Global health and innovation: A panoramic view on health human resources in the COVID-19 pandemic context.

While policy-makers in many jurisdictions are paying increasing attention to health workforce issues, human resources remain at best only partially aligned with population health needs. This paper explores the governance of human resources during the pandemic, looking at the Quebec health system as a revelatory case. We identify three issues related to health human resource (HHR) policies: working conditions, recognition at work and scope of practice. We empirically probe these issues based on an analysis of popular media, policy reports and participant observation by the lead authors in various forums and research projects. Using an integrated model of HHR, we identify major vulnerabilities in this domain. Persistent labour shortages, endemic deficiencies in working environments and inequity across occupational categories limit the ability to address critical HHR issues. We propose three ways to eliminate HHR vulnerabilities: reorganize work through participatory initiatives, implement joint policy making to rebalance power across the health workforce, and invest in the development of capacities at all system levels.

Leadership for Knowledge Translation: The Case of CLAHRCs.

Calls for successful knowledge translation (KT) in health care have multiplied over recent years. The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) program is a policy initiative in the United Kingdom aimed at speeding-up the translation of research into health care practice. Using multiple qualitative research methods and drawing on the ongoing processes used by individuals to interpret and contextualize information, we explore how new organizational forms for KT bridge the gap between research and practice. We pay particular attention to the relationship between the organization and practices of KT and leadership. Our empirical data demonstrate how the relationship between leadership and KT shifted over time from a push model where the authoritarian top-down leadership team set outcome measures by which to judge KT performance to one which aimed to distribute leadership capacity across a wide range of stakeholders in health and social care systems. The relationship between the organization and practices of KT and leadership is affected by local contextual influences on policies directed at increasing the uptake of research in clinical practice. Policy makers and service leaders need to recognize that more dispersed type of leadership is needed to accommodate the idiosyncratic nature of collective action.

Knowledge Mobilization and Academic Health Science Centres in Australia Comment on "Academic Health Science Centres as Vehicles for Knowledge Mobilisation in Australia? A Qualitative Study".

Extant research on knowledge mobilization points to barriers and opportunities for innovation. Edelman et al paper "Academic Health Science Centres as Vehicles for Knowledge Mobilisation in Australia? A Qualitative Study" builds nicely on the existing knowledge base by evaluating the early stages of organisational development of Academic Health Science Centers in Australia. This commentary discusses their research findings by drawing on relevant themes including knowledge mobilization initiatives that have been developed globally to bridge the research-practice gap and knowledge brokering roles for service improvement. Following which, the commentary draws on organizational capabilities literature for knowledge brokering to happen, the latter including the need for measuring implementation fidelity amongst other capabilities. Finally, building on Edelman et al call for more attention to action-oriented roles and knowledge mobilization processes to deliver strategic goals the commentary concludes with a note for collective leadership as an enabler of knowledge mobilization with impact and at scale.

Leadership configuration in crises: Lessons from the English response to COVID-19.

Our study examines the empirical case of the political leadership response to Covid-19 in England. It shows that, rather than the ideal configuration of leadership suggested by theory, within which individualistic and collective leadership blend, a less balanced configuration emerged that can be characterised as incoherent. In England, an individual political leader behaved in an authoritarian way, which ignored evidence about how to address Covid-19. So, rather than an individual orchestrating a collective leadership effort to address complex issues, leadership was rendered fragmented and chaotic. We suggest that the English context, characterised by populist tendencies and neoliberal economic policy, shaped the poor leadership response to Covid-19.

Opening the black box: a study of the process of NICE guidelines implementation.

OBJECTIVES: This study informs 'evidence-based' implementation by using an innovative methodology to provide further understanding of the implementation process in the English NHS using two distinctly different NICE clinical guidelines as exemplars. METHODS: The implementation process was tracked retrospectively and prospectively using a comparative case-study and longitudinal design. 74 unstructured interviews were carried out with 48 key informants (managers and clinicians) between 2007 and 2009. RESULTS: This study has shown that the NICE guidelines implementation process has both planned and emergent components, which was well illustrated by the use of the prospective longitudinal design in this study. The implementation process might be characterised as strategic and planned to begin with but became uncontrolled and subject to negotiation as it moved from the planning phase to adoption in everyday practice. The variations in the implementation process could be best accounted for in terms of differences in the structure and nature of the local organisational context. The latter pointed to the importance of managers as well as clinicians in decision-making about implementation. CONCLUSION: While national priorities determine the context for implementation the shape of the process is influenced by the interactions between doctors and managers, which influence the way they respond to external policy initiatives such as NICE guidelines. NICE and other national health policy-makers need to recognise that the introduction of planned change 'initiatives' in clinical practice are subject to social and political influences at the micro level as well as the macro level.