Leadership in Health Services最新文献

{"title":"Structure and psychological safety as complementary elements in integrated healthcare leadership teams: an exploratory case study.","authors":"Joel Simon Phillips","doi":"10.1108/LHS-03-2025-0053","DOIUrl":"https://doi.org/10.1108/LHS-03-2025-0053","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to examine how leadership approaches balancing structure with psychological safety influence team effectiveness in integrated healthcare leadership teams that span organisational boundaries. The research focuses specifically on an integrated mental health crisis service leadership team.</p><p><strong>Design/methodology/approach: </strong>A qualitative intrinsic case study design was conducted as part of MSc dissertation requirements. The study reanalysed interview data (n = 8) alongside reflective notes, and team effectiveness measures from an integrated mental health crisis service leadership team. Reflexive thematic analysis identified structure-psychological safety relationships.</p><p><strong>Findings: </strong>Reanalysis revealed three interconnected themes: clear parameters and boundaries, psychological safety within structure and structured development opportunities. Structured leadership approaches created conditions for psychological safety and team development rather than constraining them. Team effectiveness measures showed improvements, including role clarity (3.6 / 5.0-4.4 / 5.0), inter-team working (3.5-4.1), team innovation (4.2-4.7) and team objectives (4.0-4.6), though multiple factors likely influenced these changes.</p><p><strong>Research limitations/implications: </strong>The single case study design limits generalisability but suggests avenues for future research into how systematic approaches complement psychological safety in integrated healthcare settings. The exploratory data reanalysis provides preliminary insights requiring validation across diverse contexts.</p><p><strong>Practical implications: </strong>Healthcare leaders might benefit from examining how clear parameters enable rather than constrain team development across organisational boundaries, supporting current integrated care system initiatives.</p><p><strong>Originality/value: </strong>This study contributes to conversations about structure and psychological safety relationships in leadership practice. It challenges assumptions that structure necessarily constrains psychological safety, suggesting structured approaches can create enabling conditions for team development in complex healthcare environments.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new paradigm: culturally competent leadership for indigenous health care.","authors":"Courtney Hamby, Carissa R Smock, Rick Wallace","doi":"10.1108/LHS-02-2025-0037","DOIUrl":"https://doi.org/10.1108/LHS-02-2025-0037","url":null,"abstract":"<p><strong>Purpose: </strong>This paper aims to introduce an adapted, culturally competent leadership conceptual framework for indigenous health care, aiming to improve health access and address gaps in Western-centric leadership models.</p><p><strong>Design/methodology/approach: </strong>A systematic literature review and thematic analysis of 32 peer-reviewed articles were conducted, guided by transformational and cultural sensitivity frameworks to adapt a conceptual framework to support health access in indigenous communities.</p><p><strong>Findings: </strong>The adapted indigenous leadership conceptual framework (AILCF) includes 11 interrelated leadership themes - visionary leadership, supportive and empathetic leadership, adaptive leadership, integrity and ethical leadership, communicative leadership, courageous leadership, cultural competence, community engagement and relationship-building, historical trauma and healing, structural change and leadership in crisis - synthesized through transformational and culturally sensitive leadership lenses to support equitable health access and culturally grounded leadership in indigenous health-care settings.</p><p><strong>Research limitations/implications: </strong>This qualitative review is limited by secondary data and geographic concentration within the USA.</p><p><strong>Practical implications: </strong>AILCF fosters culturally attuned leadership development and practice within indigenous health organizations, providing pathways to equitable health access.</p><p><strong>Originality/value: </strong>Unlike existing Western-centric models, the proposed framework incorporates historical trauma, relational accountability and cultural alignment, dimensions rarely reflected in traditional leadership theory. By reframing leadership as a culturally grounded, healing-centered practice, the AILCF offers a necessary contrast to dominant paradigms. This model contributes not by expanding leadership theory, but by disrupting its assumptions and advancing a more inclusive, context-specific understanding of what effective leadership entails in indigenous health-care systems.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145013437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASHAs (accredited social health activist) leadership role in delivering diabetic care services to urban poor during COVID-19 in Hyderabad, India.","authors":"Sudhir Raj Thout, Aalok Khandekar","doi":"10.1108/LHS-01-2025-0005","DOIUrl":"https://doi.org/10.1108/LHS-01-2025-0005","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to explore the role of female frontline community health workers, accredited social health activists (ASHAs), in delivering health care to urban poor living with Type 2 diabetes mellitus (T2DM) in two urban slums in Hyderabad, India. The study describes the additional challenges faced by them during the COVID-19 period and their leadership role in delivering care services to people with diabetes during COVID-19.</p><p><strong>Design/methodology/approach: </strong>Research methods comprise semi-structured in-depth interviews and focus group discussions with ASHAs, individuals with T2DM, and community leaders from August 2021 to July 2023. The study tools were developed based on framework of the Explanatory Model Interview Catalogue. Data were analysed using thematic analysis.</p><p><strong>Findings: </strong>The analysis revealed three main themes, describing challenges faced by ASHAs in COVID-19 management- overburdening of ASHAs, unsafe working conditions and social stigma in communities; COVID-19 impact on people with diabetes mellitus; and leadership demonstrated by ASHAs.</p><p><strong>Practical implications: </strong>The pandemic served as a critical event that foregrounded the role of ASHAs as crucial in mitigating the impacts of the disease, resulting in increasing trust between ASHAs and impacted communities. The results, thus, highlight a potential opportunity to enable and support ASHAs better to improve the reach of primary health-care services in India overall.</p><p><strong>Originality/value: </strong>Research study is original. This research reveals vital role of ASHAs leadership in the context of health-care delivery and contributing to the battle fighting against pandemic while rendering services in the socially disadvantaged communities during COVID-19 pandemic.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leadership training to develop self-leadership of medical students.","authors":"Ni Wayan Diana Ekayani, Titi Savitri Prihatiningsih, Mora Claramita","doi":"10.1108/LHS-01-2025-0016","DOIUrl":"https://doi.org/10.1108/LHS-01-2025-0016","url":null,"abstract":"<p><strong>Purpose: </strong>As agents of change to improve the quality of health services, medical students are expected to have leadership competency. Leadership competency should start by leading themselves. Demonstrating personal qualities domain in the Medical Leadership Competency Framework can be used to design leadership education. This study aimed to evaluate the effect of leadership training on the personal qualities of medical students.</p><p><strong>Design/methodology/approach: </strong>This research was a quasi-experimental study. Thirty-three third-year medical students were included in the training. Leadership training in this study was designed based on the personal qualities domain of the Medical Leadership Competency Framework combined with other learning pedagogies. The training lasted 15 days, consisting of workshops and student project sessions. The training evaluation used Kirkpatrick's program evaluation level one and two. Level one evaluated student satisfaction. Level two evaluated affective, behavioral and cognitive learning gains. Behavioral learning gains were further explored with in-depth interviews.</p><p><strong>Findings: </strong>Participants rated workshops and student project sessions positively. This training significantly increased behavioral and cognitive learning gains (p < 0.05). However, the results showed that training did not significantly increase affective learning gains (p > 0.05). Qualitatively, participants positively described the development of their personal qualities in the learning context.</p><p><strong>Originality/value: </strong>This study describes leadership training using the Medical Leadership Competency Framework and several learning pedagogies that support the leadership development of medical students.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of leadership as a variable factor in the phenomenon of intention to stay of nurses: an integrative review.","authors":"Fabio Mozzarelli, Maria Bertuol, Elisa La Malfa, Massimo Guasconi, Mauro Parozzi, Antonio Bonacaro","doi":"10.1108/LHS-03-2025-0043","DOIUrl":"https://doi.org/10.1108/LHS-03-2025-0043","url":null,"abstract":"<p><strong>Purpose: </strong>The well-being of nurses in health-care organizations is an increasingly key factor, and the increasing phenomenon of turnover and leaving of the profession by nurses undermines their attractiveness. This integrative review aims to investigate whether the leadership enforced by leaders can influence the intention to stay of their employees and which style of leadership would be most effective in facilitating retention.</p><p><strong>Design/methodology/approach: </strong>This integrative review summarizes the scientific literature of the last 10 years to provide a comprehensive understanding of a leadership style in health-care organizations. The electronic biomedical databases were interviewed by MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science, Scopus, ERIC and, for grey literature, Google Scholar. The articles included have been submitted to a critical appraisal through the Critical Review Form for Quantitative Studies and the Critical Review Form for Qualitative Studies Version 2.0.</p><p><strong>Findings: </strong>In total, 21 articles of quantitative, qualitative and mixed method research were included, including two doctoral theses and an editorial comment from a scientific journal. Five themes are identified: Leadership style as a predictor of retention, exogenous factors, individual, organizational or endogenous factors, effects of leadership and effective leadership styles. It emerges that the leadership style strongly influences the intention to stay, and the most effective styles for this purpose are supportive, authentic or ethical and transformational.</p><p><strong>Originality/value: </strong>The leader's action influences the phenomenon of intention to stay, and proactive leadership styles contribute to the retention of nurses in their organizations. Transformational leadership appears more flexible and more suitable to favor the intention to stay.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation and impact of leadership development program for physicians in healthcare and medical education: conceptual and pragmatic considerations.","authors":"Anurag Saxena","doi":"10.1108/LHS-02-2025-0028","DOIUrl":"https://doi.org/10.1108/LHS-02-2025-0028","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study is to review the current state of the evaluation of leader and leadership development programs (LDPs) for physicians and medical learners, identify issues, suggest improvements and propose a framework.</p><p><strong>Design/methodology/approach: </strong>A narrative review of the evaluation of LDPs was performed (English language literature from 2010 to 2024, including peer-reviewed [PUBMED, EMBASE, CINAHL, MEDLINE, MedEdPORTAL, PsychInfo, Scopus, Business Source Elite and ERIC] and gray literature). Analysis and synthesis of literature included a critical examination of notions and concepts.</p><p><strong>Findings: </strong>The evidence for the positive impact of leadership development programs is growing. The main issues are a lack of a strategic organizational approach, heavy reliance on one evaluation model with findings predominantly evaluated at lower levels subjectively, lack of rigor including endogeneity issues and limited use of complex far transfer outcomes. Suggestions for improvements include a strategic approach to evaluation with a broader use of other taxonomy-based models and realist and constructivist approaches to evaluation, consideration of outcome clusters of education, training and developmental pathways, utilizing a wider array of methods and integrating findings.</p><p><strong>Practical implications: </strong>The proposed conceptual approach links individual and organizational outcomes and lower-level program evaluation with \"strategic evaluation\" using robust evaluation frameworks and a wider array of methods.</p><p><strong>Originality/value: </strong>This review has critically examined individual outcomes of three modalities - education, training and development. It has emphasized organizational strategy and proposed groups of outcomes and realized benefits that can be utilized in episodic and longitudinal manner using modifications to evaluation design.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fostering leadership and innovation in UK healthcare: insights from the NHS clinical entrepreneur programme and application of clinical leadership models - a systematic review and reflective analysis.","authors":"Mohammad Abou Salhab","doi":"10.1108/LHS-02-2025-0020","DOIUrl":"https://doi.org/10.1108/LHS-02-2025-0020","url":null,"abstract":"<p><strong>Purpose: </strong>The NHS Clinical Entrepreneur Programme (CEP) was established to promote leadership and innovation within the UK health-care system, though its implementation raises important questions about resource allocation and alignment with NHS founding principles. This study aims to systematically review the literature on the CEP and provide a critical reflective analysis of its impact, considering both its potential benefits and tensions with frontline service delivery in an already strained NHS.</p><p><strong>Design/methodology/approach: </strong>A systematic literature review was conducted using PubMed, Embase and Web of Science databases, covering publications from 2016 to 2024. This study uses a dual methodological approach, combining a systematic literature review with a reflective analysis based on personal experience as a CEP participant. The search strategy included terms related to the NHS CEP, health-care innovation and leadership development. Additionally, a reflective analysis based on personal experience as a CEP participant was incorporated to provide insights into the programme's practical implications.</p><p><strong>Findings: </strong>The systematic review identified 11 relevant studies. Key themes emerged, including the CEP's role in talent retention, cultural shift towards innovation and the development of leadership skills among health-care professionals. The reflective analysis highlighted the programme's strengths in fostering collaboration and addressing health-care challenges while also identifying areas for improvement in leadership training and integration of social responsibility principles.</p><p><strong>Originality/value: </strong>The NHS CEP has demonstrated significant potential in nurturing innovation and leadership within the UK health-care system. However, there is a need for more robust evaluation methods and integration of comprehensive leadership models to enhance its effectiveness. Future research should focus on long-term outcomes and the programme's alignment with global digital health strategies.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investing in healthcare middle-managers: how a leadership development program can improve employee engagement within healthcare.","authors":"Lesley Tomaszewski, Roemer Visser, Hannah Stolze","doi":"10.1108/LHS-01-2025-0013","DOIUrl":"10.1108/LHS-01-2025-0013","url":null,"abstract":"<p><strong>Purpose: </strong>Middle managers play a crucial role in health care, as they are responsible for executing decisions made by upper management and supervising frontline staff. Enhancing their ability to implement these decisions is essential for effective health-care delivery. The purpose of this case study is to describe a leadership development program was designed to improve employee engagement scores among health-care middle managers. The program used employee engagement survey data, experiential learning, reflection and coaching.</p><p><strong>Design/methodology/approach: </strong>The authors analyzed annual employee engagement survey data to develop a series of leadership training sessions for health-care middle managers. Three leadership development series were conducted, each featuring diverse experiential learning methods facilitated by subject matter experts. Participants' feedback was collected through open-ended surveys at the end of each series, focusing on key outcomes such as their understanding and application of leadership concepts. Descriptive statistics were used to summarize the results from the annual 2021 and 2022 engagement surveys.</p><p><strong>Findings: </strong>A total of 45 middle managers with various middle management roles and from different backgrounds (clinical and non-clinical) reported significant improvements in their engagement scores, with the overall score increasing from 80.02 to 81.98 (<i>p</i> = 0.045). Participants also reported improved team trust, valuing employee input and enhanced leadership effectiveness.</p><p><strong>Research limitations/implications: </strong>This study's limitations include that this study took place at a not-for-profit health-care system during the COVID-19 pandemic (2021-2022) and that not all participants' demographic information was collected.</p><p><strong>Practical implications: </strong>Structured, data-driven leadership development programs can enhance middle managers' skills, engagement and satisfaction in health-care organizations.</p><p><strong>Originality/value: </strong>This case study used employee engagement survey data to design a leadership development program for middle managers in health care, a group often overlooked in traditional leadership development programs.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring turnover among first-line managers in healthcare: a cohort study of span of control, management performance and stress indicators.","authors":"Jonas Svanström, Maria Lindberg, Bernice Skytt, Magnus Lindberg","doi":"10.1108/LHS-02-2025-0031","DOIUrl":"10.1108/LHS-02-2025-0031","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study is to examine if and how an expanded span of control, management performance and work-related stress indicators (control, support and relationships) influence the time until first-line managers leave their position.</p><p><strong>Design/methodology/approach: </strong>A prospective longitudinal cohort design involving 87 first-line managers in a Swedish health-care region. Cox proportional hazards regression was used to analyse expanded span of control, work-related stress indicators and management performance as predictors of turnover.</p><p><strong>Findings: </strong>The findings indicate that first-line managers who were categorized as having moderate concern and a need for improvement in the work-related stress indicators control and manager support had a significantly higher risk of turnover. In contrast, expanded span of control and the number of employees managed per first-line manager did not significantly influence turnover risk. In addition, the work-related stress indicator relationships was not significantly associated with risk of turnover.</p><p><strong>Originality/value: </strong>This study expands the understanding of actual turnover among first-line managers in health care by exploring how organizational factors influence the decision to leave. Unlike previous research, which primarily examines turnover intentions, this study takes a longitudinal perspective, capturing real turnover events over time. The findings contribute to future research on organizational conditions, providing a basis for developing strategies to improve retention and working conditions for first-line managers in health care.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":"38 5","pages":"101-112"},"PeriodicalIF":1.7,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The mediating role of employees engagement in the relationship between adaptive leadership and service quality in the health sector.","authors":"Biniam Ali Eshete, Tilaye Kassahun","doi":"10.1108/LHS-03-2025-0056","DOIUrl":"https://doi.org/10.1108/LHS-03-2025-0056","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to examine the mediating role of employee engagement in the relationship between adaptive leadership and service quality within the health-care sector in Ethiopia.</p><p><strong>Design/methodology/approach: </strong>A quantitative research design was adopted, using a cross-sectional survey method. Data was collected from health-care professionals through structured questionnaires. Partial least squares structural equation modeling was used to analyze the hypothesized relationships.</p><p><strong>Findings: </strong>This study found that adaptive leadership (ADL) indirectly enhances service quality (SVQ) through employee engagement (EME). While ADL had no direct effect on SVQ, it positively influenced EME, which, in turn, significantly improved SVQ. These findings emphasize the critical role of employee engagement in translating leadership into better service outcomes in health-care setting.</p><p><strong>Practical implications: </strong>The findings offer valuable insights for health-care managers and policymakers, emphasizing the need for ADL strategies that foster employee engagement to improve SVQ.</p><p><strong>Originality/value: </strong>This study uniquely examines how ADL translates into improved health-care SVQ through the engagement of frontline staff in a dynamic and resource-constrained environment.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":"38 5","pages":"82-100"},"PeriodicalIF":1.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}