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Healthcare providers are under pressure due to increasing and more complex demands for services. Increased pressure on budgets and human resources adds to an ever-growing problem set. Competent leaders are in demand to ensure effective and well-performing healthcare organisations that deliver balanced results and high-quality services. Researchers have made significant efforts to identify and define determining competencies for healthcare leadership. Broad terms such as competence are, however, inherently at risk of becoming too generic to add analytical value. The purpose of this study is to suggest a holistic framework for understanding healthcare leadership competence, that can be crucial for operationalising important healthcare leadership competencies for researchers, decision-makers as well as practitioners.

In the present study, a critical interpretive synthesis (CIS) was conducted to analyse competency descriptions for healthcare leaders. The descriptions were retrieved from peer reviewed empirical studies published between 2010 and 2022 that aimed to identify healthcare services leadership competencies. Grounded theory was utilised to code the data and inductively develop new categories of healthcare leadership competencies. The categorisation was then analysed to suggest a holistic framework for healthcare leadership competence.

Forty-one papers were included in the review. Coding and analysing the competence descriptions resulted in 12 healthcare leadership competence categories: (1) character, (2) interpersonal relations, (3) leadership, (4) professionalism, (5) soft HRM, (6) management, (7) organisational knowledge, (8) technology, (9) knowledge of the healthcare environment, (10) change and innovation, (11) knowledge transformation and (12) boundary spanning. Based on this result, a holistic framework for understanding and analysing healthcare services leadership competencies was suggested. This framework suggests that the 12 categories of healthcare leadership competencies include a range of knowledge, skills and abilities that can be understood across the dimension personal – and technical, and organisational internal and – external competencies.

This literature review was conducted with the results of searching only two electronic databases. Because of this, there is a chance that there exist empirical studies that could have added to the development of the competence categories or could have contradicted some of the descriptions used in this analysis that were assessed as quite harmonised. A CIS also opens for a broader search, including the grey literature, books, policy documents and so on, but this study was limited to peer-reviewed empirical studies. This limitation could also have affected the result, as complex phenomenon such as competence might have been disclosed in greater details in, for example, books.

The holistic framework for healthcare leadership competences offers a common understanding of a “fuzzy” concept such as competence and can be used to identify specific competency needs in healthcare organisations, to develop strategic competency plans and educational programmes for healthcare leaders.

This study reveals a lack of consensus regarding the use and understanding of the concept of competence, and that key competencies addressed in the included papers are described vastly different in terms of what knowledge, skills and abilities they entail. This challenges the operationalisation of healthcare services leadership competencies. The proposed framework for healthcare services leadership competencies offers a common understanding of work-related competencies and a possibility to analyse key leadership competencies based on a holistic framework.

This is the first study to evaluate ADHD-hyperactive/impulsive subtype in a large clinical sample of adults with ADHD. The Quality of Life, Effectiveness, Safety and Tolerability (QuEST) study included 725 adults who received clinician diagnoses of any ADHD sub-type. Cross-sectional baseline data from 691 patients diagnosed with the hyperactive/impulsive (HI), inattentive (IA) and combined sub-types were used to compare the groups on the clinician administered ADHD-RS, clinical features and health-related quality of life. A consistent pattern of differences was found between the ADHD-I and combined subtypes, with the combined subtype being more likely to be diagnosed in childhood, more severe symptom severity and lower HRQL. Twenty-three patients out of the total sample of 691 patients (3%) received a clinician diagnosis of ADHD -hyperactive/impulsive subtype. Review of the ratings on the ADHD-RS-IV demonstrated, however, that this group had ratings of inattention comparable to the inattentive group. There were no significant differences found between the ADHD-HI and the other subtypes in symptom severity, functioning or quality of life. The hyperactive/impulsive subtype group identified by clinicians in this study was not significantly different from the rest of the sample. By contrast, significant differences were found between the inattentive and combined types. This suggests that in adults, hyperactivity declines and inattention remains significant, making the hyperactive/impulsive sub-type as defined by childhood criteria a very rare condition and raising questions as to the validity of the HI subtype in adults.

This chapter examines how established media – that is, print, TV and radio sources which pre-existed the popularisation of social media – use social media to disseminate content. Specifically it examines the manner in which three UK media sources – BBC News, The Guardian and the Daily Mail – used Twitter during the 2014–2015 Ebola crisis. It asks five key questions concerning: the balance between factual reporting and opinion or comment; the degree to which it shifted attention to specific events within the context of the outbreak; whether the dialogical potential of social media was exploited; the degree to which social media acted as a signpost to more detailed information elsewhere, or existed as independent content; and the degree of media reflexivity. It concludes that established media used this new technology within their existing paradigms for reporting rather than exploiting some of its more innovative characteristics.

While there is increasing interest in implementing drug checking within overdose prevention, we must also consider how to scale-up these responses so that they have significant reach and impact for people navigating the unpredictable and increasingly complex drug supplies linked to overdose. The purpose of this paper is to present a distributed model of community drug checking that addresses multiple barriers to increasing the reach of drug checking as a response to the illicit drug overdose crisis.

A detailed description of the key components of a distributed model of community drug checking is provided. This includes an integrated software platform that links a multi-instrument, multi-site service design with online service options, a foundational database that provides storage and reporting functions and a community of practice to facilitate engagement and capacity building.

The distributed model diminishes the need for technicians at multiple sites while still providing point-of-care results with local harm reduction engagement and access to confirmatory testing online and in localized reporting. It also reduces the need for training in the technical components of drug checking (e.g. interpreting spectra) for harm reduction workers. Moreover, its real-time reporting capability keeps communities informed about the crisis. Sites are additionally supported by a community of practice.

This paper presents innovations in drug checking technologies and service design that attempt to overcome current financial and technical barriers towards scaling-up services to a more equitable and impactful level and effectively linking multiple urban and rural communities to report concentration levels for substances most linked to overdose.

Retirement is a complex process that can impact daily lives and relationships. While some gender differences in academic retirement experiences have been noted, few studies have focused exclusively on women academics’ retirement experiences. This follow-up study aims to explore the meaning of retirement and its impact on retired women academics' daily lives and relationships over time from an occupational perspective.

Using a qualitative, longitudinal descriptive design, semi-structured interviews (n = 11) were completed with women retirees from one university and an academically linked university-level, college of education and liberal arts, in the Republic of Ireland (n = 11). This paper presents the findings of follow-up interviews conducted one year later (n = 10). Data were analysed using Braun and Clarke’s six-phase thematic analysis. A longitudinal analysis was then undertaken using a recurrent cross-sectional approach (Grossoehme and Lipstein, 2016) to enable discussion of changes and continuity that had occurred over time in their daily lives.

The analysis yielded four themes: (i) continuing to navigate occupational identity challenges, (ii) structuring free time, (iii) appreciating health and well-being and (iv) continuing meaningful professional relationships and activities. Participants described on-going occupational identity challenges linked with contextual factors and experiences of occupational injustices of lack of recognition, lack of inclusion and a lack of choice to continue working in their paid academic employment.

These findings suggest that occupational therapists advocate for older adults, so that meaningful choices in retirement timing can be offered to all equally and so that older people are acknowledged for their contributions to society.

The purpose of this study is to analyse how academic staff cope with the new culture of performance measurement and assessment in universities. In particular, the study aims to shed light on how external pressures related to measurement of research performance are translated into organisational and individual academic responses within the university and the extent to which these responses are related specifically to the operational features of performance measurement systems (PMS).

The study is based on a case study conducted in an Italian public university and based on interviews with a cross-disciplinary sample of faculty members.

The study provides insights into how linking financial incentives and career progression to research performance metrics at the system and organisational levels may have important reorientation effects on individual behaviours and epistemic consequences for the academic work.

The study is based on interviews, so one limitation is related to the risk of researcher and interviewee personal bias. Moreover, this study is focused on one single case of a specific university setting, which cannot be fully representative of the experiences of others.

The study contributes to the literature on management accounting by exploring the factors that might explain why the unintended effects of PMS on academics’ behaviour reported by several studies might occur. From a practitioner’s point of view, it shows features of PMS that may produce unintended effects on academic activities. It also highlights the need to rethink PMS for the evaluation of university performance through the involvement of different stakeholders.