Followership in health care clinicians: a scoping review
Authors: Alanazi Sulaiman , Wiechula Richard , Foley David 
Published: May 2023

Objective:
The objective of this scoping review was to identify and map the existing literature on the current state of followership research in relation to health care clinicians.

Introduction:
Health care clinicians need to be flexible in switching between leader and follower roles, as appropriate, to advance patient care; however, much of the existing research has concentrated on leadership. Effective followership in health care organizations is necessary to enhance clinical team performance in order to improve patient safety and quality of care. This has led to recommendations to increase the amount of research on followership. It is therefore important to synthesize the available evidence on followership to identify what has been studied and to highlight the research gaps in this area.

Inclusion criteria:
Studies that involved health care clinicians (eg, physicians, nurses, midwives, allied health professionals) and were focused on the concept of followership (eg, conceptualization of followership, attitudes toward the role of followership) were included in the review. Any clinical health care practice setting where direct patient care is provided was included. The review considered studies with quantitative, qualitative, or mixed methods designs; systematic reviews; and meta-analyses.

Methods:
The search was conducted in JBI Evidence Synthesis, Cochrane Database of Systematic Reviews, CINAHL, MEDLINE, EPPI, Scopus, ScienceDirect, and Epistemonikos databases. In addition, unpublished or gray literature was searched for in ProQuest Dissertations and Theses Global and Google Scholar. No limits on the date or language were applied to the search. Data were extracted from the papers by 3 independent reviewers, and review findings are presented in tables, figures, and a narrative summary.

Results:
A total of 42 papers were included. In articles that researched followership in health care clinicians, 6 categories were identified: followership styles, followership impact, followership experience, followership features, assertive followership, and followership interventions. Several study types were employed to investigate followership among health care clinicians. Descriptive statistics were used to identify clinicians’ followership/leadership styles and characteristics in 17% of the studies. Approximately 31% of the studies were qualitative and observational studies used to understand health care clinicians’ roles, experiences, perceptions of followership, and barriers to effective followership. For 40% of the studies, an analytical approach was used to explore the impact of followership on individuals, organizations, and clinical practice. Approximately 12% of studies were interventional studies that examined the effectiveness of training and education in enhancing health care clinicians’ followership knowledge and skills.

Conclusions:
While several aspects of followership among health care clinicians have been addressed, research is still lacking in some important areas, such as the impact of followership on clinical practice and followership interventions. The literature also lacks practical capability and competency frameworks on followership. No longitudinal studies have examined the association between followership training and occurrence of clinical errors. Cultural effects on the followership styles or behaviors of health care clinicians were not addressed. There is also a lack of mixed methods approaches in followership research. More research is required to fully understand the role of followership in health care clinicians.

Supplemental digital content:
An Arabic-language version of the abstract of this review is available [http://links.lww.com/SRX/A20].