Leading Change in Health Care.

Change leadership is essential for individuals, teams, and organizations. It focuses on leadership to initiate, support, and adapt to modifications, alterations, and new situations. Many perspectives, models, theories, and steps have been offered to optimize change. Some approaches emphasize organizational change, whereas others focus on responses of individuals to change. With regard to leading change in health care, it is important to enhance well-being among health-care professionals and patients and to improve organizational and system best practices. To achieve optimal health-care changes, this article draws from several business-focused approaches to change leadership, psychological models, and the authors' Leader-Follower Framework (LF2).

Charting a Course for Leader and Leadership Education and Development in American Medical Schools.

This article was migrated. The article was marked as recommended. Problem: Leadership has been identified as an essential component for success in medicine. Many medical schools have initiated Leader and Leadership Education and Development (LEAD) programs to develop physician leaders. Currently, there is no consensus whether teaching leadership is important, who to teach, what topics to teach, and where leadership fits into the curriculum during medical school. Approach: To address these issues, the Uniformed Services University of the Health Sciences (USU) LEAD team convened an inaugural Medical Student LEAD Summit and Working Group Meeting on April 4, 2017. Participants came from public and private U.S. medical schools engaged in LEAD programs, military service academies, the Veterans Administration, and the Association of American Medical Colleges. The purpose of this meeting was to share opinions, experiences, and current practices regarding medical student LEAD. Outcomes: Participants overwhelmingly agreed that: (1) providing LEAD is an essential component of undergraduate medical education; (2) there currently is no single best LEAD program for all medical schools; (3) a clear purpose, goal, philosophy, and conceptual framework consistent with the mission and vision of each institution is needed; (4) assessment of students, programs, faculty must be incorporated; and (5) research and scholarship are essential for LEAD programs. Next Steps: Based on the positive feedback and interest from participants, the USU LEAD team will host a second Summit in April 2018 to follow up with the inaugural participants and to include representatives from additional institutions who are currently conducting or interested in starting their own medical school LEAD programs.

Commentary on "The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)": Army STARRS: a Framingham-like study of psychological health risk factors in soldiers.

Although historically the Army suicide rate has been significantly lower than the civilian rate, in 2004, the suicide and accidental death rates began trending upward. By 2008, the Army suicide rate had risen above the national average (20.2 per 100,000). In 2009, 160 active duty Soldiers took their lives, making suicide the third leading cause of death among the Army population. If accidental death, frequently the result of high-risk behavior, is included, then more Soldiers died by their own actions than in combat in 2009. The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) was thus created in 2009 to begin to address these problems. The Army STARRS project is a large consortium of seven different studies to develop data-driven methods for mitigating or preventing suicide behaviors and improving the overall mental health and behavioral functioning of Army Soldiers during and after their Army service. The first research articles from the Army STARRS project were published in late 2013 and early 2014. This work has already begun to outline important facets of risk in the military, and it is helping to drive an empirically derived approach to improvements in understanding mental disorders and risk behavior and to improve prevention and support of mental health and resilience. The Framingham Heart Study, started in the 1940s, marked a watershed event in utilizing large cross-sectional and prospective longitudinal collaborative research to identify and understand risk factors for cardiovascular disease. The Army STARRS project, through its collaborative, prospective, and robust innovative design and implementation, may provide the beginning of a similar scientific cohort in mental disorders. The work of this project will help understand biological and psychological aspects of military service, including those leading to suicide. When coupled with timely feedback to Army leadership, it permits near real-time steps to diagnose, mitigate, and manage emerging mental health issues and the root causes of risk and resilience in Army Soldiers, with potential impact extending across many traumatized populations-not unlike a parallel process that has markedly improved survival and recovery from physical combat wounds.

A model of federal interagency cooperation: the National Interagency Confederation for Biological Research.

The terrorist attacks of September 11 and the anthrax mailings a month later prompted a sweeping response by the federal government to improve the preparedness of the US to meet the potential threat posed by a terrorist using a biological agent. This response transcended traditional interagency boundaries, creating new opportunities while producing unique fiscal and leadership challenges. The National Interagency Confederation for Biological Research has made significant progress over the past 12 years because of its ability to adapt to the need for interagency cooperation and overcome many of these challenges. As construction of the National Interagency Biodefense Campus at Fort Detrick nears completion, the US has the capability to pursue a unique whole-of-government approach to the development of medical measures to counter the threat of bioterrorism. In addition to the high-level support of many in the federal government, the key success factors for this effort have been (1) a critical mass of leaders with the right leadership characteristics, (2) development of a compelling vision and accompanying narrative understood and articulated by all partnering organizations, and (3) recognition of the need for a partnership office to do the important communication and collaboration work in the organization to synchronize the information available to all the partners. The major barrier to interagency cooperative efforts of this kind is the inability to comingle funds from different appropriations.