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BACKGROUND: The study explores the significance of continuous improvement through Kaizen in the evolving landscape of anatomy education. In this study, our objectives were twofold: 1) to assess the effectiveness of incorporating games in the first-year medical curriculum for reinforcing anatomy knowledge, and 2) to explore whether game-based sessions elicit improved student responses in the learning of anatomy.
METHODS: A total of 100 first-year Bachelor of Medicine and Bachelor of Surgery (MBBS) students at All India Institute of Medical Sciences (AIIMS), Bibinagar, Hyderabad, Telangana, India, were exposed to game-based learning which involved six rounds: acronym mnemonics (Redolent), jigsaw puzzle solving (Dumbfound), Filling gaps in concept maps (Blogging), Connecting images (Kinship), case scenario creation (Penman), and rapid-fire round (Rattling).
RESULTS: At the end of the intervention, a test was taken and feedback was obtained from all the participants using a prevalidated questionnaire prepared based on a 5-point Likert scale. Questionnaire responses were subjected to descriptive analysis, and reliability analysis (Cronbach\'s α) was performed to evaluate the internal consistencies of items. A paired t-test indicated that there was a significantly large difference between before (mean (M) = 17.2, standard deviation (SD) = 9.1) and after (M = 25.9, SD = 8), t(99) = 18.4, p < .001, signifying that the performance of the students was far better with game-based learning approaches than conventional learning.
CONCLUSIONS: Combining game-based education with Kaizen principles in anatomy education not only prepares students for success in their academic pursuits but also empowers them to navigate the complexities of the ever-evolving healthcare landscape with confidence and proficiency.

The Royal College of Physicians (RCP) Chief Registrar Programme (CRP) emerged from the RCP Future Hospital Commission Report (2013) and aimed to address development of clinical leadership and quality improvement to maintain high standards of patient safety and experience. The 2016 pilot created a new senior leadership role recruiting doctors in training committed to quality improvement and leadership development to champion delivering change in trusts, supported by a year-long bespoke development programme designed and delivered by the RCP. Following validation of the pilot\'s impact, the CRP has evolved to become a \'flagship\' programme for the RCP with increasing penetrance across the UK to maximise impact for chief registrars to lead and deliver quality improvement in trusts. The longer-term goal is that enthusiastic early leaders will deliver sustainable and impactful change regionally and in the wider NHS. This article seeks to explore the CRP development themes and reflects on the learning from the programme and the experiences of chief registrars. The CRP has evolved during a time of significant healthcare challenge with the programme delivering a future generation of medical leaders to navigate these challenges, deliver improvement and innovation across the health sector. We show how chief registrars and alumni can continue to drive forward widespread impact on individuals, organisations and the wider NHS, providing a strategic solution to meet current and future challenges in the NHS.

OBJECTIVE: This study explores the evolving position of the health system chief information officer (CIO) by identifying new core roles for success.
METHODS: An advisory board of industry executives and system leaders guided the study. Purposeful sampling was used to invite chief executive officer and CIOs from 65 not-for-profit US health systems to participate. Interviews were conducted with 51 executives from 33 different systems, using a comprehensive interview topic guide. Interview transcripts were analysed using NVivo software, focusing on themes related to the evolving role of the health system CIO.
RESULTS: Analyses revealed three main themes, with the CIO as (1) enabler of strategic change and transformation, (2) strategic developer of technology and leadership talent and (3) driver of organisational culture.
CONCLUSIONS: The role of CIO has undergone transformation from technology and information system management to strategic leadership within the broader health system context. It highlights the importance of comprehensive business knowledge for CIOs and the need for other C-suite executives to have a deeper understanding of information and technology.
CONCLUSIONS: As healthcare continues to evolve, the role of the CIO is expected to expand further, requiring a blend of technical and strategic business skills. This evolution presents opportunities for health systems to enhance their leadership development programmes, preparing leaders for the complexities of the contemporary health system sector.

BACKGROUND: Debriefing in operating theatre environments leads to benefits in mortality, efficiency, productivity, and safety culture; however, it is still not regularly performed. TALK© is a simple and widely applicable team self-debriefing method to collaboratively learn and improve.
METHODS: An interventional study introducing TALK© for voluntary clinical debriefing was carried out in operating theatre environments in a UK National Health Service hospital over 18 months. It explored compliance with the Five Steps to Safer Surgery and changes in behaviour in surgical teams regarding consideration and completion of debriefing.
RESULTS: Team briefing and compliance with the WHO surgical safety checklist were performed consistently (>95% and >98%, respectively) throughout the study, which included 460 surgical lists. Consideration of debriefing increased at all data collection periods after intervention, from 35.6% to 60.3-97.4% (P≤0.003). Performance of debriefing, which was 23.3% at baseline, reached 39% at 6 months (P=0.039). Team planning of actions for improvement during debriefing also increased (P<0.001). A decline in performance of debriefing and subsequent improvement actions was observed after 6 months, albeit rates were above baseline at 18 months. The most reported reason not to carry out a debriefing was \'lack of issues\'. After implementation, nurses and allied healthcare professionals increased their contribution to initiating and leading debriefing. Reported barriers were <18% at baseline, and decreased after intervention.
CONCLUSIONS: A simple intervention introducing TALK© for voluntary debriefing in theatres prompted significant changes in team behaviour and sustained growth regarding consideration and performance of debriefing, especially in the first 6 months.

BACKGROUND: A maturity matrix can be a useful tool for organisations implementing large-system transformation (LST) initiatives in complex systems. Insights from implementation of a local LST initiative using collaborative networks, known as Alliances, highlighted a tool was needed to help health system leaders prompt discussions on how and where to focus their change efforts. In the New Zealand (NZ) health system, Alliances were introduced to integrate the planning and delivery of health care between primary and hospital care.
METHODS: The aim of this research was to use insights from Alliance members to develop a learning tool that collaborative networks could use to assess and improve their readiness for change. We constructed a maturity matrix using the knowledge of senior NZ health system leaders, in a workshop setting. The maturity matrix was empirically tested and refined with three Alliances and with feedback from the NZ Ministry of Health Māori Health Strategy and Policy team.
RESULTS: The maturity matrix described the 10 key elements that had been found to support successful implementation of LST initiatives in the NZ health system, along with success indicators and different stages of maturity from beginning to excellence. Testing of the maturity matrix with three Alliances suggested that it functioned as a learning tool and stimulated collective thinking and reflection. The Māori Health Strategy and Policy team commented on the importance of such a tool to increase health system leaders\' responsiveness to improving Māori health outcomes. Comparisons with similar international matrices revealed common elements with ours. A strength of our maturity matrix is that it is specific to the NZ context and is the first practical tool to implement large-scale change in the health system that incorporates principles of the Government\'s treaty with Māori, the indigenous people of NZ.
CONCLUSIONS: Through a regular self-assessment process, use of the maturity matrix may create feedback loops to support deliberate learning and knowledge sharing for senior health system leaders and collaborative networks. The maturity matrix fills an important gap in the NZ health system and contributes to implementation science literature internationally.
UNASSIGNED: This study was approved by the Victoria University of Wellington Human Ethics Committee (Ethics Approval Number 27,356). The research was supported by the Victoria University of Wellington research grant (222,809) and from the University of Auckland Department of Medicine research fund (H10779).

Measuring and optimizing a health system is challenging when patient care is split between many independent organizations. For example, patients receive care from their primary care provider, outpatient specialist clinics, hospitals, private providers and, in some instances, family members. These silos are maintained through different funding sources (or lack of funding) which incentivize siloed service delivery. A shift towards prioritizing patient outcomes and keeping the patient at the centre of care is emerging. However, competing philosophies on patient needs, how health is defined and how health is produced and funded is creating and engraining silos in the delivery of health services. Healthcare and health outcomes are produced through a series of activities conducted by diverse teams of health professionals working in concert. Health professionals are continually learning from each patient interaction; however, silos are barriers to information exchange, collaborative evidence generation and health system improvement. This paper presents a systems view of healthcare and provides a systems lens to approach current challenges in health systems. The first part of the paper provides a background on the current state and challenges to healthcare in Canada. The second part presents potential reasons for continued health system underperformance. The paper concludes with a system perspective for addressing these challenges.

Traditional theories of motor learning emphasize the automaticity of skillful actions. However, recent research has emphasized the role of pre-reflective self-consciousness accompanying skillful action execution. In the present paper, we present the course-of-experience framework as a means of studying elite athletes\' pre-reflective self-consciousness in the unfolding activity of performance optimization. We carried out a synthetic presentation of the ontological and epistemological foundation of this framework. Then we illustrated the methodology by an in-depth analysis of two elite windsurfers\' courses of experience. The analysis of global and local characteristics of the riders\' courses of experience reveal (a) the meaningful activities accompanying the experience of ongoing performance optimization; (b) the multidimensionality of attentional foci and the normativity of performance self-assessment; and (c) a micro-scale phenomenological description of continuous improvement. These results highlight the fruitfulness of the course-of-experience framework to describe the experience of being absorbed in an activity of performance optimization.

BACKGROUND: Aboriginal and Torres Strait Islander communities in remote Australia have initiated bold policies for health-enabling stores. Benchmarking, a data-driven and facilitated \'audit and feedback\' with action planning process, provides a potential strategy to strengthen and scale health-enabling best-practice adoption by remote community store directors/owners. We aim to co-design a benchmarking model with five partner organisations and test its effectiveness with Aboriginal and Torres Strait Islander community stores in remote Australia.
METHODS: Study design is a pragmatic randomised controlled trial with consenting eligible stores (located in very remote Northern Territory (NT) of Australia, primary grocery store for an Aboriginal community, and serviced by a Nutrition Practitioner with a study partner organisation). The Benchmarking model is informed by research evidence, purpose-built best-practice audit and feedback tools, and co-designed with partner organisation and community representatives. The intervention comprises two full benchmarking cycles (one per year, 2022/23 and 2023/24) of assessment, feedback, action planning and action implementation. Assessment of stores includes i adoption status of 21 evidence-and industry-informed health-enabling policies for remote stores, ii implementation of health-enabling best-practice using a purpose-built Store Scout App, iii price of a standardised healthy diet using the Aboriginal and Torres Strait Islander Healthy Diets ASAP protocol; and, iv healthiness of food purchasing using sales data indicators. Partner organisations feedback reports and co-design action plans with stores. Control stores receive assessments and continue with usual retail practice. All stores provide weekly electronic sales data to assess the primary outcome, change in free sugars (g) to energy (MJ) from all food and drinks purchased, baseline (July-December 2021) vs July-December 2023.
CONCLUSIONS: We hypothesise that the benchmarking intervention can improve the adoption of health-enabling store policy and practice and reduce sales of unhealthy foods and drinks in remote community stores of Australia. This innovative research with remote Aboriginal and Torres Strait Islander communities can inform effective implementation strategies for healthy food retail more broadly.
BACKGROUND: ACTRN12622000596707, Protocol version 1.

The COVID-19 pandemic highlighted the challenges that go into effective policymaking. Facing a public health crisis of epic proportion, government bodies across the world sought to manage the spread of infectious disease and healthcare-system overwhelm in the face of historic economic instability and social unrest. Recognizing that COVID-19 debates and research are still actively ongoing, this paper aims to objectively compare COVID-19 responses from countries across the world that exhibit similar economic and political models to Canada, identify notable failures, successes, and key takeaways to inform future-state pandemic preparedness.