Leadership and governance-what is needed to deliver the Aotearoa New Zealand health reforms.

Nil.

Doctors as leaders and governors.

Doctors working in healthcare are operating in complex adaptive systems that are unpredictable and have complex problems requiring new and unique skills. The Medical Council of New Zealand has specified a scope of practice for doctors involved in health system leadership, and there are several programmes of study that exist in Aotearoa New Zealand (Aotearoa NZ) to gain skills in this domain. It is crucial at this time of change that we understand why doctors as leaders and governors improve outcomes, the importance of training future medical leaders and how we validate these skills as well as the environment in which they operate. As we begin to reorganise our health system, the question we ask is when will we organise our system to recognise, develop and value these skills?

Enhancement of medical interns' levels of clinical skills competence and self-confidence levels via video iPods: pilot randomized controlled trial.

BACKGROUND: Designing and delivering evidence-based medical practice for students requires careful consideration from medical science educators. Social Web (Web 2.0) applications are a part of today's educational technology milieu; however, empirical research is lacking to support the impact of interactive Web 2.0 mobile applications on medical educational outcomes. OBJECTIVES: The aim of our study was to determine whether instructional videos provided by iPod regarding female and male urinary catheter insertion would increase students' confidence levels and enhance skill competencies. METHODS: We conducted a prospective study with medical trainee intern (TI) participants: 10 control participants (no technological intervention) and 11 intervention participants (video iPods). Before taking part in a skills course, they completed a questionnaire regarding previous exposure to male and female urinary catheterization and their level of confidence in performing the skills. Directly following the questionnaire, medical faculty provided a 40-minute skills demonstration in the Advanced Clinical Skills Centre (ACSC) laboratory at the University of Auckland, New Zealand. All participants practiced the skills following the demonstrations and were immediately evaluated by the same faculty using an assessment rubric. Following the clinical skill evaluation, participants completed a postcourse questionnaire regarding skill confidence levels. At the end of the skills course, the intervention group were provided video iPods and viewed a male and a female urinary catheterization video during the next 3 consecutive months. The control group did not receive educational technology interventions during the 3-month period. At the end of 3 months, participants completed a follow-up questionnaire and a clinical assessment of urinary catheterization skills at the ACSC lab. RESULTS: The results indicate a decline in skill competency over time among the control group for both male and female catheterizations, whereas the competency level was stable among the experimental group for both procedures. Interaction results for competency scores indicate a significant level by group and time (P = .03) and procedure and group (P = .02). The experimental group's confidence level for performing the female catheterization procedure differed significantly over time (P < .001). Furthermore, confidence scores in performing female catheterizations increased for both groups over time. However, the confidence levels for both groups in performing the male catheterization decreased over time. CONCLUSIONS: Video iPods offer a novel pedagogical approach to enhance medical students' medical skill competencies and self-confidence levels. The outcomes illustrate a need for further investigation in order to generalize to the medical school population.

Exploring the role of communications in quality improvement: A case study of the 1000 Lives Campaign in NHS Wales.

INTRODUCTION: Effective communication is critical to successful large-scale change. Yet, in our experience, communications strategies are not formally incorporated into quality improvement (QI) frameworks. The 1000 Lives Campaign ('Campaign') was a large-scale national QI collaborative that aimed to save an additional 1000 lives and prevent 50 000 episodes of harm in Welsh health care over a 2-year period. We use the Campaign as a case study to describe the development, application, and impact of a communications strategy embedded in a large-scale QI initiative. METHODS: A comprehensive communications strategy guided communications work during the Campaign. The main aims of the communications strategy were to engage the hearts and minds of frontline National Health Service (NHS) staff in the Campaign and promote their awareness and understanding of specific QI interventions and the wider patient safety agenda. We used qualitative and quantitative measures to monitor communications outputs and assess how the communications strategy influenced awareness and knowledge of frontline NHS staff. RESULTS: The communications strategy facilitated clear and consistent framing of Campaign messages and allowed dissemination of information related to the range of QI interventions. It reaffirmed the aim and value of the Campaign to frontline staff, thereby promoting sustained engagement with Campaign activities. The communications strategy also built the profile of the Campaign both internally with NHS organizations across Wales and externally with the media, and played a pivotal role in improving awareness and understanding of the patient safety agenda. Ultimately, outcomes from the communications strategy could not be separated from overall Campaign outcomes. CONCLUSION AND RECOMMENDATIONS: Systematic and structured communications can support and enhance QI initiatives. From our experience, we developed a 'communications bundle' consisting of six core components. We recommend that communications bundles be incorporated into existing QI methodology, though details should be tailored to the specific context and available resource.

Female medical students may accrue less student loan debt than their male colleagues in New Zealand.

AIMS: To quantify the current level of actual student loan debt in New Zealand (NZ) medical students at the time of graduation, and to investigate how debt burden relates to gender and ethnicity. METHODS: A questionnaire was distributed to all graduating students from The University of Auckland's School of Medicine in November 2006. This study looked specifically at debt attributable to a New Zealand Government Student Loan (NZGSL). RESULTS: The response rate was 88%. Eighty-seven percent of NZ residents in the survey had a NZGSL. Nearly three-quarters of all students (73%) reported a total NZGSL of over $45,000, with one-third reporting a total greater than $75,000. Overall, males appeared to have different borrowing behaviours than their female counterparts, as reflected in their higher loan totals. Females were also more likely to report that they had no student loan, despite comparable access to parental financial support, part-time work, and scholarships. The reported loan sizes of Maori and Pacific Island students did not differ significantly from those of other ethnicities. Only 11% of study respondents reported that the burden of a student loan had a significant impact on future career decisions. CONCLUSIONS: For the majority of Auckland medical graduates, student debt is significant and continues to be a burdensome issue. There appear to be differences in the borrowing behaviours of males and females in the medical school programme, while different ethnicities have similar debt burdens.

Passing the buck: clinical handovers at a tertiary hospital.

AIMS: To survey house officers and nurses regarding timing, structure and content of clinical handover and compare these results. Secondary aims included the development of an 'on-call' sheet and the development of guidelines for handovers from the results collated. METHODS: 60 house officers (post graduate years 1-3) and 60 nurses working at Auckland City Hospital were asked to complete a survey covering various aspects of clinical handover in their current department. RESULTS: This study showed that nurses have more handovers than house officers in a 24-hour period. Nurses had an average of 3.2 handovers compared with the 1.2 handovers reported by house officers. Nurses rated their handovers as 'good', with a mean score of 7.8/10, while house officers rated the standard of their handovers as only 'average', with a mean score of 5.1/10. This was noted to be a statistically significant difference with a p-value of 0.01. Our study found that 60.9% of house officers reported that they had encountered a problem at least seven times in their most recent clinical rotation that they could directly attribute to a poor handover. However, nurses reported a much lower incidence of problems relating to poor handover standards, with 37.5% of this group indicating that they had experienced a clinical problem with a patient related to a nursing handover. CONCLUSIONS: In this study, we identified that health professionals perceive that clinical problems can be attributed to poor clinical handover. The majority of respondents in the study felt that an effective handover system should include a set location for handover, a standardised 'on-call' sheet and training related to handovers.