EFF FFECTIVE TIVE APPROACHES CHES TO O DE DETERM RMINING INING RE RETUR URNS NS ON ON INV NVESTME STMENT NT IN HE N HEALTHC HCARE ARE LE LEADE DERSHIP RSHIP DE DEVE VELOP OPMENT MENT PROG OGRAM RAMS: S: A SC SCOP OPING ING RE REVI VIEW EW Maya ya Jeyar yarama aman n & Ah Ahmed ed Abou- Setta• May 26, 2016
OVE VERVIE VIEW W OF OF THE HE PRE RESE SENT NTATION TION 1. 1. Study dy sel elec ection ion pr proces ess 2. 2. Type pes of studi dies es id iden entif ifie ied d (2 Type pes) 3. 3. Objecti jective e 1 – ROI I det deter ermin inan ants ts as associ ciat ated ed wit ith hea ealthcare hcare lea eade dership ip qualit ity/sty y/style le 4. 4. Object jectiv ive e 2 – ROI I det deter ermin inants ts associ ciated ed wit ith lea eade dership ip de devel elopm pmen ent t pr progr grams ms/tact /tactics ics 5. 5. Object jectiv ive e 3 – ROI det deter ermin inants ts associa iated ed wit ith exis istin ing g ROI tools 6. 6. Conclusion lusions
Study selection Study selection pr process ocess Title and Abstract screening (~11,000) Full text screening (~1,500) Included studies (198) Objective 1 Objective 2 Objective 3 (73 studies) (125 studies) (11 studies) 3
Types ypes of of studies studies (Objectiv (Objective e 1) 1) Leader quality/style Patient outcomes Staff outcomes Organizational outcomes 4
Types ypes of of studies studies (Obje (Objectiv ctive e 2) 2) Leadership development programs/tactics Program ram Leader eva valuat luation ion to tools ls with metric rics Evaluation Individual & Individual Organizational development development 5
OBJECTIVE 1 • To identify and summarize evidence on ROI determinants (factors, indicators and metrics) as associat ciated ed wi with th heal althc thcare are le lead ader ership ship Staff outcomes Leader Organizational quality/style outcomes Patient outcomes 6
STUD ST UDY DE DESI SIGNS NS ~ 80% of studies are of Survey design Survey 78% 0% Interrupted Mixed time series Pre-post study Qualitative study Prospective methods 1.4% 4% 2.7% study study 1.4% 1.4%
COU OUNTRIE NTRIES 50.6 % ~ 90% of studies are from Canada & USA 50.0 35.4 % 45.0 47.2 % 40.0 50.0 35.0 45.0 37.5 % 40.0 30.0 35.0 25.0 30.0 25.0 20.0 8.9 % 20.0 15.0 9.7 % 5.1 % 15.0 5.6 % 10.0 10.0 5.0 5.0 0.0 UK Australia Canada USA 0.0 UK Australia Canada USA
LEADE LE DERS RS ~ 80% of studies focused on Nurse leadership Nurse se leader 77% CEO 6% 6% Non-clinical clinical Physi sicia cian leader leader er 4% 4% Leader er 1% 1% Direct ctor or Manage ager 1% 1% 4% 4% 3% 3% Execu cuti tive 4% 4%
EMERGING GING VS EX S EXECUTIVE UTIVE LE LEADE DERS RS ~ 60% of studies focused on Mid-level leaders 59.2% 60.0 50.0 40.0 30.0 16.9% 14.1% 20.0 0% 0% 10.0 0.0 Frontli tline ne leader Mid-level el leader Execu cuti tive e leader Emerg rgin ing g leader
LEADER ER QU QUALIT LITY/ST Y/STYLE YLE Leadership quality/style 1 . 11. Management by exception (2.1%) Transformational leadership (27.4%) 2. Effective/Good leadership (20%) 12. Relational leadership (2.1%) 3. Authentic leadership (10.5%) 13. Abusive leadership (1.1%) 4. Transactional leadership (10.5%) 14. Change-oriented leadership (1.1%) 5. Laissez-faire leadership (5.3%) 15. Exemplary leadership (1.1%) 6. Leadership practices (4.2%) 16. Managerial exclusion (1.1%) 7. Clinical nurse leader impact (4.2%) 17. Passive leadership (1.1%) 8. Emotionally intelligent leadership (2.1%) 18. Task-focused leadership (1.1%) 9. Leader-Member exchange (2.1%) 19. Visible-nursing leadership (1.1%) 10. Leader walk-rounds (2.1%) 11
PATIENT IENT OU OUTCOMES OMES 7 6 Number of studies 5 4 3 2 1 0 Pa Patien ent t Pa Patien ent t Patien Pa ent t Infect ection ion rates advers erse e mortalit ality satisf isfact action ion event nts Most reported patient outcomes
ST STAFF FF OU OUTCOMES OMES 25 Number of studies 20 15 10 5 0 Most reported staff outcomes
OR ORGANIZ NIZATIONAL TIONAL OU OUTCOM OMES ES 10 9 Number of studies 8 7 6 5 4 3 2 1 0 Most reported organizational outcomes
AUT UTHEN HENTIC TIC LE LEADE DERS RSHIP HIP (GOO OOD D LE LEADE DERSHIP) RSHIP) 4 3.5 3 2.5 Job satisfaction 2 1.5 Care quality 1 0.5 Adverse 0 Bullying events -0.5 -1
TRANS NSFORM ORMATIONA TIONAL (GOO OOD) VS VS LA LAISSE SSEZ-FAIRE AIRE (BA BAD) D) LE LEADE DERS RSHIP HIP 1 0.5 0 -0.5 -1 -1.5 -2 -2.5 -3
SUMMARY OF RESULTS (Objective 1) • Majority of studies: 1. Are surveys 2. Are published in USA & Canada 3. Are focused on Nurse leadership 4. Are focused on Mid-level leaders • Good leadership quality/style has a positive impact on healthcare outcomes (patient/ staff/ organizational outcomes) • Bad leadership quality/style has a negative impact on healthcare outcomes (patient/ staff/ organizational outcomes) 17
OBJECTIVE 2 • To identify and summarize evidence on ROI determinants (factors, indicators and metrics) associated with heal althc thcare are le lead ader ership ship development elopment programs ams Individual development Leader Leader Evaluation development Intervention Organizational purpose 18
STUD ST UDY DE DESI SIGN ~ 60% of studies are of pre-post design Pre-post post study 60% 60% Case e study 16% Clust ster er Survey randomized omized 6% 6% control olled d Qualitati itative e study trial 6% 6% 6% 6% Mixed ed Randomized omized post Longit itudin dinal met ethod od test design gn study dy study dy 1% 1% 1% 1% 4% 4%
COU OUNTRIE NTRIES 60.0 ~ 90% of studies are from Canada & USA 60.0 ~ 60% of studies are from USA 60.0% 50.0 60.0 40.0 50.0 30.0 40.0 17.6 30.0 20.0 17.6% 14.4 14.4% 20.0 7.2% 7.2 10.0 0.8% 10.0 0.8 0.0 0.0 UK UK Aus ustral alia Canada nada USA New w Zealand and UK UK Aus ustral alia Canada nada USA New w Series1 Zeala land nd
LE LEADE DER ~ 50% of studies are focused on nurse leaders Manag ager ers s 2% 2% Executiv ecutive 2% 2% Direc ector or Nu Nurse se leader der 2% 2% 54% 54% CEO 2% 2% Leade der 16% Physic sician ian leader der 20% 20% Denta tal l fellows ws Pharma macy leader der 1% 1% 1% 1%
EMERGING GING LE LEADE DER R VS EX VS EXECUTIVE UTIVE LEADE LE DER 34% 34% 28% 28% 35.0 30.0 19% 25.0 20.0 15.0 6% 6% 10.0 5.0 0.0 Frontli tline ne leader Mid-level el leader Execu cuti tive e leader er Emerging ging leader
Cont ntext xt of deliv iver ery y of leader dersh ship p develo elopment pment progra grams/ ms/tac tacti tics 66 % 70.0 34 % 60.0 50.0 40.0 30.0 20.0 10.0 0.0 Indivi vidual dual develop opme ment nt Indivi vidual dual and organizat zationa nal develo elopme pment nt 23
CON ONTEXT EXT OF OF DE DELI LIVE VERY Y (PROG OGRA RAMS/ MS/ TACTICS) TICS) ~ Majority of studies focused on Individual development 58 % 60.0 41% 50.0 40.0 30.0 3% 3% 20.0 10.0 0.0 Indivi vidual dual Indivi vidual dual and Broader der organizatio ationa nal develo elopm pment nt organiz nizati tiona nal l purp rpose ose develo elopme pment nt
OUTCOM OU COMES ES RE REPOR ORTED ED BY P PROG OGRA RAMS MS 70% 70% 70 60 50 40 30 20 10% 7% 7% 6% 6% 2% 2% 2% 2% 2% 2% 10 0
LEADER ER OU OUTCOMES ES Leader Outcomes associated with leadership development programs/tactics 1 . Increased leadership competencies 2. Ability to resolve conflicts 3. Increased assertiveness 4. Increased self-confidence & Self- awareness 5. People management skills 6. Decision making skills 7. Financial management skills 8. Communication with listening 9. Improved negotiation skills 10. Motivation to pursue higher education 26
SUMMARY OF RESULTS (Objective 2) • Majority of studies: 1. Are pre-post design 2. Are published in USA 3. Are focused on Nurse leadership 4. Are focused on Mid-level and emerging leaders 5. Are focused on individual development • Leader development programs/tactics show a positive impact on individual leadership skills and an improvement in healthcare outcomes 27
OBJECTIVE 3 • To identify and summarize the evidence on ROI determinants (indicators and metrics) from existing ROI evaluative instruments 28
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