Journal of Healthcare Leadership最新文献

Purpose: To retrieve, screen, and summarize the best evidence for the safety management of patients with Parkinson's disease (PD) accompanied by behavioral and psychiatric symptoms (BPS). Safety management in this context refers to the systematic process of identifying, assessing, and mitigating risks of harm (eg, falls, self-harm, medication adverse effects) to ensure the physical and psychological well-being of patients. This review aims to provide an evidence-based foundation for clinical healthcare professionals to implement standardized safety management.

Patients and methods: A systematic search was conducted in domestic and international databases and websites for guidelines, expert consensuses, clinical decisions, evidence summaries, and systematic reviews related to the safety management of PD patients with BPS. The search period spanned from database inception to March 31, 2025, with no additional limits applied to the publication dates of the documents. Two researchers independently evaluated the quality of the literature, extracted and summarized the evidence, and rated the evidence level of the included documents.

Results: Twenty-one documents were ultimately included: 6 guidelines, 5 expert consensuses, 5 clinical decisions, 4 systematic reviews, and 1 evidence summary. Thirty-two pieces of best evidence were summarized across five aspects: safety assessment and identification, safety management strategies, safe medication practices, safety intervention methods, and safe care environment. Key recommendations include the necessity of comprehensive risk assessment using standardized tools, the critical role of multidisciplinary care, the principle of starting low and going slow with antipsychotics, the integration of non-pharmacological interventions like cognitive-behavioral therapy and repetitive transcranial magnetic stimulation, and the importance of optimizing both the physical and psychosocial environment.

Conclusion: This study summarizes the best evidence for the safety management of PD patients with BPS, providing a reference for clinical healthcare professionals to make scientific decisions and implement standardized safety management protocols. The main recommendations for managing these patients emphasize a proactive, multifaceted approach that integrates continuous assessment, multidisciplinary collaboration, judicious medication use, evidence-based non-pharmacological strategies, and environmental modifications, all while considering patient preferences.

Background: Healthcare Action Teams (HATs) operate under high-pressure, time-sensitive conditions where effective collaboration is critical for patient outcomes. While collaborative leadership is increasingly recognized as beneficial in such contexts, the literature remains fragmented, with inconsistent terminology and limited integration of findings.

Aim: This study systematically reviews how collaborative leadership is conceptualized, operationalized, and evaluated in HATs. It identifies different forms of collaborative leadership, the mechanisms that support or constrain its effectiveness, the organizational factors that influence its implementation, and the outcomes for team performance and patient care.

Methods: A systematic literature review is conducted based on PRISMA guidelines and using a comprehensive and expanded search query in Web of Science and EBSCOhost. More than 250 studies were identified in the initial screening, and 56 peer-reviewed articles, published through September 2025, that addressed collaborative leadership in HATs were ultimately selected and included in further analyses. Analysis was guided by four research questions and integrated based on functional leadership theory and models of social differentiation in teams.

Results: Two main forms of leadership were identified: vertical differentiation (authority shifts across hierarchical roles) and horizontal differentiation (distributed leadership among peers). Collaborative leadership enhances team adaptability, shared mental models, psychological safety, and communication. However, its effectiveness depends on factors such as organizational hierarchy, professional identity salience, task complexity, and team member interpersonal familiarity. A functional definition of collaborative leadership was proposed, emphasizing four leadership functions: activating resources, framing the task environment, mobilizing support, and synthesizing collaboration.

Conclusion: Collaborative leadership in HATs is a dynamic, context-sensitive process that enables adaptive coordination in complex clinical settings. When supported by appropriate organizational structures and team-level conditions, it enhances communication, trust, and patient safety. However, under rigid hierarchies or unclear role structures, its effectiveness may be reduced. This study offers a functional lens for understanding collaborative leadership in HATs and provides future research directions.

Clinical documentation demands are increasingly eroding clinician time and morale. Large language models (LLMs) are emerging as practical allies, drafting notes in real-time and laying the groundwork for decision support. This narrative review examines both recent clinical applications of AI across healthcare domains and leadership strategies for implementing these technologies in hospitals and ambulatory networks. We conducted a narrative review of recent literature and high-quality practice reports published, focusing on leadership strategies for implementing LLMs in hospitals and ambulatory networks. Evidence shows that when executives establish multidisciplinary AI committees, run quickly iterated pilots, and embed continuous bias and safety audits, LLM deployments improve workflow efficiency and clinician satisfaction without compromising quality. Effective programs pair clear vendor scorecards with transparent communication to staff and patients and align metrics with broader equity goals. Recent regulatory frameworks in North America and Europe reinforce the need for life-cycle governance and performance monitoring. The review concludes with a leadership roadmap linking strategic vision to practical actions that sustain safe, equitable, and financially sound LLM integration.

Introduction: Perceived organizational readiness is vital to nurses' and midwives' success in leading quality improvement, yet little is known about their perceptions. This study assessed perceived organizational readiness for change among 30 nurse and midwife leaders in leading quality improvement projects following a 9-month academic leadership fellowship with the Global Leadership in Nursing and Midwifery program at the University of Global Health Equity, Kigali, Rwanda.

Methods: Using a quantitative cross-sectional design, we assessed sociodemographic characteristics and perceived organizational readiness of nurses and midwives who had implemented a quality improvement initiative at their workplace following the training. Participants completed the original, validated Organizational Readiness for Implementing Change (ORIC) questionnaire, which assesses perceived readiness, commitment, and efficacy, demonstrating high reliability (Cronbach's α =0.96). Data analysis was facilitated by RStudio and summarized using descriptive statistics. Results were presented in tables and charts to illustrate readiness levels across participants.

Results: Only 50% of the nurses and midwives perceived their organization as being supportive. There was an overall moderately to high perceived readiness score of 49 out of 60, with a higher median perception of change efficacy of 29 out of 35 among the nurses. The nurses had a lower agreement on their organizational motivation, organizational ability to get people to invest in change, and the ability to navigate internal politics. Prior experience with implementing QI in their organization, and perceived organizational supportive cultures were associated with higher readiness scores.

Conclusion: While training enhances nurses and midwifery leaders' confidence in leading QI initiatives, their implementation and sustainability require more than individual capability. Organizational commitment by ensuring supportive structures and resource alignment is essential. Leadership can operationalize readiness by fostering nurse leadership development and supportive environments that address systemic barriers. These findings advance nursing and midwifery leadership frameworks and inform future readiness assessments in healthcare.

Effective physician leadership is an essential component in modern healthcare, but medical education often lacks accessible, formal leadership training for the physicians who will move into these roles. We describe the development, implementation, and evaluation of a local leadership program developed at our institute in partnership with a local university that can be used as a template for other healthcare systems. The Medicine Institute's leadership team at Allegheny Health Network partnered with a local university to develop a year-long faculty physician leadership program tailored to minimize travel and associated costs while focusing on concepts of clinician leadership, conflict resolution, healthcare finance, and organizational culture. Participants were selected after a formal application process and completed pre- and post-course assignments and surveys. Data analysis included Wilcoxon signed-rank tests and paired t-tests, along with a qualitative analysis of key insights obtained from free-text comments. Fourteen faculty members participated in the leadership program, spread over a one- year period (January 1, 2024 through January 15, 2025). Individual and composite scores showed a statistically significant increase in self-reported awareness, confidence, and understanding after program completion (p < 0.05). Key insights gathered from the free-text comments indicated participants had increased self-awareness, enhanced leadership skills, valuable networking, immediate applicability of learned concepts, heightened motivation, and a strong desire for continued engagement. The program successfully reduced some of the common barriers to participation in existing leadership programs such as geographic accessibility, travel related costs, and time constraints. The partnership between two institutions supported improvements in leadership competencies and provided a framework for ongoing professional development, which may serve as a useful model for other organizations seeking to develop physician leaders. Our results support ongoing investment in physician leadership development programs that ensure a steady pipeline of physician leaders in healthcare systems.

Objective: To explore the mediating role of nurses' organizational innovation climate in the relationship between head nurses' research-innovation leadership and nurses' innovation behavior.

Methods: Using a convenience sampling method, 236 clinical nurses were selected from four tertiary grade-A hospitals in Hebei Province, China. Data were collected through four instruments: a general information questionnaire, the head nurses' research-innovation leadership scale, the nurses' innovation behavior scale, and the organizational innovation climate scale. An online data analysis tool SPSS was adopted to conduct descriptive analysis, correlation analysis, and structural equation model construction.

Results: The total score for head nurses' research-innovation leadership was 55.32 ± 12.18, which was at the upper middle level. The total score for organizational innovation climate among nurses was 84.35 ± 11.35, which was at the medium level. The total score for nurses' innovation behavior was 34.65 ± 6.21, which was at the medium level. Nurses' innovation behavior was positively correlated with head nurses' research-innovation leadership (r = 0.380, P < 0.01) and with the organizational innovation climate (r = 0.409, P < 0.01). Organizational innovation climate partially mediated the relationship between the head nurses' research-innovation leadership and nurses' innovation behavior, accounting for 29.6% of the total effect, 95% CI [0.0417~0.1412], the mediating effect is significant (0 excluded).

Conclusion: Head nurses' research-innovation leadership has a direct effect on nurses' innovation behavior and can also exert an indirect influence through the organizational innovation climate, but this indirect influence is not absolutely dominant. Nursing managers should enhance their leadership in research and innovation and actively foster a supportive organizational climate to promote innovation behavior among nurses.

Purpose: This study aimed to identify and explore the leadership challenges impeding the delivery of quality healthcare services in two district municipalities of the North West Province, South Africa.

Patients and methods: A qualitative phenomenological design was used. Purposive sampling selected senior healthcare managers from the Bojanala Platinum District (BPD) and the Ngaka Modiri Molema District (NMMD). Data collection involved six focus group discussions (FGDs) with 6-10 participants each and eight individual in-depth interviews (IDIs). Data analysis employed thematic and narrative analysis methods. Ethical approval was granted, and informed consent was obtained from participants.

Results: Participants identified five key themes: (1) Limited leadership empowerment, characterised by excessive centralisation of decision-making, causing delays and reduced local managerial autonomy; (2) Ineffective performance management due to poor implementation and underuse of the Performance Management and Development System (PMDS); (3) Weak policy execution, linked to inconsistent governance structures and poor oversight mechanisms; (4) Resource allocation and stewardship, including financial constraints and supply chain issues, leading to chronic shortages of essential medicines and poor equipment maintenance; and (5) Inadequate primary healthcare infrastructure and governance, resulting in diminished patient confidence, facility bypassing, and compromised service quality.

Conclusion: These findings, among the first to qualitatively examine leadership challenges within South Africa's district health system, highlight how centralised decision-making, weak performance management, and resource constraints specifically impede service delivery in the North West Province. By offering context-specific insights and practical strategies for decentralisation, governance strengthening, and resource optimisation, this study provides locally relevant evidence to inform health system reform in similar low- and middle-income settings.

Introduction: The healthcare industry is facing unprecedented challenges related to nursing shortages and staff retention. In response to escalating turnover rates, particularly after the COVID-19 pandemic, healthcare organizations are seeking evidence-based strategies to support long-term workforce stability. This study explored the gap in evidence linking perceived inclusive leadership and nurses' intent to stay at a single Midwestern faith-based medical center. Inclusive leadership-defined by behaviors that promote fairness, value uniqueness, and foster belonging-has emerged as a potential driver of employee engagement and their intent to stay employed.

Methods: A cross-sectional survey using a validated Inclusive Leadership Questionnaire (ILQ) was administered to a convenience sampling of front-line nurses and nurse managers at a single hospital. Nurses rated leadership behaviors; managers assessed organizational support. Seventy-one responses (59 nurses, 12 managers) were analyzed. The ILQ scores were then summarized by ILQ dimension categories. Associations between leadership perceptions, inclusivity and intent to stay were analyzed using one-way analysis of variance of the ILQ scores and nurse self-reported intent to stay.

Discussion: Nurses perceived their managers as inclusive, especially in fostering belonging and support. However, weaker scores in team integration highlight ongoing challenges with collaboration. A disconnect between leadership behaviors and organizational support suggests systemic gaps. Inclusive leadership was positively linked to retention, particularly for long-tenured staff, emphasizing its long-term value.

Results: Results showed that nurses who perceived higher levels of inclusive leadership were significantly more likely to express an intent to stay (p=0.01), particularly among those with longer tenure. Belonging and individual support were the highest-rated dimensions, while integration and fairness across teams were noted as areas needing improvement. Nurse managers reported moderate organizational support for inclusive leadership.

Conclusion: The study concludes that inclusive leadership is associated with a meaningful, actionable strategy for improving nurse intent to stay. Embedding inclusive practices in leadership development and aligning systems to support them may help healthcare organizations foster long-term commitment and address persistent workforce challenges.

Transthoracic echocardiography services are overwhelmed by long waiting lists, limited career progression, high attrition rates, and a shortage of future trainees. Unfortunately, leaders focus on throughput and performance targets while neglecting human factors, which drives healthcare scientists into the independent sector to perform similar roles for considerably higher salaries. Leadership theory in general, and NHS leadership efforts, are Western-centric. This perspective paper aims to broaden the leader-follower paradigm to include non-Western leadership styles - Ubuntu and Confucianism - to redirect leadership values towards changes necessary to improve service provision. Ubuntu is an ancient Indigenous African concept that emphasises "humanness" and interconnectedness, while Confucianism is an ancient Chinese philosophy that emphasises benevolence and social harmony through hierarchical structures. Such principles could fuel transparent, involving and creative decision-making processes that will likely engage staff and cultivate commitment and shared responsibility. Moreover, by establishing a clear career structure from band three to nine and dedicating resources to training, departments would combat the low "career ceiling", create career development opportunities and improve trainee success and quality. This paper advocates for a decolonised, pluralistic leadership model that combines Western principles with Ubuntu and Confucian philosophies in the leadership of echocardiography services within the NHS. Such leadership could enhance staff morale and well-being, promote upskilling, improve training regimes and help reduce high attrition rates. These improvements are vital to prevent workforce shortages, address waiting list issues, and ensure patient safety.

Introduction: Healthcare professionals routinely work under conditions that make high emotional and physical demands. Identifying workplace resources that mitigate burnout and reduce turnover intentions is crucial for maintaining workforce stability during crises. Drawing on the Job Demands-Resources model, this study tested whether (a) healthcare workers who perceive their managers as high-quality listeners would report lower turnover intentions, and (b) this protective effect would be especially pronounced among employees experiencing high emotional exhaustion.

Methods: A total of 329 Israeli healthcare professionals, including physicians (n = 96), nurses (n = 103), and support staff (n = 130), completed validated measures of managers' listening quality, emotional exhaustion, social support, negative affect, and turnover intentions during the COVID-19 lockdowns.

Results: Managers' listening quality predicted lower turnover intentions, supporting Hypothesis 1. This effect was significant for employees with high, but not low, emotional exhaustion, supporting Hypothesis 2. Subgroup analyses indicated that associations between managerial listening and turnover intentions were consistent across physicians, nurses, and other staff, with no significant subgroup differences.

Conclusion: Managers' listening quality emerged as a critical relational resource in healthcare settings, particularly under high strain. High-quality listening may help buffer the negative effects of emotional exhaustion and reduce turnover intentions. Practical interventions that enhance managers' listening skills could therefore serve as a low-cost strategy to support staff well-being and retention during crises. Because this study used a cross-sectional design, causal relationships cannot be inferred, and future longitudinal and intervention studies are needed to confirm the protective role of managerial listening over time.