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BackgroundAs systems become more complex, shared leadership (SL) has been suggested to have a dominant role in improving cross-functional working tailored to organisational needs. Little, however, is known about the benefits of SL in healthcare management, especially for UK’s recently formed integrated care system (ICS). The aim of this study was to understand current attitudes, barriers and needs of clinical and non-clinical managers sharing leadership responsibilities in the ICS.MethodTwenty clinical and non-clinical leaders in 15 organisations were interviewed to understand current cross-functional leadership collaborations, and the potential SL may have on the recently established ICS in the National Health Service (NHS). The data were transcribed and analysed thematically.ResultsFindings showed perceptions and experiences of clinical and non-clinical healthcare management in relation to: (1) motivation to execute a leadership position, including the need to step up and a sense of duty; (2) attitudes towards interdisciplinary working, which is reflected in conflicts due to different values and expertise; (3) SL skills and behaviours, including the need for mutual understanding and cooperative attitudes by means of effective communication and collaboration; and (4) barriers to achieve SL in the ICS, such as bureaucracy, and a lack of time and support.ConclusionsSL may help improve current leadership cultures within the NHS; however, for SL to have a tangible impact, it needs to be delivered as part of leadership development for doctors in postgraduate training, and development programmes for aspiring, emerging and established leaders, with clear lines of communication.

AimSystem leadership is the requirement for a leader of a single organisation to operate on behalf of a wider system, rather than their individual organisation. It is not clear to what extent the current policy landscape supports leaders in managing misalignment between the needs of their organisation and the wider system, as many national structures still emphasise a focus on individual organisations. This study aims to understand how Chief Executives implement system leadership in practice when faced with decisions that benefit the system to the detriment of their own trust.MethodologySemi-structured interviews were conducted with ten Chief Executives from a range of trust types to understand their perceptions and decision-making process in practice. Semantic thematic analysis was used to draw out themes in relation to how Chief Executives approach decisions which weigh up the system and organisation.ResultsThemes raised by interviewees included both advantages (such as support in managing demand) and disadvantages (such as increased bureaucracy) of system leadership and practical considerations in operationalisation (such as the importance of interpersonal relationships). Interviewees endorsed system leadership in principle, but did not feel that the organisational incentives as currently structured support the implementation of system leadership in practice. This was not seen as a major challenge or impediment to effective leadership.ConclusionAs a specific policy area, a direct focus on systems leadership is not necessarily helpful. Chief Executives should be supported to make decisions in a complex environment, without a specific focus on healthcare systems as a unit of operation.

Background European countries face fiscal pressure regarding the long-term sustainability of their healthcare system due to increasing levels of public health expenditures and mounting demographic pressures. The promotion of generic drugs is considered to be an efficient means to tackle these challenges; however, market diffusion remains slow. The aim of this study was to investigate the impact of price and brand cues on purchase intentions by means of Direct-to-Consumer (DTC) advertising, and to build on the market cue evaluation model by Dodd et al. Methods Participants rated purchase intentions on six DTC adverts varying in price and brand information, followed by self-reports on purchase intentions, attitudes towards generics, brand loyalty, price consciousness, as well as perceptions of quality, risk and value. Open-ended questions explored attitudes toward generic drugs. Results Brand information and purchase intentions were mediated by perceived risk and perceived quality, while price information influenced purchase intention through perceptions of quality, risk and value. Consumers’ purchase behaviour was furthermore influenced by unawareness and misconceptions, past experiences, and advertising as a decision-making tool. Conclusions Advertisements, including price and brand information, are an important tool to improve consumers’ awareness of the availability of different OTC drugs. Practical and theoretical implications are discussed.

Background Small group research in healthcare is important because it deals with interaction and decision-making processes that can help to identify and improve safer patient treatment and care. However, the number of studies is limited due to time- and resource-intensive data processing. The aim of this study was to examine the feasibility of using signal processing and machine learning techniques to understand teamwork and behaviour related to healthcare management and patient safety, and to contribute to literature and research of teamwork in healthcare. Methods Clinical and non-clinical healthcare professionals organised into 28 teams took part in a video- and audio-recorded role-play exercise that represented a fictional healthcare system, and included the opportunity to discuss and improve healthcare management and patient safety. Group interactions were analysed using the recurrence quantification analysis (RQA; Knight et al., 2016), a signal processing method that examines stability, determinism, and complexity of group interactions. Data were benchmarked against self-reported quality of team participation and social support. Transcripts of group conversations were explored using the topic modelling approach (Blei et al., 2003), a machine learning method that helps to identify emerging themes within large corpora of qualitative data. Results Groups exhibited stable group interactions that were positively correlated with perceived social support, and negatively correlated with predictive behaviour. Data processing of the qualitative data revealed conversations focused on: (1) the management of patient incidents; (2) the responsibilities among team members; (3) the importance of a good internal team environment; and (4) the hospital culture. Conclusions This study has shed new light on small group research using signal processing and machine learning methods. Future studies are encouraged to use these methods in the healthcare context, and to conduct further research on how the nature of group interaction and communication processes contribute to the quality of team and task decision-making. Electronic supplementary material The online version of this article (10.1186/s12874-019-0756-2) contains supplementary material, which is available to authorized users.

Simulation has been applied as a tool for learning and training in sports, psychology and medicine for some time, but its current use and potential for training musicians is less well understood. The aim of this study was to explore musicians’ perceptions and experiences of using simulated performance environments. Nine conservatory students performed in two simulations, each with interactive virtual elements and vivid environmental cues: a recital with a virtual audience and an audition with virtual judges. Qualitative data were collected through a focus group interview and written reflective commentaries. Thematic analysis highlighted the musicians’ experiences in terms of (1) their anticipation of using the simulations, (2) the process of performing in the simulations, (3) the usefulness of simulation as a tool for developing performance skills and (4) ways of improving simulation training. The results show that while simulation was new to the musicians and individual levels of immersion differed, the musicians saw benefits in the approach for developing, experimenting with and enhancing their performance skills. Specifically, the musicians emphasised the importance of framing the simulation experience with plausible procedures leading to and following on from the performance, and they recognised the potential for combining simulation with complementary training techniques.

Music is increasingly recognised as important in facilitating healthy ageing, yet little is known of what musicians themselves learn when they teach older adults. This article reports the practices of the Rhythm for Life project at the Royal College of Music in the UK, in which conservatoire students taught 10-week programmes of group instrumental music lessons to adult beginners aged between 46 and 90 years. In order to interrogate what four student-teachers learned from their engagement with the project, qualitative data were collected through open-ended questionnaires, diaries and video-stimulated recall interviews. Findings demonstrated that the student-teachers reformulated the ways in which they thought about and taught older adult learners, and developed skills and knowledge relevant to a wide range of educational contexts. The article concludes that models similar to Rhythm for Life, where conservatoires facilitate opportunities for students to teach older adults, may be an effective means of establishing meaningful learning experiences for music students and older adults alike.

Financial markets typically undergo periods of prosperity followed by periods of stagnation, and this undulation makes it challenging to maintain market efficiency. The efficient market hypothesis (EMH) states that there exist differences in structural complexity in security prices between regular and abnormal situations. Yet, despite a clear link between market acceleration (cf. recession in security prices) and stress in physical systems, indices of financial stress still have significant scope for further development. The overarching aim of this work is therefore to determine the characteristics of financial indices related to financial stress, and to establish a robust metric for the extent of such 'stress'. This is achieved based on intrinsic multiscale analysis which quantifies the so called complexity-loss hypothesis in the context of financial stress. The multiscale sample entropy and our proposed Assessment of Latent Index of Stress methods have successfully assessed financial stress, and have served as a measure to establish an analogy between transitions from 'normal' (relaxed) to 'abnormal' (stressed) financial periods with the sympatho-vagal balance in humans. Four major stock indices of the US economy over the past 25 years are considered: (i) Dow Jones Industrial Average, (ii) NASDAQ Composite, (iii) Standard & Poor's 500, and (iv) Russell 2000, together with FTSE 100, CAC 40 and exchange rates. Our findings support the EMH theory and reveal high stress for both the periods of Internet bubble burst and sub-prime mortgage crisis., This work was supported by the Financial Signal Processing Laboratory (http://www.fsplab.com/) at Imperial College London. The guest editor coordinating the review of this manuscript and approving it for publication was Prof. Ali N. Akansu.