Leadership Intervention Research Articles

Embedding collective leadership to foster collaborative inter-professional working in the care of older people (ECLECTIC): Study protocol.

Background: The National Integrated Care Programme for Older People (NICPOP), formerly NCPOP aims to support older people to live well in their homes by developing primary and secondary care services for older people, especially those with complex needs. The programme develops integrated intermediate care which traverses both hospital and community settings through multidisciplinary and interagency teams. This team-based approach to the integration of health services is a novel innovation in Irish health service delivery and will require, over time, a shift in cultures of care to allow for the development of competencies for inter-professional collaboration across the care continuum. The ECLECTIC project will develop an implementation framework for achieving, maintaining and monitoring competencies for interprofessional collaboration among multi-disciplinary teams charged with delivering care for older people across the continuum from acute to community settings. Design: The ECLECTIC research design has been developed in collaboration with the NICPOP. In phase one of the project, a co-design team will collaborate to define and shape competencies for interprofessional collaboration. Phase two will involve the delivery of a collective leadership intervention over a 10-month period with multidisciplinary professionals working with older people across two geographical regions (Mullingar/Midlands and Beaumont/Dublin North). Each group will comprise of members of two multidisciplinary teams charged with coordinating and delivering care to older people across the continuum of acute to community care. Observations of collaborative inter-professional working will take place before, during, and after intervention. In phase three of the study, analysis of the interview and observation data will be presented to the co-design team in order to develop an implementation framework for future teams. Discussion: The co-design process will develop core competencies and performance indicators for collaborative interprofessional working. The resulting implementation framework will be implemented nationally as part of the NICPOP.

Effect of project-based experiential learning on the health service delivery indicators: a quasi-experiment study

BackgroundKenya’s new constitution passed in 2010 recognizes the right of quality care resulting in the devolution of health service delivery to the sub-national units called counties in 2013. However, the health system performance continues to be poor. The main identified challenge is poor health systems leadership. Evidence shows that addressing health system leadership challenges using different leadership intervention models has the potential to improve health outcomes. The purpose of this study is to report findings on the effect of project-based experiential learning on the health service delivery indicators addressed by 15 health management teams from 13 counties in Kenya, as compared to the non-trained managers.MethodsA quasi-experimental design without a random sample was used to evaluate the effectiveness of the leadership program. The health managers from the 13 Counties and 15 health facilities had previously undergone a 9-month leadership training, complimented with facility-based team coaching based on 15 priority institutional service improvement projects at the Strathmore University Business School. Pre-test and post-test data were collected in three-point periods (beginning, end of the training, and 24-to-60 months post-training). The control group comprised 14 other health institutions within the same counties.ResultsLeadership training and coaching built around priority institutional health service improvement projects in the intervention institutions showed: a) skilled birth attendance increased, on average, by 71%; b) full immunization of children, increased by 52%; c) utilization of in and out-patient services, which on average, increased by 90%; d) out-patient turn-around time reduced on average by 65% and; e) quality and customer satisfaction increased by 38.8% (in all the intervention facilities). These improvements were sustained for 60 months after the leadership training. In contrast, there were minimal improvements in service delivery indicators in the comparison institution over the same period of time. Ninety-three percent of the respondents attributed team-coaching built around priority institutional health service improvement projects as a key enabler to their success.ConclusionsThe study provides support that an intervention underpinned by challenge driven learning and team coaching can improve a range of health service delivery outcome variables.

Understanding the impact of a collective leadership intervention on team working and safety culture in healthcare teams: a realist evaluation protocol

There is accumulating evidence for the value of collective and shared approaches to leadership across sectors and settings. However, relatively little research has explored collective leadership in healthcare and thus, there is little understanding of what works for healthcare teams, why, how and to what extent. This study describes the approach that will be adopted to the realist evaluation of a collective leadership intervention with four heterogenous healthcare teams in four different settings. A realist evaluation will be conducted. Realist evaluation is a theory-based approach to evaluation. It enables the use of mixed-methods to explore the research question of interest. Development of an initial programme theory (IPT) constitutes the first phase of the approach. This IPT will be informed by interviews with members of teams identified as working collectively, an examination of extant literature using realist synthesis, and will be refined through consultation with an expert panel. A multiple case study design will be adopted to explore the impact of the intervention, including quantitative scales on teamworking, leadership and safety culture, realist interviews with key informants and observations of teams during intervention sessions. Analysis of data will be guided by the IPT to refine the theory and context-mechanism-outcome configurations. Findings from the cases will be compared to identify patterns or demi-regularities and to explore if the intervention operates differently in different contexts. This analysis and synthesis of findings across the teams will inform the development of a middle range theory that will not only add to our understanding of how collective leadership influences teamwork and patient safety, but also provide guidance for future collective leadership interventions. Favourable ethical opinion has been received from the University College Dublin Ethics Committee. Results will be disseminated via publication in peer-review journals, national and international conferences and to stakeholders/interest groups.

A qualitative evaluation of participants' experiences of using co-design to develop a collective leadership educational intervention for health-care teams.

IntroductionCo‐design involves stakeholders as design partners to ensure a better fit to user needs. Many benefits of involving stakeholders in design processes have been proposed; however, few studies have evaluated participants’ experience of co‐design in the development of educational interventions. As part of a larger study, health‐care professionals, researchers and patients co‐designed a collective leadership intervention for health‐care teams. This study evaluated their experiences of the co‐design process.MethodsSemi‐structured interviews were conducted with individuals (n = 10) who took part in the co‐design workshops. Interviews were audio‐recorded, transcribed verbatim and analysed thematically.ResultsFour key themes were identified from the data: (a) Managing expectations in an open‐ended process; (b) Establishing a positive team climate; (c) Focusing on frustrations—challenging but informative; and (d) Achieving a genuine co‐design partnership.ConclusionsThe development of a positive team climate is essential to the co‐design process. Organizers should focus on building strong working relationships from the beginning to enable open discussion. Organizers of co‐design should be conscious of establishing and maintaining a genuine partnership where participants are involved as equal partners and co‐creators. This can be done through the continuous use of feedback to allow participants to influence the workshop directions, and through limiting researcher domination. Lastly, co‐design can be daunting, but organizers can positively impact participants’ experience by acknowledging the emergent nature of the process in order to reduce participant apprehension, thereby limiting the barriers to participation.

Coaching-Based Leadership Intervention Program: A Controlled Trial Study.

In spite of the potential benefits that coaching-based leadership interventions can bring to organizations, basic questions remain about their impact on developing coaching skills and increasing psychological capital (PsyCap), work engagement and in- and extra-role performance. In a controlled trial study, 41 executives and middle managers (25 in the experimental group and 16 in the waiting-list control group) from an automotive sector company in Spain received pre-assessment feedback, a coaching-based leadership group workshop, and three individual executive coaching sessions over a period of 3 months. The intervention program used a strengths-based approach and the RE-GROW model, and it was conducted by executive coaching psychologists external to the organization. Participants (N = 41) and their supervisors (N = 41) and employees (N = 180) took part in a pre-post-follow up 360-degree assessment during the research period. Quantitative data were analyzed using Analyses of Variance (ANOVA) with a 2 × 2 design, paired-samples t-tests, and univariate analyses between groups. Results indicated that the intervention program was successful in increasing the participants’ coaching-based leadership skills, PsyCap, work engagement, and in- and extra-role performance. Qualitative measures were also applied, and results from individual responses provided additional support for the study hypotheses. Regarding practical implications, the results suggest that the Coaching-based Leadership Intervention Program can be valuable as an applied positive intervention to help leaders develop coaching skills and enhance well-being and optimal functioning in organizations.

SUPPORTING PROBLEM SOLVING IN THE LEADERSHIP CLASSROOM: Using the pVASE Framework for Bridging Theory to Practice

Several models of leadership outline theories on successful intervention such as “Observe, Interpret, and Intervene” within the Adaptive Leadership model (Heifetz, Grashow, & Linsky, 2009) or the “Five Practices” within Kouzes & Posner’s (2012) work. However, during stressful moments of leadership practice, many models for leadership intervention are difficult for students to implement. The authors suggest the pVASE framework as an additional component to other intervention models of leadership in order to better support cognitive load and leadership problem-solving during real-time, emergent leadership moments within and beyond the classroom.

From principal cognitive complexity to teacher intent to leave

PurposeThe purpose of this paper is to test an innovative model for exploring the direct and indirect relationships between principals’ cognitive complexity (CC), schools’ absorptive capacity (ACAP), a teacher’s affective commitment and a teacher’s intent to leave.Design/methodology/approachData were collected from a survey of 1,664 teachers at 107 Arab elementary schools, randomly selected from the database of the Israeli educational system. To test the proposed model, multilevel structural equation modeling was conducted.FindingsThe analysis confirmed that schools’ ACAP and a teacher’s affective commitment are prominent mediators between principals’ CC and a teacher’s intent to leave.Practical implicationsUnderstanding the factors that contribute to a teacher’s intent to leave could help school principals and policy makers retain effective teachers in today’s schools.Originality/valueThis study adds to the body of research directed at identifying school principals’ characteristics, as well as work-related factors, which may decrease a teacher’s intent to leave and are amenable to leadership intervention.

Concept Development of Political Competence for Nurses

The purpose of this study was to define and clarify the concept of political competence for nurses. A hybrid model method was used to investigate the dimensions, attributes, and definitions of the concept. In the theoretical stage of the study, literature on nursing, politics, and other discipline were reviewed. In the fieldwork stage, individual in-depth interviews and focus groups interviews were conducted with politically seasoned experts or activists who had an understanding of the concept of political competence for extensive descriptions in nursing and field of health care. The concept of political competence was represented in four dimensions as political knowledge, political efficacy, political interaction, and political activity. In the political knowledge dimension, there were three attributes, namely, political knowledge, political information and systematic analysis ability. The political efficacy dimension had three attributes of internal political efficacy, external political efficacy, and self-pride of nursing profession. The political interaction dimension had three attributes of organizations and community service, networking, and persuasive power. The political activity dimension had six attributes of political leadership, political expression, assertive behavior, political advocacy, political participation, and policy intervention. This concept development might provide a basic understanding of developing a measurement tool and for constructing a theory promoting nurses' political competence.

Evaluation of iLead, a generic implementation leadership intervention: mixed-method preintervention–postintervention design

ObjectivesThe present study aimed to evaluate the iLead intervention and to investigate whether or not transfer of training can be supported by contextualising the intervention (recruiting all managers from one...

Leadership Enactment for Information System Acceptance: an Explanation from a Sensemaking Perspective

Information system (IS) projects have been seen to be failing at an alarmingly high rate. The prevailing explanations of IS failure have had only a limited success. Thus, the time may be right to look at the reasons for IS failure through an alternative perspective. This paper proposes that IS success should be explained in terms of managerial leadership intervention, from the sensemaking perspective. Managers are responsible for workplace outcomes; thus, it may be appropriate to explain their role in IS success as well. The sensemaking perspective can explain IS success through holistic user involvement, a concept which critiques of existing explanations have stated to be a requirement for explaining IS failure. This paper proposes a framework combining the theory of enactment and leadership enactment to theorize managerial leadership intervention for “IS success.” The proposed explanation postulates that the managerial leader’s envisioning of the future transaction set influences the liberation of the follower and cast enactment, while liberating followers and cast enactment constitute manager sensegiving. The managerial leader’s sense-giving influences follower sensemaking. Follower sensemaking, under the influence of managerial sensegiving, will lead to followers’ IS acceptance, and that constitutes IS success at the individual level. Further, collective level IS acceptance constitutes IS adaption/success, and this will influence the leader’s sensegiving, for the next round of sensemaking.

Achieving leadership and success: A 28-year follow-up of college women leaders

Using a life span perspective focusing on establishing early leader identity, we examine the relationship of achievement orientations, career aspirations, personal and organizational factors, and family choices of 101 women college leaders surveyed in 1985 to ascendance into senior leadership roles and occupational success 28 years later. College-age orientations toward leadership and competition best predicted later-life outcomes. Higher college-age leadership orientation differentiated between women subsequently achieving senior leadership positions and those who did not. Networking and family support positively related to career outcomes; women with and without children had similar outcomes. Women who took leaves beyond a standard maternity absence reported similar career satisfaction to those continuously employed but were less likely to reach senior leadership positions and paid a significant economic penalty in salary. College-age achievement orientations, including leadership orientation, significantly predicted adult achievement orientations, suggesting the college years as an important period for leadership development and intervention.

The research method of conceptual frameworks. The case of Pygmalion effect: A leadership style or self-fulfilling prophecy?

Conceptual frameworks are conjectural/hypothetical research tools that are particularly important and widely used in the disciplined inquiry, including educational (technology) research. However, there is a lack of guidance on how to construct them. Hence, the objective of the current research was to provide a methodological perspective through a case study on how to develop such a framework for deductive research with a complex research subject. To this end, a five-step technique was constructed and implemented: text database, research panorama, authors’ network and thread, location, and definition. The case of Pygmalion effect was actual and significant as a recent meta-analysis found it to have an outstanding impact, among other leadership interventions, and relevant to educational research as it was first experimented in educational context. The conclusion found the five steps to be intertwined as they were built upon each other, carried the thread forward and opened it up deeper and closer to the research subject by each section. The errors and limitations involved uniqueness, availability, less is more, meaningfulness, approach, and space. Hence, the recommendations were defined as the regard for the complexity of the research subject and the approach to which the defined steps were delegated, the preliminary search on the most up-to-date academic papers on the subject, the only necessary number of collected sources and classes, the sense-making in implementing the steps, and the adaptation to longer essays, theses, or to prepare the foundation of research proposals.

Business Model Innovation: The Role of Leadership

We draw on the complementarity literature in economics and management research to dimensionalize business models innovations. Specifically, such innovation can be dimensionalized in terms of the depth and the breadth of the changes to the company’s business model that they imply. In turn, different business model innovations are associated with different management challenges and require different leadership interventions to become successful.

Human resource management training of supervisors for improving health and well-being of employees.

Many workers suffer from work-related stress and are at increased risk of work-related cardiovascular, musculoskeletal, or mental disorders. In the European Union the prevalence of work-related stress was estimated at about 22%. There is consensus that stress, absenteeism, and well-being of employees can be influenced by leadership behaviour. Existing reviews predominantly included cross-sectional and non-experimental studies, which have limited informative value in deducing causal relationships between leadership interventions and health outcomes. To assess the effect of four types of human resource management (HRM) training for supervisors on employees' psychomental stress, absenteeism, and well-being. We included training aimed at improving supervisor-employee interaction, either off-the-job or on-the-job training, and training aimed at improving supervisors' capability of designing the work environment, either off-the-job or on-the-job training. In May 2019 we searched CENTRAL, MEDLINE, four other databases, and most relevant trials registers (ICTRP, TroPHI, ClinicalTrials.gov). We did not impose any language restrictions on the searches. We included randomised controlled trials (RCT), cluster-randomised controlled trials (cRCT), and controlled before-after studies (CBA) with at least two intervention and control sites, which examined the effects of supervisor training on psychomental stress, absenteeism, and well-being of employees within natural settings of organisations by means of validated measures. At least two authors independently screened abstracts and full texts, extracted data and assessed the risk of bias of included studies. We analysed study data from intervention and control groups with respect to different comparisons, outcomes, follow-up time, study designs, and intervention types. We pooled study results by use of standardised mean differences (SMD) with 95% confidence intervals when possible. We assessed the quality of evidence for each outcome using the GRADE approach. We included 25 studies of which 4 are awaiting assessment. The 21 studies that could be analysed were 1 RCT, 14 cRCTs and 6 CBAs with a total of at least 3479 employees in intervention and control groups. We judged 12 studies to have an unclear risk of bias and the remaining nine studies to have a high risk of bias. Sixteen studies focused on improving supervisor-employee interaction, whereas five studies aimed at improving the design of working environments by means of supervisor training.Training versus no interventionWe found very low-quality evidence that supervisor training does not reduce employees' stress levels (6 studies) or absenteeism (1 study) when compared to no intervention, regardless of intervention type or follow-up. We found inconsistent, very low-quality evidence that supervisor training aimed at employee interaction may (2 studies) or may not (7 studies) improve employees' well-being when compared to no intervention. Effects from two studies were not estimable due to missing data.Training versus placeboWe found moderate-quality evidence (2 studies) that supervisor training off the job aimed at employee interaction does not reduce employees' stress levels more than a placebo training at mid-term follow-up. We found low-quality evidence in one study that supervisor training on the job aimed at employee interaction does not reduce employees' absenteeism more than placebo training at long-term follow-up. Effects from one study were not estimable due to insufficient data.Training versus other trainingOne study compared the effects of supervisor training off the job aimed at employee interaction on employees' stress levels to training off the job aimed at working conditions at long-term follow-up but due to insufficient data, effects were not estimable. Based on a small and heterogeneous sample of controlled intervention studies and in contrast to prevailing consensus that supervisor behaviour influences employees' health and well-being, we found inconsistent evidence that supervisor training may or may not improve employees' well-being when compared to no intervention. For all other types of interventions and outcomes, there was no evidence of a considerable effect. However, due to the very low- to moderate-quality of the evidence base, clear conclusions are currently unwarranted. Well-designed studies are needed to clarify effects of supervisor training on employees' stress, absenteeism, and well-being.

Metacognitive Ability Effect on Leadership Development

Leadership is the single most important element for the success of an organization. This explains why leadership skill is one of the most sought after skills. The only challenge is that effective leaders are few. Leadership development is meant to eradicate the shortage of leaders but there is a widespread outcry about the effectiveness of the current leadership interventions. Despite the huge expenditure in developing leaders, the outcomes are not comparable to the resources invested. Beyond the traditional elements (content, context, program length and delivery) of leadership development, the boundaries of research and practices have to be extended to the neglected elements of learning like metacognitive ability, hence this study examines the effect metacognitive ability on leadership development. The study was conducted among MBA students within private universities in Kenya. The sample size was 314 students, with a response rate of 92 percent. The results reveal that metacognitive ability significantly predicts leadership developments. The results imply that the higher the levels of metacognitive ability that leadership development participants have, the better they are at acquiring leadership skills.

When inspiration does not fit the bill: Charismatic leadership reduces performance in a team crisis for followers high in self-direction

AbstractWe extend charismatic leadership research by identifying conditions under which charismatic leadership reduces individual performance. Previous research found a positive impact of charismatic leadership, especially in crisis situations. However, we expect that followers with high self-determination reject charismatic leadership so that performance is reduced. In a laboratory experiment built as a brainstorming competition, 88 participants were randomly assigned to a condition with a team crisis or a control condition. Half of the participants received a charismatic leadership intervention after the crisis, which led to the ostentatious departure of a group member, while the other half was led laissez-faire. The results support our hypotheses. Although charismatic leadership was overall beneficial in a team crisis, our study provides experimental evidence of how charismatic leadership reduces the performance of certain team members in crises. Future research should investigate how leadership can best meet the specific needs of followers in different types of critical team situations.

Moving From Physician Burnout to Resilience.

We contend that work ambivalence is a key building block in fostering physician burnout and its sequalae, while engagement in meaningful work and receiving family support for that work enhances resilience. No singular approach to curbing burnout in OBGYN physicians has received empirical support. Clinical experience suggests that curbing physician burnout requires a combination of workplace redesigns, positive leadership behaviors, and resilience training that teaches practical applications from the fields of resilience, emotional intelligence, positive psychology, and relationship systems. This paper highlights organizational and leadership interventions that foster physician engagement, and describes how physicians can foster personal and family resilience.

Leading from all levels: building supply chain leadership capacity in Equateur Province, Democratic Republic of Congo

A well-functioning supply chain is a critical component of the health system to ensure high-quality medicines and health products are available when and where they are needed. However, because supply...

Feasibility and usefulness of a leadership intervention to implement evidence-based falls prevention practices in residential care in Canada

BackgroundLeadership is critical to supporting and facilitating the implementation of evidence-based practices in health care. Yet, little is known about how to develop leadership capacity for this purpose. The aims of this study were to explore the (1) feasibility of delivering a leadership intervention to promote implementation, (2) usefulness of the leadership intervention, and (3) participants’ engagement in leadership to implement evidence-based fall prevention practices in Canadian residential care.MethodsWe conducted a mixed-method before-and-after feasibility study on two units in a Canadian residential care facility. The leadership intervention was based on the Ottawa model of implementation leadership (O-MILe) and consisted of two workshops and two individualized coaching sessions over 3 months to develop leadership capacity for implementing evidence-based fall prevention practices. Participants (n = 10) included both formal (e.g., managers) and informal (e.g., nurses and care aids leaders). Outcome measures were parameters of feasibility (e.g., number of eligible candidates who attended the workshops and coaching sessions) and usefulness of the leadership intervention (e.g., ratings, suggested modifications). We conducted semi-structured interviews guided by the Implementation Leadership Scale (ILS), a validated measure of 12-item in four subcategories (proactive, supportive, knowledgeable, and perseverant), to explore the leadership behaviors that participants used to implement fall prevention practices. We repeated the ILS in a focus group meeting to understand the collective leadership behaviors used by the intervention team. Barriers and facilitators to leading implementation were also explored.ResultsDelivery of the leadership intervention was feasible. All participants (n = 10) attended the workshops and eight participated in at least one coaching session. Workshops and coaching were rated useful (≥ 3 on a 0–4 Likert scale where 4 = highly useful) by 71% and 86% of participants, respectively. Participants rated the O-MILe subcategories of supportive and perseverant leadership highest for individual leadership, whereas supportive and knowledgeable leadership were rated highest for team leadership.ConclusionsThe leadership intervention was feasible to deliver, deemed useful by participants, and fostered engagement in implementation leadership activities. Study findings highlight the complexity of developing implementation leadership and modifications required to optimize impact. Future trials are now required to test the effectiveness of the leadership intervention on developing leadership for implementing evidence-based practices.

Assessing the impact of context during the implementation of a co-designed, collective leadership intervention

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)