The politics of health sector reform in Eastern Europe: the actor-centered institutionalist framework for analysis

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Developing the multi-professional clinical academic workforce in Australia and New Zealand: a scoping review

In Australia and New Zealand (ANZ), clinical academics are an important part of the workforce needed to deliver social and economic returns from health and medical research investment. This review aims to examine the extent and nature of the empirical evidence base addressing the development of the multi-professional clinical academic workforce in ANZ and to synthesise policy-relevant findings. The review adopts a scoping review design. Literature searches were undertaken in February 2019 in Medline (Ovid), Scopus, and CINAHL, with reference lists and websites also searched for additional literature. Papers eligible for inclusion were those published in English in 2000–2018 that reported results of empirical studies that addressed factors relating to developing the ANZ clinical academic workforce size, composition or role through building, enabling or sustaining its research functions. Results were reported narratively using a labour market policy framework. A total of 43 studies representing a diverse range of health professions and study designs were included in the review, only two of which reported on the New Zealand context. The majority were focused on building, supporting and sustaining research capacity and engagement among groups of clinicians within clinical settings. Use of three labour market policy levers to frame analysis enabled identification of issues relating to rural/urban workforce maldistribution, in addition to more widely reported clinical academic workforce production and retention issues. The literature addressing the development of the clinical academic health workforce in ANZ frames this workforce either as clinicians who routinely engage in research activity, or as a workforce cadre comprised of distinct, formalised research-related clinical roles. As such, developing the clinical academic workforce requires both: i) policy attention to the availability of research training opportunities for health professional students and graduates and of dedicated research-related career pathways; and ii) structures and processes that enable or inhibit research engagement among clinicians at a mid-career level

"'Academic' is a dirty word": intended impact pathways of an emerging academic health centre in tropical regional Australia

Background: The Tropical Australian Academic Health Centre (TAAHC) is being established in northern Queensland across a vast rural geography. The study aim is to identify intended impact pathways and beneficiaries of TAAHC as well as experienced and anticipated challenges. Methodology: The study is an empirical case study nested within a comparative multi‐case study on academic health centres (AHCs). Data were collected from documents, observation, and interviews with 24 health system and university stakeholders. Intended impact pathways were identified abductively from analysis of aspirations and challenges. Results: Aspirations of TAAHC reflect an ultimate aim to improve the health of the northern Queensland population. Challenges were trust and communication, understanding value and return on investment, health system receptiveness to building a research culture, prioritising and influencing the research agenda, and structure of the health system. Discussion: The study identifies three interdependent transitions that comprise the main intended impact pathway in TAAHC. Stakeholders expected TAAHC to effect health systems change and improvement rather than drive discovery‐oriented academic research associated with AHCs elsewhere. Conclusion: The findings contribute to the empirical evidence base on the role of AHCs internationally and to ongoing initiatives to establish and resource AHCs in Australia

The population health role of academic health centres: a multiple-case exploratory study in Australia and England

Background: Academic health centres (AHCs) are organisations that aim to mobilise knowledge into practice by improving the responsiveness of health systems to emerging evidence. This study aims to explore the population health role of AHCs in Australia and England, where AHCs represent novel organisational forms. Methods: A multiple-case study design using qualitative methods was used to explore population health goals and activities in four discrete AHCs in both countries during 2017 and 2018. Data from 85 interviews with AHC leaders, clinicians and researchers, direct observation, and documentation were analysed within and across the cases. Results: Comparison across cases produced four cross-case themes: health care rather than population health; incremental rather than major health system change; different conceptions of “translation” and “innovation”; and unclear pathways to impact. The ability of the AHCs to define and enact a population health role was hindered during the study period by gaps in knowledge mobilisation strategies at a health system and policy level, the biomedical orientation of government designation schemes for AHCs in Australia and England, and competing expectations of the sovereign partner organisations in AHCs against a backdrop of limited operational resources. Discussion: The study identifies several institutional elements that are likely to be needed for AHCs in Australia and England to deliver on both internal and external expectations of their population health role

Capturing Emerging Realities in Citizen Engagement in Science in Social Media : A Social Media Analytics Protocol for the Allinteract Study

In the digital era, social media has become a space for the socialization and interaction of citizens, who are using social networks to express themselves and to discuss scientific advances with citizens from all over the world. Researchers are aware of this reality and are increasingly using social media as a source of data to explore citizens' voices. In this context, the methods followed by researchers are mainly based on the content analysis using manual, automated or combined tools. The aim of this article is to share a protocol for Social Media Analytics that includes a Communicative Content Analysis (CCA). This protocol has been designed for the Horizon 2020 project Allinteract, and it includes the social impact in social media methodology. The novel contribution of this protocol is the detailed elaboration of methods and procedures to capture emerging realities in citizen engagement in science in social media using a Communicative Content Analysis (CCA) based on the contributions of Communicative Methodology (CM).Peer reviewe

Developing international guidelines for an effective process of research impact assessment

Governments, funding agencies, and research organisations all over the world are now committed to measuring the impact of research beyond academic publications. Accordingly, a multidisciplinary practice called research impact assessment is rapidly developing. However, this practice remains in its formative stages and so no systematised recommendations or accepted standards to guide researchers and practitioners are currently available. Pavel Ovseiko, Paula Adam, Kathryn Graham, and Jonathan Grant introduce initial international guidelines for an effective process of research impact assessment and invite Impact Blog readers to put them into practice and share their experience, evidence, and cultural competence with the global community

Gender equity in academic rheumatology, current status and potential for improvement: a cross-sectional study to inform an EULAR task force

OBJECTIVES Evidence on the current status of gender equity in academic rheumatology in Europe and potential for its improvement is limited. The EULAR convened a task force to obtain empirical evidence on the potential unmet need for support of female rheumatologists, health professionals and non-clinical scientists in academic rheumatology. METHODS This cross-sectional study comprised three web-based surveys conducted in 2020 among: (1) EULAR scientific member society leaders, (2) EULAR and Emerging EULAR Network (EMEUNET) members and (3) EULAR Council members. Statistics were descriptive with significance testing for male/female responses assessed by χ$^{2}$ test and t-test. RESULTS Data from EULAR scientific member societies in 13 countries indicated that there were disproportionately fewer women in academic rheumatology than in clinical rheumatology, and they tended to be under-represented in senior academic roles. From 324 responses of EULAR and EMEUNET members (24 countries), we detected no gender differences in leadership aspirations, self-efficacy in career advancement and work-life integration as well as the share of time spent on research, but there were gender differences in working hours and the levels of perceived gender discrimination and sexual harassment. There were gender differences in the ranking of 7 of 26 factors impacting career advancement and of 8 of 24 potential interventions to aid career advancement. CONCLUSIONS There are gender differences in career advancement in academic rheumatology. The study informs a EULAR task force developing a framework of potential interventions to accelerate gender-equitable career advancement in academic rheumatology

a multi-centre cross-country comparison of women in management and leadership in academic health centres in the European Union

Background Women’s participation in medicine and the need for gender equality in healthcare are increasingly recognised, yet little attention is paid to leadership and management positions in large publicly funded academic health centres. This study illustrates such a need, taking the case of four large European centres: Charité – Universitätsmedizin Berlin (Germany), Karolinska Institutet (Sweden), Medizinische Universität Wien (Austria), and Oxford Academic Health Science Centre (United Kingdom). Case The percentage of female medical students and doctors in all four countries is now well within the 40–60% gender balance zone. Women are less well represented among specialists and remain significantly under-represented among senior doctors and full professors. All four centres have made progress in closing the gender leadership gap on boards and other top-level decision-making bodies, but a gender leadership gap remains relevant. The level of achieved gender balance varies significantly between the centres and largely mirrors country-specific welfare state models, with more equal gender relations in Sweden than in the other countries. Notably, there are also similar trends across countries and centres: gender inequality is stronger within academic enterprises than within hospital enterprises and stronger in middle management than at the top level. These novel findings reveal fissures in the ‘glass ceiling’ effects at top- level management, while the barriers for women shift to middle-level management and remain strong in academic positions. The uneven shifts in the leadership gap are highly relevant and have policy implications. Conclusion Setting gender balance objectives exclusively for top-level decision-making bodies may not effectively promote a wider goal of gender equality. Academic health centres should pay greater attention to gender equality as an issue of organisational performance and good leadership at all levels of management, with particular attention to academic enterprises and newly created management structures. Developing comprehensive gender-sensitive health workforce monitoring systems and comparing progress across academic health centres in Europe could help to identify the gender leadership gap and utilise health human resources more effectively