Corporate governance: up to date

Corporate governance is the system by which companies are directed and controlled. Boards of directors are responsible for the governance of their companies. Nonprofit governance is a political and organizational process involving multiple functions and engaging multiple stakeholders. The responsibilities of the board include setting the company’s strategic aims, providing the leadership to put them into effect, supervising the management of the business and reporting to shareholders and stakeholders on their stewardship and to ensure the mission fullfillment and overall accountability.

Having a knowledgeable and engaged board, a board that understands its fiduciary role, its managerial role and depending on the type of institution its fundraising role. is very important specially in public institutions and non for profit.

The Centre for Research in Health and Economics CRES from the Universitat Pompeu Fabra has published recently some policy papers related to  Corporate Governance. 

• Dalmau-Matarrodona, E.; "Bones pràctiques del govern de les organitzacions" Health Policy Papers Collection 2026-4_ED [Download]
• López-Casasnovas, G., Planas-Miret, I.; "La gobernanza de la colaboración público-privada en sanidad. El caso de Catalunya." Health Policy Papers Collection 2026-3_GL_IP [Download]
• Ortún, V.; "Gobierno y gestión de las organizaciones sanitarias" Health Policy Papers Collection 2026-2_VO [Download]
• López-Casasnovas, G.; "Anomalies organitzatives als consells de govern de les organitzacions públiques" Policy Papers Collection 2026-3_GL [Download]

Another interesting paper published in 2014 by Yvonne D. Harrison (University of Albany) and Vic Murray (University of Victoria): Guidelines for Improving the Effectiveness of Boards of Directors of Nonprofit Organizations

photo Jordi Soldevila. Màcula Malèvich de Sant Pau

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Specialty choices among new generation of doctors - insights from a Polish survey study

Currently, healthcare systems around the world are facing serious labour crises, significant shortages, and unequal geographical distribution of doctors. One of the key issues in maintaining an adequate health workforce is young graduates’ choice of medical specialty. Their career choices substantially influence the future balance between different medical specialties. To better align the choices of young doctors with the needs of the healthcare system, we have to understand the differences between doctors who are already working and those who are only just starting. 

Three generations currently dominate the population of doctors in the workforce: the baby boomers (born 1945–1964), generation X (born 1965–1979), and generation Y (millennials: born 1980–1994). Each generation brings its characteristics to the medical profession. The baby boomers are known for working long hours and viewing medicine as a tireless vocation, while generations X and Y are more tech-savvy, value mobility, and prioritize work-life balance.

Doctors currently entering the healthcare labour market (generation Z) were born between the late 1990s and early 2010s. This generation, also known as‘Gen-Z’, differs significantly from older generations in many ways. Gen-Z individuals were born into a world of widespread access to information, largely due to the internet. They are proficient in using modern technologies, more focused on achieving a healthy work-life balance, and are more open to change in their lives compared to the generations of their parents and grandparentts. However, they do not accept the current state of workplace culture and working hours. They strongly desire a life-work balance, flexibility in working conditions, and collaboration in the workplace.

Although they have chosen a medical career, many young healthcare professionals report that their expectations are not being met, especially concerning non-clinical tasks, including the administrative burden. They understand that the success of future healthcare systems is closely linked to the implementation of new technologies, recognizing its potential to reduce administrative workload and work-related stress. Besides salary, autonomy, collaboration, and technology play a crucial role in selecting a workplace (hospital or practice). To attract and retain this younger generation, healthcare organisations need to focus on team collaboration, a friendly working atmosphere, and adapt their work organisation practices accordingly.

In Poland, many specialties are experiencing a ‘generation gap, which requires well-thought-out decisions to compensate for the forthcoming crisis that would become even more serious if doctors at retirement age were to stop working.

This article aimed to provide evidence on the factors that drive young doctors to choose their future specialties, presenting differences between those applying for non-surgical specialties and those applying for surgical ones.

Article: open acces and pdf

photo Jordi Soldevila. Màcules de Barcelona. Màcula simple del carrer Escorial

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The future hospital in Global Health Systems

Future hospitals must be able to adapt in many ways to the changing demands on their roles and functions within evolving healthcare delivery infrastructures. These include changing population structures and needs, new models of healthcare provision, technological advances, and innovations in design, all while enhancing their environmental sustainability.

This article sets out the issues that those determining healthcare policy and designing future hospitals must consider if they are to become and remain fit for purpose within the wider health and social care system. It also examines the need for, and challenges to, strategic healthcare planning, creating future hospitals that are sustainable, net‐zero carbon organisations, and ensuring resilience in the face of a range of potential shocks.

Future hospitals play a crucial role in healthcare worldwide, regardless of the country's income level. Hospitals cannot be viewed without broader health system changes, infrastructure, community and cultural factors, staffing and other considerations. Future hospitals will enhance population health in all settings and support the move towards more consumer‐centric healthcare. The authors urge clinical and policy planners to consider the factors discussed carefully to maximise the benefits.

Article (2025) open access

Sebire NJ, Adams A, Celi L, Charlesworth A, Gorgens M, Gorsky M, Landeg O, Nagasawa Y, Nimako KT, Onoka C, Roder-DeWan S, Watts N, McKee M. The Future Hospital in Global Health Systems: The Future Hospital Within the Healthcare System. Int J Health Plann Manage. 2025 May;40(3):741-751. doi: 10.1002/hpm.3891. Epub 2025 Jan 15. PMID: 39815953; PMCID: PMC12045726.

Photo Jordi Soldevila. Posidònies. Cicatriu 1

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The Great Resignation: Why women health workers are leaving

The ‘Great Resignation’ of women health workers is impacting women and health systems globally, with a concerning ‘Great Migration’ trend. This exodus exacerbates the existing health worker shortage crisis, affecting countries striving to achieve universal health coverage.The report published in October 2023 by Women in Global Health explores these issues in depth and calls for gender-transformative solutions to address workforce imbalances.

Countries competing for increasingly scarce trained health workers challenge the principles of global solidarity and ethical international recruitment, enshrined in global agreements like the WHO Code (WHO Code on the Practice of International Recruitment of Health Personnel)

"The WHO Code encourages all member states to act in solidarity, produce sufficient health workers domestically and invest in supporting countries with vulnerable health systems to strengthen their health workforce"

Health workers take years, sometimes over a decade to train, so lead times are long for producing the millions of new health workers needed to fill the gap. The urgent issue now is retaining trained health workers and reversing attrition from the sector.

Replacing domestic health workers with international recruits may just be putting new recruits into the same broken systems that caused the domestic health workers to leave. Coordinated action by governments is needed urgently to address health worker attrition in the short term and plan longer term to fill health worker shortages sustainably without reliance on unethical international recruitment.

The central role played by women health workers in the pandemic, along with the health and psychological impacts they endured in the course of their work, has placed a spotlight on their needs. Gender transformational change is needed to fix health workforce inequities and retain and attract back the women who are leaving. 

Women in the health workforce need a new social contract based on equal leadership, safe, decent and fairly paid work, to enable them to deliver health for all.

Report (pdf): 

Photo Jordi Soldevila. Els Monstres d'Ingres. IV

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When you see your neighbor's beard peeling, soak yours.

The NHS turns 77 this year 2025. Until recently, it has been widely regarded as the “crown jewel” of the British welfare state. Throughout its history, the NHS has achieved significant successes, including providing financial protection against the costs of ill health, incorporating formal assessments of new medical technologies, and delivering generally well-received care once accessed. Moreover, the NHS has been a driving force in medical research and innovation, pioneering advancements in treatments, healthcare delivery, and disease prevention. However, over a decade of austerity funding, compounded by the impact of the COVID-19 pandemic, has exposed its vulnerabilities. The NHS has shown limited resilience to external shocks and appears increasingly unsustainable in the face of growing demand.

Waiting lists are at an all-time high, population health outcomes in the UK are worsening, staff shortages and dissatisfaction remain persistent, and public confidence in the institution is wavering. In short, the NHS is in crisis.

The Labour government has increased NHS funding, but not to a level that several experts—including the LSE-Lancet Commission—deem sufficient to meet rising demands. The government has also announced a new 10-year plan. But will these measures be enough?

This event organized by the LSE last june explored the current state of the NHS, assessed whether the government's responses are adequate, and discussed whether more radical reforms are necessary. The discussion provided both critical reflection and potential solutions to address the crisis.

• Podcast to listen to.
• Video of the event to watch
• Slides and Speakers: to download here.

Photo Jordi Soldevila. Homenatge a Toni Catany Mandarina

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Doctors must live

Caroline Engen published in february 2025 the article: «Doctors must live»: a care ethics inquiry into physicians’ late modern suffering. Med Health Care and Philos 28, 275–290 (2025).

A good article to read (Free Acces) Article

Abstract: 

In 2023, thousands of young Norwegian physicians joined an online movement called #legermåleve (#doctorsmustlive) and shared stories of their own mental and somatic health issues, which they considered to be caused by unacceptable working conditions. 

This paper discusses this case as an extreme example of physicians’ and healthcare workers’ suffering in late modern societies, using Vosman and Niemeijer’s approach of rethinking care imaginaries by a structured process of thinking along, counter-thinking and rethinking, bringing to bear suffering as a heuristic device. 

1. Thinking along, taking the physicians’ stories and arguments literally, reveals an image of an unbearable workload. 
2. Counter-thinking resituates their suffering within the broader conditions of late modernity, suggesting that the root cause may lie not in the quantity of the workload itself but in its qualities and in its perceived threat to their integrity as caregivers through epistemic and moral injury and an inability to respond to this threat. 
3. In rethinking, the ambiguity of suffering– its dual potential as both a constraint and an opening– becomes central. 

Following the physicians’ own interpretations and the solutions emerging from this framing, both their suffering and that of their patients could paradoxically be exacerbated by further decentering physicians and reinforcing utilitarian, data-driven approaches. 

However, staying with their suffering and reinterpreting its causes opens possibilities to leverage critiques of medicalization at large and of their own suffering in particular, challenging the assumption that the weight of care must always grow heavier. 

From this reframing, I argue, it is possible to reclaim and reimagine care and the clinical space as a nexus of epistemic and moral privilege, recentering response-ability both relationally and socially.

Photo Jordi Soldevila. Els Monstres d'Ingres. III

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Marmot places. An initiative that must be implemented in Catalonia

"Social Injustice is killing people on a grand scale’. (M.Marmot)

Health inequalities are the systematic differences in health between social groups. Where they are judged to be avoidable differences they are inequitable, unfair. 

Putting them right is a matter of social justice. Reducing these inequities requires actions to improve the social determinants of health – the social, economic, political, physical and cultural conditions that shape our lives and our behaviours.

 
The UCL Institute of Health Equity  established in 2011 and being led by Professor Sir Michael Marmot leads and collaborates on work that addresses the social determinants of health and improves health equity. The IHE created the concept of Marmot Places. 

A Marmot Place recognises that health and health inequalities are shaped by the social determinants of health (SDH) and takes action on these social determinants at a local level. 

Sometimes called the building blocks of health, these social determinants are the conditions in which people are born, grow, live, work and age, such as education, employment and housing, and lead to wide differences in people’s health and in their life expectancy. Many places across England and Wales have become Marmot Places putting health equity at the heart of their local strategies.

Becoming a Marmot Place: 

Marmot Places develop and deliver interventions and policies to improve health equity based on eight principles:

1. Give every child the best start in life. 
2. Enable all children, young people and adults to maximise their capabilities and have control over their lives. 
3. Create fair employment and good work for all. 
4. Ensure a healthy standard of living for all. 
5. Create and develop healthy and sustainable places and communities. 
6. Strengthen the role and impact of ill health prevention. 
7. Tackle racism, discrimination and their outcomes. 
8. Pursue environmental sustainability and health equity together.

Article: Public health and health inequalities: a half century of personal involvement Michael Marmot Journal of Public Health, 2022

LSE Health's Annual Lecture:: Social justice and health equity March 2025, M.Marmot

 

Photo Jordi Soldevila. Geometries de la injustícia II

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The generational differences: Health systems leaders need to modernize the workplace and workforce practices to reflect the values of younger health care workers.

Why new generations workers are leaving from healthcare sector?

Many younger workers cite toxic cultural dynamics, such as micromanagement, hierarchical structures, and lack of support from leadership, as significant contributors to dissatisfaction and burnout.

Younger health care workers (physicians, nurses, social care, data managers, economists, lawyers....,),  have different values than older health care workers like:

1. Work-Life Balance: Many new workers prioritize flexibility and mental health, yet the rigid schedules and high stress of healthcare roles often clash with these values.
2. Communication Challenges: New employees increasingly seek purpose-driven careers, and closing the loop on communication is crucial. Are new employees instructed on how to communicate?. The practice of medicine is based on human interaction and communication, as well as science. Balancing patient needs inside an environment of mutual respect is the goal. The deskless workforce in healthcare is high-touch, with patient and co-worker interaction at the center of service delivery. Knowing how to build trust and collaborate is key, across all generations.
3. Conflict with Traditional Structures: Many younger employees feel out of sync with the hierarchical and rigid structures common in healthcare organizations, preferring collaborative and innovative environments.

Health system leaders and administrators should consider new strategies to modernize the workplace and workforce practices to reflect the values of younger health care workers.

• Create an environment to report instances of discrimination, inequalities, and racism quickly and anonymously.
• Develop equity-centered hiring and retention practices. Including (DEI) practice: diversity, equity, and inclusion. Employees want to work at organizations that prioritize DEI practices.
• Design a healthy environment that prioritizes employee wellness. Early-career health care workers who began working during the COVID-19 pandemic endured unprecedented stress and pressure that likely influenced their outlook. Both early-career and longtime health care workers increasingly report feeling burnt out; health care leaders need to create work environments that support overall wellbeing and make workers feel heard and valued. 
• Promote empathy among the managers and leaders to understand the concerns, feelings, and thoughts of their teams.
• Provide employment opportunities for people with disabilities.
• Create a specific mentoring programms to increase awareness regarding gender, young and old, diversity, equity, and inclusion in an organization.
• Support its employees at every step in their career and promote also the accountability at every step: “Accountability breeds response-ability.”― Stephen R. Covey.

Source: 

1. Morenike Ayo-Vaughan and Laurie Zephyrin, “Young Health Care Workers See More Discrimination in the Workplace, Leading to Added Stress and Burnout,” To the Point (blog), Commonwealth Fund, May 29, 2024. Blog

2. Forbes 2024

Photo Jordi Soldevila. Seqüència Xostakòvitx. Quartet número núm  8,

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Research on Integrated Care Systems: workforce

Integrated care systems (ICSs) were given statutory powers and new legal responsibilities for the first time in July 2022 in UK. 

These changes were intended to increase collaboration in the health and social care sector and to enable the NHS, local authorities and other partners to take collective responsibility for improving health outcomes, reducing inequalities, delivering better value for money, and driving local social and economic development. 

This research examines the development of ICSs by assessing their efforts to develop system-wide approaches to the recruitment, training and retention of staff. Workforce issues such as these are currently some of the biggest challenges facing the health and care sector, and require a co-ordinated response from multiple organisations of the kind that ICSs were designed to enable. 

Leading system-wide transformation is slow and the work is hard, but there are clear signs that progress is being made. 

The research identified six distinctive ways in which ICSs are adding value: ◦ organising around a shared purpose ◦ building system leadership ◦ encouraging system-focused behaviours ◦ scaling and spreading success ◦ using resources more effectively ◦ managing complexity. The degree which this is happening varies across systems. 

Despite signs of progress, there is a clear risk of ICSs going ‘off track’ as a result of pressures on services, intense political scrutiny, and extremely difficult economic circumstances – and the effect these conditions are having on the behaviours of leaders locally, regionally and nationally. There is widespread concern that ICSs may not achieve their full potential unless more is done to create an environment conducive to their success. 

The research suggests that success relies primarily on supporting people to think, plan and act in ‘system-focused’ ways. If this is to happen, different behaviours are needed at all levels of the system. National bodies need to create a more enabling environment and ensure that accountability and funding mechanisms support system working. Local leaders need to model system working in their relationships with partners across the system. 

There is considerable interest in how ICSs are performing and there is a danger that attention focuses on the things that are easier to measure. The research suggests that the less visible work of supporting people to work together differently is critical for success and must not be undervalued. The ability to do this well is one of the key factors that will determine whether ICSs succeed in delivering better population health and more joined-up care for people using services.

Kingsfund report ICS, 2024

Photo Jordi Soldevila. Iteració de les portes tancades

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Is competitive pressure essential for sustaining quality in primary care services?

The authors Eduard Brüll, Davud Rostam-Afschar, and Oliver Schlenker study how the threat of entry affects service quantity and quality of general practitioners (GPs).

They leverage Germany’s needs-based primary care planning system, in which the likelihood of new GPs reduces by 20 percentage points when primary care coverage exceeds a cut-off. They compile novel data covering all German primary care regions and up to 30,000 GP-level observations from 2014 to 2019. Reduced threat of entry lowers patient satisfaction for incumbent GPs without nearby competitors but not in areas with competitors. They find no effects on working hours or quality measures at the regional level including hospitalizations and mortality.

While entry restrictions aim to ensure equitable access to care, they can unintentionally reduce service quality by weakening competition. Policymakers must navigate this trade-off carefully, ensuring that access does not come at the expense of quality. By preserving competitive incentives even in regulated markets, healthcare systems can achieve both equitable and high-quality care.

IZA Discussion Paper No. 17534

Access to working paper 2024 (pdf)

Photo Jordi Soldevila. Merry Christmas

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Yes, Minister

Yes, Minister is a British political satire sitcom written by Antony Jay and Jonathan Lynn. Comprising three seven-episode series, it was first transmitted on BBC2 from 1980 to 1984. A sequel, Yes, Prime Minister, ran for 16 episodes from 1986 to 1988.

It is a satirical sitcom set in the office of a UK Cabinet minister, Jim Hacker MP, who struggles with Civil Service bureaucracy and political machinations as he tries to get on with government business

Video: Funniest moments 

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Human resources in the National Health System. SESPAS Report 2024 (part 3)

The Spanish Society of Public Health and Health Administration publishes in Gaceta Sanitaria its biennial SESPAS 2024 Report, which shows a series of artices analysing the current situation of the National Health System in terms of Human Resources.

• Pay for performance in public directly managed healthcare centers. Part 1: General framework.  José-Ramón Repullo y JM Freire

• Pay for performance in public directly managed healthcare centers. Part 2: The Spanish National Health System.  José-Ramón Repullo y JM Freire

• Dual practice in the Spanish health system: problem or solution? Ariadna García-Prado, Paula González

• Recruitment, selection and retention of health professionals in indirect management and private management entities Olga Pané Mena y Pau Gomar Sánchez

• Health and well-being of healthcare workers: employment and working conditions beyond the pandemic Fernando G. Benavides et. al

Video: Rosa Urbanos entrevista a J.R.Repullo y J.M Freire

Video: Vicente Ortún entrevista a R.Meneu, O.Pané, P. González, P.Gomar 

Photo Jordi Soldevila. Geometries de la injustícia. Navalni

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Human resources in the National Health System. SESPAS Report 2024 (part 2)

The Spanish Society of Public Health and Health Administration publishes in Gaceta Sanitaria its biennial SESPAS 2024 Report, which shows a series of artices analysing the current situation of the National Health System in terms of Human Resources.

• Human resource management in health. Consensual paths forward 
• Miguel Angel Negrín, Vicente Ortún
• An overview of health workforce mobility in the European Union under the current supply challenges. Angela Blanco Moreno
• Dual practice in the Spanish health system: problem or solution? Ariadna García-Prado, Paula González
• Recruitment, selection and retention staffing policies in health services directly managed. Ricard Meneu

Photo Jordi Soldevila. Deconstruccions i iteracions de la realitat. Iteració lliure en blau

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Human resources in the National Health System. SESPAS Report 2024

The Spanish Society of Public Health and Health Administration publishes in Gaceta Sanitaria its biennial SESPAS 2024 Report, which shows a series of artices analysing the current situation of the National Health System in terms of Human Resources.

• Human resources in the National Health System. Medical education. Felipe Rodríguez de Castro, Teresa Carrillo Díaz, Arcadi Gual i Sala, Jordi Palés Argullós
• Experiences in human resources planning for health: The case of physicians. Data and models. Patricia Barber Pérez, Beatriz González López-Valcárcel
• What do we know and what should we know about the imbalances of doctors in Spain? Diagnosis and proposals. Beatriz González López-Valcárcel, Patricia Barber Pérez
• Shortage of nurses in Spain: from the global case to particular situation. Paola Galbany-Estragués, Pere Millán-Martínez
• The challenges of human resources governance in public healthcare. Javier Hernández Pascual

Press conference video

Photo Jordi Soldevila. Homenatge a Toni Catany. Plats vells.

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CEO Life Cycle

No leadership position has a greater impact on an organization’s success than the CEO. Very little data exists on how CEOs tend to perform over time; CEOs, often fill the knowledge vacuum with anecdotes, assumptions, and rules of thumb.

When someone asks CEOs about the ideal tenure for the role, many mention seven-year average. They often argue that it takes minimum five years for a CEO to make a difference in their organization, to change things.

But the reality specially in the public companies is much shorter than that. The average tenure for the C-suite executives in public sector, in general, is 4.6 years. In the English NHS the average is 3.8 years. We have no data from Spain niether from the Catalan Health Service. 

CEOs in the NHS system have short tenure. 

 

To better understand the typical course of value creation over a leader’s tenure, Spencer Stuart launched what they call they CEO Life Cycle Project

Article: The CEO life-cycle

The study reveals a surprising pattern of headwinds and tailwinds that CEOs are likely to face during their years in the role and upends some common views about CEO tenure and value creation. For example, it suggests that some boards part ways with a strong CEO too early after a predictable and often temporary performance slump, while others tolerate a mediocre performer for too long.

Rarely do any two CEO tenures look alike. Each leader is on his or her own journey and faces very specific circumstances. Still, by comparing CEO performance on the basis of years in office rather than calendar years, and by viewing a composite of individual journeys, they have identified five distinct stages of value creation that many CEOs will experience during their tenure

• Year 1: The Honeymoon
• Year 2: The Sophomore Slump
• Years 3 to 5: The Recovery
• Years 6 to 10: The Complacency Trap
• Years 11 to 15: The Golden Years

CEOs in the NHS are underpressure by their politicians who have come adept at exerting outsize influence and keeping directors on their toes.The CEO life cycle gives executives, members of the boards and also politicians a common language about potential risks and opportunities at each stage. It can help boards view performance in a larger context and avoid overreacting in moments of doubt "like a political election" —or tolerating mediocrity for too long. It can also help to identify an optimal moment for the leader to step down (if he can).

Photo Jordi Soldevila. Els Monstres d'Ingres. La hipocresia 

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Teamwork in healthcare: a systematic review

Healthcare and human services increasingly rely on teams of individuals to deliver services. Implementation of evidence-based practices and other innovations in these settings requires teams to work together to change processes and behaviors. Accordingly, team functioning may be a key determinant of implementation outcomes. Understanding how team functioning influences implementation outcomes will contribute to our understanding of team-level barriers and facilitators of change.

This article is a systematic review examining associations between team functioning and implementation outcomes in healthcare and human service settings.

Affective, behavioral, and cognitive aspects of team functioning are likely to affect the ways in which teams respond to change efforts and therefore impact implementation outcomes. Better team functioning (e.g., high cohesion, effective communication) will be associated with better implementation outcomes, while problems in team functioning (e.g., poor conflict resolution, low trust) will negatively impact implementation outcomes.

Access Article

McGuier, E.A., Kolko, D.J., Klem, M.L. et al. Team functioning and implementation of innovations in healthcare and human service settings: a systematic review protocol. Syst Rev 10, 189 (2021). https://doi.org/10.1186/s13643-021-01747-w

Additional paper 

Access Article

McGuier EA, Kolko DJ, Stadnick NA, Brookman-Frazee L, Wolk CB, Yuan CT, Burke CS, Aarons GA. Advancing research on teams and team effectiveness in implementation science: An application of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Implement Res Pract. 2023 Jul 27;4:26334895231190855. doi: 10.1177/26334895231190855. PMID: 37790168; PMCID: PMC10387676.

Photo Jordi Soldevila. Estudi Geometria de la Injustícia 12

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Back to basics. Victor Fuchs (1924-2023)

Victor Fuchs was the Henry J. Kaiser, Jr., Professor of Economics and of Health Research and Policy, emeritus in Standford University.

He used economic theory to provide a framework for the collection and analysis of healthcare data. He wrote extensively on the cost of medical care and on determinants of health, with an emphasis on the role of socioeconomic factors. He spent more than five decades diagnosing the ills of the American health system, specially the health costs per capita: "The highest in the world". He also was particularly interested in the role of physician behavior and financial incentives in determining healthcare expenditures.

He was described as the dean of American health economists,

Standford obituary

Victor_Fuchs-CV (pdf)

Photo by Becky Bach

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Leadership skills necessary to improve coordination across primary, community, social and hospital services

The health needs of the population are changing, and many people need more co-ordinated care across primary, community, social and hospital services. More co-ordinated care requires organisations and staff to collaborate well across organisational and professional boundaries.

Effective working across organisations means adopting new practices to navigate challenges such as conflicting organisational goals, competing institutional norms and rules, and any perceived loss of power or resource.

The report conducted by Kings Fund draws on interview and survey data from senior leaders working in integrated care boards, NHS providers, local government and the voluntary, community and social enterprise sector, and shares insights and evidence about how to collaborate well.

The research shows health and care leaders at all levels have a critical role in modelling and rewarding collaborative behaviours but this is insufficient on its own. Leaders also need to pay attention to six leadership practices if they want to build a stronger collaborative ethos.

1. Creating a safe, inclusive and trusting environment in which everyone can contribute fully – leaders need to look at problems from perspectives beyond their own. This means leaders need to be open and trusting, to connect with others and create different spaces in which people feel safe to contribute and be heard; to listen to and value others’ contributions and ensure others do the same. 
2. Building healthy relationships – this requires sustained effort but adopting a more relational way of working based on humility, respect and trust strengthens connections between organisations and individuals leading to increased staff engagement and more co-ordinated services.
3. Developing a shared purpose and shared group identity. It is important to clearly set out the shared purpose around why organisations or/and professional groups are working together and create a shared group identity to promote engagement across the collaboration and to address any power differentials
4. Actively managing any power dynamics – so no organisation or professional group dominates. Introducing processes that create a more open and participatory environment can also be useful to enable individuals to think differently. 
5. Surfacing and managing any conflict – in collaborations you are working with different views and ideas, sometimes these will turn into conflict. It is important to approach any conflict with an open and curious mind, rather than turning away from it. 
6. Developing shared decision-making processes – designing transparent processes that enable all key organisations or groups to contribute to a decision produces a range of benefits, although it takes longer. Benefits include greater ownership over the decisions adopted and strengthening trust across a collaborating group.

This style of working is hard especially in a resource-constrained environment. The report recommend leaders give greater attention to designing more participatory processes and developing the collaborative skills of other groups of staff. Also recommend leaders extend the practice of collaborative leadership to work with a broader range of local organisations as well as local communities.

Access: Article (pdf)

Photo Jordi Soldevila. Retrat de família. Homenatge a Toni Catany

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Strengthening primary care in Europe: How to increase the attractiveness of primary care for medical students and primary care physicians?

The key messages of this policy brief published by the European Observatory on Health Systems and Policies are as follows:

1. The imperative of strengthening primary health care (PHC) has been widely acknowledged, yet many countries in Europe struggle with shortages and geographical maldistribution of general practitioners (GPs).
2. One of the root causes for these challenges is the perception among medical students and doctors that PHC is not an ‘attractive’ career option. In most contexts this is reinforced by substantial pay differentials and perceived low status between GPs and specialists.
3. Evidence on effective strategies to improve attractiveness of PHC is somewhat patchy, but a number of effective interventions covering medical education, working conditions, PHC models and workforce planning may nevertheless be distilled.
4. There is also some evidence on strategies that can help draw GPs to rural and remote areas. They cover various stages of professional life of a GP and usually aim to improve the work-life balance and reduce professional isolation.
5. On the whole, strengthening PHC will require a multifaceted strategy that employs a range of measures and targets not only medical students and physicians, but also nurses and other PHC professions, patients and the general public.
6. Crafting such a strategy will require a very good understanding of the local context and a much better understanding of the effectiveness of various interventions as the evidence for most of them is currently either patchy or absent.

Note that this policy brief presents the results of a literature review conducted in 2018-2019 before the COVID19 crises.

Acces: Policy brief 55 march 2023

Photo Jordi Soldevila. Refugi 3

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Organizational change

This research by Noora Jansson from ouluhealth scrutinizes organizational change by combining discourse and practice approaches. A case study at a public university hospital is conducted with a narrative analysis method.

The key finding of this research is that discursive practices are involved in organizational change through discourse phronesis. Discourse phronesis is a socially and contextually developed phenomenon, and hence discursive practices are particular within context. The case study revealed four particular discursive practices as examples of discourse phronesis: field practices, mandate practices, priority practices and word practices.

The results of this research advance awareness of the concealed power within discursive practices and, more importantly, invite practitioners to pursue the intellectual virtue of discourse phronesis while implementing organizational change. Discourse phronesis may be utilized as a gateway to advance change goals and to translate various discourses and actions that otherwise might remain unexplained.

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This post was inspired by an article published in a newspaper by Xavier Marcet about the complexity to undergo a transition or change in an organization.

Photo Jordi Soldevila. Homenatge a Toni Catany Final

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