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Purpose: 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. Design/methodology/approach: 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. Findings: 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. Research limitations/implications: 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. Practical implications: 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. Originality/value: 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. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to expand upon some of the issues raised in "An evaluation of a speech and language therapy eating, drinking and swallowing service for adults with intellectual disability" (Crocker et al., 2024). Design/methodology/approach: This commentary outlines considerations for multidisciplinary team working and professional roles both within and beyond the community learning disability team. It discusses models of service delivery and competency frameworks relating to eating, drinking and swallowing services. Findings: Services should be integrated, include a broad multidisciplinary team and aim to increase competency in all contexts supporting people with eating, drinking and swallowing needs. Outcomes of service provision need to be measured outside of individualised care. Originality/value: This paper broadens the discussion of quality of eating, drinking and swallowing services beyond speech and language therapy and considers a whole systems approach. [ABSTRACT FROM AUTHOR]

Purpose: Contextual to the recognition of the complex interplay between health and behavioral aspects, integrated behavioral health (IBH) has emerged. Although this model is becoming popular in the Western world, its presence in the global context is not promising. This paper aims to explore the need for IBH in India and address its barriers to implementation and possible solutions. Design/methodology/approach: We analyzed the case of IBH and its potential implications for India using the current evidence base, authors' reflections and experience of implementing similar programs. Findings: This paper identifies contextual factors, including increased instances of non-communicable diseases and psychosocial and cultural determinants of health, that necessitate the implementation of IBH programs in India. The key features of different IBH models and their applicability are outlined. The current status of IBH and potential challenges in implementation in India in terms of human resources and other factors are delineated. We also discuss the potential models for implementing IBH in India. Originality/value: Integrating behavioral health in primary care is considered an effective and sustainable model to promote health and well-being across various target populations. Towards this end, this paper is the first to discuss the contextual factors of IBH in India. It is a significant addition to the knowledge base on IBH and its possible implementation barriers and strategies in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Purpose: Being a novel public health crisis, the COVID-19 pandemic presented world leaders with difficult options and some serious dilemmas that must somehow be negotiated. Whilst these leaders had limited knowledge about the coronavirus and how the pandemic would potentially evolve, they were still expected to make high-staked judgements amidst a range of uncertainties. The purpose of this paper is to explore the response strategies used by various world leaders from the perspective of crisis leadership within the public health domain. Design/methodology/approach: Secondary data was collected from research papers, policy reports and credible media outlets to examine the construct of crisis leadership within the context of the global pandemic. Findings: The paper identified three cognitive antecedents to the COVID-19 crisis leadership failures, which helped to explain why certain policy decisions were successful and why others were less so. On this basis, a clear dichotomy was drawn between highly rated leaders and their less successful counterparts in relation to the management and governance of the coronavirus pandemic. Originality/value: The uniqueness of this paper lies in its psycho-political approach, which offered insights into the cognitive undertones that underpin the three leadership failures that emerged from the distinct approaches used by world leaders to prepare for, respond to and recover from the COVID-19 pandemic. The practical recommendations proposed in this paper are hoped to aid better decision-making for leaders faced with the task of managing future public health crises. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to describe a response to the needs of mental health workers (MHWs) in India during COVID-19 pandemic, through an online training program on trauma-informed intervention and care. Design/methodology/approach: A four-module online training program was developed. Two modules were aimed to bridge the knowledge gap on trauma for MHWs, so that they could effectively address the associated symptoms of fear and grief. The other two modules aimed to support MHWs' self-care and create supportive connections among colleagues. In this mixed method evaluation study, needs expressed before the training and lessons derived from the training were collected through questionnaires, focus group discussion and interviews. Findings: Of the 3,168 MHWs who registered for the training, 534 completed the pre-questionnaire. Of the 125 post-questionnaire records, 38 had watched all four modules. A great need for learning to work with grief and manage the increased workload without burnout was observed. Post-training gains included skills for working with fear and grief, which increased the confidence of MHWs. The importance of self-care was an eye-opener for many. Social implications: This study indicates a way to equip MHWs to address the trauma that will continue to live in people in the aftermath of crises. Originality/value: This study examined the challenges MHWs in India faced during the COVID-19 pandemic, revealing a knowledge gap on dealing with this level of trauma. It can contribute to the knowledge on how to support MHWs in such crises. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to assess the level of nurses' competencies while providing care to COVID-19 patients. Design/methodology/approach: A descriptive, correlational design was used to collect data from nurses who were providing care to COVID-19 patients at four public hospitals. Findings: A total of 377 nurses (64.5% females) aged 23–50 consented to participate and completed the survey. The mean score of nurses' competencies in providing care to COVID-19 patients was 2.5 (SD = 0.81). The results of correlation coefficient tests disclosed a significant positive correlation between reported competence level and sex rpb (377) = 0.18, p < 0.01; working area rpb (377) = 0.2, p < 0.01; disaster experience rpb (377) = 0.16, p < 0.01; disaster education rpb (377) = 0.25, p < 0.01; and disaster training rpb (377) = 0.31, p < 0.01. Research limitations/implications: The COVID-19 pandemic response heavily relied on nurses. However, they had a gap in clinical competencies that indicates an urgent need to incorporate disaster management courses in basic nursing education and to update training in hospitals based on nurses' needs to improve their capabilities in dealing with COVID-19 pandemic. Originality/value: To the best of the authors' knowledge, this is the first study that investigated the perceived level of Jordanian nurses' competencies in providing care to COVID-19. [ABSTRACT FROM AUTHOR]

Purpose: By older adulthood, the majority of individuals will have experienced at least one traumatic event. Trauma-informed care (TIC) is proposed to improve effectivity of health-care provision and to reduce likelihood of services causing retraumatisation. This study aims to assess the effectiveness of staff training in TIC in older adult services. Design/methodology/approach: TIC training was delivered across eight Older Adult Community Mental Health Teams in the same UK organisation. Questionnaires were administered before and after training: a psychometrically robust measure, the Attitudes Related to Trauma-Informed Care, was used to assess TIC-related attitudes, and a service-developed scale was used to measure changes in TIC competence. Data was analysed using linear mixed effects modelling (LMM). Qualitative data regarding the impact of training was gathered one month after training through a free-text questionnaire. Findings: There were 45 participants, all of whom were white British. LMM on pre- and post-data revealed that staff training significantly increased competencies across all measured TIC domains. Overall, staff attitudes were also significantly more trauma-informed after training. Qualitatively, staff identified time as the only additional resource required to deliver the skills and knowledge gained from training. Practical implications: Training was found to be effective in increasing TIC-related skills and attitudes. Organisations aiming to become trauma-informed should consider staff training as one aspect of a wider development plan. Originality/value: To the best of the authors' knowledge, this paper is the first to examine TIC training for staff working in Older Adults Mental Health Services. Recommendations for services aiming to develop a trauma-informed culture have been provided. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to describe the design and evaluation of a pilot leadership development programme for infection prevention and control (IPAC) professionals during the COVID-19 pandemic. The programme's aim was to improve IPAC knowledge and capacity in the health-care system by developing the leadership skills and capacities of novice and advanced Infection Control Professionals (ICPs), to respond flexibly, and competently, in their expanding and ever-changing roles. Design/methodology/approach: The leadership programme was piloted with seven nurses, who were part of a clinical nursing team in New South Wales, Australia, over a 12-month period between 2021 and 2022. The programme was designed using a leadership development framework underpinned by transformational leadership theory, practice development approaches and collaborative and experiential learning. These principles were applied during programme design, with components adapted to learners' interests and regular opportunities provided for collaboration in active learning and critical reflection on workplace experiences. Findings: The authors' evaluation suggests that the programme was feasible, acceptable and considered to be effective by this cohort. Moreover, participants valued the opportunities to engage in active and experience-based learning with peers, and with the support of senior and experienced ICPs. The action learning sets were well-received and allowed participants to critically reflect on and learn from one another's experiences. The mentoring programme allowed them to apply their developing leadership skills to real workplace challenges that they face. Research limitations/implications: Despite a small sample size, the authors' results provide empirical evidence about the effectiveness of using a practice development approach for strengthening ICP leadership capacity. The success of this pilot study has paved the way for a bigger second cohort of participants in the programme, for which further evaluation will be conducted. Practical implications: The success of this leadership programme reflects both the need for leadership development in the IPAC professions and the applicability of this approach, with appropriate facilitation, for other professions and organizations. Originality/value: ICP leadership programmes have not been previously reported in the literature. This pilot study builds on the growing interest in IPAC leadership to foster health system responsiveness and change. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to review and critically evaluate UK psychiatry national recruitment process for 2021, which was re-structured following the COVID-19 pandemic. Additionally, this paper aims to review the empirical evidence of the selection methodologies in psychiatry recruitment. Design/methodology/approach: The UK national psychiatry recruitment process is discussed, with a focus on the changes made to recruitment in 2021. The advantages and disadvantages of different selection methodologies are explored, with an emphasis on evaluating the validity, acceptability and reliability of different recruitment selection methodologies. The potential impact of the changes to psychiatry recruitment are explored. Findings: The decision of the National Recruitment Office to remove certain selection methods for recruitment in 2021 may have limited their ability to choose the best candidate for the training place and be fair to the applicant. Overall, there is a lack of research into the validity of the selection methods used in psychiatry recruitment. A framework for outcome criteria relevant to psychiatry recruitment should be developed, which would allow research into selection methods and guide the NRO to examine the evidence base effectively. Originality/value: This paper examined the recruitment methods used to choose doctors for psychiatry training in the UK, demonstrating that the empirical evidence base for psychiatry recruitment is limited. This paper can contribute to our understanding of selection methodologies used in psychiatry recruitment and highlights the value of different recruitment approaches for choosing the best psychiatrists of the future. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to provide an insight into the design, development and delivery proposals for a first of its kind "Liaison Mental Health Training Programme". In the UK, there has been a significant investment in Liaison Mental Health Services and an expansion of the workforce (NHS England, 2016). However, the complexity and varied presentations of patients who attend to acute physical health services now requires a dedicated strategy to address any skills deficit in the mental health liaison workforce and to support core competency development (DOH, 2016). Design/methodology/approach: This paper provides an overview of preparations to develop a regional educational pilot programme using a three-phased model: Phase 1 – Review of policy and best practice guidelines; Phase 2 – Stakeholder Data Collection; and Phase 3 – Synthesis and Development. Findings: An insight into the developmental processes undertaken to shape a core competency liaison mental health training programme is presented. Additionally, the authors provide insight into educational theory and an overview of the LMH Core Competency Curricula. Practical implications: This paper provides the reader with an insight into our findings and a focussed core competency training model for those working within LMH services. This programme development was reviewed throughout by both those using LMH services and the LMH practitioners working within them, ensuring the curriculum proposed was endorsed by key stakeholders. The three-phased model has transferable benefits to other training development initiatives. Originality/value: To the best of the authors' knowledge, this training is the first of its kind in the UK and addresses the education of essential core competencies of a regional liaison mental health workforce. The collaboration of clinical and academic expertise and model of co-production makes this endeavour unique. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to describe a novel community development and how the synergies arising from the interaction of diverse perspectives (including arts and health, person centredness, co-production and shared leadership) have led to a transformative initiative for individuals and a local community in the Republic of Ireland. Design/methodology/approach: This is a descriptive case study. It includes the personal narrative of an expert by experience who is one of the co-authors. Links to short digital films are also included along with references to internal evaluation documents and published literature. Reflections from the nurses who contributed to the initiative and a university academic are also incorporated. Findings: A space in the community built around the principles of relational practice has evolved into an alchemical space, enabling creativity, recovery and well-being. The benefits arising out of this network of social relationships have contributed to personal recovery, integration with the local community and generated social capital. This has enhanced mental health and well-being locally. Practical implications: Statutory Irish health policy is reflective of developments in health care internationally, with an emphasis on greater delivery of care in the community. This views citizens as active partners in the maintenance of their health and well-being. This case study illustrates how this has unfolded in practice in a rural mental health community context. Originality/value: This paper adds to the evidence base that demonstrates the potential benefits of participation in the arts to individual recovery journeys. In addition, it shows that when arts and health perspectives coalesce with the wider domain of relational practice, the synergies arising contribute positively to the health and well-being of local communities. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to describe the 4C's of Infuence framework and it's application to medicine and medical education. Leadership development is increasingly recognised as an integral physician skill. Competence, character, connection and culture are critical for effective influence and leadership. The theoretical framework, "The 4C's of Influence", integrates these four key dimensions of leadership and prioritises their longitudinal development, across the medical education learning continuum. Design/methodology/approach: Using a clinical case-based illustrative model approach, the authors provide a practical, theoretical framework to prepare physicians and medical learners to be engaging influencers and leaders in the health-care system. Findings: As leadership requires foundational skills and knowledge, a leader must be competent to best exert positive influence. Character-based leadership stresses development of, and commitment to, values and principles, in the face of everyday situational pressures. If competence confers the ability to do the right thing, character is the will to do it consistently. Leaders must value and build relationships, fostering connection. Building coalitions with diverse networks ensures different perspectives are integrated and valued. Connected leadership describes leaders who are inspirational, authentic, devolve decision-making, are explorers and foster high levels of engagement. To create a thriving, learning environment, culture must bring everything together, or will become the greatest barrier. Originality/value: The framework is novel in applying concepts developed outside of medicine to the medical education context. The approach can be applied across the medical education continuum, building on existing frameworks which focus primarily on what competencies need to be taught. The 4C's is a comprehensive framework for practically teaching the leadership for health care today. [ABSTRACT FROM AUTHOR]

Purpose In North America, delegated practice “medical direction” models are often used as a proxy for clinical quality and safety in paramedic services. Other developed countries favor a combination of professional regulatory boards and clinical governance frameworks that feature paramedics taking lead clinician roles. The purpose of this paper is to bring together the evidence for medical direction and clinical governance in paramedic services through the prism of paramedic self-regulation.Design/methodology/approach This narrative synthesis critically examines the long-established North American Emergency Medical Services medical direction model and makes some comparisons with the UK inspired clinical governance approaches that are used to monitor and manage the quality and safety in several other Anglo-American paramedic services. The databases searched were CINAHL and Medline, with Google Scholar used to capture further publications.Findings Synthesis of the peer-reviewed literature found little high quality evidence supporting the effectiveness of medical direction. The literature on clinical governance within paramedic services described a systems approach with shared responsibility for quality and safety. Contemporary paramedic clinical leadership papers in developed countries focus on paramedic professionalization and the self-regulation of paramedics.Originality/value The lack of strong evidence supporting medical direction of the paramedic profession in developed countries challenges the North American model of paramedics practicing as a companion profession to medicine under delegated practice model. This model is inconsistent with the international vision of paramedicine as an autonomous, self-regulated health profession. [ABSTRACT FROM AUTHOR]

Purpose: Assessment of complex clinical skills and abilities is a challenge in mental health education. In the present study, an objective structured clinical examination (OSCE) was adapted to psychology and implemented in a Master in Psychology program. The purpose of the present study was to examine aspects of validity of this OSCE. Design/methodology/approach: A total of 55 students enrolled in the Master in the Psychology program at Umeå University, Sweden, participated in two OSCE occasions. In addition to OSCE data, questionnaires were administered immediately after the OSCE to students (n = 18) and examiners (n = 13) to examine their perceptions of the OSCE. Findings: The results provided support for different aspects of validity. The level of internal consistency was close to acceptable, and there was a good correspondence between global ratings and checklist scores for many stations. However, adding an additional category to the global rating scale and reviewing some of the station checklists might improve the assessment further. The present cut-score of the OSCE was comparable to a cut-score set by the borderline regression model. In general, students and examiners perceived the OSCE as a high-quality examination, although examiners raised some issues that could improve the OSCE further. Originality/value: In conclusion, OSCE is a promising assessment in psychology, both from a psychometric perspective and from a test-taker and examiner perspective. The present study is an important contribution to the field as there are only a few examples where OSCE has been used in clinical psychology, and to the best of the authors' knowledge, this paper is the first to evaluate the validity of such an assessment. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to understand how the hospital staff (nurses and physicians) at two hospital wards have coped with everyday work having leaders in conflict or longer periods without one or the other leader and whether the way the staff handled the challenges was resilient. Design/methodology/approach: Through semi-structured interviews with the staff at the two wards, the authors analysed how the staff were working, if they had cooperation and interdisciplinary cooperation, how they would handle uncertainties and how they coped with the absence of their leaders. Findings: The staff at both wards were handling the everyday work in a resilient way. The authors argue that to increase the resilience in an organisation, leaders should acknowledge the need to establish strong emotional ties among staff and at the same time ensure role structures that make sense in the everyday work. Originality/value: This study reports on original work and shows what decision makers could do to increase resilience in an organisation. This paper shows that the organisational context is important for the staff to act resiliently. As leaders come and go, it can be important for the stability of the organisation to promote the staff in acting resiliently independent of the leader situation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to highlight the difficulties in identifying adults with autism spectrum disorder (ASD) and to illustrate the consequences of late diagnoses in forensic settings. Design/methodology/approach: This paper presents an overview of the literature relevant to the topic and presents the details of three clinical cases. Findings: Delayed diagnosis is not uncommon in forensic services. Cases may remain unidentified for considerable periods despite being under evaluation from clinical teams. Diagnosis in forensic settings is challenged by case complexity. Barriers to prompt diagnosis include time, resources and clinical competency. Timely diagnosis may lessen the risk of future offences, improves clinical risk management and can bring direct benefits to those with the condition. Originality/value: This is the first case series which explores the issue of late diagnosis in forensic settings. The illustration of the extent to which a diagnosis can be missed may prompt clinicians to review and identify missed cases. The discussion of the issue may also support services to review their approach to screening and diagnosis of ASD. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to describe the results of an online program evaluation survey conducted in the USA in 2018 which was designed to understand how members of an enhanced multidisciplinary team (E-MDT) use the expertise of a forensic accountant (FA) in suspected cases of elder financial exploitation. Design/methodology/approach: This paper analyzes responses to an online survey from 54 E-MDT members. Narrative responses to open-ended questions were analyzed by using cross-case thematic analysis. Data from demographic questions and those with nominal response options were analyzed using descriptive statistics. Findings: Overwhelmingly, the E-MDT members described how useful the FA's expertise and subsequent detailed reports are in helping determine whether financial exploitation is taking place and providing information needed to continue an investigation and pursue criminal charges. Practical implications: The increasing longevity and sheer number of older adults present ongoing challenges in the fight to address financial exploitation. Findings suggest that FAs working with E-MDTs can help identify signs, collect evidence and help investigate cases of suspected financial abuse of older adults. The development of training programs focused on educating accountants to fill a need in a growing area of forensic accounting may be needed. Originality/value: This paper adds to the growing evidence of multidisciplinary teams as an effective model for investigating cases of financial elder exploitation by focusing specifically on the expertise of an FA. [ABSTRACT FROM AUTHOR]

Purpose: Brain Injury Case Managers (BICMs) work closely with individuals with Acquired Brain Injury (ABI), assessing needs, structuring rehabilitation interventions and providing support, and have significant experience of clients with impairments to decision making. The purpose of this paper is to explore the application of the Mental Capacity Act (MCA) and its guidance when applied to ABI survivors. This research aimed to: first, highlight potential conflicts or tensions that application of the MCA might pose, and second, identify approaches to mitigate the problems of the MCA and capacity assessments with ABI survivors. It is hoped that this will support improvements in the services offered. Design/methodology/approach: Using a mixed method approach, 93 BICMs responded to an online questionnaire about decision making following ABI. Of these, 12 BICMs agreed to take part in a follow-up semi-structured telephone interview. Findings: The data revealed four main themes: disagreements with other professionals, hidden disabilities, vulnerability in the community and implementation of the MCA and capacity assessments. Practical implications: The findings highlight the need for changes to the way mental capacity assessments are conducted and the need for training for professionals in the hidden effects of ABI. Originality/value: Limited research exists on potential limitations of the application of the MCA for individuals with an ABI. This paper provides much needed research on the difficulties surrounding mental capacity and ABI. [ABSTRACT FROM AUTHOR]

Purpose: Relational dynamics between patients and staff in forensic settings can be complicated and demanding for both sides. Reflective practice groups (RPGs) bring clinicians together to reflect on these dynamics. To date, evaluation of RPGs has lacked quantitative focus and a suitable quantitative tool. Therefore, a self-report tool was designed. This paper aims to pilot The Relational Aspects of CarE (TRACE) scale with clinicians in a high-secure hospital and investigate its psychometric properties. Design/methodology/approach: A multi-professional sample of 80 clinicians were recruited, completing TRACE and attitudes to personality disorder questionnaire (APDQ). Exploratory factor analysis (EFA) determined factor structure and internal consistency of TRACE. A subset was selected to measure test–retest reliability. TRACE was cross-validated against the APDQ. Findings: EFA found five factors underlying the 20 TRACE items: "awareness of common responses," "discussing and normalising feelings;" "utilising feelings," "wish to care" and "awareness of complicated affects." This factor structure is complex, but items clustered logically to key areas originally used to generate items. Internal consistency (α = 0.66, 95% confidence interval (CI) = 0.55–0.76) demonstrated borderline acceptability. TRACE demonstrated good test–retest reliability (intra-class correlation = 0.94, 95% CI = 0.78–0.98) and face validity. TRACE indicated a slight negative correlation with APDQ. A larger data set is needed to substantiate these preliminary findings. Practical implications: Early indications suggested TRACE was valid and reliable, suitable to measure the effectiveness of reflective practice. Originality/value: The TRACE was a distinctive measure that filled a methodological gap in the literature. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to assess the influence of patients' expectations from healthcare service quality on their satisfaction with nursing in public and private hospitals of Pakistan. Design/methodology/approach Data ( n=456) were collected from three public sector hospitals and three private sector hospitals of Lahore, the capital of Pakistan's most populous province. Male and female patients who have experience of both sectors were surveyed using a self-administered questionnaire developed using the original SERVQUAL approach. Data were analyzed using the statistical techniques and the Laplace criterion. Findings This paper attempts to explain degree of influences of five service quality constructs (empathy, responsiveness, tangibility, reliability and assurance) on Pakistani patients' expectations from the private and public sector hospitals and thus patient satisfaction. Further, this work can offer several intuitions into the effect of five constructs of service quality on patients' expectations of healthcare service quality and patient satisfaction with the service providers/nursing. The results reveal that the patient satisfaction is most strongly related to empathy in public sector and to responsiveness in private sector. Research limitations/implications In light of the previous studies and the current research findings, the study anticipates no apparently significant improvement in healthcare sector of Pakistan in near future considering various factors discussed in the study. The study will also help the service providers and the policy makers in understanding the deteriorating situation of the Pakistani healthcare sector and will guide them in identifying the areas by improving which not only the healthcare service quality in the country can be improved but also the image of healthcare sector among the masses and competitiveness of the healthcare sector can be enhanced. Originality/value The value of the study rests in its critical analysis of the current status of the healthcare sector of Pakistan with a view to suggest the areas that need to be worked on by the service providers and policy makers. Also, the study tries to settle a controversy within Pakistani healthcare literature concerning the question that who is producing more satisfied patients: private hospitals or their public counterparts? [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to describe the design and construction of a privilege mapping system (clinical and organizational competences) of the medical staff of the Niguarda Hospital in Milan, Italy. The second aim is to measure and assess the impact of implementing an evaluation process of clinical competences at the same hospital. Design/methodology/approach The paper retraces the development and implementation of the evaluation of the privilege system, highlighting the subjects involved, the phases and outputs. Moreover, a questionnaire was distributed to 50 heads of unit involved in the planning, building and implementation of competences mapping. Five areas were investigated: competences evaluation for professional development; the impact on work organization and professional roles; professional collaboration; its impact according to context (hospital or unit) and time scale (short or long term); and ability to evaluate clinical outcome. Findings Results reveal success factors for the development and implementation of a privilege mapping system. Furthermore, the survey revealed that clinical leaders are aware of the importance of competences evaluation. In particular, they consider it as a management tool useful for professional development, for identifying excellence and planning operational activities. Originality/value Literature and practical evidence recognize the need to assess the clinical and organizational competences in order to assign tasks and responsibilities. However, there are no studies that describe the construction of systems of evaluation of privileges, as it has never been investigated as professionals perceive these tools. [ABSTRACT FROM AUTHOR]

Purpose Personality disorder is reported to elicit strong emotional responses and negative attitudes in mental health staff (Bodner et al., 2015). The purpose of this paper is to provide an overview of the design and development of a co-produced e-learning training package for personality disorder awareness and an evaluation of its effectiveness. This study was carried out to explore if e-learning is an effective mode of training delivery for raising personality disorder awareness.Design/methodology/approach The e-learning was uniquely developed by subject matter experts working in co-production with people with lived experience. Self-reported measures were completed at three separate intervals to evaluate the effectiveness of the training: at pre-, post- and three-month follow up. Quantitative data were collected via these questionnaires.Findings The results from this evaluation show that e-learning is an effective mode of delivery for raising the awareness of personality disorder among mental health professionals, achieving similar outcomes to those reported following face-to-ace training.Research limitations/implications Attrition at follow-up phase was high which was consistent with other similar studies. The evaluation was led by the lead contributors and in the geographical area of its development. The study was relatively small and the participants were self-selected, therefore findings should be treated with caution.Practical implications E-learning can provide flexible training to compliment and act as an alternative to face-to-face personality disorder training. E-learning may provide an alternative refresher course to knowledge and understanding framework or other face-to-face methods. Co-produced training can be mirrored within an e-learning programme, careful planning to ensure the service user voice is heard and that their lived experience is embraced is required.Originality/value This is the first evaluation of a co-produced e-learning only personality disorder awareness training. It is also the first paper to carry out a review of the published evaluations of personality awareness training in the UK with comparisons explored across the studies. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to outline the "Hybrid" "International" Emergency Medicine (HIEM) programme, which is an ethical pathway for the recruitment, employment and training of Emergency Medicine doctors; with a rotation through the NHS on a two-year medical training initiative with a Tier 5 visa, "earn, learn and return" programme. The HIEM programme offers an advantage to the Tier 2 visa by combining training, education and employment resulting in new learning to help improve the health system in Nepal and provide continued cultural support, clinical and leadership development experience in the UK NHS. Finally, this programme also provides a Return on Investment to the NHS. Design/methodology/approach: A shortage of doctors in the UK, combined with a need to develop Emergency Medicine doctors in Nepal, led to a UK Emergency Medicine Physician (PS) to facilitate collaboration between UK/Nepal partners. A mapping exercise of the Royal College of Emergency Medicine curriculum with the competencies for the health system and quality improvement leaders and partners with patients produced a "HIEM programme". The HIEM programme aims to develop first-class doctors to study in Emergency Departments in the UK NHS while also building trainee capability to improve the health system in Nepal with a research thesis. Findings: The HIEM programme has 12 doctors on its programme across years one and two, with the first six doctors working in the UK NHS and progressing well. There are reports of high levels of satisfaction with the trainees in their transition from Nepal to the UK and the hospital is due to save £720,000 (after costs) over two years. Each trainee will earn £79,200 over two years which is enough to pay back the £16,000 cost for the course fees. Nepal as a country will benefit from the HIEM programme as each trainee will submit a health system improvement Thesis. Research limitations/implications: The HIEM programme is in its infancy as it is two years through a four-year programme. Further evaluation data are required to assess the full impact of this programme. In addition, the HIEM programme has only focussed on the development of one medical speciality which is Emergency Medicine. Further research is required to evaluate the impact of this model across other medical and surgical specialties. Practical implications: The HIEM programme has exciting potential to support International Medical Graduates undertake a planned programme of development while they study in the UK with a Tier 5 visa. IMGs require continuous support while in the UK and are required to demonstrate continued learning through continuous professional development (CPD). The HIEM programme offers an opportunity for this CPD learning to be structured, meaningful and progressive to enable new learning. There is also specific support to develop academic and research skills to undertake a thesis in an area that requires health system improvement in Nepal. Originality/value: This is the first time an integrated clinical, leadership, quality improvement and patient partnership model curriculum has been developed. The integrated nature of the curriculum saves precious time, money and resources. The integrated nature of this "hybrid" curriculum supports the development of an evidence-based approach to generating attitudes of collaboration, partnership and facilitation and team building in medical leadership with patient engagement. This "hybrid" model gives hope for the increased added value of the programme at a time of global austerity and challenges in healthcare. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore and capture workforce perceptions, experiences and insights of the phenomena of integrated care (IC) in a community health and care NHS trust in England; including whether there are any associated factors that are enablers, barriers, benefits or challenges; and the level of workforce engagement in the process of integrated health and care. Design/methodology/approach: A qualitative design based on an interpretivist research paradigm was used with a purposive sampling technique. Five in-depth semi-structured interviews were conducted with community nursing, social workers and allied health professionals. Colaizzi's (1978) descriptive phenomenological seven-step method was applied to analyse data, with the emergence of 170 significant statements, 170 formulated meanings and 8 thematic clustering of themes to reveal 4 emergent themes and 1 fundamental structure capturing the essential aspects of the structure of the phenomenon IC. Findings: This study revealed four interdependent emergent themes: (1) Insight of IC and collaboration: affording the opportunity for collaboration, shared goals, vision, dovetailing knowledge, skills and expertise. Professional aspirations of person-centred and strength-based care to improve outcomes. (2) Awareness of culture and professionalism: embracing inter-professional working whilst appreciating the fear of losing professional identity and values. Working relationships based on trust, respect and understanding of professional roles to improve outcomes. (3) Impact of workforce engagement: participants felt strongly about their differing engagement experience in terms of restructuring and redesigning services. (4) Impact of organisational structure: information technology (IT) highlighted a barrier to IC as differing IT platforms prevent interoperability with one system to one patient. Shared positivity of IC, embracing new ways of working. Originality/value: This study proposes considerations for future practice, policy and research from a local, national and global platform, highlighting the need for any IC strategy or policy to incorporate the uniqueness of the "voice of the workforce" as a key enabler to integration developments, only then can IC be a fully collaborative approach. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims at the implementation and early evaluation of a comprehensive, formative annual physician performance feedback process in a large academic health-care organization. Design/methodology/approach: A mixed methods approach was used to introduce a formative feedback process to provide physicians with comprehensive feedback on performance and to support professional development. This initiative responded to organization-wide engagement surveys through which physicians identified effective performance feedback as a priority. In 2013, physicians primarily affiliated with the organization participated in a performance feedback process, and physician satisfaction and participant perceptions were explored through participant survey responses and physician leader focus groups. Training was required for physician leaders prior to conducting performance feedback discussions. Findings: This process was completed by 98 per cent of eligible physicians, and 30 per cent completed an evaluation survey. While physicians endorsed the concept of a formative feedback process, process improvement opportunities were identified. Qualitative analysis revealed the following process improvement themes: simplify the tool, ensure leaders follow process, eliminate redundancies in data collection (through academic or licensing requirements) and provide objective quality metrics. Following physician leader training on performance feedback, 98 per cent of leaders who completed an evaluation questionnaire agreed or strongly agreed that the performance feedback process was useful and that training objectives were met. Originality/value: This paper introduces a physician performance feedback model, leadership training approach and first-year implementation outcomes. The results of this study will be useful to health administrators and physician leaders interested in implementing physician performance feedback or improving physician engagement. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to identify and describe the international and New Zealand (NZ) evidence for models of integrated ambulatory care and describe key implementation issues and lessons learnt. Design/methodology/approach: A scoping review was conducted for published and grey literature on integrated care. Publications from 2000 to February 2019 that described integrated ambulatory care were included. Findings: A total of 34 articles were included. Internationally and in NZ, the most common models of integrated care found were: transfer, relocation and joint working. The international literature showed that transferring care from hospitals to community and other integrated models of care between the primary–specialist interface increased access and convenience for patients. However, there was insufficient evidence of clinical and economic outcomes. Very few NZ-based studies reported on effectiveness of models of care. Key implementation issues were: no viable and sustainable funding, lack of infrastructure, lack of confidence, trust and communication between providers, increased workload and time and knowledge and skills gap to perform new roles. The NZ literature highlighted the need for an appropriate location for services, committed leadership, development of a governance group representing different provider groups, strong communication mechanisms, new workforce skills and overall change management. Originality/value: The review provides an overview of key components of integrated care models in ambulatory settings and identifies some common elements across the models of care. The findings can inform the design and implementation of integrated ambulatory care in health systems. [ABSTRACT FROM AUTHOR]

Purpose: People with intellectual disability (ID) experience significant health and social inequality compared to their non-disabled peers. Individuals with ID who access mental health services can have complex comorbidities and presentations. In the UK, a significant proportion of individuals with ID are supported within general adult mental health services not by specialist ID teams. The purpose of this study is to explore whether psychiatry trainees in the Maudsley Training Programme (MTP) feel adequately skilled to support individuals with ID. Design/methodology/approach: An online survey of trainee psychiatrists in the MTP was completed to evaluate self-perceived skills and knowledge in the care of individuals with ID in mental health services. Statistical analysis of the results was completed. Findings: Experience of working in specialist ID teams is positively associated with greater confidence and skills among trainees in the care of people with ID; this is beyond what would be expected based on seniority alone. Research limitations/implications: The response rate was 16.7 per cent; a larger sample size would add strength to the study. Like all online surveys, there exists the risk of selection bias. Practical implications: UK Policy states that people with ID should be supported to access mainstream services where possible, including psychiatric care. Practical experience for all psychiatry trainees involving specialist ID services and people with ID could improve the care given to that particularly disadvantaged group. Originality/value: This is the only paper known to the authors that has focused specifically on the skills and knowledge of psychiatry trainees in the UK with regards to ID. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to evaluate the longer-term impact of the 12-month Welsh clinical leadership fellowship. Design/methodology/approach: Semi-structured interviews with 10 out of 14 trainee doctors who were fellows between 2013-2016, exploring how leadership knowledge and skills were used in clinical practice, impact on patient care and influence on careers. Data, gathered in 2017 when participants had completed the fellowship between 1-3 years, were analysed thematically. Findings: All found the fellowship rewarding. The experience was felt to advantage them in consultant interviews. They gained insight into the wider influence on organisations and the complexity of issues facing senior clinicians. Although subtle, the impact was significant, equipping fellows with negotiation skills, enabling them to better influence change. Indirect impact on clinical practice was evidenced by enhanced confidence, teamworking skills and progression of improvement projects. However, the use of skills was limited by lack of seniority within teams, demands of medical training and examinations. The negativity of others towards management and leadership was also noted by some. Research limitations/implications: Small participant numbers limit generalisability. Practical implications: The fellowship is designed to equip participants with skills to lead improvements in healthcare delivery. Those more advanced in their medical training had greater opportunity and seniority to lead change and were better placed to apply the learning. This has implications for whom the training should be targeted. Originality/value: A rare study exploring the longer-term impact of a leadership programme on later clinical practice, which adds to the body of knowledge of impact and efficacy of leadership training programmes in healthcare environments. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to investigate the factors influencing the leadership effectiveness of hospital managers in Iran. Design/methodology/approach: Top managers (15), middle managers (10) and operational managers (5) of public, private or social security hospitals in Tehran participated in a qualitative study using semi-structured in-depth interviews. Data were recorded, transcribed and then analyzed via MAXQDA 10 software. Findings: The findings were categorized into two main themes of internal and external factors with eight sub-themes. The most important internal factors that had an influence on the leadership of the hospital managers were intra-organizational relations, manager's personality traits, knowledge, attitude and skills of the manager. The most important external factors included extra-organizational relations, macro-level health policies, access to special financial resources, and social, economic and political factors. Research limitations/implications: The results call for a need to understand and analyze the socioeconomic factors influencing managers' leadership while adopting appropriate strategies. Practical implications: The results of the current study can help design training programs for hospital managers, and suggest criteria for appointing hospital managers across the country and this can enhance the effectiveness of their leadership. Health sector policymakers and decision makers should reform the programs that target training and empowerment of hospital managers so that the right people with the right competencies will hold such positions. Social implications: The results of this study showed that leadership effectiveness is also influenced by social and external factors. On the other hand, the effectiveness of management leadership can play a significant role in the quality of care provided to the community, patient satisfaction and in hospital social performance through the appropriate management of all hospital resources. Such factors should also be considered in training and appointing hospital managers. Originality/value: Although there are several studies on hospital managers' leadership worldwide, this study is the first to investigate the leadership effectiveness of hospital managers in Iran. [ABSTRACT FROM AUTHOR]

Purpose: Wales Applied Risk Research Network (WARRN) is a formulation-based technique for the assessment and management of serious risk (e.g. violence to others, suicide, etc.) for users of mental health services. It has been gradually adopted as the risk evaluation and safety-planning technique for all seven health boards in Wales. The purpose of this paper is to examine the opinions of WARRN as used within these health boards. Design/methodology/approach: An online survey was disseminated to NHS clinicians in secondary mental health services to evaluate their perceptions of the use and effectiveness of WARRN. Data from 486 clinicians were analysed with both quantitative and qualitative methods. Findings: Results indicated that the overall impact of WARRN on secondary mental health care was very positive, with clinicians reporting increased skills in the domains of clinical risk formulation, safety-planning and communication, as well as increased confidence in their skills and abilities in these areas. Clinicians also reported that the "common-language" created by having all NHS health boards in Wales using the same risk assessment process facilitated the communication of safety-planning. Crucially, NHS staff believed that the safety of service users and of the general public had increased due to the adoption of WARRN in their health board and many believed that lives had been saved as a result. Originality/value: WARRN is perceived to have improved clinical skills in risk assessment and safety-planning across Wales and saved lives. [ABSTRACT FROM AUTHOR]

Purpose: Nowadays health systems in most of the countries are trying to build their healthcare provision system based on scientific knowledge based evidence. Evidence-based practice (EBP) is a crucial factor for quality improvement focusing on compliance with clinical standards. The purpose of this paper is to assess evidence-based knowledge and skills among healthcare providers in Qazvin hospitals in 2016.Design/methodology/approach: This was a descriptive study conducted among 300 health professionals working in hospitals affiliated by Qazvin University of Medical Sciences in 2016. A self-administered questionnaire was used to gather data on health providers' attitude, knowledge and skill regarding EBP. Descriptive statistics and multiple linear regressions were used to analyze data using SPSS 16 software.Findings: A total of 254 participants (84.6 percent) completed the questionnaire in which their attitude, knowledge and skill toward EBP were assessed at a low level. Study results indicated that among different occupational groups, physicians and those with greater awareness toward EBP terminology had a more positive attitude compared with others. Furthermore, a higher level of knowledge and skill toward EBP was associated with being a physician and having a positive attitude toward the issue.Practical Implications: Given the importance of EBP and due to insufficient knowledge of healthcare providers about the issue, it is necessary to hold appropriate educational courses to empower health workforce in implementing EBP principles.Originality/value: The authors applied a self-administered questionnaire to assess health workforce knowledge and skills toward EBP. The results obtaining from the analysis not only highlights weaknesses related to service providers' knowledge and capabilities to implement EBP but also reveals facilities required for realization of the subject in hospital settings. [ABSTRACT FROM AUTHOR]

Purpose: First-line nurse managers are frequently torn between conflicting demands from management and employees, and previous research suggests that nurse managers use a variety of responses to cope with these demands. The purpose of this paper is to explore the influence of social support on nurse managers' responses to role-conflict. Design/methodology/approach: Two focused ethnographic studies involving participant observation and interviews with seven first-line nurse managers were completed. One study included first-line nurse managers from four units in two municipalities (2005), while the second included three first-line nurse managers from a hospital in Norway (2015-2016). Findings: Three types of responses were identified: the embracing managerialism career, the emphasising managerialism career and the emphasising professionalism career. Emphasising managerialism was associated with role distance from the role of nurse, whereas emphasising professionalism involved role distance from the managerial role. Originality/value: This study provides insights into first-line nurse managers' responses to role conflict, by identifying the mechanisms involved and an opportunity to develop a theoretical framework for future studies among nurse managers. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is twofold: first, to identify the types of adaptations made by service providers (i.e. practitioners) during a large-scale US statewide implementation of SafeCare®, an evidence-based intervention to reduce child neglect; and second, to place adaptations within a taxonomy of types of adaptations. Design/methodology/approach: Semi-structured interviews and focus groups were conducted with 138 SafeCare providers and supervisors. Grounded theory methods were used to identify themes, specific types of adaptations and factors associated with adaptation. Findings: Adaptations were made to both peripheral and core elements of the evidence-based practice (EBP). The taxonomy of adaptations included two broad categories of process and content. Process adaptations included presentation of materials, dosage/intensity of sessions, order of presentation, addressing urgent concerns before focusing on the EBP and supplementing information to model materials. Content adaptations included excluding parts of the EBP and overemphasizing certain aspects of the EBP. Adaptations were motivated by client factors such as the age of the target child, provider factors such as a providers' level of self-efficacy with the EBP and concerns over client/provider rapport. Client factors were paramount in motivating adaptations of all kinds. Research limitations/implications: The present findings highlight the need to examine ways in which adaptations affect EBP implementation and sustainment, client engagement in treatment, and client outcomes. Practical implications: Implementers and EBP developers and trainers should build flexibility into their models while safeguarding core intervention elements that drive positive client outcomes. Originality/value: This study is unique in examining and enumerating both process and content types of adaptations in a large-scale child neglect implementation study. In addition, such adaptations may be generalizable to other types of EBPs. [ABSTRACT FROM AUTHOR]

Purpose Mental health simulation is the educational practice of recreating clinical situations in safe environments using actors, followed by structured debriefing, to foster professional development and improve care. Although evidence outlines the benefits of simulation, few studies have examined the impact of interprofessional mental health simulation on healthcare trainees, which is more reflective of clinical care. The purpose of this paper is to evaluate the impact of mental health simulation training on students' confidence, attitudes, knowledge and perceived professional development and anticipated clinical practice.Design/methodology/approach Participants (n=56) were medical (41 per cent) and mental health nursing students (41 per cent), and clinical psychology trainees (18 per cent). Six simulated scenarios, involving one to three trainees, were followed by structured debriefs with trained facilitators. Scenarios, using actors, reflected patient journeys through emergency, medical and psychiatric settings. Participants' confidence, knowledge and attitudes were measured quantitatively using pre- and post-course self-report questionnaires. Perceptions of impact on professional development and clinical practice were assessed using thematic analysis of post-course questionnaire responses.Findings Knowledge, confidence and attitudes scores showed statistically significant increases, with large effect sizes. Thematic analyses highlighted themes of: interprofessionalism, communication skills, reflective practice, personal resilience, clinical skills and confidence.Research limitations/implications Further research should clarify the impact of interprofessional simulation training on mental health practice in the context of other training received.Practical implications Simulation training may begin to influence participants' professional development and future clinical practice and subsequently care delivered, supporting its increased use in mental health.Originality/value This study adds to nascent understandings of the use and potential of interprofessional mental health simulation, outlining innovative training, its positive outcomes and implications. [ABSTRACT FROM AUTHOR]

Purpose Nurses working in acute mental-health services are vulnerable to occupational stress. One stressor identified is the challenging behaviour of some service users (Jenkins and Elliott, 2004). The purpose of this paper is to discuss the discourses drawn on by nurses to understand challenging behaviour and talk about its management.Design/methodology/approach Nurses working on acute and psychiatric intensive care unit (PICU) wards were interviewed, and data were analysed using discourse analysis.Findings Biomedical and systemic discourses were found to be dominant. Alternative psychosocial and emotional discourses were drawn on by some participants but marginalised by the dominant biomedical construction of challenging behaviour.Originality/value Existing studies have not considered how discourses socially construct challenging behaviour and its management in inpatient mental-health services. [ABSTRACT FROM AUTHOR]

Purpose -- This paper aims to provide an overview of the design and initial outcomes of a leadership and service improvement program for junior medical staff. Design/methodology/approach -- This paper describes the rationale, initial set-up, structure, program outcomes and future directions of the Medical Service Improvement Program for junior doctors. This program is a recent initiative of the Western Australian public healthcare system. Findings -- The Medical Service Improvement Program illustrates a successful approach to developing junior doctors to lead improvements in health service delivery. The program has resulted in tangible personal outcomes for participants, in addition to important organisational outcomes. Practical implications -- This paper provides an evidence-based structured approach to developing the leadership abilities of junior medical staff. It provides practical information on the design of the leadership program that aligns the participant learning outcomes to postgraduate medical competencies. The program has demonstrated clear service outcomes, confirming that junior medical staff is both capable and committed to leading service improvement and reform. Originality/value -- This paper provides clear evidence for the benefits of providing dedicated non-clinical time for junior medical staff to lead quality and improvement initiatives. This case study will assist hospital administrators, postgraduate education units and those involved in designing and administering clinical leadership development programs. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to summarise the Law Commissions' final report and draft Bill on the regulation of health and social care professionals. Design/methodology/approach -- To summarise the key recommendations that are relevant to adult safeguarding. Findings -- The final report concludes that new legislation is needed to govern the UK regulators of health and social care professionals. Originality/value -- The paper sets out the recommended new legal framework. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to explore educator competencies and roles needed to perform participatory patient education, and develop a comprehensive model describing this. Design/methodology/approach -- Data collection in the qualitative study proceeded through two phases. In the first phase, 28 educators were involved in exploring educator competencies needed to perform participatory, group-based patient education. The paper used qualitative methods: dialogue workshops, interviews and observations. In the second phase, 310 educators were involved in saturating and validating the insights from phase one using workshop techniques such as brainstorming, reflection exercises and the story-dialogue method. A grounded theory approach was used to analyse data. Findings -- A model called "The Health Education Juggler" was developed comprising four educator roles necessary to perform participatory patient education: the Embracer, the Facilitator, the Translator and the Initiator. The validity of the model was confirmed in phase two by educators and showed fit, grab, relevance, workability and modifiability. Practical implications -- The model provides a tool that can be used to support the focus on "juggling" skills in educators: the switching between different educator roles when performing participatory, group-based patient education. The model is useful as an analytical tool for reflection and supervision, as well as for observation and evaluation of participatory, group-based patient education. Originality/value -- The study proposes a comprehensive model consisting of four equally important roles for educators performing participatory, group-based patient education. [ABSTRACT FROM AUTHOR]

Purpose: Research into the skills and competencies required by staff working with people with learning disabilities has concentrated on staff views. The purpose of this paper is to explore what people with learning disabilities want from the workforce supporting them. The evaluation was commissioned by Health Education England working across Kent, Surrey and Sussex (HEE KSS). Design/methodology/approach: An easy read questionnaire, co-produced with people with learning disabilities, was completed with 70 participants, 65 of whom attended one of 10 workshops. Two questionnaires were also completed by parents on behalf of their child. The workshops also allowed for open discussion. Findings: People with learning disabilities value a workforce with a positive attitude, with staff who are skilled in supporting people to gain independence and have a voice. Research limitations/implications: Findings are relevant to staff recruitment, matching of staff to services and staff training. Originality/value: Although there is some previous research around service user views, this evaluation had a larger sample size. The findings were similar to previous studies, particularly around the kind of qualities required from staff, which were the ability to listen, have trust and be able to learn specific skills. Although the highest representation was from young people and young adults, participants ranged from 12 to over 65 years. Differences in views according to participant age ranges are also noted. [ABSTRACT FROM AUTHOR]

Purpose A major component of hospital stroke care involves prompt identification of stroke in admitted patients. Delays in recognizing stroke symptoms and initiating treatment for in-hospital stroke can adversely impact patient outcomes. This quality improvement intervention used simulation together with a traditional lecture to instruct nurses at a university hospital about a new stroke protocol being implemented to increase rapid recognition of stroke and meet Joint Commission National Hospital Inpatient Quality Measures. The paper aims to discuss these issues. Design/methodology/approach In total, 86 registered nurses from the neurology and cardiology units attended a lecture and participated in a simulation scenario with a standardized patient exhibiting stroke symptoms. Participants completed a ten-item pre-test to measure their knowledge of stroke care prior to the lecture; they repeated the test pre-simulation and once again post-simulation to evaluate changes in knowledge. Findings Overall mean stroke knowledge scores increased significantly from pre-lecture to pre-simulation, and from pre-simulation to post-simulation. Simulation plus lecture was more effective than lecture alone in increasing knowledge about hospital stroke protocol despite assigned unit (cardiology or neurology), years of experience, or previous exposure to simulation. Research limitations/implications All eligible nurses who agreed to participate received training, making it impossible to compare improvements in knowledge to those who did not receive the training. Originality/value A diverse array of nursing professionals and their patients may benefit from simulation training. This quality improvement intervention provides a feasible model for establishing new care protocols in a hospital setting. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to validate measures of professional self-efficacy for detecting and responding to child abuse and neglect presentations, and then evaluate a clinical training programme for health professionals in a tertiary-level hospital in Vietnam.Design/methodology/approach A prospective, cohort design was used and professional self-efficacy was measured immediately prior to, and shortly after, training 116 nurses and doctors in emergency settings. Longer-term follow-up was measured six months later.Findings Linear mixed modelling showed that there was a statistically significant improvement in efficacy expectations for both suspected and known cases of child abuse and neglect between the pre- and post-test measures at zero and six weeks. These improvements did not persist to the six-month follow-up.Research limitations/implications The training succeeded in improving detection and clinical response to child abuse and neglect presentations but not faith in the provision of ongoing support for children and families.Practical implications Practice change in emergency settings in Vietnam can be achieved using a sustainable theoretically driven training programme.Social implications Building the capacity of health professionals to respond to cases of child abuse and neglect relies on the strength of the community and support services within which the hospital is located.Originality/value Measures of self-efficacy expectations and outcome expectations for responding to child abuse and neglect presentations in emergency settings in Vietnam are now validated. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine whether the current Royal College of Psychiatrists Membership (MRCPsych) written examination is a suitable assessment tool to distinguish between candidates in a high-stakes examination.Design/methodology/approach Review of current educational theory and evidence in relation to the use of multiple-choice questions (MCQs) as an assessment form.Findings When MCQ’s are constructed correctly they provide an efficient and objective assessment tool. However, when developing assessment tools for high-stakes scenarios, it is important that MCQs are used alongside other tests that may scrutinize other aspects of competence. It may be argued that written assessment can only satisfy the first stage of Miller’s pyramid. The evidence outlined demonstrates that this may not be the case and higher order thinking and problem solving can be assessed with appropriately constructed questions. MCQs or any other singular assessment alone, cannot demonstrate clinical competence or mastery.Originality/value Increasingly, the MRCPsych examination is used around the world to establish levels of competency and expertise in psychiatry. It is therefore essential that the Royal College of Psychiatrists lead the way in innovation of assessment procedures which are linked to current educational theory. The author has evidenced how the current MRCPsych, may at least in part, hold inherent biases which are not related to a candidate’s competency. [ABSTRACT FROM AUTHOR]

Purpose: Care of complex patients requires collaboration across hospital and community settings. Yet there is little recognition of the capabilities that healthcare workers need to effectively implement integrated care. An adaptive expertise theoretical framework can inform educational efforts that aim to give providers the abilities to navigate complexity and ambiguity in the healthcare system, including across hospital and community settings. Prior education research in the HIV sector has demonstrated that adaptive expert skills can be cultivated through education that emphasizes perspective exchange, inviting uncertainty in practice and integration of diverse perspectives on care. Design/methodology/approach: These principles informed the creation of an Extension for Community Healthcare Outcomes (ECHO) in HIV Psychiatry – the first ECHO directed at a non-clinical, community health worker (CHW) audience. The goal was to improve informal collaborations across hospitals and communities. Findings: Participation in the ECHO was robust, with significant on-camera engagement. Participants attributed success of the ECHO to key themes: explicit value placed on all kinds of knowledge (not simply clinical knowledge), emphasis on approaches for navigating ambiguity and complexity and engagement in perspective exchange for provision of integrated, team-based care. Future cycles of ECHO HIV Psychiatry are being pursued, with a focus on the development of adaptive expert capabilities and the impact on integration of care between community and hospital services. Originality/value: To our knowledge, this is the only ECHO that is specifically aimed at frontline CHWs. [ABSTRACT FROM AUTHOR]

Purpose -- The aim of this paper is to offer a framework that captures the clinical activity of mental health nursing academics. Design/methodology/approach -- Through an exploration of relevant literature and an examination of the practices of a team of mental health nursing academics, the key clinical activities that academics were engaged in were identified. Findings -- The Practice Engagement Framework offers a structure to identify the range and breadth of clinical engagement for nursing academics. Originality/value -- This framework might be useful for other mental health academics from other professional groups such as social work and occupational therapy. [ABSTRACT FROM AUTHOR]

This paper describes how psychosocial interventions (PSI) have been integrated into an undergraduate mental health nursing programme. The first part of the paper provides the broad context of PSI in nurse education and justifies the need to incorporate skills for PSI into the undergraduate nursing curriculum. A variety of educational theories and research are presented, which have informed the development, structure and delivery of the skills programme underpinned by PSI into the undergraduate programme. The successes and limitations of this skills programme are considered in light of the key issues and challenges concerning the integration of PSI skills into undergraduate nursing education. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to address how adult development (AD) theories can contribute to quality improvement (QI). Design/methodology/approach A theoretical analysis and discussion on how personal development empirical findings can relate to QI and Deming's four improvement knowledge domains. Findings AD research shows that professionals have qualitatively diverse ways of meaning-making and ways to approach possibilities in improvement efforts. Therefore, professionals with more complex meaning-making capacities are needed to create successful transformational changes and learning, with the recognition that system knowledge is a developmental capacity. Practical implications In QI and improvement science there is an assumption that professionals have the skills and competence needed for improvement efforts, but AD theories show that this is not always the case, which suggests a need for facilitating improvement initiatives, so that everyone can contribute based on their capacity. Originality/value This study illustrates that some competences in QI efforts are a developmental challenge to professionals, and should be considered in practice and research. [ABSTRACT FROM AUTHOR]

Purpose The current healthcare environment provides several challenges to the existing roles of healthcare professionals. The value of the professional expert is also under scrutiny. The purpose of this paper is to generate a construction of professional expertise amongst practitioners in the current healthcare environment. It used the speech-language therapy community in New Zealand (NZ) as an example. Design/methodology/approach Speech-language therapists currently practicing in NZ completed an online survey including qualitative and quantitative components. The range of experience and work settings of participants ( n=119) was representative of the workforce. Findings Participants clearly identified being "highly experienced" and "having in-depth knowledge" as essential elements of professional expertise. Thematic analysis generated two interconnected themes of a professional expert being a personal leader and teacher, and a highly experienced, knowledgeable and skilful practitioner. Additionally, practitioners needed to be seen to contribute to the community in order to be known as experts. Clinical practice was valued differently from research generation. Originality/value This study is novel in exploring a construction of professional expertise amongst practitioners in a current healthcare community. Within that community, experts could be viewed as highly effective practitioners that visibly contribute to the professional community. The study draws attention to the role of reputation and the impacts of being a clinical teacher or leader compared with pursuing a research role. This could be particularly relevant in the promotion of evidence-based practice. [ABSTRACT FROM AUTHOR]

Purpose – The evidence base for what works with forensic patients in high-security inpatient settings has typically focused on outcome research and not included clinical expertise from practice-based experience, which is an important facet of evidence-based practice. The purpose of this paper is to establish whether experts with clinical and/or research experience in this setting could reach consensus on elements of high-security hospital services that would be essential to the rehabilitation of forensic patients. Design/methodology/approach – A three-round Delphi survey was conducted to achieve this aim. Experts were invited to rate agreement with elements of practice and interventions derived from existing research evidence and patient perspectives on what worked. Experts were also invited to propose elements of hospital treatment based on their individual knowledge and experience. Findings – In the first round 54 experts reached consensus on 27 (out of 39) elements that included physical (e.g. use of CCTV), procedural (e.g. managing restricted items) and relational practices (e.g. promoting therapeutic alliances), and to a lesser extent-specific medical, psychological and social interventions. In total, 16 additional elements were also proposed by experts. In round 2 experts (n=45) were unable to reach a consensus on how essential each of the described practices were. In round 3 (n=35), where group consensus feedback from round 2 was provided, consensus was still not reached. Research limitations/implications – Patient case complexity, interventions with overlapping outcomes and a chequered evidence base history for this population are offered as explanations for this finding alongside limitations with the Delphi method. Practical implications – Based on the consensus for essential elements derived from research evidence and patient experience, high-secure hospital services might consider those practices and interventions that experts agreed were therapeutic options for reducing risk of offending, improving interpersonal skills and therapeutic interactions with patients, and mental health restoration. Originality/value – The study triangulates what works research evidence from this type of forensic setting and is the first to use a Delphi survey in an attempt to collate this information. [ABSTRACT FROM AUTHOR]

Purpose: The quality improvement in colonoscopy study was a region wide service improvement study to improve adenoma detection rate at colonoscopy by implementing evidence into routine colonoscopy practice. Implementing evidence into clinical practice can be challenging. The purpose of this paper is to perform a qualitative interview study to evaluate factors that influenced implementation within the study.Design/methodology/approach: Semi-structured interviews were conducted with staff in endoscopy units taking part in the quality improvement in colonoscopy study, after study completion. Units and interviewees were purposefully sampled to ensure a range of experiences was represented. Interviews were conducted with 11 participants.Findings: Key themes influencing uptake of the quality improvement in colonoscopy evidence bundle included time, study promotion, training, engagement, positive outcomes and modifications. Areas within themes were increased awareness of quality in colonoscopy (QIC), emphasis on withdrawal time and empowerment of endoscopy nurses to encourage the use of quality measures were positive outcomes of the study. The simple, visible study posters were reported as useful in aiding study promotion. Feedback sessions improved engagement. Challenges included difficulty arranging set-up meetings and engaging certain speciality groups.Originality/value: This evaluation suggests that methods to implement evidence into clinical practice should include identification and empowerment of team members who can positively influence engagement, simple, visible reminders and feedback. Emphasis on timing of meetings and strategies to engage speciality groups should also be given consideration. Qualitative evaluations can provide important insights into why quality improvement initiatives are successful or not, across different sites. [ABSTRACT FROM AUTHOR]