Healthcare Leadership Development Research Articles

Development and psychometric testing of the clinical leadership needs analysis (CLeeNA) instrument for nurses and midwives.

The aim of this study is to report the development and psychometric testing of the clinical leadership needs analysis instrument (CLeeNA). Limited emphasis is placed on the clinical leadership needs of nurses and midwives that are fundamental to supporting the delivery of high quality, safe patient care. A development and validation study of CLeeNA was undertaken using cross-sectional data. A sample of 324 registered nurses and midwives completed the questionnaire using a 7-point adjectival scale. Principal component analysis was conducted to explore scale grouping of items (n=103 items). Principal component analysis, item reduction and parallel analysis on the items of the instrument resulted in seven factors consisting of 56 items. These factors were identified as: Staff and Care Delivery; Technology and Care Initiatives; Self and Team Development; Standards of Care; Financial and Service Management; Leadership and Clinical Practice; Patient Safety and Risk Management. The identified factors are reflective of an ever-changing health care environment. Potentially, after further testing, this instrument could be used by nursing management and educators to measure clinical leadership needs, inform the design of clinical leadership training programmes and provide valuable information about health care leadership development.

Leadership development in health care in low and middle-income countries: Is there another way?

Leadership and management capacity is an important factor in the health care systems of low and middle-income countries (LMICs) due to resource scarcity and a high burden of disease. The paper identifies the key concerns of health care policy-makers and health care leaders and managers in LMICs and, in the case of the latter, what is led and managed. It examines the two major education and training approaches adopted to develop such capacity and the cultural context against which development takes place, noting that leadership and management development in LMICs needs to reflect local cultures. From this consideration, it is proposed that action learning (which already has a track-record of application in LMICs) would be a practical way forward.

Return on investment in healthcare leadership development programs.

Purpose Strong leadership has been shown to foster change, including loyalty, improved performance and decreased error rates, but there is a dearth of evidence on effectiveness of leadership development programs. To ensure a return on the huge investments made, evidence-based approaches are needed to assess the impact of leadership on health-care establishments. As a part of a pan-Canadian initiative to design an effective evaluative instrument, the purpose of this paper was to identify and summarize evidence on health-care outcomes/return on investment (ROI) indicators and metrics associated with leadership quality, leadership development programs and existing evaluative instruments. Design/methodology/approach The authors performed a scoping review using the Arksey and O'Malley framework, searching eight databases from 2006 through June 2016. Findings Of 11,868 citations screened, the authors included 223 studies reporting on health-care outcomes/ROI indicators and metrics associated with leadership quality (73 studies), leadership development programs (138 studies) and existing evaluative instruments (12 studies). The extracted ROI indicators and metrics have been summarized in detail. Originality/value This review provides a snapshot in time of the current evidence on ROI indicators and metrics associated with leadership. Summarized ROI indicators and metrics can be used to design an effective evaluative instrument to assess the impact of leadership on health-care organizations.

Evaluation of a primary care triumvirate leadership development programme

This paper evaluates a primary care triumvirate leadership programme from the perspectives of key stakeholders (General Practitioners, General Practice Nurses, Practice Managers, programme and practice colleagues); and to provide evidencedinformed recommendations for future primary care triumvirate healthcare leadership development. Kirkpatrick's Four/Five Levels of Evaluation Model was used as the evaluation approach. Data was collected by the use of face to face and telephone focus group interviews. Thematic analysis was used to generate themes relating to the four levels of Kirkpatrick's model. Findings show how adopting a primary care triumvirate leadership approach offers a promising platform for operationalising the contemporary collective and distributed approaches to leadership development. Future programmes could benefit further by adopting a multi-dimensional leadership development model. This would expose the primary care triumvirate leader to the evidence based Six 'E's' approach to leadership development (evaluate, examine, exposure, education, environment, experience).

Stakeholder Perspectives of an Approach to Healthcare Leadership Development through Use of a Multidimensional Leadership Development Conceptual Model

Leadership is often the driver used to transform healthcare services. Healthcare leadership development is often situated around conceptual frameworks or leadership development models. The aim of the study reported here was to evaluate multistakeholder perspectives on leadership development when applying a Multidimensional Leadership Development Conceptual Model to post-graduate healthcare leadership programmes at a university in England. This exploratory qualitative study of healthcare leadership development comprised face-to-face interviews. Six interviews were undertaken with academics from a post-graduate leadership programme team, a family carer and service-user of health care services, and current United Kingdom students and former United Kingdom and international students who had undertaken the leadership development programme. Transcripts were thematically analysed. Three themes emerged: Expectations of the contemporary healthcare leader; Experiences of the Multidimensional Leadership Development Conceptual Model on leadership development; and Improvements to the model. We conclude that framing post-graduate leadership programmes around a conceptual model can aid identification of the key components required for effective leadership development. Evidence-informed recommendations are provided which seek to optimise healthcare leadership development using a leadership development conceptual model which (1) represents the values and beliefs of all stakeholders involved; (2) is reviewed annually to critically explore the internal and external evidence base for leadership development; gain stakeholder consensus of expectations of the healthcare leader; and provide the reality check to ensure a ‘fit for purpose’ programme; and (3) is constructively aligned to leadership programme curricula with sufficient flexibility to tailor an effective teaching and learning platform for preparing the individual leader, noting unique circumstances and contexts.

Health care leadership development and training: progress and pitfalls.

Formal training in the multifaceted components of leadership is now accepted as highly desirable for health care leaders. Despite natural leadership instincts, some core leadership competencies (“differentiating competencies”) must be formally taught or refined. Leadership development may begin at an early career stage. Despite the recognized need, the number of comprehensive leadership development opportunities is still limited. Leadership training programs in health care were started primarily as internal institutional curricula, with a limited scope, for the development of faculty or practitioners. More comprehensive national leadership programs were developed in response to the needs of specific cohorts of individuals, such as programs for women, which are designed to increase the ranks of senior women leaders in the health sciences. As some programs reach their 20th year of existence, outcomes research has shown that health care leadership training is most effective when it takes place over time, is comprehensive and interdisciplinary, and incorporates individual/institutional projects allowing participants immediate practical application of their newly acquired skills. The training should envelop all the traditional health care domains of clinical practice, education, and research, so the leader may understand all the activities taking place under his/her leadership. Early career leadership training helps to develop a pipeline of leaders for the future, setting the foundation for further development of those who may chose to pursue significant leadership opportunities later in their career. A combination of early and mid-to-late career development may represent the optimal training for effective leaders. More training programs are needed to make comprehensive leadership development widely accessible to a greater number of potential health care leaders. This paper addresses the skills that health care leaders should develop, the optimal leadership development concepts that must be acquired to succeed as a health care leader today, some resources for where such training may be obtained, and what gaps are still present in today’s system.

Early Careerist Interest and Participation in Health Care Leadership Development Programs

Health care organizations are increasingly embracing leadership development programs. These programs include a variety of specific activities, such as formally structured leadership development, as well as mentoring, personal development and coaching, 360-degree feedback, and job enlargement, in order to increase the leadership skills of managers and high-potential staff. However, there is a lack of information on how early careerists in health care management view these programs and the degree to which they participate. This article reports on a study undertaken to determine how early careerists working in health care organizations view leadership development programs and their participation in such programs offered by their employers. Study findings are based on a survey of 126 early careerists who are graduates of an undergraduate health services administration program. We found varying levels of interest and participation in specific leadership development activities. In addition, we found that respondents with graduate degrees and those with higher compensation were more likely to participate in selected leadership development program activities. Implications of study findings for health care organizations and early careerists in the offering of, and participation in, leadership development programs are discussed.

The Leadership Practice Circle Program: An Evidence-Based Approach to Leadership Development in Healthcare

The Institute of Medicine report The Future of Nursing 1 calls for the development of nurse leaders who possess the necessary skills to act as full partners with physicians and other professional colleagues in leading change and improving health outcomes. In contrast to the historical advancement of the nurse leader from expert clinician to frontline manager specializing in microsystem oversight, today's nurse leaders must rapidly develop comprehensive leadership skills inclusive of macrosystem concepts. As the number of nurses choosing leadership as a career is in decline, the profession is even more so at risk from a significant number of experienced leaders, clinicians, and educators who plan to leave practice in the years to come. 2 Organizations are faced with the challenge of identifying future leaders and fostering the professional development of managers who are capable of ensuring quality care, financial viability, and patient satisfaction in an environment that is increasingly complex. 3,4 Significant human and financial losses can ensue when newly appointed leaders fail to adjust to their new roles, making leadership transitions a topic of urgent importance in the healthcare industry. 5

Responsibilising managers and clinicians, neglecting system health? What kind of healthcare leadership development do we want?: Comment on "Leadership and leadership development in healthcare settings - a simplistic solution to complex problems?".

Responding to Ruth McDonald's editorial on the rise of leadership and leadership development programmes in healthcare, this paper offers three arguments. Firstly, care is needed in evaluating impact of leadership development, since achievement of organisational goals is not necessarily an appropriate measure of good leadership. Secondly, the proliferation of styles of leadership might be understood in part as a means of retaining control over public services while distributing responsibility for their success and failure. Thirdly, it makes a plea for the continued utility of good administrative skills for clinicians and managers, which are likely to become all-the-more important given recent developments in healthcare policy and governance.

Medical leadership is the new black: or is it?

Considerable resources are being invested in healthcare leadership development programs and there is a new requirement for leadership teaching for Australian medical students. The new attention to medical leadership may be a reaction to loss of medical status and power. There is little evidence for return on investment from such programs. It is simply not clear what kind of leadership training is needed for collaborative work to improve healthcare nor what kind of organisational structures enable productive exercise of medical leadership skills. Caution is recommended.

Developing a leadership pipeline: the Cleveland Clinic experience.

The complexity of health care requires excellent leadership to address the challenges of access, quality, and cost of care. Because competencies to lead differ from clinical or research skills, there is a compelling need to develop leaders and create a talent pipeline, perhaps especially in physician-led organizations like Cleveland Clinic. In this context, we previously reported on a cohort-based physician leadership development course called Leading in Health Care and, in the current report, detail an expanded health care leadership development programme called the Cleveland Clinic Academy (CCA). CCA consists of a broad suite of offerings, including cohort-based learning and ‘a la carte’ half- or full-day courses addressing specific competencies to manage and to lead. Academy attendance is optional and is available to all physicians, nurses, and administrators with the requisite experience. Course selection is guided by competency matrices which map leadership competencies to specific courses. As of December 2012, a total of 285 course sessions have been offered to 6,050 attendees with uniformly high ratings of course quality and impact. During the past 10 years, Cleveland Clinic’s leadership and management curriculum has successfully created a pipeline of health care leaders to fill executive positions, search committees, board openings, and various other organizational leadership positions. Health care leadership can be taught and learned.

Global perspectives on nursing leadership: Lessons learned from an international nursing and health care leadership development program

Background: Nurses and health care professionals who practice in the global health arena must develop the leadership skills to lead interprofessional teams that direct individual and population-based healthcare, shape health policy, and develop responses to a changing environmental, socioeconomic, and technological landscape. Programs aimed at developing these skills including nurses and health professionals from low and middle resource nations are limited. Since 2008, the Pan American Health Organization (PAHO)/World Health Organization (WHO) Collaborating Center on International Nursing at the University of Alabama at Birmingham (UAB) has offered a biennial International Nursing and Healthcare Leadership Development Program composed of: a) didactic classes; b) mentorship/coaching; c) health/service organization site visits; and d) cultural enrichment. This paper presents program evaluation data from international participants from South America and Africa (n = 69), UAB students (n = 13), faculty (n = 32), and mentors/coaches (n = 45) from programs held from 2008-2012. Implications for future programs aimed at international nursing and healthcare leadership skill development are discussed. Methods: A mixed methods approach employing investigator-designed surveys at the end of each program was used to collect quantitative and qualitative evaluation data. Questions that guided the program evaluation were: 1) What were participants’ perceptions about the extent to which objectives of the leadership classes and overall program were achieved?; 2) What were participants’ and faculty mentor/coaches’ evaluation of the mentoring/coaching component of the program?; and 3) What were participants’ and faculty mentor/coaches’ perceptions of program strengths, weaknesses, and need for change? Themes from narrative comments were identified using content analysis procedures and the NVivo9© qualitative data analysis software package. Results: Mean scores on all of the quantitative evaluation items ranged from 3.71-4.9 out of 5 possible points indicating very positive perceptions of the program and agreement that objectives had been achieved. Quantitative and qualitative findings suggest that participants were more satisfied with the mentoring/coaching component of the program than were faculty. The primary challenges identified were time limitations and communication difficulties that included both language and information technology barriers. Participants and faculty agreed that program strengths included program content and organization, the ability for cross-cultural interaction with peers, formulation of personal leadership development plans, and mentor/coach engagement. Suggestions for program improvement were aimed at providing unstructured time to allow participants to explore their host surroundings, providing sufficient breaks between classes and activities, inclusion of problem-based learning such as case study analysis, and more time allotted to mentor/coach engagement. Conclusion: The program has been successful in preparing future leaders in nursing and other health-related disciplines to better meet global health needs. The desire of program participants for more time to engage in a mentoring/coaching relationship and free time to experience the host country surroundings suggests that program length is an important influence in participant satisfaction. Even when increased costs are taken into consideration, a 3-week program duration may be more desirable than a 2-week duration. Because communication barriers contributed to participant and faculty dissatisfaction, care should be taken to ensure a basic level of English fluency for all participants if simultaneous translations services aren’t offered is recommended.

Global health care leadership development: trends to consider

This paper provides an overview of trends associated with global health care leadership development. Accompanying these trends are propositions based on current available evidence. These testable propositions should be considered when designing, implementing, and evaluating global health care leadership development models and programs. One particular leadership development model, a multilevel identity model, is presented as a potential model to use for leadership development. Other, complementary approaches, such as positive psychology and empowerment strategies, are discussed in relation to leadership identity formation. Specific issues related to global leadership are reviewed, including cultural intelligence and global mindset. An example is given of a nurse leadership development model that has been empirically tested in Canada. Through formal practice-academic-community collaborations, this model has been locally adapted and is being used for nurse leader training in Hong Kong, Taiwan, and Brazil. Collaborative work is under way to adapt the model for interprofessional health care leadership development.

The Patchwork Text Assessment – An Integral Component of Constructive Alignment Curriculum Methodology to Support Healthcare Leadership Development

Background: A responsive and innovative postgraduate programme curriculum that produces an effective and competent multi professional healthcare leader whom can lead within the United Kingdom (UK) and international healthcare context offers a promising approach to contributing towards the challenging global healthcare agenda Aims : The aim of the study is to evaluate the impact of utilising constructive alignment curricular methodology incorporating the Patchwork Text Assessment on the healthcare leadership development of UK and international postgraduate students Design: Case study design, incorporating Kirkpatrick's Five Levels of Evaluation Model Settings and Participants : 12 post graduate students (multi-professional, UK and international) studying on a healthcare leadership and management programme at one UK University in the North West of England. Methods : Rretrieval of the critical commentary produced and submitted by students as part of the Patchwork Text Assessment process Data Analysis : Thematic content analysis approach Results : Four key themes emerged demonstrating how the success of constructive alignment and the Patchwork Text Assessment in promoting deep learning for UK and international postgraduate healthcare leadership students is underpinned by principles of good practice and these include: a) Curriculum planners incorporating work based learning activities into the generated learning activities b) Curriculum planners creating the best learning environment so the student can achieve the learning activities c) Providing the learning activities that reflect the real world of healthcare leadership d) Providing students with opportunities to contextualise theory and practice through relevant patchwork activity and learning activities e) Equipping students with the transferable postgraduate skills (through learning activities and patch working) to embark on a journey of lifelong learning and continuous professional development f) Targeting the postgraduate programme /module intended learning outcomes and assessment patches against contemporary leadership qualities frameworks g) Providing students with opportunities to reflect in multi- professional groups that remain constant in terms of facilitator and supervisor h) Creating the learning opportunities for students to apply their learning to their own healthcare organisation

Using Leadership Development Programs to Improve Quality and Efficiency in Healthcare

With heightened emphasis on the imperatives to improve the quality and efficiency of healthcare delivered in U.S. hospitals and health systems, healthcare managers are challenged to consider innovative approaches to address these issues. Leadership development programs are increasingly common offerings within healthcare organizations, but linking such initiatives to quality and efficiency improvement programs remains rare. This article uses data from three qualitative studies of leadership development in healthcare to answer the question, "What opportunities might exist to use leadership development programs to improve quality and efficiency?" Interviews from 200 individuals were conducted between September 2003 and December 2007 with hospital and health system managers and executives, academic experts, consultants, individuals representing associations and vendors of leadership development programs, and program participants. Analyses of these data showed that leadership development programs provide four important opportunities to improve quality and efficiency in healthcare: (1) by increasing the caliber of the workforce, (2) by enhancing efficiency in the organization's education and development activities, (3) by reducing turnover and related expenses, and (4) by focusing organizational attention on specific strategic priorities. Several concrete examples of how to leverage leadership development in these ways are provided to help managers consider how to apply these research findings. Healthcare managers can use the results reported from these studies to extend the reach of current leadership development programs or to inform the design of new initiatives that focus specifically on quality and efficiency improvement. Although quantitative metrics are required to measure definitive improvements in quality and efficiency in healthcare, these qualitative data highlight opportunities through which leadership development initiatives can contribute to improvement efforts.

A systemic approach to developing frontline leaders in healthcare

The purpose of this case study is to extend the understanding of leadership development in healthcare by documenting the impact of a systemic approach to developing frontline leaders in a large Canadian healthcare organization. A total of 92 participants working in acute and community settings participated in an eight-day certificate program that combined classroom instruction, practical skill development, and applied projects. Program content was based on a learning needs assessment conducted with potential participants and their supervisors. Frontline leaders and their supervisors rated the program positively in terms of its impact on participants' confidence and willingness to lead, awareness of leadership opportunities, communication, problem solving, response to conflict, and the ability to support their teams through change. It was also found, however, that supervisors' ratings were generally lower than those of participants. Systemic approaches to leadership development offer healthcare the best chance of addressing the current leadership crisis. The challenge is finding innovative ways to demonstrate sustainable benefits in an industry that is struggling to address cost pressures. In the present study, personal and supervisor evaluations were used in conjunction with completion of applied change projects to demonstrate a tangible return on investment. Leadership can be learned and there is no better point of entry for development than those in frontline leadership positions. However, developing future leaders requires the commitment of an entire leadership community. Healthcare organizations that are experiencing leadership gaps must be prepared to make a long term investment if they want to achieve lasting healthcare reforms.

Leadership development in healthcare: a qualitative study

AbstractChallenges associated with leading a $1.7 trillion industry have created a need for strong leaders at all levels in healthcare organizations. However, despite growing support for the importance of leadership development practices across industries, little is known about leadership development in healthcare organizations. An extensive qualitative study comprised of 35 expert interviews and 55 organizational case studies included 160 in‐depth, semi‐structured interviews and explored this issue. Across interviews, several themes emerged around leadership development challenges that were particularly salient to healthcare organizations. Informants described how the relative newness of leadership development practices in a majority of healthcare organizations contributes to an overall perception of haphazard practices throughout the industry. In addition, respondents noted challenges associated with developing leaders who would be representative of the patient community served, and commented on the pressure to segregate different professional groups for leadership development. Framed by these challenges, I propose a conceptual model of commitment to leadership development in healthcare organizations as influenced by three factors—strategy, culture, and structure. These, in turn, influence program design decisions and can impact organizational effectiveness. In the context of inherently complex healthcare organizations where leaders must respond to multiple stakeholders and meet performance goals across multiple dimensions of effectiveness, addressing these reported challenges and considering the importance of organizational commitment to leadership development can help ensure that programs are effectively designed, delivered, and sustained. Copyright © 2006 John Wiley & Sons, Ltd.

Reflections on executive coaching

My view of coaching changed dramatically 6 years ago when I participated in 10 months of intensive study to become a certified executive coach. I decided on formal training to deepen my career-long focus on leadership development in health care. Since that experience, I have had the privilege of teaching coaching skills and delivering coaching services to many nurse leaders, their teams, and other health care professionals throughout the country.

Leadership development in health care: a word of caution

Leadership development is seen as central to the modernisation agenda of the NHS. It has been identified in key policy documents and a range of leadership development programmes have been developed to meet this need This paper reviews the evidence concerning leadership development in nursing. The conclusion reached is that leadership is only one element in the changes that need to occur in health care. Too much emphasis on leadership without an equal concern for transforming the organisations nurses and other health personnel work in may result in leadership being added to the list of transient management "fads" which have characterised health care in recent years.

Where are the healthcare leaders" the need for investment in leadership development.

Is there a crisis in healthcare leadership? In order to understand this question we must first look at what is meant by the term leadership. We prize and admire leadership skills, yet we have little understanding of how and why some persons are more effective leaders than others. This paper describes the changing concept of leadership in the context of both corporate and healthcare settings. The approaches taken in corporate leadership development programs are contrasted with the way in which leaders have been developed in healthcare. The authors assert that there are unique characteristics of health systems and organizations that warrant a tailored approach. A new model of developing healthcare leaders is proposed, one that could transform the educational process and improve outcomes. The authors call for a "back to basics" about how adults learn and outline an approach to leadership development in healthcare that includes principles of competency-based development, interdisciplinary and team learning and continuous assessment. Their conclusion is that leadership development is not done solely to improve the leadership skills of one individual but is an essential component of the development of the organization as a whole. Progressive health systems that invest in leadership development for the entire senior management team will have the more significant return on investment in terms of organizational effectiveness.