Rigorous assessment of leadership development programs in health care
NEJM Catalyst; by Amanda Woods Herron, Katelyn J. Cavanaugh, Courtney L. Holladay; 4/26
Effective leadership is increasingly recognized as a critical determinant of organizational performance within health care systems, but funding for such programs is frequently in jeopardy as revenues fail to keep up with other expenses. Therefore, the managers of such programs should adopt rigorous methods for evaluating the impact of their work. Despite the proliferation of leadership development programs, few institutions systematically evaluate these initiatives. This article presents a comprehensive framework for the evaluation of leadership development, grounded in implementation science and organizational research, as applied within a large academic health care institution. The framework emphasizes the necessity of clear eligibility criteria, integrated data sources, and alignment with institutional strategic priorities to assess program effectiveness and support continuous improvement. 

Ketamine for depression in serious illness: Evidence, safety, and practical approaches
Journal of Pain & Symptom Management; by Paul Noufi, Joshua B. Borris, Danielle Chammas, Cara L. McDermott, Nneka N. Ufere, Jason A. Webb, Daniel Shalev; 4/26
Patients with serious illness and short prognoses often experience depression and suicidal ideation. Traditional antidepressants are limited by delayed onset, creating a need for rapidly acting therapies. Ketamine and esketamine [nasal spray] offer the strongest evidence among rapid-acting antidepressants and may be preferred when urgent symptom relief is needed. However, rigorous psychiatric trials in serious illness are lacking. Clinicians should consider prognosis, access to Risk Evaluation and Mitigation Strategies-certified esketamine programs or equivalent regulatory frameworks outside the US, and the need for an appropriate maintenance regimen when integrating ketamine into palliative care depression management.

Voluntarily stopping eating and drinking (VSED) with hospice support in America: A case series
Journal of Pain and Symptom Management; by Hope A Wechkin, Elizabeth T Loggers; 5/26
Despite increasing public awareness of voluntary stopping of eating and drinking (VSED), there are no descriptions of the clinical course of US patients who pursue VSED, with or without hospice support... We employed retrospective chart review methodology to review a consecutive case series of 20 patients who requested and received hospice support for VSED... While this study has significant limitations, VSED was completed by all who initiated the process and death generally occurred within 10 days. Therefore, those initiating VSED should be considered eligible for hospice care, with care initiated quickly. Symptoms during VSED were typical of hospice patients and can be managed using common hospice techniques and medications.

Making a health system merger succeed: Michigan Medicine’s journey toward a high-quality, coordinated statewide system of care
NEJM Catalyst; by Scott A. Flanders, Margaret Dimond, David C. Miller; 4/26
After its April 2023 acquisition of Sparrow Health, Michigan Medicine and its five-hospital system, University of Michigan Health, launched a major effort to advance business, clinical, and cultural integration across the new 11-hospital enterprise. The goal was to achieve a coordinated, integrated statewide system of care that delivered improved quality and better experience, while providing academic hospital-caliber care closer to home for patients across the state. Those efforts have led to improved financial performance, [increased employee satisfaction and reduced RN annual turnover]. Clinical integration, driven by the development of local clinical programs, initiatives to coordinate statewide care, and innovative technology solutions, has resulted in a higher quality of care delivered closer to home. For cultural integration, the keys to success have been leadership alignment, a clear vision and goals, a supportive infrastructure, strong systemwide communication, and achieving and celebrating early wins.

[Ireland] Developing a reflective practice program to support oncology and palliative care staff with patient death
Journal of Palliative Medicine; by Geena Kelly; 4/26
Oncology and palliative care staff frequently encounter death yet often lack structured opportunities for reflection following these experiences. Oncology and palliative care staff in an Irish acute hospital collaboratively developed a structured reflective practice program to support coping with patient death. Using insider-action research, this pilot study demonstrates a feasible, staff-led approach to embedding reflective practice into routine clinical practice.  The project has contributed an adaptable model for structured reflection in the acute hospital setting and underscores the importance of acknowledging the emotional toll of caring for patients at the end of life. This is an important step towards embedding reflective practice into the culture of health care, with potential for future AR cycles to build on this work even more, involving greater numbers of staff and further evaluating the intervention’s effectiveness.



 
 

Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom. ~Viktor E. Frankl