**5. Conclusions**

relationships, business skills, knowledge of the health care environment, professionalism, and leadership [5, 10, 11, 65]. A close look at these domains of competencies shows that some, including communication, interpersonal relationships, professionalism and leadership, are people and relationship centred. This is not surprising, given the fact that health care organisations are comprised of human systems where people of diverse backgrounds interact with one another for successful management of the health care system [66], and provision of safe,

Although certain competencies may be common to most health contexts, in practice they are likely to be demonstrated differently, depending on certain factors such as management levels and sectors [5, 11, 14, 21]. In other words, while some competencies may be similar across most health contexts, the competence level (proficiency) required to demonstrate them will vary from one management level or organisational setting to another. Thus, in addition to identifying the essential competencies required by health management and leadership workforces generally, the health care sector should also focus on the competencies required by

One of the main goals of competency identification and assessment in health care organisations is to facilitate the development of competency or competence frameworks which are applicable to specific organisations or groups of individuals. Competence-based systems serve as useful means of identifying gaps in proficiency to inform appropriate training, education, or professional development to improve individual competence and organisational performance [69]. The basis for the use of training and professional development to improve health management and leadership competence is found in the evidence that human behaviour can be developed in adulthood [70], and that individuals can change their behaviour,

The importance of improving the competence in health leadership in both management and clinical workforces has been widely emphasised [10, 11, 22, 39, 60, 61, 73]. In the health care sector, approaches and priorities may differ for health management and clinical leadership development. In the light of this, different training and professional development strategies are currently being used to address identified gaps in proficiencies, develop new competencies and improve existing ones. Such strategies include formal training and professional development in the form of structured academic programmes [74], and informal training approaches such as coaching, mentoring, role modelling, work-based or contextual learning and experiential learning [74, 75]. Both training approaches have been recognised as important in strengthening the capabilities of the management and leadership workforce [75, 76], especially in complex systems like health [74]. In health care organisations, competency-based training or professional development can be directed at improving the capabilities of individual managers or leaders for effective performance in roles, a concept known as 'leader development' [77]. On the other hand, such training or professional development interventions

effective, and high-quality patient care [67, 68].

**4. Leadership development in the health care sector**

moods and self-images through training [71] and education [72].

specific groups and organisations.

88 Leadership

The health care sector is complex, characterised by constant changes and reforms. Strong and competent management and leadership workforces are thus required to navigate the sector through the complex web of interacting factors and lead reforms for effective and efficient health care delivery. An added challenge to leadership development is that leadership is spread across health management and clinical workforces; while some clinical leaders may work in management roles, for others leadership is exercised from a clinical position. The need for competent management and leadership workforces has fuelled an upsurge in interest in health management and leadership, as reflected in the large number of studies examining the concept across different countries since the turn of the century. A notable trend in health management and leadership literature is the increasing focus on identification and assessment of essential competencies required by leaders from both health management and clinical backgrounds for effective performance in leadership roles. The purpose of competency identification and assessment in most cases is to inform the development of competency frameworks which are used to assess performance, identify gaps in proficiency and target appropriate training and development opportunities. However, evidence for the impacts of such training or development interventions on the competence of health managers and leaders is currently limited and contentious. Thus, further research is needed to build the evidence on the relationships between targeted training and professional development interventions, individual competence of leaders from health management and clinical backgrounds and organisational performance.

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