Clarke Jenelle M, Waring Justin, Bishop Simon, Hartley Jean, Exworthy Mark, Fulop Naomi J, Ramsay Angus, Roe Bridget
School of Social Policy, HSMC, University of Birmingham, Park House, 40 Edgbaston Park Road, Birmingham, B15 2RT, UK.
Business School North, University of Nottingham, Jubilee Campus, Triumph Road, Nottingham, NG8 1BB, UK.
BMC Health Serv Res. 2021 Mar 20;21(1):260. doi: 10.1186/s12913-021-06272-z.
The implementation of strategic health system change is often complicated by informal 'politics' in healthcare organisations. Leadership development programmes increasingly call for the development and use of 'political skill' as a means for understanding and managing the politics of healthcare organisations. The primary purpose of this review is to determine how political skill contributes to the implementation of health services change, within and across organisations. The secondary purpose is to demonstrate the conceptual variations within the literature.
The article is based upon a narrative synthesis that included quantitative, qualitative and mixed methods research papers, review articles and professional commentaries that deployed the concept of political skill (or associated terms) to describe and analyse the implementation of change in healthcare services.
Sixty-two papers were included for review drawn from over four decades of empirically and conceptually diverse research. The literature is comprised of four distinct literatures with a lack of conceptual coherence. Within and across these domains, political skill is described as influencing health services change through five dimensions of leadership: personal performance; contextual awareness; inter-personal influence; stakeholder engagement, networks and alliances; and influence on policy processes.
There is a growing body of evidence showing how political skill can contribute to the implementation of health services change, but the evidence on explanatory processes is weak. Moreover, the conceptualisation of political skill is variable making comparative analysis difficult, with research often favouring individual-level psychological and behavioural properties over more social or group processes.
战略卫生系统变革的实施常常因医疗保健组织中的非正式“政治”而变得复杂。领导力发展项目越来越多地呼吁培养和运用“政治技能”，以此作为理解和管理医疗保健组织政治的一种手段。本综述的主要目的是确定政治技能如何在组织内部和跨组织层面促进卫生服务变革的实施。次要目的是展示文献中的概念差异。
本文基于叙述性综合分析，纳入了定量、定性和混合方法的研究论文、综述文章以及专业评论，这些文献运用了政治技能（或相关术语）的概念来描述和分析医疗保健服务变革的实施情况。
从四十多年来经验和概念各异的研究中选取了62篇论文进行综述。该文献由四个不同的文献类别组成，缺乏概念上的连贯性。在这些领域内部和之间，政治技能被描述为通过领导的五个维度影响卫生服务变革：个人绩效；情境意识；人际影响；利益相关者参与度（网络和联盟）；以及对政策过程的影响。
越来越多的证据表明政治技能如何有助于卫生服务变革的实施，但关于解释过程的证据薄弱。此外，政治技能的概念化存在差异，使得比较分析困难，研究往往更倾向于个体层面的心理和行为特征，而非更多的社会或群体过程。
