Followership: A Systematic Review of the Literature in Healthcare and Beyond

Caleb Leung MD*, Amanda Lucas BN RN**, Lawrence Gillman MD MMed FRCSC FACS*
Section of General Surgery, University of Manitoba*
Oncology Program, Health Sciences Centre, Winnipeg, Manitoba**

Introduction: Research in healthcare leadership has previously focused on leaders, even though organizational success and failure may be even more influenced by its followers. Kelly (1992) described five followership styles each with two characteristics: active engagement and independent critical thinking. This manuscript provides a systematic review on the association between followership style and healthcare practitioner outcomes. We also review the wider literature on followership. 

Methods: All articles from MEDLINE, CINAHL, EMBASE and reference lists of relevant articles were searched. Given the paucity of studies identified, we expanded our search to include two additional non-healthcare databases: ProQuest Dissertations and Business Source Premier. Two independent reviewers identified all studies examining followership styles and their association with job satisfaction and/or performance outcomes. The included studies were evaluated using the GRADE approach. 

Results: There is approximately one article on followership for every 26 articles on leadership. Ten observational studies on followership met the inclusion criteria: 4 studies examined followership styles within healthcare and 6 studies from non-healthcare settings. Measured outcomes were survey-based and heterogeneous, ranging from individual practitioner outcomes to organizational level outcomes. As a result, no synthesized analysis could be performed. Followership styles that had greater active engagement and independent critical thinking were associated with increased job satisfaction, decreased burnout, and increased adherence to best practices such as infection prevention or safety guidelines. 

Conclusions: There is a relative dearth of studies on followership. The available literature suggests that followership characterized by greater independence was associated with positive individual and performance outcomes. Further research could interrogate whether followership styles are associated with outcomes across healthcare trainee levels, and whether followership styles are innate or modifiable.

Followership styles: A systematic review of the literature in medicine and healthcare.