Leadership and organizational performance: Is it essential in healthcare systems improvement? A review of literature

The Reality of Healthcare Professionals in Leadership Positions at the Onset of the COVID-19 Pandemic

While pandemics have long been a topic of discussion in public health, COVID-19 placed healthcare leaders in a completely new and challenging situation. This qualitative study sought to understand the personal experiences of healthcare professionals in leadership roles at the beginning of the COVID-19 pandemic. Sixteen in-depth interviews were conducted and recorded via Zoom. Most participants were men (n = 8, 57.1%) and had a doctorate or master's degree (n = 8, 57.1%). The themes of mental health, dynamic infrastructure, and transformative experience emerged from our participants' narratives. Most respondents reported heightened stress during that time and shared the institutional and personal mechanisms they used to deal with the situation. They were proud of their profession and their work. They discussed the "dynamic infrastructure" they experienced at the time that helped them lead. Feeling overworked was a common experience for them. Most considered leading during COVID-19 a "transformative experience" that taught them valuable lessons. They also witnessed acts of heroism as their colleagues continued to work during difficult times, even though some succumbed to COVID-19. Despite all the challenges and uncertainties healthcare professionals in leadership positions faced at the onset of COVID-19, their resilience, dedication, and commitment to their profession prevailed. In conclusion, the firsthand experiences recounted by healthcare leaders in this study shed light on the multifaceted nature of leadership during a global health crisis. Their unwavering resilience, dedication, and commitment stand as a testament to the fortitude required in such demanding circumstances. As the COVID-19 pandemic continues to evolve, the insights gleaned from this research bear significant implications for informing future strategies and support systems aimed at bolstering healthcare leadership worldwide.

Challenges of using evidence in managerial decision-making of the primary health care system

BACKGROUND

Managerial Evidence-Based Decision-Making [EBDM] in the primary is a systematic approach that directs the decision-maker in a conscientious, explicit, and judicious utilization of reliable and best evidence based on the professional experiences and preferences of stakeholders and patients from various sources. This study aimed to investigate the challenges primary healthcare managers encounter while undertaking decision-making processes.

METHOD

A systematic review was conducted in 2022 with the aim of identifying and collecting all qualitative articles pertaining to evidence-based decision-making in the primary healthcare system. To achieve this, a meticulous search was conducted using the relevant keywords, including primary health care and evidence-based decision making, as well as their corresponding synonyms, across the databases Web of Science, Scopus, and Pubmed. Importantly, there were no limitations imposed on the timeframe for the search. To carefully analyze and consolidate the findings of this systematic review, the meta-synthesis approach was employed.

RESULTS

A total of 22 articles were assessed in this systematic review study. The results revealed the main categories including evidence nature, EBDM barriers, utilizing evidence, decision-makers ability, organizational structure, evidence-based, EBDM support, communication for EBDM, evidence sides, EBDM skill development, public health promotion, and health system performance improvement.

CONCLUSION

The primary healthcare system is crucial in improving health outcomes and ensuring access to healthcare services for all individuals. This study explored the utilization of evidence-based EBDM within the primary healthcare system. We identified five key dimensions: causal, contextual, and intervening conditions, strategies, and consequences of EBDM as a core phenomenon. The findings will help policymakers and administrators comprehend the importance of evidence-based decision-making, ultimately leading to enhanced decision quality, community well-being, and efficiency within the healthcare system. EBDM entails considering the best reliable evidence, and incorporating community preferences while also exploiting the professional expertise and experiences of decision-makers. This systematic review has the potential to provide guidance for future reforms and enhance the quality of decision-making at the managerial level in primary healthcare.

Palliative medicine integration in the USA: cancer centre executives' attitudes

OBJECTIVES

To compare cancer centre (CC) executives' attitudes towards palliative care between National Cancer Institute-designated CCs (NCI-CCs) and non-NCI-designated CCs (non-NCI-CCs) in 2018 and to examine the changes in attitudes and beliefs between 2009 and 2018.

METHODS

CC chief executives at all NCI-CCs and a random sample of non-NCI-CCs were surveyed from April to August 2018. Twelve questions examined the executives' attitudes towards palliative care integration, perceived barriers and self-assessments. The primary outcome was agreement on the statement 'a stronger integration of palliative care services into oncology practice will benefit patients at my institution.' Survey findings from 2018 were compared with data from 2009 to examine changes in attitudes.

RESULTS

52 of 77 (68%) NCI-CCs and 88 of 126 (70%) non-NCI-CCs responded to the survey. A vast majority of executives at NCI-CCs and non-NCI-CCs endorsed palliative care integration (89.7% vs 90.0%; p>0.999). NCI-CCs were more likely to endorse increasing funding for palliative care (52.5% vs 23.1%; p=0.01) and hiring physician specialists (70.0% vs 37.5%; p=0.004) than non-NCI-CCs. The top three perceived barriers among NCI-CCs and non-NCI-CCs were limited institutional budgets (57.9% vs 59.0%; p=0.92), poor reimbursements (55.3% vs 43.6%; p=0.31), and lack of adequately trained palliative care physicians and nurses (52.6% vs 43.6%; p=0.43). Both NCI-CCs and non-NCI-CCs favourably rated their palliative care services (89.7% vs 71.8%; p=0.04) with no major changes since 2009.

CONCLUSION

CC executives endorse integration of palliative care, with greater willingness to invest in palliative care among NCI-CCs. Resource limitation continues to be a major barrier.

What Do Medical Physicists Do? Leadership and Challenges in Administration and Various Business Functions

The goal of the present study was to investigate the primary role of medical physicists (MPs) in radiation oncology (RO) administration and key business functions, besides various challenges facing today. An experienced MP leader formulates a well-structured department administration and management system in RO. The essential role of MP team leaders in health care is not only limited to supervising routine department clinical works but also being substantially involved in key business functions such as leadership, operations, project management, decision making, and many more. Furthermore, leadership appointments are equally important for the department and the health care organizations to a significant extent; the right competitive leaders with the right education and ample experience are necessary to operate administration and to perform various related business functions. To improve leadership qualities for individuals, a structured formal education with intensive training is necessary because leadership positions are associated with several complex business-related functions. A structured education or training could be received from various premier academies or institutions in the nation. Structured university academic programs (certificate, degree, or doctoral) in health care administration or management are highly beneficial for MPs who aspire to future leadership positions in RO due to high business complexities in health care organizations; however, this element is currently not enforced for MP leadership positions in the United States.

The leadership styles of primary healthcare center managers and center performance outcomes in Riyadh, Saudi Arabia: A correlational study

BACKGROUND

Leadership is a wide concept that is rapidly developing. Diverse theories suggest different styles of leadership, with strong relationships between the different styles and their outcomes. The transformational style emphasizes motivating employees and encouraging them to find new ways of dealing with issues. The transactional (TL) style promotes ideas of rewards and punishments. The Laissez-faire style is characterized by relaxation and the tendency to leave things to happen with minimal interference.

MATERIALS AND METHODS

This is a descriptive cross-sectional study design conducted in Primary Healthcare Centers in Riyadh, Saudi Arabia. The leadership styles were assessed using a Multi-Factor Leadership Questionnaire, which identifies the different styles of leadership. SPSS v 26.0 was used for data analysis. t-test employed to compare leadership style between raters and managers. Logistics regression model used to determine the influence of leadership styles of managers. Pearson correlation coefficient determined the linear relationship between leadership styles and its domains.

RESULTS

A total of 130 respondents (65 managers vs. 65 raters) took part. "Raters" refer to any persons other than the manager, such as a secretary, nurse, doctor. The "manager" is when the person rates himself. The global transformation mean score was 3.55, for TL it was 3.42 and for passive avoidant, the mean score was 0.93. The passive avoidant (t = 2.005; P = 0.047) and management by exception (passive) (MBEP) mean scores of raters were statistically significantly higher than managers. In the binary regression model, MBEP was the independent significant predictor of manager.

CONCLUSION

The perceived leadership style of Primary Healthcare Center managers was transformational but with TL. Transformational leadership was positively correlated with TL leadership but negatively correlated with passive avoidant (The Laissez-faire style). The outcome of this study demonstrated that intellectual stimulation, idealized attributes, and inspirational motivation are perhaps better than contingent reward, active management.

The relationship between different types of leadership, client's identity, and self-confidence and auditors' impartiality

Purpose

This paper aims to assess the effect of different leadership types, the client's identity and auditors' self-confidence on auditors' impartiality.

Design/methodology/approach

This paper is a descriptive-survey type, and the collected data are based on a predesigned questionnaire distributed in January 2020. The PLS software is used for data analysis, and the statistical population of this paper includes employed auditors in enlisted audit firms on the Official Association of Auditors. When the parameters were insignificant, the obtained probability from the model fitting was used for hypothesis testing, and the appropriateness of the model was assessed via the structural equations.

Findings

The results show a significant relationship between charismatic, transformational, participatory, delegating and bureaucratic leadership and auditors' impartiality. There is also an association between the client's identity and the auditor's impartiality. The client's identity mediates the relationship between transformational leadership and the auditor's impartiality. Moreover, there is a significant relationship between self-confidence and auditor's impartiality.

Originality/value

This paper enjoys an innovative method in the field of behavioural auditing. The effect of transformational leadership on auditor's impartiality with the mediatory role of the client's identity shows the in-depth client–auditor relationship has been taken for granted and not examined previously, so the results of this paper can lend a helping hand to audit firms to enhance the organisational performance.