The impact of an integrated medical leadership programme

Nursing department directors' perspectives on leadership training programme: A descriptive qualitative study

BACKGROUND

Leadership training is crucial for nurses to navigate changes, but research on nursing department directors' views of such programmes is limited.

AIM

To explore the perspectives and experiences of nursing department directors regarding a national leadership training programme for mid-level nurse managers.

DESIGN

Descriptive Qualitative Study.

SETTINGS

A national nurses association in Taiwan.

PARTICIPANTS

A purposive sample of 11 nursing department directors who recommended mid-level nurse managers for the programme.

METHODS

Eleven individual face-to-face interviews were conducted and analysed thematically between November 2022 and April 2023.

RESULTS

Three themes and eight subthemes emerged, including directors' strategies for identifying potential successors, providing coaching and guidance, and observing changes in trainees. Directors reported the programme broadened perspectives, fostered responsibility, and enhanced leadership skills in mid-level managers.

CONCLUSIONS

The engagement of nursing department directors and their adoption of a coaching style, such as fostering a growth mindset, were instrumental in the programme's success.

Maximizing the Impact and ROI of Leadership Development: A Theory- and Evidence-Informed Framework

Globally, organizations invest an estimated USD 60 billion annually in leadership development; however, the workplace application of learning is typically low, and many programs underperform or fail, resulting in wasted time and money and potential harm. This article presents a novel theory- and evidence-informed framework to maximize the outcomes and return on investment (ROI) of leadership development programs. The foundation of the framework derives from four separate literature reviews: three systematic reviews on leadership development, including the only two to isolate gold-standard elements of effective design, delivery, and evaluation, and one on "training transfer". Informed by innovative principles of leadership development and unique theoretical models and frameworks, this framework consists of 65 evidence-informed strategies that can be applied as a foundation (9), and before (23), during (17), at the conclusion of (11), and sometime after (5), programs, to maximize impact and ROI. Implications for practice and further research are also presented. Given the stakes, there is an urgent need for evidence and tools to maximize the impact and ROI of leadership development. This novel framework provides robust theory- and evidence-informed guidance for governments, policymakers, and those funding, designing, delivering, and supporting development.

Gold standard research and evidence applied: The Inspire Nursing Leadership Program

Billions of dollars are invested annually in leadership development globally; however, few programs are evidence-based, risking adverse outcomes, and wasted time and money. This article describes the novel Inspire Nursing Leadership Program (INLP) and the outcomes-based process of incorporating gold standard evidence into its design, delivery, and evaluation. The INLP design was informed by a needs analysis, research evidence, and by nursing, Indigenous, and equity, diversity, and inclusion experts. The program's goals include enabling participants to develop leadership capabilities, cultivate strategic community partnerships, lead innovation projects, and connect with colleagues. Design features include an outcomes-based approach, the LEADS framework, and alignment with the principles of adult learning. Components include leadership impact projects, 360-assessments, blended interactive sessions, coaching, mentoring, and application and reflection exercises. The evaluation framework and subsequent proposed research design align to top-quality standards. Healthcare leadership programs must be evidence-based to support leaders in improving and transforming health systems.

Evaluating the impact of a national strategic leader development programme for UK doctors: myth-busting, mind-changing, mood-enhancing

Background

The drive towards engaging UK doctors in clinical leadership and management has involved many initiatives at various levels.

Methods

This paper reports on the findings of an in-depth evaluation of a national medical leadership programme for doctors in the late stages of specialty or general practitioner (GP) training or have just become consultants or GPs.

Results

The evaluation clearly demonstrates the impact of this programme and the benefits for the individuals and organisations involved, particularly around stimulating a shift in mood and a major mindset shift in what medical leadership is (and is not) and what they can achieve as medical leaders. The programme structure and activities allowed participants to learn from a range of senior decision-makers about policy and strategic developments and processes. However, the evaluation also highlighted that some pervasive myths still exist around medical leadership and management which, if not addressed, will hamper efforts to fully engage doctors in taking on strategic leadership roles.

Conclusion

Clinical leadership programmes are valuable, but must be carefully managed to extract the full value from them.

Evidence-based medical leadership development: a systematic review

Health systems invest significant resources in leadership development for physicians and other health professionals. Competent leadership is considered vital for maintaining and improving quality and patient safety. We carried out this systematic review to synthesise new empirical evidence regarding medical leadership development programme factors which are associated with outcomes at the clinical and organisational levels. Using Ovid MEDLINE, we conducted a database search using both free text and Medical Subject Headings. We then conducted an extensive hand-search of references and of citations in known healthcare leadership development reviews. We applied the Medical Education Research Study Quality Indicator (MERSQI) and the Joanna Briggs Institute (JBI) Critical Appraisal Tool to determine study reliability, and synthesised results using a meta-aggregation approach. 117 studies were included in this systematic review. 28 studies met criteria for higher reliability studies. The median critical appraisal score according to the MERSQI was 8.5/18 and the median critical appraisal score according to the JBI was 3/10. There were recurring causes of low study quality scores related to study design, data analysis and reporting. There was considerable heterogeneity in intervention design and evaluation design. Programmes with internal or mixed faculty were significantly more likely to report organisational outcomes than programmes with external faculty only (p=0.049). Project work and mentoring increased the likelihood of organisational outcomes. No leadership development content area was particularly associated with organisational outcomes. In leadership development programmes in healthcare, external faculty should be used to supplement in-house faculty and not be a replacement for in-house expertise. To facilitate organisational outcomes, interventions should include project work and mentoring. Educational methods appear to be more important for organisational outcomes than specific curriculum content. Improving evaluation design will allow educators and evaluators to more effectively understand factors which are reliably associated with organisational outcomes of leadership development.

Professional learning, organisational change and clinical leadership development outcomes

INTRODUCTION

The aim of this study is to develop a conceptually sound outcome model for clinical leadership (CL) development in healthcare, linking individual professional learning and organisational change. Frontline doctors' CL is often offered as a solution to healthcare challenges worldwide. However, there is a paucity of rigorous evidence of effectiveness of CL development, or theories supporting it. Importantly, the literature currently lacks robust outcome models for CL development, impeding robust impact evaluations.

METHODS

This multi-source, sequential integrated mixed-methods study draws on systematic content analysis of NHS policy documents and empirical data from a CL programme evaluation study: exploratory factor analysis (EFA) of 142 participants' survey responses and thematic qualitative analysis of 30 in-depth participant interviews across six cohorts. Through integrating findings from the three analyses we examine: (a) the expected organisational outcomes of CL, (b) individual learning outcomes of CL development, and (c) the mechanisms linking the two.

RESULTS

The policy analysis identified three desired solutions to key healthcare problems which CL is expected to offer: Speeding up good practice, Inter-professional collaboration and dialogue, and Change and transformation. Triangulating the EFA results with the qualitative analysis produced five individual outcome constructs: Self-efficacy, Engaging stakeholders, Agency, Boundary-crossing expertise, and Willingness to take risks and to learn from risks and failures. Further qualitative analysis uncovered key mechanisms linking the individual outcomes with the desired organisational changes.

DISCUSSION

Despite significant investments into CL development in the UK and worldwide, the absence of conceptually robust and operationally specific outcome models linking individual and organisational impact impedes rigorous evaluations of programme effectiveness. Our study developed a novel individual and organisational outcome model including a theory of change for clinical leadership. Our findings further contribute to professional learning theory in medical settings by conceptualising and operationalising the mechanisms operating between individual and organisational learning outcomes.

The Chief Registrar role in the UK: leadership capacity and development of hybrid leaders

PURPOSE

The purpose of the study is to evaluate the first cohort of the Royal College of Physicians' (RCP) Chief Registrar programme in 2016/7. Chief Registrars provide medical leadership capacity through leadership development posts.

DESIGN/METHODOLOGY/APPROACH

The study adopted a mixed methods design, comprising a monthly survey of the 21 Chief Registrars in the first cohort, interviews with Chief Registrars, and six cases studies where Chief Registrars and colleagues were interviewed.

FINDINGS

Chief Registrars enjoyed high levels of practical, professional, and leadership support from their employing organisations, the RCP, and the Faculty of Medical Leadership and Management. They had high degrees of autonomy in their roles. As a result, roles were enacted in different ways, making direct comparative evaluation problematic. In particular, we identified variation on two dimensions: first, the focus on medical leadership generally, or quality improvement more specifically, and second, the focus on personal development or organisational leadership capacity.

RESEARCH LIMITATIONS/IMPLICATIONS

The data are limited and drawn from the first cohort's experience. The Chief Registrar scheme, unlike many other leadership fellowships, maintains a high level of clinical practice (with a minimum 40 per cent leadership work). This suggests a clearer preparation for future hybrid leadership roles.

PRACTICAL IMPLICATIONS

This paper may offer some support and guidance for Chief Registrars and those who work with and support them.

ORIGINALITY/VALUE

This study adds to the literature on leadership development for doctors in hybrid roles, and highlights the distinctiveness of the scheme compared with other schemes.

Is postgraduate leadership education a match for the wicked problems of health systems leadership? A critical systematic review

PURPOSE

There have been a growing number of leadership education programs for physicians. However, debates about the value and efficacy of leadership education in medicine persist, and there are calls for systematic and critical perspectives on medical leadership development. Here, we review evidence on postgraduate leadership education and discuss findings in relation to contemporary evidence on leadership education and practice.

METHOD

We searched multiple databases for papers on postgraduate leadership development programs, published in English between 2007 and 2017. We identified 4,691 papers; 31 papers met the full inclusion criteria. Data regarding curricular content and design, learner demographics, instructional methods, and learning outcomes were abstracted and synthesized.

RESULTS

There was modest evidence for effectiveness of programs in influencing knowledge and skills gains in select domains. However, the conceptual underpinnings of the 'leadership' training delivered were often unclear. Contemporary theory and evidence on leadership practice was not widely incorporated in program design. Programs were almost exclusively uni-professional, focused on discrete skill development, and did not address systems-level leadership issues. Broader leadership capacity building strategies were underutilized. A new wave of longitudinal, integrated clinical and leadership programming is observed.

CONCLUSIONS

Our findings raise questions about persistent preparation-practice gaps in leadership education in medicine. Leadership education needs to evolve to incorporate broader collective capacity building, as well as evidence-informed strategies for leadership development. Barriers to educational reform need to be identified and addressed as educators work to re-orientate education programs to better prepare budding physician leaders for the challenges of health system leadership.

Clinical leadership training: an evaluation of the Welsh Fellowship programme

Purpose UK fellowship schemes have been set up to address low-level engagement of doctors with leadership roles. Established in 2013, the Welsh Clinical Leadership Fellowship (WCLF) programme aims to recruit aspiring future clinical leaders and equip them with knowledge and skills to lead improvements in healthcare delivery. This paper aims to evaluate the 12-month WCLF programme in its first two years of operation. Design/methodology/approach Focused on the participants ( n = 8), the authors explored expectations of the programme, reactions to academic components (provided by Academi Wales) and learning from workplace projects and other opportunities. The authors adopted a qualitative approach, collecting data from four focus groups, 20 individual face-to-face or telephone interviews with fellows and project supervisors and observation of Academi Wales training days. Findings Although from diverse specialties and stages in training, all participants reported that the Fellowship met expectations. Fellows learned leadership theory, developing understanding of leadership and teamwork in complex organisations. Through workplace projects, they applied their knowledge, learning from both success and failure. The quality of communication with fellows distinguished the better supervisors and impacted on project success. Research limitations/implications Small participant numbers limit generalisability. The authors did not evaluate longer-term impact. Practical implications Doctors are required to be both clinically proficient and influence service delivery and improve patient care. The WCLF programme addresses both the need for leadership theory (through the Academi Wales training) and the application of learning through the performance of leadership roles in the projects. Originality/value This work represents an evaluation of the only leadership programme in Wales, and outcomes have led to improvements.

Self-determining medical leadership needs of occupational health physicians

Purpose

The purpose of this study was to explore which factors motivate doctors to engage in leadership roles and to frame an inquiry of self-assessment within Self-Determination Theory (SDT) to identify the extent to which a group of occupational health physicians (OHPs) was able to self-determine their leadership needs, using a National Health Service (NHS) England competency approach promoted by the NHS England Leadership Academy as a self-assessment leadership diagnostic. Medical leadership is seen as crucial to the transformation of health-care services, yet leadership programmes are often designed with a top-down and centrally commissioned “one-size-fits-all” approach. In the UK, the Smith Review (2015) concluded that more decentralised and locally designed leadership development programmes were needed to meet the health-care challenges of the future. However, there is an absence of empirical research to inform the design of effective strategies that will engage and motivate doctors to take up leadership roles, while at the same time, health-care organisations continue to develop formal leadership roles as a way to secure medical leadership engagement. The problem is further compounded by a lack of validated leadership qualities assessment instruments which support researching this problem.

Design/Methodology/approach

The analysis draws on a sample of about 25 per cent of the total population size of the Faculty of Occupational Medicine (n = 1,000). The questionnaire used was the Leadership Qualities Framework tool as a form of online self-assessment (NHS Leadership Academy, 2012). The data were analysed using descriptive statistics and simple inferential methods.

Findings

OHPs are open about reporting their leadership strengths and leadership development needs and recognise leadership learning as an ongoing development need regardless of their level of personal competence. This study found that the single most important factor to affect a doctor’s confidence in leadership is their experience in a management role. In multivariate regression, management experience accounted for the usefulness of leadership training, suggesting that doctors learn best through applied “leadership learning” as opposed to theory-driven programmes. Drawing on SDT (Deci and Ryan, 1985; 2000; Ryan and Deci, 2000), this article provides a theoretical framework that helps to understand those doctors who are likely to engage in leadership and management activities in the organisation. More choice and self-determination of medical leadership programmes are likely to result in more relevant leadership learning that builds on doctors’ previous experience in this area.

Research limitations/implications

While this study benefitted from a large sample size, it was limited to the use of purely quantitative methods. Future studies would benefit from the application of a mixed methodology to combine quantitative data with one-to-one interviews or a focus group.

Practical implications

This study suggests that doctors are able to determine their own learning needs reliably and that they are more likely to increase their confidence in leadership and management if they are exposed to leadership and management experience.

Originality/value

This is the first large-scale study of this kind with a large sample within a single medical specialty. The study is considered as insider research, as the first author is an OHP with knowledge of how to engage OHPs in this work.

The impact of accreditation on healthcare quality improvement: a qualitative case study

Purpose Research on accreditation has mostly focused on assessing its impact using large scale quantitative studies, yet little is known on how quality is improved in practice through an accreditation process. Using a case study of an acute teaching hospital in Portugal, the purpose of this paper is to explore the dynamics through which accreditation can lead to an improvement in the quality of healthcare services provided. Design/methodology/approach Data for the case study was collected through 46 in-depth semi-structured interviews with 49 clinical and non-clinical members of staff. Data were analyzed using a framework thematic analysis. Findings Interviewees felt that hospital accreditation contributed to the improvement of healthcare quality in general, and more specifically to patient safety, as it fostered staff reflection, a higher standardization of practices, and a greater focus on quality improvement. However, findings also suggest that the positive impact of accreditation resulted from the approach the hospital adopted in its implementation as well as the fact that several of the procedures and practices required by accreditation were already in place at the hospital, albeit often in an informal way. Research limitations/implications The study was conducted in only one hospital. The design of an accreditation implementation plan tailored to the hospital's context can significantly contribute to positive outcomes in terms of quality and patient safety improvements. Originality/value This study provides a better understanding of how accreditation can contribute to healthcare quality improvement. It offers important lessons on the factors and processes that potentiate quality improvements through accreditation.

Tomorrow's leaders - the role of leadership in medical -education and training

Delivering safe, high-quality patient care is dependent on high-quality clinical leadership. The General Medical Council has outlined the capabilities expected to be achieved through the medical curricula leading to full registration and Certificate of Completion of Training but our training programmes are not yet consistent on how the capabilities are best acquired. Trainees can begin by understanding their own strengths and reflecting on how they interact in the team; trainers can use existing opportunities to enable greater and more specific learning on how to lead across all the opportunities available during routine clinical activity. Some trainees may wish to expand on their leadership portfolio through national and local fellowships; however, all doctors need to understand how to lead in different situations to ensure the safest possible patient care.