Leadership in Health Services最新文献

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: 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.

Purpose: This paper aims to explore the paradigm shift in leadership and strategic management driven by the integration of responsible artificial intelligence (AI) in healthcare. It explores the evolving role of leadership in adapting to AI technologies while ensuring ethical governance, transparency and accountability in healthcare decision-making.

Design/methodology/approach: This study conducts a comprehensive review of current literature, case studies and industry reports to evaluate the implications of responsible AI adoption in healthcare leadership. It focuses on key areas such as AI-driven decision-making, resource optimisation, crisis management and patient care, while also addressing challenges in integrating AI technologies effectively.

Findings: The integration of AI in healthcare is transforming leadership from traditional, experience-based decision-making to data-driven, AI-enhanced strategies. Responsible leadership emphasises addressing ethical concerns such as bias, transparency and accountability. AI technologies improve resource allocation, crisis management and patient care, but challenges such as workforce resistance and the need for upskilling healthcare professionals remain.

Practical implications: Healthcare leaders must adopt a responsible leadership framework that balances AI's potential with ethical and human-centred care principles. Recommendations include developing AI literacy programmes for healthcare professionals, ensuring inclusivity in AI algorithms and establishing governance policies that promote transparency and accountability in AI applications.

Originality/value: This paper provides a critical, forward-looking perspective on how responsible AI can drive a paradigm shift in healthcare leadership. It offers novel insights into the integration of AI within healthcare organisations, emphasising the need for leadership that prioritises ethical AI usage and promotes patient well-being in a rapidly evolving digital landscape.

Purpose: The purpose of this study is to review the current state of the evaluation of leader and leadership development programs (LDPs) for physicians and medical learners, identify issues, suggest improvements and propose a framework.

Design/methodology/approach: A narrative review of the evaluation of LDPs was performed (English language literature from 2010 to 2024, including peer-reviewed [PUBMED, EMBASE, CINAHL, MEDLINE, MedEdPORTAL, PsychInfo, Scopus, Business Source Elite and ERIC] and gray literature). Analysis and synthesis of literature included a critical examination of notions and concepts.

Findings: The evidence for the positive impact of leadership development programs is growing. The main issues are a lack of a strategic organizational approach, heavy reliance on one evaluation model with findings predominantly evaluated at lower levels subjectively, lack of rigor including endogeneity issues and limited use of complex far transfer outcomes. Suggestions for improvements include a strategic approach to evaluation with a broader use of other taxonomy-based models and realist and constructivist approaches to evaluation, consideration of outcome clusters of education, training and developmental pathways, utilizing a wider array of methods and integrating findings.

Practical implications: The proposed conceptual approach links individual and organizational outcomes and lower-level program evaluation with "strategic evaluation" using robust evaluation frameworks and a wider array of methods.

Originality/value: This review has critically examined individual outcomes of three modalities - education, training and development. It has emphasized organizational strategy and proposed groups of outcomes and realized benefits that can be utilized in episodic and longitudinal manner using modifications to evaluation design.

Purpose: This study aims to explore the role of female frontline community health workers, accredited social health activists (ASHAs), in delivering health care to urban poor living with Type 2 diabetes mellitus (T2DM) in two urban slums in Hyderabad, India. The study describes the additional challenges faced by them during the COVID-19 period and their leadership role in delivering care services to people with diabetes during COVID-19.

Design/methodology/approach: Research methods comprise semi-structured in-depth interviews and focus group discussions with ASHAs, individuals with T2DM, and community leaders from August 2021 to July 2023. The study tools were developed based on framework of the Explanatory Model Interview Catalogue. Data were analysed using thematic analysis.

Findings: The analysis revealed three main themes, describing challenges faced by ASHAs in COVID-19 management- overburdening of ASHAs, unsafe working conditions and social stigma in communities; COVID-19 impact on people with diabetes mellitus; and leadership demonstrated by ASHAs.

Practical implications: The pandemic served as a critical event that foregrounded the role of ASHAs as crucial in mitigating the impacts of the disease, resulting in increasing trust between ASHAs and impacted communities. The results, thus, highlight a potential opportunity to enable and support ASHAs better to improve the reach of primary health-care services in India overall.

Originality/value: Research study is original. This research reveals vital role of ASHAs leadership in the context of health-care delivery and contributing to the battle fighting against pandemic while rendering services in the socially disadvantaged communities during COVID-19 pandemic.

Purpose: The NHS Clinical Entrepreneur Programme (CEP) was established to promote leadership and innovation within the UK health-care system, though its implementation raises important questions about resource allocation and alignment with NHS founding principles. This study aims to systematically review the literature on the CEP and provide a critical reflective analysis of its impact, considering both its potential benefits and tensions with frontline service delivery in an already strained NHS.

Design/methodology/approach: A systematic literature review was conducted using PubMed, Embase and Web of Science databases, covering publications from 2016 to 2024. This study uses a dual methodological approach, combining a systematic literature review with a reflective analysis based on personal experience as a CEP participant. The search strategy included terms related to the NHS CEP, health-care innovation and leadership development. Additionally, a reflective analysis based on personal experience as a CEP participant was incorporated to provide insights into the programme's practical implications.

Findings: The systematic review identified 11 relevant studies. Key themes emerged, including the CEP's role in talent retention, cultural shift towards innovation and the development of leadership skills among health-care professionals. The reflective analysis highlighted the programme's strengths in fostering collaboration and addressing health-care challenges while also identifying areas for improvement in leadership training and integration of social responsibility principles.

Originality/value: The NHS CEP has demonstrated significant potential in nurturing innovation and leadership within the UK health-care system. However, there is a need for more robust evaluation methods and integration of comprehensive leadership models to enhance its effectiveness. Future research should focus on long-term outcomes and the programme's alignment with global digital health strategies.

Purpose: The purpose of this study is to examine if and how an expanded span of control, management performance and work-related stress indicators (control, support and relationships) influence the time until first-line managers leave their position.

Design/methodology/approach: A prospective longitudinal cohort design involving 87 first-line managers in a Swedish health-care region. Cox proportional hazards regression was used to analyse expanded span of control, work-related stress indicators and management performance as predictors of turnover.

Findings: The findings indicate that first-line managers who were categorized as having moderate concern and a need for improvement in the work-related stress indicators control and manager support had a significantly higher risk of turnover. In contrast, expanded span of control and the number of employees managed per first-line manager did not significantly influence turnover risk. In addition, the work-related stress indicator relationships was not significantly associated with risk of turnover.

Originality/value: This study expands the understanding of actual turnover among first-line managers in health care by exploring how organizational factors influence the decision to leave. Unlike previous research, which primarily examines turnover intentions, this study takes a longitudinal perspective, capturing real turnover events over time. The findings contribute to future research on organizational conditions, providing a basis for developing strategies to improve retention and working conditions for first-line managers in health care.