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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.

The purpose of this study is to examine the moderating effects of mindfulness on the relationships between work stressors (perceived organisational politics [POP] and effort–reward imbalance [ERI]) and work outcomes (job burnout [JBO] and job satisfaction [JS]).

Time-lagged data were collected from public sector employees in France and Pakistan. The final samples (France, N = 204; Pakistan, N = 217) were tested using multiple moderating regression.

Mindfulness moderates the relationship between work stressors and work outcomes. Mindfulness serves as a personal resource for employees: it mitigates the negative influence that POP and ERI have on JBO and JS.

This study extends current knowledge on the relationships between work stressors and work outcomes across cultures by testing mindfulness as a valuable personal resource.

Drawing on the challenge–hindrance stressor framework and the “too-much-of-a-good-thing” principle, this study examined the curvilinear effects of two emic social challenge stressors (guanxi beliefs and participative decision-making (PDM)) and the moderating effect of an etic social hindrance stressor (perceived organizational politics) on Hong Kong and United States nurses’ job satisfaction.

A quantitative survey method was implemented, with the data provided by 355 Hong Kong nurses and 116 United States nurses. Structural equation modeling was used to examine the degree of measurement equivalence across Hong Kong and US nurses. The proposed model and the research questions were tested using nonlinear structural equation modeling analyses.

The results show that while guanxi beliefs only showed an inverted U-shaped relation on Hong Kong nurses’ job satisfaction, PDM had an inverted U-shaped relation with both Hong Kong and United States nurses’ job satisfaction. The authors also found that Hong Kong nurses experienced the highest job satisfaction when their guanxi beliefs and perceived organization politics were both high.

The results add to the comprehension of the nuances of the often-held assumption of linearity in organizational sciences and support the speculation of social stressors-outcomes linkages.

Managers need to recognize that while the nurturing and development of effective relationships with employees via social interaction are important, managers also need to be aware that too much guanxi and PDM may lead employees to feel overwhelmed with expectations of reciprocity and reconciliation to such an extent that they suffer adverse outcomes and become dissatisfied with their jobs.

First, the authors found that influences of guanxi beliefs and PDM are not purely linear and that previous research may have neglected the curvilinear nature of their influences on job satisfaction. Second, the authors echo researchers’ call to consider an organization’s political context to fully understand employees’ attitudes and reactions toward social interactions at work. Third, the authors examine boundary conditions of curvilinear relationships to understand the delicate dynamics.

The purpose of this paper is to evaluate the causal relationship between Lean practices and team performance. Specifically, the authors tried to demonstrate which practices act as enablers of continuous improvement and waste elimination and what is their impact on team performance.

A survey was carried out in a Higher Education Institution (HEI) in Southern Brazil. The authors obtained a sample of 785 respondents. The data analysis procedures involved confirmatory factor analysis and structural equations modeling.

The results of the research provided support for the positive influence of continuous improvement on waste elimination and of these two practices on team performance. In addition, empirical support was obtained for the effect of leadership support, employee involvement and internal process customers on continuous improvement.

Data collection was carried out online, so we were not able to maintain full control of the research respondents. This research generates relevant insights for decision-makers in the HEI environment, especially concerning Lean practices and team performance. The effects analyzed are even more relevant given the pandemic context.

This study shows how some higher education Lean practices can positively affect continuous improvement and better team performance. The results raise important insights for decision-makers to offer better higher education public services, especially given the context and changes imposed by the pandemic situation.

This paper initiates the discussion about enablers of continuous improvement and waste elimination in HEI and demonstrates their impact on team performance.

This study aims to examine the effects of coworker incivility on employees' behaviors using a moderated mediation model that conceptualizes coworker exchange (CWX) as a mediator and servant leadership as a moderator.

The data were collected using a multi-temporal research design. The hypotheses were tested on a sample of 1,272 participants using confirmatory factor analysis (CFA), hierarchical regression analysis and moderated path analysis. In addition, supervisor incivility was added as a control variable to partial out the potential influence on employees' behaviors.

The results of CFA ensured that all measures had discriminant and convergent validity. In addition, the results of hierarchical regression analysis and moderated path analysis indicated that CWX mediates the relationship between coworker incivility and employees' behaviors. Furthermore, servant leadership exacerbates the negative relationship between coworker incivility and CWX.

Leaders and practitioners should invest in communication training programs for developing employees' communication skills to avoid incivility. In addition to viewing incivility as inappropriate behavior, leaders and practitioners should understand the meaning beyond those incivilities.

This study utilized incivility spiral theory to examine how coworker incivility affects employees' behaviors. The mediated path analysis found that CWX mediates the relationship between these variables, which has been ignored by previous research. Furthermore, this study introduced servant leadership as a moderator to account for the “when” in incivility spiral theory, i.e. what kind of social context facilitates or inhibits the influence of coworker incivility on CWX.

Drawing on the conservation of resources theory, this study aims to explore how individuals’ perceptions of telework effects associate with their adaptive performance by shaping their negative emotional experiences, with perceived leadership effectiveness acting as a critical moderator in this relationship.

A cross-sectional design was used, with data collected from a final sample of 209 teleworkers via an online survey.

The results demonstrated a significant indirect effect of the perceived effects of teleworking on adaptive performance through negative affect. Furthermore, leadership effectiveness moderated the indirect effect, in a way that the indirect effect was only significant for those who had ineffective leaders and moderate effective leaders; therefore, the indirect effect was strengthened for those who had less effective leaders (versus effective leaders).

This study examines the positive link between teleworking perceptions and adaptive performance through the reduction of negative affect, in line with the conservation of resources theory. Moreover, a reduction in negative emotions among employees during telework is associated with enhanced performance. Notably, the study reveals that leadership effectiveness moderates this connection as playing a crucial role in moderating these effects, particularly when leaders are perceived as less effective, offering insights for organizations considering telework strategies.

This empirical study uncovers emotional sensemaking factors that cause changes in management perceptions about wicked strategic problems under dynamic complexity. These perception changes improve understanding of, and solutions to, the wicked problem.

Senior managers from three large organizations in different sectors participated in gaming simulation workshops. The strategic issues at stake were intractable and divisive. Qualitative methods captured participants' perceptions of the problems and the dynamic complexity that they faced and how they changed.

Flawed management perceptions were revised as sensemaking processes were catalyzed by emotions of shock/surprise that came from experiencing unexpected stakeholder conduct within a simulation. The plausibility of the conduct was strengthened because managers were role-playing stakeholders. The shock/surprise emotion uncoupled attachment to entrenched beliefs, leading to a willingness to revise the flawed perceptions. The changed perceptions created new insights for a solution to the wicked problem.

Practical implications are how management practitioners can improve the tackling of wicked strategic problems through the use of shock and surprise in a gaming simulation.

This research extends theory on the role of emotions in sensemaking under dynamic complexity. The authors uncover how a hierarchy of managers' emotions used in sensemaking explains the catalytic effect of the shock and surprise of unexpected stakeholder conduct on revisions to their perceptions of the outcomes of the dynamic complexity.