A randomised study of leadership interventions for healthcare managers

Leadership Styles and Nurses' Innovative Behaviors: A Systematic Review

OBJECTIVE

In an increasingly competitive healthcare climate, ensuring an innovative nursing workforce is essential for organizational success and survival.

BACKGROUND

The authors aimed to evaluate the literature examining the association between leadership styles and innovative behaviors in the nursing workforce.

METHODS

A systematic review of articles from 5 databases was conducted from August 2022 to October 2022.

RESULTS

A total of 21 articles published in the English language were included in the review. This study provides evidence for the vital role of "relationship-oriented" leadership styles in fostering innovative behaviors among nurses. However, more research is needed to examine how "task-oriented" leadership styles contribute to innovativeness in nurses. Twelve mediators linking leadership styles to healthcare workers' innovative behaviors were identified and clustered into motivation-based, relation-based, and affective mediators.

CONCLUSION

Organizational strategies to foster relationship-based leadership styles among healthcare leaders are vital to support nurses' innovative behaviors.

Developing engaged and 'teamful' leaders: A randomized controlled trial of the 5R identity leadership program

The social identity approach to leadership argues that leaders' capacity to influence and inspire others is grounded in a shared sense of social identity (or 'us-ness') that those leaders create, advance, represent, and embed for the groups they lead. The approach therefore argues that a key task for leaders is to develop insights and skills of (social) identity leadership that allow them to motivate and mobilize groups and transform them into a potent social and organizational force. In contrast to other approaches and programs which focus on leaders' leader identity (their 'I-ness'), the 5R leadership development program supports the development of leaders' social identity by raising awareness of the importance of social identity ('we-ness') for leadership and taking leaders through structured activities that help them build engaged and inclusive teams. The present research assessed the benefits of facilitated and learner self-directed versions of the 5R program (Ns = 27, 22 respectively) relative to a no-treatment control (N = 27). Results (including those of an intention-to-treat analysis; N = 76) indicated that, relative to leaders in the control condition, those who participated in both forms of 5R reported large increases in identity leadership knowledge, as well as medium-sized increases in both team engagement (a compound factor comprised of team identification, team OCB, team efficacy, and work engagement) and 'teamfulness' (comprised of team reflexivity, team psychological safety, team goal clarity, and inclusive team climate). We reflect on the importance of teamfulness for leadership and team functioning and on the value of programs that help leaders develop this.

A Training Intervention through a 360° Multisource Feedback Model

Physicians and other health sciences professionals need continuous training, not only in technical aspects of their activity but also in nontechnical, transversal competencies with a cost-efficient impact on the proper functioning of healthcare. The objective of this paper is to analyze the behavioral change among health professionals at a large public hospital following a training intervention on a set of core nontechnical competencies: Teamwork, Adaptability-Flexibility, Commitment-Engagement, Results Orientation, and Leadership Skills for Supervisors. The 360° Multisource Feedback (MSF) model was applied using three sources of information: supervisors, co-workers, and the workers themselves (self-assessment). A quasi-experimental pretest–post-test single-group design with two points in time was utilized. The training intervention improved the scores of only one of the trained competencies—the “Results Orientation” competency—although the scores were slightly inflated. Moreover, significant discrepancies were detected between the three sources, with supervisors awarding the highest scores. The magnitude of behavioral change was related to certain sociodemographic and organizational variables. The study was not immune to the ceiling effect, despite control measures aimed at avoiding it. The empirical evidence suggests that the 360° MSF model must be maintained over time to enhance and reinforce an evaluation culture for better patient care.

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.

Examining How Formal Leadership Development Programs Positively Influence Hospital Leaders' Individual Competencies and Organizational Outcomes - An Evidence-Based Literature Review

Background

Leadership development programs (LDPs) are known to be educational and valuable, yet time consuming and costly for a healthcare organization and participants alike. This study is aimed to determine the impact that participation in a formal LDP has on hospital managers and leaders’ competencies, as well as to identify the positive organizational outcomes that can be achieved.

Materials and Methods

We conducted a literature review focusing on hospital managers and leaders who participated in formal LDPs. From there, we extracted data to determine the outcomes achieved by participating in LDPs.

Results

The search yielded 7420 articles, of which 23 articles were used for this literature review. Overall, there were a wide range of positive outcomes for participants of LDPs and some outcomes appeared more frequently than others. The beneficial outcome that appeared most frequently was that participants were able to gain knowledge of management and leadership roles and responsibilities which appeared 13 times. An increase in participant’s confidence and communication skills appeared 10 times, respectively. The ability to network with others within the organization and an increase in job positivity and satisfaction appeared 7 times each.

Discussion

LDPs provided an array of positive outcomes for hospital leaders who had participated. However, there was a lack of studies on the topic and more research is needed in order to have a better understanding of the correlation between LDPs and beneficial organizational outcomes.

Evaluation of iLead, a generic implementation leadership intervention: mixed-method preintervention-postintervention design

OBJECTIVES

The present study aimed to evaluate the iLead intervention and to investigate whether or not transfer of training can be supported by contextualising the intervention (recruiting all managers from one branch of the organisation while focusing on one implementation case, as well as training senior management).

DESIGN

A pre-evaluation-postevaluation design was applied using mixed methods with process and effect surveys and interviews to measure the effects on three levels.

SETTING

Healthcare managers from Stockholm's regional healthcare organisation were invited to the training.

PARTICIPANTS

52 managers participated in the iLead intervention. Group 1 consisted of 21 managers from different organisations and with different implementation cases. Group 2, representing the contextualised group, consisted of 31 managers from the same organisation, working on the same implementation case, where senior management also received training.

INTERVENTION

iLead is an intervention where healthcare managers are trained in implementation leadership based on the full-range leadership model.

PRIMARY OUTCOME MEASURES

Reactions, knowledge and implementation leadership are measured.

RESULTS

Quantitative and qualitative analyses indicate that iLead was perceived to be of high quality and capable of increasing participants' knowledge. Mixed effects were found regarding changes in behaviours. The contextualisation did not have a boosting effect on behaviour change. Hence, group 2 did not increase its active implementation leadership in comparison with group 1.

CONCLUSIONS

iLead introduces a new approach to how implementation leadership can be trained when knowledge of effective leadership for implementations is combined with findings on the importance of environmental factors for the transfer of training. Even though managers reported general positive effects, transfer was not facilitated through the contextualisation of the intervention. There is a need to further develop approaches to help participants subsequently apply the learnt skills in their work environment.