This joint Norwegian and UK project aims to explore the effectiveness of the teaching, learning and assessment programmes of Leadership Training for healthcare clinicians in three universities (Oslo University, Norway; Oxford Brookes University, UK; and Green Templeton College, Oxford, UK). The aims of this qualitative research study are to: assess the effectiveness of the different programmes on the participants’ leadership skills in the work environment; to explore the extent to which the programmes influence career decisions and development; and to develop a cross-European tool for assessing the leadership programmes for healthcare professionals. 

In Norway and the UK, as well as other parts of the world, there has been an increase in the need to develop leadership in cross-functional quality-improvement teams in the Health Environment (Norwegian Ministry of Health and Care Services, 2015; Francis, 2013; Rao et al., 2017). The programmes in this research are at graduate level and designed for existing healthcare professionals as CPD for their leadership skills in a changed working environment. The leadership modules can be taken as individual courses of study or as part of an MSc programme in Leadership and Management in Health Care. 

There has been some research on assessing the impact of leadership programmes in Sweden and Ireland as well as Australia and USA. However, the underpinning theoretical basis of leadership programmes and their effectiveness has not been widely explored (McKimm and Swanwick, 2011). Many of the programmes are of the view that leadership can be taught with their roots often based in leadership skills and development approaches in business organisations. Rao et al. (2017) evaluated a leadership programme with a specific focus on quality improvement. They highlight that although leadership skills are being incorporated in the initial training for doctors and allied health care professionals, there are fewer training opportunities for clinicians who are currently practising. It may be that the leadership skills required of various clinical groups may be different, particularly for doctors and nurses (Roche, et al. 2015).

Spehar et al. (2012) suggest that the specific context of healthcare may lead to a separation between the skills of managers and leaders. This could be particularly the case when considering patients as a group (management) rather than individual patients (clinical leadership). Role identity theory (Stryker and Burke, 2000) explores how participants perceive their role and career leading us to take a qualitative approach. This individual perspective is explored through a phenomenological approach using systematic text condensation (Malterud, 2012).

The first phase in this project is to conduct a qualitative study, using the same semi-structured format into the perceptions of programme participants as to whether the leadership modules met their needs; increased their understanding and competence of leadership; and how the programmes could be made most appropriate for the learners’ needs. This research project uses the same methodology of earlier work by Spehar et al. (2012) at Oslo University. The three universities in this reseach agreed to collect the data separately, using the same semi-structured interview protocol, then share their data at the analysis stage. 

This presentation focuses on the research methodology. We discuss the justification for the sample size; the development of a common semi-structured interview protocol; and the application of Systematic Text Condensation (Malterud, 2012) for data analysis. With increasing numbers of researchers working cross-culturally and in different languages this paper presents some of the issues that can arise and how they could be minimised. This is in the context of one of the aims to develop a cross-European method for assessing Leadership programmes for healthcare professionals.

Higher Education institutes do gather students’ responses to courses, mainly through surveys, focusing on the content of the course/module. Spehar et al. (2017) identified that taking a phenomenological view of how the training provision was translated into the work place and individual’s skills development and career aspirations can provide in-depth evidence of the impact of teaching and learning. The universities in this project agreed to use the same theoretical and methodology approach to gather and analyse data. Each institute gained separate ethical approval for data gathering using the same sampling approach and semi-structured interview schedule. The challenge is to ensure that the questions and conduct of the interviews are very similar. The protocol for the semi-structured interviews was originally in Norwegian. Discussions and iterations led to agreement by the researchers of the interview format to align the English and Norwegian versions. The schedule is constantly reviewed so that it is effective in gathering data appropriate to the research aims. To demonstrate transparency in data collection all modifications to the interview scheduled are documented along with the rational for the changes. A particular difficulty for qualitative researchers is specifying the number of participants required at the ethical approval stage. For some approaches such as Interpretative Phenomenological Analysis (IPA) (Smith et al. 2009), small sample sizes are justified by the in-depth nature of the analysis. Grounded Theory applies the concept of ‘saturation’, deemed to be reached when no new or different points of views are forthcoming from interviews (Glaser and Strauss, 1999), with suggestions that twelve participants suffices. ‘Saturation’ has been applied to other methods (Malterud, 2012). Guest et al.’s (2006) review of the literature concluded that twelve to twenty five participants provides sufficient depth to the data without overwhelming researchers in terms of volume of data. Participants in this research are mostly in full-time employment, so a volunteer sample was chosen. The main shortcoming is that the volunteers may not be representative, but generalization of findings is less of an issue in qualitative research. All interviews were audio-recorded with participant permission then transcribed by the interviewer. Pseudonyms were used for participants. Systematic Text Condensation (Malterud, 2012) was used for data analysis. The transcripts were reviewed independently by two researchers. A detailed log book was devised to explain the rational for the development of the themes. This provides an audit trail of the decisions and aids transparency of the analysis process.

The data for this project is still being gathered. The focus of this paper is on the development and application of the data collection methods and results. It is thought that of particular note for the audience is the way in which a protocol can be developed in a pan-European context. This is especially so when working in more than one language. The findings are expected to provide evidence of the translation of training in HE institutes, particularly in the context of CPD, to improvement in leadership skills and behaviours in the workplace. Through listening to the participants about their perceptions of what is effective and what needs to be included in such programmes, it is envisaged that the institutions will offer appropriate training with impact on performance and result in patient benefit. One of the aims of this project is to to develop a cross-European tool for assessing the leadership programmes for healthcare professionals. The literature suggests that there is more commonality for the requirements of such provision in developed countries across the world. Through developing methods and protocols which are applicable in different countries and can be adhered to by different researchers, it is an aspiration of this research that the findings and conclusions will lead to greater transparency and rigour in the findings. This could have potential for enhancing the acceptance of qualitative methods.

Francis, R. (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery Office. Glaser, B. and Strauss, A. (1999) The discovery of grounded theory: Strategies of qualitative research. New York: Aldine de Gruyter. Guest, g., Bunce, A. and Johnson, L. (2006) How many interviews are enough? An experiment with Data Saturation and Variability. Field Methods, 18:1, 59-82. Malterud, K. (2012) Systematic text condensation: a strategy for qualitative analysis. Scandinavian Journal of Public Health, 40, 795-805. McKimm, J. and Swanwick, T. (2011) Leadership development for clinicians: what are we trying to achieve? The Clinical Teacher, 8, 181-185. Norwegian Ministry of Health and Care Services (2015) Care Plan 2020. Oslo: Norwegian Government Security and Service Organisation. Available on line at: https://www.regjeringen.no/contentassets/af2a24858c8340edaf78a77e2fbe9cb7/careplan2020_eng.pdf Rao, S., Carballo, V., Cummings, B., Millham, F. and Jacobson, J. (2017) Developing an Interdisciplinary, Team-based Quality Leadership Training Program for Clinicians: The Partners Clinical Process Improvement Leadership Program. American Journal of Medical Quality, 32(3), 271-277. Roche, M, Duffield, M., Dimitrelis, S. and Frew, B. (2015) Leadership Skills for nursing unit managers to decrease intention to leave. Nursing: Research and Reviews, 5, 57-64. Smith, J., Flowers, P. and Larkin, M. (2009) Interpretative Phenomenological Analysis: Theory, method and research. London: Sage. Spehar, I., Frich, J., Kjekshus, L. (2012) Clinicians’ experiences of becoming a clinical manager: a qualitative study. BMC Health Services Research, 12, 1-11. Spehar, I., Sjovik, H., Karevoid, K., Rosvold, E. and Frich, J. (2017) General Practitioners’ views on leadership roles and challenges in primary health care: a qualitative study. Scandinavian Journal of Primary Health Care, 35(1), 105-110. Stryker, S. and Burke, P. (2000) The past, present and future of an identity theory. Social Psychology Quarterly, 63(4), 284-297.