Studying the relationships between authentic leadership, structural empowerment, and civility in the palliative care sector in Portugal

Purpose This paper aims to propose a model studying the relationship of authentic leadership (AL), structural empowerment (SE) and civility in the palliative care sector. This model proposes SE as a mediator between AL and civility. Design/methodology/approach Data was collected from 213 employees working in five major public palliative care hospitals in central Portugal. The study sample was predominantly female (80.3%) and the response rate was 42.6%. Variables were measured using the Authentic Leadership Inventory, Workplace Civility Scale and Conditions of Work Effectiveness Questionnaire II scales. Hayes’ PROCESS macro for mediation analysis in SPSS was used to test the hypothesized model. Findings Results suggest that AL has a significant positive direct relationship with both SE and civility. Furthermore, SE demonstrated to play a partial mediation effect between AL and civility. Practical implications This study may be of use for healthcare administration encouraging the development of AL, suggesting that the more leaders are seen as authentic, the more employees will perceive they have access to workplace empowerment structures and a civil environment. Originality/value Considering the mainstream literature in healthcare management, to the best of the authors’ knowledge, this is the first study to date to integrate the relation of AL, SE and civility in the palliative care sector. Further, the research model has not previously been introduced when considering the mediating role structural empowerment can play between AL and civility.

Using an employee resource group to develop GRIT in female healthcare leaders: a case study

Purpose This case study aims to demonstrate how the Greater Leadership Opportunities for Women (GLOW) Mayo Clinic Employee Resource Groups (MERG) has positively impacted leadership development focusing on growth, resilience, inspiration and tenacity (GRIT) and increased advancement for female leaders at Mayo Clinic. It will also establish how the innovative utilization of employee resource groups can positively impact the development of leaders within an institution in general and specially can enhance behaviors related to GRIT. Design/methodology/approach This case study design was used to measure the impact of the GLOW MERG’s interventions through qualitative and quantitative approaches that highlight both process and outcome to increase study validity through complementarity, which “seeks elaboration, enhancement, illustration, clarification of the results from one method with the results from another” (Greene, et al., 1989, p. 259) as well as completeness and context (Onghena et al., 2019; Schoonenboom and Johnson, 2017; Bryman, 2006). Learning outcomes (knowledge), skill accomplishments and attitude development were evaluated within two weeks after each session and annually through standardized surveys sent to participants via email. The surveys were designed to capture key information about the sessions, including the impact of the session content, the willingness and ability of attendees to apply the learning and identification of opportunities for improvement in session design and delivery, as well as measure satisfaction with the activities offered, the frequency and method(s) of communication, barriers to session attendance and particular topics or speakers of interest to members (Appendix 1). Response options included dichotomous scales, Likert-type scales, multi-select and free text. This provided a voluntary response sampling, as post-session surveys were sent to all session attendees and annual surveys were sent to all GLOW MERG members, which allowed individuals to choose if they would respond to the surveys (Creswell and Creswell, 2018). To foster an environment of continuous improvement, plan-do-study-act (PDSA) cycles (Langley et al., 2009) were conducted after every survey by the event planning team and the GLOW MERG Board. Interventions were tested, reviewed and discussed during monthly board meetings and event planning. Improvements were made and results were shared with key stakeholders through regular communication channels. Additionally, 30 past and present GLOW MERG leaders were surveyed to measure their perceived impact of participation in the GLOW MERG interventions using dichotomous scales, multi-select and free text responses (Appendix 2). This targeted purposive sample was selected because of their high level of engagement with the MERG to provide a retrospective evaluation of the success of the GLOW MERG, and its interventions for career advancement related to the development of GRIT attributes, knowledge and skills resulting in career advancement for those who are/have been highly engaged with the MERG. Findings The results spanning the past few years of GLOW MERG interventions has shown that the GLOW MERG has been successful in providing targeted educational events that address the GRIT knowledge, skills and attributes, needed for female health-care leaders to be successful in developing GRIT capabilities. By staying true to its mission and vision, the GLOW MERG has been able to promote, educate and empower female leaders at Mayo Clinic while actively breaking down the barriers that can prevent women from obtaining leadership positions. Research limitations/implications There are several limitations with this case study’s data collection and sampling methods. First, the post-session and annual survey sampling was based mainly on ease of access, with responses obtained from respondents who are more likely to volunteer or those with the strongest opinions. This allowed for potential bias as responses may not be representative of all GLOW MERG member opinions. Furthermore, the purposive sample of present and past GLOW MERG leaders was also subject to volunteer bias and may not have be representative of the GLOW MERG population. Additionally, the case study examined the practices of only one site and MERG group and may not be representative of all sites or employee resources groups. Practical implications The interventions implemented by the GLOW MERG to assist women with developing GRIT knowledge, skills and attributes – barriers women often face in leadership roles – were tested, reviewed and discussed during monthly board meetings and event planning. PDSA cycles were conducted, improvements were made and results were shared with key stakeholders through regular communication channels (Langley et al., 2009). Key lessons learned from these assessments include: One size does not fit all for leadership development. GLOW members have a wide variety of backgrounds, skills and experiences. Repetition is important in the development of GRIT knowledge, skills and attributes associated with GRIT. A one-time event provides attendees with an information overview and the steps to start developing a new skill but no dedicated time to practice and implement that skill. Originality/value The innovative utilization of employee resource groups can positively impact the development of leaders within an institution in general and specially can enhance behaviors related to GRIT.

Leadership competencies of first-line nurse managers: a quantitative study

Purpose This paper aims to examine the leadership competencies of first-line nurse managers (FLNMs) at the unit level in the eastern region of Ghana. Design/methodology/approach The paper is a quantitative cross-section design. Findings Nurse managers exhibited a moderate level of knowledge and ability to apply leadership competencies. Gender, rank, qualification, professional experience, management experience and management training jointly predicted the leadership competencies of FLNMs [(R2 = 0.158, p = 0.016]. However, only management training was a significant predictor in the model. Practical implications Inappropriate leadership competencies have severe consequences for patients and staff outcomes. This situation necessitates a call for a well-structured program for the appointment of FLNMs based on competencies. Originality/value This study is the first in Ghana which we are aware of that examined the leadership competencies at the unit level that identifies predictors of leadership competencies.

Leading through the first wave of COVID: a Canadian action research study

Purpose This first phase of a three-phase action research project aims to define leadership practices that should be used during and after the pandemic to re-imagine and rebuild the health and social care system. Specifically, the objectives were to determine what effective leadership practices Canadian health leaders have used through the first wave of the COVID-19 pandemic, to explore how these differ from pre-crisis practices; and to identify what leadership practices might be leveraged to create the desired health and care systems of the future. Design/methodology/approach The authors used an action research methodology. In the first phase, reported here, the authors conducted one-on-one, virtual interviews with 18 health leaders from across Canada and across leadership roles. Data were analyzed using grounded theory methodology. Findings Five key practices emerged from the data, within the core dimension of disrupting entrenched structures and leadership practices. These were, namely, responding to more complex emotions in self and others. Future practice identified to create more psychologically supportive workplaces. Agile and adaptive leadership. Future practice should allow leaders to move systemic change forward more quickly. Integrating diverse perspectives, within and across organizations, leveling hierarchies through bringing together a variety of perspectives in the decision-making process and engaging people more broadly in the co-creation of strategies. Applying existing leadership capabilities and experience. Future practice should develop and expand mentorship to support early career leadership. Communication was increased to build credibility and trust in response to changing and often contradictory emerging evidence and messaging. Future practice should increase communication. Research limitations/implications The project was limited to health leaders in Canada and did not represent all provinces/territories. Participants were recruited through the leadership networks, while diverse, were not demographically representative. All interviews were conducted in English; in the second phase of the study, the authors will recruit a larger and more diverse sample and conduct interviews in both English and French. As the interviews took place during the early stages of the pandemic, it may be that health leaders’ views of what may be required to re-define future health systems may change as the crisis shifts over time. Practical implications The sponsoring organization of this research – the Canadian Health Leadership Network and each of its individual member partners – will mobilize knowledge from this research, and subsequent phases, to inform processes for leadership development and, succession planning across, the Canadian health system, particularly those attributes unique to a context of crisis management but also necessary in post-crisis recovery. Social implications This research has shown that there is an immediate need to develop innovative and influential leadership action – commensurate with its findings – to supporting the evolution of the Canadian health system, the emotional well-being of the health-care workforce, the mental health of the population and challenges inherent in structural inequities across health and health care that discriminate against certain populations. Originality/value An interdisciplinary group of health researchers and decision-makers from across Canada who came together rapidly to examine leadership practices during COVID-19’s first wave using action research study design.

Adaptive leadership of doctors during COVID-19

Purpose This study aims to examine the adaptive leadership of doctors during COVID-19 to understand the leadership competencies required for adaptive events. Design/methodology/approach Phenomenology-based qualitative design was used. Data were collected from six doctors from the state of Kerala, India using semi-structured interviews. Findings Five themes were identified. The first theme, core leadership shows that doctors perceive leaders as educators, learners and social beings. The second theme, adaptive challenges, describes the ambiguous pandemic-related challenges that doctors are facing including, unusual occupational demands, information overload, sociocultural issues and personal intricacies. The third theme reflects that for doctors, adaptive work during the pandemic included – new learning to address unique issues, changing perspectives and establishing and maintaining a safe and engaging workplace environment. The fourth theme describes the adaptive leadership competencies such as regulating distress, providing direction, maintaining disciplined action, fostering collaboration, empowering, understanding organizational linkages, strategic vision and communication skills. The fifth theme elucidates the lacunae in leadership training as perceived by the doctors. Research limitations/implications The findings can help in developing and enhancing competency frameworks for doctors’ adaptive leadership. Originality/value This is one of the earliest studies to systematically examine components of adaptive leadership for doctors during COVID-19 and identify associated competencies.

COVID-19 vaccination in South Asia: a call for responsible leadership among SAARC countries

Purpose Coronavirus, also known as COVID-19, has presented an opportunity to set aside traditional regional collaborations and take responsible leadership to overcome difficult times. This paper aims to explore the current COVID-19 vaccination progress and pandemic status for the South Asian Association for Regional Cooperation (SAARC) countries and suggests responsible leadership to combat the COVID-19 pandemic and to think beyond. Design/methodology/approach This paper offers a viewpoint of the current COVID-19 vaccination among eight SAARC nations. It scrutinises the recent COVID-19 vaccination statistics for the eight South Asian countries based on Web-based analytics and comparative analysis until 28 August 2021. Findings This paper calls for collaborative decisions and responsible actions for policymakers in the SAARC countries to deal with the COVID-19 vaccination crisis. When South Asian countries are fraught with the increasing number of populations with COVID-19 cases, deaths and acute shortage of life-saving vaccines, it is time for their national and SAARC leaders to strengthen regional cooperations and initiate collaborative actions. The paper demonstrates that implementing responsible leadership can result in favourable outcomes for individuals, organisations, regions and the world. Moreover, this paper suggests SAARC, through responsible actions, has the potentiality to overcome the current crisis of COVID-19 vaccination and enhance the regional sustainability of the South Asian nations. Originality/value This paper delivers information about the present developing situation of COVID-19 vaccination in SAARC countries, how the governments and regional leadership are handling and future challenges that have been raised and can be overcome effectively. This paper can be helpful for the policymakers and SAARC leaders for effective public health interventions in the region and to develop a recovery roadmap for the sustainable economic zone.

The factors influencing the innovative performance of leaders in nurses’ professional: a developing country perspective

Purpose The health-care services in Iraq currently face many challenges. The most noted is the lack of effective nursing leaders to meet the growing needs of the health-care services. Effective nursing leadership is critical to the health-care system, affecting work performance, quality of care and staff satisfaction. The literature suggests that nursing leaders in Iraq are not adequately trained to provide leadership to improve the nursing profession and have limited involvement in decision-making. The purpose of this study is to explore the views of nurses on what they believe constitutes effective leadership in Iraq. Design/methodology/approach A qualitative methods approach is used involving 20 semi-structured interviews of senior nurses. The sample of nurses came from two large general hospitals in Iraq. The qualitative data was thematically analyzed and interpreted. Findings The study results indicated that there were factors that influence the performance of nurse leader, namely, excessive workload, personal relationship with nursing staff, professional recognition of nursing and selection criteria of leaders. Test results show that there were significant differences in views of the nurses toward nurse leaders’ performance. This research concludes that the nurse leader performance in developing countries is affected by excessive workload, personal relationship with nursing staff, professional recognition of nursing and selection criteria of leaders. Originality/value The relevance of the study stems from the scarcity of research on the leader performance in developing countries, while studies on the factors influencing the innovative performance of leaders in nurses’ professional are significantly limited. This study is one of the earliest studies that investigate these factors influencing the nurse leader’s performance.

The impact of perceived servant leadership traits and safety climate on task performance and risk-taking behavior in times of crisis

Purpose The adverse effects of the COVID-19 pandemic have opened the door to investigations of the leadership practices needed to guarantee positive work-related outcomes among employees in organizations. Therefore, building on the norm of reciprocity, this research aims to propose a model to examine servant leadership’s role in stimulating task performance and risk-taking behaviors during crisis times. In this model, safety climate was hypothesized to serve as a mediating variable between servant leadership, task performance and risk-taking behavior. Design/methodology/approach Data were collected from 237 staff (medial and administrative staff) working in Palestinian hospitals. Partial least squares structural equation modeling was used to analyze the data. Common method bias remedies were presented. Findings This study demonstrates that servant leadership is effective in fostering task performance and risk-taking behaviors in times of crisis through the mediation of safety climate. According to the results, safety climate demonstrated to fully mediate relationship between servant leadership and task performance (ß = 0.225, p-value = 0.000), and the relationship between servant leadership and risk-taking behavior (ß = 0.248, p-value = 0.000). Moreover, the results demonstrated that employees with higher experience tend to be more willing to engage in risk-taking behavior. Practical implications The findings may be useful for hospital managers on the role servant leadership can play in generating positive work-related outcomes during crisis times. Originality/value The paper is among the few empirical endeavors which examine the consequences of servant leadership in times of crisis, taking into account the intervening role of safety climate.

Improving long-term care services: insights from high-reliability organizations

Purpose Long-term care (LTC) organizations have struggled to protect their vulnerable clients from the ravages of the COVID-19 pandemic. Although various suggestions on containing outbreaks in LTC facilities have gained prominence, ensuring the safety of residents is not just a crisis issue. In that context, the authors must reasses the traditional management practices that were not sufficient for handling unexpected and demanding conditions. The purpose of this paper is to suggest rethinking the underlying attributes of LTC organizations and drawing insight from the parallels they have to high-reliability organizations (HROs). Design/methodology/approach The authors analyzed qualitative data collected from a Canadian LTC facility to shed light on the current state of reliability practices and culture of the LTC industry and to identify the strengths and weaknesses of the traditional management approaches. Findings To help the LTC industry develop the necessary crisis management capacity to tackle unexpected future challenges, there is an urgent need for adopting a more systemic top-down approach that cultivates mindfulness, learning and resilience. Originality/value This study contributes by applying the HRO theoretical lens in the LTC context. The study provides the LTC leaders with insights into creating a unified effort at the industry level to give rise to a high-reliability-oriented industry.

Leading change in health care: the challenge of anxiety

Purpose The purpose of this paper is to identify the centrality of anxiety in health care, especially in the context of leading change. It identifies the importance of emotional labour for clinical professionals and the resultant development of defensive routines. The idea of containment is central to addressing anxiety. Design/methodology/approach The approach involves identification of anxiety as a key factor in leading change in health care, but one which is often ignored. Findings Anxiety is the elephant in the room vis-a-vis leading change in health care. To address the use of defensive routines, a range of activities can act as “containers” for anxiety and help with leading change. Practical implications To lead change in health care implies addressing the existence and importance of anxiety and the emotional labour which health-care professionals undertake. Originality/value The existence of anxiety and the profound impact it has on leading change in health care has typically been under-estimated or avoided. The paper aims to remedy this.