Crisis leadership behaviors in healthcare: survey validation and influence on staff outcomes in primary care clinics during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic triggered an unprecedented transition from in-person to virtual delivery of primary health care services. Leaders were at the helm of the rapid changes required to make this happen, yet outcomes of leaders' behaviours were largely unexplored. This study (1) develops and validates the Crisis Leadership and Staff Outcomes (CLSO) Survey and (2) investigates the leadership behaviours exhibited during the transition to virtual care and their influence on select staff outcomes in primary care. METHODS: We tested the CLSO Survey amongst leaders and staff from four Community Health Centres in Ontario, Canada. The CLSO Survey measures a range of crisis leadership behaviors, such as showing empathy and promoting learning and psychological safety, as well as perceived staff outcomes in four areas: innovation, teamwork, feedback, and commitment to change. We conducted an exploratory factor analysis to investigate factor structure and construct validity. We report on the scale's internal consistency through Cronbach's alpha, and associations between leadership scales and staff outcomes through odds ratios. RESULTS: There were 78 staff and 21 middle and senior leaders who completed the survey. A 4-factor model emerged, comprised of the leadership behaviors of (1) "task-oriented leadership" and (2) "person-oriented leadership", and select staff outcomes of (3) "commitment to sustaining change" and (4) "performance self-evaluation". Scales exhibited strong construct and internal validity. Task- and person-oriented leadership behaviours positively related to the two staff outcomes. CONCLUSION: The CLSO Survey is a reliable measure of leadership behaviours and select staff outcomes. Our results suggest that crisis leadership is multifaceted and both person-oriented and task-oriented leadership behaviours are critical during a crisis to improve perceived staff performance and commitment to change.

Nurse practitioners, physician assistants, and trust: A systematic review.

BACKGROUND: The use of physician extenders (e.g., nurse practitioners [NPs] and physician assistants [PAs]) has risen in recent years in the U.S. health care domain, yet some scholars have questioned if physician extenders are being fully utilized in the health care field. PURPOSES: The purpose of this research was to conduct a systematic review to determine if trust in the NP/PA might be influential in the ways these professionals are utilized. We view trust through the lens of Mayer et al. and their model of organizational trust, and we seek to examine how patients, physicians, and NPs/PAs themselves view one another. METHODS: This systematic review spanned from 1996 to 2022 and applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses strategy. The final sample consisted of 29 articles. RESULTS: The findings point to how the antecedents of trust according to Mayer et al.; i.e., trustee's ability, benevolence, and integrity) influence the trusting relationships between patients and NPs/PAs and between physicians and NPs/PAs. Consequences and outcomes of trust are also discussed. Importantly, a trustor's propensity to trust and repeat interactions over time (e.g., feedback loop) is influential to trusting relationships. PRACTICE IMPLICATIONS: These findings offer health care organizations insight into the mechanisms for building trust as physician extenders become more prominent in the health care field.

System justification theory as a foundation for understanding relations among toxic health care workplaces, bullying, and psychological safety.

BACKGROUND: Toxic work environments and bullying are rampant in health care organizations. The Joint Commission asserted that bullying is a threat to patient safety, and furthermore, it implied that bullying affects clinician psychological safety. However, after decades of trying to reduce bullying, it persists. PURPOSE: The purpose of this study was to determine if system justification (SJ) theory can help explain the persistence of bullying in health care organizations. SJ theory posits that people are motivated to justify the systems with which they are embedded, even if those systems are dysfunctional or unfair. METHOD: A cross-sectional survey of health care workers ( n = 302) was used to test a moderated mediation model to examine relations between instrumental work climate perceptions and psychological safety, as mediated by SJ and moderated by experiences of workplace bullying. RESULTS: Analysis revealed that SJ fully mediated negative relations between instrumental climate and psychological safety; because of SJ the instrumental climate no longer had a direct negative association with psychological safety. Furthermore, bullying was found to play a moderating role in the instrumental climate-SJ relationship. CONCLUSION: This study found some support for the role of SJ in perpetuating instrumental workplaces and workplace bullying in health care. PRACTICE IMPLICATIONS: Some scholars have proposed that a focus on disrupting workplace contexts that trigger SJ in workers could help break patterns of behavior that enable toxic work environments and bullying to persist.

Caring work environments and clinician emotional exhaustion: Empirical test of an exploratory model.

BACKGROUND: Burnout has been a chronic problem in the workplace, especially in health care. Although the literature has examined many antecedents to burnout, specific workplace practices to reduce burnout remain elusive. Nascent research has begun to examine how health care work places can become more caring for workers. Although psychological safety has been proposed as an important predictor of burnout, relations have not yet been comprehensively examined. PURPOSE: Underpinned by conservation of resources theory, we argue that a caring work environment, in which compassion and interpersonal support are key priorities, provides resources for workers, which should increase psychological safety and in turn help reduce emotional exhaustion. METHOD: To explore our proposed model, we conducted a paper-and-pencil survey of clinical health care providers working in medical units of a large acute care hospital. Response rate was 44% (n = 631). RESULTS: Analysis found support for a moderated-mediation model in which psychological safety partially mediated relations between caring climate and emotional exhaustion, and this effect was stronger for those who were less empowered in their jobs. CONCLUSION: Our findings suggest that a caring work environment holds psychological resources that may help buffer against resource losses through increased psychological safety. PRACTICAL IMPLICATIONS: Although health care work environments will continue to experience constraints on key resources, worker emotional exhaustion may be mitigated through a focus on systematically increasing caring and compassion in the work environment, as opposed to relying on individual workers to support one another in an uncaring workplace.

Seven years after Meaningful Use: Physicians' and nurses' experiences with electronic health records.

Although the federal government's Meaningful Use electronic health record (EHR) implementation program resulted in some successes, there have been many challenges. The purpose of this study was to obtain detailed empirical data to better understand physicians' and nurses' experiences with EHRs. We conducted in-depth interviews with 30 physicians and nurses from two large health systems that were focused on attaining Stage 3 Meaningful Use criteria. Thematic framework analysis identified themes related to perceived benefits and challenges with EHR use. Participants appreciated benefits such as real-time patient data and easier access to information. Challenges included lack of interoperability across units, and this seemed to underlie many other noted challenges such as increased workload, insufficient training, and the perceived need for workarounds. Two key findings included mixed messages about trust in the EHR's information and its interference with interpersonal relationships. Results suggest that conservation of resources theory may be a useful strategy for understanding behaviors that enhance or undermine effective EHR use. Implications for policy and practice are discussed.

Building trust: The influence of mentoring behaviors on perceptions of health care managers' trustworthiness.

BACKGROUND: In health care organizations, trust is critical for effective workplace relationships that ensure patient-centered outcomes. Although research has focused on trust in the relationship between patients and clinicians, less is known about what influences workers to trust their managers. An understanding is needed of the specific behaviors that influence health care workers' evaluations of their managers' trustworthiness. Mentoring research focuses on the developmental assistance that a more experienced worker provides to a less experienced worker. Building upon seminal research on mentoring functions, we argue that health care managers can build trust by providing informational (career-related) and interpersonal (psychosocial) support. PURPOSE: The aim of the study was to investigate the influence of health care managers' informational and interpersonal mentoring behaviors on workers' perceptions of their managers' trustworthiness and the mediating role of trustworthiness on trust in the managers. METHODOLOGY/APPROACH: Surveys were completed during work hours by 315 health care workers at an acute care hospital and associated clinics in the Midwest. FINDINGS: Results showed that managers' mentoring behaviors influenced worker perceptions of their managers' trustworthiness, in terms of ability, integrity, and benevolence. Ability partially mediated the relationship between informational mentoring and trust in managers, whereas integrity and benevolence partially mediated the relationship between interpersonal mentoring and trust in managers. PRACTICE IMPLICATIONS: Health care managers can actively build trust through mentoring behaviors that inspire positive assessments of managers' ability, integrity, and benevolence.

Physicians as leaders: a systematic review through the lens of expert leadership.

PURPOSE: The purpose of this paper is to provide a systematic review of the current state of physician leadership. Theory of expert leadership (TEL) was applied to explore the effects of physician inherent knowledge, industry experience and leadership capabilities on leader behaviors and outcomes. DESIGN/METHODOLOGY/APPROACH: This review (August 2011-February 2022) applied the preferred reporting items for systematic review and meta-analysis strategy. Our search began with 3,537 studies and a final sample of 12 articles. FINDINGS: The findings offer a number of studies that note the relationship between physician leadership and the three dimensions of TEL. How influential these are on leadership behaviors and health-related outcomes varies. We also found a number of studies that described general physician leadership behaviors that were not directly linked to factors of TEL, as well as two additional themes: leader identity and trust. ORIGINALITY/VALUE: To the best of the authors' knowledge, this is the first systematic review that has applied a highly cited theory (i.e. TEL) to the data and the first that has focused solely on a U.S. population. These findings offer healthcare organizations insight into the potential strengths and challenges of physician leadership.

Pandemics and the Impact on Physician Mental Health: A Systematic Review.

Physician mental health is a major area of concern with physician burnout on the rise, while at the same time pandemics are becoming more frequent and serious in nature. This combination of physician burnout and pandemics has the potential for serious negative implications for physicians, patients, and health care organizations. Thus, we conduct a systematic review that examines the effect of pandemics on physician mental health using the burnout cascade as a framework. We identified 30 quantitative studies for inclusion. We find that Stages 4 and 5 of the burnout cascade are particularly troublesome with physicians experiencing high levels of anxiety and depression. Furthermore, we find in the degradation phase that physicians experience stigma which may intensify other negative effects. Physicians who are women, younger, and have less training are more susceptible to the negative effects of pandemics. We discuss overall implications and recommendations for future research.

Measuring Bullying in Sexual Minorities: Testing Two Bullying Scales in an LGB Sample.

The working experience for those in the sexual minority is not well understood, particularly with respect to interpersonal mistreatment based on sexual orientation. This study breaks new ground by utilizing a sample of 416 LGB working adults to assess the relative usefulness of two bullying measures (the Negative Acts Questionnaire-Revised (Person-Related) and the Homophobic Bullying Scale) to determine their convergent, discriminant, and criterion validity in predicting organizational commitment, turnover, and post-traumatic stress disorder (PTSD). Results show that discriminant and convergent validity exist between these scales and both measure similar levels of perceived bullying (from the victim's perspective). We concluded that although there are similarities and differences between these measures, more research is needed to determine the most appropriate instrument to assess perceived bullying in a sexual minority population. Several areas for subsequent research are noted.

Physician leadership and health information exchange: literature review.

BACKGROUND: Notwithstanding two decades of health information exchange (HIE) failures across the country, the US government has incorporated HIE into Meaningful Use Stage 2, which, in turn, has sparked renewed physicians' interest in HIE. OBJECTIVE: The purpose of this paper was to conduct a literature review to understand how physician leadership might have assisted in supporting organisations in achieving HIE collaboration. METHOD: The authors conducted a review of the literature about HIE and physician challenges from 2009 to present to identify peer-reviewed publications which might apply. Reviewers abstracted each publication for predetermined issues related to physician leadership. Themes were identified based on the literature findings. RESULTS: The literature review demonstrated four important themes (physician leader characteristics) that can assist in bridging the gap and creating collaboration in an HIE. The themes found in this study were: trust among physicians, promote involvement and buy-in, infuse value proposition and competition. CONCLUSION: This paper contributes to the healthcare literature by conducting a literature review of the existing literature of surrounding HIE implementation and physician leaders. Specifically, we sought to gain insight into the change process and how physician leaders have demonstrated an impact on the process. This research is the first of its kind to synthesise leadership issues related to HIE and specifically explore the role of physician leader impact on HIE.

An exploratory study of gender and motivation to lead in millennials.

This study explores how gender predicts millennial employee motivation to take a leadership role within a work organization. Previous studies have considered multiple factors in predicting three distinct types of employee motivation to lead, but none have considered how gender may impact this relationship, specifically within the millennial population. Using a sample of 210 employees from a range of industries, results indicate that gender directly affects two types of motivation to lead. In addition to enhancing the theoretical model of employee motivation to accept organizational leadership responsibilities, the results have practical significance for organizations concerned with attracting and developing millennial organizational leaders.

Team development among physician-leaders at the Cleveland Clinic.

Purpose Since 1990, the Cleveland Clinic has trained physicians in team skills through various iterations of a program called Leading in Healthcare (LHC). In the present study, the authors utilize a case study approach to gain insight into the LHC curriculum, and more specifically, the team project. The purpose of this paper is to better understand the Cleveland Clinic's position on the issue and its approach to education - specifically among physicians. Design/methodology/approach The authors utilized a case study approach with four key program architects. Findings The results of this exploratory research yielded three themes: There is a lack of formal physician education in teamwork, there is a growing trend of inter-disciplinary teams and the team project was an important component of teambuilding in LHC. Research limitations/implications A breakdown in team function adversely impacts patient care. While formal and informal participation in teams is imbedded in the role, physicians are rarely trained in leadership or teambuilding in their formal medical education - much of it is learned on the job in hidden curricula. In addition to the adverse effects of dysfunctional teams on patient care, the authors have explored another area that will be affected by a lack of education - the team experience at the administrative level. As more and more physicians take on leadership roles in healthcare, there is an additional need to build competencies around teams (e.g. team theory, cross-functional team participation and leading teams) from an administrative perspective. Originality/value This is one of only a few studies which have specifically examined the impact of a teamwork education for physicians.