Table 1

Studies included in systematic review

AuthorTitleYearJournalRelevanceProgramme typeOutcome metricOutcome result
High relevance
Boyle and Kochinda29 Enhancing collaborative communication of nurse and physician leadership in two intensive care units2004 J Nurs Adm HighIntervention to enhance collaborative communication among nurse and physician leaders in two diverse ICUs.Changes in unit staff perceptions on collaborative communication before and after interventions; changes in unit staff perceptions of ICU outcomes.Staff perceived improvement on 5 dimensions of collaborative communication measured, with statistically significant improvement (p<0.05) for problem solving between groups and nursing leadership; staff perceived improvements on ICU outcomes that were not statistically significant.
Chang et al 30 Retaining faculty in academic medicine: the impact of career development programs for women2016 J Womens Health HighEvaluation of three Career Development Programs (CDP) aiming to support women faculty at academic medical centres, including by preparing them for leadership roles.Retention rates of CDP women compared with non-CDP women and CDP men.Higher retention rates for CDP women compared with non-CDP women and men (p<0.001).
Gilfoyle et al 31 Development of a leadership skills workshop in paediatric advanced resuscitation2007 Med Teach HighWorkshop designed to train residents in leadership specifically relevant to patient resuscitation.Performance on a 20-item checklist that evaluated specific leadership skills (assigning roles, limitations of team, communication and overall team atmosphere); self-assessment of confidence in leadership role.Workshop participants scored significantly better on checklists 6 months after workshop compared with controls (p<0.01); participants self-reported statistically significant increases in their competencies.
Jeon et al 18 Cluster randomized controlled trial of an aged care specific leadership and management program to improve work environment, staff turnover, and care quality2015 J Am Med Dir Assoc HighEvaluation of the Clinical Leadership in Aged Care (CLiAC) programme in Australian aged care services.Measures of workplace environment behaviours using the Work Environment Scale-R (WED-R) and the Multifactor Leadership Questionnaire (MLQ) Rater FormStatistically significant improvement on transformation leadership, reduction in transactional leadership and passive avoidant behaviour, and improved outcomes of leadership (extra effort, effectiveness and satisfaction).
Shirazi et al 19 The effects of intervention based on supportive leadership behaviour on Iranian nursing leadership performance: a randomized controlled trial2016 J Nurs Manag HighWorkshop on supportive leadership behaviour for head nurses.Demonstration of supportive leadership behaviours, as reported by head nurses’ subordinates.Statistically significant increase in supportive leadership behaviours (p<0.0001) among workshop participants compared with control group.
Medium relevance
Anonymous40 Assessment tool helps hospital conquer challenges2006 T + D MediumThree-pronged approach to improving leadership in a hospital, including top-down dissemination of training, annual leadership forums and the use of personality-type tests to enhance communication.Improvement on patient satisfaction scores across 7 metrics, such as ‘nurses took time to listen’ and ‘doctor’s concern for comfort’.Per cent of patients reporting positive experience in creased 4.5%– 9.0% across seven different metrics.
Dannels et al 25 Medical school deans’ perceptions of organizational climate: useful indicators for advancement of women faculty and evaluation of a leadership program’s impact2009 Acad Med MediumSurvey of medical school deans’ perceptions of ELAM and its impacts.Perceptions of ELAM programme, including agreement with the statement, ‘I am confident that our ELAM alumnae are more likely to stay at our institution than other women faculty here.’Average score of 5.11 on Likert scale of 7 (with 7 indicating ‘strongly agree’).
Foster et al 23 Residency education, preventive medicine, and population health care improvement: the Dartmouth-Hitchcock leadership preventive medicine approach2008 Acad Med MediumLeadership Preventive Medicine residency, which focuses on leadership of small systems in healthcare, measurement of illness burden in individuals and populations, measurement of the outcomes of health service interventions, leadership of change for improvement of quality, value and safety of healthcare of individuals and populations, and reflection on personal professional practice enabling personal and professional development.Results of the participant-led practicum projects.Of the 12 graduates of the programme, the article reports on 8 which achieved positive results (other 4 not reported on).
Green and Plsek43 Coaching and leadership for the diffusion of innovation in health care: a different type of multi-organization improvement collaborative2002 Journal on Quality Improvement MediumCoaching and leadership initiative to develop new methods of collaborating for organisational learning of best practices, with a focus on generalisable change and deliberate leadership support for deployment, diffusion and sustainability.Improvement on management indicators for various topics (eg, reduction time from abnormal mammogram findings to definitive diagnosis, reduce patient registration time, improvement in patient experience/self-reported pain, and so on).Improvement across multiple management and performance indicators.
Haseman et al 39 Practising inspired leadership: the use of applied theatre ‘prophetical’ in the executive Leadership Development Program for Queensland Health2009 Aust Health Rev MediumLeadership Program including residential workshop for executives, non-residential workshop for managers and supervisors, 360° feedback, executive coaching, web-based support and online learning modules.Changes in formal grievances, consumer complaints, absenteeism, retention of staff and other metrics.56% reduction in formal grievances; 28% reduction in consumer complaints; 14% improvement in absenteeism; 17% improvement in retention.
Hultman et al 32 Sometimes you can't make it on your own: the impact of a professionalism curriculum on the attitudes, knowledge, and behaviors of an academic plastic surgery practice2013 J Surg Res MediumCourse on professionalism in plastic surgery for professionals of all levels (faculty, residents, nurses and medical students).Number of unprofessional behaviours requiring involvement by senior administrators during the 6 months before and after the course.Number of events reduced from 12 to 3.
Levine et al 42 Chief resident immersion training in the care of older adults: an innovative interspecialty education and leadership intervention2008 J Am Geriat Soc MediumTwo-day Chief Resident Immersion Training programme formally preparing chief residents for their role; programme required chief residents to develop an action project focused on the management of complex older patients over the following year.Per cent of participants completing their action projects (paper also reports self-report data related to role performance; these data are not summarised here).60% of chief residents had completed at least half of their action project, and 18% of chief residents had completed their entire project.
Mansour et al 44 Scaling up proven public health interventions through a locally owned and sustained leadership development programme in rural Upper Egypt2010 Hum Resour Health MediumLeadership Development Program in three districts in Egypt aimed to improve health services by increasing managers’ ability to create high-performing teams and lead them to achieve results.Achievement of teams’ intended population health goals.Eight of the 10 health teams achieved 95% of more of their desired results, and family planning visits increased by 20%−68% in the three districts where the programme took place.
Orton et al 41 Management academy for public health: creating entrepreneurial managers2007 Am J Public Health MediumTrainings for teams, often from local public health agencies, to conduct an action-learning project where teams develop a public health business plan for a sustainable new programme.Per cent of plans fully implemented, implemented midway, or at initial stages of implementation; per cent of team generating revenue after 2 years.22%, 17% and 15%, respectively; 38% generating revenue (28 teams generating a total of $4 million).
Terzic-Supic et al 45 Training hospital managers for strategic planning and management: a prospective study2015 BMC Med Educ MediumTraining sessions for multidisciplinary teams in Serbia on basic health management, hospital management, health information management and total quality management.Third-party experts’ evaluations of SWOT analyses before and after the training programme.Statistically significant (p<0.001) improvement on all 16 components of the SWOT analysis.
Tumerman and Carlson36 Increasing medical team cohesion and leadership behaviors using a 360 degree evaluation process2012 WMJ Medium360° evaluation process.Per cent of staff seeing changes for the better in physician behaviours in connection to the process (willingness to change, respect, quality of care, support of team members, compassion, efficiency, teamwork).Per cent of staff seeing improvements ranged from 17% for quality of care to 63% for respect and teamwork.
West et al 35 Evaluation of a clinical leadership initiative2004 Nurs Stand MediumSystem of mentorship, education and training to address issues with treating mental health issues and care of older people.Multiple measures by participants’ colleagues, including changes in direct care management, decision-making, communication processes, clinical nursing care, reporting and evaluation, and support strategies and processes.Majority of results suggested that all skills improved.
Low relevance
Anderson and Lavoie-Tremblay65 Evaluation of the Executive Training for Research Application (EXTRA) program: design and early findings2008 Healthc Policy LowProgramme ‘to support evidence-informed decision-making in the organization, management and delivery of health services through funding research, building capacity and transferring knowledge’ for health service professionals in senior management positions.Per cent of participants who believed their knowledge of change management was ‘very good’ or ‘excellent’.Increase from 37% before the programme to 95% 2 years into the programme.
Bowles and Bowles46 A comparative study of transformational leadership in nursing development units and conventional clinical settings2000 J Nurs Manag LowNursing development units (NDU) to serve as centres of nursing excellence, innovation and leadership development.Total leadership score on Leadership Practice Inventory (LPI) by observers.8% higher score on LPI among NDU nurses than non-NDU nurses.
Brandon and Mullan49 Teaching medical management and operations engineering for systems-based practice to radiology2013 Acad Radiol LowProgramme to enhance resident’s knowledge and ability to apply concepts from medical management and industrial/operations engineering to radiology practice.Knowledge of seven domains taught in the programme.Participants showed statistically significant improvement on all seven domains tested.
Brinkert50 Conflict coaching training for nurse managers: a case study of a two-hospital health system2011 J Nurs Manag LowTraining of nurse managers as conflict coaches to improve conflict understanding, interaction strategies and/or interaction skills.Response to question: To what degree have your goals for the conflict coaching training programme been met?95% reporting high or moderately high at 3 and 6 months’ follow-up.
Burns and Papa51 Self-reported changes in nurse manager proficiency resulting from participation in the Rising Star Leadership Program2008 Pa Nurse LowThree-day programme to assist nurses to improve the quality of their individual work environments and units, advocate for health employee lifestyles, become vigilant about patient safety and develop oneself and develop others.Per cent of nurse managers rating training as useful for their work 3 and 6 months after the training (response of ‘high’ or ‘moderately high’).95% at 3 and 6 months.
Cooper66 An evaluation of the Leading an Empowered Organisation programme2003 Nurs Stand LowNHS leadership development programme Leading an Empowered Organisation (LEO).Change in self-rating of performance on five leadership behaviours (articulating the goal, maintaining organisational objectives, exhibiting trust, presenting challenging opportunities and getting outside support) before and after the programme.P<0.05 for four out of five behaviours, and p=0.052 for exhibiting trust.
Crites and Schuster26 A preliminary report of an educational intervention in practice management2004 BMC Medical Education LowExploratory study on a practice management curriculum for primary care residents.Practice knowledge on 12 management topics, including revenue management, dynamics of group practice and risk management.Mean correct score on the practice knowledge test increased from 71% before participating in the curriculum to 91% after the curriculum.
Dannels et al 52 Evaluating a leadership program: a comparative, longitudinal study to assess the impact of the Executive Leadership in Academic Medicine (ELAM) program for women2008 Acad Med LowExecutive Leadership in Academic Medicine (ELAM)—yearlong development programme for senior women faculty in US and Canadian medical schools.Comparison of self-report of leadership competencies between ELAM participants and controls: knowledge of theory, environmental scanning, financial management, communication skills, conflict management, diversity competence, tolerance for demands of leadership and leadership positioning.ELAM participants self-reported higher scores for all competencies, with p<0.001 for all except for conflict management (p<0.05) and diversity competence (not statistically significant).
Day et al 27 Effectiveness of the AAOS leadership fellows program for orthopaedic surgeons2010 The Journal of Bone & Joint Surgery LowOne-year programme designed to train young orthopaedic surgeons to become future leaders in orthopaedics.Comparison of self-reported confidence on knowledge of theory, environmental scanning, financial management, communication skills, conflict management, diversity competence, tolerance for demands of leadership and leadership positioning between programme participants and rejected applicants.Higher confidence by programme participants on all dimensions except financial management, with statistically significant differences (p<0.05) for knowledge of theory, tolerance for demands of leadership and leadership positioning.
Duygulu and Kublay33 Transformational leadership training programme for charge nurses2011 J Adv Nurs LowTransformational leadership training programme on unit charge nurses’ leadership practices.Scores on LPI for five traits (model the way, inspire a shared vision, challenge the process, enabling others to act and encourage the heart) over the course of four evaluations by observers (colleagues).Nurses showed statistically significant improvement (p=0.001) for all five traits.
Edler et al 67 Leadership lessons from military education for postgraduate medical curricular improvement2010 The Clinical Teacher LowLeadership Education and Development Program for paediatric anaesthesia residents.‘Leadership evaluation’ of residents by faculty (scored from 1 to 9).Preintervention score 6.8; postintervention score 7.6 (p<0.05).
Fiset et al 59 Clinical nursing leadership education in long-term care: intervention design and evaluation2017 J Gerontol Nurs LowTargeted intervention on leadership education for RNs, registered practical nurses and nursing administrators.Self-reported perceptions of improvement on various competencies, such as ‘self-awareness and personal insight’ and ‘ability to give feedback to others’ in survey 3 months after intervention.All nurses agreed that they had improved along all dimensions measured.
Group Health Research Institute53 NLAPH cohort 2 evaluation report: executive summary2014LowTeam-based applied leadership programmes that use real-world community health improvement projects to provide opportunities for participants to apply new leadership skills and approaches in a multisector operating environment.Self-reported scores on five domains: individual leadership mastery, effectively work across sectors, application of continuous QI, appropriately use data and public health perspective.Participants reported improvements on all five domains.
Hanna et al 54 Training future surgeons for management roles: the resident-surgeon-manager conference2012 Arch Surg Low1-day management seminar for senior surgical residents.Self-report of competence levels for nine managerial skills required for efficient management of a surgical service or practice (% rating themselves ‘Good’ or ‘Excellent’).Statistically significant improvement on 7 of 9 skills.
Hartley and Garrett60 Impact of a management assessment centre in developing proficient health managers1997 Aust Health Rev LowAustralian Management Competencies Assessment Centre, which assesses participants on 10 leadership/management dimensions and allows them practice skills in those dimensions.Self-report by programme participants on management competencies, use of a professional development plan and use of continuing professional education, compared with non-programme participants.Programme participants self-rated high on four dimensions: leadership, achievement, strategic planning and innovation (p<0.05), completed more work using their personal development plan (p<0.05), and accessed more continuing education resources (p<0.05).
Korschun et al 68 Realizing the vision of leadership development in an academic health center: the Woodruff Leadership Academy2007 Academic Medicine LowLeadership academy including physicians, PhD faculty, academic administrators and other staff focused on developing leadership skills relevant to the Woodruff Health Sciences Center (WHSC).Self-report in response to various questions about the impact of the leadership academy.Select results: 98% of participants agreed or strongly agreed that the academy increased their commitment to and support of the vision and strategies of WHSC; 96% of participants strongly agreed, agreed, or slightly agreed that participation in the academy made the more likely to stay at WHSC.
Krejci and Malin55 Impact of leadership development on competencies1997 Nurs Econ LowLeadership programme designed to train nurse managers to improve outcomes in a cost-effective manner.Self-reported ability on 12 competencies, including change, communication and systems thinking.Statistically significant (p<0.01) improvement on self-report ability for all 12 competencies.
Leslie et al 61 Training young paediatricians as leaders for the 21st century2005 Pediatrics LowTraining programme for young paediatricians focused on self-management skills, systems management skills and leadership competencies within the context of a team.Self-reported competencies on taught domains and achievement of personal goals in one or more of the domains.Statistically significant increase in self-rated performance on all 20 competencies measured; 87% of respondents reported that they had at least partially achieved their goal.
LoPresti et al 48 Using a simulated practice to improve practice management learning2009 Family Medicine Low‘Simulated practice’ with 20 modules on specific practice management tasks for residents.Pretest/post-test comparison (between-group compared with control and within-group analysis) on a practice management examination.Programme participants showed better performance on examination compared with controls (p=0.006) and in within-group pretest/post-test analysis (p=0.0060).
Martin et al 47 Evaluation of a clinical leadership programme for nurse leaders2012 J Nurs Manag LowClinical leadership programme focused on leadership competencies for nurse leaders in Switzerland.Observer-reported scores on five leadership competencies over time: model the way, inspire a shared vision, challenge the process, enable others to act and encourage the heart.Statistically significant improvement on observer-reported scores for Inspire a Shared Vision and Challenge the Process.
McAlearney et al 13 Developing effective physician leaders: changing cultures and transforming organizations2005 Hospital Topics LowMedical leadership development programme for academic and community physicians at a hospital in Ohio.Self-report by participants on their current leadership, their ability to lead teams, their ability to work in teams and several other dimensions, before and after the programme.Increases in self-report on all dimensions.
McDade et al 69 Effects of participation in the Executive Leadership in Academic Medicine (ELAM) program on women faculty’s perceived leadership capabilities2004 Academic Medicine LowLeadership skill development, mentoring and networking for women faculty members in medical and dental schools.Changes in self-report on 10 constructs/skills related to leadership.Statistically significant improvement (p<0.001) on all 10 constructs.
Omar et al 56 Training evaluation: a case study of training Iranian health managers2009 Hum Resour Health LowTrainings for lower level managers given new roles and responsibilities in a newly decentralised health system in Iran.Self-report of participants stating that knowledge was used ‘often’ for 12 skills.Respondents saying they used knowledge often ranged from ~25% for ‘leadership role’ to ~77% for ‘work effectively in a group’.
Patel et al Building the pipeline: the creation of a residency training for future physician leaders in health care quality2015 Acad Med LowHealthcare Leadership in Quality (HLQ) programme that included integration into an interprofessional healthcare leadership team.Knowledge of the Quality Improvement Knowledge Assessment Tool before and after training.Statistically significant increase (p<0.05) in knowledge as assessed by this tool.
Pollitt70 Guinness Northern Counties begins to build a coaching culture2012 Training & Management Development Methods LowTraining for middle managers on modern leadership, team branding, value for money, influencing, team development and management change.Cost savings identified during training of middle managers.£900 000 (compared with £108 000 investment in training programme).
Porter et al 57 The management academy for public health: a new paradigm for public health management development2002 J Public Health Manag Pract LowCurriculum designed to train teams of managers on skills such as managing money, people and data.Self-reported skill levels for 10 competencies, such as managing and executing strategies, managing people and communication.Statistically significant improvement (p<0.0001) on all 10 competencies.
Richman et al 24 Advancing women and closing the leadership gap: the Executive Leadership in Academic Medicine (ELAM) program experience2001 Journal of Women's Health an d Gender-Based Medicine LowEvaluation of ELAM across participating schools.Self-report of performance on six curricular areas from the first three ELAM classes (financial management, career advancement, personal leadership, converging paradigms of academic and corporate leadership, emerging issues and strategic planning).Increase in self-reported performance on all six curricular areas (p<0.0001).
Richter et al 28 Evaluation results of the CDC/ASPH Institute for HIV Prevention Leadership: a capacity-building educational program for HIV prevention program managers2007 J Public Health Manag Pract LowCapacity-building programme for HIV prevention programme managers in minority-based, community-based organisations.Self-reported frequency of and confidence performing 11 relevant public health prevention and strategic planning and management activities, such as community assessments, advocacy and creating a learning environment.Statistically significant increase in self-reported frequency and confidence on all activities.
Saleh et al 58 Evaluating the effectiveness of public health leadership training: the NEPHLI experience2004 American J ournal of P ublic H ealth LowYearlong experiential programme aimed at building and improving the leadership skills of current and future public health practitioners.Self-reported competency levels and frequency of use of 15 leadership practices, including ‘cope with and lead changes in public health practice’ and ‘mobilize resources in the community needed to increase access to public health services’.Statistically significant (p<0.05) increase on self-reported competence for all practices and on self-reported frequency of use for four practices (cope with and lead changes in public health practice; deal with cultural and ethnic diversity in the context of access to health services; understand the administrative, social and political implications of alternative policy options; use visual representation of data to identify public health problems).
Talbot et al 71 Five Weekend National Family Medicine Fellowship Program for faculty development1997 Can Fam Physician LowFive Weekend National Family Medicine Fellowship which focuses on the essentials of education, management, communication, critical appraisal skills and the principles of family medicine to develop leadership and team-building skills for faculty and community-based physicians.Results of projects completed as part of the programme.>20 presentations at College of Family Physicians of Canada (CFPC), >10 publications being developed and various other applications of projects (out of a total 34 projects).
Null effect
Cummings et al 64 Worklife improvement and leadership development study: a learning experience in leadership development and ‘Planned’ organizational change2013 Health C are M anagement R eview Null effectLeadership Development Initiative to facilitate organisational learning among healthcare managers at the Alberta Cancer Board.Six subscales on the Areas of Worklife Survey: workload, control, reward, community, fairness and values.No statistically significant changes in self-reported worklife by initiative participants.
Wallen et al 63 Implementing evidence-based practice: effectiveness of a structured multifaceted mentorship programme2010 J Adv Nurs Null effectStructured multifaceted mentorship programme designed to implement evidence-based practice (EBP).Comparison of Mentorship Program Group and Comparison Group on EBP beliefs, organisational culture and readiness, EBP implementation, job satisfaction, group cohesion, nurse retention index and intent to leave.No statistically significant differences between control and intervention groups except for an improvement on EBP beliefs in the intervention group.
Qualitative study
Boomer and McCormack34 Creating the conditions for growth: a collaborative practice development programme for clinical nurse leaders2010 J Nurs Manag QualitativeLeadership practice development using work-based and action learning.N/AReports indicated progress towards various leadership skills, including becoming reflexive, becoming proactive, valuing teamwork, becoming a facilitator and nursing processes.
Champagne et al 72 Organizational impact of evidence-informed decision making training initiatives: a case study comparison of two approaches2014 Implement Sci QualitativeImpact of two programmes on evidence-informed decision-making (EIDM).N/ATraining programmes can improve attitudes towards EIDM and, to a lesser extent, conversion of these attitudes into skills.
Dierckx de Casterle et al 38 Impact of clinical leadership development on the clinical leader, nursing team and care-giving process: a case study2008 J Nurs Manag QualitativeClinical leadership programme (CLP) for nurses in a large academic hospital.N/ALeadership learning seen as iterative, ongoing process which can increase personal effectiveness, self-awareness, communication skills and other relevant skills.
Enterkin et al 73 Clinical leadership for high-quality care: developing future ward leaders2013 J Nurs Manag QualitativeSeries of workshops for improving personal influencing skills, high-impact communication, creating a positive ward environment, leading service and practice innovation, managing change, quality improvement and managing staff among ward leaders (nurses).N/AParticipants reported increased political, organisational and self-awareness, increased confidence, feelings of empowerment and the ability to empower others.
Singer et al 37 A case for safety leadership team training of hospital managers2011 Health C are M anagement R eview QualitativeSafety Leadership Team Training with modules on (1) introduction and appreciative inquiry, (2) theoretical framework and employee survey, (3) simulation exercise and debrief, (4) the ‘Game Plan’ project management exercise, and (5) a follow-up programme.N/ARespondents reported that the training increased behaviours such as ‘showing you really care’, ‘demonstrating a welcoming/nondefensive attitude’, ‘encouraging speaking up’, ‘facilitating teamwork and communication’, ‘taking action’, ‘mobilizing information’ and ‘seeking input’.
Singer et al 74 Making time for learning-oriented leadership in multidisciplinary hospital management groups2015 Health C are M anagement R eview QualitativeSafety Leadership Team Training with modules on (1) introduction and appreciative inquiry, (2) theoretical framework and employee survey, (3) simulation exercise and debrief, (4) the ‘Game Plan’ project management exercise, and (5) a follow-up programme.N/ALearning-oriented leadership which promoted a mutually supportive environment and which specifically made time for learning facilitated achievement of these outcomes.
  • ICU, intensive care unit; N/A, not applicable; NHS, National Health Service; QI, quality improvement; RN, registered nurse; SWOT, strengths, weaknesses, opportunities and threats.