Leadership in Health Services最新文献

{"title":"The 4C's of influence framework: fostering leadership development through character, competence, connection and culture.","authors":"Victor Do,&nbsp;Jerry M Maniate,&nbsp;Nabil Sultan,&nbsp;Lyn Sonnenberg","doi":"10.1108/LHS-05-2022-0060","DOIUrl":"https://doi.org/10.1108/LHS-05-2022-0060","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this paper is to describe the 4C's of Infuence framework and it's application to medicine and medical education. Leadership development is increasingly recognised as an integral physician skill. Competence, character, connection and culture are critical for effective influence and leadership. The theoretical framework, \"The 4C's of Influence\", integrates these four key dimensions of leadership and prioritises their longitudinal development, across the medical education learning continuum.</p><p><strong>Design/methodology/approach: </strong>Using a clinical case-based illustrative model approach, the authors provide a practical, theoretical framework to prepare physicians and medical learners to be engaging influencers and leaders in the health-care system.</p><p><strong>Findings: </strong>As leadership requires foundational skills and knowledge, a leader must be competent to best exert positive influence. Character-based leadership stresses development of, and commitment to, values and principles, in the face of everyday situational pressures. If competence confers the ability to do the right thing, character is the will to do it consistently. Leaders must value and build relationships, fostering connection. Building coalitions with diverse networks ensures different perspectives are integrated and valued. Connected leadership describes leaders who are inspirational, authentic, devolve decision-making, are explorers and foster high levels of engagement. To create a thriving, learning environment, culture must bring everything together, or will become the greatest barrier.</p><p><strong>Originality/value: </strong>The framework is novel in applying concepts developed outside of medicine to the medical education context. The approach can be applied across the medical education continuum, building on existing frameworks which focus primarily on what competencies need to be taught. The 4C's is a comprehensive framework for practically teaching the leadership for health care today.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":"ahead-of-print ahead-of-print","pages":""},"PeriodicalIF":1.7,"publicationDate":"2023-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9269698","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":"Upstreamist leaders: how risk factors for unscheduled return visits (URV) to the emergency department can inform integrated healthcare.","authors":"Martha Zuluaga Quintero,&nbsp;Buddhike Sri Harsha Indrasena,&nbsp;Lisa Fox,&nbsp;Prakash Subedi,&nbsp;Jill Aylott","doi":"10.1108/LHS-06-2022-0069","DOIUrl":"https://doi.org/10.1108/LHS-06-2022-0069","url":null,"abstract":"<p><strong>Purpose: </strong>This paper aims to report on research undertaken in an National Health Service (NHS) emergency department in the north of England, UK, to identify which patients, with which clinical conditions are returning to the emergency department with an unscheduled return visit (URV) within seven days. This paper analyses the data in relation to the newly introduced Integrated Care Boards (ICBs). The continued upward increase in demand for emergency care services requires a new type of \"upstreamist\", health system leader from the emergency department, who can report on URV data to influence the development of integrated care services to reduce further demand on the emergency department.</p><p><strong>Design/methodology/approach: </strong>Patients were identified through the emergency department symphony data base and included patients with at least one return visit to emergency department (ED) within seven days. A sample of 1,000 index visits between 1 January 2019-31 October 2019 was chosen by simple random sampling technique through Excel. Out of 1,000, only 761 entries had complete data in all variables. A statistical analysis was undertaken using Poisson regression using NCSS statistical software. A review of the literature on integrated health care and its relationship with health systems leadership was undertaken to conceptualise a new type of \"upstreamist\" system leadership to advance the integration of health care.</p><p><strong>Findings: </strong>Out of all 83 variables regressed with statistical analysis, only 12 variables were statistically significant on multi-variable regression. The most statistically important factor were patients presenting with gynaecological disorders, whose relative rate ratio (RR) for early-URV was 43% holding the other variables constant. Eye problems were also statistically highly significant (RR = 41%) however, clinically both accounted for just 1% and 2% of the URV, respectively. The URV data combined with \"upstreamist\" system leadership from the ED is required as a critical mechanism to identify gaps and inform a rationale for integrated care models to lessen further demand on emergency services in the ED.</p><p><strong>Research limitations/implications: </strong>At a time of significant pressure for emergency departments, there needs to be a move towards more collaborative health system leadership with support from statistical analyses of the URV rate, which will continue to provide critical information to influence the development of integrated health and care services. This study identifies areas for further research, particularly for mixed methods studies to ascertain why patients with specific complaints return to the emergency department and if alternative pathways could be developed. The success of the Esther model in Sweden gives hope that patient-centred service development could create meaningful integrated health and care services.</p><p><strong>Practical implications: </stro","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":"ahead-of-print ahead-of-print","pages":""},"PeriodicalIF":1.7,"publicationDate":"2022-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10480926","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":"How hospital top managers reason about the central leadership task of balancing quality of patient care, economy and professionals' engagement: an interview study.","authors":"Fredrik Bååthe,&nbsp;Mia von Knorring,&nbsp;Karin Isaksson-Rø","doi":"10.1108/LHS-02-2022-0009","DOIUrl":"https://doi.org/10.1108/LHS-02-2022-0009","url":null,"abstract":"Purpose This study aims to deepen the understanding of how top managers reason about handling the relationships between quality of patient care, economy and professionals’ engagement. Design/methodology/approach Qualitative design. Individual in-depth interviews with all members of the executive management team at an emergency hospital in Norway were analysed using reflexive thematic method. Findings The top managers had the intention to balance between quality of patient care, economy and professionals’ engagement. This became increasingly difficult in times of high internal or external pressures. Then top management acted as if economy was the most important focus. Practical implications For health-care top managers to lead the pursuit towards increased sustainability in health care, there is a need to balance between quality of patient care, economy and professionals’ engagement. This study shows that this balancing act is not an anomaly top-managers can eradicate. Instead, they need to recognize, accept and deliberately act with that in mind, which can create virtuous development spirals where managers and health-professional communicate and collaborate, benefitting quality of patient care, economy and professionals’ engagement. However, this study builds on a limited number of participants. More research is needed. Originality/value Sustainable health care needs to balance quality of patient care and economy while at the same time ensure professionals’ engagement. Even though this is a central leadership task for managers at all levels, there is limited knowledge about how top managers reason about this.","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":"ahead-of-print ahead-of-print","pages":""},"PeriodicalIF":1.7,"publicationDate":"2022-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10427974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10016484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The dynamic nature of leader-member exchange relationships in health-care organizations.","authors":"Sari Hirvi,&nbsp;Sanna Laulainen,&nbsp;Kristiina Junttila,&nbsp;Johanna Lammintakanen","doi":"10.1108/LHS-06-2022-0073","DOIUrl":"https://doi.org/10.1108/LHS-06-2022-0073","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to make visible the dynamic nature of leader-member exchange (LMX) in the changing realm of health-care leadership.</p><p><strong>Design/methodology/approach: </strong>The qualitative study used an open questionnaire, which was distributed amongst nursing staff and managers at a Finnish public university hospital.</p><p><strong>Findings: </strong>The participants described partly LMX theory, but the leader-member relationship was also influenced by the organizational culture and the existing management practices. Nursing staff were found to have a more variable and dynamic role in the LMX relationship than has previously been reported. The research therefore provided novel information for the field of health-care research.</p><p><strong>Research limitations/implications: </strong>The presented research was limited by the content of the data, as the collected single narratives were rather short; however, the fact that a large number of narratives were collected from diverse participants strengthened the ability to reliably answer the research questions.</p><p><strong>Practical implications: </strong>Although the participants described partly LMX theory, the leader-member relationship is also influenced by the organizational culture and existing management practices; the finding that nurses have more variable roles in LMX relationships in the health-care context was new insight in this field. Therefore, the presented findings can help decision-makers change the current, perhaps antiquated, leadership practices at health-care organizations.</p><p><strong>Originality/value: </strong>This study provides new insight into the field of LMX research in terms of the important role of nursing staff, the organizational factors that influence the LMX relationship and the dynamic nature of LMX relationships.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":"ahead-of-print ahead-of-print","pages":""},"PeriodicalIF":1.7,"publicationDate":"2022-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10427970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10007605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evaluation of health care leadership development programmes: a scoping review of reviews.","authors":"Emily Burn,&nbsp;Justin Waring","doi":"10.1108/LHS-05-2022-0056","DOIUrl":"https://doi.org/10.1108/LHS-05-2022-0056","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this paper is to report a scoping review of reviews which investigated HLDP evaluations to determine: how the conceptualisation of leadership development programmes (HLDPs), and despite growing calls for robust evaluations of their pedagogic design, delivery and effectiveness, there are concerns regarding the quality of data associated with their evaluation. This scoping review of reviews investigated the reporting of HLDP evaluations to determine: how the conceptualisation of leadership underpinning HLDPs influence their evaluation; how the pedagogical approaches within HLDPs influence their evaluation; and the evaluation designs and measures used to assess HLDPs.</p><p><strong>Design/methodology/approach: </strong>The scoping review was conducted on reviews of HLDPs. Searches were performed on four databases and on the grey literature. Data were extracted and a narrative synthesis was developed.</p><p><strong>Findings: </strong>Thirty-one papers were included in the scoping review of reviews. A great deal of heterogeneity in HLDPs was identified. Evaluations of HLDPs were affected by poor data quality, and there were limitations in the evidence about \"what works\". Leadership was conceptualised in different ways across HLDPs, and consequently, there was a lack of consistency as to what is being evaluated and the methods used to assess HLDPs.</p><p><strong>Originality/value: </strong>This review of reviews summarises the current evidence on the evaluation of HLDPs. Evaluations of HLDPs need to explicitly account for the complexity of health systems, how this complexity impacts on the development and articulation of leadership practice, and how the underlying conceptualisation of leadership and the associated theory of change articulate a set of assumptions about how HLDPs support leaders to affect change within complex systems.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":"ahead-of-print ahead-of-print","pages":""},"PeriodicalIF":1.7,"publicationDate":"2022-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10479749","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 of a leadership development impact assessment toolkit: a comparative case study of experts' perspectives in three Canadian provinces.","authors":"Mehri Karimi-Dehkordi,&nbsp;Graham Dickson,&nbsp;Kelly Grimes,&nbsp;Suzanne Schell,&nbsp;Ivy Bourgeault","doi":"10.1108/LHS-06-2022-0068","DOIUrl":"https://doi.org/10.1108/LHS-06-2022-0068","url":null,"abstract":"<p><strong>Purpose: </strong>This paper aims to explore users' perceptions of whether the Leadership Development Impact Assessment (LDI) Toolkit is valid, reliable, simple to use and cost-effective as a guide to its quality improvement.</p><p><strong>Design/methodology/approach: </strong>The Canadian Health Leadership Network codesigned and codeveloped the LDI Toolkit as a theory-driven and evidence-informed resource that aims to assist health-care organizational development practitioners to evaluate various programs at five levels of impact: reaction, learning, application, impact and return on investment (ROI) and intangible benefits. A comparative evaluative case study was conducted using online questionnaires and semistructured telephone interviews with three health organizations where robust leadership development programs were in place. A total of seven leadership consultants and specialists participated from three Canadian provinces. Data were analyzed sequentially in two stages involving descriptive statistical analysis augmented with a qualitative content analysis of key themes.</p><p><strong>Findings: </strong>Users perceived the toolkit as cost-effective in terms of direct costs, indirect costs and intangibles; they found it easy-to-use in terms of clarity, logic and structure, ease of navigation with a coherent layout; and they assessed the sources of the evidence-informed tools and guides as appropriate. Users rated the toolkit highly on their perceptions of its validity and reliability. The analysis also informed the refinement of the toolkit.</p><p><strong>Originality/value: </strong>The refined LDI Toolkit is a comprehensive online collection of various tools to support health organizations to evaluate the leadership development investments effectively and efficiently at five impact levels including ROI.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":"ahead-of-print ahead-of-print","pages":""},"PeriodicalIF":1.7,"publicationDate":"2022-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10471035","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":"Managers' strategies in handling the COVID-19 pandemic in Norwegian nursing homes and homecare services.","authors":"Eline Ree,&nbsp;Siri Wiig,&nbsp;Camilla Seljemo,&nbsp;Torunn Wibe,&nbsp;Hilda Bø Lyng","doi":"10.1108/LHS-05-2022-0052","DOIUrl":"https://doi.org/10.1108/LHS-05-2022-0052","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to explore nursing home and home care managers' strategies in handling the COVID-19 pandemic.</p><p><strong>Design/methodology/approach: </strong>This study has a qualitative design with semistructured individual interviews conducted digitally by videophone (Zoom). Eight managers from nursing homes and five managers from home care services located in a large urban municipality in eastern Norway participated. Systematic text condensation methodology was used for the analysis.</p><p><strong>Findings: </strong>The managers used several strategies to handle challenges related to the COVID-19 pandemic, including being proactive and thinking ahead in terms of possible scenarios that might occur, continuously training of staff in new procedures and routines and systematic information sharing at all levels, as well as providing different ways of disseminating information for staff, service users and next-of-kins. To handle staffing challenges, managers used strategies such as hiring short-term staff that were temporary laid off from other industries and bringing in students.</p><p><strong>Originality/value: </strong>The COVID-19 pandemic heavily affected health-care systems worldwide, which has led to many health-care studies. The situation in nursing homes and home care services, which were strongly impacted by the pandemic and in charge of a vulnerable group of people, has not yet received enough attention in research. This study, therefore, seeks to contribute to this research gap by investigating how managers in nursing homes and home care services used different strategies to handle the COVID-19 pandemic.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":"ahead-of-print ahead-of-print","pages":""},"PeriodicalIF":1.7,"publicationDate":"2022-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10433966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10023434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A scoping review of the literature pertaining to burnout and leadership in mental health clinicians.","authors":"Jenny Gravestock","doi":"10.1108/LHS-04-2022-0043","DOIUrl":"https://doi.org/10.1108/LHS-04-2022-0043","url":null,"abstract":"<p><strong>Purpose: </strong>This paper aims to explore what is known in the literature about leadership and burnout within mental health clinicians (MHC).</p><p><strong>Design/methodology/approach: </strong>The Arksey and O'Malley (2005) framework was used to conduct a systematised scoping review of three databases: PsycInfo, PubMed and CINAHL. To ensure a broad scope of the literature, Google, Google Scholar and three sources of grey literature were also searched.</p><p><strong>Findings: </strong>In total 1,087 articles were identified and 36 were included in the final review, 23 of which were cross-sectional and correlational studies. There is a lack of experimental studies, longitudinal research and qualitative approaches. The literature repeatedly demonstrated an association between leadership and burnout; transformational-leadership style, good quality supervision, supportive relationships, positive communication and fostering autonomy are areas of interest.</p><p><strong>Research limitations/implications: </strong>Future research activity should aim to follow the recommendations made in the literature; more experimental and longitudinal approaches are needed to support practical application of the findings.</p><p><strong>Originality/value: </strong>To the best of the author's knowledge there is no other review which maps out the research pertaining to leadership and burnout among MHC. These findings can be used to guide future research to ensure that efforts are directed toward original, meaningful and practical ventures that will add to the evidence base and benefit clinical practice.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":"ahead-of-print ahead-of-print","pages":""},"PeriodicalIF":1.7,"publicationDate":"2022-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10479581","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":"Building health care leadership capacity in a developing country via Talent Grooming Programme (TGP): experience sharing from the Ministry of Health Malaysia.","authors":"Kun Yun Lee, Munirah Ismail, Pangie Bakit, Norhaniza Zakaria, Nursyahda Zakaria, Norehan Jinah, Delina Kamil, Nor Hayati Ibrahim","doi":"10.1108/LHS-06-2022-0071","DOIUrl":"10.1108/LHS-06-2022-0071","url":null,"abstract":"<p><strong>Purpose: </strong>Formal structured leadership training is increasingly incorporated as a regular fixture in developed nations to produce competent leaders to ensure the provision of quality patient care. However, most low- and middle-income countries (LMICs) rely on one-off external training opportunities for selected individuals as they lack the necessary resources to implement long-term training for a wider pool of potential health care leaders. This case study shares the establishment process of the Talent Grooming Programme for technical health care professionals (TGP), a three-year in-house leadership training programme specially targeted at potential health care leaders in Malaysia.</p><p><strong>Design/methodology/approach: </strong>This case study aims to share a comprehensive overview of the ideation, conceptualisation and implementation of TGP. The authors also outlined its impact from the individual and organisational perspectives, besides highlighting the lessons learned and recommendations for the way forward.</p><p><strong>Findings: </strong>TGP set out to deliver experiential learning focusing on formal training, workplace experiences, practical reflection and mentoring by supervisors and other esteemed leaders to fulfil the five competency domains of leadership, organisational governance, communication and relationship, professional values and personal values. The successes and challenges in TGP programme delivery, post-training assessment, outcome evaluation and programme sustainability were outlined.</p><p><strong>Practical implications: </strong>The authors' experience in setting up TGP provided valuable learning points for other leadership development programme providers. As for any development programme, a continuous evaluation is vital to ensure its relevance and sustainability.</p><p><strong>Originality/value: </strong>Certain aspects of TGP establishment can be referenced and modified to adapt to country-specific settings for others to develop similar leadership programme, especially those in LMICs.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":"ahead-of-print ahead-of-print","pages":""},"PeriodicalIF":1.7,"publicationDate":"2022-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10433964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10024195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowing, relating and the absence of conflict: relational leadership processes between hospital boards and chairs of nurse councils.","authors":"Arjan Verhoeven,&nbsp;Erik Van de Loo,&nbsp;Henri Marres,&nbsp;Pieterbas Lalleman","doi":"10.1108/LHS-06-2022-0067","DOIUrl":"https://doi.org/10.1108/LHS-06-2022-0067","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to enhance understanding of the collaboration between chairs of nurse councils (CNCs) and members of executive hospital boards (BM) from a relational leadership perspective.</p><p><strong>Design/methodology/approach: </strong>The authors used a qualitative and interpretive methodology. The authors study the daily interactions of BM and CNCs of seven Dutch hospitals through a relational leadership lens. The authors used a combination of observations, interviews and document analysis. The author's qualitative analysis was used to grasp the process of collaborating between BM and CNCs.</p><p><strong>Findings: </strong>Knowing each other, relating with and relating to are distinct but intertwined processes that influence the collaboration between BM and CNC. The absence of conflict is also regarded as a finding in this paper. Combined together, they show the importance of a relational process perspective to understand the complexity of collaboration in hospitals.</p><p><strong>Originality/value: </strong>Collaboration between professional groups in hospitals is becoming more important due to increasing interdependence. This is a consequence of the complexity in organizing qualitative care. Nevertheless, research on the process of collaborating between nurse councils (NCs) and executive hospital boards is scarce. Furthermore, the understanding of the workings of boards, in general, is limited. The relational process perspective and the combination of observations, interviewing and document analysis proved valuable in this study and is underrepresented in leadership research. This process perspective is a valuable addition to skills- and competencies-focused leadership literature.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2022-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40475255","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}