Collective leadership to improve professional practice, healthcare outcomes and staff well-being

Collective leadership is an increasingly advocated approach to healthcare wherein all healthcare professionals and patients are directly involved in making decisions. The current rise in longevity, and thus the growth in the number of complex patients, leads to increasingly complex healthcare systems in which interprofessional cooperation is needed. This open process is interactive and interdependent, focusing on shared decisions and responsibilities while empowering and motivating the patients. This is in opposition to traditional hierarchical leadership, which is focused on individual work, thus being limited and exclusive. In this scenario, leaders may be required to shift their perspective from competition to a patient-centered and collaborative approach. This kind of work optimizes different knowledge and expertise to solve problems, delegating responsibilities through active sharing and collective decision-making.

This review investigated the effects of collective leadership on healthcare professionals on their practice, well-being, and healthcare outcomes compared to traditional centralized leadership.

This review is important for

Healthcare professionals, because the quality of leadership influences the efficiency of the health system. Inadequate leadership weakens health systems as it may contribute to quality failings, safety issues, and decreased staff well-being. Thus, this review may be helpful to health professionals, policymakers, and researchers to plan collective leadership interventions to improve the organization of the healthcare system, promoting collaborative decision-making and empowering the patients, caregivers, and team members.

Outcomes of this review

This is a new Cochrane Systematic Review (CSR) published in 2022. The outcomes analyzed were leadership team performance and clinical performance; health status; staff well-being; burnout, psychological symptoms, and professional quality of life; any unintended safety of care events; patient satisfaction; and staff turnover/intention to quit and absenteeism.

The CSR included three trials published and/or registered up to January 2021, with 955 healthcare professionals participating. Meta-analysis was possible only for leadership, whereas a narrative synthesis was provided for the remaining outcomes. Results showed that collective leadership compared to centralized or hierarchical interventions probably improves leadership and may improve team performance. It is uncertain whether it improves clinical performance, healthcare outcomes, or staff absenteeism. Collective leadership may slightly improve staff well-being. Lastly, no direct evidence concerning burnout and psychological symptoms was demonstrated.

These results must be interpreted with caution because (i) no trial reported on burnout or psychological symptoms or unintended consequences in professional or organizational outcomes. (ii) There was no study analyzing the effects of collective leadership on the safety of care events; the (iii) heterogeneity of the intervention and the fact that studies were conducted in high- and upper-middle-income countries limit the generalizability of the results. (iv) All studies were judged at unclear risk of bias and imprecision, and (v) in many cases, the absolute number of events was low and confidence intervals were wide and included no difference.

Author’s conclusion of the review

Sharing viewpoints and knowledge is at the base of collective leadership. This review brought moderate evidence of this type of intervention on professional practice, healthcare outcomes, and staff well-being; low evidence in team performance and stress; and very low evidence for clinical performance, inpatient mortality, and staff absence. The evidence was downgraded due to the risk of bias and imprecision.

Future recommendations

The authors recommended high-quality studies, particularly (a) to find out how to characterize or estimate collective leadership, and (b) to evaluate the impact of varied interventions like team-based training. (c) Other outcomes should be investigated like mortality at 30 days from discharge, staff well-being, and unexpected events regarding the safety of care like errors and healthcare-associated complications. (d) Further studies should inquire about factors that influence the actual feasibility of collective leadership in order to inform future intervention strategies.

by Robin Kuruvila Sentinella