Background Amid concerns about the decline of empathy during the clinical training of medical clerks, evidence that empathy improves patient outcomes suggests some potential for teaching empathy in ways that will affect the knowledge, attitude and behaviour of medical clerks. This potential alone cannot, however, guarantee the success of educational innovations to introduce empathy to the medical curriculum. This research aims to identify the barriers and facilitators of the implementation of a specific clinical initiative to enhance the empathy skills of clerks, namely the training of clerks to act as a ‘MedGezel’ or ‘medical coach’. Method We conducted an explorative qualitative study based on interview data collected and analyzed using reflexive thematic analysis and the readiness for change theory. We conducted semi-structured interviews with relevant stakeholders in this particular qualitative study. Thematic analysis was based on open and axial coding using ATLAS.ti 9, which facilitated the emergence of common themes of interest and meaning for the study. Results A total of 13 relevant stakeholders participated as interviewees in our study. The data was collected from April to June 2021. Our analysis generated 6 main themes which can provide insights into why the implementation of the MedGezel educational innovation failed so far. The following themes emerged: the case for change: why change?; practical necessity; leadership; management and resources; staff culture; and alignment with the corporate strategy. Discussion The implementation failure can be partially explained as resulting from the personal attitudes and choices of participants, who struggled to reconcile a vision that they liked with side effects that they feared. While participants repeatedly mentioned management and leadership issues, these organizational issues seemed less important as they could be easily resolved in practice. What was more important and fatal for the initiative was its lack of alignment with staff culture, despite its alignment with corporate strategy. Conclusion This investigation into the barriers and facilitators influencing the implementation of the MedGezel program identified 6 explanatory themes, the most impactful one being staff culture.

Health systems all over the world are in a process of transition and may even need a paradigm shift for sustainable development. This is where activism may play a role. This study focused on why some physicians become activists and how these physicians have either achieved successes or failed to do so. This study is inspired by grounded theory. Semi-structured, in-depth interviews were conducted to evaluate the experiences of seven purposefully sampled physician-activists from the Netherlands. Our research suggests that activism originates from an awareness of problems in the area of health inequalities, resulting in moral discomfort combined with a strong drive to speak up against perceived failings, even when personal risks may be involved. Activists that were most successful in achieving political and health changes meandered effectively along the borders of the system, taking care to preserve ties with supporters within that system and, at the same time, taking a relatively isolated position while using strategies to oppose the system. Diverging too much from the system resulted in measures taken by the system to silence them. Successful activism may be regarded as a social and professional skill that may be learned.

Background: Amid concerns about the decline of empathy during clinical training of medical clerks, evidence that empathy improves patient outcomes suggests some potential for teaching empathy in ways that will affect the knowledge, attitude and behaviour of medical clerks. This potential alone cannot, however, guarantee the success of educational innovations to introduce empathy to the medical curriculum. This research aims to investigate an implementation failure of a specific clinical initiative to enhance the empathy skills of clerks, namely the training of clerks to act as ‘MedGezels’ or ‘medical coaches’.Method: We conducted an explorative qualitative study on the basis of interview data collected and analyzed in a manner inspired by grounded theory and viewed through the lens of the readiness for change theory. We conducted semi-structured interviews with the most important stakeholders in the particular case study. Thematic analysis was done based on open and axial coding using ATLAS.ti 9, a qualitative data analyzing software program, which facilitated the emergence of common themes of interest for the study.Results: A total of 13 relevant stakeholders participated as interviewees in our study. The data was collected over a period of 3 months, from April to June 2021. Our analysis generated 6 main themes which can provide insights into why the implementation of the MedGezel educational innovation failed so far. The themes that emerged were: the case for change: why change?; practical necessity; leadership; management and resources; staff culture and the alignment with the corporate strategy. Discussion: The implementation failure is partially explainable as resulting from the personal attitudes and choices of participants who struggled to reconcile a vision that they liked but whose side effects they feared. While participants mentioned management and leadership issues several times, the importance of these was downplayed given that such organizational issues could be easily resolved in practice. What was more important and fatal to the initiative was its lack of alignment with staff culture, despite its alignment with corporate strategy. Conclusion: This investigation into the reasons behind the implementation failure of the MedGezel program produced 6 explanatory themes of which staff culture was most convincing.