Introducing a framework to support the identification and tackling of health inequalities within specialised services

BACKGROUND

The potential for addressing healthcare inequalities in prescribed specialised services has historically been overlooked. There is evidence that prescribed specialised services can exacerbate inequalities even though they are often accessed at the end of complex pathways and by relatively small numbers of people. Leadership is required to facilitate a systematic approach to identifying and addressing inequalities in this area.

METHODS

A rapid literature review of articles from 2015 onwards and engagement with stakeholders was used to inform the development of a framework that both supports the identification of health inequalities within specialised services and provides recommendations for how to address them.

RESULTS

The framework aligns with existing national approaches in England to addressing health inequalities in other healthcare settings. It is prepopulated with features of services that may create inequalities and recommended ways of addressing them and can be readily adapted to suit population specific needs.

CONCLUSION

The potential for addressing health inequalities should be considered at all points along a healthcare pathway. Local service leaders need to be empowered and encouraged to identify and deliver on opportunities for change to continually improve patient access, experience and outcomes.

Impact of decentralized management on sickness absence in hospitals: a two-wave cohort study of frontline managers in Danish hospital wards

BACKGROUND

This study explores the impact of decentralized management on the sickness absence among healthcare professionals. Sickness absence is a reliable indicator of employees' wellbeing and it is linked to management quality. However, the influence of decentralized management on sickness absence has not been adequately studied.

METHODS

The research design combined a two-wave, web-survey of frontline managers in two Danish university hospitals with administrative data on sickness absence at the ward-level. The first and second wave included data from 163165 and 137 frontline managers linked to 121 wards and 108 wards. Data was analysed using an ordinal logistic regression model.

RESULTS

Wards where frontline managers had the highest level of decentralised decision authority compared to none showed lower odds of ward-level sickness absence (ORcrude: 0.20, 95% CI: 0.05-0.87). A very high extent of cross-functional decision authority showed lower odds of sickness absence (ORcrude: 0.08, 95% CI: 0.01-0.49). Overall, the results showed a clear data trend, although not all results were statistically significant.

CONCLUSION

Higher levels of decentralized management in wards were positively associated with lower risks of sickness absence in hospital wards. The study supports future research on how to empower decision autonomy at the frontline level of management.

DPD. Formal leadership perceptions about the autonomy of Pharmacy: a SWOT analysis

INTRODUCTION

Autonomy is considered a vital principle of professionalism. In recent years, despite important advances, the Pharmacy and pharmacists' autonomy has been questioned due to conflicts that jeopardize the consolidation of this profession in the division of work in health.

OBJECTIVE

to understand the construct of autonomy based on perceptions of formal leaders associated with professional organizations.

METHODS

A qualitative study was conducted through interviews with key informants. The data obtained were submitted to content analysis.

RESULTS

Perceptions about the autonomy in pharmaceutical practice were categorized according to strengths, weaknesses, opportunities, and threats to this construct.

CONCLUSION

The findings allowed us to understand the autonomy of pharmaceutical practice in Brazil, generate hypotheses about the future of Pharmacy, and build strategies to maintain its occupational status.

Model of multidisciplinary teamwork in hip fracture care: a qualitative interview study

OBJECTIVES

Hip fractures are common injuries in older age with high mortality requiring multidisciplinary clinical care. Despite guidance, there is considerable variation in hip fracture services and patient outcomes; furthermore, little is known about how successful multidisciplinary working can be enabled. This study aimed to characterise professionals' views about the core components of multidisciplinary teamwork in hip fracture care.

DESIGN

The study comprised qualitative interviews with healthcare professionals delivering hip fracture care. Interviews were audio recorded, transcribed and analysed abductively: material was coded inductively and grouped into higher level concepts informed by theories and frameworks relating to teamwork.

SETTING

Four hospitals in England.

PARTICIPANTS

Participants were 40 healthcare professionals including orthopaedic surgeons, orthogeriatricians, physiotherapists and service managers.

RESULTS

Results identified four components of successful multidisciplinary teamwork: (1) defined roles and responsibilities, (2) information transfer processes, (3) shared goals and (4) collaborative leadership. These were underpinned by a single concept: shared responsibility. Defined roles and responsibilities were promoted through formal care pathways, reinforced through induction and training with clear job plans outlining tasks. Information transfer processes facilitated timely information exchange to appropriate individuals. Well-defined common purpose was hindered by complex interdisciplinary professional relationships, particularly between orthogeriatric and orthopaedic staff, and encouraged through multidisciplinary team meetings and training. Clinical service leads were integral to bridging interdisciplinary boundaries. Mutual trust and respect were based on recognition of the value of different professional groups. Teamwork depended on formal clinical leads with facilitative and motivational roles, and on hospital leadership that created an environment supporting collaboration. Shared responsibility for patients was encouraged by joint orthopaedic and orthogeriatric care models. Staff shared responsibility by assisting colleagues when needed.

CONCLUSIONS

Shared responsibility across the multidisciplinary team is fundamental to delivery of hip fracture care. Findings will inform development of clinical practice recommendations and training to build teamworking competencies.

Experiences of Frontline Managers during the COVID-19 Pandemic: Recommendations for Organizational Resilience

The COVID-19 pandemic caused a global health crisis directly impacting the healthcare system. Healthcare leaders influence and shape the ability of an organization to cope with and recover from a crisis such as the COVID-19 pandemic. Their actions serve to guide and support nurses' actions through unpredictable health service demands. The purpose of this paper was to examine frontline managers' experiences and organizational leadership responses that activated organizational resilience during the COVID-19 pandemic, and to learn for ongoing and future responses to healthcare crises. Fourteen managers participated in semi-structured interviews. We found that: (1) leadership challenges (physical resources and emotional burden), (2) the influence of senior leader decision-making on managers (constant change, shortage of human resources, adapting care delivery, and cooperation and collaboration), and (3) lessons learned (managerial caring behaviours and role modelling, adaptive leadership, education and training, culture of care for self, and others) were evidence of managers' responses to the crisis. Overall, the study provides evidence of managers experiences during the early waves of the pandemic in supporting nurses and fostering organizational resilience. Knowing manager's experiences can facilitate planning, preparing, and strengthening their leadership strategies to improve work conditions is a high priority to manage and sustain nurses' mental health and wellbeing.

Digital Leadership's Influence on Individual Creativity and Employee Performance: A View through the Generational Lens

Today's digitalized business atmosphere places significant emphasis on digital leadership, as digital transformation can only be successful for leaders who are capable of overseeing the entire digitalization process. In this study, we examine the employee-level outputs of digital leadership in terms of individual creativity and employee performance. Based on the data of 348 employees and by using PLS-SEM, we find that (i) digital leadership is a significant antecedent of individual creativity, and (ii) individual creativity fully mediates the relationship between digital leadership and employee performance. When digital leadership abilities are a matter of concern, it becomes necessary to mention the importance of generational differences between those leaders, as OB studies also underline the generational differences toward new technologies. Hence, we also conducted a multigroup analysis (MGA) to determine if those interrelationships among digital leadership, individual creativity, and employee performance differ due to the generations of the managers. Surprisingly, the MGA results reveal minor differences. The findings of this study highlight the importance of embracing digital leadership in fostering a creative and high-performing work environment and provide insights for organizations aiming to harness the unique strengths and talents of their multigenerational workforce. Digital leaders who foster a culture of innovation, adaptability, and open communication can inspire employees to think creatively and come up with novel ideas. By leveraging digital tools and providing a supportive environment, digital leaders can also enhance employee creativity and performance.

Advancing leadership in surgery: a realist review of interventions and strategies to promote evidence-based leadership in healthcare

BACKGROUND

Healthcare systems invest in leadership development of surgeons, surgical trainees, and teams. However, there is no agreement on how interventions should be designed, or what components they must contain to be successful. The objective of this realist review was to generate a programme theory explaining in which context and for whom surgical leadership interventions work and why.

METHODS

Five databases were systematically searched, and articles screened against inclusion considering their relevance. Context-mechanism-outcome configurations (CMOCs) and fragments of CMOCs were identified. Gaps in the CMOCs were filled through deliberation with the research team and stakeholder feedback. We identified patterns between CMOCs and causal relationships to create a programme theory.

RESULTS

Thirty-three studies were included and 19 CMOCs were developed. Findings suggests that interventions for surgeons and surgical teams improve leadership if timely feedback is delivered on multiple occasions and by trusted and respected people. Negative feedback is best provided privately. Feedback from senior-to-junior or peer-to-peer should be delivered directly, whereas feedback from junior-to-senior is preferred when delivered anonymously. Leadership interventions were shown to be most effective for those with awareness of the importance of leadership, those with confidence in their technical surgical skills, and those with identified leadership deficits. For interventions to improve leadership in surgery, they need to be delivered in an intimate learning environment, consider implementing a speak-up culture, provide a variety of interactive learning activities, show a genuine investment in the intervention, and be customised to the needs of surgeons. Leadership of surgical teams can be best developed by enabling surgical teams to train together.

CONCLUSIONS

The programme theory provides evidence-based guidance for those who are designing, developing and implementing leadership interventions in surgery. Adopting the recommendations will help to ensure interventions are acceptable to the surgical community and successful in improving surgical leadership.

TRIAL REGISTRATION

The review protocol is registered with PROSPERO (CRD42021230709).

A qualitative study exploring hospital-based team dynamics in discharge planning for patients experiencing delayed care transitions in Ontario, Canada

BACKGROUND

In attempt to improve continuity of patient care and reduce length of stay, hospitals have placed an increased focus on reducing delayed discharges through discharge planning. Several benefits and challenges to team-based approaches for discharge planning have been identified. Despite this, professional hierarchies and power dynamics are common challenges experienced by healthcare providers who are trying to work as a team when dealing with delayed discharges. The objective of this study was to explore what was working well with formal care team-based discharge processes, as well as challenges experienced, in order to outline how teams can function to better support transitions for patients experiencing a delayed discharge.  METHODS: We conducted a descriptive qualitative study with hospital-based healthcare providers, managers and organizational leaders who had experience with delayed discharges. Participants were recruited from two diverse health regions in Ontario, Canada. In-depth, semi-structured interviews were conducted in-person, by telephone or teleconference between December 2019 and October 2020. All interviews were recorded and transcribed. A codebook was developed by the research team and applied to all transcripts. Data were analyzed inductively, as well as deductively through directed content analysis.

RESULTS

We organized our findings into three main categories - (1) collaboration with physicians makes a difference; (2) leadership should meaningfully engage with frontline providers and (3) partnerships across sectors are critical. Regular physician engagement, as equal members of the team, was recommended to improve consistent communication, relationship building between providers, accessibility, and in-person communication. Participants highlighted the need for a dedicated senior leader who ensured members of the team were treated as equals and advocated for the team. Improved partnerships across sectors included the enhanced integration of community-based providers into discharge planning by placing more focus on collaborative practice, combined discharge planning meetings, and having embedded and physically accessible care coordinators in the hospital.

CONCLUSIONS

Team-based approaches for delayed discharge can offer benefits. However, to optimize how teams function in supporting these processes, it is important to consistently collaborate with physicians, ensure senior leadership engage with and seek feedback from frontline providers through co-design, and actively integrate the community sector in discharge planning.

Dialectics of distributed leadership in an interorganizational entrepreneurship hub

In this study, we widen the understanding of how the dialectics of distributed leadership develop as part of discursive interactions in an interorganizational setting directed at renewal. Using a dialectical perspective, we analyzed developmental meetings of an entrepreneurship hub and identified three dialectics, namely disagreement versus encouragement, organizational dependency versus interorganizational engagement and status quo versus transformation, by which the discussion reached the resolution. Our study widens the current understanding of distributed leadership and offers a nuanced account of how dissent and consent act as equally important forces for the development of the distributed leadership practice, as well as for reaching the collective resolution directed at organizational renewal. Our study also highlights the significance of co-created visual representations for converting complex discursive dialectics into a more tangible form. More generally, our study opens an approach in leadership to study tension-laden organizational dynamics in discursive and processual terms, especially in complex interorganizational contexts.

Implementing Coordinated Care Networks: The Interplay of Individual and Distributed Leadership Practices

How does leadership emerge and function when multiple health care organizations come together to form a network? In this qualitative comparative case study, we draw on distributed leadership theory to examine the leadership practices that manifested during the implementation of three coordinated care networks. Thirty leaders and care providers participated in semistructured interviews. Interview data were inductively analyzed using thematic analysis. Although established in response to the same policy initiative, each case differed in its leadership approach and implementation strategy. We found that manifestation of distributed leadership was contingent on the presence of an individual leader who acted as a unifying force across their respective network. Our findings suggest that policies to encourage the development of interorganizational networks should include sufficient resources to support an individual leader who enables distributed leadership.

General practitioners' perceptions of distributed leadership in providing integrated care for elderly chronic multi-morbid patients: a qualitative study

Background

Distributed Leadership (DL) has been suggested as being helpful when different health care professionals and patients need to work together across professional and organizational boundaries to provide integrated care (IC). This study explores whether General Practitioners (GPs) adopt leadership actions that transcend organizational boundaries to provide IC for patients and discusses whether the GPs’ leadership actions in collaboration with patients and health care professionals contribute to DL.

Methods

We interviewed GPs (n = 20) of elderly multimorbid patients in a municipality in Norway. A qualitative interpretive case design and Gioia methodology was applied to the collection and analysis of data from semi-structured interviews.

Results

GPs are involved in three processes when contributing to IC for elderly multimorbidity patients; the process of creating an integrated patient experience, the workflow process and the process of maneuvering organizational structures and medical culture. GPs take part in processes comparable to configurations of DL described in the literature. Patient micro-context and health care macro-context are related to observed configurations of DL.

Conclusion

Initiating or moving between different configurations of DL in IC requires awareness of patient context and the health care macro-context, of ways of working, capacity of digital tools and use of health care personnel.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08460-x.

Enhancing leadership training in health services - an evidence-based practice-oriented approach

PURPOSE

Globally, private and public organisations invest ever increasing amounts of money, time and effort to develop leadership capabilities in current and future leaders. Whilst such investment results in benefits for some, the full value of developmental strategies on offer is not always realised. Challenges inhibiting achievement of full value include struggling to identify learning programs that best fit with the organisational structure, culture, mission and vision and difficulties in maximising engagement of personnel at multiple levels of the management structure.

DESIGN/METHODOLOGY/APPROACH

The purpose of this study is to introduce a pathway for health services to develop and embed simulation-based educational strategies that provide targeted learning for leaders and teams. Aligning this approach to leadership development through presentation of case studies in which the model has been applied illustrates the pathway for application in the health-care sector.

FINDINGS

The findings of the approach to leadership development are presented through the presentation of a case study illustrating application of the ADELIS model to simulation-based learning.

PRACTICAL IMPLICATIONS

The ADELIS model, outlined in this study, provides a guide for creating customised and flexible learning designs that apply simulation-based learning, enabling organisations to develop and provide leadership training for individuals, units and teams that is appropriately fit for purpose.

ORIGINALITY/VALUE

The key contribution to health-care leadership development offered in this study is the rationale for using simulation-based learning accompanied by a model and pathway for creating such a pedagogical approach, which embraces the reality of workplace circumstances.

Leading through the first wave of COVID: a Canadian action research study

PURPOSE

This first phase of a three-phase action research project aims to define leadership practices that should be used during and after the pandemic to re-imagine and rebuild the health and social care system. Specifically, the objectives were to determine what effective leadership practices Canadian health leaders have used through the first wave of the COVID-19 pandemic, to explore how these differ from pre-crisis practices; and to identify what leadership practices might be leveraged to create the desired health and care systems of the future.

DESIGN/METHODOLOGY/APPROACH

The authors used an action research methodology. In the first phase, reported here, the authors conducted one-on-one, virtual interviews with 18 health leaders from across Canada and across leadership roles. Data were analyzed using grounded theory methodology.

FINDINGS

Five key practices emerged from the data, within the core dimension of disrupting entrenched structures and leadership practices. These were, namely, responding to more complex emotions in self and others. Future practice identified to create more psychologically supportive workplaces. Agile and adaptive leadership. Future practice should allow leaders to move systemic change forward more quickly. Integrating diverse perspectives, within and across organizations, leveling hierarchies through bringing together a variety of perspectives in the decision-making process and engaging people more broadly in the co-creation of strategies. Applying existing leadership capabilities and experience. Future practice should develop and expand mentorship to support early career leadership. Communication was increased to build credibility and trust in response to changing and often contradictory emerging evidence and messaging. Future practice should increase communication.

RESEARCH LIMITATIONS/IMPLICATIONS

The project was limited to health leaders in Canada and did not represent all provinces/territories. Participants were recruited through the leadership networks, while diverse, were not demographically representative. All interviews were conducted in English; in the second phase of the study, the authors will recruit a larger and more diverse sample and conduct interviews in both English and French. As the interviews took place during the early stages of the pandemic, it may be that health leaders' views of what may be required to re-define future health systems may change as the crisis shifts over time.

PRACTICAL IMPLICATIONS

The sponsoring organization of this research - the Canadian Health Leadership Network and each of its individual member partners - will mobilize knowledge from this research, and subsequent phases, to inform processes for leadership development and, succession planning across, the Canadian health system, particularly those attributes unique to a context of crisis management but also necessary in post-crisis recovery.

SOCIAL IMPLICATIONS

This research has shown that there is an immediate need to develop innovative and influential leadership action - commensurate with its findings - to supporting the evolution of the Canadian health system, the emotional well-being of the health-care workforce, the mental health of the population and challenges inherent in structural inequities across health and health care that discriminate against certain populations.

ORIGINALITY/VALUE

An interdisciplinary group of health researchers and decision-makers from across Canada who came together rapidly to examine leadership practices during COVID-19's first wave using action research study design.

Psychometric properties of leadership scales for health professionals: a systematic review

Background

The important role of leaders in the translation of health research is acknowledged in the implementation science literature. However, the accurate measurement of leadership traits and behaviours in health professionals has not been directly addressed. This review aimed to identify whether scales which measure leadership traits and behaviours have been found to be reliable and valid for use with health professionals.

Methods

A systematic review was conducted. MEDLINE, EMBASE, PsycINFO, Cochrane, CINAHL, Scopus, ABI/INFORMIT and Business Source Ultimate were searched to identify publications which reported original research testing the reliability, validity or acceptability of a leadership-related scale with health professionals.

Results

Of 2814 records, a total of 39 studies met the inclusion criteria, from which 33 scales were identified as having undergone some form of psychometric testing with health professionals. The most commonly used was the Implementation Leadership Scale (n = 5) and the Multifactor Leadership Questionnaire (n = 3). Of the 33 scales, the majority of scales were validated in English speaking countries including the USA (n = 15) and Canada (n = 4), but also with some translations and use in Europe and Asia, predominantly with samples of nurses (n = 27) or allied health professionals (n = 10). Only two validation studies included physicians. Content validity and internal consistency were evident for most scales (n = 30 and 29, respectively). Only 20 of the 33 scales were found to satisfy the acceptable thresholds for good construct validity. Very limited testing occurred in relation to test-re-test reliability, responsiveness, acceptability, cross-cultural revalidation, convergent validity, discriminant validity and criterion validity.

Conclusions

Seven scales may be sufficiently sound to be used with professionals, primarily with nurses. There is an absence of validation of leadership scales with regard to physicians. Given that physicians, along with nurses and allied health professionals have a leadership role in driving the implementation of evidence-based healthcare, this constitutes a clear gap in the psychometric testing of leadership scales for use in healthcare implementation research and practice.

Trial registration

This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (see Additional File 1) (PLoS Medicine. 6:e1000097, 2009) and the associated protocol has been registered with the PROSPERO International Prospective Register of Systematic Reviews (Registration Number CRD42019121544).

Supplementary Information

The online version contains supplementary material available at 10.1186/s13012-021-01141-z.

Distributed leadership in healthcare: leadership dyads and the promise of improved hospital outcomes

PURPOSE

This paper aims to extend the consideration of distributed leadership in health-care settings. Leadership is typically studied from the classical notion of the place of single leaders and continues to examine distributed leadership within small teams or horizontally. The purpose is to develop a practical understanding of how distributed leadership may occur vertically, between different layers of the health-care leadership hierarchy, examining its influence on health-care outcomes across two hospitals.

DESIGN/METHODOLOGY/APPROACH

Using semi-structured interviews, data were collected from 107 hospital employees (including executive leadership, clinical management and clinicians) from two hospitals in Australia and the USA. Using thematic content analysis, an iterative process was adopted characterized by alternating between social identity and distributed leadership literature and empirical themes to answer the question of how the practice of distributed leadership influences performance outcomes in hospitals?

FINDINGS

The perceived social identities of leadership groups shaped communication and performance both positively and negatively. In one hospital a moderating structure emerged as a leadership dyad, where leadership was distributed vertically between hospital hierarchal layers, observed to overcome communication limitations. Findings suggest dyad creation is an effective mechanism to overcome hospital hierarchy-based communication issues and ameliorate health-care outcomes.

ORIGINALITY/VALUE

The study demonstrates how current leadership development practices that focus on leadership relational and social competencies can benefit from a structural approach to include leadership dyads that can foster these same competencies. This approach could help develop future hospital leaders and in doing so, improve hospital outcomes.

Austerity, resilience and the management of actors in public hospitals: a qualitative study from South Africa

Background

Global economic recession coupled with internal inefficiencies and corruption has led to a period of austerity in the South African healthcare system.

This paper examines the strategies used by management in response to austerity in the three public hospitals and their effect on organisational functioning.

Methods

We used a comparative qualitative case study approach, collecting data using a combination of in-depth interviews with managers, and focus group discussion and interviews with shop stewards and staff.

Results

Austerity, imposed by the introduction of a provincial cost containment committee, has led to a reduction in staff, benefits, shortages of equipment and delayed procurement and recruitment processes. Managers in the first hospital maintained training on labour relations for staff and managers, they jointly planned how to cope with reduced staff and initiated a new forum for HR and finance staff. These strategies improved the way actors engaged, enabling them to resolve problems. Good communication ensured that staff understood what was within the hospitals control and what was not. A second hospital relied on absorptive strategies, such as asking staff to do more with less. The result was resistance, and greater use of sick leave. Some staff gave their own money to help feed patients but were angry at management for putting them in this difficult position. Leadership in the third hospital did not manage actors well either; help from the Government’s Expanded Public Works Programme was rejected by the unions, managers did not attend meetings as they felt their contributions were not listened to. Poor communication meant that the managers and staff did not understand what was within the hospital’s control and what was not; a misunderstanding led to a physical fight between managers.

Conclusion

Organisational resilience in the face of austerity requires leaders to manage different stakeholders well. Hospital managers who promote democratic or participatory leadership and management, open communication, teamwork and trust among all stakeholders will lead better functioning organisations. A special focus should be placed on such practices to develop the resilience of health systems’ organisations.

Time to get serious about distributed leadership: lessons to learn for promoting leadership development for non-consultant career grade doctors in the UK

COVID-19 has exposed the National Health Service (NHS) to the greatest challenge in its existence, highlighting the need for nimble, reactive and inclusive leadership. It is set against a backdrop of a workforce recruitment and retention crisis predicted to worsen in coming years. There is a need to do things differently in healthcare, including better diversity and distribution of leadership. We make the case for senior non-consultant doctors, in the UK more usually referred to as specialty and associate specialist or locally employed doctors. These skilled, experienced medics have much to offer yet are frequently overlooked, with little guidance or support from central organisations and medical colleges or within NHS Trusts themselves. In this commentary, we suggest ways this workforce might be better tapped into, to the benefit of patients and healthcare systems, as well as the doctors themselves.

How are empowering leadership, self-efficacy and innovative behavior related to nurses' agency in distributed leadership in Denmark, Italy and Israel?

AIM

The purpose of the study was to introduce the concept of distributed leadership to international nursing management by conducting a cross-national investigation of its relationships with empowering nursing leadership, nurses' work self-efficacy and nurses' innovative behaviour.

BACKGROUND

Distributed leadership theory suggests that when more people lead processes together, innovation will be superior to solo leadership. However, we need knowledge about how nurse managers may enhance nurses' distributed leadership agency (DLA), and whether such results are generalizable across countries.

METHOD

The cross-national survey with an overall purposeful sampling method used questionnaire data from hospital nurses from Israel (n = 239), Italy (n = 226) and Denmark (n = 709). We used validated scales measuring Empowering Leadership, Self-efficacy, Innovative Work Behavior and DLA.

RESULTS

The results from all three countries showed that empowering leadership and work self-efficacy were positively related to DLA, which, in turn, was also related to more innovation.

CONCLUSION

The results may imply that nursing managers can increase workplace innovativeness by adopting an empowering leadership style that supports nurses' self-efficacy and distributes leadership tasks.

IMPLICATIONS FOR NURSING MANAGEMENT

The cross-country robustness of the results may encourage further research in distributed leadership in nurse management, notably with a focus on causal mechanisms.

The inseparable connection between leadership, agency, power and collaboration in a primary educational setting

This paper critiques the empirically supported normative argument that distributed leadership allows for shared accountability and responsibility. Through the means of cognitive mapping and semi-structured interviews, we engaged in understanding how practices and structural conditions of distributed leadership within two English state primary school settings were established and accepted and where the inseparable connections between leadership, agency, power and collaboration positioned some members less well to participate and exercise influence than others. Our study utilises Foucault’s critical concepts of power as an interaction of social relations and his concept of ‘technologies of self’ whereby individuals undertake practices in order to shape themselves in particular ways to be accepted. Furthermore, drawing upon Bourdieu’s concepts of capital, habitus and field, findings indicate how within a distributed model of leadership individuals can be disconnected from the collective but enabled to feel good about this. We conclude by discussing the implications of these findings for distributed leadership and the necessity to problematise power more generally within a distributed model of leadership.

Shared leadership in tertiary care: design of a simulation for patient safety decision-making in healthcare management teams

Introduction

Simulation-based training (SBT) on shared leadership (SL) and group decision-making (GDM) can contribute to the safe and efficient functioning of a healthcare system, yet it is rarely incorporated into healthcare management training. The aim of this study was design, develop and validate a robust and evidence-based SBT to explore and train SL and GDM.

Method

Using a two-stage iterative simulation design approach, 103 clinical and non-clinical managerial students and healthcare professionals took part in an SBT that contained real-world problems and opportunities to improve patient safety set within a fictional context. Self-report data were gathered, and a focus group was conducted to address the simulation's degree of realism, content, relevance, as well as areas for improvement.

Results

Participants experienced the simulation scenario, the material and the role assignment as realistic and representative of real-world tasks and decision contexts, and as a good opportunity to identify and enact relevant tasks, behaviours and knowledge related to SL and GDM. Areas for improvement were highlighted with regard to involving an actor who challenges SL and GDM; more preparatory time to allow for an enhanced familiarisation of the content; and, video debriefs to reflect on relevant behaviours and team processes.

Conclusions

Our simulation was perceived as an effective method to develop SL and GDM within the context of patient safety and healthcare management. Future studies could extend this scenario method to other areas of healthcare service and delivery, and to different sectors that require diverse groups to make complex decisions.

Sharing leadership: current attitudes, barriers and needs of clinical and non-clinical managers in UK’s integrated care system

Background

As systems become more complex, shared leadership (SL) has been suggested to have a dominant role in improving cross-functional working tailored to organisational needs. Little, however, is known about the benefits of SL in healthcare management, especially for UK’s recently formed integrated care system (ICS). The aim of this study was to understand current attitudes, barriers and needs of clinical and non-clinical managers sharing leadership responsibilities in the ICS.

Method

Twenty clinical and non-clinical leaders in 15 organisations were interviewed to understand current cross-functional leadership collaborations, and the potential SL may have on the recently established ICS in the National Health Service (NHS). The data were transcribed and analysed thematically.

Results

Findings showed perceptions and experiences of clinical and non-clinical healthcare management in relation to: (1) motivation to execute a leadership position, including the need to step up and a sense of duty; (2) attitudes towards interdisciplinary working, which is reflected in conflicts due to different values and expertise; (3) SL skills and behaviours, including the need for mutual understanding and cooperative attitudes by means of effective communication and collaboration; and (4) barriers to achieve SL in the ICS, such as bureaucracy, and a lack of time and support.

Conclusions

SL may help improve current leadership cultures within the NHS; however, for SL to have a tangible impact, it needs to be delivered as part of leadership development for doctors in postgraduate training, and development programmes for aspiring, emerging and established leaders, with clear lines of communication.

Institutional stress and job performance among hospital employees

Purpose

The purpose of this study was to investigate if institutional stress is related to job performance among hospital employees, and if institutional stress is fully or partly mediated by motivational resources with regards to the relation with job performance.

Design/methodology/approach

A self-completion survey was distributed to four public hospitals in Norway, and had a response rate of 40% (N = 9,162). Structural equation modelling was conducted on two groups of hospital employees with (N = 795) and without (N = 8,367) managerial responsibilities.

Findings

Institutional stress was negatively related to job performance for hospital employees without managerial responsibilities. The motivational resources autonomy, competence development and social support partly mediated the relationship between institutional stress and job performance in the group of employees without managerial responsibilities. In the leader group, the motivational resources fully mediated the relationship between institutional stress and job performance. Social support from leaders had a non-significant influence on job performance in both groups.

Research limitations/implications

The main limitation with this study is its cross-sectional design.

Originality/value

The study enables us to extend how work-related stress is related to job performance and the mediating role of the job resources autonomy, competence development and social support. The focus on productivity, and top management’s wish to improve hospital performance, may have unintended consequences, leading to a gap between managerial and clinical worldviews and understanding of goals, policies, values and prioritizing. This can lead to institutional stress. The findings of this study suggest that institutional stress has negative effects on hospital employees’ work motivation and job performance.

Dynamics of distributed leadership during a hospital merger

Purpose Mergers have become an influential part of public hospital development, and the successful implementation of such mergers requires skillful management. Recent studies have pointed to the impact of the distribution of leadership tasks amongst employees for implementing planned radical changes, yet this lacks examination with regard to hospital mergers. The purpose of this paper is to investigate the emergence of distributed leadership and this leadership's influence on the implementation of a hospital merger. Design/methodology/approach The emergence of distributed leadership is examined through a qualitative case study of two Danish hospital units in the context of a large hospital merger. The data consist of 21 interviews and documents collected over a three-year period. Findings The findings suggest dynamics of widened and restricted distributed leadership being influenced by and influencing the merger at hospital and local-unit levels, respectively. Importantly, the perceived purpose of widened and restricted distributed leadership mediated the actual effects of widened and restricted distributed leadership on the implementation of a merger. Moreover, the findings show that mergers on both the hospital and local level lead to variations in top-down and bottom-up distributed leadership across pre-merger organizational boundaries. Practical implications Perceived purposeful widening and restriction of distributed leadership at various hospital levels enables merger integration and collaboration across organizational boundaries and hierarchies. Originality/value The paper addresses the need to understand the complex dynamics of widened and restricted leadership distribution in a merger context.

Employee Responses to Empowering Leadership: A Meta-Analysis

A recent and growing number of studies examined how empowering leadership influences employee outcomes. At the individual level, we meta-analyzed 55 independent samples to determine the association between empowering leader behaviors and subordinates’ responses. Results confirmed the positive links of empowering leadership with evaluations of the leader as well as with employee motivation and resources, attitudes, and performance; the strongest correlation was between empowering leadership and attitudes toward the leader (ρ = .59), whereas the weakest correlation was for empowering leadership with behavioral and performance outcomes (ρ = .31). However, the relationship of empowering leadership with subordinates’ emotions was not significant. Examination of potential moderators, including rating sources, nationality of sample, gender, and industry, did not explain much of the heterogeneity in the results. In sum, findings highlight the potential benefit of empowering leadership for individual and organizational outcomes. Thus, more knowledge about what causes empowering leadership could be useful.