The impact of cognitive biases, mental models, and mindsets on leadership and change in the health system.

Understanding how cognitive biases, mental models, and mindsets impact leadership in health systems is essential. This article supports the notion of cognitive biases as flawed thinking or cognitive traps which negatively influence leadership. Mental models that do not fit with current evidence limit our ability to comprehend and respond to system issues.

Process and findings informing the development of a provincial emergency medicine network.

We describe the process undertaken to inform the development of the recently launched British Columbia (BC) Emergency Medicine Network (EM Network). Five methods were undertaken: (1) a scoping literature review, (2) a survey of BC emergency practitioners and EM residents, (3) key informant interviews, (4) focus groups in sites across BC, and (5) establishment of a brand identity. There were 208 survey respondents: 84% reported consulting Internet resources once or more per emergency department shift; however, 26% reported feeling neutral, somewhat unsatisfied, or very unsatisfied with searching for information on the Internet to support their practice.

The British Columbia Emergency Medicine Network: A Paradigm Shift in a Provincial System of Emergency Care.

As generalists, emergency practitioners face challenges in providing state-of-the-art care owing to the broad spectrum of practice and the rapid rate of new knowledge generation. Networks have become increasingly prevalent in health care, and it was in this backdrop, and the resulting opportunity to advance evidence-informed emergency care in the Canadian province of British Columbia (BC), that a new "Emergency Medicine Network" (EM Network) was launched in 2017. The EM Network consists of four programs, each led by a physician with expertise and a track record in the domain: (1) Clinical Resources; (2) Innovation; (3) Continuing Professional Development; and (4) Real-time Support.

Exploring distributed leadership in the BC Sepsis Network.

Commissioned research was undertaken to explore the role of networks in supporting large-scale change and improvement. Participatory action research and social network analysis were used to study the BC Sepsis Network. Findings of this research include insights into distributed leadership, enablers and barriers within a network approach; the importance of relationships and trust; and the need for meaningful and timely data.

Leadership needs to shift in the health system: three emerging perspectives to inform our way forward.

Zimmerman et al. have brought to light a number of issues that lead to a collective failure in healthcare safety culture, and propose how to overcome them. Front-line ownership (FLO) is a great success story in that respect, acknowledging that much of the problem and, therefore, solution, relates to how, not what, approaches and solutions have been implemented.

Twisting the lion's tail: Collaborative health policy making in British Columbia.

The respective roles of government, academia and health authorities in supporting health systems and service delivery research in the context of health policy making have often been unclear. A new strategy is necessary, one that encompasses the interdependence of research and practice and respects different kinds of knowledge and the needs and capacity of all stakeholders. Reform efforts to date have focused mainly on structural change and genuine collaboration has been pushed to the back seat.

Re-examining the paradox of structure: a child health network perspective.

In their lead paper, Huerta, Casebeer and VanderPlaat argue that there are several key forces driving the development of health services delivery (HSD) networks, and propose a series of paradoxes and propositions to initiate this timely and essential dialogue. Ultimately, they submit that networks are likely to remain within the healthcare system to build system capacity and drive integration. Given this, they challenge us to further the dialogue and investigate these networks.

Evidence-based decision-making in healthcare: exploring the issues though the lens of complex, adaptive systems theory.

Browman, Snider and Ellis have articulated several reasons as to why and how managers should address the implementation of evidence-based decision-making (EBDM) in healthcare. While their observations are acknowledged to be from the unique perspective of an oncology setting, this is a timely and welcome lead article with significance in other settings. The authors invite opinions on transferability, thus forming the basis of this commentary.