Health leadership education programs, best practices, and impact on learners' knowledge, skills, attitudes, and behaviors and system change: a literature review

Figures & data

Table 1 List of terms used in the literature search according to each concept

Terms (keyword, MESH terms, explodables, and/or headings)
Collaboration	Leadership	Education
Collaborat[?/$]	Accountability	Communication
Cooperative	Administrative	Competency-based
behavior	personnel	education
“cross	Change	Continuing professional
discipline[?,$]”	management	development
“health care team”	Complex adaptive systems	*curriculum
Interdisciplin[?/$]	Decision-making	Curriculum development
Interdisciplinary communication	Financial management	Decision-making
“interdisciplinary	*leaders	Education
health team[?,$]”
Interprofession[?,$]	*leadership	Faculty development
Interprofessional communication	Nursing, supervisory	“Interdisciplinary education”
Interprofessional relations	Personnel management	“Interdisciplinary medical education”
Interoccupation[?,$]	Quality improvement	“Interprofessional education”
“medical care team”	Quality management	“Interprofessional competence”
multidisciplin[?,$]	Social responsibility	“Interprofessional teaching”
multiprofession[?$]	Supervis*	Inservice training/or staff development
multisector	Total quality management	Mentors
Patient care team		Models, educational
Teambuilding		*professional competence
Teamwork		*professional development
Transdisciplin[?,$]		*professional role~Students, health occupations

Figure 1 Selection process.

Figure 2 Number of articles by publication year.

Note: ^a2012 – publications from January to August.

Table 2 Number of programs that address each identified topic

Topics^a	Frequency
	n	%^b
Individual level
Power of information technology for learning	17	6.8
Lifelong learning	24	9.6
Team level
Interprofessional communication	79	31.6
Teamwork and collaboration within and across disciplines	66	26.4
Interprofessional conflict resolution	58	23.2
Capacity to develop partnerships	55	22.0
depending on expertise
Patient/client/family/community centered care	50	20.0
Shared problem-solving	35	14.0
Role clarification	33	13.2
Collaborative leadership	21	8.4
Nonhierarchical relationships in team	14	5.6
System level
Entrepreneurial development:	63	25.2
economics and finance knowledge
Evaluation of individual/collective	52	20.8
performance for quality/safety improvement
Care delivery system	34	13.6
Ethical care	28	11.2
Values around social accountability	24	9.6
Health policy development	23	9.2
Priority health concerns of local community, region, and/or nation	21	8.4
Changing local conditions drawing on global resources	9	3.6
Needs of underserved populations	5	2.0

Notes:

a Topics could be designated as learning objectives, content, or competency; bpercentage of 250 analyzed articles.

Table 3 Characteristics of learning context

Characteristics	Percentage of all articles reviewed
Location
Academic settings	65.4
Workplace settings	34.6
Delivery format/learning activities
Lecture/didactic	27.6
Mentoring	20.4
Reflective exercises	18.0
Face-to-face discussion group	17.6
Simulated cases	14.0
Coaching	13.2
Article review/written assessment	12.8
Workshop	11.2
e-learning/online discussion group	10.8
Role playing	10.0
Clinical projects (individual or group)	8.0
Community based projects	8.0
Patient case analysis	4.0
Shadowing	3.2
Videoconferencing	2.4
Patient interaction	2.0
Blended group (face-to-face and online)	0.4
Duration
>One term to ≤1 year	40.0
> 1 day to ≤ 1 week	13.6
≤ 1 day	12.8
>8 weeks to ≤one term	11.6
> 1 week to ≤8 weeks	9.6
> 1 year	7.2
Not specified	5.2
Profession stream
Nursing	45.6
Medicine	26.8
Dentistry	4.8
Social work	4.4
Psychology	2.4
Pharmacy	1.6
Pedagogy	1.6
Occupational therapy	0.4
Physiotherapy	0.4
Speech language pathology	0.4
Audiology	0.4
Technicians	0.4
Level of collaboration among learners
Uniprofessional	68.0
Multiprofessional	22.0
Interprofessional	10.0

Table 4 Correlation between program characteristics and learning audience (Pearson r coefficients)

Characteristics	Learner type
	Undergraduate	Postgraduate	Faculty	Practitioner	Manager/executive
Collaborative leadership	–	–	0.109^**	−0.137^*	−0.124^*
Noncollaborative leadership	0.316^**	0.218^*	–	0.126^*	–
Location of education
Classroom	0.337^**	0.107^*	0.147^**	−0.160^**	−0.212^**
e-learning	–	–	–	−0.105^*	–
Community clinic	–	–	–	–	−0.124^*
Hospital classroom	–	–	–	0.119^*	–
Work e-learning	−0.136^*	0.116^*	–	0.133^*	–
Workplace	–	0.151^**	–	0.174^**	–
Duration
>2 days to 1 week	–	–	–	0.128^*	–
One term	0.232^**	−0.108^*	0.120^*	–	−0.178^**
One year	−0.140^*	–	0.157^**	–	0.156^**
Curriculum delivery format
Lecture/didactic – large group	–	–	−0.118^*	0.146^**	–
Face-to-face – discussion group	0.242^**	0.122^*	–	0.117^*	–
Blended group, face-to-face – online	–	–	–
Facilitated small group/PBL	–	0.128^**	–	–	−0.181^**
Real cases – patient case analysis	–	–	–	–	−0.106^*
Simulated cases	–	–	–	−0.112^*	–
Article review/written assignments	0.135^*	–	–	−0.127^*	–
Videoconferencing	–	0.142^**	–	0.135^*	–
Coaching	–	–	–	0.221^**
Mentoring	–	–	–	–	−0.120^*
Community-based projects	0.279^**	–	–	−0.118^*	−0.101^*
Reflective exercise	–	0.131^**	–	–	–
Level of collaboration
Uniprofessional	–	–	−0.141^*	–	–
Multiprofessional	–	–	0.194^*	–	–
Interprofessional	–	0.140^*	0.184^*	–	–
Focus of curriculum impact
Learner knowledge	0.140^*	0.127^*	–	–	−0.128^*
Learner attitude	0.133^*	–	−0.125^*	–	–
Learner behavior/processes	–	–	–	0.121^*	–
Learner satisfaction	−0.147^*	–	–	–	0.158^**
Patient-centered outcome	–	–	–	–	0.103^*
Outcomes measured at program level	–	–	–	0.132^*	–
Outcomes measured at system level	–	–	–	–	0.212^**
Post delivery assessment methods
Knowledge test	0.315^**	–	–	–	−0.185^**
Self-assessment	−0.127^*	−0.122^*	–	–	–
Reflection journaling	–	0.130^*	–	−0.106^*	–
Program evaluation feedback	–	–	−0.131^*	0.150^**	–
Peer or 360 degree assessment	−0.106^*	–	–	–	0.120^*
Observation eg, skills	–	–	–	−0.137^*	0.116^*
Presentation	0.143^**	–	–	–	−0.116^*
Interview/focus group/debrief	–	0.103^**	–	–	0.120^*
Competence analysis alignment
Towards health and social needs	–	–	–	0.140^*	–
Engage other health professionals appropriate to the specific care situation	–	0.161^**	–	0.124^*	–
Economics and finance knowledge	0.224^**	0.205^**	–	0.206^**	–
Interprofessional conflict resolution	0.130^**	–	–	0.193^**	−0.169^**
Knowledge of values and ethical care	–	–	–	0.252^**	–
Knowledge on how to work in team and collaborate within and across discipline	–	–	–	0.122^*	−0.129^*
Knowledge on care delivery system	0.335^*	0.272^*	–	0.190^**	–
Lifelong learning	–	0.135^*	0.110^*	0.225^**	−0.139^*
Participating in health policy development	−0.128^*	–	–	0.127^*	–
Patient/client/family/community centered	0.338^**	–	–	0.164^**	–
Promote a new professionalism	−0.118^*	–	–	0.177^**	–
Role classification	–	–	–	0.201^**	−0.108^*
Shared problem solving	–	0.109^*	–	0.171^**	–
To be able to rapidly change local conditions drawing on global resources	–	0.130^*	–	–	–

Notes: –, not statistically significant;

* P<0.05;

** P<0.01.

Abbreviation: PBL, problem-based learning.

Table 5 Program postdelivery assessment methods

Assessment methods	Percentage of all articles reviewed
Satisfaction questionnaires	40.4
Program evaluation feedback	30.4
Interview/focus group/debrief	24.4
Self-assessment on leadership development	19.2
Peer or 360 degree assessment	10.0
Quality improvement project evaluation	9.6
Observation of skills and behaviors	9.2
Knowledge test	6.0
Reflection/journaling	5.6
Presentation	4.4
Other (class participation, stakeholder satisfaction, number of educational innovations, educational portfolio preparation)	6.4
Not specified	16.8