Strong leadership is essential for efficient crisis management within public administration throughout global poly crises to alleviate the crisis's effect on individuals and bolster organizational resilience. This meta-analysis examined the correlations between leadership styles and crisis management outcomes in the context of public administration. Following the PRISMA guidelines, the study conducted a systematic search of the eight databases for studies published till December 2025. Methodological quality was evaluated using the Joanna Briggs Institute (JBI) critical appraisal tools. The final analysis included 50 studies, resulting in 72 effect sizes, 26 leadership styles, and representing 21815 participants. A random-effects model was employed to conduct the main meta-analysis, moderator analyses, and publication bias tests. The findings discovered that transformational leadership is the prevalent style in public administration amid crisis management. The meta-analysis revealed that leadership styles exhibited a significant positive correlation with crisis management outcomes, including crisis phases, sense-making, meaning-making, and learning-related outcomes. The moderating effects of the administrative subfields, administrative continent, types of crises, and hierarchy level significantly influence the nexus between leadership styles and crisis management outcomes. No substantial publication bias was detected (Egger's test, p = 0.29). This meta-analysis highlights the significance of leadership in crisis management within public administration and shows the necessity for context-specific leadership strategies adapted to the crisis environment and institutional framework. Systematic review registration: https://osf.io/qt98p/overview, Open Science Framework (OSF).
Recent mpox outbreaks highlight the need for novel, effective, and scalable vaccines against monkeypox virus (MPXV). The quadrivalent mRNA vaccine candidate BNT166a encoding MPXV antigens A35, B6, M1, and H3 was selected for clinical development based on evidence of immunogenicity and protective efficacy against multiple orthopoxviruses in preclinical models. We aimed to investigate the safety and immunogenicity of BNT166a in healthy adults. In this open-label, uncontrolled, non-randomised, dose-escalation, first-in-human, phase 1 trial, we included healthy adults with no history of mpox, smallpox, or vaccinia virus (VACV) infection. We assigned VACV-naive participants (ie, individuals with no history of smallpox or mpox vaccination) to receive two intramuscular injections of 10 μg, 30 μg, or 60 μg BNT166a 4 weeks apart, and we assigned VACV-experienced participants (ie, individuals with a history of smallpox vaccination and no other orthopoxvirus vaccination) to receive two 30 μg BNT166a injections 4 weeks apart. The primary endpoints were solicited reactions within 7 days and unsolicited adverse events within 28 days after vaccination in participants who received at least one BNT166a vaccination. Exploratory endpoints of binding and neutralising antibody titres were assessed until 12 months after the second dose in participants who received both BNT166a vaccinations. This trial is registered with ClinicalTrials.gov, NCT05988203, and is ongoing. Of 159 individuals screened for eligibility between Sept 21, 2023, and March 14, 2024, 48 VACV-naive participants (median age 35 years [IQR 24·0-39·0], 24 [50%] men, and 24 [50%] women) and 16 VACV-experienced participants (median age 58 years [54·5-60·5], five [31%] men, and 11 [69%] women) were enrolled, all of whom received at least one BNT166a vaccination. Among VACV-naive participants, local reactions (grade ≥1) were reported in eight (50%) of 16 participants in the 10-μg group, 13 (81%) of 16 in the 30-μg group, and 14 (88%) of 16 in the 60-μg group after the first dose, and in nine (60%) of 15 participants in the 10-μg group, 12 (86%) of 14 in the 30-μg group, and 13 (93%) of 14 in the 60-μg group after the second dose. Local reactions were reported in 11 (69%) of 16 VACV-experienced participants after the first dose and 14 (88%) of 16 after the second dose. Among VACV-naive participants, systemic events were reported in ten (63%) of 16 participants in the 10-μg group, seven (44%) of 16 in the 30-μg group, and 11 (69%) of 16 in the 60-μg group after the first dose, and in 11 (73%) of 15 participants in the 10-μg group, 13 (93%) of 14 in the 30-μg group, and 14 (100%) of 14 in the 60-μg group after the second dose. Systemic adverse events were reported in seven (44%) of 16 VACV-experienced participants after the first dose and in 13 (81%) of 16 after the second. Most events were mild to moderate in severity; two participants in the 60-μg group reported systemic events of grade 3 or worse after the second dose (one reported grade 3 fatigue and grade 3 fever and the other reported grade 4 fever). Adverse events considered BNT166a-related within 28 days of either vaccination were experienced by 18 (28%) participants; all but one (grade 3 neutropenia in a 60-μg dose recipient) were mild to moderate in severity. Three participants (two 10-μg dose recipients and one VACV-experienced participant) had serious adverse events, none of which were considered related to vaccination. BNT166a induced binding antibodies against all four mRNA-encoded antigens in all participants, with a 100% seroresponse rate 2 weeks after the second dose; titres persisted until 12 months after the second dose. MPXV clade IIb neutralising antibodies were detected in eight (62%) of 13 VACV-naive participants in the 10-μg group, ten (71%) of 14 in the 30-μg group, and 11 (92%) of 12 in the 60-μg group, and in 14 (93%) of 15 VACV-experienced participants. VACV neutralising antibodies were detected in six (46%) of 13 VACV-naive participants in the 10-μg group, 11 (79%) of 14 in the 30-μg group, and 12 (100%) of 12 in the 60-μg group, and in 14 (93%) of 15 VACV-experienced participants. MPXV and VACV neutralising titres peaked at 2 weeks after the second dose in the VACV-naive groups and at 1 month after the second dose in the VACV-experienced group and declined towards baseline concentrations in all groups over 12 months after the second dose. In both VACV-naive and VACV-experienced participants, BNT166a was well tolerated, with local and systemic reactogenicity events occurring more frequently after the second dose than the first. BNT166a efficiently induced multiantigen-directed MPXV antibodies, which persisted until 12 months. MPXV clade IIb and VACV neutralising capacity was shown but with waning long-term responses. The overall safety and immunogenicity profile supported BNT166a's advancement to phase 2 trials. BioNTech and the Coalition for Epidemic Preparedness Innovations.
As a key indicator in sports psychology reflecting athletes' complex physiological and psychological responses to challenges or threats, athlete burnout has become a focal issue in research on athlete-coach interactions and athletic performance.Objective To investigate the impact of coaches' leadership behaviors on athlete burnout among Chinese collegiate student-athletes and to validate the mediating roles of psychological resilience and emotion regulation in this relationship.Method Using convenience sampling combined with cluster sampling, 519 student athletes from multiple Chinese universities were selected as participants. The study employed the Coach Leadership Behavior Scale, the Burnout Scale, the Psychological Resilience Scale, and the emotion regulation Difficulty Scale for measurement. Data analysis utilized SPSS 21.0 and the Hayes Process macro for correlation analysis and mediation effect testing.Results (1) Significant gender differences emerged: Male athletes exhibited lower levels of psychological resilience and emotion regulation difficulties (i.e., stronger regulation abilities), with significantly lower sports burnout scores than female athletes (P < 0.05). No significant differences were found based on age or athletic level (P > 0.05). (2) Coach leadership behaviors showed a significant negative correlation with athletic burnout (R = -0.543, P < 0.01) and exerted a direct negative predictive effect on burnout (β = -0.276, t = -7.726, P < 0.001). Positive leadership behavior significantly enhanced psychological resilience (β = 0.615, t = 12.956, P < 0.001) and reduced emotion regulation difficulties (β =-0.472, t=-7.929, P < 0.001). Psychological resilience positively predicted emotion regulation levels (β = -0.513, t = 10.696, P < 0.001) and indirectly reduced burnout (β = -0.116, t = -3.857, P < 0.001); Reduced emotion regulation difficulties also significantly decreased burnout (β = -0.160, t = -6.394, P < 0.001); (3) Mediational analysis revealed that psychological resilience and emotion regulation difficulties jointly mediated the relationship between leadership behaviors and athlete burnout. Direct effects accounted for 58.35% of the total effect, while indirect effects accounted for 41.65%. Examining individual pathways: psychological resilience alone mediated 15.01%, emotion regulation difficulties alone mediated 15.86%, and their chained mediation effect accounted for 10.78%. This indicates that positive leadership behaviors alleviate sports burnout through dual pathways: enhancing psychological resilience and reducing emotion regulation difficulties.Conclusion Coaches' positive leadership behaviors significantly reduce athletes' burnout levels by enhancing psychological resilience and reducing emotion regulation difficulties. Psychological resilience and emotion regulation difficulties play crucial chain-mediated roles in this mechanism. This finding expands the theoretical implications of leadership behaviors and mental health in sports psychology, providing an empirical foundation for psychological promotion, fatigue management, and performance enhancement among college athletes. Future research should integrate longitudinal tracking, multi-source data, and AI-based behavioral analysis methods to enhance model explanatory power and generalizability, thereby revealing the dynamic mechanisms linking sports leadership to athletes' psychological adaptation.
Leadership initiatives are increasingly recognized as crucial drivers of policy implementation, well-being, and nutritional literacy. However, the relationship between health-oriented leadership, healthcare policy, community well-being, and community nutritional literacy remains underexplored. With increasing awareness of health and nutrition in developing countries, this study explores the role of Health-Oriented Leadership (HOL) in the implementation of human health policies, well-being, and nutritional literacy. Based on a multi-source, multi-wave survey of 355 management personnel and 360 community and stakeholder personnel in Pakistan, this study highlights the cross-level trickle-down effect of health-oriented leadership. The proposed model was tested using qualitative methods, and for analysis, this study employed multilevel structural equation modeling and regression analysis to examine direct, mediating, and moderating effects. Drawing on the human needs theory, our findings show that health-oriented leadership positively impacts the implementation of public health policy and fosters well-being and nutritional literacy in communities. Furthermore, NGO support (NS) moderates the relationship between health-oriented leadership and the execution of healthcare policy. This research is innovative and the first to examine HOL's role in implementing public health policy with NGO backing, promoting well-being, and enhancing nutritional literacy within communities. It makes a valuable contribution to the literature on nutrition and health management by providing practical insights for governments, NGOs, and community stakeholders seeking to implement leadership strategies that protect community health and promote initiatives for a balanced diet and improved living standards.
Nursing leadership and organizational culture are critical determinants of health care quality, staff well-being, and patient safety. This study investigated the research landscape of nursing leadership and organizational culture from 2001 to 2024. A bibliometric analysis was conducted using the Web of Science Core Collection database, searching publications from 2001 to 2024. Data were analyzed using VOSviewer to identify publication trends, geographical distribution, keyword co-occurrence networks, and thematic clusters of research output. A thematic diagram was developed to illustrate the interrelationships among the identified thematic clusters. Research activity surged significantly after 2009, with a marked citation increase post-2015. "Leadership," "Nurses," and "Nursing leadership" were the most frequent keywords. Five main thematic clusters were identified: leadership and patient safety, workplace dynamics, nurse leaders' well-being, evidence-based practice implementation, and burnout and job satisfaction. To clarify the relationships between clusters, an input-mediator-output thematic diagram was derived. Cluster 4 (evidence-based practice in nursing implementation) was the input and influenced the mediating processes that manifested in Cluster 1 (leadership and patient safety culture), Cluster 2 (workplace dynamics and culture), and Cluster 3 (well-being of nurse leaders and managers). These processes culminate in Cluster 5 (burnout and job satisfaction), which is a result of organizational leadership, culture, and process effectiveness. This study highlights the global prioritization of nursing leadership and organizational culture as essential research domains. The thematic clusters and diagram emphasize the critical role of effective nursing leadership in shaping positive organizational cultures that promote patient safety and support nurse well-being.
The Kingdom of Saudi Arabia and the Kingdom of Bahrain are transforming their health care systems toward more self-sustained, autonomous systems. Effective leadership at all management levels, particularly middle management, is critical for operational success. The study aimed to develop a feasible, reliable, and valid scale for measuring leadership and managerial competencies of middle managers in health care and medical education in the Gulf region. A mixed methods approach was adopted. Semistructured interviews were conducted with top management, middle management, and lower management staff (N=27). Reflexivity of coders and thematic saturation were considered to ensure the reliability and transparency of qualitative findings. Thematic analysis informed scale item creation. A total of 202 participants from medical education and health care sectors completed the scale. Cronbach α, exploratory factor analysis (principal axis factoring), and confirmatory factor analysis validated internal consistency and factor structure. Responses marked as "6=unable to assess" were treated as missing data during quantitative analysis. Seven themes emerged: personality, agility, attitude, managerial skills, work ethics, mental ability, and interaction. Three constructs were identified: professionalism and problem-solving, team management and adaptation, and time management and expertise. A validated scale with 17 competency measure points and 16 characteristic items was finalized. Only competency measure points underwent exploratory factor analysis and confirmatory factor analysis, while characteristic items were retained for descriptive evaluation. The Leadership and Managerial Competency Scale for Middle Managers in the Gulf Region reflects perceived competencies valued at all management levels. The scale measures perceived importance, not actual performance; the conclusions align with the validated scope.
Enteric infectious diseases claim more than 1 million lives annually and are among the top ten causes of death in children younger than 5 years. Remarkable global investment has been dedicated to enteric infectious disease prevention and control; however, the shifting global health landscape is testing the continuance of progress. To evaluate the current status and guide future interventions, we present the latest epidemiological estimates of enteric infectious diseases from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 and assess progress towards the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) mortality target of fewer than 20 deaths per 100 000 children younger than 5 years by 2025. We quantified the incidence, mortality, and disability-adjusted life-years (DALYs) of enteric infectious diseases by age, sex, and year across 204 countries and territories from 1990 to 2023. In GBD 2023, the following were considered under the category of enteric infectious diseases: diarrhoeal diseases, enteric fever (typhoid and paratyphoid), invasive non-typhoidal Salmonella spp (iNTS) infections, and other intestinal infectious diseases. We also examined 15 aetiologies contributing to diarrhoeal diseases. Incidence and prevalence were estimated with DisMod-MR (version 2.1), a Bayesian meta-regression tool, drawing on data from systematic reviews, population-based surveys, claims data, and hospital sources. Cause-specific mortality was modelled with Cause of Death Ensemble Modelling based on data from sources including vital registration, mortality surveillance, verbal autopsy, and minimally invasive tissue sampling. Years of life lost and years lived with disability were computed and combined to derive DALYs. For aetiology-specific estimation, population-attributable fractions (PAFs) for 15 pathogens were derived with a counterfactual framework. Point estimates and 95% uncertainty intervals (UIs) were generated from 250 draws from the posterior distribution. In 2023, enteric infectious diseases resulted in an estimated 1·27 million (95% UI 0·963-1·68) deaths globally, declining from 3·69 million (3·04-4·56) in 1990. The global age-standardised mortality rate (ASMR) decreased from 74·1 (62·0-92·9) per 100 000 population to 16·4 (12·6-21·3) per 100 000 population during the same period. Diarrhoeal diseases accounted for most deaths in 2023 (1·11 million [0·811-1·54]), followed by enteric fever and iNTS. South Asia and sub-Saharan Africa remained the most affected regions in 2023, with 599 000 (441 000-882 000) and 501 000 (373 000-648 000) deaths due to enteric infectious diseases, respectively, predominantly from diarrhoeal disease. Rotavirus was the leading cause of all-age diarrhoeal disease deaths (PAF 16·3% [12·0-21·5]), followed by norovirus (10·2% [2·4-17·0]) and Shigella spp (9·3% [5·4-15·2]). Among children younger than 5 years, PAFs of deaths due to diarrhoeal diseases were 40·2% (32·5-48·5) for rotavirus, 24·0% (15·1-36·7) for Shigella spp, and 23·4% (13·7-34·3) for adenovirus. Across 204 countries and territories, 141 met the GAPPD mortality target in 2023. The driving aetiologies among countries that did not meet the target in 2023 varied slightly by GBD super-region, but the highest or second-highest number of deaths in children younger than 5 years were consistently attributed to rotavirus. Astrovirus and sapovirus, newly included in GBD 2023, were responsible for 24 600 (6290-49 000) and 18 800 (4650-44 400) deaths, respectively, in 2023, mainly in children younger than 5 years. Our findings show that mortality and ASMRs of enteric infectious diseases declined substantially between 1990 and 2023. This decline is consistent with the expansion of public health measures and broader socioeconomic development. However, the burden in 2023 remains considerably high, with the highest mortality concentrated in sub-Saharan Africa and south Asia. Considering that more than a quarter of all countries had yet to meet the GAPPD mortality target in 2023, sustained efforts are needed to address the persistent burden in affected countries and to adapt to the changing global health landscape. Gates Foundation.
Deep learning ability is essential for nursing students to navigate complex knowledge acquisition and intelligent healthcare challenges. However, information overload in digital learning environments may hinder the mastery of complex knowledge. This study aims to investigate the current status of deep learning ability and its influencing factors among undergraduate nursing students, and to explore the mediating role of self-efficacy between time management disposition and deep learning ability. A cross-sectional, correlational study. A total of 238 full-time undergraduate nursing students were recruited from medical colleges via convenience sampling between September and December 2025. Data were collected using the Deep Learning Ability Scale, Time Management Disposition Scale, and General Self-Efficacy Scale. Analyses included t-tests, ANOVA, Pearson correlations, multiple regression, and mediation analysis using the PROCESS macro (Model 4). The mean total scores for the 238 undergraduate nursing students were 105.17 ± 19.03 for deep learning ability, 163.06 ± 28.33 for time management disposition, and 27.03 ± 5.11 for self-efficacy. Correlation analysis indicated that deep learning ability was significantly and positively correlated with time management disposition (r = 0.755, P < 0.001) and self-efficacy (r = 0.754, P < 0.001). Additionally, a significant positive correlation was observed between time management disposition and self-efficacy (r = 0.770, P < 0.001). Student leadership experience, self-efficacy, and time management disposition were identified as significant predictors, collectively explaining 66.2% of the variance in deep learning ability. Furthermore, self-efficacy partially mediated the relationship between time management disposition and deep learning ability (β = 0.217, 95% CI [0.138, 0.303]), accounting for 41.41% of the total effect. The deep learning ability of undergraduate nursing students is at a moderately high level. Self-efficacy serves as a crucial partial mediator between time management and deep learning. Nursing educators should adjust teaching strategies to enhance deep learning ability and improve the quality of nursing talent cultivation.
Lean management (LM) has been implemented in healthcare organisations, promising efficient operations, rapid patient access to care, improved staff satisfaction and lower costs. However, use of LM is questioned because there is no strong evidence of its outcomes, so proof of long-term and organisation-wide use is needed. The aim of the study is to increase understanding of the long-term effects of LM in healthcare. This is a case study done at the Helsinki University Hospital in Finland. A retrospective qualitative study was conducted in three sectors (A, B and C) of the hospital. Fourteen healthcare leaders from three sectors participated in interviews by answering structured and open-ended questions. The interviews were used to evaluate the outcomes that are experienced by the leaders in the hospital setting over a five-year period and evaluate indicators that they used to assess these outcomes. The interviews were analysed using qualitative and quantitative content analysis with ATLAS.ti analysis software (ATLAS.ti Scientific Software Development GmbH, Berlin, Germany). The outcomes of LM can be grouped into three main categories (organisation, patient and staff) that are divided into six subcategories: experiential, care-related, work-related, economic, leadership and management, and image effects. The leaders experienced the greatest benefits on the organisation level, as it enhanced the effectiveness of the organisation's structure and operations, fostered continuous development, improved staff retention and attraction and promoted patient-centredness. According to the leaders, the most important benefits for patients included improved access to care, better care flow, enhanced safety of care and greater participation in improving operations. In addition, the leaders highlighted that the biggest benefits for staff, were increased work satisfaction, work competence, work commitment and ethical behaviour. We found that the use of LM also has disruptive and contradictory effects caused by the lack of organisation-wide Lean commitment and structure, and the media have bias towards negative portrayals of hospital efficiency. We found that six subcategories provide a comprehensive framework for qualitatively assessing organisation-wide experienced outcomes of LM in the hospital. Our findings emphasise that the organisation should be fully committed to the Lean method, and its structure should be clear so that the best benefits of LM can be achieved. We noticed that more qualitative LM research is needed to complement the Lean knowledge gained from quantitative research, develop more comprehensive and high-quality evaluation indicators and increase evidence for its use in healthcare.
Pediatric cancer treatment is a difficult and distressing experience that often results in sustained, interrelated distress in young children and parents, and traumatic stress symptoms for some parents. Few evidence-based interventions address this dyadic distress. Active Music Engagement (AME) is a manualized, evidence-based music play intervention that significantly reduces distress in child/parent dyads and mitigates traumatic stress and improves well-being among highly distressed parents and those experiencing sociodemographic risk. Successfully integrating AME into standard care requires a systematic understanding of implementation factors. This study aimed to identify site-specific barriers and facilitators that influenced successful AME delivery during a recently completed randomized controlled trial, leveraging multidisciplinary team insights to inform the selection of implementation strategies needed to successfully integrate AME into standard care. Semi-structured interviews (n = 10) were conducted with study personnel responsible for coordination and delivery of AME in a previous multisite randomized controlled trial; this included Advanced Practice Nurses and Board-Certified Music Therapists from our three participating sites. Interview questions were informed by the Consolidated Framework for Implementation Research. Data were analyzed using Rapid Qualitative Analysis and reported following the Planning for and Assessing Rigor in Rapid Qualitative Analysis framework. Findings highlighted that AME was strongly supported by staff with direct exposure to the intervention. Key barriers were primarily structural, including limited clinic space, competing demands in the outpatient setting, and limited awareness of the music therapy role among executive leadership. Key facilitators included the intervention's strong theoretical structure, the perceived high compatibility of AME principles with inpatient care needs, and the value of peer support/collaboration among music therapists. Participants recommended aligning AME delivery with existing inpatient infrastructure, enhancing referral and prioritization systems to manage demand, and refining therapist training to prioritize core theoretical constructs over manualized content. Future research and implementation efforts should focus on integrating AME into routine inpatient pediatric care, where service structure and patient/parent needs compatibility are highest. Strategies should include broader engagement with hospital leadership and parents, a clear plan for staffing/resource allocation, modified intervention training that supports flexible delivery, and the development of structured decision-support tools for targeted patient referral.
Clinical trial accrual monitoring is a critical component of trial operations, influencing feasibility, timeliness, and scientific validity. Despite its importance, many National Cancer Institute-designated cancer centers continue to rely on static spreadsheets or manually generated reports that provide delayed and incomplete insight for study teams. These limitations hinder timely identification of recruitment challenges, reduce transparency across stakeholders, and constrain proactive operational decision‑making. Scalable, institution‑wide systems that support near-real‑time accrual oversight remain uncommon in academic settings. This study aimed to design, implement, and operationalize a near-real‑time clinical trial accrual dashboard within a National Cancer Institute-designated cancer center, and to evaluate its use, adoption, and early operational impact on accrual monitoring workflows. We developed an enterprise accrual dashboard integrating daily extracts from the institutional clinical trial management system with automated data quality validation and time series accrual forecasting. The system supported multiple stakeholder roles through role‑based access and was deployed within existing governance and oversight workflows. Implementation and evaluation were guided by the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework and the Guidelines and Checklist for the Reporting on Digital Health Implementations framework, with system logs used to assess reach and adoption, and qualitative operational feedback used to characterize use in practice. From May 2022 to May 2026, the dashboard was used institution wide for monitoring therapeutic and nontherapeutic trials, logging 1605 unique user sessions across investigators, coordinators, data managers, and leaders. Automated daily validation enabled earlier detection and correction of missing or invalid accrual data, improving the reliability of institutional reporting over time. The dashboard replaced manual monthly reports with continuous monitoring and was incorporated into routine operational and leadership reviews, enabling earlier identification of lagging studies and more timely discussions regarding resource allocation and recruitment strategies. Accrual forecasting models demonstrated stable in sample and out of sample performance and were used to support anticipatory planning rather than prescriptive decision making. Initial increases in data correction workload and user resistance decreased as workflows matured and data transparency became normalized. Implementation of a near-real‑time accrual dashboard within an academic cancer center is feasible and sustainable and can meaningfully improve accrual oversight by strengthening data quality, transparency, and integration into routine workflows. The primary value of such systems lies not only in visualization or analytics but in their ability to shift accrual monitoring from retrospective reporting to proactive, institution‑wide operational review. With appropriate governance and clinical trial management system infrastructure, similar dashboards are transferable to other research centers seeking to modernize trial oversight.
Patient engagement is the practice of "meaningful and active collaboration [of patient partners] in governance, priority setting, conducting research and knowledge translation." Patient engagement has been implemented in various settings including clinical, research, and quality improvement, with varying levels of patient contributions and decision-making responsibility. However, little is known about the experiences of patient partners who are in leadership roles in patient-led events. For Patients, By Patients (PxP) is an annual, virtual, patient-led conference that focuses on topics important to patient partners in research. Each year's PxP steering committee is comprised of those with patient experiences and consequently, offers an opportunity for our research team to explore patient leadership within a conference setting. Understanding more about the intricacies of patient-led events is necessary if we wish to support patient leadership as a valuable form of patient engagement. The aim of this study was to explore (1) the benefits and challenges experienced by PxP steering committee members in a patient-led event and (2) how to better support patient leadership. We conducted a qualitative descriptive study of semi-structured virtual interviews with PxP conference steering committee members. Thematic analysis was used to identify core themes that were salient to the data. The Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis in Vancouver, Canada, and an international virtual setting via Zoom from January 2025 to April 2025. Purposive sampling was used to conduct interviews with thirteen PxP patient partner steering committee members. Four core themes were identified in the data: (1) institutional support: how institutions can support patient leadership, (2) steering committee environmental characteristics: what characteristics are conducive to patient leadership, (3) personal growth: how patient leadership promotes growth among patient partners and (4) new possibilities: how patient-led events foster future expansion and opportunities. Power dynamics, intersectionality, and accessibility were also identified as central to supporting patient leadership and building safe and supportive environments. Patient partners are capable of leading events which promote interpersonal relationships and advance patient engagement practices and governance. Important facilitators include institutional support and governance that considers power dynamics, accessibility and intersectionality.
This study aimed to develop and validate a tool for assessing communication as a leadership competency among graduate healthcare students. Drawing from the American College of Healthcare Executives 2023 Competencies Assessment Tool and the National Center for Healthcare Leadership Competency Model 3.0, a survey was designed to capture essential domains of communication within leadership contexts. The initial instrument included six domains: relationship management, written communication, facilitation and negotiation, listening skills, verbal communication and effective speaking, and communicating in groups. After initial pilot testing revealed issues with item clarity and scale consistency, the survey was revised to improve content alignment and measurement accuracy. Subsequent testing incorporated exploratory factor analysis (EFA), internal consistency measures, and test-retest reliability analysis. As a result, eight components emerged and ultimately categorized as the following seven domains: communicating in groups, verbal communication and effective speaking, relationship management, written communication, listening skills, ethical collaboration, and respectful interactions. Most domains demonstrated acceptable to excellent psychometric properties, with Cronbach's alpha values and intraclass correlation coefficients (ICC) supporting internal consistency and stability over time. This tool, the Communication Competency Assessment in Health Professions (CCAHP) survey, provides a validated framework for assessing communication competencies in graduate health professions education and offers practical applications for guiding curriculum design, fostering interprofessional development, and sup¬porting professional identity formation.
Antimicrobial resistance (AMR) is a global health crisis requiring multisectoral responses that extend beyond biomedical interventions. Participatory approaches can ensure that policies and practices reflect community realities, yet evidence from low- and middle-income countries (LMICs) remains limited. To examine how the Responsive Dialogues (RD) framework was implemented in Malawi and Thailand, and to identify lessons on adapting participatory methods for AMR engagement, managing power dynamics, overcoming structural barriers, and supporting policy uptake. This cross-country evaluation applied the RD toolkit developed by the Wellcome Trust, which included three phases: groundwork, community conversations, and post-conversation sharing. Both countries followed this framework but adapted it to their social and political contexts. Data included field observations, facilitator reflections, participant feedback, and analysis of policy outcomes. Four themes emerged across both sites. First, adaptation was engagement process which shaped by trust, flexibility, and cultural sensitivity. Second, entrenched hierarchies influenced participation; strategies such as stakeholder briefings, ground rules, and rotating leadership roles helped mitigate imbalances, while in Malawi, village leaders' authority supported antibiotic regulation. Third, although Malawi's RD recommendations informed its revised National Action Plan on AMR, Thailand's community generated ideas were less visible in the national strategy, underscoring persistent gaps between local insights and high-level policy. Finally, reflective practice strengthened iterative learning and inclusivity. Overall, RD offers a promising model for facilitating participation in AMR mitigation plan. However, the differences in policy uptake in both countries highlight the limits of participatory approaches when not aligned with policy scale and resourcing. Main findings: Responsive Dialogues enabled inclusive dialogue across community and policy stakeholders in Malawi and Thailand, demonstrating how relational adaptation, power-aware facilitation, and reflective learning are essential for effective participatory AMR engagementAdded knowledge: This study offers new empirical evidence from LMIC settings on how participatory methods can surface community-generated solutions, navigate hierarchical constraints, and support pathways for policy influence in AMR policies.Global health impact for policy and action: Strengthening institutional support and resourcing for participatory engagement can help embed community insights into AMR policy design and implementation, promoting more equitable, sustainable, and context-responsive strategies worldwide.
This study investigates the impact of ecocentric leadership on environmental performance in the Egyptian hospitality and tourism sector. It explores the mediating roles of green organizational learning, as well as the sequential mediation of digital green culture and green work engagement, grounded in the Resource-Based View (RBV) and Social Exchange Theory (SET). Data were collected from 404 middle-level managers working in five-star hotels and category-A travel agencies in Greater Cairo using a structured questionnaire. A non-probability convenience sampling method was employed. Structural Equation Modeling (SEM) was used to test the hypothesized relationships. Findings confirm that ecocentric leadership significantly enhances environmental performance, both directly and indirectly through digital green culture and green work engagement, indicating a clear sequential mediation pathway. Moreover, green organizational learning partially mediates the relationship between ecocentric leadership and digital green culture, and digital green culture positively affects green work engagement, while green work engagement positively influences environmental performance. Hospitality and tourism organizations should invest in ecocentric leadership development and promote a culture of green learning and engagement to improve environmental outcomes. This study provides an integrated model linking leadership, learning, culture, and engagement to sustainability performance based on RBV and SET, offering practical and theoretical contributions within an emerging market context like Egypt.
As a pivotal dimension of sustainable career development, employee thriving at work has garnered substantial scholarly and practical attention as a salient indicator of optimal psychological functioning in organizational settings. Extant literature has preliminarily established correlations between general leadership styles and employee thriving; however, the precise mechanisms and contextual contingencies through which inclusive leadership-characterized by openness, availability, and accessibility-fosters thriving at work among young university teachers remain inadequately theorized and empirically underexplored. This study integrates social cognitive theory with the socially embedded model of thriving to conceptualize a moderated mediation framework. Using questionnaire data collected from 755 young faculty members across Chinese universities, we examine the mediating role of teaching efficacy-a core belief in one's instructional capability-in transmitting the influence of inclusive leadership to thriving at work, as well as the moderating function of professional identity in strengthening these relational pathways. Our analyses reveal four key findings: (1) Inclusive leadership exerts a significant positive effect on thriving at work; (2) It also substantially enhances teachers' sense of teaching efficacy; (3) Teaching efficacy partially mediates the relationship between inclusive leadership and thriving; (4) Professional identity not only amplifies the direct effect of inclusive leadership on teaching efficacy but also reinforces the strength of the indirect effect of inclusive leadership on thriving via teaching efficacy. By contextualizing the thriving construct within the unique socio-cultural milieu of Chinese higher education, this study provides a nuanced theoretical account of how and when inclusive leadership cultivates thriving at work among early-career academics. These insights contribute meaningfully to the growing discourse on leadership and workplace well-being, while also offering actionable implications for academic institutions seeking to foster supportive environments that enhance both teaching and research performance.
BackgroundSupporting workers with post-COVID condition in returning to work is critical. Qualitative evidence may provide insight into the complex factors shaping this process and inform intervention and policy development.ObjectiveTo identify and synthesize qualitative evidence on barriers and facilitators influencing return to work following post-COVID condition.MethodsWe conducted a scoping review using the Arksey and O'Malley framework, refined by Levac et al. MEDLINE, EMBASE, CINAHL, and Scopus were searched from inception to July 2025. Eligible qualitative and mixed-methods studies examined barriers and facilitators to returning to work among working-age adults with post-COVID condition or healthcare professionals involved in their care. Data were synthesized using critical interpretive synthesis, informed by the International Classification of Functioning, Disability and Health framework.ResultsTwenty-nine qualitative or mixed-methods studies (n=1902 participants) were included. Barriers and facilitators operated across domains within broader organizational and systemic contexts. Fluctuating, unpredictable symptoms were major barriers, while gradual rehabilitation and energy management facilitated return to work. Mismatches between work capacity and job demands limited work participation. Environmental barriers included stigma, inflexible policies, limited accommodations, and financial or compensation pressures, while facilitators included flexible work arrangements, supportive leadership, and collaborative planning. Guilt and fear of underperformance were personal barriers, while acceptance and motivation facilitated return to work. Specialists identified fragmented services and limitations of current care models as systemic concerns.ConclusionsPost-COVID condition necessitates flexible, multidisciplinary return-to-work models that accommodate symptom variability and address psychosocial needs. Improved coordination across healthcare, workplace, and social systems is essential for sustainable workforce participation.RegistrationThe review protocol was publicly registered on the Open Science Framework prior to screening and was approved by all team members (https://osf.io/nrbu5/).
Research suggests that community health worker (CHW) integration within clinical care teams can improve chronic disease outcomes and address health-related social needs. However, the processes by which CHWs are integrated in Federally Qualified Health Centers (FQHCs) and organizational factors enabling their success remain incompletely understood. Within the context of a national initiative sponsored by the Centers for Disease Control and Prevention, this study assessed CHW integration across three North Carolina FQHCs with distinct patient populations, management systems, and levels of prior CHW experience to identify facilitators, barriers, and CHW impact. We conducted a qualitative evaluation using inductive thematic analysis of semistructured key informant interviews with CHWs, their managers, and clinicians at each FQHC. Transcripts were analyzed using reflexive thematic analysis to identify themes and extract representative quotes. Facilitators included collaboration, targeted training, management systems, prior CHW and clinician experience, and organizational support. Barriers included unclear CHW role definition, CHW capacity and community resource constraints, and inconsistent communication about integration strategies. CHWs supported care coordination, health-related social needs referrals, and chronic disease management, improving patient engagement and outcomes. Findings confirmed known enablers and barriers to CHW integration, including role definition, capacity constraints, resource availability, and supportive leadership. We additionally identified novel factors impacting CHW integration, including the influence of prior experience of CHWs and clinical staff, CHW leadership in workflow development, the role of peer-learning collaboratives, and the importance of inclusive communication and data practices. Integration was most successful when CHWs shaped workflows, clinicians and managers had foundational CHW understanding, and collaborative learning spaces enabled peer exchange. These findings highlight the importance of CHW-centered program design and implementation, and may enhance existing frameworks for clinical integration of CHWs in FQHCs and similar settings.
To explore the barriers and facilitators influencing the use of point-of-care ultrasound (POCUS) for confirming the position of gastric tubes in preterm infants in the neonatal intensive care unit (NICU). Many research studies indicated that POCUS is an effective and repeatable technique for monitoring the tip position of gastric tubes; however, the application rate of this technique among nurses in the NICU for confirming the position of gastric tubes in preterm infants remains low. Using a qualitative descriptive research design, we conducted interviews with direct care nurses (n = 8), frontline doctors (n = 2), and nursing leaders (n = 2) at a tertiary-level hospital to explore the barriers and facilitators influencing nurses' use of POCUS for confirming the position of gastric tubes in preterm infants. The study identified two main themes: facilitators and barriers. The facilitators include the following six subthemes: adequate resource allocation and equipment; demonstrable safety and clinical efficacy; intrinsic motivation and professional development; supportive and innovative work environment; strong managerial and leadership support; and clear pathways for process optimization. The barriers also include six subthemes: deficiencies in competency development systems; complexity of neonatal clinical presentations; absence of institutional policies and standardized protocols; sociocultural and cognitive resistance; perceived legal and ethical risks; and unclear team collaboration dynamics. This study explored the main factors hindering and promoting the implementation of the POCUS for gastric tube position confirmation from the perspectives of direct care nurses, frontline doctors, and nursing leaders. Participants pointed out that there were issues with insufficient protection and support in areas such as training systems, institutional regulations, cognitive levels, and team collaboration. Therefore, it is necessary to formulate strategies and policies to address these obstacles.
Those working within the South African (SA) District Health System (DHS) have various roles in addressing population health and wellbeing needs. These include motivating and co-ordinating local providers offering community, primary healthcare facility and district hospital services, including prevention and promotion services, and facilitating whole-of-government and whole-of-society collaboration with other government and social actors. These roles cannot be fulfilled by exercising traditional, command-and-control public sector managerial authority. Instead, distributed system leadership is required: a form of leadership practised by individuals and teams that enables the collective action needed to address complex health needs, and that is supported by wider organisational structures and processes. Based on a range of experience, this in-practice article presents the rationale for, and description of, system leadership within the DHS; appraises current approaches to leadership and management development in South Africa from this perspective; and outlines a system leadership development approach that offers promise for DHS and health system strengthening.