Complex Leadership in Healthcare: A Scoping Review

Belrhiti, Zakaria; Giralt, Ariadna Nebot; Marchal, Bruno

doi:10.15171/ijhpm.2018.75

Cited by 66 publications

(94 citation statements)

References 73 publications

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“…He also disciplined the space by using an agenda to systematise the processes in the meeting and drew on distributed leadership to create an environment that reinforced the overall goal (64). As these experiences demonstrate, complexity-sensitive managers adopt a contingency approach to leadership, balancing transactional, transformational and distributed leadership styles based on the needs, the situation and the problem at hand , adapting leadership practices as required in particular contexts (36). A study on the daily management practices of sub district managers in South Africa found, for example, that improving practices in daily routines, such as facilitation styles in meetings, minute taking, etc.…”

Section: Sensegiving and Social Sensemakingmentioning

confidence: 99%

“…This has resulted in the development of many managerial competency frameworks (28)(29)(30)(31) and the delineation of the twelve practices of managers, grouped as (1) leading (2) managing (3) and governing (13). Over time, as the DHS has come to be recognised as a complex adaptive system (CAS) (32)(33)(34), understanding of the competencies and capabilities that district managers need has evolved (10,(35)(36)(37)(38). As a result, capacity development efforts have moved beyond a traditional focus on administrative management and health professional practice training.…”

Section: Introductionmentioning

confidence: 99%

“…and softer competencies (communication, trust building, networking etc.) (20,35,36,(39)(40)(41)(42), and intersections with the organisational environment (19,43). The recognition of complexity demands different ways of managing and measuring capacity development interventions.…”

Section: Introductionmentioning

confidence: 99%

“…There are several calls for further research on management and leadership capacity in the DHS. These identify as important the role and capacity of middle managers in bridging policy and practice, how management practices become part of organisational routines, 'how' capacity development interventions work for managers in diverse settings, more knowledge on complex leadership and strategic management of the health workforce and operational research on how to develop capacity in decentralised systems (8,16,20,36,(46)(47)(48).…”

Section: Introductionmentioning

confidence: 99%

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Bottom Up Innovation for Health Management Capacity Development: a Qualitative Case Study in a South African Health District

Orgill

Marchal

Shung-King

et al. 2020

Preprint

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Background As part of health system strengthening in South Africa (2012- 2017) a new district health manager, taking a bottom-up approach to developing managerial capacity, developed a suite of innovations to improve the processes and practices of managers and NGO partners in monthly district management team meetings. Using a systems perspective on capacity development, the research explored the initial sensemaking by the district manager, how these homegrown innovations interacted with existing social processes and norms, the mechanisms for change that were triggered and the emergent capacity outputs. Methods We conducted a realist evaluation complemented by a case study approach over a two-year period (2013-2015) in the district. The initial programme theory development included ten senior manager interviews and literature review. To understand processes and mechanisms triggered in local context and identify emergent capacity outputs we conducted fifteen interviews with managers in the management team and with seven non-state actors, supplemented by researcher notes and time spent in the district. Thematic analysis was conducted using the Context-Mechanism-Outcome -Actor configuration alongside theoretical constructs. Results The new district manager drew on complex frames, tacit and experiential knowledge to design bottom up innovations, and collective capacity development was triggered through micro-practices of sensemaking and sense-giving. Sensegiving included using sticks (positional authority, enforcement of policies, over-coding), intentionally providing justification for change and setting the scene (a new agenda, distributed leadership). These micro practices, managers engaging with the new practices and social sense-making, influenced the motivation of managers and partners to further participate in new meeting practices, and triggered a generative process of buy-in and emergent capacity in a routine meeting structure. Conclusion District managers are well placed to design local level capacity development innovations and must draw on multiple knowledge forms to enable relevant ‘bottom-up’ capacity development in complex health systems. Managers must draw on their intangible soft skills and the tangible policy resources (hardware) of the system to influence motivation and buy-in for improved management practices. From a systems perspective, we argue that capacity development can be conceived of as part of the daily activity of managing in routine spaces, to unleash capacity.

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Section: Sensegiving and Social Sensemakingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Bottom Up Innovation for Health Management Capacity Development: a Qualitative Case Study in a South African Health District

Orgill

Marchal

Shung-King

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…The involvement of FLNMs is central to the development of structures and cultures to improve patient safety and achieve sustained quality in nursing care [1]. There is growing awareness of the complexity perspective in healthcare among scholars, academics, practitioners, and policy-makers [7] and of how different types of leadership influence outcomes [8]. Within healthcare generally and QI work specifically, adaptive leadership that regards human interaction [9] and is responsive, flexible, and open to change [4], seems to be more useful than leadership based on control [4].…”

Section: Introductionmentioning

confidence: 99%

“Navigation to prioritizing the patient” – first-line nurse managers’ experiences of participating in a quality improvement collaborative

Sjølie

Hartviksen

Bondas

2020

BMC Health Serv Res

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Background: First-line nurse managers are central to quality improvement work when changing work practices into better patient outcomes. Quality improvement collaboratives have been adopted widely to support quality management in healthcare services and shared learning. We have little knowledge of the first-line nurse managers' own perspectives concerning their need for support and knowledge in quality improvement work. Therefore, the aim of this study was to gain understanding of first line nurse managers' experiences in leading quality improvement work in their own organization when participating in a quality improvement collaborative. Methods: An interpretive approach was chosen following Graneheim and Lundman's qualitative content analysis. Data was collected through three focus group interviews with first-line nurse managers representing different workplaces: the local hospital, a nursing home, and a homecare service in a rural area of Norway. Results: "Navigation to prioritizing the patient" emerged as an overarching metaphor to describe the first-line nurse managers experiences of leading quality improvement work, based on three themes: 1) fellowship for critical thinking and prioritizing the patient; 2) mastering the processes in quality improvement work; and 3) the everyday reality of leadership as a complex context. Conclusions: A quality improvement collaborative encompassing knowledge transfer and reflection may create an important fellowship for health care leaders, encouraging and enabling quality improvement work in their own organization. It is crucial to invite all leaders from an organization to be able to share the experience and continue their collaboration with their staff in the organization. Continuity over time, following up elements of the quality improvement work at joint meetings, involvement by users, and self-development of and voluntary involvement in the quality improvement collaborative seem to be important for knowledge development in quality improvement. The supportive elements of the quality improvement collaborative fellowship were crucial to critical thinking and to the first-line nurse managers' own development and security in mastering the quality improvement work processes. They preferred prioritizing the patients in quality improvement work, despite haste and obstructive situations in an everyday context.

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The need for management education of healthcare management employees

Jankelová

Joniaková

Romanová

2021

Health Planning & Management

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SummaryGiven the wide professional discussion on the dominating professional focus of healthcare managers at the expense of management knowledge, the main goal of this paper is to verify the extent, to which management education of healthcare workers affects the level of their management skills.MethodologyThe Descriptive statistics methods have been used to answer research questions regarding the differences in the perception of the managerial skills and their disposition importance between managers with a completed management education and without it. Emphasis was placed on people management skills and communication skills. The research sample consisted of 253 healthcare managers.ResultsManagers with a completed specialized management study are characterized by higher values of entrepreneurial competences and communication skills. They also have exceptional skills in the area of initiator of change. Another significant difference is the higher adaptation of roles and low critique of their subordinates. They are oriented at workers and relationships with them.ConclusionOur results show that management education of healthcare managers significantly contributes to the implementation of newer approaches to people management and the use of the necessary management skills, which are a source of higher efficiency in the context of the present world of work and its challenges.

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Complex Leadership in Healthcare: A Scoping Review

Cited by 66 publications

References 73 publications

Bottom Up Innovation for Health Management Capacity Development: a Qualitative Case Study in a South African Health District

Bottom Up Innovation for Health Management Capacity Development: a Qualitative Case Study in a South African Health District

“Navigation to prioritizing the patient” – first-line nurse managers’ experiences of participating in a quality improvement collaborative

The need for management education of healthcare management employees

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