Healthcare middle managers’ experiences of developing capacity and capability: a systematic review and meta-synthesis

Abstract

Background Healthcare middle managers play a central role in reducing harm, improving patient safety, and strengthening the quality of healthcare. The aim of this systematic review was to identify the present knowledge and critically discuss how healthcare middle managers experienced to develop the capacity and capability for leadership in a healthcare system characterized by high complexity. Methods This comprehensive systematic review provided evidence of healthcare middle managers’ experiences in developing the capacity and capability for leadership in public healthcare. The three-step literature search was based on six databases and led by a PICo question. The review had a critical hermeneutic perspective and was based on an a priori published, protocol. The methods were inspired by the Joanna Briggs Institute and techniques from Kvale and Brinkmann. The results were illustrated by effect size, inspired by Sandelowski and Barroso. Results Twenty-three studies from four continents and multiple contexts (hospitals and municipal healthcare) published from January 2005–February 2019 were included. Based on experiences from 482 healthcare middle managers, 2 main themes, each with 2 subthemes, were identified, and from these, a meta-synthesis was developed: Healthcare middle managers develop capacity and capability through personal development processes empowered by context. The main themes included the following: 1. personal development of capacity and capability and 2. a need for contextual support. From a critical hermeneutic perspective, contrasts were revealed between how healthcare middle managers experienced the development of their capacity and capability and what they experienced as their typical work situation. Conclusions This review provides evidence of the need for a changed approach in healthcare in relation to criticisms of present organizational structures and management methods and suggestions for how to strengthen healthcare middle managers’ capacity and capability for leadership in a healthcare system characterized by high complexity. Evidence of how leadership development affected the clinical context and, thus, the quality of healthcare was found to be a field requiring further research. PROSPERO registration number CRD42018084670

“Navigation to prioritizing the patient” – first-line nurse managers’ experiences of participating in a quality improvement collaborative

“…Several studies report that employees show restraint and consider the QI work to be useless if they feel forced to take part in it [2,4,9,21]. Other studies confirm that positive relationships and aligning QI work with professional logic [22], in conjunction with work structures that empower employees [13], influence how employees engage in QI work. The supervision and learning methods inspired by Illeris' [24] perspective of transformative learning, which involves changes in the learners' perspectives as a result of critical reflection and open discourse, might have been an effective contribution to back up the leaders and give them a new understanding in practice.…”

“…It is suggested that a comprehensive network of processes is needed to support the continuing development in nursing leadership, and is best suited to take place within the organization [12]. Studies show that FLNMs who play an essential role in quality management need contextual support to develop the capacity and capability for leadership [13]. Promoting a supportive working atmosphere can contribute to professional networking and collaboration, where FLNMs feel free to share their vision and purpose, thereby developing decision-making, managerial, and leadership abilities [14].…”

Healthcare middle managers’ capacity and capability to quality improvement

“…The members of top management were experienced to value economic reporting and budgetary control. Previous research shows how HMMs’ development of capacity and capability for leadership should be supported by bottom-up processes, interactions within networks and an empowering upper management (Hartviksen et al , 2019).…”

“…HMMs’ development of capacity and capability for leadership have been identified as part of a bottom-up development process that involves building self-confidence, knowledge, skills and tools. This process was facilitated by interaction in networks and an empowering approach from upper management (Hartviksen et al , 2019).…”

“…QICs are shown to improve targeted clinical processes and patient outcomes (Wells et al , 2017). It is unclear if participation in learning networks (Hartviksen et al , 2019; Cunningham et al , 2012) or other means for developing HMMs’ capacity and capability for leadership (Hartviksen et al , 2019) influences the quality of patient care in the participants clinical contexts (Hartviksen et al , 2019; Cunningham et al , 2012). This is, thus, an area in need of additional research.…”