within veterinary ophthalmology, as reflected in editorial leadership, association-level initiatives, and professional development programs. To translate these professional commitments into daily practice requires more than isolated efforts by individual practitioners. This paper proposes disclosure-responsivity cycles as a practical framework to empower leaders to embed DEI concepts into their daily operations. Disclosure is an individual's decision to share personal or professional information (e.g., acknowledge medical errors or reveal identity characteristics). Responsivity describes the degree to which individuals feel supported after disclosure, both interpersonally and organizationally. Research shows that when organizations are consistently responsive, disclosure reduces psychological strain, builds trust, and enhances inclusivity. The key challenge, therefore, is to cocreate organizations that support disclosure with fair and reliable responsivity. Drawing on organizational theory, change management, and veterinary literature, this paper identifies four domains where disclosure-responsivity cycles can be institutionalized: shared vision, communication channels, competency development, and policy transparency. Together, these domains create interdependent systems that embed DEI into daily practice. For veterinary ophthalmologists, this framework offers a path to cultivate organizations that are adaptive, inclusive, and resilient.