Leadership for knowledge translation : the case of CLAHRCs

Calls for successful knowledge translation (KT) in healthcare have multiplied over recent years. The NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) program is a policy initiative in the UK aimed at speeding-up the translation of research into healthcare practice. Using multiple qualitative research methods and drawing on the ongoing processes used by individuals to interpret and contextualize information, we explore how new organizational forms for KT bridge the gap between research and practice. We pay particular attention to the relationship between the organization and practices of KT and leadership. Our empirical data demonstrate how the relationship between leadership and KT shifted over time from a push model where the authoritarian top-down leadership team set outcome measures by which to judge KT performance to one which aimed to distribute leadership capacity across a wide range of stakeholders in a health and social care systems. The relationship between the organization and practices of KT and leadership is affected by local contextual influences on policies directed at increasing the uptake of research in clinical practice. Policy-makers and service leaders need to recognize that more dispersed type of leadership are needed to accommodate the idiosyncratic nature of collective action

Interpretation of multiple institutional logics on the ground : actors' position, their agency and situational constraints in professionalized contexts

Our study examines how interdependent actors in a professionalized context interpret the co-occurrence of a professional logic and a policy-driven logic. The empirical setting comprises two hospitals in the English National Health Service. Two issues stand out. First, our study shows that any logic is variegated and ambiguous, so policymakers and organizational managers cannot assume that they are easily blended. Second, it shows how nurse consultants exhibit agency in blending these two logics in pursuit of positional gain in professional and managerial organization. They can do so because of their ambiguous status level: in comparison to doctors, their status as nurses is low; within the nursing profession their status is high. Theoretically, by focusing upon interpretation of multiple institutional logics at the micro level, our study renders visible the agency of interpreting actors, interdependency of actors, their interpretation of institutional logics, situational context, and the effect of, and upon, social position of actors

The translational role of hybrid nurse middle managers in implementing clinical guidelines : effect of, and upon, professional and managerial hierarchies

Our study uses qualitative and interpretative design to analyse what hybrid nurse middle managers do in their managerial practice, what affects this, and to what effect, focusing upon implementing policy-driven guidelines on the clinical frontline. Examining two comparative hospital cases and drawing upon Scandinavian institutionalism, we conceive their role as one of ‘translation’. On the one hand, they exhibit strategic agency. On the other hand, their managerial role not only influences, but is influenced by, professional and managerial hierarchies. In both hospitals, in the short term we see how hybrid nurse middle managers are able to mediate professional and managerial hierarchies and implement clinical guidelines through translational work. However, in one case, they less effectively accommodate policy-driven, managerial pressure towards compliance with government regulations and financial parsimony. In this case, the outcome of their translational work is not sustained in the longer term, as professional and managerial hierarchies reassert themselves. Drawing upon the example of their managerial role in healthcare, we highlight that hybrid middle managers enact a strategic translational role and outline situational constraints that impact this more strategic role

Sharing leadership for diffusion of innovation in professionalized settings

Innovation often flourishes in organizational pockets, but then fails to diffuse more widely. This represents a particular global challenge in healthcare where demands of an ageing population with increasing long - term conditions need to be addressed in the face of financial constraints. Shared leadership to support diffusion of innovation may offer a panacea for the challenge. Our study shows how changing configurations of shared leadership support diffusion and adaption of innovation. Managers remain important actors for the mandate and resourcing of innovation but, over time, powerful professionals, specifically doctors come to the fore, to engage their peers and influence resource allocation. Nurses complement doctors’ leadership efforts around engagement of frontline professionals and in adapting innovation to local context. Significant contingencies in shaping shared leader ship for diffusion and adaption of innovation are : organ izational financial performance; whether nurse s enact hybrid leadership roles; whether organization is hierarchical or collaborative. Theoretically, by focusing upon leadership configuration in the process of diffusion of innovation, our study renders visible practices of shared leadership, interdependency of hierarchical managerial or professional influence , its effect upon innovation diffusion and contingencies that underpin this

Effects of emotional labor on leadership identity construction among healthcare hybrid managers

In this longitudinal study, we extend theory on leadership identity construction by integrating the process of emotional labor into leadership identity claims. The study aims to fulfill the gap in the relevant literature about how emotions are managed to gain relational recognition in the process of leadership identity construction, specifically among healthcare hybrid managers who fulfill both clinical and managerial duties. Using random coefficient modeling, effects of deep acting, surface acting, and genuine emotion on the change of leadership identity at the relational level were tested on a sample of 106 manager-employee dyads over three consecutive time points. The results suggest variability in both initial leadership identity and changing rates. Hybrid managers conducting effortful strategies: deep and surface acting, have lower initial leadership identity. However, the effortful strategies help hybrid managers improve their leadership identity over time, while the effortless strategy or genuine emotion negatively interacts with the process of leadership identity construction. Our findings highlight the importance of cognitive attention required in the emotional process of leadership identity construction

From what we know to what we do : enhancing absorptive capacity in translational health research

Background Globally, evidence about what works is slow to translate into frontline healthcare delivery. As a response, government policy has focused on translational health initiatives, such as the National Institute for Health Research funded Applied Research Collaborations in England. Concepts from organisation science prove useful to support such translational initiatives. We critique the application of two organisation science concepts linked to the broad domain of what is commonly termed ‘knowledge mobilisation’ in healthcare settings, specifically ‘knowledge brokers’ and ‘absorptive capacity’, to provide lessons for leaders of translational initiatives. Results The presence of knowledge brokers to ‘move from what we know to what we do’ in healthcare delivery appears necessary but insufficient to have a system level effect. To embed knowledge brokers in the wider healthcare system so they draw on various sources of evidence to discharge their role with greatest effect, we encourage leaders of translational health research initiatives to take account of the concept of absorptive capacity (ACAP) from the organisation science literature. Leaders should focus on enhancing ACAP though development of ‘co-ordination capabilities’. Such co-ordination capability should aim not just to acquire different types of evidence, but to ensure that all types of evidence are used to develop, implement and scale up healthcare delivery that best benefits patients. Specific co-ordination capabilities that support translation of evidence are: clinician involvement in research and its implementation; patient and public involvement in research and its implementation; business intelligence structures and processes at organisational and system level. Conclusion Attention to the dimensions and antecedents of ACAP, alongside the implementation of the knowledge brokering solution, in translational health research initiatives, is likely to better ensure the latter’s success

Translation textual cultural heritage: The translation of 27 Italian jokes of Domenichi in Greek in an 1812 Paris edition located in Kozani’s library

This article presents a textual cultural heritage case study. In particulate, in this study we describe an 1812 Paris edition produced by the typographer J. M. Eberhart that contains a collection of jokes. The title of the book is “Ιεροκλέους φιλοσόφου αστεία” that means “Ierokles philosopher’s jokes” and contains two parts:a collection of the philosopher’s jokes created by M. from Chios,a 1574 published collection of 27 Italian jokes translated from Italian to Greek in 1812 by M. from Chios.The text was located in Kozani’s public library “Kοβεντάρειος Δημοτική Βιβλιοθήκη της Κοζάνης” from now on Kozani’s public library. We argue that the presence of this small collection of 16th century Italian jokes translation in a Greek library constitutes an element of Italian-greek intercultural influence and relations, many years before the Greek and the Italian independence movements and the foundation of the Greek (1830) and Italian (1861) national States

Patient and public involvement in healthcare quality improvement: how organizations can help patients and professionals to collaborate

Citizens across the world are increasingly called upon to participate in healthcare improvement. It is often unclear how this can be made to work in practice. This 4- year ethnography of a UK healthcare improvement initiative showed that patients used elements of organizational culture as resources to help them collaborate with healthcare professionals. The four elements were: (1) organizational emphasis on nonhierarchical, multidisciplinary collaboration; (2) organizational staff ability to model desired behaviours of recognition and respect; (3) commitment to rapid action, including quick translation of research into practice; and (4) the constant data collection and reflection process facilitated by improvement methods

Xenomateriality: designing with hekate

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The spirit of design distilled

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