School of Health Sciences, University of Manchester, Manchester, UK.
Centre for Health Services Studies, University of Kent, Canterbury, UK.
J Health Organ Manag. 2022 Aug 19;ahead-of-print(ahead-of-print). doi: 10.1108/JHOM-02-2022-0037.
The article aims to argue that the concept of "distributed leadership" lacks the specificity required to allow a full understanding of how change happens. The authors therefore utilise the "Strategic Action Field Framework" (SAF) (Moulton and Sandfort, 2017) as a more sensitive framework for understanding leadership in complex systems. The authors use the New Care Models (Vanguard) Programme as an exemplar.
DESIGN/METHODOLOGY/APPROACH: Using the SAF framework, the authors explored factors affecting whether and how local Vanguard initiatives were implemented in response to national policy, using a qualitative case study approach. The authors apply this to data from the focus groups and interviews with a variety of respondents in six case study sites, covering different Vanguard types between October 2018 and July 2019.
While literature already acknowledges that leadership is not simply about individual leaders, but about leading together, this paper emphasises that a further interdependence exists between leaders and their organisational/system context. This requires actors to use their skills and knowledge within the fixed and changing attributes of their local context, to perform the roles (boundary spanning, interpretation and mobilisation) necessary to allow the practical implementation of complex change across a healthcare setting.
ORIGINALITY/VALUE: The SAF framework was a useful framework within which to interrogate the data, but the authors found that the category of "social skills" required further elucidation. By recognising the importance of an intersection between position, personal characteristics/behaviours, fixed personal attributes and local context, the work is novel.
本文旨在论证“分布式领导力”的概念缺乏充分理解变革发生机制所需的特异性。因此，作者利用“战略行动场框架”（SAF）（Moulton 和 Sandfort，2017）作为一个更敏感的框架，来理解复杂系统中的领导力。作者以新护理模式（先锋）计划为例。
设计/方法/途径：作者使用 SAF 框架，通过定性案例研究方法，探讨了影响当地先锋计划是否以及如何根据国家政策实施的因素。作者将此应用于 2018 年 10 月至 2019 年 7 月在六个案例研究地点进行的焦点小组和各种受访者访谈的数据中，涵盖了不同类型的先锋。
虽然文献已经认识到领导力不仅仅是关于个体领导者，而是关于共同领导，但本文强调，领导者与其组织/系统环境之间存在进一步的相互依存关系。这要求参与者在其本地环境的固定和变化属性内运用其技能和知识，以履行跨越医疗保健环境实现复杂变革所需的角色（跨越边界、解释和动员）。
原创性/价值：SAF 框架是一个有用的框架，可以对数据进行审查，但作者发现，“社会技能”类别需要进一步阐明。通过认识到职位、个人特征/行为、固定个人属性和本地环境之间交叉的重要性，这项工作具有创新性。
