Keywords

FormalPara What Will You Learn in This Chapter?

  • Leadership is a research area but also a set of skills to influence, motivate, and inspire followers.

  • Leadership styles indicate different approaches in directing, guiding, deciding, and motivating a group toward a goal-directed behavior.

  • Considering healthcare, a complex system a novel and effective leadership approach should be developed according to Industry 4.0 and digital transformation.

  • Integrity, self-confidence, awareness, active listening, team player, creative thinking, technical and financial are just a few skills that are needed to become a successful healthcare executive.

  • Revised educational and training programs should be promoted to educate future healthcare leaders able to manage and overcome twenty-first-century challenges.

Leadership can be defined as a research area and a set of skills indicating the capability of an individual, a group, or an organization to lead and influence others. Hence, leadership represents a goal-directed behavior in which different styles, such as giving direction, planning actuation, inspiring, and motivating group activities, should be considered [1]. Indeed, different leadership styles were identified in several areas (e.g., military, political, business, government). Although only a few studies considered leadership in healthcare, most theories developed for business sectors were also adopted in healthcare. Therefore, innovative theories and styles suitable to face healthcare challenges are needed to improve patient care, system organization, and management.

If leadership styles indicate specific characteristics and behaviors of the leader in guiding, motivating, and managing the team to achieve goals, different theories were developed to identify these styles. Initially, the trait theory of leadership was proposed to detect recurrent personality traits associated with successful leaders when interacting with different situations and environments [1]. Moreover, besides the well-known leadership styles of Lewis [1] and its further extension [1], a recent approach was also developed [1] to identify those traits observed in high-quality leaders. These traits include adaptability and flexibility, assertiveness, capacity to motivate people, courage and resolution, creativity, decisiveness, eagerness to accept responsibility, emotional stability, intelligence, action-oriented judgment, need for achievement, people skills, self-confidence, task competence, trustworthiness, and understanding followers and their needs. Furthermore, different leadership theories were also developed over the last century to explain how certain individuals become successful leaders. From the early Great Man theory approach to different behavioral (e.g., authoritarian, democratic, and laissez-faire), situational, and contingency approaches, recent theories based on a supportive type of leadership were also proposed valuing interactions, trusted relationships, team empowerment, and job satisfaction [2].

In a context such as healthcare, composed of multiple interactions among multidisciplinary professionals, departments, and specialists, leadership needs to manage and organize this complex system with high efficiency and effectiveness to guarantee the achievement of multidirectional goals and the avoidance of conflicts [2], while interfacing with exponential changes brought by Industry 4.0 and digital transformation. Thus, overcoming twenty-first-century challenges in the healthcare industry requires a novel leadership approach that effectively guarantees high-quality care services. In incorporating exponential technologies, revising ethical regulations, and delivering quality services more efficiently, the role of a healthcare leader is to plan, direct and coordinate health services, managing specific departments, and entire structures. In addition, healthcare leaders need to manage finances and interact with clinicians and key stakeholders; tasks require learning a novel set of skills. These include integrity to follow ethical standards when dealing with moral issues, vision to set and achieve goals, and listening skills to consider others’ opinions while valuing their contribution [3].

Providing high-quality care that is patient-centered, cost-effective and efficient, reliable, and safe depends on specific leadership styles. In fact, increasing the quality of services would positively affect productivity, benefiting the entire healthcare system and its management. In this regard, effective leadership may be associated with patient satisfaction (e.g., better health outcomes, lower mortality rates); thus, healthcare professionals should employ adequate leadership styles accordingly with diverse challenges and responsibilities [3].

FormalPara Transactional Leadership

Valuing performance (e.g., at the group, organization, or supervision levels), it conceptualizes the relationship between healthcare executives and staff as a transaction, in which “reward and punishments” are implemented to sustain motivation toward goal achievements. Moreover, this type of leadership highlights respect for rules and procedures, clearly defined roles, and attentive supervision. This type of leadership results effectively in situations in which employees need a clear direction on how to proceed while following rules and decisions of their superiors, who can ensure the completeness of tasks. Nevertheless, this type of approach does not encourage, inspire, or support creativity toward problem-solving, although very effective in those situations that require focus and clear direction [3].

FormalPara Challenges and Opportunities

Digitalization of healthcare procedures, facilitating patient-provider communication and collaboration, might be affected by the lack of proper cybersecurity. Indeed, healthcare professionals and executives must adopt novel policies and procedures to guarantee data safety for the entire organization. Hence, a transactional leadership style may be suitable for defining roles, procedures, standards, and guidelines to execute a proper data-security plan while solving cybersecurity threats [3].

FormalPara Innovative Leadership

To bring innovation in the healthcare sector, leaders aim to approach situations with innovative thinking, particularly when dealing with uncertainty and unpredictability. This type of leadership overcomes obstacles with strategies, initiatives, ambitious goals, adaptability, and flexibility, leaving out conventional approaches to problem-solving. Innovative leaders aim to create a novel organizational culture where innovative thinking (“think out of the box”) is the key to unlocking unlimited possibilities, resources, and potential while supporting and encouraging team members’ creativity. However, innovative leaders need to manage, organize, direct, and grow this abundance for more innovation. Indeed, leaders have to supervise team members and their roles so that everything can properly function. Inviting and supporting employees to express their thoughts stimulates motivation, satisfaction, and productivity. Thus, innovative leadership may apply to those contexts in which a change and a novel team-building approach are needed, concrete decision-making, and effective management among different key stakeholders [3].

FormalPara Challenges and Opportunities

Digitizing healthcare services requires big data management and ease of the process. Hence, big data management would help healthcare executives improve the flow of operations more effectively and efficiently, eliminate administrative obstacles (paperwork), and promote a novel payment model (value-based payment). However, this outcome can only be reached by investing in advanced technologies and training on how to implement them for gaining insight into proper data management. In this perspective, innovative leadership results in the right approach in managing big data more efficiently. Indeed, an innovative thinking style is needed when investing in technologies and coordinating and training team members in their utilization to enhance an organization’s outcome [3].

FormalPara Charismatic Leadership

Engaging in charismatic communication is a valuable way to empower visions while building trusted relationships, inspiring teams toward goal-directed actions. Hence, charismatic leaders support effective communication based on feelings expression valuing emotional connections, the importance of regulating emotions, social interactions, and sensitivity to interpret situations and social control. Leaders are mission-driven and aim to change healthcare toward valuable outcomes. Indeed, charismatic leaders consider loyalty and commitment in the workplace, generate innovation, transform challenges into opportunities, empower the team toward creative solutions and less risk-averse, increase high-quality productivity while valuing trust and respect. However, being strong, popular, personality-driven, and excellent speakers, charismatic leaders need to improve their listening skills and pay more attention to others’ thoughts instead of compromising a professional business practice. Indeed, welcoming feedback would be highly recommended to promote further success in the healthcare system, as compassion is necessary to lead and support team members’ skills and personal development [3].

FormalPara Challenges and Opportunities

Managing worker stress is another challenge to be faced when coping with long working hours, emergency and life-threatening situations, or any other healthcare routine. The effect on mental and physical stress of taking responsibility or coordinating activities can be highly demanding. In this case, a charismatic leader would be beneficial in dealing with stressful circumstances while encouraging and emotionally supporting the team to avoid burnout and risky behaviors [3].

FormalPara Situational Leadership

Situational leaders understand that a “one-size-fits-all” approach is not suitable when dealing with complex healthcare situations. Indeed, different circumstances need different approaches. Thus, they determine which leadership style is more appropriate when encountering a particular situation. In this regard, four approaches are adopted: telling (giving guidance and directives), selling (influencing others to adopt their vision), participating (encouraging and sharing decisions among members), and delegating (responsibilities and tasks). Assessing different situational factors, the nature, and capabilities of the team, as well as different phases of a project is prioritized when adapting different leadership styles (e.g., a selling leadership style may be adopted at the beginning of a project when team members are unfamiliar with the task or the environment. Whereas, during later stages of a project, a delegating leadership style can be applied when team members have already acquired confidence and needed skills to complete the task). Evaluating the team’s “level of maturity” (i.e., members’ competence and knowledge) is a central characteristic of a situational leader, supporting the team toward their growth and development. Indeed, this evaluation process goes from assessing the level of knowledge and skills (level 1), willingness and enthusiasm (level 2) regardless of limited ability, competence, and skills to achieve a task (level 3), advanced skills, and high motivation (level 4) [3].

FormalPara Challenges and Opportunities

Digital transformation and the implementation of advanced technologies in healthcare had the effect of revising regulatory procedures and ethical approvals. Hence, hospitals and any healthcare provider have to interface with different regulatory agencies (e.g., licensing, addressing frauds), investing time, money, and effort. The need for flexible, adaptable, and ready actions is the key to accomplishing this challenge. Thus, situational leaders’ skills in encouraging participation, giving clear directions, and delegating responsibilities, are the key to accomplishing this challenge with flexible, adaptable, and ready actions [3].

FormalPara Transformational Leadership

Focused on empowering and encouraging the participation of team members, transformational leaders aim to transform the healthcare structure by sharing responsibilities and decisions among employees, independently of their roles in the organization. Healthcare executives value self-confidence and respect through participatory and motivating behavior while building a shared vision for a growing and enriched future. With goal-directed actions, performance and productivity are enhanced, as well as job satisfaction and a positive workplace environment. A few components have been identified as core concepts of transformational leadership: (i) intellectual stimulation (supporting creativity to generate innovation), (ii) individualized consideration (encouraging communication, shared ideas, trusted relationships), (iii) inspirational motivation (empowering the team with passion and motivation toward a vision), and (iv) idealized influence (act as role models) [3].

FormalPara Challenges and Opportunities

In shifting the value of payment toward health outcomes, the entire healthcare system needs to deal with an innovative payment method in which the possible threat of financial risk should be mitigated. Thus, a novel “value-based care” approach requires better synchronization and coordination with multiple health procedures and data acquisition. These measures need high accuracy and performance with a cost reduction. To overcome this challenge, transformational leadership may be suitable when dealing with disruption and exponential changes and managing costs and operations [3].

Furthermore, the need for great leaders to inspire and guide teams while increasing productivity and performance is high on demand nowadays to stimulate and support healthcare innovation. However, developing a proper set of skills and quality traits is necessary when leading organizations toward a successful outcome. In this regard, five leadership traits that healthcare executives should acquire were presented [4].

  • Leaders mentor others: whether formal or informal, mentorship plays an important role when training and educating future generations to become public health leaders and professionals, guiding and inspiring them in building their career path.

  • Leaders face challenges: overcoming difficulties while testing new approaches, with an innovative and growth mindset is a fundamental requirement to move out from a “comfort zone” while determining effective changes.

  • Leaders educate others: similar to mentorship, education through awareness, communication, and empowerment are relevant in supporting public health and healthcare development.

  • Leaders practice humility: accepting and welcoming different points of view or opinions is the key to development, change, and learning.

  • Leaders create opportunities for others: mentoring, innovative thinking, educating, and an open-minded approach are the steps needed to greatly empower future generations, raising opportunities and space for growing toward innovation.

Effective leadership is needed in healthcare professionals to cope with new challenges brought by the modern healthcare system and increase efficiency and productivity while improving the quality and the management of healthcare services. Participation and engagement in novel training programs to develop further healthcare leaders are essential; indeed, learning to adopt diverse leadership styles facing different situations is a key point in fostering improvements and changes [5].

However, to become effective leaders, healthcare professionals need to develop new skills in responding to the increasing demand for quality health services. Therefore, based on the NHS, quality in healthcare can be measured in relation to patient safety and positive patient experience. Moreover, the Care Quality Commission (CQC) identified quality as efficient and cost-effective services. For this reason, a good leader knows where to apply changes, adapt novel approaches when facing different environments and situations, and make the proper decisions to create a novel organizational culture. In this context, a transformational leadership approach would be the most successful in engaging and empowering the medical staff in decision-making, responsibilities, managing tasks, and contributing to the process of change [5].

Recently, besides the well-known Medical Leadership Competency Framework [6] supporting clinicians in developing leader’s skills, to further grow healthcare workers into becoming effective leaders, a Healthcare Leadership Model has been proposed, designed over nine dimensions [7]:

  • Leading with care: the recognition of team needs and behaviors while creating a caring and supportive environment

  • Sharing the vision: communication based on trust to set and achieve long-term goals while inspiring confidence and credibility

  • Engaging the team: the support of team members’ participation

  • Influencing for results: engaging in creating a collaborative environment, to properly commit

  • Evaluating information: innovative and creative thinking approach to solve problems and to develop new concepts

  • Inspiring shared purpose: taking risks and overcoming challenges based on NHS principles and values

  • Connecting our service: the understanding of the system structure, organization, and politics, to connect with the inside and outside of the system

  • Developing capability: seeking opportunities to support the growth of the team and to develop their skills further

  • Holding to account: creating an innovative and growth mindset based on clear ideas and continuous improvement

Lastly, successful leadership programs aim to develop effective healthcare leaders, promote followership, and exploit changes and ameliorations. Hence, this approach would fit the concept of collective leadership for Healthcare [5]. Through an innovative culture, everyone would contribute to the organization’s success in generating high-quality healthcare services.

1 Educating Future Healthcare Leaders

Leading healthcare innovation in the twenty-first-century requires effective and well-prepared executives managing the medical staff, key stakeholders, health providers, and distributors. Therefore, novel training and educational programs to prepare future healthcare leaders are necessary to empower professionals with a new role model balancing autonomy, accountability, teamwork in a value-based outcome, patient-centric approach, and interdisciplinary environment [8].

A few skills are indispensable in becoming an effective leader. Among these are organization and time management, building solid and trusted networks, and effective communication. Moreover, welcoming feedback and self-awareness are useful when adjusting behavioral habits toward dealing with different situations [8]. Furthermore, considering healthcare a complex system and organization, collaborations and teamwork are fundamental aspects. Indeed, developing proper communication skills while sending and receiving messages should be clear, congruent, stimulating, and reinforced by active talking and listening [8, 9].

Defying and planning novel curricula and training programs requires attention to encourage the development and assessment of future emerging leaders. Indeed, several experienced healthcare professionals and educators will retire in the following years [8], leaving the lead to new generations. Thus, promoting mentorship to support innovation should be considered to foster a novel organizational culture in healthcare, supervised by effective and responsible leaders [8]. A few practices suggested in supporting leadership development are reading more about leadership, attending training workshops and courses [8], joining mentorship programs, welcoming opportunities, and learning to take responsibilities.

A transformational approach based on teamwork is optimal to enable effective leadership and management, in which collaboration with multiple health professionals, educators, and providers leads to the achievement of goals. Moreover, leadership can be extended to the management and organization of different areas, from teaching to administration, research, and clinical setting. Training to use tools to stay organized while matching schedules or learning to delegate tasks can be useful when preparing future leaders. A few examples are defying milestones, a list of needed resources (e.g., staff requirements/qualities/skills), effective communication to set directions and complete tasks. Based on Oates (2012), a list of needed competencies to educate effective healthcare leaders is reported in Table 29.1 [8, 10].

Table 29.1 Needed leadership competencies for educators, leaders, and professionals in healthcare (suggested and structured by van Diggele et al., 2020; revised and adapted from Oates, 2012) [8, 10]
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Challenges

A novel healthcare education for leaders that is extended among different professional areas, organizations (e.g., universities, hospitals, and other health services) might be influenced by the type of structure, policies, regulations, and culture within the organization. Thus, educators in healthcare leadership should define their approach to leadership (e.g., postgraduate, undergraduate education). To this, McKimm (2004) [9] (see Table 29.2) listed a few challenges that need to be considered when educating future healthcare leaders [8]. Learning novel leadership competencies become mandatory in any health sector, in which a multidisciplinary environment represents a new space of improvement based on mutual exchange across disciplines. In conclusion, to generate innovation in healthcare leadership, educators and revised training programs (or curricula) should promote teamwork, clinical skills, a patient-centered approach, responsibility, and autonomy [8] (see Fig. 29.1).

Table 29.2 Challenges to be considered for educators, leaders, and professionals in healthcare (suggested and structured by van Diggele et al., 2020; revised and adapted from McKimm, 2004) [8, 9]
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Fig. 29.1
figure 1

Graphical representation of needed skills and competencies for innovative healthcare leadership

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Take-Home Messages

  • Healthcare is a complex and dynamic system and a novel leadership approach is needed to lead, actuate, and manage the process of health innovation.

  • A novel set of skills is required when facing twenty-first-century challenges brought by Industry 4.0 and digital transformation

  • Self-confident, aware, active listener, team player, creative thinker, technical and financial expert, visionary, and good communicator: the new profile of a successful healthcare leader

  • Revised educational and training programs should be considered to educate future healthcare leaders to overcome challenges in any clinical situation.