The purpose of this study is to synthesis current literature and propose a hospital leadership structure that includes Advanced Practice Providers (APPs). Additionally, this study identified the need for formal leadership training for APPs like those that have been created for physicians which have shown to improve leadership skills, patient care and hospital performance. This study proposes a core foundational structure for leadership programs for APPs for hospitals to enact.
This study is a scoping review and narrative synthesis. Particular attention was paid to literature pertaining to APP leadership position creation as well as leadership development training programs.
APPs are essential in the delivery of quality patient care in hospital systems. With the increase in the number of APPs employed at hospital systems, there is a lack of opportunity for leadership positions or leadership training. A few hospital systems have reported departmental or hospital creation of leadership positions for APPs, which have found improvement in APP retention and job satisfaction. There needs to be a widespread and uniform transition in the leadership structure to include APPs.
Literature review relied on published literature and institutional reports, which may be subject to publication bias and variability in reporting quality. Additionally, much of the available literature was US-based, which may limit international generalizability. The available literature was limited by variability in study design, frequent reliance on single-institution reports and lack of outcome data limited comparative evaluation of leadership models. Few studies reported measurable leadership or patient outcomes, constraining comparative evaluation. The absence of standardized leadership metrics constrained formal quality appraisal. Additionally, APP-specific leadership literature remains relatively sparse, requiring selective inclusion of physician and nursing leadership studies to identify transferable models and competencies.
This paper fills a gap of knowledge by identifying a lack of unity of leadership positions and lack of formal APP leadership training at the institutional level. Creation of APP leadership positions with formal leadership development training will improve APP job satisfaction, retention, quality of patient care and culture of the hospital system.
