Emerging evidence in the operational functional domain highlights leaders’ need to navigate ethical and risk management issues by establishing robust governance structures prioritizing patient data privacy and security while ethically integrating AI technologies within existing workflows. Additionally, the literature emphasizes that implementing AI in health care will require leaders to ensure new AI solutions comply with existing regulatory and control systems. The literature highlighted that leaders need to pay attention to process agility through continuous monitoring to ensure AI solutions can adapt to contextual changes.
Finally, the organizational functional domain emerges from the thematic analysis as a pivotal area for AI leadership. The literature emphasizes the importance of stakeholder engagement in building collaboration. Furthermore, it underscores the importance of decision makers’ sense-making to enhance their trust in AI opportunities and ensure that AI integration is supported by individuals across the organization. Further, the literature underscored the importance of organizational culture readiness to support physicians and nurses through protected time and incentive pay to engage, innovate, and adopt AI solutions. Table 3 provides a summary of how operational and organizational functional domains map across the papers.
Author | Functional domain | Key themes | Functional domain | Key themes | ||||||
Operational | Ethical and risk management | Regulatory compliance | Process agility | Organizational | Stakeholder engagement or collaboration | Trust and sense-making | Organizational culture and readiness | |||
Barbour et al [ ] | ||||||||||
Darcel et al [ ] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||
Dicuonzo et al [ ] | ✓ | ✓ | ✓ | |||||||
Dixit et al [ ] | ✓ | ✓ | ✓ | |||||||
Ergin et al [ ] | ✓ | ✓ | ||||||||
Galsgaard et al [ ] | ✓ | ✓ | ||||||||
Ganapathi and Duggal [ ] | ✓ | ✓ | ✓ | |||||||
Gillan [ ] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||
Hakim et al [ ] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||
Henriksen and Bechmann [ ] | ✓ | ✓ | ✓ | |||||||
Laukka et al [ ] | ✓ | ✓ | ✓ | |||||||
Li et al [ ] | ✓ | ✓ | ||||||||
Morley et al [ ] | ✓ | ✓ | ✓ | ✓ | ✓ | |||||
Nasseef et al [ ] | ✓ | ✓ | ✓ | |||||||
Olaye and Seixas [ ] | ✓ | ✓ | ✓ | ✓ | ✓ | |||||
Petersson et al [ ] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||
Ronquillo et al [ ] | ✓ | ✓ | ✓ | ✓ | ||||||
Sawers et al [ ] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||
Strohm et al [ ] | ✓ | ✓ | ✓ | ✓ | ||||||
Upshaw et al [ ] | ✓ | ✓ | ||||||||
Willis et al [ ] | ✓ | ✓ | ||||||||
Yang et al [ ] | ✓ | ✓ | ✓ | ✓ | ✓ |
We categorized the themes related to skills and behaviors into 3 essential capacities that a leader must demonstrate to achieve desired goals—technical capacity, adaptive capacity, and interpersonal capacity. Technical capacity encompasses (1) AI literacy, (2) subject matter knowledge, (3) change leadership skills, and (4) innovation mindset to identify AI innovation opportunities. The interpersonal capacity involves several vital facets such as (1) the ability to foster partnerships among diverse stakeholders, (2) the ability to comprehend diverse stakeholder perspectives and deftly influence adoption, (3) the ability to build trust and collaboration, (4) self-awareness and humility to assemble teams with complementary skills, and (5) the integrity and accountability to embody ethical principles. The adaptive capacity encompasses (1) the foresight and sense-making abilities to discern emerging technologies and their implications within the health care sphere; (2) the agility to identify and capitalize on transformative opportunities, swiftly adapting and aligning strategies with evolving contexts; and (3) systems thinking to enable an understanding of how elements interconnect and how changes in 1 area can reverberate throughout the entire system.
The emerging themes from our review reveal that dynamic environmental and situational factors, including regulatory, technology, and organizational contexts, shape AI transformation within health care organizations. For instance, the regulatory context and frameworks related to health professions and health care organizations play a critical role in how AI can be integrated within the organizations. Similarly, the technology context such as the availability of AI technical talent, the retention of technical expertise, the dynamic nature of AI maturity, and the presence of incentives and technological resources for AI innovation or adoption will significantly influence a leader’s ability to effectively drive AI readiness. Finally, the organization context is a critical influence on leaders’ capacity for AI adoption and implementation. Organizations that promote and reward innovation and that have transparent communication practices shape leaders’ ability to pursue AI opportunities.
For the technological domain, the included papers discussed approaches such as upskilling clinical experts with the necessary AI technical skills and ensuring the presence of specialized experts, such as computer scientists, to enable the subject matter experts to develop, test, and seamlessly integrate AI solutions. Further, the papers discussed collaborative strategies such as clinicians and computer scientists working together to effectively identify AI opportunities and develop, adopt, and implement AI solutions in clinical or operational areas.
For the strategic domain, organizational support was essential in supporting leaders to assess and identify AI opportunities that strategically align with organizational priorities and develop strategies to ensure AI transformation garners support from key stakeholders within the complex regulatory and environmental contexts. The literature also highlighted the competition for AI talent in health care and emphasized the significance of talent retention strategies to preserve the organization’s AI technical expertise.
Then, in the operational domain, the emphasis was on establishing governance structures to continuously monitor data quality, patient privacy, and patient care experiences and assess the feasibility and financial implications of AI transformation. These governance structures ensure effective oversight and management of AI initiatives within health care organizations.
Finally, for the organizational domain, the focus was on the pivotal role of organizational culture in AI leadership. Leaders require organizational support to cultivate an environment that fosters innovation and actively incentivizes clinical leaders, such as physicians and nurses, through protected time and incentive pay to innovate and adopt AI solutions. Transparent decision-making processes related to AI solutions are essential cultural elements that build trust in AI systems and promote collaboration among the diverse stakeholders involved in AI transformation within health care organizations.
The purpose of a scoping review is not to draw definitive conclusions but to map the literature, identify emerging patterns, and develop critical propositions. As described in Figure 2 , analysis of current literature shows that leading organizations toward AI transformation requires multidimensional leadership. As such, health care organizations need to engage leaders in the technological, strategic, operational, and organizational domains to facilitate AI transformation in their organizations. Further, the reviewed papers suggest that individuals in AI-related leadership roles need to demonstrate (1) technical capacity to understand the technology and innovation opportunities, (2) adaptive capacity to respond to contextual changes, and (3) interpersonal capacity to navigate the human aspects of the AI transformation process effectively. Furthermore, our study illuminates that leaders in the AI-related leadership roles need to navigate regulatory context, the dynamic nature of changing technology context, and organization context.
Health care organizations are marked by multifaceted interdependencies among medical facilities, health care providers, patients, administrative units, technology, and the regulatory environment. Therefore, the leadership required for AI transformation—which includes identifying AI opportunities, implementing AI solutions, and achieving full-scale AI adaptation—is not a static role but a continuous and dynamic process. Effective leadership involves the capacity to continuously identify opportunities for AI transformation, influence the thoughts and actions of others, and navigate the complex dynamics of the health care setting and AI technology landscape simultaneously. However, the current literature has not fully articulated this multidimensionality, often focusing on leadership through a linear approach.
Further, multiple situational factors can shape AI transformation. First, the rapid growth of AI technologies introduces an element of uncertainty, making it challenging to anticipate the long-term impact and sustainability of specific AI solutions [ 6 ]. Second, AI implementation involves many stakeholders, from technical experts and domain specialists to clinicians, administrators, patients, vendors, and regulatory bodies. Each stakeholder group brings its unique perspectives, priorities, and control systems into the equation, necessitating leaders to navigate competing values, trade-offs, and paradoxes [ 27 ]. Third, once alignment is achieved, the integration of AI within an organization triggers a need for a cultural shift, altering work practices and decision-making processes [ 38 , 59 ]. Fourth, the effectiveness of AI solutions hinges on the availability of high-quality data for informed insights and decision-making. When implementing solutions originally developed within different contexts, local organizations must ensure data integrity and the solution’s adaptability to the organization’s unique context [ 18 ]. This challenge is compounded by emerging regulatory frameworks, which add a layer of complexity. Ensuring compliance and the responsible use of AI technologies has become a critical consideration [ 29 , 50 , 60 ]. Finally, introducing AI may provoke resistance from employees concerned about job displacement or disruptions to established workflows. This problem is further compounded when an organization transitions toward integrating multiple AI systems, as these changes can lead to periods of chaos and confusion [ 59 ].
Emerging key opinions and evidence from outside the health domain indicate that leaders must possess an understanding of data quality nuances, assess process risks, and manage AI as a new team member. Additionally, leaders should have a firm grasp of technology, articulate clear business objectives, define precise goals, uphold a long-term vision, prepare their teams for AI transformation, manage data resources effectively, and foster organizational collaboration [ 3 , 61 - 67 ].
Our findings on the leadership required for AI transformation in health care organizations reinforce this multidimensionality of leadership to effectively navigate the complexities of AI transformation and successfully leverage its potential to drive transformative change. Leaders must operate across different functional domains—technological, strategic, operational, and organizational—while demonstrating technical, adaptive, and interpersonal capacities.
Further, our findings show contingency leadership theories, complexity theory, and transformational leadership theory as relevant theoretical domains for further explaining the different facets of leadership behaviors needed to navigate the multidimensionality of leadership required for AI transformation.
Contingency theories suggest that leadership effectiveness depends on situational factors, which should be considered in future AI implementation studies in the context of AI adaptation and integration within health care organizations [ 68 , 69 ]. Complexity theory provides a framework for examining leadership behaviors in interconnected, dynamic environments where leaders must balance innovation and stability and demonstrate an adaptive approach to challenges, characterized by uncertainty and change [ 70 - 73 ]. Transformational leadership theory emphasizes motivating, empowering, and developing others by fostering trust and collaboration while challenging the status quo to drive organizational change and innovation [ 74 , 75 ]. These theories should be considered in future AI implementation studies within health care organizations.
Future research and training programs related to AI in health care should examine the leadership required for AI transformation through the lens of multidimensionality, providing insights into the interrelatedness of functional domains, leadership capacities, and contextual enablers and barriers, while exploring the key theoretical domains related to contingency, complexity, and transformational leadership to further understand the interpersonal dynamics shaping AI transformation in health care.
Some limitations to our scoping review are worth noting. First, given the contextual variability in the included studies and the methodological variations, we could not establish firm correlations about specific leadership domains, capacities, and contextual factors; the effectiveness of leadership approaches; or the moderating effects of contextual factors. Consequently, we have presented only the overarching emergent themes.
Second, our study is limited by the significant variation in conceptual definitions of leadership and leadership competencies found in the current literature, which often lacks more standardized definitions or instruments for measurement. This variation caused conceptual inconsistencies. We addressed the inconsistencies by clearly defining what constitutes a functional domain, capacity, and context before our data analysis to address this. We iteratively coded the data into themes to ensure all relevant aspects were captured.
Third, our search strategy focused on MEDLINE-indexed journals, which may exclude some newer journals indexed in PubMed but not yet in MEDLINE. While this might limit the capture of the very latest advancements in digital health, it does not diminish the robustness of the review. Fourth, we retrieved only articles written in English, which possibly limited the comprehensiveness of our findings. Fifth, we looked at AI as a system and did not look at the relationship between the implementation of different types of AI tools and leadership behaviors which was beyond the scope of our review. Finally, our analysis used an inductive approach and was not informed by a predetermined theory to aid the mapping of the literature. This may have limited our analysis in capturing different elements of an umbrella theory.
Leading organizations toward AI transformation is an adaptive challenge influenced by a myriad of interwoven situational factors that create a dynamic and intricate environment. The body of literature related to AI in health care is rapidly expanding, and the recommendations imparted by this review, alongside the multidimensional leadership framework ( Figure 2 ), stand poised to guide research and practice to empower health care organizations in their AI transformation journey. Future research on AI transformation, which includes innovation identification, implementation, and scaling, can use this framework to understand the role of leadership in driving successful outcomes.
Further, future research must undergo methodological expansion by embracing qualitative and mixed methods approaches to illuminate the intricate temporal aspects of AI transformation and corresponding evolving leadership behaviors.
In summary, emerging evidence shows that multidimensional leadership plays crucial role in AI transformation in health care organization. Leaders must adeptly balance technology opportunities while demonstrating unwavering empathy for stakeholder needs and nimble adaptability to accommodating the ever-changing contextual landscape, which encompasses the regulatory frameworks, the evolution of technology, and the organization’s priorities.
This work is supported through a grant from the University of Toronto’s Connaught Global Challenges. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the study.
The main study data are the data extraction materials and quality ratings of included papers, most of which are included in the study tables. The data sets generated and analyzed during this study are available from the corresponding author on reasonable request.
All authors were involved in conception and design of the study and approved the protocol. AS and NS were responsible for overseeing the search of databases and literature. AS, NS, and SS were involved in the screening of articles, data extraction and data verification, and analysis of data. All authors were involved in data interpretation, supported in the drafting of the paper, which was led by AS, and all authors supported in revising and formatting of the paper. All authors have provided final approval of the version of the paper submitted for publication, and all authors agree to be accountable for all aspects of the work.
None declared.
Updated PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) checklist.
artificial intelligence |
Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews |
Edited by T de Azevedo Cardoso, G Eysenbach; submitted 14.11.23; peer-reviewed by D Chrimes, TAR Sure, S Kommireddy, J Konopik, M Brommeyer; comments to author 20.02.24; revised version received 12.03.24; accepted 15.07.24; published 14.08.24.
©Abi Sriharan, Nigar Sekercioglu, Cheryl Mitchell, Senthujan Senkaiahliyan, Attila Hertelendy, Tracy Porter, Jane Banaszak-Holl. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 14.08.2024.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research (ISSN 1438-8871), is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.
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