Guest editorial

Relevant trends health-care leaders must navigate

Health care is one of the world’s fastest-growing industries, with over $10tn in spending projected by 2022 (Deloitte, 2019). Despite this growth, the industry faces numerous challenges, including care delivery outside urban areas, value-based care models, digital transformation, aging populations and public health crises. These challenges exist largely due to the interplay of high stakeholder fragmentation (Cairns et al., 2006), rising costs (Popescu, 2014) and changing institutional environments (Savino and Latifi, 2019). In addition to the increased spending, there is growing pressure of consumerism in health care primarily driven by the entry of retailers such as CVS and Walmart and greater consumer expectations of providers and health-care plans (Loria, 2019).

The COVID-19 pandemic further magnified these challenges, imposing new demands on health-care providers faced with diminishing resources and the unknowable challenges the virus presented (Mental Health America, 2020). It is not surprising, then, that multiple studies and large-scale reports have indicated rising stress levels among health-care providers and, consequently, increased burnout (Evans, 2021; Landay et al., 2021). Indeed, Halbesleben and Buckley (2004, p. 859) note that burnout “is the result of a significant accumulation of work-related stress,” indicative of what health-care providers are experiencing today.

To navigate these challenges and find paths toward a sustainable future, the field is ripe for new insight into the leadership development process for health care. Indeed, health-care leaders are responsible not only for their organizations’ financial viability but also for the positive outcomes and experiences of patients and providers (Braithwaite and Travaglia, 2008; Hillman and Dalziel, 2003). The key element of leadership in the future of health care, thus, is the ability to build and manage complex dynamics occurring in the space between the organization and a wide range of internal and external stakeholders. In doing so, leadership development must focus on building new capacities and knowledge of how to remain adaptive in the face of novel and unknown challenges (Milosevic et al., 2017; Uhl-Bien and Arena, 2018). The purpose of this special issue, thus, is threefold. First, we hope to elucidate the challenges health-care leaders will face now and in the future. Second, given the growing interest in the leadership development process on the business side, we worked to bridge the insights across fields and present theory-informed, evidence-based cases relevant to health-care providers. In doing so, our final objective is to bring business tools for analysis and solution generation to the forefront in complex contexts such as health care. We present the theoretical background of our endeavor next.

Key components of successful leadership development in context

Leadership development continues to be an essential yet increasingly complex process in contemporary institutions due to the ever-increasing external pressures for change and the need for leaders to navigate them (McCall, 2010). Leadership development embodies “expanding the collective capacity of organizational members to engage effectively in leadership roles and processes […] those that generally enable groups of people to work together in meaningful ways” (Day, 2000, p. 582). In doing so, it positions organizational members to optimally learn from problems by building collective capabilities across contexts and enhancing anticipation of future challenges (Day et al., 2021; Dixon, 1993; Milosevic et al., 2017; Uhl-Bien and Arena, 2018).

Given the numerous and dynamic changes the health-care industry has been experiencing, developing leaders able to navigate those changes and anticipate future opportunities becomes essential. According to Day et al. (2021), successful leadership development must embrace a longitudinal perspective in which reflection, building experience and engaging in learning are present, in addition to critically examining biases and inequity. In terms of a longitudinal perspective, any effort at development must consider time, even assuming development as a lifelong pursuit occurring via careful interweaving of bottom-up (experiences leading) and top-down (formal learning) approaches (Guerin et al., 2011; Liu et al., 2021; Murphy and Johnson, 2011). Indeed, Liu et al. (2021) point to the importance of “dynamic experiences” across the lifespan and in the multiple work and nonwork contexts for leadership development to occur.

In terms of the learning process, leadership development must create opportunities for both bottom-up (i.e. experiences leading) and top-down (i.e. formal learning) acquisition of new knowledge (Sun and Zhang, 2004). Through top-down opportunities, organizational members learn about leadership skills and what makes leaders effective across various situations through classes and readings on the topic. The assumption is that when organizational members are exposed to new knowledge, they are more likely to embrace it and use it in their daily activities (Day et al., 2021). Conversely, bottom-up acquisition of new knowledge occurs through experiences in which leadership activities provide the opportunity to experience real-life skill development. However, the extant literature tends to overemphasize the acquisition process and underemphasize the importance of reflection on the content learned and experiences gained (Day, 2010). Indeed, as Day et al. (2021) argue, new learning may not turn into action without ongoing reflection and coaching.

Finally, a growing concern within leadership development is bias and inequity in access to development opportunities (Acker, 2006; Dugan, 2017). Due to limited resources in many organizations, leadership development opportunities tend to be reserved for those perceived as having the greatest leadership potential (Day et al., 2021; Silzer and Church, 2010). However, given the lack of established measures of leadership potential, bias may permeate those perceptions leading to inequitable access to development opportunities (Church et al., 2021). Indeed, a number of studies have pointed to the lack of inclusivity in boards and CEO suites, increasing tokenism and slowing down the advancements of diversity and inclusion (Bass, 2019; Combs et al., 2019).

Therefore, the literature on leadership development offers guidance and opportunities for improvement in the process via careful consideration of teaching cases. Teaching cases allow for a more longitudinal approach to development, combining the top-down and bottom-up acquisition of knowledge with reflection on the new skills and inclusion of diverse voices through the careful selection of contexts and authors. Finally, selected teaching cases focus on the specific tools and frameworks leaders in health care may use to analyze complex situations and generate innovative solutions.

Special issue: Leadership development in health care

In this special issue, you will find six teaching cases on Leadership Development in Healthcare. We sought to curate a collection of cases focused on complex decision-making as it is experienced by leaders in health care, with special attention paid to some of the challenges identified above, including leadership in digital transformation, for aging populations and during COVID-19. The future of health care relies on strong, adaptive leaders, and these cases provide the opportunity for students and instructors of many varieties to explore the unique challenges and opportunities health-care leaders face. More specifically, these cases provide insight into recent advancements in evidence-based management research, enable the development of actionable knowledge and skills based on contextually relevant insights and provide tools to build and enhance critical thinking and the ability to generate solutions to complex issues.

All of the cases focus on situations or challenges encountered by health-care leaders to provide insight into the complexities that these leaders face in their workplaces (see Table 1 for details):

• a predicament of oxygen supply system at an Indian hospital during COVID-19;

• Albert Bourla: leading Pfizer’s successful vaccine rollout to tackle the COVID-19 pandemic;

• CitiusTech: employee engagement amidst disruption;

• Dozee: Crafting opportunities during the COVID-19 pandemic;

• lessons on social entrepreneurship in the health sector – the Swasth story; and

• Moderna’s Spikevax: a prickly pricing decision.

Thank you to The CASE Journal for providing the arena for a special issue on this important topic. Thank you to all the authors who responded to this special issue call and submitted their work as it reflects their research and experience with leadership development in health care. Thank you to the authors who plan to continue developing cases and advancing our knowledge on this topic. It is challenging to collect data in this context, and we appreciate the current and future authors’ perseverance to tell the stories of leaders in health care and the challenges they face.

We would especially like to thank the work of all the reviewers who provided valuable feedback throughout the review process. Without your insights, the special issue would not have come to life and we would not have these strong contributions to our understanding of leadership development in health care. Thanks to the North American Case Research Association (NACRA) for allowing us the venue to present a symposium on this topic, and to Dr Abbey Fingeret and Dr Kristin Sohl for sharing their stories as health-care leaders with NACRA attendees and calling attention to the need to have this special issue. Finally, a special thanks to Gabriella (Ellie) Rizzo for sharing her time, energy and expertise in bringing this special issue to life. Your knowledge of both the business and health-care worlds helped shape this special issue and the cases therein.

Our gratitude is evidence of the large community of people that were needed to make this special issue a success, and we hope that the knowledge shared by this special issue continues to inspire work in this area and advances our understanding of leadership development in health care.