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Healthcare providers are under pressure due to increasing and more complex demands for services. Increased pressure on budgets and human resources adds to an ever-growing problem set. Competent leaders are in demand to ensure effective and well-performing healthcare organisations that deliver balanced results and high-quality services. Researchers have made significant efforts to identify and define determining competencies for healthcare leadership. Broad terms such as competence are, however, inherently at risk of becoming too generic to add analytical value. The purpose of this study is to suggest a holistic framework for understanding healthcare leadership competence, that can be crucial for operationalising important healthcare leadership competencies for researchers, decision-makers as well as practitioners.

In the present study, a critical interpretive synthesis (CIS) was conducted to analyse competency descriptions for healthcare leaders. The descriptions were retrieved from peer reviewed empirical studies published between 2010 and 2022 that aimed to identify healthcare services leadership competencies. Grounded theory was utilised to code the data and inductively develop new categories of healthcare leadership competencies. The categorisation was then analysed to suggest a holistic framework for healthcare leadership competence.

Forty-one papers were included in the review. Coding and analysing the competence descriptions resulted in 12 healthcare leadership competence categories: (1) character, (2) interpersonal relations, (3) leadership, (4) professionalism, (5) soft HRM, (6) management, (7) organisational knowledge, (8) technology, (9) knowledge of the healthcare environment, (10) change and innovation, (11) knowledge transformation and (12) boundary spanning. Based on this result, a holistic framework for understanding and analysing healthcare services leadership competencies was suggested. This framework suggests that the 12 categories of healthcare leadership competencies include a range of knowledge, skills and abilities that can be understood across the dimension personal – and technical, and organisational internal and – external competencies.

This literature review was conducted with the results of searching only two electronic databases. Because of this, there is a chance that there exist empirical studies that could have added to the development of the competence categories or could have contradicted some of the descriptions used in this analysis that were assessed as quite harmonised. A CIS also opens for a broader search, including the grey literature, books, policy documents and so on, but this study was limited to peer-reviewed empirical studies. This limitation could also have affected the result, as complex phenomenon such as competence might have been disclosed in greater details in, for example, books.

The holistic framework for healthcare leadership competences offers a common understanding of a “fuzzy” concept such as competence and can be used to identify specific competency needs in healthcare organisations, to develop strategic competency plans and educational programmes for healthcare leaders.

This study reveals a lack of consensus regarding the use and understanding of the concept of competence, and that key competencies addressed in the included papers are described vastly different in terms of what knowledge, skills and abilities they entail. This challenges the operationalisation of healthcare services leadership competencies. The proposed framework for healthcare services leadership competencies offers a common understanding of work-related competencies and a possibility to analyse key leadership competencies based on a holistic framework.

The purpose of this research is to examine the effect of ability, motivation and opportunity (AMO) practices on organizational citizenship behaviour (OCB), in medical staff working in specialized units. In addition, we check the mediating role of work-related well-being, understood as engagement, trust and exhaustion, in the relationship between AMO practices and OCB. Furthermore, the moderating role of service leadership is analysed in the relationship between AMO practices and work-related well-being.

Using the AMO framework under the job demands-resources (JD-R) model, and based on a sample of 214 employees from public healthcare, a time-lagged moderation-mediation model was performed.

Results provide evidence that AMO practices have a positive effect on OCB. Further, work-related well-being mediated the effect of AMO practices on OCB. In addition, service leadership exerted a moderating role between AMO practices and work-related well-being.

Building on recent research which has emphasized the knowledge gap regarding how human resource practices might positively affect both employees and organizations, this is the first study that indicates that said practices positively affect both employee well-being and OCBs in the public healthcare context.

There is robust evidence that good teamwork is essential to the delivery of high‐quality healthcare. This paper reports on a leadership intervention to improve team‐working in multidisciplinary clinical teams and the health outcomes of those populations served by them. The Shared Leadership for Change initiative was funded and managed by The Health Foundation as part of its portfolio of leadership awards. The initiative sought to support the development of ‘shared’ leadership in the teams through the intervention of specially trained and supported leadership development consultants who worked with clinical teams delivering diabetes care working across primary and secondary sectors. The paper explains the rationale underpinning the approach, describes how the intervention was operationalied, and presents findings on its impact to date. The authors conclude by advocating that given the right context this intervention is an effective approach that leads to improved clinical team effectiveness and better multidisciplinary working in modern healthcare. The difficulties of ascribing any improvements in clinical outcomes or the patient experience to the interventions are also explored.

Healthcare service quality in the USA has gained importance under value-based payment models. Providing feedback to front-line staff is a vital component of managing service performance, but complex organizational dynamics can prevent effective communication. This work explored the performance management of appointment desk staff at Mayo Clinic Arizona, identified barriers to effective management and sought to standardize the process for monitoring service performance.

Multiple data sources, including qualitative inquiry with 31 employees from the primary care and surgery departments, were used. The research was conducted in two phases – facilitated roundtable discussions with supervisors and semi-structured interviews with supervisors and staff six months after implementation of service standards. Participants were probed for attitudes about the service standards and supervisor feedback after implementation.

While all staff indicated a positive work environment, there was an unexpected and pervasive negative stigma surrounding individual feedback from one’s supervisor. Half the participants indicated there had been no individual feedback regarding the service standards from the supervisor. Presenting service standards in a simple, one-page format, signed by both supervisor and the patient service representative (PSR), was well received.

Combining rapid-cycle quality improvement methodology with qualitative inquiry allowed efficient development of role-specific service standards and quick evaluation of their implementation. This unique approach for improving healthcare service quality and identifying barriers to providing individual feedback may be useful to organizations navigating a more value- and consumer-driven healthcare market.

The Health Foundation invests more than £7 million in developing leaders in the British health services. In February 2005 it invited external scrutiny of its approach to evaluation. This led to a radical development of its approach to leadership and to a broadening of the range of its evaluation methods and tools. The result of this work is that the Health Foundation is better able to measure the return on its investment in leadership and understand more about the ways in which improvements in leadership can lead to improvements in healthcare services.

Coronavirus disease (COVID-19) has challenged leadership in hospitals worldwide. The experiences of leadership during the pandemic changed leadership significantly. This study aims to describe nurse leaders’ perceptions of what future leadership in hospital settings in the post-pandemic era needs to be like.

A qualitative descriptive study was used. A total of 20 nurse leaders from the Finnish central hospital were interviewed from June to October 2021. The data were analysed using inductive content analysis.

The analysis revealed five main categories describing nurse leaders’ perceptions of future leadership in hospital settings in the post-pandemic era: digitalisation and hybrid working culture, development of sustainable working conditions, moving smoothly to the post-pandemic era, dissolution of traditional regimes of organisation and flexibility in leadership.

In the post-pandemic era, the constantly changing demands and challenges currently facing healthcare systems have significantly increased the complexity of hospital organisations. This requires critical evaluation and change to traditional leadership. Enhancing flexibility and authenticity in leadership, strengthening competencies, implementing a wide range of digital resources and increasing the appeal of the nursing profession to build the next generation of nurses – all of these are needed to provide sustainability in future healthcare.

The results identify the critical points of leadership that need to be developed for future challenges and for maintaining a sufficient supply of qualified professionals. Acting on this information will enhance flexibility in organisations and lead to acceleration of changes and the development of new kinds of leadership in the future

The purpose of this paper is to outline an alternative view of leadership development that acknowledges the likelihood of unintended and contradictory outcomes in leadership work. Helping leaders to engage with contradictions is as important as developing their positive capabilities. A focus on the contradictions of leadership can help to address the emotional and political limitations that development programmes unwittingly impose on learning.

The paper discusses how leadership development currently falls short in helping people to lead in complex organizational environments. This argument is illustrated by examples taken from MBA teaching programme in a School of Management together with an analysis of contradictions in the National Health Service Healthcare Leadership Model. The final section gives four examples of how to put the contradictions back into leadership development.

The paper does not seek to present empirical findings. The illustrations support an argument for changes in practice. Examples are provided of a different approach to leadership development.

The paper critiques approaches to leadership development on the grounds of its relentless positivity regarding leadership behaviour and that focusses primarily on the development of individuals. Attention is called to the contradictions inherent in leadership work which extend to the leadership development process itself. Once acknowledged, these contradictions offer important leadership learning opportunities for both individuals and organizations.

In the previous chapter, I introduced trauma-informed care as an approach to organisational change and a shift in culture to recognise that many employees and people attending services have past trauma experiences. In this chapter, I recast servant leadership (SL) as a trauma-informed leadership model that naturally operationalises some of the principles discussed in the TIA literature. The first section of this chapter addresses the societal need for a more ethical and moral leadership approach, before briefly outlining the prevalence of trauma experienced by service users and employees. The next section provides an overview and definition of SL in a general sense, before articulating a trauma-informed model of SL and its characteristics. Finally, some of the outcomes associated with SL are discussed with a key focus on how this approach operationalises the principle of psychological safety, trust and empowerment found in trauma-informed approaches, as they relate to employees.

Practitioners, organisations and policy makers in health and social care settings are increasingly recognising the need for trauma-informed approaches in organisational settings, with morbidity and financial burdens a growing concern over the past few years. Servant leadership has a unique focus on emotional healing, service to others as the first priority, in addition to the growth, well-being and personal and professional development of key stakeholders. This paper aims to discuss Trauma Informed Servant Leadership (TISL).

A targeted review of the servant leadership and trauma-informed care literature was conducted. Relevant studies, including systematic review and meta-analysis, were sourced, with the resulting interpretation informing the conceptual model.

Although there are general guidelines regarding how to go about instituting trauma-informed approaches, with calls for organisational leadership to adapt the often cited six trauma-informed principles, to date there has not been a leadership approach elucidated which takes as its starting point and core feature to be trauma informed. At the same time, there is a paucity of research elucidating trauma outcomes for service users or employees in the literature when a trauma-informed approach is used. However, there is a large body of evidence indicating that servant leadership has many of the outcomes at the employee level that trauma-informed approaches are attempting to attain. Thus, the author builds on a previous conceptual paper in which a model of servant leadership and servant leadership supervision are proposed to mitigate against compassion fatigue and secondary trauma in the health and social care sector. The author extends that research to this paper by recasting servant leadership as a trauma-informed model of leadership that naturally operationalises trauma-informed principles.

A lack of primary data limits the extent to which conclusions can be drawn on the effectiveness of this conceptual model. However, the model is based on robust research across the differential components used; therefore, it can act as a framework for future empirical research designs to be studies at the organisational level. Both the servant leadership and trauma-informed literatures have been extended with the addition of this model.

TISL can complement the trauma-informed approach and may also be viable as an alternative to trauma-informed approaches. This paper offers guidelines to practitioners and organisations in health and social care on how to operationalise important trauma-informed principles through leadership.

This conceptual model may help reduce the burden of trauma and re-traumatisation encountered by practitioners and service users in health and social care settings, impacting on morbidity.

To the best of the author’s knowledge, this is a novel approach, the first of its kind.