Knowledge management as a mediator for the efficacy of transformational leadership and quality management initiatives in U.S. health care

Personal and organisational attributes that support transformational leadership in acute healthcare: scoping review

Objective Transformational leadership benefits both patients and staff. The objective of this scoping review was to explore personal and organisational attributes that support transformational leadership in acute health care. Methods A scoping review was undertaken using Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, Medline Complete, PsycInfo and Emerald Insight databases. Search terms were related to transformational leadership and acute care hospitals. Results A total of 18 studies were included: 14 reported personal attributes and 8 reported organisational attributes supporting transformational leadership. The most common personal attributes were manager educational preparation (n  = 5), years of management experience (n  = 4), age (n  = 3) and emotional intelligence (n  = 3). The most common organisational attributes reported were larger organisational size (n  = 2) and culture (n  = 2). Personal (manager) attributes were synthesised into the following categories: demographics, role characteristics, leadership preparation and traits. Organisational attributes were categorised as manager support, organisational characteristics and organisational processes. Conclusions Despite the beneficial outcomes of transformational leadership for patients, staff and organisations, the personal and organisational attributes supporting transformation leadership are not well understood.

An emerging knowledge management framework adopted by healthcare workers in China to combat COVID ‐19

This study examines elements of knowledge management (KM) applied during the treatment of the coronavirus disease 2019 (COVID‐19) and proposes a KM framework that can be applied to respond quickly to a new virus outbreak. Following a content analysis of the press conferences held in China, this study found that various elements of KM, including strategic KM, the knowledge codification strategy vs. the knowledge personalization strategy, a knowledge‐friendly culture, knowledge‐based leadership, KM‐based human resource management, and KM‐related information technologies, were widely used by Chinese authorities and healthcare workers to improve treatment effectiveness for COVID‐19 patients. This paper provides a unique case study on how KM helps the government and the healthcare workers to respond to an unexpected public hygiene crisis.ⁱ

Sustainability of Nursing Leadership and Its Contributing Factors in a Developing Economy: A Study in Mongolia

The sustainability of nursing leadership is a very important problem. Every country continually strives to find the best ways to advance in nurse management and patient care services. Nursing leadership is most desirable in the delivery of health care services. Since there is limited information about leadership skills in Mongolia, to solve the problem of the sustainability of nursing leadership, we carried out this study to explore factors contributing to the sustainability of nursing leadership and their correlation relatively to nurse managers in healthcare institutions. A sample of 205 nurse managers from all forms of health facilities participated in this study. The data were analyzed by descriptive, correlation, and multiple linear regression models using SPSS 19 version. The linear combination of the five independent variables was significantly related to the dependent variable (nurse leadership). Both the behavior and problem-solving are significant regressors of the dependent variable. The correlation analysis significance of the independent study variables, two were found to have a significant effect on nursing leadership: behavior and performance of nurses significantly and positively effect nursing leadership. The transformational role and nurse leadership produced a significantly positive Correlation coefficients give a direction of causation in the relationships of variables, and the multiple linear regression analysis says that two of the variables, namely, behavior and problem-solving, positively contribute to nursing leadership, two of the variables namely, work environment and performance nurse manager do not support; however, variable transformational ability majorly contributes to the sustainability of nursing leadership.

The Effects of Transformational Leadership on Organizational Performance: Testing the Mediating Effects of Knowledge Management

Transformational leadership is a sustainable and exemplary form of leadership that liberates subordinates’ ideas, enables subordinates to view problems from a different perspective, helps adaptation to changing environments, and increases Human Resources Management effectiveness in public and service institutions. The effects of transformational leadership on organizational performance by means of knowledge management have been examined in this study on the northern Cyprus Security Forces. In addition, the study aims to analyze the relationships between transformational leadership, knowledge management, organizational performance, job satisfaction, organizational learning, and knowledge creation processes. The questionnaire was conducted in three different periods using a time-lag method, and data were collected from 1229 employees for this study. The collected data were analyzed using structural equation modeling (Lisrel 8.54). The findings of the research include 17 hypotheses that were supported, and 1 hypothesis that was not. In addition, it was determined that organizational learning, knowledge management, and job satisfaction mediate the effect of transformational leadership on organizational performance.

A multi-level perspective on trust, collaboration and knowledge sharing cultures in a highly formalized organization

Purpose

The purpose of this study is to investigate organizational culture’s perceived importance and practice as it unfolds across hierarchal layers of a formalized organization. Organizational culture is important in innovation and change and becomes significant if its importance and practice are shared across all levels of an organization. Highly formalized organizations are not an exception to this. Yet, there is a shortage of empirical evidence on how the organizational culture’s perceived importance and practice unfold across the senior-management, middle-management and operational levels of a formalized organization.

Design/methodology/approach

Applying a theoretical frame incorporating information asymmetry, knowledge sharing and cultural participation, this paper examined three important facets of culture, namely, trust, collaboration and knowledge-sharing. Using a Jordanian bank’s case study, this paper collected data using a mixed-methods approach; quantitative to identify variations across levels and, subsequently, qualitative to explore the nuanced patterns in the perceived importance and practice of the three facets across different organizational levels in the context of a formalized organization.

Findings

The findings suggest that the importance and practice of the three cultural facets are shared, as well as differentiated across organizational levels based on purposiveness, person/situation-dependency and nature of work and nature/relevance of knowledge.

Originality/value

Using a multi-level lens provided insight not yet gained by current work in the field. This allowed us to unearth nuanced differences in the perception of organizational culture across organizational hierarchies. The paper contributes to the scholarship on organizational culture in the context of formalized organizations and to managerial practice by offering insights on how a shared practice of trust, collaboration and knowledge sharing is distributed across organizational levels, not captured before. This paper also suggests propositions related to each of three cultural facets, not spelled out before.

Sustainable Quality Management Systems in the Current Paradigm: The Role of Leadership

This study supports the proposition that sustainability’s integration into Quality Management Systems (QMS) could be a viable pathway to the development of the Emergency paradigm, in which leadership plays a crucial role. A Systematic Literature Review (SLR) was performed in order to deepen leadership’s relationship with Quality Management (QM) from an evolutionary perspective. An exploratory survey was then conducted to assess quality managers’ perceptions of sustainability’s integration into QMS and their leadership styles, using the 5X Short Leader Form MLQ instrument. The results indicate that leadership is a critical element of QMS performance, enhancing transformational leadership, which appears to be the dominant self-perceived style of the quality managers who participated. Nevertheless, these practitioners recognise the difficulties in committing all employees to the sustainability journey. The theoretical and managerial implications give rise to this work. The SLR results could be a useful database to support future QM and Leadership research. The organisations could follow the suggested pathway to evolve their QMS to support solutions to some of the current challenges. At the same time, quality managers could reflect on their future professional challenges. This work has taken a step forward, indicating sustainable quality management systems as a viable pathway to explore QM knowledge regarding the Emergency paradigm, and thus enhancing leadership’s role.

Servant Leadership, Innovative Capacity and Performance in Third Sector Entities

This paper analyses the relationship between servant leadership, innovative capacity and performance in Third Sector entities and proposes a mediation model. This research is based on a two-fold theoretical approach: the servant leadership approach and the resource-based approach. The data have been obtained through a survey sent to territorial and functional managers of Third Sector entities. The fieldwork ran from June to September 2019. At the end of the entire process, 85 valid questionnaires were obtained. For the analysis of the results, a double methodology has been used: (1) a method of second order structural equations (PLS-SEM) and, (2) qualitative comparative analysis (QCA). The main contributions of this work are: 1) a double theoretical approach has been applied in this work, which has allowed to adequately define the relationships between servant leadership, innovation capacity and performance in Third Sector entities; (2) the application of a double data analysis methodology has allowed us to obtain robust and reliable results; (3) the measures of the three composites used (servant leadership, innovative capacity and performance) have adequate reliability and validity values; (4) the servant leadership positively influences the performance of Third Sector entities being able to explain the 35.6% of the variation of the performance of these entities and besides, it is a necessary condition for this performance to take place, (5) the average innovative capacity in the influence of the servant leadership in the performance of the entities of the Third Sector, being a necessary condition. Mediation is total, eliminating the direct effect of servant leadership on the performance of third Sector entities and increasing the capacity to explain the variation in the performance of Third Sector entities up to 44.7%.

Transformational leadership and employee knowledge sharing: explore the mediating roles of psychological safety and team efficacy

Purpose

This paper aims—based on past research works which have shown that transformational leadership has positive impact on knowledge sharing—to explore the impact of different leadership dimensions of transformational leadership on knowledge sharing and further to explore the mechanism through which transformational leadership affects employee knowledge sharing in China.

Design/methodology/approach

Based on the transformational leadership theory and the team learning theory, it is proposed that all four dimensions of transformational leadership, including intellectual stimulation, individualized consideration, inspirational motivation and idealized influence, have unique impact on employee knowledge sharing. It is further proposed that psychology safety and team efficacy mediate these relationships. Then data were collected from over 400 employees from knowledge-based companies in China to empirically test the proposed relationships with the method of structural equation modeling.

Findings

The results show that psychological safety fully mediated the impact of intellectual stimulation on knowledge sharing, and team efficacy fully mediated the impact of inspirational motivation on knowledge sharing. Both factors also mediated the impact of individualized consideration on knowledge sharing. The results thus provide empirical support for the impact of transformational leadership on employee knowledge sharing in an international context.

Originality/value

The past years have seen increasing interest in leadership and knowledge sharing in emerging markets, yet the mechanism through which leadership affects employee knowledge sharing remains understudied. This study explores the impact of different dimensions of transformational leadership on employee knowledge sharing, and further shows that psychological safety and team efficacy mediate these relationships in a collectivistic society where knowledge sharing is consistent with cultural norms. The findings help develop more robust knowledge sharing theories in the international context and provide insightful suggestions for management practitioners in emerging markets.

Modeling the Pathways of Knowledge Management Towards Social and Economic Outcomes of Health Organizations

Despite the increasing emphasis placed on knowledge management (KM) by the business sector and the common belief that creating, acquiring, sharing, and the use of knowledge enable individuals, teams, and communities to achieve superior performance, within the healthcare context, there is still room from improvements from both the theoretical and empirical perspectives. The purpose of this paper is to outline the contribution of KM process to the social- and economic-related outcomes in the context of health organizations. Given the theoretical approach on the considered concepts and their relationships, a conceptual model and seven research hypotheses were proposed. The empirical data were provided by a cross-sectional investigation including 459 medical and nonmedical employees of Romanian heath organizations, selected by a mixed method sampling procedure. A partial least squares structural equation modeling (PLS-SEM) approach was selected to provide information on the relevance and significance of the first- and second-order constructs, test the hypotheses, and conduct an importance performance matrix analysis. The PLS-SEM estimation showed positive and significant relationships between KM process and quality of healthcare, and organizational-level social and economic outcomes. Moreover, the research results provided evidences for the complex complementary mediation of the quality of healthcare and social-related outcomes on the relationships between KM process and social and economic outcomes. The theoretical and managerial implications are discussed and suggestions for future research are provided at the end of the paper.

Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review

BACKGROUND

Leadership is critical in building quality work environments, implementing new models of care, and bringing health and wellbeing to a strained nursing workforce. However, the nature of leadership style, how leadership should be enacted, and its associated outcomes requires further research and understanding. We aimed to examine the relationships between various styles of leadership and outcomes for the nursing workforce and their work environments.

METHODS

The search strategy of this systematic review included 10 electronic databases. Published, quantitative studies that examined the correlations between leadership behaviours and nursing outcomes were included. Quality assessments, data extractions and analysis were completed on all included studies by independent reviewers.

RESULTS

A total of 50,941 titles and abstracts were screened resulting in 129 included studies. Using content analysis, 121 outcomes were grouped into six categories: 1) staff satisfaction with job factors, 2) staff relationships with work, 3) staff health & wellbeing, 4) relations among staff, 5) organizational environment factors and 6) productivity & effectiveness. Our analysis illuminated patterns between relational and task focused leadership styles and their outcomes for nurses and nursing work environments. For example, 52 studies reported that relational leadership styles were associated with higher nurse job satisfaction, whereas 16 studies found that task-focused leadership styles were associated with lower nurse job satisfaction. Similar trends were found for each category of outcomes.

CONCLUSIONS

The findings of this systematic review provide strong support for the employment of relational leadership styles to promote positive nursing workforce outcomes and related organizational outcomes. Leadership focused solely on task completion is insufficient to achieve optimum outcomes for the nursing workforce. Relational leadership practices need to be encouraged and supported by individuals and organizations to enhance nursing job satisfaction, retention, work environment factors and individual productivity within healthcare settings.

Knowledge management, health information technology and nurses' work engagement

BACKGROUND

Knowledge management (KM) extends the health information technology (HIT) literature by addressing its impact on creating knowledge by sharing and using the knowledge of health care professionals in hospitals.

PURPOSE

The aim of the study was to provide insight into how HIT affects nurses' explicit and tacit knowledge of their ongoing work processes and work engagement.

METHODOLOGY

Data were collected from 74 nurses in four wards of a Dutch hospital via a paper-and-pencil survey using validated measurement instruments. In a quasiexperimental research design, HIT was introduced in the two experimental wards in contrast to the two control wards. At the time of the HIT introduction, a pretest was administered in all four wards and was followed by a posttest after 3 months. Data were analyzed via partial least squares modeling.

RESULTS

Generally, nurses' tacit knowledge (i.e., their insight into and their capacity to make sense of the work processes) appears to be a significant and strong predictor of their work engagement. In contrast, nurses' explicit knowledge (i.e., information feedback about patients and tasks) only indirectly affects work engagement via its effect on tacit knowledge. Its effect on work engagement therefore depends on the mediating role of tacit knowledge. Interestingly, introducing HIT significantly affects only nurses' explicit knowledge, not their tacit knowledge or work engagement.

PRACTICE IMPLICATIONS

Nurses' tacit and explicit knowledge needs to be systematically distinguished when implementing HIT/KM programs to increase work engagement in the workplace. Tacit knowledge (insight into work processes) appears to be pivotal, whereas efforts aimed only at improving available information will not lead to a higher level of work engagement in nurses' work environments.

Return on investment in healthcare leadership development programs

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.

Towards a taxonomy for integrated care: a mixed-methods study

INTRODUCTION

Building integrated services in a primary care setting is considered an essential important strategy for establishing a high-quality and affordable health care system. The theoretical foundations of such integrated service models are described by the Rainbow Model of Integrated Care, which distinguishes six integration dimensions (clinical, professional, organisational, system, functional and normative integration). The aim of the present study is to refine the Rainbow Model of Integrated Care by developing a taxonomy that specifies the underlying key features of the six dimensions.

METHODS

First, a literature review was conducted to identify features for achieving integrated service delivery. Second, a thematic analysis method was used to develop a taxonomy of key features organised into the dimensions of the Rainbow Model of Integrated Care. Finally, the appropriateness of the key features was tested in a Delphi study among Dutch experts.

RESULTS

The taxonomy consists of 59 key features distributed across the six integration dimensions of the Rainbow Model of Integrated Care. Key features associated with the clinical, professional, organisational and normative dimensions were considered appropriate by the experts. Key features linked to the functional and system dimensions were considered less appropriate.

DISCUSSION

This study contributes to the ongoing debate of defining the concept and typology of integrated care. This taxonomy provides a development agenda for establishing an accepted scientific framework of integrated care from an end-user, professional, managerial and policy perspective.

A review on leadership of head nurses and patient safety and quality of care

PURPOSE

The purpose of the study was to explore in literature what different leadership styles and behaviors of head nurses have a positive influence on the outcomes of patient safety or quality of care.

DESIGN/METHODOLOGY/APPROACH

We reviewed the literature from January 2000 until September 2011. We searched Pubmed, Embase, Cinahl, Psychlit, and Econlit.

FINDINGS

We found 10 studies addressing the relationship between head nurse leadership and safety and quality. A wide array of styles and practices were associated with different patient outcomes. Transformational leadership was the most used concept in the studies. A trend can be observed over these studies suggesting that a trustful relationship between the head nurse and subordinates is an important driving force for the achievement of positive patient outcomes. Furthermore, the effects of these trustful relationships seem to be amplified by supporting mechanisms, often objective conditions like clinical pathways and, especially, staffing level.

VALUE/ORIGINALITY

This study offers an up-to-date review of the limited number of studies on the relationship between nurse leadership and patient outcomes. Although mostly transformational leadership was found to be responsible for positive associations with outcomes, also contingent reward had positive influence on outcomes. We formulated some comments on the predominance of the transformational leadership concept and suggested the application of complexity theory and political leadership for the current context of care. We formulated some implications for practice and further research, mainly the need for more systematic empirical and cross cultural studies and the urgent need for the development of a validated set of nurse-sensitive patient outcome indicators.

Discussion of patient-centered care in health care organizations

The tradition of inherent knowledge and power of health care providers stands in stark contrast to the principles of self-determination and patient participation in patient-centered care. At the organizational level, patient-centered care is a merging of patient education, self-care, and evidence-based models of practice and consists of 4 broad domains of intervention including communication, partnerships, health promotion, and physical care. As a result of the unexamined discourse of knowledge and power in health care, the possibilities of patient-centered care have not been fully achieved. In this article, we used a critical social theory lens to examine the discursive influence of power upon the integration of patient-centered care into health care organizations. We begin with an overview of patient-centered care, followed by a discussion of the various ways that it has been introduced into health care organizations. We proceed by deconstructing the inherent power and knowledge of health care providers and shed light on how these long-standing traditions have impeded the integration of patient-centered care. We conclude with a discussion of viable solutions that can be used to implement patient-centered care into health care organizations. This article presents a perspective through which the integration of patient-centered care into health organizations can be examined.

The Role of Transformational Leadership Styles in the Home Health Care Industry

The concept of transformational leadership styles has been popular in medical communities in recent years but very limited information is available in the literature on the role of transformational leadership in relation to workplace performance among home health aides. A secondary data analysis was conducted using the 2007 National Home Health Aides Survey ( n = 1,828). A multivariate regression analysis was performed to estimate the association of transformational leadership styles with workplace performance among home health aides. Transformational leadership styles were positively linked to performance in reducing injury, increasing career satisfaction, and choosing their career again if they had to choose. Our finding suggests that introducing transformational leadership practices may benefit home health aides in improving their workplace performance.

Understanding and managing organizational change: implications for public health management

Managing organizational change has become a significant responsibility of managers. Managing the change process within public health organizations is important because appropriately and systematically managing change is linked to improved organizational performance. However, change is difficult and the change process poses formidable challenges for managers. Managers themselves face increased pressure to respond to environmental influences and provide the necessary leadership to their organizations in the change process. In fact, managing organizational change has become a key competency for healthcare managers. This article addresses the important topic of organizational change in public health organizations. It provides a conceptual foundation for understanding organizational change and its relationship to healthcare organizational performance, and then discusses the types and nature of change, using some examples and evidence from those organizations that have successfully managed change. A framework for guiding public health managers in the change management process is provided. The article concludes with suggested management competencies to establish a change-oriented organization with the culture and capacity for change.

Using Improvement Science to Promote Evidence-Based Practice in a Childhood Cancer and Hematology Center

A major children’s cancer and hematology center established a Quality Transformation (QT) Core to develop and monitor empirical outcomes that demonstrate excellence in clinical care. The QT Core, based on the Institute of Medicine’s domains of quality health care, aims to ensure that care is safe, effective, patient centered, timely, efficient, and equitable. Specific goals for the first year of the QT Core were to develop a team of improvement science experts, engage faculty and staff in QT initiatives, promote accountability for excellence in clinical care, and establish specific metrics to evaluate process, structure, and outcomes for QT Core projects. The purpose of this article is to discuss the successful development of a quality transformation core within a pediatric subspecialty and demonstrate the principles of improvement science through an actual quality transformation project designed to implement an evidence-based guideline for procedural sedation for children with cancer. The QT Core within this subspecialty was founded on principles of successful transformation of patient care that includes motivation to change, leaders committed to quality, active engagement of staff in meaningful problem-solving initiatives, alignment with organization goals with resource allocation, and integration to bridge boundaries throughout an organization. These key principles are demonstrated through the discussion of the development of the QT Core and implementation of an evidence-based procedure sedation guideline. Pediatric and pediatric subspecialty groups can be on the forefront of national initiatives that promote quality health care, exemplified by the QT Core developed within the cancer and hematology center.