Review question/objective

This systematic review seeks to identify and explore the experiences of health and aged care professionals including health managers in the utilization of distributed leadership modelling. It also seeks to identify and explore their experiences in creating the conditions that enable or impede distributed leadership.

Background

Distributed leadership is a broad concept in which the role of formal leaders is less about "leading from the front", but rather more focused on enabling others to lead. A general principle outlined by key theorists is that distributed leadership empowers individuals to contribute ideas and expand on knowledge within groups and throughout an organization.1,2,3,4 Research into leadership in health and aged care is particularly relevant as there is an urgent need for change and reform which is being driven by pressures related to an aging population, changing care/service modelling, and increased funding requirements.5,6

Dickson and Tholl succinctly describe the leadership challenge for health care as a need "to convert a fragmented set of activities into a well-functioning whole".5(p7) As an example of the implications of fragmentation, the examination of healthcare organizations has underlined system failures which are attributed to poor responses to early cues of potential or actual client harm. One solution is for healthcare professionals to build competence in quality and safety research for the provision of evidence-based early detection systems.8 Leadership is recognized as a crucial element in uniting divergences towards a common goal.8 The lessons learned and principles arising from Greenfield and colleagues' experiences in providing distributed leadership to mobilize capacity for quality and safety research have been positive.8 However, what is required for the wider international healthcare community is a collation of how these researchers reached this positive outcome and enabled the process of distributed leadership. It is not completely understood as to how this success compares to that of other healthcare researchers or where similarities or differences exist within the application of distributed leadership modelling.8

The theory underpinning distributed leadership has been growing since it was first discussed in leadership literature in the late 1990s.1 Distributed leadership is distinctly different from other more traditional types of leadership theory as it is concerned with actions of a group rather than individual traits of leaders.1,2,4,5,10

There has been some research into the application of distributed leadership in practice in the education sector, a sector that is also recognized as being largely fragmented.4 This research has shown the effects of a more holistic approach on engaging members of a school or university, creating a positive impact on the quality of teaching and learning.2,4,9 There are still calls for further research into the application of distributed leadership practice in education.2,4,9,10

The research literature on distributed leadership in health and aged care indicates that distributed leadership could have positive impacts on the quality and safety in healthcare.3,5,8 However there are very limited empirical research studies to inform understanding in how to utilize the distributed leadership theory in practice in health and aged care.9,10 This limited research in the application of distributed leadership theory in health and aged care means there is uncertainty around the processes through which health and aged care organizations can promote, apply and embrace distributed leadership.3,9,11 Considerable time, effort and resources are required to build relationships between stakeholders in order to promote understanding of different needs and interests. A clear cost effective evidence-based approach is yet to be realized. Distributed leadership appears as a key determinant in achieving positive healthcare outcomes, particularly when engaging with complex adaptive systems.10,11

The majority of the literature on distributed leadership has focused on why it is required in healthcare and the definitions and history behind its evolution. The need for distributed leadership is therefore well documented. A significant gap does exist, however, in the collated evidence of approaches which are transferrable to other collaborative healthcare contexts.12

Searching for evidence has identified some qualitative studies on distributed leadership in health and aged care; no systematic reviews investigating the experiences of health and aged care providers utilization of distributed leadership have been identified nor those on the conditions that enable or impede distributed leadership. Initial searching in the JBI Database of Systematic Reviews and Implementation Reports, the York University Database and the Cochrane Library revealed that while there is growing literature on distributed leadership in healthcare, but relatively few of this literature focus on the specific issue of utilization of distributed leadership. There are however published qualitative studies which describe outcomes of distributed leadership.12,13,14

An example found was a qualitative longitudinal case study undertaken by Chreim et al.13 which aimed to fill a gap in the research evidence by exploring and understanding the process through which distributed leadership develops. Through extensive interviews and observations, the researchers documented changes in leadership and the roles of different agents. In their findings, the researchers recommended that further exploration is needed for outlining the processes that can facilitate effective distributed leadership modelling. This systematic review therefore aims to uncover and collate similar qualitative findings from other research that outline perceptions pertaining to distributed leadership utilization.

It is in this context that the proposed review would provide value in bringing together meaningful perceptions of health and aged care professionals in guiding future utilization of distributed leadership in health and aged care. This will provide insights into and directions for others considering utilization of distributed leadership leading to the creation of conditions to enact distributed leadership within the context of health and aged care.

Inclusion criteria

Types of participants

This review will consider any healthcare professionals, health service planners and or managers who have experienced utilization of distributed leadership. To be included, participants must have been actively engaged in distributed leadership.

The review will include healthcare professionals including health managers who have been working in the acute, aged care and/or community sectors.

Exclusion criteria will include participants who have not actively engaged in distributed leadership and hence have not provided insight into the utilization of distributed leadership.

Phenomena of interest

This review will consider studies that investigate the experiences of health and aged care professionals, including health managers, who have utilized distributed leadership modelling in the health and aged care sector.

The review will also consider the barriers and facilitators to utilization of distributed leadership. Research studies that have investigated leadership broadly and not distributed leadership specifically will also be excluded.

Context

An international perspective will be considered regardless of relationship, age, sex, ethnic origin and socioeconomic status. A comprehensive coverage of all representations in health and aged care is required to distinguish between differences in experience and support systems as per the varied contexts of health and aged care professionals, i.e. relationships, age, ethnic origin/language, sex and socio-economic status, and workplace. There will be no limitations to country of residence.

Types of studies

This review will consider for inclusion all qualitative studies published in English that have examined the phenomena of interest including, but not limited to, research designs such as phenomenology, grounded theory, ethnography, action research and feminist research.

Search strategy

The search strategy aims to find both published and unpublished studies. A three-step search strategy will be utilized in this review. An initial limited search of the CINAHL will be undertaken. Subsequent searches of E-Journals, Health Source Academic Edition and the Psychology and Behavioral Science Collection will then be undertaken, followed by an analysis of the text words contained in the title and abstract and of the index terms used to describe the article. A second search using all identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference lists of all identified reports and articles will be searched for additional studies. Studies published in English will be considered for inclusion in this review. International studies published between 2000 and 2015 will be considered for inclusion in this review. These years were chosen because publications related to distributed leadership in healthcare began to appear in the literature during this time period.

The databases to be searched include:

CINAHL

E-Journals

Health Source Nurse Academic Edition

Pubmed

PsychInfo

Psychology and Behavioural Science Collection.

Hand searching will not be conducted.

Initial keywords to be used will be: distributed leadership, aged care, health, shared leadership, collaborative leadership, strategies, designing, planning, building, utilization.

Assessment of methodological quality

Papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer.

Data extraction

Data will be extracted from papers included in the review using the standardized data extraction tool from JBI-QARI (Appendix II). The data extracted will include specific details about the phenomena of interest, populations, study methods and outcomes of significance to the review question and specific objectives.

Data synthesis

Qualitative research findings will, where possible, be pooled using JBI-QARI. This will involve the aggregation or synthesis of findings to generate a set of statements that represent that aggregation, through assembling the findings rated according to their quality, and categorizing these findings on the basis of similarity in meaning. These categories are then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesized findings that can be used as a basis for evidence-based practice. Where textual pooling is not possible the findings will be presented in narrative form.

Conflicts of interest

The authors have no conflicts of interest to declare.

Acknowledgments

The authors would like to thank the support provided by the Department of Health and Ageing as part of ACH Group and University of Southern Queensland Teaching, Research Aged Care (TRACS) projects.

References