BMJ Leader

Background Effective interprofessional collaboration (IPC) in primary care is essential in providing high-quality care for patients with chronic illness. However, the traditional role-based leadership approach may hinder IPC. Instead, physicians should also take followership roles, allowing other healthcare team members (OHCTMs) to lead when they have expertise and/or experience. Understanding of leadership and followership within IPC remains limited in primary care for patients with chronic illness. Hence, this review aims to explore the definitions and conceptualisations of leadership and followership and to map relevant training in this context. Methods Following the Joanna Briggs Institute methodology for scoping reviews, an electronic search was conducted across PubMed, Embase and Web of Science. Three independent reviewers assessed publications for eligibility. Descriptive and thematic analysis were employed. Results From 2194 identified articles, 57 were included. Only two articles defined leadership approaches, and none explicitly addressed followership. Nevertheless, our analysis identified leadership shifts from physicians to OHCTMs, and vice versa for followership, driven by complexity of care, physician shortages and healthcare costs. Enablers of these shifts included physician trusting OHCTMs, collaborative practice agreements and physicians’ interprofessional experience. Barriers included traditional hierarchies, OHCTMs’ lack of competence and physicians’ lack of IPC experience. Four articles mentioned relevant training however without detailed information. Discussion Leadership in IPC for chronic illness in primary care is rarely defined, and followership is largely neglected. Nevertheless, leadership–followership shifts do occur in leadership and followership roles of physicians and OHCTMs. Further research needs to explore physicians’ followership and relevant competencies, and relevant training is required.

Guoyang Zhang

Renée E Stalmeijer

Fury Maulina

Frank W J M Smeenk

Carolin Sehlbach

Interprofessional collaboration in primary care for patients with chronic illness: a scoping review mapping leadership and followership

慢性病患者初级保健中的跨专业合作：领导力与追随力的范围综述

Background/Aim Overweight and obesity (OAO) is a major and growing public health crisis in the world. There is convincing medical evidence that caloric overconsumption, rather than lack of exercise, is the primary driver of OAO. Methods In this translation piece, we summarise our programme of research on laypeople’s beliefs about the primary cause of OAO, the origins of these beliefs and implications for clinicians and leadership in healthcare organisations. Results In contrast to the medical consensus, our research conducted in several countries has found that approximately half of the population mistakenly believes that lack of exercise is the primary cause of obesity. These misbeliefs have consequences: people who mistakenly believe that exercise is the most important factor are more likely to be overweight or obese than people who correctly believe that diet is the primary cause of obesity. We argue that these misbeliefs are caused in part by systematic and multipronged communications efforts by the food and beverage industry—a phenomenon we term ‘leanwashing’. Conclusions Not only does leanwashing require public policy intervention by the government, healthcare professionals also need to respond appropriately. In this article, we focus on the implications of leanwashing for leaders of public health organisations, health delivery organisations and clinicians.

Aneel Karnani

Brent McFerran

Anirban Mukhopadhyay

Obesity, laypeople’s beliefs and implications for clinicians and leaders of healthcare organisations

肥胖、公众认知及其对临床医生和医疗组织领导者的启示

Mumta Hargovan

Shrikant Maurice Peters

Jamiu O Busari

BMJ Lead

Why<i>BMJ Leader</i>is focusing on healthcare leadership in Africa

《为什么<i>BMJ Leader</i>关注非洲的医疗领导力》

Sam van Elk

Kirsten Armit

Juan Baeza

Alec Fraser

Ruth Harris

Lorelei Jones

Jessica Lubin

Gerry McGivern

Justin Waring

Research agenda for integrated care: supporting collaboration in turbulent times

综合护理研究议程：在动荡时期支持协作

Background In the landscape of Indian healthcare, the role of leadership in addressing disparities and driving change is often overlooked, particularly within medical education. Through the lens of the author journeying from a volunteer to ultimately a leader of a student-led non-profit organisation, this article explores the reason, rhyme and possible resolutions to the quiet effect of lacking leadership in healthcare education. Methods Drawing from personal experience and reflections, the article highlights the profound impact of grassroots initiatives in reaching underserved populations and how inadequate leadership hindered their ability to scale effectively. Insights into the challenges encountered and the barriers that needed to be overcome have been elaborated to unravel the possible origins of this problem and address potential solutions throughout various levels of health education. Results Although there is rarely a simple solution to a complex challenge, building adequate mentorship and support can help sustain leadership efforts in leadership by providing a pillar to lean on without diminishing individualised effort for growth. Cultivating collaborative networks can further provide opportunities to kindle the flame of leadership among young doctors. Conclusions By fostering a culture of leadership, medical education can produce professionals who are skilled clinicians and innovative leaders capable of driving change in the community.

Nithya Arigapudi

Quiet effect of lacking leadership in healthcare education

医疗教育中缺乏领导力的静默效应

Background Since the outbreak of the COVID-19 pandemic, healthcare workers (HCWs) have faced multiple difficulties in their work and personal lives. However, most of the quantitative reviews have focused on the extent of the pandemic’s impact on the HCWs and have thus failed to fully capture the HCWs’ experiences and the complexity of the problems they encountered. Therefore, this qualitative systematic review elucidates the HCWs’ challenges brought about by the pandemic, their perceptions of the existing support and the support that require further attention. Methods The literature search spanned five databases: Scopus, PubMed, Web of Science, CINAHL and PsycInfo, targeting qualitative studies of HCWs’ pandemic experiences from December 2019 to December 2023. These studies underwent strict quality and relevance assessment, emphasising critical appraisal and selection. Findings were unified through meta-synthesis, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study was registered in PROSPERO. Results This study analysed 29 qualitative studies on HCWs’ experiences during the pandemic and their perceptions of support, identifying four themes of HCWs’ physical and mental well-being, the impact of the pandemic on their professional and personal lives, their work environments and the support they received. These themes encompassed 8 main categories and 25 codes. The research revealed that the pandemic and work conditions negatively influenced their health, affecting their professional and personal lives. Current support has lessened the pandemic’s effects on HCWs but should also address future requirements like long-term psychological support. Conclusion The studies identified the challenges faced by HCWs during the pandemic, and the existing support. However, due to the complex interactions between the work and environmental factors, the effectiveness of the existing support remains challenging. To improve their effectiveness, the future support should target the interactions between the HCWs and the work system. PROSPERO registration number CRD42023426238.

Siyuan Zhang

Xiuzhu Gu

Healthcare workers’ well-being and perspectives on support during the COVID-19 pandemic: a systematic review and meta-synthesis of qualitative studies

医护人员在COVID-19疫情期间的福祉及支持观点：一项定性研究的系统综述与元合成

The National Health Service (NHS) is the world's largest single healthcare delivery system. While research that takes place within the NHS is world leading, in clinical practice, it can feel slow, bureaucratic and difficult to enact change or embrace new innovations.1 To keep up with the evolving challenges that continue to face the NHS, we believe adopting the principles of the National Aeronautics and Space Administration (NASA) Pirate Innovation is required to ensure healthcare is adaptable, dynamic and resilient. Traditional, insular and hierarchical business models are a barrier to innovation in many large organisations. An example of this was in the 1980s, when a group of young NASA engineers were surprised to find the mission control computer systems in operation were outdated and unlikely to effectively support the increasing demands and complexity of upcoming space programmes.2 3 The team's ideas were met with strong internal resistance. Cost, regulations and a 'tried and tested' incumbent system were cited as reasons against the endeavour. Dubbing themselves 'Pirates', this young engineering team took it on themselves to develop a new shuttle mission control system using borrowed off-the-shelf hardware and tailor-made code that not only offered higher visualisation, analytical and diagnostic capabilities to the agency but also was cheaper to operate than the previous system. The Pirates' open innovation practices transformed NASA's approach to problem-solving and technology development, resulting in improved exploration capabilities and efficiencies when executing projects. Based on their success, NASA requested the Pirates develop the international space station mission control and have since embraced open innovation processes. The NASA Pirates codified the 'Pirate Paradigm': a set of values and principles that challenged the established culture to achieve results while maintaining personal responsibility.3 These include:

Anna Yarlini Allan

Shehan Hettiaratchy

We need more NHS Pirates

我们需要更多的NHS海盗

Abbreviation	leader
Journal Impact	1.67
Quartiles(Global)	HEALTH CARE SCIENCES & SERVICES(Q3)

ISSN	2398-631X
h-index	15

Publication Information	Publisher: BMJ Publishing Group，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 2017，Proportion of original research papers: 93.02%，Self Citation Rate:11.80%， Gold OA Rate: 27.60%

BMJ Leader

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Interprofessional collaboration in primary care for patients with chronic illness: a scoping review mapping leadership and followership

Obesity, laypeople’s beliefs and implications for clinicians and leaders of healthcare organisations

WhyBMJ Leaderis focusing on healthcare leadership in Africa

Research agenda for integrated care: supporting collaboration in turbulent times

Quiet effect of lacking leadership in healthcare education

Obesity, laypeople’s beliefs and implications for clinicians and leaders of healthcare organisations

Interprofessional collaboration in primary care for patients with chronic illness: a scoping review mapping leadership and followership

Healthcare workers’ well-being and perspectives on support during the COVID-19 pandemic: a systematic review and meta-synthesis of qualitative studies

We need more NHS Pirates

Research agenda for integrated care: supporting collaboration in turbulent times