Our research goal was to gain a deeper understanding of how senior leaders in healthcare delivery settings lead through change. Healthcare systems are complex,(1) partly because professional healthcare is highly regulated in the United States and must respond to multiple stakeholders.(2) Change has become a constant in this system,(3) particularly as the COVID-19 pandemic and other global health threats progressed.(4) The increasing complexity of healthcare systems and the widening diversity of patient needs illuminate the critical need for individuals to effectively lead teams through change.(3) Thus, a deeper understanding of how leaders of healthcare systems approach leadership can provide a foundation for preparing future leaders to be highly effective.
Senior leaders in healthcare delivery systems often are called upon to be change leaders, charged with facilitating teams that respond to clinical and administrative exigencies. However, the range of skills, knowledge, temperament, and experience necessary to lead teams through the complicated change process may limit the desire for many to seek leadership positions. Our study investigated the phenomenon of leading teams through change using a series of semistructured interviews with senior leaders in a rural healthcare system. The intention was to create dialogue around an essential aspect of healthcare delivery that is often overlooked in the day-to-day practice of medicine.
Conceptual Framework
Our study aligns with a social constructionist philosophical stance that acknowledges the social nature of knowledge construction. In our research, we used a lens of social interactions to examine how senior leaders developed their leader identity and then experienced and applied their leadership. Burr(5) advises that “we should not assume that our ways of understanding are necessarily any better, in terms of being any nearer the truth than any others.” Instead, researchers must center the experiences of our participant partners, value the truth of their experience, and recognize that their understanding is historically, socially, and culturally constructed.(5,6)
The question we attempted to answer in this study is how senior leaders experience leading teams through change and whether there are commonalities among their experiences useful for encouraging further dialogue to affect patients and those who participate in their care delivery in a positive way.
Leading through Change
To operationalize leading through change, we considered the work of Woodward and Hendry,(7) who assert, “Leading and coping with change in the process of implementing change is a dynamic, holistic process, with change as intrinsic and, therefore, that changing the ‘organization’ is achieved simultaneously with changing the relationships, competencies, and capabilities that define it.” We contend that leading through change is a constant part of leadership, particularly in healthcare organizations. We also contend change takes place implicitly and explicitly. In healthcare organizations, implicit change is associated with the frequent changes taking place within personnel, the individuals working at the organization as they grow, societal expectations and needs, the clients and those visiting the organizations, in procedures and processes to treat those in need, and the leadership of the organizations. We argue that implicit constant change requires management, because there is not a specific end goal for the process, and the objective is to mediate the change for minimal organizational disruption.
In contrast, explicit change in healthcare organizations is typically disruptive to the system, involves planning, has a strategy, is monitored at checkpoints, and is determined to be completed by meeting end goals. Thus, the strategy and disruption in a system associated with explicit change requires leadership beyond management. The conditions of explicit change require individuals to accept they are leaders and embrace their responsibility in the role. Our interest is in how leaders navigate the process of leading (or managing) through the lens of constant implicit change within organizations while engaging in the leadership required for situations of explicit change.
Literature Review
Healthcare Leaders
Healthcare leadership has been defined as “the ability to effectively and ethically influence others for the benefit of individual patients and populations.”(8) With the shift in how healthcare is delivered, from smaller solo clinician settings to more extensive healthcare delivery settings, those who provide leadership may have varying educational backgrounds, experiences, and philosophies. To succeed, healthcare leaders must have subject matter expertise, a flexible leadership style, highly developed interpersonal skills, and a broad, inclusive attitude.(9)
Preparation of Healthcare Leaders
While leadership in medicine previously was often equated with management, it has become clear that both are important, and that having skills in one does not necessarily align with having skills in the other.(10) Physicians and other clinicians see value in leadership, although they do not always have formal leadership preparation or experience working with non-clinicians.(10) Healthcare leaders typically do not receive education on leadership concepts such as followership, social identity, or social influence.(11) Although numerous leadership models are used in leadership development and management schools and professions, few take into consideration all of the competencies that may be necessary for effective healthcare leadership, such as selfless service, integrity, critical thinking, emotional intelligence, and teamwork.(8)
Leading Teams
Most clinicians in the United States are now employed by larger entities made up of healthcare delivery systems.(12) Coming from a traditionally paternalistic and hierarchical culture,(13) some medical leaders may be more comfortable with the command-and-control approach to leadership, which does not lend itself easily or well to the collaborative leadership approach that teams may require.(11) “Medical supervision…goes alongside adequate team building activities and an appropriate sharing of decision power.”(14) In particular, team-based care has increased job satisfaction among clinicians, staff, and others who participate in this approach.(15)
It has become increasingly evident that a team-based approach to healthcare is as important to patients as to clinicians. Patients are as complex as the system that attempts to provide them care. The complexity is particularly evident when we attempt to move beyond simply diagnosing and treating disease to a wellness orientation. Maintaining wellness in the face of social determinants of health, such as poverty, lack of access to nutritious food, and insufficient education, is challenging. A single clinician cannot handle a complex patient easily within a complex system. Peek et al.(16) define complexity as “the person-specific factors that interfere with the delivery of usual care and decision-making for whatever conditions the patient has.” These factors include overuse or inappropriate visits; testing and services; challenging patient/clinician relationships; and a lack of shared understanding regarding patient symptoms.(16) This type of interference with the traditional model of care leads to patient, clinician, educator, payer, and system dissatisfaction, and also to adverse patient outcomes.(16) Rather than simply relying on a disease-focused approach to care, addressing complexity is more easily achieved using a team-based approach.
It is equally important to recognize patients as members of their care teams. Because medicine traditionally has been paternalistic and hierarchical, patients have been asked to participate in a structure where they have diminished power, less knowledge, and inadequate decision-making support.(13) French-Bravo and Crow(17) suggest shared governance to promote individual control and autonomy. Long recognized within nursing, the importance of shared governance has gained a foothold in healthcare settings more generally.(18) Shared governance can increase patient and healthcare team engagement and improve patient experience, quality, outcomes, and cost.
Moving toward shared governance requires significant buy-in from those involved, which may mean a shifting of personal ideology around authority and knowledge ownership. Shared governance also necessitates having the intellectual, behavioral, and emotional capacity to engage in the process. Thomson et al.(19) define buy-in as an emotional commitment and intellectual understanding leading to engagement. Psychological meaningfulness and availability are essential prerequisites to buy-in.(20) Coupled with these prerequisites, French-Bravo and Crow(17) suggest that engagement, trust, balance of options, personal connection, and adequate time to engage in an initiative can be cultivated to promote buy-in for shared governance. By engaging cooperatively in shared governance, individuals are also participating in collaborative leadership, which ultimately moves everyone to a place of mutual benefit.(21)
Based on current changes in the profession, healthcare leaders need to understand how to create teams that best support patients, one another, and the larger community. Healthcare leaders often hold both official and unofficial roles that place them in a position to interact with others, such as less experienced medical staff or clinical staff with a different type of education, who have previously been considered (in leadership parlance) to be “followers,” but who may more accurately be referred to as contributors. Xu and Thomas(22) found that followers’ strongest engagement predictors were leadership behaviors focused on supporting and developing the team. In some cases, this means a better understanding of women, minorities, and other previously marginalized groups in the healthcare setting, from both a patient and clinician perspective.(23) In supporting, developing, and understanding others on their teams, leaders are meeting their needs to help them achieve their goals, which is foundational to servant leadership.(24) Directive leaders, in contrast, use instructions and external motivational techniques to meet the goals identified as being important to the organization.(25)
Change Leadership
In addition to the changes inherent in moving toward team-based care, healthcare leaders face multiple external and internal changes. One example is the implementation of communications technology. Over the past two-plus decades, medicine has moved firmly (albeit somewhat belatedly) into the digital world. Use of the EHR and secure messaging have created new and different connections between members of the healthcare team and patients who may now access their medical practitioners. Although ultimately beneficial, implementing EHRs also has proven to be disruptive and needs to be approached as a change process, not just a technical overhaul.(26) EHR implementations are complex social adaptive projects that require specific leadership competencies.(26) These types of planned disruptions pale in comparison with unplanned disruptions, such as the COVID-19 pandemic, which caused multiple challenges, such as the need for new staffing models and communication strategies, all of which contribute to the need for change leadership skills.(27) Adaptive leaders use change leadership skills to enable their teams to move through challenges by understanding change-related stressors and facilitating collaboration to enact new solutions.(24) Transformational leaders use idealized influence, inspirational motivation, intellectual stimulation, and idealized consideration to move team members beyond their own self-interest to perform above expectations for the benefit of the team as a whole.(24)
Barriers to Effective Leadership
Given medicine’s traditional hierarchical structure, moving into a more equitable team-based approach to care will require that leaders have strong change leadership skills, focusing on team building and collaboration. Prior research has identified potential barriers to adequate healthcare leadership, including supervisory structure, the pace of change, the complexity of the clinical data infrastructure, an overreliance on technology for communication, and gaps in available leadership training.(28) These gaps may include conflict management and team-building skills, motivation techniques, difficult news delivery, and formal mentoring.(28) It also may be necessary to engage in situational leadership, which requires employing different leadership strategies depending on the needs of a given context.(25)
Method
Research Question
Our overarching research question was: how do leaders of healthcare systems approach leading through change in their organizations? To answer this question, we formed the following guiding research questions:
What are the leaders’ philosophies of leadership?
How were the leaders prepared to lead?
What are the goals of the leaders as they lead through change?
What barriers do the leaders encounter as they lead through change, and how do they navigate them?
How do leaders work with their team(s) when leading through change?
Study Methodology
We used a descriptive phenomenological methodology to research and document the healthcare system leaders’ experiences leading through change. Our ultimate goal was “to describe as accurately as possible the phenomenon, refraining from any pre-given framework, but remaining true to the facts.”(29) We selected a descriptive phenomenology methodology to document and describe the experience of leaders as they work to lead teams through change to allow for more transferability across clinical and nonclinical settings. We selected a phenomenology methodology because the process allows us to effectively and empirically document the processes of leaders as they embrace and lead change. Given the myriad models in change leadership,(30) there is justification for exploring the lived experiences of those who are actually engaging in the process in unique and under-researched contexts. Thus, how one perceives change and leadership is based on personal experience, which indicates that the conditions are directly aligned with a phenomenology methodology.(31)
Participants
The participants in this study were the ten senior leaders who were the members of a healthcare delivery system leadership team. We chose them using purposive critical case sampling, as we identified them as being in roles that require leading teams through change. Our sample size was limited by the small number of participants on the senior leadership team (10), each of whom was likely to have had relevant experience leading through change. Six of the leaders self-identified as male and four as female. Eight were from 51 to 60 years old, and two were from 61 to 70 years of age. Eight self-identified as white, one as Hispanic, and one as other (“two races”) (Table 1).
Interview Protocol
We used a semistructured interview protocol to provide clear direction regarding what we asked and the responses we sought to gather. The semistructured design allowed for a broader range of responses, allowing participants to provide relevant insights or experiences we did not anticipate. We created the interview protocol in alignment with our research questions. Our goal was to ensure the interview prompts were likely to elicit responses that we could use to answer our research questions. For example, to gather the data needed to document our participants’ leadership philosophy, we asked, “How do you approach leading in your organization?” We included at least one interview prompt for each of our guiding research questions.
To validate our protocol, we vetted the protocol with a group of experts in social science research and leading in healthcare systems. We then piloted the protocol with some healthcare leaders who were not part of the leadership team we studied. Based on the feedback and piloting experience, we made minor adjustments to the protocol results in the final product we used for data collection.
Data Collection
We gathered data by conducting semistructured interviews over the course of two months. The semistructured interviews allowed for a generative conversation, which was more likely to result in the participants sharing perspectives aligned with our research focus. Each interview lasted about 30 minutes. We read the prompts to the participants, listened to their responses, and asked follow-up questions if needed to prompt additional responses that provided clarity or more details of the participants’ thoughts or experiences. We audio-recorded the interviews for transcription.
Data Analysis
We analyzed the participants’ responses using a combination of deductive and inductive coding, classifying the participant’s responses to our interview prompts into categories represented by a term or a phrase in their responses. For our deductive coding, we used the a priori codes we created before our analysis based on extant change leadership research and our knowledge and experience as organizational leaders leading through change. As we analyzed the data, we engaged in inductive coding, remaining open to new codes based on the responses, resulting in multiple emergent codes (Table 2).
We began our coding by establishing intercoder reliability. To establish intercoder reliability, we coded a small subset of the data with one another to ensure code definition and application consistency. Once established, we coded the same subset of the data independently and compared our coding for consistency. We repeated the process until we reached Cohen’s kappa,(32) representative of a high level of consistency (i.e., greater than .80). We then proceeded with coding the remaining data independently.
Following data coding, we created a composite summary of the frequency of the codes for all the participants. We followed determining the coding frequency count by gathering representative responses for each of the codes to provide contextual and empirical examples of the participants’ reflections, thoughts, and experiences associated with the themes and codes.
Trustworthiness
We took multiple steps to establish the trustworthiness of our research(33):
First, we consistently used an interview protocol that we created in alignment with our research questions that was vetted by a panel of experts and refined through a piloting process. We used the interview protocol to increase the consistency of the data collection and provide a means for replicating our research.
Second, we recorded the interviews and transcribed them using the online automated services Otter and Rev. These services mark questionable words or phrases for users to clarify and include direct links to the audio recording. The process of recording, transcribing, and rechecking ensured our transcripts were accurate and representative of the participants’ responses.
Third, we created a set of a priori codes for each of our research questions to ensure our deductive coding was aligned with our intended themes.(29) Similarly, we added additional codes through inductive coding which increased the effectiveness of our data analysis.
Fourth, we established a Cohen’s kappa of .92, indicating an acceptable level of intercoder reliability, reflecting our efforts to ensure consistency and accuracy in our independent data coding.
Results
Leadership Philosophy
Our first question was: What are the leaders’ leadership philosophies? To answer this question, we examined the data for indicators of leadership philosophy. We found that the participants tended to focus on elements and processes that are common to the philosophy of servant leadership, such as collaboration, influence, emotional intelligence, and authenticity (Figure 1). Our analysis also exposed a moderate frequency of codes aligned with the philosophy and practices of transformational leaders. The codes reflect many of the needs and activities common to leading a healthcare organization, including the culture and mission of the organization. For example, the organization requires a team approach, thus the high frequency of collaboration. The responses also reflect the diversity of the individuals and leadership roles within the organization.
Figure 1. Codes and frequencies for leadership philosophy.
The statements associated with the most frequent codes reflect leadership engagement in complex conditions and an evolving consideration of their leadership roles (Table 3). The responses also reflect the leaders’ learning about being leaders as they lead, suggesting they engage in reflective leadership practices with a perspective of leading through change that requires learning and remaining open-minded. The leaders also recognize their influence and responsibility in their leadership role, and they embrace their power to influence and the opportunity to make a difference by facilitating organizational change.
Preparation to Lead
Our second guiding research question was: how were the leaders prepared to lead? To answer this question, we examined the data for indicators of leadership preparation. We found that although leaders did have formal education in leadership and had leadership incorporated into their non-leadership education, most leaders learned to lead through experience (Figure 2). Leaders’ interest and expertise in leadership evolved and was developmental. Several leaders had college-level preparation through extracurricular activities (e.g., sports, fraternity, military academy roles), and business-related leadership classes through undergraduate programs and graduate programs (e.g., a master’s degree in business administration). Leaders’ experiences in leading and being led provided them with positive and negative examples of the impact of leadership traits and behaviors.
Figure 2. Codes and frequencies for preparation to lead.
The statements associated with the most frequent codes reflect leadership preparation through experience and education (Table 4). The responses also reflect that leaders prepare to lead by leading and being led and finding some level of success in reaching goals. Leaders are also prepared by teaching and being taught about formal and informal leadership. Leaders with a clinical background indicate that this impacted their decision to become leaders.
Goals for Leading Through Change
Our third guiding research question was: What are the goals of the leaders as they lead through change? To answer this question, we examined the data for indicators of goals when leading through change (Figure 3). We found that maintaining perspective and hope was salient to leaders, given that change is a process requiring the involvement and commitment of others. The leaders needed to be flexible to shift focus from maintaining perspective and hope to meeting institutional goals.
Figure 3. Codes and frequencies for leading through change goals.
The statements associated with the most frequent codes reflect that the goal of leading through change is to help others maintain perspective and be aspirational in the face of uncertainty (Table 5). The responses also reflect that leaders are trying to understand where there is and is not room for interpretation and how to be flexible in their approach. In their responses, leaders suggest balancing multiple institutional goals and creating team cohesiveness around balancing these goals with maintaining perspective and flexibility.
Barriers to Leading Through Change
Our fourth guiding research question was: What barriers do leaders encounter as they lead through change, and how do they navigate them? To answer this question, we examined the data for indicators of leadership barriers and how they were navigated (Figure 4). We found that participants focused more on navigating the barriers rather than explicitly identifying them and that communication proved to be both a barrier and a solution. The organizational structure could similarly be both a barrier and helpful in navigating other barriers. When leading through change, leaders described creativity and knowledge of the subject matter as essential to the process. They used both in problem-solving, which was another aspect of leading through change.
Figure 4. Codes and frequencies for barriers to leading through change.
The statements associated with the most frequent codes reflect the importance of the support network in understanding and navigating barriers to leading through change (Table 6). The responses reflect that communication can be both a challenge and an opportunity. Leaders’ responses suggest that they worked with teams to address issues creatively, providing access to additional knowledge and skills when needed. Leaders identified the importance of collective problem-solving as necessary to the change navigation process.
Working with Teams
Our fifth guiding research question was: How do leaders work with their team(s) when leading through change? To answer this question, we examined the data for indicators of working with teams (Figure 5). We found that there was, again, a significant focus on communication (N = 170), which reflects the importance of collaboration and leads to the creativity of finding solutions. Leaders also re-emphasized the importance of relationships (n = 119), maintaining perspective (n = 93), and pursuing goals as a team (n = 72).
Figure 5. Codes and frequencies for working with teams when leading through change.
The statements associated with the most frequently used codes reflect the importance of communicating and collaborating when leading teams through change (Table 7). The responses reflect that communication is inherently important as an information distribution process and a means of generating new ideas. As the representative response shows, communication is also critical to building relationships. Leaders’ responses also reflect the idea that communication is essential to frame a situation, as well as moving a team toward meeting identified goals.
Discussion and Implications
The goal of our research was to document how leaders in a healthcare organization define their leadership, prepare to be leaders, and lead teams through change. We examined different aspects of these constructs and activities, gathering data from multiple senior leaders in a healthcare organization. Our findings have several potential explanations, many implications for leadership practices, and a high potential for structuring future research.
Philosophy of Leadership
We found that the philosophy of the leaders tended to align with the perspectives of servant leaders, but also had some elements of directive leadership. Servant leadership showed up in statements such as “I rely on relationship building, trust, and getting to know what motivates people,” while directive leadership was reflected in statements like, “People knew what was non-negotiable and what was negotiable.” We speculate that the leaders strive to lead by working to create an inclusive environment and fostering collaboration, but also recognize the importance of completing tasks and making decisions that may be time-sensitive, motivating them to use their position to make the decisions that are necessary to achieve the desired goals. The leaders’ models for leadership come from a range of contexts, which influences how they frame their roles as being both collaborative and responsible for decision-making. Thus, their leadership philosophy may be contextual. There is a need for more in-depth research exploring the philosophy of healthcare organization leaders, how their philosophy was formed, how it may be influenced by the decisions they have to make and the context for the findings.
Preparation to Lead
Our results indicate that the leaders were primarily prepared to lead through early and sustained leadership engagement, with fewer participants engaging in formal leadership preparation. The limited practice would explain why the participants did not seek to be leaders, but shared that their involvement as leaders evolved over time. Although it is not unusual for people to learn to lead from personal experience, the impact of negative interactions with leaders seemed to affect our participants equally to their positive interactions. Thus, through being led, the participants likely learned how to lead and how not to lead. We speculate that many of the leaders were focused on their career paths because of personal interests or goals, and accepted some level of leadership associated with their paths, which subsequently evolved to primarily leadership positions perhaps with limited attention toward preparation. We also posit that early leadership position engagement influenced the participants’ likely acceptance of future leadership opportunities, unintentionally gaining practice to lead over time because of positional interactions. Overall, teaching preparation could have been more intentional and strategic but was often relatively informal and by chance. More research is needed to examine the effectiveness between leaders who plan to lead and the effectiveness of leaders who were prepared informally or by chance. Another interesting direction for further research is an exploration of the process that leaders in the positions of our participants engage in for ongoing professional development to enhance their leadership preparation. It may also be worth examining the differences between how clinical and nonclinical leaders are prepared to lead, and if the number of years in healthcare leadership preparation or direct experience changes the way people approach leading.
Goals for Leading Through Change
We found that leaders tended to focus on maintaining perspective and hope, reflecting a consideration of change as a process that requires the involvement and commitment of others. The participants considered that leading through change needs the flexibility to shift focus to and from attaining goals to maintaining hope. The participants seemed to recognize that although achieving their goals was the desired outcome, they would likely need to adjust or change their process because of encounters with unknowns along the way. Leaders have had to be flexible in their prior work and realize the importance of maintaining an open mind to other pathways to achieving their goals. The finding implies that organizations seeking leaders to lead through change would benefit from considering candidates who prioritize maintaining perspective and hope. An interesting potential direction for research is determining the extent to which organizations seeking leaders to lead through change consider the candidate’s ability to maintain perspective and embrace hope.
Barriers to Leading Through Change
Leaders tended to be goal-oriented in leading through change. Because the leaders assume the responsibility of completing tasks, implementing initiatives, or developing solutions and have many other duties, they are eager to complete assignments so they may devote time to other responsibilities. As a result, leaders are more likely to work to complete assignments quickly by focusing on the efficiency of assuming the responsibilities personally and rapidly moving toward problem-solving. Because of the motivation to move rapidly toward resolving the change, they are more likely to focus on navigating the barriers and problem-solving rather than identifying them, suggesting that the status quo may be a barrier to change. The implications for this finding are the potential for leaders of change not to work toward collective understanding but, rather, to navigate the shift based on barrier navigation using limited input from followers. Another potential implication is that the limited scope of the leader may only be expanded with information from followers, leaving the leader to work toward implementing change, which may not be as effective as it could be with follower input. Thus, examining how leaders’ decisions and approaches to attaining goals change with increases in consideration of follower input is a potentially fruitful direction for future research.
Working with Teams
We found that the leaders indicated a strong focus on communication when leading teams through change, which is consistent with the recommendations for engaging in doing so.(7) Similarly, the leaders’ focus on building and maintaining relationships is fundamental to creating effective teams and gaining the support needed to navigate change.(7) We speculate that building relationships and communication are fundamental to achieving the goal of developing creative solutions to problems and maintaining flexibility when navigating change. The implications for our findings are that the processes being used when a team plans and implements change are similar to the processes used in design thinking.(34) Thus, with relatively minor changes to existing structures, the leaders could alter their current processes to be iterative and aligned with the design thinking cycle. An interesting direction for future research is examining how those leading through change using design cycle thinking integrate communication, relationships, creativity, and flexibility to develop viable solutions.
Limitations and Delimitations
Limitations
Our first limitation was the evolution of the use of the protocol over time. We used the same protocol for all interviews, but how we used it evolved, impacting the implementation fidelity. We used the same questions; however, the interviews influenced how they were used, which could have affected the responses we collected from the participants. Although we did not plan for this as a limitation, we were not surprised that evolution occurred.
Our second limitation was the interview protocol itself. We had a group of experts review the protocol, and we piloted the protocol with practice interviews. However, once we began collecting data, it was necessary to align the participants’ responses to our prompts with our expectations for the content or focus on the answer. For example, we sought to gather from the participants the barriers they faced when leading through change, yet their responses focused on finding solutions to overcome the obstacles. Thus, while we asked about identifying the barriers they face, the reactions were about navigating them.
Our third limitation is that the perception of the change may be highly contextual and individualized. The highly contextualized nature of the change likely led the participants to share very different experiences with leading through change. We had anticipated more similarities than differences. However, the differences limited our ability to report ubiquitous trends confidently, given the difficulty of identifying commonalities based on diverse leadership experiences and perspectives. The participants were all senior leaders at the same organization but in different roles. Our research suggests that the position may be more influential than the organization on attitudes. Future research should focus on leaders in similar roles at similar institutions.
Delimitations
Our first delimitation was the constrained availability of leaders of healthcare organizations who were likely to participate in our research. This constraint may have impacted the scope and depth of our results. However, our inclusion of a diversity of leaders from within a single organization may have provided diverse perspectives that may include those of leaders at other organizations. Further research is needed to expand the empirical documentation of how leaders in healthcare organizations engage in and lead through change.
Our second delimitation is the need to determine whether followers of the leaders perceive how they are leading and if their experiences, expectations, and processes are effectively communicated to the followers. We could not triangulate the accuracy of the leader’s interview responses to determine whether others perceived or witnessed similar conditions, communications, or actions. Therefore, further research should include input from followers of these leaders to determine whether their intentions and efforts are being interpreted consistently and effectively by those they are leading.
Our third delimitation is the cross-sectional nature of our data collection. Although our initial intention was to gather data at one point in time, our results suggest there would be a benefit to approaching future research from a longitudinal perspective, collecting data at different periods to determine progress and potential changes because of experience and progression of change.
Conclusion
Our goal was to document how leaders within healthcare organizations lead through change empirically. We found five primary themes that aligned with the practices of leading through change. Our results indicate that leaders may benefit from additional education and professional development, given the broad diversity of their past training. We found that focused on relationships, collaboration, communication, flexibility, and creativity. We focused on overcoming barriers and implementing change rather than exploring why the walls were there and examining various possible solutions. Our results support enhancing leaders’ knowledge and considering design thinking as a potential approach to navigating change. Leadership requires flexibility and the ability to adapt to evolving situations. We hope others will build on our research and continue to explore how leaders in healthcare organizations perceive and engage in leading through change.
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