leadership in healthcare essay

Leadership in Healthcare

First Online: 26 January 2021

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Trude Furunes 3

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Effective leadership of healthcare professionals is critical for creating supportive work environments but also for strengthening quality of care. Based on current evidence, the aim of this chapter is to synthesize how different approaches to leadership are associated with healthy and unhealthy employee and patient outcomes. Further the chapter points to promising Healthy Healthcare approaches and discusses potential strengths and weaknesses. The increasing research interest in the links between leadership and quality of care is also outlined.

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The Need for Healthy Leadership in the Health Care Sector: Consideration of Specific Conditions for Implementation

Inclusive Leadership in Health Care Organizations: Promises and Prospects

Pathway to Professionalization of Health Leadership

Abraham, P. J. (2011). Developing nurse leaders: A program enhancing staff nurse leadership skills and professionalism. Nursing Administration Quarterly, 35 (4), 306–312. https://doi.org/10.1097/NAQ.0b013e31822ecc6e

Article PubMed Google Scholar

Aiken, A., Sloane, D. M., Bruyneel, L. V., den Heede, K., & Sermeus, W. (2013). Nurses’ reports of working conditions and hospital quality of care in 12 countries in Europe. International Journal of Nursing Studies, 50, 143–153. https://doi.org/10.1016/j.ijnurstu.2012.11.009

Akerjordet, K., Furunes, T., & Haver, A. (2018). Health-promoting leadership: An integrative review and future research agenda. Journal of Advanced Nursing, 74 (7), 1505–1516. https://doi.org/10.1111/jan.13567

Aktaş, M., & Sargut, A. S. (2011). How followers’ need for leadership differs according to cultural values?: A theoretical framework. TODAĐE’s Review of Public Administration, 5 (4), 195–217.

Google Scholar

Al-Sawai, A. (2013). Leadership of healthcare professionals: Where do we stand? Oman Medical Journal, 28 (4), 285–287. https://doi.org/10.5001/omj.2013.79

Article PubMed PubMed Central Google Scholar

Amanchukwu, R. N., Stanley, G. J., & Ololube, N. P. (2015). A review of leadership theories, principles and styles and their relevance to educational management. Management, 5 (1), 6–14. https://doi.org/10.5923/j.mm.20150501.02

Article Google Scholar

Antonovsky, A. (1996). The salutogenic model as a theory to guide health promotion. Health Promotion International, 11 (1), 11–18. https://doi.org/10.1093/heapro/11.1.11

Arnold, K. A. (2017). Transformational leadership and employee psychological well-being: A review and directions for future research. Journal of Occupational Health Psychology, 22 (3), 381–393.

Bass, B. M., & Stogdill, R. M. (1990). Bass & Stogdill’s handbook of leadership: Theory, research, and managerial applications . New York: The Free Press.

Clarke, S. (2013). Safety leadership: A meta-analytic review of transformational and transactional leadership styles as antecedents of safety behaviours. Journal of Occupational and Organizational Psychology, 86 (1), 22–49.

Colbjørnsen, T., & Knudsen, K. (2018). Underveis Menns og kvinners lederkarrierer [On the way. Men’s and women’s managerial careers in Norway]. Tidsskrift for samfunnsforskning, 59 (2), 131–156. https://doi.org/10.18261/ISSN.1504-291X-2018-02-01

Collini, S. A., Guidroz, A. M., & Perez, L. M. (2015). Turnover in healthcare: The mediating effects of employee engagement. Journal of Nursing Management, 23, 169–178.

Cowden, T., Cummings, G., & Profetto-Mcgrath, J. (2011). Leadership practices and staff nurses’ intent to stay: A systematic review. Journal of Nursing Management, 19 (4), 461–477. https://doi.org/10.1111/j.1365-2834.2011.01209.x

Dellve, L., Skagert, K., & Vilhelmsson, R. (2007). Leadership in workplace health promotion projects: 1- and 2-year effects on long-term work attendance. European Journal of Public Health, 17 (5), 471–476.

Deshpande, S., Sahni, S., Karemore, T., et al. (2018). Evaluation of relationship between leadership style and job satisfaction amongst healthcare professionals. MedEdPublish, 7 (1), 24. https://doi.org/10.15694/mep.2018.0000024.1

Dickson, M. W., Den Hartog, D. N, & Mitchelson, J. K. (2003). Research on leadership in a cross-cultural context: Making progress, and raising new questions. The leadership quarterly, 14 (6), 729–768. https://doi.org/10.1016/j.leaqua.2003.09.002

Eriksson, A. (2011). Health-promoting leadership. A study of the concepts and critical conditions for implementation and evaluation (PhD thesis). Gothenburg, Sweden.

Eriksson, A., Axelsson, R., & Axelsson, S. B. (2007). Development of health promoting leadership—Experiences of a training programme. Health Education, 110 (2), 109–124.

Eriksson, A., Orvik, A., Strandmark, M., Nordsteinen, A., & Torp, S. (2017). Management and leadership approaches to health promotion and sustainable workplaces: A scoping review. Societies, 7, 1–17. https://doi.org/10.3390/soc7020014

Franke, F., Felfe, J., & Pundt, A. (2014). The impact of health-oriented leadership on follower health: Development and test of a new instrument measuring health-promoting leadership. German Journal of Human Resource Management, 28 (1–2), 139–161.

Furunes, T., Grindland, I., & Akerjordet, K. (2020). Health-promoting leadership: Core tasks and leader behaviour . Submitted for publication.

Furunes, T., Kaltveit, A., & Akerjordet, K. (2018). Health-promoting leadership: A qualitative study from experienced nurses’ perspective. Journal of Clinical Nursing, 27 (23–24), 4290–4301. https://doi.org/10.1111/jocn.14621

Furunes, T., Mykletun, R. J., Einarsen, S., & Glasø, L. (2015). Do low-quality leader-member relationships matter for subordinates? Evidence from three samples on the validity of the Norwegian LMX scale. Nordic Journal of Working Life Studies, 5 (2).

Graen, G. B., & Uhl-Bien, M. (1995). Relationship-based approach to leadership: Development of leader-member exchange (LMX) theory of leadership over 25 years: Applying a multi-level multi-domain perspective. Leadership Quarterly, 6 (2), 219–247.

Grönlund, A., & Stenbock-Hult, B. (2014). Vårdpersonalens syn på hälsofrämjande ledarskap [Caring professionals’ attitudes to health-promoting leadership]. Nordic Journal of Nursing Research, 34 (1), 36.

Haaland, G. H., Olsen, E., & Mikkelsen, A. (2019). Making a career in hospitals: Determinants of registered nurses’ aspirations to become a manager. Journal of Advanced Nursing . https://doi.org/10.1111/jan.14002

Hannah, S. T., Avolio, B., Luthans, F., & Harms, P. D. (2008). Leadership efficacy: Review and future directions. The Leadership Quarterly . https://doi.org/10.1016/j.leaqua.2008.09.007

Hofmann, D. A., & Mark, B. (2006). An investigation of the relationship between safety climate and medication errors as well as other nurse and patient outcomes. Personnel Psychology, 59 (4), 847–869. https://doi.org/10.1111/j.1744-6570.2006.00056.x

Hofstede, G. (1980). Culture’s consequences: International differences in work-related values . Beverly Hills, CA: Sage.

Hofstede, G. (2001). Culture’s consequences: Comparing values, behaviors, institutions and organizations across nations . Thousand Oaks, CA: Sage.

Hofstede, G., & McCrae, R. R. (2004). Personality and culture revisited: Linking traits and dimensions of culture. Cross-Cultural Research, 38 (1), 52–88.

Hutchinson, M., & Jackson, D. (2013). Transformational leadership in nursing: Towards a more critical interpretation. Nursing Inquiry, 20 (1), 11–22.

Johannessen, T., Ree, E., Strømme, T., Aase, I., Bal, R., & Wiig, S. (2019). Designing and pilot testing of a leadership intervention to improve quality and safety in nursing homes and home care (the SAFE-LEAD intervention). British Medical Journal Open . https://doi.org/10.1136/bmjopen-2018-027790

Kelley, T. L. (1927). Interpretation of educational measurements . Yonkers-on-Hudson, NY: World Book Company.

Khan, I., & Nawaz, A. (2016). The leadership styles and the employees performance: A review. Gomal University Journal of Research [GUJR], 32 (2). ISSN: 1019-8180.

Khan, Z. A., Nawaz, A., & Khan, I. (2016). Leadership theories and styles: A literature review. Journal of Resources Development and Management, 6 .

Kirwan, M., Matthews, A., & Scott, P. A. (2013). The impact of the work environment of nurses on patient safety outcomes: A multi-level modelling approach. International Journal of Nursing Studies, 50 (2), 253–263. https://doi.org/10.1016/j.ijnurstu.2012.08.020

Kleinman, C. (2004). The relationship between managerial leadership behaviors and staff nurse retention. Hospital Topics, 82 (4), 2–9.

Landis, E. A., Hill, D., & Harvey, M. R. (2014). A synthesis of leadership theories and styles. Journal of Management Policy and Practice, 15 (2), 97–100.

Laschinger, H. K., & Finegan, J. (2005). Using empowerment to build trust and respect in the workplace: A strategy for addressing the nursing shortage. Nursing Economics, 23 (1), 6–13.

PubMed Google Scholar

Laschinger, H. K. S., Finegan, J., & Wilk, P. (2009). New graduate burnout: the impact of professional practice environment, workplace civility, and empowerment. Nursing Economic, 27 (6), 377–383.

Laschinger, H. K. S., & Smith, K. M. (2013). The influence of authentic leadership and empowerment on new-graduate nurses’ perceptions of interprofessional collaboration. JONA: The Journal of Nursing Administration, 43 (1), 24–29. https://doi.org/10.1097/NNA.0b013e3182786064

Laschinger, H. K., Wong, C. A., & Grau, A. L. (2012). The influence of authentic leadership on newly graduated nurses’ experiences of workplace bullying, burnout and retention outcomes: A cross-sectional study. International Journal of Nursing Studies, 49 (10), 1266–1276.

Lindström, B., & Eriksson, M. (2006). Contextualizing salutogenesis and Antonovsky in public health development. Health Promotion International, 21 (3), 238–244. https://doi.org/10.1093/heapro/daI016

Ma, C., Olds, D. M., & Dunton, N. E. (2015). Nurse work environment and quality of care by unit types: A cross-sectional study. International Journal of Nursing Studies, 52 (10), 1565–1572.

McElligott, D., Siemers, S., Thomas, L., & Kohn, N. (2009) Health promotion in nurses: Is there a healthy nurse in the house? Applied Nursing Research, 22 (3), 211–215. https://doi.org/10.1016/j.apnr.2007.07.005

McGuire, E., & Kennerly, S. M. (2006). Nurse managers as transformational and transactional leaders. Nursing Economics, 24 (4), 179–185.

Minkov, M. (2018). A revision of Hofstede’s model of national culture: Old evidence and new data from 56 countries. Cross Cultural & Strategic Management, 25 (2), 231–256. https://doi.org/10.1108/CCSM-03-2017-0033

Montano, D., Reeske, A., Franke, F., & Hüffmeier, J. (2017). Leadership, followers’ mental health and job performance in organizations: A comprehensive meta-analysis from an occupational health perspective. Journal of Organizational Behavior, 38, 327–350. https://doi.org/10.1002/job.2124

Nelson, P. A., Bradley, F., McBride, A., Hodgson, D., & Martindale, A.-M. (2019). Skill-mix change in general practice: A qualitative comparison of three ‘new’ non-medical roles in English primary care. British Journal of General Practice . https://doi.org/10.3399/bjgp19X704117

Nielsen, K., & Daniels, K. (2016). The relationship between transformational leadership and follower sickness absence: The role of presenteeism. Work & Stress, 30 (2), 193–208. https://doi.org/10.1080/02678373.2016.1170736

Nielsen, K., & Taris, T. W. (2019). Leading well: Challenges to researching leadership in occupational health psychology—And some ways forward. Work & Stress, 33 (2), 107–118. https://doi.org/10.1080/02678373.2019.1592263

Nilsson, K., Hertting, A., Petterson, I.-L., & Theorell, T. (2005). Pride and confidence at work: Potential predictors of occupational health in a hospital setting. BMC Public Health, 5 (1), 92.

Norwegian Ministry of Health and Care Services. (2012). Meld. St. 10 (2012–2013). God kvalitet—trygge tjenester. Kvalitet og pasientsikkerhet i helse‐ og omsorgstjenesten . [High quality- safe services. Quality and patient safety in health- and wellfare services], Oslo, Norway.

Norwegian Ministry of Health and Care Services. (2016). Forskrift om ledelse og kvalitetsforbedring i helse‐ og omsorgstjenesten [Regulation on leadership and quality improvement in the health and care services] . Oslo, Norway: Helse‐ og omsorgsdepartementet [Ministry of Health and Care Services]. Retrieved from https://lovdata.no/dokument/LTI/forskrift/2016-10-28-1250

NOU. (2015). Med åpne kort. Forebygging og oppfølging av alvorlige hendelser i helse og omsorgstjenestene [‘With open cards. Prevention and follow up of critical incidents in health and wellfare services.’ Norway’s public investigations on behalf of the Government] . Oslo, Norway: Helse og omsorgsdepartementet [Ministry of Health and Care Services].

Ollo-López, A., & Goñi-Legaz, S. (2017). Differences in work–family conflict: Which individual and national factors explain them? The International Journal of Human Resource Management, 28 (3), 499–525. https://doi.org/10.1080/09585192.2015.1118141

Read, E. A., & Laschinger, H. K. S. (2015). The influence of authentic leadership and empowerment on nurses’ relational social capital, mental health, and job satisfaction over the first year of practice. Journal of Advanced Nursing, 71 (7), 1611–1623. https://doi.org/10.1111/jan.12625

Ree, E., & Wiig, S. (2019a). Employees’ perceptions of patient safety culture in Norwegian nursing homes and home care services. BMC Health Services Research, 19, 607. https://doi.org/10.1186/s12913-019-4456-8

Ree, E., & Wiig, S. (2019b). Linking transformational leadership, patient safety culture and work engagement in home care services. Nursing Open .

Rudolph, C. W., Murphy, L. D., & Zacher, H. (2020). A systematic review and critique of research on “healthy leadership”. The Leadership Quarterly, 31 (1). https://doi.org/10.1016/j.leaqua.2019.101335

Salmela, S., Koskinen, C., & Eriksson, K. (2017). Nurse leaders as managers of ethically sustainable caring cultures. Journal of Advanced Nursing, 73 (4), 871–882. https://doi.org/10.1111/jan.13184

Sammer, C. E., Lykens, K., Singh, K. P., Mains, D. A., & Lackan, N. A. (2010). What is patient safety culture? A review of the literature. Journal of Nursing Scholarship, 42 (2), 156–165. https://doi.org/10.1111/j.1547-5069.2009.01330.x

Sfantou, D. F., Laliotis, A., Patelarou, A. E., Sifaki-Pistolla, D., Matalliotakis, M., & Patelarou, E. (2017). Importance of leadership style towards quality of care measures in healthcare settings: A systematic review. Healthcare, 5 (73). https://doi.org/10.3390/healthcare5040073

Shanafelt, T. D., et al. (2015). Impact of organizational leadership on physician burnout and satisfaction. Mayo Clinic Proceedings, 90 (4).

Skarholt, K., Blix, E. H., Sandsund, M., & Andersen, T. K. (2016). Health promoting leadership practices in four Norwegian industries. Health Promotion International, 31 (4), 936–945.

Smith, M., & Cusack, L. (2006). Commentary on Whitehead D (2004). Health-promoting hospitals: The role and function of nursing. Journal of Clinical Nursing, 15 (2), 230–232. https://doi.org/10.1111/j.1365-2702.2006.01263.x

Sorensen, R., Iedema, R., & Severinsson, E. (2008). Beyond profession: Nursing leadership in contemporary healthcare. Journal of Nursing Management, 16 (5), 535–544. https://doi.org/10.1111/j.1365-2834.2008.00896.x

Spehar, I., Frich, J. C., & Kjekshus, L. E. (2012). Clinicians’ experiences of becoming a clinical manager: A qualitative study. BMC Health Services Research, 12 (421). https://doi.org/10.1186/1472-6963-12-421

Tafvelin, S., von Nielsen, K., Thiele Schwarz, U., & Stenling, A. (2019). Leading well is a matter of resources: Leader vigour and peer support augments the relationship between transformational leadership and burnout. Work & Stress, 33 (2), 156–172. https://doi.org/10.1080/02678373.2018.1513961

Taylor, J. A., Dominici, F., Agnew, J., Gerwin, D., Morlock, L., & Miller, M. R. (2012). Do nurse and patient injuries share common antecedents? An analysis of associations with safety climate and working conditions. BMJ Quality & Safety, 21 (2), 101–111. https://doi.org/10.1136/bmjqs-2011-000082

Tewes, R., & Fischer, T. (2017). Editorial: Too busy to lead? Current challenges for German nurse leaders. Journal of Nursing Management, 25 (1), 1–3.

Titzer, J. L., Shirey, M. R., & Hauck, S. (2014). A nurse manager succession planning model with associated empirical outcomes. Journal of Nursing Administration, 44 (1), 37–46. https://doi.org/10.1097/NNA.0000000000000019

Trinchero, E., Farr-Wharton, B., & Brunetto, Y. (2019). A social exchange perspective for achieving safety culture in healthcare organizations. International Journal of Public Sector Management, 32 (2), 142–156. https://doi.org/10.1108/IJPSM-06-2017-0168

Twigg, D., & McCullough, K. (2014). Nurse retention: A review of strategies to create and enhance positive practice environments in clinical settings. International Journal of Nursing Studies, 51, 85–92.

von Thiele Schwarz, U., Hasson, H., & Tafvelin, S. (2016). Leadership training as an occupational health intervention: Improved safety and sustained productivity. Safety Science, 81, 35–45. https://doi.org/10.1016/j.ssci.2015.07.020

Wang, X., Liu, K. E., You, L.-M., Xiang, J.-G., Hu, H.-G., Zhang, L.-F., & Zhu, X.-W. (2014). The relationship between patient safety culture and adverse events: A questionnaire survey. International Journal of Nursing Studies, 51 (8), 1114–1122. https://doi.org/10.1016/j.ijnurstu.2013.12.007

Weddle, J. (2013). Levels of decision making in the workplace . Retrieved March 13, 2014, from https://www.jobdig.com/articles/1115/Levels_of_Decision_Making_in_the_Workplace.html

Whitehead, D. (2006). Workplace health promotion: The role and responsibilities of nursing managers. Journal of Nursing Management, 14, 59–68.

Wong, C. A., & Cummings, G. G. (2009). The influence of authentic leadership behaviors on trust and work outcomes of health care staff. Journal of Leadership Studies, 3, 6–23. https://doi.org/10.1002/jls.20104

Wong, C. A., & Laschinger, H. K. S. (2013). Authentic leadership, performance, and job satisfaction: The mediating role of empowerment. Journal of Advanced Nursing, 69 (4), 947–959. https://doi.org/10.1111/j.1365-2648.2012.06089.x

Yukl, G., & Gardner, W. L. (2019). Leadership in organizations (global edition, 9th ed.). Harlow, England: Pearson.

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Furunes, T. (2020). Leadership in Healthcare. In: Tevik Løvseth, L., de Lange, A.H. (eds) Integrating the Organization of Health Services, Worker Wellbeing and Quality of Care. Springer, Cham. https://doi.org/10.1007/978-3-030-59467-1_6

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Volume 20 Supplement 2

Peer Teacher Training in health professional education

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Published: 03 December 2020

Leadership in healthcare education

Christie van Diggele 1 , 2 ,
Annette Burgess 2 , 3 ,
Chris Roberts 2 , 3 &
Craig Mellis 4

BMC Medical Education volume 20 , Article number: 456 ( 2020 ) Cite this article

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Effective leadership is a complex and highly valued component of healthcare education, increasingly recognised as essential to the delivery of high standards of education, research and clinical practice. To meet the needs of healthcare in the twenty-first century, competent leaders will be increasingly important across all health professions, including allied health, nursing, pharmacy, dentistry, and medicine. Consequently, incorporation of leadership training and development should be part of all health professional curricula. A new type of leader is emerging: one who role models the balance between autonomy and accountability, emphasises teamwork, and focuses on improving patient outcomes. Healthcare education leaders are required to work effectively and collaboratively across discipline and organisational boundaries, where titles are not always linked to leadership roles. This paper briefly considers the current theories of leadership, and explores leadership skills and roles within the context of healthcare education.

Leadership has many interpretations, and has been likened to “ the abominable snowman whose footprints are everywhere but who is nowhere to be seen” [ 1 ]. It is an influential process, through which groups of people work towards the achievement of a common goal [ 2 ]. Leaders have the ability to shape and influence their followers’ values, attitudes and behaviours through a dyadic relationship. They are able to gain and enlist the support of others in order to achieve shared goals [ 3 , 4 ]. Effective leadership is a complex and highly valued component of healthcare education, increasingly recognised as essential to the delivery of high standards of education, research and clinical practice [ 3 ]. In order to achieve more effective outcomes, leadership and management skills are now an expectation and requirement in the healthcare education setting [ 5 ]. However, leaders within healthcare education should not rely on formal positions of authority, but instead, utilise their own appropriate leadership qualities irrespective of their level within the organisation [ 3 ]. A new type of leader is emerging: one who role models the balance between autonomy and accountability, emphasises teamwork, and focuses on improving patient outcomes [ 3 ]. This paper briefly considers the theories of leadership, and explores leadership skills and roles within the context of healthcare education.

Management versus leadership

Management and leadership are considered just as important as each other in accomplishing organisational goals. However, there are differences in the functions of the two roles. Management produces order and consistency, while leadership produces change and movement [ 2 ]. Management has the responsibility of organising all elements within the organisation, so that the leader’s vision and goals are successfully achieved. If poor management is in place, then goals cannot be achieved; and if poor leadership is in place, then there is no clear goal or vision to work towards. Leadership is seen as “setting direction, influencing others and managing change: with management concerned with the marshalling and organisation of resources and maintaining stability” [ 6 ]. These differences are summarised in Table 1 [ 6 , 7 ].

Transactional and transformational leadership

Leadership is a social construct, and there are many different leadership models [ 6 ]. Two broad types of leadership are identifiable: “transactional” and “transformational”. And their respective features are a useful way to think about the many types of leadership. Transactional and transformational leadership models are normally amalgamated within organisations to “empower others” (transformational) while holding individuals “accountable” (transactional) for their actions [ 7 , 8 , 9 ]. While it is clear that both transformational and transactional leadership paradigms are needed for an organisation to be effective, the optimal leader predominantly practices the transformational aspects of leadership, rather than transactional [ 10 ].

Transactional leadership

The transactional model is seen as an authoritative relationship that is transaction based, where exchanges occur between a leader and follower, once specific goals are identified or decided upon. Transactional leaders value order and structure, and have formal authority, with positions of responsibility within organisations. They achieve organisational goals through a rewards system and through positive reinforcement. A weakness of this model is the lack of innovation, as individuals are driven by predetermined outcomes, and there is lack of incentive and motivation to perform beyond what is expected [ 6 ].

Transformational leadership

Since the introduction of transformational leadership, the concept of leadership has undergone a major shift from representing an authoritative relationship (transactional), to a process of influencing individuals (transformational). Transformational leadership involves leadership through the transformation of individuals or ‘followers’, to work towards a common organisational goal [ 9 , 10 , 11 ]. This contemporary form of leadership is based on inspiring individuals, and forming teams to achieve goals. Transformational leaders define organisations through the articulation of a clear vision and clear values. The four “I”s of transformational leadership are outlined in Table 2 [ 9 ].

Team leadership

More recently, the focus has shifted towards “team leadership” , with distributed leadership becoming more prevalent within healthcare education, where different professions share influence [ 12 , 13 ]. Increasingly, leadership involves a collaborative role, with an emphasis on shared leadership and thoughtful allocation of responsibilities. Team-based organisations shift central control from the one leader, to the team. Teams are comprised of members who are interdependent, needing to coordinate their activities in order to accomplish their shared goals [ 14 , 15 ]. Personal autonomy, accountability, appropriate recognition, and clarity of roles, are all elements that contribute to optimal team performance. However, to ensure success, the organisational culture needs to support the involvement of individuals in these teams, and encourage leadership qualities [ 15 ]. Teams often fail when they exist in a traditional authority structure, where organisational culture is not supportive of collaborative work, and lower level decision making. Distributed leadership entails sharing of influence by team members, who step forward, or take a step back as needed. Leadership is provided by the person who meets the specific needs of the team at the time, hence providing faster responses to more complex issues in today’s organisations [ 15 , 16 , 17 ]. Effective leaders have an understanding of the conditions needed for teams to function well. For a team to achieve its potential, the operational roles of its members should be matched to their members’ abilities [ 18 ]. Belbin (1991) classified nine roles of team members that contribute to its process and function [ 19 ], outlined in Table 3 . Importantly, within team leadership, no single team role should be regarded as more important than another. Successful teams thrive on their diversity, drawing from the strengths of each member [ 13 ].

Effective leadership

Leaders need to have good time management and organisational skills, the ability to network professionally, display political nous and most importantly, they need to have strong communication skills [ 4 , 20 , 21 ]. Ready acceptance of feedback and self-awareness are important in development of leadership skills [ 20 , 21 ]. Behaviour, habits and biases can be deliberately corrected by utilising received feedback. Although there is not one set of qualities that apply to being an effective leader, certain competencies are valued and contribute to the leadership model in different ways [ 5 ]. Leadership competencies relevant for all health professional educators are outlined in Table 4 [ 3 ].

Language of leadership

Just as education and healthcare organisations have evolved, so too has the team leader. The role of the modern leader reinforces the tenets of stepping forward, collaborating and contributing. This role involves encouraging others by practising followership, and lending meaningful support to other leaders. As already stated, when it comes to leadership, excellent communication skills are a must. In order for successful communication to occur, both the sender and receiver must understand the message. This means that active listening is just as important as active talking [ 22 ]. Language used needs to be [ 22 ]:

Communicate with clarity of your purpose and the role of others

Stimulating

Deliver messages in a powerful, inspiring and dramatic way

Lead by example and walk the talk

Include active listening

Acknowledge what has been communicated, and use questioning skills

Show that you value others and their contributions

Challenges for leaders in healthcare education

There are a number of unique challenges in healthcare education. Healthcare education is delivered across professional disciplines, and notably, across organisational boundaries, involving universities, hospitals, and healthcare services. In turn, these organisations are bound by their own systems, structures, policies, cultures and values. At some point, most leaders in healthcare education need to make a decision about their leadership direction, and whether it lies predominantly in higher education or the clinical setting; and whether it lies in undergraduate education or postgraduate education. It can be difficult to merge roles between organisations, and McKimm (2004) has identified a number of issues and challenges specific to health education leaders, outlined in Table 5 [ 22 , 23 ]. Throughout a career, it may be necessary to maintain an awareness of available opportunities within organisations, and match these to the required experiences and capabilities [ 22 , 23 ] (see Fig. 1 ).

Reflection task

Development of leadership skills

Workforce data indicates that many experienced clinicians and healthcare educators will retire over the next ten years [ 24 , 25 ]. The need for effective succession planning and leadership training is well recognised [ 25 , 26 , 27 ], with a current shortage of emerging leaders moving into leadership roles. Effective leaders need to be nurtured and supported by the organisations in which they are educated, train and work [ 6 ]. As a learned skill, the topic of leadership is gathering momentum as a key curriculum area. Leadership development, assessment and feedback are necessary throughout the education and training of health professionals. Aspiring and current leaders can be identified, trained and assessed through formal leadership development programs, and through supportive organisational cultures. This requires embedding leadership training programs, opportunities for leadership practice, and promotion of professional networks within and beyond the organisation. The importance of mentorship within healthcare education is well recognised, offering a means to further enhance leadership and engagement within the workforce [ 28 ].

While many are assigned as leaders through their job title, it is important to identify, support and develop emerging leaders [ 2 ]. Leadership consists of a learnable set of practices and skills that can be developed by reading literature and attending leadership courses [ 29 ]. Additionally, investment in the social capital of organisations, fostering interprofessional learning and communication in the work setting, and collaboration across organisations assists in leadership development. Developing leadership skills is a life-long process [ 21 ]. Resources and opportunities should be considered to assist in the development of leadership skills. Some examples include:

Reading about leadership e.g. theories on leadership styles

Attending leadership training workshops

Participating in mentorship programs either as mentee or mentor

Joining small group seminars on leadership development

Accepting more responsibilities when required, or when opportunities arise.

Process for effective leadership

A title is not required to enable effective leadership. Leadership may occur in everyday work, and occurs in collaboration with other professionals within the education and healthcare systems. For example, leadership in teaching, administration, research, and/or excellence in clinical practice.

Leadership roles include the important concept of management of both personal and professional practice. Priorities need to be set and time managed to integrate work and personal life. Tools can be used to stay organised, and deliberately manage busy schedules. Effective delegation may be used to share the work of new projects:

Organisation to ensure an understanding of tasks, priorities and deadlines

Establish steps and a sequence to achieve the desired outcomes

List required resources, considering the competencies of individual team members, and match tasks appropriately (also consider skill development needs)

Communicate with team members, monitor progress in activities and provide guidance to team members.

Leadership competencies, and the incorporation of leadership development as part of curricula, are identified as important across all health professions, including allied health, nursing, pharmacy, dentistry, and medicine, in meeting the needs of healthcare in the twenty-first century [ 30 ]. With an increase in interprofessional teams and an emphasis on collaboration, more effective outcomes are achieved [ 5 ]. Healthcare education leaders are required to work effectively and collaboratively across discipline and organisational boundaries, where titles are not always linked to leadership roles, but may occur in everyday work. Good leadership also means knowing when, and how to support others in their endeavours. Provision of opportunities for leadership development is crucial in improving education sectors and health services, and effecting change. The future belongs to healthcare education leaders who demonstrate excellence in teamwork, clinical skills, patient centred care [ 3 ], and responsibly balance accountability with autonomy.

Take-home message

Availability of data and materials.

Not applicable.

Abbreviations

Human Resources

Bennis W, Nanus. Leaders: the strategies for taking charge. New York: Harper & Row; 1985.

Google Scholar

Northouse P. Leadership: theory and practice. 6th ed. London: Sage; 2011.

Oates K. The new clinical leader. J Paediatr Child Health. 2012;48(6):472–5.

Article Google Scholar

Laverack G. The pocket guide to health promotion. McGraw-Hill Education: Maidenhead; 2014.

Clarke J. In: Patole S, editor. Management and Leadership – A Guide for Clinical Professionals. Switzerland: Springer International Publishing; 2015.

Swanwick T, McKimm J. What is clinical leadership and why is it important. Clin Teach. 2011;8:22–6.

Byrman A. Leadership in organisations. In: Clegg SR, Harvey C, Nord WR, editors. Handbook of Organisational studies. London: Sage; 2006.

Westley F, Minztberg H. Visionary leadership and strategic management. Strateg Manag J. 1989;10:17–37.

Bass B, Avolio B. Improving Organisational effectiveness through transformational leadership. Thousand Oaks, CA: Sage; 1994.

Coulson A. The managerial work of Headteachers. Sheffield: Sheffield City Polytechnic; 1986.

Alimo-Metcalfe B, Alban-Metcalfe J. Leadership in public organisations. In: Storey, editor. Leadership in Organisations: current issues and key trends. London: Routledge; 2004.

McKimm J, Swanwick T. Educational leadership. Scotland, Edinburgh: Associate for the Study of Medical Education; 2007.

Levi D. Group dynamics for teams. Thousand Oaks, CA: Sage; 2011.

Burgess A, McGregor D, Mellis C. Applying guidelines in a systematic review of team-based learning in medical schools. Acad Med. 2014;89(4):678–88.

Pearce CL, Manz CC, Sims HP. Where do we go from here? Is shared leadership the key to team success? Orgnisational Dynamics. 2009;38(3):234–8.

Morgeson FP, DeRue DS, Karan EP. Leadership in teams: a functional approach to understanding leadership structures and processes. J Manag. 2010;36(1):5–39.

Kozlowski SWJ, Gully SM, Salas E, Cannon-Bowers JA. Team leadership and development: theory, principles, and guidelines for training leaders and teams. Dallas, TX: Third Symposium on Work Teams, University of North Texas; 1995.

Tuckman B. Developmental sequence in small groups. Psychol Bull. 1965;63:384–9.

Belbin RM. Management teams: why they succeed or fail. London: Heinmann; 1991.

Glover Takahshi S, Abbott C, Oswalk A, Frank JR. CanMEDS Teaching and Assessment Tools Guide. Royal College of Physicians and Surgeons of Canada; 2015.

Clawson J. Level three leadership: Getting below the surface (3rd ed.). Saddle River, N.J: Pearson Prentice Hall; 2006.

McKimm J. Developing tomorrow’s leaders in health and social care education. Case studies in leadership in medical and health care education. Special report 5. Newcastle-upon-Tyne: Higher Education Academy, Medicine Dentistry and Veterinary Medicine, 2004.

McKimm J, Swanwick T. Leadership development for clinicians: what are we trying to achieve? Clin Teach. 2011;8:181–5.

Norcini JJ, Banda SS. The global health workforce shortage: role of surgeons and other providers. Adv Surg. 2008;42:63–85.

Kim T. Succession planning in hospitals and association with organizational performance. Nurs Econ. 2012;30(1):14–20.

Swanwick T, McKimm J. Clinical leadership development requires system-wide interventions, not just courses. Clin Teach. 2012;9:89–93.

Matthews JH, Morley GL, Crossley E, Bhanderi S. Teaching leadership: the medical student society model. Clin Teach. 2017;15:2.

Burgess A, van Diggele C, Mellis C. Mentorship in the health professions: a review. Clin Teach. 2018;14:1–6.

Burgess A, Dornan T, Clarke A, Menezes A, Mellis C. Peer tutoring in a medical school: perceptions of tutors and tutees. BMC Medical Education. 2016;16:85.

Druker PF. What makes an effective executive? Harv Bus Rev. 2004;82(6):58–63 136.

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Published: 06 April 2022

An analysis of student essays on medical leadership and its educational implications in South Korea

I Re Lee 1 na1 ,
Hanna Jung 1 na1 ,
Yewon Lee 2 ,
Jae Il Shin 3 &
Shinki An 1 , 4

Scientific Reports volume 12 , Article number: 5788 ( 2022 ) Cite this article

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Health care
Medical research

To examine medical students’ perceptions of leadership and explore their implications for medical leadership education. We conducted a qualitative analysis of the essays submitted by students in the medical leadership course from 2015 to 2019. We categorised the essays by the characteristics of the selected model leaders (N = 563) and types of leadership (N = 605). A statistically significant proportion of students selected leaders who were of the same gender as themselves (P < 0.001), graduate track students chose leaders in science (P = 0.005), while; military track students chose leaders in the military (P < 0.001). Although the highest proportion of students chose politicians as their model leaders (22.7%), this number decreased over time (P < 0.001), and a wider range of occupational groups were represented between 2015 and 2019. Charismatic leadership was the most frequently selected (31.9%), and over time there was a statistically significant (P = 0.004) increase in the selection of transformational leadership. Students tended to choose individuals whose acts of leadership could be seen and applied. Medical leadership education should account for students’ changing perceptions and present a feasible leadership model, introducing specific examples to illustrate these leadership skills.

A systematic review and meta-analysis of the benefits of school-based, peer-led interventions for leaders

The influence of transformational leadership and teachers’ trust in principals on teachers’ working commitment

RETRACTED ARTICLE: Creating an optimal environment for distance learning in higher education: discovering leadership issues

Introduction.

Contemporary medical environments are facing complex issues, such as rising costs of treatment and inadequate access to and inconsistent quality of health care 1 . To address the ever-perplexing issues in medicine, there is an increasing need for effective leadership in health care 2 , 3 . In the past, medical care was primarily conducted by an individual physician. In addition, medical education heavily focused on the diagnosis and treatment of illnesses rather than working as a team to provide solutions that ensure higher quality medical care and safety 4 . However, in modern health care environments, a doctor’s role as a leader has become much more significant not only in physician–patient relationships but also in coordinating team-based tasks in the hospital and managing medical organizations 5 . For instance, as the socioeconomic environment becomes an essential component of a community’s health, physicians are expected to exert leadership in organisations that address public health issues 6 . Accordingly, physicians must be prepared to serve as leaders in health care.

Following the increasing need for leadership in healthcare, leadership skills are being included in physician evaluation criteria. The Association of American Medical Colleges has included leadership as the core requirement for medical students entering residency 7 . The Royal College of Physicians and Surgeons in Canada also includes the role of a leader as one of the main capability frameworks and has reflected this in their medical education 8 . Medical schools in the United States are proceeding with various leadership programs and incorporating leadership curricula into their undergraduate medical education 9 . Further, research shows that medical students now recognize the need for leadership education following the changing environment; 85% of medical students agreed that they should be taught leadership communication skills and teamwork abilities during their medical school years 10 . Korean medical educators also attempt to incorporate medical leadership education into medical education curriculum 11 . Yonsei University College of Medicine (YUCM) offers a leadership curriculum, Doctoring & Medical Humanities: Medical Leadership (DMH-ML), which is a core course covering 16 h (two hours per week for eight weeks) and offered to first-year medical students in the final quarter since 2014. The first 3 weeks feature lectures on basic concepts of leadership. The next three weeks are divided into three elective tracks, from which students choose lessons about leadership taken from: (1) the history of Severance Hospital in South Korea; (2) medical missions and international public health development; (3) business aspects of medicine. The final two weeks of the curriculum provide a summary of the topics covered. The written assignment of the course is a leadership model critique whereby students select a leader of their choice, summarize the leader’s accomplishments, and analyse the strengths and weaknesses found in that leadership. The course aims to facilitate medical students’ understanding of the nature of leadership from various leaders and help them recognize that their role as a leader is one of the fundamental responsibilities as physicians. All students who participated in the class submitted the written assignment, and the prompts for the written assignments were not changed between 2015 and 2019.

As no profiles have been reported on the leader models selected by medical students to date, in this study, we aimed to examine the medical students’ perceptions of leadership and provide directions for leadership education by analysing the characteristics and types of leadership models presented in leadership model critique essays.

We analysed a total of 585 essays submitted between 2015 and 2019. After excluding 35 essays that did not present a model, and double-counting 13 essays that presented two individuals, a total of 563 essays were chosen for this study (125 in 2015, 84 in 2016, 113 in 2017, 120 in 2018, and 121 in 2019). Of the 563 essays, 407 (72.3%) were written by male students and 156 (27.7%) by female students. Regarding admission types, 381 students (67.7%) were identified as undergraduate , 153 students (27.1%) as transfer/graduate, and 29 students (5.2%) as military (Table 1 ). We analysed the demographic characteristics of the model leaders selected in the essays (Table 2 ). A total of 563 individuals were selected as model leaders, 499 men (88.6%), 55 women (9.8%) and 9 other (1.6%), such as names of industries. The comparison of the gender ratio between the selected model leaders and the students showed that male students tended to select male leaders while female students were significantly more likely to select female leaders (P < 0.001) (Table 3 ). A total of 331 leaders (58.8%) belonged to the present generation category, and 232 (41.2%) belonged to the previous generation category. The occupational groups of the model leaders were as follows: politics (n = 128, 22.7%), business (n = 121, 21.5%), science (n = 117, 20.8%), sports (n = 45, 8.0%), social activism (n = 34, 6.0%), arts (n = 33, 5.9%), military (n = 32, 5.7%), religion (n = 18, 3.2%), education/law/exploration (n = 7, 1.2%), and other (n = 28, 5.0%). The comparative analysis of the selected model leaders’ occupational groups and the demographic characteristics of the students showed that a statistically significant proportion of female students (P = 0.0014) chose leaders in science, and a statistically significant proportion of male students chose leaders in sports (P = 0.003) (Table 4 ). Further, a statistically significant proportion of undergraduate students (P = 0.049) chose leaders in politics, transfer/graduate students (P = 0.005) chose leaders in science, and military students chose leaders in the military. When we analysed the changes in the occupational groups of the selected model leaders from 2015 to 2019, the decrease in the number of students who chose leaders in politics was statistically significant (P < 0.001), and the increase in the number of students who chose leaders in sports was statistically significant (P = 0.015) (Table 5 ).

Qualitative analysis

We analysed the leadership types of the selected models in 563 essays according to a qualitative framework developed from thematic and content analysis. Based on the analysis, a total of 605 essays were selected (seven essays with no specific category of leadership type were excluded, and 49 essays that presented two types of leadership were counted twice). Six types of leadership were identified in the following order: (1) Charismatic leadership (193; 31.9%) represented by the keywords “authority”, “ability”, “drive”, “firmness”, “determination”, and “strong execution”, (2) Servant leadership (150; 24.8%) by the keywords “sacrifice”, “serving”, “devotion”, “empathy”, “listening”, “respect”, “embrace”, “humility”, and “love”, (3) Collaborative leadership (117;19.3%) by the keywords “communication”, “team”, “cooperation”, “together”, “member”, “network”, and “horizontal”, (4) Transformative leadership (109;18.0%) by the keywords “change”, “innovation”, “creativity”, “novelty”, “pioneering”, “boldness”, “challenge”, and “creation”, (5) Self-leadership (23; 3.8%) by the key phrases “achievement of one’s goals and achievement of tasks”, and (6) Super-leadership (13;2.1%) by key phrases such as “education”, “teaching”, “human resources”, and “making good leaders” (Table 6 ). A comparison of the proportion of the leadership types in the selected models from 2015 to 2019 revealed that the selection of the transformative leadership type has significantly increased (P = 0.004) (Table 7 ).

The role models as leaders selected by students differed on the basis of the students’ gender and admission type. Although male leaders were dominant, the proportion of female leaders selected by female students was higher than that selected by male students. The selection of the contemporary leaders of the present generation was more common than those leaders of the previous generation. A high proportion of the transfer/graduate students, many with bachelor’s degrees in the sciences, chose leaders who worked in science fields, and a high proportion of the military students chose leaders related to the military. These findings imply that students tend to admire models as leaders among the contemporary figures whose acts of leadership can be observed in real-time as well as models with whom they share more in common, such as gender, academic backgrounds, or occupations, likely because the actions and achievements of such leaders are more understandable and more applicable to their own lives. The educational implication of these findings is the importance of role modelling as well as the influence of the informal, hidden curriculum 12 , 13 , 14 , 15 , 16 , 17 . Just as clinical knowledge and skills can be transmitted formally and informally in clinical situations, leadership in health care can also be transmitted through formal and informal means 18 . Although there are individuals officially designated as leaders in healthcare settings, the presence of individuals influencing other persons in informal ways should be acknowledged. Since individuals can be role models regardless of whether they are officially designated as leaders or whether they have an educational intention, medical educators need to understand the role of informal leadership training 19 . Although many medical schools strive to implement leadership education using various methods 20 , they overlook how informal leadership such as students’ experiences in leading and organizational culture play an important role in developing students' leadership skills 21 . Therefore, medical schools need to develop a faculty development program based on the importance of role modelling, recognizing the fact that role modelling can have both positive and negative effects on medical students 22 . A training program to enhance the leadership abilities of the instructors for better transfer of knowledge to the new generation of students is necessary 23 .

The occupations of leaders chosen by the students changed over the course of the 5 years analysed. At first, many students chose politicians as their model leaders, but the percentage of politicians selected decreased over time, and a wider variety of occupations were represented. This change implies that the students’ perceptions of leadership are shifting and that leaders recognized by society are emerging in various occupational fields. Therefore, medical leadership education and research need to incorporate the interdisciplinary and transdisciplinary approaches to meet continuous social changes 22 . Building a leadership curriculum based on a balanced interdisciplinary approach through the theoretical background in various fields, introducing specific examples of leadership in various areas, and having students reflect on case studies will help students develop various leadership-related competencies 24 .

The types of leadership delineated by the qualitative analysis of the essays showed that the most common type of leadership among the six types was the charismatic type, which is the most traditional leadership type. The traditional figure of a physician with ability, a firm and determined mind, the power to execute, and authority remains the most prominent model as a leader for medical students. As the charismatic leadership type tends to parallel the traditional heroic medical practice led by one-person, medical educators need to emphasize the possible limitations of charismatic leadership in the current health care context, which requires a substantially more team-based approach. As the ratio of students choosing diversified leadership types has gradually increased, it can be considered that the students’ primary concept of medical leadership is changing according to changes in medical society.

The second and third types of leadership stated by students were the servant and collaborative leadership types, which were increasingly recognized as essential in the healthcare field. Earlier, the servant leadership, with its image of dedication to treating patients and contributing to the community 18 , was exemplified as the prominent model for healthcare 25 . The function of collaborative leadership has been increasingly emphasized in the changing medical environment where facilitating successful collaboration within teams and flexibly adapting to changes is becoming more important 26 . Moreover, effective team management and cooperation in health care are known to be closely related to improved outcomes in the treatment of patients 27 . The prevalence of the selection of these types of leadership by the students may reflect their correct understanding of the modern health care approach.

The proportion of transformational leadership increased significantly over time. Transformational leadership is a more suitable leadership type for a constantly changing environment such as that of health care where quick adaptation and decision-making are required 25 , 28 . Recently, The fourth industrial revolution is characterised by developments such as precision medicine, AI-based medical treatment, and telemedicine, and related discussions are underway in medical education. This increase in the proportion of transformational leadership indicates that students recognize the importance of leadership that is sensitive to change and can respond quickly and with sound judgment.

When we compared the selected leaders' occupations and leadership types, it was confirmed that the students presented various leadership types in the same occupational group (Supplementary Table S1 ). This finding implied that there is no stereotyped leadership for a specific occupation but that different types of leadership can be manifested depending on the situations and followers in regard to which the leadership is exercised 28 . In other words, physicians as a leader needs to lead organizations, teams, or themselves using various leadership types rather than pursuing one fixed style. Moreover, mature leaders are more proficient in using different types of leadership, and different leadership levels require different skills 29 . These findings suggest that leadership in health care can be learned through case studies of other occupational groups and the curriculum should include various leadership types rather than emphasizing one style.

Limitations

This study has the following limitations. First, the sample of this study is limited to the medical students in South Korea. Considering that effective leadership behaviors are being accepted to be culture-specific, it is difficult to generalize the qualitative analysis conducted on essays collected from a single medical school 30 . Second, although the percentage of students in each admission type corresponds with the average percentages of undergraduate track (70%) and graduate track (30%) admissions in South Korea, the fact that students in the graduate track would have been in their first year of medical school at the time of essay submission is a limitation. Third, it is possible that the essays submitted by the students were influenced by the lectures held in class. In selecting a model leader, the student may have considered leaders, leadership theories, and types of leadership presented by the instructor. Nevertheless, this study is meaningful because it explores the experiences of the medical students over the past five years, analyses leadership recognized by the students, and examines the changes in their perceptions over time.

Conclusions

Whether leadership is innate or acquired remains a matter of debate, but many experts argue that education and experience can teach the skills and behaviours necessary for developing the ability to lead others 23 , 31 . Therefore, a well-designed leadership curriculum that presents feasible leadership models is needed because students imitate familiar and applicable leaders. Further, in the rapidly changing medical environment, leadership roles are diversifying, and students' perceptions of leadership are changing. Therefore, when medical schools encourage the various approaches to leadership required in modern society, students can foster broad skills in medical leadership.

We reviewed all essays submitted in the first-year core course, titled Doctoring & Medical Humanities: Medical Leadership , from 2015 to 2019, to investigate changes in the perceptions of leadership among medical students. The prompt of the essay required students enrolled in the DMH-ML course to select a model leader, summarize that leader’s achievements, and reflect on the strengths and weaknesses of leadership found. We collected a total of 585 essays and performed quantitative and qualitative analysis (Fig. 1 ).

Schematic diagram of quantitative and qualitative analyses on the essays.

Student demographics and data collection

To perform quantitative analysis, we classified the characteristics of the students as well as those of the leaders they selected. We collected demographic information such as gender and type of admission of the medical students at YUCM who submitted the essays and classified them into three groups: (1) undergraduate track, (2) graduate track, and (3) military track. The undergraduate track is a conventional 6-year program in South Korea and is for students who have immediately graduated from high school. The first two years are equivalent to the pre-med years of an undergraduate degree, and the remaining 4 years are equivalent to the medical years (2 years for preclinical and 2 years for clerkship) of medical schools elsewhere. Thus, by the time of their essay submission, students in the undergraduate track would be in their third year having enrolled at medical school. The graduate track is a four-year program for those with an undergraduate degree. Thus, students transfer straight into the medical years, skipping the pre-med years of medical school. This track is typical of admission to medical school in the United States and Canada. In Australia, England, Ireland, Singapore and South Korea, the undergraduate track and the graduate track are mixed (Fig. 2 ) 32 . Finally, the military track is for the military students with an undergraduate degree commissioned by the army.

Schematic diagram of medical educational system in South Korea.

Quantitative analysis

We also classified the gender, generation, and occupational groups of the selected model leaders. We classified the selected leaders as (1) the previous generation if they had passed away before 2000 and (2) the present generation if they had passed away after 2000 or were still living at the time of the study. The occupational groups of the model leaders were classified as politics, business, science, sports, social activism, arts, military, religion, and education/law/exploration. In addition, when students selected an individual with whom they had a personal relationship such as a parent or a character in a book or movie, we classified them as “other”.

After classifying the characteristics of students and leaders, we analysed the characteristics of selected leaders according to the characteristics of students and observed how the students' perceptions of leadership changed over time from 2015 to 2019.

We used a combination of thematic and contents analyses for our qualitative analysis 33 , 34 . Two authors independently analysed each essay. We omitted essays that did not establish a model leader. For essays with two selected leaders, we analysed them as two separate model leaders. The strengths of each selected model leader portrayed by students were summarized. Disagreements were resolved through group discussion and consensus.

In the first step, we extracted the main contents that delineated the selected leaders' performance, strengths, and weaknesses from the essays for thematic analysis. We then, classified these extracted contents by thematic keywords with similar meanings.

Second, we developed a framework for content analysis through a review of previously published literature.

Finally, the result of the thematic analysis was combined with the result of the content analysis. The framework was formed based on six types of model leadership by matching the 10 leadership types (adaptive, authentic, charismatic, collaborative, servant, self, situational, super, transformational, and transactional) selected through the analysis of previous studies with the leadership types described by the students 27 , 35 , 36 , 37 , 38 , 39 , 40 , 41 : charismatic, servant, collaborative, transformational, super-, and self-leadership.

The six leadership model types are defined as follows. Charismatic leadership centres on the leader’s strong charisma and resolute style that allows members to follow the decisions they make 35 . Servant leadership is based on respect for humans, whereby the leader volunteers to serve each member to help develop their full potential 36 . Collaborative leadership is exerted by leaders who establish a horizontal and trusting relationship with members that enables the group to complete the given tasks through cooperation 27 . Transformational leadership recognises the need for a change within the organisation and opportunities for a leader to envision and enact change 37 . Self-leadership is a force that drives leaders themselves to accomplish their goals, whereas super-leadership nurtures other individuals(followers) and empowers them to lead themselves 38 .

Statistical analysis

We used descriptive statistics to analyse the characteristics of the study subjects. We indicated frequencies and percentages for categorical variables, and a chi-square test and linear-by-linear association were performed to analyse the correlation between two categorical variables. Fisher's exact test was performed if the expected frequency was five or less in the chi-square test. All statistical analyses were performed using IBM SPSS ver. 25.0 (IBM Corp., Armonk, NY, USA), and the statistical significance level was set to p = 0.05.

Ethical considerations

The Yonsei University Health System Institutional Review Board (IRB No: Y-2020-0206) approved the study. We used anonymised materials collected in commonly accepted educational settings according to Article 2 of the Bioethics and Safety Act Enforcement Rule in South Korea. The informed consent requirement was exempt from institutional review board approval. All procedures were conducted in accordance with the relevant guidelines and regulations.

Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Gupta, A. & Sao, D. The constitutionality of current legal barriers to telemedicine in the United States: Analysis and future directions of its relationship to national and international health care reform. Health Matrix Clevel 21 , 385–442 (2011).

ADS PubMed Google Scholar

Feeley, D. Leading improvement in population health: Focusing on population health requires a new leadership approach. Healthc. Exec. 29 (82), 84–85 (2014).

Google Scholar

Gabow, P., Halvorson, G. & Kaplan, G. Marshaling leadership for high-value health care: An Institute of Medicine discussion paper. JAMA 308 , 239–240. https://doi.org/10.1001/jama.2012.7081 (2012).

Article CAS PubMed Google Scholar

Varkey, P., Peloquin, J., Reed, D., Lindor, K. & Harris, I. Leadership curriculum in undergraduate medical education: A study of student and faculty perspectives. Med. Teach. 31 , 244–250. https://doi.org/10.1080/01421590802144278 (2009).

Article PubMed Google Scholar

Mann, K., Gordon, J. & MacLeod, A. Reflection and reflective practice in health professions education: A systematic review. Adv. Health Sci. Educ. Theory Pract. 14 , 595–621. https://doi.org/10.1007/s10459-007-9090-2 (2009).

Gianfredi, V. et al. Leadership in public health: Opportunities for young generations within scientific associations and the experience of the “Academy of Young Leaders”. Front. Public Health 7 , 378. https://doi.org/10.3389/fpubh.2019.00378 (2019).

Article PubMed PubMed Central Google Scholar

Association of American Medical Colleges. Core Entrustable Professional Activities (EPAs) for Entering Residency . https://www.aamc.org/media/20211/download (2021).

Royal College of Physicians and Surgeons of Canada. CanMEDS: Better Standards, Better Physicians, Better Care . https://www.royalcollege.ca/rcsite/canmeds/canmeds-framework-e (2021).

Larson, D. B., Chandler, M. & Forman, H. P. MD/MBA programs in the United States: Evidence of a change in health care leadership. Acad. Med. 78 , 335–341. https://doi.org/10.1097/00001888-200303000-00021 (2003).

Abbas, M. R., Quince, T. A., Wood, D. F. & Benson, J. A. Attitudes of medical students to medical leadership and management: A systematic review to inform curriculum development. BMC Med. Educ. 11 , 93. https://doi.org/10.1186/1472-6920-11-93 (2011).

Lee, S. S. et al. Development and evaluation of the “doctor and leadership” curriculum. Korean J. Med. Educ. 19 , 279–286. https://doi.org/10.3946/kjme.2007.19.4.279 (2007).

Article Google Scholar

Brown, M. E. L., Coker, O., Heybourne, A. & Finn, G. M. Exploring the Hidden Curriculum’s Impact on Medical Students: Professionalism, Identity Formation and the Need for Transparency. Medical Science Educator 30 , 1107–1121. https://doi.org/10.1007/s40670-020-01021-z (2020).

Hafferty, F. W. Beyond curriculum reform: Confronting medicine’s hidden curriculum. Acad. Med. 73 , 403–407. https://doi.org/10.1097/00001888-199804000-00013 (1998).

Harden, R. M. & Crosby, J. AMEE Guide No 20: The good teacher is more than a lecturer—The twelve roles of the teacher. Medl. Teach. 22 , 334–347. https://doi.org/10.1080/014215900409429 (2000).

Martimianakis, M. A. et al. Humanism, the hidden curriculum, and educational reform: A scoping review and thematic analysis. Acad. Med. 90 , S5-s13. https://doi.org/10.1097/acm.0000000000000894 (2015).

Doja, A. et al. The hidden and informal curriculum across the continuum of training: A cross-sectional qualitative study. Med. Teach. 38 , 410–418. https://doi.org/10.3109/0142159x.2015.1073241 (2016).

Joynt, G. M., Wong, W. T., Ling, L. & Lee, A. Medical students and professionalism—Do the hidden curriculum and current role models fail our future doctors?. Med. Teach. 40 , 395–399. https://doi.org/10.1080/0142159x.2017.1408897 (2018).

Skochelak, S. E. Health Systems Science 2nd Edition (Elsevier Health Sciences, 2020).

Berghout, M. A., Fabbricotti, I. N., Buljac-Samardžić, M. & Hilders, C. Medical leaders or masters?-A systematic review of medical leadership in hospital settings. PLoS ONE 12 , e0184522. https://doi.org/10.1371/journal.pone.0184522 (2017).

Article CAS PubMed PubMed Central Google Scholar

Neeley, S. M., Clyne, B. & Resnick-Ault, D. The state of leadership education in US medical schools: Results of a national survey. Med. Educ. Online 22 , 1301697. https://doi.org/10.1080/10872981.2017.1301697 (2017).

Arnold, L., Cuddy, P. G., Hathaway, S. B., Quaintance, J. L. & Kanter, S. L. Medical school factors that prepare students to become leaders in medicine. Acad. Med. 93 , 274–282. https://doi.org/10.1097/acm.0000000000001937 (2018).

Mohammadi, E., Mirzazadeh, A., Shahsavari, H. & Sohrabpour, A. A. Clinical teachers’ perceptions of role modeling: A qualitative study. BMC Med. Educ. 21 , 261. https://doi.org/10.1186/s12909-021-02648-1 (2021).

Cavagnaro, E. & van der Zande, I. S. Reflecting on responsible leadership in the context of higher education. J. Leadership Educ. https://doi.org/10.12806/V20/I3/T1 (2021).

Watt, W. M. Effective leadership education: Developing a core curriculum for leadership studies. J. Leadership Educ. 2 , 13–26. https://doi.org/10.12806/V2/I1/RF1 (2003).

Allen, G. P. et al. The role of servant leadership and transformational leadership in academic pharmacy. Am. J. Pharm. Educ. 80 , 113. https://doi.org/10.5688/ajpe807113 (2016).

Browning, H. W., Torain, D. J. & Patterson, T. E. Collaborative healthcare leadership: A six-part model for adapting and thriving during a time of transformative change. in Center for Creative Leadership White Papers (2011).

VanVactor, J. D. Collaborative leadership model in the management of health care. J. Bus. Res. 65 , 555–561. https://doi.org/10.1016/j.jbusres.2011.02.021 (2012).

Lo, D., McKimm, J. & Till, A. Transformational leadership: Is this still relevant to clinical leaders?. Br. J. Hosp. Med. (Lond.) 79 , 344–347. https://doi.org/10.12968/hmed.2018.79.6.344 (2018).

Saxena, A., Desanghere, L., Stobart, K. & Walker, K. Goleman’s leadership styles at different hierarchical levels in medical education. BMC Med. Educ. 17 , 169. https://doi.org/10.1186/s12909-017-0995-z (2017).

Wang, H., Waldman, D. A. & Zhang, H. Strategic leadership across cultures: Current findings and future research directions. J. World Bus. 47 , 571–580 (2012).

Chen, T. Y. Medical leadership: An important and required competency for medical students. Ci Ji Yi Xue Za Zhi 30 , 66–70. https://doi.org/10.4103/tcmj.tcmj_26_18 (2018).

Nara, N., Suzuki, T. & Tohda, S. The current medical education system in the world. J. Med. Dent. Sci. 58 , 79–83 (2011).

PubMed Google Scholar

Hsieh, H. F. & Shannon, S. E. Three approaches to qualitative content analysis. Qual. Health Res. 15 , 1277–1288. https://doi.org/10.1177/1049732305276687 (2005).

Michelle, E. K. & Lara, V. Thematic analysis of qualitative data: AMEE Guide No. 131. Med. Teach. 42 , 846–854. https://doi.org/10.1080/0142159X.2020.1755030 (2020).

Nikoloski, K. Charismatic leadership and power: Using the power of charisma for better leadership in the enterprises. J. Process Manag. New Technol. 3 , 18–26 (2015).

Spears, L. C. Character and servant leadership: Ten characteristics of effective, caring leaders. J. Virtues Leadership 1 , 25–30 (2010).

Murphy, L. Transformational leadership: A cascading chain reaction. J. Nurs. Manag. 13 , 128–136. https://doi.org/10.1111/j.1365-2934.2005.00458.x (2005).

Manz, C. C. & Sims, H. P. The New Superleadership: Leading Others to Lead Themselves (Berrett-Koehler Publishers, 2001).

Peter, G. N. Leadership: Theory and Practice (Sage Publications, 2019).

Thompson, G. & Glasø, L. Situational leadership theory: A test from a leader-follower congruence approach. Leadersh. Org. Dev. J. 39 , 574–591. https://doi.org/10.1108/LODJ-01-2018-0050 (2018).

Antonakis, J. & House, R. J. Instrumental leadership: Measurement and extension of transformational-transactional leadership theory. Leadersh. Q. 25 , 746–771. https://doi.org/10.1016/j.leaqua.2014.04.005 (2014).

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These authors contributed equally: I Re Lee and Hanna Jung.

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Department of Medical Education, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, CPO Box 8044, Seoul, 03722, Republic of Korea

I Re Lee, Hanna Jung & Shinki An

Eulji University School of Medicine, Daejeon, Republic of Korea

Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea

Jae Il Shin

Yonsei Institute for Global Health, Yonsei University Health System, Seoul, Republic of Korea

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S.A. and J.I.S. designed the study. I.R.L. and H.J. collected the data, and I.R.L., H.J., and S.A. conducted the analysis. I.R.L., H.J., Y.L., S.A. and J.I.S. wrote the first draft of the manuscript. All authors had full access to all of the study data. All authors reviewed, wrote, and approved the final version.

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Lee, I.R., Jung, H., Lee, Y. et al. An analysis of student essays on medical leadership and its educational implications in South Korea. Sci Rep 12 , 5788 (2022). https://doi.org/10.1038/s41598-022-09617-8

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Please note you do not have access to teaching notes, is leadership a useful concept in healthcare an essay.

Leadership in Health Services

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Article publication date: 1 July 2014

The purpose of this paper is to stimulate thinking about the relative importance of leaders and leadership or teamworking and teamsmanship in promoting progressive improvements in health care provision. The author argues that much more emphasis should be placed on the purpose and functioning of health care teams than on developing traditional heroic leaders. The attributes that the author has come to see as important in leaders within healthcare teams have been described. Some of these are far from glamorous and include good organisation, hard work and self-discipline.

Design/methodology/approach

Over the past five years, the author has read widely on leadership, as well as on “lean” philosophies of working. During that time the author has tried to introduce changes to improve the working practices of their inpatient care team. The essay was written on the basis of reflection and discussion. This is a free-form article, in the old style of essay writing. This format is ideal for stimulating high-level thinking in readers’ minds.

There should be far more emphasis on training in and development of teams, team-working and teamsmanship than on individual leaders and leadership skills in health care.

Originality/value

The author hopes this essay is original, stimulating thinking, expressed in a readable format, and that it will prove valuable to those responsible for making improvements in health care provision at both the macro-and microlevels.

Quality improvement
Teamsmanship
Teamworking
Health care culture

Caldwell, G. (2014), "Is leadership a useful concept in healthcare? An essay", Leadership in Health Services , Vol. 27 No. 3, pp. 185-192. https://doi.org/10.1108/LHS-03-2014-0017

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Published: 24 April 2019

Priorities and challenges for health leadership and workforce management globally: a rapid review

Carah Alyssa Figueroa ORCID: orcid.org/0000-0002-8825-7796 1 ,
Reema Harrison 1 ,
Ashfaq Chauhan 1 &
Lois Meyer 1

BMC Health Services Research volume 19 , Article number: 239 ( 2019 ) Cite this article

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Health systems are complex and continually changing across a variety of contexts and health service levels. The capacities needed by health managers and leaders to respond to current and emerging issues are not yet well understood. Studies to date have been country-specific and have not integrated different international and multi-level insights. This review examines the current and emerging challenges for health leadership and workforce management in diverse contexts and health systems at three structural levels, from the overarching macro (international, national) context to the meso context of organisations through to the micro context of individual healthcare managers.

A rapid review of evidence was undertaken using a systematic search of a selected segment of the diverse literature related to health leadership and management. A range of text words, synonyms and subject headings were developed for the major concepts of global health, health service management and health leadership. An explorative review of three electronic databases (MEDLINE®, Pubmed and Scopus) was undertaken to identify the key publication outlets for relevant content between January 2010 to July 2018. A search strategy was then applied to the key journals identified, in addition to hand searching the journals and reference list of relevant papers identified. Inclusion criteria were independently applied to potentially relevant articles by three reviewers. Data were subject to a narrative synthesis to highlight key concepts identified.

Sixty-three articles were included. A set of consistent challenges and emerging trends within healthcare sectors internationally for health leadership and management were represented at the three structural levels. At the macro level these included societal, demographic, historical and cultural factors; at the meso level, human resource management challenges, changing structures and performance measures and intensified management; and at the micro level shifting roles and expectations in the workplace for health care managers.

Contemporary challenges and emerging needs of the global health management workforce orient around efficiency-saving, change and human resource management. The role of health managers is evolving and expanding to meet these new priorities. Ensuring contemporary health leaders and managers have the capabilities to respond to the current landscape is critical.

Peer Review reports

Health systems are increasingly complex; encompassing the provision of public and private health services, primary healthcare, acute, chronic and aged care, in a variety of contexts. Health systems are continually evolving to adapt to epidemiological, demographic and societal shifts. Emerging technologies and political, economic, social, and environmental realities create a complex agenda for global health [ 1 ]. In response, there has been increased recognition of the role of non-state actors to manage population needs and drive innovation. The concept of ‘collaborative governance,’ in which non-health actors and health actors work together, has come to underpin health systems and service delivery internationally [ 1 ] in order to meet changing expectations and new priorities. Seeking the achievement of universal health coverage (UHC) and the Sustainable Development Goals (SDGs), particularly in low- and middle-income countries, have been pivotal driving forces [ 2 ]. Agendas for change have been encapsulated in reforms intended to improve the efficiency, equity of access, and the quality of public services more broadly [ 1 , 3 ].

The profound shortage of human resources for health to address current and emerging population health needs across the globe was identified in the World Health Organization (WHO) landmark publication ‘Working together for health’ and continues to impede progress towards the SDGs [ 4 ]. Despite some improvements overall in health workforce aggregates globally, the human resources for health challenges confronting health systems are highly complex and varied. These include not only numerical workforce shortages but imbalances in skill mix, geographical maldistribution, difficulty in inter-professional collaboration, inefficient use of resources, and burnout [ 2 , 5 , 6 ]. Effective health leadership and workforce management is therefore critical to addressing the needs of human resources within health systems and strengthening capacities at regional and global levels [ 4 , 6 , 7 , 8 ].

While there is no standard definition, health leadership is centred on the ability to identify priorities, provide strategic direction to multiple actors within the health system, and create commitment across the health sector to address those priorities for improved health services [ 7 , 8 ]. Effective management is required to facilitate change and achieve results through ensuring the efficient mobilisation and utilisation of the health workforce and other resources [ 8 ]. As contemporary health systems operate through networks within which are ranging levels of responsibilities, they require cooperation and coordination through effective health leadership and workforce management to provide high quality care that is effective, efficient, accessible, patient-centred, equitable, and safe [ 9 ]. In this regard, health leadership and workforce management are interlinked and play critical roles in health services management [ 7 , 8 ].

Along with health systems, the role of leaders and managers in health is evolving. Strategic management that is responsive to political, technological, societal and economic change is essential for health system strengthening [ 10 ]. Despite the pivotal role of health service management in the health sector, the priorities for health service management in the global health context are not well understood. This rapid review was conducted to identify the current challenges and priorities for health leadership and workforce management globally.

This review utilised a rapid evidence assessment (REA) methodology structured using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist [ 11 ]. An REA uses the same methods and principles as a systematic review but makes concessions to the breadth or depth of the process to address key issues about the topic under investigation [ 12 , 13 , 14 ]. An REA provides a balanced assessment of what is already known about an issue, and the strength of evidence. The narrower research focus, relative to full systematic reviews, make REAs helpful for systematically exploring the evidence around a particular issue when there is a broad evidence base to explore [ 14 ]. In the present review, the search was limited to contemporary literature (post 2010) selected from leading health service management and global health journals identified from exploring major electronic databases.

Search strategy

An explorative review of three core databases in the area of public health and health services (MEDLINE®, Pubmed and Scopus) was undertaken to identify the key publication outlets for relevant content. These databases were selected as those that would be most relevant to the focus of the review and have the broadest range of relevant content. A range of text words, synonyms and subject headings were developed for the major constructs: global health, health service management and health leadership, priorities and challenges. Regarding health service management and health leadership, the following search terms were used: “healthcare manag*” OR “health manag*” OR “health services manag*” OR “health leader*”. Due to the large volume of diverse literature generated, a systematic search was then undertaken on the key journals that produced the largest number of relevant articles. The journals were selected as those identified as likely to contain highly relevant material based on an initial scoping of the literature.

Based on the initial database search, a systematic search for articles published in English between 1 January 2010 and 31 July 2018 was undertaken of the current issues and archives of the following journals: Asia-Pacific Journal of Health Management; BMC Health Services Research; Healthcare Management Review; International Journal of Healthcare Management; International Journal of Health Planning and Management; Journal of Healthcare Management; Journal of Health Organisation and Management; and, Journal of Health Management. Hand-searching of reference lists of identified papers were also used to ensure that major relevant material was captured.

Study selection and data extraction

Results were merged using reference-management software (Endnote) and any duplicates removed. The first author (CF) screened the titles and abstracts of articles meeting the eligibility criteria (Table 1 ). Full-text publications were requested for those identified as potentially relevant. The inclusion and exclusion criteria were then independently applied by two authors. Disagreements were resolved by consensus or consultation with a third person, and the following data were extracted from each publication: author(s), publication year, location, primary focus and main findings in relation to the research objective. Sixty-three articles were included in the final review. The selection process followed the PRISMA checklist [ 11 ] as shown in Fig. 1 .

PRISMA flow chart of the literature search, identification, and inclusion for the review

Data extraction and analysis

A narrative synthesis was used to explore the literature against the review objective. A narrative synthesis refers to “an approach to the systematic review and synthesis of findings from multiple studies that relies primarily on the use of words and text to summarise and explain the findings of the synthesis” [ 15 ]. Firstly, an initial description of the key findings of included studies was drafted. Findings were then organised, mapped and synthesised to explore patterns in the data.

Search results

A total of 63 articles were included; Table 2 summarizes the data extraction results by region and country. Nineteen were undertaken in Europe, 16 in North America, and one in Australia, with relatively fewer studies from Asia, the Middle East, and small island developing countries. Eighteen qualitative studies that used interviews and/or focus group studies [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ] were identified. Other studies were quantitative [ 33 , 34 , 35 , 36 , 37 , 38 , 39 ] including the use of questionnaires or survey data, or used a mixed-method approach [ 40 , 41 , 42 , 43 , 44 ]. Other articles combined different types of primary and secondary data (key informant interviews, observations, focus groups, questionnaire/survey data, and government reports). The included literature also comprised 28 review articles of various types that used mixed data and bibliographic evidence.

Key challenges and emerging trends

A set of challenges and emerging trends were identified across healthcare sectors internationally. These were grouped at three levels: 1) macro, system context (society, demography, technology, political economy, legal framework, history, culture), 2) meso, organisational context (infrastructure, resources, governance, clinical processes, management processes, suppliers, patients), and 3) micro context related to the individual healthcare manager (Table 3 ). This multi-levelled approach has been used in previous research to demonstrate the interplay between different factors across different levels, and their direct and indirect reciprocal influences on healthcare management policies and practices [ 45 ].

Societal and system-wide (macro)

Population growth, ageing populations, and increased disease burdens are some of the common trends health systems are facing globally. Developing and developed countries are going through demographic and epidemiological transitions; people are living longer with increasing prevalence of chronic diseases requiring health managers and leaders to adjust to shifting healthcare needs at the population level, delivering preventative and long-term care beyond acute care. Countries in Africa, Europe, the Pacific Islands, Middle East, Asia and Caribbean are seeing an increase in number of patients with non-communicable diseases and communicable diseases [ 21 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ].

Although many countries have similar emerging health system concerns, there are some differences in the complexities each country faces. For many small countries, outmigration, capacity building and funding from international aid agencies are affecting how their health systems operate, while in many larger countries, funding cuts, rise in private health insurance, innovations, and health system restructuring are major influences [ 21 , 34 , 50 , 53 , 54 ]. In addition, patients are increasingly health literate and, as consumers, expect high-quality healthcare [ 34 , 53 , 54 ]. However, hospitals and healthcare systems are lacking capacity to meet the increased demand [ 16 , 34 , 43 ].

Scientific advances have meant more patients are receiving care across the health system. It is imperative to have processes for communication and collaboration between different health professionals for high-quality care. However, health systems are fragmented; increasing specialisation is leading to further fragmentation and disassociation [ 31 , 54 , 55 ]. Adoption of technological innovations also require change management, hospital restructure, and capacity building [ 56 , 57 , 58 ].

Changes in health policies and regulations compound the challenge faced by healthcare managers and leaders to deliver high quality care [ 53 , 54 , 59 ]. Political reforms often lead to health system restructuring requiring change in the values, structures, processes and systems that can constrain how health managers and leaders align their organisations to new agendas [ 24 , 28 , 31 , 60 ]. For example, the distribution of health services management to local authorities through decentralisation has a variable impact on the efficacy and efficiency of healthcare delivery [ 24 , 27 , 35 , 59 ].

Governments’ decisions are often made focusing on cost savings, resulting in budgetary constraints within which health systems must operate [ 16 , 19 , 53 , 61 ]. Although some health systems have delivered positive results under such constraint [ 53 ], often financial resource constraints can lead to poor human and technical resource allocation, creating a disconnect between demand and supply [ 23 , 27 , 40 , 47 , 57 ]. To reduce spending in acute care, there is also a push to deliver health services in the community and focus on social determinants of health, though this brings further complexities related to managing multiple stakeholder collaborations [ 27 , 32 , 34 , 38 , 40 , 49 , 55 ].

Due to an increase in demand and cost constraints, new business models are emerging, and some health systems are resorting to privatisation and corporatisation [ 22 , 48 , 62 ]. This has created competition in the market, increased uptake of private health insurance and increased movement of consumers between various organisations [ 22 , 48 ]. Health managers and leaders need to keep abreast with continuously changing business models of care delivery and assess their impact [ 59 , 62 ]. The evolving international health workforce, insufficient numbers of trained health personnel, and maintaining and improving appropriate skill mixes comprise other important challenges for managers in meeting population health needs and demands (Table 3 ).

Organisational level (meso)

At the organisation level, human resource management issues were a central concern. This can be understood in part within the wider global human resources for health crisis which has placed healthcare organisations under intense pressure to perform. The evidence suggests healthcare organisations are evolving to strengthen coordination between primary and secondary care; there is greater attention to population-based perspectives in disease prevention, interdisciplinary collaboration, and clinical governance. These trends are challenged by the persistence of bureaucratic and hierarchical cultures, emphasis on targets over care quality, and the intensification of front-line and middle-management work that is limiting capacity.

Healthcare managers and leaders also face operational inefficiencies in providing primary health and referral services to address highly complex and shifting needs which often result in the waste of resources [ 49 , 63 , 64 ]. Considering the pace of change, organisations are required to be flexible and deliver higher quality care at lower cost [ 21 , 53 , 65 ]. To achieve this, many organisations in developing and developed countries alike are adopting a lean model [ 17 , 21 ]. However, there are challenges associated with ensuring sustainability of the lean system, adjusting organisational hierarchies, and improving knowledge of the lean model, especially in developing countries [ 17 , 21 ].

Healthcare organisations require various actors with different capabilities to deliver high quality care. However, a dominant hierarchical culture and lack of collaborative and distributed culture can limit the performance of healthcare organisations [ 22 , 36 , 54 ]. In addition, considering high turnover of executive leadership, healthcare organisations often rely on external talent for succession management which can reduce hospital efficiency [ 44 , 66 ]. Other contributors to weakened hospital performance include: the lack of allocative efficiency and transparency [ 24 , 30 , 64 , 67 ]; poor hospital processes that hamper the development of effective systems for the prevention and control of hospital acquired infections (HAIs) [ 53 , 68 ]; and, payment reforms such as value-based funding and fee-for-service that encourage volume [ 18 , 23 , 24 , 61 , 62 , 69 , 70 ].

Managerial work distribution within organisations is often not clearly defined, leading to extra or extreme work conditions for middle and front-line managers [ 29 , 42 , 53 , 70 ]. Unregulated and undefined expectations at the organisation level leads to negative effects such as stress, reduced productivity, and unpredictable work hours, and long-term effects on organisational efficiency and delivery of high quality care [ 22 , 28 , 29 , 37 , 42 , 51 , 71 ]. Furthermore, often times front-line clinicians are also required to take the leadership role in the absence of managers without proper training [ 20 ]. Despite this, included studies indicate that the involvement of middle and front-line managers in strategic decision-making can be limited due to various reasons including lack of support from the organisation itself and misalignment of individual and organisational goals [ 16 , 26 , 31 , 72 ].

Individual level (micro)

Worldwide, middle and front-line health managers and leaders are disproportionately affected by challenges at the system and organisational level, which has contributed to increasing and often conflicting responsibilities. Some countries are experiencing a growth in senior health managers with a clinical background, while in other countries, the converse is apparent. Indistinct organisational boundaries, increasing scope of practice, and lack of systemic support at policy level are leaving healthcare managers with undefined roles [ 28 , 59 ]. Poorly defined roles contribute to reduced accountability, transparency, autonomy, and understanding of responsibilities [ 24 , 30 , 31 , 67 ]. Studies also indicate a lack of recognition of clinical leaders in health organisations and inadequate training opportunities for them as such [ 20 , 67 ].

The number of hybrid managers (performing clinical and managerial work concurrently) in developed countries is increasing, with the perception that such managers improve the clinical governance of an organization. In contrast, the number of non-clinical managers in many developing countries appears to be increasing [ 63 , 73 , 74 , 75 ]. Included studies suggest this approach does not necessarily improve manager-clinical professional relationships or the willingness of clinicians becoming managers, limiting their participation in strategic decisions [ 28 , 70 , 71 , 74 ].

This rapid review highlights the current global climate in health service management, the key priority areas, and current health management approaches being utilised to address these. The multitude of issues emerging demonstrate the complex and evolving role of health service management in the wider complex functioning of health systems globally in a changing healthcare landscape. Key themes of achieving high quality care and sustainable service delivery were apparent, often evidenced through health reforms [ 5 ]. The influence of technological innovation in both its opportunities and complexities is evident worldwide. In the context of changing healthcare goals and delivery approaches, health management is seeking to professionalise as a strategy to build strength and capacity. In doing so, health managers are questioning role scope and the skills and knowledge they need to meet the requirements of the role.

Global challenges facing health management

Understanding how the features of the macro, meso and micro systems can create challenges for managers is critical [ 19 ]. With continual healthcare reform and increasing health expenditure as a proportion of GDP, distinct challenges are facing high-income Organisation for Economic Co-operation and Development (OECD) countries, middle-income rapidly-developing economies, and low-income, resource-limited countries. Reforms, especially in OECD countries, have been aimed at controlling costs, consolidating hospitals for greater efficiencies, and reconfiguring primary healthcare [ 1 , 76 ]. The changing business models for the delivery of care have wider implications for the way in which health managers conceptualise healthcare delivery and the key stakeholders [ 59 ], for example, the emerging role of private healthcare providers and non-health actors in public health. Changes to the business model of healthcare delivery also has implications for the distribution of power amongst key actors within the system. This is evident in the evolved role of general practitioners (GPs) in the UK National Health Service as leaders of Clinical Commissioning Groups (CCGs). Commissioning requires a different skill set to clinical work, in terms of assessing financial data, the nature of statutory responsibilities, and the need to engage with a wider stakeholder group across a region to plan services [ 77 ]. With new responsibilities, GPs have been required to quickly equip themselves with new management capabilities, reflecting the range of studies included in this review around clinician managers and the associated challenges [ 18 , 28 , 53 , 63 , 70 , 71 , 74 , 75 ].

Central to the role of healthcare managers is the ability to transition between existing and new cultures and practices within healthcare delivery [ 59 ]. Bridging this space is particularly important in the context of increasingly personalized and technologically-driven healthcare delivery [ 54 ]. While advances in knowledge and medical technologies have increased capability to tackle complex health needs, the integration of innovations into existing healthcare management practices requires strong change management [ 73 ]. Health leaders and managers need to be able to rapidly and continually assess the changes required or upon them, the implications, and to transform their analysis into a workable plan to realise change [ 10 ]. Focusing only on the clinical training of health professionals rather than incorporating managerial and leadership roles, and specifically, change management capability may limit the speed and success of innovation uptake [ 22 ].

Implications

Our findings highlight the implications of current priorities within the health sector for health management practice internationally; key issues are efficiency savings, change management and human resource management. In the context of efficiency approaches, health system and service managers are facing instances of poor human and technical resource allocation, creating a disconnect between demand and supply. At the service delivery level, this has intensified and varied the role of middle managers mediating at two main levels. The first level of middle-management is positioned between the front-line and C-suite management of an organisation. The second level of middle-management being the C-suite managers who translate regional and/or national funding decisions and policies into their organisations. Faced with increasing pace of change, and economic and resource constraints, middle managers across both levels are now more than ever exposed to high levels of stress, low morale, and unsustainable working patterns [ 29 ]. Emphasis on cost-saving has brought with it increased attention to the health services that can be delivered in the community and the social determinants of health. Connecting disparate services in order to meet efficiency goals is a now a core feature of the work of many health managers mediating this process.

Our findings also have implications for the conceptualisation of healthcare management as a profession. The scale and increasing breadth of the role of health leaders and managers is evident in the review. Clarifying the professional identity of ‘health manager’ may therefore be a critical part of building and maintaining a robust health management workforce that can fulfil these diverse roles [ 59 ]. Increasing migration of the healthcare workforce and of population, products and services between countries also brings new challenges for healthcare. In response, the notion of transnational competence among healthcare professionals has been identified [ 78 ]. Transnational competence progresses cultural competence by considering the interpersonal skills required for engaging with those from diverse cultural and social backgrounds. Thus, transnational competence may be important for health managers working across national borders. A key aspect of professionalisation is the education and training of health managers. Our findings provide a unique and useful theoretical contribution that is globally-focused and multi-level to stimulate new thinking in health management educators, and for current health leaders and managers. These findings have considerable practical utility for managers and practitioners designing graduate health management programs.

Limitations

Most of the studies in the field have focused on the Anglo-American context and health systems. Notwithstanding the importance of lessons drawn from these health systems, further research is needed in other regions, and in low- and middle-income countries in particular [ 79 ]. We acknowledge the nuanced interplay between evidence, culture, organisational factors, stakeholder interests, and population health outcomes. Terminologies and definitions to express global health, management and leadership vary across countries and cultures, creating potential for bias in the interpretation of findings. We also recognise that there is fluidity in the categorisations, and challenges arising may span multiple domains. This review considers challenges facing all types of healthcare managers and thus lacks discrete analysis of senior, middle and front-line managers. That said, managers at different levels can learn from one another. Senior managers and executives may gain an appreciation for the operational challenges that middle and front-line managers may face. Middle and front-line managers may have a heightened awareness of the more strategic decision-making of senior health managers. Whilst the findings indicate consistent challenges and needs for health managers across a range of international contexts, the study does not capture country-specific issues which may have consequences at the local level. Whilst a systematic approach was taken to the literature in undertaking this review, relevant material may have been omitted due to the limits placed on the rapid review of the vast and diverse health management literature. The inclusion of only materials in English language may have led to further omissions of relevant work.

Health managers within both international and national settings face complex challenges given the shortage of human resources for health worldwide and the rapid evolution of national and transnational healthcare systems. This review addresses the lack of studies taking a global perspective of the challenges and emerging needs at macro (international, national and societal), meso (organisational), and micro (individual health manager) levels. Contemporary challenges of the global health management workforce orient around demographic and epidemiological change, efficiency-saving, human resource management, changing structures, intensified management, and shifting roles and expectations. In recognising these challenges, researchers, management educators, and policy makers can establish global health service management priorities and enhance health leadership and capacities to meet these. Health managers and leaders with adaptable and relevant capabilities are critical to high quality systems of healthcare delivery.

Abbreviations

Clinical Commissioning Groups

General practitioners

Hospital acquired infections

Organisation for Economic Co-operation and Development

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Rapid evidence assessment

Sustainable Development Goals

Universal health coverage

World Health Organization

Senkubuge F, Modisenyane M, Bishaw T. Strengthening health systems by health sector reforms. Glob Health Action. 2014;7(1):23568.

Article Google Scholar

World Health Organization, Global Health Workforce Alliance. Human resources for health: foundation for universal health coverage and the post-2015 development agenda. Report of the Third Global Forum on Human Resources for Health, 2013 November 10–13. Recife, Brazil: WHO; 2014.

Reich MR, Harris J, Ikegami N, Maeda A, Cashin C, Araujo EC, et al. Moving towards universal health coverage: lessons from 11 country studies. Lancet. 2016;387(10020):811–6.

World Health Organisation. Working together for health: the world health report 2006: policy briefs. Geneva: World Health Organisation; 2006.

Google Scholar

West M, Dawson J. Employee engagement and NHS performance. London: King's Fund; 2012.

World Health Organization. Global strategy on human resources for health: workforce 2030. Geneva: World Health Organisation; 2016.

Reich MR, Javadi D, Ghaffar A. Introduction to the special issue on “effective leadership for health systems”. Health Syst Reform. 2016;2(3):171–5.

Waddington C, Egger D, Travis P, Hawken L, Dovlo D, World Health Organization. Towards better leadership and management in health: report of an international consultation on strengthening leadership and management in low-income countries, 29 January-1 February. Ghana: Accra; 2007.

World Health Organization. Quality of care: a process for making strategic choices in health systems. Manila: WHO Regional Office for the Western Pacific; 2006.

Ginter PM, Duncan WJ, Swayne LE. The strategic management of health care organizations: John Wiley & Sons; 2018.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Int Med. 2009;151(4):264–9.

Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Inf Libr J. 2009;26(2):91–108.

Varker T, Forbes D, Dell L, Weston A, Merlin T, Hodson S, et al. Rapid evidence assessment: increasing the transparency of an emerging methodology. J Eval Clin Pract. 2015;21(6):1199–204.

Tricco AC, Langlois EV, Straus SE. Rapid reviews to strengthen health policy and systems: a practical guide. Geneva, Switzerland: World Health Organization; 2017.

Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, et al. Guidance on the conduct of narrative synthesis in systematic reviews. A product from the ESRC methods programme Version. 2006;1:b92.

Taylor A, Groene O. European hospital managers’ perceptions of patient-centred care: a qualitative study on implementation and context. J Health Organ Manag. 2015;29(6):711–28.

Costa LBM, Rentes AF, Bertani TM, Mardegan R. Lean healthcare in developing countries: evidence from Brazilian hospitals. Int J Health Plann Manage. 2017;32(1).

Chreim S, Williams BE, Coller KE. Radical change in healthcare organization: mapping transition between templates, enabling factors, and implementation processes. J Health Organ Manag. 2012;26(2):215–36.

Greenwald HP. Management challenges in British Columbia’s healthcare system. J Health Organ Manag. 2017;31(4):418–29.

Mercer D, Haddon A, Loughlin C. Leading on the edge: the nature of paramedic leadership at the front line of care. Health Care Manag Rev. 2018;43(1):12–20.

Reijula J, Reijula E, Reijula K. Healthcare management challenges in two university hospitals. Int J Healthc Tech Manag. 2016;15(4):308–25.

Srinivasan V, Chandwani R. HRM innovations in rapid growth contexts: the healthcare sector in India. Int J Hum Res Manage. 2014;25(10):1505–25.

Afzali HHA, Moss JR, Mahmood MA. Exploring health professionals' perspectives on factors affecting Iranian hospital efficiency and suggestions for improvement. Int J Health Plann Manag. 2011;26(1):e17–29.

Jafari M, Rashidian A, Abolhasani F, Mohammad K, Yazdani S, Parkerton P, et al. Space or no space for managing public hospitals; a qualitative study of hospital autonomy in Iran. Int J Health Plann Manag. 2011;26(3):e121–e37.

Lapão LV, Dussault G. From policy to reality: clinical managers' views of the organizational challenges of primary care reform in Portugal. Int J Health Plann Manag. 2012;27(4):295–307.

Andreasson J, Eriksson A, Dellve L. Health care managers' views on and approaches to implementing models for improving care processes. J Nurs Manag. 2016;24(2):219–27.

Maluka SO, Hurtig AK, Sebastián MS, Shayo E, Byskov J, Kamuzora P. Decentralization and health care prioritization process in Tanzania: from national rhetoric to local reality. Int J Health Plann Manag. 2011;26(2):e102–e20.

Taytiwat P, Briggs D, Fraser J, Minichiello V, Cruickshank M. Lessons from understanding the role of community hospital director in Thailand: clinician versus manager. Int J Health Plann Manag. 2011;26(2):e48–67.

Buchanan DA, Parry E, Gascoigne C, Moore C. Are healthcare middle management jobs extreme jobs? J Health Organ Manag. 2013;27(5):646–64.

Longenecker CO, Longenecker PD. Why hospital improvement efforts fail: a view from the front line. J Healthc Manag. 2014;59(2):147–57.

Reyes DJ, Bekemeier B, Issel LM. Challenges faced by public health Nurs leaders in Hyperturbulent times. Public Health Nurs. 2014;31(4):344–53.

Louis CJ, Clark JR, Gray B, Brannon D, Parker V. Service line structure and decision-maker attention in three health systems: implications for patient-centered care. Health Care Manag Rev. 2017. https://doi.org/10.1097/HMR.0000000000000172 .

Oppel EM, Winter V, Schreyogg J. Evaluating the link between human resource management decisions and patient satisfaction with quality of care. Health Care Manag Rev. 2017;42(1):53–64.

Ramanujam P. Service quality in health care organisations: a study of corporate hospitals in Hyderabad. J Health Manag. 2011;13(2):177–202.

Diana A, Hollingworth SA, Marks GC. Effects of decentralisation and health system reform on health workforce and quality-of-care in Indonesia, 1993–2007. Int J Health Plann Manag. 2015;30(1):e16–30.

Prenestini A, Lega F. Do senior management cultures affect performance? Evidence from Italian public healthcare organizations. J Healthc Manag. 2013;58(5):336–51.

Giauque D. Stress among public middle managers dealing with reforms. J Health Organ Manag. 2016;30(8):1259–83.

Jennings JC, Landry AY, Hearld LR, Weech-Maldonado R, Snyder SW, Patrician PA. Organizational and environmental factors influencing hospital community orientation. Health Care Manag Rev. 2017. https://doi.org/10.1097/HMR.0000000000000180 .

Tasi MC, Keswani A, Bozic KJ. Does physician leadership affect hospital quality, operational efficiency, and financial performance? Health Care Manag Rev. 2017. https://doi.org/10.1097/HMR.0000000000000173 .

Hall W, Williams I, Smith N, Gold M, Coast J, Kapiriri L, et al. Past, present and future challenges in health care priority setting: findings from an international expert survey. J Health Organ Manag. 2018;32(3):444–62.

Nelson SA, Azevedo PR, Dias RS, de Sousa SdMA, de Carvalho LDP, Silva ACO, et al. nursing work: challenges for health management in the northeast of Brazil. J Nurs Manag 2013;21(6):838–849.

Ireri S, Walshe K, Benson L, Mwanthi MA. A qualitative and quantitative study of medical leadership and management: experiences, competencies, and development needs of doctor managers in the United Kingdom. J Manag Marketing Healthc. 2011;4(1):16–29.

Powell M. The snakes and ladders of National Health Service management in England. Int J Health Plann Manag. 2014;29(3):260–79.

Groves KS. Examining the impact of succession management practices on organizational performance: A national study of U.S. hospitals. Health Care Manage Rev. 2017; doi: https://doi.org/10.1097/hmr.0000000000000176 .

Syed J, Özbilgin M. A relational framework for international transfer of diversity management practices. Int J Hum Res Manage. 2009;20(12):2435–53.

Adindu A. The need for effective management in African health systems. J Health Manag. 2013;15(1):1–13.

Greaves DE. Health management/leadership of Small Island developing states of the English-speaking Caribbean: a critical review. J Health Manag. 2016;18(4):595–610.

Khan MI, Banerji A. Health Care Management in India: some issues and challenges. J Health Manag. 2014;16(1):133–47.

Moghadam MN, Sadeghi V, Parva S. Weaknesses and challenges of primary healthcare system in Iran: a review. Int J Health Plann Manag. 2012;27(2):e121–e31.

Taylor R. The tyranny of size: challenges of health administration in Pacific Island states. Asia Pac J Health Manag. 2016;11(3):65.

Jooste K, Jasper M. A south African perspective: current position and challenges in health care service management and education in nursing. J Nurs Manag. 2012;20(1):56–64.

Sen K, Al-Faisal W. Reforms and emerging noncommunicable disease: some challenges facing a conflict-ridden country—the case of the Syrian Arab Republic. Int J Health Plann Manag. 2013;28(3):290–302.

Carney M. Challenges in healthcare delivery in an economic downturn, in the Republic of Ireland. J Nurs Manag. 2010;18(5):509–14.

Bowden DE, Smits SJ. Managing in the context of healthcare's escalating technology and evolving culture. J Health Organ Manag. 2012;26(2):149–57.

Meijboom BR, Bakx SJWGC, Westert GP. Continuity in health care: lessons from supply chain management. Int J Health Plann Manag. 2010;25(4):304–17.

Lega F, Calciolari S. Coevolution of patients and hospitals: how changing epidemiology and technological advances create challenges and drive organizational innovation. J Healthc Manag. 2012;57(1):17–34.

Kim Y, Kang M. The performance management system of the Korean healthcare sector: development, challenges, and future tasks. Public Perform Manag. 2016;39(2):297–315.

CAS Google Scholar

Hernandez SE, Conrad DA, Marcus-Smith MS, Reed P, Watts C. Patient-centered innovation in health care organizations: a conceptual framework and case study application. Health Care Manag Rev. 2013;38(2):166–75.

Briggs D, Isouard G. The language of health reform and health management: critical issues in the management of health systems. Asia Pac J Health Manag. 2016;11(3):38.

Zuckerman AM. Successful strategic planning for a reformed delivery system. J Healthc Manag. 2014;59(3):168–72.

Gantz NR, Sherman R, Jasper M, Choo CG, Herrin-Griffith D, Harris K. Global nurse leader perspectives on health systems and workforce challenges. J Nurs Manag. 2012;20(4):433–43.

Jeurissen P, Duran A, Saltman RB. Uncomfortable realities: the challenge of creating real change in Europe’s consolidating hospital sector. BMC Health Serv Res. 2016;16(2):168.

Kirkpatrick I, Kuhlmann E, Hartley K, Dent M, Lega F. Medicine and management in European hospitals: a comparative overview. BMC Health Serv Res. 2016;16(2):171.

Akbulut Y, Esatoglu AE, Yildirim T. Managerial roles of physicians in the Turkish healthcare system: current situation and future challenges. J Health Manag. 2010;12(4):539–51.

Naranjo-Gil D. The role of top management teams in hospitals facing strategic change: effects on performance. Int J Healthc Manag. 2015;8(1):34–41.

Ford EW, Lowe KB, Silvera GB, Babik D, Huerta TR. Insider versus outsider executive succession: the relationship to hospital efficiency. Health Care Manag Rev. 2018;43(1):61–8.

Leggat SG, Balding C. Achieving organisational competence for clinical leadership: the role of high performance work systems. J Health Organ Manag. 2013;27(3):312–29.

Baylina P, Moreira P. Healthcare-associated infections – on developing effective control systems under a renewed healthcare management debate. Int J Healthc Manag. 2012;5(2):74–84.

Jha R, Sahay B, Charan P. Healthcare operations management: a structured literature review. Decis. 2016;43(3):259–79.

Kuhlmann E, Rangnitt Y, von Knorring M. Medicine and management: looking inside the box of changing hospital governance. BMC Health Serv Res. 2016;16(2):159.

Spehar I, Frich JC, Kjekshus LE. Clinicians’ experiences of becoming a clinical manager: a qualitative study. BMC Health Serv Res. 2012;12(1):421.

Rodriguez CA. Challenges to effectiveness in public health organizations: the case of the Costa Rican health ministry. J Bus Res. 2016;69(9):3859–68.

Cinaroglu S. Complexity in healthcare management: why does Drucker describe healthcare organizations as a double-headed monster? Int J Healthc Manag. 2016;9(1):11–7.

Rotar A, Botje D, Klazinga N, Lombarts K, Groene O, Sunol R, et al. The involvement of medical doctors in hospital governance and implications for quality management: a quick scan in 19 and an in depth study in 7 OECD countries. BMC Health Serv Res. 2016;16(2):160.

Edmonstone JD. Whither the elephant?: the continuing development of clinical leadership in the UK National Health Services. Int J Health Plann Manag. 2014;29(3):280–91.

Naylor C, Ross S, Curry N, Holder H, Marshall L, Tait E. Clinical commissioning groups: supporting improvement in general practice? London: The King's Fund; 2013.

Holder H, Robertson R, Ross S, Bennett L, Gosling J, Curry N. Risk or reward? The changing role of CCGs in general practice. London: Kings Fund/Nuffield Trust; 2015.

Koehn PH, Rosenau JN. Transnational competence in an emergent epoch. Int Stud Perspect. 2002;3(2):105–27.

Antunes V, Moreira JP. Skill mix in healthcare: an international update for the management debate. Int J Healthc Manag. 2013;6(1):12–7.

Seitio-Kgokgwe OS, Gauld R, Hill PC, Barnett P. Understanding human resource management practices in Botswana’s public health sector. J Health Organ Manag. 2016;30(8):1284–300.

Miners C, Hundert M, Lash R. New structures for challenges in healthcare management. Healthc Manage Forum. 2015;28(3):114–7.

Hopkins J, Fassiotto M, Ku MC, Mammo D, Valantine H. Designing a physician leadership development program based on effective models of physician education. Health Care Manag Rev. 2017. https://doi.org/10.1097/hmr.0000000000000146 .

Miranda R, Glenn SW, Leighton JA, Pasha SF, Gurudu SR, Teaford HG, et al. Using hybrid change strategies to improve the patient experience in outpatient specialty care. J Healthc Manag. 2015;60(5):363–76.

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The rapid review is part of a larger study on global health management priorities and qualities, supported by the University of New South Wales, Sydney.

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The Leadership in Healthcare: The Intelligent Quotient and Technical Aspects Essay

Introduction, study setting research question, consequences of nm’s leadership styles on the oc, leadership styles as identified in the research and oc characteristics.

Leadership plays a very important role in healthcare organizations and this fact is indisputable. Individual styles of superb leadership vary so much. The intelligent quotient and technical aspects are very critical for leaders. Organizational leaders create vision and describe a dream in a way that people would want to follow.

The study setting of the investigation was in New Jersey where a manageable sample of Nurse Managers in administrative positions together with a convenient number of registered staff nurses (SN’s) were studied. These participants were selected from acute care departments of the major health facilities in the region (Casida 2008). A fundamental assumption taken by the investigator was that the sample was a true and realistic representation of a natural or normal population in an organization. The members of the population are also assumed to be sharing similar viewpoints, values and mission (Nemetz-Mills, 2007).

The question of research was developed from the fact that there is no evidence to connect culture and organizational leadership in nursing. As a consequence the research question was; “is there a relationship between Nursing Manager’s way of headship and the organizational culture in the nursing units as professed by staff nurses?” The main hypothesis was then developed with further sub-hypotheses to ensure that the investigation is done exhaustively.

There are several leadership styles being studied by scholars worldwide. This survey covered only three types coded as TF, TS and LF styles (Casida 2008). Correlation analyses carried out revealed that Nurse Managers who used TF style of leadership correlated positively with the organizational culture in the nursing unit. The TS leadership indicated a positive relationship with the organizational culture though with lesser organizational culture correlation as compared to the TF style. However, LF type of leadership indicated a negative relationship with OC in the nursing unit (Casida 2008). TF type of leadership is therefore considered to be the way forward to influence and shape the healthcare culture in a way that will epitomize the basic culture attributes (adaptableness, involvement, constancy, and mission).

Essentially, the staff nurses viewed the categories of leadership into two basic types; Transactional and transformational types (Robbins & Davidhizar, 2007). As a result the nurses rated patient satisfaction and quality of healthcare service based on these two paradigms. The transactional leadership did not indicate any relationship with greater performance in acute care patient nursing units. On the other hand, those Nurse Managers who practiced transformational leadership were closely connected with their staff nurses, hence greater patient satisfaction (Robbins & Davidhizar, 2007). This means that transformational leadership encourages employee retention and significantly averted turnover (McGuire & Kennerly 2006). TF is closely related to transformational type of management hence they deliver same type of results. LF is more like transactional management.

Organizational culture concerns exemplifying behavior and reinforcing practices by a group of people (McNamara 2004). The OC is wide, delicate, and strong force exclusive to work groups like nursing units. It’s usually based on core values but it’s manifested via character.

Making a comparison of the three types of leadership styles investigated, it’s evident that the TF style of headship is very effective performance and better service delivery since it has indicated that there is high level of job satisfaction on the part of the staff nurses (McGuire & Kennerly 2006). The major aim of medical care service is to make sure that the patients are well attended to and that they leave the facility satisfied. Nursing being very sensitive career dealing directly with human life, it’s very important the patients get the care they deserve in the best way possible. Generally the research revealed that TF leadership by the hospital management translated to better nursing units. The organizational culture precipitating from this type of leadership also portrayed high levels of realistic cultural traits like adaptability and constancy (Robbins & Davidhizar, 2007). Suggestions to better performance point out that these leaders should be trained and mentored towards achieving transformational kind of leadership (McNamara 2004), essential in establishing organizational culture in acute patient departments to align with the hospitals mission and other strategic objectives.

According to the investigation, the TS leaders come second to TF’s in terms of performance. This can be set as a contingence initiative to be used by nurse managers since they also encourage involvement and constancy. This leadership type is considered to be very practical particularly in acute patient section (McNamara 2004). This can effectively augment TF strategies. On the contrary, LF did not have any influence on the culture of the organization since this type of leadership is deficient in decisive interaction between Nurse Managers and their staff. It therefore lacks better performance and job satisfaction (Nemetz-Mills, 2007).

Further Studies on NM and OC: More extensive studies need to be carried out to offer more statistically significant results to draw conclusions from. Definitive conclusions need to be found since the research did not address causation. This is because tackling two variables makes the design very limited in scope. Leaders mainly in the healthcare organizations need a great amount of emotional intellect since cultural diversity is being embraced all over the world in many organizations. It’s a challenge for organizations to build their own organizational culture.

Casida J (2008). Leadership: Organization Culture Association in Nursing Units. Acute Healthcare Hospital. Nursing Economics, 26 (1), 7-15

McGuire E. & Kennerly. S.M. (2006). Nursing Managers. Transactional and Transformational headship. Nurse Economics, 24 (4), 178 – 186

McNamara. C. (2004). Indication of Leadership in an Organization. Web.

Nemetz-Mills, P.(2007). Leadership Basics. Web.

Robbins, B., & Davidhizar, R. (2007). Transformation Leaders in Health care. The Healthcare Management, 26, 233 – 238.

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Analysis of The Importance of Management and Leadership in Healthcare

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Works Cited

Amanchukwu, R. N., Stanley, G. J., & Ololube, N. P. (2015). A review of leadership theories, principles and styles and their relevance to educational management. Management, 5(1), 6-14.
Avolio, B. J., Walumbwa, F. O., & Weber, T. J. (2009). Leadership: Current theories, research, and future directions. Annual Review of Psychology, 60, 421-449.
Bennis, W. G. (1969). Theories of changing. In Handbook of organizations (pp. 317-346). Rand McNally.
Burnes, B. (2000). Managing change: A strategic approach to organizational dynamics. Pitman Publishing.
Charry, K. (2012). Effective leadership in the church. AWW Press.
Cox, C. (2016). Exploring the similarities and differences between leadership and management. Journal of Leadership, Accountability and Ethics, 13(6), 109-117.
Halligan, P. (2010). Leadership for healthcare. McGraw-Hill Education.
Lamb, B. (2013). Contingency leadership theories: How they have contributed to our understanding of effective leadership. International Journal of Management, Business, and Administration, 16(1), 1-9.
Naylor, J. (1999). Management and leadership. In J. Naylor (Ed.), Introduction to health care management (pp. 267-292). Aspen Publishers.
Wolinski, S. (2010). Leadership theory: An overview. Journal of Leadership Education, 9(4), 62-83.

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The gathering storm in US healthcare: How leaders can respond and thrive

Addie Fleron is an associate partner in McKinsey’s Chicago office and Shubham Singhal is a senior partner in the Detroit office.

The authors wish to thank Katherine Baicker, Gretchen Berlin, Daniel Brown, Brandon Carrus, Christopher Chen, Sam Hazen, David Knott, Bob Kocher, Pooja Kumar, Sarah London, Steve Markovich, Peter McCanna, Emad Rizk, Jim Skogsbergh, Sven Smit, Mandy Tilton, Drew Ungerman, and Nithya Vinjamoori for their contributions to this article.

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The Impact of Leadership in Healthcare Institutions

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In the rapidly evolving landscape of healthcare, strong leadership is not just beneficial—it’s essential. The impact of effective physician leadership extends far beyond the executive suite, influencing patient outcomes, staff morale, and the overall operational efficiency of healthcare institutions. At Academic Med, we understand the pivotal role that physician executives play in driving excellence within healthcare organizations. As part of our continued Insights series, in this post we’ll explore the multifaceted impact of leadership in healthcare institutions and why investing in top-tier executive talent is crucial.

Transforming Patient Outcomes

At the heart of every healthcare institution is its commitment to patient care. Effective leadership is instrumental in creating a culture of quality and safety, ensuring that patient care standards are consistently met or exceeded. Physician leaders with a clear vision and the ability to inspire their teams can implement best practices, foster a culture of continuous improvement, and lead initiatives that directly enhance patient outcomes.

For instance, research has shown that hospitals with strong leadership are more likely to adopt innovative practices and evidence-based medicine, leading to improved clinical outcomes. Leaders who prioritize patient safety and quality can reduce medical errors, decrease hospital-acquired infections, and improve overall patient satisfaction.

Enhancing Staff Morale and Retention

The healthcare environment can be challenging, with high stress levels, demanding workloads, and the emotional toll of patient care. Effective leadership plays a critical role in shaping the work environment and influencing staff morale. Physician executives who demonstrate empathy, provide support, and foster open communication can create a positive workplace culture that boosts employee satisfaction and retention.

Leaders who invest in their teams through professional development opportunities, mentorship programs, and recognition initiatives not only enhance staff morale but also build a loyal and motivated workforce. High staff morale translates to better patient care, as satisfied and engaged employees are more likely to go above and beyond in their roles.

Driving Operational Efficiency

Healthcare institutions are complex organizations that require efficient and effective management to thrive. Physician leaders bring a unique perspective to the executive table, combining clinical expertise with strategic acumen. This dual skill set is invaluable in navigating the complexities of healthcare operations.

Effective physician executives can streamline processes, optimize resource allocation, and drive cost-saving initiatives without compromising on quality. Their ability to bridge the gap between clinical and administrative functions ensures that operational decisions are informed by clinical realities, leading to more sustainable and patient-centered outcomes.

Fostering Innovation and Adaptability

The healthcare industry is constantly evolving, with new technologies, treatments, and regulatory changes shaping the landscape. Strong leadership is essential for fostering a culture of innovation and adaptability. Physician leaders who are forward-thinking and open to change can guide their institutions through transitions, ensuring they stay ahead of industry trends and remain competitive.

Leaders who champion innovation encourage their teams to think creatively, embrace new technologies, and pursue research and development opportunities. This proactive approach not only improves patient care but also positions healthcare institutions as leaders in the field.

The impact of leadership in healthcare institutions cannot be overstated. Effective physician executives are the driving force behind improved patient outcomes, enhanced staff morale, operational efficiency, and a culture of innovation. At Academic Med, we are dedicated to connecting healthcare institutions with exceptional physician leaders who can steer their organizations toward success. Investing in top-tier executive talent is an investment in the future of healthcare, ensuring that institutions are well-equipped to meet the challenges and opportunities of tomorrow.

If you’re looking to elevate your institution with transformative leadership, contact Academic Med today. Let us help you find the leaders who will shape the future of healthcare.

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BMC Med Educ
v.20(Suppl 2); 2020

Leadership in healthcare education

Christie van diggele.

1 The University of Sydney, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006 Australia

2 The University of Sydney, Faculty of Medicine and Health, Sydney Health Professional Education Research Network, The University of Sydney, Sydney, Australia

Annette Burgess

3 The University of Sydney, Faculty of Medicine and Health, Sydney Medical School – Education Office, The University of Sydney, Sydney, Australia

Chris Roberts

Craig mellis.

4 The University of Sydney, Faculty of Medicine and Health, Sydney Medical School – Central Clinical School, The University of Sydney, Sydney, Australia

Associated Data

Not applicable.

Management versus leadership

Leadership versus Management (adapted from Swanwick & McKimm, 2011) [ 6 ]

Transactional and transformational leadership

Leadership is a social construct, and there are many different leadership models [ 6 ]. Two broad types of leadership are identifiable: “transactional” and “transformational”. And their respective features are a useful way to think about the many types of leadership. Transactional and transformational leadership models are normally amalgamated within organisations to “empower others” (transformational) while holding individuals “accountable” (transactional) for their actions [ 7 – 9 ]. While it is clear that both transformational and transactional leadership paradigms are needed for an organisation to be effective, the optimal leader predominantly practices the transformational aspects of leadership, rather than transactional [ 10 ].

Transactional leadership

Transformational leadership

Since the introduction of transformational leadership, the concept of leadership has undergone a major shift from representing an authoritative relationship (transactional), to a process of influencing individuals (transformational). Transformational leadership involves leadership through the transformation of individuals or ‘followers’, to work towards a common organisational goal [ 9 – 11 ]. This contemporary form of leadership is based on inspiring individuals, and forming teams to achieve goals. Transformational leaders define organisations through the articulation of a clear vision and clear values. The four “I”s of transformational leadership are outlined in Table 2 [ 9 ].

The four “I”s of transformational leadership (adapted from Bass & Aviolo, 1994) [ 9 ]

Team leadership

More recently, the focus has shifted towards “team leadership” , with distributed leadership becoming more prevalent within healthcare education, where different professions share influence [ 12 , 13 ]. Increasingly, leadership involves a collaborative role, with an emphasis on shared leadership and thoughtful allocation of responsibilities. Team-based organisations shift central control from the one leader, to the team. Teams are comprised of members who are interdependent, needing to coordinate their activities in order to accomplish their shared goals [ 14 , 15 ]. Personal autonomy, accountability, appropriate recognition, and clarity of roles, are all elements that contribute to optimal team performance. However, to ensure success, the organisational culture needs to support the involvement of individuals in these teams, and encourage leadership qualities [ 15 ]. Teams often fail when they exist in a traditional authority structure, where organisational culture is not supportive of collaborative work, and lower level decision making. Distributed leadership entails sharing of influence by team members, who step forward, or take a step back as needed. Leadership is provided by the person who meets the specific needs of the team at the time, hence providing faster responses to more complex issues in today’s organisations [ 15 – 17 ]. Effective leaders have an understanding of the conditions needed for teams to function well. For a team to achieve its potential, the operational roles of its members should be matched to their members’ abilities [ 18 ]. Belbin (1991) classified nine roles of team members that contribute to its process and function [ 19 ], outlined in Table 3 . Importantly, within team leadership, no single team role should be regarded as more important than another. Successful teams thrive on their diversity, drawing from the strengths of each member [ 13 ].

Roles of team members that contribute to its process and function (adapted from Belbin, 1991) [ 19 ]

Effective leadership

Leadership competencies for health professional educators (adapted from Oates, 2012) [ 3 ]

Language of leadership

Communicate with clarity of your purpose and the role of others

Stimulating

Deliver messages in a powerful, inspiring and dramatic way
Lead by example and walk the talk

Include active listening

Acknowledge what has been communicated, and use questioning skills
Show that you value others and their contributions

Challenges for leaders in healthcare education

Issues and challenges of health education leaders (adapted from McKimm, 2004) [ 22 , 23 ]

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Object name is 12909_2020_2288_Fig1_HTML.jpg

Reflection task

Development of leadership skills

Workforce data indicates that many experienced clinicians and healthcare educators will retire over the next ten years [ 24 , 25 ]. The need for effective succession planning and leadership training is well recognised [ 25 – 27 ], with a current shortage of emerging leaders moving into leadership roles. Effective leaders need to be nurtured and supported by the organisations in which they are educated, train and work [ 6 ]. As a learned skill, the topic of leadership is gathering momentum as a key curriculum area. Leadership development, assessment and feedback are necessary throughout the education and training of health professionals. Aspiring and current leaders can be identified, trained and assessed through formal leadership development programs, and through supportive organisational cultures. This requires embedding leadership training programs, opportunities for leadership practice, and promotion of professional networks within and beyond the organisation. The importance of mentorship within healthcare education is well recognised, offering a means to further enhance leadership and engagement within the workforce [ 28 ].

Reading about leadership e.g. theories on leadership styles
Attending leadership training workshops
Participating in mentorship programs either as mentee or mentor
Joining small group seminars on leadership development
Accepting more responsibilities when required, or when opportunities arise.

Process for effective leadership

Organisation to ensure an understanding of tasks, priorities and deadlines
Establish steps and a sequence to achieve the desired outcomes
List required resources, considering the competencies of individual team members, and match tasks appropriately (also consider skill development needs)
Communicate with team members, monitor progress in activities and provide guidance to team members.

Take-home message

Acknowledgements, about this supplement.

Abbreviation

Authors’ contributions.

No funding was received.

Availability of data and materials

Ethics approval and consent to participate, consent for publication, competing interests.

The authors have no competing interests to declare.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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