ObjectiveLeadership is associated with organisational performance in healthcare, including quality, safety and clinical outcomes for patients. Leadership development programmes have proliferated in recent years. Nevertheless, very few have examined participant experiences in depth in order to understand which programmatic aspects they regard as most valuable relative to leadership in increasingly complex systems, or whether and how learnings may sustain over time. Accordingly, we explored experiences of participants in an interdisciplinary leadership development programme using qualitative methods over an extended look-back period.SettingHealth and social care sectors in the UK.ParticipantsKey informants from three cohorts of individuals working in leadership roles in health and social care in the UK: 2013/2014, 2015/2016 and 2017/2018. We contacted 32 participants, and 26 completed interviews (81% response rate).Primary and secondary outcomesWe explored (1) whether and how specific skills and competencies developed during the programme were applied and/or sustained over time, and (2) whether and how the impact of the programme changed as alumni progressed through their career.ResultsThree major recurrent themes emerged from participants’ experiences: (1) specific features of the programme meaningfully impact professional development at multiple levels; (2) the coupling of a professional network and practical tools allowed participants to address system-wide problems in new ways and (3) participants describe a level of learning that sustained and amplified over time with increased complexity in their work.ConclusionThis work highlights specific design characteristics of leadership development programmes that may help promote relevance and impact. Programme learnings can be translated into practice in substantive ways, with potential for the benefits of successful leadership development efforts to amplify, not fade, over time.

Background Sepsis affects 1.7 million patients in the US annually, is one of the leading causes of mortality, and is a major driver of US healthcare costs. African American/Black and LatinX populations experience higher rates of sepsis complications, deviations from standard care, and readmissions compared with Non-Hispanic White populations. Despite clear evidence of structural racism in sepsis care and outcomes, there are no prospective interventions to mitigate structural racism in sepsis care, nor are we aware of studies that report reductions in racial inequities in sepsis care as an outcome. Therefore, we will deliver and evaluate a coalition-based intervention to equip health systems and their surrounding communities to mitigate structural racism, driving measurable reductions in inequities in sepsis outcomes. This paper presents the theoretical foundation for the study, summarizes key elements of the intervention, and describes the methodology to evaluate the intervention. Methods Our aims are to: (1) deliver a coalition-based leadership intervention in eight U.S. health systems and their surrounding communities; (2) evaluate the impact of the intervention on organizational culture using a longitudinal, convergent mixed methods approach, and (3) evaluate the impact of the intervention on reduction of racial inequities in three clinical outcomes: a) early identification (time to antibiotic), b) clinical management (in-hospital sepsis mortality) and c) standards-based follow up (same-hospital, all-cause sepsis readmissions) using interrupted time series analysis. Discussion This study is aligned with calls to action by the NIH and the Sepsis Alliance to address inequities in sepsis care and outcomes. It is the first to intervene to mitigate effects of structural racism by developing the domains of organizational culture that are required for anti-racist action, with implications for inequities in complex health outcomes beyond sepsis.

Background and Objectives Partnerships between health care and social service organizations may contribute to lower health care use and spending. Such partnerships are increasing, including Area Agencies on Aging (AAAs) working and contracting with health care organizations. Nevertheless, knowledge about how AAAs establish and manage successful collaborations is limited. We sought to understand how AAAs establish and manage partnerships with health care organizations. Research Design and Methods We conducted an explanatory sequential mixed-methods study using a positive deviance approach. We used national-level data to identify AAAs with multiple health care partners serving areas with low utilization of nursing homes by residents with low-care needs (n=9), and AAAs with few health care partners and high utilization for comparison (n=3). We conducted in-depth interviews with key informants from these 12 AAAs and their partner organizations (total n=130). A 5-person multidisciplinary team used the constant comparative method of analysis, supported by Atlas.ti software. Results Highly-partnered AAAs were characterized by 3 distinctive features of organizational culture: 1) attention to external environments, 2) openness to innovation and change, and 3) risk taking to learn, improve and grow. AAAs and partners describe a broad set of organizational strategies and partnership development tactics, depending on their local contexts. These features were underdeveloped in AAAs with few health care partnerships. Discussion and Implications While federal and state policies can create more favorable environments for AAA-health care partnerships, AAAs can also work internally to foster an organizational culture that allows them to thrive in dynamic and challenging environments.

Background and Objectives Area Agencies on Aging (AAAs) have funded, coordinated and provided services since the 1960’s, evolving in response to changes in policy, funding, and the political arena. Many of their usual service delivery programs and processes were severely disrupted with the onset of the COVID-19 pandemic. Increasing evidence suggests the importance of partnerships in AAA’s capacity to adapt services; however, specific examples of adaptations have been limited. We sought to understand how partnerships may have supported adaptation during the pandemic, from the perspectives of both AAAs and their partners. Research Design and Methods We conducted a secondary analysis of qualitative data from an explanatory sequential mixed methods parent study. Data were collected from 12 AAAs diverse in terms of geographic region, governance structure and size, as well as a range of partner organizations. We completed 105 in depth interviews from July 2020 to April 2021. A five-member multidisciplinary team coded the data using a constant comparative method of analysis, supported by ATLAS.ti Scientific Software. Results AAAs and their partners described strategies and provided examples of ways to rapidly transform service delivery including reducing isolation, alleviating food insecurity, adapting program design and delivery, and leveraging partnerships and repurposing resources. Implications AAAs and partner organizations are uniquely positioned to innovate during times of disruption. Findings may enhance AAA and partner portfolios of evidence-based and evidence-supported programs.

Stronger relationships among service providers in the health care and social service sectors may contribute to positive outcomes such as lower health care use and spending. Such partnerships have grown in recent years, including Area Agencies on Aging (AAAs) contracting with health care organizations, and their impact on health care utilization has been demonstrated. Nevertheless, knowledge about how AAAs establish and manage successful collaborations is limited. This study was designed to understand how AAAs in regions with low levels of avoidable health care utilization develop and sustain partnerships with health care organizations. We conducted an explanatory sequential mixed-methods, positive deviance study. In the quantitative phase, we identified 8 AAAs with multiple health care partners serving areas with little utilization of nursing homes by residents with low-care needs, and 3 with few partners and high utilization for comparison. In the qualitative phase, we identified key informants within AAAs and their partners for in-depth interviews (total n = 123). We used the constant comparative method of analysis to identify 5 factors that characterized partnerships in the highly-partnered, low-utilization sites: 1) Regional context (e.g., breadth of health care provider market, cross-sectoral coalitions), 2) AAA human resource assets (e.g., community expertise, business acumen), 3) AAA organizational culture (e.g., visionary leadership, risk taking), 4) Interdependence among organizations (e.g., mutual benefit, alignment), and 5) Interpersonal dynamics (e.g., trust, relationships). The importance of these regional, organizational, and relational factors suggests that AAA business acumen is necessary but not sufficient to build and sustain robust cross-sectoral partnerships.