Adaptive Leadership Framework Research Articles

The Influence of Protecting Leadership Voices from Below Behaviour on the Digital Transformation of Insurance Firms in Kenya

This research investigated the impact of protecting leadership voices from below behaviour on the digital transformation of insurance firms in Kenya. This study, grounded in adaptive leadership framework, adopted a positivist approach and a descriptive research design to study a target population of 392 supervisors from the 56 registered insurance firms listed by the Insurance Regulatory Authority. The final sample of 127 respondents, represented a response rate of 63%, was drawn using a stratified random sampling technique. Protecting leadership voices from below behaviour was operationalized through the dimensions of employee voice, employee engagement, and work environment, while digital transformation was assessed using metrics such as digital innovation, customer experience, and returns on assets. Inferential statistical analyses, including correlation analysis, chi-square test, one-way ANOVA, ordinal logistic regression were adopted to test the research hypotheses. The findings from the ordinal logistic regression analysis, indicated by the Nagelkerke Pseudo R-square coefficient, demonstrate that protecting leadership voices from below behaviour explains 37% of the variance in digital transformation (Nagelkerke Pseudo R² = .37). Moreover, the parameter estimates obtained from the ordinal regression analysis revealed a statistically significant and positive relationship between protecting leadership voices from below behaviour and digital transformation, β6 = -18.647, p≤.05. In conclusion, this study establishes a substantial connection between protecting leadership voices from below behaviour, and the digital transformation of insurance firms in Kenya. Specifically, when leaders create a conducive work environment that encourages employees voice and engagement, this adaptive leadership behaviour significantly and positively influences digital transformation. Consequently, leaders are recommended to proactively embrace protecting leadership voices from below behaviour by implementing policies and practices that promote employee voice, enhance employee engagement, and establish supportive work environments. These efforts will facilitate and enhance the prospects of achieving successful digital transformation within the Kenyan insurance industry. Further studies on the adaptive leadership framework in the broader financial services industry are recommended.

ENGAGEMENT OF FAMILY IN ASSISTED LIVING: SECONDARY QUALITATIVE ANALYSIS USING THE ADAPTIVE LEADERSHIP FRAMEWORK

Abstract Assisted living (AL) residents are at high risk for safety issues (e.g., falls) and poor quality of life (QoL) because they can lose their personal preferences and autonomy in personal care or social activities once they enter AL. Family engagement (FE) plays a significant role in addressing these challenges while considering residents’ needs and preferences. The purpose of this study was to explore family caregivers’ perspectives about FE strategies in AL and contextual factors influencing FE. This study used a secondary analysis of the interview data from a larger study investigating 34 family caregivers’ opinions on AL safety and strategies to increase FE. The Adaptive Leadership Framework guided our directed content analyses to identify how family caregivers address the challenges with AL residents and staff. Family caregivers described adaptive leadership strategies pertaining to getting the residents to recognize the seriousness of their health status, finding available resources to support them, and planning for potential challenges. Family caregivers also described adaptive and collaborative work (with AL residents or staff) strategies such as advocating for resident needs, involvement in direct care or social activities, shared understanding of care plan, and making decisions together. We also found that contextual factors such as fear of speaking up and retaliation, previous experiences in FE, influenced family caregivers’ engagement in AL safety. These findings highlight the important role of family caregivers in addressing AL resident safety challenges. Also, our study provides the rationale for developing practical FE strategies to enhance residents’ safety and QoL.

Comparing the Experiences of Participants With Mild Cognitive Impairment and Mild Dementia During an Oral Health Intervention.

Cognitive impairment is associated with poor oral health outcomes. Oral hygiene tasks are an essential target of interventions aiming to improve oral health for older adults with cognitive impairment. We aimed to examine whether experiences in an oral health intervention based on the Adaptive Leadership Framework for Chronic Illness differed between individuals with mild cognitive impairment (MCI) or mild dementia (MD) and their respective care partners. This was a secondary analysis using directed content analysis and then an interpretive-description approach to analyze the data from a theory-driven intervention study. We included 10 people with MCI and their care partners (n = 20) and 8 people with MD and their care partners (n = 16) in the treatment arm of the intervention. For each participant, we analyzed audio recordings of 4 intervention coaching sessions, each ranging between 30 and 45 min. We managed the data and coding using ATLAS.TI software. Participants in both the MCI and MD groups experienced similar challenges in adapting to changes in oral hygiene techniques, and both groups worked on learning new oral hygiene techniques taught by the dental hygienist and meeting individualized goals developed with their care partner, interventionist, and hygienist. On the other hand, there were subtle differences in technical challenges between participants in MCI and MD groups; participants in the MCI group reacted more actively to dental hygienist suggestions than the MD group. Study findings provide information about how researchers and clinicians might tailor interventions to meet the learning needs of individuals and care partners in each group.

Influence of Getting on the Balcony Behavior on Digital Transformation of Insurance Firms in Kenya

This paper examines the influence of getting on the balcony behavior on digital transformation of insurance firms in Kenya within the framework of adaptive leadership theory. The study acknowledges the pivotal role of adaptive leadership behavior in fostering leader-organization value-congruence, perspective-taking, and self-awareness. A positivist approach and a descriptive research design were employed; targeting a population of 392 supervisors from the 56 registered insurance firms listed by the Insurance Regulatory Authority. Using a stratified random sampling technique, a final sample of 127 respondents was obtained, representing a response rate of 63% from the initial study sample of 198. Getting on the balcony behavior was operationalized through value congruence, perspective taking, and self-awareness dimensions. At the same time, digital transformation was assessed using digital innovation, customer experience, and returns on assets capabilities metrics. Descriptive and inferential statistical analyses, including means, standard deviation, correlation analysis, chi-square test, one-way ANOVA, and ordinal logistic regression, were employed to analyze the research data and to test the study hypothesis. The ordinal logistic regression analysis findings, represented by the Nagelkerke Pseudo R-square coefficient, indicated that getting on the balcony behavior explains 37.2% of the variance in digital transformation (Nagelkerke Pseudo R² = .372). Furthermore, the parameter estimates derived from the ordinal regression analysis revealed that getting on the balcony behavior predicted digital transformation, with a significant beta coefficient of -4.100, p≤.05. In conclusion, this study establishes a substantial connection between "getting on the balcony" behavior, encompassing value congruence, perspective taking, and self-awareness, and the digital transformation of insurance firms in Kenya. Specifically, when leaders actively pursue value congruence through perspective-taking and self-awareness practices, this adaptive leadership behavior significantly and positively influences digital transformation. Consequently, the study recommends insurance leaders to proactively embrace getting on the balcony behavior by implementing policies and practices that promote value congruence, enhance perspective-taking, and establish self-awareness. Further, the adaptive leadership framework should be evaluated in broader financial services sector and other industries and regions.

The Emerging Leaders in Public Health Initiative: Individual Leadership Transformation.

The Emerging Leaders in Public Health (ELPH) Initiative, sponsored by The Kresge Foundation, provided leadership development to local governmental public health leaders. An adaptive leadership framework was used to shape the curriculum. The coleads attended multiday convenings and webinars over a 16- to 18-month period. Key components of the initiative included using applied learning to solidify their leadership skills as they worked to develop a new role for their agencies provision of a resource grant from The Kresge Foundation to support agency transformation and technical assistance and consultation provided by a National Program Office. An external evaluator conducted a multicomponent evaluation of individual leadership skill change. Graduates assessed change in their own leadership and change in their colead. Colleagues of ELPH participants were surveyed about their observed changes in the leadership actions of the program graduates. One hundred four leaders from 30 states participated in the initiative in 3 successive cohorts. Leaders demonstrated improvement as shown by self-report and external observation. Improved ability to communicate in a way that inspires others was one of the most significant changes in leadership behaviors. Additional leadership actions were strengthened including the ability to create and maintain high-performing teams, the ability to ask transformational questions, and the ability to actively listen to understand. The pandemic has shown the importance of developing the field, starting with leadership. Leadership development and agency transformation are synergistic; they depend on each other and support each other.

Factors Influencing Admission Decisions in Skilled Nursing Facilities: Retrospective Quantitative Study.

Occupancy rates within skilled nursing facilities (SNFs) in the United States have reached a record low. Understanding drivers of occupancy, including admission decisions, is critical for assessing the recovery of the long-term care sector as a whole. We provide the first comprehensive analysis of financial, clinical, and operational factors that impact whether a patient referral to an SNF is accepted or denied, using a large health informatics database. Our key objectives were to describe the distribution of referrals sent to SNFs in terms of key referral- and facility-level features; analyze key financial, clinical, and operational variables and their relationship to admission decisions; and identify the key potential reasons behind referral decisions in the context of learning health systems. We extracted and cleaned referral data from 627 SNFs from January 2020 to March 2022, including information on SNF daily operations (occupancy and nursing hours), referral-level factors (insurance type and primary diagnosis), and facility-level factors (overall 5-star rating and urban versus rural status). We computed descriptive statistics and applied regression modeling to identify and describe the relationships between these factors and referral decisions, considering them individually and controlling for other factors to understand their impact on the decision-making process. When analyzing daily operation values, no significant relationship between SNF occupancy or nursing hours and referral acceptance was observed (P>.05). By analyzing referral-level factors, we found that the primary diagnosis category and insurance type of the patient were significantly related to referral acceptance (P<.05). Referrals with primary diagnoses within the category "Diseases of the Musculoskeletal System" are least often denied whereas those with diagnoses within the "Mental Illness" category are most often denied (compared with other diagnosis categories). Furthermore, private insurance holders are least often denied whereas "medicaid" holders are most often denied (compared with other insurance types). When analyzing facility-level factors, we found that the overall 5-star rating and urban versus rural status of an SNF are significantly related to referral acceptance (P<.05). We found a positive but nonmonotonic relationship between the 5-star rating and referral acceptance rates, with the highest acceptance rates found among 5-star facilities. In addition, we found that SNFs in urban areas have lower acceptance rates than their rural counterparts. While many factors may influence a referral acceptance, care challenges associated with individual diagnoses and financial challenges associated with different remuneration types were found to be the strongest drivers. Understanding these drivers is essential in being more intentional in the process of accepting or denying referrals. We have interpreted our results using an adaptive leadership framework and suggested how SNFs can be more purposeful with their decisions while striving to achieve appropriate occupancy levels in ways that meet their goals and patients' needs.

ORGANISATIONAL ADAPTIVE LEADERSHIP FRAMEWORK THROUGH SYSTEMS THINKING

Leadership is a system that includes interconnected elements. Adaptive leadership is about enabling followers to handle adaptive challenges and to adapt to an ever-evolving environment. Organisations are experiencing the most dynamic era of the business environment owing to the influence of vulnerability, uncertainty, complexity, and ambiguity (VUCA). The VUCA nature of the environment presents adaptive challenges, which, unlike technical problems, need dynamic people-focused solutions. Current leadership frameworks are inadequate in practice, and a framework is needed to aid in creating adaptive organisations through systems thinking to succeed in a VUCA environment. This research approach starts with a systematic literature review to create a conceptual framework of adaptive leadership through systems thinking for a VUCA environment. The conceptual framework is validated through interviews with practising industry leaders to obtain their opinions and comments. The research provides a new perspective on using systems thinking in applying leadership practices to create an adaptive leadership framework to overcome the VUCA environment.

Examining Stigma and Disclosure Among Women With HIV in the Southern United States: Qualitative Study Guided by the Adaptive Leadership Framework for Chronic Illness.

Stigma is a fundamental cause of health inequities. Guided by the Adaptive Leadership Framework for Chronic Illness (ALFCI), this descriptive qualitative study explored the challenges of stigma and disclosure experienced by women with HIV (WWH) in the Southern United States. A convenience sample of 22 WWH aged 36 to 62 years were interviewed for this study. Analysis of participant interviews revealed that WWH face a multitude of stigma-related technical and adaptive challenges, which are consistent with the ALFCI. Once identified, technical challenges, such as recognizing the need for support, lack of trust, and fear of rejection, can be overcome by technical work, including providing assistance with HIV disclosure and building a trusted network. By identifying specific adaptive and technical challenges faced by WWH and engaging in technical and adaptive work, the WWH and the provider can reduce the fear of disclosure and the effect of stigma.

UNDERSTANDING LEADERSHIP IN NURSING HOME CONTEXT THROUGH ADAPTIVE LEADERSHIP FRAMEWORK FOR CHRONIC ILLNESS

Abstract The case studies were conducted as an early component of a pan-Canada project entitled Translating Research in Elder Care (TREC). This sub-project provided insights into the challenges and leadership of facilitating care model changes, care quality improvement, and quality of work enhancement of three long-term care (LTC) facilities in Canada. Through the lens of Adaptive Leadership Framework for Chronic Illness (ALFCI), leadership emerged as a critical element of their organizational context. Staff reported that contextual factors of high intensity of work and inadequate staff were barriers that added to the complexity of challenges facing them. Data collectors observed that frontline staff exhibited leadership behaviors in knowledge transmission, information sharing, teamwork, and person-centered strategies to address challenges. However, top-down facilitation can lead to misunderstanding and a lack of motivation from the frontline staff to follow the facilitation. The findings also suggested tailored facilitation about including frontline staff in formal interactions.

Adaptive leadership in clinical encounters with women living with HIV

BackgroundWomen living with HIV (WLWH) report low engagement in health care, missed office visits, and less engagement in the clinical encounter. Strengthening the clinical encounter for WLWH may improve health outcomes and quality of life. The Adaptive Leadership Framework for Chronic Illness offers specific adaptive leadership strategies for providers to improve patient-provider interactions. The purpose of this study was to examine adaptive leadership behaviors that contribute to the development of effective patient-provider communication from the perspectives of WLWH.MethodsThe descriptive, cross-sectional and qualitative study conducted interviews with 22 WLWH to assess perceptions of the clinical encounter related to HIV-related stigma, engagement in care, medical distrust, and experiences with discrimination and quality of life. Members of the study team using a set of a priori codes analyzed data using NVivo 12.0.ResultsParticipants described two primary themes and subthemes of each for adaptive leadership behaviors. The primary theme for adaptive leadership of providers was “my provider cares about me”; subthemes were communication, trust building takes time, and supportive providers are trusted. The primary theme for adaptive leadership of WLWH themselves was “I care about me; subthemes were self-advocacy and self-empowerment.ConclusionsProviders can use adaptive leadership behaviors during clinical encounters to support WLWH, improve patient-provider communication, enhance trust, and improve patient outcomes.

Using a Theoretical Framework in a Qualitative Metasummary About Fatigue Adaptation After Stroke

We describe how we used a theoretical framework, Adaptive Leadership Framework for Chronic Illness (ALFCI), to complete a qualitative metasummary in a scoping review of 26 articles. We abstracted and grouped qualitative findings relevant to fatigue adaptation in stroke survivors using constructs of the ALFCI as 4 main themes: 1) adaptive challenges, 2) adaptive work, 3) adaptive leadership and collaborative work, and 4) technical challenges and technical work. We found that stroke survivors encountered different aspects of challenges (e.g., physical dysfunction vs. mental distress) and utilized various adaptive work (e.g., conserving energy vs. restructuring normality) as well as what stroke survivors needed from healthcare professionals (e.g., basic knowledge about fatigue). The ALFCI provides a useful lens to synthesize qualitative findings regarding fatigue adaptation and therefore researchers can target different problems that need to be tackled for stroke survivors, care partners, or healthcare professionals, respectively.

Research Applying Adaptive Leadership Framework for Chronic Illness Across Settings of Care

The carepartner is an essential member of the team to facilitate and assist in maximizing the independence of the older adult. The four papers in this symposium applies The Adaptive Leadership Framework for Chronic Illness (ALFCI) at the point of design, as well as an analytic framework for literature synthesis, intervention design, and analysis of existing data. In the first paper, a qualitative metasummary of a scoping review synthesizes qualitative findings about fatigue adaptation and challenges for stroke survivors, care partners, and healthcare professionals. The second paper describes the use of the ALFCI in an intervention study to manage symptom challenges in older adults with acute myeloid leukemia. The third paper shares staff’s experiences of providing direct care for older residents with advanced dementia in long-term care facilities. The fourth paper describes use of the carepartner–assisted intervention to improve oral hygiene of older adults with cognitive impairment. The ALFCI is a useful framework for intervention design 1) this framework provides a comprehensive way to examine the context of symptoms/behaviors (not just the symptom/behavior in isolation), 2) the framework guides “collaborative work”, 3) analytically it can help guide development of shared meaning of communication and “collaborative work” of dyads (family caregivers, long-term care staff and older adults), and 4) helps understand process of staff utilizing their strengths and doing adaptive work to facilitate interactions and communication, managing older residents’ behavioral and psychological symptoms of dementia, and improving their care provision and work life.

Using the Adaptive Leadership Framework for Chronic Illness to Design a Palliative and Collaborative Intervention

Our study addresses symptoms and functional management early in acute myeloid leukemia treatment using a PAlliative and Collaborative Care inTervention (PACT) delivered by clinical staff. PACT is an interdisciplinary nurse-led intervention of nursing [RN], occupational therapy [OT], physical therapy [PT] for adults ≥ 60 years of age at time of initial treatment. Finding from our preliminary qualitative work led to use of the Adaptive Leadership Framework for Chronic Illness to guide optimal engagement of the patient in self-management of symptoms and functional activities to address QOL outcomes. We share lessons learned of how the ALFCI was applied to the PACT intervention to empower patients with self-management skills to reduce symptoms and optimize function. In summary, the team and patient identify and address emotional, motivational, attitudinal barriers so that the patient can do the work required for self- management to reduce symptoms and avoid functional decline.

Providing Care for Older Residents With Dementia in Nursing Homes in China: Through the Lens of Adaptive Leadership

This study aims to understand staff’s experiences of providing direct care for older residents with advanced dementia in long-term care facilities through the lens of Adaptive Leadership Framework for Chronic Illness (ALFCI). Semi-structured interviews were conducted with health care aides (N=35) from 2 government-owned and 2 private long-term care facilities in urban China. Directed and conventional content analysis were used, drawing upon core constructs of ALFCI. We found that health care aides are confronted with multiple challenges such as high intensity of work, stress from managing older residents’ behavioral and psychological symptoms of dementia (BPSD), a lack of access to on-the-job dementia-specific training, and a lack of support from nurses and managing team. Some of the health care aides demonstrated use of their strengths and doing adaptive work to improve work life and care for older residents by using communication cues, enhancing person-centeredness in their care, and facilitate peer interactions.

Qualitative Analysis of Coaching With Care Partners of People With Cognitive Impairment

We apply the adaptive leadership framework for chronic Illness in a care partner–assisted intervention to improve oral hygiene of older adults with cognitive impairment. Care partners receive four coaching sessions which we recorded and transcribed verbatim. We will describe how our team of seven investigators codes the data using a priori codes from the framework. The data from 17 care-partners contributes 68 individual sessions for coding. We have two subgroups of 7 individuals with mild dementia (MD) and 10 with mild cognitive impairment (MCI). We will discuss the plan for multiple comparisons such as (a) longitudinal across 3 months of intervention, b) within MD and within MCI and c) between MD and MCI. To illustrate, we will discuss our approaches to reaching coding consensus and rigor and will present results of the within group analyses. Finally, we will discuss next steps and the end products we aim to achieve.

Adaptive Challenges and Family Support: Patient Self-Management during Treatment for Chronic Hepatitis C.

The authors describe a family's adaptive challenges and adaptive work during a family member's treatment for Chronic Hepatitis C. We audiorecorded index and final clinical visits and interviewed participants (patients and providers) following the visits. We interviewed by telephone and reviewed medical records over the course of treatment. Transcripts were analyzed using directed content analysis. Three themes were identified: family adaptive challenges, patient-described aspects of family members' adaptive challenges, and family adaptive work. There were four subthemes related to family adaptive work. The adaptive leadership framework for chronic illness provided direction for future family intervention.

Adaptive Challenges, Adaptive Work, and Adaptive Leadership Among Women Living With HIV in the Southern United States: Findings From a Qualitative Study.

Women living with HIV have a higher burden of non-AIDS comorbidities and prevalence of chronic conditions. The Adaptive Leadership Framework for Chronic Illness clarifies living with complex health challenges by delineating the technical work of health care providers as well as the adaptive work and leadership behaviors of patients and their providers. We conducted a descriptive, qualitative study of women residing in the Southern United States who were participating in the Women's Interagency HIV Study in North Carolina. Twenty-two participants (mean age = 52.2 years; 90.9% self-identifying as Black or African American) completed semi-structured qualitative interviews. We identified adaptive challenges (e.g., affective and disclosure challenges) and adaptive work and leadership behaviors. Women learned skills to care for their health and support their families and to work with their providers to manage their care. Findings support the importance of identifying leadership behaviors for the purpose of developing person-centered interventions.

Abstract P115: Fatigue Adaptation Among Stroke Survivors: A Sc oping Review

Introduction: No study has systematically examined stroke survivors’ challenges with fatigue. We use the Adaptive Leadership Framework for Chronic Illness (ALFCI) to synthesize what survivors’ challenges are with fatigue and how they respond or collaborate with others to achieve poststroke fatigue adaptation. Methods: We searched PubMed, CINAHL, Embase, and PsycInfo using PRISMA-ScR guidelines, gathering studies between 2012 and 2020. Qualitative studies or qualitative findings in mixed-method studies were included if they described stroke survivors’ (cerebral infarction, TIA, and brain hemorrhage) experiences with fatigue and/or care partners’ experiences to help survivors adapt to fatigue. We excluded studies which were not full-text English and did not report empirical data (e.g., literature review or editorial). We used interpretive synthesis to analyze the published qualitative data. Results: Of 714 papers identified, we retained 25 papers (22 qualitative and 3 mixed-method studies). Using ALFCI to synthesize data, we found that survivors with fatigue had many types of adaptive challenges. Fatigue made them less productive and it affected their cognitive, language, and physical functions, as well as sleeping patterns and social activities. To respond to these challenges, survivors did adaptive work such as changing mindset, using energy-conservation strategies, restructuring routines, and exercising. Care partners, health professionals, and others showed leadership by helping survivors adapt to fatigue by giving information about fatigue, assessing survivors’ fatigue levels, reducing survivors’ workload, and collaboratively negotiating for new daily routines. However, some studies indicated survivors needed fatigue education from professionals. No study interviewed care partners to examine their experiences helping survivors adapt to fatigue. Conclusions: Survivors had many types of challenges and responses towards fatigue. Care partners and others showed leadership by facilitating survivors with fatigue adaptation. Future studies can identify targets for interventions to address poor adaptation to fatigue and also explore care partners’ perspectives.

Addressing Complex Issues and Crises in Higher Education With an Adaptive Leadership Framework

In Short While American universities have historically been centers of free thought, college campuses have become increasingly divided on free speech issues. Adaptive leadership, a conceptual frame...

Adaptive Leadership in Parents Caring for their Children Born with Life-Threatening Conditions

PurposeThe purpose of this study was to chronicle the adaptive challenges and adaptive work, including emerging leadership behaviors, recounted over time by the parents of very young children diagnosed before birth with life threatening conditions. Design and methodsA descriptive, follow-up study design was used for the current study. Following the original grounded dimensional analysis study completed in 2012, the corpus for this analysis was collected in 2014. In-depth, audio-recorded interviews were conducted with 15 families (8 couples, 7 mothers). The 15 children, born with cardiac, abdominal, and cerebrospinal anomalies, were 14 - 37 months or deceased at follow-up. A directed content analysis of transcribed verbatim interviews was structured by the Adaptive Leadership framework. ResultsParents described behaviors that indicated a non-linear development towards adaptive leadership as they accomplished the adaptive work within intra- and interpersonal domains that was necessary to address challenges over time. Not all parents described abilities and/or a willingness to mobilize others to do adaptive work, suggesting that adaptive leadership remained an unrealized potential. ConclusionsUnderstood as a complex adaptive system, parents of medically at-risk children hold potential for development towards adaptive leadership and collaborative partnership within the family and with healthcare providers. Practice implicationsDue to improved survival rates, parents face ongoing challenges related to their children's unpredictable and often chronic health needs. Study findings illustrate parents' adaptive work and leadership behaviors, which can inform nursing assessments, as well as the type and timing for intervention.