Leadership Research in Healthcare: A Realist Review

According to Gilmartin and D’Aunno (2008), researchers were missing the opportunity to develop general leadership theory in healthcare sector mainly because they weren’t stressing enough the role of professionals as leaders and the need of understanding the role of gender in leadership; and because of the barriers to collaborative, multidisciplinary studies.

The present study aims to investigate which progresses researchers have done in order to understand: 1) Who are the leaders in the healthcare sector and which factors (i.e. traits, skills, competencies, behaviors and styles) are needed for such a role?; 2) How can leadership impact the healthcare sector and what challenges are addressed?; 3) Which efforts are in place in order to educate leaders in healthcare and how relevant are those?; 4) Is leadership in healthcare going towards a systemic, cross-cultural and collaborative approach?

To achieve these goals, we identified the realist review as the best methodology to analyze the relevant researches sample. We have answered questions such as "what works, for whom, and in which circumstances" highlighting: the effectiveness and acceptance of transformational and collaborative approaches; professionalism, expertise, and good task delegation within operational teams; distributed leadership, relationships, and social responsibility at a systemic level.

The relevancy and need of leadership development programs, framed within a wider strategy, emerged. Nonetheless, gaps still exist and require further investigation: particular needs in public vs. private contexts; professionals' and women's differentiating characters; generational gaps; associations between leadership and recruitment HR practices research; how (and if) leaders (should) influence the organizational culture and values; and developing countries specific challenges. Also, a greater proportion of relevant findings should be drawn by empirical and more rigorous studies. Finally, major attention could be paid to interactions happening at the team, organizational, and systemic level among different leaders, and among leaders, followers and external actors.