Medical students as health workers during the COVID-19 pandemic.

BACKGROUND: We describe efforts at one tertiary university teaching hospital to rapidly recruit, train and deploy medical students into paid clinical support worker roles during the COVID-19 pandemic. METHODS: Recruitment was conducted by means of a single email outlining the emergent clinical situation and specifying role descriptions, terms and conditions, and temporary staff enrolment paperwork. Applicants could begin work provided they were in good standing and received departmental orientation. Student representatives liaised with teaching faculty and participating departments. Roles were modified in response to student and departmental feedback. RESULTS: Between 25 December 2020 and 9 March 2021, 189 students contributed 1335 shifts, providing 10 651 hours of clinical care in total. The median number of shifts worked per student was 6 (mean: 7; range: 1-35). Departmental leaders attested that the student workers eased the burden on hospital nursing teams. CONCLUSION: Medical students contributed usefully and safely to the provision of healthcare within well-defined and supervised clinical support worker roles. We propose a model of working which could be adapted in the event of future pandemics or major incidents. The pedagogical value to medical students of working in clinical support roles warrants closer evaluation.

Is it time for a paradigmatic shift in relation to healthcare in the UK? A reflection.

CONTEXT: Conflict is a driver of change and unions representing professional groups across the National Health Service (NHS) are currently engaged in direct conflict with the government. For the first time in the history of the NHS, healthcare professionals have taken industrial strike action. Junior doctors and consultant physicians are currently engaged in their respective union ballots and indicative poll surveys regarding potential strike action in the future. In the wake of such widespread industrial action, we have taken time to think deeply about the confronting challenges and issues and offer this reflection as an opportunity to redefine and re-frame an unsustainable healthcare system into one that is the best it can be in terms of fit for purpose. INSIGHTS AND RESOURCE SIGNPOSTING: We present the current context with a reflective framework table focused on 'What do we do well? What is not done so well? What could some possible ideas and solutions be? and How could this change be supported?'We outline how a culture of well-being could be strategically and operationally introduced into the NHS workplace using research-based evidence and practical tools supported by expert guidance.

Case for mandatory COVID-19 vaccinations for workers in health and aged care settings: a guide for leaders.

BACKGROUND: This brief paper provides an overview of the analysis in support of mandating COVID-19 vaccinations for all workers in health and aged care settings in Australia. Leaders of health and aged care organisations have a duty of care under work health and safety legislation to eliminate and/or control the risk of transmission of vaccine-preventable disease in their facilities, including COVID-19. METHODS: Key issues that should be considered by healthcare leaders when mandating that all health and aged care workers be vaccinated against COVID-19 were analysed by executives from a large Australian national health and aged care provider and discussed in this paper. RESULTS: This paper summarises the medical/scientific, ethical, legal, work health and safety, workers' compensation and industrial relations considerations when mandating COVID-19 vaccination for healthcare workers. CONCLUSION: Leaders of health and aged care organisations must provide a safe environment and workplace for all those who work for them, as well as for those who receive care or treatment at one of their facilities. It is hoped that this paper will assist leaders of healthcare organisations in making their own decisions during this time.

Addressing leadership communication, parenting demands and mental health challenges: a mixed-methods case study of clinical and translational scientists during COVID-19.

BACKGROUND: In March 2020, academic research centres in Colorado were closed to prevent the spread of COVID-19. Scientists and research staff were required to continue their work remotely with little time to prepare for the transition. METHODS: This survey study used an explanatory sequential mixed-method design to explore clinical and translational researcher and staff experiences of the transition to remote work during the first 6 weeks of the COVID-19 pandemic. Participants indicated the level of interference with their research and shared their experiences of remote work, how they were impacted, how they were adapting and coping, and any short-term or long-term concerns. RESULTS: Most participants indicated that remote work interfered with their research to a moderate or great degree. Participant stories illuminated the differences of remote work prior to and during COVID-19. They described both challenges and silver linings. Three themes that highlight the challenges of transitioning to remote work during a pandemic were: (1) Leadership communication: 'Leadership needs to revisit their communication strategy'; (2) Parenting demands: Parents are 'multitasked to death' every day and (3) Mental health challenges: The COVID-19 experience is 'psychologically taxing'. CONCLUSIONS: The study findings can be used to guide leaders in building community, resiliency and support productivity during current and future crises. Potential approaches to address these issues are proposed.

Seven leadership and followership lessons from kidney transplantation during lockdown.

BACKGROUND: The renal transplant team in Northern Ireland performed 70 transplants in 61 days during the first wave of COVID-19, an 8-fold increase in their typical activity. Mobilising diverse professional skills to achieve this number, especially under COVID-19 conditions, required extraordinary effort on the part of everyone involved along the transplant patient pathway, management and staff from other patient groups. METHODS: Fifteen transplant team members were interviewed to explore their experiences during this time. RESULTS: Seven key leadership and followership lessons, contextualised within The Healthcare Leadership model, were learnt from these experiences. CONCLUSIONS: While circumstances were untypical, the achievement and motivation of staff were no less commendable. We contend that this was not only because of the unusual circumstances but as a result of extraordinary leadership and followership, teamworking and individual agility.Recommendations for those leading services which require a quick response and collaborative effort are made.

Burn-out in the health workforce during the COVID-19 pandemic: opportunities for workplace and leadership approaches to improve well-being.

BACKGROUND: Burn-out is a long-standing problem among healthcare workers (HCWs) and leads to poorer quality and less safe patient care, lower patient satisfaction, absenteeism and reduced workforce retention. Crises such as the pandemic not only generate new challenges but also intensify existing workplace stresses and chronic workforce shortages. As the COVID-19 pandemic continues, the global health workforce is burnt-out and under immense pressure, with multiple individual, organisational and healthcare system drivers. METHOD: In this article, we examine how key organisational and leadership approaches can facilitate mental health support for HCWs and identify strategies to support HCWs that are critical for supporting workforce well-being during the pandemic. RESULTS: We identified 12 key approaches at the organisational and individual levels for healthcare leadership to support workforce well-being during the COVID-19 crisis. These approaches may inform leadership responses to future crises. CONCLUSION: Governments, healthcare organisations and leaders must invest and deliver long-term measures to value, support and retain the health workforce to preserve high-quality healthcare.

Psychological impact of COVID-19 on healthcare leaders: a cross-sectional survey in Friuli-Venezia Giulia, Italy.

INTRODUCTION: Although several studies highlighted the psychological burden of 2019 coronavirus disease (COVID-19) pandemic, no data are available regarding professionals leading healthcare organisations. This study aims to assess the psychological impact of COVID-19 on healthcare leaders (HeLs), along with the leadership skills and coping strategies needed for successful leadership. METHODS: A cross-sectional survey was conducted in Friuli-Venezia Giulia (Italy) between October and November 2020. We assessed the presence of depressive symptoms (DS), anxiety symptoms (AS), perceived stress (PS) and insomnia using internationally validated tools. Coping strategies and skills needed to overcome the crisis were examined, along with the most challenging phases. RESULTS: A total of 48 HeLs participated. The prevalence of DS and AS was 14.6% and 12.5%, respectively. Moderate and severe insomnia was found in 12.5% and 6.3% of them, respectively. Leaders showed moderate (45.8%) and high 4,2%) level of PS. The two most challenging phases were recognised in early recognition (45.2%) and peak phase (31.0%). Concerning healthcare leaders' skills required to manage with pandemic, the most reported were communication (35.1%) and decision-making (25.5%). CONCLUSION: The high level of PS, insomnia, DS and AS experienced by healthcare leaders shows the COVID-19 pandemic's psychological impact. The two most challenging phases identified enhances the importance of public health surveillance and monitoring systems, and communication appeared a critical success skill for healthcare leaders. Given the key role these professional play in addressing the current crisis in healthcare organisations, their mental health and well-being deserve greater attention.

Guest editorial: Contextualising leadership – the impact of strategy and culture in healthcare and disability services

More contemporary approaches, as Schedlitzki and Edwards (2021) outline, encompass concerns with context, followership, power and politics, a wider distribution of leaders, culture, communication, learning, gender and diversity, ethics and even the Phoenix leaders managing change in contemporary firestorm disruption (Woodward et al., 2021). The flip side of this is what Hofmann and Vermunt (2020, p. 252) claim is the need "to develop a conceptually sound outcome model for clinical leadership (CL) development in healthcare, linking individual professional learning and organisational change.” Yet, context is crucial in consideration of aspects of leadership in health services. [...]for us, the interconnectedness of healthcare and the disability sector is an ever-growing consideration and challenge, especially with the introduction and implementation of the National Disability Insurance Scheme in Australia and the recent Australian Royal Commission into the Disability sector. Leaders were required to develop innovative responses to service delivery (including face-to-face and digital responses), redirect and re-train workforces, develop new clinical and social supports, and manage the safe return to work to those who fell ill (Phillips et al., 2022;Whelehan et al., 2021).

Leading COVID-19 vaccination centres in England: managing and overcoming challenges.

BACKGROUND: This study explored the challenges, and actions leaders took to manage them, in delivering the COVID-19 vaccine in vaccination centres in England. METHODS: Following informed consent, 20 semi-structured interviews were conducted with 22 senior leaders working within vaccination centres, mostly clinical and operational leads, using Microsoft Teams. Transcripts were analysed thematically using 'template analysis'. RESULTS: Some of the challenges leaders faced included leading dynamic and transient teams, interpreting and sharing communications received through national and regional and system vaccination operations centres. The simpler nature of the service allowed for leaders to delegate and reduce hierarchies among staff to support a more cohesive work environment that encouraged staff, often working through bank or agency, to return. Many leaders felt communication skills as well as the attributes of resilience and adaptability were particularly important to lead in these novel settings. CONCLUSION: Illustrating the types of challenges faced by leaders in vaccination centres and how they handled them can help others in similar leadership positions in vaccine centres or other novel settings. As healthcare teams are increasingly dynamic and transient due to more flexible working patterns the need for leaders to apply these skills becomes ever more important.

Leadership experiences of elite football team physicians during the COVID-19 pandemic: a pilot study.

OBJECTIVES: The purpose of this study was to explore the leadership experiences of elite football team physicians during the COVID-19 pandemic. METHODS: A pilot-study based on a cross-sectional design by means of an electronic survey was conducted. The survey relied on 25 questions divided into distinct sections including among others professional and academic experience, leadership experiences and perspectives. RESULTS: A total of 57 physicians (91% male; mean age: 43 years) gave their electronic informed consent and completed the survey. All participants agreed that the demands of their role had increased during the COVID-19 pandemic. Fifty-two (92%) participants reported that they felt they were expected to take more of a leadership role during the COVID-19 pandemic. Eighteen (35%) reported feeling under pressure to make clinical decisions which were not in keeping with best clinical practice. Additional roles, duties and demands expected of team doctors during the COVID-19 pandemic were subdivided into communication, decision-making, logistical, and public health demands. CONCLUSION: The findings from this pilot study suggest that the way in which team physicians at professional football clubs operate has altered since the onset of the COVID-19 pandemic, with greater demands placed on leadership skills including decision-making, communication and ethical stewardship. This has potential implications for sporting organisations, clinical practice and research.

Designing the careful and kind clinic: an evidence-based approach.

BACKGROUND: There is evidence that creating a 'healthy workplace' can be of profound importance for clinicians, team members and patients. Yet there have been few papers that have proposed mechanisms to take decades of research and translate this into a practical list of options for leaders and managers to take into account when structuring a clinic based on care and kindness to achieve optimal health. EVIDENCE: We bring together 20 years of scholarship linking care of the caregivers with outcomes for caregivers and patients. The data are used to support both structures and cultures that will result in satisfied and thriving healthcare team members, as well as satisfied and healthy patients. RESULTS: The clinic based on care of the caregivers will be structured to address key aspects of worklife that are known to cause either satisfaction or burnout. Aspects of care, such as time pressure, chaotic environments and worker control of their workplace, will be taken into account in clinical design; organisational culture will be supportive and cohesive, emphasising quality, values and communication. Experiences based on gender and race will be measured and continuously improved; and performance will be evaluated in a new, human-centred manner. OUTCOMES: The careful and kind clinic will be a remarkable place to work; in contrast to industrialised healthcare, this will be an environment where health can indeed be optimised, for both workers and patients.

'Mali Matters': reflections on a leadership and quality improvement project to improve blood transfusion safety at Maluti Adventist Hospital, Mapoteng, Lesotho.

INTRODUCTION: This report outlines a quality improvement (QI) project aiming to improve blood transfusion safety at Maluti Adventist Hospital (MAH), Lesotho, from August 2019 to January 2020.The project team comprised nine local staff members and two UK doctors working through the NHS 'Improving Global Health through Leadership Development' (IGH) programme. METHODS: Baseline data was gathered and a 'process mapping' meeting held to understand existing processes and identify methods for improvement.Improvements were implemented using Plan-Do-Study-Act (PDSA) methodology.The NHS Healthcare Leadership Model was used as a framework for leadership development and team members reflected on their personal learning. RESULTS: Varied interventions included introduction of a pre-transfusion bedside safety checklist and staff training.Documentation of critical patient identifiers for transfusion improved. Completion of the bedside safety checklist was 65.5% by 3 months. Knowledge scores improved post-transfusion training. 77% of staff strongly agreed and 21% agreed that the training was useful.Challenges and further work were reflected on. DISCUSSION: This collaborative system-strengthening project provided varied, reciprocal learning experiences including skills in leadership, teamwork, teaching, QI methodology, communication and IT.Our experiences will help to inform ongoing work at MAH and may be helpful to others conducting similar work in related settings.

Addressing the challenges restoring clinical services during the COVID-19 pandemic by harnessing the alignment of clinical and management leadership: an example from a large colorectal service.

BACKGROUND: The COVID-19 pandemic has posed the greatest operational challenge to the English National Health Service since its inception. Elective surgical services have struggled due to the need to protect both staff and patients from viral exposure, and perioperative COVID-19 infection has been associated with significant excess mortality. INTERVENTIONS: In this brief report, we describe how through necessity, it has provided an opportunity to redesign services for the benefit of both patients and organisations, with attendant improvement in activity compared with prepandemic metrics. We present the experience of a large district general hospital, using the department of colorectal surgery as a case study, in responding to the pandemic by restoring services and achieving improved short-term outcomes and processes in newly redesignated facilities. CONCLUSIONS: These reorganised surgical services represent a 'silver lining' of the pandemic. Clinician-led service restructuring, with positive engagement with staff at all levels, has not only addressed backlogs of urgent elective patients in a safe environment, but has also led to patient benefits and high levels of patient and staff satisfaction.

Change starts with me: an impact evaluation of a multiprofessional leadership programme to support primary care networks in the South East of England

Purpose>This paper aims to present the impact evaluation findings from a multiprofessional leadership programme commissioned in the South East of England to support primary care networks (PCNs) to lead system improvement together. It identifies programme impact at micro and meso system levels;a leadership impact continuum that can be used by individuals and teams to evidence impact of improvements in PCN practices;the learning and development strategies that were effective and proposes implications for other networks.Design/methodology/approach>Mixed methods underpinned by practice development methodology were used to explore the impact of the programme on two practitioner cohorts across 16 PCNs. Data were collected at the start, mid-point and end of the eight-month programme.Findings>Results illustrate an innovative approach to collective leadership development. A continuum of impact created with participants offers insight into the journey of transformation, recognising that “change starts with me”. The impact framework identifies enablers, attributes and consequences for measuring and leading change at micro, meso and macro levels of the health-care system. Participants learned how to facilitate change and collaboratively solve problems through peer consulting which created a safe space for individuals to discuss workplace issues and receive multiprofessional views through action learning. These activities enabled teams to present innovative projects to commissioners for service redesign, enabling their PCN to be more effective in meeting population health needs. The authors believe that this programme may provide a model for other PCNs England and other place-based care systems internationally.Originality/value>This study offers insight into how to enable a journey of transformation for individuals and PCN teams to enhance team effectiveness and collective leadership for system-wide transformation required by the National Health Service Long Term Plan (2019).Contribution to Impact>