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Reflective practice (RP) is a key skill for developing one’s professional practice. It has, however, not been unanimously prioritised in public health (PH) competency and education frameworks. Reflection activities are often unstructured in higher education. There is also a dearth of literature on the RPs of undergraduate PH students. This study aims to explore in greater depth how RP helps undergraduate PH students explore their own learning in internships.

Reflection prompts were designed using the DEAL model. 124 written reflection entries from 32 students were collected and analysed thematically using a deductive-inductive approach. The conceptual framework of internship learning goals by Ash and Clayton (2009) was used to guide the deductive analysis.

Three themes were identified: initial engagement with reflective learning; gradual integration of reflective learning, and a transformative phase involving professional development, personal growth, civic learning, growth through struggle, being confronted with differences in expectations, and skill acquisition.

This study extends the limited evidence regarding RP in undergraduate non-medical PH education, and contributes toward informing the revision of undergraduate PH programmes, for example, by integrating structured reflection earlier in the curricula, and establishing/supporting mentorship programmes between institutions. The findings call for PH educators to be more intentional in creating opportunities to nurture RP among budding PH professionals.

This chapter focuses on the COVID-19 pandemic’s impact on the recognition through discourses of essentiality, of low-status workers and more specifically of care aides as an occupational group that performs society’s ‘dirty work’. The pandemic appears as a privileged moment to challenge the normative hegemony of how work is valued within society. However, public recognition through political discourse is a necessary but insufficient element in producing social change. Based on the theory of performativity, this chapter empirically probes conditions and mechanisms that enable a transition from discourse of essentiality to substantive recognition of the work performed by care aides in healthcare organizations. The authors rely on three main sources of data: scientific-scholarly works, documents from government, various associations and unions, and popular media reports published between February 2020 and 1 July 2022. While discourse of essentiality at the highest level of politics is associated with rapid policy response to value the work of care aides, it is embedded in a system structure and culture that restrains the establishment of substantive policy that recognizes the nature, complexity, and societal importance of care aide work. The chapter contributes to the literature on performativity by demonstrating the importance of the institutionalization of competing logics in contemporary health and social care systems and how it limits the effectiveness of discourse in promulgating new values and norms and engineering social change.

Medical disruptive innovation is essential for deepening the reform of health-care system. The theory of general disruptive innovation assumes that innovations can diffuse by benefiting and attracting consumers through observed and objective relative advantages. Yet decision-makers for adoption in health-care settings are safety-sensitive professionals whose cognitions barriers about underperformance in focal attributes will impede further evaluation of innovation's ancillary performance. Existing studies do not answer the question of how such innovations can overcome safety barriers, find early adopters and grow to the early majority. The purpose of this study is to investigate the process, mechanism, and path of early diffusion of medical disruptive innovation.

The authors conduct a longitudinal case study of the diffusion of Enhanced Recovery After Surgery (ERAS) in China during 2011–2018.

The authors find that the diffusion process of medical disruptive innovations can be viewed as a cognitive evolutionary process that sequentially establishes conformity, differentiation and normalization. Cognition reframing of expert, meaning and benefit for professionals is its implicit mechanism. When adoption may trigger cognitive concerns, actors’ very early (dis)adoption is driven by a combination of structural position, innovation attributes and performance perceptions; central actors then play amplifier roles in the development from early adopters to the early majority.

This study proposes a process theoretical framework for the early diffusion of disruptive innovation. By dissecting the key processes and mechanisms from a cognitive perspective, the study offers theoretical contributions and practical insights into the diffusion of disruptive innovation in professional settings.

This study aims to summarize studies that compared the performance of health-care institutions led by leaders with medical background versus those with no medical background.

A systematic search was conducted on three databases: PubMed, Ovid Medline and Google Scholar to identify relevant peer-reviewed studies using the keywords “performance,” “impact,” “physician,” “medical,” “doctor,” “leader,” “healthcare institutions” and “hospital.” Only quantitative studies that compared the performance of health-care institutions led by leaders with medical background versus non-medical background were included. Articles were screened and assessed for eligibility before the relevant data were extracted to summarize, appraise and make a narrative account of the findings.

A total of eight studies were included, four were based in the USA, two in the UK and one from Germany and one from the Arab World. Half of the studies (n = 4) reported overall better health-care institutional performance in terms of hospital quality ranking such as clinical effectiveness and patient safety under leaders with medical background, whereas one study showed poorer performance. The remaining studies reported mixed results among the different performance indicators, especially financial performance.

While medical background leaders may have an edge in clinical competence to manage health-care institutions, it will be beneficial to equip them with essential management skills to optimize leadership competence and enhance organizational performance.

The exclusive inclusion of quantitative empirical studies that compared health-care institutional performance medical and non-medical leaders provides a clearer link between the relationship between health-care institutional performance and the leaders’ background.

The purpose of this mixed-methods study was to explore how medical secretaries experience digital transformation in a Swedish healthcare organisation, with a focus on workplace climate and health.

Data were collected using a sequential exploratory mixed-methods design based on grounded theory, with qualitative data collection (a Quality Café and individual interviews) followed by quantitative data collection (a questionnaire).

Four categories with seven underlying factors were identified, emphasising the crucial need for effective organisation of digital transformation. This is vital due to the increased knowledge and skills in utilising technology. The evolving roles and responsibilities of medical secretaries in dynamic healthcare settings should be clearly defined and acknowledged, highlighting the importance of professionality. Ensuring proper training for medical secretaries and other occupations in emerging techniques is crucial, emphasising equal value and knowledge across each role. Associations were found between some factors and the health of medical secretaries.

This study adds to the knowledge on digital transformation in healthcare by examining an important occupation. Most data were collected online, which may be a limitation of this study.

Several aspects of the medical secretaries’ experiences were identified. Knowledge of these is valuable for healthcare managers to make digital transformation more effective while avoiding excessive strain on medical secretaries.

Medical secretaries are expected to contribute to the digitalisation of healthcare. However, minimal research has been conducted on the role of medical secretaries in workplace digitalisation, focusing on workplace roles and its dynamics.

Value-based health care (VBHC) argues that health-care needs to re-focus to maximise value creation, defining value as the quota when dividing the outcomes important for the patient, by the cost for health care to deliver such outcomes. This study aims to explore the perception of value among different stakeholders involved in the process of implementing VBHC at a Swedish hospital to support leaders to be more efficient and effective when developing health care.

Participants comprised 19 clinicians and non-clinicians involved in the implementation of VBHC. Semi-structured interviews were conducted and content analysis was performed.

The clinicians described value as a dynamic concept, dependent on the patient and the clinical setting, stating that improving outcomes was more important than containing costs. The value for non-clinicians appeared more driven by the interplay between the outcome and the cost. Non-clinicians related VBHC to a strategic framework for governance or for monitoring different continuous improvement processes, while clinicians appreciated VBHC, as they perceived its introduction as an opportunity to focus more on outcomes for patients and less on cost containment.

There is variation in how clinicians and non-clinicians perceive the key concept of value when implementing VBHC. Clinicians focus on increasing treatment efficacy and improving medical outcomes but have a limited focus on cost and what patients consider most valuable. If the concept of value is defined primarily by clinicians’ own assumptions, there is a clear risk that the foundational premise of VBHC, to understand what outcomes patients value in their specific situation in relation to the cost to produce such outcome, will fail. Health-care leaders need to ensure that patients and the non-clinicians’ perception of value, is integrated with the clinical perception, if VBHC is to deliver on its promise.

Drawing on interviews with two types of essential workers – wound clinicians and care workers – the chapter examines stigma management in dirty care work through the lens of emotion management. The study combines two dimensions of dirty work: physical taint in relation to bodywork and social taint linked to working in close proximity to socially stigmatized clients. Hence, stigma management extends to dealing with the physically and socially dirty features of essential care work. In addition, the authors’ assessment of social stigma includes how essential care workers also sought to alleviate the social stigma encountered by their clients. In so doing, the authors extend the literature on dirty work to identify how emotion management skills are central to the stigma management strategies of the essential care workers in this study. The authors demonstrate how both groups deal with their stigma by emphasizing the emotion management skills in ‘doing’ dirty work and in the ‘purpose’ of this work, which includes acknowledging how the authors attempt to address the social taint encountered by their clients. Additionally, by comparing two occupations with different contexts and conditions of work, the authors show how complex emotion management skills are gendered in care work to expand the understanding of gender and stigma management. Furthermore, these emotion management skills emanate from the deep relational work with clients rather than through occupational communities. The authors argue that by focussing on emotion management, the hidden skills of dirty work in gendered care work are illuminated and contribute to contemporary debates about whether stigma can be overcome.

The main aim of this article is to broaden the notion of strategic intent in public relations. It also develops an understanding of the social value of what can be defined as the first modern health communication campaign in Europe based on strategic intents and the development of modernity.

The study is based on both historical research and empirical material from the Norwegian tuberculosis campaign from 1889 up to 1913, when Norwegian women achieved suffrage. The campaign is analysed in the framework of modernity and social theory. The literature on lobbying and social movements is also used to develop a theoretical framework for the notion of strategic intent.

The study shows that strategic intent can be divided into two layers: (1) the implicit strategic intent is the real purpose behind the communication efforts, whereas (2) the explicit intent is found directly in the communication efforts. The explicit intent may be presented as a solution for the good of society at the right political moment, giving an organisation the possibility to mobilise for long-term social changes, in which could be the implicit intent.

The distinction between explicit and implicit strategic intent broadens our understanding on how to make long-term social changes as well as how social and political changes occur in modern societies. The article also gives a historical account of what is here defined as the first modern health communication campaign in Europe and its social value.

Society is critically dependent on an adequate supply of hospital doctors to ensure optimal health care. Voluntary turnover amongst hospital doctors is, however, an increasing problem for hospitals. The aim of this study was to systematically review the extant academic literature to obtain a comprehensive understanding of the current knowledge base on hospital doctor turnover and retention. In addition to this, we synthesise the most common methodological approaches used before then offering an agenda to guide future research.

Adopting the PRISMA methodology, we conducted a systematic literature search of four databases, namely CINAHL, MEDLINE, PsycINFO and Web of Science.

We identified 51 papers that empirically examined hospital doctor turnover and retention. Most of these papers were quantitative, cross-sectional studies focussed on meso-level predictors of doctor turnover.

Selection criteria concentrated on doctors who worked in hospitals, which limited knowledge of one area of the healthcare environment. The review could disregard relevant articles, such as those that discuss the turnover and retention of doctors in other specialities, including general practitioners. Additionally, being limited to peer-reviewed published journals eliminates grey literature such as dissertations, reports and case studies, which may bring impactful results.

Globally, hospital doctor turnover is a prevalent issue that is influenced by a variety of factors. However, a lack of focus on doctors who remain in their job hinders a comprehensive understanding of the issue. Conducting “stay interviews” with doctors could provide valuable insight into what motivates them to remain and what could be done to enhance their work conditions. In addition, hospital management and recruiters should consider aspects of job embeddedness that occur outside of the workplace, such as facilitating connections outside of work. By resolving these concerns, hospitals can retain physicians more effectively and enhance their overall retention efforts.

Focussing on the reasons why employees remain with an organisation can have significant social repercussions. When organisations invest in gaining an understanding of what motivates their employees to stay in the job, they are better able to establish a positive work environment that likely to promote employee well-being and job satisfaction. This can result in enhanced job performance, increased productivity and higher employee retention rates, all of which are advantageous to the organisation and its employees.

The review concludes that there has been little consideration of the retention, as opposed to the turnover, of hospital doctors. We argue that more expansive methodological approaches would be useful, with more qualitative approaches likely to be particularly useful. We also call on future researchers to consider focussing further on why doctors remain in posts when so many are leaving.

This paper brings attention to the role of hybrid middle managers. In particular it explores the relationship of organisational purpose and role requirements.

The primary research question for the original research was: What does it mean to hybrid managers to lead and deal with imposed changes (restructuring) to services? A novel narrative approach based on a synthesis of Czarniawska, Gabriel and Boje was applied. Accounts from interviews were condensed into narratives by initially using the categories defined by Gabriel (2000) as epic, tragic, comic and romantic and then further categorised into stories, themes and a serial (Czarniawska, 1997). The final stage of the three-way synthesised narrative approach incorporated Boje’s (2001) notion of “antenarrative” to include pre-emplotment elements.

Four narratives are provided that give insight to the nature of the struggles the hybrid middle managers were in the midst of. A struggle to address incongruent demands being placed on them that cause tension with their sense of purpose, organisational goals and their hybrid clinical roles and management roles. In the midst of these struggles the narratives illustrate the dynamic of ethical resistance that seeks a way forward. However, this appears to come at a health and well-being cost to the middle managers.

The paper offers up the notion of an added third bind to the traditional double, that of “ethical resistance”, a struggle to align organisational purpose with clinical and management role requirements. Theorising this third bind provides a new insight into understanding the context and dynamics of the hybrid middle manager role and behaviour. Indeed, the idea of ethical resistance may cause a revision of how resistance is understood.