Going beyond the hero in leadership development: the place of healthcare context, complexity and relationships Comment on “Leadership and leadership development in healthcare settings – a simplistic solution to complex problems?”

There remains a conviction that the torrent of publications and the financial outlay on leadership development will create managers with the skills and characters of perfect leaders, capable of guiding healthcare organisations through the challenges and crises of the 21st century. The focus of much attention continues to be the search for the (illusory) core set of heroic qualities, abilities or competencies that will enable the development of leaders to achieve levels of supreme leadership and organisational performance. This brief commentary adds support to McDonald’s ( 1 ) call for recognition of the complexity of the undertakin

Going beyond the hero in leadership development: the place of healthcare context, complexity and relationships Comment on "Leadership and leadership development in healthcare settings -a simplistic solution to complex problems?"

Abstract There remains a conviction that the torrent of publications and the financial outlay on leadership development will create managers with the skills and characters of perfect leaders, capable of guiding healthcare organisations through the challenges and crises of the 21st century. The focus of much attention continues to be the search for the (illusory) core set of heroic qualities, abilities or competencies that will enable the development of leaders to achieve levels of supreme leadership and organisational performance

Performative seduction: How management consultants influence practices of leadership

Purpose This paper tracks how a policy recommended by management consultants becomes embedded as an integral part of leadership practice. It explores the launch of the concept of “talent management” by McKinsey & Company and how it becomes adopted as part of expected leadership practices in the English National Health Service. The use of Management Consultants globally has increased exponentially, and the paper considers this phenomenon and the ways in which management consultant advice influences public sector leadership and practice at local level. Design/methodology/approach A case study approach is adopted, focussing on the introduction of the concept of talent management into the English NHS, following the wider emergence of the concept through influential reports published by McKinsey & Company in the late 1990s. An analysis of the emergence of the concept is conducted drawing on this series of reports and the adoption of talent management policies and practices by the English government's Department of Health. Findings These influential reports by the management consultancy firm, McKinsey & Company, constituted an urgent need for this newly identified concept of talent management and the secrecy surrounding its reception. It is this mystery surrounding the decisions about a talent management strategy in the NHS and the concealment of decisions behind closed doors, which leads us to offer a theory of management consultants' influence on leaders as one of performative seduction. Originality/value Management consultancy is a vast business whose influence reaches deeply into public and private sector organisations around the world. Understanding of the variegated policies and practices that constitute contemporary modes of governance therefore requires comprehension of management consultants' role within those policies and practices. This paper argues that management consultants influence public sector leadership through insertion of their products into definitions of, and performative constitution of, local level leadership

“Giving something back”: a systematic review and ethical enquiry into public views on the use of patient data for research in the United Kingdom and the Republic of Ireland

Background: Use of patients’ medical data for secondary purposes such as health research, audit, and service planning is well established in the UK. However, the governance environment, as well as public understanding about this work, have lagged behind. We aimed to systematically review the literature on UK and Irish public views of patient data used in research, critically analysing such views though an established biomedical ethics framework, to draw out potential strategies for future good practice guidance and inform ethical and privacy debates. Methods: We searched three databases using terms such as patient, public, opinion, and electronic health records. Empirical studies were eligible for inclusion if they surveyed healthcare users, patients or the public in UK and Ireland and examined attitudes, opinions or beliefs about the use of patient data for medical research. Results were synthesised into broad themes using a framework analysis. Results: Out of 13,492 papers and reports screened, 20 papers or reports were eligible. While there was a widespread willingness to share patient data for research for the common good, this very rarely led to unqualified support. The public expressed two generalised concerns about the potential risks to their privacy. The first of these concerns related to a party’s competence in keeping data secure, while the second was associated with the motivation a party might have to use the data. Conclusions: The public evaluates trustworthiness of research organisations by assessing their competence in data-handling and motivation for accessing the data. Public attitudes around data-sharing exemplified several principles which are also widely accepted in biomedical ethics. This provides a framework for understanding public attitudes, which should be considered in the development in any guidance for regulators and data custodians. We propose four salient questions which decision makers should address when evaluating proposals for the secondary use of dat

Can the use of Bayesian analysis methods correct for incompleteness in electronic health records diagnosis data? Development of a novel method using simulated and real-life clinical data

Background Patient health information is collected routinely in electronic health records (EHRs) and used for research purposes, however, many health conditions are known to be under-diagnosed or under-recorded in EHRs. In research, missing diagnoses result in under-ascertainment of true cases, which attenuates estimated associations between variables and results in a bias towards the null. Bayesian approaches allow the specification of prior information to the model, such as the likely rates of missingness in the data. This paper describes a Bayesian analysis approach which aimed to reduce attenuation of associations in EHR studies focussed on conditions characterised by under-diagnosis. Methods Study 1: We created synthetic data, produced to mimic structured EHR data where diagnoses were under-recorded. We fitted logistic regression (LR) models with and without Bayesian priors representing rates of misclassification in the data. We examined the LR parameters estimated by models with and without priors. Study 2: We used EHR data from UK primary care in a case-control design with dementia as the outcome. We fitted LR models examining risk factors for dementia, with and without generic prior information on misclassification rates. We examined LR parameters estimated by models with and without the priors, and estimated classification accuracy using Area Under the Receiver Operating Characteristic. Results Study 1: In synthetic data, estimates of LR parameters were much closer to the true parameter values when Bayesian priors were added to the model; with no priors, parameters were substantially attenuated by under-diagnosis. Study 2: The Bayesian approach ran well on real life clinic data from UK primary care, with the addition of prior information increasing LR parameter values in all cases. In multivariate regression models, Bayesian methods showed no improvement in classification accuracy over traditional LR. Conclusions The Bayesian approach showed promise but had implementation challenges in real clinical data: prior information on rates of misclassification was difficult to find. Our simple model made a number of assumptions, such as diagnoses being missing at random. Further development is needed to integrated the method into studies using real-life EHR data. Our findings nevertheless highlight the importance of developing methods to address missing diagnoses in EHR data

Should free text data in electronic medical records be shared for research? A citizens’ jury study in the United Kingdom

Background Use of routinely collected patient data for research and service planning is an explicit policy of the UK National Health Service and UK government. Much clinical information is recorded in free-text letters, reports and notes. These text data are generally lost to research, due to the increased privacy risk compared with structured data. We conducted a citizens’ jury which asked members of the public whether their medical free-text data should be shared for research for public benefit, to inform an ethical policy. Methods Eighteen citizens took part over 3 days. Jurors heard a range of expert presentations as well as arguments for and against sharing free text, and then questioned presenters and deliberated together. They answered a questionnaire on whether and how free text should be shared for research, gave reasons for and against sharing and suggestions for alleviating their concerns. Results Jurors were in favour of sharing medical data and agreed this would benefit health research, but were more cautious about sharing free-text than structured data. They preferred processing of free text where a computer extracted information at scale. Their concerns were lack of transparency in uses of data, and privacy risks. They suggested keeping patients informed about uses of their data, and giving clear pathways to opt out of data sharing. Conclusions Informed citizens suggested a transparent culture of research for the public benefit, and continuous improvement of technology to protect patient privacy, to mitigate their concerns regarding privacy risks of using patient text data

Re/searching leadership: A critique in two agonies and nine fits

Since the nineteenth century much academic effort has been expended researching leadership. Bodies of theory have risen to dominance, proved unsatisfactory, and been replaced by another generation of ultimately-disappointing leadership thought. This repetitive pattern continues, so we ask what motivates this continuing, seemingly fruitless search? Focusing on researchers and not leadership per se, our analysis is inspired by two surprisingly complementary sources: psychoanalytical theory and Lewis Carroll’s epic nonsense poem The Hunting of the Snark: An Agony in Eight Fits. Together they lead to a theory that re/search is motivated by unconscious desires to experience the transformational object – an ultimately unachievable search but one that unconsciously sustains the ever-growing field of leadership research. In contributing a new psychoanalytical theory of unconscious motivations that inspire our research, we also demonstrate the inspiration poetry may offer organizational researchers. We conclude by offering a ninth fit which leaps into the void of future thought and finds that the leadership Snark was, in fact, a Boojum

Protocol: Are primary care consultations for insomnia associated with dementia in later life?

Insomnia has been defined as a difficulty initiating or maintaining sleep, leading to sleep that is either insufficient or unrefreshing. It is well-established that insomnia is more common in people with dementia, but it is not clear if insomnia predates dementia in these individuals. This latter question is an important one: if it can be shown that people with insomnia are more likely to develop dementia in later life, this may improve our ability to predict an individual’s dementia risk, and possibly to help manage that risk. Several recent studies have found a link between insomnia and later dementia, but typically give little information about the time between the onset of insomnia and the onset of dementia, raising the possibility that the insomnia is an early symptom of dementia, rather than a risk factor or potential cause of the disease. Furthermore, in some studies the link between insomnia and dementia becomes weaker when factors such as depression and sleeping tablet use are taken into account. The proposed study uses primary care records to learn whether people with dementia are more likely to have consulted with their general practitioner (GP) about insomnia 5-10 years earlier, compared to those who do not have dementia