No abstract

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

Purpose This first phase of a three-phase action research project aims to define leadership practices that should be used during and after the pandemic to re-imagine and rebuild the health and social care system. Specifically, the objectives were to determine what effective leadership practices Canadian health leaders have used through the first wave of the COVID-19 pandemic, to explore how these differ from pre-crisis practices; and to identify what leadership practices might be leveraged to create the desired health and care systems of the future. Design/methodology/approach The authors used an action research methodology. In the first phase, reported here, the authors conducted one-on-one, virtual interviews with 18 health leaders from across Canada and across leadership roles. Data were analyzed using grounded theory methodology. Findings Five key practices emerged from the data, within the core dimension of disrupting entrenched structures and leadership practices. These were, namely, responding to more complex emotions in self and others. Future practice identified to create more psychologically supportive workplaces. Agile and adaptive leadership. Future practice should allow leaders to move systemic change forward more quickly. Integrating diverse perspectives, within and across organizations, leveling hierarchies through bringing together a variety of perspectives in the decision-making process and engaging people more broadly in the co-creation of strategies. Applying existing leadership capabilities and experience. Future practice should develop and expand mentorship to support early career leadership. Communication was increased to build credibility and trust in response to changing and often contradictory emerging evidence and messaging. Future practice should increase communication. Research limitations/implications The project was limited to health leaders in Canada and did not represent all provinces/territories. Participants were recruited through the leadership networks, while diverse, were not demographically representative. All interviews were conducted in English; in the second phase of the study, the authors will recruit a larger and more diverse sample and conduct interviews in both English and French. As the interviews took place during the early stages of the pandemic, it may be that health leaders’ views of what may be required to re-define future health systems may change as the crisis shifts over time. Practical implications The sponsoring organization of this research – the Canadian Health Leadership Network and each of its individual member partners – will mobilize knowledge from this research, and subsequent phases, to inform processes for leadership development and, succession planning across, the Canadian health system, particularly those attributes unique to a context of crisis management but also necessary in post-crisis recovery. Social implications This research has shown that there is an immediate need to develop innovative and influential leadership action – commensurate with its findings – to supporting the evolution of the Canadian health system, the emotional well-being of the health-care workforce, the mental health of the population and challenges inherent in structural inequities across health and health care that discriminate against certain populations. Originality/value An interdisciplinary group of health researchers and decision-makers from across Canada who came together rapidly to examine leadership practices during COVID-19’s first wave using action research study design.

The COVID-19 pandemic is now endemic and has taken a terrible toll on the health workforce and its leaders. Stress and burnout are rampant, and health workers are leaving in record numbers. Using data collected during the first four waves of the pandemic, and a longitudinal analysis of these data, the authors identify ongoing challenges to health leadership related to building resilience and psychologically healthy workplaces. The paper is organized around three questions: What happened during Waves 1 to 4? What did we learn? And what should be done differently? Eight actions emerged around the theme of “leaders supporting leaders”: build personal resilience; practice compassionate leadership; model effective interpersonal leadership behaviour; ensure frequent and authentic communication; participate in networks and communities of practice; balance short- and long-term commitments; apply systems thinking; and contribute to a collaborative, national strategy.

COVID-19 has created a unique context for the practice of leadership in healthcare. Given the significant use of the LEADS in a Caring Environment capabilities framework (LEADS) in Canada’s health system, it is important to document the relevancy of LEADS. The authors reviewed literature, conducted research, and reflected on their own experience to identify leadership practices during the pandemic and related them to LEADS. Findings are presented in three sections: Hindsight (before), Insight (during), and Foresight (post). We profile the issue of improving Long-Term Care to provide an example of how LEADS can be applied in crisis times. Our analysis suggests that while LEADS appears to specify the leadership capabilities needed, it requires adaptation to context. The vision Canada has for healthcare will dictate how LEADS will be used as a guide to leadership practice in the current context or to shape a bolder vision of healthcare’s future.