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1 – 10 of over 21000Fury Maulina, Mubasysyir Hasanbasri, Jamiu O. Busari and Fedde Scheele
This study aims to examine how an educational intervention, using the lens of the LEADS framework, can influence the development of primary care doctors’ leadership skills in…
Abstract
Purpose
This study aims to examine how an educational intervention, using the lens of the LEADS framework, can influence the development of primary care doctors’ leadership skills in Aceh, Indonesia. In order to persevere in the face of inadequate resources and infrastructure, particularly in rural and remote settings of low- and middle‐income countries, physicians require strong leadership skills. However, there is a lack of information on leadership development in these settings.
Design/methodology/approach
This study applied an educational intervention consisting of a two-day workshop. The authors evaluated the impact of the workshop on participants’ knowledge and skill by combining quantitative pre- and post-intervention questionnaires (based on Levels 1 and 2 of Kirkpatrick’s model) with qualitative post-intervention in-depth interviews, using a phenomenological approach and thematic analysis.
Findings
The workshop yielded positive results, as evidenced by participants’ increased confidence to apply and use the information and skills acquired during the workshop. Critical success factors were as follows: participants were curiosity-driven; the use of multiple learning methodologies that attracted participants; and the use of authentic scenarios as a critical feature of the program.
Originality/value
The intervention may offer a preliminary model for improving physician leadership skills in rural and remote settings by incorporating multiple teaching approaches and considering local cultural norms.
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Steve Willcocks and Tony Conway
The purpose of this paper is to explore leadership in the context of the policy shift to collaborative working and integration currently being pursued in the UK NHS. As ways of…
Abstract
Purpose
The purpose of this paper is to explore leadership in the context of the policy shift to collaborative working and integration currently being pursued in the UK NHS. As ways of integrating care are being explored in other countries it can be argued that this topic may have wider policy significance. This paper is particularly concerned with leadership in Primary Care Networks in the English NHS.
Design/methodology/approach
This paper is a conceptual paper using literature relating to the antecedents of shared leadership and relevant policy documents pertaining to the English NHS. The paper is informed, theoretically by the conceptual lens of shared leadership. A conceptual framework is developed identifying the antecedents of shared leadership that help to explain how shared leadership may be developed.
Findings
The paper identifies the challenges that may be faced by policymakers and those involved in Primary Care Networks in developing shared leadership. It also reveals the implications for policymakers in developing shared leadership.
Research limitations/implications
The paper is conceptual. It is acknowledged that this is a preliminary study and further work will be required to test the conceptual framework empirically.
Practical implications
The paper discusses the policy implications of developing leadership in primary care networks. This has relevance to both the NHS and other countries.
Originality/value
There is limited research on the antecedents of shared leadership. In addition, the conceptual framework is applied to a new policy initiative.
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Maria Mathews, Dana Ryan, Lindsay Hedden, Julia Lukewich, Emily Gard Marshall, Judith Belle Brown, Paul S. Gill, Madeleine McKay, Eric Wong, Stephen J. Wetmore, Richard Buote, Leslie Meredith, Lauren Moritz, Sarah Spencer, Maria Alexiadis, Thomas R. Freeman, Aimee Letto, Bridget L. Ryan, Shannon L. Sibbald and Amanda Lee Terry
Strong leadership in primary care is necessary to coordinate an effective pandemic response; however, descriptions of leadership roles for family physicians are absent from…
Abstract
Purpose
Strong leadership in primary care is necessary to coordinate an effective pandemic response; however, descriptions of leadership roles for family physicians are absent from previous pandemic plans. This study aims to describe the leadership roles and functions family physicians played during the COVID-19 pandemic in Canada and identify supports and barriers to formalizing these roles in future pandemic plans.
Design/methodology/approach
This study conducted semi-structured qualitative interviews with family physicians across four regions in Canada as part of a multiple case study. During the interviews, participants were asked about their roles during each pandemic stage and the facilitators and barriers they experienced. Interviews were transcribed and a thematic analysis approach was used to identify recurring themes.
Findings
Sixty-eight family physicians completed interviews. Three key functions of family physician leadership during the pandemic were identified: conveying knowledge, developing and adapting protocols for primary care practices and advocacy. Each function involved curating and synthesizing information, tailoring communications based on individual needs and building upon established relationships.
Practical implications
Findings demonstrate the need for future pandemic plans to incorporate formal family physician leadership appointments, as well as supports such as training, communication aides and compensation to allow family physicians to enact these key roles.
Originality/value
The COVID-19 pandemic presents a unique opportunity to examine the leadership roles of family physicians, which have been largely overlooked in past pandemic plans. This study’s findings highlight the importance of these roles toward delivering an effective and coordinated pandemic response with uninterrupted and safe access to primary care.
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Carolyn Jackson, Kim Manley and Mayur Vibhuti
This paper aims to present the impact evaluation findings from a multiprofessional leadership programme commissioned in the South East of England to support primary care networks…
Abstract
Purpose
This paper aims to present the impact evaluation findings from a multiprofessional leadership programme commissioned in the South East of England to support primary care networks (PCNs) to lead system improvement together. It identifies programme impact at micro and meso system levels; a leadership impact continuum that can be used by individuals and teams to evidence impact of improvements in PCN practices; the learning and development strategies that were effective and proposes implications for other networks.
Design/methodology/approach
Mixed methods underpinned by practice development methodology were used to explore the impact of the programme on two practitioner cohorts across 16 PCNs. Data were collected at the start, mid-point and end of the eight-month programme.
Findings
Results illustrate an innovative approach to collective leadership development. A continuum of impact created with participants offers insight into the journey of transformation, recognising that “change starts with me”. The impact framework identifies enablers, attributes and consequences for measuring and leading change at micro, meso and macro levels of the health-care system. Participants learned how to facilitate change and collaboratively solve problems through peer consulting which created a safe space for individuals to discuss workplace issues and receive multiprofessional views through action learning. These activities enabled teams to present innovative projects to commissioners for service redesign, enabling their PCN to be more effective in meeting population health needs. The authors believe that this programme may provide a model for other PCNs England and other place-based care systems internationally.
Originality/value
This study offers insight into how to enable a journey of transformation for individuals and PCN teams to enhance team effectiveness and collective leadership for system-wide transformation required by the National Health Service Long Term Plan (2019).
Contribution to Impact
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Janna Skagerström, Hanna Fernemark, Per Nilsen, Ida Seing, Maria Hårdstedt, Elin Karlsson and Kristina Schildmeijer
At the outbreak of the COVID-19 pandemic, health care was at the centre of the crisis. New demands made existing organizational practices and services obsolete. Primary health…
Abstract
Purpose
At the outbreak of the COVID-19 pandemic, health care was at the centre of the crisis. New demands made existing organizational practices and services obsolete. Primary health care had a great deal of responsibility for COVID-19-related care. The pandemic demanded effective leadership to manage the new difficulties. This paper aims to explore experiences and perceptions of managers in primary health care in relation to their efforts to manage the COVID-19 crisis in their everyday work.
Design/methodology/approach
The authors used a qualitative approach based on 14 semi-structured interviews with managers in primary health care from four regions in Sweden. The interviews were conducted during September to December 2020. Data were analysed using conventional qualitative content analysis.
Findings
Data analysis yielded three categories: lonely in decision-making; stretched to the limit; and proud to have coped. The participants felt lonely in their decision-making, and they were stretched to the limit of their own and the organization’s capacity. The psychosocial working conditions in primary care worsened considerably during the pandemic because demands on leaders increased while their ability to control the work situation decreased. However, they also expressed pride that they and their employees had managed the situation by being flexible and having a common focus.
Originality/value
Looking ahead and using lessons learnt, and apart from making wise decisions under pressure, an important implication for primary health-care leaders is to not underestimate the power of acknowledging the virtues of humanity and justice during a crisis. Continuing professional education for leaders focusing on crisis leadership could help prepare leaders for future crises.
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Richard Q. Lewis and Nav Chana
The purpose of this paper is to consider how the evolving concept of the “primary care home” (PCH) that is developing in England might be an effective vehicle for the delivery of…
Abstract
Purpose
The purpose of this paper is to consider how the evolving concept of the “primary care home” (PCH) that is developing in England might be an effective vehicle for the delivery of the goals of “population health”. The authors examine evidence from earlier initiatives to achieve similar objectives of primary care-led health system planning and care integration to understand relevant lessons for the PCH.
Design/methodology/approach
This paper is based on a descriptive review of the PCH using documentary sources and a non-systematic review of literature relating to primary care commissioning initiatives and recent initiatives to deliver general practice services on a larger scale.
Findings
The PCH is likely to bring forth relatively high engagement from general practitioners due to its neighbourhood scale, voluntary nature and its focus on professional partnership, personalisation of care and outcomes. It is important that participants have sufficient autonomy to act and that financial incentives are aligned with the goals of population health. It is also important that, unlike some earlier primary care initiatives, the PCH is given time to develop to maturity.
Originality/value
The PCH is a recent phenomenon that is developing in England and elsewhere. This paper locates the PCH within a historical context and draws conclusions from a relevant evidence base.
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Thomas Round, Mark Ashworth, Tessa Crilly, Ewan Ferlie and Charles Wolfe
A well-funded, four-year integrated care programme was implemented in south London. The programme attempted to integrate care across primary, acute, community, mental health and…
Abstract
Purpose
A well-funded, four-year integrated care programme was implemented in south London. The programme attempted to integrate care across primary, acute, community, mental health and social care. The purpose of this paper is to reduce hospital admissions and nursing home placements. Programme evaluation aimed to identify what worked well and what did not; lessons learnt; the value of integrated care investment.
Design/methodology/approach
Qualitative data were obtained from documentary analysis, stakeholder interviews, focus groups and observational data from programme meetings. Framework analysis was applied to stakeholder interview and focus group data in order to generate themes.
Findings
The integrated care project had not delivered expected radical reductions in hospital or nursing home utilisation. In response, the scheme was reformulated to focus on feasible service integration. Other benefits emerged, particularly system transformation. Nine themes emerged: shared vision/case for change; interventions; leadership; relationships; organisational structures and governance; citizens and patients; evaluation and monitoring; macro level. Each theme was interpreted in terms of “successes”, “challenges” and “lessons learnt”.
Research limitations/implications
Evaluation was hampered by lack of a clear evaluation strategy from programme inception to conclusion, and of the evidence required to corroborate claims of benefit.
Practical implications
Key lessons learnt included: importance of strong clinical leadership, shared ownership and inbuilt evaluation.
Originality/value
Primary care was a key player in the integrated care programme. Initial resistance delayed implementation and related to concerns about vertical integration and scepticism about unrealistic goals. A focus on clinical care and shared ownership contributed to eventual system transformation.
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Anna Coleman, Julie D. MacInnes, Rasa Mikelyte, Sarah Croke, Pauline W. Allen and Kath Checkland
The article aims to argue that the concept of “distributed leadership” lacks the specificity required to allow a full understanding of how change happens. The authors therefore…
Abstract
Purpose
The article aims to argue that the concept of “distributed leadership” lacks the specificity required to allow a full understanding of how change happens. The authors therefore utilise the “Strategic Action Field Framework” (SAF) (Moulton and Sandfort, 2017) as a more sensitive framework for understanding leadership in complex systems. The authors use the New Care Models (Vanguard) Programme as an exemplar.
Design/methodology/approach
Using the SAF framework, the authors explored factors affecting whether and how local Vanguard initiatives were implemented in response to national policy, using a qualitative case study approach. The authors apply this to data from the focus groups and interviews with a variety of respondents in six case study sites, covering different Vanguard types between October 2018 and July 2019.
Findings
While literature already acknowledges that leadership is not simply about individual leaders, but about leading together, this paper emphasises that a further interdependence exists between leaders and their organisational/system context. This requires actors to use their skills and knowledge within the fixed and changing attributes of their local context, to perform the roles (boundary spanning, interpretation and mobilisation) necessary to allow the practical implementation of complex change across a healthcare setting.
Originality/value
The SAF framework was a useful framework within which to interrogate the data, but the authors found that the category of “social skills” required further elucidation. By recognising the importance of an intersection between position, personal characteristics/behaviours, fixed personal attributes and local context, the work is novel.
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Luís Velez Lapão and Gilles Dussault
This paper aims to describe the training strategy developed to provide the leadership of a new coordination structure of health centers in Portugal, with managerial competencies…
Abstract
Purpose
This paper aims to describe the training strategy developed to provide the leadership of a new coordination structure of health centers in Portugal, with managerial competencies adapted to the requirements of their function, in support of primary care reform.
Design/methodology/approach
Pre and post‐program questionnaires were exploited. These focused on the perceptions of the new managers of their needs and of the benefits derived from their participation in learning activities during 2008 and 2009.
Findings
The findings outline that although the program created opportunities for executive directors to identify and analyze planning and management problems and to share potential solutions with colleagues, a training program is not sufficient to create the conditions that facilitate change.
Research limitations/implications
More research is required to better understand the impact of the program on executive directors' attitudes and behaviors. More research on measuring the impact of leadership training is needed to provide policy‐makers with strategies to support their reforms.
Practical implications
The PACES training program was designed to develop and strengthen the managerial capacities of a group of managers of a new administrative structure in the health sector; it could be also applicable to other sectors like education, environment, etc.
Social implications
If a reform process is to be effective, policy‐makers need to address, in addition to building individual capacities, organizational and institutional capacity needs, and design mechanisms to support managers on a continuing basis.
Originality/value
This paper describes the development of a new program focused on management and leadership to fit the needs of a reform in primary‐care.
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Akwatu Khenti, Jaime C. Sapag, Consuelo Garcia‐Andrade, Fernando Poblete, Ana Raquel Santiago de Lima, Andres Herrera, Pablo Diaz, Henok Amare, Avra Selick and Sandra Reid
Since 2002, the Centre for Addiction and Mental Health in Ontario, Canada, has been working closely with partners in Latin America and the Caribbean (LAC) to implement mental…
Abstract
Purpose
Since 2002, the Centre for Addiction and Mental Health in Ontario, Canada, has been working closely with partners in Latin America and the Caribbean (LAC) to implement mental health capacity‐building focused on primary health care. From an equity perspective, this article seeks to critically analyze the process and key results of this capacity‐building effort and to identify various implications for the future.
Design/methodology/approach
This analysis of capacity‐building approaches is based on a critical review of existing documents such as needs assessments and evaluation reports, as well as reflective discussion. Previous health equity literature is used as a framework for analysis.
Findings
More than 1,000 professionals have been engaged in various kinds of training in Chile, Peru, Brazil, Nicaragua, Mexico, and Trinidad and Tobago. These capacity‐building initiatives have had an impact on primary health care from both an equity and systems perspective because participants were engaged at all stages of the process and implementation lessons incorporated into the final efforts. Stigma was also reduced through the collaborations.
Originality/value
Using concrete examples of capacity‐building in mental primary healthcare in LAC, as well as evidence gathered from the literature, this article demonstrates how primary healthcare can play a strong role in addressing health equity and human rights protection for people with mental health and/or substance abuse problems.
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