Journal of Healthcare Leadership最新文献

Introduction: Despite achieving gender parity among medical and graduate students, women remain underrepresented in academic medical center leadership. This highlights a need for inclusive leadership development programs which impact both individuals and the organization. In response, we developed and evaluated a novel, comprehensive, and collaborative training designed for both mid-career to senior faculty and administrative leaders which addresses leader development and institutional culture.

Methods: A novel 18-month program for faculty and administrative leaders which includes 14 days of immersive workshops, a 360° assessment, personalized executive coaching, and an institutional group project was implemented and evaluated. Pre- and post-program assessments were analyzed using factor analysis to create seven composite scales defining various aspects of leadership competencies. Analysis of survey data used a t-test to determine significantly different scores pre- and post-test for each composite measure.

Results: Participants in this intensive program reported increased agreement with skill development across all competencies except for personal growth, where there was no statistically significant increase, and increased expectations about the program's ability to enhance recognition, visibility, and opportunities to impress institutional leadership. Over 80% of participants in a five-year follow-up survey found the program beneficial for leadership development, and half of the participants felt the program influenced their decision to stay at their institution long-term. Ninety-four percent of faculty received promotions or new leadership roles within eight years.

Discussion: Determining the impact of leadership programming is difficult but institutional immersive leadership programs have demonstrated significant impact through the advancement of core leadership competencies, faculty and administrative staff promotion, and long-lasting collaborations across the academic medical center. Future comparative studies are needed to look across institutions to determine which elements of the program are most effective.

Purpose: To examine the sustained impact of a faculty leadership program at an academic health center (AHC) on participants' perceived effectiveness in leadership skills and leadership attainment compared to faculty controls.

Methods: The sample included 95 faculty members who participated in the year-long Faculty Leadership Institute (FLI). We compared FLI participants to 156 unmatched faculty controls. Participants completed online surveys self-reporting on perceived effectiveness in leadership skills, and leadership positions attained an average of 7 years after program completion. Background information, such as demographic characteristics and academic rank, was obtained from the faculty affairs office.

Results: The sample of participants was 47% female, 76% White, with an average age of 52.39 years. Academic ranks were higher in the FLI group; 62% of FLI graduates and 44% of controls were Full Professors (p < 0.001). FLI participants reported moderate-to-high effectiveness in overall leadership skills, which was significantly greater than controls (p < 0.001; d = 0.62). FLI participants had higher self-reports of effectiveness on 25 of 26 (96%) leadership skills and these differences were significant in 16 of 26 areas (62%), (p < 0.034 to 0.001) with small to moderate effect sizes (ds = 0.34 to 0.57). FLI participants attained a greater number of leadership positions. However, after correcting for multiple comparisons, the difference was not significant (p = 0.1). FLI participants were more likely to have held a leadership position in clinical operations (p = 0.018). Group differences in perceived effectiveness in leadership skills and leadership attainment did not vary by gender or race.

Conclusion: Findings support sustained benefits of the FLI program, particularly in perceived effectiveness of leadership skills, regardless of gender or race. Although additional research is needed to demonstrate how the positive effects translate to system-level outcomes (eg, research funding, patient care), continued efforts to develop talented faculty members are important to ensure a succession of well-prepared leaders at AHCs.

Background: Nursing leadership competency is important for staff empowerment, quality improvement, and patient safety, yet inadequate investment in its development hinders its development. This highlights the urgent need for strategic leadership competency building in nursing management.

Purpose: This study aims to examine the importance of self-assessing leadership competency in guiding Nursing Directors' leadership development and the relationship between nursing directors' leadership quality and nursing staff empowerment.

Methods: The cross-sectional quantitative study included two online surveys completed by 21 Nursing Directors and 260 nursing staff from two hospitals with >90% response rate. Two surveys were conducted: Survey for Nursing Directors adapting items from Management Competency Assessment Project to self-assess competency on leadership and professionalism; Survey for nursing staff using Leadership Behavioral Scales to reflect on Nursing Directors' leadership behaviors as observed by nursing staff. Descriptive statistical analysis (mean, frequencies and percentages) of the 21 behavioral items self-assessed by Nursing Directors and 19 leadership behaviors assessed by nursing staff were performed and reported Pearson correlation test was performed to test corrections of different variables.

Results: Nursing Directors' self-assessment on competencies of leadership and professionalism yielded a combined mean score of 4.63 and 4.85 respectively. Between 35% and 60% of staff recognized Nursing Directors' positive leadership behavior which were significantly and positively correlated with four dimensions of psychological empowerment scale used. The study also found consistent differences in the results of the assessment by Nursing Directors and nursing staff between two targeted hospitals.

Conclusion: The study confirmed that leadership demonstrated by Nursing Directors are important to empower nursing staff and organizational context plays an important role in developing nursing leadership and improving nursing management effectiveness. The study supports the value of management competency self-assessment in identifying competency gaps and competency development needs amongst Nursing Directors.

The World Health Organization (WHO) recognizes the importance of Integrated Health Systems (IHS) in translating health information and its determinants into tangible outcomes. However, effective implementation of an IHS has not been realized due to the lack of a structured Health Information System (HIS) for centralized data analytics and accessibility. This is further exacerbated in developing nations because of the complex interplay between limited resources, inadequate infrastructure, and high disease burden. Therefore, the perspectives presented provide an enhanced engine in the form of a structured HIS to propel the IHS, such that the health system is driven by efficient health data management and analytics. The transformational IHS presented considers resource limitations within the context of the factors influencing political, structural, and economic reforms. This provides an adaptive and progressive approach to address multifaceted health challenges in developing nations. Importantly, the IHS framework presented provides a health system paradigm shift that integrates health practices and their determinants within an artificially intelligent-enabled data-driven architecture to achieve structured and seamless universal health coverage.

Purpose: Healthcare organizations face challenges in balancing efficiency and innovation, known as ambidexterity. Leadership plays an important role, with transformational leadership driving innovation and transactional leadership supporting efficiency. The dominant leadership framework is the Full-Range Leadership Theory (FRLT), which identifies three leadership behaviors: transformational, transactional, and passive avoidant. Organizational structures, following Mintzberg, Pugh and Galbraith, including span of control (SoC), unit grouping, and lateral linkages, significantly influence leadership dynamics. This study examines the impact of structural changes on perceived leadership styles in a Dutch radiotherapy center (RTc) following the implementation of proton therapy, a radical innovation.

Patients and methods: A mixed-method approach combined leadership surveys, with data collected at three time points, before and after structural changes in 2022. The multifactor leadership questionnaire (MLQ) was distributed among the employees in November 2021, March 2022, and March 2023. Three interventions were introduced: (1) appointing dedicated team leaders (TLs) to improve information flow and reduce management SoC; (2) integrating a Patient Care (PC) manager into the advisory board to facilitate direct communication within the governance structure, including other hierarchical layers; and (3) adding a proton therapy manager as a liaison to improve coordination. Leadership perceptions were measured using the Multifactor Leadership Questionnaire (MLQ) at three time points (T1, T2, T3). The Independent-Samples Mann-Whitney U-Test (p<0.05), was used to compare T1, T2, and T3, managers' self-ratings with employee ratings, and scores between photon and proton treatment employees.

Results: Transformational leadership significantly increased across all groups, with PC scores rising from 2.3 at T1/T2 to 2.5 at T3, and MT-PC scores from 1.8 at T1 to 2.4 at T3. Passive avoidant leadership significantly decreased (eg, MT-PC: 1.6 at T1 to 1.0 at T3). Transactional leadership showed less pronounced and non-significant changes. Photon therapy staff experienced earlier improvements in leadership perceptions, while proton therapy staff showed delayed but stronger shifts by T3.

Conclusion: In this study, structural changes positively influenced leadership perceptions, supporting ambidexterity. Significant increases in transformational leadership and decreases in passive avoidant leadership align leadership styles with the dual demands of innovation and operational efficiency, demonstrating the importance of organizational design in healthcare leadership. Our findings show that healthcare management could use organizational structure changes to promote transformational leadership.

Purpose: Effective leadership is one of the most important factors contributing to an organization's effectiveness and success. The objective of this study is to identify the leadership styles of primary healthcare managers and explore associated sociodemographic factors.

Methods: A cross-sectional study was conducted at Prince Sultan Military Medical City (PSMMC) in Riyadh, Saudi Arabia, among primary healthcare managers in different aspects of 6 primary healthcare centers (PHC). Data were collected using a self-assessment questionnaire composed of two main sections: sociodemographic characteristics of the participants and the emotional intelligence questionnaire to assess the various competencies of emotional intelligence of leadership style.

Results: A total of 50 primary healthcare managers were included in the study. Approximately half of them (52%) were aged between 35 and 44 years. The highest applied statement was "I know when I am happy (4.42±0.95)", whereas the lowest applied statement was "I rarely worry about work or life in general (3.20±1.26)". Self-awareness was considered a strength in most of the participants (78%), while, managing emotions needs attention in 52% of them. Intrinsic motivating, empathy, and social skill were considered strengths in most of the participants (70%, 74%, and 68%, respectively). Participants aged (25-34 years) were more likely than others to need attention in the component of "intrinsic motivating" (31.6%), p=0.053. Single participants were more likely than married participants to need attention in the component of "intrinsic motivating" (70% versus 18.4%). P=0.006. Nurses, pharmacists and radiologists were more likely to need attention in the component of "self-awareness" than doctors and directors, p = 0.041.

Conclusion: This study highlights the significance of emotional intelligence components, such as self-awareness, empathy, and social skills, as strengths among primary healthcare managers in Riyadh, Saudi Arabia. The findings emphasize that enhancing emotional intelligence is essential for fostering effective leadership within primary healthcare sitting.

Purpose: Planetary health is the idea that human health and the health of our planet are inextricably linked. The healthcare sector promotes human health but has a significant impact on our natural world. In Canada, some hospitals are leading the way towards promoting planetary health in an increasingly challenging context. The purpose of this study was to understand how Canadian hospitals support planetary health, specifically through green teams and sustainability offices.

Patients and methods: People working in Canadian hospitals, either in sustainability offices or green teams, were invited to participate in this study. Participants completed an online survey and indicated if they would like to take part in a semi-structured interview via Zoom. Twenty-nine participants were interviewed and asked about how they supported planetary health and how their teams were integrated into the hospital setting. Interview transcripts were analyzed and data were summarized using thematic analysis. Demographic information was collected through the survey.

Results: Three main themes were: 1) From grassroots to corporate: Green teams and sustainability offices. This theme defined, compared, and contrasted teams and offices; 2) Operationalizing this work: Five green team exemplars. The five teams were: 1) the single-person green team; 2) the health profession-specific green team; 3) the green team pilot project; 4) external partners supporting green teams; and 5) the "bottom up" meets "top down" green team; and 3) Paving the path forward and tracking success. This theme explored how teams used metrics and other broader indicators to understand success.

Conclusion: This study examined the work of Canadian sustainability offices and green teams in the hospital setting. The former promoted planetary health from a "top-down" perspective while the latter did so from a "bottom-up" perspective. Teams that integrated both approaches were the most effective in promoting planetary health.

Purpose: Health care leaders have a significant impact on workforce engagement, making investments in leadership development essential. At Weill Cornell Medicine, a faculty development offering exists for early career faculty called Leadership in Academic Medicine Program (LAMP). This study aimed to identify the leaderships skills that LAMP participants found most challenging and applied an evidence-based leadership model to address those challenges.

Methods: The authors analyzed pre- and post-program surveys of LAMP participants (2013-2023) to assess their agreement with statements regarding their leadership and other professional skills. Percent disagreement was compared pre- and post-program. Statements with disagreements at or above the pre-program median were classified as areas of leadership discomfort. Statements with disagreements at or above the post-program median were classified as areas of persistent leadership discomfort. These areas were cross referenced with a leadership model shown to positively influence constituent well-being to inform specific curricular additions to LAMP.

Results: A total of 328 paired responses were analyzed, identifying three areas of persistent leadership discomfort: (1) Negotiating (2) Managing Competing Demands and (3) Managing Conflict. All were successfully cross referenced to teachable behaviors in an established leadership model.

Conclusion: Leadership behaviors that positively impact health care workers and that address skill gaps articulated by early career leaders can be used to enhance a curriculum in a faculty development program.

Background: Second Victim Syndrome (SVS) refers to the significant emotional and psychological distress experienced by healthcare professionals following adverse patient events. While numerous interventions have been developed to support second victims, their effectiveness remains poorly understood. This systematic review aimed to synthesize the evidence on the outcomes of available interventions targeting SVS.

Methods: We systematically searched MEDLINE, Embase, and the Cochrane Library databases, covering all records up to July 7, 2024. We included studies that evaluated the impact of SVS interventions on psychological, professional, and institutional outcomes. We assessed the quality of the included studies using the Joanna Briggs Institute (JBI) critical appraisal tool and evaluated the certainty of evidence using the GRADE framework. Due to heterogeneity in study designs and outcome measures, we opted for a narrative synthesis.

Results: Fifteen studies were included, predominantly of moderate quality. Peer support programs were the most commonly implemented interventions, often structured around the Scott Three-Tiered Model. These programs demonstrated consistent short-term benefits, such as reduced emotional distress and perceived isolation. However, evidence for long-term outcomes-including professional resilience, burnout reduction, and retention-was mixed and generally of low certainty. Structured psychological interventions, including cognitive behavioral therapy (CBT) and mindfulness-based programs, showed more promising long-term results but remain underexplored. Standardized outcome measures, such as the Second Victim Experience and Support Tool (SVEST), were infrequently used, limiting comparability across studies.

Conclusion: SVS interventions, particularly peer support, offer short-term relief but limited long-term impact. There is a critical need for longitudinal research using standardized outcome measures to better evaluate effectiveness. This review highlights the need for system-wide, evidence-based interventions and standardized evaluation metrics to support healthcare professionals effectively.

Introduction: Primary care has strategic importance in Australia's complex health system, attracting one-third of the country's health budget. Primary Health Networks (PHNs), established in 2015 to act as commissioners for non-hospital health and social care across Australia, enable a more comprehensive health planning approach to identify and prioritise service gaps and commission appropriate health services. Hence, building PHNs' capability in health commissioning is critical to maximising health outcomes of the Australian population.

Objective: This study was conducted to identify the skill development needs of PHNs employees to lead and manage commissioning, and strategies to build commissioning capabilities across PHNs.

Methods: A multiphase mixed-method approach was used, including an anonymous online survey and two focus group discussions.

Results: The health commissioning practices of PHNs directly affect PHN staff's confidence (Pearson's r=0.484, p<0.001) and self-perceived competence in their commissioning practices (Pearson's r=0.335, p<0.001). This study confirms that systematic upskilling commissioning among PHN employees, focusing on the commissioning cycle, complex healthcare environments, and data management, is required to improve their capabilities. This highlights the importance of organisational support in strengthening the six key factors for effective commissioning.

Discussion: The enhancement of PHNs' capability in health commissioning should be centered around employees' capability building guided by the proposed PHN health commissioning capability building model. Organisation investment in performance monitoring and enhancement, organisations' multi-strategy approach towards internal support and development, and external learning and development opportunities are the three key pillars.

Conclusion: Enhancing robust commissioning processes and strengthening leadership capabilities in health commissioning are essential for PHNs to meet the evolving healthcare needs of the population. Effective commissioning requires skilled and confident teams, systematic upskilling, organisational support, and strategic approaches to address challenges, deliver high-quality primary care, and improve population health outcomes. Building PHNs' commissioning capability requires a systematic and progressive skill development approach that prioritises a staff-centred model.