Leadership in Health Services最新文献

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.

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: Patient safety's inconsistent progress remains a prominent concern. Influential advocates recently identified faltering leadership in stalled initiatives. This study aims to identify how patient care quality and safety can be improved by analyzing leadership and organizational frameworks.

Design/methodology/approach: This multimethod study began with narrative review of existing literature on leadership for organizational frameworks in the context of patient-care quality and safety. The review informed development of scripted questions followed by semi-structured interviews with a purposeful sample of 11 healthcare leaders across Canada and the USA.

Findings: Key findings include consistent themes, along with indication by cited authors that important yet widely unfamiliar historical lessons from leading innovators along the past 100 years seem lost to institutional memory. Three themes emerged from the literature review: organizational ideology, the right leadership and organizational resilience. Several unique practical methods were discovered to be associated with consistent success. Additional interview themes include: a clear organizational mission, values and vision; personal values driving passion; all leaders and teams should collaborate; importance of a role model figure; importance of transparency; and flexibility to lead differently.

Originality/value: Important achievements and innovations exist in isolated examples. Now is the time to rethink leadership for organizations to widely steady a continuous evolution of patient care quality and safety progress. This manuscript identifies methods for improvement that have not been considered from business literature and recognizes current perspectives of healthcare leaders, for application in the realm of patient safety.

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 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: 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: Middle managers play a crucial role in health care, as they are responsible for executing decisions made by upper management and supervising frontline staff. Enhancing their ability to implement these decisions is essential for effective health-care delivery. The purpose of this case study is to describe a leadership development program was designed to improve employee engagement scores among health-care middle managers. The program used employee engagement survey data, experiential learning, reflection and coaching.

Design/methodology/approach: The authors analyzed annual employee engagement survey data to develop a series of leadership training sessions for health-care middle managers. Three leadership development series were conducted, each featuring diverse experiential learning methods facilitated by subject matter experts. Participants' feedback was collected through open-ended surveys at the end of each series, focusing on key outcomes such as their understanding and application of leadership concepts. Descriptive statistics were used to summarize the results from the annual 2021 and 2022 engagement surveys.

Findings: A total of 45 middle managers with various middle management roles and from different backgrounds (clinical and non-clinical) reported significant improvements in their engagement scores, with the overall score increasing from 80.02 to 81.98 (p = 0.045). Participants also reported improved team trust, valuing employee input and enhanced leadership effectiveness.

Research limitations/implications: This study's limitations include that this study took place at a not-for-profit health-care system during the COVID-19 pandemic (2021-2022) and that not all participants' demographic information was collected.

Practical implications: Structured, data-driven leadership development programs can enhance middle managers' skills, engagement and satisfaction in health-care organizations.

Originality/value: This case study used employee engagement survey data to design a leadership development program for middle managers in health care, a group often overlooked in traditional leadership development programs.

Purpose: As agents of change to improve the quality of health services, medical students are expected to have leadership competency. Leadership competency should start by leading themselves. Demonstrating personal qualities domain in the Medical Leadership Competency Framework can be used to design leadership education. This study aimed to evaluate the effect of leadership training on the personal qualities of medical students.

Design/methodology/approach: This research was a quasi-experimental study. Thirty-three third-year medical students were included in the training. Leadership training in this study was designed based on the personal qualities domain of the Medical Leadership Competency Framework combined with other learning pedagogies. The training lasted 15 days, consisting of workshops and student project sessions. The training evaluation used Kirkpatrick's program evaluation level one and two. Level one evaluated student satisfaction. Level two evaluated affective, behavioral and cognitive learning gains. Behavioral learning gains were further explored with in-depth interviews.

Findings: Participants rated workshops and student project sessions positively. This training significantly increased behavioral and cognitive learning gains (p < 0.05). However, the results showed that training did not significantly increase affective learning gains (p > 0.05). Qualitatively, participants positively described the development of their personal qualities in the learning context.

Originality/value: This study describes leadership training using the Medical Leadership Competency Framework and several learning pedagogies that support the leadership development of medical students.

Purpose: Grounded on the affective event theory, this study aims to investigate the mediating effect of psychological distress in the relationship between abusive supervision and three negative outcomes, namely, solitary-oriented behavior, boreout and sabotage behavior. The study also examined the moderating of anger in the link between abusive supervision and psychological distress.

Design/methodology/approach: Data was collected from nurses working in private and public hospitals in Iran. Structural equation modeling and bootstrapping techniques have been applied.

Findings: This study confirmed that abusive supervision eventually leads to unfavorable employee outcomes via the mediation effect of psychological distress. Moreover, anger moderates the association between abusive supervision and psychological distress.

Originality/value: This research contributes to the existing service literature by investigating the consequences of abusive supervision among nurses.

Purpose: The well-being of nurses in health-care organizations is an increasingly key factor, and the increasing phenomenon of turnover and leaving of the profession by nurses undermines their attractiveness. This integrative review aims to investigate whether the leadership enforced by leaders can influence the intention to stay of their employees and which style of leadership would be most effective in facilitating retention.

Design/methodology/approach: This integrative review summarizes the scientific literature of the last 10 years to provide a comprehensive understanding of a leadership style in health-care organizations. The electronic biomedical databases were interviewed by MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science, Scopus, ERIC and, for grey literature, Google Scholar. The articles included have been submitted to a critical appraisal through the Critical Review Form for Quantitative Studies and the Critical Review Form for Qualitative Studies Version 2.0.

Findings: In total, 21 articles of quantitative, qualitative and mixed method research were included, including two doctoral theses and an editorial comment from a scientific journal. Five themes are identified: Leadership style as a predictor of retention, exogenous factors, individual, organizational or endogenous factors, effects of leadership and effective leadership styles. It emerges that the leadership style strongly influences the intention to stay, and the most effective styles for this purpose are supportive, authentic or ethical and transformational.

Originality/value: The leader's action influences the phenomenon of intention to stay, and proactive leadership styles contribute to the retention of nurses in their organizations. Transformational leadership appears more flexible and more suitable to favor the intention to stay.