Manager Onboarding to Improve Knowledge and Confidence to Lead

Background: Primary care (PC) is increasingly the setting for affordable, coordinated, end-to-end patient care, with PC managers in charge of organizational performance. While PC managers are central to high-functioning teams, they often receive inadequate onboarding. Local Problem: Primary care onboarding competes with other operational priorities and faces time constraints, lack of mentorship, and cost. Context: At an integrated healthcare system, a need was identified to develop structured, role-specific onboarding for newly hired PC managers to improve knowledge and confidence to lead. Interventions: Bauer’s Four Cs framework for onboarding guided the development of a manager onboarding program for 12 new PC managers. Content drew on best practices from the literature and was informed by the knowledge gap discovered through a needs assessment. Outcome Measures: Knowledge, confidence to lead, and intent to stay were chosen to assess the impact of onboarding on the competencies of new PC managers to be successful in their roles. The metrics were percent change from pre- to post-implementation. Data to evaluate outcomes were obtained from the pre- and post-intervention surveys. Results: Confidence to lead increased 13% (t(21) = 2.33, p = .03); knowledge increased 29% ((t(21) = 2.94, p = .01). Intent to stay in the role did not show a significant increase. Conclusions: Evidence from the literature and the project results suggest strong connections between structured onboarding practices for new managers and preparedness to lead high-functioning teams. Empirical research is needed to examine the implications of onboarding relative to hire date on intent to stay in the role

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries