Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, Oakland, CA, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
Glob Health Action. 2024 Dec 31;17(1):2427434. doi: 10.1080/16549716.2024.2427434. Epub 2024 Nov 18.
Leadership skills are essential for middle-level healthcare manager efficacy. Capacity-building efforts may attempt behavioural change by filling 'knowledge gaps' while neglecting a sustainable application of that knowledge. Sustainable application of that knowledge, or implementation know-how, must resonate with local cultural patterns. When it is neglected, root issues like unclear decision-making space and local authority to interpret policy during implementation remain unaddressed. Particularly in decentralized healthcare systems, the impact can appear in implementation challenges, subjective decision-making, poor teamwork, and an absence of disseminating best practices.
The SEARCH-IPT trial led a series of mini-collaborative meetings, which provided business leadership and management training for an intervention group of mid-level healthcare system managers in rural Eastern, East-Central, and Southwestern Uganda to see whether this would increase uptake of isoniazid-prevention therapy (IPT) for people living with HIV (PLHIV) in intervention districts. IPT is known to reduce active tuberculosis (TB), a leading cause of death among PLHIV, by 40-60%.
We performed a thematic analysis of six focus-group discussions from this intervention (held in May 2019, January 2020, September 2021) and 23 key informant interviews with control group participants (between February and August 2019 and September and December 2020).
Analysis revealed five implementation skill sets District Health Officers (DHOs) and District Tuberculosis and Leprosy Supervisors (DTLSs) deployed to achieve sustainable implementation and realize their decision-making space. The five practices were as follows: data-based decision-making, root-cause analysis, quality assurance, evidence-based empowerment, and sharing best practices with colleagues.
These practices reached beyond outcome measures to address root problems around the DHO's range of authority and elicit buy-in from district health workers. For successful capacity building at the mid-manager level, focusing on core practices as part of competency is objectively implementable and measurable at the system level and does not rely on DHO self-assessments.
领导技能对于中层医疗保健经理的效能至关重要。能力建设工作可能试图通过填补“知识空白”来实现行为改变，而忽略了知识的可持续应用。知识的可持续应用，或实施诀窍，必须与当地文化模式产生共鸣。当它被忽视时，决策空间不明确和当地当局在实施过程中解释政策的权力等根本问题仍然没有得到解决。特别是在分散的医疗保健系统中，其影响可能表现在实施挑战、主观决策、团队合作不佳以及缺乏传播最佳实践方面。
SEARCH-IPT 试验组织了一系列小型合作会议，为乌干达东部、中东部和西南部农村地区的中层医疗系统管理人员干预组提供了业务领导和管理培训，以了解这是否会增加干预地区艾滋病毒感染者（PLHIV）采用异烟肼预防治疗（IPT）的比例。IPT 已知可将 PLHIV 的活动性结核病（TB）发病率降低 40-60%，TB 是 PLHIV 的主要死因之一。
我们对该干预措施中的六次焦点小组讨论（2019 年 5 月、2020 年 1 月、2021 年 9 月）和 23 次对照组参与者的关键知情人访谈（2019 年 2 月至 8 月和 2020 年 9 月至 12 月）进行了主题分析。
分析揭示了区卫生官员（DHO）和区结核病和麻风病监督员（DTLS）为实现可持续实施并实现其决策空间而部署的五个实施技能集。这五种做法如下：基于数据的决策、根本原因分析、质量保证、基于证据的赋权以及与同事分享最佳实践。
这些做法超越了结果衡量标准，解决了 DHO 职权范围内的根本问题，并从地区卫生工作者那里获得了认可。为了在中层管理人员层面实现成功的能力建设，将重点放在作为能力一部分的核心实践中，在系统层面上是客观可行的和可衡量的，并且不依赖于 DHO 的自我评估。
