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Contemporary healthcare practitioners require leadership skills for a variety of professional roles related to improved patient/client outcomes, heightened personal and professional development, as well as strengthened interprofessional collaboration and teamwork.
The aim of this study is to systematically catalogue literature on leadership in healthcare practice and education to highlight the leadership characteristics and skills required by healthcare practitioners for collaborative interprofessional service delivery and the leadership development strategies found to be effective.
A rapid review was conducted. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) diagram shows that the 11 databases, yielded 465 records. A total of 147 records were removed during the initial screening phase. The remaining 318 records were uploaded onto Rayyan, an online collaborative review platform. Following abstract level screening, a further 236 records were removed with 82 records meeting the eligibility criteria at full text level, of which 42 were included in the data extraction. The Mixed Methods Appraisal Tool (MMAT) was used for quality appraisal.
Results showed variability in methodologies used, representing various healthcare disciplines with a range in population size (n = 6 to n = 537). Almost half of the results reported on new programs, with interprofessional collaboration and teamwork being the most frequently mentioned strategies. The training content, strategies used as well as the length of training varied. There were five outcomes which showed positive change, namely skills, knowledge, confidence, attitudes, and satisfaction.
This rapid review provided an evidence-base, highlighted by qualitative, quantitative, and mixed methods research, which presents distinct opportunities for curriculum development by focusing on both content and the methods needed for leadership programs. Anchoring this evidence-base within a systematic search of the extant literature provides increased precision for curriculum development.
Keywords: collaboration, healthcare practitioners, interprofessional healthcare, leadership development, strategies
Changes in healthcare worldwide have led to an emphasis on leadership development in healthcare professions, which include medical, dental, public health, nursing, and allied health providers (eg, audiology, nutrition, occupational therapy, physical therapy, pharmacy, respiratory therapy, radiography, speech-language therapy) to meet current healthcare needs. 1–3 These changes have been brought about by factors, such as advances in information technology, automation, human interconnectivity, cross-sector mergers, advances in precision medicine, community involvement, providing services during periods of financial instability, and more recently the global COVID-19 pandemic. 1 , 4 , 5
As a result, effective leadership is now needed at all levels of healthcare for safety assurance, to drive service development, to ensure good clinical outcomes, 6 to foster engagement of healthcare practitioners (HCP), 2 to advocate for their patients/clients, to be self-aware and prioritize personal and professional development, to become innovative thinkers and to practice ethically. 7 , 8
Importantly, leadership skills enhance HCPs willingness to participate in team care and facilitates the long-term sustainability of team care. 5 Internationally, clinical leadership has been emphasized to ensure quality of care, job satisfaction and retention of HCP. 9
Global changes in healthcare necessitated new strategies and ways of working in HCP. Currently, there is widespread international recognition that bridging the boundaries of professional disciplines is required to address the challenges posed by changes in healthcare, 1 , 10 validating the World Health Organization’s 11 call to meet the complex service needs of the future through interprofessional collaboration (IPC).
In the IPC approach, members work collaboratively to complete an activity collectively. 12 IPC is defined by a diversity of skills, roles, and perspectives, bringing practitioners who have divergent expertise together with the purpose of combining their skills and insights to realize a shared goal that could not otherwise be achieved through the reliance on a single skill set of one disciplinary group. Leadership is essential for interprofessional collaboration. 13 A scoping review 14 (n = 114) examined how leadership is referred to and used in IPC and found that most papers did not refer to a specific leadership approach, nor did they identify, define, describe, or theorize leadership capabilities. A more critical examination of interprofessional leadership and the capabilities required to lead the necessary changes in both education and practice settings is needed.
As leadership is now valued by HCP at all levels, new models of leadership have emerged as important contributions to HCPs who work collaboratively, including, but not limited to collaborative leadership, 3 , 13 transformational leadership, 15 , 16 systemic leadership, 17 ethical leadership, 18 , 19 and recently remote leadership. 20 Collaborative leadership models feature largely in Interprofessional Education (IPE) 13 and includes shared and team leadership with an emphasis on a common vision. As such, shared leadership involves the distribution of leadership influence in the team across multiple team members. Shared leadership has been shown to enhance processes, effectiveness, and performances in interprofessional teams 21 while increasing HCP satisfaction and reducing burnout. 22 Similarly, in team leadership different professions share influence and there is a thoughtful allocation of responsibilities. Central control is shifted from a leader to the team. Team members are independent and coordinate their activities to reach the shared team goal. 3
Transformational leadership is a contemporary form of leadership, and the underlying tenets are to inspire individuals and to form teams to inspire goals through idealized influence, inspirational motivation, individualized consideration, and intellectual stimulation. 3 Transformational leadership is important to retaining HCP and to achieve overall patient satisfaction. 16
Leadership beliefs of clinicians and how it differs between professions has been explored in the research. 5 The link found between group identification and leadership beliefs, suggests that strategies which promote strong identification in both professional and interprofessional teams are likely to be conducive to clinicians supporting principles of shared leadership. HCPs benefit from developing not only leadership skills and characteristics, but also followership skills as leaders and followers co-produce the leadership that is needed in teamwork. 23 A pervasive leadership myth is that leadership is lodged in positional power in a specific organization. This type of thinking is false and flawed. HCPs at many levels and with many different roles daily display leadership, eg, leading an item on a case discussion, or leading a discussion with family members or with students. 19 This points to the requirement of HCPs to be adaptable and able to switch effortlessly between leadership and followership roles as it is beneficial to advance patient care.
HCPs are highly qualified and skilled professionals who work in range of health care settings. HCP providers require knowledge, clinical skills and competency, efficiency and productivity, and positive relationships with clients/patients. 24 In addition, HCPs require leadership skills to ensure the quality of care, to improve patient/client outcomes, to advocate for their patients/clients, to be self-aware and prioritize personal and professional development, to become innovative thinkers and to practice ethically. 7 , 25 , 26 Importantly, leadership skills enhance HCPs willingness to participate in team care and facilitates the long-term sustainability of team care, which relies on shared leadership. 5 However, the skills needed to be an effective HCP are different to those required to be an effective leader. 27 Training in HCP prepares individuals for leadership in a multitude of ways, for example, by taking care of patients, interacting with interdisciplinary team members, guiding groups, writing grant proposals with colleagues and emulating mentors or professors. 28 It is commonly acknowledged that although formal training in the multifaceted components of leadership has become accepted as highly desirable for healthcare leaders, 29 clinical HCPs have generally not been prepared for their expected role as effective health care leaders. 9 , 27 Furthermore, there are also gaps in leadership development practices in higher education settings of HCP. 1 , 30
Leadership development in HCP is an emerging research field and has been studied in various contexts by using a variety of methodologies, such as bibliometric analysis, 31 survey research, 5 qualitative research, 10 , 30 systematic reviews, 6 scoping reviews, 32 rapid reviews 17 and theoretical papers. 3 , 33 However, despite the broad diversity of the research there are limitations and a lack of consensus regarding the theoretical and conceptual frameworks applied, leadership models promoted, competencies required, training approach and strategies used to leadership development of HCP. 1 , 32 It was proposed that a universally applicable framework for leadership development in HCP will support leadership development programs aimed at multiple disciplines, both in professional training and in continuing education. Such a universal model can also lead to greater efficiency in developing new leadership development programs. 1
A new type of leader is emerging in healthcare, namely one who focuses on teamwork, improving patient outcomes and models the balance between autonomy and accountability. 3 Leadership development programs need to prepare and equip HCPs to fulfill this role expectation.
The aim of this study is to systematically catalogue literature on leadership in healthcare practice and education, in an unbiased manner, using a rapid review methodology by highlighting the leadership characteristics and skills required by HCPs for collaborative interprofessional service delivery and the leadership development strategies found to be effective.
A rapid review was undertaken due to its potential for producing timely and relevant research. 17 , 34 Rapid reviews are also attracting interest as a research method in the discipline of speech-language pathology (SLP). For example, Bolton et al 35 conducted a rapid review on aerosol generating procedures, dysphagia assessment and COVID-19 in response to urgent clinical needs, while Malandraki and colleagues 36 conducted a rapid systematized review of telehealth for dysphagia across the life span.
While there is no standardized procedure for conducting rapid reviews, several approaches have been suggested and used. 37 This rapid review used systematic review methodology and follows the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement. 38 , 39
To ensure that the rapid review included information relevant to the main aim, the review question was formulated in a PIO-format (Population-Intervention-Outcome): What are the leadership characteristics, skills, and strategies (Outcomes) required by HCPs (Population) in IPC and IPE (Intervention)?
A systematic search of 11 relevant databases was conducted to capture a wide variety of potential papers that may be indexed across different databases. 40 A librarian assisted in identifying the relevant databases and interfaces as well as in refining search terms. Search terms using keywords were generated through the PIO method that categorizes the population, intervention, and outcome to identify search terms (see Table 1 ). The keywords included Boolean operators AND and OR to link the population to the intervention and outcomes in the search as well as truncation. No hand searches were performed due to restrictions brought on by the global COVID-19 pandemic.
| Population | Intervention | Outcome |
|---|---|---|
| Speech- language pathology (SLP) Audiology (AUD) Occupational therapy (OT) Physiotherapy (PT) Nursing Medical/Physicians Healthcare Practitioners (HCPs) | Interprofessional practice Interprofessional education (IPE) Interprofessional collaboration (IPC) Education Interprofessional networking Interprofessional practice | Leadership characteristics Leadership skills Leadership strategies Leadership practice Leadership in crisis Leadership in health emergency Leadership advocacy |
The following four criteria were applied in the searches: (1) Only material published between January 2000 and December 2022; (2) any study design (ie, qualitative studies, quantitative studies or mixed-method research designs); (3) studies published in English; and (4) no grey literature (eg, reports, fact sheets, conference proceedings, chapters of academic textbooks, websites, newspapers and policy documents) as preliminary searches of the grey literature yielded limited information relevant to the pre-determined inclusion criteria of this review. 41
The 11 databases yielded a total of 465 records when employing the search terms, namely PubMed (n = 86), EBSCO (n = 71), Academic Search Complete (n = 58), CINAHL (n = 58), Web of Science (n =56), Health Source – Nursing Academic Edition (n = 55), PsychInfo (n = 42), Scopus (n = 18), PsychArticles (n = 9), Taylor and Francis (n = 7) and AccessMedicine (n = 5). An independent librarian versed in systematic reviews reviewed the search strategy and recommended databases related to health sciences and based on the topic. 42 Using multiple databases increased the depth of the search.
As mentioned earlier, of the 465 records, a total of 95 duplicates were identified and removed (n = 370 remained). The 370 remaining records were uploaded onto Rayyan, an online platform where researchers can perform collaborative systematic reviews. 43 The Rayyan platform was beneficial as it increased the objectivity of study selection and aided in improving the interrater agreement. The remaining 370 records were screened on title level of which 52 were excluded as the focus of these records was not on the topic of the current rapid review.
The remaining 318 abstracts were reviewed independently by two reviewers. The reviewers agreed on 291 abstracts, resulting in a 91.5% interrater agreement. The remaining 27 abstracts were discussed with two additional reviewers until 100% consensus was reached. 38 Studies were excluded on abstract level due to the non-target population, non-target outcome, or non-target focus of the study. The same process was followed to determine eligibility on the full text level of the remaining 82 records using the a priori inclusion and exclusion criteria by two reviewers. The initial interrater agreement for this stage was also high (88.9%). Table 2 shows the inclusion- and exclusion criteria that was used for the screening and eligibility phases.
Screening – Eligibility Criteria: Title and Abstract Level
| Eligibility Criteria | Inclusion Criteria | Exclusion Criteria |
|---|---|---|
| Date of publication | January 2000 - December 2022 | |
| Publication type | Only peer-reviewed literature | Grey literature |
| Language | Studies published in English | Studies not published in English |
| Study type | Studies that report on original results (qualitative, quantitative, or mixed methods) | Non-research papers (eg, tutorials, expert comments, or critical essays), systematic reviews and meta-analyses |
| Target population | Any of the following professions: SLP, audiology, HCP, physiotherapy, occupational therapy, nursing, medicine, | Does not focus on practitioners from the following professions, or focuses on clients or on family members |
| Intervention | Focuses on: interprofessional practice, interprofessional education, interprofessional collaboration, interprofessional networking, interprofessional practice | Papers that have a different focus |
| Outcome measures | Focuses on leadership with any of the following specific foci: leadership characteristics, leadership skills, leadership strategies, leadership practice, leadership in crisis/health emergency, advocacy in leadership | Does not focus on leadership development. Focuses on continuing professional development (CPD) with any other focus but leadership (eg, cleft, etc.). Undergraduate training (general) |
After the screening at abstract level, 318 records remained. The remaining 82 records were read at full text level and assessed for eligibility by two reviewers. The initial interrater agreement was 89.0% (reviewers agreed on 73 of the 82 records), which is regarded as a high agreement. 44 Disagreements were discussed with two additional members of the research team until 100% consensus was reached for every study record. A total of 42 studies were selected for full-text inclusion, based on the criteria in Table 1 .
The PRISMA diagram is shown in Figure 1 .
PRISMA diagram for scoping review process.
Notes: Adapted from Moher D, Liberati A, Tetzlaff J, Altman, DG, and The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009;6(7):1–6. Creative Commons. 39
A data extraction tool was developed to compile consistent and independent data reports. It included general information (ie, authors, year of publication and publication type), descriptive information (ie, the discipline involved, country of publication and design used), as well as information related to the specific population (ie, the specific discipline, the number of participants and their experience), the intervention (ie, whether a specific course/module on leadership is described and if so, the type of course) and the outcomes (ie, leadership characteristics, skills, etc.). All data were extracted independently by at least two reviewers. As was the case for the initial screening, disagreements were resolved through consensus meetings and upon full consensus, the extracted data were transferred from the data extraction tool to a synthesized Excel spreadsheet.
Following the data extraction, the quality of the included studies was appraised using the MMAT 45 to systematically check each article for biases. The MMAT firstly considers if there is a clear research question and if the collected data address the research questions before looking at specific questions depending on the study method. The MMAT overall quality score used descriptors such as numbers ranging from 1 (indicating 20% quality criteria) to 5 (indicating 100% quality criteria met). Two raters initially scored each of the 42 papers, but the interrater reliability was unacceptably low (64.3%). Hence, an additional two raters with more experience were added and the agreement level increased to 97.6%. 46 The consensus MMAT scores for the 42 studies included are shown in Table 3 .
Descriptive Information and Population (N = 42)
| Population | |||||||
|---|---|---|---|---|---|---|---|
| Author | Year | Country | Research Design | MMAT Score | Professions | Participant Size (n) | Level |
| Quantitative studies | |||||||
| Brashers et al 47 | 2020 | USA | Survey | 5/5 | Non-specific: various health professionals | 113 | Clinicians and Faculty |
| Brewer et al 48 | 2018 | Australia | Survey | 5/5 | Nurses, PTs, SLPs, OTs, Dieticians, Social workers, Midwives, Podiatrists, Radiologists | 53 | Clinicians and Faculty |
| Budak & Özer 49 | 2018 | Turkey | Survey | 5/5 | Physicians, Nurses | 261 | Clinicians |
| Case 50 | 2020 | USA | Survey | 4/5 | Nurses, Radiologists, Respiratory Therapists | 104 | Undergraduate students |
| Chang et al 51 | 2019 | USA | Survey | 5/5 | Dentists, Physicians (Geriatrics, Palliative, ER, Dermatology, Hematology/Oncology, Infectious Diseases, Rheumatology), Nurses, Pharmacists, Psychologists, Social workers, SLPs | 4 x 65 = 260 | Clinicians |
| El Bakry et al 52 | 2018 | Malaysia | Pre-post survey | 5/5 | Physicians (Pediatrics and Gynecology), Nurses | 38 | Clinicians |
| Fernandez et al 53 | 2016 | USA | Pre-post survey | 5/5 | Physicians (Gynecology and Obstetrics) | 37 | Clinicians |
| Ferris et al 54 | 2018 | USA | Survey | 4/5 | Physicians (Palliative medicine) | 39 | Clinicians |
| Forstater et al 55 | 2019 | USA | Pre-post survey | 5/5 | Physicians (GPs), OTs Nurses, Pharmacists, Radiologists | 537 | Undergraduate students |
| Fowler & Gill 56 | 2015 | USA | Survey | 4/5 | Physicians (GPs) | 107 | Clinicians and Non-clinicians (eg, trainers) |
| Franco et al 57 | 2018 | Brazil | Survey | 4/5 | Physicians (Family) | 74 | Clinicians |
| Goldstein et al 58 | 2009 | USA | Survey | 4/5 | Physicians (GPs) | Not stated | Undergraduate students |
| Green et al 59 | 2017 | USA | Survey | 5/5 | Physicians (Pediatrics and Critical care), Nurses | 518 | Clinicians and Fellows |
| Hartiti et al 60 | 2020 | Malaysia | Pre-post survey | 5/5 | Nurses | 94 | Clinicians and Graduate students |
| Hendricks et al 61 | 2010 | Australia | Pre-post survey | 5/5 | Nurses | 10 | Undergraduate students |
| Hlongwa & Rispel 12 | 2021 | South Africa | Survey | 5/5 | Physicians (Plastic Surgery), Dentists, SLPs, Geneticists, Nurses, Psychologists, Social workers | 52 | Clinicians |
| Humphreys et al 62 | 2018 | USA | Survey | 5/5 | Family Members, Social workers, SLPs, OTs, Nutritionists, Nurses, Physicians (Peds and Public Health) | 102 | Undergraduate students, Clinicians, and Non-clinicians (eg, self-advocates and family members) |
| Malling et al 63 | 2020 | Denmark | Survey | 5/5 | Physicians (not specified) | 45 | Clinicians (new graduates) |
| Mano et al 64 | 2019 | Latin America | Survey | 5/5 | Physicians (Oncology) | 217 | Clinicians |
| McGrath et al 65 | 2019 | USA | Pre-post survey | 5/5 | Physicians (Family, Genetics, Pediatrics), Health Administration, Nurses, Nutritionists, OTs, Pediatric Dentists, PTs, Psychologists, Public health practitioners, Social workers, Special education teachers, SLPs | Pre-training: 93, Post-training: 103 | LEND-fellows: Graduate, Doctoral, and Post-doctoral students |
| Paterson et al 66 | 2015 | Australia | Survey | 4/5 | Nurses | 124 | Junior clinicians |
| Rose et al 67 | 2003 | USA | Survey | 5/5 | Physicians, Nurses, OTs, PTs, Social workers | 22 | Undergraduate students |
| Rosenman et al 68 | 2019 | USA | Survey | 5/5 | Physicians (Trauma, ER and Surgery) | 36 | Undergraduate students |
| Rotenstein et al 69 | 2019 | USA | Survey | 5/5 | Physicians, Dentists, Nurses, Public Health Practitioners, and Business | 33 | Undergraduate students |
| Scott & Swartz 70 | 2015 | USA | Survey | 5/5 | Physicians, Nurses | 18 | Undergraduate students |
| True et al 71 | 2020 | USA | Survey | 5/5 | Physicians (Internal medicine) | 26 | Residents |
| Qualitative studies | |||||||
| Curry et al 72 | 2020 | UK | Interviews | 5/5 | Multidisciplinary health and social care team members | 26 | Clinicians and Non-clinicians |
| Embree et al 73 | 2018 | USA | Case study | 4/5 | Nurses | 25 | Clinicians |
| Hendricks &Toth-Cohen 74 | 2018 | South Africa | Interviews | 5/5 | OTs | 12 | Undergraduate students |
| Hoying et al 75 | 2017 | USA | Case study | 3/5 | Interprofessional teams involved in emergency events | 43 | Clinicians |
| Hu & Broome 76 | 2020 | China | Interviews | 4/5 | Physicians (not specified), Nurses Administrators | 15 | Clinicians, Faculty, Undergraduate students |
| Jaffe et al 77 | 2016 | USA | Interviews | 5/5 | Physicians (Surgery) | 24 | Clinicians |
| Keshmiri & Moradi 78 | 2020 | Iran | Interviews | 4/5 | Physicians (ER), Nurses | 15 | Clinicians |
| Koya et al 79 | 2017 | India | Interviews | 5/5 | Physicians (Chief Physicians), Nurses | 14 | Clinicians |
| Kozakowski et al 80 | 2015 | USA | Case study and interviews | 5/5 | Physicians (Family) | 14 | Clinicians |
| Lakshminarayana et al 81 | 2015 | UK | Interviews | 5/5 | Physicians (Not specified), Nurses | 81 | Novel clinicians and trainees |
| Leenstra et al 82 | 2016 | The Netherlands | Interviews | 5/5 | Physicians (ER, Trauma, Anesthesiology), Nurses (ER) | 28 | Clinicians |
| Södersved Källestedt et al 83 | 2020 | Sweden | Interviews | 5/5 | Nurses | 9 | Clinicians |
| Way & Dixon 84 | 2019 | UK | Case study | 5/5 | Midwives, Nurses (Mental Health), PTs, OTs | 420 | Undergraduate students |
| Mixed-methods studies | |||||||
| Debono et al 85 | 2016 | Australia | Interviews and scales | 5/5 | Nurses, Midwives | 60 | Clinicians |
| Moore et al 86 | 2016 | USA | Survey and focus groups | 5/5 | Physicians (Internal medicine) | 125 | Undergraduate students |
| Robins et al 87 | 2016 | USA | Longitudinal case study with survey | 4/5 | Nurses, Physicians, Pharmacists, Public Health Practitioners | 8 | Fellows |
Abbreviations: ER, Emergency Room; GPs, General practitioners; LEND, Leadership Education in Neurodevelopmental and Related Disabilities; MMAT, Mixed Methods Appraisal Tool (Hong et al, 2018); OTs, Occupational therapists; PTs, Physical therapists; SLPs, Speech language pathologists; USA, United States of America.
The results of the rapid review are presented as descriptive information related to the 42 included studies (authors, year of publication, country, research design) and the study population (discipline, number of participants and their level) (see Table 3 ). First, the quantitative studies are shown, followed by the qualitative and mixed methods studies. This is followed by an analysis of the intervention that was used, as well as the outcomes of the intervention described in the various studies included (see Table 4 ).
Intervention Applied and Outcomes Achieved (N = 42)
| Intervention / Leadership Training | Outcome | |||
|---|---|---|---|---|
| Author | New/Exist | Content Focus | Training Strategies | Positive Change |
| Brashers et al 47 | Exist | Knowledge, skills, and abilities regarding interprofessional collaboration in service delivery; respecting cultures, values, roles/responsibilities, and expertise; ethics | Train-The-Trainer IPC/teamwork | Improved knowledge |
| Brewer et al 48 | New | Knowledge and skills regarding interprofessional teamwork, embedding teamwork in patient care, team implementation strategies and facilitation techniques and general leadership outcomes | IPC/teamwork | Improved knowledge Skills: patient care Increased confidence |
| Budak & Özer 49 | N/S | Personal qualities, working with others, managing, and improving services, goal setting and clinical leadership | IPC/teamwork | N/S |
| Case 50 | N/S | Teamwork (mutual performance monitoring, shared mental models, and mutual trust), leadership and communication skills | IPC/teamwork Simulation | Improved knowledge Skills: teamwork Skills: communication |
| Chang et al 51 | New | Self-management skills, planning, execution, communication, empathy | Group learning | Satisfaction Increased confidence |
| El Bakry et al 52 | New | Communication, teamwork, management | IPC/teamwork | Satisfaction Skills: teamwork Skills: communication |
| Fernandez et al 53 | Exist | Creating collaborative organizational cultures, change management, communication skills, motivational skills, advocacy skills, and negotiation skills | Collaborative learning | Skills: teamwork Skills: motivating others Skills: coping with and managing change |
| Ferris et al 54 | New | Broad leadership skills | N/S | Improved knowledge Positive attitude |
| Forstater et al 55 | New | Communication skills, conflict resolution, teamwork | Simulation | Skills: teamwork Skills: communication Skills: conflict resolution Increased confidence |
| Fowler & Gill 56 | N/S | Listening skills, reflective practice, giving/receiving feedback, conflict resolution, time management, delegation, flexibility, coping skills, teamwork, resources management, financial planning | Workshops, tutorials, debriefs, mentorship, group learning | Skills: self-aware/id/conf |
| Franco et al 57 | N/S | Communication skills, therapeutic relationships, patient-centered care, teamwork, involving family | N/S | Skills: communication |
| Goldstein et al 58 | New | Fundraising, networking, motivational skills, setting a vision, teamwork, collaboration, community organization, media advocacy, change, management, presentation skills | N/S | Skills: teamwork Skills: communication Skills: conflict resolution Skills: motivating others |
| Green et al 59 | N/S | Management skills, self-management/self-awareness skills, task management skills, change management | N/S | Skills: self-aware/id/conf |
| Hartiti et al 60 | New | Work ethics (eg, compliance, precision), interpersonal/soft skills, self-management skills, communication skills, problem-solving, collaboration | N/S | Skills: problem-solving |
| Hendricks et al, 2010 61 | New | Leadership knowledge, communication skills, goal setting, conflict management teamwork, change management, negotiation skills, viewing problems as opportunities | N/S | Skills: teamwork Skills: communication Skills: conflict resolution Skills: problem-solving Skills: coping with and managing change Increased confidence |
| Hlongwa & Rispel 12 | N/S | Interprofessional collaboration, collaborative leadership, shared decision-making, optimizing professional role groupwork, communication skills | IPC/teamwork | Skills: communication |
| Humphreys et al 62 | Exist | Self-reflection, ethics and professionalism, critical thinking, negotiation and conflict resolution, communication, cultural competence, teamwork, community mobilization, family involvement, policy, and advocacy | N/S | Skills: self-aware/id/conf Skills: motivating others |
| Malling et al 63 | New | Professional relations management, communication, skills conflict management, and emerging leadership skills | IPC/teamwork | Skills: teamwork Skills: communication Skills: conflict resolution |
| Mano et al 64 | N/S | Task management, self-management, social responsibility, innovation and leading others | N/S | Skills: self-aware/id/conf |
| McGrath et al 65 | New | Personal leadership, leading others, decision-making skills conflict resolution, team building, cultural competency | IPC/teamwork | Skills: teamwork Skills: patient care |
| Paterson et al 66 | Exist | Setting a vision, staff development, mentoring skills, building trust, teamwork, problem solving skills, self-awareness skills | N/S | Skills: teamwork |
| Rose et al 67 | New | Attitudinal training | Practical experiences | Positive attitude |
| Rosenman et al 68 | New | Teamwork, problem-solving, information management, prioritization, change management | Simulation IPC/teamwork | Skills: communication |
| Rotenstein et al 69 | New | Goal setting, advocacy, community outreach, innovation, interprofessional, and medical education | N/S | Skills: teamwork Positive attitude |
| Scott & Swartz 70 | Exist | Leadership perceptions and skills, interprofessional collaboration, career planning | N/S | Positive attitude |
| True et al 71 | New | Emotional intelligence, teambuilding and teamwork, and conflict management | N/S | Skills: self-aware/id/conf |
| Curry et al 72 | Exist | Strategic problem solving, building a learning community, adaptive leadership | Collaborative learning | Skills: problem-solving |
| Embree et al 73 | New | Leadership skills (goal setting, setting a vision, challenge the process, empowerment skills, motivational skills) | IPC/teamwork | Skills: communication |
| Hendricks & Toth-Cohen 74 | New | Life stories, authentic leadership, leadership, ethics, self-management skills | N/S | Skills: self-aware/id/conf |
| Hoying et al 75 | New | Crisis management, meta-leadership skills, resource management | IPC/teamwork | Skills: teamwork Skills: self-aware/id/conf |
| Hu & Broome 76 | N/S | Act as a role model and mentor, knowledge and skill, creating shared vision, respecting and valuing diversity, communication skills | N/S | Skills: teamwork |
| Jaffe et al 77 | N/S | Communication skills, conflict resolution skills, ability to develop a compelling vision and creating collaborative, effective and diverse teams | No intervention | Improved knowledge Skills: teamwork Skills: communication Skills: self-aware/id/conf |
| Keshmiri & Moradi 78 | N/S | Supportive management, collaborative leadership skills, teamwork | IPC/teamwork | Skills: teamwork |
| Koya et al 79 | N/S | Change management, self-awareness skills, communication skills, reflective practice, decision-making skills, ethics, teamwork, relationship skills, professional development, emotional intelligence, resilience | N/S | Skills: teamwork Skills: self-aware/id/conf |
| Kozakowski et al 80 | New | Change management, financial management, cultural and contextual awareness skills, setting a vision, demonstrating courage and resilience | N/S | Skills: coping with and managing change |
| Lakshminarayana et al 81 | N/S | Teamwork, leading by example, delegation skills, stress management, patient management, time management, organization skills, teaching skills | N/S | Skills: teamwork Skills: communication |
| Leenstra et al 82 | N/S | Information coordination skills, decision making, communication skills, coaching skills and teamwork | N/S | Skills: teamwork Skills: communication |
| Södersved Källestedt et al 83 | N/S | Building relationships, developing clinical skills, developing leadership skills | N/S | Skills: teamwork Skills: patient care |
| Way & Dixon 84 | New | Self-management skills, critical thinking skills; teamwork; ethics | N/S | Improved knowledge Skills: teamwork Skills: self-aware/id/conf Skills: patient care Increased confidence |
| Debono et al 85 | Exist | Management skills to facilitate change management | IPC/teamwork | Skills: communication Skills: motivating others Increased confidence |
| Moore et al 86 | Exist | Value of leadership | N/S | Skills: patient care |
| Robins et al 87 | New | Change management, attitudinal training, knowledge and skills, behavioral change | N/S | Improved knowledge Positive attitude |
Abbreviations: IPC, Interprofessional collaboration; N/S, Not specified; self-aware/id/conf, self-awareness/identity/confidence.
It is evident that there has been a steady increase in the number of studies published on the topic of leadership with only three studies published in the period 2000–2012 (7%) fulfilling the criteria set for the current review; five studies in the period 2013–2015 (12%), 17 studies between 2016 and 2018 (40%), and 17 studies between 2019 up to December 2022 (40%).
The methodologies used in the 42 studies included 26 surveys (62%) of which six (14%) specifically mentioned being offered pre- and post-training; 13 were qualitative studies (31%) of which four were case studies and nine were interviews; and three mixed-methods studies (7%) and one study (2%) was longitudinal in nature.
Geographically, half of the studies (n = 20) were conducted in the USA. The other half were split between the United Kingdom (n = 4), Australia (n = 4); Malaysia (n = 2); South Africa (n = 3) and one each from Sweden, Denmark, the Netherlands, Turkey, Iran, India, China, Brazil, and Latin America (n = 9).
Regarding the quality appraisal, the one study that met 60% of the quality indicators (score of 3/5) was a qualitative case study. The 10 studies that met 80% of the quality indicators (score of 4/5) consisted of seven studies that employed surveys of which one study was longitudinal in nature, although none of the pre- and post-surveys fell into this category, as well as two qualitative studies which made use of interviews (one study used an in-depth interview and the other study used a semi-structured interview) and one case study. Most of the studies (n = 31) obtained a score of 5 which indicated 100% descriptive quality.
The number of participants ranged from six 81 to 537. 55 Slightly more than a quarter of the studies (11/42 = 26%) reported on more than 100 participants, while 10 studies (24%) reported on 20 or less participants. The remaining 50% of papers (21) reported on between 21 and 99 participants. One study 58 did not report on the number of participants.
Of the specific disciplines that were included, three studies 47 , 72 , 75 did not specify the disciplines which were included, but simply mentioned “multi-disciplinary teams”. Figure 2 shows the distribution of the professions which were included.
Distribution of professions.
In the 29 studies that mentioned physicians, and the 24 studies that mentioned nurses, some differentiated the type of medicine (oncology, emergency medicine, surgery, pediatrics, family medicine and public health) as shown in Table 3 . HCPs in the applied professions included SLPs (five studies); occupational therapists (OTs) (seven studies), physiotherapists (PTs) (four studies) and nutritionists (three studies). Other HCPs included midwives, dentists, pharmacists, and podiatrists.
Regarding the level at which these practitioners were functioning, it is evident that most studies (26/42 = 62%) reported on clinicians (ie, practicing professionals), although four of these studies reported on both clinicians and students while two studies reported on both clinicians and the academic faculty. A total of 16 students at different levels of their studies participated (ranging from under-graduate to master’s level).
Table 4 reports on the specific interventions that were described in the different programs. Nearly half of the studies (20/42) reported on new training programs, while eight studies reported on existing programs. 47 , 53 , 66 , 70 , 72 , 76 , 85 , 86 In total, 14 studies did not specify whether the research reported on a new or on an existing program. 7 , 12 , 49 , 50 , 56 , 57 , 59 , 76 , 78 , 81–83 , 88 Most of the studies did not report on the length of training, although there appeared to be variability ranging from intensive-three and a half day courses 53 to courses spanning over two years. 54 Different training strategies were used, of which interprofessional teamwork (ie, working in teams across disciplinary boundaries) was the most prominent, and was mentioned in 13 of the 42 studies. 12 , 47–50 , 52 , 63 , 65 , 68 , 73 , 75 , 78 , 85 Three studies mentioned the use of group or collaborative learning, 51 , 53 , 72 while the use of simulation activities as a means of knowledge application was also mentioned in three studies. 50 , 55 , 68 Practical experiences was mentioned in the study by Rose and colleagues 67 and the use of the “train-the-trainer” method in the Brashers et al 47 study as forms of hands-on learning. In total, 23 studies did not mention what type of training strategy was used.
Regarding the content on which the training focused, it appeared that aspects related to the importance of teamwork (including a variety of teamwork elements, as well as collaboration across disciplines) received high priority in 25 of the 42 studies. 12 , 47–50 , 52–54 , 56–58 , 62 , 65 , 66 , 68 , 71 , 73 , 76–79 , 81 , 82 , 84 , 88 This was an expected finding given the focus on leadership, as leadership often involves teamwork. The aspects related to teamwork included conflict resolution, communication skills in teams, problem-solving, setting a joint vision and motivating others towards such a vision, roles and responsibilities of team members, time management and resource management. The important roles of the family as team members were also highlighted.
Another aspect that received attention was self-management, which also included demonstrating courage and resilience, empathy, reflection, and self-awareness. 51 , 60 , 65 , 66 , 71 , 74 , 76 , 79 , 80 , 84 A number of the studies specifically highlighted the importance of managing change and assisting others in this regard 53 , 58 , 59 , 61 , 67 , 68 , 79 , 80 , 85 as well as practicing in an ethically responsive manner. 47 , 60 , 62 , 74 , 79 , 84 Some studies did not specify the leadership skills, but merely reported on broad or general leadership skills, 50 , 54 , 61 , 63 , 64 , 70 , 73 , 75 , 83 , 86 while other studies were more specific and mentioned, for example, clinical leadership, 49 adaptive leadership, 72 authentic leadership, 74 collaborative leadership, 12 , 78 personal leadership, 65 or in some cases, not leadership skills but management skills. 59 , 60 , 63 , 64 , 68 , 78–81 , 87
Table 4 also shows the main outcomes (ie, positive change) that could be directly attributed to the interventions described in the various studies. There were five main types of outcomes achieved. The majority of the 42 studies focused on increasing specific skills with seven studies each reporting on an increase in knowledge 47 , 48 , 50 , 54 , 77 , 84 , 87 and in confidence, 48 , 51 , 55 , 60 , 61 , 84 , 85 while more positive attitudes were reported in four studies 54 , 67 , 70 , 87 and satisfaction with the leadership training program in two studies. 51 , 52 The nature of the skills which were addressed in the different studies varied greatly and hence resulted in different types of skills such as IPC or teamwork skills that improved in 18 studies, 50 , 52 , 53 , 55 , 58 , 60 , 61 , 65 , 75–79 , 81–84 followed by 15 studies that emphasized communication skills, 12 , 50 , 52 , 55 , 57 , 58 , 60 , 61 , 63 , 68 , 73 , 77 , 81 , 82 , 85 and increased self-awareness/self-identity and self-confidence in 10 studies. 59 , 60 , 62 , 64 , 71 , 74 , 75 , 77 , 79 , 84 Four studies each reported back on improved skills related to conflict resolution, 55 , 58 , 61 , 63 patient care, 48 , 65 , 83 , 84 and motivating others, 53 , 58 , 62 , 85 while three studies each reported on skills related to coping with change, 53 , 61 , 80 and problem-solving. 61 , 72 , 85 From Table 4 , it is possible to see that any combination of outcomes was possiblefor example, improving both knowledge and skills, or improving skills and facilitating a positive attitude. Furthermore, some studies only reported on one skill improving, 68 while some reported on multiple skills (eg, Jaffe 77 ).
The aim of the present rapid review is to investigate literature on leadership in health and education practice to highlight the leadership characteristics, skills and strategies of HCPs required for collaborative interprofessional service delivery. Leadership literature dated between 2010 and 2022 was studied, using a number of criteria. The main findings of this review are discussed below.
Leadership is viewed as a core role and responsibility of HCPs across a variety of care disciplines to ensure improved service delivery and patient care. A trend of more published research in leadership in HCPs was noted from the year 2010. Although studies from around the globe were included, the USA appears to lead the research in the current study. This trend was also noted by Brewer and colleagues 14 who mentioned that most empirical studies included in their review were undertaken by researchers based in North America. This may be attributed to the vast healthcare system in the USA and requirements for evidence-based practice that permeates all healthcare professions. In contrast to early intervention and early childhood special education where Movahedazarhouligh 89 reported a paucity of research on leadership research, this topic is well studied in the healthcare profession.
This review identified a variety of methodologies employed, which can be attributed to the different types of training programs reported on. Survey research was the predominant methodology (60%) employed to study the outcomes of leadership training. Qualitative research, including case studies and interviews, mixed-methods research and a longitudinal study were included in the 42 articles included and analyzed in this review. Complying with quality indicators of research design is essential to the development of an evidence base of leadership within healthcare. 90 The different disciplines within the healthcare profession were widely represented in the populations studied, although three studies did not specify which disciplines were studied. This variation points to the strength of the research evidence which can be used to inform the development of future quality training programs within the healthcare profession.
Similar to the review by Brewer et al, 14 most articles in the present review also did not refer to, or operationalize any specific leadership approaches or models. Bahreini et al 91 emphasize the importance of developing and adhering to a framework for training leadership in HCPs, especially one that can be adapted for use in local situations. Therefore, the extracted components of the current rapid review can be viewed as a first step in developing an evidence base, building on a comprehensive overview of leadership in HCPs.
Leadership is viewed to be an inherent quality and characteristic of HCPs. 90 However, the complex and dynamic nature of leadership in HCPs precludes the unanimously accepted description of the characteristics required to perform an effective leadership role. Smith et al 92 conclude that effective interprofessional health and social care team leadership requires a unique blend of understanding and skills that support innovation and improvement. Some of the ways through which leadership is often evidenced is through advocacy (ie, to promote the self-advocacy of the clients with whom HCPs work), training of families and other role players, mentoring (eg, of less experienced colleagues), supervision, continuing education, and research. It is thus self-explanatory that leadership necessitates a complex set of knowledge, skills and attitudes which require formal education, either at a pre-professional or professional level. 7 Despite this acknowledgement of the importance of leadership, formal training for the development of skill sets and abilities is generally lacking to better prepare future HCPs and in continuing education for practicing HCPs. In rare cases where leadership is included in curricula, the emphasis is on aspects, such as leadership for healthcare systems, advancing careers, etc., rather than on, for example advocacy. 7
The current review reveals some gaps in reporting on the specific nature of the training programs, for example gaps related to the length and intensity of programs, which is important in evaluating the training outcomes. Regarding training strategies, an interprofessional teamwork approach was followed by 31% of the programs and three studies followed a collaborative learning approach. These approaches reflect the recent trends in healthcare service delivery. 13 There is, however, a need for research to clearly justify and describe the training strategies employed, as 55% of the studies did not describe this in their methods. The content of the training programs was focused on different elements of leadership including interprofessional collaboration and teamwork and the specific skills required to lead in that context, personal leadership skills such as self-management, strategies for managing change and ethical responsibilities of leaders. Furthermore, not all programs identified their approach to leadership, which is the framework for selecting the knowledge and skills to be trained. Although the studies had sound research methodologies, the training program development could be more rigorous, which would allow for the replication of training programs. Rao et al 93 point to the importance of course design when developing quality improvement educational leadership programs.
Although all the articles reported positive changes which were attributed to the training programs, the question remains how to ensure retention, as only a few studies included post-surveys and long-term training. Since leadership is a desired outcome of HCPs training programs, whether on a pre-professional or professional level, it should instill a process of lifelong reflection and development. 88 By identifying specific leadership competencies relating to knowledge and skill development, defined objectives can be formulated. Curriculum mapping on the pre-professional level can be implemented to determine the overage of leadership-related competencies across the curriculum. 88 , 94
Lastly, the global COVID-19 pandemic added urgency and importance to leadership skills in the healthcare profession internationally. Difficulties in accessing services due to COVID-19 restrictions led to telehealth. However, the use of technology is challenging and could be limiting in managing complex situations. HCPs were further challenged in a variety of ways such as applying universal precautions and accessing personal protection equipment, to name but a few. The COVID-19 health emergency called for crisis leadership with specific competencies such as signal detection, prevention and preparation, containment and damages and learning and reflection. 95
This rapid review includes strengths with its size, method, and scope, but also has limitations. Firstly, it is possible that the identified search terms did not identify all possible papers as only 11 databases were searched, and no hand-searching of papers was included. The present review focused only on papers published in English and only from the year 2000 onwards. One study met the 60% MMAT quality appraisal score with many studies reflecting “missing data” (eg, did not specify the sample size; did not specify the methods used for leadership training; did not specify the length of training).
The international scope of this rapid review presents distinct challenges for research conducted across varying disciplines and the methods used in the different contexts. Papers covered a range of HCP disciplines which may not result in the same implications across disciplines. However, it is expected that it would contribute to the existing body of literature and assist HCPs when developing leadership curricula for their specific discipline.
Future research could build on the current data and focus on a more critical examination of interprofessional leadership, and the capabilities required to lead the changes required in both education and practice settings. 14 To further support the emerging trend of including leadership development programs in HCP curricula, sustainability of the outcomes of leadership development programs in different contexts can be explored.
This rapid review was designed to systematically catalogue literature on leadership in healthcare practice and education in an unbiased manner to highlight the leadership characteristics and skills required by HCPs for collaborative interprofessional service delivery. It also described the leadership development strategies that had been found to be effective. As the change in healthcare leadership continues to evolve, leadership development programs need to attend to the needs of HCP on all levels. The review revealed that a paucity exists in the description of leadership approaches and models used. Moreover, a dearth of information was found on retention and long-term impact of leadership development programs. The evidence-based highlighted by qualitative, quantitative, and mixed methods research presents distinct opportunities for curriculum development by focusing on both content and the methods needed for leadership programs. Anchoring this evidence-base within a systematic search of the extant literature provides increased precision for curriculum development.
The Carnegie African Diaspora Fellowship (ADF) Program (PS00174859 and PS00157223) and the University of Pretoria’s Research Office are gratefully acknowledged for sponsoring this research project. The authors also wish to thank Gabrielle Saliba and Mary Catherine Smith who assisted with the search, screening, and data extraction as well as with the technical editing of the manuscript.
We have no known conflicts of interest to disclose.
(All studies included in the review are marked with an asterisk*)
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