Toward an emergent Asian behavioural model of perceived managerial and leadership effectiveness: a cross-nation comparative analysis of effective and ineffective managerial behaviour of private sector managers in India and South Korea

This Type 4 (emic-and-etic) indigenous cross-case/cross-nation comparative study compares the results of two Type 3 (emic-as-emic) indigenous replication studies of effective and ineffective managerial behaviour carried out within private companies in India and South Korea respectively. The method used was ‘realist qualitative content analysis’ involving inductive open and axial coding. Of the Indian findings 100% were found to be convergent in meaning with 94.43% of the equivalent South Korean findings. This has led to the identification of a two-factor emergent Asian behavioural model of perceived managerial and leadership effectiveness comprised of 16 positive (effective) and 6 negative (ineffective) generic behavioural criteria. These criteria could be used in both countries to critically review and improve extant, or develop new, competency-based management/leadership development programmes. The research findings lend no support to claims that national culture has a major impact on managerial and leadership practices, styles, and effectiveness

Toward a universalistic behavioural model of perceived managerial and leadership effectiveness for the health services sector

This is an accepted manuscript of a paper published by SAGE, available online at: https://doi.org/10.1177/09514848211065462 The accepted manuscript of the publication may differ from the final published version.Much management and leadership development provision for healthcare professionals has been the subject of considerable criticism, and there have been numerous calls for training programmes explicitly focused on the specific managerial (manager/leader) behaviours healthcare managers, physician leaders and nurse managers need to exhibit to be perceived effective. The aim of our multiple cross-case/cross-nation comparative study has been to: i) identify similarities and differences between the findings of published qualitative critical incident studies of effective and ineffective managerial behaviour observed within British, Egyptian, Mexican and Romanian public hospitals, respectively, and ii) if possible, deduce from the identified commonalities a healthcare-related behavioural model of perceived managerial and leadership effectiveness. Adopting a philosophical stance informed by pragmatism, epistemological instrumentalism and abduction, we used realist qualitative analytic methods to code and classify into a maximum number of discrete behavioural categories empirical source data obtained from five previous studies. We found high degrees of empirical generalization which resulted in the identification of five positive (effective) and four negative (ineffective) behavioural dimensions (BDs) derived, respectively, from 14 positive and 9 negative deduced behavioural categories (BCs). These BDs and underpinning BCs are expressed in the form of an emergent two-factor universalistic behavioural model of perceived managerial and leadership effectiveness. We suggest the model could be used to critically evaluate the relevance and appropriateness of existing training provision for physician leaders, nurse managers and other healthcare managers/leaders in public hospitals or to design new explicit training programmes informed and shaped by healthcare-specific management research, as called for in the literature

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Toward a Unified Framework of Perceived Negative Leader Behaviors Insights from French and British Educational Sectors

In this paper, we challenge the commonly held assumption that actors in the education sector are largely ethical, and that there is therefore little need to scrutinize leader behaviors in this sector. We also overcome past scholars’ tendencies to either focus selectively on positive leader behaviors, or to stay content with categorizing leader behaviors into effective and ineffective (if at all they do focus on negative leader behaviors). Using data (Critical Incidents) from three case studies previously conducted in eight British and French academic establishments, we show that not only do negative leader behaviors abound in the education sector, but they can also be differentiated into three types: (1) behaviors emanating from leaders’ lack of functional skills i.e., ineffective behaviors, (2) behaviors emanating from leaders’ insouciance toward harming the organization and its members i.e., dysfunctional behaviors, and (3) behaviors emanating from leaders’ lack of honesty, integrity, ethicality, and transparency i.e., unauthentic behaviors. We enrich current understanding on ineffective, dysfunctional, and unauthentic leader behaviors, and offer a unified (yet differentiated) framework of negative leader behaviors in the academic sector. Since each type of negative behavior emanates from different motivational drivers, different measures are required to curb them. These are also discussed. A comparison of our findings with those from leadership studies in other sectors reveals that negative leader behaviors in the education sector are quite similar to those in other sectors

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Toward a generic framework of perceived negative manager/leader behavior: A comparative study across nations and private sector industries

This is an accepted manuscript of an article published by Wiley in European Management Review on 15/02/2022. The accepted version of the publication may differ from the final published version.Reviewing three relevant streams of extant literature reveals a marked absence of a generic framework comprised of a full range of negative manager/leader behaviors (from moderate to extreme) across sectors and countries, a void particularly detrimental to the effectiveness of management and leadership development (MLD) programs. To address this concern, we conduct a multiple cross-case/cross-nation comparative analysis (MCCA) of data collected from our own 13 previous empirical replication studies (using the critical incident technique) of effective/ineffective managerial/leader behavior across nine culturally diverse countries and varied private sector industries, resulting in a comprehensive framework of perceived negative manager/leader behavior. Our generic framework is comprised of five behavioral dimensions: general inadequate behavior, unethical behavior, impersonal domineering behavior, depriving behavior, and closed/negative-minded behavior, and lends support to the universal school of culture in business literature by showing that neither national culture nor sectorial specificities influence people’s perceptions of negative manager/leader behavior. It also stresses the importance of the mundane (as opposed to the glorious) in managerial/leadership work by revealing that employees’ perceptions of negative manager/leader behavior includes not only conspicuously ‘bad’ behaviors, but also less conspicuous ‘poor’ behaviors