Transforming Kidney Health: The Role of Nursing Leadership in Value-Based Care.

This article examines the critical role of nursing leadership in the transition of nephrology care toward value-based models, highlighting how interdisciplinary care teams and population health management strategies are instrumental in improving patient outcomes and achieving health equity in kidney care. By reviewing both historical and present value-based care models in nephrology, this article showcases the evolution of care delivery and the strategic alignment of health care practices with value-based objectives. We introduce "HEALTH" as an innovative blueprint for nephrology nursing leadership, encapsulating key strategies to enhance kidney health care within the framework of value-based models. The acronym HEALTH stands for Holistic Care Integration, Equity and Tailored Care, Analytics and Machine Learning, Leverage Federal Programs, Training and Education, and Habit of Improvement, each representing a cornerstone in the strategic approach to advancing nephrology care. Through this lens, we discuss the impact of nursing leadership in fostering a culture of continuous improvement, leveraging technological advancements, and advocating for comprehensive and equitable patient care. This article aims to provide a roadmap for nursing leaders in nephrology to navigate the complexities of health care delivery, ensuring high-quality, cost-effective care that addresses the needs of a diverse patient population.

Commitment to inclusion: The importance of collaboration in gender equity work.

Despite decades of faculty professional development programs created to prepare women for leadership, gender inequities persist in salary, promotion, and leadership roles. Indeed, men still earn more than women, are more likely than women to hold the rank of professor, and hold the vast majority of positions of power in academic medicine. Institutions demonstrate commitment to their faculty's growth by investing resources, including creating faculty development programs. These programs are essential to help prepare women to lead and navigate the highly matrixed, complex systems of academic medicine. However, data still show that women persistently lag behind men in their career advancement and salary. Clearly, training women to adapt to existing structures and norms alone is not sufficient. To effectively generate organizational change, leaders with power and resources must commit to gender equity. This article describes several efforts by the Office of Faculty in the Johns Hopkins University School of Medicine to broaden inclusivity in collaborative work for gender equity. The authors are women and men leaders in the Office of Faculty, which is within the Johns Hopkins University School of Medicine dean's office and includes Women in Science and Medicine. Here, we discuss potential methods to advance gender equity using inclusivity based on our institutional experience and on the findings of other studies. Ongoing data collection to evaluate programmatic outcomes in the Johns Hopkins University School of Medicine will be reported in the future.

How attitudes of state and community leaders regarding health equity and social determinants of health are associated with behavioral intentions to improve population health.

A critical driver of population health, well-being, and equity is making health a shared value, or the belief that health is a priority for oneself and one's community. For people in positions of influence, attitudes regarding their organization's perspective may result in decisions that advance health equity or reinforce inequities. Yet despite the potential role of leaders in influencing health and well-being, little is known about their attitudes regarding their organization's perspective on what shapes health, or how their attitudes translate into actions that improve population health. The objectives of this study are twofold: (1) to understand leaders' attitudes with regard to their organization's perspective on population health and (2) to identify the attitudes associated with leaders' perspectives regarding their organization's intention to engage in behaviors that advance population health. We designed a survey instrument grounded in the Theory of Planned Behavior and fielded the survey to 18,367 state and community leaders across all 50 U.S. states, 325 U.S. cities, and nine sectors from fall 2020 until spring 2022. We received surveys from 5,450 leaders, yielding a 32 percent response rate. Survey respondents viewed social determinants of health and health equity as important factors influencing population health. Additionally, two attitudes were most associated with leaders' intentions to promote population health-"self-efficacy" (a leader's confidence in taking action to promote health for all) and "behaviors valued by important others" (how much certain groups want the organization to take action that promotes health for all). Efforts to improve population health through leaders should focus on supporting leaders' self-efficacy and on increasing leaders' perceptions regarding behaviors valued by important others. Governmental entities and funders can use these data to support leaders' efforts in improving population health, well-being, and equity.

Building a New Generation of Public Health Leaders Forged in a Public Health Crisis.

The COVID-19 pandemic presented wide-ranging leadership challenges to public health leaders and public health organizations. In its wake, as the necessity of reconstructing public health and modernizing the Centers for Disease Control and Prevention (CDC) is considered, we reviewed reports from the Commonwealth Fund and the CDC and other leadership-focused literature to identify common themes for a new generation of public health leaders. We posit that this new generation must have the ability to communicate (build and maintain trust and accountability); forge, facilitate, and promote partnerships; connect public health and health care systems; build information systems that provide accessible, actionable data; engage in systems and strategic thinking and action; center equity and inclusivity and understand structural racism as a fundamental driver and creator of health inequities; and achieve and maintain resilience and self-care. For each of the 7 abilities, we offer a description, assess what COVID-19 taught us about the necessity of the ability for public health leaders, and offer suggestions for developing (or honing) one's skill set, mindset, and tool set in this regard. (Am J Public Health. 2024;114(6):626-632. https://doi.org/10.2105/AJPH.2024.307633).

Mind the Gap! Working Toward Gender Equity in Pediatric and Congenital Heart Disease: Present and Future.

Evidence from medicine and other fields has shown that gender diversity results in better decision making and outcomes. The incoming workforce of congenital heart specialists (especially in pediatric cardiology) appears to be more gender balanced, but past studies have shown many inequities. Gender-associated differences in leadership positions, opportunities presented for academic advancement, and recognition for academic contributions to the field persist. In addition, compensation packages remain disparate if evaluated based on gender with equivalent experience and expertise. This review explores these inequities and has suggested individual and institutional changes that could be made to recruit and retain women, monitor the climate of the institution, and identify and eliminate bias in areas like salary and promotions.

GLIM criteria for definition of malnutrition in peritoneal dialysis: a new aspect of nutritional assessment.

Background: The aim of our study was to evaluate the effectiveness of Global Leadership Initiative on Malnutrition (GLIM) criteria in assessing malnutrition within the peritoneal dialysis (PD) population.Methods: We conducted a retrospective analysis involving 1057 PD patients across multiple institutions, characterized by an age of 56.1 ± 14.4 years, 464 (43.9%) female, and a median follow-up of 45 (25, 68) months. Malnutrition was diagnosed according to GLIM criteria. The endpoint event was overall mortality. The survival rate and hazard ratio (HR) of death between malnutrition and well-nourished were analyzed in all patients and various subgroups. Receiver operator characteristic curve and integrated discrimination improvement (IDI) were used to distinguish the efficacy of the nutritional tools prediction model.Results: According to the GLIM criteria, the prevalence of malnutrition among the study population was 34.9%. The adjusted HR of overall mortality was 2.91 (2.39 - 3.54, p < 0.001) for malnutrition versus well-nourished. In sensitivity analyses, the HR remained robust except the cardiovascular disease subgroup. The area under the curve of GLIM predicting 5-year mortality was 0.65 (0.62-0.68, p < 0.001). As a complex model for forecast the long-term mortality, the performance of adjusted factors combined with GLIM was poorer than combined malnutrition inflammation score (MIS) (IDI >0, p < 0.001), but fitter than combined geriatric nutritional risk index (GNRI) (IDI <0, p < 0.001).Conclusions: The GLIM criteria provide a viable tool for nutritional assessment in patients with PD, and malnutrition defined according to the GLIM can predict prognosis with an acceptable performance.

Lessons from Two Latino Communities Working with Academic Partners to Increase Access to COVID-19 Testing.

OBJECTIVE: We sought to examine the experiences of community partners in a community-academic partnership to promote COVID-19 testing in two majority Latino communities. METHODS: We conducted semistructured, in-depth interviews in English and Spanish with community-based organization leaders and community health workers/promotoras (n = 10) from June to July 2021. Interviews focused on identifying partner roles in planning and testing implementation and evaluating communication among partners. Interviews were transcribed and analyzed in ATLAS.ti version 8.4.5. Analyses involved deductive and inductive approaches to identify key themes. RESULTS: Participants described both strengths and challenges to the collaborative approach within each of three core themes: building relationships in the time of COVID-19; uplifting existing community leadership; and commitment of the academic partners and community-based organizations to conduct partnership activities in Spanish. CONCLUSION: Community-academic partnerships that invest in strong relationships, community leadership, and a commitment to the community's preferred language offer a promising approach to addressing COVID-19 testing barriers. Findings provide direction for future research on how community members and academic partners can come together to inform strategies to continue addressing the COVID-19 pandemic.

Big Challenges Meet Big Leadership in 2024.

As we begin the year 2024, we do so with some very big challenges that have spilled over from 2023 and, indeed, many years before that. Every day, we are confronted with concerning experiential and research-based evidence about worsening access to healthcare, pervasive racism and widening disparities. Clearly, there is a great deal of work to be done in our healthcare system to support and improve the health of the diverse populations that we serve. Yet, along with the challenges come opportunities to reflect, collaborate, innovate, evaluate and learn. When I look at issues of the Canadian Journal of Nursing Leadership (CJNL) from the past 20 years, I am astounded at how some concerns have changed and some have remained the same. Can you believe that there was a time when nursing positions in practice and in education were actually being cut? Of course, many of the big issues we face today were emerging even then, and we have long since passed the tipping point that has put the country into a healthcare crisis.

Advancing Gender Equality in Healthcare Leadership: Protocol to Co-Design and Evaluate a Leadership and Mentoring Intervention in Tanzania.

Background: Women constitute almost two thirds of the health and social workforce. Yet, the proportion of women in decision-making positions remains significantly low leading to gender inequities in access to and appropriateness of healthcare. Several barriers which limit women's advancement to leadership positions have been documented and they generally constitute of gender stereotypes, discrimination and inhibiting systems; these hinderances are compounded by intersection with other social identities. Amelioration of the barriers has the potential to enhance women's participation in leadership and strengthen the existing health systems. Objective: This protocol describes a proposed study aimed at addressing the organisational and individual barriers to the advancement of women to leadership positions in the Tanzanian health sector, and to evaluate the influence on leadership competencies and career advancement actions of the female health workforce. Method: The study utilises a gender transformative approach, co-design and implementation science in the development and integration of a leadership and mentorship intervention for women in the Tanzanian health context. The key steps in this research include quantifying the gender ratio in healthcare leadership; identifying the individual and organisational barriers to women's leadership; reviewing existing leadership, mentorship and career advancement interventions for women; recruiting programme participants for a leadership and mentorship programme; running a co-design workshop with programme participants and stakeholders; implementing a leadership and mentorship programme; and conducting a collaborative evaluation and lessons learnt. Conclusions: This research underscores the notion that progression towards gender equality in healthcare leadership is attained by fashioning a system that supports the advancement of women. We also argue that one of the pivotal indicators of progress towards the gender equality sustainable development goal is the number of women in senior and middle management positions, which we hope to further through this research.

Leagility in the healthcare research: a systematic review.

BACKGROUND: Expenditure of healthcare services has been growing over the past decades. Lean and agile are two popular paradigms that could potentially contain cost and improve proficiency of the healthcare system. However no systematic review was found on leagilty in the healthcare research. This study aims at synthesizing the extant literature of leagility in the healthcare area to consolidate its potential and identify research gaps for future study in the field. METHODS: A systematic literature review is conducted following the PRISMA checklist approach. Studies were searched in multiple databases. The selection of articles was executed by dual-scanning of two researchers to ensure quality of data and relevance to the topic. Scientific articles published between January 1999 and November 2023 concerning leagile healthcare are analysed using Microsoft Excel and VOSviewer (version 1.6.18). RESULTS: Out of 270 articles identified from the inclusion and exclusion criteria, 24 were included in the review. A total of 11 target areas were identified in leagility applications in healthcare. Success and limiting factors of leagile healthcare were classified into macro and micro aspects and further categorized into six dimensions: policy, organization, human resources, marketing, operation management and technology. Moreover, four research gaps were revealed and suggestions were provided for future study. CONCLUSION: Leagility in the healthcare context is still being in its infancy. Few empirical validation was found in leagile healthcare literature. Further exploration into the application of theory in various sectors under the scope of healthcare is appealed for. Standardization and modularization, leadership support, skillfulness of professionals and staff training are the factors most frequently mentioned for a successful implementation of leagility in the healthcare sector.

Gender Disparity in Non-ACGME (Accreditation Council for Graduate Medical Education) Otolaryngology Fellowship Leadership.

OBJECTIVE: Women are underrepresented among practicing otolaryngology physicians with increasing disparities in leadership roles and higher levels of professional attainment in academic medicine. The purpose of this study is to determine the gender gap among fellowship directors within specific otolaryngology subspecialties, and how this compares to disparities among all academic appointments held by otolaryngologists. Additionally, we seek to better understand how years practiced, H-index, professorship status, and academic productivity differ between men and women in fellowship director roles. DESIGN: Cross-sectional. Publicly available data from non-ACGME accredited otolaryngology fellowships was collected from department websites and Doximity including gender, years of practice, and professor status of fellowship directors. Scopus was used to find H-index for identified fellowship directors. Fisher's Exact tests were used to determine if significant gender disparity existed between each fellowship and academic otolaryngology as whole. H-index and years of practice were plotted for men and women comparing the slope of lines of best fit as a measure of academic productivity. SETTING: Non-ACGME accredited otolaryngology fellowships in the US. PARTICIPANTS: Fellowship directors in non-ACGME accredited otolaryngology fellowships. RESULTS: Among 174 fellowship positions in our analysis, head and neck (17.3% women), laryngology (17.2% women), rhinology (5.7% women), and facial plastics (8.1% women) had significantly lower overall women representation compared to academic otolaryngology (36.6% women) (p < 0.05). As fellowship directors, women were significantly more productive than men given years practiced and H-index (p = 0.008). CONCLUSIONS: Gender disparities among otolaryngologists are amplified in the role of fellowship directors compared to broader academic otolaryngology. This is true despite women in these roles demonstrating higher academic productivity.

Demographics and Career Trends of Urology Fellowship Directors in the United States.

INTRODUCTION: Fellowship directors (FDs) hold significant leadership roles within the academic urology community. We sought to characterize common trends in training and academic productivity among urology FDs. Moreover, we aimed to characterize gender differences across subspecialties to better inform gender-based inclusion efforts and contemporary leadership pathways. METHODS: FDs were studied across 6 urologic subspecialties. Society and institutional websites were queried for demographics, education/training institutions, timelines of career milestones, and academic productivity. χ2, Mann-Whitney U, and Kruskal-Wallis tests and Kendall tau rank correlation were employed with an alpha cutoff of .05. RESULTS: There were 219 FDs included, representing 208 fellowship programs at 93 institutions. FDs were 176 (80%) males and 43 (20%) females. There was a significant association between gender and subspecialty. The median age for all FDs was 52 years old. Significant differences in age were demonstrated across subspecialties. For all FDs, females were younger than males, at 49 and 53 years, respectively (P = .001). The median H-index for all FDs was 23.5. H-index was significantly different between genders and subspecialities. There was a strong, positive correlation between age vs H-index for all FDs. Half of FDs had completed fellowship training at one of 14 institutions. CONCLUSIONS: We describe the landscape of leadership in urology subspecialty training. There are an increasing number of female FDs. Composition of leadership varies by subspecialty; however, the careers of all current urology FDs are marked by lifelong achievements in academic productivity. Moreover, a small group of institutions produce a substantial number of FDs.

Organizing Primary Care Clinicians to Expand Reproductive Health Access: A Qualitative Program Evaluation.

BACKGROUND AND OBJECTIVES: Comprehensive sexual reproductive health care (SRH) in the United States, including abortion, is siloed from primary care, making it more difficult to access. The crisis in access has drastically worsened following the overturning of Roe v Wade, 410 US 113 (1973). Primary care clinicians (PCC) are well-positioned to protect and expand SRH access but do not receive sufficient training or support. The Reproductive Health Access Network ("Network") was created to connect like-minded clinicians to engage in advocacy, training, and peer support to enhance access to SRH in their communities and practices. This evaluation explores PCC leaders' experiences within this SRH organizing network. METHODS: In 2021, we conducted 34 semistructured phone interviews with a purposive sample of current (n=27) and former (n=7) PCC leaders in the Network (N=87). The program's theory of change and network evaluation framework guided reflexive thematic analysis. RESULTS: Participants viewed Network support as critical to ending isolation through three mechanisms: connecting to a supportive community of like-minded peers, empowering leadership, and providing infrastructure for local organizing. They viewed mentorship as critical in building a sustainable and equitable pipeline of PCC leaders. Participants identified challenges to engaging fully, such as burnout and discrimination experienced both within and outside the Network. CONCLUSIONS: Community-building, peer support, and mentorship are critical to building and sustaining PCC leadership in SRH-organizing communities. Efforts are needed to mitigate burnout, support SRH education and mentorship for PCCs, and transform into a truly inclusive community. The Network structure is promising for amplifying efforts to enhance SRH access through clinician leadership.