Leadership competencies in the context of health services

Developing and Implementing Postoperative Pain Management Guidelines for Breast Cancer Surgery: A Leadership Perspective

Introduction Persistent postoperative pain significantly diminishes the quality of life in breast cancer patients. Effective pain management post-surgery is critical for patient satisfaction, reducing complications, and facilitating quick recovery and hospital discharge. This study addresses the lack of patient-centered postoperative pain management guidelines for breast cancer patients. Aim The primary goal of this study was to develop tailored postoperative pain management guidelines for the local community in the United Arab Emirates, integrating these into a broader network of oncology facilities. Methods and Materials Employing a mixed-methods approach with a qualitative emphasis, the study gathered data from 10 female breast cancer patients (aged 39-65 years) with postoperative satisfaction surveys. Additionally, semi-structured interviews with six healthcare professionals involved in guideline development were conducted. Results A significant 90% of patients reported experiencing moderate-to-extreme pain post-surgery, indicating a need for improved pain management. Key factors identified included the need for enhanced nurse training and patient education on pain management preoperatively. The study team unanimously recognized the necessity for dedicated postoperative guidelines. Conclusion The study underscores the critical need for adequate postoperative pain management in breast cancer care. The findings advocate for creating multidisciplinary, evidence-based guidelines focused on patient-centered care. Furthermore, the study highlights the importance of international collaboration and continuous quality improvement measures, such as the Plan-Do-Study-Act (PDSA) cycle, for developing and refining these guidelines.

Elements of management and leadership strengthening in health systems: a qualitative study from Iran

Purpose

The importance of management capacity in the health sector has been increasingly recognized. The World Health Organization (WHO) (2008) has claimed that limited “management capacity” in low-income countries is one of the main obstacles toward achieving health-related goals. The aim of this study is to answer the research question: “What are the elements of management and leadership capacity of senior managers from the perspective of senior managers.”

Design/methodology/approach

Semi-structured individual interviews were conducted with 20 senior health managers. Sampling method was purposive. Data were collected using a researcher-made interview guide. The transcribed text was analyzed using framework analysis.

Findings

Five main themes emerged from the analysis are: (1) competencies required for managers; (2) selection and appointment of managers; (3) establishment of managers' database; (4) deployment of functional support system; and (5) environmental sensitivity. Each of these themes contains sub-themes.

Research limitations/implications

Due to the COVID-19 pandemic, the interviews were conducted virtually. This may have had an impact on obtaining wealthy data because in a face-to-face interview, it is possible to question and answer, get additional explanations and understand the interviewee's mentality.

Practical implications

Extracting elements of management and leadership capacity helps managers to assess management capacity and leadership comprehensively and effectively. In addition, effective and useful operations can be done to strengthen the management and leadership capacity.

Originality/value

This is the first study that has identified the main elements of management and leadership capacity from the perspective of senior health managers in Iran. This article provides the components of the health system management and leadership capacity that can be used at top management level.

Components of contributing conditions to strengthen health system management and leadership capacity building: a systematic review and decision making framework

PURPOSE

The purpose of this study is to identify components of contributing conditions to strengthen leadership and management capacity in the health system.

DESIGN/METHODOLOGY/APPROACH

A systematic search was undertaken in databases including PubMed, Scopus, Web of Science and local resources of Scientific Information Database and Magiran in January 2020. Two independent researchers checked the research process, screening of articles and quality assessment. The quality of the studies was assessed by JBI critical appraisal tools for qualitative studies. The components of the dimensions of health system management and leadership capacity were categorized according to the WHO conceptual framework using a content analysis approach.

FINDINGS

A total of 17 articles were included in this study. In total, 16 categories of components include human resource information system (n = 5); criteria, plans and procedures for selection and appointment (n = 5); development of education system (n = 11); skills (n = 39); knowledge (n = 8); attitudes (n = 6); behaviors (n = 10); resource and critical management system (n = 7); performance and processes management (n = 3); operational planning for critical systems (n = 4); establish control systems (n = 2); inputs and outputs of organizations (n = 2); accountability and responsibility to customers and stakeholders (n = 4); legal authority and requirements to play the role of managers (n = 9); external and internal environment management (n = 7); establish a system of appreciation and encouragement (n = 6). Each of these categories also contains subcategories.

ORIGINALITY/VALUE

Identifying prerequisite conditions are necessary for building leadership and management capacity in health systems. Therefore, extracted components provide a simple but coherent framework that can be adapted or modified for use in local situations. The components have a variety of uses, including mapping current activities, needs assessment, planning leadership and management development strategies and monitoring and evaluation.

Exploring the Human Factors Affecting Health Service Managers: A Qualitative Study

BACKGROUND

In recent decades, managing health-service systems has faced multiple challenges. Identifying and resolving these challenges promote the efficiency and effectiveness of hospital activities.

AIM

The present study aimed to explore the human factors affecting health service managers.

MATERIAL AND METHODS

In this qualitative study, in-depth unstructured interviews were conducted with 29 employees who were in close contact with the health service managers. All the interviews were transcribed verbatim. Data were collected using purposeful sampling and were analysed using conventional content analysis via MAXQDA software.

RESULTS

A group of 29 participants were interviewed (male 65.5%, female 34.4%). "Managing managers" has been identified as the primary theme with four supporting secondary themes including the inappropriate appointment of managers, the impact of human and social needs of managers, influential employees, and disrupting organisational communications. These are the challenges faced by managers in managing human resources in health-service organisations.

CONCLUSION

Results showed that employees manage their managers within the organisation so that they can prevent managers from concentrating on their management affairs and tasks resulting in the distortion of management practices. The results of this study can help the key policy makers and planners in health-service organisations to guide the organisation to pursue its goals through appointing appropriate managers and identifying influential employees.

Elements for harnessing participatory action research to strengthen health managers' capacity: a critical interpretative synthesis

BACKGROUND

Health managers play a key role in ensuring that health services are responsive to the needs of the population. Participatory action research (PAR) is one of the approaches that have been used to strengthen managers' capacity. However, collated knowledge on elements for harnessing PAR to strengthen managers' capacity is missing. This paper bridges this gap by reviewing existing literature on the subject matter.

METHODS

A critical interpretive synthesis method was used to interrogate eight selected articles. These articles reported the use of PAR to strengthen health managers' capacity. The critical interpretive synthesis method's approach to analysis guided the synthesis. Here, the authors interpretively made connections and linkages between different elements identified in the literature. Finally, the Atun et al. (Heal Pol Plann, 25:104-111, 2010) framework on integration was used to model the elements synthesised in the literature into five main domains.

RESULTS

Five elements with intricate bi-directional interactions were identified in the literature reviewed. These included a shared purpose, skilled facilitation and psychological safety, activity integration into organisational procedures, organisational support, and external supportive monitoring. A shared purpose of the managers' capacity strengthening initiative created commitment and motivation to learn. This purpose was built upon a set of facilitation skills that included promoting participation, self-efficacy and reflection, thereby creating a safe psychological space within which the managers interacted and learnt from each other and their actions. Additionally, an integrated intervention strengthened local capacity and harnessed organisational support for learning. Finally, supportive monitoring from external partners, such as researchers, ensured quality, building of local capacity and professional safety networks essential for continued learning.

CONCLUSIONS

The five elements identified in this synthesis provide a basis upon which the use of PAR can be harnessed, not only to strengthen health managers' capacity, but also to foster other health systems strengthening initiatives involving implementation research. In addition, the findings demonstrated the intricate and complex relations between the elements, which further affirms the need for a systems thinking approach to tackling health systems challenges.

Management and leadership competence in hospitals: a systematic literature review

Purpose

– The purpose of this study is to describe the characteristics of management and leadership competence of health-care leaders and managers, especially in the hospital environment. Health-care leaders and managers in this study were both nursing and physician managers. Competence was assessed by evaluating the knowledge, skills, attitudes and abilities that enable management and leadership tasks.

Design/methodology/approach

– A systematic literature review was performed to find articles that identify and describe the characteristics of management and leadership competence. Searches of electronic databases were conducted using set criteria for article selection. Altogether, 13 papers underwent an inductive content analysis.

Findings

– The characteristics of management and leadership competence were categorized into the following groups: health-care-context-related, operational and general.

Research limitations/implications

– One limitation of the study is that only 13 articles were found in the literature regarding the characteristics of management and leadership competence. However, the search terms were relevant, and the search process was endorsed by an information specialist. The study findings imply the need to shift away from the individual approach to leadership and management competence. Management and leadership need to be assessed more frequently from a holistic perspective, and not merely on the basis of position in the organizational hierarchy or of profession in health care.

Originality/value

– The authors’ evaluation of the characteristics of management and leadership competence without a concentrated profession-based approach is original.

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

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

Use of card sort methodology in the testing of a clinical leadership competencies model

The purpose of this paper is to examine the utility of a qualitative 'card sort' research tool - when it is merged with traditional quantitative data gathering methods - to add to our understanding about the nature of competency-based approaches to leadership studies. The study demonstrates how a qualitative technique (card sort) was used for the task of testing a clinical leadership competencies model. All the steps in the card sort methodology are described through its application to the research problem. The paper concludes that card sort has considerable use in adding to the validity of research into the competency approach to leadership. The study reports only one single case. Therefore, the technique must be repeated to secure its validation as a testing technique. The card sort method is proven to be a viable tool to ascertain the individual subjects perceptions regarding competencies. The methodology is described in sufficient detail so as to enable its replication and application by professionals and academic researchers alike. Both groups will find this methodology useful and interesting. The paper seeks to improve upon existing methods for studying leadership competencies. By addressing the limitations of different methods, and also by merging different independent approaches, this project provides an innovative integrated knowledge that can be of significant value.