Collective leadership to improve professional practice, healthcare outcomes and staff well-being

Jaqueline Alcantara Marcelino Silva; Vivian Aline Mininel; Heloise Fernandes Agreli; Marina Peduzzi; Reema Harrison; Andreas Xyrichis

doi:10.1002/14651858.CD013850.pub2

Collective leadership to improve professional practice, healthcare outcomes and staff well-being

Jaqueline Alcantara Marcelino Silva, Vivian Aline Mininel, Heloise Fernandes Agreli, Marina Peduzzi, Reema Harrison, Andreas Xyrichis

Digital Health & Applied Tech Assessment

Federal University of São Carlos
Hospital Israelita Albert Einstein, Sao Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil.; Center for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo, Sao Paulo, Brazil.
Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia; Department of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, New York.

Research output: Contribution to journal › Review article › peer-review

6 Citations (Scopus)

Abstract

BACKGROUND: Collective leadership is strongly advocated by international stakeholders as a key approach for health service delivery, as a response to increasingly complex forms of organisation defined by rapid changes in health technology, professionalisation and growing specialisation. Inadequate leadership weakens health systems and can contribute to adverse events, including refusal to prioritise and implement safety recommendations consistently, and resistance to addressing staff burnout. Globally, increases in life expectancy and the number of people living with multiple long-term conditions contribute to greater complexity of healthcare systems. Such a complex environment requires the contribution and leadership of multiple professionals sharing viewpoints and knowledge. OBJECTIVES: To assess the effects of collective leadership for healthcare providers on professional practice, healthcare outcomes and staff well-being, when compared with usual centralised leadership approaches.

SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, five other databases and two trials registers on 5 January 2021. We also searched grey literature, checked references for additional citations and contacted study authors to identify additional studies. We did not apply any limits on language.

SELECTION CRITERIA: Two groups of two authors independently reviewed, screened and selected studies for inclusion; the principal author was part of both groups to ensure consistency. We included randomised controlled trials (RCTs) that compared collective leadership interventions with usual centralised leadership or no intervention.

DATA COLLECTION AND ANALYSIS: Three groups of two authors independently extracted data from the included studies and evaluated study quality; the principal author took part in all groups. We followed standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care (EPOC) Group. We used the GRADE approach to assess the certainty of the evidence.

MAIN RESULTS: We identified three randomised trials for inclusion in our synthesis. All studies were conducted in acute care inpatient settings; the country settings were Canada, Iran and the USA. A total of 955 participants were included across all the studies. There was considerable variation in participants, interventions and measures for quantifying outcomes. We were only able to complete a meta-analysis for one outcome (leadership) and completed a narrative synthesis for other outcomes. We judged all studies as having an unclear risk of bias overall. Collective leadership interventions probably improve leadership (3 RCTs, 955 participants). Collective leadership may improve team performance (1 RCT, 164 participants). We are uncertain about the effect of collective leadership on clinical performance (1 RCT, 60 participants). We are uncertain about the intervention effect on healthcare outcomes, including health status (inpatient mortality) (1 RCT, 60 participants). Collective leadership may slightly improve staff well-being by reducing work-related stress (1 RCT, 164 participants). We identified no direct evidence concerning burnout and psychological symptoms. We are uncertain of the intervention effects on unintended consequences, specifically on staff absence (1 RCT, 60 participants). AUTHORS' CONCLUSIONS: Collective leadership involves multiple professionals sharing viewpoints and knowledge with the potential to influence positively the quality of care and staff well-being. Our confidence in the effects of collective leadership interventions on professional practice, healthcare outcomes and staff well-being is moderate in leadership outcomes, low in team performance and work-related stress, and very low for clinical performance, inpatient mortality and staff absence outcomes. The evidence was of moderate, low and very low certainty due to risk of bias and imprecision, meaning future evidence may change our interpretation of the results. There is a need for more high-quality studies in this area, with consistent reporting of leadership, team performance, clinical performance, health status and staff well-being outcomes.

Original language	English
Article number	CD013850
Pages (from-to)	CD013850
Journal	The Cochrane database of systematic reviews
Volume	2022
Issue number	10
DOIs	https://doi.org/10.1002/14651858.CD013850.pub2
Publication status	Published - 10 Oct 2022

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10.1002/14651858.CD013850.pub2

Cite this

@article{e620c5c003cd40759e36c958ae60b082,

title = "Collective leadership to improve professional practice, healthcare outcomes and staff well-being",

abstract = "BACKGROUND: Collective leadership is strongly advocated by international stakeholders as a key approach for health service delivery, as a response to increasingly complex forms of organisation defined by rapid changes in health technology, professionalisation and growing specialisation. Inadequate leadership weakens health systems and can contribute to adverse events, including refusal to prioritise and implement safety recommendations consistently, and resistance to addressing staff burnout. Globally, increases in life expectancy and the number of people living with multiple long-term conditions contribute to greater complexity of healthcare systems. Such a complex environment requires the contribution and leadership of multiple professionals sharing viewpoints and knowledge. OBJECTIVES: To assess the effects of collective leadership for healthcare providers on professional practice, healthcare outcomes and staff well-being, when compared with usual centralised leadership approaches.SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, five other databases and two trials registers on 5 January 2021. We also searched grey literature, checked references for additional citations and contacted study authors to identify additional studies. We did not apply any limits on language.SELECTION CRITERIA: Two groups of two authors independently reviewed, screened and selected studies for inclusion; the principal author was part of both groups to ensure consistency. We included randomised controlled trials (RCTs) that compared collective leadership interventions with usual centralised leadership or no intervention.DATA COLLECTION AND ANALYSIS: Three groups of two authors independently extracted data from the included studies and evaluated study quality; the principal author took part in all groups. We followed standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care (EPOC) Group. We used the GRADE approach to assess the certainty of the evidence.MAIN RESULTS: We identified three randomised trials for inclusion in our synthesis. All studies were conducted in acute care inpatient settings; the country settings were Canada, Iran and the USA. A total of 955 participants were included across all the studies. There was considerable variation in participants, interventions and measures for quantifying outcomes. We were only able to complete a meta-analysis for one outcome (leadership) and completed a narrative synthesis for other outcomes. We judged all studies as having an unclear risk of bias overall. Collective leadership interventions probably improve leadership (3 RCTs, 955 participants). Collective leadership may improve team performance (1 RCT, 164 participants). We are uncertain about the effect of collective leadership on clinical performance (1 RCT, 60 participants). We are uncertain about the intervention effect on healthcare outcomes, including health status (inpatient mortality) (1 RCT, 60 participants). Collective leadership may slightly improve staff well-being by reducing work-related stress (1 RCT, 164 participants). We identified no direct evidence concerning burnout and psychological symptoms. We are uncertain of the intervention effects on unintended consequences, specifically on staff absence (1 RCT, 60 participants). AUTHORS' CONCLUSIONS: Collective leadership involves multiple professionals sharing viewpoints and knowledge with the potential to influence positively the quality of care and staff well-being. Our confidence in the effects of collective leadership interventions on professional practice, healthcare outcomes and staff well-being is moderate in leadership outcomes, low in team performance and work-related stress, and very low for clinical performance, inpatient mortality and staff absence outcomes. The evidence was of moderate, low and very low certainty due to risk of bias and imprecision, meaning future evidence may change our interpretation of the results. There is a need for more high-quality studies in this area, with consistent reporting of leadership, team performance, clinical performance, health status and staff well-being outcomes.",

author = "Silva, {Jaqueline Alcantara Marcelino} and Mininel, {Vivian Aline} and {Fernandes Agreli}, Heloise and Marina Peduzzi and Reema Harrison and Andreas Xyrichis",

note = "Funding Information: We acknowledge the help and support of the Cochrane Effective Practice and Organisation of Care (EPOC) Group. The authors would also like to thank the following editors and peer referees who provided comments to improve our earlier protocol: Michelle Butler (Contact Editor), Helen Wakeford (Editor), Signe Flottorp (Senior Editor and internal referee for the review), Paul Miller (Information Specialist), Daniela C Gon{\c c}alves-Bradley (Internal Referee for the protocol), Chris Cooper and Joey Kwong (Managing Editors), Michael West, Aoife De Br{\'u}n and Adele Nightingale (External referees), and Faith Armitage (Copy Editor). This review was supported by the National Institute for Health Research (NIHR), via Cochrane Infrastructure funding to the EPOC Group. The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, National Health Service (NHS), or the Department of Health. We thank Faith Armitage for copy editing this review. Funding Information: Funding: this work was supported with a grant from the Tehran University of Medical Sciences. Funding Information: Funding: supported by the Ontario Ministry of Health through the Hospital Incentive Fund, project number 28 Funding Information: This review was supported by the National Institute for Health Research (NIHR), via Cochrane Infrastructure funding to the EPOC Group. The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, National Health Service (NHS), or the Department of Health. Funding Information: Funding: supported, in part, by a grant from the Agency for Healthcare Research and Quality (1R18HS022458-01A1) and the Department of Defense (W81XWH-18-1-0089). The paper also describes individual funding received by the authors. Publisher Copyright: Copyright {\textcopyright} 2022 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.",

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day = "10",

doi = "10.1002/14651858.CD013850.pub2",

language = "English",

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Collective leadership to improve professional practice, healthcare outcomes and staff well-being. / Silva, Jaqueline Alcantara Marcelino; Mininel, Vivian Aline; Fernandes Agreli, Heloise et al.
In: The Cochrane database of systematic reviews, Vol. 2022, No. 10, CD013850, 10.10.2022, p. CD013850.

Research output: Contribution to journal › Review article › peer-review

TY - JOUR

T1 - Collective leadership to improve professional practice, healthcare outcomes and staff well-being

AU - Silva, Jaqueline Alcantara Marcelino

AU - Mininel, Vivian Aline

AU - Fernandes Agreli, Heloise

AU - Peduzzi, Marina

AU - Harrison, Reema

AU - Xyrichis, Andreas

N1 - Funding Information: We acknowledge the help and support of the Cochrane Effective Practice and Organisation of Care (EPOC) Group. The authors would also like to thank the following editors and peer referees who provided comments to improve our earlier protocol: Michelle Butler (Contact Editor), Helen Wakeford (Editor), Signe Flottorp (Senior Editor and internal referee for the review), Paul Miller (Information Specialist), Daniela C Gonçalves-Bradley (Internal Referee for the protocol), Chris Cooper and Joey Kwong (Managing Editors), Michael West, Aoife De Brún and Adele Nightingale (External referees), and Faith Armitage (Copy Editor). This review was supported by the National Institute for Health Research (NIHR), via Cochrane Infrastructure funding to the EPOC Group. The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, National Health Service (NHS), or the Department of Health. We thank Faith Armitage for copy editing this review. Funding Information: Funding: this work was supported with a grant from the Tehran University of Medical Sciences. Funding Information: Funding: supported by the Ontario Ministry of Health through the Hospital Incentive Fund, project number 28 Funding Information: This review was supported by the National Institute for Health Research (NIHR), via Cochrane Infrastructure funding to the EPOC Group. The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, National Health Service (NHS), or the Department of Health. Funding Information: Funding: supported, in part, by a grant from the Agency for Healthcare Research and Quality (1R18HS022458-01A1) and the Department of Defense (W81XWH-18-1-0089). The paper also describes individual funding received by the authors. Publisher Copyright: Copyright © 2022 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

PY - 2022/10/10

Y1 - 2022/10/10

N2 - BACKGROUND: Collective leadership is strongly advocated by international stakeholders as a key approach for health service delivery, as a response to increasingly complex forms of organisation defined by rapid changes in health technology, professionalisation and growing specialisation. Inadequate leadership weakens health systems and can contribute to adverse events, including refusal to prioritise and implement safety recommendations consistently, and resistance to addressing staff burnout. Globally, increases in life expectancy and the number of people living with multiple long-term conditions contribute to greater complexity of healthcare systems. Such a complex environment requires the contribution and leadership of multiple professionals sharing viewpoints and knowledge. OBJECTIVES: To assess the effects of collective leadership for healthcare providers on professional practice, healthcare outcomes and staff well-being, when compared with usual centralised leadership approaches.SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, five other databases and two trials registers on 5 January 2021. We also searched grey literature, checked references for additional citations and contacted study authors to identify additional studies. We did not apply any limits on language.SELECTION CRITERIA: Two groups of two authors independently reviewed, screened and selected studies for inclusion; the principal author was part of both groups to ensure consistency. We included randomised controlled trials (RCTs) that compared collective leadership interventions with usual centralised leadership or no intervention.DATA COLLECTION AND ANALYSIS: Three groups of two authors independently extracted data from the included studies and evaluated study quality; the principal author took part in all groups. We followed standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care (EPOC) Group. We used the GRADE approach to assess the certainty of the evidence.MAIN RESULTS: We identified three randomised trials for inclusion in our synthesis. All studies were conducted in acute care inpatient settings; the country settings were Canada, Iran and the USA. A total of 955 participants were included across all the studies. There was considerable variation in participants, interventions and measures for quantifying outcomes. We were only able to complete a meta-analysis for one outcome (leadership) and completed a narrative synthesis for other outcomes. We judged all studies as having an unclear risk of bias overall. Collective leadership interventions probably improve leadership (3 RCTs, 955 participants). Collective leadership may improve team performance (1 RCT, 164 participants). We are uncertain about the effect of collective leadership on clinical performance (1 RCT, 60 participants). We are uncertain about the intervention effect on healthcare outcomes, including health status (inpatient mortality) (1 RCT, 60 participants). Collective leadership may slightly improve staff well-being by reducing work-related stress (1 RCT, 164 participants). We identified no direct evidence concerning burnout and psychological symptoms. We are uncertain of the intervention effects on unintended consequences, specifically on staff absence (1 RCT, 60 participants). AUTHORS' CONCLUSIONS: Collective leadership involves multiple professionals sharing viewpoints and knowledge with the potential to influence positively the quality of care and staff well-being. Our confidence in the effects of collective leadership interventions on professional practice, healthcare outcomes and staff well-being is moderate in leadership outcomes, low in team performance and work-related stress, and very low for clinical performance, inpatient mortality and staff absence outcomes. The evidence was of moderate, low and very low certainty due to risk of bias and imprecision, meaning future evidence may change our interpretation of the results. There is a need for more high-quality studies in this area, with consistent reporting of leadership, team performance, clinical performance, health status and staff well-being outcomes.

AB - BACKGROUND: Collective leadership is strongly advocated by international stakeholders as a key approach for health service delivery, as a response to increasingly complex forms of organisation defined by rapid changes in health technology, professionalisation and growing specialisation. Inadequate leadership weakens health systems and can contribute to adverse events, including refusal to prioritise and implement safety recommendations consistently, and resistance to addressing staff burnout. Globally, increases in life expectancy and the number of people living with multiple long-term conditions contribute to greater complexity of healthcare systems. Such a complex environment requires the contribution and leadership of multiple professionals sharing viewpoints and knowledge. OBJECTIVES: To assess the effects of collective leadership for healthcare providers on professional practice, healthcare outcomes and staff well-being, when compared with usual centralised leadership approaches.SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, five other databases and two trials registers on 5 January 2021. We also searched grey literature, checked references for additional citations and contacted study authors to identify additional studies. We did not apply any limits on language.SELECTION CRITERIA: Two groups of two authors independently reviewed, screened and selected studies for inclusion; the principal author was part of both groups to ensure consistency. We included randomised controlled trials (RCTs) that compared collective leadership interventions with usual centralised leadership or no intervention.DATA COLLECTION AND ANALYSIS: Three groups of two authors independently extracted data from the included studies and evaluated study quality; the principal author took part in all groups. We followed standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care (EPOC) Group. We used the GRADE approach to assess the certainty of the evidence.MAIN RESULTS: We identified three randomised trials for inclusion in our synthesis. All studies were conducted in acute care inpatient settings; the country settings were Canada, Iran and the USA. A total of 955 participants were included across all the studies. There was considerable variation in participants, interventions and measures for quantifying outcomes. We were only able to complete a meta-analysis for one outcome (leadership) and completed a narrative synthesis for other outcomes. We judged all studies as having an unclear risk of bias overall. Collective leadership interventions probably improve leadership (3 RCTs, 955 participants). Collective leadership may improve team performance (1 RCT, 164 participants). We are uncertain about the effect of collective leadership on clinical performance (1 RCT, 60 participants). We are uncertain about the intervention effect on healthcare outcomes, including health status (inpatient mortality) (1 RCT, 60 participants). Collective leadership may slightly improve staff well-being by reducing work-related stress (1 RCT, 164 participants). We identified no direct evidence concerning burnout and psychological symptoms. We are uncertain of the intervention effects on unintended consequences, specifically on staff absence (1 RCT, 60 participants). AUTHORS' CONCLUSIONS: Collective leadership involves multiple professionals sharing viewpoints and knowledge with the potential to influence positively the quality of care and staff well-being. Our confidence in the effects of collective leadership interventions on professional practice, healthcare outcomes and staff well-being is moderate in leadership outcomes, low in team performance and work-related stress, and very low for clinical performance, inpatient mortality and staff absence outcomes. The evidence was of moderate, low and very low certainty due to risk of bias and imprecision, meaning future evidence may change our interpretation of the results. There is a need for more high-quality studies in this area, with consistent reporting of leadership, team performance, clinical performance, health status and staff well-being outcomes.

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DO - 10.1002/14651858.CD013850.pub2

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JO - The Cochrane database of systematic reviews

JF - The Cochrane database of systematic reviews

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Collective leadership to improve professional practice, healthcare outcomes and staff well-being

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