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Role of Healthcare Leaders in the Digitalization of Health System: A Review 1
International Journal of Health System Resilience www.injhsr.com Fernando & Purva (2022)
Abstract
Digitalization of health system is defined as adaption of digital technology in health care service to offer
high quality patient care. WHO has directed to implement digital system to health care service in order
to achieve sustainable development goals. However, digitalization of health care system is lagging
behind compared to other business environment due to poor leadership skills of the health care leaders.
The objective of this review is to identify the roles and attributes of the health care leaders in order to
perform in digital world. Best 30 articles were referred from the 80 articles related to digitalization of
health care and leadership to write this review. Leaders need to come out of their comfort zone and
understand the rapidly changing business field with the digitalization. Healthcare leaders are advised to
go beyond their traditional leadership style and develop new leadership skills. The transformational
leadership theory was identified as the starting point for ‘new-genre leadership’ models emphasizing
that a leader’s style should be visionary, ideological, and participative, servant, or authentic where digital
leader needs to perform. Leader-member exchange theory focuses on the nature and quality of the
relationship between leaders and their team members which is the ideal for implementation of the
digital health. Therefore, digital leader need to be flexible and adaptable to new ideas, intellectual
curiosity, having transformative vision, forward-looking perspective, change-oriented, open minded,
adaptable, innovative and a hunger for new knowledge. They need to be maintained a more egalitarian
and results-oriented approach unlike previous traditional leaders. In addition, healthcare leaders need
to developed better skills to manage finances, understanding of project management timeline and
alternative options before digitalization of the health system. Digital leaders need to developed
attributes such as the ability to influence, inspiring a shared vision, being proactive, and ability to avoid
blaming others, being visionary and being innovative. They need to develop their analytics capability of
the health care leaders are essential to ensure effective professional leadership. Delegation of work and
effective communication are very important attributes a leader should perform when dealing with the
digital health. To effective digitalization of health system to improve patient care service health care,
leaders need to develop new leadership skills.
Key words: Leadership, Digital leadership, Health care quality
Role of Healthcare Leaders in the Digitalization of Health System: A Review
Fernando G.H.S1 , Makani Purva1
1Hull University Teaching Hospital, NHS Trust, United Kingdom
Review
International Journal of
Health Systems Resilience
ISSN 2950-7405
INJHSR
International Journal of
Health Systems Resilience
*Correspondence: ghsfernando@gmail.com https://orcid.org/0000-0001-7356-6257
Submitted: 08/01/2023 https://doi.org/10.51595/INJHSR22/017/
Published: 05/02/2023
Role of Healthcare Leaders in the Digitalization of Health System: A Review 2
International Journal of Health System Resilience www.injhsr.com Fernando & Purva (2022)
1. Introduction
Digital transformation is defined as incorporation
of computer-based technologies into an
organization's products, processes and strategies to
create new or modify existing business processes,
culture, and customer experiences to meet
changing business and market requirements (1,2).
Digital health, or digital healthcare, is a broad,
multidisciplinary concept that is an intersection
between technology and healthcare. It includes
mobile health (mHealth) apps, electronic health
records (EHRs), electronic medical records
(EMRs), wearable devices, telehealth and
telemedicine, as well as personalized medicine (3).
Terms related to digital health include health
information technology (health IT), healthcare
tools, health analytics, healthcare informatics,
hospital IT and medical technology.
The World Health Organization (WHO) defines
digital health as the field of knowledge and practice
associated with any aspect of adopting digital
technologies to improve health, from inception to
operation (5). Currently most of the countries in
the world are adapting Health Information
Technology (HIT) to patient care services in order
to improve quality, safety and efficiency of health
care service (6,7). COVID-19 pandemic
contributed to speed up the new technology
innovation in recent years (8). Programs conducted
in recent years highlighted the importance of
having information technology to face current
challengers in the health care service such as aging,
communicable diseases and environmental
sustainability (9,10). The government of the United
Kingdom (UK) is expected solve such health care
challenges through digitalization of health care by
giving one of three top priorities in their
parliamentary report (11). Currently digital
technology is used in health care in different
dimensions such as maintaining of electronic
medical records, diagnostics, issuing and
administration of medicine, 3D printing, artificial
organs design, robotic surgery and virtual reality
(telehealth) which improve health and patent safety
(12). National Health Service (NHS) in UK uses
information technology (IT) for planning,
monitoring, inventory management and
procurement to improve efficacy and effectiveness
(13)
Most of the developed countries have adapted IT
to their health system to offer efficient and
effective quality health care to end users and has
become an integral part of the health system to
improve operational efficiency with regard to
standard of care (13). Digital technology has been
used in many areas in the health care include,
1. Improved access to medical information and
data: Digital health has the ability to store and
access data from any ware easily within few minutes
and able to share with other specialties to provide
optimum care to the patient.
2. Big data: Digital health allow clinicians to collect
big data within few minutes which can be used for
epidemiological studies, research or clinical trials.
Therefor these data can be used for health
professionals to take preventive measures more
efficiently.
3. Improved lines of communication: Digital
technology allow health provider to communicate
with the patient very easily via emails, smartphones,
and text messaging and test result without coming
to hospital. Medical professionals can make their
own webinars, videos and use online platforms and
social media using new technology to communicate
with other professionals to provide efficient and
effective service to people.
4. Electronic health records: This allows to make
the paperless system to manage patient in virtual
file. This prevent movement of large files to
different places in the patient management
pathways. Storage and retrieval are very easy any
time.
5. Telemedicine/telehealth: This allow to provider
to service even in rural areas where specialized care
is not available. For example, radiological images
can be sent to the distant places to take decisions
from the experts. Telecommunication is used to
conduct training and education programs for more
people at a time cost effectively.
6. Online education: Health care associated degrees
can be conducted using digital technology. It allows
students to get their degrees according to their
choice by recognized organization nationally or
internationally.
Role of Healthcare Leaders in the Digitalization of Health System: A Review 3
International Journal of Health System Resilience www.injhsr.com Fernando & Purva (2022)
7. Health apps: The digital revolution has also
resulted in the development of hundreds of health
apps. It can be used to monitor health of the
patient. Patient can be educated regarding their
heath regularly. Patient can receive their test result
through these app without going to laboratories.
In most of the developed countries such as UK,
Australia and Singapore, information technology
has been adapted to offer high quality of health care
service. Most of the developing countries including
Sri Lanka are still at their early stage of embracing
digital technology due to varies barriers such as lack
of access to information, inadequate information,
lack of knowledge on usefulness and usability of
the technologies, cost and technical problems (14).
However, the business world is applying new
concepts such as just-in-time, lean production,
kaizen, business reengineering or total quality
management with the help of Information
Technology (IT) (15). This emphasises the
importance of digital leadership to implement
above concept to business world (15). World
leading business organizations emphasise that all
barriers are not due to technological crisis but
mainly due to leadership crisis. Therefore,
leadership is essential competency in the current
digital era for the adoption of IT in the modern
healthcare industry (16). This review aims to
identify the requirements of a current health leaders
to implement digital technology within the health
systems in order to improve health care service and
patient safety efficiently and effectively.
2. Methodology
A literature search was performed using the
databases Medline, Google Scholar and PubMed.
Search terms used are ‘Leadership, Digital
leadership, Quality health care service and role of
digital leaders in health care service. The literature
search was confined to articles in the English
language. Since there were few numbers of articles
on the topic, a specific time period was not
considered for the literature review. About 80
relevant articles were studied and among them 30
directly related articles were selected to this review.
3. Results
Role of the health leader is an essential component
in order to face the digital era and all the leaders are
needed to out of their comfort zone and
understand the fast changing business environment
(16). The main differences between digital leader
and non-leader or traditional leaders are their
different skills, attitudes, knowledge, and
professional and personal experiences
(17).Therefore, digital leader need to be flexible
and adaptable to new ideas, intellectual curiosity,
having transformative vision, forward-looking
perspective, change-oriented, open minded,
adaptable, innovative and a hunger for new
knowledge (17). They seek solutions and challenges
globally and are hungry for continuous learning.
Leadership style of a health care leader
Studies have found that leadership style is
influencing to implementation of digital health
successfully (18). The transformational leadership
theory was identified as the starting point for ‘new-
genre leadership’ models emphasizing that a
leader’s style should be visionary, ideological, and
participative, servant, or authentic where digital
leader needs to perform (19). Whatever the
leadership style, the main focal point is the
relationship between the leader and the follower on
the project. This is well explained in the leader-
member exchange theory (LMX)(20). Leader-
member exchange theory focuses on the nature and
quality of the relationship between leaders and their
team members. The studies on digitalization and
leadership, identified four main relationships; the
relationship between e-leaders and organizations,
how leaders adopt technology to solve complex
organizational problems; the impact of digital
technologies on ethical leadership and the leader’s
use of digital technologies to influence social
movements on digitalization (20).
Capacity development role of a digital leader
As a digital leader, he/she need to mobilize the
organization through generating proper digital
awareness (21). In order to possess the digital
power to influence over the people in digital health,
he/she must obtain more knowledge and skills in
the digital field (22,23). Capacity building program
on the digital health information on the health care
Role of Healthcare Leaders in the Digitalization of Health System: A Review 4
International Journal of Health System Resilience www.injhsr.com Fernando & Purva (2022)
leaders is needed to be a priority in the organization
to fulfil the demand (16). Digital leader needs to
develop creativity, innovation and willingness to
investigate new way of using technology to
improve quality and effectiveness of the service
(24). It is highlighted that digital leaders must
developed their image on the employee through
professional development in order to digital culture
in the organization (15). In many occasions health
care leaders have failed to maintain the
sustainability of the digital project as well as fail to
deliver service timely according to the demand (25,
26). Therefore, it has recommended to ensure
competency in clinical healthcare service, proper
management and adequate knowledge of digital
technology related to health information among the
health care leaders (26,27,28). And healthcare
leaders need to develop better skills to manage
finances, understanding of project management
timeline and alternative options before
digitalization of the health system (29). In order to
move to digital health, leaders need to offer new
carrier opportunity to engage in digital health
training for health workers (30).
Data analytical capacity in essential component
when leaders need to get more befits from
digitalization of health service and which was a
common barrier (31). Therefore, development of
analytics capability of the health care leaders are
essential to ensure effective professional leadership
(32). Most of the time leaders are facing challengers
to develop digital skills among the clinicians and
lower-level managers, when introducing digital
health (33). Therefore, arranging digital ready
workforce program should be the top priority of
the leaders in the health care service (32).
Interpersonal relationship of a digital leader
As a digital leader, he should be capable enough to
develop skills to maintain inter-professional and
inter-sectoral collaboration in order to perform on
the digital world (34). Specially they should attempt
to work with external leaders with deep digital
transformation experience who can provide the
necessary expertise and perspective (35). The
quality of this relationship, which is characterized
by trust, respect, and mutual obligation, is thought
to predict individual, group and organizational
outcomes (36). This will develop positive impact on
the employee on IT information sharing (16).
Leaders need to understand that followers are
changing compared to the past and there is less
hierarchical distance between leader and member
because digitalization democratizes information
(37).
Delegation skills a digital leader
Healthcare leaders need to understand that digital
leaders would come from a range of backgrounds
and may not follow a traditional path but one that
may still offer significant value (30). Research
findings proved that IT and digitalization have an
impact on tasks and practices. Delegation of work
is a very important attribute a leader should
perform when dealing with the digital health (32)
while participation with the followers (participative
e-leader) to maintain the sustainability of the digital
system (38). A study has identified that nursing
leaders seem to be very active in planning the
implementation of digital health service and held
the chief responsibility since they are often more
involved in the early stage of implementation (34).
Planning and project management of a digital
leader
Some digital projects have been unsuccessful due
to faulty planning process, inability to identify the
scope of the project, failure to identify the correct
stakeholder and lack of effective communication
among the team members (39,40,41). Because of
fragmentation of the NHS, they have face to
seriousness difficulties to implement digital system
to patient care management (42). UK National
health service has developed a long-term plan
which places digital developments at the heart of
steps to improve health care and deliver services in
a sustainable way and escaped from the above
barriers faced through fragmentation (32).
Therefore, leaders need to focus on development
long-term plan to implement digital health rather
than going to short term plan.
Decision making role of digital leader
An e-leader should be able to select suitable
technology to their organization as well as capable
enough to transiting a positive attitude to
employees about their adopting of new technology
(43). They maintain a more egalitarian and result-
oriented approach unlike previous traditional
leaders (17). On individual level digital leaders
Role of Healthcare Leaders in the Digitalization of Health System: A Review 5
International Journal of Health System Resilience www.injhsr.com Fernando & Purva (2022)
develop their skills to think on how organization
can transform using technology according to
customer needs (44) and take decisions accordingly.
Other leadership Skills of digital leaders
Digital leaders need to develop attributes such as
the ability to influence, inspiring a shared vision,
being proactive, and ability to avoid blaming others,
being visionary and being innovative (16). It is said
that digital leadership is cross-hierarchical, fast,
team oriented and cooperative (45). Health care
leaders must use personal competences, their mind-
set as well as their ability to apply new methods in
digital health (17). Therefore, it is suggested to
leaders to improve their skills and knowledge on
effective communication, information
management, coaching, knowledge management,
collaboration and decision-making performance in
digital health (46, 47).
Identification of barriers in the implementation of
digital health
Leaders need to identify the main barriers of
implementing information technology to health
system in order to its adoption (14). Previous
researchers have identified main six primary
barriers, the cost, legality, time, fear, usefulness and
complexity (48, 49). The most important barrier to
adoption of new technology is the cost, which is
very difficult to assess cost and benefits because of
the high capital cost and maintenance cost (50).
Because of complexity of the health care system
conceptualizing leadership in digital health is
important guidance for service development (34).
4. Discussion
Because of complexity in the health care system
leadership in digital health services has been
scrutinized in relation to issues HIT adoption and
implementation (51). According to the Avolio and
Kahai implementation of information technology
in health care system has lagged behind compare to
other business. This was mainly due to poor
leadership in the health care service (52).This
implies health care leaders need to change their
leadership style in order to successful
implementation of digital technology to offer high
quality and efficient service. Conceptualization of
leadership is the best suggestion given to capture
digital health to health system (34). According to
the WHO recommendation digitalization of health
service is an essential criterial to achieve universal
health coverage (53). Therefore health care leaders
need to improve their leadership qualities to face
new digital world. It was identified that leadership
is the main contributing factor to transform
healthcare digitally (16). Therefore, health care
leaders need to develop their leadership style
beyond the traditional style, especially health care
leader should be a strategic manager and effective
communicator (16). Leader is the someone who
can influence others to achieve organizational goal.
Therefore he is considered in a key position in
dealing with digital health (17). Knowledge power
is an essential attribute to influence other on the
digitalization. So health care leader must update
their digital knowledge to fulfil the organizational
requirements. They need to participate IT training
program, workshops and study visits at digitalized
health care organization to improve their
knowledge. Leader must developed Interpersonal
relationship with the professional digital leaders in
order to improve their knowledge on the digital
health. Digital solution group in NHS, England
consist of heath care leaders, Administrators and
professional digital leaders and conducting regular
meeting locally as well as nationally and discuss
future digital health care solutions to the country.
It updates the knowledge, skills of the health care
leaders regularly through this group. Establishment
of such a framework to health service beneficial to
develop the health care leaders in future
digitalization. By identifying the importance of
development of digital leaders in healthcare, NHS
digital academy was established aiming to train
future digital health leaders (54). This academy
planned to give more knowledge on essentials of
health systems, implementing strategy and
transformational change, health information
systems and technologies, user-centred design and
citizen-driven informatics, decision support,
knowledge management and actionable data
analytics (27). That type of educational institute will
be helpful to developed future health care leaders
to adapt for digital transformation. It is not easy to
implement digital system in the hospitals due to its
complexity. There are many barriers block the
transformation. Barriers to implement digital health
in NHS UK mitigated through development of
digital strategic long term plan. Therefore health
care leaders need to develop long term
digitalization plan to their organization. Capital cost
Role of Healthcare Leaders in the Digitalization of Health System: A Review 6
International Journal of Health System Resilience www.injhsr.com Fernando & Purva (2022)
for implementation of the digital health is very
high. Therefore, health care leaders must plan to
identify clear budget line to maintain the
implemented project to get expected benefits to the
service. Relationship of the leaders and employees
are an essential feature to implement and maintain
the digital health. Resistance to implement of digital
system coming from the employee due to poor
digital skills. Therefore, leader need to organized
regular training program to employees in the
organization to develop their digital skills. Regular
communication with the employees will help to
identify the barriers of new digital project which
can be resolve at the beginning. Delegation is an
essential feature to develop by the digital leaders.
Leaders should have identify the key people in the
organization and delegate the authority to
implement the digital health. Nursing leaders play a
key role in implementing the digital health at the
very begging (34). Therefore nursing leaders need
to develop their knowledge and skills related to
digital health. Health care leaders should facilitate
to develop digital leaders in nursing field for
implementation and monitoring of the digital
projects. Hierarchy is one of limiting factor to
implement the digital health. Therefore, leaders
need to develop good relationship with the
employees without considering hierarchal level to
implement digital system successfully.
5. Conclusions
Leaders play a main role in digitalization of the
health care system. Use of digital technology in the
health care system is lagging behind compared to
the other business environment because of poor
leadership skills in the health care leaders.
Therefore, health care leaders need to go beyond
from their traditional leadership style to a new
transformational leadership style. Successful
leaders in the digital health shows good
interpersonal relationship, effective
communication, risk taking ability, delegation of
authority, self and organizational capacity
development ability, innovation ability and
knowledge on good project management.
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