Effective Clinical Leadership Research Articles

The right care in the right place: a scoping review of digital health education and training for rural healthcare workers

BackgroundDigital health offers unprecedented opportunities to enhance health service delivery across vast geographic regions. However, these benefits can only be realized with effective capabilities and clinical leadership of the rural healthcare workforce. Little is known about how rural healthcare workers acquire skills in digital health, how digital health education or training programs are evaluated and the barriers and enablers for high quality digital health education and training.ObjectiveTo conduct a scoping review to identify and synthesize existing evidence on digital health education and training of the rural healthcare workforce.Inclusion criteriaSources that reported digital health and education or training in the healthcare workforce in any healthcare setting outside metropolitan areas.MethodsWe searched for published and unpublished studies written in English in the last decade to August 2023. The databases searched were PubMed, Embase, Scopus, CINAHL and Education Resources Information Centre. We also searched the grey literature (Google, Google Scholar), conducted citation searching and stakeholder engagement. The JBI Scoping Review methodology and PRISMA guidelines for scoping reviews were used.ResultsFive articles met the eligibility criteria. Two case studies, one feasibility study, one micro-credential and one fellowship were described. The mode of delivery was commonly modular online learning. Only one article described an evaluation, and findings showed the train-the-trainer model was technically and pedagogically feasible and well received. A limited number of barriers and enablers for high quality education or training of the rural healthcare workforce were reported across macro (legal, regulatory, economic), meso (local health service and community) and micro (day-to-day practice) levels.ConclusionsUpskilling rural healthcare workers in digital health appears rare. Current best practice points to flexible, blended training programs that are suitably embedded with interdisciplinary and collaborative rural healthcare improvement initiatives. Future work to advance the field could define rural health informatician career pathways, address concurrent rural workforce issues, and conduct training implementation evaluations.Review registration numberOpen Science Framework: https://doi.org/10.17605/OSF.IO/N2RMX.

Appraising LaQshya’s potential in measuring quality of care for mothers and newborns: a comprehensive review of India’s Labor Room Quality Improvement Initiative

BackgroundPoor intrapartum care in India contributes to high maternal and newborn mortality. India’s Labor Room Quality Improvement Initiative (LaQshya) launched in 2017, aims to improve intrapartum care by minimizing complications, enforcing protocols, and promoting respectful maternity care (RMC). However, limited studies pose a challenge to fully examine its potential to assess quality of maternal and newborn care. This study aims to bridge this knowledge gap and reviews LaQshya’s ability to assess maternal and newborn care quality. Findings will guide modifications for enhancing LaQshya’s effectiveness.MethodsWe reviewed LaQshya’s ability to assess the quality of care through a two-step approach: a comprehensive descriptive analysis using document reviews to highlight program attributes, enablers, and challenges affecting LaQshya’s quality assessment capability, and a comparison of its measurement parameters with the 352 quality measures outlined in the WHO Standards for Maternal and Newborn Care. Comparing LaQshya with WHO standards offers insights into how its measurement criteria align with global standards for assessing maternity and newborn care quality.ResultsLaQshya utilizes several proven catalysts to enhance and measure quality- institutional structures, empirical measures, external validation, certification, and performance incentives for high-quality care. The program also embodies contemporary methods like quality circles, rapid improvement cycles, ongoing facility training, and plan-do-check, and act (PDCA) strategies for sustained quality enhancement. Key drivers of LaQshya’s assessment are- leadership, staff mentoring, digital infrastructure and stakeholder engagement from certified facilities. However, governance issues, understaffing, unclear directives, competency gaps, staff reluctance towards new quality improvement approaches inhibit the program, and its capacity to enhance quality of care. LaQshya addresses 76% of WHO’s 352 quality measures for maternal and newborn care but lacks comprehensive assessment of crucial elements: harmful labor practices, mistreatment of mothers or newborns, childbirth support, and effective clinical leadership and supervision.ConclusionLaQshya is a powerful model for evaluating quality of care, surpassing other global assessment tools. To achieve its maximum potential, we suggest strengthening district governance structures and offering tailored training programs for RMC and other new quality processes. Furthermore, expanding its quality measurement metrics to effectively assess provider accountability, patient outcomes, rights, staff supervision, and health facility leadership will increase its ability to assess quality improvements.

Preparedness of Senior Public Service Pharmacists for Clinical Leadership Roles: A Cross-Sectional Study

Background The Seven-star Pharmacist concept as promulgated by the World Health Organization identifies the pharmacist as a leader, among many other roles. Clinical leadership skills are essential in all healthcare organizations, regardless of position or area of practice, yet many pharmacists remain unaware of how leadership can be integrated into their daily clinical practice. While there is limited literature on pharmacist and clinical leadership preparedness in the sub-Saharan African region, particularly in Ghana, concerns about the hospital working environment and learning opportunities suggest that pharmacists feel unprepared for the responsibilities of clinical leadership. Furthermore, most leadership preparedness literature focuses on physicians, nurses, and public health professionals, with pharmacists being underrepresented. This study aims to address these gaps and provide insights into methods to enhance pharmacist leadership readiness in Ghana. Methodology The current study was an anonymous, online based, quantitative, cross-sectional survey conducted between April and June 2022. Participants were public service pharmacists drawn from the Government and Hospital Pharmacist Association (GHOSPA) of Ghana, who worked in government-funded health facilities within the Greater Accra region of Ghana, one of the sixteen administrative regions of the country. The questionnaire consisted of a set of questions that employed a combination of Likert scales, multiple-choice, open-ended, and closed-ended questions. The questionnaire comprised the following sections: biodata of participants and ratings of their level of preparedness for clinical leadership roles using a 5 point Likert scale. Results Nearly half of respondents (46%, n=67) reported their level of preparedness for a clinical leadership role was poor (32%) or very poor (14%). Self-reported level of knowledge and understanding of their clinical leadership roles at the time of their appointment was fair for 35% (n=51) of the respondents, whereas 23% (n=34) reported poor or very poor knowledge of the participants in the study, 65% reported receiving some form of training on clinical leadership either at the time of appointment or during their assignment, with only 35% reporting their training to be effective. Conclusion The study underscores the importance of addressing the knowledge gaps and training needs of pharmacists to enhance their preparedness for clinical leadership roles. Furthermore, organizational policies, career development opportunities, and support systems need to be established to promote effective clinical leadership roles among pharmacists. Keywords: Clinical leadership, pharmacist, preparedness, Ghana

Effective clinical nursing leadership in hospitals: barriers from the perspectives of nurse managers

AimThe purpose of this study was to identify barriers to effective clinical nursing leadership in Jordanian hospitals from the perspectives of nurse managers (NMs).BackgroundClinical leadership is about expertise in specialised...

Last Steps as a Trainee, First Steps as a Consultant Specialist

The transition from being a senior trainee to a qualified specialist presents a variety of challenges under normal circumstances, with the pandemic further disrupting the experience of trainees. This presents an environment where the acquisition of key competencies, both clinical skills and wider capabilities, becomes more demanding for trainees and where training organisers need to re-evaluate their programmes to consider the different opportunities available. This introduction to the interactive session will consider how the experience in the United Kingdom led to new ways of delivering training, the challenges faced and consider the key skills new specialists need to be effective clinical leaders as they move into a senior role.DisclosureNo significant relationships.

A Vicious Cycle of Bias: Residents' Perceptions of Leadership in Health Care.

Despite growing interest in shared leadership models, autocratic physician leadership remains the norm in health care. Stereotype and bias limit leadership by members of other professions. Furthermore, traditional views of effective clinical leadership emphasize agentic behaviors associated with male gender. To shift the prototypical concept of a leader from a male physician to a more inclusive prototype, a better understanding of prototype formation is needed. This study examines leader prototypes and their development among resident physicians through the lens of leadership categorization theory. One researcher conducted semistructured interviews with anesthesia and internal medicine residents at a single institution, asking participants to describe their ideal team leader and comment on the video-recorded performance of either a male or female nurse practitioner (NP) leading a simulated resuscitation. Interview questions explored participants' perceptions of NPs as team leaders and how these perceptions developed. The researchers conducted deductive analysis to examine leadership prototypes and prototype formation, and inductive analysis to derive additional themes. The majority of residents described a male physician as the ideal resuscitation team leader. Exposure to male physician leaders, and lack of exposure to NP leaders, contributed to this prototype formation. Residents described a vicious cycle in which bias against female and NP leaders diminished acceptance of their leadership by team members, resulting in decreased confidence and performance, further aggravating bias. These results provide suggestions for interventions that can help shift the leadership prototype in health care and promote shared leadership models. These include increasing exposure to different professionals of either gender in leadership roles and increased representation in educational materials, education about effective leadership strategies to create awareness of the benefits of shared leadership, and reflection during team training to increase awareness of bias and the backlash effect faced by individuals whose behaviors counter established stereotypes.

Exploring clinical leadership in long-term care: An integrative literature review.

The aim of this study is to understand the concept of clinical leadership and clinical leadership development for nurses working with older adults in long-term care health care facilities. In Canada, clinical care within long-term care is undertaken by registered nurses and licenced practical nurses working with health care aides. Effective clinical leadership is essential for providing quality nursing care. An integrative literature review using the framework of Whittemore and Knafl (2005). All selected articles were quality appraised using the Critical Appraisal Skills Program and the accuracy, authority, coverage, objectivity, date and significance checklist. The analysis resulted in four themes: ambiguous definitions, practice-based and value-driven care, the impact of clinical leadership and clinical leadership development for Canadian nurses. The findings suggest that ambiguity surrounds the concept of clinical leadership, with the term denoting both 'management' as a formal administrative role and 'leadership' in general. More recently, the clinical leadership focus has been on informal leadership by nurses at the bedside, where personal and professional values align with clinical action. Effective clinical leadership can have a positive impact on quality care and employee job satisfaction.

Advancing leadership in medical radiation sciences: Incorporating systematic leadership education in pre-registration curricula

Advancing leadership in medical radiation sciences: Incorporating systematic leadership education in pre-registration curricula

Learning lessons from the paediatric critical care response to the SARS-CoV-2 pandemic in England and Wales: a qualitative study

ObjectivesTo explore the experiences of clinical leads in paediatric critical care units (PCCUs) in England and Wales during the reorganisation of services in the initial surge of the SARS-CoV-2 pandemic...

Implementing the PIE (Person, Interaction and Environment) programme to improve person-centred care for people with dementia admitted to hospital wards: a qualitative evaluation

Background: In the UK, improving person-centred care for people with dementia in hospitals is a policy priority. The PIE (Person, Interaction, Environment) programme comprises cycles of observation of care by staff, identification of areas for improvement and plans for practice change and evaluation. Aim: To describe and evaluate PIE implementation in three UK NHS regions. Methods: A qualitative design was adopted at 10 case study sites (wards), selected on the basis of readiness for change criteria. Following a training workshop, PIE cycles were introduced into each ward. Data collection comprised observation, interviews, documentary analysis and an events log. Normalisation process theory provided a guiding framework for analysis. Results: PIE was fully adopted in two study wards over 18 months, which resulted in sustained practice change and increased awareness of person-centredness. Partial implementation of PIE took place in a further two wards but progress stalled before significant action. The remaining six wards did not implement the programme. Factors influencing the likelihood of implementation were: relevance of PIE; collective team involvement; fit with strategic priorities; adequate resourcing; effective clinical leadership; good facilitation; and organisational stability. Conclusion: PIE has the potential to help staff improve person-centred care for people with dementia admitted to hospital wards. However, the evidence provided by this article is limited to 10 wards, of which only two fully implemented the programme. Implications for practice: A programme for improving person-centred care for people with dementia in acute hospital wards requires sustained commitment from the ward and the wider organisation Successful practice change depends on multiple factors, including effective clinical leadership and good facilitation Contextual factors at various levels of an organisation need to be considered Use of the PIE tool has the potential to enable staff to focus on person-centred care for older people with dementia in acute settings

Strengthening Geriatric Expertise in Swiss Nursing Homes: INTERCARE Implementation Study Protocol.

Nursing home (NH) residents with complex care needs ask for attentive monitoring of changes and appropriate in-house decision making. However, access to geriatric expertise is often limited with a lack of geriatricians, general practitioners, and/or nurses with advanced clinical skills, leading to potentially avoidable hospitalizations. This situation calls for the development, implementation, and evaluation of innovative, contextually adapted nurse-led care models that support NHs in improving their quality of care and reducing hospitalizations by investing in effective clinical leadership, geriatric expertise, and care coordination. An effectiveness-implementation hybrid type 2 design to assess clinical outcomes of a nurse-led care model and a mixed-method approach to evaluate implementation outcomes will be applied. The model development, tailoring, and implementation are based on the Consolidated Framework for Implementation Research (CFIR). NHs in the German-speaking region of Switzerland. Eleven NHs were recruited. The sample size was estimated assuming an average of .8 unplanned hospitalizations/1000 resident days and a reduction of 25% in NHs with the nurse-led care model. The multilevel complex context-adapted intervention consists of six core elements (eg, specifically trained INTERCARE nurses or evidence-based tools like Identify, Situation, Background, Assessment and Recommendation [ISBAR]). Multilevel implementation strategies include leadership and INTERCARE nurse training and support. The primary outcomes are unplanned hospitalizations/1000 care days. Secondary outcomes include unplanned emergency department visits, quality indicators (eg, physical restraint use), and costs. Implementation outcomes included, for example, fidelity to the model's core elements. The INTERCARE study will provide evidence about the effectiveness of a nurse-led care model in the real-world setting and accompanying implementation strategies. J Am Geriatr Soc 67:2145-2150, 2019.

The technology implications of master’s level education in the professionalization of nursing: A narrative inquiry

(a) To explore the meanings of master's education in the professionalization of nursing; and (b) to describe the core attributes that nurses gained through master's study. Narrative inquiry. From June 2017 to June 2018, unstructured interviews were conducted with 12 master-prepared nurses at advanced nursing position with minimum 5years of postregistration experience. Collaborative thematic narrative analysis was conducted on verbatim transcripts. Members checking, peer validation and audience validation assured verisimilitude and utility. There was a need to fit one's own assertion for professional growth in nursing career structure. Master's study equipped nurses with specialty skills and knowledge with enhanced reflexivity, which nurtured morality, problem-solving ability and capacity to collaborate inter-professionally. Master-prepared nurses demonstrated effective clinical leadership through acting as change agents. Master's level education and master-prepared nurses are instrumental to the professionalization of nursing by expanding the roles of nurses. Nursing career mentoring will maximize nurses' agency in healthcare system. Developing innovative inter-professional pedagogy will nurture the reflexivity of master-prepared nurses.

A Call to Action: Nurse Leader Succession Plan in Acute Care

Nurse leader succession plan in acute care is a business strategy that has a financial impact. Quality care and patient safety is reliant on effective clinical leadership. Efficiency and effectiveness in care delivery processes and outcomes translate into corporate financial sustainability. The premise of nurse leader succession plan is to build leadership capacity for clinicians, and enlarge nursing portfolio. Potential candidates acquire skills and knowledge pertinent to professional growth and leadership roles. Structured mentorship program focus on inter-professional collaboration that enhance clinical and leadership competencies. Individualized professional development plans align competencies with personal career goals. Emerging nurse leaders are inspired to demonstrate commitment and ownership of healthcare processes and outcomes. Regular performance appraisal and feedback provide objectivity in training and development programs. Additionally, communication and relationship management lead to efficiency and mentorship program integration. Succession plan and leadership development advances nursing discipline, autonomy, career development and job satisfaction. Therefore, a nurse leader succession plan provides a reflection on the voice of a nurse in hospital environment.

Clinical leadership and nursing explored: A literature search.

To explore what we know of the concept of clinical leadership and what the term means. Clues to the definition of clinical leadership, the attributes of effective and less effective clinical leaders, models of clinical leadership and the barriers that hinder clinical leadership development were explored. While nursing leadership and healthcare leadership are terms that have been evident in nursing and health industry literature for many decades, clinical leadership is a relatively new term and is may still be misunderstood. A search was undertaken of formal and informal literature using a library database and a range of search engines for the words "clinical leadership" and "clinical leadership in nursing." In each case, the full search parameters were employed with searches between 1974-2016. Full-text articles were requested, and English was the preferred language. In total, 3,259 publications were located through seven database search tools, although these included a large number of duplications. Following further informal searches and removing irrelevant material, 27 research or literature review focused papers were retained that included 17 qualitative studies, one quantitative study, one mixed method study, one Delphi study and two that compared other research studies. As well, five literature reviews were retained in the synthesis. The data synthesis resulted five categories: definitions of clinical leadership, characteristics most likely or least associated with clinical leadership, models applied to clinical leadership and limits to clinical leadership development. Clinical leaders are recognised for having their values and beliefs parallel their actions and interventions. They are found across the spectrum of health organisations, often at the highest level for clinical interaction, but not commonly at the highest management level in a ward or unit team and they are seen in all clinical environments. Clinical Leadership and an understanding on how clinical leaders contribute to the health service is central to the application of values-based practice and how clinical leaders impact on innovation, change and making care better.

Leadership theory in clinical practice

Abstract In current clinical settings, effective clinical leadership ensures a high-quality health care system that consistently provides safe and efficient care. It is useful, then, for health care professionals to be able to identify the leadership styles and theories relevant to their nursing practice. Being adept in recognizing these styles not only enables nurses to develop their skills to become better leaders but also improves relationships with colleagues and leaders who have previously been challenging to work with. This article aims to use different leadership theories to interpret a common scenario in clinical settings in order to improve leadership effectiveness. Ultimately, it is found that different leadership styles are needed for different situations, and leaders should know which approach is most effective in a given scenario to achieve the organization's goals.

Leadership in Allied Health: A Review of the Literature

Background: It is well established that effective clinical leadership improves the quality of healthcare service provision and promotes leadership outcomes. [1,2] Leadership capacity and capability of allied health professionals is needed for successful clinical service provision, [3] but less is known about allied health leadership than about other clinical groups.
 Aims: The literature review aimed to identify research about leadership and leadership development of allied health practitioners in healthcare settings.
 Methods: A database review was undertaken using SCOPUS, CINAHL, Medline and Business Elite databases from December 2014-September 2015. Three leadership journals were also hand searched. A total of 1665 articles were identified. These were scanned and 129 articles were retrieved with 70 articles shortlisted for indepth review.
 Results: After application of inclusion and exclusion criteria, seven journal articles were included in the literature review. Review of the studies identified two areas of primary focus: leadership styles and outcomesand leadership development programs.
 Conclusions: Findings showed that there are currently a limited number of robust published reports in relation to leadership and allied health practitioners. Implications for Practice: Well-designed research studies to further evaluate leadership skills of allied health practitioners as well as to determine the effectiveness of leadership programs in developing transformational leaders are required.
 Abbreviations: CASP – Clinical Appraisal Skills Program; NHMRC – National Health and Medical Research Council.

Health professionals’ perceptions of clinical leadership. A pilot study

Aim: To identify how clinical leadership was perceived by Health Professionals (HPs) (excluding nurses and doctors) and to understand how effective clinical leadership relates to initiating and establishing a culture of change and progression in the health services. Methodology: This pilot study used a mixed methods approach, although quantitative methodological principles dominated. An on-line (SurveyMonkey) questionnaire was distributed via email links to HPs throughout the Western Australian Department of Health. Qualitative data was analysed by Statistical Product and Service Solutions (Version 21). Results: A total of 307 complete surveys were returned. Participants represented 6.1% of the total WA HP workforce and a wide range of HP disciplines. The majority of respondents were female (86.5%), the median age was 38.9 years and the majority of respondents worked in acute hospital environments (59.9%) and in a metropolitan location (73.7%). Most participants (79.2%) saw themselves or were reportedly seen by others (76.2%) as clinical leaders. The main attributes associated with clinical leadership were; effective communicator, clinical competence, approachability, role model and supportive. The main attribute identified least with clinical leadership was “controlling”. Only 22.2% saw clinical leaders as managers, while the majority saw a clinical focus as important (85.3%). Clinical leaders were perceived as having an impact on how clinical care is delivered, staff support and leading change and service improvement. Many respondents (81.4%) suggested barriers hindered their effectiveness as clinical leaders. Conclusions: Improvements in clinical care and changes in practice can be initiated by clinical leaders.

Intentional Modelling: A Process for Clinical Leadership Development in Mental Health Nursing

Clinical leadership is becoming more relevant for nurses, as the positive impact that it can have on the quality of care and outcomes for consumers is better understood and more clearly articulated in the literature. As clinical leadership continues to become more relevant, the need to gain an understanding of how clinical leaders in nursing develop will become increasingly important. While the attributes associated with effective clinical leadership are recognized in current literature there remains a paucity of research on how clinical leaders develop these attributes. This study utilized a grounded theory methodology to generate new insights into the experiences of peer identified clinical leaders in mental health nursing and the process of developing clinical leadership skills. Participants in this study were nurses working in a mental health setting who were identified as clinical leaders by their peers as opposed to identifying them by their role or organizational position. A process of intentional modeling emerged as the substantive theory identified in this study. Intentional modeling was described by participants in this study as a process that enabled them to purposefully identify models that assisted them in developing the characteristics of effective clinical leaders as well as allowing them to model these characteristics to others. Reflection on practice is an important contributor to intentional modelling. Intentional modelling could be developed as a framework for promoting knowledge and skill development in the area of clinical leadership.

What are the effective ways to translate clinical leadership into health care quality improvement?

The presence and/or absence of effective leaders in health care can have a stark consequence on the quality and outcomes of care. The delivery of safe, quality, compassionate health care is dependent on having effective clinical leaders at the frontline. In light of the Kirkup and Francis reports, this article explores some ways of translating clinical leadership into health care quality improvement. This is achieved by exploring what is clinical leadership and why and how this is important to health care quality improvement, clinical leadership, and a duty of candor, along with the importance clinical leadership plays in the provision of quality care improvement and outcomes. Clinical leaders are not predefined roles but emerge from the complex clinical setting by gaining an acquired expertise and from how they then internalize this to develop and facilitate sound relationships within a team. Clinical leaders are effective in facilitating innovation and change through improvement. This is achieved by recognizing, influencing, and empowering individuals through effective communication in order to share and learn from and with each other in practice. The challenge for health care organizations in regard to creating organizational cultures where a duty of candor exists is not to reinvent the wheel by turning something that is simple into something complex, which can become confusing to health care workers, patients, and the public. By focusing on the clinical leader’s role and responsibilities we would argue they play a crucial and pivotal role in influencing, facilitating, supporting, and monitoring that this duty of candor happens in practice. This may be possible by highlighting where and how the duty of candor can be aligned within existing clinical governance frameworks.

Systematic review: what interventions improve dignity for older patients in hospital?

To review the evidence for interventions to improve dignity for older patients in acute care. High profile cases have highlighted failure to provide dignified care for older people in hospitals. There is good evidence on what older people consider is important for dignified care and abundant recommendations on improving dignity, but it is unclear which interventions are effective. Narrative systematic review. The Cochrane library, MEDLINE, EMBASE, CINAHL, BNI and HMIC electronic databases were searched for intervention studies of any design aiming to improve inpatients' dignity. The main population of interest was older patients, but the search included all patients. Studies that focused on 'dignity therapy' were excluded. There were no intervention studies found in any country which aimed to improve patient dignity in hospitals which included evaluation of the effect. A narrative overview of papers that described implementing dignity interventions in practice but included no formal evaluation was, therefore, undertaken. Five papers were identified. Three themes were identified: knowing the person; partnership between older people and health care professionals; and, effective communication and clinical leadership. The effect on dignity of improving these is untested. There are currently no studies that have tested interventions to improve the dignity of older people (nor anyone else) in hospitals. Further research using well designed trials of interventions is needed. There is also a need to develop and validate outcome measures for interventions to improve dignity. At present nurses lack robust evidence on how to improve dignity. There is ample evidence on what undermines patients' dignity and there is a need to develop and test interventions designed to improve patient dignity.