Leadership during a Crisis: Observations by Emerging Leaders during the COVID-19 Pandemic.

During crises, leaders must address fear, give people a role and purpose and emphasize experimentation, learning and self-care. A survey of emerging health leaders rated the frequency with which they observed their organizational leaders and themselves engage in these crisis leadership functions during the COVID-19 pandemic. Findings revealed significant differences between emerging and more experienced leaders' behaviours in acknowledging fears and providing reassurance, managing individual health and role modelling good self-care and encouraging others to practise good self-care. Emerging leaders rated themselves as engaging in these behaviours more frequently. Barriers preventing these practices included heavy workloads and communication issues. Enablers included good team dynamics, clear communication and incorporating technology. Implications for leadership are presented.

An Innovative Model for Healthcare Leadership Education.

A key goal of programs in health management, policy and research is to transform students into effective leaders. Academic experience can impart knowledge about the skills or competencies required but may not be sufficient to transform students into leaders of health system change.

A Model for Physician Leadership Development and Succession Planning.

Although the presence of physicians in formal leadership positions has often been limited to roles of department chiefs, MAC chairs, etc., a growing number of organizations are recruiting physicians to other leadership positions (e.g., VP, CEO) where their involvement is being genuinely sought and valued. While physicians have traditionally risen to leadership positions based on clinical excellence or on a rotational basis, truly effective physician leadership that includes competencies such as strategic planning, budgeting, mentoring, network development, etc., is essential to support organizational goals, improve performance and overall efficiency as well as ensuring the quality of care. In this context, the authors have developed a physician leader development and succession planning matrix and supporting toolkit to assist hospitals in identifying and nurturing the next generation of physician leaders.

Emergency physician workload modeling.

BACKGROUND: A variety of models are used by hospitals, provincial governments, and departments of emergency medicine to "predict" the number of physician hours of coverage necessary to staff emergency departments. These models have arisen to meet specific requirements-some for the purpose of determining hourly rates of compensation, others to determine the amount of funding that will be provided to "purchase" physician coverage, and others to determine the number of hours of coverage necessary to maintain patient waits within "acceptable" limits. All such models have their strengths and weaknesses and have been criticized as not reflecting the "real" needs of any given department. OBJECTIVE: In the article that follows, a review of existing models is presented, annotating their strengths and weaknesses to derive the characteristics of an "ideal" workload model. CONCLUSION: None of the models currently used to measure emergency department workload can be relied on to accurately predict the number of staffed hours necessary. Models that may achieve this objective are suggested.

360-degree physician performance assessment.

Few jurisdictions have a robust common approach to assessing the quantitative and qualitative dimensions of physician performance. In this article, we examine the need for 360-degree physician performance assessment and review the literature supporting comprehensive physician assessment. An evidence-based, "best practice" approach to the development of a 360-degree physician performance assessment framework is presented, including an overview of a tool kit to support implementation. The focus of the framework is to support physician career planning and to enhance the quality of patient care. Finally, the legal considerations related to implementing 360-degree physician performance assessment are explored.

Implementing a physician leader compensation program at a major community hospital.

The roles of physician leaders in Canadian hospitals and health regions are becoming more complex and time consuming. Physician leaders are increasingly being seen by hospital boards and executives as key to achieving strategic and operational outcomes. Given the growing importance of these roles and the increasing performance expectations being placed on physician leaders, it is critical that organizations are able to recruit and retain individuals who demonstrate the skills required to fulfill these critical roles or commit themselves to acquiring them.

Are physician executive pay-for-performance programs the future of physician leader compensation in Canada?

This article explores the growing trend of physician executive pay-for-performance plans in the U.S. and Canada and discusses the underlying principles of incentive-based compensation models. Pay-for-performance plans are becoming increasingly popular with boards of many healthcare organizations across the country. They may offer an opportunity for increased accountability in the context of the 2003 Health Accord. Although there is little current evidence to support the notion that incentive-based compensation has long-term implications for quality improvement, their popularity continues to increase.

Outcomes of referrals to the ED by family physicians.

Patients are commonly referred to the emergency department (ED) by family physicians (FPs). This study was undertaken to determine the outcome of these referred patients. A prospective cohort study of 196 patients referred by FPs to the ED of an urban, tertiary referral center was performed. Key outcome measures were the rate at which investigations or interventions were performed, consultation and admission rates, and the percentage of referrals that were appropriate. Comparison was made with a random cohort of non-referred patients. Information was collected from a questionnaire completed by the emergency physician and by chart review. Eighty-six percent of patients referred to the ED had some sort of investigation or intervention performed, which was significantly higher than the 66.7% rate in non-referred patients (P <.001). Twenty-nine percent of referred patients received a consultation in the ED compared with 16.4% of non-referred patients (P <.01), and 16.0% were admitted to hospital compared with 10.0% in the non-referred group (P <.10). By using the process of care method, 75.5% of referrals by FPs to the ED were appropriate. Family physicians are quite selective in their referrals to the ED. There is a high rate of admission and specialist consultation for referred patients. The vast majority of patients who are referred receive at least 1 investigation or intervention in the ED, and most referrals are appropriate.

Can specific patient variables be used to predict outcome of intracranial hemorrhage?

The study objective was to identify the demographic, physiologic, and anatomic variables associated with outcomes of patients with intracranial hemorrhages. We performed a prospective study of all patients with known or suspected intracranial hemorrhages transferred from a community hospital to the neurosurgical service of tertiary care centers in Toronto. Outcomes measured were patient disposition (admitted v discharged immediately), management (neurosurgical interventions v observation) and survival until discharge v death. Patient variables recorded pre- and post-transfer were analyzed using the statistical programs C.H.A.I.D. and C.A.R.T.(Answer-Tree Software, SPSS Inc.Headquarters, Chicago, IL). Two linear regression trees were constructed to reveal associations with each outcome. Sixty-seven patients between the ages of 24 and 89 were included in the study. Of these, 1 was referred for an epidural bleed, 20 for subdural bleeds, 21 for subarachnoid hemorrhages, and 25 for intracerebral hemorrhages. Thirteen of the patients in the study died or remained with permanent, severe neurological deficits. Of these, none had epidural hemorrhages, 4 had subdural hemorrhages, 5 had subarachnoid hemorrhages, and 4 had intracerebral hemorrhages. The linear regression tree constructed with C.A.R.T. revealed that the most important predictor of outcome was the GCS score of the patient on arrival at the neurosurgical center. Specifically, 71.43% of individuals arriving with a GCS score less than or equal to 7 died or remained with a severe neurological deficit, whereas only 5.66% of individuals arriving with a GCS score greater than or equal to 8 had such an outcome (P<.11). The regression tree constructed using C.H.A.I.D. revealed a similar result. Patients with a GCS score less than or equal to 5 on arrival at the neurosurgical center had a 70% chance of dying or remaining with a severe neurological deficit, whereas those with a GCS score greater than or equal to 13 had a 0% chance of having such an outcome (P <.0001). Furthermore, 100% of patients with post-transfer GCS scores less than or equal to 5 and an absent gag reflex died or remained with a severe neurological deficit compared with only 25% of those with a GCS score less than or equal to 5 with an intact gag reflex (P =.0005). This study also revealed a number of incidental findings. The presence of bilateral unreactive pupils, absent corneal reflex or absent vestibulo-ocular reflex (dolls-eye) independently predicted mortality in 100% of patients (not statistically significant). No patient with any of the following characteristics: any pupillary abnormality or age > 62 with a GCS < 5, achieved a normal functional outcome. Within the population of patients referred from community hospitals to a neurosurgical center for evaluation of intracranial hemorrhage, specific clinical findings are powerful predictors of mortality and poor functional outcome. Patients with a post-transfer GCS score <= 5 and an absent gag reflex had a 100% incidence of death or severe, permanent neurological dysfunction compared with only 25% of those arriving with GCS scores <= 5 with an intact gag reflex (P =.0005). Additionally, The presence of bilateral unreactive pupils, absent corneal reflex and absent vestibulo-ocular reflex independently predicted mortality in 100% of patients (not statistically significant). Other clinical findings including any pupillary abnormality and GCS <=5 combined with age => 62 negated the possibility of normal functional outcome (not statistically significant). These findings may have wide-ranging implications regarding the transfer and treatment of patients with intracranial hemorrhages, use of resources and counseling of families.