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The Hidden Opportunity in Paradoxes
Leading an organization involves making constant choices and decisions, many of which may seem straightforward. However, in an increasingly complex world, leaders are facing a different kind of challenge known as paradoxes. Paradoxes are persistent contradictions that contain elements that appear to contradict each other. These paradoxes can arise at various levels, from individual teams to entire industries. For example, the energy industry is facing the paradox of needing to increase output while reducing its impact on the planet. Two major energy companies have taken contrasting approaches to this paradox. To address these paradoxes, leaders can shift perspectives, adopt a paradox mindset, and hold paradox sparring sessions. By thinking beyond apparent constraints, leaders can find both-and solutions to seemingly irreconcilable tensions and drive organizational success.
Journal Article
Is the evidence on the effectiveness of pay for performance schemes in healthcare changing? Evidence from a meta-regression analysis
Background
This study investigated if the evidence on the success of the Pay for Performance (P4P) schemes in healthcare is changing as the schemes continue to evolve by updating a previous systematic review.
Methods
A meta-regression analysis using 116 studies evaluating P4P schemes published between January 2010 to February 2018. The effects of the research design, incentive schemes, use of incentives, and the size of the payment to revenue ratio on the proportion of statically significant effects in each study were examined.
Results
There was evidence of an increase in the range of countries adopting P4P schemes and weak evidence that the proportion of studies with statistically significant effects have increased. Factors hypothesized to influence the success of schemes have not changed. Studies evaluating P4P schemes which made payments for improvement over time, were associated with a lower proportion of statistically significant effects. There was weak evidence of a positive association between the incentives’ size and the proportion of statistically significant effects.
Conclusion
The evidence on the effectiveness of P4P schemes is evolving slowly, with little evidence that lessons are being learned concerning the design and evaluation of P4P schemes.
Journal Article
Does digital health technology improve physicians’ job satisfaction and work–life balance? A cross-sectional national survey and regression analysis using an instrumental variable
ObjectivesTo examine the association between physicians’ use of digital health technology and their job satisfaction and work–life balance.DesignA cross-sectional nationally representative survey of physicians and probit regression models were used to examine the association between using digital health technology and the probability of reporting high job satisfaction and a good work–life balance. Models included a rich set of covariates, including physicians’ personality traits, and instrumental variable analysis was used to control for bias from unobservable confounders and reverse causality.SettingClinical practice settings in Australia, including physicians working in primary care, hospitals, outpatient settings, and physicians working in the public and private sectors.ParticipantsRespondents to wave 11 (2018–2019) of the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal survey of doctors. The analysis sample included a broadly nationally representative sample of 7043 physicians, including general practitioners, specialists and physicians in training.Primary and secondary outcome measuresThe proportion of respondents who used any digital health technology; proportion answered ‘moderately satisfied’ or ‘very satisfied’ to the statement on job satisfaction: ‘Taking everything into account, how do you feel about your work’; proportion agreeing or strongly agreeing to the statement on work–life balance: ‘The balance between my personal and professional commitments is about right.’ResultsPhysicians with positive beliefs about the effectiveness of using digital health technology were 3.8 percentage points (95% CI 2.7 to 5.0) more likely to use digital health technology compared with those who did not. Physicians with colleagues who already used digital health technology were also 4.1 percentage points (95% CI 2.6 to 5.6) more likely to use digital health technology. The availability of IT support and lack of privacy concerns increased the probability of using digital health technology by 1.6 percentage points (95% CI 1.0 to 2.3) and 0.5 percentage points (95% CI 0.1 to 1.0). Physicians who used digital health technology were 14.2 percentage points (95% CI −1.3 to 29.7) and 20.3 percentage points (95% CI 2.4 to 38.1) more likely to report respectively higher job satisfaction and good work–life balance, compared with the physicians who did not use it.ConclusionsFindings suggested digital health technology served more as a work resource than work demand for physicians who used it.
Journal Article
Relation between falciparum malaria and bacteraemia in Kenyan children: a population-based, case-control study and a longitudinal study
Many investigators have suggested that malaria infection predisposes individuals to bacteraemia. We tested this hypothesis with mendelian randomisation studies of children with the malaria-protective phenotype of sickle-cell trait (HbAS).
This study was done in a defined area around Kilifi District Hospital, Kilifi, Kenya. We did a matched case-control study to identify risk factors for invasive bacterial disease, in which cases were children aged 3 months to 13 years who were admitted to hospital with bacteraemia between Sept 16, 1999, and July 31, 2002. We aimed to match two controls, by age, sex, location, and time of recruitment, for every case. We then did a longitudinal case-control study to assess the relation between HbAS and invasive bacterial disease as malaria incidence decreased. Cases were children aged 0–13 years who were admitted to hospital with bacteraemia between Jan 1, 1999, and Dec 31, 2007. Controls were born in the study area between Jan 1, 2006, and June 23, 2009. Finally, we modelled the annual incidence of bacteraemia against the community prevalence of malaria during 9 years with Poisson regression.
In the matched case-control study, we recruited 292 cases—we recruited two controls for 236, and one for the remaining 56. Sickle-cell disease, HIV, leucocyte haemozoin pigment, and undernutrition were positively associated with bacteraemia and HbAS was strongly negatively associated with bacteraemia (odds ratio 0·36; 95% CI 0·20–0·65). In the longitudinal case-control study, we assessed data from 1454 cases and 10 749 controls. During the study period, the incidence of admission to hospital with malaria per 1000 child-years decreased from 28·5 to 3·45, with a reduction in protection afforded by HbAS against bacteraemia occurring in parallel (p=0·0008). The incidence of hospital admissions for bacteraemia per 1000 child-years also decreased from 2·59 to 1·45. The bacteraemia incidence rate ratio associated with malaria parasitaemia was 6·69 (95% CI 1·31–34·3) and, at a community parasite prevalence of 29% in 1999, 62% (8·2–91) of bacteraemia cases were attributable to malaria.
Malaria infection strongly predisposes individuals to bacteraemia and can account for more than half of all cases of bacteraemia in malaria-endemic areas. Interventions to control malaria will have a major additional benefit by reducing the burden of invasive bacterial disease.
Wellcome Trust.
Journal Article
Skeleton crew showdown
Fred's friend invites the Mystery Inc. gang on a \"vacation\" on the old pirate ship he just bought, but there seems to be another crew on board--a crew of skeleton pirates who intend to take their ship back.
Book
IL-15 is a component of the inflammatory milieu in the tumor microenvironment promoting antitumor responses
Previous studies have provided evidence that IL-15 expression within human tumors is crucial for optimal antitumor responses; however, the regulation of IL-15 within the tumor microenvironment (TME) is unclear. We report herein, in analyses of mice implanted with various tumor cell lines, soluble IL-15/IL-15Rα complexes (sIL-15 complexes) are abundant in the interstitial fluid of tumors with expression preceding the infiltration of tumor-infiltrating lymphocytes. Moreover, IL-15 as well as type I IFN, which regulates IL-15, was required for establishing normal numbers of CD8 T cells and natural killer cells in tumors. Depending on tumor type, both the tumor and the stroma are sources of sIL-15 complexes. In analyses of IL-15 reporter mice, most myeloid cells in the TME express IL-15 with CD11b⁺Ly6Chi cells being the most abundant, indicating there is a large source of IL-15 protein in tumors that lies sequestered within the tumor stroma. Despite the abundance of IL-15–expressing cells, the relative levels of sIL-15 complexes are low in advanced tumors but can be up-regulated by local stimulator of IFN genes (STING) activation. Furthermore, while treatment of tumors with STING agonists leads to tumor regression, optimal STING-mediated immunity and regression of distant secondary tumors required IL-15 expression. Overall, our study reveals the dynamic regulation of IL-15 in the TME and its importance in antitumor immunity. These findings provide insight into an unappreciated attribute of the tumor landscape that contributes to antitumor immunity, which can be manipulated therapeutically to enhance antitumor responses.
Journal Article