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Machine learning tools are increasingly used to improve the quality of care and the soundness of a treatment plan. Explainable AI (XAI) helps users in understanding the inner mechanisms of opaque machine learning models and is a driver of trust and adoption. Explanation methods for black-box models exist, but there is a lack of user studies on the interpretability of the provided explanations. We used a Think Aloud Protocol (TAP) to explore oncologists' assessment of a lung cancer relapse prediction system with the aim of refining the purpose-built explanation model for better credibility and utility. Novel to this context, TAP is used as a neutral methodology to elicit experts' thought processes and judgements of the AI system, without explicit prompts. TAP aims to elicit the factors which influenced clinicians' perception of credibility and usefulness of the system. Ten oncologists took part in the study. We conducted a thematic analysis of their verbalized responses, generating five themes that help us to understand the context within which oncologists' may (or may not) integrate an explainable AI system into their working day.

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BACKGROUND: Job satisfaction and retention of healthcare staff remains an ongoing issue in many health systems. Huddles have been endorsed as a mechanism to improve patient safety by improving teamwork, collaboration, and communication in teams. AIM: This study aims to synthesises the literature to investigate the impact of huddles on job satisfaction, teamwork, and work engagement in multidisciplinary healthcare teams. METHODS: Five academic databases were searched to conduct a systematic review of peer-reviewed literature published from January 2000 to January 2020. Articles were included if they (1) featured a daily huddle, were conducted in a healthcare setting, and involved a multidisciplinary team and (2) measured variables including job satisfaction, work engagement, or teamwork. Results were reported in accordance with the systematic synthesis without meta-analysis and preferred reporting items for systematic reviews and meta-analysis guidelines. We identified 445 articles of which 12 met the eligibility criteria and are included in this review. RESULTS: All 12 included studies found a predominantly positive impact on teamwork and job satisfaction. None of the studies discussed or reported evidence of the impact of huddles on work engagement. This review highlights the value of a daily multidisciplinary healthcare team huddle in improving job satisfaction and teamwork for the healthcare staff involved. However, there is a dearth of high-quality, peer-reviewed evidence regarding the direct impact of huddles on job satisfaction, teamwork and in particular on work engagement. Further research-particularly controlled studies on adoption, implementation and outcomes for healthcare team culture-is needed to further assess this intervention.

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The widespread impact of COVID-19 on healthcare has demanded new ways of working across many organisation types and many forms of healthcare delivery while at the same time endeavouring to place minimal, or no, additional burden on already strained healthcare teams. This is a cross-sectional mixed-method study which captured the experiences of teamwork during the COVID-19 pandemic contributing to successful collaboration. We hypothesised that work engagement and psychological safety separately contribute to collective leadership and organisational citizenship behaviours. Participants were healthcare staff on active duty during the COVID-19 pandemic in Ireland (n = 152) who responded to our social media (Twitter) invitation to participate in this study. Survey and free-text responses were collected through an online platform. Structural equation modelling examined the relationships between work engagement and psychological safety, and collective leadership and OCBs. Open text responses relating to experiences of teamworking during the pandemic were analysed for latent themes. From the survey data, the structural model demonstrated excellent statistical fit indicating that psychological safety, but not work engagement, was predictive of collective leadership and OCBs. From the qualitative data, two key themes were generated: (1) Contrasting experiences of working in a team during the pandemic; and (2) The pandemic response: a tipping point for burnout. This study offers a valuable starting point to explore the factors driving change and the shift to more collective ways of working observed in response to COVID-19. Future studies should use longitudinal data to capture the temporal relationship of these variables which could be moderated by prolonged pressure to healthcare staff during the pandemic.

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BACKGROUND: The mental health system in Indonesia comprises attempts to modernise a colonial relic. There is still a disconnect between available services and help-seeking behaviours at the grassroots level. This study aims to explore the perceptions of Javanese people on the aetiology of mental illness and their ideas on how to deal with individuals who may have mental illness. METHODS: This qualitative study involves semi-structured interviews, embedded in a cluster randomised trial examining the clinical and cost-effectiveness of primary mental health services. Interviews were conducted with Indonesian and Javanese. The recruitment procedure was aligned to the trial. Participants were primary care patients recruited from 21 sites across Yogyakarta province. Interviews were recorded, transcribed, and translated into English. Thematic analysis was used to analyse the interview transcripts. RESULTS: 75 participants took part in the study: 51 women (68%) and 24 men (32%). Key themes emerged around perceived causes of mental health problems (including 'extrinsic factors'; 'intrinsic factors'; and 'spiritual factors'), and perceived appropriate pathways of care ('modern medical science'; 'social support and activities'; and 'religious or spiritual interventions'). Gender potentially influenced some of the responses. CONCLUSIONS: Themes indicate the variety of preconceptions towards mental health problems and assumptions regarding the best management pathways. Some of these preconceptions and assumptions support the utility of modern medical care, while the rest promote spiritual or religious healers. Participants' ideas of the appropriate care pathways largely correspond to their perception of what the symptoms are caused by. Despite hints to some understanding of the bio-psycho-social model of mental illness, most participants did not capture the complexity of mental health and illness, indicating the importance of contextual (especially culturally and religiously-aligned) public education around mental health, illness and care.

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Traditional hierarchical leadership has been implicated in patient safety failings internationally. Given that healthcare is almost wholly delivered by multidisciplinary teams, there have been calls for a more collective and team-based approach to the sharing of leadership and responsibility for patient safety. Although encouraging a collective approach to accountability can improve the provision of high quality and safe care, there is a lack of knowledge of how to train teams to adopt collective leadership. The Collective Leadership for Safety Cultures (Co-Lead) programme is a co-designed intervention for multidisciplinary healthcare teams. It is an open-source resource that offers teams a systematic approach to the development of collective leadership behaviours to promote effective teamworking and enhance patient safety cultures. This paper provides an overview of the co-design, pilot testing, and refining of this novel intervention prior to its implementation and discusses key early findings from the evaluation. The Co-Lead intervention is grounded in the real-world experiences and identified needs and priorities of frontline healthcare staff and management and was co-designed based on the evidence for collective leadership and teamwork in healthcare. It has proven feasible to implement and effective in supporting teams to lead collectively to enhance safety culture. This intervention overview will be of value to healthcare teams and practitioners seeking to promote safety culture and effective teamworking by supporting teams to lead collectively.

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Background: The National Integrated Care Programme for Older People (NICPOP), formerly NCPOP aims to support older people to live well in their homes by developing primary and secondary care services for older people, especially those with complex needs. The programme develops integrated intermediate care which traverses both hospital and community settings through multidisciplinary and interagency teams. This team-based approach to the integration of health services is a novel innovation in Irish health service delivery and will require, over time, a shift in cultures of care to allow for the development of competencies for inter-professional collaboration across the care continuum. The ECLECTIC project will develop an implementation framework for achieving, maintaining and monitoring competencies for interprofessional collaboration among multi-disciplinary teams charged with delivering care for older people across the continuum from acute to community settings. Design: The ECLECTIC research design has been developed in collaboration with the NICPOP. In phase one of the project, a co-design team will collaborate to define and shape competencies for interprofessional collaboration. Phase two will involve the delivery of a collective leadership intervention over a 10-month period with multidisciplinary professionals working with older people across two geographical regions (Mullingar/Midlands and Beaumont/Dublin North). Each group will comprise of members of two multidisciplinary teams charged with coordinating and delivering care to older people across the continuum of acute to community care. Observations of collaborative inter-professional working will take place before, during, and after intervention. In phase three of the study, analysis of the interview and observation data will be presented to the co-design team in order to develop an implementation framework for future teams. Discussion: The co-design process will develop core competencies and performance indicators for collaborative interprofessional working. The resulting implementation framework will be implemented nationally as part of the NICPOP.

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INTRODUCTION: Co-design involves stakeholders as design partners to ensure a better fit to user needs. Many benefits of involving stakeholders in design processes have been proposed; however, few studies have evaluated participants' experience of co-design in the development of educational interventions. As part of a larger study, health-care professionals, researchers and patients co-designed a collective leadership intervention for health-care teams. This study evaluated their experiences of the co-design process. METHODS: Semi-structured interviews were conducted with individuals (n = 10) who took part in the co-design workshops. Interviews were audio-recorded, transcribed verbatim and analysed thematically. RESULTS: Four key themes were identified from the data: (a) Managing expectations in an open-ended process; (b) Establishing a positive team climate; (c) Focusing on frustrations-challenging but informative; and (d) Achieving a genuine co-design partnership. CONCLUSIONS: The development of a positive team climate is essential to the co-design process. Organizers should focus on building strong working relationships from the beginning to enable open discussion. Organizers of co-design should be conscious of establishing and maintaining a genuine partnership where participants are involved as equal partners and co-creators. This can be done through the continuous use of feedback to allow participants to influence the workshop directions, and through limiting researcher domination. Lastly, co-design can be daunting, but organizers can positively impact participants' experience by acknowledging the emergent nature of the process in order to reduce participant apprehension, thereby limiting the barriers to participation.

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BACKGROUND: For a decade, experts have suggested integrating mental health care into primary care to help bridge mental health Treatment Gap. General Practitioners (GPs) are the first port-of-call for many patients with mental ill-health. In Indonesia, the WHO mhGAP is being systematically introduced to its network of 10,000 primary care clinics as an add-on mental health training for pairs of GPs and Nurses, since the end of 2015. In one of 34 provinces, there exists an integrated care model: the co-location of clinical psychologists in primary care clinics. This trial evaluates patient outcomes among those provided mental health care by GPs with those treated by clinical psychologists in primary care. METHODS: In this partially-randomised, pragmatic, two-arm cluster non-inferiority trial, 14 primary care clinics were assigned to receive the WHO mhGAP training and 14 clinics with the co-location framework were assigned to the Specialist arm. Participants (patients) were blinded to the existence of the other pathway, and outcome assessors were blinded to group assignment. All adult primary care patients who screened positive for psychiatric morbidity were eligible. GPs offered psychosocial and/or pharmacological interventions and Clinical Psychologists offered psychosocial interventions. The primary outcome was health and social functioning as measured by the HoNOS and secondary outcomes include disability measured by WHODAS 2.0, health-related quality of life measured by EQ-5D-3L, and resource use and costs evaluated from a health services perspective, at six months. RESULTS: 153 patients completed the outcome assessment following GP care alongside 141 patients following Clinical Psychologists care. Outcomes of GP care were proven to be statistically not inferior to Clinical Psychologists in reducing symptoms of social and physical impairment, reducing disability, and improving health-related quality of life at six months. Economic analyses indicate lower costs and better outcomes in the Specialist arm and suggest a 50% probability of WHO mhGAP framework being cost-effective at the Indonesian willingness to pay threshold per QALY. CONCLUSION: General Practitioners supported by nurses in primary care clinics could effectively manage mild to moderate mental health issues commonly found among primary care patients. They provide non-stigmatising mental health care within community context, helping to reduce the mental health Treatment Gap. TRIAL REGISTRATION: ClinicalTrials.gov NCT02700490.

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INTRODUCTION: Worldwide, there are between 50-67 million migrant domestic workers, the majority of whom are women. In many countries, provisions are not in place to protect female migrant domestic workers. These women may be at risk of occupational and social stressors, including exploitation and abuse, which may negatively impact on their quality of life, including psychological health. Research examining the occupational, social, and psychological needs of FMDWs from a public health perspective is critical to guide the development of policies which ensure wellbeing, prevent abuse, and align with international priorities to improve population health. Though there have been a number of high-profile incidents of exploitation and abuse, there has been limited research on the stressors experienced by these communities, their perceived impact, or coping mechanisms. MATERIALS AND METHODS: Thematic analysis was used to analyse qualitative free-text written responses collected as part of a cross-sectional survey on the relationship between social and occupational stressors and the health and quality of life of FMDWs in Singapore. Responses correspond to open-ended questions in the qualitative component of the survey examining three domains: causes of stress, coping strategies, and what people can do to help with stress. RESULTS: Responses from 182 FMDWs were analysed. Key themes were identified around causes of stress (including 'work and agency', 'the pervasiveness of financial need', and 'family and obligation'), coping strategies, and social support. Each theme describes key factors which contribute to the occupational and social stressors experienced and reported by FMDWs. DISCUSSION: This research highlights the stressors FMDWs in Singapore experience, as well as key coping mechanisms. There is a clear need for policies which facilitate FMDWs' ability to utilise these coping resources, and which protect against coercive or exploitative employment conditions. Strategies are also needed to monitor and evaluate policies intended to protect FMDWs, and to strengthen the implementation of global frameworks targeted at improving workplace conditions and workers' rights.

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