The impact of servant leadership dimensions on leader-member exchange among health care professionals

Evidence behind the exhortation? A rapid review of servant leadership's influence and claims in healthcare over the last decade

Servant leadership is an other-oriented approach to leadership with multiple positive outcomes. However, its influence in the context of medicine, particularly on healthcare leaders, is less clear. We conducted a rapid review to examine the impact of servant leadership in healthcare over the last decade. We included a total of 28 articles, 26 of which described beneficial organisational, relational and personal outcomes of servant leadership. However, most of these were either conceptual or opinion-based articles. Moreover, most quantitative studies were cross-sectional, precluding causal inferences. Our review demonstrates that the purported positive association between servant leadership and healthcare outcomes lacks a strong evidence base. We conclude by calling for more rigorous empirical research to examine the effects and potential challenges of implementing servant leadership in healthcare contexts.

Servant Leadership in the Healthcare Literature: A Systematic Review

Servant leadership has received a growing consideration among scholars and practitioners as a viable leadership model capable of bringing positive changes in the increasingly complex healthcare system. The increasing servant leadership literature in healthcare requires an integrated research work that provides a holistic picture of the existing studies. This systematic review aims to synthesize servant leadership conceptualizations, theoretical frameworks, measurement tools, and nomological networks (antecedents, mediators, outcomes, and moderators) associated with prior research in healthcare. A systematic synthesis of 55 pertinent healthcare-specific conceptual and empirical studies demonstrated that servant leadership assumes a crucial role in developing a committed workforce that contributes towards the achievement of performance excellence in healthcare. The review uncovers that the Global Servant Leadership Scale is the most utilized measure of servant leadership in sector-specific studies in healthcare. Moreover, social exchange theory is the dominant underpinning mechanism explaining the influence of servant leadership on specific variables of interest. The findings further revealed that servant leadership has a positive relationship with a range of valued individual and organizational outcomes in healthcare. Our review contributes to the development of servant leadership theory and practice through ascertaining sector-specific studies in the territory of healthcare. We finally conclude by providing a detailed panorama for future healthcare-specific servant leadership research in terms of potential topics, methodological rigor, and less explored variables in prior studies.

Structural and Psychological Empowerment of Learners Enrolled in Continuing Nursing Leadership Education in Finland: A Quasi-Experimental Longitudinal Study

BACKGROUND

This study was conducted to assess structural and psychological empowerment among learners enrolled in a continuing leadership education program. Although the number of nurse leadership development interventions has increased, there is little evidence on how they influence leaders' empowerment.

METHOD

A longitudinal study was employed, with learners (N = 85) enrolled in a continuing leadership education program as the participants. Data were collected in the beginning, at the end, and 8 months after the completion of the program using internationally validated instruments. Data were analyzed statistically.

RESULTS

A total of 25 learners (29%) responded to the questionnaire at all three data collection points. The education significantly increased psychological and structural empowerment across all dimensions except formal power. These increased levels of empowerment were partially sustained at the 8-month follow-up time point.

CONCLUSION

Continuing education seems to benefit nurse leaders, and the continuing nursing leadership education program was positively associated with learners' perceived empowerment. [J Contin Educ Nurs. 2023;54(10):462-471.].

Leadership Development: Exploring Relational Leadership Implications in Healthcare Organizations

(1) Background: Relational Leadership Theory (RLT) has been gaining rising attention for the past 20 years with studies investigating multiple implications and practices of relationships within organizations. Yet, less attention has been given in healthcare settings. By virtue of the emerging need to move beyond exploring the quality of relationships and to move towards the exploitation of relational dynamics that influence leadership development in healthcare organizations, this study explores both the dyad relationships and the context in which those occur. With recent attention directed to the implementation of human-centered practices and the creation of effective networks to bring desired results, RLT is called on to advance this agenda within healthcare organizations. (2) Material and Methods: Research articles that examined leadership theories over the past thirty years were selected from computerized databases and manual searches. (3) Results: It is argued that the way and context in which relationships are formed between leaders and members is a social process that, in turn, shapes the effectiveness of the management of those organizations. Leadership is not rank-it is the relationship with the relational dynamics that play in the same context, creating evolutionary organizational processes. (4) Conclusions: This paper challenges leadership theory one step further. Exploring an organization through relational leadership theory is much like wearing the lens of 'cause and effect' in leadership behavioral studies. Therefore, this study contributes to this direction with a robust co-examination of relational dynamics that take place in the healthcare sector, showcasing a broader framework in which relational leadership is germinated and influences its outcomes.

Working together, thinking differently? HRM practices and trust in the health care context

PURPOSE

Providing health care services requires collaboration between several occupations. This study aimed to reveal how three occupational groups (nurses, physicians, and administrators) perceive human resources management practices (HRMP) and whether these practices are differently associated with trust in the clinic manager.

DESIGN/METHODOLOGY/APPROACH

The study included 290 employees from 29 primary care clinics, all affiliated with a health care organisation that operates in the public sector. Self-reporting questionnaires measured participants' perceptions of six HRMP across occupations and their association with trust in the clinic manager. Variation between occupational groups was analysed through one-way analysis of variance (for groups' perceptions of HRMP and trust in manager) and t-tests (for the association between perceived HRMP and trust in manager).

FINDINGS

The results indicate some differences in perceived HRMP and trust across groups. Also, some differences were found across occupations regarding the relationship between HRMP and trust in the clinic manager: Nurses' perceptions significantly differed from those of physicians and administrators, yet there was no significant difference between the two latter groups.

PRACTICAL IMPLICATIONS

Health care organisations should expand their human resources architecture and customise their HRMP for each occupational group based on that group's perceptions of the workplace. This can nurture trust in managers and create a climate for trust as a mechanism that encourages employees from distinct occupational groups to work together for the benefit of their clinic, organisation, and patients.

ORIGINALITY/VALUE

This study contributes to the discussion about the contextualisation of HRMP, providing insights regarding perceptions of HRMP as an enabler of an organisation's strategy.

Empowering or addicting? An analysis of the effects of team members–supervisor relationships on job satisfaction in healthcare

Patient-centredness relies on integrated care, which requires teamwork to be effectively implemented. Positive relationships between team members and supervisors are crucial to enhance health professionals’ satisfaction with their job and, consequently, to increase their commitment to organizational excellence. However, the positive effects of team members–supervisor exchange may dilute when the team is endowed with autonomy at work. The article proposes a moderation analysis aimed at collecting evidence of the implications of team members–supervisor relationships on job satisfaction (JS) with team autonomy (TA) as a moderating variable. Results of the study suggest that positive exchanges between team members and supervisors enhance health professionals’ satisfaction with their job. However, TA acts as a negative and statistically significant moderator. Good exchanges between team members and their supervisor seem to lose their positive effects on JS when health professionals are provided with a greater self-determination to accomplish their organizational activities. Tailored management interventions should be designed to sustain teamwork when increased autonomy at work is assigned to health professionals.

The need for management education of healthcare management employees

Given the wide professional discussion on the dominating professional focus of healthcare managers at the expense of management knowledge, the main goal of this paper is to verify the extent, to which management education of healthcare workers affects the level of their management skills.

METHODOLOGY

The Descriptive statistics methods have been used to answer research questions regarding the differences in the perception of the managerial skills and their disposition importance between managers with a completed management education and without it. Emphasis was placed on people management skills and communication skills. The research sample consisted of 253 healthcare managers.

RESULTS

Managers with a completed specialized management study are characterized by higher values of entrepreneurial competences and communication skills. They also have exceptional skills in the area of initiator of change. Another significant difference is the higher adaptation of roles and low critique of their subordinates. They are oriented at workers and relationships with them.

CONCLUSION

Our results show that management education of healthcare managers significantly contributes to the implementation of newer approaches to people management and the use of the necessary management skills, which are a source of higher efficiency in the context of the present world of work and its challenges.

Fragilities and potentialities in the training of nurse leaders

OBJECTIVE

To know the perception of nursing professors about the fragilities and potentialities in the training of nurse leaders.

METHOD

Multiple case study, with a qualitative approach, performed with 36 nursing professors from a public university in the State of Bahia, Brazil. Data were collected through semi-structured interviews, interpreted in the light of Paulo Freire's theoretical framework and analyzed according to Thematic Analysis and the Nvivo®11 software.

RESULTS

Were highlighted as fragilities the need to improve the transversality of leadership throughout graduation and teaching focused on the banking model. The potentialities refer to the insertion of the students in the practice scenarios, enabling the approximation with the nursing and multidisciplinary teams, the use of active methodologies and participation in research groups.

FINAL CONSIDERATIONS

Professors consider the importance of problematizing pedagogical practices and invest in methodological strategies capable of promoting the training of nurse leaders.

Nursing and values-based leadership: A literature review

AIM

To explore literature that supports an understanding of values-based leadership in nursing.

BACKGROUND

Understanding values-based leadership in nursing means understanding several leadership theories such as authentic, servant and congruent leadership.

EVALUATION

Electronic databases were systematically searched to locate studies with the terms values-based, authentic, servant and congruent leadership. The literature was assessed with the Joanna Briggs Institute Critical Appraisal Tools and the Preferred Reporting Items for Systematic Reviews and meta-analysis approach and a thematic analysis.

KEY ISSUES

Existing evidence focuses on specific perspectives within three dominant leadership approaches under the umbrella of values-based leadership: authentic, servant and congruent leadership. Limited literature suggests that values-based leadership can support professional collaboration, enhanced trust and voice for nurses, support for staff well-being, empowerment, job satisfaction, patient-focused outcomes and quality care.

CONCLUSIONS

A dearth of empirical literature concerning values-based leadership and nursing exists. Evidence suggests that authentic, servant and congruent leadership correlate with values-based leadership theories and core nursing values.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers should recognize the potential benefits of a values-based leadership approach for staff well-being, enhanced professional collaboration and the nurses voice, improved insight into clinical leadership attributes and improvements in quality patient care.

Exploring the impact of decentralized leadership on knowledge sharing and work hindrance networks in healthcare teams

This paper adopts an explanatory sequential mixed method design to explore the impact of decentralized (vs. centralized) leadership on cross-functional teams' resource exchanges at a long-term care facility in Canada. In the quantitative phase, social network analyses were used to examine the direct and moderated effects (via leader–follower relationship quality; LMX) of the presence of formal decentralized leaders on: (1) knowledge sharing, and (2) work hindrance networks within cross-functional healthcare teams. In the qualitative phase, team members were interviewed regarding the impact of their decentralized leaders. Collectively, the findings suggest that the presence of a decentralized leader may enhance knowledge sharing and safeguard against work hindrance behaviors in cross-functional healthcare teams. However, these effects are contingent on the situation (e.g., LMX quality and status-based hierarchies). Implications for research and healthcare practice are discussed.

Identity and relationship frames in medical leadership communication

PURPOSE

A frame is an interpretive scheme of meanings that guide participants' interpretations of social interaction and their actions in social situations (Goffman, 1974). By identifying early-career physicians' identity and relationship frames, this study aims to produce information about socially constructed ways to interpret leadership communication in a medical context.

DESIGN/METHODOLOGY/APPROACH

The data consist of essays written by young physicians (n = 225) during their specialization training and workplace learning period. The analysis was conducted applying constructive grounded theory.

FINDINGS

Three identity and relationship frames were identified: the expertise frame, the collegial frame and the system frame. These frames arranged the meanings of being a physician in a leader-follower relationship differently.

ORIGINALITY/VALUE

The findings suggest that identity questions discussed recently in medical leadership studies can be partly answered with being aware of and understanding socially constructed and somewhat contradictory frames.

Reconfiguration of palliative oncological nursing care: nursing contributions

OBJECTIVE

to analyze the strategies implemented by nurses to reconfigure palliative oncological care due to the hospital accreditation process in Hospital do Câncer IV (Hospital of Cancer IV).

METHOD

qualitative research of historical-social approach, whose direct sources in use were written documents and four spoken accounts.

RESULTS

implemented strategies were: creation of the Nursing Division; nursing staff management; consolidation of Continuing Education sector; creation of Internal Nursing Bylaws through development of norms and routines; meetings; discussion of clinical cases; training and classes; creation of Núcleo de Assistência de Enfermagem (Nursing Assistance Core); creation of a tumoral and ostomy wound-dressing ambulatory; and organization of the 5th Vital Sign Forum. Final considerations: nurses, supported by an alliance with the institution directors, implemented effective strategies and reached significant advancement. As they took part in this endeavor, they became legitimate spokespeople of an authorized discourse in the field of oncological nursing care in Brazil.

A lonely business: reflections on the wellbeing and morale of dental teams

With the evolution of humanising patient-dentist interaction within healthcare has come an equal need to humanise staff interaction in order to optimise patient care. There is growing evidence to support the need to invest in enhancing team morale, given that its impact, when low, results in reduced quality of patient care. This paper endeavours to reflect on dental teams' wellbeing and morale and propose a strategy for change to enhance these aspects of team interactions. The theme throughout is to focus on staff wellbeing, in order to initiate a change in work ethic which should in turn initiate a positive work environment. The two strategies discussed are leadership changes conducive to a servant leadership style and a mentorship/buddy programme focusing on reducing stress among dental professionals. Both strategies have their merits and faults, but the purpose of the paper is to prompt food for thought as to how to raise team morale in dental practice.

Use of instruments to evaluate leadership in nursing and health services

OBJECTIVE

To identify the available scientific evidence about the use of instruments for the evaluation of leadership in health and nursing services and verify the use of leadership styles/models/theories in the construction of these tools.

METHOD

Integrative literature review of indexed studies in the LILACS, PUBMED, CINAHL and EMBASE databases from 2006 to 2016.

RESULTS

Thirty-eight articles were analyzed, exhibiting 19 leadership evaluation tools; the most used were the Multifactor Leadership Questionnaire, the Global Transformational Leadership Scale, the Leadership Practices Inventory, the Servant Leadership Questionnaire, the Servant Leadership Survey and the Authentic Leadership Questionnaire.

CONCLUSIONS

The literature search allowed to identify the main theories/styles/models of contemporary leadership and analyze their use in the design of leadership evaluation tools, with the transformational, situational, servant and authentic leadership categories standing out as the most prominent. To a lesser extent, the quantum, charismatic and clinical leadership types were evidenced.

Leadership in nursing: from teaching to practice in a hospital environment

Abstract Objective: To analyze the knowledge of nurses on teaching of leadership in the undergraduate and its exercise in a hospital environment. Method: Qualitative, descriptive and exploratory study. There were interviewed 37 nurses working in a public hospital in the state of Rio Grande do Sul, Brazil. Data were collected through semi-structured interviews and it was categorized according the Thematic Analysis method, using the NVivo software. Results: The nurses recognize leadership as professional competence and mentioned positive aspects related to the leadership formation in graduation, which was obtained from significant theoretical contribution, provided by nursing professors. The institution lacks investments to offer theoretical and practical leadership support. Final Thoughts: Teaching leadership during graduation requires transversal approach, as well as strategies of permanent education that potentiate the exercise of leadership in a hospital environment.

Leadership requirements for Lean versus servant leadership in health care: a systematic review of the literature

As health care organizations face pressures to improve quality and efficiency while reducing costs, leaders are adopting management techniques and tools used in manufacturing and other industries, especially Lean. Successful Lean leaders appear to use a coaching leadership style that shares underlying principles with servant leadership. There is little information about specific similarities and differences between Lean and servant leaderships. We systematically reviewed the literature on Lean leadership, servant leadership, and health care and performed a comparative analysis of attributes using Russell and Stone's leadership framework. We found significant overlap between the two leadership styles, although there were notable differences in origins, philosophy, characteristics and behaviors, and tools. We conclude that both Lean and servant leaderships are promising models that can contribute to the delivery of patient-centered, high-value care. Servant leadership may provide the means to engage and develop employees to become successful Lean leaders in health care organizations.