Introduction
Healthcare is a growing and leading $1.7 trillion industry and there has thus emerged the need for competent management and leadership based on diversity at all levels of healthcare organizations. The growing need for leadership and balanced practice with involvements of both genders is the growing need of the industry. This can be achieved by qualitative study and analysis based on intensive interviews, examination of case studies, and the interpretation of the facts in light of the information obtained. There is an urgent sense of crisis as to how healthcare organizations will meet their leadership role in the future (Schneller,1997). There is an urgent need for increased investments in information technologies (Benchmarks, 2002). The gaps within the framework of healthcare need to be addressed and focused on in order to meet future demands.
Healthcare is identified for its complexity in the characteristics of the industry, which creates unique challenges for leadership and leadership development, which emerges from both environmental and organizational factors. The regulatory influences are multiple and out of range for administration or organization. Since many healthcare units are funded by state or outside sources, the primary control of the organization is very limited and leads to challenges faced by fragile budgets, reimbursements, and still maintaining a high quality of care regardless of monetary benefits. Another major challenge area of leadership development in healthcare is related to clinical and organizational hurdles, which in combination increase the need for strong leadership at all levels of the healthcare organization. There is a strong need for leadership development practices, which are considered as educational processes designed to improve the leadership capabilities of the individuals. They need to be understood and analyzed within a consistent framework to explore the program development challenges and decisions which are unique to a particular set of healthcare organizations.
Research Question
There is a growing need for the development of leadership and diversity in the arena of healthcare, as it is one of the fastest-growing industries in the world.
Design of Study
The design of the study is to examine and analyze if there is evidence in the suggestion that the healthcare industry lags behind other industries with respect to leadership development practices and other human resource functions. This is meant to be an exploratory study designed to improve our understanding of leadership development practices in healthcare organizations. This would require feedback from the experts and organizational representatives, who can propose future directions for healthcare leadership development.
Methodology
The methodology used is a qualitative study based on interviews, case studies, and a study design framework. In this context qualitative design enables to meet the objectives of the research, permitting exploration of the different issues that emerged around the topic of leadership development in healthcare. (Maxwell, 1996) A qualitative approach was appropriate for this study because of the exploratory nature of the research, and because there was a need to examine the perspective of experts and organizations about leadership development in a multidimensional environment, making them difficult to examine quantitatively (Miles & Huberman, 1994). In addition, the use of qualitative methods enabled to explore both experiences and predictions of experts and organizational representatives and provided rich information about the multiple facets of leadership development challenges in healthcare (Crabtree & Miller, 1999; Miles & Huberman, 1994). No potential informant contacted refused to participate in the study. All participants were assured that their voluntary participation would remain anonymous.
The qualitative study began with a formal study of the review of the literature concerning development and the competencies in the healthcare and other industries. The study also involved a number of open-ended interviews with key informants from a set of selected individuals of national reputation.
Participants
The interviews were conducted on 35 key informants interviews with individuals considered experts in healthcare leadership on the basis of their national reputation, and studied 55 organizations reported to provide healthcare leadership development training either in-house or as a vendor to healthcare provider organizations.
The combination of expert interviews and organizational case studies included a total of 160 interviews conducted between September 2003 and December 2004. The characteristics of the study were based on selected participants across expert interviews and case studies. The method used was standard, semi-structured interview guides including open-ended questions to both frame the interviews and permit probing for additional information (Miles & Huberman, 1994) in the expert interviews and case studies. The original interview guides were pilot tested with healthcare leaders and provider organizations in the local area. (McAlearney, 2006).
Procedures
The procedure involved the selection of candidates for expert interview and selection of cases for case studies, which would be evaluated in the light of the literature review of the qualitative methodology used for the study.
Expert Interview
The expert key informants were selected based on their reputation in the healthcare industry, and were identified as sampling techniques. The procedure adopted was to develop an original sample key informant and gradually this sample was extended by study informants who were asked to suggest additional experts. Thus a network of experts was built over a period of time for the study of interviews. Experts were from a variety of backgrounds and had a variety of current and former affiliations, including healthcare industries associations, universities, consulting magazines, organizations, and provider organizations. Data saturation was judged to be reached when informants’ suggestions about key informants were repetitive, and when no new insights were emerging from the ongoing data analysis (Morse, 2000). Interviews were conducted both in-person and telephonically, using rigorous ethnographic interview techniques (Spradley, 1979). Experts were asked to describe their own healthcare leadership and leadership development experiences, and to comment on both the current status of and program development opportunities for leadership development in healthcare.
Organizational case Studies
The procedure for the selection of organizations was very similar to that of the expert interview informants. The selection of the organization was primarily based on their reported experience and reputation in the area of leadership development in healthcare. There was a selection of the original sample and based on that extended sample was developed based on which conversations were conducted with the experts and other organizational informants. Fifty-five organizations were studied between September 2003 and December 2004. Five organizations were studied in person in order to efficiently complete multiple key informant interviews, while the remaining organizations were studied using numerous telephone interviews. One hundred twenty-five interviews were held as part of the organizational case studies.
These case studies (Yin, 1984) consisted of interviews with key informants, in addition to collection and study of documents associated with the leadership development programs, and a review of publicly available program information accessible through formal publication or the Internet.
Framework or Instruments
The framework used was a combination of deductive and inductive methods, with an assessment of the coding and harmony with the ideas which are read and inductively coded in the transcripts. Prior to coding the data, advanced code development was evolved. This coding process permitted to organize the data into categories of findings, and allowed me to identify broad themes that emerged from the data (Miles & Huberman, 1994).
Analysis
From the study one can analyze some trends about the organizational leaders within the field of healthcare. Organizational leaders who believe in the value of learning and growth are likely to invest heavily in leadership development activities and commit to sustaining the program over time. In several health care organizations studied, the hiring of a Chief Learning Officer provides evidence of this organizational value and demonstrates a commitment to leadership development within the organization (McAlearney, 2006).
Many individuals in healthcare give great emphasis to the uniqueness of the industry and encourage the thinking that there should be more directed effort to improve their management capabilities. They emphasize that looking outside healthcare can provide creative options with regard to program design decisions and practices which can best be adopted within healthcare organizations. These design programs can be universities, with an administrative strategy to address the issues related to the setting and the environment. This would help determine the strategy and the definition of the organizational mission, which can be applied to hospital direction. Study of university leadership development programs may provide insight that is transferable to healthcare organizations. In addition, recruiting individuals with relevant experience in other industries into healthcare organizations may be an effective way to improve leadership development in healthcare. Thus despite healthcare organizations’ reluctance to consider evidence-based management in the same favorable light as evidence-based medicine (Kovner & Rundall, 2006), healthcare organizations can apply lessons learned about leadership development to make important strides to accelerate leadership development in healthcare, and to better position themselves for the future.
Results
The results indicated that across the organization, the majority of the respondents reported that leadership development programs were greatly at risk, and this inability has an impact on future programs. Those who were involved in the leadership development programs emphasized the need for commitment to development and job security in designing and developing the program. Finances appeared more problematic in healthcare organizations owned independently as opposed to system-owned. Hospitals that were part of a healthcare system were reportedly more likely to be able to build and sustain leadership development capacities than their free-standing counterparts, and often promoted leadership development activities as part of the corporate support function.
Conclusion
The study and the qualitative analysis of the leadership issue in a healthcare organization, pose leadership challenges as in any other industry. Just like any other organizational leader, the executives of healthcare are expected to lead their organizations and their employees with vision, integrity, and focus. There is an additional responsibility which is a distinct feature of the healthcare leaders; they have to promote excellence in quality care, patient satisfaction, and complex relationship with physicians as well as communities. This additional challenge demands from healthcare organizations greater leadership development challenges and aspects of organizational commitment. This will help the organization strive for developing better leaders and aim to achieve maximum overall organizational performance (McAlearney, 2006).
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