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There is currently a shortage of applications for the role of principal. There are a range of factors contributing to this, one of which may be the considerable levels of stress and burnout reported by principals and deputy principals. Distributed leadership may offer some solutions to this challenge. This study aimed to explore the lived experiences of distributed leadership from a role sustainability perspective of school principals and deputy principals.

This paper follows a qualitative interpretivist approach based upon 15 semi-structured interviews with principals and deputy principals working in Irish post-primary schools. Data were analysed via thematic analysis.

Results indicate challenges to the sustainability of the role of senior school leaders comprising administrative overload, policy proliferation and challenges due to the complexity and breadth of the role of these school leaders. It was reported that engagement with distributed leadership could aid the sustainability of participants in their roles and the importance of focusing on well-being practices was also highlighted.

Recommendations include the need to reconsider policy proliferation and the need to reconceptualise school leadership. Further consideration regarding how distributed leadership can aid the sustainability of the role of senior school leaders, without adversely contributing to the already busy role of schoolteachers is also recommended.

The findings of this study are valuable as they reflect previous findings relating to the current challenges to sustainable school leadership as well as highlight distributed leadership as a potential aid to mitigate against these challenges.

The paper examines interviewee insights into accountability for clinical governance in high-consequence, life-and-death hospital settings. The analysis draws on the distinction between formal “imposed accountability” and front-line “felt accountability”. From these insights, the paper introduces an emergent concept, “grounded accountability”.

Interviews are conducted with 41 clinicians, managers and governors in two large academic hospitals. The authors ask interviewees to recall a critical clinical incident as a focus for elucidating their experiences of and observation on the practice of accountability.

Accountability emerges from the front-line, on-the-ground. Together, clinicians, managers and governors co-construct accountability. Less attention is paid to cost, blame, legal processes or personal reputation. Money and other accountability assumptions in business do not always apply in a hospital setting.

The authors propose the concept of co-constructed “grounded accountability” comprising interrelationships between the concept’s three constituent themes of front-line staff’s felt accountability, along with grounded engagement by managers/governors, supported by a culture of openness.

The Model for Dementia Palliative Care Project will develop a service-delivery model for community-based dementia palliative care. Many countries provide dementia palliative care services, albeit with considerable variability within these. However, little is known about what service providers consider to be the most important components of a dementia palliative care model. This study aimed to address this knowledge gap.

An exploratory design using a survey method was used as an initial phase of the wider project. A web-based survey was developed, piloted (n = 5), revised, and distributed within five healthcare jurisdictions: the Republic of Ireland, Northern Ireland, England, Scotland, and Wales. The target population was health and social care professionals, policymakers, and academics interested in dementia and palliative care. Content analysis of open-ended questions identified common themes; descriptive statistics were applied to the closed-ended questions.

Overall, N = 112 complete surveys were received. Key care principles incorporated the philosophies of palliative care and dementia care; many described “holistic” and “person-centred care” as the core. Important individual service components were the support for carers, advanced care planning, information, education and training, activities for “meaningful living”, comprehensive disease management, coordinated case management, and linking with community health services and social activities. Barriers included poor availability and organisation of healthcare services, stigma, misconceptions around dementia prognosis, insufficiently advanced care planning, and dementia-related challenges to care. Facilitators included education, carer support, and therapeutic relationships.

This study, as part of the larger project, will directly inform the development of a novel service delivery Model of Dementia Palliative Care for Ireland. The results can also inform service planning and design in other countries.