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The influence of political disagreements and corruption on state health leader turnover during the COVID-19 pandemic in Brazil. 巴西 COVID-19 大流行期间政治分歧和腐败对州卫生领导更替的影响。
IF 1.7 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-06-18 DOI: 10.1108/LHS-01-2024-0008
Lorena G Barberia, Gilmar Masiero, Iana Alves de Lima, Luciana Santana, Tatiane C Moraes de Sousa

Purpose: Governments faced formidable challenges in coordinating public health responses to the COVID-19 pandemic. This study aims to enhance the understanding of effective organizational leadership during crises by investigating the factors influencing the turnover of health leaders during the COVID-19 pandemic in Brazil.

Design/methodology/approach: Using primary data encompassing all appointments and dismissals of federal and state health secretaries, this paper conducted a quantitative analysis of the relational and reputational factors that contributed to leader turnover during the COVID-19 pandemic. This paper also examined whether leaders' management and public health experience increase the duration of tenure.

Findings: States encountered significant challenges in retaining experienced and effective leadership during the health emergency, primarily due to political conflicts in policymaking and, to a lesser extent, allegations of corruption. Furthermore, leaders with expertise in public health were found to be less likely to be removed from office. However, managerial experience did not prolong the tenure of state health secretaries during the emergency.

Research limitations/implications: Since most health leaders have public health and management experience, the contributions of each factor to the duration of a secretary's tenure are difficult to separate and analyze separately.

Practical implications: This study provides empirical insights into what factors drive health leader turnover during major health emergencies.

Social implications: During major health emergencies, health leaders often strongly disagree with elected officials on the response. This paper test how crisis leadership theories help explain state health leaders' duration in one of the world's largest public health systems during the COVID-19 pandemic. This paper find that policy disagreements contributed to significant turnover.

Originality/value: To the best of the authors' knowledge, this paper is the first that are aware of that uses novel primary data on public health executive leader characteristics and turnover causes in the context of the COVID-19 pandemic. It provides empirical evidence contributing to the crisis leadership literature by examining health leader turnover in one of the world's largest public health systems.

目的:各国政府在协调应对 COVID-19 大流行病的公共卫生措施时面临着严峻的挑战。本研究旨在通过调查影响巴西 COVID-19 大流行期间卫生领导人更替的因素,加深对危机期间有效组织领导力的理解:本文利用包含联邦和州卫生部长所有任免的原始数据,对 COVID-19 大流行期间导致领导人更替的关系和声誉因素进行了定量分析。本文还研究了领导者的管理和公共卫生经验是否会延长任期:在卫生紧急状态期间,各州在留住经验丰富且有效的领导层方面遇到了巨大挑战,这主要是由于决策过程中的政治冲突,其次是腐败指控。此外,具有公共卫生专业知识的领导人被免职的可能性较小。然而,管理经验并没有延长州卫生部长在紧急状态下的任期:由于大多数卫生领导人都具有公共卫生和管理经验,因此很难将每个因素对卫生部长任期的影响分开分析:本研究提供了关于在重大突发卫生事件中哪些因素会导致卫生领导人更替的经验性见解:社会影响:在重大突发卫生事件中,卫生领导人往往与民选官员在应对措施上存在强烈分歧。本文检验了危机领导理论如何帮助解释世界上最大的公共卫生系统之一在 COVID-19 大流行期间州卫生领导人的任期。本文发现,政策分歧导致了大量人员流失:据作者所知,本文是第一篇在 COVID-19 大流行的背景下,使用有关公共卫生行政领导人特征和离职原因的新颖原始数据的论文。本文通过研究世界上最大的公共卫生系统之一的卫生部门领导者更替情况,为危机领导力文献提供了经验证据。
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引用次数: 0
Do health-care institutions perform better under leaders with medical or non-medical backgrounds? A scoping review. 医疗机构在具有医学背景或非医学背景的领导者领导下业绩更好吗?范围综述。
IF 1.7 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-05-29 DOI: 10.1108/LHS-11-2023-0084
Shazwani Mohmad, Kun Yun Lee, Pangie Bakit

Purpose: This study aims to summarize studies that compared the performance of health-care institutions led by leaders with medical background versus those with no medical background.

Design/methodology/approach: A systematic search was conducted on three databases: PubMed, Ovid Medline and Google Scholar to identify relevant peer-reviewed studies using the keywords "performance," "impact," "physician," "medical," "doctor," "leader," "healthcare institutions" and "hospital." Only quantitative studies that compared the performance of health-care institutions led by leaders with medical background versus non-medical background were included. Articles were screened and assessed for eligibility before the relevant data were extracted to summarize, appraise and make a narrative account of the findings.

Findings: A total of eight studies were included, four were based in the USA, two in the UK and one from Germany and one from the Arab World. Half of the studies (n = 4) reported overall better health-care institutional performance in terms of hospital quality ranking such as clinical effectiveness and patient safety under leaders with medical background, whereas one study showed poorer performance. The remaining studies reported mixed results among the different performance indicators, especially financial performance.

Practical implications: While medical background leaders may have an edge in clinical competence to manage health-care institutions, it will be beneficial to equip them with essential management skills to optimize leadership competence and enhance organizational performance.

Originality/value: The exclusive inclusion of quantitative empirical studies that compared health-care institutional performance medical and non-medical leaders provides a clearer link between the relationship between health-care institutional performance and the leaders' background.

目的:本研究旨在总结比较有医学背景和无医学背景的领导者所领导的医疗机构绩效的研究:在三个数据库中进行了系统搜索:使用关键词 "绩效"、"影响"、"医生"、"医疗"、"医生"、"领导者"、"医疗机构 "和 "医院",在 PubMed、Ovid Medline 和 Google Scholar 上进行了系统搜索,以确定相关的同行评审研究。只有比较医疗机构中由具有医学背景和非医学背景的领导者领导的医疗机构的绩效的定量研究才被纳入。对文章进行筛选和资格评估,然后提取相关数据,对研究结果进行总结、评估和叙述:共纳入八项研究,其中四项来自美国,两项来自英国,一项来自德国,一项来自阿拉伯世界。半数研究(n = 4)报告称,在具有医学背景的领导者的领导下,医疗机构在医院质量排名(如临床效果和患者安全)方面的整体表现较好,而一项研究则显示表现较差。其余研究报告的不同绩效指标结果不一,尤其是财务绩效:实践意义:虽然医学背景的领导者可能在管理医疗机构的临床能力方面具有优势,但让他们掌握基本的管理技能将有利于优化领导能力和提高组织绩效:独有的定量实证研究比较了医疗机构中医学背景和非医学背景领导者的绩效,为医疗机构绩效与领导者背景之间的关系提供了更清晰的联系。
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引用次数: 0
Global research trends in nursing leadership from 1985 to 2022: a bibliometric analysis. 1985-2022年全球护理领导力研究趋势:文献计量分析。
IF 1.7 Q2 Medicine Pub Date : 2024-05-10 DOI: 10.1108/LHS-09-2023-0074
Changchang Chen, Xutong Zheng, Wenjie Chen, Hezi Mu, Man Zhang, Hongjuan Lang, Xuejun Hu

Purpose: Developing nursing leadership has become a key policy priority to achieve universal health coverage. This study aims to explore the current status, developing trends and research frontiers in the field of nursing leadership.

Design/methodology/approach: In total, 1,137 articles and reviews on nursing leadership from 1985 to 2022 were retrieved from the Web of Science Core Collection database. Trends of publications, journals, countries/regions, institutions, documents and keywords were visualized and analyzed using Microsoft Excel and CiteSpace software.

Findings: Nursing leadership research showed an overall increase in number despite slight fluctuations in annual publications. The USA was the leading country in nursing leadership research, and the University of Alberta was the most productive institution. The Journal of Nursing Management was the most widely published journal that focused on nursing leadership, followed by the Journal of Nursing Administration. Keyword analysis showed that the main research hotspots of nursing leadership are improvement, practice and impact of nursing leadership.

Originality/value: This article summarizes the current state and frontiers of nursing leadership for researchers, managers and policy makers, as well as follow-up, development and implementation of nursing leadership. More research is needed that focuses on the improvement, practice and impact of nursing leadership, which are cyclical, complementary and mutually reinforcing. Longitudinal and intervention studies of nursing leadership, especially on patient prognosis, are also particularly needed.

目的:发展护理领导力已成为实现全民医保的一项重要优先政策。本研究旨在探索护理领导力领域的现状、发展趋势和研究前沿:从 Web of Science Core Collection 数据库中检索了 1985 年至 2022 年有关护理领导力的 1,137 篇文章和综述。使用 Microsoft Excel 和 CiteSpace 软件对出版物、期刊、国家/地区、机构、文献和关键词的趋势进行了可视化分析:尽管每年的出版物数量略有波动,但护理领导力研究的数量总体呈上升趋势。美国是护理领导力研究领域的领先国家,阿尔伯塔大学是成果最多的机构。护理管理杂志》是发表护理领导力研究论文最多的杂志,其次是《护理管理杂志》。关键词分析表明,护理领导力的主要研究热点是护理领导力的改进、实践和影响:本文为研究者、管理者和决策者总结了护理领导力的现状和前沿,以及护理领导力的后续、发展和实施。需要更多的研究关注护理领导力的改进、实践和影响,这三者是循环往复、相辅相成、相互促进的。还特别需要对护理领导力进行纵向和干预研究,尤其是对病人预后的研究。
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引用次数: 0
Effect of authentic leadership on nurses' stress, burnout, presenteeism during COVID-19. 真实领导对 COVID-19 期间护士压力、职业倦怠和缺勤的影响。
IF 1.7 Q2 Medicine Pub Date : 2024-05-07 DOI: 10.1108/LHS-10-2023-0082
Preeadashnie Pillay, Caren Brenda Scheepers, Rick Diesel

Purpose: The COVID-19 pandemic has burdened the health-care system and exposed nurses to immense stress. This study therefore aims to investigate nurses' mental well-being who are working with COVID-19-positive patients. Burnout leads to decreased productivity and manifests as emotional exhaustion, depersonalisation (cynicism) and low personal accomplishment (professional efficacy). Authentic leadership is built on a humanistic value system, which is the core value of nurses and other health-care professionals. This study therefore used authentic leadership as the independent variable.

Design/methodology/approach: A cross-sectional quantitative research method was adopted by distributing validated online questionnaires to 1,334 nurses in a private pathology laboratory and 241 questionnaires were analysed with 93.4% female respondents. Multiple linear regression model testing was conducted.

Findings: Multiple regression analyses showed statistically significant negative correlations between authentic leadership and emotional exhaustion, cynicism, job stress and job-stress-related presenteeism, and a positive correlation between authentic leadership and professional efficacy.

Practical implications: This study provides empirical data to encourage organisations to focus on developing authentic leaders to decrease nurses' burnout, job stress and presenteeism. The health-care sector should strive to create an environment where nurses are valued and their talent is recognised to increase employee engagement and commitment.

Originality/value: There were two contributions in this study: first, to determine whether there is a relationship between authentic leadership job stress and job-stress-related presenteeism. Second, to determine whether there is a relationship between authentic leadership and the three sub-constructs of burnout.

目的:COVID-19 大流行给医疗保健系统带来了沉重负担,也使护士面临巨大压力。因此,本研究旨在调查与 COVID-19 阳性患者共事的护士的心理健康状况。职业倦怠会导致工作效率下降,并表现为情绪衰竭、人格解体(愤世嫉俗)和个人成就感低(职业效能)。真实领导力建立在人文价值体系之上,而人文价值体系正是护士和其他医护人员的核心价值。因此,本研究将真实领导力作为自变量:本研究采用横断面定量研究方法,向一家私立病理实验室的 1334 名护士发放了经过验证的在线问卷,并对 241 份问卷进行了分析,其中女性受访者占 93.4%。进行了多元线性回归模型检验:多元回归分析表明,真实领导力与情绪衰竭、愤世嫉俗、工作压力和与工作压力相关的旷工之间存在统计学意义上的显著负相关,而真实领导力与专业效能之间存在正相关:本研究提供了实证数据,鼓励各机构重视培养真实型领导,以减少护士的职业倦怠、工作压力和旷工现象。医疗保健部门应努力创造一个护士受到重视、其才能得到认可的环境,以提高员工的参与度和承诺度:本研究有两个贡献:第一,确定真实领导工作压力与工作压力相关的旷工之间是否存在关系。第二,确定真实领导力与职业倦怠的三个子结构之间是否存在关系。
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引用次数: 0
Excellence in healthcare: nurturing servant leadership, fostering collaborative culture and promoting social sustainability in the UAE - strategies for transformation. 卓越的医疗保健:在阿联酋培养仆人式领导、培育协作文化和促进社会可持续发展--转型战略。
IF 1.7 Q2 Medicine Pub Date : 2024-04-30 DOI: 10.1108/LHS-01-2024-0012
Divya Upadhyay

Purpose: This study aims to investigate the healthcare sector of the United Arab Emirates (UAE) to explore the significance of servant leadership and collaborative culture in fostering social sustainability. The primary objective of this paper is to investigate how servant leadership and a collaborative culture contribute to social sustainability in health care in the UAE. With a focus on promoting well-being within healthcare organizations, the paper aims to uncover the synergies between servant leadership, collaborative culture, and social sustainability.

Design/methodology/approach: This paper conducted a multilayer literature review of existing literature on servant leadership, collaborative culture and social sustainability in health care, both globally and specifically in the UAE context, and a conceptual model was proposed.

Findings: Servant leadership proves to be a culturally pertinent and effective leadership model within the UAE due to its alignment with cultural values, emphasis on community support, and the robust health-care system that contributes to individual well-being. This combination establishes a solid foundation for fostering a healthy and sustainable society.

Research limitations/implications: Limitations and implications are discussed. The current research has not identified the boundary conditions under which servant leadership and collaborative culture may be more or less effective. This could involve exploring industry-specific influences or contextual factors. Theoretical and practical implications are discussed.

Originality/value: The research seeks to unravel the interconnections between servant leadership, collaborative culture and social sustainability. To the best of the author's knowledge, none of the studies have explored the interrelationships of these constructs, particularly in the UAE context.

目的:本研究旨在调查阿拉伯联合酋长国(UAE)的医疗保健行业,探讨仆人式领导和协作文化在促进社会可持续发展方面的意义。本文的主要目的是研究仆人式领导和协作文化如何促进阿联酋医疗保健行业的社会可持续发展。本文以促进医疗保健组织内部的福祉为重点,旨在揭示仆人式领导、协作文化和社会可持续性之间的协同作用:本文对现有文献进行了多层次的文献综述,内容涉及仆人式领导、协作文化和医疗保健领域的社会可持续发展,既包括全球范围内的文献,也包括阿联酋背景下的文献,并提出了一个概念模型:研究结果:在阿联酋,仆人式领导被证明是一种与文化相关且有效的领导模式,因为它符合文化价值观,强调社区支持,以及有助于个人福祉的强大医疗保健系统。这种结合为建立一个健康和可持续发展的社会奠定了坚实的基础:讨论了局限性和影响。目前的研究还没有确定在哪些边界条件下,仆人式领导和协作文化会更有效或更无效。这可能涉及探索特定行业的影响因素或背景因素。讨论了理论和实践意义:本研究试图揭示仆人式领导、协作文化和社会可持续性之间的相互联系。就作者所知,还没有任何一项研究探讨过这些概念之间的相互关系,尤其是在阿联酋的背景下。
{"title":"Excellence in healthcare: nurturing servant leadership, fostering collaborative culture and promoting social sustainability in the UAE - strategies for transformation.","authors":"Divya Upadhyay","doi":"10.1108/LHS-01-2024-0012","DOIUrl":"https://doi.org/10.1108/LHS-01-2024-0012","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to investigate the healthcare sector of the United Arab Emirates (UAE) to explore the significance of servant leadership and collaborative culture in fostering social sustainability. The primary objective of this paper is to investigate how servant leadership and a collaborative culture contribute to social sustainability in health care in the UAE. With a focus on promoting well-being within healthcare organizations, the paper aims to uncover the synergies between servant leadership, collaborative culture, and social sustainability.</p><p><strong>Design/methodology/approach: </strong>This paper conducted a multilayer literature review of existing literature on servant leadership, collaborative culture and social sustainability in health care, both globally and specifically in the UAE context, and a conceptual model was proposed.</p><p><strong>Findings: </strong>Servant leadership proves to be a culturally pertinent and effective leadership model within the UAE due to its alignment with cultural values, emphasis on community support, and the robust health-care system that contributes to individual well-being. This combination establishes a solid foundation for fostering a healthy and sustainable society.</p><p><strong>Research limitations/implications: </strong>Limitations and implications are discussed. The current research has not identified the boundary conditions under which servant leadership and collaborative culture may be more or less effective. This could involve exploring industry-specific influences or contextual factors. Theoretical and practical implications are discussed.</p><p><strong>Originality/value: </strong>The research seeks to unravel the interconnections between servant leadership, collaborative culture and social sustainability. To the best of the author's knowledge, none of the studies have explored the interrelationships of these constructs, particularly in the UAE context.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":"ahead-of-print ahead-of-print","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
What keeps you up at night? Moral distress in nurse leaders in the USA, Germany, Austria and Switzerland. 是什么让你夜不能寐?美国、德国、奥地利和瑞士护士长的道德困扰。
IF 1.7 Q2 Medicine Pub Date : 2024-04-23 DOI: 10.1108/LHS-09-2023-0075
M. Beil-Hildebrand, Firuzan Kundt Sari, P. Kutschar, Lorri Birkholz
PURPOSENurse leaders are challenged by ethical issues in today's complex health-care settings. The purpose of this study was to describe and analyze key elements of moral distress identified by nurse leaders from health-care systems in the USA, Germany, Austria and Switzerland. The aim was to develop an understanding of distressing ethical issues nurse leaders face in the USA and three German-speaking European countries.DESIGN/METHODOLOGY/APPROACHThis descriptive cross-sectional study surveyed a convenience sample of nurse leaders in the USA, Germany, Austria and Switzerland. The voluntary, anonymous survey also included qualitative questions and was distributed using the Qualtrics® platform. A thematic analysis of the qualitative data in each country was carried out and a comparative analysis identified similarities and differences between the groups of nurse leaders comparing the US data to that from three German-speaking European countries.FINDINGSThe survey was completed by 316 nurse leaders: Germany, Austria, and Switzerland (n = 225) and the USA (n = 91). Similar themes identified as causing all nurse leaders moral distress included a lack of individual and organizational integrity, hierarchical and interprofessional issues, lack of nursing professionalism, patient care/patient safety concerns, finances negatively impacting care and issues around social justice. Within these six themes, there were also differences between the USA and the three German-speaking European countries.ORIGINALITY/VALUEUnderstanding the experiences associated with distressing ethical situations can allow nurse leaders and organizations to focus on solutions and develop resilience to reduce moral distress in the USA and three German-speaking European countries.
目的 在当今复杂的医疗环境中,护士长面临着道德问题的挑战。本研究旨在描述和分析来自美国、德国、奥地利和瑞士医疗保健系统的护士领导所发现的道德困扰的关键因素。设计/方法/结果这项描述性横断面研究对美国、德国、奥地利和瑞士的护士长进行了抽样调查。自愿、匿名的调查还包括定性问题,并通过 Qualtrics® 平台发布。对每个国家的定性数据进行了专题分析,并通过比较分析确定了护士长群体之间的异同,将美国的数据与三个德语欧洲国家的数据进行了比较:德国、奥地利和瑞士(n = 225)以及美国(n = 91)的 316 名护士长完成了调查。导致所有护士长精神痛苦的类似主题包括:缺乏个人和组织诚信、等级制度和跨专业问题、缺乏护理专业精神、患者护理/患者安全问题、财务对护理的负面影响以及社会公正问题。在这六个主题中,美国和三个欧洲德语国家之间也存在差异。原创性/价值了解与令人痛苦的道德状况相关的经历可以使护士领导和组织关注解决方案,并发展复原力,以减少美国和三个欧洲德语国家的道德困扰。
{"title":"What keeps you up at night? Moral distress in nurse leaders in the USA, Germany, Austria and Switzerland.","authors":"M. Beil-Hildebrand, Firuzan Kundt Sari, P. Kutschar, Lorri Birkholz","doi":"10.1108/LHS-09-2023-0075","DOIUrl":"https://doi.org/10.1108/LHS-09-2023-0075","url":null,"abstract":"PURPOSE\u0000Nurse leaders are challenged by ethical issues in today's complex health-care settings. The purpose of this study was to describe and analyze key elements of moral distress identified by nurse leaders from health-care systems in the USA, Germany, Austria and Switzerland. The aim was to develop an understanding of distressing ethical issues nurse leaders face in the USA and three German-speaking European countries.\u0000\u0000\u0000DESIGN/METHODOLOGY/APPROACH\u0000This descriptive cross-sectional study surveyed a convenience sample of nurse leaders in the USA, Germany, Austria and Switzerland. The voluntary, anonymous survey also included qualitative questions and was distributed using the Qualtrics® platform. A thematic analysis of the qualitative data in each country was carried out and a comparative analysis identified similarities and differences between the groups of nurse leaders comparing the US data to that from three German-speaking European countries.\u0000\u0000\u0000FINDINGS\u0000The survey was completed by 316 nurse leaders: Germany, Austria, and Switzerland (n = 225) and the USA (n = 91). Similar themes identified as causing all nurse leaders moral distress included a lack of individual and organizational integrity, hierarchical and interprofessional issues, lack of nursing professionalism, patient care/patient safety concerns, finances negatively impacting care and issues around social justice. Within these six themes, there were also differences between the USA and the three German-speaking European countries.\u0000\u0000\u0000ORIGINALITY/VALUE\u0000Understanding the experiences associated with distressing ethical situations can allow nurse leaders and organizations to focus on solutions and develop resilience to reduce moral distress in the USA and three German-speaking European countries.","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":"19 10","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140671261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Untangling the perception of value in value-based healthcare - an interview study. 解读以价值为基础的医疗保健中的价值认知--访谈研究。
IF 1.7 Q2 Medicine Pub Date : 2024-04-16 DOI: 10.1108/LHS-07-2023-0051
Axel Wolf, Annette Erichsen Andersson, Ewa Wikström, Fredrik Bååthe
PURPOSEValue-based health care (VBHC) argues that health-care needs to re-focus to maximise value creation, defining value as the quota when dividing the outcomes important for the patient, by the cost for health care to deliver such outcomes. This study aims to explore the perception of value among different stakeholders involved in the process of implementing VBHC at a Swedish hospital to support leaders to be more efficient and effective when developing health care.DESIGN/METHODOLOGY/APPROACHParticipants comprised 19 clinicians and non-clinicians involved in the implementation of VBHC. Semi-structured interviews were conducted and content analysis was performed.FINDINGSThe clinicians described value as a dynamic concept, dependent on the patient and the clinical setting, stating that improving outcomes was more important than containing costs. The value for non-clinicians appeared more driven by the interplay between the outcome and the cost. Non-clinicians related VBHC to a strategic framework for governance or for monitoring different continuous improvement processes, while clinicians appreciated VBHC, as they perceived its introduction as an opportunity to focus more on outcomes for patients and less on cost containment.ORIGINALITY/VALUEThere is variation in how clinicians and non-clinicians perceive the key concept of value when implementing VBHC. Clinicians focus on increasing treatment efficacy and improving medical outcomes but have a limited focus on cost and what patients consider most valuable. If the concept of value is defined primarily by clinicians' own assumptions, there is a clear risk that the foundational premise of VBHC, to understand what outcomes patients value in their specific situation in relation to the cost to produce such outcome, will fail. Health-care leaders need to ensure that patients and the non-clinicians' perception of value, is integrated with the clinical perception, if VBHC is to deliver on its promise.
目的以价值为基础的医疗保健(VBHC)认为,医疗保健需要重新关注价值创造的最大化,将价值定义为将对患者重要的结果与提供这些结果的医疗保健成本相除的定额。本研究旨在探讨瑞典一家医院实施 VBHC 过程中不同利益相关者对价值的认识,以支持领导者在发展医疗保健时提高效率和效益。结果临床医生认为价值是一个动态的概念,取决于患者和临床环境,并指出提高疗效比控制成本更重要。非临床医生的价值似乎更多地取决于疗效和成本之间的相互作用。非临床医生将 VBHC 与管理或监控不同持续改进流程的战略框架联系起来,而临床医生则对 VBHC 表示赞赏,因为他们认为引入 VBHC 是一个机会,可以更多地关注患者的治疗效果,而较少关注成本控制。临床医生注重提高治疗效果和改善医疗结果,但对成本和患者认为最有价值的东西关注有限。如果价值的概念主要由临床医生自己的假设来定义,那么 VBHC 的基本前提,即了解患者在其特定情况下所看重的结果与产生这种结果的成本之间的关系,显然有可能会失败。医疗保健领导者需要确保患者和非临床医生对价值的认识与临床认识相结合,这样才能实现自愿基础保健的承诺。
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引用次数: 0
Suggesting a holistic framework for understanding healthcare services leadership competence - a critical interpretive synthesis. 提出理解医疗服务领导能力的整体框架--批判性解释综合。
IF 1.7 Q2 Medicine Pub Date : 2024-04-15 DOI: 10.1108/LHS-08-2023-0059
Ingrid Marie Leikvoll Oskarsson, Erlend Vik
PURPOSEHealthcare providers are under pressure due to increasing and more complex demands for services. Increased pressure on budgets and human resources adds to an ever-growing problem set. Competent leaders are in demand to ensure effective and well-performing healthcare organisations that deliver balanced results and high-quality services. Researchers have made significant efforts to identify and define determining competencies for healthcare leadership. Broad terms such as competence are, however, inherently at risk of becoming too generic to add analytical value. The purpose of this study is to suggest a holistic framework for understanding healthcare leadership competence, that can be crucial for operationalising important healthcare leadership competencies for researchers, decision-makers as well as practitioners.DESIGN/METHODOLOGY/APPROACHIn the present study, a critical interpretive synthesis (CIS) was conducted to analyse competency descriptions for healthcare leaders. The descriptions were retrieved from peer reviewed empirical studies published between 2010 and 2022 that aimed to identify healthcare services leadership competencies. Grounded theory was utilised to code the data and inductively develop new categories of healthcare leadership competencies. The categorisation was then analysed to suggest a holistic framework for healthcare leadership competence.FINDINGSForty-one papers were included in the review. Coding and analysing the competence descriptions resulted in 12 healthcare leadership competence categories: (1) character, (2) interpersonal relations, (3) leadership, (4) professionalism, (5) soft HRM, (6) management, (7) organisational knowledge, (8) technology, (9) knowledge of the healthcare environment, (10) change and innovation, (11) knowledge transformation and (12) boundary spanning. Based on this result, a holistic framework for understanding and analysing healthcare services leadership competencies was suggested. This framework suggests that the 12 categories of healthcare leadership competencies include a range of knowledge, skills and abilities that can be understood across the dimension personal - and technical, and organisational internal and - external competencies.RESEARCH LIMITATIONS/IMPLICATIONSThis literature review was conducted with the results of searching only two electronic databases. Because of this, there is a chance that there exist empirical studies that could have added to the development of the competence categories or could have contradicted some of the descriptions used in this analysis that were assessed as quite harmonised. A CIS also opens for a broader search, including the grey literature, books, policy documents and so on, but this study was limited to peer-reviewed empirical studies. This limitation could also have affected the result, as complex phenomenon such as competence might have been disclosed in greater details in, for example, books.PRACTICAL IMPLICATIONSThe ho
目的由于对服务的需求越来越多、越来越复杂,医疗服务提供者面临着压力。预算和人力资源压力的增加使问题越来越多。为了确保医疗保健机构能够提供有效和良好的表现,实现平衡的结果和高质量的服务,需要有能力的领导者。研究人员在确定和定义医疗保健领导的决定性能力方面做出了巨大努力。然而,能力等宽泛的术语本身就有可能变得过于笼统,无法增加分析价值。本研究的目的是提出一个理解医疗保健领导能力的整体框架,该框架对于研究人员、决策者和从业人员操作重要的医疗保健领导能力至关重要。设计/方法/途径在本研究中,我们采用了批判性解释综合法(CIS)来分析医疗保健领导的能力描述。这些描述是从 2010 年至 2022 年间发表的旨在确定医疗保健服务领导能力的同行评审实证研究中获取的。利用基础理论对数据进行编码,并归纳出医疗保健领导能力的新类别。然后对分类进行分析,提出了医疗服务领导能力的整体框架。通过对能力描述进行编码和分析,得出了 12 个医疗保健领导能力类别:(1)性格;(2)人际关系;(3)领导力;(4)专业精神;(5)软性人力资源管理;(6)管理;(7)组织知识;(8)技术;(9)医疗保健环境知识;(10)变革与创新;(11)知识转化;(12)边界跨越。根据这一结果,提出了一个理解和分析医疗服务领导能力的整体框架。该框架认为,医疗服务领导能力的 12 个类别包括一系列知识、技能和能力,这些知识、技能和能力可以从个人能力、技术能力、组织内部能力和外部能力等维度进行理解。因此,有可能存在一些实证研究,这些研究可能对能力类别的发展起到补充作用,也可能与本分析中使用的某些描述相矛盾,而这些描述被评估为相当协调。综合信息系统还可以进行更广泛的搜索,包括灰色文献、书籍、政策文件等,但本研究仅限于经同行评审的实证研究。这一局限性也可能会影响研究结果,因为复杂的现象(如胜任能力)可能会在书籍等资料中得到更详细的披露。实践启示医疗保健领导能力的整体框架为胜任能力这样一个 "模糊 "概念提供了一种共识,可用于确定医疗保健组织的具体能力需求,制定战略能力计划和医疗保健领导者教育计划。本研究的原创性/价值本研究揭示了在能力概念的使用和理解方面缺乏共识,而且所收录论文中涉及的关键能力在知识、技能和能力方面的描述大相径庭。这对医疗服务领导能力的可操作性提出了挑战。拟议的医疗服务领导能力框架提供了对工作相关能力的共同理解,并为基于整体框架分析关键领导能力提供了可能性。
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引用次数: 0
Assessing the mediating role of organizational justice between the responsible leadership and employee turnover intention in health-care sector. 评估组织公正在医疗保健行业责任型领导与员工离职意向之间的中介作用。
IF 1.7 Q2 Medicine Pub Date : 2024-03-26 DOI: 10.1108/LHS-06-2023-0046
Zeba Khanam, Zebran Khan, Mohd Arwab, Ariba Khan

Purpose: The aim of this study is to investigate the extent to which organizational justice (OJ) mediates between responsible leadership (RL) and employee turnover intention (TI).

Design/methodology/approach: Both online and offline questionnaire was used to collect the data from 387 Indian health-care employees, and the data were analyzed using partial least squares structural equation modeling (PLS-SEM) with the help of SmartPLS 4.

Findings: The study's findings demonstrated a significant positive association between RL and OJ and a negative association between OJ and employee TI. Furthermore, results also confirmed the mediating role of OJ between RI and TI.

Research limitations/implications: The generalizability of the study's data collection is limited because it is based on the responses of Indian health-care sector employees to an online and offline survey. The authors propose that the health-care sector uses RL as an approach that takes a broad view of the parties with a stake and focuses on creating fairness in acts and justice at the workplace to address the major issue of employee turnover.

Originality/value: This study expanded on previous research by demonstrating that the influence of responsible leadership on employee TI is mediated by OJ in the context of India's health-care sector. It also contributes to the literature regarding RI, OJ and TI. The study also enriched the body of knowledge about using the PLS-SEM approach to predict employee TI.

目的:本研究旨在探讨组织公正(OJ)在多大程度上对责任型领导(RL)和员工离职意向(TI)起到中介作用:在 SmartPLS 4 的帮助下,采用偏最小二乘法结构方程模型(PLS-SEM)对数据进行分析:研究结果表明,RL 与 OJ 之间存在显著的正相关,而 OJ 与员工 TI 之间存在负相关。此外,研究结果还证实了 OJ 在 RI 和 TI 之间的中介作用:研究的局限性/启示:由于本研究的数据收集是基于印度医疗保健部门员工对在线和离线调查的回答,因此其普遍性受到了限制。作者建议,医疗保健部门使用 RL 作为一种方法,从广泛的视角看待利益相关方,并侧重于在行为中创造公平,在工作场所创造公正,以解决员工流失这一主要问题:本研究以印度医疗保健行业为背景,证明了责任型领导对员工 TI 的影响是以 OJ 为中介的,从而拓展了以往的研究。它还为有关责任领导、OJ 和 TI 的文献做出了贡献。这项研究还丰富了使用 PLS-SEM 方法预测员工 TI 的知识体系。
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引用次数: 0
Assessment of management styles among top nursing leaders in Slovenian primary health centers: a cross-sectional analysis. 斯洛文尼亚初级保健中心高层护理领导的管理风格评估:横断面分析。
IF 1.7 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-02-27 DOI: 10.1108/LHS-10-2023-0083
Melita Peršolja, Boštjan Žvanut, Špela Rot, Mirko Markič

Purpose: This study aims to endeavor to discern the predominant leadership styles used by nursing managers within the framework of Slovenian primary health centers. Using a quantitative research approach, the study was conducted through the administration of a structured questionnaire.

Design/methodology/approach: The investigation encompassed 67 nursing managers, representing the entire spectrum of primary health centers in Slovenia. A stratified representative subset comprising 53 top nursing managers actively participated in this study.

Findings: The prevailing leadership style among nursing managers predominantly manifests as the "integrated" style, characterized by a balanced emphasis on both interpersonal relationships and task-oriented elements. These nursing leaders exhibited a proclivity for fostering collaborative teamwork, with their leadership approach notably shaped by traits such as positive thinking, self-assuredness, comprehensive leadership knowledge and an intrinsic motivation to guide and inspire individuals. Notably, leadership knowledge emerged as the most influential factor in determining the selected leadership style. The study's findings recognize specific areas in which leadership competencies among nurse managers may require further enhancement and development.

Originality/value: The study's findings are based on a specific subset of nursing leaders in a particular region, which can add to the originality, especially as there is limited prior research in this specific context. The study's exploration of leadership styles is original in the sense that it provides insights into the leadership behaviors and traits of nursing managers in the given context. The emphasis on factors such as positive thinking and leadership knowledge as influential elements adds originality to the study.

目的:本研究旨在努力发现斯洛文尼亚初级保健中心框架内护理管理者所采用的主要领导风格。研究采用定量研究方法,通过发放结构化问卷进行:调查对象包括 67 名护理经理,他们代表了斯洛文尼亚初级保健中心的所有人员。由 53 名高层护理经理组成的分层代表子集积极参与了此次研究:护理管理者的主流领导风格主要表现为 "综合 "风格,其特点是平衡强调人际关系和任务导向两个要素。这些护理领导者表现出促进团队协作的倾向,他们的领导方法主要由积极思维、自我肯定、全面的领导知识以及引导和激励个人的内在动机等特质形成。值得注意的是,领导知识是决定所选领导风格的最有影响力的因素。研究结果确认了护士管理人员的领导能力可能需要进一步提高和发展的具体领域:本研究的发现基于特定地区的特定护理领导者群体,这可以增加研究的原创性,尤其是在这一特定背景下的先前研究十分有限。本研究对领导风格的探索具有独创性,因为它提供了对特定背景下护理管理者领导行为和特质的见解。本研究强调积极思维和领导知识等因素的影响,这为研究增添了新意。
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引用次数: 0
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Leadership in Health Services
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