The evaluation of health care leadership development programmes: a scoping review of reviews

Abstract

Purpose The purpose of this paper is to report a scoping review of reviews which investigated HLDP evaluations to determine: how the conceptualisation of leadership development programmes (HLDPs), and despite growing calls for robust evaluations of their pedagogic design, delivery and effectiveness, there are concerns regarding the quality of data associated with their evaluation. This scoping review of reviews investigated the reporting of HLDP evaluations to determine: how the conceptualisation of leadership underpinning HLDPs influence their evaluation; how the pedagogical approaches within HLDPs influence their evaluation; and the evaluation designs and measures used to assess HLDPs. Design/methodology/approach The scoping review was conducted on reviews of HLDPs. Searches were performed on four databases and on the grey literature. Data were extracted and a narrative synthesis was developed. Findings Thirty-one papers were included in the scoping review of reviews. A great deal of heterogeneity in HLDPs was identified. Evaluations of HLDPs were affected by poor data quality, and there were limitations in the evidence about “what works”. Leadership was conceptualised in different ways across HLDPs, and consequently, there was a lack of consistency as to what is being evaluated and the methods used to assess HLDPs. Originality/value This review of reviews summarises the current evidence on the evaluation of HLDPs. Evaluations of HLDPs need to explicitly account for the complexity of health systems, how this complexity impacts on the development and articulation of leadership practice, and how the underlying conceptualisation of leadership and the associated theory of change articulate a set of assumptions about how HLDPs support leaders to affect change within complex systems.

What keeps you up at night? Moral distress in nurse leaders in the USA, Germany, Austria and Switzerland

“…According to Morley et al (2019), the presence of constrained moral judgment is both a necessary and sufficient condition and the literature offers innumerable publications focusing on moral distress in nurses (Al-Majid et al, 2018;Epstein and Delgado, 2010;Lown, 2018;Nikbakht Nasrabadi, 2021;Pavlish et al, 2016;Rodney, 2017;Wocial and Weaver, 2013). However, there is much less written on moral distress in nurse leaders as they are also challenged by ethical issues such as inadequate staffing, inappropriate end-of-life care, discrimination, harassment, unethical accounting, lack of voice, data privacy, health and safety in today's complex health-care settings (Atli Özbas and Kovanci, 2022;Burn and Waring, 2022;Drago et al, 2020;Ganz et al, 2015;Mitton et al, 2010;Whitehead et al, 2021). These ethical issues tend to interfere with the principles of nursing and nursing leadership and can be described as situations occurring as a consequence of a moral conflict that must be addressed, such as situations at the threshold between patient care and higher levels of administration.…”

“…Furthermore, the research literature is void on multicountry comparative studies (although there are several publications that focus on ethical issues and moral distress among nurse leaders within single countries, such as Atli Özbas and Kovanci, 2022;Burn and Waring, 2022;Drago et al, 2020;Ganz et al, 2015;Mitton et al, 2010;Whitehead et al, 2021) looking to identify similarities and differences on a cross-national comparative level in causes of moral distress as nurse leaders have additional responsibility to be a resource, preceptor, mentor and leading role model for their nursing employees. Therefore, ethical issues and moral distress can negatively impact organizational leadership practices, professional integrity and workplace cultures, causing nurse leaders to avoid certain work situations and ultimately leave their leadership position and/or the nursing profession.…”

“…At the same time, however, nurse leaders are challenged by ethical issues involving the principles of beneficence, nonmaleficence, respect for autonomy and justice. As such, they must be competent in ethical decision-making to successfully maneuver in today's health-care settings, which includes managing advances in health-care technology, practicing within economical constraints that often appear diametrically opposed to delivering high-quality care, and facing complex ethical situations (Atli Özbas and Kovanci, 2022;Burn and Waring, 2022;Drago et al, 2020;Ganz et al, 2015;Mitton et al, 2010;Stanley and Stanley, 2018). Consequently, nurse leaders are not immune to experiencing moral distress, as demonstrated in the study by Prestia et al (2017, p. 103), who validated and identified six experiential themes: "lacking psychological safety, feeling a sense of powerlessness, seeking to maintain a moral compass, drawing strength from networking, moral residue, and living with the consequences."…”

“…In addition, the same authors identified that the authorities of health-care settings are obligated to acknowledge and address moral distress as nurse leaders want to fulfill their responsibilities to create healthy work environments. Burn and Waring (2022) also recommend that evaluations of leadership development programs should be less descriptive and focus on theoretical underpinnings while developing "approaches to evaluation that account for the complexity of leadership in a health system" (p. 330).…”

“…Similarly, there exists The Code of Ethics and Conduct for European Nursing, which was developed by European Federation of Nursing Regulators (Sasso et al, 2008), and the International Council of Nursing's (ICN, 2021) ICN Code of Ethics for Nurses. Despite these normative documents designed to guide ethical analysis and provide an ethical decision-making framework, nurse leaders in clinical practice or administrative roles continue to report that they experience high levels of moral distress (Atli Özbas and Kovanci, 2022;Burn and Waring, 2022;Drago et al, 2020;Ganz et al, 2015;Mitton et al, 2010;Prestia et al, 2017;Whitehead et al, 2021). Furthermore, moral reasoning and ethical decisionmaking are necessary requirements for nurse leaders to possess, yet there are no consistent methods for teaching and developing these leadership skills (van Knippenberg and Sitkin, 2013).…”