Unlocking medical leadership’s potential:a multilevel virtuous circle?

Background and aim: Medical leadership (ML) has been introduced in many countries, promising to support healthcare services improvement and help further system reform through effective leadership behaviours. Despite some evidence of its success, such lofty promises remain unfulfilled. Method: Couched in extant international literature, this paper provides a conceptual framework to analyse ML's potential in the context of healthcare's complex, multifaceted setting. Results: We identify four interrelated levels of analysis, or domains, that influence ML's potential to transform healthcare delivery. These are the healthcare ecosystem domain, the professional domain, the organisational domain and the individual doctor domain. We discuss the tensions between the various actors working in and across these domains and argue that greater multilevel and multistakeholder collaborative working in healthcare is necessary to reprofessionalise and transform healthcare ecosystems

Impact on maternity professionals of novel approaches to clinical audit feedback

We compared three approaches to feedback of clinical audit findings relating to miscarriage in 15 Scottish maternity services (printed report alone; report plus Action Planning Letter; report plus face-to-face Facilitated Action Planning). We surveyed clinicians to measure Theory of Planned Behaviour constructs (in the context of two audit criteria) before and after feedback (n=253) and assessed perceptions of the audit through in-depth interviews (n=17). Pre-feedback, clinicians had positive attitudes and strong subjective norms and intentions to comply, although perceived behavioural control was lower. Generally, positive attitudes, subjective norms and intentions increased after feedback but for one of the two criteria (providing a 7-day miscarriage service), perceived behavioural control decreased. No changes over time reached statistical significance and analysis of covariance (adjusting for pre-feedback scores) showed no consistent relationships between method of feedback and post-feedback construct scores. Interviews revealed positive perceptions of audit but frustration at lack of capacity to implement changes. While interventions which increased intensity of feedback proved feasible and acceptable to clinicians, we were unable to demonstrate that they increased intention to comply with audit criteria.This study was funded by NHS Quality Improvement Scotland

On three-dimensional dilational elastic metamaterials

Dilational materials are stable three-dimensional isotropic auxetics with an ultimate Poisson's ratio of -1. We design, evaluate, fabricate, and characterize crystalline metamaterials approaching this ideal. To reveal all modes, we calculate the phonon band structures. On this basis, using cubic symmetry, we can unambiguously retrieve all different non-zero elements of the rank-4 effective metamaterial elasticity tensor, from which all effective elastic metamaterial properties follow. While the elastic properties and the phase velocity remain anisotropic, the effective Poisson's ratio indeed becomes isotropic and approaches -1 in the limit of small internal connections. This finding is also supported by independent static continuum-mechanics calculations. In static experiments on macroscopic polymer structures fabricated by three-dimensional printing, we measure Poisson's ratios as low as -0.8 in good agreement with theory. Microscopic samples are also presented.Comment: 8 figure

A strategic action fields perspective on organizational trust repair

While the extant literature on organizational trust repair has considered the agency and trust repair actions of individual organizations, it has neglected repair following trust-damaging events affecting specific industries. Drawing on the theory of strategic action fields we ask two research questions: (1) How do reputational scandals involving a few transgressing firms affect trust in the whole institutional field? (2) Do the transgressing firms repair trust in the same way as the blameless ones in the same field? To answer these questions we investigated four cases of retail organizations that engaged in trust repair actions following a food safety scandal, two widely held to have transgressed, and two that were held to be relatively blameless. We compared the trust repair strategies of both groups, finding that even the blameless organizations felt compelled to act to repair trust. However, blameless organizations also sought to differentiate themselves from the transgressing ones by using specific strategies to restore trust

‘Organizational recidivism’ and trust repair:A story of failed detectives

Purpose: Over the last decade, trust repair has become an important theoretical and practical concern in HRM. The purpose of this paper is to explain why organisations fail to repair their stakeholders’ trust following a series of trust breaches. Design/methodology/approach: Archival data is used to investigate the Royal Bank of Scotland (RBS). Using the analytical frame of the detective novel, the authors analyse reputational scandals in RBS, and in doing so, they explore the interweaving of two stories: the story of the “crime” (the bank's actions which led to breaches of trust) and the story of the “detectives” (parliamentary, regulatory and press investigators). Findings: Based on their analysis, the authors argue that the organisation's failure to repair trust is associated with ineffective detection of what went wrong in the bank and why. Practical implications: HR practitioners dealing with similar situations should understand the complicated and unfolding nature of repeated transgressions, and the reasons why previous trust repair efforts may have failed. Social implications: An organisation may be showing willingness to accept responsibility for the violation of trust, but while new transgressions happen, trust repair efforts may fail. Therefore, what is needed in organisations is a longitudinal analysis that takes into account organisational history, including earlier wrongdoings. Originality/value: The paper is one of the few analysing trust repair from a process perspective and using the metaphor of the detective novel to provide insights into organizational reintegration

Perfluorocarbon Enhanced Glasgow Oxygen Level Dependent (GOLD) magnetic resonance metabolic imaging identifies the penumbra following acute ischemic stroke

The ability to identify metabolically active and potentially salvageable ischaemic penumbra is crucial for improving treatment decisions in acute stroke patients. Our solution involves two complementary novel MRI techniques (Glasgow Oxygen Level Dependant (GOLD) Metabolic Imaging), which when combined with a perfluorocarbon (PFC) based oxygen carrier and hyperoxia can identify penumbra due to dynamic changes related to continued metabolism within this tissue compartment. Our aims were (i) to investigate whether PFC offers similar enhancement of the second technique (Lactate Change) as previously demonstrated for the T2*OC technique (ii) to demonstrate both GOLD metabolic imaging techniques working concurrently to identify penumbra, following administration of Oxycyte® (O-PFC) with hyperoxia. Methods: An established rat stroke model was utilised. Part-1: Following either saline or PFC, magnetic resonance spectroscopy was applied to investigate the effect of hyperoxia on lactate change in presumed penumbra. Part-2; rats received O-PFC prior to T2*OC (technique 1) and MR spectroscopic imaging, which was used to identify regions of tissue lactate change (technique 2) in response to hyperoxia. In order to validate the techniques, imaging was followed by [14C]2-deoxyglucose autoradiography to correlate tissue metabolic status to areas identified as penumbra. Results: Part-1: PFC+hyperoxia resulted in an enhanced reduction of lactate in the penumbra when compared to saline+hyperoxia. Part-2: Regions of brain tissue identified as potential penumbra by both GOLD metabolic imaging techniques utilising O-PFC, demonstrated maintained glucose metabolism as compared to adjacent core tissue. Conclusion: For the first time in vivo, enhancement of both GOLD metabolic imaging techniques has been demonstrated following intravenous O-PFC+hyperoxia to identify ischaemic penumbra. We have also presented preliminary evidence of the potential therapeutic benefit offered by O-PFC. These unique theranostic applications would enable treatment based on metabolic status of the brain tissue, independent of time from stroke onset, leading to increased uptake and safer use of currently available treatment options