Given the importance of equal opportunity for all staff, this study will assist employers and policy makers better understand issues pertaining to engagement differences experienced by male, female and non-binary medical staff working in non-profit Australian hospitals by sex. A survey was emailed to all medical staff working at two public hospitals and five private hospitals in three states, seeking responses to 30 pre-determined items. The survey used a valid and reliable instrument which provided an overall index of medical engagement, against which male, female and non-binary respondents relative engagement is ranked highest to lowest. The results indicate that overall, male doctors (N=659) are more engaged than their female colleagues. Female doctors (N=316) working at the seven sites are less empowered and valued when compared to their male counterparts. The data also indicate that females feel the work culture is less collaborative than it is for males. This is particularly evident when comparing the results to the Australian (AU) norms. Non-binary doctors were significantly more disengaged compared to male and female colleagues. The results vary when compared by site, sex, jurisdiction, and sector. The profile of medical engagement varies at the sites, and by sex. Differences appear to be related to how valued and empowered doctors feel and whether they are encouraged to develop their skills to progress their careers. Activity aimed at female and non-binary staff are required to address the lower levels of engagement then their male counterparts, particularly for non-binary staff.

BACKGROUND:Despite comprising over 70% of the global healthcare workforce, women remain significantly underrepresented in healthcare leadership. This imbalance has implications for care quality, as leadership diversity is increasingly recognised as a determinant of care quality, equitable outcomes, and health system performance. Structural barriers persist across academic medicine, health services, and professional organisations, limiting career progression and leadership opportunities for women. Existing efforts have largely prioritised individual-level interventions, with limited attention to the systems- and organisational-level determinants that influence adoption, implementation, and sustainability of gender equity initiatives. Coordinated action is needed to address gender inequality through sustainable, evidence-informed systems change. METHODS:This protocol outlines the Organisational Change Management workstream within the Australian Advancing Women in Healthcare Leadership initiative, a nationally implemented, multi-sector partnership. Using a mixed-methods, co-produced implementation research approach, the workstream will implement and evaluate multi-level interventions and associated implementation strategies across system and organisational levels. Guided by the Consolidated Framework for Implementation Research, the Learning Health System framework, and the Reach, Effectiveness, Adoption, Implementation and Maintenance evaluation model, stakeholders are engaged across outer (policy, regulation, funding) and inner (organisational culture, leadership structures) settings. Data collection includes administrative datasets and policy documents, semi-structured interviews, and surveys. Qualitative data will be analysed thematically and quantitative data analysed descriptively. Findings will be triangulated to inform the selection, tailoring, and evaluation of implementation strategies and a codesigned implementation toolkit, supported by iterative learning cycles. DISCUSSION:This protocol describes a national initiative applying a systems- and organisational-level, co-produced approach to advancing gender equality in healthcare leadership, engaging health services, professional colleges and associations, government, and women in the workforce. By leveraging implementation science and systems change methodologies, the initiative aims to support sustainable organisational transformation. The protocol provides a replicable framework for advancing gender equality in healthcare leadership and beyond and contributes to implementation science by demonstrating how multiple established frameworks can be integrated to operationalise large-scale, system-level organisational change in complex healthcare systems.

Background: Despite comprising over 70% of the global healthcare workforce, women remain significantly underrepresented in healthcare leadership. Structural and systemic barriers persist across academic medicine, health services, and professional organisations, limiting career progression and leadership opportunities for women. Existing efforts often focus on individual-level interventions, overlooking the broader organisational and systemic contexts that shape leadership pathways. Urgent, coordinated action is needed to address gender inequity through sustainable, evidence-informed systems change. Methods: This protocol outlines the Organisation Change Management (OCM) workstream within the Australian Advancing Women in Healthcare Leadership (AWHL) initiative - a nationally implemented, multi-sector partnership. The initiative applies a mixed-methods, coproduction approach to implement and evaluate multi-level interventions aimed at advancing gender equity in healthcare leadership. Guided by the Consolidated Framework for Implementation Research, the Learning Health System framework, and the Reach, Effectiveness, Adoption, Implementation and Maintenance evaluation model, the study engages stakeholders across outer (policy, regulation, funding) and inner (organisational culture, leadership structures) settings to drive systemic and organisational changes to enhance gender equity in leadership. Data collection includes administrative datasets and policy documents, semi-structured interviews, and surveys across partner organisations. Findings will inform tailored interventions and an implementation toolkit, developed and evaluated through iterative stakeholder engagement. Discussion: This is the first national initiative to apply a systems-level, coproduced approach to gender equity in healthcare leadership, engaging strategic partners including health services, professional colleges and associations, government, and women in the workforce. By leveraging implementation science and systems change methodologies, the initiative aims to accelerate sustainable organisational transformation. The protocol provides a replicable framework for advancing equity in healthcare leadership and beyond. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This project is supported by two National Health and Medical Research Council Partnership Grants (APP1191837 & APP2018718) and partner contributions. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Monash University Human Research Ethics Committee I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes No datasets were generated or analysed for this protocol. The data arising from the study described in this protocol will not be shared, as it contains personal narratives that may reveal participant identities even after anonymisation.

Abstract Background Unprofessional behaviours between healthcare workers are highly prevalent. Evaluations of large-scale culture change programs are rare resulting in limited evidence of intervention effectiveness. We conducted a multi-method evaluation of a professional accountability and culture change program “Ethos” implemented across eight Australian hospitals. The Ethos program incorporates training for staff in speaking-up; an online system for reporting co-worker behaviours; and a tiered accountability pathway, including peer-messengers who deliver feedback to staff for ‘reflection’ or ‘recognition’. Here we report the final evaluation component which aimed to measure changes in the prevalence of unprofessional behaviours before and after Ethos. Methods A survey of staff (clinical and non-clinical) experiences of 26 unprofessional behaviours across five hospitals at baseline before (2018) and 2.5–3 years after (2021/2022) Ethos implementation. Five of the 26 behaviours were classified as ‘extreme’ (e.g., assault) and 21 as incivility/bullying (e.g., being spoken to rudely). Our analysis assessed changes in four dimensions: work-related bullying; person-related bullying; physical bullying and sexual harassment. Change in experience of incivility/bullying was compared using multivariable ordinal logistic regression. Change in extreme behaviours was assessed using multivariable binary logistic regression. All models were adjusted for respondent characteristics. Results In total, 3975 surveys were completed. Staff reporting frequent incivility/bullying significantly declined from 41.7% (n = 1064; 95% CI 39.7,43.9) at baseline to 35.5% (n = 505; 95% CI 32.8,38.3; χ2(1) = 14.3; P < 0.001) post-Ethos. The odds of experiencing incivility/bullying declined by 24% (adjusted odds ratio [aOR] 0.76; 95% CI 0.66,0.87; P < 0.001) and odds of experiencing extreme behaviours by 32% (aOR 0.68; 95% CI 0.54,0.85; P < 0.001) following Ethos. All four dimensions showed a reduction of 32–41% in prevalence post-Ethos. Non-clinical staff reported the greatest decrease in their experience of unprofessional behaviour (aOR 0.41; 95% CI 0.29, 0.61). Staff attitudes and reported skills to speak-up were significantly more positive at follow-up. Awareness of the program was high (82.1%; 95% CI 80.0, 84.0%); 33% of respondents had sent or received an Ethos message. Conclusion The Ethos program was associated with significant reductions in the prevalence of reported unprofessional behaviours and improved capacity of hospital staff to speak-up. These results add to evidence that staff will actively engage with a system that supports informal feedback to co-workers about their behaviours and is facilitated by trained peer messengers.

There is broad recognition of the under-representation of women in health care and medical leadership.1-4 The World Health Organization landmark report Delivered by women, led by men5 showed women make up 70% of the global health workforce but only 25% of the leadership. Decades of parity in men and women graduating from medical schools have not translated to gender equality in medical leadership,6 with variable gender participation in medical and surgical specialties and exacerbated by the "leaky" pipeline into medical leadership.2, 3, 7-10 Despite improvement, the disparity in Australian medical leadership remains, with only 33% of private hospital Chief Executive Officers and 30% of heads of Australian medical schools being women.11-13 Advancing women into health care leadership is an issue of equity and social justice. Furthermore, diversity, including more women into leadership, is likely to improve health system performance and health of the workforce and community.14 Women leaders are more likely to support equitable health policy and delivery, including immunisation, antenatal care, and community health practices, and have improved outcomes, including decreasing neonatal mortality.15, 16 Women have been shown generally to display transformational democratic leadership, being team-focused, motivating and empowering, with benefits of leadership diversity well demonstrated.17, 18 The burden of addressing barriers on a woman's path to leadership16 should not sit with individuals but rather with changing the culture, organisations and systems where women work.17 The Advancing Women in Healthcare Leadership (AWHL) initiative focuses on this system-level change. Funded by the National Health and Medical Research Council (NHMRC) and partner contributions, AWHL integrates health services, policy makers, professional colleges and member organisations with cross-sector academic expertise. It aims to deliver coproduced, evidence-based organisational and systems change to have an impact on the workplaces and systems where women work, enabling career goal attainment (Box 1). This figure was originally created by the AWHL team, chaired by Helena Teede, and is copyrighted to Monash University (2022). There are no patents or royalties, but we reserve the right to use the diagram again in other publications. Five AWHL research streams have emerged through coproduction with partners: organisational change management; leadership development; exploring intersectionality across race, ethnicity and gender diversity; nursing leadership; and collective action by member organisations. Here, we focus on this last stream, recognising the important role member organisations (including professional associations and colleges), play in medical careers. We aim to (i) explore the current and potential roles of partner professional colleges and member organisations, reaching within, across and beyond these entities to the broader health care sector; (ii) map organisational activity against evidenced-based interventions; and (iii) identify opportunities and priorities for interventions moving forward. We apply the Consolidated Framework for Implementation Research (CFIR)19, 20 for insights into (i) broad societal norms, expectations and culture where implementation occurs (outer setting); (ii) internal organisational culture and prioritisation of gender equity (inner setting); (iii) evidence base and quality of interventions already underway to address gender equity (intervention characteristics); (iv) the appetite and readiness of people within organisations to engage in implementation (individuals involved); and (v) the process of implementation19, 20 (Supporting Information, figure 1). The phases of formative research for this national initiative are outlined in Box 2. The cross-sector academic team engaged multiple stakeholders, including medical member organisations and colleges, with partnership involving cash and in-kind contributions, matched in a nationally competitive grant by the NHMRC. Coproduction approaches were applied to explore, map, identify and prioritise the roles of partners within their organisations and across the broader health care sector. These relied on close collaboration with partner organisations, building trust and mutual respect across all stages, in their role as both knowledge generators and end users. We performed a systematic search with a narrative literature review including grey literature and organisational website search (Supporting Information, table 1). We interrogated publicly available information and field notes from meetings with partners to gain insight into the roles and activities of member organisations in gender equity. We captured strategic plans, policies, reports, regulations, training accreditation standards and guidelines of member organisations. These included, but were not limited to, flexible and interrupted training, parental leave, diversity, inclusion and gender equity. We then mapped these against five categories of evidence-based organisational strategies shown to advance women in leadership21 (Supporting Information, table 2). We applied the CFIR to examine the "outer" broader social, political and "inner" organisational contexts in which the work of promoting gender equity was occurring. Ethics approval was provided by the Monash University Human Research Ethics Committee (Project ID 25097). Eight colleges and membership organisations partnered initially in AWHL: the Royal Australasian College of Medical Administrators, the Royal Australasian College of Physicians, the Royal Australasian College of Surgeons, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the Australian College of Nursing, the Australasian College of Dermatologists, the Royal Australian College of General Practitioners and the Australian Medical Association. The literature review and engagement with partners identified multiple roles of these organisations in medical careers, despite not being significant employers of the medical workforce (Box 3). Partners' roles included career development, overseeing postgraduate medical training and continuing professional development. These organisations provide leadership opportunities and skills through participation in internal organisational education, policy, and governance committees and promote academic engagement and networking. They assign membership based on criteria and remove membership privileges if professional standards and codes of conduct are breached. Externally, these organisations are a respected voice for the health care industry, are key public and political advocacy stakeholders, and negotiate industrial agreements for medical staff. Participation in: Mapping of current activity against evidence-based interventions21 (Box 4) showed that most partner organisations had gender equity or diversity and inclusion working groups, and all recognised the importance of preventing harassment and discrimination. Two had leadership and board approval for gender equity plans and gender targets for representation on leadership committees, examinations and conference panels. Two had established targets for gender representation in training programs, yet only one had formally reported on progress on these. Two had committed to collecting data on participation of women within subspecialties and investigating barriers to subspecialty entry. Only one had reported on progress and had committed to regular review and reporting. No evidence of collective action was identified. Most partner organisations had policies for bullying, harassment and discrimination, flexible training, interrupted training, and principles for parental leave. Many policies were contingent on flexible training positions availability at health service level, which is left to arguably disempowered early career doctors to negotiate in the absence of workplace system-level solutions. One college reported flexible training positions online. There was no available evidence of implementation or enforcement of relevant policies, standards or regulations. Accreditation of training standards for health services included availability of flexible training and a culture of respect. These were not linked to gender equity and no public record of implementation was found. Although all organisations provided networking opportunities such as annual academic meetings, only one had public evidence of a mentoring program for women. One organisation had established leadership training for its leaders and another focused on training medical leaders across all disciplines. Relevant literature, and mapping of organisational activities compared with the evidence and to an implementation framework, showed that most partners had positive intent, yet they did not fully grasp potential opportunities and roles, and were early in their implementation journeys. During the workshop, it was acknowledged that publicly available information did not reflect the activities within many organisations, only reflected a single time point on an evolving issue, and collaboration was extended to collect further data. Workshop participants shared their motivations, updates on their organisation's progress, achievements to date and challenges they were facing. Member organisations unanimously agreed that collective action was a priority to increase the reach and impact of organisational interventions to advance women in leadership. They explored the opportunities, identified and prioritised strategies to deliver organisational and systems-level change. Partners were highly invested and engaged, and this was reflected in a commitment to improving organisational policies and practices, and to collectively developing gender equity-focused training accreditation standards. They recognised the importance of reducing gender bias within training programs by implementing flexible training options and parental leave, as well as their vital role in providing broader advocacy within, across and beyond their own organisations to the broader health care sector. The partner organisations enthusiastically agreed to establish and participate in a Community of Practice as a priority, to share experiences and learnings and more effectively influence the settings where women work. Further priorities of the Community of Practice include: developing aligned principles for flexible training and parental leave policies, considering the development of a shared accreditation standard focused on gender equitable practices, and engaging in broader advocacy (Supporting Information, table 3). Using the CFIR to frame implementation efforts, the "outer setting" context in Australia includes the establishment of the national Workplace Gender Equality Agency (WGEA)22 and, in Victoria, the Gender Equality Act 2020,23 both requiring mandatory collection and reporting of gender equity indicators. This has enhanced interest and commitment of member organisations and health services to advance women in health care leadership. Despite not being direct employers of the medical workforce, they recognise their ability to advance gender equality. Understanding and actioning their potential roles to drive policy-mandated change is key to progress. Evidence-based interventions to advance women in health care leadership are now established,21 and here the literature and publicly available data24-27 on member organisation activities were mapped against the evidence, showing gaps and opportunities. We contextualised these findings in terms of understanding the internal organisational commitment to implementing evidence-based change, aligned to the CFIR. Partner member organisations' "inner" context shows general awareness of the importance of gender equity, and increasing organisational engagement and commitment, reflected by strong engagement in the AWHL initiative. However, organisations varied considerably in maturity, readiness, and actions to implement change, with most early in the journey. Only three organisations had published a strategy to manage issues of women in leadership, including implementation of gender targets, with only two reporting on progress. Nevertheless, they all enthusiastically agreed to continue shared communication and collaboration through a Community of Practice, and the coproduction of collective evidence-based interventions that can be applied in their own contexts. Interest in this national initiative has resulted in substantial expansion to include multiple additional medical colleges, and a second successful NHMRC partnership grant has now been obtained to fund and deliver this work. Extensive engagement and in-depth qualitative research and surveys are now underway to further understand the "inner" partner context, such as attitudes, knowledge, policies, and behaviours of the leadership, members, trainees and early career professionals. Data will be triangulated with available public information, such as that reported here, to inform further implementation research and activities. Ongoing coproduction with the partner organisations continues, using the newly established Community of Practice as the platform to bring to life these next phases of collective knowledge generation, intervention development, implementation and evaluation. These efforts aim beyond the problem and barriers to evidence-based solutions to advance women into health care leadership for equity. Jenny Proimos is supported by an Australian Government Research Training Program (RTP) stipend. We acknowledge the contribution of the partner organisations: the Australian Medical Association, the Australian College of Nursing, the Australasian College of Dermatologists, the Royal Australian College of General Practitioners; the Royal Australasian College of Medical Administrators, the Royal Australasian College of Physicians, the Royal Australasian College of Surgeons, and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. We also acknowledge Mariam Mousa, author of the systematic review of evidence-informed organisational interventions to advance women in leadership, on which the mapping exercise in this article is based. Open access publishing facilitated by Monash University, as part of the Wiley – Monash University agreement via the Council of Australian University Librarians. No relevant disclosures. Not commissioned; externally peer reviewed. Supplementary figure and tables Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

BackgroundAs healthcare systems rapidly become more complex, healthcare leaders are navigating expanding role scopes and increasingly varied tasks to ensure the provision of high-quality patient care. Despite a range of leadership theories, models, and training curricula to guide leadership development, the roles and competencies required by leaders in the context of emerging healthcare challenges (e.g., disruptive technologies, ageing populations, and burnt-out workforces) have not been sufficiently well conceptualized. This scoping review aimed to examine these roles and competencies through a deep dive into the contemporary academic and targeted gray literature on future trends in healthcare leadership roles and competencies.MethodsThree electronic databases (Business Source Premier, Medline, and Embase) were searched from January 2018 to February 2023 for peer-reviewed literature on key future trends in leadership roles and competencies. Websites of reputable healthcare- and leadership-focused organizations were also searched. Data were analyzed using descriptive statistics and thematic analysis to explore both the range and depth of literature and the key concepts underlying leadership roles and competencies.ResultsFrom an initial 348 articles identified in the literature and screened for relevance, 39 articles were included in data synthesis. Future leadership roles and competencies were related to four key themes: innovation and adaptation (e.g., flexibility and vision setting), collaboration and communication (e.g., relationship and trust building), self-development and self-awareness (e.g., experiential learning and self-examination), and consumer and community focus (e.g., public health messaging). In each of these areas, a broad range of strategies and approaches contributed to effective leadership under conditions of growing complexity, and a diverse array of contexts and situations for which these roles and competencies are applicable.ConclusionsThis research highlights the inherent interdependence of leadership requirements and health system complexity. Rather than as sets of roles and competencies, effective healthcare leadership might be better conceptualized as a set of broad goals to pursue that include fostering collaboration amongst stakeholders, building cultures of capacity, and continuously innovating for improved quality of care.

In Australia, there are only two publicly reported disciplinary cases against specialist medical administrators. In the most recent decision of Medical Board of Australia v Gruner, the Victorian Civil and Administrative Tribunal confirmed that specialist medical administrators owe patients and the public the same professional obligations as medical practitioners with direct patient contact. More controversially, the Tribunal also held that medical administrators have a professional obligation only to accept roles with clear position descriptions that afford them sufficient time and resources to ensure the safe delivery of health services. We argue that this imposes unrealistic expectations on medical administrators engaged by rural, regional, or private health services that already struggle to attract and retain specialist medical expertise. This may exacerbate existing health inequalities by disincentivising specialist medical administrators from seeking fractional appointments that assist under-funded areas of workforce shortage.

In this chapter, you will learn about: In this chapter, the reader will consider the relationship between management and medical leadership. Management is the process of control and coordination of activities and resources, people, material and financial, in an organisation to achieve the organisation's purpose—and managers, the people who perform this process. Managers manage within the context of organisations, so we will first to explore the function and structure of organisations. The definitions of leadership and different leadership styles and approaches make it difficult to spell them out simply. Amongst the different viewpoints and perspectives, some common and classic components might be knowing yourself, having a vision that is well communicated, building trust among colleagues and taking effective action to realise your own leadership potential, establishing direction, aligning people, motivating and inspiring [1]. The King's Fund [2] succinctly stated that leadership is when a staff member chooses to do the minimum or more.

© Author(s) (or their employer(s)) 2023. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION By now, most readers will have heard of the Chat Generative Pretrained Transformer (ChatGPT) artificial intelligence (AI) chatbot tool released to the public by the AI company OpenAI on 30 November 2022, to be used for free (at least for now), and which, by January 2023, had reached over 100 million users, making it the fastest growing consumer application to date. The ability of ChatGPT and other similar generative AI tools to generate text that appear to be similar to those created by human has led to both critics and supporters of this new technology. These new AI technologies have created challenges for medical leaders in the health system and offer new opportunities as well. This paper summarises these challenges and opportunities and provides a potential way forward. The main concern that AI tools such as ChatGPT raise is their ability to generate blocks of text that are so fluent and wellwritten that they are indistinguishable from content authored by human beings, which raises concerns of its use in fraud and plagiarism. Part of the problem is that ChatGPTgenerated text can be difficult to distinguish from humangenerated ones even for specialist AItext detection software, leading to its creator, OpenAI, to release its own AI detection tool; however, this tool itself is not entirely accurate as it concluded that the first few text passages from the Bible were likely to be AIgenerated during a test.

There is mounting recognition that healthcare is increasingly complex. Attempts to make the system run smoother and faster will be countered by rising health consumer expectations, constrained budgets and demands to keep pace with new technology. Short-term, technical solutions to health service delivery problems will, at best, support the status quo but they lack the power to really transform the future.

Background Unprofessional behaviour among hospital staff is common. Such behaviour negatively impacts on staff wellbeing and patient outcomes. Professional accountability programs collect information about unprofessional staff behaviour from colleagues or patients, providing this as informal feedback to raise awareness, promote reflection, and change behaviour. Despite increased adoption, studies have not assessed the implementation of these programs utilising implementation theory. This study aims to (1) identify factors influencing the implementation of a whole-of-hospital professional accountability and culture change program, Ethos , implemented in eight hospitals within a large healthcare provider group, and (2) examine whether expert recommended implementation strategies were intuitively used during implementation, and the degree to which they were operationalised to address identified barriers. Method Data relating to implementation of Ethos from organisational documents, interviews with senior and middle management, and surveys of hospital staff and peer messengers were obtained and coded in NVivo using the Consolidated Framework for Implementation Research (CFIR). Implementation strategies to address identified barriers were generated using Expert Recommendations for Implementing Change (ERIC) strategies and used in a second round of targeted coding, then assessed for degree of alignment to contextual barriers. Results Four enablers, seven barriers, and three mixed factors were found, including perceived limitations in the confidential nature of the online messaging tool (‘Design quality and packaging’), which had downstream challenges for the capacity to provide feedback about utilisation of Ethos (‘Goals and Feedback’, ‘Access to Knowledge and Information’). Fourteen recommended implementation strategies were used, however, only four of these were operationalised to completely address contextual barriers. Conclusion Aspects of the inner setting (e.g., ‘Leadership Engagement’, ‘Tension for Change’) had the greatest influence on implementation and should be considered prior to the implementation of future professional accountability programs. Theory can improve understanding of factors affecting implementation, and support strategies to address them.

BACKGROUND:Workplace behaviours of healthcare staff impact patient safety, staff well-being and organisational outcomes. A whole-of-hospital culture change programme, Ethos, was implemented by St. Vincent's Health Australia across eight hospitals. Ethos includes a secure online submission system that allows staff across all professional groups to report positive (Feedback for Recognition) and negative (Feedback for Reflection) coworker behaviours. We analysed these submissions to determine patterns and rates of submissions and identify the coworker behaviours reported.METHOD:All Ethos submissions between 2017 and 2020 were deidentified and analysed. Submissions include structured data elements (eg, professional role of the reporter and subjects, event and report dates) and a narrative account of the event and coworker behaviours. Descriptive statistics were calculated to assess use and reporting patterns. Coding of the content of submissions was performed to classify types of reported coworker behaviours.RESULTS:There were a total of 2504 Ethos submissions, including 1194 (47.7%) Recognition and 1310 (52.3%) Reflection submissions. Use of the submission tool was highest among nurses (20.14 submissions/100 nursing staff) and lowest among non-clinical services staff (5.07/100 non-clinical services staff). Nurses were most frequently the subject of Recognition submissions (7.56/100 nurses) while management and administrative staff were the least (4.25/100 staff). Frequently reported positive coworker behaviours were non-technical skills (79.3%, N=947); values-driven behaviours (72.5%, N=866); and actions that enhanced patient care (51.3%, N=612). Medical staff were the most frequent subjects of Reflection submissions (12.59/100 medical staff), and non-clinical services staff the least (4.53/100 staff). Overall, the most frequently reported unprofessional behaviours were being rude (53.8%, N=705); humiliating or ridiculing others (26%, N=346); and ignoring others' opinions (24.6%, N=322).CONCLUSION:Hospital staff across all professional groups used the Ethos messaging system to report both positive and negative coworker behaviours. High rates of Recognition submissions demonstrate a strong desire of staff to reward and encourage positive workplace behaviours, highlighting the importance of culture change programmes which emphasise these behaviours. The unprofessional behaviours identified in submissions are consistent with behaviours previously reported in surveys of hospital staff, suggesting that submissions are a reliable indicator of staff experiences.

The COVID-19 pandemic has changed the way we relate to data. This paper summarises how data has been used during the pandemic, how the use of artificial intelligence (AI) algorithms has been accelerated, and what the post-pandemic future could look like. The pandemic has changed the way we release research data. The confluence of improved wireless connectivity, the rise of wearable sensors with smart internet of things, and the improvements in artificial intelligence (AI), has the potential to transform personalised medicine. The holy grail of data is to be able to help us predict what is to come, plan ahead and prevent future crisis and problems. Technologies like AI are helping us to do just this during the pandemic. Our ability to synthesise big data from genomics databases and population health statistics, with the support of AI, will allow us to carry out real-time molecular epidemiology - not just help us track past pandemics and manage current ones, but predict and prevent future ones. The main reason is that the current technology may not be mature enough. Despite the positive studies, there are also other studies that suggest caution needs to be taken before introducing AI systems into live production settings in health. In addition, for AI systems to be effective, they need access to data. However, a lot of data is proprietary and not shared publicly. We need to establish policies for a robust data governance framework – the “who, how, where and when” of data. We also need to establish the purpose of the data being collected and used – the “why” of data. As health information is the most valuable data that exists on the darkweb, steps must be taken to ensure that the data is protected. There are strong laws around ensuring privacy of health information, and policies and processes, as well as training, must be in place to maintain confidentiality and compliance with the law. We need more funding for further research into AI in health to support their safe and effective use in healthcare settings. Last but not least, we need to design our data systems to be patient-centred. In summary, the COVID-19 pandemic has accelerated the way data is used to help us understand our past, manage our present and predict our future, with the support of AI, and it is up to all of us, especially those who are in medical and digital health leadership roles, to ensure that we sustain these improvements in the post-pandemic world, so that we can prevent future pandemics.

The shift in surgery toward minimally invasive approaches requires transitioning from an analog world to a digitally transformed system and presents a huge opportunity in this emerging field. Artificial intelligence (AI) in healthcare has the potential to transform the role of doctors and revolutionize the practice of medicine. The convergence between AI and medical robotic technologies creates an interesting area for research and development activities for the medical technology industry. Despite rapid improvements in robotic-assisted surgery over the past decade, the level of adoption remains low due to high costs, which is cited as a major challenge. This chapter outlines the current trends and perspectives of AI in medical robotics, with a rapid review of AI-supported robotics in allied health, radiology, rehabilitation medicine, with a specific focus on surgical applications. The chapter looks at how AI is being used in medical robotics for teaching and training, through to surgical planning and robotic-assisted surgery, using case studies. Some challenges with the use of AI in medicine include the issue of legal liability and attribution of negligence when errors occur. The chapter provides insights on ethical and legal issues of AI in medical robotics, with a discussion around implementation and adoption of this new technology.

Background This brief paper provides an overview of the analysis in support of mandating COVID-19 vaccinations for all workers in health and aged care settings in Australia. Leaders of health and aged care organisations have a duty of care under work health and safety legislation to eliminate and/or control the risk of transmission of vaccine-preventable disease in their facilities, including COVID-19. Methods Key issues that should be considered by healthcare leaders when mandating that all health and aged care workers be vaccinated against COVID-19 were analysed by executives from a large Australian national health and aged care provider and discussed in this paper. Results This paper summarises the medical/scientific, ethical, legal, work health and safety, workers’ compensation and industrial relations considerations when mandating COVID-19 vaccination for healthcare workers. Conclusion Leaders of health and aged care organisations must provide a safe environment and workplace for all those who work for them, as well as for those who receive care or treatment at one of their facilities. It is hoped that this paper will assist leaders of healthcare organisations in making their own decisions during this time.

A survey administered to staff at five hospitals investigated changes in unprofessional behaviour, teamwork and co‐operation during the COVID‐19 pandemic. From 1583 responses, 76.1% (95% confidence interval (CI): 74.0–78.2%) reported no change or a decrease in unprofessional behaviours. Across all professional groups, 43.6% ( n = 579, 95% CI: 41.0–46.3%) reported improvements in teamwork and co‐operation. Findings suggest that intensifying work demands, such as those resulting from the pandemic, are not a major trigger for unprofessional behaviour, and root causes lie elsewhere.