Transformations in Canadian health systems leadership: an analytical perspective

Identifying leadership practices to support the uptake of reusable elastomeric half mask respirators in health delivery settings

An increase in reusable Elastomeric Half Mask Respirators (EHMRs) among healthcare personnel has been documented during pandemic emergencies; however, research has not detailed leadership practices to support their use. Forty-three organizations implemented EHMRs received from the United States federal government which prompted interviews with 73 individuals who managed respirator distribution and fit testing between October 2021 and November 2022. Interview data was qualitatively analyzed. Themes around organizational culture and leadership practices emerged when discussing how elastomeric half mask respirators were integrated into health delivery settings including communication and outreach methods to aid worker support. Example included on-line and hands-on training, peer support, leadership support, and a culture that supports respirator use. To support a shift to reusable respiratory protection being procured and implemented, organizational- and individual-level perspectives are needed. Employee engagement, respirator champions, and updated verbal and written communication mechanisms are important takeaways for leaders to consider during any routine or emergency scenario.

What can clinical leaders contribute to the governance of integrated care systems?

BACKGROUND

Integrated care systems present enduring governance challenges associated with fostering interorganisational collaboration.

AIM

To understand how clinical leaders can make a distinct contribution to the governance and system leadership of integrated care systems.

METHODS

A qualitative interview study carried out between 2018 and 2019 with 24 clinical leaders, and a further 47 non-clinical leaders, involved in the governance of three Sustainability and Transformation Partnership in the English National Health Service.

RESULTS

Clinical leaders were found to make four distinct contributions: (1) making analytical insights into integration strategies that ensured their relevance and quality to clinical communities; (2) representing the views of clinicians in system decision-making thereby enhancing the legitimacy of change; (3) translation and communication activities to articulate integration strategies in favourable ways and ensure clinical engagement; and (4) relational work in the form of brokering and building connections and mediating conflict between multiple stakeholders. These activities varied across the levels of system governance and at different stages in the processes of change.

CONCLUSIONS

Clinical leaders can make a distinct contribution to the governance and leadership of integrated care systems based on their clinical expertise, membership professional networks, reputation and formal authority.

Leadership in the Context of Digital Health Services: A Concept Analysis

AIM

To define and clarify the concept of leadership in the context of digital health services using Walker's and Avant's concept analysis model.

BACKGROUND

Conceptualizing leadership in the context of digital health services is needed to deliver higher quality services and advance research.

METHOD

Searches were conducted of MEDLINE (Ovid), Scopus, CINAHL (EBSCO), and ProQuest (ABI/INFORM). Empirical articles were included if they reported attributes, antecedents, or consequences of leadership in the study context. A total of 4,037 references were identified; 23 were included.

RESULTS

Leadership attributes concerned leaders' behavior, roles, and qualities. Antecedents concerned informatics skills and competence, information and tools, understanding care systems and their complexity, and education. Consequences related to organization, professionals, and patient and care.

CONCLUSION

Based on our results, the term 'e-leadership' should be more widely utilized in nursing practice and research.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse leaders need to be strong leaders; they need to be visionary and use strategic thinking to develop existing and new digital solutions. By becoming e-leaders, nurse leaders may increase the successful development and implementation of eHealth, and benefit clinicians and patients.

Remote leadership in health care: a scoping review

Purpose

The degree of remote working has increased in the health-care sector, but remote leadership in health-care contexts has not been systematically studied. Thus, the purpose of this review was to map existing literature and research themes of remote leadership in health care and identify potential research gaps to guide future studies.

Design/methodology/approach

A scoping review with narrative synthesis was conducted, covering all published literature addressing remote, virtual, online or distance leadership practices. The ABI/INFORM Collection, CINALH, PsycArticles, Scopus and Web of Science, MedNar, Open Grey and PQDT Open databases were searched electronically, and Finnish Journal of eHealth and eWelfare was searched manually.

Findings

In total 15 articles were included in the review. Most literature concerning remote leadership in health care has been published during the past three decades. The main themes discerned in this research stream are related to interactions, work environments, leadership in practice, use of technology and needs for more study of remote leadership and guidance for remote leaders.

Research limitations/implications

Research on remote leadership in health care is limited, patchy and associated concepts vary substantially. More comprehensive research on the phenomenon is needed, with more systematic attention to, and coverage of, relevant populations, concepts, contexts and the identified themes.

Originality/value

To the best of the authors’ knowledge, this appears to be the first review to map research on remote leadership in health care and identify research gaps, which is important as its prevalence has rapidly increased.

Linking authentic leadership and management capability to public hospital performance: the role of work engagement

Purpose

This paper aims to propose a model of the effect of both authentic leadership and management capability on hospital performance. This model proposes work engagement as an intervening mechanism between the aforesaid links.

Design/methodology/approach

Data were collected from 380 medical staff working in Jordanian Public hospitals and were analysed using the structural equation modelling analysis technique.

Findings

The results suggest that both authentic leadership and management capability have a positive effect on hospital performance. Although positive, the direct effect of management capability on performance was not significant. Furthermore, work engagement demonstrated to play a full mediation effect between management capability and hospital performance and a partial mediation effect between authentic leadership and hospital performance.

Practical implications

This study may be of use for public medical services providers in general and other services sectors in terms of the role authentic leadership and management resources can play in contributing to positive work-related outcomes at the individual and organisational levels.

Originality/value

Considering the mainstream literature in health-care management, to the best of the authors’ knowledge, this is the first study to date to integrate the impact of both authentic leadership and management capabilities in the public health-care sector. Further, the research model has not previously been introduced when taking into account the role that work engagement can play between the examined variables.

Leadership in Digital Health Services: Protocol for a Concept Analysis

Background

Due to the rapid digitalization of health care, leadership is becoming more complex. Leadership in digital health services is a term that has been used in the literature with various meanings. Conceptualization of leadership in digital health services is needed to deliver higher quality digital health services, update existing leadership practices, and advance research.

Objective

The aim of this study is to outline a concept analysis that aims to clarify and define the concept of leadership in digital health services.

Methods

The concept analysis will be performed using the Walker and Avant model, which involves eight steps: concept selection, determination of aims, identification of uses, determination of defining attributes, construction of a model case, construction of additional cases, identification of antecedents and consequences, and definition of empirical referents. A scoping literature search will be performed following the search protocol for scoping reviews by the Joanna Briggs Institute to identify all relevant literature on leadership in digital health services. Searches will be conducted in 6 scientific databases (CINAHL, MEDLINE, Scopus, ProQuest, Web of Science, and the Finnish database Medic), and unpublished studies and gray literature will be searched using Google Scholar, EBSCO Open Dissertations, and MedNar.

Results

An initial limited search of MEDLINE was undertaken on October 19, 2020, resulting in 883 records. The results of the concept analysis will be submitted for publication by July 2021.

Conclusions

A robust conceptualization of leadership in digital health services is needed to support research, leadership, and education. The concept analysis model of Walker and Avant will be used to meet this need. As leadership in digital health services appears to be an interprofessional and intersectoral collaboration, defining this concept may also facilitate collaboration between professionals and sectors. The concept analysis to be conducted will also expand our understanding of leadership in digital health services.

International Registered Report Identifier (IRRID)

PRR1-10.2196/25495

FORMAÇÃO EM GESTÃO PARA APOIO À REFORMA DA ATENÇÃO PRIMÁRIA À SAÚDE EM PORTUGAL E PAÍSES AFRICANOS LUSÓFONOS

Resumo Apresentamos lições que resultaram de atividades de capacitação dos gestores conduzidas em Portugal no contexto da reforma da atenção primária em saúde e nos países africanos de língua oficial portuguesa, em termos do planejamento e da gestão dos serviços hospitalares e de saúde pública. Descrevemos três programas de formação-ação realizados pela Unidade de Saúde Pública Internacional do Instituto de Higiene e Medicina Tropical de Lisboa, com o apoio de parceiros portugueses e internacionais como a Organização Mundial da Saúde e o Instituto de Medicina Social da Universidade do Estado do Rio de Janeiro. Os programas foram desenvolvidos na base da identificação das necessidades de competências dos participantes e focaram a resolução de problemas concretos com o objetivo de ajudar os gestores a enfrentar as dificuldades inerentes aos processos de reforma. Apesar do seu valor intrínseco, por si só não se mostram suficientes, uma vez que são sempre necessários outros mecanismos, como o acompanhamento continuado dos gestores, sistemas de incentivos coerentes com os objetivos das reformas, ferramentas e recursos (financiamento, sistemas de informação, pessoal qualificado suficiente) adequados para implementar as mudanças. Além disso, a sustentabilidade das intervenções de fortalecimento das capacidades carece de apoio continuado dos decisores políticos.

The state-of-play in physician health systems leadership research

Purpose

This paper aims to review a decade of evidence on physician participation in health system leadership with the view to better understand the current state of scholarship on physician leadership activity in health systems. This includes examining the available evidence on both physicians’ experiences of health systems leadership (HSL) and the impact of physician leadership on health system reform.

Design/methodology/approach

A state-of-the-art review of studies (between 2007 and 2017); 51 papers were identified, analyzed thematically and synthesized narratively.

Findings

Six main themes were identified in the literature as follows: (De)motivation for leadership, leadership readiness and career development, work demands and rewards, identity matters: acceptance of self (and other) as leader, leadership processes and relationships across health systems and leadership in relation to health system outcomes. There were seemingly contradictory findings across some studies, pointing to the influence of regional and cultural contextual variation on leadership practices as well entrenched paradoxical tensions in health system organizations.

Research limitations/implications

Future research should examine the influence of varying structural and psychological empowerment on physician leadership practices. Empirical attention to paradoxical tensions (e.g. between empowerment and control) in HSL is needed, with specific attention to questions on how such tensions influence leaders’ decision-making about system reform.

Originality/value

This review provides a broad synthesis of diverse papers about physician participation in health system leadership. Thus, it offers a comprehensive empirical synthesis of contemporary concerns and identifies important avenues for future research.

Lean leadership attributes: a systematic review of the literature

Purpose

Emphasis on quality and reducing costs has led many health-care organizations to reconfigure their management, process, and quality control infrastructures. Many are lean, a management philosophy with roots in manufacturing industries that emphasizes elimination of waste. Successful lean implementation requires systemic change and strong leadership. Despite the importance of leadership to successful lean implementation, few researchers have probed the question of ideal leadership attributes to achieve lean thinking in health care. The purpose of this paper is to provide insight into applicable attributes for lean leaders in health care.

Design/methodology/approach

The authors systematically reviewed the literature on principles of leadership and, using Dombrowski and Mielke’s (2013) conceptual model of lean leadership, developed a parallel theoretical model for lean leadership in health care.

Findings

This work contributes to the development of a new framework for describing leadership attributes within lean management of health care.

Originality/value

The summary of attributes can provide a model for health-care leaders to apply lean in their organizations.

Physician leadership in e-health? A systematic literature review

Purpose This paper aims to systematically review the literature on roles of physicians in virtual teams (VTs) delivering healthcare for effective "physician e-leadership" (PeL) and implementation of e-health. Design/methodology/approach The analyzed studies were retrieved with explicit keywords and criteria, including snowball sampling. They were synthesized with existing theoretical models on VT research, healthcare team competencies and medical leadership. Findings Six domains for further PeL inquiry are delineated: resources, task processes, socio-emotional processes, leadership in VTs, virtual physician-patient relationship and change management. We show that, to date, PeL studies on socio-technical dynamics and their consequences on e-health are found underrepresented in the health literature; i.e. no single empirical, theoretic or conceptual study with a focus on PeL in virtual healthcare work was identified. Research limitations/implications E-health practices could benefit from organization-behavioral type of research for discerning effective physicians' roles and inter-professional relations and their (so far) seemingly modest but potent impact on e-health developments. Practical implications Although best practices in e-health care have already been identified, this paper shows that physicians' roles in e-health initiatives have not yet received any in-depth study. This raises questions such as are physicians not yet sufficiently involved in e-health? If so, what (dis)advantages may this have for current e-health investments and how can they best become involved in (leading) e-health applications' design and implementation in the field? Originality/value If effective medical leadership is being deployed, e-health effectiveness may be enhanced; this new proposition needs urgent empirical scrutiny.

Authentic leadership in healthcare: a scoping review

Purpose

The purpose of this paper is to review peer-reviewed original research articles on authentic leadership (AL) in health care to identify potential research gaps and present recommendations for future research. The objectives are to examine and map evidence of the main characteristics, research themes and methodologies in the studies. AL is a leader’s non-authoritarian, ethical and transparent behaviour pattern.

Design/methodology/approach

A scoping review with thematic analysis was conducted. A three-step search strategy was used with database and manual searches. The included studies were composed of English language peer-reviewed original research articles referring to both AL and health care.

Findings

In total, 29 studies were included. The studies favoured Canadian nurses in acute care hospitals. AL was understood as its original definition. The review identified four research themes: well-being at work, patient care quality, work environment and AL promotion. Quantitative research methodology with the authentic leadership questionnaire and cross-sectional design were prevalent.

Research limitations/implications

Future research needs more variation in research themes, study populations, settings, organisations, work sectors, geographical origins and theory perspectives. Different research methodologies, such as qualitative and mixed methods research and longitudinal designs, should be used more.

Originality/value

This is presumably the first literature review to map the research on AL in health care.

A literature review for large-scale health information system project planning, implementation and evaluation

Information technology is perceived as a potential panacea for healthcare organisations to manage pressure to improve services in the face of increased demand. However, the implementation and evaluation of health information systems (HIS) is plagued with problems and implementation shortcomings and failures are rife. HIS implementation is complex and relies on organisational, structural, technological, and human factors to be successful. It also requires reflective, nuanced, multidimensional evaluation to provide ongoing feedback to ensure success. This article provides a comprehensive review of the literature about evaluating and implementing HIS, detailing the challenges and recommendations for both evaluators and healthcare organisations. The factors that inhibit or promote successful HIS implementation are identified and effective evaluation strategies are described with the goal of informing teams evaluating complex HIS.

Developmental health services leadership: Integrating hierarchical and shared leadership for health services organizational learning

The purpose of this article is to articulate a model of, as well as a call to action for, health services leadership, with a particular emphasis on the role of health services leadership in organizational learning. More specifically, I articulate a model that poses two antecedents of health services hierarchical leadership—leader responsibility disposition and environmental cues—as important predictors of empowering leadership. In turn, I assert that empowering leadership from above will engender an inclination toward shared leadership among followers. Subsequently, I venture that both empowering hierarchical leadership and shared leadership are precursors of health services organizational learning. I specify several research directions for future scholarship. More importantly, I identify multiple measures that policy makers and practitioners can take to enhance health services leadership and organizational learning.

The medical leadership challenge in healthcare is an identity challenge

Purpose

– The purpose of this article is to describe and analyse the identity challenges that physicians with medical leadership positions face.

Design/methodology/approach

– Four qualitative case studies were performed to address the fact that identity is processual, relational and situational. Physicians with managerial roles were interviewed, as well as their peers, supervisors and subordinates. Furthermore, observations were made to understand how different identities are displayed in action.

Findings

– This study illustrates that medical leadership implies identity struggles when physicians have manager positions, because of the different characteristics of the social identities of managers and physicians. Major differences are related between physicians as autonomous individuals in a system and managers as subordinates to the organizational system. There are psychological mechanisms that evoke the physician identity more often than the managerial identity among physicians who are managers, which explains why physicians who are managers tend to remain foremost physicians.

Research limitations/implications

– The implications of the findings, that there are major identity challenges by being both a physician and manager, suggest that managerial physicians might not be the best prerequisite for medical leadership, but instead, cooperative relationships between physicians and non-physician managers might be a less difficult way to support medical leadership.

Practical implications

– Acknowledging and addressing identity challenges can be important both in creating structures in organizations and designing the training for managers in healthcare (both physicians and non-physicians) to support medical leadership.

Originality/value

– Medical leadership is most often related to organizational structure and/or leadership skills, but this paper discusses identity requirements and challenges related to medical leadership.

Reforma na atenção primária à saúde e implicações na cultura organizacional dos Agrupamentos dos Centros de Saúde em Portugal

A crescente complexidade dos desafios do setor da saúde implica um aumento das responsabilidades para aqueles que nela assumem funções de gestão. Há consenso que a qualidade da força de trabalho em saúde é um fator crítico para o sucesso de qualquer reforma no setor. O objetivo desta investigação é estudar e analisar a alteração induzida por uma intervenção de formação-ação intensiva na cultura organizacional de 73 diretores executivos dos Agrupamentos dos Centros de Saúde (ACES) em Portugal durante a reforma na atenção primária à saúde. Os dados foram coletados e analisados em dois períodos temporais, antes e depois da intervenção do Programa Avançado em Gestão, Governação Clínica e Liderança para os ACES, o qual teve um ano de duração. O modelo Competing Values Framework permitiu observar que, depois da intervenção de formação-ação, as percepções dos diretores executivos sobre a sua cultura organizacional se encontram mais alinhadas com a reforma da atenção primária à saúde, valorizando o tipo de práticas e valores que esta defende. É necessário continuar a monitorizar os resultados em vários períodos temporais para elaborar conclusões a esse respeito.

From policy to reality: clinical managers' views of the organizational challenges of primary care reform in Portugal

The primary healthcare reform in Portugal is based on the development of a new management model and clinical governance framework. The objective is to strengthen primary healthcare services to reduce the inappropriate utilization of secondary and emergency services and to make efficiency gains and to better control costs. New interventions include the introduction of a system of production-based incentives for family health units. This paper presents an initial assessment of the implementation of the new policies and tries to explain the gap between its expected results and what was observed in the field 5 years later. We used a Strengths, Weaknesses, Opportunities, and Threats analysis conducted in 12 regions, to collect the perceptions of members of Clinical Councils of Health Centers Groups, responsible for the implementation of the reform. The analysis looked at the dimensions of coverage, productivity, technical quality, and service quality. It identifies weaknesses in human resources management (shortages, incentives, team management) and lack of support from central and regional management. There is a perceived gap between the framework for reform as defined by law and the support made available for its implementation, leading to tensions between decision makers, managers, and health professionals.

From the inside out: the engagement of physicians as leaders in health care settings

Health care delivery must be transformed to manage spiraling costs and preserve quality care. Transforming complex health systems will require the engagement of physicians as leaders in their health care settings, in both formal and informal roles. In this article we explore the experience of physician leader engagement and identify factors operating at the individual, team, and organizational levels related to increased or decreased physician leader engagement. Using an inductive approach, our analysis of the transcribed interviews yielded a rich understanding of what motivates physicians to be engaged as leaders, how they experience engagement, the role of the physician leader, how physicians understand other physicians' engagement, what encourages and discourages their engagement efforts, and the role that education and training has in physician engagement. We conclude by offering strategies that physicians, health care organizations, and educational institutions can implement to increase the engagement of physician leaders.