With the development of the significance of leadership and strategy implementation, how leadership strategy affects research use in healthcare systems is getting increased consideration. The current critical review appraises the previously published articles under the strategic leadership and evidence-based practice (EBP) implementation based on journal articles from 2016-2021. A knowledge gap was identified in methodology, research designs, and leadership implementation with regards to EBP. Academic databases (CINAHL Complete (EBSCO), PUBMED, SCOPUS, MEDLINE, and Google Scholar) were searched for quality articles in healthcare and leadership implementation for research use for the inclusion criteria using such keywords as leadership, strategies, healthcare, and evidence-based practice. A total of 20 peer-reviewed articles were recorded for the systematic review. The principal themes that were generally evident in the research articles included collaborative functions, common leadership communication, and context of leadership settings and culture. EBPs are vital to progressing strategic leadership execution.
Index Terms: leadership, implementation, strategy, healthcare, evidence-based practice.
Background
In many healthcare organizations, there exist one or more leadership problems related to evidence-based practice (EBP) implementation. The challenges call for effective utilization of resources for quality healthcare systems delivery (Schein and Schein, 2017). Effective leadership has been indicated to increase successful organizational change by achieving a good climate and culture for change, amplified positive perception towards EIPs, and improved patient healthcare outcomes (Cheng et al., 2018; Ehrhart et al., 2018; Schein and Schein, 2017). Despite the myriad of positive effects of EBP in health-related leadership, few leadership development strategies highlight precise models that healthcare organizations and managers can use to promote a positive climate or culture (Aarons et al., 2020; Jabbar and Hussein, 2017). As such, determinants which do not factor in contextual and person-specific features may result in poor healthcare delivery systems and reduced public health outcomes.
With the development of the significance of leadership and strategy implementation, how leadership strategy affects research use in healthcare systems is getting increasing consideration. To comprehend the leadership strategy implementation in a healthcare system, the application of theory is imperative. Behavioral leadership theory (BLT) describes efficient leadership as a component that comprises such characteristics based on conceptual classifications as change-driven, relation-driven, and task-driven behaviors. Change-oriented actions are apprehensive primarily with delivering leadership ideas and courses for invention, generating a sense of belonging, and constructing partnerships to sustain change (Yukl and Gardner, 2020). Relation-oriented behaviors encompass association and alliance creation through the development and recognition of other actors of healthcare for the objective of providing quality healthcare, thus increasing trust, corporation, and commitment among members (Yukl and Gardner, 2020). Task-oriented behaviors involve identification of roles, preparation, observing performance and results, and exhausting capital funds resourcefully (Yukl and Gardner, 2020).
As illustrated, the comprehension of the leadership behaviors to improve research utilization is central for redesigning leadership strategies for organizations, thus helping in the promotion of healthcare delivery and patient-centered outcome. The current study explores the available evidence in the literature on the relationship between leadership behaviors among managers and the utilization of EBP by healthcare providers for articles published from the past five years. As such, the contemporary critical review is determined to identify the efficiency of leadership implementations for identifying the gap in knowledge for developing leadership strategies in facilitating research use by healthcare providers.
Critical Review
Academic databases (CINAHL Complete (EBSCO), PUBMED, SCOPUS, MEDLINE, and Google Scholar) were searched for quality articles in healthcare and leadership for the inclusion criteria using such keywords as leadership, strategies, healthcare, and education. A total of 20 peer-reviewed articles were recorded for the systematic review. The articles comprised qualitative and quantitative study designs, mixed-method research articles, and descriptive journals. The basis of all the articles included instrumental research or actual use of research knowledge to interpret the delivery of healthcare policies through behavior changes in health and nursing practice. Documented evidence comprised of guidelines, procedures, and strategies, which were based on the current research question. The overall fundamental themes identified throughout the journal research studies were collaborative activities, the context of leadership culture, and a common leadership message. Furthermore, subthemes derived from each theme will be discussed.
Collaborative Functions
Based on the BLT framework concerning the partnership and alliance creation, participation in leadership planning, and effective communication with healthcare staff, the studies reveal identical inter-reliant managers’ relationships. In this case, managers applied the integrated leadership strategies within and without healthcare departments to cultivate a sense of communal and cultural diversity that support EBPs (Guerrero et al., 2016). According to Moullin et al. (2019), managers are indicated to go the extra mile in encouraging the staff members to perform health-related procedures that abide by care policies. Further, senior managers are established to enter into performance engagements tailored through internal and external departments (Guerrero et al., 2016). The essence of such moves is to allow exchanges that predisposed the work setting and encourage research use.
According to Bakhour et al. (2018), managers’ priorities and their focus on staff can trigger work-related environmental culture influence by collaborative leadership. For instance, the current research findings illustrated the use of such collaborative leadership functions as the creation of alliances with multidisciplinary teams that nurture staff uses of research in healthcare practice. As such, the collaboration encompassed activities such as negotiation and collaborative engagements with other research-related use (Lyon et al., 2018). Evidently, with interprofessional partnerships’ prominence for quality results in healthcare backgrounds, directors play a significant part in adopting these alliances to backing staff use of EBPs in the healthcare and nursing field.
Common Leadership Communication
The use of managers or healthcare staff is critical in the provision of EBP and its subsequent translation into action. According to Hu and Gifford (2018), strategic leadership for research application goes beyond a manager as a leader and a role model to include change and task-driven behavioral characteristics necessary for quantifying leadership message that meets organizational needs and preferences. In this regard, the illustrated common leadership behaviors have been shown to influence such processes as supporting the company’s mission and goals, enactment of policy measures, and allocation of resources. In terms of organizational resources, such allocations play a key role in leading strategic implementation. Munce et al. (2017) explain that leadership strategic implementation should allocate enough resources and amenities for its workers to enable the creation of an enabling milieu for strategy implementation. Munce et al. (2017) further highlight that only those firms that thrive in the implementation of leadership strategy have in one way or the other provided necessary resources to their employees. In this regard, the execution of the leadership change process is a challenging encounter that requires the attention of all healthcare workers because of the possibility of resistance from some employees to initiate the change process.
The effect is the strategic leadership conceptualization that focuses on both micro and macro-level actions to empower persons, the healthcare working systems, and organizational infrastructures to change goals (Ben Charif et al., 2017; Wandersman et al., 2016). Egeland et al. (2019) define the essence of a leadership focus and postulates the significance of communicating healthcare urgencies as prime entrenching mechanisms, which are influential for cultivating a labor atmospheric conducive environment for change implementation. The available outcomes emphasize that managers associated with the idea of EBPs to wider organizational goals often signal to workers the macro-level management provision for EBPs in the healthcare business. According to Aarons et al. (2017), the association indicated that harmonized and concentrated care from managers at various structural stages, as well as a mutual communication that associates EBPs to the administration’s objectives, goals, standards, and processes led to positive leadership implementation.
Context of Leadership and Culture
The aspect of leadership and culture offer imperial evidence for strategic leadership implementation in healthcare and its related systems. In this case, leadership behaviors in this category that effectively emerged were communication, inspiration, support to change, and learning activities (Hu and Gifford, 2018). Despite the findings, the overall outcome for these research articles regarding cultural contexts is not clear, specifically with the view on whether leadership control and its conceptualization may be dissimilar with language use and societal desires and needs. According to Bokhour et al. (2018), managers working with native members of a particular community must consider healthcare provider’s use of EBPs within the larger framework of cultural expansionism, discernment, and past injustices. Moreover, in another research by (Bokhour et al., 2018), the cultural competencies of the healthcare providers were related to the cultural competencies of their managers as leaders for quality change implementation.
Precisely, the association continued to be significant even with such areas of cultural competencies as intervention and paradigm, thus controlling the contextual and sociodemographic data. Based on the research, the association suggested that the leadership impact varied with the level of cultural competence of the managers who are the key leaders for healthcare change implementation. The cultural aptitude among employees is acquired partially through leadership for quality research use and application (Mubarak and Wan Yusoff, 2019). Social interactions and leadership effects within a care service provider should be considered when establishing executing culturally competent strategies for research use. Notably, this requires thoughtful approaches since a majority of central persons are not always the same people as the formal leaders. Therefore, it is explicitly uncertain how leadership behaviors based on the current literature review can decipher the diverse goals and cultural preferences.
Problem Statement
Data published from 2016 to 2021 proposes that strategic leadership is attainment momentum in health-related studies. Whereas a positive relationship has been indicated between leadership and healthcare services’ EBPs in communities, culturally-based backgrounds, and language diversifications, these studies indicated a gap in knowledge with regards to clear strategic leadership implementation that results in quality patient outcomes. However, research by Aaron et al. (2016) established results that are consistent with the current study’s findings, hence signifying the full range of leadership behaviors. In support of these findings is the research conducted by Birken et al. (2017), whose leadership behavior findings impact the recognition and use of EBPs in healthcare. With few research articles related to healthcare strategic leadership execution, little to no significant knowledge can be extracted from the research information in terms of manager’s leadership implementation.
Moreover, despite the healthcare providers being part of the multidisciplinary group with an expert role of integrating the preeminent accessible EBPs into actions, their system of healthcare is predominantly autonomous as compared to other business-related enterprises. As such, the present research findings may contain restricted transferability to management guidelines of leaders operating within other allied healthcare professionals. To improve the self-assurance in future research studies exploring the strategic leadership implementation and research utilization, research designs with higher validity are required. From the foregoing research findings; three core areas still need quality improvement.
First, an investigation is compulsory to comprehend the theoretical connections and variances between management behaviors acknowledged in this literature analysis, as well as studies examining leadership in diverse ethnic settings to magnify the strategic leadership execution model. Second, constructing theoretical leadership change for research implementation and utilization, there is a necessity for reliable processes across studies since only one of such instruments was applied in several of the studies under this review; the Implementation Leadership Scale (ILS) (Ehrhart et al., 2018; Finn et al., 2016; Torres et al., 2018). Otherwise, the nonexistence of collective actions may make it challenging to cultivate a strong and robust body of knowledge. Third, while current conclusions are significant to appraising how executives and employees identify with leadership for EBPs utilization, vigorous methodological explorations are necessary to influence behaviors that forecast healthcare providers’ research practice and progress theory-oriented leadership mediations to develop quality patient care.
The literature review contains some research limitations, despite engaging dynamic methodologies to direct the research. For instance, little research was done concerning gray literature databases since the majority of the articles were based on primary data from peer-reviewed journals, thus increasing the possibility of missing relevant and informative unpublished studies. Moreover, research articles published in non-English languages were excluded with little reference to the amount of information that is pertinent to the research questions under study. Moreover, critical appraisals on the validity of the research materials used to identify strengths and weaknesses were not considered during the determination of the literature conclusion. Additionally, based on the analysis of the literature, the determinations of changing healthcare culture and attitude towards leadership implementation require a dynamic, multi-faceted efforts at all stages of the organization and departments because leadership is just but the beginning of change. Therefore, more vigorous study schemes that explicitly comprise reliable and effective management actions for EBPs are vital to progressing strategic leadership execution.
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