Shared Leadership in Healthcare Settings and Its Effects

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Background/Introduction

Surgery leadership and its effects are barely investigated in recent literature (Barling, Akers, Di Lena, & Beiko, 2017; DInnocenzo, Mathieu, & Kukenberger, 2016). Also, the methods of the introduction of SL in healthcare settings are rarely studied (Brún, ODonovan, & McAuliffe, 2019). However, the existing literature suggests that SL training can introduce and improve SL (Brún et al., 2019; Tafvelin, Hasson, Holmström, & Schwarz, 2018). Also, it is fairly well-established that SL is correlated with improved performance (DInnocenzo et al., 2016; Fausing, Joensson, Lewandowski, & Bligh, 2015; Wu, Cormican, & Chen, 2018). Finally, it is well-known that leadership in surgical settings is critical (Brún et al., 2019; DInnocenzo et al., 2016). As a result, it is proposed to consider the relationship between SL and team performance in surgery settings with attention paid to the improvements in SL associated with SL training. The proposed research involves an evidence-based intervention (SL and SL training), but it is also associated with a topic that is rarely researched (SL in surgical units). Thus, the project is significant due to its ability to cover research gaps in an area that can benefit from additional research (surgical leadership), but it is also feasible.

PICOT Search Format Questions

PICOT 1: in a surgical unit team (P), does an SL training (I) improve critical team performance (O) as compared to pre-training data (C) over four weeks before and after the training (T)?

PICOT 2: in a surgical unit team (P), does SL training (I) improve SL score (O) as compared to pre-training outcomes (C) four weeks after the training (T)?

Search Strategy/Results

Based on the presented PICOTs, the literature that covers SL effects (especially its relationship with performance) and SL training is to be reviewed. Table 1 summarizes the search with databases, keywords, and numbers of articles found and reviewed. The keywords included SL, training, surgery, surgical, effectiveness, and outcomes; they were refined as more literature was reviewed. They were used in most combinations to ensure the presence of literature on SL training, SL in surgical or surgery units, and SL effectiveness.

The databases included medical ones (PubMed and PMC), as well as Google Scholar, which was used as a search engine for non-medical literature. The latter category was included after searches 1-12 (see Table 1) failed to produce a sufficient amount of specifically medical literature on SL that could contribute important information. As a result, it was deemed acceptable to study the effects of SL outside of medical settings to expand SL understanding. The limitations and inclusion criteria ensured that the search only involved peer-reviewed articles that were recent (no older than 2014) and that contained either primary research, systematic reviews, or meta-analyses, which incorporated all the key elements of an article (especially a detailed methodology section). According to Garrard (2011) and Polit and Beck (2017), these requirements can improve the quality of the evidence.

The final number of reviewed studies amounted to 15 to fit the current task criteria; they included meta-analyses, systematic reviews, experiments, and many observational and correlational studies. Most of the articles were relevant to only one or two aspects of the chosen topic (SL training and SL effectiveness in surgical settings). As a result, it can be assumed that the recent literature that is directly relevant to the projects topic has been reviewed and that it is very scarce.

Table 1: Search Strategy and Results

Database Search Number Search Results
PubMed 1 (shared leadership[Title]) AND surgery[Title] 0
2 (shared leadership[Title]) AND surgery 1
3 (shared leadership) AND (surgery OR surgical) 104
4 (shared leadership) AND (surgery OR surgical) + Past five years 4
5 (shared leadership) + Past five years 70
6 (shared leadership) + (effectiveness OR outcomes) + Past five years 30
7 (shared leadership) AND training AND surgery + Past five years 0
8 (shared leadership) AND training 22
PMC 9 (shared leadership) AND (surgery OR surgical) + Past five years 81
10 (shared leadership) + (effectiveness OR outcomes) + Past five years 319
11 (shared leadership) AND training AND surgery + Past five years 75
12 (shared leadership) AND training+ Past five years 313
Google Scholar 13 (shared leadership) AND (surgery OR surgical) + Past five years 1,080
14 (shared leadership) + (effectiveness OR outcomes) + Past five years 14100
15 (shared leadership) + (effectiveness OR outcomes) + Past five years 31
16 allintitle: shared leadership training + since 2014 23
17 allintitle: shared leadership (outcomes OR effectiveness) + since 2014 44
18 allintitle: shared leadership (surgery OR surgical) 0
Conclusion. One of the articles from search 4 is relevant, and some of the results from other searches are relatively relevant.

Evidence Quality

The quality of available evidence depends on the specific topic. The presented search only included recent peer-reviewed high-quality sources, and with such inclusion criteria, there is little information about SL training and SL in surgical settings. However, there is a high-quality meta-analysis of SL in terms of surgical settings, even though it is not limited to reviewing surgical teams (DInnocenzo et al., 2016), and there is an observational study about surgical leadership that does not focus on SL (Barling et al., 2017). Also, there are studies that incorporate SL training and demonstrate its effectiveness (Brún et al., 2019; Tafvelin et al., 2018). As for SL and its effects or effectiveness, evidence of diverse quality is available for it, including meta-analyses and systematic reviews of non-experimental data (Aufegger et al., 2019; DInnocenzo et al., 2016; Wang, Waldman, & Zhang, 2014; Wu et al., 2018), randomized controlled trials (Serban & Roberts, 2016; Xu, Chiu, & Treadway, 2019), and lower-level evidence. The majority of the presented studies (seven) are correlational or observational single studies (Barling et al., 2017; Choi, Kim, & Kang, 2017; Fausing et al., 2015; Forsyth & Mason, 2017; Guenter et al., 2017; Sousa & Dierendonck, 2016; Tafvelin et al., 2018), which makes them level-IV evidence according to Polit and Beck (2017). One study included both correlational and experimental evidence (Sun et al., 2016).

Not all of the reviewed articles covered SL in healthcare workers; only five studies did that (Aufegger et al., 2019; Barling et al., 2017; Brún et al., 2019; DInnocenzo et al., 2016; Forsyth & Mason, 2017). It is noteworthy that the systematic reviews of SL effects suggest that more research is required, especially with larger samples and randomization (Aufegger et al., 2019). Thus, there is a shortage of recent, high-quality, and high-level evidence on the topics of surgery SL and SL training, and while SL effects are better-studied, further investigation in that direction is justified as well.

Evidence Matrix

Table 2 presents an evidence matrix developed in accordance with the recommendations of Garrard (2011) and created to incorporate systematic reviews, meta-analyses, and research articles with diverse designs. The matrix was modified to fit into the paper and respond to the key questions of the review, which is why it includes key information about the design, evidence levels, and contribution of the studies to the literature review.

Table 2: Evidence Matrix

Author, Year, Title, Journal Purpose Design Sample Level Contribution
Aufegger, L., Shariq, O., Bicknell, C., Ashrafian, H., & Darzi, A. (2019). Can shared leadership enhance clinical team management? A systematic review. Leadership in Health Services. To explore SL in acute healthcare and evaluate its benefits Systematic review Primary research of SL in acute care; 11 studies III Association of SL with increased satisfaction and performance; negatively associated with seniority
Barling, J., Akers, A., & Beiko, D. (2018). The impact of positive and negative intraoperative surgeons leadership behaviors on surgical team performance. The American Journal of Surgery. To examine the effects of surgeon leadership Observational 150 random operations IV Negative relationships between abusive leadership and psychological safety and efficiency. Over-controlling leadership associated with reduced efficiency. No direct SL focus, but the article covers surgical leadership
Brún, A., ODonovan, R., & McAuliffe, E. (2019). Interventions to develop collectivistic leadership in healthcare settings: A systematic review. BMC Health Services Research. To review existing literature on how to achieve SL Systematic review (observation and experiment) 21 healthcare studies III Mostly discusses the effectiveness of team training (11 studies). Suggests that interventions are likely to be successful but might fail; very heterogeneous in terms of methodology
Choi, S., Kim, K., & Kang, S. (2017). Effects of transformational and shared leadership styles on employees perception of team effectiveness. Social Behavior and Personality: An International Journal. To review the perceived effectiveness of SL and transformational leadership Correlational 424 Korean employees IV Different effectiveness outcomes correlate with different leadership styles. SL improves organizing and planning
DInnocenzo, L., Mathieu, J., & Kukenberger, M. (2016). A meta-analysis of different forms of shared leadershipteam performance relations. Journal of Management. To search for relationships between SL and performance Meta-analysis 50 published and unpublished studies (n=3,198) III Evidence of a relationship between team performance and SL; evidence of task complexity affecting the relationship. The article discusses SL in terms of surgery
Fausing, M., Joensson, T., Lewandowski, J., & Bligh, M. (2015). Antecedents of shared leadership: Empowering leadership and interdependence. Leadership & Organization Development Journal. To test a hypothesis about the predictors of SL Correlational 81 teams (Danish; manufacturing and knowledge) IV Empowering leadership are task interdependence were evidenced to predict SL; SL is correlated with team performance
Forsyth, C., & Mason, B. (2017). Shared leadership and group identification in healthcare: The leadership beliefs of clinicians working in interprofessional teams. Journal of Interprofessional Care. To explore leadership beliefs in healthcare professionals Survey and correlational 229 healthcare workers IV Support for SL among healthcare professionals; professional and team identification associated with SL
Guenter, H., Gardner, W., Davis McCauley, K., Randolph-Seng, B., & Prabhu, V. (2017). Shared authentic leadership in research teams: Testing a multiple mediation model. Small Group Research, 48(6). To determine mediators in the relationship between SL and various outcomes in research teams Survey-based correlational study 142 research teams IV Team coordination mediates the relationship between SL and effectiveness; also, trust and shared mentality improve satisfaction but not publication success. Different aspects of SL and mediating variables can modify SL effects. Specific setting and type of SL, which is not surgery
Serban, A., & Roberts, A. (2016). Exploring antecedents and outcomes of shared leadership in a creative context: A mixed-methods approach. The Leadership Quarterly. To explore antecedents and outcomes of SL in creative task-based teams Mixed methods with experimental data 120 students II Indicates that SL causes task satisfaction and is caused by positive team environment and task cohesion. Small sample and specific task (creative teams), which is not surgery
Sousa, M., & Dierendonck, D. (2016). Introducing a short measure of shared servant leadership impacting team performance through team behavioral integration. Frontiers in Psychology. To study the impact of SL on team performance; to validate an SL measure 2 validation studies (round-robin); correlational methods 244 and 288 students (61 and 72 teams) IV The tool is validated; SL predicted team integration and, therefore, performance
Sun, X., Jie, Y., Wang, Y., Xue, G., & Liu, Y. (2016). Shared leadership improves team novelty: The mechanism and its boundary condition. Frontiers in Psychology. To examine the mechanism of SL affecting creativity 3 studies; correlational and experimental designs Chinese students (55 in 17 groups, 62 in 21 groups, 108 in 36 teams) II and IV The role of constructive controversy in enhancing creativity is indicated; SL relationship with creativity is supported
Tafvelin, S., Hasson, H., Holmström, S., & Schwarz, U. (2018). Are formal leaders the only ones benefitting from leadership training? A shared leadership perspective. Journal of Leadership & Organizational Studies. To determine effects of shared transformational leadership training Pre- and post-test study 20-day training for 74 Swedish pulp factory formal (47) and informal (27) leaders IV Improved leadership in both groups of leaders; formal leaders associated with improved well-being in employees, and informal  with efficiency
Wang, D., Waldman, D., & Zhang, Z. (2014). A meta-analysis of shared leadership and team effectiveness. Journal of Applied Psychology. To examine relationships between SL and team effectiveness. Correlational meta-analysis 42 samples (work and student teams; 3,439 people) III SL is associated with improved effectiveness; the relationship is stronger for novel (e.g., transformational) and all-team SL. The source is rather old (2014) and not healthcare-focused
Wu, Q., Cormican, K., & Chen, G. (2018). A meta-analysis of shared leadership: Antecedents, consequences, and moderators. Journal of Leadership & Organizational Studies. To explore the variables that are in a relationship with SL Meta-analysis (correlational) 40 studies of teams (over 3,000 teams) III Demonstrates SL predictors (heterogeneity, environment), outcomes (performance, attitudes), and moderators (trust, task interdependence). Very diverse teams
Xu, N., Chiu, C., & Treadway, D. (2019). Tensions between diversity and shared leadership: The role of team political skill. Small Group Research. To study relationships between SL, performance, and diversity Experiment 63 student teams II Diversity faultlines had negative effects on SL and performance; further provides evidence to the connection between SL and performance

References

Aufegger, L., Shariq, O., Bicknell, C., Ashrafian, H., & Darzi, A. (2019). Can shared leadership enhance clinical team management? A systematic review. Leadership in Health Services, 32(2), 309-335.

Barling, J., Akers, A., & Beiko, D. (2018). The impact of positive and negative intraoperative surgeons leadership behaviors on surgical team performance. The American Journal of Surgery, 215(1), 14-18.

Brún, A., ODonovan, R., & McAuliffe, E. (2019). Interventions to develop collectivistic leadership in healthcare settings: A systematic review. BMC Health Services Research, 19(1), 1-22.

Choi, S., Kim, K., & Kang, S. (2017). Effects of transformational and shared leadership styles on employees perception of team effectiveness. Social Behavior and Personality: An International Journal, 45(3), 377-386. ]

DInnocenzo, L., Mathieu, J., & Kukenberger, M. (2016). A meta-analysis of different forms of shared leadershipteam performance relations. Journal of Management, 42(7), 1964-1991.

Fausing, M., Joensson, T., Lewandowski, J., & Bligh, M. (2015). Antecedents of shared leadership: Empowering leadership and interdependence. Leadership & Organization Development Journal, 36(3), 271-291.

Forsyth, C., & Mason, B. (2017). Shared leadership and group identification in healthcare: The leadership beliefs of clinicians working in interprofessional teams. Journal of Interprofessional Care, 31(3), 291-299.

Garrard, J. (2011). Health sciences literature review made easy: The matrix method (3rd ed.). Sudbury, MA: Jones & Bartlett.

Guenter, H., Gardner, W., Davis McCauley, K., Randolph-Seng, B., & Prabhu, V. (2017). Shared authentic leadership in research teams: Testing a multiple mediation model. Small Group Research, 48(6), 719-765.

Polit, D.F., & Beck, C.T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Serban, A., & Roberts, A. (2016). Exploring antecedents and outcomes of shared leadership in a creative context: A mixed-methods approach. The Leadership Quarterly, 27(2), 181-199.

Sousa, M., & Dierendonck, D. (2016). Introducing a short measure of shared servant leadership impacting team performance through team behavioral integration. Frontiers in Psychology, 6, 1-12.

Sun, X., Jie, Y., Wang, Y., Xue, G., & Liu, Y. (2016). Shared leadership improves team novelty: The mechanism and its boundary condition. Frontiers in Psychology, 7, 1-12.

Tafvelin, S., Hasson, H., Holmström, S., & Schwarz, U. (2018). Are formal leaders the only ones benefitting from leadership training? A shared leadership perspective. Journal of Leadership & Organizational Studies, 26(1), 32-43.

Wang, D., Waldman, D., & Zhang, Z. (2014). A meta-analysis of shared leadership and team effectiveness. Journal of Applied Psychology, 99(2), 181-198.

Wu, Q., Cormican, K., & Chen, G. (2018). A meta-analysis of shared leadership: Antecedents, consequences, and moderators. Journal of Leadership & Organizational Studies, 27(1), 49-64.

Xu, N., Chiu, C., & Treadway, D. (2019). Tensions between diversity and shared leadership: The role of team political skill. Small Group Research, 50(4), 507-538.

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