Strengthening nursing, midwifery and allied health professional leadership in the UK – a realist evaluation

• Published in: International journal of health care quality assurance incorporating Leadership in health services 2021-09, Vol.34 (4), p.392-453
• Main Authors: Jackson, Carolyn, McBride, Tamsin, Manley, Kim, Dewar, Belinda, Young, Beverley, Ryan, Assumpta, Roberts, Debbie
• Format: Article
• Language: English
• Subjects: Allied health professionals; Ambition; Appreciative inquiry; Boundaries; Clinical outcomes; Colleges & universities; Corporate culture; Credibility; Cultural change; Empowerment; Evaluation; Health care; Health services; Innovations; Integrated care; Leadership; Mass media effects; Medical personnel; Metaphor; Midwifery; Needs; Nurses; Nursing; Pandemics; Patient safety; Patient satisfaction; Patients; Policy making; Professional development; Professionals; Self evaluation; Social media; Social services; Stakeholders; Teams; Theory; Transformation; Transformational leadership; Workforce; Workplaces
• ISSN: 1751-1879; 1751-1887
• DOI: 10.1108/LHS-11-2020-0097

Purpose This paper aims to share the findings of a realist evaluation study that set out to identify how to strengthen nursing, midwifery and allied health professions (NMAHP) leadership across all health-care contexts in the UK conducted between 2018 and 2019. The collaborative research team were from the Universities of Bangor, Ulster, the University of the West of Scotland and Canterbury Christ Church University. Design/methodology/approach Realist evaluation and appreciative inquiry were used across three phases of the study. Phase 1 analysed the literature to generate tentative programme theories about what works, tested out in Phase 2 through a national social media Twitter chat and sense-making workshops to help refine the theories in Phase 3. Cross-cutting themes were synthesised into a leadership framework identifying the strategies that work for practitioners in a range of settings and professions based on the context, mechanism and output configuration of realist evaluation. Stakeholders contributed to the ongoing interrogation, analysis and synthesis of project outcomes. Findings Five guiding lights of leadership, a metaphor for principles, were generated that enable and strengthen leadership across a range of contexts. – “The Light Between Us as interactions in our relationships”, “Seeing People’s Inner Light”, “Kindling the Spark of light and keeping it glowing”, “Lighting up the known and the yet to be known” and “Constellations of connected stars”. Research limitations/implications This study has illuminated the a-theoretical nature of the relationships between contexts, mechanisms and outcomes in the existing leadership literature. There is more scope to develop the tentative programme theories developed in this study with NMAHP leaders in a variety of different contexts. The outcomes of leadership research mostly focussed on staff outcomes and intermediate outcomes that are then linked to ultimate outcomes in both staff and patients (supplemental). More consideration needs to be given to the impact of leadership on patients, carers and their families. Practical implications The study has developed additional important resources to enable NMAHP leaders to demonstrate their leadership impact in a range of contexts through the leadership impact self-assessment framework which can be used for 360 feedback in the workplace using the appreciative assessment and reflection tool. Social implications Whilst policymakers note the increasing importa