Examining clinical leadership in Kenyan public hospitals through the distributed leadership lens

Abstract

Clinical leadership is recognized as a crucial element in health system strengthening and health policy globally yet it has received relatively little attention in low and middle income countries (LMICs). Moreover, analyses of clinical leadership tend to focus on senior-level individual leaders, overlooking a wider constellation of middle-level leaders delivering health care in practice in a way affected by their health care context. Using the theoretical lens of ‘distributed leadership’, this article examines how middle-level leadership is practised and affected by context in Kenyan county hospitals, providing insights relevant to health care in other LMICs. The article is based on empirical qualitative case studies of clinical departmental leadership in two Kenyan public hospitals, drawing on data gathered through ethnographic observation, interviews and focus groups. We inductively and iteratively coded, analysed and theorized our findings. We found the distributed leadership lens useful for the purpose of analysing middle-level leadership in Kenyan hospitals, although clinical departmental leadership was understood locally in more individualized terms. Our distributed lens revealed medical and nursing leadership occurring in parallel and how only doctors in leadership roles were able to directly influence behaviour among their medical colleagues, using inter-personal skills, power and professional expertize. Finally, we found that Kenyan hospital contexts were characterized by cultures, norms and structures that constrained the way leadership was practiced. We make a theoretical contribution by demonstrating the utility of using distributed leadership as a lens for analysing leadership in LIMC health care contexts, revealing how context, power and inter-professional relationships moderate individual leaders’ ability to bring about change. Our findings, have important implications for how leadership is conceptualized and the way leadership development and training are provided in LMICs health systems.

Developing Soft Skills: Exploring the Feasibility of an Australian Well-Being Program for Health Managers and Leaders in Timor-Leste

“…It could also consider the value of "distributed leadership" in advancing change. Nzinga, McGivern, and English (2018) utilize distributed leadership in the context of leadership in health systems (clinical leadership) in Kenya. Distributed leadership "provides a holistic sense to leadership as a product of leaders and followers co-constructing performance in collective and group context, and provides a dynamic, nonlinear frame on how people and events interact in organizations" (Nzinga, McGivern, & English, 2018, p. ii28).…”

“…Distributed leadership "provides a holistic sense to leadership as a product of leaders and followers co-constructing performance in collective and group context, and provides a dynamic, nonlinear frame on how people and events interact in organizations" (Nzinga, McGivern, & English, 2018, p. ii28). Nzinga et al (2018) provide insights into the value of soft skills for doctors in leadership roles. Importantly, their work demonstrated the power of distributed leadership in bringing about change.…”

“…This comment also leads to consideration for future FWB studies, where adoption of an action learning approach that captures longer term perceptions and changes in behavior (as suggested above) is worthwhile. Such studies could use techniques from other studies, such as Nzinga et al (2018) and utilize participant observation, respondents' reflective journals, interviews, and focus groups.…”

Strengthening health system leadership for better governance: what does it take?

“…Comparing two urban district hospitals in Ghana, one with specialist services and one without, Aberese-Ako et al (2018) explore what strategies managers working at all levels of the hospitals used to cope with the contextual constraints they faced. In Kenya, meanwhile, Nzinga et al (2018) working in two county (district) hospitals, reveal the individualized decision-making and often intimidatory leadership practices of mid-level managers, the clinical heads and nurses in charge of inpatient wards.…”

Influence of leadership skills on effectiveness of departmental leadership in Mogotio Sub County hospitals in Kenya

“…In Kenya, a study conducted by Nzinga, McGivern, and English (2018) showed that most departments are headed by surgeons or senior doctors who are highly trained in the medical area but exhibit but have little training on leadership. These leaders exhibit unfamiliarity with leadership and organizational behaviour techniques because of inadequate on-the-job leadership and management training courses, and in many cases, managers' disbelief in the effectiveness and necessity of learning these techniques.…”