Guidelines as governance: Critical reflections from a documentary analysis of guidelines to support user involvement in research.

Although guidelines to regulate user involvement in research have been advocated and implemented for several years, literature still describes the process as challenging. In this qualitative study, we take a critical view on guidelines that are developed to regulate and govern the collaboration process of user involvement in research. We adapt a social constructivist view of guidelines and our aim is to explore how guidelines construct the perception of users and researchers and thus the process of involvement. Twenty-two guidelines published between 2006 and 2019 were analyzed iteratively. The analysis focuses on values which are emphasized in the guidelines on the distribution of entities, knowledge, and tasks between users and researchers. The analysis indicates that users and researchers are constructed differently; researchers are mainly constructed as responsible initiators and caretakers, while users are constructed as powerless and vulnerable. The guidelines portray the collaboration process as harmonious and assume a normative perspective. In doing so, challenges described in the literature related to power imbalances are not addressed. Based on these findings, we ask if these guidelines might function to maintain existing power imbalances between users and researchers.

Mapping the peer-reviewed literature on accommodating nurses' return to work after leaves of absence for mental health issues: a scoping review.

BACKGROUND: The complexity of nursing practice increases the risk of nurses suffering from mental health issues, such as substance use disorders, anxiety, burnout, depression, and posttraumatic stress disorder (PTSD). These mental health issues can potentially lead to nurses taking leaves of absence and may require accommodations for their return to work. The purpose of this review was to map key themes in the peer-reviewed literature about accommodations for nurses' return to work following leaves of absence for mental health issues. METHODS: A six-step methodological framework for scoping reviews was used to summarize the amount, types, sources, and distribution of the literature. The academic literature was searched through nine electronic databases. Electronic charts were used to extract code and collate the data. Findings were derived inductively and summarized thematically and numerically. RESULTS: Academic literature is scarce regarding interventions for nurses' return to work following leaves of absence for mental health issues, and most focused on substance use concerns. Search of the peer-reviewed literature yielded only six records. The records were primarily quantitative studies (n = 4, 68%), published between 1997 and 2018, and originated in the United States (n = 6, 100%). The qualitative thematic findings addressed three major themes: alternative to discipline programs (ADPs), peer support, and return to work policies, procedures, and practices. CONCLUSIONS: While the literature supports alternative to discipline programs as a primary accommodation supporting return to work of nurses, more on the effectiveness of such programs is required. Empirical evidence is necessary to develop, maintain, and refine much needed return to work accommodations for nurses after leaves of absence for mental health issues.

Moritz Meyer and the Medical Board: Preventing Refugee Doctors from Practising Medicine in Victoria, Australia, 1937-1958.

In 1937, the Medical Board of Victoria (the Board) declined to register Moritz Meyer to practise medicine in Victoria, Australia. Meyer was a Jewish doctor who had completed his medical degree in Germany and obtained postgraduate qualifications in Scotland. Meyer successfully challenged the Board's decision in the Supreme Court of Victoria and the Board's appeal against that decision to the High Court of Australia, which was dismissed. In response to Meyer's victory, the Board, under the influence and together with the British Medical Association, successfully lobbied the Victorian Parliament to prevent doctors from practising medicine in Victoria unless they had completed their studies in Victoria or in a country in which Victorian doctors, by virtue of their registration in Victoria, were entitled to practise medicine. Meyer's case received substantial press coverage, but historians have referred to it only in passing. This article fills a notable gap in the historiography about this period by illuminating the significance of Meyer's matter. It analyses the decisions in this case and considers their impact on European doctors who sought refuge in Victoria immediately before, during and after World War II, and on the medical profession and lay community. It then seeks to explain these reactions to Meyer's matter.

Closing the gender leadership gap: 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.

A Metasynthesis Exploring Nurses and Women on Governing Boards.

OBJECTIVE: The purpose of this article is to present the results of a metasynthesis addressing significant issues relating to board appointments for nurses and women. BACKGROUND: Nurses are rarely engaged as voting board members even though they are positioned to add value. When nurses and women are appointed to boards, their experiences reflect the struggles associated with traditional patriarchal board norms. METHOD: A metasynthesis of qualitative studies was conducted. Seven studies from nursing and business literature were analyzed using the meta-ethnography methodology. RESULTS: Proving worth is the central issue of nurses and women on boards. CONCLUSION: Boardroom parity for nurses and women is an important social agenda with implications for strategic decision making in healthcare and business.

Responding to State Licensure Board Investigations.

State licensing board investigations can subject a healthcare provider to serious discipline, up to and including license revocation. Providers can navigate these investigations by cooperating and complying with board directives, including self-reporting requirements. Additionally, state laws are designed to afford pro- viders due process rights before revoking or restricting a professional license, and these laws govern board investigations and the subsequent disciplinary proceedings. Providers should ensure that their due process rights are respected and that the board follows proper administrative procedures when their licen- sure is at stake. Further, providers should consider HIPAA, patient privilege, and medical records laws to guarantee that any patient information disclosed to a licensing board is disclosed in a legally compliant manner. Finally, special con- sideration should be given to providers impaired by substance abuse to ensure that they receive the treatment they need.

A delayed inheritance: the Medical Board of Victoria's 75-year wait to find doctors guilty of "infamous conduct in a professional respect".

The Medical Board of Victoria (Board) was created in 1844 to register "legally qualified medical practitioners". It was not until 1933, however, that the Board attained the power to remove from its register a doctor who had engaged in "infamous conduct in a professional respect" (the power), even though the General Council of Medical Education and Registration of the United Kingdom on which the Board was modelled had been granted the power 75 years earlier. This article argues that the delay in the Board's inheritance was attributable to successive Victorian Parliaments' distrust of the Board and that this attitude was unwarranted, at least from early in the 20th century. The article maintains that the granting of the power to the Board was a crucial event in the history of the regulation of the Victorian medical profession. This is illustrated both by the difficulty encountered by the medical profession in dealing with doctors' unethical conduct before 1933, and the Board's concern to use its new authority responsibly and appropriately to protect the public and the profession in the three years after it attained the power.

Assessing the role of regulatory bodies in managing health professional issues and errors in Europe.

OBJECTIVE: This paper explores how medical regulatory bodies in nine European countries manage professional issues involving quality and patient safety, to build on limited existing information on procedures for regulating medical professionals in Europe. DESIGN: Twelve vignettes describing scenarios of concerns about standards of physicians were developed, covering clinical, criminal and administrative matters. Medical regulatory bodies in nine European countries were asked what action they would normally take in each situation. Their responses were related to their regulatory mandate. RESULTS: Responses varied greatly across participating countries. Regulators are always involved where patients are at risk or where a criminal offence is committed within the clinical setting. Non-criminal medical issues were generally handled by the employer, if any, at their discretion. Countries varied in the use of punitive measures, the extent to which they took an interest in issues arising outside professional activities, and whether they dealt with issues themselves or referred cases to another regulatory authority or took no action at all. CONCLUSIONS: There is little consistency across Europe on the regulation of medical professionals. There is considerable diversity in the range of topics that regulatory bodies oversee, with almost all covering health care quality and safety and others encompassing issues related to reputation, respect and trust. These inconsistencies have significant implications for professional mobility, patient safety and quality of care.

New responsibilities in purchasing and developing services.

The role of nursing in the NHS commissioning structure in England is developing. Since April 2013 more than 200 clinical commissioning groups (CCGs), which comprise all GP practices in the locality, have taken on responsibility for health budgets in their areas. This article describes the challenges ahead and nurses' responsibilities in CCGs when working with local citizens and across the health and social care system to assure the delivery of high quality, safe services.

[Examinandi, doctors and medical councils. Reform proposals concerning surgico-medical education and examinations at the University of Vienna around 1800]. / Examinandi, Doktoren und medizinische Kollegien. Reformpläne für die medizinisch-chirurgische Lehre und Prüfungsordnung an der Universität Wien um 1800.

This essay examines the workings of the so called Court Committee for the Revision of University Studies. The main duty of this institution was to evaluate the structure of the whole educational system of the Habsburg Empire. These records have not received much notice hitherto from historians of medicine. Nevertheless, they deserve attention, as they are quite full of information regarding the "how" of medical education and health care management around 1800. Johann Peter Frank, at that time professor at the Medical Faculty of Vienna was responsible for reform proposals. His deliberations shed fresh light not only on the structures of Viennese Medical Faculty itself but also on different educational policies in the medical sciences in Central Europe around 1800.

Will HEE and LETBs deliver the 'right nurse'?

The restructuring of the NHS in England will see the loss of strategic health authorities, with their workforce education remit being transferred to a completely new structure comprising Health Education England (HEE) and Local Education and Training Boards (LETBs). HEE will provide national oversight of strategic workforce planning and allocate the education and training budget, and will also be responsible for national schemes like junior doctor training. The LETBs will be populated by representatives of health-care providers and professionals, and will be the interface with HEE. They will be charged with ensuring high-quality outcomes from educational investment and meeting the needs of health-care delivery, patients and the public. The universities, colleges, employers and other local education providers will remain responsible for educating the health-care workforce.

Massachusetts needs a PGY-1 option for licensure.

The American Dental Association (ADA) House of Delegates voted to eliminate live patient clinical exams in the year 2000. Canadian dental graduates take an objective structured clinical examination (OSCE) for licensure. Several states have changed their dental practice acts to permit licensure by mentored experience of a general residency or specialty Dental students have led the fight, with some results, to eliminate a practice--live patient exams--that perpetuates unprofessional and potentially illegal activity.

Regulation of executive compensation at nonprofit health care organizations: coming changes?

Executive compensation in health care organizations, particularly tax-exempt organizations, has come under increasing scrutiny in recent years. This paper identifies the implications for tax-exempt health care organizations of recent efforts to regulate executive pay, as well as some changes that the boards of nonprofit health care providers and insurers should consider to minimize the case for further scrutiny and regulation of their executive pay practices.