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Healthcare tribalism refers to the phenomenon through which different groups in a healthcare setting strictly adhere to their profession-based silo, within which they exhibit stereotypical behaviours. In turn, this can lead to deleterious downstream effects upon productivity and care delivered to patients. This study highlights a clinician-led governance model, implemented at a National Health Service (NHS) trust, to investigate whether it successfully overcame tribalism and helped drive innovation.

This was a convergent mixed-methods study including qualitative and quantitative data collected in parallel. Qualitative data included 27 semi-structured interviews with representatives from four professional groups. Quantitative data were collected through a verbally administered survey and scored on a 10-point scale.

The trust arranged its services under five autonomous business units, with a clinician and a manager sharing the leadership role at each unit. According to interviewees replies, this equivalent authority was cascaded down and enabled breaking down professional siloes, which in turn aided in the adoption of an innovative clinical model restructure.

This study contributes to the literature by characterizing a real-world example in which healthcare tribalism was mitigated while reflecting on the advantages yielded as a result.

Previous studies from all over the world identified major differences in the perspectives of different healthcare professional groups. In the United Kingdom, clinicians largely felt cut off from decision-making and dissatisfied with their managerial role. The study findings explain a governance model that allowed harmony and inclusion of different professions. Given the long-standing strains on healthcare systems worldwide, stakeholders can leverage the study findings for guidance in developing and implementing innovative managerial approaches.

This research study provides insight into students’ perceptions of teaching through virtual and face-to-face clinicals in an introductory education course in a pre-education program at a minority-serving institution.

This study took place at an urban–suburban-centered community college in the Midwestern United States and was reviewed by the higher education institutional review board (IRB). Data were collected from pre-education majors enrolled in a four-hour Introduction to Education with field experiences.

The findings indicated that both virtual and face-to-face clinicals were beneficial to the development of pre-service teachers, particularly in an early introduction to education course.

The finding that virtual clinicals are significant to teacher growth is significant to teacher recruitment and preparation.

The flexibility of a virtual clinical provides greater opportunities for low-income and marginalized populations with limited means and access.

This finding can lead to strategies to diversify teacher candidates.

This study sought to answer the following question: how do pre-education students reflect to understand the roles and responsibilities of teaching through virtual options vs face-to-face clinicals? The interest of this research is to expand pathways into the teaching profession to nontraditional, ethnically and culturally marginalized groups and historically underrepresented groups.

This study aims to deepen the understanding of how top managers reason about handling the relationships between quality of patient care, economy and professionals’ engagement.

Qualitative design. Individual in-depth interviews with all members of the executive management team at an emergency hospital in Norway were analysed using reflexive thematic method.

The top managers had the intention to balance between quality of patient care, economy and professionals’ engagement. This became increasingly difficult in times of high internal or external pressures. Then top management acted as if economy was the most important focus.

For health-care top managers to lead the pursuit towards increased sustainability in health care, there is a need to balance between quality of patient care, economy and professionals’ engagement. This study shows that this balancing act is not an anomaly top-managers can eradicate. Instead, they need to recognize, accept and deliberately act with that in mind, which can create virtuous development spirals where managers and health-professional communicate and collaborate, benefitting quality of patient care, economy and professionals’ engagement. However, this study builds on a limited number of participants. More research is needed.

Sustainable health care needs to balance quality of patient care and economy while at the same time ensure professionals’ engagement. Even though this is a central leadership task for managers at all levels, there is limited knowledge about how top managers reason about this.

Nurse leaders are challenged by ethical issues in today’s complex health-care settings. The purpose of this study was to describe and analyze key elements of moral distress identified by nurse leaders from health-care systems in the USA, Germany, Austria and Switzerland. The aim was to develop an understanding of distressing ethical issues nurse leaders face in the USA and three German-speaking European countries.

This descriptive cross-sectional study surveyed a convenience sample of nurse leaders in the USA, Germany, Austria and Switzerland. The voluntary, anonymous survey also included qualitative questions and was distributed using the Qualtrics® platform. A thematic analysis of the qualitative data in each country was carried out and a comparative analysis identified similarities and differences between the groups of nurse leaders comparing the US data to that from three German-speaking European countries.

The survey was completed by 316 nurse leaders: Germany, Austria, and Switzerland (n = 225) and the USA (n = 91). Similar themes identified as causing all nurse leaders moral distress included a lack of individual and organizational integrity, hierarchical and interprofessional issues, lack of nursing professionalism, patient care/patient safety concerns, finances negatively impacting care and issues around social justice. Within these six themes, there were also differences between the USA and the three German-speaking European countries.

Understanding the experiences associated with distressing ethical situations can allow nurse leaders and organizations to focus on solutions and develop resilience to reduce moral distress in the USA and three German-speaking European countries.

New Public Management-informed pay-for-performance policies are common in public sectors internationally but can be controversial with delivery agents. More attention is needed on contingent forms of bottom-up implementation of challenging policies, in emerging market economies, for professionals who face tensions between policies and their codes of practice. Street-level bureaucrats (SLBs) mediate policy implementation through discretionary practices; health professionals have enhanced space for discretion based on autonomy derived from professional status. The authors explore policy implementation, adaptation and resistance by physicians, focusing on payments for health workers in Turkey.

The researchers conducted semi-structured qualitative interviews with 12 physicians in Turkish hospitals and thematic analysis of interview transcripts, using a blended (deductive and inductive) approach.

The policy fostered discretionary behaviours such as cherry-picking (high volume, low risk procedures) and pro-social rule-breaking (e.g. “upcoding”), highlighting clinical autonomy to navigate within policy restrictions. Respondents described damage to relationships with patients and colleagues, and dissonance between professional practice and perverse policy incentives, sometimes leading to disengagement from clinical work. Policymakers were perceived to be detached from the realities experienced by SLBs. Tensions between the policy and professional values risked alienating physicians.

This study utilises participant self-reported perceptions of discretionary behaviours. Further work may adopt alternative methods to explore the relationship between self-reporting and observed practice.

The authors contribute to research on differentiated, contingent roles of groups with high scope for discretion in bottom-up implementation, pointing to the potential for policy-professional role conflicts between top-down P4P policies, and the values and codes of practice of professional SLBs.

This chapter investigates the ongoing process of academization within the field of educational therapy in Germany, particularly in the context of the introduction of university degrees in integrative educational therapy and the psychology of learning. The introduction of these degrees brought about transformative changes in the professional landscape. Educational therapists holding such degrees often demonstrate a more advanced understanding of their roles, which is underpinned by thorough university education and the legitimizing influence of their academic titles. Prior to the establishment of these degree programs, the field of educational therapy was notably unregulated, devoid of a protected professional title or a specific qualification. This lack of regulation resulted in a proliferation of varied providers, giving rise to what’s known as the “after-school market” phenomenon. This chapter explores the genesis and institutionalization of degree programs in educational therapy as a path toward professionalizing the field. It reveals the crucial role that professional associations along with scientific experts have played in launching these degree programs. Additionally, it discusses the impact of competition among different approaches to educational therapy within this rapidly evolving landscape.

In this chapter, the author critically examines the deeply entrenched practices and theories within counselor education, revealing their roots in historically dominant, Eurocentric, and often racially oppressive assumptions. This study brings to light the pervasive impact of these traditional approaches, illuminating their role in perpetuating racial oppression and disparities in mental health care. The author presents a compelling argument for adopting Critical Race Theory (CRT) as an effective pedagogical and clinical practice framework in the counseling profession, a step toward its much-needed liberation. CRT's tenets are examined as a robust alternative, promoting socially just outcomes in counseling and psychotherapy. The article highlights CRT's capacity to address the well-established relationship between racism, white supremacy, and minority mental health. It proposes a groundbreaking model for praxis, predicated on CRT, which holds potential not only to challenge and disrupt oppressive structures but also to pave the way for the liberation of both the oppressed and the oppressor. This seminal work prompts a re-envisioning of counselor education, asserting a call for a transformative shift toward a liberation-based, social justice pedagogy.

While spontaneous and voluntary knowledge contribution in online communities promotes value co-creation, dysfunctional knowledge behaviors hamper the effectiveness and development of such communities. The study conceptualizes physicians' proactive knowledge sharing and knowledge withholding behaviors in physician-driven online health communities (OHCs) and integrates the theories of role identity as well as communal and exchange relationships to understand the root causes and motivations behind these two types of knowledge behaviors.

The authors collected survey data from 166 users from one of the largest physician-driven OHCs in China and applied the covariance-based structural equation modeling approach to test the hypotheses.

The findings suggest that (1) physicians' professional role identity had a positive indirect effect on proactive knowledge sharing behaviors through communal motivation, and work pressure weakened this indirect effect; and (2) professional role identity had a negative indirect impact on knowledge withholding behaviors through exchange motivation.

This study extends proactive knowledge sharing and knowledge withholding behaviors from the organizational management domain to the online environment, exploring the underlying causes and motivations behind both behaviors in the unique context of physician-driven OHCs. The findings offer practical suggestions for the effective management of OHC platforms, as well as policy implications that respond to the workforce shortage of healthcare providers, a crisis that is unfolding globally.