Distributed leadership in healthcare: leadership dyads and the promise of improved hospital outcomes.

PURPOSE: This paper aims to extend the consideration of distributed leadership in health-care settings. Leadership is typically studied from the classical notion of the place of single leaders and continues to examine distributed leadership within small teams or horizontally. The purpose is to develop a practical understanding of how distributed leadership may occur vertically, between different layers of the health-care leadership hierarchy, examining its influence on health-care outcomes across two hospitals. DESIGN/METHODOLOGY/APPROACH: Using semi-structured interviews, data were collected from 107 hospital employees (including executive leadership, clinical management and clinicians) from two hospitals in Australia and the USA. Using thematic content analysis, an iterative process was adopted characterized by alternating between social identity and distributed leadership literature and empirical themes to answer the question of how the practice of distributed leadership influences performance outcomes in hospitals? FINDINGS: The perceived social identities of leadership groups shaped communication and performance both positively and negatively. In one hospital a moderating structure emerged as a leadership dyad, where leadership was distributed vertically between hospital hierarchal layers, observed to overcome communication limitations. Findings suggest dyad creation is an effective mechanism to overcome hospital hierarchy-based communication issues and ameliorate health-care outcomes. ORIGINALITY/VALUE: The study demonstrates how current leadership development practices that focus on leadership relational and social competencies can benefit from a structural approach to include leadership dyads that can foster these same competencies. This approach could help develop future hospital leaders and in doing so, improve hospital outcomes.

Report on the SCRA Nuts and Bolts Workshop II: case studies of citrus greening, Ultra-low Gossypol Cotton, and blight tolerant, low-acrylamide potato.

To be commercialized and grown in the US, genetically engineered (GE) crops typically go through an extensive food, feed, and environmental safety assessment process which, in certain instances, requires complex consultations with three different US regulatory agencies. Many small market, niche, and specialty crops have been genetically engineered using the modern tools of recombinant DNA but few have been commercialized due to real or perceived regulatory constraints. This workshop discussed the practical aspects of developing dossiers on GE specialty, niche, or small-market crops/products for submission to US regulatory agencies. This workshop focused on actual case studies, and provided an opportunity for public or private sector scientists and crop developers to spend time with regulatory officials to learn the specifics of compiling a dossier for regulatory approval. The objective of the workshop was to explain and demystify data requirements and regulatory dossier compilation by small companies, academics, and other developers.

Scope of practice of the breast care nurse: a comparison of health professional perspectives.

AIM: The Breast Care Nurse (BCN) supports people with breast cancer, co-ordinating services, and providing information and psychosocial support, yet there is ambiguity surrounding the scope of the role, with implications for both BCNs and service provision. The current studies investigated the scope of practice of BCNs from the perspective of both BCNs and other health professionals. METHOD: In study 1, semi-structured in-depth interviews were conducted with 11 BCNs and 7 other key health professionals (HPs) involved in the care of those with breast cancer. Participants were questioned about the scope of practice of the BCN role and the challenges facing the role. In Study 2, 27 BCNs and 21 HPs then completed a survey asking about the importance of the different elements of practice identified in Study 1, together with the extent to which each aspect of practice was part of the day to day practice of BCNs. RESULTS AND CONCLUSION: Provision of information and support to people with breast cancer and their families were identified as core to the role. BCNs and other health professionals differed in their perceptions of both the length and breadth of practice of the BCN, with implications for workload and burnout in BCNs, as well as multidisciplinary team functioning and patient care. Scope of practice also differed across practice contexts.

The hemodynamic effects of diaspirin cross-linked hemoglobin in dopamine-resistant endotoxic shock in swine.

As the blood substitute Diaspirin Cross-linked Hemoglobin (DCLHb) has potent vasopressor activity, we assessed its hemodynamic effects in a clinically relevant dopamine-resistant endotoxic shock model in swine. In a randomized and controlled study, E. coli LPS was administered to anesthetized and invasively monitored swine. Group I (n = 3) control pigs were not resuscitated. Groups II (n = 5) and III (n = 6) pigs received dopamine (DA) after MAP decreased 30%, and hetastarch and DCLHb, respectively, after dopamine-resistance occurred. Progressive hemodynamic decline occurred in Group I pigs. DA failed to restore MAP to baseline. However, 0% and 67% of pigs also treated with heta-starch and DCLHb, respectively, achieved temporary restoration of baseline MAP (p = 0.03), prompting a reduction in the dose of DA in 0% of hetastarch vs. 50% of DCLHb treated pigs. Except for increased MPAP and decreased heart in DCLHb treated pigs (p<0.001), hemodynamics and survival were not different (p>0.05). In conclusion, although DCLHb exacerbated pulmonary hypertension and did not improve O2 utilization or survival, because DCLHb restored MAP to baseline and had a dopamine sparing effect, further investigation of DCLHb's hemodynamic effects in adrenergic agent-resistant endotoxemia is warranted.

Effect of medium tonicity and dextran on neutrophil function in vitro.

BACKGROUND: Multiple investigations have demonstrated that hypertonic saline (HS) diminishes the response of polymorphonuclear leukocytes (PMNs) to stimulation. Recent meta-analysis suggests that hypertonic saline in dextran (HSD) is clinically superior to HS. No work to date has examined the effect of added dextran on this immunomodulatory property. METHODS: Human PMNs were exposed to media of varying osmolarity (220-360 mOsm/L) and stimulated with f-met-leu-phe with or without dextran present in the medium. Cell volume, respiratory burst, PMN aggregation, and beta(2)-integrin (CD18) expression were measured. RESULTS: Stimulation with f-met-leu-phe increased cell volume, respiratory burst, aggregation, and CD18 expression. The increases in cell volume, respiratory burst, and aggregation were significantly attenuated by exposure to hypertonic medium. The addition of dextran to the media did not change the results. CONCLUSION: The alterations in PMN function associated with HS are not changed or attenuated by the addition of dextran, suggesting that the clinically superior HSD may have effects similar to HS in mitigating the tissue damage associated with activated PMNs.