Executive Leadership Research Articles

Learning from the End of the Public-Private Partnership for Lesotho's National Referral Hospital Network.

Public-private partnerships (PPP) are one strategy to finance and deliver healthcare in lower-resourced settings. Lesotho's Queen 'Mamohato Memorial Hospital Integrated Network (QMMH-IN) was sub-Saharan Africa's first and largest integrated healthcare PPP. We assessed successes and challenges to performance of the QMMH-IN PPP. We conducted 26 semi-structured interviews among QMMH-IN executive leadership and staff in early 2020. Questions were guided by the WHO Health System Building Blocks Framework. We conducted a thematic analysis. Facilitators of performance included: 1) PPP leadership commitment to quality improvement supported by protocols, monitoring, and actions; 2) high levels of accountability and discipline; and 3) well-functioning infrastructure, core systems, workflows, and internal referral network. Barriers to performance included: 1) human resource management challenges and 2) broader health system and referral network limitations. Respondents anticipated the collapse of the PPP and suggested better investing in training incoming managerial staff, improving staffing, and expanding QMMH-IN's role as a training facility. The PPP contract was terminated approximately five years before its anticipated end date; in mid-2021 the government of Lesotho assumed management of QMMH-IN. Going forward, the Lesotho government and others making strategic planning decisions should consider fostering a culture of quality improvement and accountability; ensuring sustained investments in human resource management; and allocating resources in a way that recognizes the interdependency of healthcare facilities and overall system strengthening. Contracts for integrated healthcare PPPs should be flexible to respond to changing external conditions and include provisions to invest in people as substantively as infrastructure, equipment, and core systems over the full length of the PPP. Healthcare PPPs, especially in lower-resource settings, should be developed with a strong understanding of their role in the broader health system and be implemented in conjunction with efforts to ensure and sustain adequate capacity and resources throughout the health system.

Clinical Nurse Specialist Role Advocacy: Quantifying the Financial Contributions Via Development of a Scorecard.

The purpose of this article is to guide the clinical nurse specialist in constructing a scorecard to track clinical outcomes and identify the associated financial impact. Creation of a scorecard highlighting the financial impact of the clinical nurse specialist team was used to disseminate financial outcomes to hospital executive stakeholders, allowing the clinical nurse specialist team to demonstrate its clinical and financial value. During development and ongoing maintenance of the scorecard, the clinical nurse specialist team cultivated skills to identify the financial impact of projects. The team also utilized financial implications of individual and group projects to prioritize work. At the end of fiscal year 2022, the clinical nurse specialist team demonstrated revenue generation of $29 890 and cost avoidance of $2 854 807.30. The clinical nurse specialist scorecard was presented quarterly to the chief nursing officer, who shared with executive leadership. Clinical nurse specialists are positioned to make significant and positive financial impact to organizations. A scorecard presented to executive leadership offers a clinical nurse specialist team a tool to capture and disseminate a clinical nurse specialist team's unique financial contribution at the system level.

Measuring executive leadership teaming dynamics for leading learning organizations.

Measuring executive leadership teaming dynamics for leading learning organizations.

Roles for Implicit Bias Science in Antidiscrimination Law

Abstract Declining scholarly interest in intentional discrimination may be due to rapid growth of interest in systemic biases and implicit biases. Systemic biases are produced by organizational personnel doing their assigned jobs, but nevertheless causing adverse impacts to members of protected classes as identified in civil rights laws. Implicit biases are culturally formed stereotypes and attitudes that cause selective harms to protected classes while operating mostly outside of conscious awareness. Both are far more pervasive and responsible for much greater adversity than caused by overt, explicit bias, such as hate speech. Scientific developments may eventually influence jurisprudence to reduce effects of systemic and implicit biases, but likely not rapidly. We conclude by describing possibilities for executive leadership in both public and private sectors to ameliorate discrimination faster and more effectively than is presently likely via courts and legislation.

The Education Leadership Challenges for Universities in a Postdigital Age

AbstractThe executive leadership of universities internationally faces significant uncertainty in how to respond to ongoing technological innovation in a postdigital age. The current rapid progress in generative artificial intelligence (GAI) is exacerbating their plight. This study uses emergent research on GAI in learning and teaching to problematise the challenges of university education leadership in the face of such disturbances to core academic work. Considering the benefits and risks associated with the design of GAI, its inclusion in learning and teaching, and how it is reconfiguring the design of degree programmes and the strategies of local leaders providing support services through university organisational structures, this paper offers a principled ecosystemic approach to leadership that considers key elements for effective strategy implementation. The interrelatedness of strategy, governance, policy, management, and investment are discussed and a way forward for effective education leadership in a context of uncertainty is offered.

Characterizing Global Gender Representation in Veterinary Executive Leadership.

Veterinary medicine is an increasingly feminized field, with growing numbers of veterinary students and professionals identifying as women. Increased representation of women in senior veterinary education leadership has not yet been examined across all global regions. To address this question, we compiled a comprehensive list of veterinary academic executives from veterinary educational institutions listed by the World Veterinary Association, the American Veterinary Medical Association, and the World Organisation for Animal Health. In total, data from 720 veterinary schools in 118 countries were obtained via an online search of each school's webpage to retrieve information on executive-level leaders and their gender representation. Out of 2263 executive leaders included, 784 (34.6%) were inferred to be women. Of 733 top executives-deans or their equivalents-187 (25.5%) were inferred to be women. At the national level, the proportion of women in executive teams was positively correlated with Gross Domestic Product, Gender Development Index, and negatively correlated with Gender Inequality Index. This is the first study to demonstrate inequity in the gender composition of veterinary educational leadership across the majority of veterinary schools worldwide, and regional trends thereof. It also identifies potential socioeconomic issues closely connected to gender equity in these spaces. To monitor progress towards gender equity within the profession, future work is needed to assess gender representation over different phases of veterinary career tracks, including in student populations. Analysis of gendered trends over time will also help to establish trends and evaluate progress in gender equity.

Uncovering the Driving Forces behind Succession Planning in Namibian Commercial Public Enterprises: A Look at Executive Leadership

A robust succession plan for executive leadership is vital for organizational growth. This study examines challenges faced by Namibian human resource managers in maintaining effective executive leadership within Commercial Public Enterprises (CPEs). Employing a constructivist approach, it explores managers' perspectives on succession planning as a crucial tool for learning and development among Namibia's CPE managerial cadre. Using a convergent mixed-methods design, the study combines qualitative and quantitative data collection and analysis. Simple random sampling determines the quantitative sample, while purposive sampling selects the qualitative sample, involving 210 participants from 22 CPEs, resulting in a sample of 63 participants. Findings highlight the importance of education, mentoring, and training in shaping executive leadership succession planning in CPEs. Charismatic Chief Executive Leadership and a transactional leadership style emerge as pivotal for sustained organizational success. The study recommends strategic focus on educational programs, mentorship, and training to enhance succession planning in Namibia's CPEs, contributing to broader discussions on organizational leadership and succession planning, particularly in African nations.

Key informants perspectives on creating a high impact research department in family and community medicine: a qualitative project.

Primary care is integral to the health system and population health. Primary care research is still in development and most academic departments lack effective research investments. High impact primary care research programs are needed to advance the field to ensure a robust primary care system for the future. The project objective was to understand key informants' views of structures, functions, and processes required to create a high impact research program in an academic primary care department. A descriptive qualitative project with key informants from research programs in primary care. Participants included international research leaders in primary care (n = 10), department of family and community researchers (n = 37) and staff (n = 9) in an academic primary care department, other university leaders (n = 3) and members of the departmental executive leadership team (1 department; 25 members). Semi-structured interviews (n = 27), and focus groups (n = 6) were audio recorded, transcribed, and analyzed using thematic analysis. We used a socioecological framework which described micro, meso, macro levels of influence. At the micro level despite barriers with respect to funding, protected time and lack of formal mentorship, personal motivation was a key factor. At the meso level, the organizational structure that promoted collaboration and a sense of connection emerged as a key factor. Specifically research leaders identified a research faculty development pipeline based on equity, diversity, inclusion, indigeneity, and accessibility principles with thematic areas of focus as key enablers. Lastly, at the macro level, an overarching culture and policies that promoted funding and primary care research was associated with high impact programs. The alignment/complementarity of micro, meso, and macro level factors influenced the creation of a high impact research department in primary care. High impact research in primary care is facilitated by the development of researchers through formalized and structured mentorship/sponsorship and a department culture that promote primary care research.

Leadership to Accelerate Healthcare's Digital Transformation: Evidence From 33 Health Systems.

The COVID-19 pandemic, healthcare market disruptors, and new digital healthcare technologies have made a substantial impact on the delivery of healthcare services, highlighting the critical roles of leaders in hospitals and health systems. This study sought to understand the evolving roles of CEOs, CIOs, and other executive leaders in the postpandemic era and highlight the adaptability and strategic vision of executives in shaping the future of healthcare delivery. Between October 2022 and May 2023, 51 interviews were conducted with CEOs, CIOs, and other executives responsible for delivering technology solutions for 33 nonprofit health systems in the United States. They were asked to describe their backgrounds; how information solutions and technologies were viewed within their organizations' strategy, operations, and governance; and the key characteristics of executive leaders. The study has found that effective CEOs have an authentic belief in technology's role in achieving their organization's mission and that contemporary CIOs are strategic executive partners who align strategy with culture to improve care. This study examines how healthcare systems are creating digitally savvy executive leadership teams that operate in a new, integrated model that unites previously siloed functions. Some healthcare CIOs are unprepared for current and future business challenges, and some CEOs are unsure how to leverage digital technologies and C-suite expertise to transform their organizations. This research provides insights into how the nation's health systems are building and sustaining leadership teams capable of adapting to the healthcare environment and accelerating organizational transformation.

Responsible Leadership with Chinese Characteristics

AbstractResponsible leadership (RL) has become a buzz word in the current lexicon of business and politics, but there is still limited agreement on the components, scope, and characteristics. The confusion is rooted, in part, in the dominance of normative perspectives that take RL as a universal phenomenon. However, embedded in a specific culture, RL cannot be understood fully without understanding the moral traditions of that culture. In this article, we used a case study method to explore how RL is understood and practiced in China. Taking the role theory perspective, we conducted in-depth interviews with 9 highly regarded responsible executive leaders and 92 stakeholders in and outside of their companies who were well acquainted with the leaders. Our findings reveal that in China, the moral character of leaders guides them to define and take responsibility for themselves, their employees, companies, and external stakeholders. The five dimensions of RL we identified and the relationships among the dimensions include characteristics that reflect Chinese culture, such as strong sentiment for the nation, self-discipline, developing employees philosophically, and ‘jun zi wu ben’ (a gentleman should focus on fundamental matters). We conclude by discussing the implications of our study for RL research and practice.

A tale of 2 digital hospitals: A qualitative study of antimicrobial stewardship teams.

We aim to examine and understand the work processes of antimicrobial stewardship (AMS) teams across 2 hospitals that use the same digital intervention, and to identify the barriers and enablers to effective AMS in each setting. Employing a contextual inquiry approach informed by the Systems Engineering Initiative for Patient Safety (SEIPS) model, observations and semistructured interviews were conducted with AMS team members (n= 15) in 2 Australian hospitals. Qualitative data analysis was conducted, mapping themes to the SEIPS framework. Both hospitals utilized similar systems, however, they displayed variations in AMS processes, particularly in postprescription review, interdepartmental AMS meetings and the utilization of digital tools. An antimicrobial dashboard was available at both hospitals but was utilized more at the hospital where the AMS team members were involved in the dashboard's development, and there were user champions. At the hospital where the dashboard was utilized less, participants were unaware of key features, and interoperability issues were observed. Establishing strong relationships between the AMS team and prescribers emerged as key to effective AMS at both hospitals. However, organizational and cultural differences were found, with 1 hospital reporting insufficient support from executive leadership, increased prescriber autonomy and resource constraints. Organizational and cultural elements, such as executive support, resource allocation and interdepartmental relationships, played a crucial role in achieving AMS goals. System interoperability and user champions further promoted the adoption of digital tools, potentially improving AMS outcomes through increased user engagement and acceptance.

Integrating Hospital-Based Harm Reduction Care-Harnessing the Nursing Model.

Hospitals are risk environments for people who use drugs, and most hospitals are unprepared to deliver substance use disorder (SUD) care, including harm reduction (HR) interventions. HR philosophy clashes with traditional hospital hierarchy and norms, and staff may resist HR interventions due to stigma, fear of enabling substance use, legal and safety concerns. Nurses are central to hospital culture and care and could promote and deliver HR care. Our US hospital has an inter-professional addiction consult service (ACS) that includes medical providers, social workers, and peers. We developed and launched a hospital-based registered nurse-(RN) led HR intervention, including distributing safe-use supplies (eg, syringes). We describe model development and early experience, using an Exploration, Preparation, Implementation, and Sustainment framework. ACS experiences and community HR interventions informed our exploration phase. In the preparation phase we secured funding from Medicaid payers for a 2-year pilot, including full-time RN salary and HR supplies. We elicited buy-in from hospital executive leaders, partly by partnering with nurse champions who described unmet patient care and staff education needs. We consulted hospital lawyers and developed an institution-wide media campaign targeting staff, including in-person booths distributing naloxone and materials promoting international overdose awareness day (eg, "#EndOverdose" buttons). We collaborated with local and national experts to develop the intervention, which includes RN bedside HR education and staff trainings. The Implementation was from September 2022 to March 2023. We trained 459 staff (over 15 trainings) and conducted 209 patient encounters. Generally, patients and staff embraced the HR RN role, including previously controversial safe-use supply distribution. Sustainment efforts include engaging stakeholders in continuous improvement and evaluation efforts. A nurse-led hospital-based HR intervention can expand patient services, support staff, and bridge HR and medical models.

Overcoming Career Advancement Barriers to Executive Leadership Roles of Nurses From Racial and Ethnic Minority Backgrounds

There is underrepresentation of nurses with racial and ethnic minority backgrounds in executive nursing leadership positions as compared with the general population. The management problem is that even when academically prepared, nurses with racial and ethnic minority backgrounds perceive that they face both singular and systemic barriers to promotional opportunities to executive nurse positions. A literature gap exists as to why this phenomenon persists. The purpose of this qualitative narrative inquiry study was to explore the personal stories and lived experiences of executive nurses with racial and ethnic minority backgrounds concerning the barriers they faced and overcame on their pathway to an executive leadership position. The conceptual framework combined the intersectionality of race and internal and external capabilities. Data collected through semistructured interviews underwent a 3-dimensional-space narrative structure and thematic analysis process. Eleven themes in 3 major categories emerged: (a) facing the challenges; (b) overcoming barriers; and (c) where my help came from. The social change implications include new knowledge for multiple stakeholders in supporting and developing nurses from racial and ethnic minority backgrounds to assist them in achieving executive nursing leadership positions, thereby increasing the number of these nurses in executive roles.

Examining the experience of healthcare workers who led staff wellness rounding during the COVID-19 pandemic.

ObjectiveStaff wellness rounding (SWR) is a process in which healthcare leaders have real-time conversations with healthcare workers (HCW) to identify safety and wellness issues. This study examined the experience of multidisciplinary healthcare leaders, who were not trained in psychology, who delivered SWR during the surge phase of the COVID-19 pandemic.MethodsA mixed methods approach was used. Phase 1 included a survey of HCW who participated in SWR during July-October 2021. Phase 2 included semi-structured interviews of leaders who delivered SWR.ResultsThere were 403 respondents to the survey, with 169 participants (41.9%) being eligible for the study. More than 67% of eligible respondents would recommend SWR to other colleagues, and 77.5% reported that SWR provided an opportunity to escalate issues or concerns about COVID-19. Eleven SWR leaders were interviewed about their experience of leading SWR. Four key themes were identified: SWR (1) offered a defined process for communication between executive leaders and HCW; (2) enabled escalation and actioning of issues to and from executive teams in the organisation; (3) required flexible scheduling to meet varied work schedules of HCW; and (4) required the leaders to have a core set of skills and competencies.ConclusionThis study examined the contribution that an SWR intervention can make to support HCW wellbeing during crisis-type events. The model facilitated interactions between executive leaders, managers and frontline staff. It fostered collegiality with peers, managers and leaders, supported recognition and acknowledgment of peers and used available resources effectively to support staff wellness during the surge phase of the COVID-19 pandemic.

Senior Management Succession Challenges for U.S. Healthcare Facility Operations

ABSTRACT Purpose The purpose of this research was to better understand current state of mid- and senior-level healthcare facility managers to explore potential roadblocks to FM succession related to demographics, backgrounds, and perceptions in supporting future research prioritization for healthcare facility executive leadership development. Methodology A survey was designed to collect information on facility managers’ gender, race, age, job level, employer industry, retirement timeframe, educational attainment, and perceptions of their employers’ recruiting and succession planning. The survey was sent electronically in February 2021 to more than 12,400 FM professionals with a 29% response rate. Only information from U.S. respondents working in healthcare facility operations was used in this study. Findings The healthcare industry is struggling to attract and retain senior-level facility managers. The difficulty in finding qualified facility managers to fill senior-level positions does not appear to be related to a lack of interested candidates or pay. Factors impeding recurring facility workforce development and succession to senior healthcare FM roles may be related to low succession planning adoption by healthcare organizations, an aged facility workforce, and limited undergraduate education achievement from traditional candidates. Originality Healthcare organizations may prioritize these factors in addressing ongoing FM workforce attrition and development challenges to ensure a sustainable pipeline of qualified facility managers prepared to successfully navigate the unique expectations of leading the healthcare built environment.

Leadership Intervention: Strategies and Outcomes in Public Education of Tambopata

The research aimed to determine the influence of the executive leadership workshop on the educational quality of public educational institutions in Tambopata - Madre de Dios, 2023. This purpose was achieved, as the general hypothesis was validated, supporting that the executive leadership workshop positively influences the educational quality of public educational institutions in Tambopata - Madre de Dios, 2023. This is based on the Mann Whitney U test, since a significance of p-value 0,000 < 0,05 was reached; therefore, it is evident that the educational quality is favored by the executive leadership workshop. Guiding leadership is essential to promote and improve the quality of education. Educational leaders, such as school principals or department heads, are responsible for establishing a clear vision, motivating their teams, and promoting an environment conducive to learning and student development, which is achieved through leadership that impacts the quality of education in a certain way, establishing a shared vision and setting clear and achievable goals for the educational institution

Executive leadership and educational management in the educational field

The synergy between executive leadership and educational management in the educational field is essential to ensure the excellence of the service provided. However, obstacles such as the lack of training dedicated to leadership and budgetary constraints represent significant barriers to effective educational management. Overcoming these challenges is crucial to ensure a dynamic and high-quality educational environment. The purpose of the study is to establish the correlation between executive leadership and educational management in prominent institutions within the Cusco Educational Management Unit. Its methodology is a quantitative approach with a non-experimental correlation scope; information was collected from 234 participants through non-stratified probabilistic sampling, composed of 26 executives and 208 teachers. The study employed structured questionnaires, while the data were analyzed using the Pearson correlation coefficient. The results revealed a significant correlation of 0.763 between the themes, indicating a strong and positive relationship. It concludes that as executive leadership improves, the quality of educational management tends to increase, and vice versa: this highlights that investing in the development of leadership skills in directors is not only crucial for the effective management of resources and the implementation of educational policies but can also have a multiplier effect, improving the educational environment as a whole; in turn, effective educational management can reinforce leadership capabilities.

Leadership Practices in Scaling Efforts in Community Colleges

ABSTRACT Leadership in community colleges, and postsecondary institutions more broadly, plays a central role in the sustainability and scaling of promising innovations within institutions. Understanding what leaders do to support the sustainability and scaling of these innovations is crucial for helping leaders develop practices that enable them to support these efforts. Using practice theory as a guiding frame, this study sought to unveil central practices that shape efforts to scale a promising, evidence-based mathematics course within two two-year colleges. We found that executive and mid-level leaders engaged in the intertwined practices of tracking and leveraging, where they attended to institutional culture, practices, and policies, and drew on these institutional features to both constrain and enable efforts to scale. Our study highlights the power of examining practices in the day-to-day work of leaders to illuminate what leaders do to scale or inhibit innovations in their institutions.

THE LTSS STATE SCORECARD AND MULTISECTOR PLANS FOR AGING

Abstract Strong, comprehensive plans are crucial to secure lasting success in state LTSS systems. State Multisector Plans for Aging meet this need and are present and/or under development in more than a dozen states and DC. A Multisector Plan for Aging, a concept led by The SCAN Foundation, is a blueprint that: a) includes planning for 10 or more years; b) is often led by a governor with other executive and legislative leaders; and c) is developed to guide the restructuring of state and local policy, programs, and funding toward aging well in the community. For the first time, the LTSS State Scorecard credits states for having these plans. This portion of the symposium will describe Scorecard findings on Multisector Plans for Aging and address more broadly the important role of these plans to state leadership.

Power and politics of leading change in emergency departments: A qualitative study of Australasian emergency physicians.

The ability to lead change is well recognised as a core leadership competency for clinicians, including emergency physicians. However, little is known about how emergency physicians' think about change leadership. The present study explores Australasian emergency physicians' beliefs about the factors that help and hinder efforts to lead change in Australasian EDs. An online modified Delphi study was conducted with 19 Fellows of the Australasian College for Emergency Medicine. To structure the process, participants were sorted into four panels. Using a three-phase Delphi process, participants were guided through a process of brainstorming, narrowing down and ranking the factors that help and hinder attempts to lead change. Reflexive thematic analysis was used to code and interpret the qualitative data set emerging from participants' responses through the final ranking phase. A wide array of self-, ED- and hospital-related enablers and barriers of leading change were identified, the relative importance of which varied as a function of panel. Five core themes characterised emergency physicians' conceptions of change leadership in hospitals: challenging environments of competing interests and tribalism; need for trust and psychological safety to sustain collaboration; challenges of navigating complex hierarchies; need to garner executive leadership support and; need to maintain a growth mindset and motivation to practice change leadership. The findings of our study provide new insight into emergency physicians' conceptions of the nature, barriers to and enablers of change and point to new directions in leadership development to support emergency physicians' aspirations in the context of quality, organisation and health systems improvement.