Changing estimates of leadership ability before a programme: retrospective self-assessments and response-shift bias.

BACKGROUND: Most evaluations of clinical leadership development programmes rely on self-assessments. Self-assessments are vulnerable to response-shift bias. Using retrospective then-tests may help to avoid this bias.In this study, we investigate whether post-programme then-tests (retrospective self-assessments) are more sensitive to change in clinical leadership development programme participants than traditional pre-programme pre-tests when paired with post-test self-assessments. METHODS: 17 healthcare professionals participated in an 8-month single-centre multidisciplinary leadership development programme. Participants completed prospective pre-test, retrospective then-test and traditional post-test self-assessments using the Primary Colours Questionnaire (PCQ) and Medical Leadership Competency Framework Self-Assessment Tool (MLCFQ). Pre-post pairs and then-post pairs were analysed for changes using Wilcoxon signed-rank tests and compared with a parallel multimethod evaluation organised by Kirkpatrick levels. RESULTS: A greater number of significant changes were detected using then-test pairs than pre-test pairs for both the PCQ (11 of 12 vs 4 of 12 items) and MLCFQ (7 of 7 vs 3 of 7 domains). The multimethods data showed positive outcomes at all Kirkpatrick levels. CONCLUSIONS: In ideal circumstances, both pre-test and then-test evaluations should be conducted. We cautiously suggest that if only one post-programme evaluation can be conducted, then-tests may be appropriate means of detecting change.

Next Generation Leaders Programme: A Multi-Methods Evaluation of a Leadership Development Programme for Biomedical Researchers.

Background: Biomedical scientists have become de facto leaders for their research teams. Theories of expert leadership suggest that the specialist knowledge and credibility these researcher-leaders bring to their roles can lead to improved performance. Formal leadership development for biomedical researchers remains uncommon, and it is unclear whether existing leadership development programmes achieve improved individual and organisational outcomes. Our study evaluates the effectiveness of a single centre leadership development programme for biomedical researchers using a mixed-methods approach. Methods: 26 biomedical researchers participated in an 8 month single centre multidisciplinary leadership development programme. Participants completed prospective pre-test, retrospective then-test and traditional post-test self-assessments using the Primary Colours Questionnaire (PCQ) and Medical Leadership Competency Framework Self-Assessment Tool (MLCFQ). Pre-post pairs and then-post pairs were analysed for changes using Wilcoxon signed-rank tests and compared with a parallel mixed-methods evaluation organised by Kirkpatrick levels. Results: There were significant increases in 3/7 domains and 1/5 tasks of leadership in the PCQ, in both pre-post and then-post paired assessments. There were statistically significant but small increases in 2/7 domains of the MLCFQ. The mixed-methods data showed positive outcomes at all Kirkpatrick levels. Participants said the programme was relevant, interesting and well-organised, with 63% reporting increased confidence and motivation. Participants had a significant change in behaviour, spending 1-2 hours per week on group projects, which were successfully implemented locally. 42% of participants expected these projects to continue beyond the programme. Discussion: This study demonstrates a local leadership programme can have positive impact within a biomedical research centre despite time and financial constraints. We encourage future studies to utilise a mixed-methods approach to evaluating the impact of leadership development programmes.

Nevirapine-induced Stevens-Johnson syndrome in children living with HIV in South Africa.

BACKGROUND: Although adverse drug reactions resulting from the use of nevirapine (NVP) are well described in adults (estimated frequency of 6% - 10%), it has previously been considered less common in children (0.3% - 1.4%). Stock-outs of antiretroviral agents occur frequently in South Africa and result in interruptions in therapy and drug substitutions. OBJECTIVES: To report on a case series of paediatric patients who suffered cutaneous drug reactions to NVP at rates not previously described in children. METHOD: We describe a retrospective observational case series of six children living with HIV who developed Stevens-Johnson Syndrome (SJS) following exposure to NVP because of a prolonged stock-out of efavirenz 200 mg tablets in South Africa. RESULTS: Of the 392 paediatric patients receiving antiretroviral therapy at the institution, 172 were affected by the efavirenz stock-out. Of these, 85 children were changed to NVP of which six developed NVP-induced SJS (7.1% incidence rate). The median time between initiating NVP and developing symptoms was 27 days (range 12-35 days). All patients responded well to NVP cessation and symptomatic treatment. One patient was referred for specialist care. Two patients were successfully rechallenged with efavirenz after developing SJS and three continued lopinavir/ritonavir. CONCLUSIONS: This is the second largest case series of NVP-induced SJS in children to date and raises the possibility that the incidence of SJS in children may be higher than previously described. Further research is required to explore the risk factors associated with NVP-induced SJS in children. This case series highlights the negative impact of drug stock-outs on patient health outcomes.

Doctors' Extended Shifts as Risk to Practitioner and Patient: South Africa as a Case Study.

Extended shifts are common in medical practice. This is when doctors are required to work continuously for more than 16 h, with little or no rest, often without a maximum limit. These shifts have been a part of medical practice for more than a century. Research on the impact of fatigue presents compelling evidence that extended shifts increase the risk of harm to patients and practitioners. However, where the number of doctors is limited and their workloads are not easily reduced, there are numerous barriers to reform. Some of these include a perceived lack of safer alternatives, concerns about continuity of care, trainee education, and doctors' preferences. As such, working hour reorganisation has been contentious globally. South Africa, a middle-income country where extended shifts are unregulated for most doctors, offers a useful case study of reform efforts. The South African Safe Working Hours campaign has promoted working hour reorganization through multi-level advocacy efforts, although extended shifts remain common. We propose that extended shifts should be regarded as an occupational hazard under health and safety legislation. We suggest options for managing the risks of extended shifts by adapting the hierarchy of controls for occupational hazards. Despite the challenges reform pose, the practice of unregulated extended shifts should not continue.

Agents of change: The role of healthcare workers in the prevention of nosocomial and occupational tuberculosis.

Healthcare workers (HCWs) play a central role in global tuberculosis (TB) elimination efforts but their contributions are undermined by occupational TB. HCWs have higher rates of latent and active TB than the general population due to persistent occupational TB exposure, particularly in settings where there is a high prevalence of undiagnosed TB in healthcare facilities and TB infection control (TB-IC) programmes are absent or poorly implemented. Occupational health programmes in high TB burden settings are often weak or non-existent and thus data that record the extent of the increased risk of occupational TB globally are scarce. HCWs represent a limited resource in high TB burden settings and occupational TB can lead to workforce attrition. Stigma plays a role in delayed diagnosis, poor treatment outcomes and impaired well-being in HCWs who develop TB. Ensuring the prioritization and implementation of TB-IC interventions and occupational health programmes, which include robust monitoring and evaluation, is critical to reduce nosocomial TB transmission to patients and HCWs. The provision of preventive therapy for HCWs with latent TB infection (LTBI) can also prevent progression to active TB. Unlike other patient groups, HCWs are in a unique position to serve as agents of change to raise awareness, advocate for necessary resource allocation and implement TB-IC interventions, with appropriate support from dedicated TB-IC officers at the facility and national TB programme level. Students and community health workers (CHWs) must be engaged and involved in these efforts. Nosocomial TB transmission is an urgent public health problem and adopting rights-based approaches can be helpful. However, these efforts cannot succeed without increased political will, supportive legal frameworks and financial investments to support HCWs in efforts to decrease TB transmission.

Why healthcare workers are sick of TB.

Dr Thato Mosidi never expected to be diagnosed with tuberculosis (TB), despite widely prevalent exposure and very limited infection control measures. The life-threatening diagnosis of primary extensively drug-resistant TB (XDR-TB) came as an even greater shock. The inconvenient truth is that, rather than being protected, Dr Mosidi and thousands of her healthcare colleagues are at an increased risk of TB and especially drug-resistant TB. In this viewpoint paper we debunk the widely held false belief that healthcare workers are somehow immune to TB disease (TB-proof) and explore some of the key factors contributing to the pervasive stigmatization and subsequent non-disclosure of occupational TB. Our front-line workers are some of the first to suffer the consequences of a progressively more resistant and fatal TB epidemic, and urgent interventions are needed to ensure the safety and continued availability of these precious healthcare resources. These include the rapid development and scale-up of improved diagnostic and treatment options, strengthened infection control measures, and focused interventions to tackle stigma and discrimination in all its forms. We call our colleagues to action to protect themselves and those they care for.