National School of Public Health, Rabat, Morocco.
Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium.
Int J Health Policy Manag. 2018 Dec 1;7(12):1073-1084. doi: 10.15171/ijhpm.2018.75.
Nowadays, health systems are generally acknowledged to be complex social systems. Consequently, scholars, academics, practitioners, and policy-makers are exploring how to adopt a complexity perspective in health policy and system research. While leadership and complexity has been studied extensively outside health, the implications of complexity theories for the study of leadership in healthcare have received limited attention. We carried out a scoping review of complex leadership (CL) in healthcare to investigate how CL in healthcare has been defined, theorised and conceptualised and to explore how 'CL' has been applied in healthcare settings.
We followed the methodological steps proposed by (Arksey and O'Malley, 2005): (1) specifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data, (5) collating and summarizing the findings, and (6) reporting the results. We searched using Medline, Psychinfo, Wiley online library, and Google Scholar. Our inclusion criteria were: publication type (peer reviewed articles, theses, and book chapters); phenomenon of interest: complex leadership; context: healthcare and period of publication: between 2000 and 2016.
Our search and selection resulted in 37 papers (16 conceptual papers, 14 empirical studies and 7 advocacy papers). We note that empirical studies on CL are few and almost all research reported by these papers was carried out in the North (mainly in USA and UK). We found that there is some variation in definitions of CL. Furthermore, the research papers adopt mostly an explorative or explanatory approach and do not focus on assessing effectiveness of CL approaches. Finally, we found that the majority of researchers seem to adhere to the mathematical complexity perspective.
Complexity concepts derived from natural sciences may not automatically fit management of health services. Further research into how social complexity theories may offer researchers useful grounds to empirically test CL theories in health settings is warranted. Specific attention should be paid to the multi-layered nature of leadership.
如今，人们普遍认为卫生系统是复杂的社会系统。因此，学者、学术界人士、从业者和政策制定者正在探索如何在卫生政策和系统研究中采用复杂性视角。虽然领导力和复杂性在卫生领域之外已经得到了广泛研究，但复杂性理论对医疗保健领导力研究的影响却受到了有限关注。我们对医疗保健中的复杂领导力（CL）进行了范围界定审查，以调查医疗保健中的 CL 是如何被定义、理论化和概念化的，并探讨“CL”在医疗保健环境中的应用方式。
我们遵循（Arksey 和 O'Malley，2005）提出的方法步骤：（1）明确研究问题，（2）确定相关研究，（3）研究选择，（4）数据图表，（5）整理和总结研究结果，以及（6）报告结果。我们使用 Medline、Psychinfo、Wiley 在线图书馆和 Google Scholar 进行了搜索。我们的纳入标准是：出版物类型（同行评议文章、论文和书籍章节）；感兴趣的现象：复杂领导力；背景：医疗保健；出版时间：2000 年至 2016 年。
我们的搜索和选择结果产生了 37 篇论文（16 篇概念性论文、14 篇实证研究论文和 7 篇倡导性论文）。我们注意到关于 CL 的实证研究很少，而且几乎所有这些论文报道的研究都是在北方（主要在美国和英国）进行的。我们发现，CL 的定义存在一些差异。此外，研究论文大多采用探索性或解释性方法，而不专注于评估 CL 方法的有效性。最后，我们发现大多数研究人员似乎都坚持数学复杂性视角。
源自自然科学的复杂性概念可能并不自动适用于卫生服务管理。有必要进一步研究社会复杂性理论如何为研究人员在卫生环境中实证检验 CL 理论提供有用的依据。应特别关注领导力的多层次性质。
