Leadership in Health Services

Bond, Carmel; Stacey, Gemma; Westwood, Greta; Long, Louisa

2024 Leadership in Health Services

doi: 10.1108/lhs-09-2022-0092pmid: 37382291

The purpose of this paper is to evaluate the impact of leadership development programmes, underpinned by Transformational Learning Theory (TLT).Design/methodology/approachA corpus-informed analysis was conducted using survey data from 690 participants. Data were collected from participants’ responses to the question “please tell us about the impact of your overall experience”, which culminated in a combined corpus of 75,053 words.FindingsFindings identified patterns of language clustered around the following frequently used word types, namely, confidence; influence; self-awareness; insight; and impact.Research limitations/implicationsThis in-depth qualitative evaluation of participants’ feedback has provided insight into how TLT can be applied to develop future health-care leaders. The extent to which learning has had a transformational impact at the individual level, in relation to their perceived ability to influence, holds promise for the wider impact of this group in relation to policy, practice and the promotion of clinical excellence in the future. However, the latter can only be ascertained by undertaking further realist evaluation and longitudinal study to understand the mechanisms by which transformational learning occurs and is successfully translated to influence in practice.Originality/valuePrevious research has expounded traditional leadership theories to guide the practice of health-care leadership development. The paper goes some way to demonstrate the impact of using the principles of TLT within health-care leadership development programmes. The approach taken by The Florence Nightingale Foundation has the potential to generate confident leaders who may be instrumental in creating positive changes across various clinical environments.

Maulina, Fury; Hasanbasri, Mubasysyir; Busari, Jamiu O.; Scheele, Fedde

2024 Leadership in Health Services

doi: 10.1108/lhs-02-2023-0011pmid: 37527213

This study aims to examine how an educational intervention, using the lens of the LEADS framework, can influence the development of primary care doctors’ leadership skills in Aceh, Indonesia. In order to persevere in the face of inadequate resources and infrastructure, particularly in rural and remote settings of low- and middle‐income countries, physicians require strong leadership skills. However, there is a lack of information on leadership development in these settings.Design/methodology/approachThis study applied an educational intervention consisting of a two-day workshop. The authors evaluated the impact of the workshop on participants’ knowledge and skill by combining quantitative pre- and post-intervention questionnaires (based on Levels 1 and 2 of Kirkpatrick’s model) with qualitative post-intervention in-depth interviews, using a phenomenological approach and thematic analysis.FindingsThe workshop yielded positive results, as evidenced by participants’ increased confidence to apply and use the information and skills acquired during the workshop. Critical success factors were as follows: participants were curiosity-driven; the use of multiple learning methodologies that attracted participants; and the use of authentic scenarios as a critical feature of the program.Originality/valueThe intervention may offer a preliminary model for improving physician leadership skills in rural and remote settings by incorporating multiple teaching approaches and considering local cultural norms.

Vuorivirta-Vuoti, Eeva; Kuha, Suvi; Kanste, Outi

2024 Leadership in Health Services

doi: 10.1108/lhs-05-2023-0032pmid: 37750849

Coronavirus disease (COVID-19) has challenged leadership in hospitals worldwide. The experiences of leadership during the pandemic changed leadership significantly. This study aims to describe nurse leaders’ perceptions of what future leadership in hospital settings in the post-pandemic era needs to be like.Design/methodology/approachA qualitative descriptive study was used. A total of 20 nurse leaders from the Finnish central hospital were interviewed from June to October 2021. The data were analysed using inductive content analysis.FindingsThe analysis revealed five main categories describing nurse leaders’ perceptions of future leadership in hospital settings in the post-pandemic era: digitalisation and hybrid working culture, development of sustainable working conditions, moving smoothly to the post-pandemic era, dissolution of traditional regimes of organisation and flexibility in leadership.Practical implicationsIn the post-pandemic era, the constantly changing demands and challenges currently facing healthcare systems have significantly increased the complexity of hospital organisations. This requires critical evaluation and change to traditional leadership. Enhancing flexibility and authenticity in leadership, strengthening competencies, implementing a wide range of digital resources and increasing the appeal of the nursing profession to build the next generation of nurses – all of these are needed to provide sustainability in future healthcare.Originality/valueThe results identify the critical points of leadership that need to be developed for future challenges and for maintaining a sufficient supply of qualified professionals. Acting on this information will enhance flexibility in organisations and lead to acceleration of changes and the development of new kinds of leadership in the future

Östergård, Kevin; Kuha, Suvi; Kanste, Outi

2024 Leadership in Health Services

doi: 10.1108/lhs-06-2023-0043pmid: 37823549

The purpose of this study is to identify and synthesise the best evidence on health-care leaders’ and professionals’ experiences and perceptions of compassionate leadership.Design/methodology/approachA mixed-methods systematic review was conducted in accordance with the Joanna Briggs Institute methodology for mixed-methods systematic reviews using a convergent integrated approach. A systematic search was done in January 2023 in PubMed, CINAHL, Scopus, Medic and MedNar databases. The results were reported based on Preferred Reporting Items for Systematic Reviews and Meta-analyses. The data was analysed using thematic analysis.FindingsTen studies were included in the review (five qualitative and five quantitative). The thematic analysis identified seven analytical themes as follows: treating professionals as individuals with an empathetic and understanding approach; building a culture for open and safe communication; being there for professionals; giving all-encompassing support; showing the way as a leader and as a strong professional; building circumstances for efficient work and better well-being; and growing into a compassionate leader.Practical implicationsCompassionate leadership can possibly address human resource-related challenges, such as health-care professionals’ burnout, turnover and the lack of patient safety. It should be taken into consideration by health-care leaders, their education and health-care organisations when developing their effectiveness.Originality/valueThis review synthesised the knowledge of compassionate leadership in health care and its benefits by providing seven core elements of health-care leaders’ and professionals’ experiences and perceptions of compassionate leadership.

Skytt, Bernice; Högberg, Hans; Engström, Maria

2024 Leadership in Health Services

doi: 10.1108/lhs-01-2023-0004pmid: 37962108

The Purpose of the study was to investigate the construct validity and internal consistency of the LaMI among staff in the context of elderly care in Sweden.Design/methodology/approachQuestionnaire data from a longitudinal study of staff working in elderly care were used. Data were collected using the Leadership and Management Inventory. First data collection was for explorative factor analysis (n = 1,149), and the second collection, one year later, was for confirmatory factor analysis (n = 1,061).FindingsThe explorative factor analysis resulted in a two-factor solution that explained 70.2% of the total variance. Different models were tested in the confirmatory factor analysis. The final model, a two-factor solution where three items were omitted, showed acceptable results.Originality/valueThe instrument measures both leadership and management performance and can be used to continually measure managers’ performances as perceived by staff to identify areas for development.

James, Inger; Kihlgren, Annica; Norell Pejner, Margaretha; Tavemark, Sofia

2024 Leadership in Health Services

doi: 10.1108/lhs-05-2023-0035pmid: 38262006

The purpose of this paper is to describe how first-line managers (FLMs) in home care (HC) reason about the opportunities and obstacles to lead the work according to the individual’s needs and goals.Design/methodology/approachIn this participatory appreciative action reflection project, eight managers within one Swedish municipality were interviewed. The data were analysed using a thematic analysis.FindingsThe results showed a polarization between two different systems that FLMs struggle to balance when attempting to lead HC that adapts to the needs and goals of individuals. One system was represented by the possibilities of a humane system, with human capital in the form of the individual, older persons and the co-workers in HC. The second system was represented by obstacles in the form of the economic needs of the organization in which the individual receiving HC often felt forgotten. In this system, the organization’s needs and goals governed, with FLMs needing to adapt to the cost-effectiveness principle and keep a balanced budget. The managers had to balance an ethical conflict of values between the human value and needs-solidarity principles, with that of the cost-effectiveness principle.Originality/valueThe FLMs lack the opportunity to lead HC according to the needs and goals of the individuals receiving HC. There is a need for consensus and a value-based leadership model based on ethical principles such as the principles of human value and needs-solidarity to lead the HC according to the individual’s needs and goals.

Oskarsson, Ingrid Marie Leikvoll; Vik, Erlend

2024 Leadership in Health Services

doi: 10.1108/lhs-08-2023-0059pmid: 38619933

Healthcare 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 holistic framework for healthcare leadership competences offers a common understanding of a “fuzzy” concept such as competence and can be used to identify specific competency needs in healthcare organisations, to develop strategic competency plans and educational programmes for healthcare leaders.Originality/valueThis study reveals a lack of consensus regarding the use and understanding of the concept of competence, and that key competencies addressed in the included papers are described vastly different in terms of what knowledge, skills and abilities they entail. This challenges the operationalisation of healthcare services leadership competencies. The proposed framework for healthcare services leadership competencies offers a common understanding of work-related competencies and a possibility to analyse key leadership competencies based on a holistic framework.

Wolf, Axel; Erichsen, Annette; Wikström, Ewa; Bååthe, Fredrik

2024 Leadership in Health Services

doi: 10.1108/lhs-07-2023-0051pmid: 38635293

Value-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.

Mohmad, Shazwani; Lee, Kun Yun; Bakit, Pangie

2024 Leadership in Health Services

doi: 10.1108/lhs-11-2023-0084pmid: 38809264

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/approachA 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.FindingsA 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 implicationsWhile 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/valueThe 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.

Peršolja, Melita; Žvanut, Boštjan; Rot, Špela; Markič, Mirko

2024 Leadership in Health Services

doi: 10.1108/lhs-10-2023-0083pmid: 38390728

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/approachThe 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.FindingsThe 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/valueThe 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.