Leadership & management: Overview

Abstract
Importance: Leaders of healthcare organizations play a key role in developing, prioritizing, and implementing plans to adopt new evidence-based practices. This study examined whether a letter with peer comparison data and social norms messaging impacted healthcare leaders' decision to access a website with resources to support evidence-based practice adoption.

Methods: Pragmatic, parallel-group, randomized controlled trial completed from December 2019 -June 2020. We randomized 2,387 healthcare leaders from health systems, hospitals, and physician practices in the United States, who had previously responded to our national survey of healthcare organizations, in a 1:1 allocation ratio to receive one of two cover letter versions via postal mail (all) and email (for the 60.6% with an email address), accompanying a report with their survey results. The "nudge" letter included messaging that highlighted how an organization's results compared to peers using text, color, and icons. Both nudge and control letters included links to a resource website. We interviewed 14 participants to understand how the letter and report impacted behaviors.

Results: Twenty-two of 1,194 leaders (1.8%) sent the nudge letter accessed online resources, compared to 17 of 1193 (1.4%) sent the control letter (p = 0.424). Nine of the 14 interviewed leaders stated that viewing the letter (regardless of version) and accompanying report influenced their decision to take a subsequent action other than accessing the website. Seven leaders forwarded the report or discussed the results with colleagues; two leaders stated that receiving the letter and report resulted in a concrete practice change.

Conclusions: Receiving cover letters with a behavioral nudge did not increase the likelihood that organizational leaders accessed a resource website. Qualitative results suggested that the survey report's peer comparison data may have been a motivator for prioritizing and delegating implementation activities, but leaders themselves did not access our online resources.

Abstract
In healthcare, improvement leaders have been inspired by the frameworks from industry which have been adapted into control systems and certifications to improve quality of care for people. To address the challenge to regain trust in healthcare design and delivery, we propose a conceptual framework, i.e. the "House of Trust". This House brings together the Juran Trilogy, the emerging concept of co-production in quality management and the multidimensional definition of quality, which describes core values as an integral part of the system to deliver person- and kin-centered care. In the "House of Trust" patients, their kin, healthcare providers, executives and managers feel at home, with a sense of belonging. If we want to build a care organization that inspires and radiates confidence to all stakeholders, highlighting the basic interactions between front- and back-office is required. An organization with both well-organized back- and front-offices can enable all to benefit from the trust each of them needs and deserves. A quality system does not depend on government inspection and regulations nor on external accreditation to develop itself into a House of Trust. Success will only be achieved if all involved continuously question themselves about the technical dimensions of quality and their core values during the "moment of truth".

Abstract
This qualitative study aims to investigate the competencies and effectiveness of humor use in workplace leadership. By exploring the elements underlying successful and unsuccessful humor use, this research offers insights into the competencies required for leaders to leverage humor effectively. Adopting a qualitative inductive approach, fifteen individual semi-structured interviews were conducted, generating a dataset of 51 critical incidents of humor use. Reflexive thematic analysis was employed to identify key themes, resulting in the identification of five central elements: Reading the context, Intention and motivation, Judgement and decision, Skillful delivery, and Understanding reactions. These elements provide a comprehensive framework for understanding humor use in the context of workplace leadership, emphasizing the importance of cognitive and emotional intelligence / competencies. The study proposes a theoretical framework based on these findings, providing the foundation of a new paradigm for understanding and measuring humor use. This research contributes to a deeper understanding of the competencies and complexities involved in using humor as a leadership tool and provides practical implications for leaders aiming to enhance their leadership effectiveness through humor.