Identifying and developing effective post-2020 conservation bridging leaders.

Effective bridging leaders interact within and outside their group to facilitate collaboration required in multistakeholder contexts. This is particularly crucial to community-based conservation interventions that strive to achieve both ecological and social objectives by actively engaging or devolving decision-making and management authority to local communities. Although a viable approach in many contexts, achieving "unprecedented collaboration" called for by the Post-2020 Global Biodiversity Framework in community-based conservation is problematic given the multiple and diverse actors affecting and affected by these interventions. Therefore, effective leadership becomes crucial to implementing necessary strategies to engage actors and resolve conflict inclusively. Yet, weak leadership commonly constrains these interventions. I reviewed relevant literature and devised a framework of effective bridging leadership characteristics. I then used this framework to appraise bridging leadership in two African coastal-marine community-based conservation cases. I employed social network analysis and semistructured and group interviews in the two cases. Several local leaders emerged as key (potential) bridging leaders. Furthermore, I found that effective bridging leaders require not only legal recognition but also perceived legitimacy resulting from building trust with other actors. Additionally, the inclusive collaboration required multiple sources of emotionally intelligent bridging leaders with the integrity, humility, empathy, and cultural awareness necessary to mitigate elite capture, effectively communicate, and empower and provide support to others. Because emotional intelligence in conservation leadership remains a knowledge gap, particularly in community-based conservation research, insights from this study should be useful to diverse conservation actors.

Los líderes vinculantes efectivos interactúan dentro y fuera de su grupo para facilitar la colaboración requerida en contextos con múltiples actores. Esto es crucial para las intervenciones de conservación basada en la comunidad que buscan alcanzar objetivos ecológicos y sociales mediante la participación y transferencia de la autoridad gestora y la toma de decisiones a la comunidad local. Aunque es una estrategia viable, es problemático lograr la "colaboración sin precedentes" en la conservación basada en la comunidad que exige el Marco Mundial de Biodiversidad Post-2020 debido a los múltiples y diversos actores que afectan y han sido afectados por estas intervenciones. Por lo tanto, el liderazgo efectivo se vuelve crucial para la implementación de las estrategias necesarias para involucrar a los actores y resolver los conflictos de manera inclusiva. Sin embargo, es común que el liderazgo deficiente limite estas intervenciones. Revisé la literatura relevante y diseñé un marco de trabajo de las características del liderazgo vinculante efectivo. Después usé este marco para valorar el liderazgo vinculante en dos casos de conservación costera-marina basada en la comunidad en África. Analicé las redes sociales y realicé entrevistas grupales y semiestructuradas en ambos casos. Además, descubrí que los líderes vinculantes efectivos requieren no sólo de un reconocimiento legal, sino también de la legitimidad resultante de la construcción de la confianza con otros actores. Asimismo, la colaboración inclusiva requirió de líderes vinculantes de múltiples orígenes con inteligencia emocional y con la integridad, humildad, empatía y conciencia cultural para mitigar la captura elite, comunicar efectivamente y empoderar y proporcionarles apoyo a los demás. Ya que la inteligencia emocional todavía es un vacío de conocimiento en el liderazgo de la conservación, particularmente en la investigación sobre la conservación basada en la comunidad, el conocimiento que brinda este estudio debería ser útil para diversificar a los actores de la conservación.

Reflections on our efforts to help mental health agencies become more "culturally competent".

This paper reflects on our decades-long cultural training experiences, offering details on training efforts we made and considers in hindsight interventions we wish we had been able to implement. The paper describes what we think could be necessary for organizational training/consultation to facilitate the transformation of organizations in the direction of social justice and the delivery of efficient and effective services to a community. We reflect on organizational training to promote cultural competence and social justice. We encourage readers to take the broadest possible perspective on the larger systems issues that tend to undermine such efforts, so they can better achieve their goals for organizational change.

En este artículo reflexionamos sobre nuestras experiencias de capacitación cultural desde hace décadas, ofrecemos detalles sobre los esfuerzos de capacitación que hicimos y tenemos en cuenta las intervenciones posteriores que hubiéramos querido implementar y no pudimos. También describimos lo que consideramos que podría ser necesario para que la consulta/capacitación organizativa facilite la transformación de las organizaciones en dirección de la justicia social y la prestación de servicios eficaces y efectivos para una comunidad. Reflexionamos sobre la capacitación organizativa para promover la competencia cultural y la justicia social. Animamos a los lectores a adoptar la perspectiva más amplia posible con respecto a los problemas de los sistemas más grandes que tienden a socavar dichos esfuerzos, de manera que puedan lograr mejor sus objetivos para el cambio organizativo.

Developing an interdisciplinary and cross-sectoral community of practice in the domain of forests and livelihoods.

Although significant resources are being spent researching and fostering the relationship between forests and livelihoods to promote mutually beneficial outcomes, critical gaps in understanding persist. A core reason for such gaps is that researchers, practitioners, and policy makers lack the structured space to interact and collaborate, which is essential for effective, interdisciplinary research, practice, and evaluation. Thus, scientific findings, policy recommendations, and measured outcomes have not always been synthesized into deep, systemic understanding; learning from practice and implementation does not easily find its way into scientific analyses, and science often fails to influence policy. Communities of practice (CofPs) are dynamic sociocultural systems that bring people together to share and create knowledge around a common topic of interest. They offer participants a space and structure within which to develop new, systemic approaches to multidimensional problems on a common theme. Uniquely informed by a systems-thinking perspective and drawing from the scientific and gray literatures and in-depth interviews with representatives of established CofPs in the natural resource management and development domain, we argue that a well-designed and adequately funded CofP can facilitate interdisciplinary and cross-sectoral relationships and knowledge exchange. Well-designed CofPs integrate a set of core features and processes to enhance individual, collective, and domain outcomes; they set out an initial but evolving purpose, encourage diverse leadership, and promote collective-identity development. Funding facilitates effective communication strategies (e.g., in person meetings). We urge our colleagues across sectors and disciplines to take advantage of CofPs to advance the domain of forests and livelihoods.

[Translated article] Hospital pharmacy towards 2030.

Hospital Pharmacy is today a profession marked by therapeutic advances, with a proactive attitude, focussed on people and their health. The evolution of processes is constant, with the full presence of digitalisation, robotisation, and even artificial intelligence, in an environment that also requires the efficient and sustainable use of these tools. In this context, it is necessary to have a roadmap that guides the advancement of the profession and Hospital Pharmacy Services. Continuing with the philosophy of the 2020 initiative which, with the slogan "Towards the future, safely", defined the strategic lines to advance in the improvement of Hospital Pharmacy practice, the Spanish Society of Hospital Pharmacy wanted to raise the challenges the profession is currently facing and with a view to 2030. With this strategic planning objective, 20 challenges have been identified and developed, which cover the different areas of action and involvement of Hospital Pharmacy and which cover clinical activities, transversal aspects, training, and research, as well as areas related to people and to the organisations or health systems. For each of them, the objectives, standards, tools, and resources have been defined. It is also planned to provide tools that facilitate monitoring of implementation and the impact on the profession, patients, and the environment.

Hospital pharmacy towards 2030. / La farmacia hospitalaria rumbo al 2030.

Hospital pharmacy is today a profession marked by therapeutic advances, with a proactive attitude, focused on people and their health. The evolution of processes is constant, with the full presence of digitalization, robotization and even artificial intelligence, in an environment that also requires the efficient and sustainable use of these tools. In this context, it is necessary to have a roadmap that guides the advancement of the profession and hospital pharmacy services. Continuing with the philosophy of the 2020 initiative which, with the slogan "Towards the future, safely", defined the strategic lines to advance in the improvement of hospital pharmacy practice, the Spanish Society of Hospital Pharmacy wanted to raise the challenges the profession is currently facing and with a view to 2030. With this strategic planning objective, twenty challenges have been identified and developed, which cover the different areas of action and involvement of hospital pharmacy and which cover clinical activities, transversal aspects, training and research, as well as areas related to people and to the organizations or health systems. For each of them, the objectives, standards, tools and resources have been defined. It is also planned to provide tools that facilitate monitoring of implementation and the impact on the profession, patients and the environment.

[Sistematic review on the influence of leadership style on job satisfaction of health professionals]. / Revisión sistemática sobre la influencia del estilo de liderazgo en la satisfacción laboral de los profesionales de la salud.

INTRODUCTION AND OBJECTIVES: Healthcare organisations are highly complex entities that live with a high risk of instability. In order to minimise this instability, interactions and personal relationships play a major role and accordingly the figure of the leader gains full significance. The leadership style used can produce different reactions and lead to multiple outcomes, including job satisfaction. The aim of the present review is to correlate leadership style with job satisfaction in healthcare professionals. MATERIAL AND METHODS: A systematic review was carried out in BVS, Cochrane plus, CINAHL, ApaPsycinfo and Pubmed, selecting publications that mentioned leadership styles and job satisfaction in healthcare professionals. Publications search strategy were limited for the 5-10last years, full text availability and language of writing: English, French and Spanish. Review-type publications were excluded. Of the 1566 initial titles, 15 were selected for analysis. RESULTS AND CONCLUSIONS: The transformational style showed the highest number of positive correlations, followed by the authentic and transactional styles. On the other hand, the passive and laissez-faire styles showed a negative correlation regardless of the professional category to which they belonged. The results of this study provide a starting point for adopting effective leadership styles to optimise the recruitment and training processes of staff in management and coordination roles.

Comparison of the Global Leadership Initiative on Malnutrition and the Patient-Generated Subjective Global Assessment for diagnosing malnutrition in patients undergoing surgery for hepatobiliary and pancreatic malignancies.

Introduction: Objective: to analyse the differences in malnutrition assessment between the Global Leadership Initiative on Malnutrition (GLIM) criteria and the Patient-Generated Subjective Global Assessment (PG-SGA) among patients with hepatobiliary and pancreatic malignancies. Method: this study was a cross-sectional study and included 126 hospitalised patients who underwent surgery for hepatobiliary and pancreatic malignancies between November 1, 2019 and August 1, 2020. The patients' clinical data were collected, and malnutrition assessments were completed using the different nutritional assessment tools. The consistency of both tools was analysed using Cohen's kappa coefficient. Results: the prevalence of malnutrition showed a difference in diagnosis results between the GLIM criteria (36.51 %) and the PG-SGA (55.56 %). The two methods had moderate consistency (kappa = 0.590, p < 0.01). The sensitivity of a malnutrition diagnosis using a combination of GLIM and PG-SGA was 65.7 % (53.3 % and 76.4 %, respectively), and specificity was 100 % (92 % and 100 %, respectively). When malnutrition was evaluated using only PG-SGA, sensitivity was 88.9 % (95 % confidence interval (CI) 63.9 % to 98.1 %), whereas when only the GLIM score was used for malnutrition evaluation, sensitivity was 98.2 % (95 % CI, 92.8 % to 99.7 %). In addition, the PG-SGA score and the GLIM score had significant correlations. Conclusion: GLIM performed better than PG-SGA in the correlation analysis of nutritional indicators. GLIM is more suitable for patients with hepatobiliary and pancreatic malignancies than PG-SGA.

Introducción: Objetivo: analizar las diferencias en la evaluación de la desnutrición en pacientes con tumores malignos hepatobiliares y pancreáticos entre los criterios de la Iniciativa Global de Liderazgo en Desnutrición (Global Leadership Initiative on Malnutrition, GLIM) y la Evaluación Global Subjetiva Generada por el Paciente (PG-SGA). Métodos: el estudio fue un estudio transversal que incluyó a 126 pacientes hospitalizados que fueron operados de tumores malignos hepatobiliares y pancreáticos entre el 1 de noviembre de 2019 y el 1 de agosto de 2020. Recopilar datos clínicos de pacientes y completar la evaluación de la desnutrición con diferentes herramientas de evaluación nutricional. La consistencia de las dos herramientas se analizó utilizando el coeficiente Kappa de Cohen. Resultados: los criterios GLIM (36,51 %) y PG-SGA (55,56 %) presentan diferencias en los resultados diagnósticos de desnutrición. Ambos métodos tienen una consistencia moderada (kappa = 0590, p < 0,01). La sensibilidad de GLIM y PG-SGA para el diagnóstico conjunto de desnutrición es del 65,7 % (53,3 % y 76,4 %, respectivamente). La especificidad fue del 100 % (92 % y 100 %, respectivamente). Cuando solo se utilizó la PG-SGA para evaluar la desnutrición, la sensibilidad fue del 88,9 % (intervalo de confianza del 95 % (IC) 63,9 % a 98,1 %), mientras que cuando solo se utilizó la GLIM para evaluar la desnutrición, la sensibilidad fue del 98,2 % (IC del 95 %: 92,8 % a 99,7 %. Además, la puntuación PG-SGA tuvo una correlación significativa con la puntuación GLIM. Conclusión: en el análisis de correlación de los indicadores nutricionales, GLIM es mejor que PG-SGA. GLIM es más adecuado para pacientes con tumores malignos hepatobiliares y pancreáticos que PG-SGA.

Women in Radiology: A perspective from Spain.

INTRODUCTION: There are gender inequalities in all fields, including radiology. Although the situation is improving, the presence of radiologists in leadership positions continues to be a minority. The objective of this article is to analyse the situation of women in the spanish radiology, comparing it with Europe and the United States. MATERIALS AND METHODS: We selected the years 2000-2022 as reference period to make a comparison with feminization data throughout history. In addition, relevant specific data from the just begun 2023 were also included. The variables in which we investigated feminization were the following: medical students, medical graduates, radiology residents and specialists, section chiefs, department chairs, radiology residency programme directors, radiology university professors, presidents of the main radiological entities and societies in Spain, Europe and the United States, recipients of the main awards given by these radiological societies and chief editors of their journals. In order to perform this analysis we conducted an in-depth bibliographic research, we contacted the radiological societies of Spain, Europe and the USA and we carried out a survey in the main Spanish radiology departments. RESULTS: The female presence in radiology decreases as we rise to leadership positions, a situation that is patent in Spain, Europe and the US, comparison that will be analysed in depth throughout the article. In Spanish hospitals in 2021 there were 58.1% female radiology residents, 55% female radiologists, 42.9% female section chiefs and 24.4% female department chairs. In SERAM's history there have been 10% female presidents, 22% female gold medallists and 5% female editors-in-chief. If we analyse data from 2000 to 2023, female presidents reach 32% and female gold medallists 31%. CONCLUSIONS: Although gender inequality is declining, in radiology women continue to be underrepresented in leadership positions. Work must be done in order to build a diverse and inclusive profession that reflects demographic reality.

Leadership in a hospital of the Andalusian Public Health System.

OBJECTIVE: To analyse, from a gender perspective, the characteristics and perception of the effects of leadership of nurses in a hospital of the Andalusian Public Health System. METHODOLOGY: Qualitative study with a phenomenological approach. The participants were nurses in care and intermediate positions with a contract of more than 6 months. A qualitative content analysis was carried out. Four phases were established for data analysis, from which 5 categories resulted. NVivo 11 software was used to analyse the dialogues. RESULTS: The participants' discourses endow the leader with characteristics that define him as a reference person. The contribution of middle management is necessary for the achievement of the objectives of the care units and the cohesion of the group, although this group perceives it only in relation to the management of resources. Access to management positions is not linked to gender. CONCLUSIONS: The participants' discourses endow the leader with characteristics that define him as a reference person. The contribution of middle management is necessary for the achievement of the objectives of the care units and the cohesion of the group, although this group perceives it only in relation to the management of resources. Access to management positions is not linked to gender.

[Influence of leadership style on knowledge management and hospital efficiency]. / Influencia del liderazgo en gestión del conocimiento y eficiencia hospitalaria.

OBJECTIVE: To analyse the effect of leadership style on knowledge management in hospitals and hospital efficiency based on the opinion of experts in hospital management, applying fuzzy cognitive maps (FCM). METHOD: FCM are relational models that can be used to graphically represent expert opinion and knowledge to infer cause-effect relationships between different concepts. The use of FCM as a simulation tool allows the evaluation of possible scenarios based on different leadership styles in hospitals. RESULTS: In the resulting augmented matrix, standardized effects range from 0.02 to 0.84, with the highest value representing the strongest relationship between knowledge exploitation and hospital efficiency. From the viewpoint of experts, knowledge creation within the hospital also influences hospital efficiency. Regarding variables reflecting leadership characteristics, positive effects have been identified, though with varying intensities, between authority, benevolence, and charisma, both in terms of knowledge creation and exploitation, as well as hospital efficiency. The transformational leadership style is associated with coefficients having higher values for knowledge management and hospital efficiency. CONCLUSIONS: Experts suggest that hospitals with authoritarian leadership styles would exhibit lower levels of knowledge creation and management, as well as lower hospital efficiency. On the other hand, they associate hospitals managed with a paternalistic leadership style with better values in both knowledge creation and exploitation, as well as hospital efficiency, compared to the authoritarian leadership style. Finally, they attribute the highest levels in aspects related to knowledge management and hospital efficiency to the transformational leadership style.

Design and implementation of a "crisis resource management" training program for the initial assessment of polytrauma patients.

INTRODUCTION: To describe the design and implementation of a Crisis Resource Management (CRM) training program for the initial assessment of polytrauma patients. METHODS: Prospectively implemented CRM training program in acute-care tertiary hospital by hospital personnel involved in the care of polytraumatisms. The program has a blended format and 23-h duration, including 11 h of online theoretical training followed by 12-h simulation modules and practical cases devoted to the roles of members of the trauma team, functioning of the polytrauma room, and key aspects of teamwork. The Human Factors Attitude Survey (HFAS) was used to assess attitudes related to non-technical skills, and the End-of-Course Critique (ECC) survey to evaluate satisfaction with training. We evaluated changes in the pre- and post-training assessments. RESULTS: Eighty staff personnel (26% specialists, 16% residents, 29% nurses, 14% nursing assistant, 15% stretcher bearer) participated in three editions of the program. Theoretical knowledge improved from a mean (SD) of 5.95 (1.7) to 8.27 (2.1) (P < .0001). In the HFAS, statistically significant differences in 18 of 23 attitudinal markers were observed, with improvements in all items of "leadership" and "roles", in 4 of 5 items of "situational awareness", and in 4 of 8 items of "communication". Mean values obtained in the ECC questionnaire were also very high. CONCLUSIONS: A CRM training model developed for the initial care of polytrauma patients improved theoretical knowledge and participants perceptions and attitudes regarding leadership, communication, roles, and situational awareness of members of the trauma team.

Application of artificial neural networks in assigned leadership and academic success in medical graduates.

OBJECTIVE: To apply an artificial neural networks analysis (ANN) model to identify variables that predict assigned leadership and academic success in graduates of six generations of medical school. METHOD: Analytical, retrospective, comparative study. A total of 1434 graduates participated. A questionnaire was sent to them by e-mail including a voluntary participation consent. A multivariate statistical analysis using multi-layer perceptron ANN, decision trees and driver analysis was performed. RESULTS: The ANN identified seven independent variables that predicted professional success and eight for leadership in medical graduates. The decision trees identified significant differences in the variables professional performance (p = 0.000), age (p = 0.005) and continuing education activities (p = 0.034) related to professional success, and for leadership the variables gender (p = 0.000), high school grades (p = 0.042), performing clinical practice during the social service year (p = 0.002) and continuing education activities (p = 0.011). CONCLUSIONS: The ANN identified the main independent predictor variables of professional success and leadership of the graduates. This study opens up two new lines of research little studied with the techniques of in the area of medicine.

OBJETIVO: Aplicar un modelo de análisis de redes neuronales artificiales (RNA) para identificar las variables que predicen el liderazgo asignado y el éxito académico en egresados de seis generaciones de la carrera de Medicina. MÉTODO: Estudio analítico, retrospectivo y comparativo. Participaron 1434 egresados. Se envió un cuestionario por correo electrónico que incluyó el consentimiento de participación voluntaria. Se realizó análisis estadístico multivariado mediante RNA del tipo perceptrón multicapa, árboles de decisión y análisis de impulsores. RESULTADOS: Las RNA identificaron siete variables independientes que predijeron el éxito profesional y ocho para el liderazgo en los médicos egresados. Los árboles de decisión identificaron diferencias significativas en las variables desempeño profesional (p = 0.000), edad (p = 0.005) y actividades de educación continua (p = 0.034) relacionadas con el éxito profesional, y para el liderazgo las variables sexo (p = 0.000), promedio en el bachillerato (p = 0.042), realizar práctica clínica en el servicio social (p = 0.002) y actividades de educación continua (p = 0.011). ­. CONCLUSIONES: Las RNA identificaron las principales variables independientes predictoras del éxito profesional y el liderazgo de los egresados. El estudio abre dos líneas de investigación poco estudiadas con las técnicas de RNA en el área de la medicina.

TeamSTEPPS®-based clinical simulation training program for critical care professionals: A mixed-methodology study.

INTRODUCTION: The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) programme has been shown to improve interprofessional work among healthcare professionals by enhancing teamwork. Intensive care professionals were trained in this methodology through the course "Simulation Trainer: Improving Teamwork through TeamSTEPPS®". OBJECTIVES: To analyse the teamwork performance and good practice in simulation of the intensive care professionals attending the course and to explore their perceptions of the training experience carried out during the course. METHODS: A cross-sectional descriptive and phenomenological study was carried out using a mixed methodology. The 18 course participants were administered the questionnaires "TeamSTEPPS™ 2.0 Team Performance Observation Tool" to evaluate teamwork performance and "Educational Practices Questionnaire" for good practices in simulation after the simulated scenarios. Subsequently, a group interview was conducted through a focus group with 8 attendees using the Zoom™ videoconferencing platform. A thematic and content analysis of the discourses was carried out using the interpretative paradigm. Quantitative and qualitative data were analysed using IBM SPSS Statistics™ 27.0 and MAXQDA Analytics Pro™ respectively. RESULTS: Both the level of teamwork performance (mean = 96.25; SD = 8.257) and good practice in simulation (mean = 75; SD = 1.632) following the simulated scenarios were adequate. The following main themes were identified: satisfaction with the TeamSTEPPS® methodology, usefulness of the methodology, barriers to methodology implementation and non-technical skills improved through TeamSTEPPS®. CONCLUSIONS: TeamSTEPPS® methodology can be a good interprofessional education strategy for the improvement of communication and teamwork in intensive care professionals, both at the care level (through on-site simulation strategies) and at the teaching level (through its inclusion in the students' curriculum).

El papel del cirujano moderno como líder de los equipos de atención sanitaria: una revisión narrativa sobre una facultad ubicua, pero poco definida.

OBJECTIVE: The objective is to describe the role of leadership in the training of the general surgeon and to point out its relevance. METHOD: A search of the medical literature was carried out to identify studies that reported on topics related to leadership in the context of medical education and surgery. We used the search engine of Medline/PubMed databases including related terms such as "leadership" AND "medicine" OR "surgery". RESULTS: Leadership is a valued characteristic in surgery, it implies professionalism, technical competence, motivation, innovation, teamwork, communication skills, decision making, emotional competence, resilience, and effective teaching. Leadership is measurable and can be developed through experience, observation, and education. CONCLUSIONS: Priority must be given to actions that improve leader traits. This has been shown to create a work environment where efficient work is performed, and failures are minimized. The current vision of the leader must be expanded to reduce the gender gap between the positions as leader occupy in this moment.

OBJETIVO: Describir el papel de liderazgo en la formación del cirujano general y puntualizar su relevancia en nuestro entorno. MÉTODO: Se realizó una búsqueda en la literatura médica para identificar estudios que informaran sobre temas relacionados al liderazgo en el contexto de la enseñanza médica y en cirugía. Se utilizó el motor de búsqueda de las bases de datos Medline/PubMed incluyendo términos relacionados como "leadership" AND "medicine" OR "surgery". RESULTADOS: El liderazgo es una característica valorada en cirugía, que implica profesionalismo, competencia técnica, motivación, innovación, trabajo en equipo, habilidades comunicativas, toma de decisiones, competencia emocional, resiliencia y enseñanza eficaz. Es medible y susceptible de desarrollarse a través de la experiencia, la observación y la educación. CONCLUSIONES: En la formación del cirujano general se deben priorizar las acciones que mejoren los rasgos de líder. Se ha demostrado que esto genera un ambiente de trabajo donde se realiza una labor eficiente y se minimizan las fallas. Se debe expandir la visión actual que se tiene de líder y permitir que se disminuya la brecha de género entre los puestos que hoy se ocupan.

Transforming a public university hospital and its area of influence into a comprehensive resource in response to the COVID-19 pandemic.

INTRODUCTION AND OBJECTIVES: The outbreak of COVID-19 has overwhelmed healthcare systems all over the world. The aim of this article is to describe the process of transforming the Vall d'Hebron University Hospital, the second largest hospital in Spain, into a COVID-19 centre coordinating response to the pandemic in its reference area. MATERIALS AND METHODS: The study draws on the experience of the authors in transforming the hospital into a comprehensive resource in response to the COVID-19 pandemic. The strategy is based on four central strategies: early planning, coordination of all healthcare agents in its reference area, definition of clear leadership roles, and the organisation of care based on multidisciplinary teams with minimal recruitment of new staff. RESULTS: The transformation strategy enabled the hospital to cope with the surge in patients without exceeding its capacity. During the response phases, which amounted to a period of 57 days, 3106 patients consulted the ER and 2054 were admitted, 346 of whom were treated at the ICU. To accommodate the number of adult COVID-19 patients, adult ICU availability was progressive increased by 371%, and ordinary beds increased by 240. A total of 671 staff members went on sick leave after testing positive for COVID-19. CONCLUSION: The transformation experience of the hospital provides insight into how effectively adapt the structures and functioning of large hospitals. The relevance of territorial coordination during the pandemic is stressed as an effective strategy that contributed coping the pandemic.

The value of human resources: Experience of critical care nurses during the COVID-19 epidemic.

The COVID-19 pandemic has caused an unprecedented health crisis. Pressure on the National Health System has created unique demand particularly in certain services and care units like the critical care units. OBJECTIVE: To learn about the experience of nurses in caring for people with coronavirus in critical care units. METHOD: A qualitative phenomenological study that constitutes the second phase of a mixed methodology project. We conducted interviews with 17 nurses caring for patients affected by COVID-19 in critical care units. The interviews were audio-recorded, transcribed, and analysed using thematic discourse analysis. RESULTS: This article shows the findings around the theme "the value of human resources" which is nuanced through sub-themes "it's not the beds, it's the expert staff", "shouldering the patient's burden", and suffering because "they have not cared well". DISCUSSION: Expert nurses have emerged as leading professionals in the care of the critical patient during the COVID-19 pandemic. This leadership is executed from a profile framed in an inclusive philosophy where wisdom, agility and intuition are the key elements underpinning problem identification and solving in a creative way, while adapting to the needs of the patient and healthcare team as they emerge. CONCLUSIONS: Expert nurses have played an advanced role in the management of care and human resources by exercising effective leadership in the clinical setting. Care has been hampered due to the crisis, which causes nurses moral distress because they have been unable to meet standards of quality and excellence in care.

Buurtzorg Nederland, a proposal for nurse-led home care.

Buurtzorg Nederland is a Dutch healthcare organization in which nursing teams provide home care in all the skills that affect their profession. This article raises some questions regarding more internal aspects of the organization based on three dimensions. The first, the organizational dimension, in which the teams are structured based on 8 roles, without hierarchies and supported by the coaching system. The second, the nursing dimension, in which it is highlighted that nurses deal with all the competences that affect their profession, from basic care to more complex care, with the aim of defragmenting care. And the third, the economic dimension, in which it stands out that the sustainability of the organization is in being a system without managers, of small teams that work in small geographic areas, with a computer system that supports all organizational matters, healthcare and financial. The main characteristics of Buurtzorg Nederland are the self-management of the teams and the defragmented care that both the nurse and the patient satisfy. However, this defragmentation has been achieved in terms of patient care, with the same team attending to all basic and complex care needs at home, but at other levels of care it has not been achieved, and the patient must visit other providers, therefore, health care at other levels continues to be fragmented.

Leadership problems in the management of health institutions.

In health institutions, physicians or other health professionals frequently occupy senior management positions, usually without any administrative expertise. In such a way that an excellent clinician can become a lousy leader and administrator. In this article, the administrative and organizational consequences of a bad exercise of leadership are displayed, interpreting the phenomenon from the classical and contemporary theories of leadership and exposing the problems that top management in health frequently faces in hospitals. Leadership is not innate; it is a skill that can be developed. Leading and managing health institutions is a science and an art that should be learned from undergraduate and perfected in the postgraduate course. Unless the health professional has a solid administrative and political career, holding senior positions in the hospital is a fortuitous matter.

En las instituciones de salud es frecuente que los médicos u otros profesionales de la salud ocupen altos cargos directivos, habitualmente sin ninguna experiencia administrativa, de tal modo que un excelente clínico se puede convertir en un pésimo líder y administrador. En este artículo se abordan las consecuencias administrativas y organizativas de un mal ejercicio del liderazgo, interpretando el fenómeno desde las teorías clásicas y contemporáneas del liderazgo y exponiendo los problemas que la alta dirección en salud enfrenta frecuentemente en los hospitales. El liderazgo no es innato, es una habilidad que puede ser desarrollada. Liderar y administrar instituciones de salud es una ciencia y un arte que bien debiese aprenderse desde el pregrado y perfeccionarse en el posgrado, puesto que, a menos que el profesional de la salud posea una sólida carrera administrativa y política, el ocupar altos cargos de responsabilidad es un asunto fortuito.

Relationship between leadership support and operational excellence in health care sector: A study of Indian health care managers.

BACKGROUND AND OBJECTIVE: Leadership communicates purpose and innovative ways to thrive for performance. Leadership support influences and impacts operational excellence in the health sector as a patient-centered operation, with effective management, excellence framework, challenges and constraints, teamwork and value stream mapping. It is hypothesized that: (1) perceived leadership support will positively correlate with perceived operational excellence (Patient-centered Operations, Effective Resource Management, Excellence framework, Eliminating Challenges or Constraints, Team Work, Value Stream Mapping) and (2) the correlation would be highest with Patient-centered Operations. The aim of this study was to examine the relationship between leadership support and operational excellence in the health care sector among a selected group of healthcare managers. MATERIALS AND METHOD: A correlation study between leadership support and operational excellence was designed for a group of health care managers (n=80) from eight hospitals in Kerala, South India. The selection of executives was from NABH accredited hospitals from districts with a minimum of four NABH accredited hospital. A survey was sent to a selected study sample. The respondents were cooperative and provided responses on perceived leadership support for operational excellence. RESULTS: Factors of leadership support correlated to operational excellence. CONCLUSION: In the health care sector, leadership support for patient-centered operations helps achieve operational excellence.

Buurtzorg Nederland, a proposal for nurse-led home care. / Buurtzorg Nederland: una propuesta de atención domiciliaria dirigida por enfermeras.

Buurtzorg Nederland is a Dutch healthcare organization in which nursing teams provide home care in all the skills that affect their profession. This article raises some questions regarding more internal aspects of the organization based on 3dimensions. The first, the organizational dimension, in which the teams are structured based on 8 roles, without hierarchies and supported by the coaching system. The second, the nursing dimension, in which it is highlighted that nurses deal with all the competences that affect their profession, from basic care to more complex care, with the aim of defragmenting care. And the third, the economic dimension, in which it stands out that the sustainability of the organization is in being a system without managers, of small teams that work in small geographic areas, with a computer system that supports all organizational matters, healthcare and financial. The main characteristics of Buurtzorg Nederland are the self-management of the teams and the defragmented care that both the nurse and the patient satisfy. However, this defragmentation has been achieved in terms of patient care, with the same team attending to all basic and complex care needs at home, but at other levels of care it has not been achieved, and the patient must visit other providers, therefore, health care at other levels continues to be fragmented.