Clinical governance in the Irish health system – a review of progress

Medical consultants' experience of collective leadership in complexity: a qualitative interview study

PURPOSE

The aim of this study was to explore and understand the leadership experiences of medical consultants prior to a major hospital move. Health and care is becoming increasingly complex and there is no greater challenge than the move to a new hospital. Effective leadership has been identified as being essential for successful transition. However, there is very little evidence of how medical consultants experience effective leadership.

DESIGN/METHODOLOGY/APPROACH

A qualitative methodology was utilized with one-to-one semi-structured interviews conducted with ten medical consultants. These were transcribed verbatim and analyzed using inductive thematic analysis. The research complied with the consolidated criteria for reporting qualitative research (COREQ).

FINDINGS

Four themes were found to influence medical consultants' experience of leadership: collaboration, patient centredness, governance and knowledge mobilization. Various factors were identified that negatively influenced their leadership effectiveness. The findings suggest that there are a number of factors that influence complexity leadership effectiveness. Addressing these areas may enhance leadership effectiveness and the experience of leadership in medical consultants.

RESEARCH LIMITATIONS/IMPLICATIONS

This study provides a rich exploration of medical consultants' experience of collective leadership prior to a transition to a new hospital and provides new understandings of the way collective leadership is experienced in the lead up to a major transition and makes recommendations for future leadership research and practice.

PRACTICAL IMPLICATIONS

The findings suggest that there are a number of factors that influence complexity leadership effectiveness. Addressing these areas may enhance leadership effectiveness and the experience of leadership in medical consultants.

SOCIAL IMPLICATIONS

Clinical leadership is associated with better outcomes for patients therefore any interventions that enhance leadership capability will improve outcomes for patients and therefore benefit society.

ORIGINALITY/VALUE

This is the first research to explore medical consultants' experience of collective leadership prior to a transition to a new hospital.

Exploring the potential for collective leadership in a newly established hospital network

PURPOSE

Achieving integrated care is a key focus for health systems and has resulted in various structures between and within organisations. The reorganisation of the Irish health system into hospital networks/groups aims to encourage work across hospitals to integrate care. This study evaluated if collective leadership emerged over time through increased interaction and collaboration following the organisation of hospitals into a network. A secondary aim was to elucidate the potential for collective leadership, through understanding the barriers and enablers perceived by participants.

DESIGN/METHODOLOGY/APPROACH

This study employed social network analysis and qualitative interviews. Leaders across the hospital group were invited to participate in an online network survey and interviews (analysed using thematic analysis) at three time points over an 18-month period.

FINDINGS

Although there was evidence that some parts of network were beginning to operate collectively, the structures observed were more typical of a hierarchical network. Disruption in the network and uncertainty regarding permanence of the organisational structure had a negative impact on the potential for collective leadership. Yet, progress was evident in terms of establishing building blocks for collective leadership and integration, including developing trust, mutual understanding and creating space for change.

PRACTICAL IMPLICATIONS

This study contributes to the literature by reflecting on the mechanisms and initiatives perceived as enabling/inhibiting collective leadership. Based on this research, it is important to communicate a clear and consistent message about the plans for the organisations involved and be clear regarding the roles and expectations for those involved in introducing new approaches to leadership and integration. Honest collaboration, openness and certainty in communication will likely be important in order to help create the contextual conditions to enable collective and system approaches to introduce "stepping stones" to change. These conditions include developing interpersonal relationships between leaders, creating time and space for deep and shared reflection, and enhancing trust among colleagues.

ORIGINALITY/VALUE

A key strength of this study is the linking of leadership-as-networks theory with social network methods to investigate collective leadership in practice. This study contributes to the literature by reflecting on the mechanisms and initiatives perceived as enabling/inhibiting collective leadership.

Best leadership practices of nurses in hospital risk management: case study

OBJECTIVE

To highlight the best leadership practices of nurses who contribute to hospital risk management.

METHOD

Single case study with two integrated units of analysis, with a qualitative approach. Data collected from April to November 2018, through focused interviews with nurse managers, non-participant observation and documentary research. Analysis using the analytical technique to the explanation construction.

RESULTS

Three thematic categories were evidenced, demonstrating that the best leadership practices involve technical and non-technical competencies anchored in behavioral development, scientific knowledge, guidelines for quality and patient safety and participatory management of the health team.

CONCLUSION

The best leadership practices of nurses who contribute to hospital risk management pervade technical skills and/or formal positions, valuing each team professional in a unique way and emphasizing the importance of scientific knowledge and the professional reference model that the nurse exercises in hospitals.

Impact of organisational change for leaders in mental health

PURPOSE

The purpose of this paper is to examine the impact of organisational and structural change on the evolution of quality and safety in health organisations, specifically in mental health services.

DESIGN/METHODOLOGY/APPROACH

Data were gathered through semi-structured interviews. In total, 25 executive management team members in both public and private mental health services were interviewed and data were analysed using Burnard's framework.

FINDINGS

Three overarching themes emerged: organisational characteristics, leadership and accountability; sustaining collaboration and engagement with stakeholders; and challenges to and facilitators of quality and safety. Taken together, the findings speak to the disruptive and disorienting impact of on-going organisational change and restructuring on leaders' ability to focus on, and advance, the quality and safety agenda.

RESEARCH LIMITATIONS/IMPLICATIONS

Typical with qualitative research of this nature, the potentially limited generalisability of the findings must be acknowledged.

PRACTICAL IMPLICATIONS

There is a need for strategies to implement change that are informed by evidence and theory and informed by decades of research on this topic, rather than introduced ad hoc. Change agents must pair effective change management and implementation science strategies to specific contexts, depending on what is being implemented and ensure appropriate evaluation of organisational change to bolster the evidence base around quality and safety and inform future decision-making.

ORIGINALITY/VALUE

The study explores an identified gap in the literature on the impact of on-going organisational re-structuring and transformation on the evolution of quality and safety in mental health services.