Transformational nurse leadership attributes in German hospitals pursuing organization-wide change via Magnet® or Pathway® principles: results from a qualitative study.

BACKGROUND: Budget constraints, staff shortages and high workloads pose challenges for German hospitals. Magnet® and Pathway® are concepts for implementing organization-wide change and redesigning work environments. There is limited research on the key elements that characterize nurse leaders driving the implementation of Magnet®/Pathway® principles outside the U.S. We explored the key attributes of nurse leaders driving organization-wide change through Magnet®/Pathway® principles in German hospitals. METHODS: Using a qualitative study design, semi-structured interviews (n = 18) were conducted with nurse leaders, managers, and clinicians, in five German hospitals known as having started implementing Magnet® or Pathway® principles. The interviews were recorded and transcribed verbatim. Data were analyzed in Atlas.ti using content analysis. For the analysis, a category system was created using a deductive-inductive approach. RESULTS: Five leadership attributes and eleven sub-attributes were identified as main themes and sub-themes: Visionary leaders who possess and communicate a strong vision and serve as role models to inspire change. Strategic leaders who focus on strategic planning and securing top management support. Supportive leaders who empower, emphasizing employee motivation, individualized support, and team collaboration. Stamina highlights courage, assertiveness, and resilience in the face of challenges. Finally, agility which addresses a leader's presence, accessibility, and rapid responsiveness, fostering adaptability. CONCLUSIONS: The study demonstrates leadership attributes explicitly focusing on instigating and driving organization-wide change through Magnet®/Pathway® principles in five German hospitals. The findings suggest a need for comprehensive preparation and ongoing development of nurse leaders aimed at establishing and sustaining a positive hospital work environment.

A Focus on Leadership Communication and Feeling Valued to Prevent Burnout and Turnover Among Healthcare Professionals.

OBJECTIVE: The purpose of this study was to examine the relative importance of leadership communication in predicting burnout and intention to stay among faculty and staff while controlling for other factors such as satisfaction with compensation and work-home flexibility. METHODS: This study involved a secondary analysis of data derived from an organizational engagement survey that included 2336 faculty members (75% response rate) and 17,664 staff members (72% response rate). RESULTS: Effective leadership communication was a stronger predictor of burnout and intent to stay than satisfaction with compensation and work-home flexibility. Feeling valued by the organization mediated the relationship between leadership communication and the outcome variables. CONCLUSIONS: Leadership communication provides a low-cost solution to burnout and staff shortages and is primarily effective because it conveys to both faculty and staff that they are valued by the organization.

Navigating AI transitions: how coaching leadership buffers against job stress and protects employee physical health.

The dynamic interplay between Artificial Intelligence (AI) adoption in modern organizations and its implications for employee well-being presents a paramount area of academic exploration. Within the context of rapid technological advancements, AI's promise to revolutionize operational efficiency juxtaposes challenges relating to job stress and employee health. This study explores the nuanced effects of Artificial Intelligence (AI) adoption on employee physical health within organizational settings, investigating the potential mediating role of job stress and the moderating influence of coaching leadership. Drawing from the conservation of resource theory, the research hypothesized that AI adoption would negatively impact employee physical health both directly and indirectly through increased job stress. Critically, our conceptual model underscores the mediating role of job stress between AI adoption and physical health. Further, introducing a novel dimension to this discourse, we postulate the moderating influence of coaching leadership. To empirically test the hypotheses, we gathered survey data from 375 South Korean workers with a three-wave time-lagged research design. Our results demonstrated that all the hypotheses were supported. The results have significant implications for organizational strategies concerning AI implementation and leadership development.

What keeps you up at night? Moral distress in nurse leaders in the USA, Germany, Austria and Switzerland.

PURPOSE: Nurse leaders are challenged by ethical issues in today's complex health-care settings. The purpose of this study was to describe and analyze key elements of moral distress identified by nurse leaders from health-care systems in the USA, Germany, Austria and Switzerland. The aim was to develop an understanding of distressing ethical issues nurse leaders face in the USA and three German-speaking European countries. DESIGN/METHODOLOGY/APPROACH: This descriptive cross-sectional study surveyed a convenience sample of nurse leaders in the USA, Germany, Austria and Switzerland. The voluntary, anonymous survey also included qualitative questions and was distributed using the Qualtrics® platform. A thematic analysis of the qualitative data in each country was carried out and a comparative analysis identified similarities and differences between the groups of nurse leaders comparing the US data to that from three German-speaking European countries. FINDINGS: The survey was completed by 316 nurse leaders: Germany, Austria, and Switzerland (n = 225) and the USA (n = 91). Similar themes identified as causing all nurse leaders moral distress included a lack of individual and organizational integrity, hierarchical and interprofessional issues, lack of nursing professionalism, patient care/patient safety concerns, finances negatively impacting care and issues around social justice. Within these six themes, there were also differences between the USA and the three German-speaking European countries. ORIGINALITY/VALUE: Understanding the experiences associated with distressing ethical situations can allow nurse leaders and organizations to focus on solutions and develop resilience to reduce moral distress in the USA and three German-speaking European countries.

A Retrospective Analysis of Leadership, Awardees, and Member Gender Representation of the Canadian Society for Immunology.

The Canadian Society for Immunology (CSI) established a formal Equity, Diversity, and Inclusion (EDI) Committee with the goal of providing EDI advocacy and leadership within the CSI, as well as in the broader scientific community. A first task of this committee was to review the publicly available historical data on gender representation within the CSI's membership, leadership, award recipients, and conference chairs/presenters as a step in establishing a baseline reference point and monitoring the trajectory of future success in achieving true inclusion. We found that, except for overall membership and a specific subset of awards, all categories showed a historical bias toward men, particularly prior to 2010. Bias persists in various categories, evident even in recent years. However, we note an encouraging trend toward greater gender parity, particularly in the roles of President, symposium presenters, and workshop chairs, especially from 2017 onward. We present these findings as well as our recommendations to enhance inclusivity. These include a more comprehensive collection and secure storage of self-identification data, emphasis on EDI as an essential component of all annual meeting activities, and innovative measures of outreach, collaboration, and leadership with the aim of making the CSI a model for improving EDI in other professional research societies.

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.

Validation and analysis of the metric properties of the Leadership Virtues Questionnaire in work and organizational psychologists and individuals who perform leadership functions in Chile.

The literature on leadership and personal competencies exhibits limitations in terms of construct definition, behavior specifications and valid theory-based measuring strategies. An explanatory design with latent variables and the statistical software SAS 9.4 were used for the validation and adaptation to Spanish of the Leadership Virtues Questionnaire applied to work and organizational psychologists and people who exercise leadership functions in Chile. The levels of agreement between judges for the adaptation to the Spanish language and the confirmatory factor analysis of first order with four dimensions shows insufficient statistical indices for the absolute, comparative and parsimonious adjustments. However, a second-order confirmatory factor analysis with two dimensions presents a satisfactory fit for the item, model, and parameter matrices. The measurement of Virtuous Leadership would provide relevant inputs for further evaluation and training based on ethical competencies aimed at improving management, which would, in turn, allow for its treatment as an independent variable to generate an ethical organizational culture.

How attitudes of state and community leaders regarding health equity and social determinants of health are associated with behavioral intentions to improve population health.

A critical driver of population health, well-being, and equity is making health a shared value, or the belief that health is a priority for oneself and one's community. For people in positions of influence, attitudes regarding their organization's perspective may result in decisions that advance health equity or reinforce inequities. Yet despite the potential role of leaders in influencing health and well-being, little is known about their attitudes regarding their organization's perspective on what shapes health, or how their attitudes translate into actions that improve population health. The objectives of this study are twofold: (1) to understand leaders' attitudes with regard to their organization's perspective on population health and (2) to identify the attitudes associated with leaders' perspectives regarding their organization's intention to engage in behaviors that advance population health. We designed a survey instrument grounded in the Theory of Planned Behavior and fielded the survey to 18,367 state and community leaders across all 50 U.S. states, 325 U.S. cities, and nine sectors from fall 2020 until spring 2022. We received surveys from 5,450 leaders, yielding a 32 percent response rate. Survey respondents viewed social determinants of health and health equity as important factors influencing population health. Additionally, two attitudes were most associated with leaders' intentions to promote population health-"self-efficacy" (a leader's confidence in taking action to promote health for all) and "behaviors valued by important others" (how much certain groups want the organization to take action that promotes health for all). Efforts to improve population health through leaders should focus on supporting leaders' self-efficacy and on increasing leaders' perceptions regarding behaviors valued by important others. Governmental entities and funders can use these data to support leaders' efforts in improving population health, well-being, and equity.

Building resilience: analysis of health care leaders' perspectives on the Covid-19 response in Region Stockholm.

BACKGROUND: The Covid-19 pandemic has tested health care organizations worldwide. Responses have demonstrated great variation and Sweden has been an outlier in terms of both strategy and how it was enacted, making it an interesting case for further study. The aim of this study was to explore how health care leaders experienced the challenges and responses that emerged during the initial wave of the Covid-19 pandemic, and to analyze these experiences through an organizational resilience lens. METHODS: A qualitative interview study with 12 senior staff members who worked directly with or supervised pandemic efforts. Transcripts were analyzed using traditional content analysis and the codes directed to the Integrated Resilience Attributes Framework to understand what contributed to or hindered organizational resilience, i.e. how organizations achieve their goals by utilizing existing resources during crises. RESULTS/FINDINGS: Organizational resilience was found at the micro (situated) and meso (structural) system levels as individuals and organizations dealt with acute shortages and were forced to rapidly adapt through individual sacrifices, resource management, process management, and communications and relational capacity. Poor systemic resilience related to misaligned responses and a lack of learning from previous experiences, negatively impacted the anticipatory phase and placed greater pressure on individuals and organizations to respond. Conventional crisis leadership could hamper innovation, further cement chronic challenges, and generate a moral tension between centralized directives and clinical microsystem experiences. CONCLUSIONS: The pandemic tested the resilience of the health care system, placing undue pressure on micro and meso systems responses. With improved learning capabilities, some of this pressure may be mitigated as it could raise the anticipatory resilience potential, i.e. with better health systems learning, we may need fewer heroes. How crisis leadership could better align decision-making with frontline needs and temper short-term acute needs with a longer-term infinite mindset is worth further study.

Creating a Vibrant Organization Using the Dynamic Leadership Model and a Teaming Approach.

The pandemic exposed existing weaknesses in the health care system, and innovative leaders stepped up to address the compounding effects the novel anomaly created. Postpandemic disruption persists, and the behaviors and actions of these positive deviants demonstrate that new ways of leadership are available to those who are willing to embrace the dynamic leadership model and teaming methodology to shape health care delivery of the future. As we look to new ways of being and leading, we begin from a changed world-one that has been reset and cannot go back. Dynamic leaders are called upon to create cultures that reflect the needs of the future workplace and workforce. They pave new pathways and new ways of thinking, reimagine new realities, and create abundance. Their consistent practice of 5 essential behaviors-self-awareness, deep listening, curiosity, empathy, and decisiveness-strengthen their leadership and ability to meet the demands of health care today.

Leadership Coaching for Team Support: Prioritize Self-Care First!

Self-care quickly became a buzzword for health care workers during the recent pandemic. Strategies to improve self-care and build resiliency for our first-line workers were often seen in the literature or as topics at conferences and webinars. One strategy that was missing was the importance of leaders to be self-care role models for our employees. Just as leaders need to role model the organization's values, they also need to role model self-care so employees can follow their example and be assured that their leader views self-care as important. Leadership coaching must now include self-care as a strategy to improve not only the leader's mental, physical, and emotional health but also the health and wellness of their team as well as the entire organization.

Exploring the stability of the gender gap in faculty perceptions of gender climate at a rural regional university.

Increasing awareness of gender barriers and biases in academic institutions is an essential component of institutional change strategies to promote equity and inclusion. There is an established perception gap in recognizing gender inequities in the workplace, whereby men faculty under acknowledge the stressors, barriers, and biases faced by their women faculty colleagues. This study explored the gender gap in faculty perceptions of institutional diversity climate at a rural comprehensive regional university in the United States. In addition to gender, differences across academic discipline and time were explored using 2 (men and women) x 2 (STEM and other) x 2 (2017 and 2022) between-groups ANOVAs. Results revealed a gender gap that persisted across time and perceptions of stressors, diversity climate, student behavior, leadership, and fairness in promotion/tenure procedures, with marginalized (women) faculty consistently reporting greater barriers/concern for women faculty relative to the perceptions of their men faculty colleagues. These findings are largely consistent with the extant literature and are discussed both with regard to future research directions and recommendations for reducing the perception gap and addressing institutional barriers to gender equity.

Leadership dynamics in musical groups: Quantifying effects of musical structure on directionality of influence in concert performance videos.

Music ensemble performance provides an ecologically valid context for investigating leadership dynamics in small group interactions. Musical texture, specifically the relative salience of simultaneously sounding ensemble parts, is a feature that can potentially alter leadership dynamics by introducing hierarchical relationships between individual parts. The present study extended previous work on quantifying interpersonal coupling in musical ensembles by examining the relationship between musical texture and leader-follower relations, operationalised as directionality of influence between co-performers' body motion in concert video recordings. It was hypothesised that the directionality of influence, indexed by Granger Causality, would be greater for 'homophonic' textures with a clear distinction between melody and accompaniment parts than for 'polyphonic' textures with less distinction between melody and accompaniment. This hypothesis was tested by using pose estimation algorithms to track instrumentalists' body movements in a string quartet and a clarinet quintet, and then applying Granger Causality analysis to their head motion to estimate directional influence between instrumentalist pairs for sections of the pieces that varied in texture. It was found that Granger Causality values were generally higher (indicating greater directionality of influence) for homophonic than polyphonic textures. Furthermore, considering melody and accompaniment instrument roles revealed more evidence for the melody instrument influencing accompanying instruments than vice versa, plus a high degree of directionality among accompanying instruments, in homophonic textures. These observed patterns of directional information flow in co-performer body motion are consistent with changing leader-follower relations depending on hierarchical relations between ensemble parts in terms of the relative salience of melodic material in the musical texture. The finding that automatic pose estimation can detect modulations of leadership dynamics in standard video recordings under naturalistic performance conditions has implications for investigating interpersonal coordination in large-scale music video datasets representing different cultural traditions, and for exploring nonverbal communication in group activities more generally.

GLIM criteria for definition of malnutrition in peritoneal dialysis: a new aspect of nutritional assessment.

Background: The aim of our study was to evaluate the effectiveness of Global Leadership Initiative on Malnutrition (GLIM) criteria in assessing malnutrition within the peritoneal dialysis (PD) population.Methods: We conducted a retrospective analysis involving 1057 PD patients across multiple institutions, characterized by an age of 56.1 ± 14.4 years, 464 (43.9%) female, and a median follow-up of 45 (25, 68) months. Malnutrition was diagnosed according to GLIM criteria. The endpoint event was overall mortality. The survival rate and hazard ratio (HR) of death between malnutrition and well-nourished were analyzed in all patients and various subgroups. Receiver operator characteristic curve and integrated discrimination improvement (IDI) were used to distinguish the efficacy of the nutritional tools prediction model.Results: According to the GLIM criteria, the prevalence of malnutrition among the study population was 34.9%. The adjusted HR of overall mortality was 2.91 (2.39 - 3.54, p < 0.001) for malnutrition versus well-nourished. In sensitivity analyses, the HR remained robust except the cardiovascular disease subgroup. The area under the curve of GLIM predicting 5-year mortality was 0.65 (0.62-0.68, p < 0.001). As a complex model for forecast the long-term mortality, the performance of adjusted factors combined with GLIM was poorer than combined malnutrition inflammation score (MIS) (IDI >0, p < 0.001), but fitter than combined geriatric nutritional risk index (GNRI) (IDI <0, p < 0.001).Conclusions: The GLIM criteria provide a viable tool for nutritional assessment in patients with PD, and malnutrition defined according to the GLIM can predict prognosis with an acceptable performance.

How Transformational Leadership Affects the Off-work Recovery of Daily Personal Energy Resources via Work Engagement: Resource and Demand-based Pathways.

This study focuses on the transformational leadership-work engagement relationship by investigating resource and demand pathways for daily off-work recovery and employee wellbeing (EWB). While previous research highlighted how transformational leadership energizes employees to engage at work, energy is a finite resource requiring daily restoration for EWB. Yet, how the leader's energizing effect relates to daily employees' recovery remains unknown. Following job demands-resource-recovery theory, we test two pathways that relate the transformational leadership-work engagement relationship to daily employee recovery: (a) Resource-based via resource-building, (b) demand-based via increased demands. Utilizing a 10-day, two daily measurement (N = 88) study, multilevel path analyses revealed: transformational leadership predicted via work engagement (b = .17, p < .05) role clarity (b = .56, p < .01), then positive (b = .39, p < .01), and negative work-nonwork spillover (b = -.38, p < .01). Positive work-nonwork spillover predicted recovery positively (b = .25, p < .01), negative work-nonwork spillover negatively (b = -.40, p < .01). Recovery predicted EWB for positive (b = .38, p < .01) and for negative (b = -.43, p < .01) affect. Work engagement predicted workload (b = .35, p < .01), further negative (b = .33, p < .01) and positive work-nonwork spillover (b = -.16, p < .01), hampering EWB. As one pathway effect might cancel the other, the main effect of transformational leadership on EWB was not significant in the integrative model (p > .05). Results highlight dark and bright sides of the transformational leadership-work engagement relationship regarding daily recovery.