Policy options to improve leadership of middle managers in the Australian residential aged care setting: a narrative synthesis

Abstract

BackgroundThe prevalence of both chronic diseases and multi-morbidity increases with longer life spans. As Australia's population ages, the aged care sector is under increasing pressure to ensure that quality aged care is available. Key to responding to this pressure is leadership and management capability within the aged care workforce. A systematic literature review was conducted to inform the policy development necessary for the enhancement of clinical and managerial leadership skills of middle managers within residential aged care.MethodsUsing scientific journal databases, hand searching of specialist journals, Google, snowballing and suggestions from experts, 4,484 papers were found. After a seven-tiered culling process, we conducted a detailed review (narrative synthesis) of 153 papers relevant to leadership and management development in aged care, incorporating expert and key stakeholder consultations.Results• Positive staff experiences of a manager's leadership are critical to ensure job satisfaction and workforce retention, the provision of quality care and the well-being of care recipients, and potentially a reduction of associated costs.• The essential attributes of good leadership for aged care middle management are a hands-on accessibility and professional expertise in nurturing respect, recognition and team building, along with effective communication and flexibility. However, successful leadership and management outcomes depend on coherent and good organisational leadership (structural and psychological empowerment).• There is inadequate preparation for middle management leadership roles in the aged care sector and a lack of clear guidelines and key performance indicators to assess leadership and management skills.• Theory development in aged care leadership and management research is limited. A few effective generic clinical leadership programs targeting both clinical and managerial leaders exist. However, little is known regarding how appropriate and effective they are for the aged care sector.ConclusionsThere is an urgent need for a national strategy that promotes a common approach to aged care leadership and management development, one that is sector-appropriate and congruent with the philosophy of person-centred care now predominant in the sector. The onus is on aged care industries as a whole and various levels of Government to make a concerted effort to establish relevant regulation, legislation and funding.

Liderazgo en los servicios de salud

“…Los atributos esenciales de un buen liderazgo de los mandos intermedios favorecen la construcción de una cultura organizacional con respeto, el valor del reconocimiento y el trabajo en equipo, así como la comunicación efectiva y la flexibilidad. Sin embargo, el éxito del liderazgo y los resultados de la gestión dependen de una buena organización de los procesos de liderazgo y la formación de los lideres, ya que no existe una preparación adecuada para ocupar cargos directivos de mandos medios en el sector y la falta de una clara directriz y estandarización de indicadores clave de rendimiento para evaluar las habilidades de liderazgo y gestión (44).…”

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

“…218 Moreover, positive staff experiences of their managers' leadership are critical to workforce retention, 219 thus demonstrating that the care industry may be undermined by a vicious circle where managers are overwhelmed with dealing with high turnover and staff cannot be retained because of the limited encouragements made by their managers. Consistent with the international literature, our study also demonstrates that leadership in care homes remains key to the sustainability of service improvements in care homes, [219][220][221] with additional benefits to stabilisation in the workforce. 222 Also consistent with the literature, 223 supervision from a specialist was seen as important, but in this case care is needed to avoid the negative effects on staff of reduced supervision and support from their own managers in the home.…”

Setting a course: A critical review of the literature on nurse leadership in Australia

“…Hierarchical traditional structures co-exist with new nursing roles such as nurse practitioners, who with expertise and a remit to influence health care can be easily identified as being leaders who build care teams and generate professional respect (Gardner, Carryer, Gardner, & Dunn, 2006). Simultaneously, the same nurse practitioner may not be actively engaged in wider organizational leadership roles such as work force retention or overarching care quality provision (Jeon, Glasgow, Merlyn, & Sansoni, 2010).…”

“…Contrasting these aspirations for nursing in Australia against the means to develop nurse leaders potentially offers partial explanation to the arguably fragmented and hesitant pace of expanding nursing leadership. As highlighted by Jeon et al (2010) in their narrative synthesis, there is no single national institute for nursing leadership and leadership is often immersed within other aspects of university nurse education, rather than being distinctive and prominent. This theme of diffused approaches to nurse leadership preparation is evident in the literature on leadership models for nurse in Australia.…”