leadership in healthcare assignment

Healthcare Leadership: What Is It and Why Is It Important?

Industry Advice Healthcare Leadership

There’s an immense need, now more than ever, for effective leadership in healthcare. Specifically, the global pandemic has highlighted the importance of innovative healthcare leaders who are able to quickly formulate effective solutions. Additional challenges such as healthcare accessibility and affordability require effective forward-thinking leaders.

If you’re interested in learning more about how you can make a mark in healthcare today, here’s an overview of what healthcare leadership is, why it’s important, and what makes an effective leader in the healthcare system.

What is Healthcare Leadership?

Leadership is often defined as an ability to manage a team effectively. This definition, however, is only a part of what makes an effective leader. Healthcare leadership isn’t about maintaining the status quo, but identifying challenges in the system and finding solutions to those problems.

According to Dr. Robert Baginski, the program director of Northeastern University’s Doctor of Medical Science (DMSc) in Healthcare Leadership program, “Healthcare leadership is taking an active role in the direction of healthcare today.” It involves more than managing a healthcare organization, overseeing staff, or dealing with insurance. Baginski continues to explain that “Healthcare leadership ideally should be guiding healthcare in the direction that we feel it should go in the future.”

Importance of Leadership in Healthcare

Effective leadership in healthcare is incredibly important, especially when considering the expense of modern care. Here’s a closer look at the various ways that effective leadership can make a lasting impact.

1. Improves Quality of Care

Effective leadership is integral to quality healthcare . If a healthcare team is uncoordinated or unfocused, patients often pay the price. Great leaders facilitate communication, boost productivity, and put others first. This ability is critical to quality patient care since healthcare often requires a rapid response to issues that arise. In such situations, communication and efficiency are vital.

2. Creates Adaptable Leaders

One of the most prominent examples of needing adaptability in healthcare is the COVID-19 pandemic. In 2020, the American Psychological Association identified seven crucial leadership qualities necessary for combatting the pandemic.

• Effective stress management
• Empathy and optimism when sharing information
• Building trust with expertise and dependability
• Honesty and transparency
• Consistent communication
• Openness to feedback
• Should be role models

When unpredictability and uncertainty is rampant, effective leadership is crucial. An excellent leader won’t just be able to navigate a stressful situation but also lead others through it and find solutions for the future.

3. Encourages Forward-Thinking

Leadership and management are often used as synonyms, but the reality is that leadership involves much more than the day-to-day operations of a business. Healthcare in particular has a need for leaders who are looking to the future of healthcare and how to improve it.

While healthcare leadership is important to every country, according to the World Population Review , the United States has higher healthcare costs than any other country. Furthermore, while the number of uninsured individuals in the U.S. is lower than ever , the healthcare system is highly dependent on access to this type of coverage.

According to a report from the Peterson-KFF Health System Tracker , compared to similar countries, the United States has:

• The highest pregnancy-related mortality rate
• A higher-than-average rate of diabetes and congestive heart failure
• A higher percentage of reported medication and treatment errors than the majority of comparable countries

According to Baginski, improvements to the healthcare system are possible with effective leadership. “Ideally, I feel healthcare should be looking to the future, toward solutions where we can provide the best and the most healthcare to those who need it most, regardless of insurance status, access to money, or where they live.”

4. Produces Innovative Leaders

One of the most prevalent challenges facing the healthcare industry today is the chronic shortage of healthcare professionals . An increasing number of healthcare professionals are experiencing burnout, and approximately 47 percent of healthcare workers in the U.S. are planning to leave their current position within the next three years. A 2022 survey of 1,000 healthcare staff found that 48 percent don’t believe their organization is doing enough to address burnout.

The healthcare industry is in need of leaders who are able to identify the problems that are leading to burnout and resolve them. Baginski explains that good leaders do two things differently when compared to ineffective leaders:

• Identification: Recognizing problems as they arise, and proactively considering potential problems. For example, the same survey reported that 57 percent of healthcare workers are concerned that their highly repetitive tasks will ultimately lead to burnout.
• Innovation: Finding solutions to those problems and contributing to the future of healthcare. To address the repetitive tasks in healthcare, many healthcare workers are hopeful that technology and automation will improve their overall experience and allow them to focus more closely on patient care.

What Makes a Healthcare Leader Effective?

Individuals who take on a leadership role in healthcare need several skills to be effective. Five essential leadership skills in healthcare are:

• Mentorship: An effective leader doesn’t stand above others but seeks to foster leadership qualities in them.
• Challenging the status quo: Leaders aren’t content with the status quo but are always seeking opportunities to innovate and improve.
• Educating others: In addition to mentoring others at the individual level, effective leaders seek to educate others outside of their direct influence.
• Humility: An effective leader isn’t afraid to accept feedback or criticism. Since much is unknown about healthcare, mistakes are often inevitable. A good leader will admit their mistakes or skill and expertise gaps.
• Creating opportunities for others: Leaders always look to the future. Instead of sole personal improvement, an effective leader will prioritize helping the next generation of healthcare professionals obtain leadership traits.

One of the most detrimental traits to quality healthcare is complacency. Self-satisfaction often leads to stagnation rather than proactivity. An effective leader recognizes their limitations and understands that there’s always something new to learn. According to Baginski, “Bad leadership is keeping things as they always have been because that’s the way they’ve been done previously. That doesn’t get you anywhere.”

Ready to Develop Your Leadership Skills?

If you’re hoping to advance your career in healthcare to a leadership position, it’s important to ensure that you’re prepared. One of the best ways to obtain the relevant skills and qualifications to advance to a leadership role is to obtain a relevant degree.

“Get all of your education and your experience first, and then get all of your information before you address that problem,” says Baginski. “Learn how to critically assess information and get all your ducks in a row before you start to confront change.”

If you want to become a more effective leader and advance your career, consider obtaining Northeastern University’s Doctor of Medical Science (DMSc) in Healthcare Leadership . This degree will provide you with the skills and knowledge necessary to take your first steps into a successful leadership role.

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Leadership in Healthcare: A Review of the Evidence

• In Healthmanagement
• Mon, 11 May 2015

HealthManagement, Volume 15 - Issue 2, 2015

The delivery of clinical care is based on careful research to determine the most effective way of providing care for patients. At the same time the UK National Health Service (NHS) spends huge amounts on leadership development without a clear understanding of what kind of leadership and leadership development has most impact on patient outcomes.

The Leadership Task

The leadership task is to ensure direction, alignment and commitment within teams and organisations (Drath et al. 2008). Direction ensures agreement among people in relation to the organisation’s vision, values and strategy. Alignment refers to effective coordination of the work. Commitment is manifested by everyone in the organisation taking responsibility and making it a personal priority to ensure the success of the organisation as a whole, rather than focusing only on their individual or immediate team’s success in isolation.

Research Evidence

Despite thousands of publications on the topic of leadership in healthcare, a recent review (West et al. 2015) reveals relatively little research conducted to a high academic standard. In addition, much of what is written about leadership and much effort on leadership development in the NHS is based on fads and fashions rather than theory-driven evidence. Moreover, successive government reviews often fail to draw on the evidence base, only adding confusion via strong opinion to the vast body of writing on what constitutes good leadership in healthcare. The evidence is clear though: leadership at every level – from frontline leadership in wards, primary care and community mental health teams, to board leadership in trusts, to national leadership in overseeing bodies – is influential in determining organisational performance. The evidence points towards the need for what we call collective leadership. Collective leadership is characterised by shared leadership, where there is still a formal hierarchy, but power is more dependent on who has the expertise at each moment. Leadership is most effective w hen all staff, e specially doctors, nurses and other clinicians, accept responsibility for their leadership roles. Collective leadership is characterised by leaders working together to nurture a shared culture, adopting leadership styles that are consistent across the organisation, and cooperating and supporting each other across boundaries within the organisation to deliver continually improving, high quality and compassionate patient care.

We conducted a literature review across a large number of databases, including Business Source Complete (EBSCO), Web of Science, British Nursing Index (BNI), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and JSTOR. We limited our search terms to articles published in the last 10 years, in English, and peer-reviewed. A separate review was conducted, which looked at the grey literature and trade press. Below, we briefly summarise some of the evidence we found from our review, in relation to key leadership groups.

Nurse Leaders

Nurses prefer managers who are participative, facilitative and emotionally intelligent, and such styles are in turn linked to team cohesion, lower stress, and higher empowerment and self-efficacy. Effective nurse leaders are characterised as flexible, collaborative, power-sharing, and as using personal values to promote high quality performance. Van Bogaert et al. (2010) examined the effects of nursing environments and burnout on job outcomes and quality of care. Nursing management was positively related to perceived quality of care and staff satisfaction in this study, while other studies found relationships with medication errors and staff levels of wellbeing, burnout and turnover intention. In their literature review Wong et al. (2013) also note a relationship between nurses’ relational leadership styles and lower levels of mortality rates and medication errors.

Katrinli et al. (2008) examined the quality of nurse managers’ relationships with their staff, nurses’ organisational identification, and whether job involvement mediated any relationship between these factors. When nurse leaders gave nurses opportunities for participation in decision-making, nurses reported high levels of organisational identification and job performance as a consequence. Empowerment of nurses to bring about quality improvement emerges from the literature as a possible key factor. Wong and Laschinger (2013) describe how authentic leadership can influence job satisfaction and outcomes through empowerment. Authentic leadership is characterised by honesty, altruism, kindness, fairness, accountability, and optimism; authenticity implies consistency with values of providing high quality and compassionate patient care.

Medical Leaders

In a large scale review of medical leadership models Dickinson et al. (2013) found that medical or clinical leadership varied across the case study sites they assessed. There were reported variations both between and within organisations in the extent to which doctors felt engaged in the work of their organisations. Those organisations with high levels of medical engagement performed better on available measures of organisational performance than others. In an earlier study Hamilton et al. (2008) found that in high-performing trusts, interviewees consistently identified higher levels of medical engagement. Additionally, Veronesi et al. (2013) examined strategic governance in NHS hospital trusts, and found that the greater the percentage of clinicians on governing boards the better the performance, patient satisfaction and morbidity rates (inversely) were.

Team Leaders in Healthcare

Effective team working is an essential factor for organisational success, frequently cited in the grey literature. The largest study to date used team member ratings of leadership in an NHS sample of 3,447 respondents. The results revealed that leadership clarity was associated with clear team objectives, high levels of participation, commitment to quality of care and support for innovation. Where there was conflict about leadership within the team, team processes and outcomes were poor. However, more recent metaanalyses of research consistently indicate that, across sectors, shared leadership in teams predicts team effectiveness (eg D’Innocenzo et al. 2014; Wang et al. 2014). These findings are not inconsistent, because having a clearly designated team leader may be associated with less conflict over leadership and as a consequence the enhanced ability of team members to smoothly assume leadership roles and responsibilities when their expertise is relevant.

Organisational Leaders

In one of the few studies examining the relationship between leadership and organisational outcomes in healthcare, Shipton et al. (2008) investigated the impact of leadership and climate for high quality care on hospital performance. The research revealed that top management team leadership predicted the performance of hospitals. Specifically, top management team leadership was strongly and positively associated with clinical governance review ratings, hospital ‘star’ ratings, and significantly lower levels of patient complaints.

Leadership, Culture and Climate in Healthcare

In the largest study of culture in the English National Health Service (NHS), Dixon-Woods et al. (2014) concluded that six key elements were necessary for sustaining cultures that ensure high quality, compassionate care for patients: inspiring visions operationalised at every level by leaders; leaders ensuring clear aligned objectives for all teams, departments and individual staff; supportive and enabling people management; high levels of staff engagement; leaders focused on ensuring learning, innovation and quality improvement in the practice of all staff; and effective team working.

Another large scale, longitudinal study, involving all 390 NHS organisations in England, identified a link between aspects of climate (eg working in wellstructured team environments, support from immediate managers, opportunities for contributing toward improvements at work) and a variety of indicators of healthcare organisation performance (West et al. 2011). Climate scores were linked to outcomes such as patient mortality, patient satisfaction, staff absenteeism, turnover intentions, quality of patient care and financial performance. The results revealed (among many other relevant relationships) that patient satisfaction was highest in organisations that had clear goals, and whose staff saw their leaders in a positive light. Staff satisfaction was directly related to subsequent patient satisfaction.

Leader and Leadership Development

Leader and leadership development are vital for healthcare, with considerable resources dedicated from budgets always under great pressure. In the UK, NHS England has invested many tens of millions of pounds through the NHS Leadership Academy in order to increase leadership capabilities across the NHS. Summative figures for local and regional investment are lacking, but estimates are between 20 and 29 percent of an organisation’s training and development budget is dedicated to leadership development.

One approach relies on the definition of leadership competencies. Numerous competency frameworks, competency libraries and assessments are available off-the-shelf, and organisations have been using them for many years to map the leadership competencies required for the success of their organisations. The UK NHS competency orientation derives from the multiple and overlapping competency frameworks and career structures developed over recent years. A wide range of programmes based on these competency models have been delivered, and varied instruments are used to underpin these competency frameworks, with the majority having, at best, poor psychometric properties and unclear theoretical underpinnings. Consequently there is little evidence that the use of these competency frameworks translates into improved leader effectiveness or evidence about which framework is most appropriate. The research literature on leadership generally does not yet show that competency frameworks are potent in enabling leaders to improve their effectiveness.

Evidence of the effectiveness of leader development in healthcare mainly derives from research with medical and other clinical leaders. One-off programmes generally do not provide the sustained support and continual improvement in leadership training likely to be necessary to ensure impact on key outcomes, such as quality of care. However, there are examples of more successful programmes from within the NHS such as the Royal College of Nursing Clinical Leadership Programme (CLP), which has been offered since 1995, and which has been shown as successful in improving nurses’ transformational leadership competencies. There is no evidence of benefits to patient care, however.

In comparison with the focus on leader development, leadership development – the development of the capacity of groups and organisations for leadership as a shared and collective process – is far less well explored and researched. However, as previously noted much of the available evidence, particularly in the NHS, highlights the importance of collective leadership, and advocates a balance between individual skill-enhancement and organisational capacity building. Research evidence suggests the value of this, particularly at team level: meta analyses demonstrate that shared leadership in teams predicts team effectiveness, particularly, but not exclusively, within healthcare.

The need for leadership cooperation across boundaries is not only intra organisational. Health and social care services must be integrated in order to meet the needs of patients, service users and communities both efficiently and effectively. Healthcare has to be delivered increasingly by an interdependent network of organisations. This requires that leaders work together, spanning organisational boundaries both within and between organisations, prioritising overall patient care rather than the success of their component of it. That means leaders working collectively and building a cooperative, integrative leadership culture – in effect collective leadership at the system level.

The implication of this new understanding of leadership is that our approach to leader and leadership development is distorted by a preoccupation with individual leader development (important though it is), often provided by external providers in remote locations. Developing collective leadership for an organisation depends crucially on context and is likely to be best done ‘in house’ with expert support, highlighting the important contribution of Organisation Development and not just Leader Development.

Evidence-based approaches to leadership development in healthcare are needed to ensure a return on the huge investments made. It remains true that experience in leadership is demonstrably the most valuable factor in enabling leaders to develop their skills, especially when they have appropriate guidance and support. Focusing on how to enhance such learning from experience should also be a priority.

National Level Leadership

National level leadership plays a major role in influencing the cultures of NHSorganisations. Many reports have called for the bodies that provide national leadership to develop a single integrated approach, characterised by a consistency of vision, values, processes and demands. The approach of national leadership bodies is most effective when it is supportive, developmental, appreciative and sustained; when health service organisations are seen as partners in developing health services; and when health service organisations are supported and enabled to deliver ever improving high quality patient care. The cultures of these national organisations should be collective models of leadership and compassion for the entire service.

Conclusions

The key challenge facing all NHS organisations is to nurture cultures that ensure the delivery of continuously improving high quality, safe and compassionate care. Leadership is the most influential factor in shaping organisational culture, so ensuring the necessary leadership behaviours, strategies and qualities are developed is fundamental. There is clear evidence of the link between leadership and a range of important outcomes within health services. The challenges that face healthcare organisations are too great and too many for leadership to be left to chance, to fads and fashions or to piecemeal approaches. This review suggests that approaches to developing leaders, leadership and leadership strategy can and should be based on robust theory with strong empirical support and evidence of what works in healthcare. Healthcare organisations can confidently face the future and deliver the high quality, compassionate care that is their mission by developing and implementing leadership strategies that will deliver the cultures they require to meet the healthcare needs of the populations they serve.

• Leadership in NHS organisations needs to ensure direction, alignment and commitment to the core task of developing cultures that deliver continually improving, high-qualit y and compassionate patient care.
• Leaders need to wor k together, spanning boundaries within and between organisations, prioritisingoverall patient care rather than the success of individual components, and to build a cooperative, integrative leadership culture – in ef fect collective leadership.
• Developing collective leadership for an organisation depends crucially on local contexts and is likely to be done best ‘in house’ with exper t suppor t , integrating both organisational development and leadership development .
• Evidence-based approaches to leadership development in healthcare are needed to ensure a return on the huge investments made.

References:

Dickinson H, Ham C, Snelling I et al. (2013). Are we there yet ? Models of medical leadership and their effectiveness: An exploratory study. Final report. NIHR Service Delivery and Organisation programme. [Accessed: 7 April 2015] Available from http://www.netscc.ac.uk/hsdr/files/project/SDO_FR_08-1808-236_V07.pdf

D’Innocenzo L, Mathieu JE, Kukenberger MR (2014) A meta-analysis of different forms of shared leadership–team performance relations. Journal of Management 0149206314525205, doi:10.1177/0149206314525205.

Dixon-Woods M, Baker R, Charles K et al. (2014) Culture and behaviour in the English National Health Service: overview of lessons from a large multimethod study. BMJ Qual Saf, 23(2): 106-15.

Drath WH, McCauley CD, Palus CJ et al. (2008) Direction, alignment, commitment: Toward a more integrative ontology of leadership. The Leadership Quarterly, 19(6): 635-53.

Hamilton P, Abraham R, Bamford C et al. (2008) Engaging doctors: can doctors influence organisational performance. Coventry: NHS Institute for Innovation and Improvement. [Accessed: 7 April 2015] Available from http://www.institute.nhs.uk/images//documents/BuildingCapability/Medical_Leadership/49794_Engaging_Doctors.pdf

Katrinli A, Atabay G, Gunay G et al. (2008) Leadermember exchange, organizational identification and the mediating role of job involvement for nurses.Journal Adv Nurs, 64(4): 352-62.

Shipton H, Armstrong C, West M et al. (2008) The impact of leadership and quality climate on hospital performance. Int J Qual Health Care, 20(6): 439–45.

Van Bogaert P, Kowalski C, Weeks SM et al. (2013) Impacts of unit-level nurse practice environment, workload and burnout on nurse-reported outcomes in psychiatric hospitals: a multilevel modelling approach. Int J Nurs Stud, 50(3): 357–65.

Veronesi G, Kirkpatrick I, Vallascas F (2013) Clinicians on the board: what difference does it make? Soc Sci Med, 77: 147-55.

Wang D, Waldman DA, Zhang Z (2014) A meta-analysis of shared leadership and team effectiveness. J Appl Psychol, 99(2): 181–98.

West M, Armit K, Lowenthal L et al. (2015) Leadership and leadership development in health care: the evidence base. [Accessed: 7 April 2015] Available from http://www.kingsfund.org.uk/publications/leadership-and-leadership-developmenthealth-care

West M, Dawson J, Admasachew L et al. (2011) NHS staff management and health service quality: results from the NHS staff survey and related data. [Accessed: 7 April 2015] Available from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215455/dh_129656.pdf

Wong C, Cummings GG, Ducharme L (2013) The relationship between nursing leadership and patient outcomes: a systematic review update. J Nurs Manag, 21(5): 709–24.

Wong CA, Laschinger HK (2013) Authentic leadership, performance, and job satisfaction: the mediating role of empowerment. J Adv Nurs, 69(4): 947–59.

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Leadership in healthcare education

• Christie van Diggele 1 , 2 ,
• Annette Burgess 2 , 3 ,
• Chris Roberts 2 , 3 &
• Craig Mellis 4  

BMC Medical Education volume  20 , Article number:  456 ( 2020 ) Cite this article

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Effective leadership is a complex and highly valued component of healthcare education, increasingly recognised as essential to the delivery of high standards of education, research and clinical practice. To meet the needs of healthcare in the twenty-first century, competent leaders will be increasingly important across all health professions, including allied health, nursing, pharmacy, dentistry, and medicine. Consequently, incorporation of leadership training and development should be part of all health professional curricula. A new type of leader is emerging: one who role models the balance between autonomy and accountability, emphasises teamwork, and focuses on improving patient outcomes. Healthcare education leaders are required to work effectively and collaboratively across discipline and organisational boundaries, where titles are not always linked to leadership roles. This paper briefly considers the current theories of leadership, and explores leadership skills and roles within the context of healthcare education.

Leadership has many interpretations, and has been likened to “ the abominable snowman whose footprints are everywhere but who is nowhere to be seen” [ 1 ]. It is an influential process, through which groups of people work towards the achievement of a common goal [ 2 ]. Leaders have the ability to shape and influence their followers’ values, attitudes and behaviours through a dyadic relationship. They are able to gain and enlist the support of others in order to achieve shared goals [ 3 , 4 ]. Effective leadership is a complex and highly valued component of healthcare education, increasingly recognised as essential to the delivery of high standards of education, research and clinical practice [ 3 ]. In order to achieve more effective outcomes, leadership and management skills are now an expectation and requirement in the healthcare education setting [ 5 ]. However, leaders within healthcare education should not rely on formal positions of authority, but instead, utilise their own appropriate leadership qualities irrespective of their level within the organisation [ 3 ]. A new type of leader is emerging: one who role models the balance between autonomy and accountability, emphasises teamwork, and focuses on improving patient outcomes [ 3 ]. This paper briefly considers the theories of leadership, and explores leadership skills and roles within the context of healthcare education.

Management versus leadership

Management and leadership are considered just as important as each other in accomplishing organisational goals. However, there are differences in the functions of the two roles. Management produces order and consistency, while leadership produces change and movement [ 2 ]. Management has the responsibility of organising all elements within the organisation, so that the leader’s vision and goals are successfully achieved. If poor management is in place, then goals cannot be achieved; and if poor leadership is in place, then there is no clear goal or vision to work towards. Leadership is seen as “setting direction, influencing others and managing change: with management concerned with the marshalling and organisation of resources and maintaining stability” [ 6 ]. These differences are summarised in Table  1 [ 6 , 7 ]. 

Transactional and transformational leadership

Leadership is a social construct, and there are many different leadership models [ 6 ]. Two broad types of leadership are identifiable: “transactional” and “transformational”. And their respective features are a useful way to think about the many types of leadership. Transactional and transformational leadership models are normally amalgamated within organisations to “empower others” (transformational) while holding individuals “accountable” (transactional) for their actions [ 7 , 8 , 9 ]. While it is clear that both transformational and transactional leadership paradigms are needed for an organisation to be effective, the optimal leader predominantly practices the transformational aspects of leadership, rather than transactional [ 10 ].

Transactional leadership

The transactional model is seen as an authoritative relationship that is transaction based, where exchanges occur between a leader and follower, once specific goals are identified or decided upon. Transactional leaders value order and structure, and have formal authority, with positions of responsibility within organisations. They achieve organisational goals through a rewards system and through positive reinforcement. A weakness of this model is the lack of innovation, as individuals are driven by predetermined outcomes, and there is lack of incentive and motivation to perform beyond what is expected [ 6 ].

Transformational leadership

Since the introduction of transformational leadership, the concept of leadership has undergone a major shift from representing an authoritative relationship (transactional), to a process of influencing individuals (transformational). Transformational leadership involves leadership through the transformation of individuals or ‘followers’, to work towards a common organisational goal [ 9 , 10 , 11 ]. This contemporary form of leadership is based on inspiring individuals, and forming teams to achieve goals. Transformational leaders define organisations through the articulation of a clear vision and clear values. The four “I”s of transformational leadership are outlined in Table  2 [ 9 ].

Team leadership

More recently, the focus has shifted towards “team leadership” , with distributed leadership becoming more prevalent within healthcare education, where different professions share influence [ 12 , 13 ]. Increasingly, leadership involves a collaborative role, with an emphasis on shared leadership and thoughtful allocation of responsibilities. Team-based organisations shift central control from the one leader, to the team. Teams are comprised of members who are interdependent, needing to coordinate their activities in order to accomplish their shared goals [ 14 , 15 ]. Personal autonomy, accountability, appropriate recognition, and clarity of roles, are all elements that contribute to optimal team performance. However, to ensure success, the organisational culture needs to support the involvement of individuals in these teams, and encourage leadership qualities [ 15 ]. Teams often fail when they exist in a traditional authority structure, where organisational culture is not supportive of collaborative work, and lower level decision making. Distributed leadership entails sharing of influence by team members, who step forward, or take a step back as needed. Leadership is provided by the person who meets the specific needs of the team at the time, hence providing faster responses to more complex issues in today’s organisations [ 15 , 16 , 17 ]. Effective leaders have an understanding of the conditions needed for teams to function well. For a team to achieve its potential, the operational roles of its members should be matched to their members’ abilities [ 18 ]. Belbin (1991) classified nine roles of team members that contribute to its process and function [ 19 ], outlined in Table  3 . Importantly, within team leadership, no single team role should be regarded as more important than another. Successful teams thrive on their diversity, drawing from the strengths of each member [ 13 ].

Effective leadership

Leaders need to have good time management and organisational skills, the ability to network professionally, display political nous and most importantly, they need to have strong communication skills [ 4 , 20 , 21 ]. Ready acceptance of feedback and self-awareness are important in development of leadership skills [ 20 , 21 ]. Behaviour, habits and biases can be deliberately corrected by utilising received feedback. Although there is not one set of qualities that apply to being an effective leader, certain competencies are valued and contribute to the leadership model in different ways [ 5 ]. Leadership competencies relevant for all health professional educators are outlined in Table  4 [ 3 ].

Language of leadership

Just as education and healthcare organisations have evolved, so too has the team leader. The role of the modern leader reinforces the tenets of stepping forward, collaborating and contributing. This role involves encouraging others by practising followership, and lending meaningful support to other leaders. As already stated, when it comes to leadership, excellent communication skills are a must. In order for successful communication to occur, both the sender and receiver must understand the message. This means that active listening is just as important as active talking [ 22 ]. Language used needs to be [ 22 ]:

Communicate with clarity of your purpose and the role of others

Stimulating

Deliver messages in a powerful, inspiring and dramatic way

Lead by example and walk the talk

Include active listening

Acknowledge what has been communicated, and use questioning skills

Show that you value others and their contributions

Challenges for leaders in healthcare education

There are a number of unique challenges in healthcare education. Healthcare education is delivered across professional disciplines, and notably, across organisational boundaries, involving universities, hospitals, and healthcare services. In turn, these organisations are bound by their own systems, structures, policies, cultures and values. At some point, most leaders in healthcare education need to make a decision about their leadership direction, and whether it lies predominantly in higher education or the clinical setting; and whether it lies in undergraduate education or postgraduate education. It can be difficult to merge roles between organisations, and McKimm (2004) has identified a number of issues and challenges specific to health education leaders, outlined in Table  5 [ 22 , 23 ]. Throughout a career, it may be necessary to maintain an awareness of available opportunities within organisations, and match these to the required experiences and capabilities [ 22 , 23 ] (see Fig. 1 ).

Reflection task

Development of leadership skills

Workforce data indicates that many experienced clinicians and healthcare educators will retire over the next ten years [ 24 , 25 ]. The need for effective succession planning and leadership training is well recognised [ 25 , 26 , 27 ], with a current shortage of emerging leaders moving into leadership roles. Effective leaders need to be nurtured and supported by the organisations in which they are educated, train and work [ 6 ]. As a learned skill, the topic of leadership is gathering momentum as a key curriculum area. Leadership development, assessment and feedback are necessary throughout the education and training of health professionals. Aspiring and current leaders can be identified, trained and assessed through formal leadership development programs, and through supportive organisational cultures. This requires embedding leadership training programs, opportunities for leadership practice, and promotion of professional networks within and beyond the organisation. The importance of mentorship within healthcare education is well recognised, offering a means to further enhance leadership and engagement within the workforce [ 28 ].

While many are assigned as leaders through their job title, it is important to identify, support and develop emerging leaders [ 2 ]. Leadership consists of a learnable set of practices and skills that can be developed by reading literature and attending leadership courses [ 29 ]. Additionally, investment in the social capital of organisations, fostering interprofessional learning and communication in the work setting, and collaboration across organisations assists in leadership development. Developing leadership skills is a life-long process [ 21 ]. Resources and opportunities should be considered to assist in the development of leadership skills. Some examples include:

Reading about leadership e.g. theories on leadership styles

Attending leadership training workshops

Participating in mentorship programs either as mentee or mentor

Joining small group seminars on leadership development

Accepting more responsibilities when required, or when opportunities arise.

Process for effective leadership

A title is not required to enable effective leadership. Leadership may occur in everyday work, and occurs in collaboration with other professionals within the education and healthcare systems. For example, leadership in teaching, administration, research, and/or excellence in clinical practice.

Leadership roles include the important concept of management of both personal and professional practice. Priorities need to be set and time managed to integrate work and personal life. Tools can be used to stay organised, and deliberately manage busy schedules. Effective delegation may be used to share the work of new projects:

Organisation to ensure an understanding of tasks, priorities and deadlines

Establish steps and a sequence to achieve the desired outcomes

List required resources, considering the competencies of individual team members, and match tasks appropriately (also consider skill development needs)

Communicate with team members, monitor progress in activities and provide guidance to team members.

Leadership competencies, and the incorporation of leadership development as part of curricula, are identified as important across all health professions, including allied health, nursing, pharmacy, dentistry, and medicine, in meeting the needs of healthcare in the twenty-first century [ 30 ]. With an increase in interprofessional teams and an emphasis on collaboration, more effective outcomes are achieved [ 5 ]. Healthcare education leaders are required to work effectively and collaboratively across discipline and organisational boundaries, where titles are not always linked to leadership roles, but may occur in everyday work. Good leadership also means knowing when, and how to support others in their endeavours. Provision of opportunities for leadership development is crucial in improving education sectors and health services, and effecting change. The future belongs to healthcare education leaders who demonstrate excellence in teamwork, clinical skills, patient centred care [ 3 ], and responsibly balance accountability with autonomy.

Take-home message

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Abbreviations

Human Resources

Bennis W, Nanus. Leaders: the strategies for taking charge. New York: Harper & Row; 1985.

Google Scholar  

Northouse P. Leadership: theory and practice. 6th ed. London: Sage; 2011.

Oates K. The new clinical leader. J Paediatr Child Health. 2012;48(6):472–5.

Article   Google Scholar  

Laverack G. The pocket guide to health promotion. McGraw-Hill Education: Maidenhead; 2014.

Clarke J. In: Patole S, editor. Management and Leadership – A Guide for Clinical Professionals. Switzerland: Springer International Publishing; 2015.

Swanwick T, McKimm J. What is clinical leadership and why is it important. Clin Teach. 2011;8:22–6.

Byrman A. Leadership in organisations. In: Clegg SR, Harvey C, Nord WR, editors. Handbook of Organisational studies. London: Sage; 2006.

Westley F, Minztberg H. Visionary leadership and strategic management. Strateg Manag J. 1989;10:17–37.

Bass B, Avolio B. Improving Organisational effectiveness through transformational leadership. Thousand Oaks, CA: Sage; 1994.

Coulson A. The managerial work of Headteachers. Sheffield: Sheffield City Polytechnic; 1986.

Alimo-Metcalfe B, Alban-Metcalfe J. Leadership in public organisations. In: Storey, editor. Leadership in Organisations: current issues and key trends. London: Routledge; 2004.

McKimm J, Swanwick T. Educational leadership. Scotland, Edinburgh: Associate for the Study of Medical Education; 2007.

Levi D. Group dynamics for teams. Thousand Oaks, CA: Sage; 2011.

Burgess A, McGregor D, Mellis C. Applying guidelines in a systematic review of team-based learning in medical schools. Acad Med. 2014;89(4):678–88.

Pearce CL, Manz CC, Sims HP. Where do we go from here? Is shared leadership the key to team success? Orgnisational Dynamics. 2009;38(3):234–8.

Morgeson FP, DeRue DS, Karan EP. Leadership in teams: a functional approach to understanding leadership structures and processes. J Manag. 2010;36(1):5–39.

Kozlowski SWJ, Gully SM, Salas E, Cannon-Bowers JA. Team leadership and development: theory, principles, and guidelines for training leaders and teams. Dallas, TX: Third Symposium on Work Teams, University of North Texas; 1995.

Tuckman B. Developmental sequence in small groups. Psychol Bull. 1965;63:384–9.

Belbin RM. Management teams: why they succeed or fail. London: Heinmann; 1991.

Glover Takahshi S, Abbott C, Oswalk A, Frank JR. CanMEDS Teaching and Assessment Tools Guide. Royal College of Physicians and Surgeons of Canada; 2015.

Clawson J. Level three leadership: Getting below the surface (3rd ed.). Saddle River, N.J: Pearson Prentice Hall; 2006.

McKimm J. Developing tomorrow’s leaders in health and social care education. Case studies in leadership in medical and health care education. Special report 5. Newcastle-upon-Tyne: Higher Education Academy, Medicine Dentistry and Veterinary Medicine, 2004.

McKimm J, Swanwick T. Leadership development for clinicians: what are we trying to achieve? Clin Teach. 2011;8:181–5.

Norcini JJ, Banda SS. The global health workforce shortage: role of surgeons and other providers. Adv Surg. 2008;42:63–85.

Kim T. Succession planning in hospitals and association with organizational performance. Nurs Econ. 2012;30(1):14–20.

Swanwick T, McKimm J. Clinical leadership development requires system-wide interventions, not just courses. Clin Teach. 2012;9:89–93.

Matthews JH, Morley GL, Crossley E, Bhanderi S. Teaching leadership: the medical student society model. Clin Teach. 2017;15:2.

Burgess A, van Diggele C, Mellis C. Mentorship in the health professions: a review. Clin Teach. 2018;14:1–6.

Burgess A, Dornan T, Clarke A, Menezes A, Mellis C. Peer tutoring in a medical school: perceptions of tutors and tutees. BMC Medical Education. 2016;16:85.

Druker PF. What makes an effective executive? Harv Bus Rev. 2004;82(6):58–63 136.

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This article has been published as part of BMC Medical Education Volume 20 Supplement 2, 2020: Peer Teacher Training in health professional education. The full contents of the supplement are available online at URL. https://bmcmedicaleducation.biomedcentral.com/articles/supplements/volume-20-supplement-2 .

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Christie van Diggele, Annette Burgess & Chris Roberts

The University of Sydney, Faculty of Medicine and Health, Sydney Medical School – Education Office, The University of Sydney, Sydney, Australia

Annette Burgess & Chris Roberts

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Alban-Metcalfe J, Alimo-Metcalfe B. Reliability and validity of the ‘leadership competencies and engaging leadership scale’. International Journal of Public Sector Management. 2013; 26:(1)56-73 https://doi.org/10.1108/09513551311294281

Avery GC. Understanding leadership: paradigms and cases.London: Sage; 2004

Avolio BJ, Waldman DA, Yammarino FJ. Leading in the 1990s: the four I's of transformational leadership. Journal of European Industrial Training. 1991; 15:(4) https://doi.org/10.1108/03090599110143366

Baker SD. Followership: the theoretical foundation of a contemporary construct. Journal of Leadership & Organizational Studies. 2007; 14:(1)50-60 https://doi.org/10.1177/0002831207304343

Binci D, Cerruti C, Braganza A. Do vertical and shared leadership need each other in change management?. Leadership and Organization Development Journal. 2016; 37:(5)558-578 https://doi.org/10.1108/LODJ-08-2014-0166

Braun S, Peus C, Weisweiler S, Frey D. Transformational leadership, job satisfaction, and team performance: a multilevel mediation model of trust. Leadership Quarterly. 2013; 24:(1)270-283 https://doi.org/10.1016/j.leaqua.2012.11.006

Carson JB, Tesluk PE, Marrone JA. Shared Leadership in teams: an investigation of antecedent conditions and performance. Academy of Management Journal. 2007; 50:(5)1217-1234

Summary of key research findings from the NHS staff survey. NHS Survey Coordination Centre. 2018. https://tinyurl.com/y4ofshoy (accessed 13 March 2019)

Deinert A, Homan AC, Boer D, Voelpel SC, Gutermann D. Transformational leadership sub-dimensions and their link to leaders' personality and performance. Leadership Quarterly. 2015; 26:(6)1095-1120 https://doi.org/10.1016/j.leaqua.2015.08.001

Report of the committee of inquiry into allegations of ill-treatment of patients and other irregularities at the Ely Hospital.Cardiff. London: HMSO; 1969

D'Innocenzo L, Mathieu JE, Kukenberger MR. A meta-analysis of different forms of shared leadership–team performance relations. Journal of Management. 2016; 42:(7)1964-1991 https://doi.org/10.1177/0149206314525205

Authentic leadership theory and practice: origins, effects and development. In: Gardner WL, Avolio BJ, Walumbwa FO (eds). Bingley: Emerald Press; 2005

Gillespie NA, Mann L. Transformational leadership and shared values: the building blocks of trust. Journal of Managerial Psychology. 2004; 19:(6)588-607 https://doi.org/10.1108/02683940410551507

Improving quality in the English NHS. A strategy for action. 2016. https://tinyurl.com/yxavguvr (accessed 13 March 2013)

Hamlin RG. A study and comparative analysis of managerial and leadership effectiveness in the National Health Service: an empirical factor analytic study within an NHS trust hospital. Health Serv Manage Res.. 2002; 15:(4)245-263 https://doi.org/10.1258/095148402320589046

Health Foundation. Transformational change in NHS providers. 2015. https://tinyurl.com/y5jryfgu (accessed 13 March 2013)

Jackson B, Parry K. A very short, fairly interesting and reasonably cheap book about studying leadership, 2nd edn. London: Sage; 2011

Investigating collaborative leadership for communities of practice in learning and skills. 2007. https://tinyurl.com/y5uuhly9 (accessed 13 March 2019)

The King's Fund. The future of management and leadership: no more heroes. 2011. https://tinyurl.com/yakyju8b (accessed 13 March 2019)

Merkens BJ., Spencer JS. A successful and necessary evolution to shared leadership: a hospital's story. Leadership in Health Services. 1998; 11:(1)1-4

NHS Leadership Academy. Healthcare leadership model: the nine dimensions of leadership behaviour. 2013. https://tinyurl.com/ybwfg7b7 (accessed 13 March 2019)

NHS Survey Coordination Centre. NHS staff survey 2017. National briefing. 2018. https://tinyurl.com/y6tla4bw (accessed 13 March 2019)

Nicolaides VC, LaPort KA, Chen TR The shared leadership of teams: a meta-analysis of proximal, distal, and moderating relationships. The Leadership Quarterly. 2014; 25:(5)923-942

Pearce CL, Sims HP. Shared leadership: toward a multi-level theory of leadership. Advances in Interdisciplinary Studies of Work Teams. 2000; 7:115-139

Robert LP, You S. Are you satisfied yet? Shared leadership, individual trust, autonomy, and satisfaction in virtual teams. Journal of the Association of Information Science and Technology. 2018; 69:(4)503-511

Saks AM. Antecedents and consequences of employee engagement. Journal of Managerial Psychology. 2006; 21:(7)600-619

Can we never learn? Abuse, complaints and inquiries in the NHS. History and Policy. 2015. https://tinyurl.com/yypm45ae (accessed 13 March 2019)

Tsai Y, Wu S-W. The relationships between organisational citizenship behaviour, job satisfaction and turnover intention. J Clin Nurs.. 2010; 19:(23–24)3564-3574 https://doi.org/10.1111/j.1365-2702.2010.03375.x

Tse H, Chiu W. Transformational leadership and job performance: a social identity perspective. Journal of Business Research. 2014; 67:(1)2827-2835 https://doi.org/10.1016/j.jbusres.2012.07.018

Uhl-Bien M, Riggio R, Lowe K, Carsten M. Followership theory: a review and research agenda. Leadership Quarterly. 2014; 25:(1)83-104 https://doi.org/10.1016/j.leaqua.2013.11.007

Wang XF., Howell JM. A multilevel study of transformational leadership, identification, and follower outcomes. Leadership Quarterly. 2012; 23:(5)775-790 https://doi.org/10.1016/j.leaqua.2012.02.001

It's not about the money: staff engagement comes first. 2018. https://tinyurl.com/yxnpqhj3 (accessed 13 March 2019)

Leadership and leadership development in health care: the evidence base. 2015. https://tinyurl.com/ybsmpmwn (accessed 13 March 2019)

Zhua W, Avolio BJ, Riggio RE, Sosik JJ. The effect of authentic transformational leadership on follower and group ethics. Leadership Quarterly. 2011; 22:(5)801-817

Models of leadership and their implications for nursing practice

S'thembile Thusini

MSc Student, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London

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Julia Mingay

Lecturer, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London

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Leadership in today's NHS, either as a leader or follower, is everybody's business. In this article, an MSc student undertaking the Developing Professional Leadership module at King's College London describes two leadership models and considers their application to two dimensions of the NHS Healthcare Leadership Model: ‘Engaging the team’ and ‘Leading with care’. The author demonstrates the value of this knowledge to all those involved in health care with a case scenario from clinical practice and key lessons to help frontline staff in their everyday work.

The Ely inquiry into the systematic brutal treatment of patients in a Cardiff mental institution was the first formal inquiry into NHS failings ( Department of Health and Social Security, 1969 ). Since that time there have been more than 100 inquiries with inadequate leadership persistently identified as a major concern ( Sheard, 2015 ). National responses have included the NHS Healthcare Leadership Model, delivered by the NHS Leadership Academy and its partners (2013) . A range of online and face-to-face programmes aim to increase an organisation's leadership capacity by developing leaders who pay close attention to their frontline staff, understand the contexts in which they work and the situations they face and empower them to lead continuous improvements that enhance patient outcomes and safety ( NHS Leadership Academy, 2013 ).

At King's College London, ‘Developing Professional Leadership’ is a core module of the Advanced Practice (Leadership) pathway. The module critically appraises theoretical and professional perspectives on leadership and supports participants to take up leadership roles with attention to ethical practice. Both national and college leadership activities promote an understanding of vertical transformational leadership (VTL) and shared leadership (SL).

Vertical transformational leadership

VTL is a hierarchical leadership model that describes an individual leader who, through various influences and mechanisms, elevates himself or herself and followers towards self-actualisation ( Pearce and Sims, 2000 ). VTL values collaboration and consensus, integrity and justice, empowerment and optimism, accountability and equality, and honesty and trust ( Braun et al, 2013 ). A vertical transformational leader inspires others by interpreting complex data, creating a vision and formulating a strategy for its attainment ( Avery, 2004 ). They aim to create an organisation that is agile, responsive, open to learning and future ready through innovation and creativity. They do this by appealing to followers' emotions and internal motivations, and by building rewarding relationships and raising morale. They use delegation, consultation and collaboration to engage followers but retain power so that responsibility and accountability for a vision and its strategy rests with the leader ( Avery, 2004 ).

Behaviours associated with this leadership style have been classified by Avolio et al (1991) as the four ‘I's: idealised influence, individualised consideration, inspirational motivation, and intellectual stimulation:

• ‘Idealised influence’ represents the charismatic part of VTL. Leaders model integrity, optimism and confidence, and act with courage and conviction demonstrating their intellectual and technical skills
• ‘Individualised consideration’ requires self-awareness and an appreciation of the values, aspirations, motivations, strengths and weaknesses of others. From this perspective leaders need to be able to listen and communicate effectively, and may be called upon to teach, coach, mentor or counsel
• ‘Inspirational motivation’ necessitates a clearly communicated vision and belief in a team's abilities to achieve a desired goal
• Through ‘intellectual stimulation’ leaders support and facilitate independent thinking, encouraging followers to be more rational, creative and innovative in their decision-making and problem-solving.

Tse and Chiu (2014) have advised that leaders adopt a balanced approach to the use of the four Is that is contingent upon their followers' orientation. For example, if group cohesion is required then idealised influence and inspirational motivation are appropriate leader behaviours. However, if greater creativity is needed from staff, then a leader is advised to exhibit individual consideration and provide intellectual stimulation. Conversely, mismatching leadership behaviour to follower orientation can have detrimental effects. For example, providing intellectual stimulation with high expectations but offering insufficient individualised consideration.

During times of large-scale dramatic organisational change an effective vertical leader is necessary for recalibrating and reviving an organisation ( Binci et al, 2016 ). They can provide clarity, motivation and empowerment. There are several examples of positive VTL outcomes in NHS trusts that have managed to improve their Care Quality Commission ratings. This was achieved through measures to revive cultures and empower staff with open communications and active support ( Health Foundation, 2015 ). Critics argue that VTL dependence on a single figure can be futile for an organisation, especially if the individual is prone to dysfunctional behaviour ( Wang and Howell, 2012 ). In response, an ‘authentic leader’ is proposed ( Jackson and Parry, 2011 ); this is someone with a ‘high socialised power orientation’, who is humble, modest, deflects recognition for achievements, who celebrates the team, and exhibits vertical and shared leadership behaviours. Through self-awareness and reflecting on actions a VTL leader can exhibit authentic leadership behaviour.

VTL overlaps other leadership approaches including authentic, servant, charismatic, inspirational and visionary ( Avery, 2004 ). What often differentiates VTL is its motivation or focus, which is typically on achieving organisational goals. VTL is also associated with pseudo-transformational and transactional leadership. The former is a dysfunctional form of charismatic leadership, characterised by narcissistic behaviours associated with dictators and sensational political and corporate leaders. Transactional leadership is practised by positional managers whose job it is to set expectations and engage in corrective or autocratic measures that aim to maintain efficiency. Transformational leaders do utilise some transactional methods to achieve goals and the two leadership styles can be complementary. However, VTL is two-way leadership with follower influence whereas transactional leadership represents one-directional hierarchical leadership.

Shared leadership

SL is a non-hierarchical leadership model that describes leadership that emerges within a group, depending on the context and skills required at a given time ( D'Innocenzo et al, 2016 ). SL values openness and trust, engagement and inclusiveness, reciprocity and fluidity, democracy and empowerment, and networking and support ( Jameson, 2007 ). Shared leaders are peers who possess no authority over the group outside the context of their shared contribution. Individual leadership is de-emphasised and a vision and its strategy are created and owned by the group. Open discursive engagement is favoured for mutual sense making through the pooling of diverse skills, knowledge and experience. SL is dynamic, multidirectional and collaborative. Power is shared so that responsibility and accountability for a vision and its strategy rests with the group ( Avery, 2004 ).

SL is often associated with, but different conceptually from, co-leadership, distributed leadership, and self-managing teams. Carson et al (2007) suggested that these all lie on a continuum with co-leadership at one end and shared leadership at the other. Participation, consultation and delegation are used in SL as are the four Is of transformational leadership. SL has been described as a type of group transformational leadership as transformational behaviours within a shared leadership model achieve similar results to VTL ( Wang and Howell, 2012 ). SL necessarily exists in organisations such as the NHS where different professional groups with their own leadership structures need to collaborate. Transforming a culture through shared leadership requires patience and investment. It is an iterative process involving cycles of learning and reflection that require trust, personal and professional maturity, and organisational support.

SL leadership behaviours can become widespread within teams, lessening their dependence on one leader and the potential effects of rogue single leaders ( The King's Fund, 2011 ). This is vital in environments where problems are increasingly complex and leaders are required to possess multiple problem-solving skills. Cost efficiencies can result from diminishing hierarchical leaders' workloads and a consequent reduction in their posts among highly skilled cohesive groups ( Tse and Chiu, 2014 ). Critics argue that SL efficiency is influenced by group dynamics, which may be prone to relationship conflicts that lead to decision paralysis ( Pearce and Sims, 2000 ). Additionally, the emergence of a vertical leader who could manipulate the workforce for political or corporate gain may be an unintended consequence of SL.

Both VTL and SL are moderated by internal and external factors. VTL is influenced by levels of trust, follower receptiveness, personality traits, task complexity and urgency. Stress and burnout can lessen leadership benefits while trust can enhance performance outcomes ( Robert and You, 2018 ). SL is moderated by trust, time, group size and cohesion, skill mix, confidence, task complexity and interdependence ( Nicolaides et al, 2014 ). Trust, sufficient time, a balanced skill mix and group cohesion have a positive influence, while task complexity, especially at formative stages, hinders effective SL.

The two approaches are complementary. During the formative stages of shared leadership, a vertical leader is crucial to guide and sustain shared leadership. Some final decisions will need to rest with the hierarchical leader. As the team gains confidence, a vertical transformational leader's role evolves to consultant, mentor, facilitator and, at times, recipient of group leadership. A significant body of evidence associates VTL and SL with positive individual, group and organisational outcomes ( Wang and Howell, 2012 ; Nicolaides et al, 2014 ; D'Innocenzo et al, 2016 ). VTL predominantly influences individual and organisational outcomes while SL is more influential at the group and organisational levels. Table 1 summarises some of the differences between the approaches, although they share much more in common.

VTL and SL are both appropriate in healthcare contexts and can be complementary under the right circumstances. The key is being able to recognise appropriate opportunities to develop and utilise each as either a leader or follower ( Binci et al, 2016 ). Familiarity with the models, their methods and uses are important in these respects. It is equally important to recognise and engage in any cultural change that may be necessary for leadership to be effective. Transformational change does not have to be revolutionary or top-down. Minor changes at the frontline can deliver significant benefits if team members are engaged and led with care.

• Whether you are a leader or a follower, leadership is at the heart of NHS activity and all nurses have a responsibility to ensure it is effective
• Vertical transformational and shared leadership models are promoted by national leadership programmes that support the development of NHS staff
• The two models are complementary, and it is important to be aware of opportunities to develop and utilise each as either a leader or follower
• Leading with care can inspire and motivate teams to engage in transformative change
• Familiarisation with leadership models and their application in practice is important for the development of nurses and the organisations in which they work, and for the assurance of patient safety

CPD reflective questions

• What can you do to demonstrate leadership within your own capacity in your clinical setting?
• Considering that ‘followership’ is an integral part of NHS leadership, what can you do to demonstrate responsible followership?
• Reflect on a time where you demonstrated leadership or observed leadership in your clinical area; what leadership qualities can you recognise from that scenario?

• Research article
• Open access
• Published: 24 April 2019

Priorities and challenges for health leadership and workforce management globally: a rapid review

• Carah Alyssa Figueroa   ORCID: orcid.org/0000-0002-8825-7796 1 ,
• Reema Harrison 1 ,
• Ashfaq Chauhan 1 &
• Lois Meyer 1  

BMC Health Services Research volume  19 , Article number:  239 ( 2019 ) Cite this article

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Health systems are complex and continually changing across a variety of contexts and health service levels. The capacities needed by health managers and leaders to respond to current and emerging issues are not yet well understood. Studies to date have been country-specific and have not integrated different international and multi-level insights. This review examines the current and emerging challenges for health leadership and workforce management in diverse contexts and health systems at three structural levels, from the overarching macro (international, national) context to the meso context of organisations through to the micro context of individual healthcare managers.

A rapid review of evidence was undertaken using a systematic search of a selected segment of the diverse literature related to health leadership and management. A range of text words, synonyms and subject headings were developed for the major concepts of global health, health service management and health leadership. An explorative review of three electronic databases (MEDLINE®, Pubmed and Scopus) was undertaken to identify the key publication outlets for relevant content between January 2010 to July 2018. A search strategy was then applied to the key journals identified, in addition to hand searching the journals and reference list of relevant papers identified. Inclusion criteria were independently applied to potentially relevant articles by three reviewers. Data were subject to a narrative synthesis to highlight key concepts identified.

Sixty-three articles were included. A set of consistent challenges and emerging trends within healthcare sectors internationally for health leadership and management were represented at the three structural levels. At the macro level these included societal, demographic, historical and cultural factors; at the meso level, human resource management challenges, changing structures and performance measures and intensified management; and at the micro level shifting roles and expectations in the workplace for health care managers.

Contemporary challenges and emerging needs of the global health management workforce orient around efficiency-saving, change and human resource management. The role of health managers is evolving and expanding to meet these new priorities. Ensuring contemporary health leaders and managers have the capabilities to respond to the current landscape is critical.

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Health systems are increasingly complex; encompassing the provision of public and private health services, primary healthcare, acute, chronic and aged care, in a variety of contexts. Health systems are continually evolving to adapt to epidemiological, demographic and societal shifts. Emerging technologies and political, economic, social, and environmental realities create a complex agenda for global health [ 1 ]. In response, there has been increased recognition of the role of non-state actors to manage population needs and drive innovation. The concept of ‘collaborative governance,’ in which non-health actors and health actors work together, has come to underpin health systems and service delivery internationally [ 1 ] in order to meet changing expectations and new priorities. Seeking the achievement of universal health coverage (UHC) and the Sustainable Development Goals (SDGs), particularly in low- and middle-income countries, have been pivotal driving forces [ 2 ]. Agendas for change have been encapsulated in reforms intended to improve the efficiency, equity of access, and the quality of public services more broadly [ 1 , 3 ].

The profound shortage of human resources for health to address current and emerging population health needs across the globe was identified in the World Health Organization (WHO) landmark publication ‘Working together for health’ and continues to impede progress towards the SDGs [ 4 ]. Despite some improvements overall in health workforce aggregates globally, the human resources for health challenges confronting health systems are highly complex and varied. These include not only numerical workforce shortages but imbalances in skill mix, geographical maldistribution, difficulty in inter-professional collaboration, inefficient use of resources, and burnout [ 2 , 5 , 6 ]. Effective health leadership and workforce management is therefore critical to addressing the needs of human resources within health systems and strengthening capacities at regional and global levels [ 4 , 6 , 7 , 8 ].

While there is no standard definition, health leadership is centred on the ability to identify priorities, provide strategic direction to multiple actors within the health system, and create commitment across the health sector to address those priorities for improved health services [ 7 , 8 ]. Effective management is required to facilitate change and achieve results through ensuring the efficient mobilisation and utilisation of the health workforce and other resources [ 8 ]. As contemporary health systems operate through networks within which are ranging levels of responsibilities, they require cooperation and coordination through effective health leadership and workforce management to provide high quality care that is effective, efficient, accessible, patient-centred, equitable, and safe [ 9 ]. In this regard, health leadership and workforce management are interlinked and play critical roles in health services management [ 7 , 8 ].

Along with health systems, the role of leaders and managers in health is evolving. Strategic management that is responsive to political, technological, societal and economic change is essential for health system strengthening [ 10 ]. Despite the pivotal role of health service management in the health sector, the priorities for health service management in the global health context are not well understood. This rapid review was conducted to identify the current challenges and priorities for health leadership and workforce management globally.

This review utilised a rapid evidence assessment (REA) methodology structured using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist [ 11 ]. An REA uses the same methods and principles as a systematic review but makes concessions to the breadth or depth of the process to address key issues about the topic under investigation [ 12 , 13 , 14 ]. An REA provides a balanced assessment of what is already known about an issue, and the strength of evidence. The narrower research focus, relative to full systematic reviews, make REAs helpful for systematically exploring the evidence around a particular issue when there is a broad evidence base to explore [ 14 ]. In the present review, the search was limited to contemporary literature (post 2010) selected from leading health service management and global health journals identified from exploring major electronic databases.

Search strategy

An explorative review of three core databases in the area of public health and health services (MEDLINE®, Pubmed and Scopus) was undertaken to identify the key publication outlets for relevant content. These databases were selected as those that would be most relevant to the focus of the review and have the broadest range of relevant content. A range of text words, synonyms and subject headings were developed for the major constructs: global health, health service management and health leadership, priorities and challenges. Regarding health service management and health leadership, the following search terms were used: “healthcare manag*” OR “health manag*” OR “health services manag*” OR “health leader*”. Due to the large volume of diverse literature generated, a systematic search was then undertaken on the key journals that produced the largest number of relevant articles. The journals were selected as those identified as likely to contain highly relevant material based on an initial scoping of the literature.

Based on the initial database search, a systematic search for articles published in English between 1 January 2010 and 31 July 2018 was undertaken of the current issues and archives of the following journals: Asia-Pacific Journal of Health Management; BMC Health Services Research; Healthcare Management Review; International Journal of Healthcare Management; International Journal of Health Planning and Management; Journal of Healthcare Management; Journal of Health Organisation and Management; and, Journal of Health Management. Hand-searching of reference lists of identified papers were also used to ensure that major relevant material was captured.

Study selection and data extraction

Results were merged using reference-management software (Endnote) and any duplicates removed. The first author (CF) screened the titles and abstracts of articles meeting the eligibility criteria (Table 1 ). Full-text publications were requested for those identified as potentially relevant. The inclusion and exclusion criteria were then independently applied by two authors. Disagreements were resolved by consensus or consultation with a third person, and the following data were extracted from each publication: author(s), publication year, location, primary focus and main findings in relation to the research objective. Sixty-three articles were included in the final review. The selection process followed the PRISMA checklist [ 11 ] as shown in Fig. 1 .

PRISMA flow chart of the literature search, identification, and inclusion for the review

Data extraction and analysis

A narrative synthesis was used to explore the literature against the review objective. A narrative synthesis refers to “an approach to the systematic review and synthesis of findings from multiple studies that relies primarily on the use of words and text to summarise and explain the findings of the synthesis” [ 15 ]. Firstly, an initial description of the key findings of included studies was drafted. Findings were then organised, mapped and synthesised to explore patterns in the data.

Search results

A total of 63 articles were included; Table 2 summarizes the data extraction results by region and country. Nineteen were undertaken in Europe, 16 in North America, and one in Australia, with relatively fewer studies from Asia, the Middle East, and small island developing countries. Eighteen qualitative studies that used interviews and/or focus group studies [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ] were identified. Other studies were quantitative [ 33 , 34 , 35 , 36 , 37 , 38 , 39 ] including the use of questionnaires or survey data, or used a mixed-method approach [ 40 , 41 , 42 , 43 , 44 ]. Other articles combined different types of primary and secondary data (key informant interviews, observations, focus groups, questionnaire/survey data, and government reports). The included literature also comprised 28 review articles of various types that used mixed data and bibliographic evidence.

Key challenges and emerging trends

A set of challenges and emerging trends were identified across healthcare sectors internationally. These were grouped at three levels: 1) macro, system context (society, demography, technology, political economy, legal framework, history, culture), 2) meso, organisational context (infrastructure, resources, governance, clinical processes, management processes, suppliers, patients), and 3) micro context related to the individual healthcare manager (Table 3 ). This multi-levelled approach has been used in previous research to demonstrate the interplay between different factors across different levels, and their direct and indirect reciprocal influences on healthcare management policies and practices [ 45 ].

Societal and system-wide (macro)

Population growth, ageing populations, and increased disease burdens are some of the common trends health systems are facing globally. Developing and developed countries are going through demographic and epidemiological transitions; people are living longer with increasing prevalence of chronic diseases requiring health managers and leaders to adjust to shifting healthcare needs at the population level, delivering preventative and long-term care beyond acute care. Countries in Africa, Europe, the Pacific Islands, Middle East, Asia and Caribbean are seeing an increase in number of patients with non-communicable diseases and communicable diseases [ 21 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ].

Although many countries have similar emerging health system concerns, there are some differences in the complexities each country faces. For many small countries, outmigration, capacity building and funding from international aid agencies are affecting how their health systems operate, while in many larger countries, funding cuts, rise in private health insurance, innovations, and health system restructuring are major influences [ 21 , 34 , 50 , 53 , 54 ]. In addition, patients are increasingly health literate and, as consumers, expect high-quality healthcare [ 34 , 53 , 54 ]. However, hospitals and healthcare systems are lacking capacity to meet the increased demand [ 16 , 34 , 43 ].

Scientific advances have meant more patients are receiving care across the health system. It is imperative to have processes for communication and collaboration between different health professionals for high-quality care. However, health systems are fragmented; increasing specialisation is leading to further fragmentation and disassociation [ 31 , 54 , 55 ]. Adoption of technological innovations also require change management, hospital restructure, and capacity building [ 56 , 57 , 58 ].

Changes in health policies and regulations compound the challenge faced by healthcare managers and leaders to deliver high quality care [ 53 , 54 , 59 ]. Political reforms often lead to health system restructuring requiring change in the values, structures, processes and systems that can constrain how health managers and leaders align their organisations to new agendas [ 24 , 28 , 31 , 60 ]. For example, the distribution of health services management to local authorities through decentralisation has a variable impact on the efficacy and efficiency of healthcare delivery [ 24 , 27 , 35 , 59 ].

Governments’ decisions are often made focusing on cost savings, resulting in budgetary constraints within which health systems must operate [ 16 , 19 , 53 , 61 ]. Although some health systems have delivered positive results under such constraint [ 53 ], often financial resource constraints can lead to poor human and technical resource allocation, creating a disconnect between demand and supply [ 23 , 27 , 40 , 47 , 57 ]. To reduce spending in acute care, there is also a push to deliver health services in the community and focus on social determinants of health, though this brings further complexities related to managing multiple stakeholder collaborations [ 27 , 32 , 34 , 38 , 40 , 49 , 55 ].

Due to an increase in demand and cost constraints, new business models are emerging, and some health systems are resorting to privatisation and corporatisation [ 22 , 48 , 62 ]. This has created competition in the market, increased uptake of private health insurance and increased movement of consumers between various organisations [ 22 , 48 ]. Health managers and leaders need to keep abreast with continuously changing business models of care delivery and assess their impact [ 59 , 62 ]. The evolving international health workforce, insufficient numbers of trained health personnel, and maintaining and improving appropriate skill mixes comprise other important challenges for managers in meeting population health needs and demands (Table 3 ).

Organisational level (meso)

At the organisation level, human resource management issues were a central concern. This can be understood in part within the wider global human resources for health crisis which has placed healthcare organisations under intense pressure to perform. The evidence suggests healthcare organisations are evolving to strengthen coordination between primary and secondary care; there is greater attention to population-based perspectives in disease prevention, interdisciplinary collaboration, and clinical governance. These trends are challenged by the persistence of bureaucratic and hierarchical cultures, emphasis on targets over care quality, and the intensification of front-line and middle-management work that is limiting capacity.

Healthcare managers and leaders also face operational inefficiencies in providing primary health and referral services to address highly complex and shifting needs which often result in the waste of resources [ 49 , 63 , 64 ]. Considering the pace of change, organisations are required to be flexible and deliver higher quality care at lower cost [ 21 , 53 , 65 ]. To achieve this, many organisations in developing and developed countries alike are adopting a lean model [ 17 , 21 ]. However, there are challenges associated with ensuring sustainability of the lean system, adjusting organisational hierarchies, and improving knowledge of the lean model, especially in developing countries [ 17 , 21 ].

Healthcare organisations require various actors with different capabilities to deliver high quality care. However, a dominant hierarchical culture and lack of collaborative and distributed culture can limit the performance of healthcare organisations [ 22 , 36 , 54 ]. In addition, considering high turnover of executive leadership, healthcare organisations often rely on external talent for succession management which can reduce hospital efficiency [ 44 , 66 ]. Other contributors to weakened hospital performance include: the lack of allocative efficiency and transparency [ 24 , 30 , 64 , 67 ]; poor hospital processes that hamper the development of effective systems for the prevention and control of hospital acquired infections (HAIs) [ 53 , 68 ]; and, payment reforms such as value-based funding and fee-for-service that encourage volume [ 18 , 23 , 24 , 61 , 62 , 69 , 70 ].

Managerial work distribution within organisations is often not clearly defined, leading to extra or extreme work conditions for middle and front-line managers [ 29 , 42 , 53 , 70 ]. Unregulated and undefined expectations at the organisation level leads to negative effects such as stress, reduced productivity, and unpredictable work hours, and long-term effects on organisational efficiency and delivery of high quality care [ 22 , 28 , 29 , 37 , 42 , 51 , 71 ]. Furthermore, often times front-line clinicians are also required to take the leadership role in the absence of managers without proper training [ 20 ]. Despite this, included studies indicate that the involvement of middle and front-line managers in strategic decision-making can be limited due to various reasons including lack of support from the organisation itself and misalignment of individual and organisational goals [ 16 , 26 , 31 , 72 ].

Individual level (micro)

Worldwide, middle and front-line health managers and leaders are disproportionately affected by challenges at the system and organisational level, which has contributed to increasing and often conflicting responsibilities. Some countries are experiencing a growth in senior health managers with a clinical background, while in other countries, the converse is apparent. Indistinct organisational boundaries, increasing scope of practice, and lack of systemic support at policy level are leaving healthcare managers with undefined roles [ 28 , 59 ]. Poorly defined roles contribute to reduced accountability, transparency, autonomy, and understanding of responsibilities [ 24 , 30 , 31 , 67 ]. Studies also indicate a lack of recognition of clinical leaders in health organisations and inadequate training opportunities for them as such [ 20 , 67 ].

The number of hybrid managers (performing clinical and managerial work concurrently) in developed countries is increasing, with the perception that such managers improve the clinical governance of an organization. In contrast, the number of non-clinical managers in many developing countries appears to be increasing [ 63 , 73 , 74 , 75 ]. Included studies suggest this approach does not necessarily improve manager-clinical professional relationships or the willingness of clinicians becoming managers, limiting their participation in strategic decisions [ 28 , 70 , 71 , 74 ].

This rapid review highlights the current global climate in health service management, the key priority areas, and current health management approaches being utilised to address these. The multitude of issues emerging demonstrate the complex and evolving role of health service management in the wider complex functioning of health systems globally in a changing healthcare landscape. Key themes of achieving high quality care and sustainable service delivery were apparent, often evidenced through health reforms [ 5 ]. The influence of technological innovation in both its opportunities and complexities is evident worldwide. In the context of changing healthcare goals and delivery approaches, health management is seeking to professionalise as a strategy to build strength and capacity. In doing so, health managers are questioning role scope and the skills and knowledge they need to meet the requirements of the role.

Global challenges facing health management

Understanding how the features of the macro, meso and micro systems can create challenges for managers is critical [ 19 ]. With continual healthcare reform and increasing health expenditure as a proportion of GDP, distinct challenges are facing high-income Organisation for Economic Co-operation and Development (OECD) countries, middle-income rapidly-developing economies, and low-income, resource-limited countries. Reforms, especially in OECD countries, have been aimed at controlling costs, consolidating hospitals for greater efficiencies, and reconfiguring primary healthcare [ 1 , 76 ]. The changing business models for the delivery of care have wider implications for the way in which health managers conceptualise healthcare delivery and the key stakeholders [ 59 ], for example, the emerging role of private healthcare providers and non-health actors in public health. Changes to the business model of healthcare delivery also has implications for the distribution of power amongst key actors within the system. This is evident in the evolved role of general practitioners (GPs) in the UK National Health Service as leaders of Clinical Commissioning Groups (CCGs). Commissioning requires a different skill set to clinical work, in terms of assessing financial data, the nature of statutory responsibilities, and the need to engage with a wider stakeholder group across a region to plan services [ 77 ]. With new responsibilities, GPs have been required to quickly equip themselves with new management capabilities, reflecting the range of studies included in this review around clinician managers and the associated challenges [ 18 , 28 , 53 , 63 , 70 , 71 , 74 , 75 ].

Central to the role of healthcare managers is the ability to transition between existing and new cultures and practices within healthcare delivery [ 59 ]. Bridging this space is particularly important in the context of increasingly personalized and technologically-driven healthcare delivery [ 54 ]. While advances in knowledge and medical technologies have increased capability to tackle complex health needs, the integration of innovations into existing healthcare management practices requires strong change management [ 73 ]. Health leaders and managers need to be able to rapidly and continually assess the changes required or upon them, the implications, and to transform their analysis into a workable plan to realise change [ 10 ]. Focusing only on the clinical training of health professionals rather than incorporating managerial and leadership roles, and specifically, change management capability may limit the speed and success of innovation uptake [ 22 ].

Implications

Our findings highlight the implications of current priorities within the health sector for health management practice internationally; key issues are efficiency savings, change management and human resource management. In the context of efficiency approaches, health system and service managers are facing instances of poor human and technical resource allocation, creating a disconnect between demand and supply. At the service delivery level, this has intensified and varied the role of middle managers mediating at two main levels. The first level of middle-management is positioned between the front-line and C-suite management of an organisation. The second level of middle-management being the C-suite managers who translate regional and/or national funding decisions and policies into their organisations. Faced with increasing pace of change, and economic and resource constraints, middle managers across both levels are now more than ever exposed to high levels of stress, low morale, and unsustainable working patterns [ 29 ]. Emphasis on cost-saving has brought with it increased attention to the health services that can be delivered in the community and the social determinants of health. Connecting disparate services in order to meet efficiency goals is a now a core feature of the work of many health managers mediating this process.

Our findings also have implications for the conceptualisation of healthcare management as a profession. The scale and increasing breadth of the role of health leaders and managers is evident in the review. Clarifying the professional identity of ‘health manager’ may therefore be a critical part of building and maintaining a robust health management workforce that can fulfil these diverse roles [ 59 ]. Increasing migration of the healthcare workforce and of population, products and services between countries also brings new challenges for healthcare. In response, the notion of transnational competence among healthcare professionals has been identified [ 78 ]. Transnational competence progresses cultural competence by considering the interpersonal skills required for engaging with those from diverse cultural and social backgrounds. Thus, transnational competence may be important for health managers working across national borders. A key aspect of professionalisation is the education and training of health managers. Our findings provide a unique and useful theoretical contribution that is globally-focused and multi-level to stimulate new thinking in health management educators, and for current health leaders and managers. These findings have considerable practical utility for managers and practitioners designing graduate health management programs.

Limitations

Most of the studies in the field have focused on the Anglo-American context and health systems. Notwithstanding the importance of lessons drawn from these health systems, further research is needed in other regions, and in low- and middle-income countries in particular [ 79 ]. We acknowledge the nuanced interplay between evidence, culture, organisational factors, stakeholder interests, and population health outcomes. Terminologies and definitions to express global health, management and leadership vary across countries and cultures, creating potential for bias in the interpretation of findings. We also recognise that there is fluidity in the categorisations, and challenges arising may span multiple domains. This review considers challenges facing all types of healthcare managers and thus lacks discrete analysis of senior, middle and front-line managers. That said, managers at different levels can learn from one another. Senior managers and executives may gain an appreciation for the operational challenges that middle and front-line managers may face. Middle and front-line managers may have a heightened awareness of the more strategic decision-making of senior health managers. Whilst the findings indicate consistent challenges and needs for health managers across a range of international contexts, the study does not capture country-specific issues which may have consequences at the local level. Whilst a systematic approach was taken to the literature in undertaking this review, relevant material may have been omitted due to the limits placed on the rapid review of the vast and diverse health management literature. The inclusion of only materials in English language may have led to further omissions of relevant work.

Health managers within both international and national settings face complex challenges given the shortage of human resources for health worldwide and the rapid evolution of national and transnational healthcare systems. This review addresses the lack of studies taking a global perspective of the challenges and emerging needs at macro (international, national and societal), meso (organisational), and micro (individual health manager) levels. Contemporary challenges of the global health management workforce orient around demographic and epidemiological change, efficiency-saving, human resource management, changing structures, intensified management, and shifting roles and expectations. In recognising these challenges, researchers, management educators, and policy makers can establish global health service management priorities and enhance health leadership and capacities to meet these. Health managers and leaders with adaptable and relevant capabilities are critical to high quality systems of healthcare delivery.

Abbreviations

Clinical Commissioning Groups

General practitioners

Hospital acquired infections

Organisation for Economic Co-operation and Development

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Rapid evidence assessment

Sustainable Development Goals

Universal health coverage

World Health Organization

Senkubuge F, Modisenyane M, Bishaw T. Strengthening health systems by health sector reforms. Glob Health Action. 2014;7(1):23568.

Article   Google Scholar  

World Health Organization, Global Health Workforce Alliance. Human resources for health: foundation for universal health coverage and the post-2015 development agenda. Report of the Third Global Forum on Human Resources for Health, 2013 November 10–13. Recife, Brazil: WHO; 2014.

Reich MR, Harris J, Ikegami N, Maeda A, Cashin C, Araujo EC, et al. Moving towards universal health coverage: lessons from 11 country studies. Lancet. 2016;387(10020):811–6.

World Health Organisation. Working together for health: the world health report 2006: policy briefs. Geneva: World Health Organisation; 2006.

Google Scholar  

West M, Dawson J. Employee engagement and NHS performance. London: King's Fund; 2012.

World Health Organization. Global strategy on human resources for health: workforce 2030. Geneva: World Health Organisation; 2016.

Reich MR, Javadi D, Ghaffar A. Introduction to the special issue on “effective leadership for health systems”. Health Syst Reform. 2016;2(3):171–5.

Waddington C, Egger D, Travis P, Hawken L, Dovlo D, World Health Organization. Towards better leadership and management in health: report of an international consultation on strengthening leadership and management in low-income countries, 29 January-1 February. Ghana: Accra; 2007.

World Health Organization. Quality of care: a process for making strategic choices in health systems. Manila: WHO Regional Office for the Western Pacific; 2006.

Ginter PM, Duncan WJ, Swayne LE. The strategic management of health care organizations: John Wiley & Sons; 2018.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Int Med. 2009;151(4):264–9.

Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Inf Libr J. 2009;26(2):91–108.

Varker T, Forbes D, Dell L, Weston A, Merlin T, Hodson S, et al. Rapid evidence assessment: increasing the transparency of an emerging methodology. J Eval Clin Pract. 2015;21(6):1199–204.

Tricco AC, Langlois EV, Straus SE. Rapid reviews to strengthen health policy and systems: a practical guide. Geneva, Switzerland: World Health Organization; 2017.

Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, et al. Guidance on the conduct of narrative synthesis in systematic reviews. A product from the ESRC methods programme Version. 2006;1:b92.

Taylor A, Groene O. European hospital managers’ perceptions of patient-centred care: a qualitative study on implementation and context. J Health Organ Manag. 2015;29(6):711–28.

Costa LBM, Rentes AF, Bertani TM, Mardegan R. Lean healthcare in developing countries: evidence from Brazilian hospitals. Int J Health Plann Manage. 2017;32(1).

Chreim S, Williams BE, Coller KE. Radical change in healthcare organization: mapping transition between templates, enabling factors, and implementation processes. J Health Organ Manag. 2012;26(2):215–36.

Greenwald HP. Management challenges in British Columbia’s healthcare system. J Health Organ Manag. 2017;31(4):418–29.

Mercer D, Haddon A, Loughlin C. Leading on the edge: the nature of paramedic leadership at the front line of care. Health Care Manag Rev. 2018;43(1):12–20.

Reijula J, Reijula E, Reijula K. Healthcare management challenges in two university hospitals. Int J Healthc Tech Manag. 2016;15(4):308–25.

Srinivasan V, Chandwani R. HRM innovations in rapid growth contexts: the healthcare sector in India. Int J Hum Res Manage. 2014;25(10):1505–25.

Afzali HHA, Moss JR, Mahmood MA. Exploring health professionals' perspectives on factors affecting Iranian hospital efficiency and suggestions for improvement. Int J Health Plann Manag. 2011;26(1):e17–29.

Jafari M, Rashidian A, Abolhasani F, Mohammad K, Yazdani S, Parkerton P, et al. Space or no space for managing public hospitals; a qualitative study of hospital autonomy in Iran. Int J Health Plann Manag. 2011;26(3):e121–e37.

Lapão LV, Dussault G. From policy to reality: clinical managers' views of the organizational challenges of primary care reform in Portugal. Int J Health Plann Manag. 2012;27(4):295–307.

Andreasson J, Eriksson A, Dellve L. Health care managers' views on and approaches to implementing models for improving care processes. J Nurs Manag. 2016;24(2):219–27.

Maluka SO, Hurtig AK, Sebastián MS, Shayo E, Byskov J, Kamuzora P. Decentralization and health care prioritization process in Tanzania: from national rhetoric to local reality. Int J Health Plann Manag. 2011;26(2):e102–e20.

Taytiwat P, Briggs D, Fraser J, Minichiello V, Cruickshank M. Lessons from understanding the role of community hospital director in Thailand: clinician versus manager. Int J Health Plann Manag. 2011;26(2):e48–67.

Buchanan DA, Parry E, Gascoigne C, Moore C. Are healthcare middle management jobs extreme jobs? J Health Organ Manag. 2013;27(5):646–64.

Longenecker CO, Longenecker PD. Why hospital improvement efforts fail: a view from the front line. J Healthc Manag. 2014;59(2):147–57.

Reyes DJ, Bekemeier B, Issel LM. Challenges faced by public health Nurs leaders in Hyperturbulent times. Public Health Nurs. 2014;31(4):344–53.

Louis CJ, Clark JR, Gray B, Brannon D, Parker V. Service line structure and decision-maker attention in three health systems: implications for patient-centered care. Health Care Manag Rev. 2017. https://doi.org/10.1097/HMR.0000000000000172 .

Oppel EM, Winter V, Schreyogg J. Evaluating the link between human resource management decisions and patient satisfaction with quality of care. Health Care Manag Rev. 2017;42(1):53–64.

Ramanujam P. Service quality in health care organisations: a study of corporate hospitals in Hyderabad. J Health Manag. 2011;13(2):177–202.

Diana A, Hollingworth SA, Marks GC. Effects of decentralisation and health system reform on health workforce and quality-of-care in Indonesia, 1993–2007. Int J Health Plann Manag. 2015;30(1):e16–30.

Prenestini A, Lega F. Do senior management cultures affect performance? Evidence from Italian public healthcare organizations. J Healthc Manag. 2013;58(5):336–51.

Giauque D. Stress among public middle managers dealing with reforms. J Health Organ Manag. 2016;30(8):1259–83.

Jennings JC, Landry AY, Hearld LR, Weech-Maldonado R, Snyder SW, Patrician PA. Organizational and environmental factors influencing hospital community orientation. Health Care Manag Rev. 2017. https://doi.org/10.1097/HMR.0000000000000180 .

Tasi MC, Keswani A, Bozic KJ. Does physician leadership affect hospital quality, operational efficiency, and financial performance? Health Care Manag Rev. 2017. https://doi.org/10.1097/HMR.0000000000000173 .

Hall W, Williams I, Smith N, Gold M, Coast J, Kapiriri L, et al. Past, present and future challenges in health care priority setting: findings from an international expert survey. J Health Organ Manag. 2018;32(3):444–62.

Nelson SA, Azevedo PR, Dias RS, de Sousa SdMA, de Carvalho LDP, Silva ACO, et al. nursing work: challenges for health management in the northeast of Brazil. J Nurs Manag 2013;21(6):838–849.

Ireri S, Walshe K, Benson L, Mwanthi MA. A qualitative and quantitative study of medical leadership and management: experiences, competencies, and development needs of doctor managers in the United Kingdom. J Manag Marketing Healthc. 2011;4(1):16–29.

Powell M. The snakes and ladders of National Health Service management in England. Int J Health Plann Manag. 2014;29(3):260–79.

Groves KS. Examining the impact of succession management practices on organizational performance: A national study of U.S. hospitals. Health Care Manage Rev. 2017; doi: https://doi.org/10.1097/hmr.0000000000000176 .

Syed J, Özbilgin M. A relational framework for international transfer of diversity management practices. Int J Hum Res Manage. 2009;20(12):2435–53.

Adindu A. The need for effective management in African health systems. J Health Manag. 2013;15(1):1–13.

Greaves DE. Health management/leadership of Small Island developing states of the English-speaking Caribbean: a critical review. J Health Manag. 2016;18(4):595–610.

Khan MI, Banerji A. Health Care Management in India: some issues and challenges. J Health Manag. 2014;16(1):133–47.

Moghadam MN, Sadeghi V, Parva S. Weaknesses and challenges of primary healthcare system in Iran: a review. Int J Health Plann Manag. 2012;27(2):e121–e31.

Taylor R. The tyranny of size: challenges of health administration in Pacific Island states. Asia Pac J Health Manag. 2016;11(3):65.

Jooste K, Jasper M. A south African perspective: current position and challenges in health care service management and education in nursing. J Nurs Manag. 2012;20(1):56–64.

Sen K, Al-Faisal W. Reforms and emerging noncommunicable disease: some challenges facing a conflict-ridden country—the case of the Syrian Arab Republic. Int J Health Plann Manag. 2013;28(3):290–302.

Carney M. Challenges in healthcare delivery in an economic downturn, in the Republic of Ireland. J Nurs Manag. 2010;18(5):509–14.

Bowden DE, Smits SJ. Managing in the context of healthcare's escalating technology and evolving culture. J Health Organ Manag. 2012;26(2):149–57.

Meijboom BR, Bakx SJWGC, Westert GP. Continuity in health care: lessons from supply chain management. Int J Health Plann Manag. 2010;25(4):304–17.

Lega F, Calciolari S. Coevolution of patients and hospitals: how changing epidemiology and technological advances create challenges and drive organizational innovation. J Healthc Manag. 2012;57(1):17–34.

Kim Y, Kang M. The performance management system of the Korean healthcare sector: development, challenges, and future tasks. Public Perform Manag. 2016;39(2):297–315.

CAS   Google Scholar  

Hernandez SE, Conrad DA, Marcus-Smith MS, Reed P, Watts C. Patient-centered innovation in health care organizations: a conceptual framework and case study application. Health Care Manag Rev. 2013;38(2):166–75.

Briggs D, Isouard G. The language of health reform and health management: critical issues in the management of health systems. Asia Pac J Health Manag. 2016;11(3):38.

Zuckerman AM. Successful strategic planning for a reformed delivery system. J Healthc Manag. 2014;59(3):168–72.

Gantz NR, Sherman R, Jasper M, Choo CG, Herrin-Griffith D, Harris K. Global nurse leader perspectives on health systems and workforce challenges. J Nurs Manag. 2012;20(4):433–43.

Jeurissen P, Duran A, Saltman RB. Uncomfortable realities: the challenge of creating real change in Europe’s consolidating hospital sector. BMC Health Serv Res. 2016;16(2):168.

Kirkpatrick I, Kuhlmann E, Hartley K, Dent M, Lega F. Medicine and management in European hospitals: a comparative overview. BMC Health Serv Res. 2016;16(2):171.

Akbulut Y, Esatoglu AE, Yildirim T. Managerial roles of physicians in the Turkish healthcare system: current situation and future challenges. J Health Manag. 2010;12(4):539–51.

Naranjo-Gil D. The role of top management teams in hospitals facing strategic change: effects on performance. Int J Healthc Manag. 2015;8(1):34–41.

Ford EW, Lowe KB, Silvera GB, Babik D, Huerta TR. Insider versus outsider executive succession: the relationship to hospital efficiency. Health Care Manag Rev. 2018;43(1):61–8.

Leggat SG, Balding C. Achieving organisational competence for clinical leadership: the role of high performance work systems. J Health Organ Manag. 2013;27(3):312–29.

Baylina P, Moreira P. Healthcare-associated infections – on developing effective control systems under a renewed healthcare management debate. Int J Healthc Manag. 2012;5(2):74–84.

Jha R, Sahay B, Charan P. Healthcare operations management: a structured literature review. Decis. 2016;43(3):259–79.

Kuhlmann E, Rangnitt Y, von Knorring M. Medicine and management: looking inside the box of changing hospital governance. BMC Health Serv Res. 2016;16(2):159.

Spehar I, Frich JC, Kjekshus LE. Clinicians’ experiences of becoming a clinical manager: a qualitative study. BMC Health Serv Res. 2012;12(1):421.

Rodriguez CA. Challenges to effectiveness in public health organizations: the case of the Costa Rican health ministry. J Bus Res. 2016;69(9):3859–68.

Cinaroglu S. Complexity in healthcare management: why does Drucker describe healthcare organizations as a double-headed monster? Int J Healthc Manag. 2016;9(1):11–7.

Rotar A, Botje D, Klazinga N, Lombarts K, Groene O, Sunol R, et al. The involvement of medical doctors in hospital governance and implications for quality management: a quick scan in 19 and an in depth study in 7 OECD countries. BMC Health Serv Res. 2016;16(2):160.

Edmonstone JD. Whither the elephant?: the continuing development of clinical leadership in the UK National Health Services. Int J Health Plann Manag. 2014;29(3):280–91.

Naylor C, Ross S, Curry N, Holder H, Marshall L, Tait E. Clinical commissioning groups: supporting improvement in general practice? London: The King's Fund; 2013.

Holder H, Robertson R, Ross S, Bennett L, Gosling J, Curry N. Risk or reward? The changing role of CCGs in general practice. London: Kings Fund/Nuffield Trust; 2015.

Koehn PH, Rosenau JN. Transnational competence in an emergent epoch. Int Stud Perspect. 2002;3(2):105–27.

Antunes V, Moreira JP. Skill mix in healthcare: an international update for the management debate. Int J Healthc Manag. 2013;6(1):12–7.

Seitio-Kgokgwe OS, Gauld R, Hill PC, Barnett P. Understanding human resource management practices in Botswana’s public health sector. J Health Organ Manag. 2016;30(8):1284–300.

Miners C, Hundert M, Lash R. New structures for challenges in healthcare management. Healthc Manage Forum. 2015;28(3):114–7.

Hopkins J, Fassiotto M, Ku MC, Mammo D, Valantine H. Designing a physician leadership development program based on effective models of physician education. Health Care Manag Rev. 2017. https://doi.org/10.1097/hmr.0000000000000146 .

Miranda R, Glenn SW, Leighton JA, Pasha SF, Gurudu SR, Teaford HG, et al. Using hybrid change strategies to improve the patient experience in outpatient specialty care. J Healthc Manag. 2015;60(5):363–76.

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Skills, Attitudes, Values, And Knowledge For Effective Healthcare Team Leadership Essay.

3,110 Words Published On: 18-07-2017

The challenges of healthcare team leadership

Write an essay on "Leadership in Healthcare".  

With the continuous reforms in the industry of healthcare to drive a fierce pace of uncertainty and change, healthcare team leaders are adapting and evolving new sets of skills for successfully leading the healthcare organizations. Team leaders face challenges of the dizzying array that ranges from filling the vacant positions to meeting reforms. For successfully facing these challenges, the team leaders from the healthcare industry should possess a wide range of leadership skills (Mitchell et al., 2012). Apart from the reforms of the industry, the team leaders continue to battle various complicated issues demanding personality traits, leadership qualities and specific skills. They should have a very clear knowledge about the mission, vision and goals of the organization and should design a plan for overcoming the challenges for achieving them. Innate agility is the virtue a team leader should exhibit in times of changing conditions and uncertainty (Kilpatrick, 2014). They should be flexible enough for maximizing and recognizing the opportunities as the healthcare reforms are reshaping the traditional care models. Efficient team leaders accept the challenges of change as the opportunities for propelling forward with their vision (Lewis et al., 2014).

The present report will analyze and discuss the knowledge, skills, attitudes and values required by an effective team leader and the potential consequences of poor leadership. A leadership analysis tool will be used for evaluating the leadership style of the team leader along with the other members of the healthcare team. The challenges and complexities of the present healthcare industry will be taken from the perspective of the present analysis and discussion. 

The team leader of a healthcare organization should possess the necessary knowledge, skills, attitudes and values of the current healthcare reforms for becoming an effective leader.

Leading a team of healthcare professionals requires the maintenance of the advanced and current knowledge of the healthcare systems and diseases. The leader must be able to support, recognize and encourage the team members to achieve the maximum level of performance by creating a positive environment of work (Hoch & Kozlowski, 2014). The leader must be able to define the terms that are related to coding, billing and documentation and articulate why it is necessary for the team members to get familiar with these terms. For example, the terms like authorization, relative value units and compliance are important to know by the healthcare leaders to pass over the information to his team members.

Efficient team leaders must possess the important skills required for the treatment and care coordination of the critically ill patients in a safe and effective manner for both the transition and hospital phase of care. The leaders should develop the leadership skills for ensuring that the care is rendered in an interdisciplinary and collaborative manner. The leaders must possess the relevant diagnostic and procedure skills for providing mentorship. They should be able to effect the change of systems by the application of the various quality improvement tools (Yoder-Wise, 2014). For example, Failure mode effects analysis and Plan do study act are the quality improvement tools that the team leaders should be aware of and possess the required skills for implementing them to improve care. They should also possess time management skills.

Knowledge required for effective healthcare team leadership

The attitude of the team leader should promote the perceptions of teamwork for improving the quality of care in the hospitals to a wide range of audience that will facilitate social change. They should demonstrate a consistent level of accountability, responsibility and commitment for rendering care to the patients (Kessel, Kratzer & Schultz, 2012). They should maintain a professional behavior and respect the contribution and skills of the members of the team. Exhibit the development of leadership skills by providing training opportunities to the team members. Lack of the appropriate attitude of the team leader adverse the patient outcome (Weaver, Dy & Rosen, 2014). For example, the conveying of the clinical information between the team members during the care of a critically ill patient in ICU needs the right attitude of the leader for the accountability, professional responsibility and clinical handover of the patient.

The team leader should possess a clear set of values that they utilize to drive the direction of the care and services provided. They should understand and respect their roles of team working, autonomy and sharing of responsibilities. They must ensure that appropriate care procedures are followed for upholding the service vision (Huber, 2013). For example, the team leader should reduce the barriers to team-based healthcare for the patients in intensive care units and facilitate effective teamwork and quick recovery.

Poor leadership has the most disastrous consequences on the team members. It is nothing but the lack of vision and is often misleading. The team members become aimless without a direction from their team leaders. They fail to realize the motive of their work and cannot trace the goals of the organization. They start working mechanically and cannot implement any intelligent direction for achieving the goal (Schyns & Schilling, 2013). The part of patient care faces the maximum damage in a work environment that is ambiguous. Poor leadership brings about frustration among the team members as their ability of decision making either biased or crippled. Finally, this results in extreme employee dissatisfaction and consequent attrition.

Poor leadership causes significant gap in the work process, strategy making, the capability for the execution of the strategies and interdepartmental communications. Cognitive gaps are created due to poor leadership as preference is given to the members of the team who are identical to the leaders from the perspectives of acting and thinking. This results in the formation of homogeneous settings in the team and significant gaps are created in the execution and making of the strategy (Johnson, 2013). Thus, the members who are not identical to the leaders become stressful and develop a lack of trust. The team members working in various departments of the hospital are not communicated properly and this results in lack of co-ordination in treatment. When the members approach the leader with an idea or issue, the poor leader either under deliver or over promise, thrust their self-agenda on the members or keeps on postponing their decision (Krasikova, Green & LeBreton, 2013). Thus, execution and communication gaps are the results of this attitude of the poor leaders.

Skills for effective healthcare team leadership

Poor leadership leads to the development of the mediocrity culture. It affects the improvement of the team members and they continue to stay with the similar performance unless the management for resolving the leadership issues acts upon it. The members are not assured of their growth due to the poor leadership skills of their leaders and they start emulating the business decisions and maneuvering styles (Skogstad et al., 2014). For example, a nurse working in the ward for a long time will be ignored by a poor leader and not be promoted to managing ICU patients unless the management recognizes the talent. This continues and over the time flows down the command chain to become an organizational culture, breeding mediocrity and contempt where the quality is low and the costs are high with an increased rate of customer dissatisfaction. Another serious consequence is that the good and talented team members will be leaving the organization and would migrate to another environment with growth opportunities. The team will be left behind with the undesired employees with poor performance profile (Alvesson & Spicer, 2013). Soon the bottom line is exposed bringing about the attrition of all the deserving team members who were striving with a hope of changing procedures and processes. Eventually, the morale and performance of the team are degraded and all because of the poor leadership of the leader. 

Contemporary healthcare settings are often confronted with the challenges of the workforce, changing demands and expectations of the consumers and fiscal constraints. The prime issues faced by the healthcare teams are the challenges concerned with the safety and quality levels of healthcare and the mandate for improving the patient-centered care. All these issues and challenges can be effectively met by able leadership skills of the leader. However, the reverse can happen with poor leadership skills and it can have a wide impact on the staff members, patients and the organization (Northouse, 2014).

Poor leaders are found to be toxic to an organization, as they tend to decrease the job satisfaction among the team members. They also affect the quality of patient care and client service, decrease the turnover, increase the attrition, and finally, decrease the patient satisfaction. Three characteristics can be attributed to a poor leader. A poor leader lacks the direction and a clear vision that makes the job stressful and makes the team members feel controlled, defensive and manipulative (Yeung et al., 2012). Poor leadership makes the progress of the organization limited and the existing clients start leaving. The bottom line of the organization starts to flounder and have a detrimental effect due to poor leadership. All these because a poor leader lacks the required skill, overall qualities and ability to effectively lead. If the team leader starts micromanaging the staff members at the lower level, they may get little opportunity to contribute towards the direction of the company and they do not feel invested in the long-term welfare of the organization (Nixon, Harrington & Parker, 2012). If the team leader limits the advancement opportunities, the members start leaving the organization for furthering their careers.

Attitudes for effective healthcare team leadership

Poor leadership has a deep impact on the failure of the organization that includes the time wasted in correcting the mistakes, monetary loss for the unproductive performance, wastage of potential and talent due to mismatch of the right jobs with the right people. The bottom line of the organization gets damaged which in turn lowers the productivity, motivation and the morale of the team members (Fullan, 2014). They do not value the communication factor, neither with the employees not with the patients. This creates a big gap in understanding as well as care. Poor leaders tend to spend a considerable period away from his office or desk and ignore the messages and emails of the staff members. They give lower priority to the points raised by his team members cut short the conversation. Staff opinions are not regarded and their inputs are ignored. New information is not passed over about the changed procedures and policies of the company and it negatively affects the performance of the performance of the staff members (Woodrow & Guest, 2014).

Poor leadership skills can hamper the patient care as well as frustrated employees fails to give their maximum devotion towards their services and therefore, the client satisfaction decreases. This is turn brings down the business of the organization. Therefore, the poor leaders should be identified and should not be offered the leadership position for the interest of the staff, patients and the organization. 

A leadership analysis tool is used for critically evaluating the leadership style of a team leader and other members of the healthcare team. The tool is designed for identification of the areas of strength and the leader can include them in his personality development plan and for the evaluation of the leadership style, as per the autocratic, democratic and liberal styles of leadership (Santos, Caetano & Tavares, 2015). The team leader can use the tool for assessing the leadership competencies of the team members and help them grow as future leaders. The tool can be used as a powerful means to facilitate the collection of information about the existing gaps and helps in developing the necessary skills for optimization of performance. The tool can be implemented for the healthcare leaders for a range of settings and roles and they define the field clearly. The critical evaluation of the leader and his team helps to improve the performance and it works by sharing the knowledge and common skills among the members that are complimentary (Ladegard & Gjerde, 2014). The various parameters provided by the leadership analysis tool have been discussed below.

Personal Characteristics

Positive attitude and self-confidence are the two critical aspects of personal development and growth of a leader. Leaders who are self-confident are often found to be inspiring and an optimistic and positive leader makes the best of any situation for motivating the team members. 

Emotional Intelligence

It includes communication and soft skills that a leader must possess. It helps to identify the feelings of the leader and his team members and manage those feelings and emotions for creating strong bonds of relationships.

Values for effective healthcare team leadership

Transformational Leadership

In this form of leadership, the leader tends to create a futuristic vision that is inspiring. This motivates the team members of the healthcare team to achieve the goal and helps to manage the successful implementation of the leadership skills for creating the future leaders among his members.

Relationship and Communication Management

The ability of the leader to communicate concisely and clearly for interacting with the external and internal clients and patients, maintain and establish relationships and facilitation of the constructive interactions with the groups and individuals (Western, 2013). The leadership criteria include communication skills, relationship management, negotiation and facilitation.

Knowledge of the Environment of Healthcare

The leader must have sound understanding and knowledge of the system of healthcare and its respective environment where the providers and managers of healthcare function. The leader should have the knowledge about the healthcare organizations and systems, the perspective of the patients, healthcare personnel and the healthcare community. 

Business Knowledge and Skills

The healthcare leader should possess the general business knowledge and skills that include financial management, general management, governance and organizational dynamics, human resource management, information management, marketing and strategic planning, quality improvement and risk management (Renko et al., 2015).

The healthcare leaders and the team members must demonstrate the competence in all the parameters of the leadership analysis tool of the critical evaluation of the leadership styles.  The style should ensure that the healthcare team fulfills the objectives of the organization and achieve the self-realization and satisfaction as well. Therefore, the tool helps to identify the leadership styles of the leaders for required growth and success of the organization. 

There is no definition for a successful leader in the healthcare industry. However, there are tendencies and practices that the leaders share to exhibit their personality. Successful and efficient team leaders have a strategy and vision for the future and they strive to become a role model for the team in terms of humility and confidence. They know the tactics to inspire performance of the team members and help them pursuit their goals. The primary mandate of the healthcare leaders is the improvement of the quality of patient care in their respective communities. Although the goals and visions vary according to the individuals, efficient team leaders tend to exhibit the core skills that are strikingly similar to building success. The personality, conduct and actions of the leader set the tone for the team and consequently, for the organization. Efficient and successful leaders create a culture of security and inclusion for the collection and interpretation of good ideas. The team members tend to share good ideas only when they gain the confidence of safety and security from their leaders. In the healthcare industry, novel approaches are widely appreciated and this should be facilitated by efficient leadership strategies and skills. Therefore, leadership in healthcare is a crucial aspect in achieving patient care of the highest level of employee satisfaction and organizational growth.  

Alvesson, M., & Spicer, A. (2013). 11. Does leadership create stupidity?.Critical perspectives on leadership: Emotion, toxicity, and dysfunction, 183.

Fullan, M. (2014). The principal: Three keys to maximizing impact. John Wiley & Sons.

Hoch, J. E., & Kozlowski, S. W. (2014). Leading virtual teams: Hierarchical leadership, structural supports, and shared team leadership. Journal of applied psychology, 99(3), 390.

Huber, D. (2013). Leadership and nursing care management. Elsevier Health Sciences.

Johnson, C. E. (2013). Meeting the ethical challenges of leadership: Casting light or shadow. Sage Publications.

Kessel, M., Kratzer, J., & Schultz, C. (2012). Psychological safety, knowledge sharing, and creative performance in healthcare teams. Creativity and innovation management, 21(2), 147-157.

Kilpatrick, K., Lavoie-Tremblay, M., Ritchie, J. A., & Lamothe, L. (2014). Advanced practice nursing, health care teams, and perceptions of team effectiveness. Journal of Trauma Nursing, 21(6), 291-299.

Krasikova, D. V., Green, S. G., & LeBreton, J. M. (2013). Destructive leadership a theoretical review, integration, and future research agenda.Journal of Management, 39(5), 1308-1338.

Ladegard, G., & Gjerde, S. (2014). Leadership coaching, leader role-efficacy, and trust in subordinates. A mixed methods study assessing leadership coaching as a leadership development tool. The Leadership Quarterly, 25(4), 631-646.

Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., & Bucher, L. (2014). Medical-surgical nursing: assessment and management of clinical problems, single volume. Elsevier Health Sciences.

Mitchell, P., Wynia, M., Golden, R., McNellis, B., Okun, S., Webb, C. E., ... & Von Kohorn, I. (2012). Core principles & values of effective team-based health care. Washington, DC: Institute of Medicine.

Nixon, P., Harrington, M., & Parker, D. (2012). Leadership performance is significant to project success or failure: a critical analysis. International Journal of productivity and performance management, 61(2), 204-216.

Northouse, P. G. (2014). Introduction to Leadership: Concepts and Practice: Concepts and Practice. Sage Publications.

Renko, M., El Tarabishy, A., Carsrud, A. L., & Brännback, M. (2015). Understanding and measuring entrepreneurial leadership style. Journal of Small Business Management, 53(1), 54-74.

Santos, J. P., Caetano, A., & Tavares, S. M. (2015). Is training leaders in functional leadership a useful tool for improving the performance of leadership functions and team effectiveness?. The Leadership Quarterly,26(3), 470-484.

Schyns, B., & Schilling, J. (2013). How bad are the effects of bad leaders? A meta-analysis of destructive leadership and its outcomes. The Leadership Quarterly, 24(1), 138-158.

Skogstad, A., Hetland, J., Glasø, L., & Einarsen, S. (2014). Is avoidant leadership a root cause of subordinate stress? Longitudinal relationships between laissez-faire leadership and role ambiguity. Work & Stress, 28(4), 323-341.

Weaver, S. J., Dy, S. M., & Rosen, M. A. (2014). Team-training in healthcare: a narrative synthesis of the literature. BMJ quality & safety, bmjqs-2013.

Western, S. (2013). Leadership: A critical text. Sage.

Woodrow, C., & Guest, D. E. (2014). When good HR gets bad results: exploring the challenge of HR implementation in the case of workplace bullying. Human Resource Management Journal, 24(1), 38-56.

Yeung, J. H., Ong, G. J., Davies, R. P., Gao, F., & Perkins, G. D. (2012). Factors affecting team leadership skills and their relationship with quality of cardiopulmonary resuscitation*. Critical care medicine, 40(9), 2617-2621.

Yoder-Wise, P. S. (2014). Leading and managing in nursing. Elsevier Health Sciences.

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Chapter 4 - Leadership and Management

4.1. leadership & management introduction, learning objectives.

• Compare and contrast the role of a leader and a manager

• Examine the roles of team members

• Identify the activities managers perform

• Describe the role of the RN as a leader and change agent

• Evaluate the effects of power, empowerment, and motivation in leading and managing a nursing team

• Recognize limitations of self and others and utilize resources

As a nursing student preparing to graduate, you have spent countless hours on developing clinical skills, analyzing disease processes, creating care plans, and cultivating clinical judgment. In comparison, you have likely spent much less time on developing management and leadership skills. Yet, soon after beginning your first job as a registered nurse, you will become involved in numerous situations requiring nursing leadership and management skills. Some of these situations include the following:

• Prioritizing care for a group of assigned clients
• Collaborating with interprofessional team members regarding client care
• Participating in an interdisciplinary team conference
• Acting as a liaison when establishing community resources for a patient being discharged home
• Serving on a unit committee
• Investigating and implementing a new evidence-based best practice
• Mentoring nursing students

Delivering safe, quality client care often requires registered nurses (RN) to manage care provided by the nursing team. Making assignments, delegating tasks, and supervising nursing team members are essential managerial components of an entry-level staff RN role. As previously discussed, nursing team members include RNs, licensed practical/vocational nurses (LPN/VN), and assistive personnel (AP).[ 1 ]

Read more about assigning, delegating, and supervising in the “ Delegation and Supervision ” chapter.

An RN is expected to demonstrate leadership and management skills in many facets of the role. Nurses manage care for high-acuity patients as they are admitted, transferred, and discharged; coordinate care among a variety of diverse health professionals; advocate for clients’ needs; and manage limited resources with shrinking budgets.[ 2 ]

Read more about collaborating and communicating with the interprofessional team; advocating for clients; and admitting, transferring, and discharging clients in the “ Collaboration Within the Interprofessional Team ” chapter.

An article published in the  Online Journal of Issues in Nursing  states, “With the growing complexity of healthcare practice environments and pending nurse leader retirements, the development of future nurse leaders is increasingly important.”[ 3 ] This chapter will explore leadership and management responsibilities of an RN. Leadership styles are introduced, and change theories are discussed as a means for implementing change in the health care system.

4.2. BASIC CONCEPTS

Organizational culture.

The formal leaders of an organization provide a sense of direction and overall guidance for their employees by establishing organizational vision, mission, and values statements. An organization’s  vision statement  defines why the organization exists, describes how the organization is unique from similar organizations, and specifies what the organization is striving to be. The  mission statement  describes how the organization will fulfill its vision and establishes a common course of action for future endeavors. See Figure 4.1 [ 1 ] for an illustration of a mission statement. A  values statement  establishes the values of an organization that assist with the achievement of its vision and mission. A values statement also provides strategic guidelines for decision-making, both internally and externally, by members of the organization. The vision, mission, and values statements are expressed in a concise and clear manner that is easily understood by members of the organization and the public.[ 2 ]

Mission Statement

Organizational culture  refers to the implicit values and beliefs that reflect the norms and traditions of an organization. An organization’s vision, mission, and values statements are the foundation of organizational culture. Because individual organizations have their own vision, mission, and values statements, each organization has a different culture.[ 3 ]

As health care continues to evolve and new models of care are introduced, nursing managers must develop innovative approaches that address change while aligning with that organization’s vision, mission, and values. Leaders embrace the organization’s mission, identify how individuals’ work contributes to it, and ensure that outcomes advance the organization’s mission and purpose. Leaders use vision, mission, and values statements for guidance when determining appropriate responses to critical events and unforeseen challenges that are common in a complex health care system. Successful organizations require employees to be committed to following these strategic guidelines during the course of their work activities. Employees who understand the relationship between their own work and the mission and purpose of the organization will contribute to a stronger health care system that excels in providing first-class patient care. The vision, mission, and values provide a common organization-wide frame of reference for decision-making for both leaders and staff.[ 4 ]

Learning Activity

Investigate the mission, vision, and values of a potential employer, as you would do prior to an interview for a job position.

Reflective Questions

1. How well do the organization’s vision and values align with your personal values regarding health care?

2. How well does the organization’s mission align with your professional objective in your resume?

Followership

Followership  is described as the upward influence of individuals on their leaders and their teams. The actions of followers have an important influence on staff performance and patient outcomes. Being an effective follower requires individuals to contribute to the team not only by doing as they are told, but also by being aware and raising relevant concerns. Effective followers realize that they can initiate change and disagree or challenge their leaders if they feel their organization or unit is failing to promote wellness and deliver safe, value-driven, and compassionate care. Leaders who gain the trust and dedication of followers are more effective in their leadership role. Everybody has a voice and a responsibility to take ownership of the workplace culture, and good followership contributes to the establishment of high-functioning and safety-conscious teams.[ 5 ]

Team members impact patient safety by following teamwork guidelines for good followership. For example, strategies such as closed-loop communication are important tools to promote patient safety.

Read more about communication and teamwork strategies in the “ Collaboration Within the Interprofessional Team ” chapter.

Leadership and Management Characteristics

Leadership and management are terms often used interchangeably, but they are two different concepts with many overlapping characteristics.  Leadership  is the art of establishing direction and influencing and motivating others to achieve their maximum potential to accomplish tasks, objectives, or projects.[ 6 ],[ 7 ] See Figure 4.2 [ 8 ] for an illustration of team leadership. There is no universally accepted definition or theory of nursing leadership, but there is increasing clarity about how it differs from management.[ 9 ]  Management  refers to roles that focus on tasks such as planning, organizing, prioritizing, budgeting, staffing, coordinating, and reporting.[ 10 ] The overriding function of management has been described as providing order and consistency to organizations, whereas the primary function of leadership is to produce change and movement.[ 11 ] View a comparison of the characteristics of management and leadership in Table 4.2a .

Management and Leadership Characteristics[ 12 ]

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Not all nurses are managers, but all nurses are leaders because they encourage individuals to achieve their goals. The American Nurses Association (ANA) established  Leadership  as a Standard of Professional Performance for all registered nurses. Standards of Professional Performance are “authoritative statements of action and behaviors that all registered nurses, regardless of role, population, specialty, and setting, are expected to perform competently.”[ 13 ] See the competencies of the ANA  Leadership  standard in the following box and additional content in other chapters of this book.

Competencies of ANA’s Leadership Standard of Professional Performance

• Promotes effective relationships to achieve quality outcomes and a culture of safety

• Leads decision-making groups

• Engages in creating an interprofessional environment that promotes respect, trust, and integrity

• Embraces practice innovations and role performance to achieve lifelong personal and professional goals

• Communicates to lead change, influence others, and resolve conflict

• Implements evidence-based practices for safe, quality health care and health care consumer satisfaction

• Demonstrates authority, ownership, accountability, and responsibility for appropriate delegation of nursing care

• Mentors colleagues and others to embrace their knowledge, skills, and abilities

• Participates in professional activities and organizations for professional growth and influence

• Advocates for all aspects of human and environmental health in practice and policy

Read additional content related to leadership and management activities in corresponding chapters of this book:

• Read about the culture of safety in the “ Legal Implications ” chapter.

• Read about effective interprofessional teamwork and resolving conflict in the “ Collaboration Within the Interprofessional Team ” chapter.

• Read about quality improvement and implementing evidence-based practices in the “ Quality and Evidence-Based Practice ” chapter.

• Read more about delegation, supervision, and accountability in the “ Delegation and Supervision ” chapter.

• Read about professional organizations and advocating for patients, communities, and their environments in the “ Advocacy ” chapter.

• Read about budgets and staffing in the “ Health Care Economics ” chapter.

• Read about prioritization in the “ Prioritization ” chapter.

Leadership Theories and Styles

In the 1930s Kurt Lewin, the father of social psychology, originally identified three leadership styles: authoritarian, democratic, and laissez-faire.[ 14 ],[ 15 ]

Authoritarian leadership  means the leader has full power. Authoritarian leaders tell team members what to do and expect team members to execute their plans. When fast decisions must be made in emergency situations, such as when a patient “codes,” the authoritarian leader makes quick decisions and provides the group with direct instructions. However, there are disadvantages to authoritarian leadership. Authoritarian leaders are more likely to disregard creative ideas of other team members, causing resentment and stress.[ 16 ]

Democratic leadership  balances decision-making responsibility between team members and the leader. Democratic leaders actively participate in discussions, but also make sure to listen to the views of others. For example, a nurse supervisor may hold a meeting regarding an increased incidence of patient falls on the unit and ask team members to share their observations regarding causes and potential solutions. The democratic leadership style often leads to positive, inclusive, and collaborative work environments that encourage team members’ creativity. Under this style, the leader still retains responsibility for the final decision.[ 17 ]

Laissez-faire  is a French word that translates to English as, “leave alone.” Laissez-faire leadership gives team members total freedom to perform as they please. Laissez-faire leaders do not participate in decision-making processes and rarely offer opinions. The laissez-faire leadership style can work well if team members are highly skilled and highly motivated to perform quality work. However, without the leader’s input, conflict and a culture of blame may occur as team members disagree on roles, responsibilities, and policies. By not contributing to the decision-making process, the leader forfeits control of team performance.[ 18 ]

Over the decades, Lewin’s original leadership styles have evolved into many styles of leadership in health care, such as passive-avoidant, transactional, transformational, servant, resonant, and authentic.[ 19 ],[ 20 ] Many of these leadership styles have overlapping characteristics. See Figure 4.3 [ 21 ] for a comparison of various leadership styles in terms of engagement.

Leadership Styles

Passive-avoidant leadership  is similar to laissez-faire leadership and is characterized by a leader who avoids taking responsibility and confronting others. Employees perceive the lack of control over the environment resulting from the absence of clear directives. Organizations with this type of leader have high staff turnover and low retention of employees. These types of leaders tend to react and take corrective action only after problems have become serious and often avoid making any decisions at all.[ 22 ]

Transactional leadership  involves both the leader and the follower receiving something for their efforts; the leader gets the job done and the follower receives pay, recognition, rewards, or punishment based on how well they perform the tasks assigned to them.[ 23 ] Staff generally work independently with no focus on cooperation among employees or commitment to the organization.[ 24 ]

Transformational leadership  involves leaders motivating followers to perform beyond expectations by creating a sense of ownership in reaching a shared vision.[ 25 ] It is characterized by a leader’s charismatic influence over team members and includes effective communication, valued relationships, and consideration of team member input. Transformational leaders know how to convey a sense of loyalty through shared goals, resulting in increased productivity, improved morale, and increased employees’ job satisfaction.[ 26 ] They often motivate others to do more than originally intended by inspiring them to look past individual self-interest and perform to promote team and organizational interests.[ 27 ]

Servant leadership  focuses on the professional growth of employees while simultaneously promoting improved quality care through a combination of interprofessional teamwork and shared decision-making. Servant leaders assist team members to achieve their personal goals by listening with empathy and committing to individual growth and community-building. They share power, put the needs of others first, and help individuals optimize performance while forsaking their own personal advancement and rewards.[ 28 ]

Visit the Greenleaf Center site to learn more about  What is Servant Leadership ?

Resonant leaders  are in tune with the emotions of those around them, use empathy, and manage their own emotions effectively. Resonant leaders build strong, trusting relationships and create a climate of optimism that inspires commitment even in the face of adversity. They create an environment where employees are highly engaged, making them willing and able to contribute with their full potential.[ 29 ]

Authentic leaders  have an honest and direct approach with employees, demonstrating self-awareness, internalized moral perspective, and relationship transparency. They strive for trusting, symmetrical, and close leader–follower relationships; promote the open sharing of information; and consider others’ viewpoints.[ 30 ]

Characteristics of Leadership Styles

Outcomes of Various Leadership Styles

Leadership styles affect team members, patient outcomes, and the organization. A systematic review of the literature published in 2021 showed significant correlations between leadership styles and nurses’ job satisfaction. Transformational leadership style had the greatest positive correlation with nurses’ job satisfaction, followed by authentic, resonant, and servant leadership styles. Passive-avoidant and laissez-faire leadership styles showed a negative correlation with nurses’ job satisfaction.[ 31 ] In this challenging health care environment, managers and nurse leaders must promote technical and professional competencies of their staff, but they must also act to improve staff satisfaction and morale by using appropriate leadership styles with their team.[ 32 ]

Systems Theory

Systems theory  is based on the concept that systems do not function in isolation but rather there is an interdependence that exists between their parts. Systems theory assumes that most individuals strive to do good work, but are affected by diverse influences within the system. Efficient and functional systems account for these diverse influences and improve outcomes by studying patterns and behaviors across the system.[ 33 ]

Many health care agencies have adopted a culture of safety based on systems theory. A  culture of safety  is an organizational culture that embraces error reporting by employees with the goal of identifying systemic causes of problems that can be addressed to improve patient safety. According to The Joint Commission, a culture of safety includes the following components[ 34 ]:

• Just Culture:  A culture where people feel safe raising questions and concerns and report safety events in an environment that emphasizes a nonpunitive response to errors and near misses. Clear lines are drawn by managers between human error, at-risk, and reckless employee behaviors. See Figure 4.4 [ 35 ] for an illustration of Just Culture.
• Reporting Culture:  People realize errors are inevitable and are encouraged to speak up for patient safety by reporting errors and near misses. For example, nurses complete an “incident report” according to agency policy when a medication error occurs or a client falls. Error reporting helps the agency manage risk and reduce potential liability.
• Learning Culture:  People regularly collect information and learn from errors and successes while openly sharing data and information and applying best evidence to improve work processes and patient outcomes.

“Just Culture Infographic.png” by Valeria Palarski 2020. Used with permission.

The Just Culture model categorizes human behavior into three categories of errors. Consequences of errors are based on whether the error is a simple human error or caused by at-risk or reckless behavior[ 36 ]:

• Simple human error:  A simple human error occurs when an individual inadvertently does something other than what should have been done. Most medical errors are the result of human error due to poor processes, programs, education, environmental issues, or situations. These errors are managed by correcting the cause, looking at the process, and fixing the deviation. For example, a nurse appropriately checks the rights of medication administration three times, but due to the similar appearance and names of two different medications stored next to each other in the medication dispensing system, administers the incorrect medication to a patient. In this example, a root cause analysis reveals a system issue that must be modified to prevent future patient errors (e.g., change the labelling and storage of look alike-sound alike medications).[ 37 ]
• At-risk behavior:  An error due to at-risk behavior occurs when a behavioral choice is made that increases risk where the risk is not recognized or is mistakenly believed to be justified. For example, a nurse scans a patient’s medication with a barcode scanner prior to administration, but an error message appears on the scanner. The nurse mistakenly interprets the error to be a technology problem and proceeds to administer the medication instead of stopping the process and further investigating the error message, resulting in the wrong dosage of a medication being administered to the patient. In this case, ignoring the error message on the scanner can be considered “at-risk behavior” because the behavioral choice was considered justified by the nurse at the time.[ 38 ]
• Reckless behavior:  Reckless behavior is an error that occurs when an action is taken with conscious disregard for a substantial and unjustifiable risk. For example, a nurse arrives at work intoxicated and administers the wrong medication to the wrong patient. This error is considered due to reckless behavior because the decision to arrive intoxicated was made with conscious disregard for substantial risk.[ 39 ]

These categories of errors result in different consequences to the employee based on the Just Culture model:

• If an individual commits a simple human error, managers console the individual and consider changes in training, procedures, and processes.[ 40 ] In the “simple human error” example above, system-wide changes would be made to change the label and location of the medications to prevent future errors from occurring with the same medications.
• Individuals committing at-risk behavior are held accountable for their behavioral choices and often require coaching with incentives for less risky behaviors and situational awareness.[ 41 ]In the “at-risk behavior” example above, when the nurse chose to ignore an error message on the barcode scanner, mandatory training on using barcode scanners and responding to errors would likely be implemented, and the manager would track the employee’s correct usage of the barcode scanner for several months following training.
• If an individual demonstrates reckless behavior, remedial action and/or punitive action is taken.[ 42 ] In the “reckless behavior” example above, the manager would report the nurse’s behavior to the State Board of Nursing for disciplinary action. The SBON would likely mandate substance abuse counseling for the nurse to maintain their nursing license. However, employment may be terminated and/or the nursing license revoked if continued patterns of reckless behavior occur.

See Table 4.2c describing classifications of errors using the Just Culture model.

Classification of Errors Using the Just Culture Model

Systems leadership  refers to a set of skills used to catalyze, enable, and support the process of systems-level change that is encouraged by the Just Culture Model. Systems leadership is comprised of three interconnected elements:[ 43 ]

• The Individual:  The skills of collaborative leadership to enable learning, trust-building, and empowered action among stakeholders who share a common goal
• The Community:  The tactics of coalition building and advocacy to develop alignment and mobilize action among stakeholders in the system, both within and between organizations
• The System:  An understanding of the complex systems shaping the challenge to be addressed

4.3. IMPLEMENTING CHANGE

Change is constant in the health care environment.  Change  is defined as the process of altering or replacing existing knowledge, skills, attitudes, systems, policies, or procedures.[ 1 ] The outcomes of change must be consistent with an organization’s mission, vision, and values. Although change is a dynamic process that requires alterations in behavior and can cause conflict and resistance, change can also stimulate positive behaviors and attitudes and improve organizational outcomes and employee performance. Change can result from identified problems or from the incorporation of new knowledge, technology, management, or leadership. Problems may be identified from many sources, such as quality improvement initiatives, employee performance evaluations, or accreditation survey results.[ 2 ]

Nurse managers must deal with the fears and concerns triggered by change. They should recognize that change may not be easy and may be met with enthusiasm by some and resistance by others. Leaders should identify individuals who will be enthusiastic about the change (referred to as “early adopters”), as well as those who will be resisters (referred to as “laggers”). Early adopters should be involved to build momentum, and the concerns of resisters should be considered to identify barriers. Data should be collected, analyzed, and communicated so the need for change (and its projected consequences) can be clearly articulated. Managers should articulate the reasons for change, the way(s) the change will affect employees, the way(s) the change will benefit the organization, and the desired outcomes of the change process.[ 3 ] See Figure 4.5 [ 4 ] for an illustration of communicating upcoming change.

Identifying Upcoming Change

Change Theories

There are several change theories that nurse leaders may adopt when implementing change. Two traditional change theories are known as Lewin’s Unfreeze-Change-Refreeze Model and Lippitt’s Seven-Step Change Theory.[ 5 ]

Lewin’s Change Model

Kurt Lewin, the father of social psychology, introduced the classic three-step model of change known as Unfreeze-Change-Refreeze Model that requires prior learning to be rejected and replaced. Lewin’s model has three major concepts: driving forces, restraining forces, and equilibrium. Driving forces are those that push in a direction and cause change to occur. They facilitate change because they push the person in a desired direction. They cause a shift in the equilibrium towards change. Restraining forces are those forces that counter the driving forces. They hinder change because they push the person in the opposite direction. They cause a shift in the equilibrium that opposes change. Equilibrium is a state of being where driving forces equal restraining forces, and no change occurs. It can be raised or lowered by changes that occur between the driving and restraining forces.[ 6 ],[ 7 ]

• Step 1: Unfreeze the status quo.  Unfreezing is the process of altering behavior to agitate the equilibrium of the current state. This step is necessary if resistance is to be overcome and conformity achieved. Unfreezing can be achieved by increasing the driving forces that direct behavior away from the existing situation or status quo while decreasing the restraining forces that negatively affect the movement from the existing equilibrium. Nurse leaders can initiate activities that can assist in the unfreezing step, such as motivating participants by preparing them for change, building trust and recognition for the need to change, and encouraging active participation in recognizing problems and brainstorming solutions within a group.[ 8 ]
• Step 2: Change.  Change is the process of moving to a new equilibrium. Nurse leaders can implement actions that assist in movement to a new equilibrium by persuading employees to agree that the status quo is not beneficial to them; encouraging them to view the problem from a fresh perspective; working together to search for new, relevant information; and connecting the views of the group to well-respected, powerful leaders who also support the change.[ 9 ]
• Step 3: Refreeze.  Refreezing refers to attaining equilibrium with the newly desired behaviors. This step must take place after the change has been implemented for it to be sustained over time. If this step does not occur, it is very likely the change will be short-lived and employees will revert to the old equilibrium. Refreezing integrates new values into community values and traditions. Nursing leaders can reinforce new patterns of behavior and institutionalize them by adopting new policies and procedures.[ 10 ]

Example Using Lewin’s Change Theory

A new nurse working in a rural medical-surgical unit identifies that bedside handoff reports are not currently being used during shift reports.

Step 1: Unfreeze:  The new nurse recognizes a change is needed for improved patient safety and discusses the concern with the nurse manager. Current evidence-based practice is shared regarding bedside handoff reports between shifts for patient safety.[ 11 ] The nurse manager initiates activities such as scheduling unit meetings to discuss evidence-based practice and the need to incorporate bedside handoff reports.

Step 2: Change:  The nurse manager gains support from the Director of Nursing to implement organizational change and plans staff education about bedside report checklists and the manner in which they are performed.

Step 3: Refreeze:  The nurse manager adopts bedside handoff reports in a new unit policy and monitors staff for effectiveness.

Lippitt’s Seven-Step Change Theory

Lippitt’s Seven-Step Change Theory expands on Lewin’s change theory by focusing on the role of the change agent. A  change agent  is anyone who has the skill and power to stimulate, facilitate, and coordinate the change effort. Change agents can be internal, such as nurse managers or employees appointed to oversee the change process, or external, such as an outside consulting firm. External change agents are not bound by organizational culture, politics, or traditions, so they bring a different perspective to the situation and challenge the status quo. However, this can also be a disadvantage because external change agents lack an understanding of the agency’s history, operating procedures, and personnel.[ 12 ] The seven-step model includes the following steps[ 13 ]:

• Step 1: Diagnose the problem.  Examine possible consequences, determine who will be affected by the change, identify essential management personnel who will be responsible for fixing the problem, collect data from those who will be affected by the change, and ensure those affected by the change will be committed to its success.
• Step 2: Evaluate motivation and capability for change.  Identify financial and human resources capacity and organizational structure.
• Step 3: Assess the change agent’s motivation and resources, experience, stamina, and dedication.
• Step 4: Select progressive change objectives.  Define the change process and develop action plans and accompanying strategies.
• Step 5: Explain the role of the change agent to all employees and ensure the expectations are clear.
• Step 6: Maintain change.  Facilitate feedback, enhance communication, and coordinate the effects of change.
• Step 7: Gradually terminate the helping relationship of the change agent.

Example Using Lippitt’s Seven-Step Change Theory

Refer to the previous example of using Lewin’s change theory on a medical-surgical unit to implement bedside handoff reporting. The nurse manager expands on the Unfreeze-Change-Refreeze Model by implementing additional steps based on Lippitt’s Seven-Step Change Theory:

• The nurse manager collects data from team members affected by the changes and ensures their commitment to success.
• Early adopters are identified as change agents on the unit who are committed to improving patient safety by implementing evidence-based practices such as bedside handoff reporting.
• Action plans (including staff education and mentoring), timelines, and expectations are clearly communicated to team members as progressive change objectives. Early adopters are trained as “super-users” to provide staff education and mentor other nurses in using bedside handoff checklists across all shifts.
• The nurse manager facilitates feedback and encourages two-way communication about challenges as change is implemented on the unit. Positive reinforcement is provided as team members effectively incorporate change.
• Bedside handoff reporting is implemented as a unit policy, and all team members are held accountable for performing accurate bedside handoff reporting.

Read more about additional change theories in the  Current Theories of Change Management pdf .

Change Management

Change management  is the process of making changes in a deliberate, planned, and systematic manner.[ 14 ] It is important for nurse leaders and nurse managers to remember a few key points about change management[ 15 ]:

• Employees will react differently to change, no matter how important or advantageous the change is purported to be.
• Basic needs will influence reaction to change, such as the need to be part of the change process, the need to be able to express oneself openly and honestly, and the need to feel that one has some control over the impact of change.
• Change often results in a feeling of loss due to changes in established routines. Employees may react with shock, anger, and resistance, but ideally will eventually accept and adopt change.
• Change must be managed realistically, without false hopes and expectations, yet with enthusiasm for the future. Employees should be provided information honestly and allowed to ask questions and express concerns.

4.4. SPOTLIGHT APPLICATION

Jamie has recently completed his orientation to the emergency department at a busy Level 1 trauma center. The environment is fast-paced and there are typically a multitude of patients who require care. Jamie appreciates his colleagues and the collaboration that is reflected among members of the health care team, especially in times of stress. Jamie is providing care for an 8-year-old patient who has broken her arm when there is a call that there are three Level 1 trauma patients approximately 5 minutes from the ER. The trauma surgeon reports to the ER, and multiple members of the trauma team report to the ER intake bays. If you were Jamie, what leadership style would you hope the trauma surgeon uses with the team?

In a stressful clinical care situation, where rapid action and direction are needed, an autocratic leadership style is most effective. There is no time for debating different approaches to care in a situation where immediate intervention may be required. Concise commands, direction, and responsive action from the team are needed to ensure that patient care interventions are delivered quickly to enhance chance of survival and recovery.

4.5. LEARNING ACTIVITIES

Learning activities.

(Answers to “Learning Activities” can be found in the “Answer Key” at the end of the book. Answers to interactive activities are provided as immediate feedback.)

Sample Scenario

An 89-year-old female resident with Alzheimer’s disease has been living at the nursing home for many years. The family decides they no longer want aggressive measures taken and request to the RN on duty that the resident’s code status be changed to Do Not Resuscitate (DNR). The evening shift RN documents a progress note that the family (and designated health care agent) requested that the resident’s status be made DNR. Due to numerous other responsibilities and needs during the evening shift, the RN does not notify the attending physician or relay the information during shift change or on the 24-hour report. The day shift RN does not read the night shift’s notes because of several immediate urgent situations. The family, who had been keeping vigil at the resident’s bedside throughout the night, leaves to go home to shower and eat. Upon return the next morning, they find the room full of staff and discover the staff performed CPR after their loved one coded. The resident was successfully resuscitated but now lies in a vegetative state. The family is unhappy and is considering legal action. They approach you, the current nurse assigned to the resident’s care, and state, “We followed your procedures to make sure this would not happen! Why was this not managed as we discussed?”[ 1 ]

1. As the current nurse providing patient care, explain how you would therapeutically address this family’s concerns and use one or more leadership styles.

2. As the charge nurse, explain how you would address the staff involved using one or more leadership styles.

3. Explain how change theory can be implemented to ensure this type of situation does not recur.

IV. GLOSSARY

The process of altering or replacing existing knowledge, skills, attitudes, systems, policies, or procedures.[ 1 ]

Anyone who has the skill and power to stimulate, facilitate, and coordinate the change effort.

Organizational culture that embraces error reporting by employees with the goal of identifying systemic causes of problems that can be addressed to improve patient safety. Just Culture is a component of a culture of safety.

The upward influence of individuals on their leaders and their teams.

A culture where people feel safe raising questions and concerns and report safety events in an environment that emphasizes a nonpunitive response to errors and near misses. Clear lines are drawn between human error, at-risk, and reckless employee behaviors.

The art of establishing direction and influencing and motivating others to achieve their maximum potential to accomplish tasks, objectives, or projects.[ 2 ],[ 3 ]

Roles that focus on tasks such as planning, organizing, prioritizing, budgeting, staffing, coordinating, and reporting.[ 4 ]

An organization’s statement that describes how the organization will fulfill its vision and establishes a common course of action for future endeavors.

The implicit values and beliefs that reflect the norms and traditions of an organization. An organization’s vision, mission, and values statements are the foundation of organizational culture.

A set of skills used to catalyze, enable, and support the process of systems-level change that focuses on the individual, the community, and the system.

The concept that systems do not function in isolation but rather there is an interdependence that exists between their parts. Systems theory assumes that most individuals strive to do good work, but are affected by diverse influences within the system.

The organization’s established values that support its vision and mission and provide strategic guidelines for decision-making, both internally and externally, by members of the organization.

An organization’s statement that defines why the organization exists, describes how the organization is unique and different from similar organizations, and specifies what the organization is striving to be.

Licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/ .

• Cite this Page Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing Management and Professional Concepts [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2022. Chapter 4 - Leadership and Management.
• PDF version of this title (18M)

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• LEADERSHIP & MANAGEMENT INTRODUCTION
• BASIC CONCEPTS
• IMPLEMENTING CHANGE
• SPOTLIGHT APPLICATION
• LEARNING ACTIVITIES

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Leadership in Healthcare Assignment

Founded in 1947, Pupa Care Services have believed in the motto that they should help people live longer, happier & healthier lives with provision of good quality latherer. Pupa not being open to shareholders works purely for the benefits of its patients. Their various initiatives in terms of investment are aimed at better healthcare for their patients. The focus of this assignment is on the leadership programmer conducted by Pupa in “Caring for elder people” Pupa, through its network of residential hospitals, retirement homes & nursing homes in the SKI, Australia, Spain and New Zealand takes care of thousands of elder patients.

Over a period of time with increase in experience they have identified lacunas in their processes and reached a maturity to excel in innovation and development of care facilities for the elderly. With collaborations with researchers, expert partners and academics they aim to find innovative ways to improve their services With the society at large being dominated by ageing individuals, it introduces the healthcare domain with new challenges to address.

Don’t waste your time! Order your assignment!

It is more prevalent in developed countries which have a strong healthcare system to support individuals during their more productive phase in life thus improving their life expectancy. Globally speaking, it is estimated in the next two decades that there would be bout twice the percentage of elders in the UK as compared to today, while individuals who have completed their centenary would be 4 times as compared to today. In Australia, the numbers are expected to increase from the current 0. 2 million to an estimated 0. Million in the next two decades. A more similar trend is predicted in New Zealand whereby the current count is estimated to be doubled in the next three decades.. The programmer aims at trying to profile care home population, support initiatives to garner funds, target improvement of healthcare aspects and a aim at the greater good for improving the standard of living of the elderly. The programmer was conducted under the able leadership of Mark Allergy, Managing Director, Pupa Care Services and Dry. Clive Bowman, Medical Director, Pupa Care Services.

Interactive Model of Leadership Response from people today in a corporate team based culture is largely influenced by the behavior of their leaders. People like if their leaders are with them rather then above them, which gives them a feeling on belonging in the team and not a slave to the system. This calls for an innovative and lateral shift in the thinking behavior on part of the leaders to be effective in their workplace. The interactive leadership development program helps leaders learn to effectively make that shift & excel as team players.

The program offers a new lease of life and offers an opportunity for to be leaders to benchmark their skills against the best practices from around the world which is supported and well documented through a world class study of more than three decades. The intent of the program is to make candidates test their inner skills and coach themselves against external actions. It provokes them to improve upon their competencies and be better leaders to achieve higher performance tit results which have a long lasting impression.

The research on interactive leadership has been conducted by founder David H. Burnham and Harvard psychologist Dry. David C. McClellan basis which they have observed the way leaders behave and most importantly how they think in the most critical of situations. The focus of the program is to inculcate a thought process to be able to engage with individuals and groups, improve the emotional intelligence and have a dedicated focus on results. Let’s now focus on applying the model to the leadership programmer at Pupa Care Services.

The primary premise on which the interactive leadership works is: Thoughts drive Actions to create Outcomes. Participants are given the opportunity to work through simulations, perform exercises and activities in each of the critical areas in order to: v” Experience and evaluate how their present thinking will help them drive outcomes in future Develop and invest in specific goals which would prepare them for any future change Identify the key areas that need development and have conscious thought process to achieve them Learn the nuances to make the change(s) happen.

Measure to Analyses Leadership Skills 1 Introduction Leaders are aware of change and it is obvious to them that they need to adapt to the change as individuals as well as a group and the industry at large. But considering today’s uncertain and complicated work culture, the importance lies in understanding the importance of leadership skills. The entire healthcare domain for years have been operating in a dynamic world with changes impacting everyone including insurance companies, healthcare providers, device firms and pharmaceutical to a great extent.

The industry has been boosted by the advent of technology, newer & improved means of care, a more dynamic business model. Regulatory authority and ethical issues add to the existing woes of the healthcare industry. With such complexities, organizations find it cumbersome to identify the leadership talent which can help them set direction, gain commitment from employees as well as from partners and drive high quality care for the patients. With a volatile environment, the healthcare sector is looming large on drastic changes ahead in time and at the present moment; it is already amidst a phase of rapid change.

This demands high levels of expertise in technology and thorough bred professionals with good leadership skills to be able to swim n the rough waters. The other problem for the healthcare domain is that it is extremely difficult for them to classify their challenges since these are multi dimensional and of a complex nature. In order to address these challenges, common strategies and processes have to be developed which would enable the organization to achieve high performance. It is the need of the hour and even a need for Pupa Care Services. 2 Critical Factors 1 .

Improve the ability to lead subordinates and work in groups. Leaders should be able to collaborate and should be capable of creating a culture to influence articulation from all members in the group. It is also important for leaders to be able to deal with problem subordinates. 2. Create strategies to provide current and future leaders broad holistic view. In order to have a holistic view, leaders are expected to have some critical qualities like self awareness, career management and functional know how. A majority of the leaders today have been found wanting in these critical areas.

Such limitations are expected to be overcome through continuous training and development, feedback sharing, coaching and succession planning. 3. Leaders possess important strengths. They are well equipped to handle change and have the ability to achieve the end results. They possess some key additional qualities like cool composure, quick learning capability and clarity in thought process. Such qualities inherited by leaders provide enough proof that the healthcare leaders are a capable bunch of individuals who are assets to the industry. Identifying Leadership Gaps Like in every exercise which involves comparison of two levels of attributes in any individual, there would always be some gaps in the expected level and actual level. With leadership this disparity can be arrived by the difference in current skills to expected skills. With this understanding, organizations can come up with powerful strategies to build a capable pool of able leaders. The process of identifying gaps leads us to the characterizing certain attributes which are important for leadership skills and certain factors that are termed as derailment factors.

Important Factors 1 . Resourcefulness. Possesses multiple qualities such as good decision making under pressure, setting up intricate systems, analytical thinking, flexible behavior and problem solving skills. Gets along with seniors and has the capability to deal with higher management responsibilities. 2. Result Oriented. Has the capability to get things done by carefully investing in ideas and thrives to overcome hindrances with a dedicated focus. Can stand up and take responsibility to handle tasks individually and at the same time is open to learn from others to accomplish the task. 3.

Quick Learner. Has the capability to quickly assimilate business and technical know-how. 4. Decisive. Always looks for prompt and precise solutions to any of the management problems which otherwise would be slow and sluggish. 5. Leading Subordinates. Strong delegation powers and provides opportunities to budding subordinates to show case their talents. Always on the look out for fresh talent for hiring. Has an unbiased approach towards his subordinates. 6. Handling Problem Subordinates. Tries to understand the problem subordinate and only after proper evaluation decides to act upon a problem employee.

Shows enough fairness and is unbiased with problem employees. 7. Encourages participation. Is a good listener and takes everyone’s opinion before arriving at a decision. 8. Handles change. Is always expecting changes and is ready to adapt. Also, takes efforts to overcome any resistance from his other subordinates with a view that the change has its benefits in the long run. 9. Build relationships. Capable of building and maintain good relations with subordinates and external parties. Masters the skills of negotiation without hurting any of the subordinate sentiments. 10.

Compassionate and Sensitive. Genuinely interested in solving others problems and is sensitivity to employees’ needs. 11. Composure. Does not get into blame game over a mistake committed by anyone in the team. Handles the problem calmly and looks at solving the same quickly. 12. Personal Life. Strikes a balance between his working commitment and personal life. Neither of them is ever side tracked. 13. Self-Awareness. Knows his strengths and weaknesses and has the willingness to improve. 14. Puts people at ease. Displays the right amount of warmth to people and has a good sense of humor.

Having a good sense of humor is not at the expense of hurting subordinates sentiments. 15. Manages his career. Remains focused towards building this career through continuous investing in training, coaching and feedback. Derailment Factors 1 . Interpersonal Relationships. Finds it difficult to get along with subordinates which indirectly impact his work. 2. Building and Leading a Team. Finds it difficult to build and lead a team. 3. Manage change. He is not able to manage change. Finds it difficult to adapt to change and inherently shows resistance to change. 4. Fails to achieve goals.

Finds it difficult to keep up with his commitments and fails to meet business objectives. 5. Narrow thinking. Does not get into details and fails to have a holistic view. 4 Closing the gaps To close the leadership gap in the areas identified, organizations and individual adders will need a solid understanding of the skills and behaviors required to be effective in each area. Here, is the starting point for understanding five areas that healthcare leaders and organizations should emphasize: 1 . Leading employees. This requires a leader to be self aware and have strong interpersonal skills.

They need to invest in creating and building a team. They provide ample opportunities and challenges to their subordinates which is followed up with continuous guidance and coaching. They look at being mentors to future leaders. 2. Encourage participation. A leader should look at getting his teams involved, build a consensus and have a concurrent decision with everyone’s strong participation. Should be able to communicate well and also be a good listener in order to be able to get the best out of his team members. Looks at multiple perspectives before arriving at a decision. 3. Relationship Management.

A leader should look at building relationships with his subordinates and also be fair in handling these relationships. He should be able to relate to all kinds of people and easily gain support and respect of peers, senior management and customers. . Self-Awareness. Be aware of ones strengths and weaknesses. Some one who is aware of his own being will always seek feedback from others and try to improve him continuously. He would be open enough to admit his mistakes and self correct himself. 5. Organizational perspective. A leader should have a broad and holistic organizational view.

If the thinking is narrow then it would hurt the team was well as the organization in the long term. Should be capable enough to handle the tactical and technical points required to manage his work. Nature of Motivation, Satisfaction & Performance Motivation is something that makes people performs better. However, not everyone gets motivated by the same things: Someone who is motivated might be satisfied and would perform better by getting additional responsibilities, whereas someone would gets some flexibility in his working style might get motivated to perform better.

It merely means that motivation to every individual might mean differently and his response to it would also differ. The various initiatives take at Pupa Care Services to contribute to the overall success of the leadership programmer are listed below 1. Clinical Leadership: Director of mental and physical disability care, Dry Graham Stokes, is responsible for driving forward the quality and scope of care for people living with mental and physical disability in Pupa’s care homes in the UK, Australia, Spain and New Zealand. 2.

Fund Raising: Pupa is continuing their successful partnership with Alchemist’s Society in England and Wales, and Alchemies Scotland for the Pupa Great Run Series. They managed to raise close to El million in 2009, which is evidence of the shared commitment to continue to raise awareness of mental and physical disability. Pupa has sponsored the Great Run Series for 17 years, making it one of the longest-running sporting partnerships in the I-J. 3. Boosting Research: Alchemist’s Society and the Pupa Foundation have formed a partnership to pioneer and boost research into physical & mental disability and its causes.

They jointly launched a E 1. 5 million fund to support research into the cause, cure, care, and prevention of physical & mental disabilities. Task Orientation among Teams Every organization wants to have a well collaborated team which can provide results effectively. There are many factors which would define a team’s SUccess UT the key factor being a leader’s vision and control over his team. Leaders have to be a mix of task and team orientation. This capability to leverage on both orientations enhances the ability build trust, create stability, and bring effectiveness among the team.

The various task orientation initiatives taken at Pupa Care Services are listed below. 1 . Pioneering Champions: Alchemist’s Society and Pupa have joined together to launch the first ever physical & mental disability Champions programmer across 190 Pupa specialist care communities in the I-J. The programmer aims to develop n-house bred leaders to combat physical & mental disability care in their place of work and has been successfully piloted in Pupa care homes. By changing the culture, the physical & mental disabilities champions aim to further improve quality of care and quality of life for people with physical & mental disability. . Supporting careers in their own communities: Pupa’s partnership with the charity for physical & mental disability aims to build capacity by developing new Admiral Nurse Posts in communities not served by this specialist nursing discipline. ‘Physical & mental disability Pioneers’ are appointed to selected areas o spearhead development plans. The work of the Admiral Nurse in helping families and those living with physical & mental disability is well proven. Admiral Nurses have a significant role in helping families cope with the difficulties faced through their journey with physical & mental disability.

Nature of group & group development There are four distinct stages that a group passes through as it comes together and starts to operate. The process can be known to all, but an understanding of the stages can help everyone attain effectiveness more quickly. 1 . Forming: Being humans, everyone thrives to be accepted in their groups and also looks to avoid getting into conflicts. Everyone has a part to play in the entire jigsaw puzzle and thus they avoid getting into issues and hurting others feeling.

But they have to accomplice their task by being in touch with their sub ordinates in order to achieve the results. 2. Storming: Every group has Individuals with varied natures. Some have a high degree of patience while some just get annoyed at everything. Similarly there is a threshold to everyone’s patience which eventually might lead to minor disputes or confrontations. These might be related or totally unrelated to work. 3. Morning: As we progress from the storming stage, the group matures and starts understanding their roles and responsibilities.

These become more clear and each one agrees to follow the same. They start understanding each other better having gone through the grind during the storming stage. This eventually would lead to forming a cohesive unit which is capable of achieving the desired results. 4. Performing: Reaching this stage for any group is an achievement as not many groups reach this stage. Having attained this stage signifies that the group is highly collaborative and works as a cohesive unit. The group possesses high morale and has created a identity for itself which reflects through their loyalty for each of the members.

Leading Virtual teams The last couple of decades have seen rapid globalization which has also made an impact on the healthcare domain. Challenges have come up with leaders expected to manage teams which are geographically diverse in terms in distances and time zones and not being co located. The problems however with managing virtual teams especially in the healthcare domain has not received enough importance the world over. 1 Creating the Virtual Team With the above problem statement, leaders today have an inherent wish to be able to select team members based on their ability to work in virtual teams.

However, in the healthcare domain, this is not an option which is readily available since there are very limited options available when it comes to having the right skill sets. The choices are therefore made as far as possible; collate team members who have experience in virtual teamwork, rest of the parameters remaining same. 1 . Discovering Commonalities: It is a difficult task to find commonalities within virtual teams as it is very much possible that the team leader has never met al members face to face and thus does not have enough data points to gauge them on a level scale.

Extra efforts have to be taken by the leaders to Identify commonalities between people to actually arrive at trying to group similar minded or similar skilled team members together. 2. Creating Trust: Trust and respect cannot be commanded, it is almost always earned from the members of a team that trust each other and will go far in working together as a team. It is important to make every member valued and appreciated. Everyone should be given the opportunity to voice their opinion and all opinions need to be heard. Understanding team dynamics: Within virtual teams, there are no visual or physical cues and thus it makes it challenging for the leader to understand the team dynamics. The likes and dislikes of the team members are also difficult to assimilate since the communication most of the times would be on phone or emails. 4. Team member interaction: An important component of virtual teams else would be difficult to handle such diverse user groups. Working virtually sometimes has its limitations that some of the team members might get missed out in the communications and which would be harmful for the team as a hole.

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