Application of Transformational Leadership Principles in the Development and Integration of Palliative Care Within an Advanced Heart Failure Program

George, S.; Leasure, A. Renee

doi:10.1097/dcc.0000000000000166

Cited by 9 publications

(8 citation statements)

References 31 publications

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“…84,92,98,102,105, The remaining 410 papers were excluded. 10,25,42,44,47,48,51,53,54,[59][60][61][62]65,75,78,89,91,94,95,97,100,101,104,106,107,110,129,149,150,153,[159][160][161][162][163][164][165][166][167][168][169][170][171][172]174, Around this time, Professor Zaccaro informed us that he had recently completed a compre...…”

Section: Adaptability Of Leadership Stylementioning

confidence: 99%

Developing programme theories of leadership for integrated health and social care teams and systems: a realist synthesis

Harris

Fletcher

Sims

et al. 2022

Health Soc Care Deliv Res

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Background As the organisation of health and social care in England moves rapidly towards greater integration, the resulting systems and teams will require distinctive leadership. However, little is known about how the effective leadership of these teams and systems can be supported and improved. In particular, there is relatively little understanding of how effective leadership across integrated care teams and systems may be enacted, the contexts in which this might take place and the subsequent implications this has on integrated care. Objective This realist review developed and refined programme theories of leadership of integrated health and social care teams and systems, exploring what works, for whom and in what circumstances. Design The review utilised a realist synthesis approach, informed by the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) publication standards, to explore existing literature on the leadership of integrated care teams and systems, complemented by ongoing stakeholder consultation. Empirical evidence specifically addressing leadership of integrated teams or services was limited, with only 36 papers included in the review. The evidence collected from these 36 papers was synthesised to identify and build a comprehensive description of the mechanisms of leadership of integrated teams and systems and their associated contexts and outcomes. Consultation with key stakeholders with a range of expertise throughout the process ensured that the review remained grounded in the reality of health and social care delivery and addressed practice and policy challenges. Results Evidence was identified for seven potentially important components of leadership in integrated care teams and systems. These were ‘inspiring intent to work together’, ‘creating the conditions to work together’, ‘balancing multiple perspectives’, ‘working with power’, ‘taking a wider view’, ‘a commitment to learning and development’ and ‘clarifying complexity’. No empirical evidence was found for an eighth mechanism, ‘fostering resilience’, although stakeholders felt that this was potentially an important, long-term component of leadership. A key message of the review was that empirical research often focused on the importance of who the leader of an integrated team or service was (i.e. their personality traits and characteristics) rather than what they did (i.e. the specific role that they played in integrated working), although stakeholders considered that a focus on leader personality was not sufficient. Other key messages highlighted the way in which power and influence are used by integrated service leaders and identified the hierarchies between health and social care which complicate the leading of integrated teams and systems. Limitations Evidence specifically addressing leadership of integrated care teams and systems was limited and lacking in detail, which restricted the degree to which definitive conclusions could be drawn around what works, for whom and in what circumstances. Conclusions Research into the leadership of integrated care teams and systems is limited and underdeveloped, with ideas often reverting to existing framings of leadership in which teams and organisations are less complex. In making explicit some of the assumptions about how leaders lead integrated care teams and systems this review has contributed significant new perspectives, offering fresh theoretical grounding that can be built on, developed and tested further. Future work By making explicit some of the assumptions underlying the leadership of integrated care teams and systems, this review has generated new perspectives that can be built on, developed and tested further. Study registration This study is registered as PROSPERO CRD42018119291. Funding This project was funded by the National Institute for Health Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 7. See the NIHR Journals Library website for further project information.

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Section: Adaptability Of Leadership Stylementioning

confidence: 99%

Developing programme theories of leadership for integrated health and social care teams and systems: a realist synthesis

Harris

Fletcher

Sims

et al. 2022

Health Soc Care Deliv Res

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“…An interesting trial (Palliative Care in Heart Failure) is in progress to explore the impact of interdisciplinary palliative care in patients with end-stage heart failure and may in due course guide further refinements of how and when palliative care is delivered in that situation [107]. Pending the results of this and other research [108][109][110][111][112], physicians treating patients with endstage heart failure should adhere as closely as possible to extant ethical recommendations.…”

Section: Shared Decision Making Is the Process Through Which Cliniciamentioning

confidence: 99%

Advanced heart failure: an appraisal of the potential of levosimendan in this end-stage scenario and some related ethical considerations

Fruhwald

Pollesello

Fruhwald

2016

Expert Review of Cardiovascular Therapy

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The later stages of heart failure are characterized by a steady decline in quality of life. Clinical priorities should be to maintain functional capacity and quality of life. In the absence of sufficient organs for transplantation, options include left ventricular assist devices and inotropic support. Areas covered: We examined data published in the last two decades on the use of inotropes and inodilators in advanced heart failure. Expert commentary: In the literature, use of conventional inotropes, including adrenergic agonists and phosphodiesterase inhibitors, appears to be suboptimal for achieving the clinical priorities of late-stage heart failure. Evidence suggests instead that the calcium-sensitizing inodilator levosimendan, administered intermittently, delivers improvements in functional capacity and quality of life and does so with no adverse impact on life expectancy. At a terminal or near-terminal stage of heart failure, the therapeutic philosophy should shift towards meeting patients' existential priorities rather than traditional heart failure-centric targets.

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“…Timing and specialist referral. The literature highlights the importance of early integration of palliative care in CHF care [25,[49][50][51][52], at diagnosis [53][54][55][56], alongside CHF treatment [19,20,38,57,58], and throughout the illness trajectory [4,32,43,[59][60][61]. Critical palliative care intervention points also includes during hospitalisation and at the time of implanting implantable cardioverter defibrillators [21].…”

Section: Clinicalmentioning

confidence: 99%

“…A multidisciplinary, collaborative team based approach is an element of integrated palliative care in CHF [26,33,34,40,43,46,71,72] and each individual within the team should understand their role [66]. It is recommended the team consist of primary care, advanced CHF clinicians, palliative care specialists, geriatricians, nurses, social workers, chaplains, pharmacists and allied health, through team meetings and collaboration, partnering health care professionals with patients and carers [14,17,19,21,23,32,36,39,40,42,48,50,51,53,60,62,63,65,71,.…”

Section: Clinicalmentioning

confidence: 99%

Elements of Integrated Palliative Care in Chronic Heart Failure Across the Care Continuum: A Scoping Review

Singh¹,

Ivynian²,

Davidson³

et al. 2022

Heart, Lung and Circulation

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Application of Transformational Leadership Principles in the Development and Integration of Palliative Care Within an Advanced Heart Failure Program

Cited by 9 publications

References 31 publications

Developing programme theories of leadership for integrated health and social care teams and systems: a realist synthesis

Developing programme theories of leadership for integrated health and social care teams and systems: a realist synthesis

Advanced heart failure: an appraisal of the potential of levosimendan in this end-stage scenario and some related ethical considerations

Elements of Integrated Palliative Care in Chronic Heart Failure Across the Care Continuum: A Scoping Review

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