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Enabling Allied Health Clinicians Into Health Systems Leadership: ‘Less About the Profession, and More About the Person’

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Thesis(7.51 MB)

Date

2025

Authors

George, Rebecca

Supervisor

Webster, Karen
Kayes, Nicola M.

Item type

Thesis

Degree name

Doctor of Health Science

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Publisher

Auckland University of Technology

Abstract

Health and disability systems are complex phenomena, enduring constant multi-level change and strategic shifts in priorities (Ayeleke et al., 2018). Leading these systems requires a breadth and depth of knowledge to foster innovation within a diverse workforce delivering an array of services (Mutonyi et al., 2024). The traditional focus of diagnostic-centric, facility-based systems for service delivery is increasingly misaligned with the emerging paradigm shift towards a consumer-focused, community-based health journey (Mather et al., 2018). Effective health systems leadership is key to the success of health organisations, and the enabling characteristics of leadership have been well documented (Sihame & Moyosolu, 2021). Allied health clinicians exemplify these effective characteristics, qualities and perspectives (Bradd et al., 2017; Mizzi & Marshall, 2024; NHS England and NHS Improvement, 2019a; Wylie & Gallagher, 2009). Yet, the health system’s design will falter if health system leadership relies on positional authority and a medico-centric perspective for achieving outcomes (Edmonstone, 2019). Enabling allied health clinicians to assume health systems leadership roles is crucial for a sustainable health system. Using Interpretive Description, founded on Social Constructionism, this research sought to understand how allied health clinicians are enabled to step into health systems leadership roles. This applied health research had three objectives: explore allied health clinicians' experiences of stepping into health systems leadership roles; identify influential elements; and develop recommendations to support and enable their leadership progression. The literature review contextualised the study within existing research, highlighting a paucity of research on allied health clinicians in health systems leadership roles, particularly in Aotearoa New Zealand. This empirical qualitative study, conducted through online interviews with 19 participants, provided new insights. Analysis and synthesis of data, in conjunction with relevant literature, led to the development of four themes. These themes were: The Leader Within, Navigating the Next Step, Overcoming Bias and At the Mercy of Infrastructure. From those themes nine recommendations were made for change to practice. This research found allied health clinicians are enabled into health systems leadership roles when their leadership identity is validated; they have equitable access to leadership development; and their environments endorse their value, creating a culture that enables them to thrive. Nine recommendations advocate for the integration of these enabling factors into policy; clear leadership career guidance for competent practice; and the shift of system perspectives through mechanisms with broad national influence. This study recommends stakeholders across the health system work together to validate, develop and endorse allied health systems leaders. The identification of elements which promote health systems leadership as a visible, viable and legitimate career pathway for allied health clinicians in Aotearoa New Zealand, contributes new knowledge. The findings offer insights into a culture of systemic bias where the environment limits their inclusion as health systems leaders. The recommendations have implications for allied health clinicians in practice, for leadership development policy and for health systems leadership culture. By reframing expectations for health systems leadership, this research challenges operational and behavioural legacies and underscores how health systems leadership diversity enhances health system sustainability.

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http://hdl.handle.net/10292/19411

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Doctoral Theses