Building leadership and management competencies of national immunization teams in 16 Gavi-eligible countries through the EPI leadership and management programme

BackgroundStrengthening leadership and management competencies among national Expanded Programme on Immunization (EPI) teams will be critical to achieving global immunization targets and other sustainable developmental goals. However, there is little empirical evidence of the effectiveness of investments in leadership and management capacity in the context of national EPI programs. Therefore, we sought to evaluate the EPI Leadership and Management Programme (EPI LAMP), a nine-month certificate program for EPI teams in national Ministries of Health from Gavi priority countries in Anglophone and Francophone Africa and Asia.MethodsWe used a mixed-methods longitudinal evaluation to describe EPI LAMP at four levels: (1) participant response to the training experience based on program administration records and satisfaction surveys; (2) change in management and leadership skill based on competency surveys and exit interviews; (3) change in behavior in the workplace based on exit interviews; and (4) impact of the training on EPI program performance based on the results of each delegate’s leadership project.ResultsIn the first three cohorts, the programme engaged 16 countries (63 participants) and achieved an 86% graduation rate (54 alumni). Participants demonstrated significant improvement in management and leadership competencies across eight domains with the largest improvement observed in the domain of governance and leadership. Women showed greater increases than men, especially in the domains of Operations Management and Political Advocacy and Dialogue. We observed no difference in the gains made by French-speaking delegates compared to English-speaking participants. Breakthrough projects developed by each team improved EPI program performance, as measured by metrics specific to each project.DiscussionOur results show that team-based leadership programs can foster improvements in management practice, collaboration, and problem-solving, and that engagement the broader policy and organizational context is needed to foster the systems thinking capacity required to address complex challenges and improve system performance.     

Culturally diverse management teams. Mercy International sponsors project on Guam

In 1989 Mercy International Health Services (MIHS) sent a team of advisers to help upgrade the skills of the managers of Guam Memorial Hospital. Their experience offers lessons for U.S. healthcare organizations as they become culturally diverse. The hospital had a number of problems, including high management turnover, troubles with financial resources, political interference, and a building that did not meet codes. The advisers also planned to prepare the hospital for an accreditation survey by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). MIHS, which has a growing presence in the Pacific, does not take charge of healthcare organizations. Instead, it trains local persons to assume leadership roles. At Guam Memorial Hospital, the MIHS advisers spent their first year assessing the organization and the various cultures represented on its staff. Then the advisers devoted three years to coaching and mentoring their Guamanian counterparts. The advisers learned that the hospital had basically been run by one person. It had no management team, either formal or informal. The advisers began their coaching by forming a management team in the dietary department. When the rest of the hospital staff saw that team perform successfully, they became willing to join similar teams themselves. Guam Memorial Hospital had changed by the time the MIHS advisers left the island in 1993. It has not yet been accredited, but it does have management teams working to meet JCAHO standards. The hospital also has in place a continuous quality improvement system, with more than three years of documentation. And the hospital building now conforms to codes.     

Disease management. A new technology in need of critical assessment

Recently, many disease management programs, especially for patients with chronic diseases, have emerged. This paper discusses the potential benefits and disadvantages of disease management, on the basis of an extensive literature review. Disease management is an innovative technology in health care management, which is diffusing throughout the health care system without critical evaluation. Evidence on its effectiveness and costs is still very scarce, while the legal, ethical, organizational, and social implications of this practice have not been analyzed seriously. Before disease management is implemented on a broader scale in different European settings, first, empirical evidence about its alleged benefits and cost-effectiveness should be collected.     

Cases of imported cholera in France, summer 2005. A. Tarantola for the incident management teams

Cholera is a bacterial infection, which causes digestive symptoms and massive diarrhoea. It may lead to dehydration and death if appropriate medical management is not rapidly initiated. Most cases of infection by choleric vibrio, however, remain symptom-free or may mimic common gastroenteritis. A review of two cases of imported cholera in France in the summer of 2005 and the community- and hospital-based investigation, which they triggered, enabled the incident management teams to assess risks of transmission. There were no secondary cases among 58 hospital contacts and 15 family contacts of the cases. Clinicians will find a discussion of possible clinical presentations and the risk of secondary transmission, in the context of progressing epidemics in countries, which have maintained close ties with France.     

Building true collaborations. A senior support network illustrates a successful partnership of healthcare and social service providers

The relationship between Catholic Social Services (CSS) of the Diocese of Scranton and Mercy Health Partners--Northeast Region, which joined forces last year to develop a senior support network for residents of Wilkes-Barre and the Borough of Kingston, PA, illustrates how collaboration grows out of cooperation and coordination of services. The network is a project of the Neighborhood-Based Senior Care National Initiative, which works to develop collaborations between Catholic health systems and Catholic Charities agencies to help poor communities meet the needs of aging persons. Barriers to successful collaboration may stem from cultural misunderstandings, differences in organizational stability and decision-making processes, attitudes toward money, and even professional vocabularies. Organizations that trust and respect each other can overcome these barriers. The Wilkes-Barre project began simply, but its success established a pattern of cooperation between CSS and Mercy Health Partners, which led to further coordination of referral programs, development of community health profiles, and cross-organizational training. After nine months on the Wilkes-Barre project, CSS and Mercy Health Partners are now developing a Program of All-Inclusive Care for the Elderly (PACE). Effective collaboration between healthcare providers and social service agencies is a long, sometimes difficult, process that requires organizational commitments of time and resources. Organizations must not yield to the temptation to take shortcuts to achieve short-term gains.     

危重症患者的气道管理

保证气道通畅是抢救和复苏的最重要环节和最基本前提,危重症患者因治疗需要,往往早期即建立人工气道,因此人工气道的管理成为危重症患者气道管理的一个重要部分。而气道的管理,包括如何开放气道、人工气道的选择、气道的护理、并发症的防治等,是保证气道通畅和救治成功的先决条件。一、人工气道的概念人工气道是将导管经鼻/口插入气管或气管切开所建立的气体通道。一般来说,上呼吸道梗阻、气道自洁能力受损导致分泌物潴留及需要机械通气者,均应建立人工气道[1]。1543年Vesalius报道经气管造口处置入空心芦苇杆等以吹气使肺膨胀的方法救治患…     

Impact of litigation on senior clinicians: implications for risk management.

OBJECTIVES: To investigate the impact of litigation on consultants and senior registrars and to establish their views on methods of reducing adverse events and litigation. DESIGN: Postal survey. SETTING: Acute hospitals in the North Thames (West) Regional Health Authority. SUBJECTS: 1011 consultants and senior registrars in acute hospitals. MAIN MEASURES: Perceived causes and effects of adverse events; views on methods of reducing litigation and adverse events. RESULTS: 769 (76%) doctors responded. 288 (37%) had been involved in litigation at some point during their career; 213 surgeons (49%) and 75 (23%) doctors in the medical specialties. Anger, distress, and feeling personally attacked were common responses to litigation. Clinicians' views on reducing litigation emphasised the need for change at the clinical level. Supervision of junior staff, workload, and training in communication skills were to the fore. CONCLUSIONS: The high frequency of doctors who have experienced litigation and the emotional responses described indicate that clinicians require support at several levels. At a personal level, support can be offered to clinicians going through the litigation process or after an adverse event. Also, managerial support is needed by offering financial and practical help in correcting the factors that have been consistently identified as producing high risk situations to minimise the possibility of a reoccurrence. Accidents in medicine are, by their very nature, costly in human and financial terms and the root causes must be tackled. Recommendations are made for clinicians and risk management teams.     

A realistic theory of health sector management. The case for critical realism

To date the practice of health sector management has not been sufficiently theorised. An adequate theory should be able to answer the pre-eminent critique of managerial rationality and ethics mounted by Alasdair MacIntyre in After Virtue and should also offer robust analytical and ethical resources to identify and engage with the social, political, economic and moral issues underlying health sector management. Critical realism with its ontology of generative mechanisms, agency-structure relationships, valorisation of activity and ideology critique offers such resources in an empirically orientated but adequately theorised realist framework. Rather than negate MacIntyre, critical realism incorporates and transcends his key arguments regarding the rationality and ethics of management. This article introduces the main elements of critical realism and clears a conceptual space for the cumulation of critical realist case-studies and managerial craft knowledge.     

Auditing senior management communication practices in the NHS: a regional study.

Increasingly, organizations are being confronted with significant strategic change. This process can only be managed effectively if human resource implications, including how effectively managers and staff communicate with each other, are taken into account. This paper outlines how communication audits provide managers with insights into patterns of communication within their organizations. The nature of communication audits are briefly delineated and explained. An investigation from within the National Health Service (NHS) is offered, which illustrates how a communication audit focusing on relationships between regional, district and local levels of management illuminated patterns of communication between senior managers at these levels. This resulted in the development of an action plan for the improvement of communication practices. The generalizability of these findings to the NHS is discussed.