What makes a socially skilled leader? Findings from the implementation and operation of New Care Models (Vanguards) in England

PURPOSE

The article aims to argue that the concept of "distributed leadership" lacks the specificity required to allow a full understanding of how change happens. The authors therefore utilise the "Strategic Action Field Framework" (SAF) (Moulton and Sandfort, 2017) as a more sensitive framework for understanding leadership in complex systems. The authors use the New Care Models (Vanguard) Programme as an exemplar.

DESIGN/METHODOLOGY/APPROACH

Using the SAF framework, the authors explored factors affecting whether and how local Vanguard initiatives were implemented in response to national policy, using a qualitative case study approach. The authors apply this to data from the focus groups and interviews with a variety of respondents in six case study sites, covering different Vanguard types between October 2018 and July 2019.

FINDINGS

While literature already acknowledges that leadership is not simply about individual leaders, but about leading together, this paper emphasises that a further interdependence exists between leaders and their organisational/system context. This requires actors to use their skills and knowledge within the fixed and changing attributes of their local context, to perform the roles (boundary spanning, interpretation and mobilisation) necessary to allow the practical implementation of complex change across a healthcare setting.

ORIGINALITY/VALUE

The SAF framework was a useful framework within which to interrogate the data, but the authors found that the category of "social skills" required further elucidation. By recognising the importance of an intersection between position, personal characteristics/behaviours, fixed personal attributes and local context, the work is novel.

The Illness Perceptions of Women Following Symptoms of Acute Myocardial Infarction: A Self-Regulatory Approach

BACKGROUND

Coronary Heart Disease (CHD) has been socially constructed as a gender-specific disease with women not seen to be at risk. Women tend to delay seeking help following the onset of symptoms of acute myocardial infarction (MI). An illness perceptions approach has been used to explain treatment-seeking behaviour.

AIMS

The aim of this study was to explore the illness perceptions of a sample of women following acute MI using the self-regulatory model of illness behaviour as the theoretical framework.

METHODS

Ten women, with a range of ages, took part in semi-structured interviews, 3 months following an acute infarct. Data were analysed thematically according to the theoretical framework.

RESULTS

The development of a serious model of the illness and the decision to seek help was influenced by the experience of severe, unusual symptoms especially if of sudden onset; the absence of co-morbidities and similarities to the known experience of others. Perceived lack of susceptibility to the disease and a belief that symptoms were benign may have resulted in a delay in seeking help. Coping strategies were initially aimed at relieving symptoms before seeking help from families and friends. This resulted in a call for professional help.

CONCLUSION

Health promotion strategies need to emphasis the uniqueness of the individual's experience. Interventions designed to alter illness perceptions may influence treatment-seeking behaviour.

The Illness Perceptions of Women Following Acute Myocardial Infarction: Implications for Behaviour Change and Attendance at Cardiac Rehabilitation

Coronary heart disease (CHD) has been socially constructed as a gender-specific disease, with women seen not to be at risk (Lockyer, 2002). This is despite CHD being the leading cause of mortality in both men and women in the Western world (DH, 2004). The aim of this research was to explore the illness perceptions of a sample of women following acute myocardial infarction (MI). Relationships between illness perceptions and adoption of health-promoting behaviours, and attendance at a programme of cardiac rehabilitation were explored. The influence of age was also considered. Leventhal and Nerenz' Self- Regulatory Model of Illness Behaviour (1985) was used as the theoretical framework. This model consists of three stages: interpretation of symptoms, coping and appraisal. A qualitative research design was used. A purposeful sample of 10 women was selected on the basis of age and decision to attend cardiac rehabilitation. Data were collected by semi-structured interview, 3 months following the acute infarct, and analysed thematically. Stress was considered to be the cause of the MI, and although lifestyle factors were recognized, their significance was uncertain; perhaps as a result, lifestyle changes were limited. Overall, women had a perceived lack of control over the illness. The decision to attend a cardiac rehabilitation programme was influenced by beliefs relating to the identification of a known cause and level of perceived control of the illness. A belief that the illness was inevitable seemed to be more prevalent in older aged women. These findings have implications for health service providers in that they suggest that illness perceptions need to be explored and addressed before the decision to attend a programme of cardiac rehabilitation is made and health-promoting behaviours adopted.

Cardiac patient assessment: putting the patient first

Nursing roles are expanding and there is a growing expectation that nurses, with appropriate education and experience, are able to perform assessments that were traditionally conducted by doctors. This article discusses patient history, vital signs and physical examination related to the cardiac patient. This will enable practitioners to enhance their knowledge and understanding of this valuable assessment influencing patient care.