Capturing what and why in healthcare innovation

Funding: Dr Davis’ time was funded from a collaborative project between University of Dundee; Tayside Academic Health Sciences Partnership; Medtronic; Scottish Enterprise; National Centre for Universities and Business.Understandings of innovation usually encompass multiple overlapping aspects, putting innovation terminology at risk of vagueness and overuse. However, innovation concepts are expected to remain powerful and useful in healthcare beyond the pandemic and into the future, so clarity will be helpful for effective leadership. To disentangle and disambiguate meanings within innovation, we offer a framework that captures and simplifies foundational substance within innovation concepts. Our method is an overview review of innovation literature from the 5 years preceding COVID-19. 51 sources were sampled and analysed for explicit definitions of healthcare innovation. Drawing on broad themes suggested from previous reviews, and gathering specific themes emergent from this literary dataset, we focused on categorising the nature of innovations (the what) and reasons given for them (the why). We identified 4 categories of what (ideas, artefacts, practice/process and structure) and 10 categories of why (economic value, practical value, experience, resource use, equity/accessibility, sustainability, behaviour change, specific-problem solving, self-justifying renewal and improved health). These categories reflect contrasting priorities and values, but do not substantially interfere or occlude each other. They can freely be additively combined to create composite definitions. This conceptual scheme affords insight and clarity for creating precise meanings, and making critical sense of imprecision, around innovation. Improved communication and clear shared understandings around innovative intentions, policies and practices cannot but improve the chances of enhanced outcomes. The all-inclusive character of this scheme leaves space for considering the limits of innovation, and notwithstanding well-established critiques, provides a basis for clarity in ongoing usage.PostprintPeer reviewe

‘That’s bang out of order, mate!’:Gendered and racialized micro-practices of disadvantage and privilege in UK business schools

The existence of gendered and racialized inequalities in academia has been well documented. To date, research has primarily addressed the intersectional disadvantages faced by members of minority groups with much less attention paid to the privileges experienced by dominant group members. This paper draws on 21 interviews and 36 audio‐diary entries completed by a diverse group of senior higher education leaders who have successfully navigated the career ladder in UK business schools. By juxtaposing minority with dominant group members' narratives, the study advances intersectionality research, offering a contextualized analysis of the micro‐practices of both disadvantage and privilege in academia. Through a focus on how micro‐practices perform differently for members of different groups, it foregrounds “obvious” as well as nuanced differences that contribute to the accumulation of disadvantage and privilege throughout an individual's career and emphasizes simultaneity as crucial to understanding the workings of gendered and racialized disadvantage and privilege

An Evaluation of a Scottish Higher Education ‘Student Transitions’ Enhancement Theme:Stakeholders’ Perceptions and Recommendations for Future Activities

We would like to acknowledge that this work was funded by QAA Scotland.The Quality Assurance Agency Enhancement Themes identify specific development themes to enhance the student learning experience in Scottish higher education (HE). This evaluation explored the second year of the ‘Student Transitions’ theme through the questions: How do stakeholders perceive the impact of the ‘Student Transitions’ work and, what are the facilitators and barriers to the successful development of projects? Data were collected during two overlapping phases. In Phase 1, 30 individuals, with national or institutional leadership roles associated with the current Enhancement Theme participated in semi-structured telephone interviews. In Phase 2, 43 online questionnaires were completed by institutionally nominated individuals. Professional, support and academic staff, and student representatives from all 19 Scottish Universities participated. Data were analysed using a thematic framework approach and descriptive statistics. Themes developed were: perceived impact; facilitators and barriers, such as support, engagement and sustainability. These themes were explored across institutions and sector wide. Participants felt ‘Student Transitions’ work was fundamental for Universities. Participants considered that Theme work had enhanced reflection on, and engagement with transition issues. Capturing direct impact was challenging for participants and it was proposed that it may take several years to evidence the outcomes of the work at the level of student experience. Broadly, participants reported that the sector was supportive and collaborative where ideas and resources for the ‘Student Transitions’ work had been openly shared. Challenges to advancing Enhancement Theme activities include limited time and other agendas competing for limited resources e.g. the Teaching Excellence Framework (TEF). The findings highlight the complexity of integrating the Theme within institutions and broadly across the sector. Key recommendations and lessons learned surround 1) defining and measuring impact; 2) enhancing engagement; 3) and Theme integration.Publisher PDFPeer reviewe

Leadership and followership in the healthcare workplace:exploring medical trainees' experiences through narrative inquiry

This research was part of LJG’s PhD research which was generously funded by NHS Education for Scotland through SMERC.OBJECTIVES: To explore medical trainees' experiences of leadership and followership in the interprofessional healthcare workplace. DESIGN: A qualitative approach using narrative interviewing techniques in 11 group and 19 individual interviews with UK medical trainees. SETTING: Multisite study across four UK health boards. PARTICIPANTS: Through maximum variation sampling, 65 medical trainees were recruited from a range of specialties and at various stages of training. Participants shared stories about their experiences of leadership and followership in the healthcare workplace. METHODS: Data were analysed using thematic and narrative analysis. RESULTS: We identified 171 personal incident narratives about leadership and followership. Participants most often narrated experiences from the position of follower. Their narratives illustrated many factors that facilitate or inhibit developing leadership identities; that traditional medical and interprofessional hierarchies persist within the healthcare workplace; and that wider healthcare systems can act as barriers to distributed leadership practices. CONCLUSIONS: This paper provides new understandings of the multiple ways in which leadership and followership is experienced in the healthcare workplace and sets out recommendations for future leadership educational practices and research.Publisher PDFPeer reviewe

Multiple and multi-dimensional transitions from trainee to trained doctor: A qualitative longitudinal study in the UK

Objectives To explore trainee doctors’ experiences of the transition to trained doctor, we answer three questions: (1) What multiple and multidimensional transitions (MMTs) are experienced as participants move from trainee to trained doctor? (2) What facilitates and hinders doctors’ successful transition experiences? (3) What is the impact of MMTs on trained doctors? Design: A qualitative longitudinal study underpinned by MMT theory. Setting: Four training areas (health boards) in the UK. Participants: 20 doctors, 19 higher-stage trainees within 6 months of completing their postgraduate training and 1 staff grade, associate specialist or specialty doctor, were recruited to the 9-month longitudinal audio-diary (LAD) study. All completed an entrance interview, 18 completed LADs and 18 completed exit interviews. Methods: Data were analysed cross-sectionally and longitudinally using thematic Framework Analysis. Results: Participants experienced a multiplicity of expected and unexpected, positive and negative work-related transitions (eg, new roles) and home-related transitions (eg, moving home) during their trainee–trained doctor transition. Factors facilitating or inhibiting successful transitions were identified at various levels: individual (eg, living arrangements), interpersonal (eg, presence of supportive relationships), systemic (eg, mentoring opportunities) and macro (eg, the curriculum provided by Medical Royal Colleges). Various impacts of transitions were also identified at each of these four levels: individual (eg, stress), interpersonal (eg, trainees’ children spending more time in childcare), systemic (eg, spending less time with patients) and macro (eg, delayed start in trainees’ new roles). Conclusions: Priority should be given to developing supportive relationships (both formal and informal) to help trainees transition into their trained doctor roles, as well as providing more opportunities for learning. Further longitudinal qualitative research is now needed with a longer study duration to explore transition journeys for several years into the trained doctor role

Enabling and inhibiting doctors transitions: introducing the social identity resource and belonginess model (SIRB)

The transition into postgraduate medical training is complex, requiring an integration into the workplace, adjustment to new identities, and understanding of the social and organisational structure of healthcare. Studies suggest that social resources, including a sense of belonging, inclusivity from social groups, and having strong social identities can facilitate positive transitions. However, little is known about the role these resources play in junior doctors’ transitions into the healthcare community. This study aimed to explore the implications of having access to social resources for junior doctors. This study undertook secondary analysis from a longitudinal qualitative study which followed 19 junior doctors (residents within two years of qualification) for nine months. Data were thematically analysed using an abductive approach, with the social identity resource and belongingness (SIRB) model as a conceptual lens to explore how social networks of support act as identity resources (IRs) for junior doctors as they experience transitions. The doctors narrated that having accessible IRs in the form of supportive workplace relationships enabled an integration and a sense of belonging into healthcare practice, supported the construction of new professional identities, and strengthened career intentions. Those with inaccessible IRs (i.e. poor workplace relationships) expressed a lack of belonging, and casted doubt on their identity as a doctor and their career intentions. Our study indicates that SIRB model would be beneficial for medical educators, supervisors, and managers to help them understand the importance and implications of having IRs within the workplace environment and the consequences of their accessibility for healthcare staff experiencing transitions