Adaptive Leadership and Independent Opinions: Lessons From the National COVID-19 Immunisation Programme

Malaysia was slow to begin its COVID-19 immunization program for various reasons. However, it is one of the fastest developing countries to vaccinate 80% of its adult population. Nontraditional health leadership played a large role in the implementation of the National COVID-19 Immunisation Programme (NCIP). Independent opinions from academia also helped the NCIP and may be useful as a way of pushing forward recommendations that may otherwise be difficult to make.

Adaptive leadership of doctors during COVID-19

Purpose This study aims to examine the adaptive leadership of doctors during COVID-19 to understand the leadership competencies required for adaptive events. Design/methodology/approach Phenomenology-based qualitative design was used. Data were collected from six doctors from the state of Kerala, India using semi-structured interviews. Findings Five themes were identified. The first theme, core leadership shows that doctors perceive leaders as educators, learners and social beings. The second theme, adaptive challenges, describes the ambiguous pandemic-related challenges that doctors are facing including, unusual occupational demands, information overload, sociocultural issues and personal intricacies. The third theme reflects that for doctors, adaptive work during the pandemic included – new learning to address unique issues, changing perspectives and establishing and maintaining a safe and engaging workplace environment. The fourth theme describes the adaptive leadership competencies such as regulating distress, providing direction, maintaining disciplined action, fostering collaboration, empowering, understanding organizational linkages, strategic vision and communication skills. The fifth theme elucidates the lacunae in leadership training as perceived by the doctors. Research limitations/implications The findings can help in developing and enhancing competency frameworks for doctors’ adaptive leadership. Originality/value This is one of the earliest studies to systematically examine components of adaptive leadership for doctors during COVID-19 and identify associated competencies.

Using a Theoretical Framework in a Qualitative Metasummary About Fatigue Adaptation After Stroke

We describe how we used a theoretical framework, Adaptive Leadership Framework for Chronic Illness (ALFCI), to complete a qualitative metasummary in a scoping review of 26 articles. We abstracted and grouped qualitative findings relevant to fatigue adaptation in stroke survivors using constructs of the ALFCI as 4 main themes: 1) adaptive challenges, 2) adaptive work, 3) adaptive leadership and collaborative work, and 4) technical challenges and technical work. We found that stroke survivors encountered different aspects of challenges (e.g., physical dysfunction vs. mental distress) and utilized various adaptive work (e.g., conserving energy vs. restructuring normality) as well as what stroke survivors needed from healthcare professionals (e.g., basic knowledge about fatigue). The ALFCI provides a useful lens to synthesize qualitative findings regarding fatigue adaptation and therefore researchers can target different problems that need to be tackled for stroke survivors, care partners, or healthcare professionals, respectively.

Research Applying Adaptive Leadership Framework for Chronic Illness Across Settings of Care

The carepartner is an essential member of the team to facilitate and assist in maximizing the independence of the older adult. The four papers in this symposium applies The Adaptive Leadership Framework for Chronic Illness (ALFCI) at the point of design, as well as an analytic framework for literature synthesis, intervention design, and analysis of existing data. In the first paper, a qualitative metasummary of a scoping review synthesizes qualitative findings about fatigue adaptation and challenges for stroke survivors, care partners, and healthcare professionals. The second paper describes the use of the ALFCI in an intervention study to manage symptom challenges in older adults with acute myeloid leukemia. The third paper shares staff’s experiences of providing direct care for older residents with advanced dementia in long-term care facilities. The fourth paper describes use of the carepartner–assisted intervention to improve oral hygiene of older adults with cognitive impairment. The ALFCI is a useful framework for intervention design 1) this framework provides a comprehensive way to examine the context of symptoms/behaviors (not just the symptom/behavior in isolation), 2) the framework guides “collaborative work”, 3) analytically it can help guide development of shared meaning of communication and “collaborative work” of dyads (family caregivers, long-term care staff and older adults), and 4) helps understand process of staff utilizing their strengths and doing adaptive work to facilitate interactions and communication, managing older residents’ behavioral and psychological symptoms of dementia, and improving their care provision and work life.

Using the Adaptive Leadership Framework for Chronic Illness to Design a Palliative and Collaborative Intervention

Our study addresses symptoms and functional management early in acute myeloid leukemia treatment using a PAlliative and Collaborative Care inTervention (PACT) delivered by clinical staff. PACT is an interdisciplinary nurse-led intervention of nursing [RN], occupational therapy [OT], physical therapy [PT] for adults ≥ 60 years of age at time of initial treatment. Finding from our preliminary qualitative work led to use of the Adaptive Leadership Framework for Chronic Illness to guide optimal engagement of the patient in self-management of symptoms and functional activities to address QOL outcomes. We share lessons learned of how the ALFCI was applied to the PACT intervention to empower patients with self-management skills to reduce symptoms and optimize function. In summary, the team and patient identify and address emotional, motivational, attitudinal barriers so that the patient can do the work required for self- management to reduce symptoms and avoid functional decline.

Providing Care for Older Residents With Dementia in Nursing Homes in China: Through the Lens of Adaptive Leadership

This study aims to understand staff’s experiences of providing direct care for older residents with advanced dementia in long-term care facilities through the lens of Adaptive Leadership Framework for Chronic Illness (ALFCI). Semi-structured interviews were conducted with health care aides (N=35) from 2 government-owned and 2 private long-term care facilities in urban China. Directed and conventional content analysis were used, drawing upon core constructs of ALFCI. We found that health care aides are confronted with multiple challenges such as high intensity of work, stress from managing older residents’ behavioral and psychological symptoms of dementia (BPSD), a lack of access to on-the-job dementia-specific training, and a lack of support from nurses and managing team. Some of the health care aides demonstrated use of their strengths and doing adaptive work to improve work life and care for older residents by using communication cues, enhancing person-centeredness in their care, and facilitate peer interactions.

Qualitative Analysis of Coaching With Care Partners of People With Cognitive Impairment

We apply the adaptive leadership framework for chronic Illness in a care partner–assisted intervention to improve oral hygiene of older adults with cognitive impairment. Care partners receive four coaching sessions which we recorded and transcribed verbatim. We will describe how our team of seven investigators codes the data using a priori codes from the framework. The data from 17 care-partners contributes 68 individual sessions for coding. We have two subgroups of 7 individuals with mild dementia (MD) and 10 with mild cognitive impairment (MCI). We will discuss the plan for multiple comparisons such as (a) longitudinal across 3 months of intervention, b) within MD and within MCI and c) between MD and MCI. To illustrate, we will discuss our approaches to reaching coding consensus and rigor and will present results of the within group analyses. Finally, we will discuss next steps and the end products we aim to achieve.