Introduction

Leadership skills are an integral part of effective social work practice in health and mental healthcare settings. Social workers employed in hospitals, primary care, community and mental health organisations require leadership skills to effectively support, treat and advocate for the complex needs of those with mental illness, multiple health challenges, and those most vulnerable and/or marginalised.1–13The changing landscape of healthcare service provision has resulted in a growing need for leadership from social workers in both health and mental healthcare settings.6–14 Formally and informally, social workers practising within interdisciplinary teams display leadership skills when engaging in crisis management, providing critical family support, developing treatment plans, resolving complex decisions to support clients and when collaborating with multiple service providers.3–7 There exists a breadth of diversity in the nature of social work roles, expectations, and skill sets within the realm of health and mental healthcare across North America. Social work roles within health and mental health can vastly differ based on the organisational contexts in which social workers are situated in, as well as the political, economic, societal and cultural factors impacting roles in these domains.3–11 Yet, an overarching commonality between social workers in both health and mental health settings is that they are situated in key positions to bridge medical models of care with behavioural health, recovery-oriented and client-centred approaches to support their clients.1–14 These require key leadership competencies to advocate for and prioritise client needs within a service delivery culture that is often compelled to meet corporate, organisational and political pressures.4–9 14–19

As the delivery of health and mental health services strives towards a value-based system, there will be a continued need for social workers to engage in formal and informal leadership roles to advocate for client-centred care.2–14 Previous research has highlighted the importance of leadership skills in increasing staff retention, effectiveness, team cohesion and reducing burnout among interdisciplinary team members, including social workers.10–13 There has also been research on social work-specific leadership competencies and the importance of recognising these as integral components of social work practice.14 15 The development of tools to assess leadership competency has become increasingly common within healthcare. Competency is often defined as holding the ‘ability, skills or knowledge to complete one’s tasks efficiently’.20 21 Within health and mental healthcare, the development of competencies for the assessment of leadership includes the Multifactorial Leadership Questionnaire22 and the Service Leadership Behaviour Scale.23 At present, there is an existing framework developed by the Network for Social Work Management24 that outlines 21 key competencies for social work managers in formal leadership positions related to executive leadership, resource management, strategic management and community collaboration. Although this framework is widely used to guide training of social work students intending to pursue management and leadership positions in the human services sector,24 it does not specify key competencies for clinical social workers in health and mental health settings. Thus, developing standardised social work leadership competencies responds to a need to better prepare social workers for the increasingly complex patient care needs within health and mental health settings.11–14

Given the increasing number of social workers in both informal and formal positions of leadership, there has been a continued need to advance social work leadership skills to support social work practice within health and mental healthcare.5–12 Yet, a critique in the literature is the consistent lack of focus on social work leadership among social work programmes in North America.5–8 18 19 This is mirrored in the mental health literature, in which there is a large focus on clinical social work skills that often neglect the importance of social work leadership as a practice-based skill.15 18 19 Despite an increasing focus on social work leadership within the last decade, and the prominence of formal and informal social work leadership roles in both health and mental healthcare organisations, there is a paucity of research on the importance of social work leadership competencies as they relate to effective social work practice within the realm of health and mental health service provision.7 18 19 Moreover, at present there does not exist a scoping review mapping the social work leadership competencies within either of these domains. Thus, it is unclear what the overarching leadership competencies are for social workers in either domain, and what differences may exist across the two domains. There is also a lack of research on how social work leadership skills impact client experiences and utilisation of health and mental health services.7 18 19 The relationship between social work leadership in health and mental healthcare, and how this may impact client outcomes warrants further research exploration. In order to bridge this gap within social work education, practice and research, this scoping review aims to synthesise and map the current literature on social work leadership competencies within health and mental healthcare. The review will also highlight any overarching leadership competencies that support social workers practising in health and mental healthcare, as well as identify domain-specific leadership competencies. Identifying leadership competencies that are specific to either health or mental health domains, as well as associated practice and organisational settings, is a key anticipated finding of this scoping review. This would serve beneficial in addressing these research gaps in the social work literature.

A key focus of this review is also to identify effective social work leadership competencies that may improve health and mental health service provision in North America. These objectives will be addressed through the following research questions: (1) What are essential social work leadership competencies for effective social work practice in health and mental healthcare? (2) What social work leadership competencies are outlined as supportive for clients and families seeking treatment within health and mental health settings? (3) How do social work leadership skills support effective service delivery, team decision-making, team dynamics and social workers’ provision of care? and (4) What are key recommendations for improving social work leadership competencies among social workers practising in health and mental health settings? Findings will also serve beneficial for a comparative analysis of leadership competencies presented in the Human Services Management Competencies framework, and contribute towards the expansion of this framework.24

At present there is no unanimous definition of social work leadership used in existing literature, yet some common attributes can be noted across definitions. In the field of leadership studies there are numerous existing definitions of leadership, shaped by both the field of scope being referenced as well as the theoretical orientation of those defining the term.25–28 Warren Bennis, an expert in the field of leadership studies, defines leadership as, ‘having vision that is well communicated among the team, establishing trust and taking action to propel leadership potential’.29 30 Another definition of leadership refers to ‘a process of social influence that motivates others in achieving their identified goals’.27 28 One definition of leadership in social work is ‘the ability of a social work leader to demonstrate professionalism, confidence, credibility, clear goal setting, solution-focused problem-solving, and effective collaboration to support and empower others’.28 This is the definition of social work leadership that guides this scoping review. However, it is crucial to recognise that the nuanced definitions of leadership warrant critical exploration of the theoretical challenges and assumptions that arise in generating a unified definition of this term. To elaborate, how leadership is conceptualised is founded on one’s understanding of leadership as an individual or an organisational attribute. This is often rooted in the sociocultural contexts of the literature.18 19 25 31–35 The growing body of leadership research is situated within the individualistic culture of the Western world, guiding conceptualisations of leadership as individual rather than organisational or collective traits.18–21 25 This dismantles the recognition of leadership as a collective shared process and how leadership may present in different sociocultural settings.

Moreover, the epistemological underpinnings of the authors also guide how this term is and has historically been defined.18 19 25 The majority of leadership literature in the last two decades is based within a North American context, and focuses on leadership within the US military, with the dominant discourse of leadership attributes founded on White hegemonic masculinity.18 19 25 These discourses perpetuate leadership traits as qualities held by those in select positions of power. Moreover, these assumptions underpinning the literature not only inform one’s understanding of what leadership is and should be, but also reject the recognition of alternative forms of leadership characteristics (collective leadership, leadership traits encompassed by all genders and leadership qualities displayed by different ethnic populations).18 19 25–27 These methodological and theoretical challenges underlying the leadership literature may also contribute to the existing lack of focus on leadership within social work research. The theoretical challenges of conceptualising and defining social work leadership (which populations and identities are privileged when discussing social work leadership competencies) warrants further exploration. Thus, this protocol will also map out how social work leadership is defined in the literature, and conclude with discussion on the theoretical and epistemological challenges that are embedded in these findings.