BackgroundThe concept of “mechanism” is central to realist approaches to research, yet research teams struggle to operationalize and apply the concept in empirical research. Our large, interdisciplinary research team has also experienced challenges in making the concept useful in our study of the implementation of models of integrated community-based primary health care (ICBPHC) in three international jurisdictions (Ontario and Quebec in Canada, and in New Zealand).MethodsIn this paper we summarize definitions of mechanism found in realist methodological literature, and report an empirical example of a realist analysis of the implementation ICBPHC.ResultsWe use our empirical example to illustrate two points. First, the distinction between contexts and mechanisms might ultimately be arbitrary, with more distally located mechanisms becoming contexts as research teams focus their analytic attention more proximally to the outcome of interest. Second, the relationships between mechanisms, human reasoning, and human agency need to be considered in greater detail to inform realist-informed analysis; understanding these relationships is fundamental to understanding the ways in which mechanisms operate through individuals and groups to effect the outcomes of complex health interventions.ConclusionsWe conclude our paper with reflections on human agency and outline the implications of our analysis for realist research and realist evaluation.

The global scale and unpredictable nature of the current COVID-19 pandemic have put a significant burden on health care and public health leaders, for whom preparedness plans and evidence-based guidelines have proven insufficient to guide actions. This article presents a review of empirical articles on the topics of “crisis leadership” and “pandemic” across medical and business databases between 2003 (since SARS) and—December 2020 and has identified 35 articles for detailed analyses. We use the articles’ evidence on leadership behaviors and skills that have been key to pandemic responses to characterize the types of leadership competencies commonly exhibited in a pandemic context. Task-oriented competencies, including preparing and planning, establishing collaborations, and conducting crisis communication, received the most attention. However, people-oriented and adaptive-oriented competencies were as fundamental in overcoming the structural, political, and cultural contexts unique to pandemics.

Using the framework of the self‐determination theory continuum, we investigated the influence of the distinct autonomous and controlled motivational regulations for engaging participants in online and offline support of charitable events for the causes of breast cancer and homeless youth. Participants were exposed online to Facebook event pages appealing to helping others. When the often omitted integrated autonomous regulation was included in the model, it was the strongest predictor of supportive intentions. Without integrated regulation in the model, we would have overestimated the relatively minor influence of controlled introjected regulation. Furthermore, rather than one overall measure of autonomous intrinsic regulation, we assessed the differential influences of three separate dimensions (to experience stimulation, to learn and to accomplish). Intrinsic motivation to experience stimulation had a unique influence on online and offline supportive intentions. Such was not the case for the dimensions of to learn or to accomplish. Follow‐up meditation analyses of self‐reported behaviours confirmed that autonomous integrated and intrinsic to experience stimulation regulations led to stronger intentions to support online behaviours, which, in turn, increased the likelihood of actual online engagement. The findings in a social media context highlight the importance of analysing distinct regulatory styles within the self‐determination theory continuum. Copyright © 2015 John Wiley & Sons, Ltd.

BackgroundThe past fifteen years have been marked by large-scale change efforts undertaken by healthcare organizations to improve patient safety and patient-centered care. Despite substantial investment of effort and resources, many of these large-scale or “radical change” initiatives, like those in other industries, have enjoyed limited success – with practice and behavioural changes neither fully adopted nor ultimately sustained – which has in large part been ascribed to inadequate implementation efforts. Culture change to “patient safety culture” (PSC) is among these radical change initiatives, where results to date have been mixed at best.DiscussionThis paper responds to calls for research that focus on explicating factors that affect efforts to implement radical change in healthcare contexts, and focuses on PSC as the radical change implementation. Specifically, this paper offers a novel conceptual model based on Organizational Learning Theory to explain the ability of middle managers in healthcare organizations to influence patient safety culture change.SummaryWe propose that middle managers can capitalize on their unique position between upper and lower levels in the organization and engage in ‘ambidextrous’ learning that is critical to implementing and sustaining radical change. This organizational learning perspective offers an innovative way of framing the mid-level managers’ role, through both explorative and exploitative activities, which further considers the necessary organizational context in which they operate.