How to Keep Home Healthcare on Target

Home visits have the power to ease the clinical trial process for patients, but complex study design, tight timelines, busy clinical operations teams, and overburdened sites can sometimes make home health feel like yet another moving piece to manage. Individual variables that play a large role in establishing timelines can include factors like: * Amount of protocol-specific training required. * Level of engagement during a visit. * On-site processing requirements. * Drug or sample stability. * Recruitment goals. [...]all training should be to the full satisfaction of the principal investigator overseeing the study. Since sites are still responsible for the conduct of home visits from a regulatory perspective, there is often a concern about how they can remain in control of the progress without overwhelming the already busy study team and staff.

Re-evaluating online oral examinations

[...]a large number of lecturers called in sick or declared that they were unable to attend for health and safety reasons. The transition required the following steps: prompt communication with the students about the new modus operandi;staff training on the use of Teams;setting up of Teams exam meetings;evaluation and re-design of the exam content. Another clear benefit of Teams meetings is the centrally stored video recordings for all examinations, which can be used for quality assurance purposes, that is, checking by external examiners, in potential student appeals or academic misconduct investigations. Unstable or poor Internet connection;2. student camera turned off;3. hardware issues with the camera or microphone;4. background noise and echo;5. poor student or examiner information technology (IT) skills.

Key performance measurement capabilities for managing distributed teams

Distributed teams are a reality for several companies nowadays, many authors covered their benefits and problems, and the rate of adoption of such team's structure by companies is growing fast. Since these teams are more present in companies, a performance measurement system must get adapted to fulfill the gap of not having a vast theory about the subject. To fill that gap, this paper brings results from previous steps in the research (Systematic Literature Review and Qualitative analysis of the data). It presents to a group of experts to reach a consensus on which capabilities are essential to managing/developing distributed teams' performance. The experts were exposed to the information following a Delphi Panel format and provided output that reached consensus and refined the list. The experts indicated that a group of six capabilities (engagement, development of a culture of performance measurement, organizational learning, alignment between planning and execution, accurate information and consistency) are essential to have their performance measurement system working correctly and reaching all functions. The work also identified the success factors for virtual teams, providing directions for the adoption and the monitoring of this kind of team that gained importance during the COVID-19 pandemic.

Assessment Processes of Dependency Situations in Spain: The Role of Social Work

The paper analyses the processes of assessment of situations of dependency in Spain and the role of Social Work in them. The study provides new information, trying to detect possible influences of Covid-19 on these processes and analysing existing territorial disparities. From an intentional documentary search, information was subsequently collected from the General Directorates or Sub -directorates, or the autonomous Institutes of social services through an ad hoc questionnaire, obtaining responses from the universe of analysis units (17 autonomous communities). Said information was organized into three categories of analysis: mandatory nature of the social report in the assessment of situations of dependency;place of application of the DAS and the SRS;and professional profiles of the teams for assessing dependency situations. The results show, among other results, the existence of very different interprofessional teams, the application of the scale in divergent contexts, and the different relevance of the social report in the processes. In conclusion, the need to deepen the inclusion of the social report and the professional figure of Social Work in the assessment processes is evident by contributing to the improvement of the coordination of objectives, processes, and resources.

Addressing the Key Pitfalls Hindering Technology Transfer Success

The key challenges that are commonly faced by companies undertaking a tech transfer include: * Client expectations and initial project scope definition: the initial assumptions of the drug developer or marketing authorization holder (MHA) based on their initial information relating to the product can be a significant challenge. Typical examples include product stability issues (typically on legacy products) being evidenced due to a change to more compliant analytical methods;change to product brought about by compliance-related requirements on legacy products, such as nitrosamines, and elemental impurities guidelines, etc.;and regulatory requirements being misjudged at the onset of the project, among other factors. * Product knowledge management: particularly when undertaking tech transfers of legacy products or products in the initial discovery phase, there may be a lack of technical knowledge on the product itself to make a comprehensive and robust tech transfer process. All this may contribute to slowing down the transfer of knowledge, with implications for tech transfer timelines. * Standardization at receiving site: another challenge typically faced by receiving sites of CDMOs is a lack of standardization of their internal processes and or documentation brought about by multiple tech transfers with varying types of clients with multiple requirements. The originating site-particularly if it belongs to a small start-up-may not have team members with specialist experience in handling a transfer, so may need additional support in collating the required information to hand over to the receiving site.

Understanding student technology teams within K-12 technology ecosystems

Access and use of computer-based educational technology within K-12 schools have been steadily increasing since the 1980s (Cuban, 1993;Delgado et al., 2015;Penuel, 2006), including more school districts providing every student with a device (1:1) after the year 2000 (Gray & Lewis, 2021;Harper & Milman, 2016;Penuel, 2006;Zheng et al., 2016). Despite this steady increase in devices, information systems, and learning platforms within schools, growth of information technology (IT) staff positions has not grown proportionally with technology and has resulted in a staff capacity issue for district technology departments (CoSN, 2021;Gao & Murphy, 2016;Kentucky Department of Education, 2017). This issue was exacerbated by the emergency switch to distance learning as a result of the COVID-19 pandemic, which relied on devices and online systems for learning to continue and further strained the technology departments (CoSN, 2022a, 2022b;Rauf, 2020;White, 2020).Since computers were introduced to these educational institutions, schools and districts have positioned students as technical and pedagogical supports for educational technology (National School Boards Association, 2002;Van Eck et al., 2001). Commonly known as student tech teams (STTs), this type of program is still frequent today within schools and there is a wealth of practitioner-created resources on the topic. Yet, studies on these programs are absent from the decades of research on technology integration within K-12 schools (Peterson & Scharber, 2017).This dissertation was designed to fill this void within the literature, provide a foundational understanding of STTs within K-12 educational technology initiatives, and identify practical strategies for school educators and leaders. Using a philosophically pragmatic lens and an ecological framework (Zhao & Frank, 2003), this explanatory sequential mixed-methods study (Creswell & Plano Clark, 2011) explored the following research questions:* How are student technology teams structured within K-12 school ecosystems?* What is the role of student technology teams within K-12 technology integration initiatives?Results from the study indicated that STTs are structured as work- and project-based courses, assistantships, and extracurriculars that can support the technical and instructional needs of staff and students within a school or district environment. STTs also provide opportunities for students to collaborate and create by tinkering with technologies and developing products that interest them while building their digital literacy skills. No two STTs are structured the same;however, staff and students' technical and instructional needs are common programmatic focus areas across STT environments.The role of STTs within K-12 technology integration initiatives is to give students autonomy, unique experiences, and opportunities to learn while serving the school and/or district community. The role of STT, as well as the benefit to its student members, is shaped by the coaches, tech department, and administrators' intentionality and mindset related to the capacity of students. Secondly, the STT's role is also shaped by the school and district's technology, schedules, and location. The findings of this study contribute to and extend the current understanding of educational technology initiatives, student tech teams, computing education in schools, and ecological framing of educational technologies. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Student perspectives on the challenges of an online orientation at a large South African university during the COVID-19 pandemic

The COVID-19 pandemic that began in March 2020 gave rise to a number of challenges for first-year experience activities at universities globally. One of the key challenges was the process of onboarding first-year students through an orientation programme that could not take place face-to-face as per the norm. In 2021, the first-year orientation at a large South African university in this study moved to an online platform, becoming a week-long programme conducted on Microsoft Teams and comprising a variety of live and pre-recorded videos. The programme included seven core learning sessions designed to introduce the students to key services available at the university and to lay the foundation for student success. Using data from the university's 2021 Orientation Week (O-Week) Survey, this paper seeks to explore - from the perspective of the students - the core challenges associated with an online orientation during the COVID-19 pandemic. The study employs descriptive statistics to decipher the profile of the survey respondents as well as participants' experience of various learning sessions. A thematic approach was used to analyse the open-ended questions to provide the contextual perspectives on the challenges that students experienced with online orientation. The study identified five categories of challenges, which had a negative impact on their process of transitioning into the university environment. The study's findings will help universities to understand the drawbacks of online orientation as well as provide empirical guidance for them as to how they could leverage online orientation for student success in shaping the remote, blended, and hybrid learning discourse. The particular university under discussion subsequently used these findings as guidelines to conceptualise a new three-week blended orientation programme, Gateway to Success, which was introduced at the beginning of 2022.

The introduction of novel bladder outlet therapies in a regional day-case unit in Northern Ireland

ContextNorthern Ireland has five health and social care trusts that provide a Urology service. COVID-19 resulted in the cessation of all but the most urgent elective urological cases. As a result there was an immediate need to enhance current facilities to improve care for our patients. Operations for bladder outlet obstruction, such as transurethral resection of the prostate (TURP), were largely on hold. Men with benign prostatic enlargement continued to suffer in terms of quality of life from symptoms and morbidity from their condition, with subsequent costly attendances through unscheduled care.Issue/ChallengeAs one trust, we had over 100 men active on a waiting list for TURP. We had over 100 patients awaiting a review to decide on surgical management. We had over 400 men awaiting routine assessment through our lower urinary tract symptom assessment clinic.Several surgical options now exist for bladder outlet obstruction. Until this project, TURP was the only option offered to men in Northern Ireland, which is out-with NICE guidance. A TURP has traditionally been an inpatient operation requiring a hospital stay of 2-3 days. During the pandemic and looking to the recovery of services, this was not a viable option.Assessment of issue and analysis of its causesA scoping exercise on where to best place any new service was performed. Key stakeholders included our clinical leaders, management colleagues in the trust and the Department of Health. With successful implementation of a traffic light system for COVID-19, a green pathway for elective surgery had been implemented with great success in our main inpatient Ulster Hospital site. Reflecting on what had been learned in this process, and with a clear need to advocate day-case as default for certain procedures, a regional centre out-with our main inpatient operating theatres was delivered – the Regional Day Procedure Centre (DPC), based at Lagan Valley Hospital.ImpactThe impact has been improved individual patient journeys and improved quality of life for men living with benign prostatic obstruction, with their treatment happening much more promptly, as well as increased staff satisfaction and a saving in theatre costs and bed days.InterventionWe learned and implemented novel bladder outlet techniques;namely Rezum steam ablation therapy to the prostate;green light laser treatment of the prostate (GLLP) and hoImium enucleation of the prostate (HoLEP). We arranged simulation-based training for our Consultant and Speciality Doctor team and mock theatre set up training with the theatre staff to include common pitfalls with equipment. We also arranged simulation-based training for postgraduate surgical trainees, enhancing training during the pandemic.Involvement of stakeholders, such as patients, carers or family members:We engaged and had the support of the clinical and managerial teams from the outset. We opened communication with the day-case unit pre-assessment and anaesthetic teams early. We introduced a new co-located outpatient prostate assessment clinic in conjunction with a nurse specialist.Key MessagesOver the last 6 months we have implemented an all options service for bladder outlet obstruction. We have performed more than 50 day-case Rezum cases, introduced day-case GLLP and inpatient HoLEP. All Rezum and GLLP cases have been day-case with the subsequent personal and institutional savings. We will report our clinical outcomes and reflect on lessons learned.Lessons learntThe introduction of novel bladder outlet therapies has led to improved quality of life for men living with bladder outlet obstruction. We have significantly reduced the waiting list and the waiting time for treatment. We have shown that service development and improvement for benign disease is possible even during a pandemic.Measurement of improvementWe are following up these men with validated symptoms and quality of life scores. We get objective measurement of improvement through repeat flow rate and measurement of post void residual urinary volumes. We have kept a database on key patien parameters and self-reported outcomes. Initial results are promising.Strategy for improvementAs an ongoing and ever evolving project, we use multiple PDSA cycles to improve our service. Weekly team briefs at the end of theatre lists allow feedback from all staff. In particular we have learned from our patients. We have introduced local anaesthetic treatment with Rezum in men unfit for other options. We have contacted other units to share their experience and there has been coverage of our work in our regional media.

The Role of Transferable Skills and Data Science in the Move to Digitally-Enabled Clinical Research

According to the job's website Recruiter, clinical data management vacancies have increased by almost 94% since 2019.' Artificial intelligence (AI), including machine learning (ML) and natural language processing (NLP), is allowing for the more intelligent analysis of trial data. New approaches, new roles Centralized statistical monitoring, which streamlines drug development by allowing for the near real-time analysis of data as it accumulates, is the perfect example of how the changing research paradigm is creating new roles.

Home team's advantage reduced without crowd support after the COVID-19 outbreak

Historically, fan attendance at sporting events has always been considered an advantage for the home team. The level of fan attendance at soccer matches was evaluated as a decisive effect to modify the performance of the home teams in the most important soccer leagues around the world. We exploit the effects of the absence of spectators driven by COVID-19 pandemic mitigation policies. We find that the advantage of the home field, measured by the proportion of wins and also by the numbers of goals and points scored, is remarkable in many leagues. We performed comparative hypothesis tests with eight of the world's top soccer leagues, confirming a decrease in the probability of a home win, greatly affecting the matches´ outcomes. [ FROM AUTHOR] Copyright of Soccer & Society is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Through the Lens of Students: MS Teams as a Sustainable Pedagogical Tool

The COVID-19 pandemic has highlighted the need for higher education institutions to modernize and embrace the post-digital age. This study evaluates students' perspectives of utilizing MS Teams as a means of facilitating remote learning during the pandemic. The Technology Acceptance Model (TAM) was employed as the theoretical framework to examine students' views on self-efficacy, facilitating conditions, ease of use, usefulness, and intention to use. The results showcase positive views of MS Teams, with self-efficacy rated the highest among the five constructs, followed by ease of use, facilitating conditions, intention to use, and usefulness. Additionally, no significant differences were found in students' perceptions based on gender. MS Teams has proven to be a successful platform for delivering online learning and communicating, bridging the divide of distance and time in teaching and learning. As discussions about the future of higher education in the post-pandemic world have commenced among academia and university officials, it is crucial to consider the impact of COVID-19 on student learning and provide suggestions for a more sustainable and effective post-pandemic education. © 2023 IEEE.

The spatial concentration, stability, and specialization of mental health calls for service: Evidence in support of proactive, place-based interventions

For many decades the police have been the de facto responders to persons with perceived mental illness (PwPMI). However, having the police in this role has come with negative repercussions for PwPMI, such as disproportionately experiencing criminalization and use of force. In recognizing these issues, the police-and more recently, the community-have developed responses that either seek to improve interactions between the police and PwPMI or remove the police from this role altogether. However, in either case, these efforts are reactivein nature, responding to crises that arguably could have been prevented had a timelier intervention taken place. Further, evidence on certain police responses to PwPMI, such as Crisis Intervention Teams (CIT) and co-response teams, suggests that they endure deployment-related challenges, thus limiting their reach to PwPMI.Drawing from the Criminology of Place and existing place-based policing strategies, the present dissertation argues that efforts focused on respondingto PwPMI should instead be proactively deployed, targeting areas where interactions between police and PwPMI concentrate spatially. Doing so would not only result in efficient deployment of scarce resources but would permit police- and community-based efforts to have a greater reach to PwPMI and thus prevent future interactions with police. To-date, however, there have been few empirical and theoretical investigations into the spatial patterns of PwPMI calls for service that could inform such proactive, place-based efforts. Specifically, we do not currently understand: (1) the degree to which PwPMI calls for service concentrate within certain geographical contexts (such as a small city);(2) whether the degree of PwPMI call concentration and the location of these calls remain stable over time;and (3) what theoretical frameworks explain why PwPMI calls for service occur where they do. Drawing on seven years (2014-2020) of calls for service data from the Barrie Police Service and data from the 2016 Canadian Census, the present dissertation employs various methods of spatial analysis to fills these specific knowledge gaps.Although the theoretical investigation confirmed the findings of previous work that found no association between social disorganization theory and the spatial patterns of PwPMI calls for service, the present dissertation revealed: (1) PwPMI calls for service are highly concentrated within the context of a small city, even more so than what has previously been uncovered in larger jurisdictions;(2) the degree of PwPMI call concentration is stable over time, falling within a narrow proportional bandwidth of spatial units;and (3) PwPMI calls for service, and their concentrations, occur in the same places over time-even during the COVID-19 pandemic-and are thus spatially stable. As such, though more scholarship is needed on theories that might help explain why PwPMI calls occur where they do, the findings of the present dissertation strongly support the proactive, place-based deployment of resources to PwPMI. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Virtual team performance: E-leadership roles in the era of COVID-19

Purpose: The coronavirus disease 2019 (COVID-19) situation has led to the emergence of virtual teams in all organizations, and the role of leadership has become more pertinent. The current research focuses on understanding the factors for better team performance in virtual teams. Based on the contingency perspective, the behavioral complexity in leadership (BCL) theory is the most appropriate as BCL requires the leader to demonstrate multiple contrasting leadership behaviors according to the situation. Both internal as well external roles were explored, which could facilitate better communication quality and role clarity to increase interpersonal trust and leadership effectiveness in the current crisis. Design/methodology/approach: Data were collected from employees who have worked in virtual teams during the crisis and who have experience of working in a virtual team environment. A total of 200 questionnaires were distributed, and 175 were received. A path model was built applying partial least squares structural equation modeling (PLS-SEM). Findings: Communication quality has come as a partial mediator for the relationship between internal and external leadership roles and trust. Role clarity fully mediated the relationship between external leadership roles and conflict. Internal and external leadership roles showed a significant effect on leadership effectiveness, which were further related to team performance in virtual teams. Additionally, synchronous technology was used more by virtual teams. Research limitations/implications: The study did not examine cultural differences or cultural adaptation in virtual teams. Instead of the BCL theory, future research may apply attribute-based or relational-based theory to examine leadership roles in virtual team performance. Originality/value: Using the BCL theory, the current study contributes to an understanding of virtual team performance and the internal as well as external role of leaders. This is relevant in an environment of extreme ambiguity such as COVID-19. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Lessons learned from the COVID-19 pandemic: implications for semiprofessional soccer clubs after the crisis- a team study

In 2019-2020 and 2020-2021, the COVID-19 pandemic led to unexpected behavioral restrictions, allowing only the individual training of the athletes. The purpose of the present study was to record the effects of a home-based training program on physical performance at a semi-professional level, after the Covid-19 confinement, in terms of external load. Twenty soccer players from one semi-professional team participated in this study. The data was collected by GPS devices, with an accelerometer and gyroscope, and a sampling rate 10Hz. The external load is evaluated by the total distance, the high-intensity runs, the sprint distance as well as the number of accelerations and decelerations. Three matches before and twelve games after the lockdown were analyzed and compared. During the confinement period, the players performed 5-6 training sessions per week. This period lasted over 4 four months. The training sessions were monitored by a free smartphone application. Similarly, the players communicated with the technical staff with a free internet application. The results showed significant increases (p < 0.05) in the total distance covered during the matches after the intervention. No significant increase in high-intensity runs and the number of accelerations were found (p > 0.05). The present data suggest that an intervention monitored by a free application could improve athletic performance at the semi-professional level, even after long-term abstinence from team training such as quarantine or off-season periods. These data might provide affordable solutions to the semi-professional soccer teams, which could be used during the off-season period leading to reduce detraining effects and higher performance in the forthcoming championship.

5 Ways DCTs Can Positively Impact Trial Diversity

The problem became so concerning that FDA expanded its guidelines for enhancing the diversity of clinical trial populations.3 Despite recent and profound medical and technological advances, there is limited evidence of these changes moving the needle toward more equitable clinical trial recruitment or improved health outcomes for racial and ethnic minorities. According to data compiled by Shonda Anderson-Williams, healthcare and life sciences digital transformation leader at Microsoft, diverse companies outperform the competition by 35%. The key to change is meeting people where they are. [...]any organization looking to make inroads with new populations must first acknowledge the historical facts that got us where we are, and then work to move past it. 4. Center the human Factor in decentralized trials Relying on digital technology to the exclusion of human interaction misses out on the texture of relationships and the very foundation of trustbuilding-a critical component of effectively en gaging communities of color who may often carry justifiable baggage.

Driving Consistency in Validation Management

FDA also explained that system designs and controls should allow for detecting errors, omissions, and unusual results-outcomes that cannot be easily identified with paper-based processes. Because the guidance requirements for record retention and review don't differ between paper or electronic, this update supports the shift to a digital model. Using paper to check and mark things off is a normal practice in life sciences, even if it is not a very good process for error detection, data collection, or metrics, says Bryony Borneo, quality assurance director at global contract research organization (CRO) Emmes. Building a solid data foundation and gaining more experience with remote ways of working are driving positive change and making it easier for quality teams to remain compliant with regulations. According to Sanjeev Kumar, senior director, data integrity and technology at Vertex Pharmaceuticals, there is greater awareness of data standardization to identify developing trends and insights from information.

Empowering oral health in the community: leadership lessons learnt from redeployment

ContextOral health knowledge is fundamental to ensure all healthcare teams achieve holistic patient care within community settings. During the COVID-19 pandemic, dentists were redeployed to district nursing teams to support wider healthcare service demands, where patients exhibited poor oral health and deficits in staff oral health knowledge were observed.During restoration and recovery of services, three post-graduate dental trainees launched a trust wide training needs analysis amongst non-dental professionals working across Birmingham Community Healthcare NHS Foundation Trust. This identified a lack of confidence in providing mouthcare and oral health advice to patients. As a result, the team created the Oral Health Ambassador Programme, placing oral health leadership with local nursing team leads and providing the resources to champion oral health for patients in their care. Creation of an online training module supported a deficit in oral health training.Issue/ChallengeWorking within a domiciliary setting provided a unique opportunity to experience first-hand the challenges nursing teams face in providing oral health care to their patients. Leading in a novel environment meant incorporating oral health into a holistic care plan whilst overcoming the time restraints of an already stretched workforce during a global pandemic.Assessment of issue and analysis of its causesOn return to service, a trust wide oral health training needs analysis was created and distributed to all patient facing non-dental staff across BCHC. To maximise stakeholder engagement and response rate, promotion via trust publications and senior endorsement within each division was essential.The results of the training needs analysis were used to design a community specific oral health training package and led to the creation of the ‘Oral Health Ambassador' scheme. Results were disseminated alongside the launch of the training package to district nursing teams and presented regionally to 300 trust leaders at the senior leadership brief and to multidisciplinary colleagues at trust quality improvement forums.ImpactResults of the training needs analysis identified that 90% of respondents had concerns about patient oral health. Despite this, 68% had received no previous oral health training. The main barriers to provision of mouthcare and delivery of oral health advice were lack of training, time, insufficient patient cooperation and lack of equipment. A likert scale identified lower confidence levels in providing support for patients with learning difficulties or challenging behaviour and in accessing resources to support patients and families.InterventionThe Oral Health Ambassador scheme was created with the patient and healthcare provider at its core. The survey results provided key themes for learning which were used to divide the online learning into modules, making specific topics easily accessible. Dedicated time was provided to ensure training was part of the working day.To incorporate learning into their daily practice, a local lead was identified in each team as the Oral Health Ambassador, bridging the gap between dental and nursing teams and acting as a direct link for dental support within nursing teams. Oral Health Ambassadors are leading team training and raising resource awareness.Oral health boxes were created and delivered to teams providing an easily accessible wealth of oral resources for providers, patients and families. Equipment was included with information for use and adaptability for individual patient need.Involvement of stakeholders, such as patients, carers or family members:Stakeholder mapping included direct input from district nurses and Health Care Assistants. Piloting the scheme across a variety of sectors provided reassurance that the training would benefit all allied health professionals across the trust.Key MessagesCommunity healthcare staff have a unique opportunity to support oral health needs of vulnerable community patients. Redeployment provided a unique opportunity to lead in changes for oral health pr motion in the community and create local leads, Oral Health Ambassadors, that can continue to champion oral health post pandemic.Lessons learntWhilst dental teams took initial responsibility, passing this onto local leads will create key ambassadors within the teams, passionate about improving patient oral health and providing support for peers to do the same.Measurement of improvementPreliminary data taken from online learning pre-and-post knowledge survey shows an improvement in knowledge and increased confidence levels. Further feedback awaits.Strategy for improvementFollowing on from a successful launch of the scheme, the team suggests creation of an oral health mobile app would allow a wealth of up-to-date information, guidance and resources at the click of a finger.

Empowering cultural change at North Manchester general hospital

ContextNorth Manchester General Hospital is a large District General Hospital in Greater Manchester, serving a relatively disadvantaged population. The overall culture change project involved practically all facets of a functioning medical organisation, including the Senior Medical Leadership Team (SMLT), Transformation team, Human Resources, Finance, and many more. However, one of the key aims of the change was to improve the experience of Junior Doctors working at NMGH. Therefore, postgraduate doctors in training have been key to all of the development, including the Medical Director's Leadership Fellow (MDLF), Junior Doctors' Leadership Group (JDLG), and every staff member that they represent.Issue/ChallengeHistorically, North Manchester General Hospital (NMGH) has had a reputation as a poor place to work;staff aimed to avoid the site. The hospital was unable to retain highly-skilled employees, and trainee experience was extremely low, impacting on patient safety metrics. The site was stuck in a continuous cycle of having this reputation, leading to an inability to attract permanent staff, causing a deficit in teaching and training opportunities, further diminishing the reputation.Rotational junior doctors are the most transient group of NHS healthcare workers (HCWs). Their experience is reflective of organisational culture and that of other, less vocal groups of HCWs. Prior to 2020, many junior doctors considered NMGH to be a ‘rite of passage' ‘ one to be avoided if possible, but if unavoidable, just get through it. On-call teams were chronically short-staffed, 3 services were in enhanced General Medical Council (GMC) monitoring, and GMC survey results were unsatisfactory. Teams were forced to be tenacious, lateral thinking, and resilient to cope with the stresses of work.2019 saw NMGH receive significant criticism from GMC and Health Education North West (HENW) monitoring visits. The General Surgery (GS) Department remained in ‘enhanced monitoring', and patient safety concerns were raised. These included inadequate ‘prescribing of admission medication', poor use of incident reporting systems, and challenges escalating sick patients. Trainees described ‘fire-fighting, not learning'. Improvement recommendations included addressing departmental culture, reinforcing the importance of incident reporting, and ensuring trainees had easy access to appropriate senior support at all times. Early in 2020, trainee experience further deteriorated in GS, due to a negative culture and deficiencies in support, education and training. This resulted in Foundation Year 1 doctors being removed from GS.The Senior Medical Leadership Team (SMLT) decided that enough was enough;the hospital culture needed a fundamental overhaul. There was a clear and urgent need to address staff experience.Assessment of issue and analysis of its causesThe Senior Medical Leadership Team (SMLT) set themselves an audacious goal: to support NMGH to transform into the best training and working experience for junior doctors in Greater Manchester. This goal was split into primary drivers, with each driver linked to specific future projects, and projects assigned to each leadership team member. These projects, identified through co-production with junior doctors, were aimed to improve employee experience, including facilitating access to breaks, improving supervision and support, and enhancing development opportunities â€' aiming to raise staff wellbeing and patient safety standards. Changes were made to General Surgery, resulting in huge investments in expanding the permanent junior doctor and consultant workforces.Several initiatives were implemented to help assess the scope of work required, including setting up a Junior Doctors' Leadership Group (JDLG), or ‘Shadow Board'. All hospital specialties are represented;some representatives sit on the SMLT, on Educational Board meetings, and the Clinical Leaders Forum. The SMLT join every JDLG meeting. Whilst acting as a conduit for rapid two-way communication between clinician and leadership teams (e.g. reliably informing doctors about last-minute changes to visiting policy during Covid surges, or effectively communicating crucial information to crash-call teams when building work closed part of the hospital), the group debates issues raised by junior doctor colleagues they represent, and feeds that back to the SMLT. Recent examples include raising patient safety concerns related to misinterpretation of the Emergency Department Referrals policy, and working collaboratively with junior doctors to address urgent staffing and patient safety risks related to the last wave of the pandemic.In addition to this, a Medical Director's Leadership Fellow (MDLF) role was established. This was fundamental in progressing projects related to the SMLT goal and ensuring appropriate input from junior doctors, Human Resources, the Communications and Transformation teams, and more. As a key member of the JDLG, the MDLF is a role designed in part to enhance junior doctor experience, foster better relationships between staff groups, and encourage feedback provision. The role has been vital in bridging the gap between doctors and hospital leaders, managers and executives – often a source of discontent amongst clinicians. Bridging this gap is important in developing the hospital's culture. Even though many projects are still ongoing, improvements are already being experienced.Impact2021 GMC Survey results showed improvement in 15/18 metrics compared to 2019. These included improvements in ‘Reporting Systems', ‘Workload', and ‘Clinical Supervision Out Of Hours'. 2020 Care Quality Commission inspection reports showed improvement in 11 individual aspects, including improvement to ‘outstanding' in 3 elements.HENW/GMC monitoring visits in 2021 reported ‘they have more robust teams to support the ward and on call workload', resulting from investment in clinicians. It also notes, ‘prescribing audits have shown improvements in prescribing of time critical medication', and demonstrable improvements in ‘use of incident reporting systems and sharing of lessons learnt'. Further comments note that there have been ‘significant improvements in culture in the [General Surgery] department over the past year';one doctor described the department as ‘the most supportive place he had worked'. The report summary noted, ‘through strong clinical leadership and oversight, and a concerted effort to improve departmental culture there have been significant improvements in General Surgical trainee experience with good support, supervision and education reported'. The department was subsequently removed from enhanced GMC monitoring.Although this rapid and impressive turnaround occurred within one department, benefits were seen elsewhere in the organisation.The efforts of the SMLT and JDLG have resulted in positive cultural changes. Surveys reflected: ‘friendly colleagues, less work-related stress, helpful management', and ‘thank you for your work to improve NMGH. I was worried about working at NMGH having heard ‘horror stories' about working there. However, these have not been reflected in reality at all, and NMGH has offered excellent training opportunities.InterventionThe JDLG helps ensure that important information is shared with the wider junior doctor group. Colleagues now feel that their voices are heard. The positives from the previous culture are still evident – leadership teams across the Trust have repeatedly recognised the ‘can-do attitudes' of NMGH staff, with the negative culture firmly in the past. Staff testimonials include: ‘there has definitely been an improvement over the years I have worked here;‘my supervisor was supportive and encouraged reflection through discussions about experiences;and ‘the senior staff are INCREDIBLE. They offer support, they teach, and they encourage us to learn new skills. I cannot be more thankful'. This is in contrast to historical Freedom To Speak Up (FTSU) submissions, which pointed to a culture of disregarding the opinions of NMGH staff.The ‘can-do' approach has been evident during the waves of Covid-19;members of the JDLG fed into management and governance structures to highlight problems in real time, increasing the organisation's responsiveness to challenges faced, working as a two-way conduit of information.During the 2021 HENW/GMC visit, the team reported that junior doctors knew the Medical Director and Director of Medical Education by first name, and felt able to raise concerns directly to them, evidencing a more flattened hierarchy. The visiting team reported being impressed by this positive change and were not aware of other organisations where this had been achieved to this extent.Having Postgraduate Doctors in Training play such a significant role within the Senior Leadership Team setup is relatively unique. As explained, empowering staff to feel they can raise any issues directly to the Medical Director or SMLT, or via the JDLG, has played a huge role in facilitating palpable cultural change through leadership structure additions. As a point of contact, the MDLF has acted as an extension of the JDLG, but works directly alongside the Medical Director and Associate Director of Medical Education, essentially enabling the SMLT to keep their ear to the ground, their fingers on the pulse of staff atmosphere and wellbeing.Examples of achievements of the MDLF include projects to introduce personalised theatre caps (benefits include enhanced communication, especially in emergencies, improving patient outcomes), formation of a Wellbeing group (representatives from all cohorts of staff across the site discuss wellbeing initiatives and colleagues' wellbeing concerns), and an impressive and rapid response to staffing crises and patient safety risks during the most recent Covid-19 wave. As a result of these outcomes, other Trusts haveapproached the SMLT, requesting further information regarding the JDLG and MDLF model;another MDLF has since been appointed at a different trust site.Involvement of stakeholders, such as patients, carers or family members:The SMLT itself is made up of clinicians from a variety of backgrounds, across medicine and surgery. SMLT members sit in morning medical handovers to actively gather clinician experience feedback. They also work closely alongside colleagues from Nursing, Finance, HR, Transformation teams, and more, which enables the SMLT to work collaboratively with the multidisciplinary team to improve culture at NMGH.The MDLF is in the perfect position to take advantage of this MDT approach. As a result, the MDLF sits on Group-level Patient Safety Panels (acting to highlight patient safety incidents, initiatives, and achievements across the entire Trust). This panel consists of representatives from hospital, community, and medical education staffing groups. The lessons learnt are then communicated to individual hospitals, no matter where the incident or initiative originated. A big part of the meeting is the FTSU aspect, and local FTSU Guardians are active within the panel.Given that the MDLF role is so closely linked to improving communication and feedback, a Freedom To Speak Up Champion role fitted well within the responsibilities of the post. Therefore, over the past year, the MDLF has worked alongside the FTSU team and has completed training as a FTSU Champion. As a consequence of working closely with shop-floor colleagues, the MDLF has received communications from a wide variety of staff roles and levels of seniority throughout the year, asking questions, or raising awareness about issues. The MDLF can then seek appropriate advice, signpost the colleague, and keep them updated on a potential resolution, further propagating the positive feedback loop and support of the wider MDT. As previously mentioned, the JDLG consists of representatives from all medical specialties, and each member is encouraged to raise concerns, suggest improvements, and lead on projects;these include an overhaul of the medical handover process, enabling a safer and more efficient handover, and escalating concerns of a coll ague speaking up about potential patient safety concerns within a department. Furthermore, speakers at JDLG meetings have included the Head of Nursing: Quality & Patient Experience, local FTSU Guardians, the Director of Human Resources, and the local Guardian of Safe Working Hours, enabling group members to share information from a wide range of disciplines with shop-floor colleagues. As a result of the efforts and MDT approach of the above groups, a placement feedback survey performed early in 2022 demonstrated that 93% of respondents felt their working environment supports a multidisciplinary approach.Key MessagesOne of the hallmarks of good medical leadership is putting all staff members, regardless of their role, seniority, or experience, in the best position for them to succeed. Giving Postgraduate doctors early opportunities to play a significant part in, and learn about, an organisation's leadership structure, is not only beneficial to the doctor, but helps the organisation capitalise on a previously relatively untapped market of ideas and solutions. Crucially, this is not limited to postgraduate doctors in training, but also locally-employed doctors, which make up a significant proportion of the workforce in any hospital yet typically remain underrepresented and under-utilised.NMGH has realised the potential that can be unlocked in Junior Doctors, through leadership placements and roles, and the positive benefit this can have on the individual, team and organisation.Lessons learntNorth Manchester General Hospital was fortunate in that the entire SMLT bought into everything: the overall project for culture change, the introduction of the MDLF into the SMLT, and empowering members of the JDLG to contribute to change at the highest level. Having spoken to other organisations looking to replicate our success, they have found that this buy-in is absolutely crucial. Recruiting effectively, to both the MDLF position and JDLG representative roles, is vital, as a huge amount of motivation to fight for change and the betterment of the system is required when overcoming barriers and challenges. Many of the barriers we faced are well-documented in literature, and to a point we expected them;these included resistance from non-medical stakeholders, which was somewhat abetted by further conversations, explanation of goals and objectives, and outlining the overall vision of the SMLT. Of course, resistance to change is important in any project, as it can highlight potential issues not yet visualised.Measurement of improvementFrom the start, we set out our intention to use openly-available, independent metrics of improvement, such as the GMC Nation Training Survey. To compliment this, the MDLF utilised a variety of temperature-check methods, including surveys (dissemination supported by the increasingly-established network of the Postgraduate doctors in training of the JDLG) and departmental visits. Importantly, having a fellow junior doctor asking for feedback, rather than a traditional member of the SMLT, enabled us to garner potentially more honest opinions, criticisms and ideas. As explained elsewhere, GMC survey results have shown improvement, and local surveys have displayed some very positive results. That said, it is recognised that the vision is a long-term project, and continuous improvement will be sought, rather than settling on the progress made thus far.Strategy for improvementThe SMLT sat down and brainstormed an overall vision alongside the individual large-scale projects that would contribute to achieving change. Within this, individual members of the SMLT were assigned roles leading one or more projects, and the MDLF role was created in part to support with the running of these projects where required. This enabled utilisation of the minds of the JDLG and other Postgraduate doctors in training. The MDLF role was instrumental in not only involving this cohort, but also reaching out to other organisations to share learned experiences when they had gone through implementation of similar projects. The team was kep accountable not by having a set timeline for implementation but by having regular away days, reporting back to their colleagues and the transformation team regarding progress.The JLDG, established in 2020, and reappointed every year, have been key to the success of the culture change, through engagement, sense-checking and feedback regarding strategy and relevant projects. Over time the organisation has increasingly engaged this Shadow Board in the development and role out of projects as well as problem solving of significant challenges. Through this team the SMLT has fedback key messages and challenges to the Junior Doctor workforce, which has resulted in increased engagement across the organisation.

The future is relational: management development for today and tomorrow

PurposeThe authors of this study aim to test a possible turn toward relational, as opposed to agentic, management development program (MDP) content.Design/methodology/approachThe authors performed a content analysis of the literature and qualitative interviews of management coaches/consultants from South Africa and the USA.FindingsIn both studies, the authors found more relational than agentic content comprising MDP content. Interviews revealed a predominance of relational strategies and that agentic and relational skills are often interwoven in development efforts.Practical implicationsThis work may guide management coaches and consultants to offer clients management development (MD) with a greater focus on relational skills.Originality/valueFuture studies should build on our findings to explore whether leadership may now require more relational as opposed to agentic skills.

Transformation of an independent sector treatment centre to a regional trauma centre during COVID pandemic

ContextOn the 11th March 2020, the WHO declared SARS-CoV-2 (COVID) outbreak a global pandemic. Healthcare facilities in the UK faced an unprecedented challenge of managing the outbreak, whilst maintaining basic healthcare services such as cancer and trauma. The NHS and independent sector partnership allowed a safe work stream, a relationship that continues now to support the elective recovery coming out of the pandemic.Issue/ChallengeReorganisation of healthcare provision led to the transformation of Practice Plus Group (PPG) hospital, Ilford to a green site for Barking Havering and Redbridge NHS University Trust (BHRUT) trauma service from 30/03/2020 to 10/06/2020. PPG Hospital had to rise to the challenge mobilising quickly from an elective service to a trauma unit serving a local population of over 1 million. The hospital transformed over one weekend, mobilising staff and equipment to deliver a trauma service. Their service went on to exemplify gold standard treatment of the very sick. The unit responded, adapted and developed outpatient clinics, plaster room, trauma ward and theatres to manage COVID-negative trauma cases that BHRUT received.Assessment of issue and analysis of its causesClinical staff had to upskill to take on the very sick (ASA 4) who may require end organ support, to carry out trauma surgery and procedures that were never performed before at the unit. Surgeons and surgical trainees from the trust became part of the multidisciplinary collaboration whilst the senior leaders developed a strong relationship to ensure good governance throughout the period. All of PPG staff had to get involved in ward care. Staff were trained with regards to personal protective equipment (PPE), Aerosol generating procedures (AGPs), pressure area care and applying traction to realign bones as some of the examples. The staff involved came from the following groups: theatre staff, outpatient staff, the anaesthetic consultants, ward staff, endoscopy, pharmacy, physio, housekeeping, infection control and portering.ImpactConsultant anaesthetists had a steep learning curve to both update their trauma knowledge and sharpen their skills. The guidelines of fracture hips were reviewed. The weekly teaching meetings’ topics were all about anaesthesia for emergency surgery, trauma and COVID. Anaesthetic work rota modified to provide a suitable recovery time following long days in theatres. The necessity of rest periods improves immunity.InterventionThere were some logistic hurdles, including the lack of availability of a suitable meeting facility that can accommodate a large number of attendees. There was a need to have a combined meeting with the BHRUT team in the red zone. On the first day, the meeting was carried out on the ‘ZOOM’ platform on smart phones. Within a couple of days. The trauma meeting was held in the capacious theatre reception, using a wall-mounted big screen for audio-visual display. This allowed better communication with all clinical teams including orthopaedic surgery, anaesthesia, nursing and coordinators.Involvement of stakeholders, such as patients, carers or family members:The PPG team implemented the pillars of clinical governance to improve the quality of care. The virtual monthly morbidity meeting included clinicians from all disciplines. A brief update of previous monthly data was reviewed. An initial internal audit showed that the average anaesthetic start time was 09:39. 19 lists (out of 23, 83%) started even after 09:15. The identified causes for this delay included late sending time, and the patient not being ready at the ward due to longer pre-operative checks and staff shortage. A ‘Golden Patient' was not always identified. A collaborative multi-disciplinary approach aimed to streamline the admission processes to ensure availability of both the surgical team and the patient to ensure a prompt theatre start. A repeat audit confirmed that the average anaesthetic start time has become 09:03. Only four out of 24 lists had an anaesthetic start time of 09:15 or later (17%). Th t is an Improvement of 69%.Key MessagesAs COVID created so much pressure on BHRUT, we quickly formed a positive can do working relationship both clinically and managerially to set up the Trauma service in just a few days. The 30 day mortality rate of patients with fracture neck of femur was less than the national average. This positive approach has enabled us to continue working together to help ease pressure off the lengthy patient waiting lists in Orthopaedics and General Surgery.Lessons learntPPG was proud to receive many compliments from patients and BHR staff. A patient wrote ‘I am so humbled and impressed by the amazing team-work and skill of the staff here that I want to congratulate you on what is an outstanding success amongst all the many stories coming out of the corona pandemic. Watching the way in which staff from so many different departments and skills bases are coming to this ward and learning nursing techniques with humility and patience as well as bonding in an upbeat, joyful team is something I will always remember. A surgical trainee mentioned The Independent Sector Treatment Centre (ISTC) team has been absolutely excellent so far. They have made us feel welcome and have worked hard to optimize the service'. This COVID cooperation paved the way for the ongoing cooperation between BHR and PPG, Ilford.Measurement of improvementThe outcome data shows that the service was able to successfully manage fractured neck of femur with better outcomes against national KPI. During the period from 30/03/20 to 10/06/2020, 85 patients had surgery for an emergency fracture neck of femur (Table 1). At PPG, the 30 days mortality rate was 3.5%. The national mortality rate for patients with fracture neck of Femur was 6.1%.75 patients with fracture neck of femur had surgical fixation within 36 hours.Strategy for improvementCollaborative cooperation between NHS and PPG led to set up of new pathways, governance and processes that enable patients to be transferred directly to us as well as creating capacity for BHRUT surgeons to operate in our hospital, supported by our theatre and ward teams.