Leadership in Health Services最新文献

Purpose: This study aims to formulate a consensus on primary care physicians' leadership competencies tailored to Indonesia's rural and remote health systems using the LEADS framework. Effective physician leaders are essential in these settings; however, many physicians lack the necessary leadership qualifications due to insufficient training. From a medical education perspective, this issue is further compounded by the lack of consensus on leadership course content.

Design/methodology/approach: The study used a mixed-method approach with a concurrent triangulation strategy. Concurrently, a two-round Delphi study and qualitative interviews were conducted. The Delphi study involved academics, rural and remote primary care physicians, intern doctors (similar to house officers), clerks and medical students and used descriptive analysis. Semi-structured interviews, guided by an interview guide, were analysed using inductive thematic analysis.

Findings: From the initial 62 LEADS framework statements, the authors identified 52 physician leadership attributes in round 1 and 41 attributes in round 2. Qualitative interviews revealed three main themes: the significance of physician leadership, the physician leadership curriculum and its potential and impact.

Originality/value: The study established consensus and provided scholarly insights into the leadership development necessary for primary care physicians in rural and remote areas. This is essential for developing Indonesia's medical leadership curriculum, with the ultimate goal of improving health outcomes in these settings.

Purpose: The purpose of this study is to explore the lived experience of leadership within outpatient physical therapists and to assess if the participants' lived experience of leadership is congruent with existing leadership theory.

Design/methodology/approach: Qualitative, in-depth, semi-structured interviews were conducted with eight outpatient physical therapists within a single southeastern state of the USA to discuss their lived experience with leadership within their professional roles. The data was analyzed inductively through in vivo coding, second cycle coding and development of themes.

Findings: The results of this study produced three themes surrounding the lived experience of leadership by outpatient physical therapists: How they lead, the important skills necessary to lead and the rewards of leadership.

Research limitations/implications: The lived experience of outpatient physical therapists appears to be congruent with transformational leadership theory. Researchers should consider using the transformational leadership theory framework to investigate and assess the effectiveness of leadership within physical therapy.

Originality/value: To the best of the authors' knowledge, this research is the first time that the perspectives of those living the experience of leadership in physical therapy have been sought out for their perspectives on what leadership is within the field, which has implications for future research, leadership development and assessment of effective leadership.

Purpose: The purpose of this paper is to describe first-line managers' (FLMs') experiences and reflections on structural conditions for management practice within hospital settings using Kanter's theory of structural empowerment.

Design/methodology/approach: A qualitative deductive approach with a descriptive design was used. Interviews were conducted with 11 FLMs in charge of medical or surgical hospital units spread across Sweden. Data were analyzed using a directed content analysis, based on Kanter's theory of structural empowerment, encompassing such as access to necessary and sufficient resources, information, support and opportunities to learn and develop.

Findings: Findings of this study from the FLMs' descriptions and reflections shed light on the impact of power dynamics on the structural conditions for management practice. The availability of nursing staff was a fundamental resource in the FLMs' work performance, ensuring delivery of care to patients and a sound work environment for staff. Additionally, the other structural elements outlined in Kanter's theory were evident in the findings, as the FLMs wished for structured information flow, identified potential and challenged opportunities for development and emphasized the importance of receiving support from people with a genuine understanding of their work situation.

Originality/value: The results of this study contribute to the understanding of FLMs' structural conditions for management practice in hospital settings. The paper's originality stems from the use of a deductive approach, providing a structured lens with the potential to inform future research and practice in the field of health-care management.

Purpose: Based on social exchange theory, this study aims to determine the relationship between inclusive leadership in their managers and organizational justice perceived by healthcare workers and work engagement and organizational citizenship behavior.

Design/methodology/approach: A cross-sectional and correlational study was performed by healthcare workers (n = 330) working in a city hospital for at least six months in Türkiye. Descriptive statistics, correlation and regression analysis were used in data analysis. The hypotheses were tested using Hayes' PROCESS macro (v4.1).

Findings: It was determined that inclusive leadership had a positive significant effect on organizational justice, work engagement and organizational citizenship behavior; and organizational justice had a positive significant effect on work engagement and organizational citizenship behavior. In addition, it was found that work engagement also had a significant effect on organizational citizenship behavior. It was found that organizational justice had a partial mediating role between inclusive leadership and work engagement, while its mediating role between inclusive leadership and organizational citizenship behavior was not statistically significant. In addition, work engagement was found to have a partial mediating role in the effect of inclusive leadership on organizational citizenship behavior.

Research limitations/implications: The limitations of this study can be summarized as follows: First, the data were collected from the employees in a hospital based on the self-reports of the participants. The fact that the study used a cross-sectional design limited the establishment of a causal relationship between variables. Since the study was planned during the COVID-19 period, the participants were reached through convenience sampling. Isolation measures due to the pandemic led to a lower response rate than expected. To reveal more generalizable results, it may be recommended to collect the data at different periods in future studies and to include different types of healthcare institutions.

Practical implications: Inclusive leadership of the healthcare managers will lead to positive employee outcomes by preventing the disadvantages brought by internal conflict in the work environment.

Originality/value: This study indicates that managers' inclusive leadership style will improve perceived organizational justice and work engagement and will lead employees to exhibit the desired extra-role behavior, such as organizational citizenship behavior.

Purpose: This paper presents a realist evaluation of leadership within an integrated care system (ICS) in England. This paper aims to examine which aspects of leadership are effective, for whom, how and under what circumstances.

Design/methodology/approach: Realist evaluation methodology was used, adopting prior realist review findings as the theoretical framework to refine explanations of how and why leadership within an ICS is effective. Between January and November 2023, 23 interviews with ICS leaders took place, alongside 7 meeting observations and documentary analysis. The Realist And Metanarrative Evidence Syntheses: Evolving Standards (RAMESES) guidance informed the study design, conduct and reporting.

Findings: The findings highlight two overarching infrastructural contexts influencing leadership in ICSs: the impact of the post-COVID-19 pandemic legacy and the differences between health and social care regulatory and financial environments. Findings demonstrate that ICS leaders identified a strong sense of purpose as crucial for guiding decisions and creating a psychologically safe environment for open, honest discussions, fostering calculated risk-taking. Whilst a shared vision directed priority setting, financial pressures led to siloed thinking. Leadership visibility was linked to workforce morale, with supportive leadership boosting morale amidst evolving ICS landscapes and confidence in data-driven decisions supported prevention activities. However, financial constraints hindered responsiveness and innovation in addressing health inequalities.

Originality/value: By examining ICS leadership post-COVID-19 pandemic and amidst varying regulatory and financial environments, this study contributes to the emerging literature on systems leadership and offers practical guidance for leaders navigating the complexities of integrated care.

Purpose: The purpose of this study is to explore the impact of EL style on key variables in health-care settings. Very few studies investigate the impact and outcomes of EL on health-care organizations. Synthesis of evidence will assist health-care leaders in making informed decisions about the outcomes they can expect from practicing EL.

Design/methodology/approach: Arksey and O'Malley's five-stage framework is used for conducting the scoping review. The databases include Scopus, Emerald Insight and Web of Science.

Findings: A total of 22 studies were finally considered for scoping review. The data are presented in terms of years, sampling techniques, sample size, data collection methods, and the directional relationship of the variables with EL.

Practical implications: Managers should be trained in EL style as it promotes the sustainability of the environment and organizations. Furthermore, EL should be promoted in health-care organizations as it improves employee resilience and voicing behavior and reduces instances of adverse events and medication errors, thus making the hospital a better and safer place.

Originality/value: This is one of the studies investigating the EL implications for health-care managers.

Purpose: Healthcare workforce shortages, particularly in rural areas, present a global challenge. The purpose of this study is to explore the leadership dynamics within federally qualified health centers (FQHC) in rural Oklahoma, focusing on recruitment, retention, job satisfaction and development practices.

Design/methodology/approach: Eighteen managers with five or more years of tenure from Oklahoma FQHCs were interviewed. Leadership's role in influencing job satisfaction, recruitment, retention and development practices was analyzed using a multilevel ecological framework through qualitative content analysis with NVivo.

Findings: The analysis includes ten key themes including the critical role of leadership in addressing recruitment and retention challenges, the importance of aligning organizational culture, rural culture, access challenges, trainings and values with workforce development initiatives, and the impact of leadership practices on job satisfaction.

Originality/value: This study uniquely examines leadership strategies in rural FQHCs, integrating ecological considerations for cultural, logistical and community-specific factors. It emphasizes the pivotal role leadership plays in shaping workforce development. As rural healthcare evolves, refining these approaches is crucial for addressing workforce challenges, improving healthcare access and ensuring that rural FQHCs remain sustainable, driving positive outcomes for healthcare professionals and communities.

Purpose: This paper aims to assess the influence of nursing leadership style on error management culture (EMC).

Design/methodology/approach: This scoping review was conducted following the integrative review methodology of the Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, CINAHL, Scopus, Web of Science, Embase and EBSCO databases were systematically searched to identify studies on nursing leadership, error management and measurement, and error management culture. The studies' methodological quality was then assessed using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies.

Findings: Thirteen manuscripts were included for review. The analysis confirmed that nursing leadership plays an important role in EMC and nurses' intention to report errors. Three emerging themes were identified: 1) leadership and EMC; 2) leadership and the intention to report errors; and 3) leadership and error rate.

Research limitations/implications: A major limitation of the studies is that errors are often analyzed in a transversal way and associated with patient safety, and not as a single concept.

Practical implications: Healthcare managers should promote training dedicated to head nurses and their leadership style, for creating a good work environment in which nurses feel free and empowered to report errors, learn from them and prevent their reoccurrence in the future.

Originality/value: There is a positive relationship between nursing leadership and error management in terms of reduced errors and increased benefits. Positive nursing leadership leads to improvements in the caring quality.

Purpose: This study aims to investigate the conceptual relationship between full-range leadership theory (FRLT) and patient safety culture in primary care settings, aiming to understand how leadership styles influence the development and sustainability of a culture prioritizing patient safety.

Design/methodology/approach: Using a conceptual analysis approach, the study builds a theoretical framework that integrates FRLT - which includes transformational, transactional and laissez-faire leadership styles - with the elements of patient safety culture. This framework serves as the basis for a comprehensive literature review, allowing for the formulation of hypotheses regarding the impact of each leadership style on patient safety culture.

Findings: The analysis demonstrates that transformational leadership bolsters patient safety culture by fostering open communication, encouraging error reporting and facilitating continuous improvement. Transactional leadership yields mixed effects, effectively supporting compliance and operational outcomes but showing limitations in promoting a proactive safety culture. Conversely, laissez-faire leadership is associated with negative outcomes for patient safety culture, mainly due to its passive and detached approach.

Originality/value: The originality of this study is rooted in its focused examination of FRLT's impact on patient safety culture within primary care settings, the development of a unique conceptual framework and its contribution of actionable insights for health-care leadership. These elements collectively advance the understanding of how leadership can enhance patient safety culture, providing a solid foundation for future research and practical application in primary care environments.