The contribution of political skill to the implementation of health services change: a systematic narrative and narrative synthesis

Research output: Contribution to journalArticlepeer-review

Authors

  • Simon Bishop
  • Jean Hartley
  • Naomi Fulop
  • Angus I. G. Ramsay

Colleges, School and Institutes

External organisations

  • University of Nottingham

Abstract

Background: The implementation of strategic health system change is often complicated by informal ‘politics’ in healthcare organisations. Leadership development programmes increasingly call for the development and use of ‘political skill’ as a means for understanding and managing the politics of healthcare organisations. The primary purpose of this review is to determine how political skill contributes to the implementation of health services change, within and across organisations. The secondary purpose is to demonstrate the conceptual variations within the literature.

Methods: The article is based upon a narrative synthesis that included quantitative, qualitative and mixed methods research papers, review articles and professional commentaries that deployed the concept of political skill (or associated terms) to describe and analyse the implementation of change in healthcare services.

Results: Sixty-two papers were included for review drawn from over four decades of empirically and conceptually diverse research. The literature is comprised of four distinct literatures with a lack of conceptual coherence. Within and across these domains, political skill is described as influencing health services change through five dimensions of leadership: personal performance; contextual awareness; inter-personal influence; stakeholder engagement, networks and alliances; and influence on policy processes.

Conclusion: There is a growing body of evidence showing how political skill can contribute to the implementation of health services change, but the evidence on explanatory processes is weak. Moreover, the conceptualisation of political skill is variable making comparative analysis difficult, with research often favouring individual-level psychological and behavioural properties over more social or group processes.

Details

Original languageEnglish
Article number260
Number of pages15
JournalBMC Health Services Research
Volume21
Issue number1
Early online date20 Mar 2021
Publication statusE-pub ahead of print - 20 Mar 2021