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This study examines potential ways to break the inequality reproduction circle faced by ethnic minority health workers and sustained by key performance indicators (KPIs)-centred management in the National Health Service (NHS) in England. It does so through the lens of signalling theory.

Three years panel data for 2018–2020 covering 207 hospitals was compiled from the annual NHS staff survey and matched with relevant administrative records. Structural equation modelling was used to test the proposed hypotheses at the organisational level.

The moderated mediating model reveals that persistent racial discrimination by managers and coworkers can disadvantage the career progression of ethnic minority health workers, which in turn reinforces and reproduces economic and health inequalities among them. More importantly, we show how the collective agreement that the senior management team acts (SMTA) on staff feedback can break this vicious circle.

While our research focuses on the not-for-profit health care sector, it opens important opportunities to extend the proposed model to understand organisational inequality and how to address it.

Perceived SMTA can send strong signals to reduce deep-rooted discrimination (race, gender, age, etc.) through resource allocations and instrumental functions. This is also a way to address the current staff burnout and shortage issues in the healthcare sector.

This article reveals why the purpose of organisations that provide public service to reduce social inequality was comprised during their business-like operations and more importantly, how to reflect their foundational purpose through management practice.

This study offers a way forward to resolve one of the unintended consequences of KPI-centred management in the not-for-profit sector through unpacking the process of inequality reproduction and, more importantly, how it is possible to break this vicious circle.

Telemedicine, similarly to social media, accelerates information exchange, enriches information, provides better access to information and, furthermore, has an impact on mobilizing resources in business-to-business relationships. This paper aims to contribute to the understanding of the changes brought about by telemedicine, as a new technology, in patient routes.

This case study method was applied to examine five health-care protocols through their patient routes (series of activities) with and without telemedicine technology. The ARA model was applied to examine the changes telemedicine engendered in relation to activities, resources and actors. The strategy of visual mapping was applied for the comparative analysis.

The analyzed cases show that the new resources applied through telemedicine technology modified the number and substance of relevant activities and the set and role of actors who were involved. The quantity or the availability of output information increased in patient routes when new resources were added by telemedicine technology. When technology change occurred, any change in data or information systems – the two building blocks of information – could result in new or modified activities. If data that is used or produced while undertaking an activity change simultaneously along with the information system used for encrypting this data, then this “joint change” will certainly entail some kind of change in the set of activities, resources or actors that are involved. If not, then the activities continued the same as with the face-to-face protocol (without the new technology).

The novelty of the paper is that the results highlight the role of information in the extent of change in interactions induced by new technology. Findings about such changes show how information influenced by activities, resources and actors can help decision-makers in relation to the use of telemedicine.

The emergence of Research Management and Administration (RMA) is a result of the pressure on academics to secure research funding from external sources, the increasing competition for these funds, as well as the rising requirements of research funders in terms of reporting and compliance with regulations. This is relevant in the case of the current Horizon Europe Framework Programme for Research and Innovation (HEU) funded by the European Union (EU) which requires important level of professionalisation of the research support staff on behalf of the applicant institutions. Data management, open science, research ethics and integrity, achieving impact beyond academia and the valorisation of project results can be regarded as non-research specific criteria which have to be met by applicant organisations to secure the highly competitive funding. Meeting these non-specific criteria is not always possible in countries whose performance is lagging behind compared to the Western European competitors in EU-funded programmes, such as Hungary.

Our findings reveal two things. First, research support in Hungary is in its early stage of maturity, similary to many countries in Central and Eastern Europe. In several cases, Research Managers and Administrators (RMAs) do not possess the knowledge necessary to meet the non-research specific criteria even if the knowledge is present at the institution or with other colleagues. Second, due to the continuously increasing participation in EU-funded framework programmes (FPs), the state of research support in Hungary is constantly evolving. There is also willingness to learn and improve capacities, which needs strategic planning, studying others’ examples and their adaptability. Such processes can support the capacity building and professionalisation of research offices not only in Hungary, but in countries of the Central and Eastern European region with a similar maturity level of RMA.

This research paper generates new insights into the challenges of implementation in women’s enterprise policy. It argues that organisations involved in policy implementation need to be understood as operating in a context of institutional pluralism and answers: How do organisations involved in the implementation of women’s enterprise policy manage the challenges of institutional pluralism?

Addressing the need for women’s enterprise policy to learn from the past, the research adopts a historical approach to the study of policy implementation through examination of the UK’s Phoenix Development Fund (1999–2008). It analyses a wide range of secondary sources to examine 34 projects funded and supported by the Phoenix Development Fund that targeted women entrepreneurs.

Potentially conflicting institutional logics associated with central government, mainstream business support and local communities were managed through four key processes: dominance; integration; constellation and bridging. The management of institutional pluralism was effective in delivering support to communities but not in providing an effective platform for learning in government or establishing sustainable, long-term mechanisms.

The paper develops an empirical contribution to practice through identification of processes to manage the challenges of institutional pluralism and lessons for community-engaged policy implementation. A theoretical contribution to academic debates is provided by the conceptualisation of these challenges in terms of institutional pluralism and the novel concept of institutional bridging. The study also demonstrates the value of historical methods for women’s enterprise policy to learn the lessons of the past.

The skillsets of science, technology, engineering and mathematics (STEM) graduates are widely recognised to be important for economic prosperity. At the same time, it is broadly accepted that in England there is a need to increase the number of people studying STEM degree courses and working in STEM. However, despite decades of interventions post-16, STEM participation rates remain lower than projected requirements. Some research reports suggest a lack of positive attitudes towards these subjects and aspirations amongst some social groups. As these debates continue, official reports such as those released by the Department for Education show these patterns from the labour market and higher education (HE) extend to both attainment and participation in science and math in school.

In this paper, the authors summarise the authors' findings from the analysis of official reports, policy documents and major research reports focussing on attainment in school science and math and post-compulsory STEM participation.

The authors identify the problematic ways in which STEM subject choices are made across the student life cycle and then discuss how the leaky pipeline metaphor can be ambiguous and needs to be used with caution.

Some aspects identified here warrant further research and will be of particular interest to researchers, practitioners and policymakers.

In this new report, the authors identify the problematic ways in which STEM subject choices are made across the student life cycle in England and then discuss how the leaky pipeline metaphor can be ambiguous and needs to be used with caution.

The purpose of this paper is to report on the dynamics of “identity leadership” with a quality improvement project undertaken by an International Medical Graduate (IMG) from Sri Lanka, on a two year Medical Training Initiative (MTI) placement in the National Health Service (NHS) [Academy of Medical Royal Colleges (AoMRC), 2017]. A combined MTI rotation with an integrated Fellowship in Quality Improvement (Subedi et al., 2019) provided the driver to implement the HEART score (HS) in an NHS Emergency Department (ED) in the UK. The project was undertaken across ED, Acute Medicine and Cardiology at the hospital, with stakeholders emphasizing different and conflicting priorities to improve the pathway for chest pain patients.

A social identity approach to leadership provided a framework to understand the insider/outsider approach to leadership which helped RH to negotiate and navigate the conflicting priorities from each departments’ perspective. A staff survey tool was undertaken to identify reasons for the lack of implementation of a clinical protocol for chest pain patients, specifically with reference to the use of the HS. A consensus was reached to develop and implement the pathway for multi-disciplinary use of the HS and a quality improvement methodology (with the use of plan do study act (PDSA) cycles) was used over a period of nine months.

The results demonstrated significant improvements in the reduction (60%) of waiting time by chronic chest pain patients in the ED. The use of the HS as a stratified risk assessment tool resulted in a more efficient and safe way to manage patients. There are specific leadership challenges faced by an MTI doctor when they arrive in the NHS, as the MTI doctor is considered an outsider to the NHS, with reduced influence. Drawing upon the Social Identity Theory of Leadership, NHS Trusts can introduce inclusion strategies to enable greater alignment in social identity with doctors from overseas.

More than one third of doctors (40%) in the English NHS are IMGs and identify as black and minority ethnic (GMC, 2019a) a trend that sees no sign of abating as the NHS continues its international medical workforce recruitment strategy for its survival (NHS England, 2019; Beech et al., 2019). IMGs can provide significant value to improving the NHS using skills developed from their own health-care system. This paper recommends a need for reciprocal learning from low to medium income countries by UK doctors to encourage the development of an inclusive global medical social identity.

This quality improvement research combined with identity leadership provides new insights into how overseas doctors can successfully lead sustainable improvement across different departments within one hospital in the NHS.

This paper evaluates the value and necessity of greater equity, diversity and inclusion (EDI) in Canadian fire departments. Rather than focussing on changing hiring practices, the paper seeks to highlight how leadership can implement a culture of EDI that will encourage all people to participate.

From a leadership perspective, this paper aims to show how EDI can improve firefighter teamwork and job performance whilst satisfying moral obligations to better represent Canadian communities. Strategies and their limitations for communication and culture change are discussed.

Leaders of Canadian fire departments can utilise organisational change models focussing on improved communication techniques and models to implement cultural changes needed to allow for more EDI. Specific recommendations based on business research into culture change, communication and EDI are outlined.

Recommendations to fire department leadership for cultural changes and communication are provided. Further, strategies and reasoning for why inclusive departments are more effective are given.

Creating a more inclusive culture in fire departments will lead to an increase in applications from people who have not typically applied in the past.

There has been little research or recommendations on increasing EDI in Canadian fire departments through cultural changes. Most existing literature is vague and tends to focus on hiring practices over an analysis of internal culture. This article provides analysis of best business practices and applies those to the cultural context of fire departments to promote culture change.

This study aims to explore whether the cultural competency training in Improving Access to Psychological Therapies (IAPT) services is sufficient to equip Psychological Wellbeing Practitioners (PWP) to support Black, Asian and Minority Ethnic (BAME) service users.

A qualitative design was adopted using semi-structured interviews with six PWP participants. Reflexive thematic analysis using Braun and Clarke’s (2006) six-step process was used in data analysis.

Three themes revealed evaluations of PWP training, factors supporting PWPs’ cultural competency and points of improvement for PWP training. The training briefly and superficially covered cultural competency content; however, it encouraged PWPs to explore potential personal and cultural biases in therapy. PWP training can also be improved by providing more culturally relevant resources and involving BAME service users.

A small sample size (N = 6) was used, impacting the findings’ generalizability.

PWP training does not sufficiently equip PWPs to support BAME service users. PWPs’ reflection of their own ethnic identity and personal experiences, when combined with training, can improve cultural competency. IAPT training should focus on cultural awareness, knowledge and skills to enhance therapeutic experience. Moreover, PWPs should reflect on their identity, personal biases and experiences when working with diverse communities.

This is one of the few qualitative studies evaluating the cultural competencies of PWPs in IAPT.