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Open Access Highly Accessed Research article

Policy options to improve leadership of middle managers in the Australian residential aged care setting: a narrative synthesis

Yun-Hee Jeon12*, Nicholas J Glasgow3, Teri Merlyn1 and Emily Sansoni1

Author Affiliations

1 The Australian Primary Health Care Research Institute, The College of Medicine, Biology and Environment, The Australian National University, Building 62, Mills Rd, Canberra, Australia

2 Sydney Nursing School, The University of Sydney, Mallett St., Camperdown, Australia

3 Medical School, The College of Medicine, Biology and Environment, The Australian National University, Frank Fenner Building 42, Canberra, Australia

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BMC Health Services Research 2010, 10:190  doi:10.1186/1472-6963-10-190

Published: 6 July 2010



The prevalence of both chronic diseases and multi-morbidity increases with longer life spans. As Australia's population ages, the aged care sector is under increasing pressure to ensure that quality aged care is available. Key to responding to this pressure is leadership and management capability within the aged care workforce. A systematic literature review was conducted to inform the policy development necessary for the enhancement of clinical and managerial leadership skills of middle managers within residential aged care.


Using scientific journal databases, hand searching of specialist journals, Google, snowballing and suggestions from experts, 4,484 papers were found. After a seven-tiered culling process, we conducted a detailed review (narrative synthesis) of 153 papers relevant to leadership and management development in aged care, incorporating expert and key stakeholder consultations.


• Positive staff experiences of a manager's leadership are critical to ensure job satisfaction and workforce retention, the provision of quality care and the well-being of care recipients, and potentially a reduction of associated costs.

• The essential attributes of good leadership for aged care middle management are a hands-on accessibility and professional expertise in nurturing respect, recognition and team building, along with effective communication and flexibility. However, successful leadership and management outcomes depend on coherent and good organisational leadership (structural and psychological empowerment).

• There is inadequate preparation for middle management leadership roles in the aged care sector and a lack of clear guidelines and key performance indicators to assess leadership and management skills.

• Theory development in aged care leadership and management research is limited. A few effective generic clinical leadership programs targeting both clinical and managerial leaders exist. However, little is known regarding how appropriate and effective they are for the aged care sector.


There is an urgent need for a national strategy that promotes a common approach to aged care leadership and management development, one that is sector-appropriate and congruent with the philosophy of person-centred care now predominant in the sector. The onus is on aged care industries as a whole and various levels of Government to make a concerted effort to establish relevant regulation, legislation and funding.