Leadership in Health Services最新文献

Purpose: This paper aims to introduce an adapted, culturally competent leadership conceptual framework for indigenous health care, aiming to improve health access and address gaps in Western-centric leadership models.

Design/methodology/approach: A systematic literature review and thematic analysis of 32 peer-reviewed articles were conducted, guided by transformational and cultural sensitivity frameworks to adapt a conceptual framework to support health access in indigenous communities.

Findings: The adapted indigenous leadership conceptual framework (AILCF) includes 11 interrelated leadership themes - visionary leadership, supportive and empathetic leadership, adaptive leadership, integrity and ethical leadership, communicative leadership, courageous leadership, cultural competence, community engagement and relationship-building, historical trauma and healing, structural change and leadership in crisis - synthesized through transformational and culturally sensitive leadership lenses to support equitable health access and culturally grounded leadership in indigenous health-care settings.

Research limitations/implications: This qualitative review is limited by secondary data and geographic concentration within the USA.

Practical implications: AILCF fosters culturally attuned leadership development and practice within indigenous health organizations, providing pathways to equitable health access.

Originality/value: Unlike existing Western-centric models, the proposed framework incorporates historical trauma, relational accountability and cultural alignment, dimensions rarely reflected in traditional leadership theory. By reframing leadership as a culturally grounded, healing-centered practice, the AILCF offers a necessary contrast to dominant paradigms. This model contributes not by expanding leadership theory, but by disrupting its assumptions and advancing a more inclusive, context-specific understanding of what effective leadership entails in indigenous health-care systems.

Purpose: The primary purpose of this systematic literature review is to provide a global, comprehensive and up-to-date synthesis of physicians' perspectives on barriers to and facilitators of physician leadership.

Design/methodology/approach: This review included peer-reviewed empirical articles and dissertations/theses published in English from January 2014 to June 2024 examining the barriers to and/or facilitators of physician leadership from physicians' perspectives, either as primary objectives or emergent findings. A comprehensive search was conducted across 10 databases, including PubMed, Embase, Web of Science, CINAHL and Scopus. Tools and frameworks such as the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist, PRISMA flow diagram, SPIDER, Zotero, Rayyan and mixed methods appraisal tool (MMAT) were used to formulate research questions, screen studies, assess methodological quality and present the results. The findings were synthesized and organized into emergent themes.

Findings: The search started with 11,691 studies and ended with a final sample of 123 articles, comprising quantitative, qualitative and mixed methods designs. Three overarching themes were identified: individual-level, organizational-level and systemic-level barriers and facilitators. A total of 11 barriers (e.g. identity conflict, inadequate leadership training, negative perceptions about the physician leader) and seven facilitators (e.g. desire for influence and change, relational and practical support, health care reforms) were identified across studies.

Research limitations/implications: The findings from this review may guide researchers, policymakers and healthcare organizations to develop and implement multi-level evidence-based interventions to help motivate, support and retain physician leaders worldwide.

Originality/value: To the best of the author's knowledge, this is the first systematic review to primarily explore barriers to and facilitators of physician leadership solely from physicians' perspectives. By analyzing 123 studies across diverse healthcare systems and contexts, this review offers a global, comprehensive and up-to-date understanding of the individual, organizational and systemic factors influencing physicians' decisions to pursue leadership.

Purpose: This study aims to explore the relationship between resilient leadership and organizational resilience in Ugandan healthcare systems, focusing on the mediating role of nurses' well-being. Given the high-stress nature of healthcare, fostering organizational resilience through effective leadership and nurses' well-being is crucial for sustaining quality service delivery.

Design/methodology/approach: A quantitative survey was conducted with 209 nurses across various healthcare facilities in Uganda. Data analysis was performed using the partial least squares (PLS) approach to examine the direct and mediating relationships between resilient leadership, nurses' well-being and organizational resilience.

Findings: The results reveal that nurse well-being significantly mediates the relationship between resilient leadership and organizational resilience. This suggests that resilient leadership positively influences nurses' well-being, which in turn enhances the overall resilience of healthcare organizations.

Practical implications: The study highlights the importance of integrating well-being initiatives into leadership strategies to strengthen healthcare institutions. Healthcare leaders should prioritize nurses' well-being as a core component of resilience-building efforts. In addition, policymakers should support the implementation of well-being programs and leadership development initiatives to enhance organizational sustainability in healthcare.

Originality/value: This study contributes to the growing body of knowledge on resilience in healthcare by providing empirical evidence on the mediating role of nurses' well-being. It underscores the significance of employee-centered leadership in fostering organizational resilience, particularly in resource-constrained healthcare systems.

Purpose: Adaptive leadership and dynamic adaptive approaches to decision-making are becoming increasingly important for organizations operating in complex and uncertain environments. This study aims to examine how the utilization of a dynamic adaptive approach influences adaptive leadership within strategic processes. Adaptive leadership enables organizations to navigate unpredictable challenges by fostering resilience, learning and change, while the applied dynamic adaptive approach supports strategic decision-making under deep uncertainty.

Design/methodology/approach: A qualitative multiple-case study design was used, involving four Dutch healthcare organizations - two elder care organizations and two disability care organizations. Each organization participated in a strategic decision-making workshop in which a dynamic adaptive approach was applied. Data were collected through workshop observations, interviews and supporting documentation.

Findings: The findings show that the applied dynamic adaptive approach strengthens a supportive environment and contributes to sensemaking necessary, helping participants engage with long-term uncertainties and strategic complexity. This, in turn, encouraged behaviors and mindsets associated with adaptive leadership. However, the study also reveals limitations: a single workshop is not sufficient to fully design an intervention for an organization and develop adaptive leadership capabilities. Iterative, ongoing engagement is necessary to build strategic resilience and adaptive capacity.

Originality/value: This research complements recent calls for more empirical research on adaptive leadership and foresight approaches. The study reveals how the dynamic adaptive approach in strategic decision-making processes empowers adaptive leadership. This is especially important in today's complex organizations facing deep uncertainties in a rapidly changing environment.

Purpose: This study aims to examine nurses' leadership orientations, patient-centered care practices and the relationship between the two.

Design/methodology/approach: Descriptive research design was used in this study. The study population consisted of 349 nurses working in adult wards of a university hospital in Turkiye. Data were collected between August 2021 and September 2021 using the "Individual Information Form", "Multidimensional Leadership Orientations Scale (MLOS)" and "Patient-Centered Care Competency Scale (PCCS)" with 185 nurses who agreed to participate in the study.

Findings: The total PCCS score was 72.90 ± 8.23 and the total MLOS was 75.9 ± 10.69. A positive, moderate relationship was found between nurses' leadership orientations and patient-centered care competencies.

Research limitations/implications: The study population consisted of nurses (N = 349) working in adult wards at a university hospital. The sample consisted of nurses working in adult medical and surgical units who were selected by simple random sampling and volunteered to participate (n = 185). Nurses working in pediatric units, where a family centered care approach is prominent, were excluded from the study to focus on patient-centered care.

Practical implications: In practice, organizations should align patient-centered care training with unit-level leadership programs; they should standardize "participation-encouraging" behaviors through phased development models for unit managers and clinical nurses. This approach can create a sustainable foundation for improving patient experience and team functioning.

Originality/value: Although there are many studies on the concepts of leadership and patient-centered care (PCC) in the literature, only a limited number of studies have examined the role of leadership in the context of PCC. In existing studies, leadership has been examined from the perspective of managers or nurse educators, not nurses. Our study fills this gap in the literature by offering a different perspective for both healthcare managers and nurses. Beyond aligning with recent evidence on education and mentorship effects on PCC, this study adds novel nurse-level quantitative evidence linking structural and political leadership orientations with the "promoting patient involvement" and "providing patient comfort" patient-centered care subscales.

Purpose: This study aims to explore the impact of transformational, transactional and servant leadership on organizational success, with specific attention to the moderating role of technology adaptation and potential mediating role of organizational culture in the Iranian healthcare system.

Design/methodology/approach: A quantitative, cross-sectional survey was conducted with 340 healthcare professionals across public and private sector, using judgmental sampling and analyzing the data using correlation, regression analysis and PROCESS MACRO to test mediation and moderation.

Findings: Results confirm that leadership strategies, when considered as a composite construct have a statistically significant positive impact on organizational success, encompassing patient care quality, operational performance and employee engagement. Contrary to the theoretical expectations, the mediating role of organizational culture in this relationship was not supported, suggesting that cultural change may be less responsive to leadership efforts in bureaucratic healthcare systems. However, the study revealed that technological adaptation moderates the relationship between leadership and success, amplifying the effectiveness of leadership strategies in technologically adaptive environments.

Originality/value: By extending leadership theory to a non-Western, resource-constrained healthcare setting, this research contributes to the global discourse on healthcare leadership and highlights the importance external contextual enablers in enhancing leadership effectiveness. It also challenges the assumed universality of cultural mediation models in leadership theory.

Purpose: Despite its significant potential to bridge and integrate, co-leadership is known to be fragile - a graphic in an organigram that doesn't transmit reality or illustrate the paralysis of tensions. Moments of transition, including changes in co-leaders, render the arrangement particularly vulnerable. Yet, we know little about how to maintain the stability of co-leadership arrangements. This study aims to explore that shortcoming in the context of frequent co-leader transitions.

Design/methodology/approach: Data was collected during a longitudinal qualitative study of co-leadership - the sharing of a leadership role by two individuals - in a military healthcare organization, where a context of frequent personnel rotations gives rise to almost yearly leadership transition events. An inductive analysis of 32 semistructured interviews with tactical-level co-leaders revealed three main factors contributing to the stability of this model, which has been in place for over 20 years.

Findings: In this case, the stability of co-leadership is rooted in three elements. First, similar structural arrangements and traditions are widely practiced and accepted within the field. Second, there is a common understanding that roles and relationships are negotiated on a temporary basis. Third, patterns of distancing contribute to maintaining the existing state.

Originality/value: The ongoing replacement of leaders in an established co-leadership structure made for a unique and extreme case of instability, revealing the paradox of stability: in this case, the stability of the arrangement derives from the instability of its membership and from a shared view of its inner workings as a temporary modus operandi.

Purpose: This study aims to develop a theory-informed typology of rural health workforce development interventions specific to Federally Qualified Health Centers (FQHCs). Guided by Bronfenbrenner's Social Ecological Model, and using a PRISMA-based systematic review, this paper synthesizes the types, characteristics and strategic orientations of interventions implemented to support recruitment, training and retention of health professionals in rural and underserved settings.

Design/methodology/approach: A systematic review followed PRISMA 2020 guidelines, drawing on five academic databases (CINAHL, MEDLINE, Science Direct, PsycInfo and Health Source Nursing/Academic). Thirty-five peer-reviewed articles published between 2010 and 2025 were analyzed using thematic coding and constant comparative methods to identify intervention categories and key characteristics.

Findings: Five dominant types of rural workforce interventions were identified: (1) Educational Pipeline Programs, (2) Policy and Partnership Models, (3) Practice Environment Enhancements, (4) Community-Embedded Workforce Strategies and (5) Financial and Incentive-Based Strategies. Educational and policy-driven models were most frequently represented, while culturally grounded, community-embedded strategies were notably underutilized. The study reveals a field in transition - shifting from short-term incentives to sustainable, leadership-informed approaches.

Originality/value: This is the first study to develop a leadership-relevant typology of rural health workforce interventions in FQHCs. The framework offers policymakers, administrators and educators a practical tool for assessing strategies, identifying gaps and designing equitable, sustainable workforce solutions.

Purpose: This study aims to examine how leadership approaches balancing structure with psychological safety influence team effectiveness in integrated healthcare leadership teams that span organisational boundaries. The research focuses specifically on an integrated mental health crisis service leadership team.

Design/methodology/approach: A qualitative intrinsic case study design was conducted as part of MSc dissertation requirements. The study reanalysed interview data (n = 8) alongside reflective notes, and team effectiveness measures from an integrated mental health crisis service leadership team. Reflexive thematic analysis identified structure-psychological safety relationships.

Findings: Reanalysis revealed three interconnected themes: clear parameters and boundaries, psychological safety within structure and structured development opportunities. Structured leadership approaches created conditions for psychological safety and team development rather than constraining them. Team effectiveness measures showed improvements, including role clarity (3.6 / 5.0-4.4 / 5.0), inter-team working (3.5-4.1), team innovation (4.2-4.7) and team objectives (4.0-4.6), though multiple factors likely influenced these changes.

Research limitations/implications: The single case study design limits generalisability but suggests avenues for future research into how systematic approaches complement psychological safety in integrated healthcare settings. The exploratory data reanalysis provides preliminary insights requiring validation across diverse contexts.

Practical implications: Healthcare leaders might benefit from examining how clear parameters enable rather than constrain team development across organisational boundaries, supporting current integrated care system initiatives.

Originality/value: This study contributes to conversations about structure and psychological safety relationships in leadership practice. It challenges assumptions that structure necessarily constrains psychological safety, suggesting structured approaches can create enabling conditions for team development in complex healthcare environments.

Purpose: This study aims to investigate how demographic variables - specifically age, gender and income - influenced community perceptions of decentralized governance leadership during the COVID-19 crisis in Elavally Panchayat, Kerala. It explores residents' varied experiences with local service delivery and support mechanisms, revealing disparities in satisfaction and access. The findings underscore the importance of inclusive, adaptive and crisis-responsive local leadership during public health emergencies.

Design/methodology/approach: Adopting a mixed-methods approach, this study combined unstructured interviews with elected local self-government leaders and primary health centre staff with a structured household survey. The survey included first 100 household respondents drawn from confirmed COVID-19 cases across all 16 wards. Six dimensions of governance performance were assessed using a three-point Likert scale (Satisfied, Neutral and Dissatisfied). Descriptive statistics and chi-square tests (p < 0.05) were applied to examine demographic variations in satisfaction levels. Qualitative insights from interviews further contextualized and deepened the findings.

Findings: The results indicate significant demographic disparities in perceived leadership effectiveness. Younger adults appreciated digital welfare schemes but felt excluded from local decision-making. Middle-aged residents experienced severe healthcare and livelihood disruptions, while elderly individuals struggled with digital health systems. Women expressed higher satisfaction due to targeted welfare schemes, whereas men cited unmet mental health and economic needs. Lower-income groups reported barriers to accessing essential services. Nonetheless, decentralized governance grounded in trust, equity and participatory approaches enabled an effective, context-specific crisis response.

Originality/value: Unlike studies that treat communities as homogeneous, this research disaggregates perceptions, offering policy insights to strengthen equity and resilience in local health governance.