Ethical health leadership: Lessons from low- and middle-income countries during COVID-19.

We adopt a holistic-micro, meso, macro-approach to health leadership ethics to examine how low- and middle-income countries have responded to the COVID-19 pandemic. Healthcare delivery happens within complex settings in low- and middle-income countries and high-income countries. These settings are riddled with systemic political and economic challenges which, in some instances, make it difficult for health leaders to be ethical. These challenges, however, are not unique to low- and middle-income countries. Globally, countries can learn from ethical health leadership missteps that occurred during low- and middle-income countries' responses to COVID-19. We discuss the implications of problematic ethics in health leadership on managing pandemics in low- and middle-income countries, using Zimbabwe as an example. We offer suggestions on what can be done to improve ethical health leadership in response to future health crises in both high-income and low- and middle-income nations.

The pop-up research centre - Challenges and opportunities.

OBJECTIVES: This article sets out to describe the concept of the "pop-up" research centre as a means to promote and develop radiography research locally, nationally and internationally, and to empower professional colleagues to set up similar initiatives in the future. KEY FINDINGS: A detailed overview of the development and management of "pop-up" research is provided based on the experiences of the authors, including specific examples. Matters such as study design, approvals, equipment and software, environment, participant recruitment and management, research teams and activity costs are discussed. Quantifiable benefits of "pop-up" research such as resultant peer reviewed publications, development of researchers' skills and potential collaborations are described. A number of "soft skill" benefits are also apparent and include enhanced organisational profiles, team building and the development of leadership skills. CONCLUSIONS: "Pop-up" research centres are a valuable option for conducting research and offer the radiography profession an achievable mechanism to increase and enhance research activity. However, careful planning and execution are essential.

"There is total silence here" Ethical competence and inter-organizational learning in healthcare governance.

PURPOSE: The purpose of this paper is to analyse ethical competence related to healthcare governance and management tasks at the county/regional level in Sweden. The paper also discusses conditions that support or constrain the development and application of such competence. DESIGN/METHODOLOGY/APPROACH: The study is based on original qualitative data from 13 interviews and 6 meeting observations. Three key groups of actors were included: politicians, civil servants and CEOs in publicly financed health-provider organizations. An abductive analysis was carried out by a stepwise method guided by thematic research questions. FINDINGS: The informants viewed themselves as having a high degree of ethical responsibility for healthcare practice. However, they did not integrate ethical reflection and dialogue into their work decisions (e.g. regarding budgets, reforms and care agreements). The current organization, control systems and underlying business principles, along with the individuals' understanding of their own and others' roles, tended to constrain the development and use of ethical competence. PRACTICAL IMPLICATIONS: Qualities of an appropriate ethical competence related to healthcare governance and management, and conditions to develop and use such competence, are suggested. ORIGINALITY/VALUE: Hardly any empirical research has examined ethical competence related to healthcare governance and management tasks. The paper integrates ethics and theories on learning in organizations and contributes knowledge about ethical competence and the conditions necessary to develop and practise ethical competence in an organizational and inter-organizational context.

Estudio descriptivo sobre la aplicación del consentimiento informado en centros sanitarios de Galicia (España) / Descriptive study on the application of informed conset in health centers of Galicia (Spain)

Objetivos: conocer la opinión y el conocimiento general de pacientes sobre el Consentimiento Informado (CI) y su participación en la Toma de Decisiones (TD). Material y métodos: Se diseñó un estudio descriptivo, transversal, observacional, con 120 pacientes encuestados aleatoriamente, en los 8 Complejos Hospitalarios Universitarios de la Comunidad Autónoma de Galicia, España. Resultados y discusión: La media de edad de los pacientes fue de 52,14 años, con un 50% de hombres. El 84,21% de los CI fueron aportados por el personal no médico, que solo se limitó a entregarlo y leerlo. Solo el 50% de los profesionales intentó involucrar al paciente en la TD. El 53,33% de los pacientes participó en la TD y el 45,83% firmó el formulario por haber entendido y aceptado la explicación, estando completamente satisfechos el 95 de los pacientes encuestados (79,17%). Conclusiones: Es indispensable modificar la actitud de los profesionales sanitarios involucrados en el proceso de TD, ya que no se está promoviendo la implicación de los pacientes en el mismo. Aunque menos de la mitad de los encuestados ha firmado el CI por haberlo entendido, el grado de satisfacción y la confianza en el médico no se vio comprometida

Objectives: The aims of this study were to know the opinion and general knowledge of patients about the informed consent (IC), and their participation in the decision-making (DM) process. Material and methods: A descriptive, transversal, observational, qualitative and quantitative study was designed with 120 patients randomly surveyed at the 8 University Hospital Complexes of Galicia, Spain. Results and discussion: The mean age was 52.14 years, with 50% of men. 84.21% of the ICs provided by non-medical personnel were limited to delivering and reading it. 90% of patients after signing the IC, trust their doctor. Only 50% of the professionals tried to involve the patient in DM. 53.33% of the patients participated in DM. 45.83% patients signed for having understood and accepted the explanation, being completely satisfied 95 of the patients surveyed (79.17%). Conclusions: It is essential to change the attitude of non-medical health professionals involved in the DM process, because their involvement is not being promoted. Although less than half of the respondents have signed the IC for having understood, the degree of satisfaction and confidence in the doctor was not compromised

Etica en salud, esencial? / Ethics in healthcare, are they essential? / Ethics in health, essential?

El punto de encuentro que representa la salud entre lo biológico y lo social, el individuo y la comunidad, la política social y la económica representa un medio para la realización personal y colectiva. Esta visión permite medir el éxito alcanzado por una sociedad y sus instituciones de gobierno en la búsqueda del bienestar y el desarrollo. Desde esta perspectiva, las relaciones humanas desde la salud comprenden varias dimensiones éticas, que pueden entenderse como una serie de círculos concéntricos que, partiendo del nivel más elemental, el paciente del sistema de salud, llegan a integrarse en el sistema global y complejo de la biosfera. Es aquí donde el análisis debería estar guiado por principios éticos como el principio de responsabilidad de Hans Jonas o del desarrollo sostenible; y donde la salud asume su rol más crítico en la agenda del desarrollo, la seguridad global y la democracia. A su vez, los cambios fácticos asociados al fenómeno de la globalización muestran con mayor claridad la insuficiencia del modelo actual del management para producir eficacia, efectividad, eficiencia, calidad y seguridad e innovación permanente, en el accionar de las organizaciones de salud; razón por la cual es necesaria su reformulación.

Health is a meeting point of the biological and the social, individuals and community, economic policy and social policy which represents a means of personal and collective accomplishment. This view allows you to measure the success of a society and its institutions of Government in the pursuit of well-being and development. From this perspective, human relations from health comprise several ethical dimensions, which can be understood as a series of concentric circles which, starting from the most basic level, the health system patient, become integrated into the global and the complex system of the biosphere. It is here where the analysis should be guided by ethical principles such as the principle of responsibility in Hans Jonas sense, or sustainable development, and where health assumes its more critical role in the development agenda, global security and democracy. At the same time, factual changes associated with the phenomenon of globalization are more clearly the inadequacy of the current model of management to produce efficiency, effectiveness, efficiency, quality and safety and ongoing innovation, the action of health organizations. This is the reason why its reformulation is necessary.

Portafolios de planificación, organización y gestión del Jefe de Servicios Clínicos / Chairman of Clinical Departments planification, organizational and management portfolio

La metodología del portafolio se usa ampliamente, incluida la formación médica permanente y la formación de especialistas por el sistema de residencias. Algunas instituciones españolas (la Universidad Nacional de Educación a Distancia y la Escuela Nacional de Sanidad) están aplicando un portafolio de siete dimensiones al ámbito de la Gestión Clínica, que podría ser utilizado como marco conceptual y lista de comprobación para elaborar diferentes documentos de planificación, programación, o evaluación en las nuevas experiencias innovadoras de Unidades de Gestión Clínica. Este artículo expone brevemente el Protocolo, considera sus potencialidades, y concluye señalando la importancia del buen gobierno y la rendición de cuentas en el nuevo profesionalismo médico

Portfolio methodology is widely applied to training, particularly in medical education and for medical trainees. Some Spanish Institutions (National University of Distance Learning and National School of Public Health) are using a seven dimension Portfolio in the field of Clinical Management, which could be used as conceptual framework and checklist for building up different documents for planning, programming and evaluating the new experiences of Clinical Units based on clinical management initiatives. This paper describe the Portfolio in short, takes into consideration its potential use, and concludes addressing the relevance of good governance and accountability for the medical professionalism

Health care institutions should not exclude smokers from employment.

Some health care institutions, including academic health centers, have adopted policies excluding smokers from employment. Claims advanced on behalf of these policies include financial savings from reduced health costs and absenteeism as well as advantages consonant with their message of healthy living. The authors suggest that the institutional savings from these policies are speculative and unproven. Also, in settings where large medical schools operate, it is likely to be the poor, including members of minority groups, who, under an employee smoker ban, will lose the opportunity to work for an employer that offers health insurance and other benefits. In response to the incentives created by such bans, some will quit smoking, but most will not. Thus, at the community level, employee smoker bans are more likely to be harmful than beneficial.Although private businesses may rightly choose not to hire smokers in the 19 states where such policies are legal, health care institutions, including academic health centers, should consider hiring choices in light of the values they profess. The traditional values of medicine include service to all persons in need, even when illness results from addiction or unsafe behavior. Secular academic communities require a shared dedication to discovery without requiring strict conformity of private behavior or belief. The authors conclude that for health care institutions, policies of hiring smokers and helping them to quit are both prudent and expressive of the norms of medical care, such as inclusion, compassion, and fellowship, that academic health professionals seek to honor.

Building an ethical organizational culture.

The success of a health care institution-as defined by delivering high-quality, high-value care, positive patient outcomes, and financial solvency-is inextricably tied to the culture within that organization. The ability to achieve and sustain alignment between its mission, values, and everyday practices defines a positive organizational culture. An institution that has a diminished organizational culture, reflected in the failure to consistently align management and clinical decisions and practices with its mission and values, will struggle. The presence of misalignment or of ethics gaps affects the quality of care being delivered, the morale of the staff, and the organization's image in the community. Transforming an organizational culture will provide a foundation for success and a framework for daily ethics-grounded operations in any organization. However, building an ethics-grounded organization is a challenging process requiring strong organization leadership and planning. Using a case study, the authors provide a multiyear, continuous step-by-step strategy consisting of identifying ethics culture gaps, establishing an ethics taskforce, clarifying and prioritizing the problems, developing strategy for change, implementing the strategy, and evaluating outcomes. This process will assist organizations in aligning its actions with its mission and values, to find success on all fronts.

Framework for ethical decision-making based on mission, vision and values of the institution.

The authors led the development of a framework for ethical decision-making for an Academic Health Sciences Centre. They understood the existing mission, vision, and values statement (MVVs) of the centre as a foundational assertion that embodies an ethical commitment of the institution. Reflecting the Patient and Family Centred Model of Care the institution is living, the MVVs is a suitable base on which to construct an ethics framework. The resultant framework consists of a set of questions for each of the MVVs. Users of the framework are expected to identify two or more possible decisions to address the issue at hand and then, by applying the provided sequence of questions to each, examine these options and determine the overall ethically preferable decision. The construction of such a framework requires the creative involvement of the institution's staff. Thus the development of the framework can represent a training process in ethical decision-making as well as advance the ethical atmosphere of the institution. This novel approach has the advantage of placing the MVVs on active duty, at the centre of ethical decision-making, and lifts it from its otherwise relative obscurity in most institutions.

Written institutional ethics policies on euthanasia: an empirical-based organizational-ethical framework.

As euthanasia has become a widely debated issue in many Western countries, hospitals and nursing homes especially are increasingly being confronted with this ethically sensitive societal issue. The focus of this paper is how healthcare institutions can deal with euthanasia requests on an organizational level by means of a written institutional ethics policy. The general aim is to make a critical analysis whether these policies can be considered as organizational-ethical instruments that support healthcare institutions to take their institutional responsibility for dealing with euthanasia requests. By means of an interpretative analysis, we conducted a process of reinterpretation of results of former Belgian empirical studies on written institutional ethics policies on euthanasia in dialogue with the existing international literature. The study findings revealed that legal regulations, ethical and care-oriented aspects strongly affected the development, the content, and the impact of written institutional ethics policies on euthanasia. Hence, these three cornerstones-law, care and ethics-constituted the basis for the empirical-based organizational-ethical framework for written institutional ethics policies on euthanasia that is presented in this paper. However, having a euthanasia policy does not automatically lead to more legal transparency, or to a more professional and ethical care practice. The study findings suggest that the development and implementation of an ethics policy on euthanasia as an organizational-ethical instrument should be considered as a dynamic process. Administrators and ethics committees must take responsibility to actively create an ethical climate supporting care providers who have to deal with ethical dilemmas in their practice.