“Hybrid” medical leadership emergency medicine training for international medical graduates

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Prakash Subedi ◽  
Jill Aylott ◽  
Naushad Khan ◽  
Niki Shrestha ◽  
Dayaram Lamsal ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Health System ◽  
International Medical Graduates ◽  
Content Type ◽  
Medical Graduates ◽  
Health System Improvement ◽  
New Learning ◽  
System Improvement ◽  
The Uk ◽  
Medical Leadership

Purpose The purpose of this paper is to outline the “Hybrid” “International” Emergency Medicine (HIEM) programme, which is an ethical pathway for the recruitment, employment and training of Emergency Medicine doctors; with a rotation through the NHS on a two-year medical training initiative with a Tier 5 visa, “earn, learn and return” programme. The HIEM programme offers an advantage to the Tier 2 visa by combining training, education and employment resulting in new learning to help improve the health system in Nepal and provide continued cultural support, clinical and leadership development experience in the UK NHS. Finally, this programme also provides a Return on Investment to the NHS. Design/methodology/approach A shortage of doctors in the UK, combined with a need to develop Emergency Medicine doctors in Nepal, led to a UK Emergency Medicine Physician (PS) to facilitate collaboration between UK/Nepal partners. A mapping exercise of the Royal College of Emergency Medicine curriculum with the competencies for the health system and quality improvement leaders and partners with patients produced a “HIEM programme”. The HIEM programme aims to develop first-class doctors to study in Emergency Departments in the UK NHS while also building trainee capability to improve the health system in Nepal with a research thesis. Findings The HIEM programme has 12 doctors on its programme across years one and two, with the first six doctors working in the UK NHS and progressing well. There are reports of high levels of satisfaction with the trainees in their transition from Nepal to the UK and the hospital is due to save £720,000 (after costs) over two years. Each trainee will earn £79,200 over two years which is enough to pay back the £16,000 cost for the course fees. Nepal as a country will benefit from the HIEM programme as each trainee will submit a health system improvement Thesis. Research limitations/implications The HIEM programme is in its infancy as it is two years through a four-year programme. Further evaluation data are required to assess the full impact of this programme. In addition, the HIEM programme has only focussed on the development of one medical speciality which is Emergency Medicine. Further research is required to evaluate the impact of this model across other medical and surgical specialties. Practical implications The HIEM programme has exciting potential to support International Medical Graduates undertake a planned programme of development while they study in the UK with a Tier 5 visa. IMGs require continuous support while in the UK and are required to demonstrate continued learning through continuous professional development (CPD). The HIEM programme offers an opportunity for this CPD learning to be structured, meaningful and progressive to enable new learning. There is also specific support to develop academic and research skills to undertake a thesis in an area that requires health system improvement in Nepal. Originality/value This is the first time an integrated clinical, leadership, quality improvement and patient partnership model curriculum has been developed. The integrated nature of the curriculum saves precious time, money and resources. The integrated nature of this “hybrid” curriculum supports the development of an evidence-based approach to generating attitudes of collaboration, partnership and facilitation and team building in medical leadership with patient engagement. This “hybrid” model gives hope for the increased added value of the programme at a time of global austerity and challenges in healthcare.

Overwriting New Public Management with New Public Governance in New Zealand's approach to health system improvement

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Tim Tenbensel ◽  
Pushkar Silwal ◽  
Lisa Walton
Keyword(s):  
Health System ◽  
Institutional Change ◽  
Public Management ◽  
New Public Management ◽  
Public Governance ◽  
Content Type ◽  
Health System Improvement ◽  
New Public ◽  
System Improvement ◽  
New Public Governance

PurposeIn 2016, New Zealand's Ministry of Health introduced the System Level Measures Framework which marked a departure from health targets and pay-for-performance incentives towards an approach based on local, collaborative approaches to health system improvement. This exemplifies an attempt to “overwrite” New Public Management (NPM) institutional practices with New Public Governance (NPG). We aim to trace this process of overwriting so as to understand how attempts to change institutional practices were facilitated, blocked, translated and edited.Design/methodology/approachWe develop a conceptual framework for understanding and tracing institutional change towards NPG which emphasises the importance of discursive strategies in policy attempts to overwrite NPM with NPG. To analyse the New Zealand case, we drew on policy documents and interviews conducted in 2017–18 with twelve national key informants and fifty interviewees closely involved in local development and/or implementation of the SLMF.FindingsPolicy sponsors of collaborative approaches to health system improvement first attempted formal institutional change, arguing that adopting collaborative, quality improvement (NPG) approaches would supplement existing performance management (NPM) practices, to create a superior synthesis. When this formal approach was blocked, they adopted an approach based on informal persuasion of local organisational actors that quality improvement should supplant performance improvement. This approach was edited and translated by local actors, and the success of local implementation varied considerably.Research limitations/implicationsThis article offers a novel conceptualisation of public management institutional change, which can help explain why it is difficult to completely erase NPM practices in health.Originality/valueThis paper explores the rhetorical practices that are used in the introduction of a New Public Governance policy framework.

Do we need medical leadership or medical engagement?

2015 ◽  
Vol 28 (3) ◽  
pp. 173-184 ◽  
Author(s):  
Peter Spurgeon ◽  
Paul Long ◽  
John Clark ◽  
Frank Daly
Keyword(s):  
Care Quality ◽  
Current Evidence ◽  
Organisational Performance ◽  
Content Type ◽  
Care Quality Commission ◽  
The Uk ◽  
Medical Leadership ◽  
First Time ◽  
Practical Implications ◽  
A Current

Purpose – The purpose of this paper is to address issues of medical leadership within health systems and to clarify the associated conceptual issues, for example, leadership versus management and medical versus clinical leadership. However, its principle contribution is to raise the issue of the purpose or outcome of medical leadership, and, in this respect, it argues that it is to promote medical engagement. Design/methodology/approach – The approach is to provide evidence, both from the literature and empirically, to suggest that enhanced medical engagement leads to improved organisational performance and, in doing so, to review the associated concepts. Findings – Building on current evidence from the UK and Australia, the authors strengthen previous findings that effective medical leadership underpins the effective organisational performance. Research limitations/implications – There is a current imbalance between the size of the databases on medical engagement between the UK (very large) and Australia (small but developing). Practical implications – The authors aim to equip medical leaders with the appropriate skill set to promote and enhance greater medical engagement. The focus of leaders in organisations should be in creating a culture that fosters and supports medical engagement. Social implications – This paper provides empowerment of medical professionals to have greater influence in the running of the organisation in which they deliver care. Originality/value – The paper contains, for the first time, linked performance data from the Care Quality Commission in the UK and from Australia with the new set of medical engagement findings.

scholarly journals Training for Health System Improvement: Emerging Lessons from Canadian and US Approaches to Embedded Fellowships

2019 ◽  
Vol 15 (SP) ◽  
pp. 34-48
Author(s):  
Meghan McMahon ◽  
Stephen Bornstein ◽  
Adalsteinn Brown ◽  
Lisa Simpson ◽  
Lucy Savitz ◽  
...  
Keyword(s):  
Health System ◽  
Health System Improvement ◽  
System Improvement

Fellowship Program in Health System Improvement: A novel approach integrating leadership development and patient-centred health system transformation

2018 ◽  
Vol 31 (2) ◽  
pp. 62-65 ◽  
Author(s):  
Donald J. Philippon ◽  
Stephanie Montesanti ◽  
Tania Stafinski
Keyword(s):  
Leadership Development ◽  
Health System ◽  
System Transformation ◽  
Fellowship Program ◽  
Early Assessment ◽  
University Of Alberta ◽  
Health System Improvement ◽  
Novel Approach ◽  
System Improvement ◽  
The University

This article highlights a novel approach to professional development, integrating leadership, development and patient-centred health system transformation in the new Fellowship Program in Health System Improvement offered by the School of Public Health at the University of Alberta. Early assessment of the program is also provided.

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