Suggesting a holistic framework for understanding healthcare services leadership competence - a critical interpretive synthesis.

PURPOSE: Healthcare providers are under pressure due to increasing and more complex demands for services. Increased pressure on budgets and human resources adds to an ever-growing problem set. Competent leaders are in demand to ensure effective and well-performing healthcare organisations that deliver balanced results and high-quality services. Researchers have made significant efforts to identify and define determining competencies for healthcare leadership. Broad terms such as competence are, however, inherently at risk of becoming too generic to add analytical value. The purpose of this study is to suggest a holistic framework for understanding healthcare leadership competence, that can be crucial for operationalising important healthcare leadership competencies for researchers, decision-makers as well as practitioners. DESIGN/METHODOLOGY/APPROACH: In the present study, a critical interpretive synthesis (CIS) was conducted to analyse competency descriptions for healthcare leaders. The descriptions were retrieved from peer reviewed empirical studies published between 2010 and 2022 that aimed to identify healthcare services leadership competencies. Grounded theory was utilised to code the data and inductively develop new categories of healthcare leadership competencies. The categorisation was then analysed to suggest a holistic framework for healthcare leadership competence. FINDINGS: Forty-one papers were included in the review. Coding and analysing the competence descriptions resulted in 12 healthcare leadership competence categories: (1) character, (2) interpersonal relations, (3) leadership, (4) professionalism, (5) soft HRM, (6) management, (7) organisational knowledge, (8) technology, (9) knowledge of the healthcare environment, (10) change and innovation, (11) knowledge transformation and (12) boundary spanning. Based on this result, a holistic framework for understanding and analysing healthcare services leadership competencies was suggested. This framework suggests that the 12 categories of healthcare leadership competencies include a range of knowledge, skills and abilities that can be understood across the dimension personal - and technical, and organisational internal and - external competencies. RESEARCH LIMITATIONS/IMPLICATIONS: This literature review was conducted with the results of searching only two electronic databases. Because of this, there is a chance that there exist empirical studies that could have added to the development of the competence categories or could have contradicted some of the descriptions used in this analysis that were assessed as quite harmonised. A CIS also opens for a broader search, including the grey literature, books, policy documents and so on, but this study was limited to peer-reviewed empirical studies. This limitation could also have affected the result, as complex phenomenon such as competence might have been disclosed in greater details in, for example, books. PRACTICAL IMPLICATIONS: The holistic framework for healthcare leadership competences offers a common understanding of a "fuzzy" concept such as competence and can be used to identify specific competency needs in healthcare organisations, to develop strategic competency plans and educational programmes for healthcare leaders. ORIGINALITY/VALUE: This study reveals a lack of consensus regarding the use and understanding of the concept of competence, and that key competencies addressed in the included papers are described vastly different in terms of what knowledge, skills and abilities they entail. This challenges the operationalisation of healthcare services leadership competencies. The proposed framework for healthcare services leadership competencies offers a common understanding of work-related competencies and a possibility to analyse key leadership competencies based on a holistic framework.

The mindful leader: a review of leadership qualities derived from mindfulness meditation.

Mindfulness has been practiced by global leaders and companies as an efficient way to build effective leadership. Because of its popularity, plus the lack of a comprehensive theoretical framework that explains it in a leadership context, the research literature has called for a coherent account of the qualities that is derived by those leaders that practice mindfulness. Here, we aim to answer that call, by clarifying what leadership qualities can develop from practicing mindfulness. We report on a semi-systematic literature review of extant research, covering 19 research articles published between 2000 and 2021, plus other relevant supporting literature from the disciplines of leadership and neuropsychology. Our proposed framework consists of three main qualities of the mindful leader: attention, awareness, and authenticity. We call them the "three pillars of mindful leaders." We also propose that mindfulness meditation must be integrated into our proposed framework, as we are convinced that leaders who hope to benefit from these qualities must integrate a regular mindfulness meditation practice into their daily leadership life.

Ethical considerations for artificial intelligence use in nursing informatics.

Artificial intelligence revolutionizes nursing informatics and healthcare by enhancing patient outcomes and healthcare access while streamlining nursing workflow. These advancements, while promising, have sparked debates on traditional nursing ethics like patient data handling and implicit bias. The key to unlocking the next frontier in holistic nursing care lies in nurses navigating the delicate balance between artificial intelligence and the core values of empathy and compassion. Mindful utilization of artificial intelligence coupled with an unwavering ethical commitment by nurses may transform the very essence of nursing.

Integrated care system leadership: a rapid realist review.

PURPOSE: Given the complex nature of integrated care systems (ICSs), the geographical spread and the large number of organisations involved in partnership delivery, the importance of leadership cannot be overstated. This paper aims to present novel findings from a rapid realist review of ICS leadership in England. The overall review question was: how does leadership in ICSs work, for whom and in what circumstances? DESIGN/METHODOLOGY/APPROACH: Development of initial programme theories and associated context-mechanism-outcome configurations (CMOCs) were supported by the theory-gleaning activities of a review of ICS strategies and guidance documents, a scoping review of the literature and interviews with key informants. A refined programme theory was then developed by testing these CMOCs against empirical data published in academic literature. Following screening and testing, six CMOCs were extracted from 18 documents. The study design, conduct and reporting were informed by the Realist And Metanarrative Evidence Syntheses: Evolving Standards (RAMESES) training materials (Wong et al., 2013). FINDINGS: The review informed four programme theories explaining that leadership in ICSs works when ICS leaders hold themselves and others to account for improving population health, a sense of purpose is fostered through a clear vision, partners across the system are engaged in problem ownership and relationships are built at all levels of the system. RESEARCH LIMITATIONS/IMPLICATIONS: Despite being a rigorous and comprehensive investigation, stakeholder input was limited to one ICS, potentially restricting insights from varied geographical contexts. In addition, the recent establishment of ICSs meant limited literature availability, with few empirical studies conducted. Although this emphasises the importance and originality of the research, this scarcity posed challenges in extracting and applying certain programme theory elements, particularly context. ORIGINALITY/VALUE: This review will be of relevance to academics and health-care leaders within ICSs in England, offering critical insights into ICS leadership, integrating diverse evidence to develop new evidence-based recommendations, filling a gap in the current literature and informing leadership practice and health-care systems.

Managing patient safety and staff safety in nursing homes: exploring how leaders of nursing homes negotiate their dual responsibilities-a case study.

Objective: Within healthcare, the role of leader is becoming more complex, and healthcare leaders carry an increasing responsibility for the performance of employees, the experience and safety of patients and the quality of care provision. This study aimed to explore how leaders of nursing homes manage the dual responsibility of both Health, Safety and Environment (HSE) and Quality and Patient Safety (QPS), focusing particularly on the approaches leaders take and the dilemmas they face. In addition, we wanted to examine how leaders experience and manage the challenges of HSE and QPS in a holistic way. Design/setting: The study was designed as a case study. Data were collected through semi structured individual interviews with leaders of nursing homes in five Norwegian municipalities. Participants: 13 leaders of nursing homes in urban and rural municipalities participated in this study. Results: Data analysis resulted in four themes explaining how leaders of nursing homes manage the dual responsibility of HSE and QPS, and the approaches they take and the dilemmas they face: 1.Establishing good systems and building a culture for a work environment that promotes health and patient safety.2.Establish channels for internal and external collaboration and communication.3.Establish room for maneuver to exercise leadership.4.Recognizing and having the mandate to handle possible tensions in the dual responsibility of HSE and QPS. Conclusions: The study showed that leaders of nursing homes who are responsible for ensuring quality and safety for both patients and staff, experience tensions in handling this dual responsibility. They acknowledged the importance of having time to be present as a leader, to have robust systems to maintain HSE and QPS, and that conflicting aspects of legislation are an everyday challenge.

Occupational health literacy and work ability: a moderation analysis including interpersonal and organizational factors in healthy organizations.

Introduction: Healthy organizations approach to occupational safety and health should holistically include individual, interpersonal, and organizational levels. There is an empirical research gap in considering different levels in organizations for health promotion in the context of maximizing work ability. This study aims to investigate the association of (1) occupational health literacy (on an individual level), (2) health-oriented leadership (interpersonal level), (3) participation possibilities in health, and (4) values of health in companies (both organizational levels) on work ability. Additionally, we examined the potentially moderating role of health-oriented leadership, participation possibilities in health, and values of health between occupational health literacy and work ability. Methods: Cross-sectional data were obtained from 828 employers and employees in small and medium-sized enterprises. Self-report measures included occupational health literacy, health-oriented leadership, work ability, participation possibilities in health at work, and values of health in the company. Occupational health literacy comprises two factors: a knowledge-/skill-based approach to occupational health and a willingness/responsibility for occupational health. Participation possibilities in health are measured regarding participatory opportunities and co-creation of health at work. Values of health in the company capture the importance of health in the workplace and the scope for improving employees' health. Data were analyzed using latent regression and latent moderation analyses controlling for age, gender, and educational level. Results: Occupational health literacy (knowledge-/skill-based), health-oriented leadership, participation possibilities in health, and values of health in companies showed positive associations with work ability. Health-oriented leadership on an interpersonal level was found to moderate the positive relationship between (knowledge-/skill-based) occupational health literacy and work ability. Participation possibilities in health on an organizational level acted as a moderator on the relationship between both occupational health literacy factors and work ability. Discussion: Individual, interpersonal, and organizational factors play important roles in maintaining work ability in healthy organizations. This study highlights the importance of promoting occupational health literacy among employees and leaders, creating a healthy workplace through health-oriented leadership, and providing participatory opportunities for co-creation in health promotion at work. Future research should further explore these factors' roles in different industries and contexts and how they may be addressed effectively in tailored workplace interventions.

Integral leadership in nursing: Development and psychometric validation of a Korean version of the Integral Nursing Leadership Scale.

BACKGROUND: With the importance of nursing leadership roles, there is a need for a more integrated approach to nursing leadership that can adapt quickly to many challenges in today's healthcare environments. In recent years, integral leadership that can apply a more holistic and inclusive approach to leadership has gained growing attention in other disciplines. However, research on integral leadership in nursing is sparse since no instrument specifically measuring integral leadership in nursing contexts is available. OBJECTIVE: The study aimed to develop an integral nursing leadership scale and evaluate its psychometric properties. METHODS: The scale was developed in two phases. In the first phase, items were generated to reflect the attributes of integral leadership in the nursing context. These attributes were identified through a conceptualization process using a literature review and semi-structured interviews. The process was based on the four dimensions of the integral leadership framework, adopting Wilber's four quadrants of integral theory. Then, the psychometric properties of the scale, including content validity, structural validity, and internal consistency reliability, were evaluated. Data were collected from a convenience sample of 806 Korean nurses and were analyzed using both exploratory factor analysis and second-order confirmatory factor analysis, using two separate random halves of the sample. RESULTS: The newly developed scale consisted of 30 items across four dimensions: individual leadership qualities, individual performance, influencing organizational culture, and organizational excellence. Content validity for the 30 items was calculated to be 0.84 for item-level content validity and 0.96 for the scale's content validity averaging method, indicating adequate content validity. The four-factor structure of integral nursing leadership was cross-validated by exploratory factor analysis and second-order confirmatory factor analysis. The internal consistency reliability was also found to be acceptable, as indicated by a Cronbach's alpha of 0.97 and a McDonald's ω estimate of 0.98. CONCLUSION: Findings demonstrate that the Integral Nursing Leadership Scale has acceptable content validity, structural validity, and reliability in measuring integral leadership, specifically in the context of nursing. More research is needed to further refine and establish strong validity of the scale.

Tailoring a specific medical leadership development program for faculty members: the Lyon-Ottawa experience.

The development of leadership skills has been the topic of several position statements over recent decades, and the need of medical leaders for a specific training was emphasized during the COVID-19 crisis, to enable them to adequately collaborate with governments, populations, civic society, organizations, and universities. However, differences persist as to the way such skills are taught, at which step of training, and to whom. From these observations and building on previous experience at the University of Ottawa, a team of medical professors from Lyon (France), Ottawa, and Montreal (Canada) universities decided to develop a specific medical leadership training program dedicated to faculty members taking on leadership responsibilities. This pilot training program was based on a holistic vision of a transformation model for leadership development, the underlying principle of which is that leaders are trained by leaders. All contributors were eminent French and Canadian stakeholders. The model was adapted to French faculty members, following an inner and outer analysis of their specific needs, both contextual and related to their time constraints. This pilot program, which included 10 faculty members from Lyon, was selected to favor interactivity and confidence in older to favor long-term collaborations between them and contribute to institutional changes from the inner; it combined several educational methods mixing interactive plenary sessions and simulation exercises during onescholar year. All the participants completed the program and expressed global satisfaction with it, validating its acceptability by the target. Future work will aim to develop the program, integrate evaluation criteria, and transform it into a graduating training.

Servant Leadership in the Healthcare Literature: A Systematic Review.

Servant leadership has received a growing consideration among scholars and practitioners as a viable leadership model capable of bringing positive changes in the increasingly complex healthcare system. The increasing servant leadership literature in healthcare requires an integrated research work that provides a holistic picture of the existing studies. This systematic review aims to synthesize servant leadership conceptualizations, theoretical frameworks, measurement tools, and nomological networks (antecedents, mediators, outcomes, and moderators) associated with prior research in healthcare. A systematic synthesis of 55 pertinent healthcare-specific conceptual and empirical studies demonstrated that servant leadership assumes a crucial role in developing a committed workforce that contributes towards the achievement of performance excellence in healthcare. The review uncovers that the Global Servant Leadership Scale is the most utilized measure of servant leadership in sector-specific studies in healthcare. Moreover, social exchange theory is the dominant underpinning mechanism explaining the influence of servant leadership on specific variables of interest. The findings further revealed that servant leadership has a positive relationship with a range of valued individual and organizational outcomes in healthcare. Our review contributes to the development of servant leadership theory and practice through ascertaining sector-specific studies in the territory of healthcare. We finally conclude by providing a detailed panorama for future healthcare-specific servant leadership research in terms of potential topics, methodological rigor, and less explored variables in prior studies.

Leadership and Teamwork During the COVID-19 Pandemic: Experiences of Music Therapy Business Leaders.

This study investigated the experiences of music therapy private practice business leaders providing services in school, healthcare, and community settings, including clients' homes, during the first 12 months of the COVID-19 pandemic. Qualitative content analysis was utilized to analyze semi-structured interview data collected from 10 business leaders (5 CEOs and 5 clinical directors) recruited from 5 businesses. 8 themes were revealed: (1) significant impact shaped by uncertainty and values, (2) temporal dimensions of change, (3) changing dynamics of relationships, (4) issues leading to burnout, (5) unexpected opportunities for all stakeholders, (6) the weight of being responsive, (7) the ambiguity of role changes, and (8) the collective functioning of the clinical team. In the context of leadership and teamwork, these themes illuminated the challenges these business leaders encountered while also providing insights into the importance of collaborative structures, transparent communication, and flexibility integral to leading organizational change. Further, resilience, robustness, and antifragility provide theoretical constructs through which to consider change processes, providing music therapy professionals with the opportunity to consider core leadership, teamwork, and organizational characteristics essential to music therapy teams.

Leadership practices that enable healthful cultures in clinical practice: A realist evaluation.

AIM: To generate, test and refine programme theories that emerged from a rapid realist review investigating practising UK Nurses' and Midwives' experiences of effective leadership strategies during the COVID-19 pandemic. BACKGROUND: The realist review of literature generated six tentative theories of healthful leadership practices reflecting, working with people's beliefs and values; being facilitative; multiple means of communication and; practical support. The review yielded little insight into the actual impact of the leadership approaches advocated. METHODS: A realist study, informed by person-centredness using mixed-methods. Online survey (n = 328) and semi-structured interviews (n = 14) of nurses and midwives across the UK in different career positions/specialities. Quantitative data analysed using descriptive statistics and exploratory factor analysis. Framework analysis for qualitative data using context (C), mechanism (M), outcome (O) configurations of the tentative theories. RESULTS: Three refined theories were identified concerning: Visibility and availability; embodying values and; knowing self. Healthful leadership practices are only achievable within organisational cultures that privilege well-being. CONCLUSIONS: Leaders should intentionally adopt practices that promote well-being. 'Knowing self' as a leader, coaching and mentoring practice development is important for leadership development. IMPLICATIONS FOR CLINICAL PRACTICE: Nurses who feel valued, heard, cared for and safe are more likely to remain in clinical practice. Job satisfaction and being motivated to practice with confidence and competence will impact positively on patient outcomes. IMPACT: The study addresses the role of leadership in developing healthful workplace cultures. The main findings were six leadership practices that promote healthful cultures. The research will have an impact on strategic and clinical leaders, nurses and midwives. REPORTING METHOD: This study used EQUATOR checklist, RAMASES II as reporting standards for realist evaluations. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Randomized crossover clinical trial of a Mindfulness-based intervention for nurse leaders: A pilot study / Ensayo clínico aleatorizado cruzado de una intervención basada en mindfulness con enfermeros líderes: estudio piloto / Ensaio clínico randomizado cruzado de uma intervenção baseada em mindfulness em enfermeiros líderes: estudo-piloto

Objective: to analyze the effects of a Mindfulness-based intervention on nurse leaders' emotional intelligence and resilience. Method: a pilot study of a randomized crossover clinical trial. The sample (n=32) was randomized into Group A (n=18) and Group B (n=14) and evaluated at the pre-test, post-test and follow-up moments. The outcomes were assessed using the Emotional Intelligence Measure, the Connor-Davidson Resilience Questionnaire and the Five Facet Mindfulness Questionnaire, and analyzed using Generalized Linear Mixed Models. Results: a total of 32 nurses with a mean age of 42.6 years old were evaluated. The analyses showed significant interactions between the effects of the group x moment factors on the Self-motivation (p=0.005), Sociability (p<0.001), Self-control (p=0.013), and Total (p=0.002) emotional intelligence skill scores; as well as on the Observe (p=0.042), Describe (p=0.008), Non-judgment (p<0.001), Act with awareness (p=0.004) and Total (p<0.001) mindfulness facets. Post-test: there was a statistically significant increase in the Sociability (p=0.009) and Self-control (p=0.015) emotional intelligence skills; as well as in the Non-judgment (p=0.022) and Total (p=0.002) mindfulness facets. Follow-up: a significant increase was observed in the Non-judgment (p=0.024) and Total (p=0.026) mindfulness facets. The "resilience" variable did not present statistical significance in the "group x moment" factor, both in the post-test and during follow-up. Conclusion: the Mindfulness-based intervention used proved to be effective in increasing nurse leaders' emotional intelligence and dispositional mindfulness skills. Brazilian Registry of Clinical Trials (RBR-3c62gy), registered on March 4 th , 2020, updated on September 16 th , 2022.

Objetivo: analizar los efectos de una intervención basada en mindfulness sobre la inteligencia emocional y la resiliencia de enfermeros líderes. Método: estudio piloto de un ensayo clínico aleatorizado cruzado. Muestra (n=32) aleatorizada en el grupo A (n=18) y grupo B (n=14), se los evaluó en el pretest, postest y seguimiento. Los resultados fueron evaluados mediante la Medida de Inteligencia Emocional, el Cuestionario de Resiliencia de Connor-Davidson y el Cuestionario Mindfulness de Cinco Facetas, y analizados por el Generalized Linear Mixed Models . Resultados: fueron evaluadas 32 enfermeras con una edad promedio de 42,6 años. Los análisis mostraron interacciones significativas de los efectos de los factores grupo vs. momento en los puntajes de las habilidades de automotivación (p=0,005), sociabilidad (p<0,001), autocontrol (p=0,013) y total (p=0,002) de inteligencia emocional; de las facetas observar (p=0,042), describir (p=0,008), no juzgar (p<0,001), actuar con conciencia (p=0,004) y total (p<0,001) de mindfulness. Postest: hubo un aumento estadísticamente significativo de las habilidades de sociabilidad (p=0,009) y autocontrol (p=0,015) de inteligencia emocional; de las facetas no juzgar (p=0,022) y total (p=0,002) de mindfulness . Seguimiento: se observó un aumento significativo en las facetas no juzgar (p=0,024) y total (p=0,026) de mindfulness . La variable resiliencia no presentó significación estadística en el factor grupo vs. momento en el postest y seguimiento. Conclusión: la intervención basada en mindfulness utilizada demostró ser eficaz para aumentar la inteligencia emocional y las habilidades de mindfulness disposicional de los enfermeros líderes. Registro Brasileño de Ensayos Clínicos (RBR-3c62gy), registrado el 4 de marzo de 2020, actualizado el 16 de septiembre de 2022.

Objetivo: analisar os efeitos de uma intervenção baseada em mindfulness na inteligência emocional e resiliência de enfermeiros líderes. Método: estudo-piloto de ensaio clínico randomizado cruzado. Amostra (n=32) randomizada em grupo A (n=18) e grupo B (n=14), avaliados nos momentos pré-teste, pós-teste e seguimento. Os desfechos foram avaliados pela Medida de Inteligência Emocional, pelo Questionário de Resiliência Connor-Davidson e pelo Questionário das Cinco Facetas de Mindfulness , e analisados pelo Generalized Linear Mixed Model . Resultados: foram avaliadas 32 enfermeiras com idade média de 42,6 anos. As análises mostraram interações significativas dos efeitos dos fatores Grupo x Momento nos escores das habilidades de automotivação (p=0,005), sociabilidade (p<0,001), autocontrole (p=0,013) e total (p=0,002) de inteligência emocional; das facetas observar (p=0,042), descrever (p=0,008), não julgar (p<0,001), agir com consciência (p=0,004) e total (p<0,001) de mindfulness . Pós-teste: houve aumento estatisticamente significante das habilidades de sociabilidade (p=0,009) e autocontrole (p=0,015) de inteligência emocional; das facetas não julgar (p=0,022) e total (p=0,002) de mindfulness . Seguimento: observou-se aumento significativo das facetas não julgar (p=0,024) e total (p=0,026) de mindfulness . A variável resiliência não apresentou significância estatística no fator Grupo x Momento, no pós-teste e seguimento. Conclusão: a intervenção baseada em mindfulness utilizada mostrou-se efetiva no aumento das habilidades de inteligência emocional e mindfulness disposicional de enfermeiros líderes. Registro Brasileiro de Ensaios Clínicos (RBR-3c62gy), registrado em 04 de março de 2020, atualizado em 16 de setembro de 2022.

A Qualitative Study on Distributed Leadership in Integrated Care: Exploring the Experiences of Elderly Multimorbid Patients with GP Collaboration.

Objective: This study explores how the collaboration between elderly multimorbid patients and general practitioners contributes to the patient's experience of integrated care in the municipality. The research also investigates whether the municipality's integrative mechanisms creating integrated care can be understood as distributed leadership. Method: In this qualitative study, we conducted a thematic analysis of semi-structured interviews with twenty elderly multimorbid patients living at home and their general practitioners. Results: Analysis of patients' and general practitioners' experience of healthcare service characterized by collective efforts identified four themes: 1) an impression of collective processes as difficult for patients to access and influence; 2) that the fluidity and location of leadership is dependent on the individual patient and his or her health condition; 3) that collective implementation of healthcare services is separated in time, geography and between organizations; and 4) that patients experience individual healthcare workers as specialized and unable to support the medical and holistic goals of the collective. The Direction, Alignment, and Commitment or DAC framework, is used to investigate the capabilities of the collective. Conclusion: To promote distributed leadership and create a patient experience of integrated care in the municipality, healthcare organizations must develop collective processes that enhance patient participation to a greater extent. General practitioners and other healthcare personnel should be encouraged to play a more central role in solving elderly multimorbid patients' healthcare needs in the municipality.

Using acceptance and commitment therapy in everyday conversations to support staff well-being.

Healthcare organisations implement a range of staff well-being initiatives and increasingly focus on compassionate leadership. While formal interventions aimed at maintaining and enhancing staff well-being can be beneficial, they have practical limitations, such as staff turnover and challenges in meeting demand. Therefore, everyday conversations between nurses in leadership positions and their team members also have an important role in supporting staff well-being. One psychological model that nurse leaders may wish to use is acceptance and commitment therapy (ACT), which involves techniques such as mindfulness, acceptance and values clarification. This article outlines the principles of ACT and explains how leaders can use these to guide well-being conversations with staff.

Safety voice climate: A psychometric evaluation and validation.

INTRODUCTION: Speaking up about safety issues, termed "safety voice," is a proactive response where people across all levels of the organization express their concerns to prevent physical hazards. An understanding of safety voice requires insight into its antecedents. A perceived need to fit in with the organization and fear of consequences can trump the courage to speak out about safety concerns. Safety voice climate can be seen as a manifestation of the social exchanges in an organization and functions as a roadmap of which speaking out behaviors are encouraged and which behaviors are not. This study conceptualizes safety voice climate, presents the Safety Voice Climate Scale (SVCS) as a measurement tool, and gathers initial evidence for its validity. The study also assesses the associations between the SVCS and safety voice behavior. METHOD: The SVCS and the measurement of safety voice behavior were derived from the Trends in Risk Level in the Norwegian Petroleum Activity questionnaire. The SVCS includes the two theoretical dimensions Work colleagues' encouragement of safety voice and Leaders' attitudes towards safety voice. Psychometric properties were tested with a representative sample from the Norwegian petroleum sector (n = 7,624). RESULTS: Confirmatory factor analyses supported the proposed two-factor model, and the internal consistency of the factors was good. Furthermore, a structural equation model including the SVCS as predictors of safety voice behavior showed a good fit, indicating acceptable criterion validity, although only the Work colleagues' encouragement of safety voice variable was significantly associated with safety voice behavior. Conclusion and practical application: The SVCS can be used as a tool to detect some of the barriers and supporting elements relating to safety voice and guidance on the efforts needed to foster work climates that promote communication of safety issues.

Facilitators influencing midwives to leadership positions in policy, education and practice: A systematic integrative literature review.

The development of midwives as leaders is a crucial step towards achieving equality in sexual, reproductive, maternal, and neonatal health, Universal Health Coverage (UHC) and Sustainable Development Goals (SDG). However, many midwives work only to implement policies made by others rather than being drivers of policy changes. Little is known and researched about why midwives are not involved in decision and policymaking related to sexual, reproductive, maternal, and neonatal health. Hence, with a focus on midwifery leadership within the global community and the limited opportunities for women to hold leadership positions, this research explores the facilitators influencing midwives' opportunities to become leaders in policy development, education and practice. Inspired by Whittemore and Knafl, this integrative literature review was conducted after twenty-two relevant articles were identified through a search of the following databases: PubMed, CINAHL, and Scopus. Inductive content analysis was applied to analyze data. The result indicates that for midwives to become influential leaders, they must be active in strategic planning at the highest level. This inevitably effects how far midwives can act as agents for change, even if they possess the knowledge and skills for a leadership position. Policies and regulations influence how midwives' status in society is acknowledged and recognized. A clearly articulated educational pathway will enable their professional growth and expertise, making them knowledgeable and skillful as leaders. Enabling midwives to step into leadership positions at government level requires reforms which include midwives in decision-making. Excluding midwives from decision-making processes is detrimental to the goal of achieving universal health coverage. The first step is to provide midwives with a protected title, enabling them to work autonomously in an enabling environment with normal pregnancy and birth to achieve the SDG 2030 goals.

'We are in for a culture change': continuing professional development leaders' perspectives on COVID-19, burn-out and structural inequities.

INTRODUCTION: The COVID-19 pandemic positioned healthcare systems in North America at the epicentre of the crisis, placing inordinate stress on clinicians. Concurrently, discussions about structural racism, social justice and health inequities permeated the field of medicine, and society more broadly. The confluence of these phenomena required rapid action from continuing professional development (CPD) leaders to respond to emerging needs and challenges. METHODS: In this qualitative study, researchers conducted 23 virtual semistructured interviews with CPD leaders in Canada and the USA. Interview audiorecordings were transcribed, deidentified and thematically analysed. RESULTS: This study revealed that the CPD leaders attributed the pandemic as illuminating and exacerbating problems related to clinician wellness; equity, diversity and inclusion; and health inequities already prevalent in the healthcare system and within CPD. Analysis generated two themes: (1) From heroes to humans: the shifting view of clinicians and (2) Melding of crises: an opportunity for systemic change in CPD. DISCUSSION: The COVID-19 pandemic increased recognition of burn-out and health inequities creating momentum in the field to prioritise and restrategise to address these converging public health crises. There is an urgent need for CPD to move beyond mere discourse on these topics towards holistic and sustainable actionable measures.

Health managers and community representatives' views of a system-wide intervention to strengthen public healthcare in the Free State, South Africa.

Background: A system-wide health system strengthening (HSS) initiative, the Health Systems Governance and Accountability (HSGA) intervention, was developed, translated to policy, and implemented in the Free State province. This study assessed health managers (HMs) and community representatives' (CRs) views of the intervention and whether it improved integration and performance. Method: A questionnaire survey among 147 HMs and 78 CRs and 14 focus group discussions (FGDs) with a mean of 10.3 participants and a total of 102 HMs and 42 CRs, were conducted. The questionnaire and FGD data were descriptively and thematically analysed to triangulate findings. Results: Many HMs (44%) mostly positioned at the operational levels indicated that implementation of the HSGA intervention did contribute to integration of health services. Most CRs (54%) believed that communities were actively involved in the intervention. However, both the self-administered questionnaire and the FGD data evidenced lack of policy awareness among, especially, operational-level HMs. Conclusion: From the perspectives of HMs and CRs, the implementation of the intervention was viewed as a step forward in strengthening public healthcare to respond to system deficiencies in the Free State province. Earlier engagement of especially operational-level HMs during reforms may be beneficial in successfully implementing HSS interventions.

Sustaining the Earth: Unraveling the Synergy of Workplace Spirituality, Responsible Leadership, and Pro-Environmental Behavior in Pakistan's SMEs.

Purpose: The purpose of this research is to investigate the synergistic impact of workplace spirituality (WPS), responsible leadership (RL), and pro-environmental behavior (PEB) within the context of Pakistan's Small and Medium Enterprises (SMEs) along with the mediating mechanism of Affective commitment (AC). Methods: Our study utilizes structural equation modeling (SEM) to analyze survey data collected from 390 employees within Pakistani SMEs. We develop a single unified framework to test the hypothesized relationships between RL, PEB, and AC as a mediator. Results: Our results unveil significant positive relationships between WPS, RL, and PEB. Our findings endorse both the direct connections between WPS, RL, and PEB, as well as the mediating mechanisms through AC. This study offers novel insights into the influence of PEB in the context of Pakistan's SMEs. Conclusion: The research significantly contributes to the existing literature by examining WPS, RL, PEB, and AC in the context of Pakistan's SMEs. The study's conclusions emphasize the potential benefits of integrating WPS and RL into business practices to encourage PEB. Additionally, we discuss the limitations of our research and suggest future avenues for further exploration in this vital area of sustainable business management.

Flow's Core Prerequisites: The Role of Servant Leadership, Mindfulness and Work-Life Balance.

Flow is an optimal mental state of being completely involved in one's activities. This correlational study explored an important, but rarely validated performance model in the workplace-flow. Building on the JD-R theory we recognized three key prerequisites of flow-servant leadership, work-life balance, and mindfulness. We analyzed 987 survey responses from two industries (service and manufacturing) in China. The study discovered that servant leadership, mindfulness, and work-life balance correlate with individual flow as key prerequisites. Further we discovered that the relationship between mindfulness and flow is moderated by the industry. Particularly, data from the manufacturing industry showed a positive relationship between mindfulness and flow but a negative relationship among service employees. Implications for performance and applied psychology research, theory, and practice are discussed.