Exploring managers’ response to a quality and safety leadership intervention: findings from a multiple case study in Norwegian nursing homes and homecare services

BackgroundImprovement interventions would be easier to treat if they were stable and uninfluenced by their environment, but in practice, contextual factors may create difficulties in implementing and sustaining changes. Managers of healthcare organisations play an important role in quality and safety improvement. We need more research in the nursing home and homecare settings to support managers in their quality and safety improvement work. The aim of this study was to explore managers’ response to a leadership intervention on quality and safety improvement.MethodsThis study reports findings from the SAFE-LEAD intervention undertaken from April 2018 to March 2019. The research design was a multiple case study of two nursing homes and two homecare services in four municipalities in Norway. We used a combination of qualitative methods including interviews, workshops, observations, site visits and document analysis in our data collection that took place over a 1-year period.ResultsManagement continuity was key for the implementation process of the quality and safety leadership intervention. In the units where stable management teams were in place, the intervention was more rooted in the units, and changes in quality and safety practice occurred. The intervention served as an arena for managers to work with quality and safety improvement. We found that the workshops and use of the leadership guide contributed to a common understanding and commitment to quality and safety improvement among the managers.ConclusionsThis is a longitudinal study of managers’ response to a leadership intervention targeted to improve quality and safety work in nursing home and homecare settings. Our research demonstrates how the mechanisms of stable management and established structures are crucial for quality and safety improvement activities. Management continuity is key for participating in interventions and for using the leadership guide in quality and safety work.

Talking AI into Being: The Narratives and Imaginaries of National AI Strategies and Their Performative Politics

How to integrate artificial intelligence (AI) technologies in the functioning and structures of our society has become a concern of contemporary politics and public debates. In this paper, we investigate national AI strategies as a peculiar form of co-shaping this development, a hybrid of policy and discourse that offers imaginaries, allocates resources, and sets rules. Conceptually, the paper is informed by sociotechnical imaginaries, the sociology of expectations, myths, and the sublime. Empirically we analyze AI policy documents of four key players in the field, namely China, the United States, France, and Germany. The results show that the narrative construction of AI strategies is strikingly similar: they all establish AI as an inevitable and massively disrupting technological development by building on rhetorical devices such as a grand legacy and international competition. Having established this inevitable, yet uncertain, AI future, national leaders proclaim leadership intervention and articulate opportunities and distinct national pathways. While this narrative construction is quite uniform, the respective AI imaginaries are remarkably different, reflecting the vast cultural, political, and economic differences of the countries under study. As governments endow these imaginary pathways with massive resources and investments, they contribute to coproducing the installment of these futures and, thus, yield a performative lock-in function.

Quality initiative (QI) in unresectable stage III non-small cell lung cancer (NCSLC): Impact on time-to-treatment (TTT) for immunotherapy post chemoradiation (CRT).

e18780 Background:In August 2019 Integra Connect (IC) partnered on a QI with University of Pittsburgh Medical Center (UPMC) to improve outcomes in patients with stage 3 and 4 NSCLC. This report details the findings and interventions in the unresectable stage 3 cohort of the QI. The addition of durvalumab (D) in the PACIFIC trial (Antonia et al. NEJM 2017) after completion of CRT in stage 3 patients who had not progressed showed significant Progression Free Survival and Overall Survival (OS) benefit with Food and Drug Administration approval on 2/16/2018 in this setting. An update (Gray et al. Thoracic Oncol 2020) on 10/14/2019 noted superior OS in patients in whom randomization to D occurred 1-14 days post CRT vs. those with interval 15-42 days (HR 0.43 vs. 0.79). Data suggest that CRT renders tumors more responsive to immunotherapy (McCall et al. Clin Can Res 2018). As part of the QI, we explored the question whether time from CRT to D (TTT) could be shortened. Methods:From the UPMC and IC real-world-data (RWD) databases, we identified 182 patients with Stage 3 unresectable NSCLC treated with CRT between 2/16/18 (D approval) and 11/16/20 for manual chart abstraction. We calculated the TTT from the latest day of radiation or chemotherapy to the first D dose. Time-to-scan (TTS) used a similar methodology. If post-CRT scan data was not found, those patients were excluded from TTS analysis. We captured caregiver perception with surveys and used RWD to determine the proportion of eligible patients treated with D, categorizing the data into 3 successive time periods: Phase 1 (240 days): 2/16/18 approval of D to Gray update 10/14/19, Phase 2 (321 days): 10/15/19 to physician leadership intervention 8/31/20, Phase 3 (76 days): 9/1/20 to 11/16/20. Patients were excluded in phase 3 who started CRT after 11/16/20 to allow for up to 2 months to start D. Our plan included baseline and ongoing monitoring of metrics complemented with physician leadership intervention to address identified gaps in care. Results: Median age of the 182 patients was 68 (range 46-87) with 60% male. Of eligible patients, 121 (66.5%) received at least 1 dose of D. Median TTS improved 16 days from Phase 1 to Phase 3 while TTT concomitantly improved 17 days (Table ). Conclusions: This QI resulted in simultaneous shortening of TTS and TTT following physician intervention with establishment of TTS as a key potential driver of TTT which ultimately may result in improved OS. To do so required overcoming the traditional paradigm of imaging 4-6 weeks post-CRT to capture maximal response with that of early imaging aimed at assuring no progression had occurred. This, as well as proportion treated with D and its resulting duration, plus any subsequent treatments that might indicate relapse, continue to be monitored in a real-time dashboard.[Table: see text]

Microfinance and Peer Health Leadership Intervention Implementation for Men in Dar es Salaam, Tanzania: A Qualitative Assessment of Perceived Economic and Health Outcomes

Men in sub-Saharan Africa continue to experience health disparities that are exacerbated by low employment. This study qualitatively assessed men’s perceptions of the economic and health-care-seeking effects of participation in an integrated microfinance and peer health leadership intervention on violence and HIV risk reduction in Tanzania. Three focus group discussions with 27 men, aged 20 to 44 years, examined the perceived effects on income generation, employability, mental health, and uptake of HIV and related health services. All discussions were recorded, transcribed, and analyzed using deductive and inductive coding methods. Men reported that the benefits of the intervention included increased employability and income-earning activities due to greater access to entrepreneurial training, low-interest microfinancing, and male-oriented group supports to start or strengthen their businesses. Increased wages through business or other forms of employment were also attributed to men’s lower anxiety and distress as financial providers for their families. However, men indicated that apart from the uptake of free HIV testing services, there was limited change in overall health-care-seeking behavior given the high clinic fees and lost time to earn income when attending routine health visits. Men recommended that future microfinance and health promotion interventions provide larger loan amounts, less frequent repayment intervals, and access to health and social insurance. Microfinance and peer health leadership interventions may help to address economic and health disparities in poor, urban men. Efforts are needed to assist lower income men in accessing financial tools as well as fee-based preventive and health-care services.

Determining and Improving Shared Leadership in an Elite Junior Volleyball Team

Shared leadership contributes to team functioning, collective efficacy, and team resilience. This applied study aimed to increase shared leadership by providing role clarification and tailored leadership interventions and to systematically evaluate the effects of these interventions. A leadership-intervention program was delivered with a female elite junior volleyball team of 20 players (age, M = 15.14, SD = 0.73). The intervention included acquaintance, recognition, analysis, and practice with leadership behavior during training/competition and was conducted before the start of the season. Changes in leadership were evaluated with a social-network analysis. Results showed that after role clarification, social- and external-leadership scores increased significantly. Task-, motivational-, and social-leadership scores improved significantly after the leadership-development intervention. The study offers a detailed description of the intervention and a systematic evaluation of results. Role clarification and a leadership program provide quick and practical avenue to increase awareness and shared leadership skills.