Abstract
Purpose This quantitative exploratory study was designed to learn about trends and forces impacting leadership development (LD) opportunities for dental hygiene (DH) program directors.
Methods A 10-item electronic survey was created and disseminated using Qualtrics system to directors of all accredited DH programs in the United States (n=325). Surveys included closed and open-ended response items to capture quantitative and qualitative data. Analysis included descriptive statistics and thematic categorization of free responses.
Results Eight-two surveys were returned (25% response rate). Leadership development training experiences varied among participants; 79% (n=65) reported completing some form of LD training. Institutional support was variable amongst the DH program directors, yet most (76%, n=62) indicated some level of school support for LD training opportunities for DH program directors. Feedback indicated that most options included campus-sponsored courses or events (28%, n=47), professional association courses or events (24%, n=40), and programs within the school, department, or division (24%, n=40).
Conclusion Study findings support positive perceptions of the need, demand, and value of LD. Respondents shared beliefs in the benefits of LD and the value of placing resources to support these opportunities, yet also acknowledged substantial challenges including time, funding, and workforce needs. By addressing barriers and capitalizing on driving forces, programs can create systemic approaches to fostering LD for current and future DH program directors.
INTRODUCTION
Educational leaders in allied dental health profession programs face growing challenges in higher education and the ever-evolving global health care system. The need for more oral health care providers combined with the necessity of additional faculty drives competition for workforce fulfillment and recruitment of academicians.1-3 These competing demands impact academia and cultivate a real need for faculty and leadership in dental (DH) programs. Leaders in DH education programs experience unique challenges surrounding the educational and health service applications of patient care.
Dental hygiene program directors are delegated with performing multi-skilled tasks. As noted in the literature, health professions program leaders experience multiple layers of responsibility in addition to service, education, and scholarship, and must be skilled with diverse abilities to meet academic and clinical missions.4-5 The DH program directors are accountable for a wide range of management and leadership responsibilities, including accreditation compliance, curriculum and student achievement, ethical training for patient care, student performance on licensure and national board examinations, patient outcomes, and the ongoing challenges educational institutions face in adapting to changes in the delivery of health care services. Effective DH program leadership must consist of knowledge of these factors and understanding the intricacies of the globalization of health care and shifts that significantly impact the education of future oral health care professionals.6 Leaders in DH education must also be well-informed of rapid technology changes in didactic and clinical teaching environments.
Academic leaders in DH programs must possess diverse skills to fulfill their many roles effectively. The traits of an educational leader must include excellent communication, logical thinking and analytical interpretation, strategic thinker, team building and collaboration, high emotional intelligence, commitment, and an innovative mindset.7 Academic leaders, including DH program directors, should spearhead and mentor professional advocacy, advancing the profession. Leadership acumen is teachable, yet it is uncommon for one to naturally encompass all characteristics, qualities, and traits of an effective academic leader. If leadership characteristics are considered a set of skills, there is the potential to develop and elevate these abilities.8
Leadership training or leadership development (LD) can enhance a person’s knowledge, confidence, and behavioral skills. Leadership development is defined as systemic and intentional educational processes designed to promote and enhance the quality of leadership capabilities in individuals.9,10 Lack of organized LD may result in the unprepared advancement of individuals in academic leadership positions, such as DH program directors, clinic coordinators, and department chairs. Ineffective placement of individuals can lead to costly measures by an institution to address issues such as poor management, inadequate operational outputs, and undeveloped relational leadership skills. These issues can impact many facets in DH education, such as retention and recruitment of faculty and qualified students, mismanaged budgets, poor clinical outcomes, and decision-making that impacts the accreditation standing of a program. Relational leadership skills, including receiving and providing feedback, listening, apologizing and thanking, conflict management, follow-up, and self-reflection, are essential in successful leadership.11-13 When academic leaders fail to demonstrate these skills, the outcome directly impacts the learning environment, hindering curricular quality, faculty development, and student success.
Dental hygiene educators in leadership positions may be best supported through LD opportunities that are specifically designed to build and elevate new skill sets by identifying and enhancing strengths, developing networks, and balancing limitations. Leadership development programs that are tailored for the multiple responsibilities of a DH program director can help prepare them for the challenges in these roles and provide the necessary preventive as well as reactionary tools for commonly encountered situations in DH education. Issues in DH education programs can arise from multiple sources including students, faculty, staff, patients, and administrators. Providing leaders and future leaders with training to enhance essential traits necessary to succeed in these roles directly impacts the quality of education and DH program outcomes.
Research has demonstrated a need for LD in professional education programs for health care,14 however, there is a gap in the literature exploring LD trends for DH program directors. The purpose of this study was to explore LD trends in DH program directorship to create an environmental scan of current practices, needs, and resources.
METHODS
This quantitative study was reviewed by the University of North Carolina Chapel Hill Office of Human Research Ethics and was determined to be exempt from further review (IRB# 21-2400). A cross-sectional quantitative study design was employed to provide a more comprehensive understanding of the data in relation to the study purpose and goals. Considerations for data collection included gaining knowledge regarding trends, barriers, resources needed, training opportunities, identification of participants, key factors, prompts for success and failure, personal opinions regarding value, and the perceived need for leadership development. The study was self-funded and no other funding was obtained.
Study Participants
The sample population included DH program directors from 325 accredited DH programs in the United States (US). Email addresses of the DH program directors were obtained from the American Dental Hygienists’ Association Entry Level Program Directory. Program directors were selected as the population of interest for this study due to their academic leadership appointments in their institutions.
Instrument
An electronic survey with closed and open-ended items was designed for this study. The survey instrument included two demographic questions, four questions inquiring about current activities and trends, and seven Likert-type scale items to measure the strength of opinion (1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5=strongly agree) regarding leadership development in dental hygiene academic settings. Three open-ended response items asked participants to volunteer their perceived barriers, enablers, and additional information regarding their experiences in leadership development training. Informed consent to collect data and share the study information was obtained before beginning the survey.
The investigator-created instrument was designed to align with the purpose and goals of the study. The survey was pilot tested by four former DH program directors. Changes were made based on the feedback provided. Pilot testers also recorded the amount of time needed to complete the survey to provide an estimate of the time needed for the study participants. An online survey platform (Qualtrics; Seattle, WA, USA) was used to disseminate the instrument via email with a single anonymous link. Survey responses were secured in a password-protected Qualtrics account. Participation in the study was voluntary; no incentives were offered to complete the survey. Data collection occurred over a 4-week time period. A follow-up email was disseminated two weeks after the initial request. To reduce multiple entries, the request asked only those who had not completed the survey to participate.
Data Analysis
Descriptive statistics were used to analyze closed-ended survey items. A software program (MAXQDA 2022, VERBI Software; Berlin, DE) was used to review and interpret the open-ended responses. Categories were established from the frequency of statements. A line–by–line review process was implemented to support the categories.
RESULTS
Of the 325 DH program directors invited to participate, 82 accepted and for a response rate of 25%. Each of the participant’s responses were included in the data review and presentation. Most respondents were located in a community college setting (42%, n=35), while 39% (n=16) were from university or four-year college (dental and non-dental school) settings. Participant demographics are shown in Table I. When asked what type of DH degree program they were currently directing, 45% (n=47) identified a certificate or associate degree, 25% (n=27) bachelor’s, 20% (n=21) degree completion, and 10% (n=10) master’s degree program. Respondents were allowed to select more than one option; and it is noteworthy that many directed multiple degree programs (total n=105). Half of the participants had been in the DH leadership role for 5-10 years (n=41), with 25% indicating holding the position less than four years (n=20).
Participant demographics (n=82)
Leadership development training experiences varied among participants. When asked if they had completed LD training or programs, most (79%, n=65) responded “yes,” while 21% (n=17) indicated no LD training. Participants reported diverse LD course types and settings, as shown in Table II. Participants also indicated that LD and training was included in courses within their master’s and doctoral degree programs.
Leadership development training opportunities
Institutional support such as financial coverage of courses, supervisor nomination for LD programs, and protected time to participate in courses varied by respondents in the current study. Most (76%, n=62) indicated some level of school support for LD training opportunities, 17% (n=14) did not have such administrative support, and 7% (n=6) were unsure. The highest notable opportunities included institution-wide sponsored courses or events (28%, n=47), professional association courses or events (24%, n=40), and programs within the individual school, department, or division (24%, n=40).
Participants were asked to indicate how individuals were chosen to participate in the various LD opportunities (Table II). Most (46%, n=49) indicated that individuals could self-nominate to participate in LD programs; some (10%, n=11) noted that LD training was required for specific roles or positions.
Respondents were asked to rate their strength of agreement with five statements regarding LD training (Table III). Most of the respondents agreed or strongly agreed to the following statements: leadership development training should be mandatory for educational leaders in higher education; there is value in leadership development training to increase success for educational leaders; and there is a need for leadership development training to prepare educational leaders to be successful in their roles. Less agreement occurred when asked if there are adequate resources and opportunities to support LD training.
Participant agreement with leadership development statements
Study participants were asked to share their perceptions regarding the impact of the COVID-19 pandemic on LD opportunities and climate trends. Respondents indicated a reduction of funding (29%, n=10), restriction on travel (41%, n=14), and limitation on the number of faculty allowed to attend courses (15%, n=5) that negatively impacted LD participation. These barriers aligned with general challenges noted in other survey items.
Three open-ended questions were included to gain context regarding barriers, enablers, and considerations regarding LD training for DH program directors. Review of the comments revealed two categories: leadership and management, and professional development (Figure 1). Leadership and management items included education, supportive administration, institutional support, opportunities, communication, and operational considerations. Professional development included networking, training, resources, career trajectory, career support, and professional growth.
Categorization of free responses from open-ended questions
Barriers
Open-ended responses added rich data to identify barriers to generating leadership and management, and professional development categories. These noted institutional and organizational barriers, including restricted financial resources, workforce shortages, and limited administrative support to attend such programs. Several responses emphasized barriers of time and funding. Comments included “time and budget,” “often funding and time are the biggest challenges to leadership development training,” and “our number of contact hours and difficulty funding substitutes for being gone, plus funding.” Data frequently demonstrated a multitude of constraints that were impediments to LD programs. For example, one respondent noted, “Insufficient time, insufficient budgets, turnover rate of administration leads to inconsistent training opportunities... and other obligations.” Additional comments shed light on cultural barriers, including, “...we are a second thought program. We are taken care of when/after the dental programs,” and “not finding it a priority.” The consensus was a lack of necessary resources, including time, funding, and administrative support.
Enabling Mechanisms
Data indicated several key factors for DH program directors to gain LD opportunities. The primary emphasis for support was noted by deans and other administrative individuals who recognized the need and provided approval. One participant noted, “Usually, the dean makes it possible through funding and encouragement of opportunities.” Other common responses included self-improvement, self-paced courses, on-campus offerings, and free courses. Several individuals noted minimal to none, including “only yourself,” “we do not really have any,” “unknown,” and “I am not aware of any.”
Additional Comments
Participants were asked to share additional information regarding experiences with LD training. These comments supported the categories of leadership and management and professional development while expanding on personal opinions and specific concerns. Participants included other contexts of their experiences, adding to the existing barriers and enabling mechanisms. Several comments also exposed cultural and professional barriers in the DH discipline and educational environment. Respondent statements regarding opinions and perceived barriers to LD training opportunities are shown in Table IV.
Open-ended comments from participants regarding leadership development
DISCUSSION
This study explored LD trends for DH program directors. Program directors must demonstrate management acumen such as budgeting, overseeing undergraduate curricula, creating student and faculty schedules, supporting student affairs through wellness and academic success programs, and collaborating with multiple levels of institutional administrators. In addition to the administrative functions, there is a need to demonstrate leadership and visionary skills through strategic planning, fundraising, faculty and student recruitment, alumni relations, and advocating for the program and profession. As a leader, program directors influence students and faculty and can inspire professional growth and advancement of leadership in DH. These roles and responsibilities require unique skill sets that are not inherent or naturally acquired through experience or observation alone. Ineffective pursual of these responsibilities can have a great impact on student achievement and program success.
The leadership structure within health professional education programs may consist of a subset of administrators managing the various disciplines housed within the institution.15 Respondents from the current study demonstrated diverse institutional settings and degree-confirming programs, each with specific requirements for students, faculty, and program. These challenges are typical in similar allied health disciplines, illustrating multiple layers of accountability in addition to teaching, service, and education.4-5 Glasgow and colleagues16 reported that nursing education leaders’ demands are complex, requiring knowledge and skills in a wide range of disciplines extending beyond education and the delivery of patient care. This study discussed that areas requiring additional knowledge and expertise included budget, politics, policy, accreditation, leadership, and management.
Faculty trends in dental hygiene education continue to show an increased need for academicians. Longstanding issues have precipitated this faculty deficit and include faculty retirement, lack of qualified applicants, and insufficient compensation.17-19 The American Dental Education Association (ADEA) Survey of Allied Dental Program Directors provides an annual report and includes a comprehensive description of faculty trends.20 The 2022 report, with a 58.4% response rate (n=192), revealed an estimated 510 DH faculty vacancies from retirements and resignations in the next five years. Faculty shortages impact current and future leaders by minimizing the quantity and quality for faculty advancement into future director roles. Fewer faculty will also exacerbate prevailing barriers, such as increased teaching responsibilities for program directors and less protected time to participate in LD training. The ADEA survey also revealed that 25% of respondents were relatively new DH program directors with four or fewer years of experience. With the continued need for more faculty and the emergence of new leaders, it will become increasingly difficult to recruit and hire experienced DH program directors. DH faculty may be advanced into program director positions with minimal guidance, yet have the same expectations of a seasoned director, creating a steep learning curve to acclimate into the role.
Completion of LD programs can provide current and new leaders with knowledge, skills, and behavioral changes needed to support individual and institutional success. These programs may offer multiple benefits to individuals seeking leadership roles and the institution by investing in future leaders and creating a succession of future leaders who are prepared and ready to move into those roles when needed. Individuals in current leadership positions may gain critical skills to enhance their effectiveness, and future leaders may gain skills and confidence to support their career advancement. Outcomes from a systematic review of faculty development for leadership in medical education revealed multiple areas that benefitted from LD programs.21 Articles reviewed in the report consistently demonstrated high satisfaction with faculty development programs, with participants noting the value, relevance, application, and usefulness for personal and professional aspects of their lives. Findings illustrated increased knowledge of leadership principles and skills, confidence, and self-awareness in strengths and limitations. Key findings also revealed increased engagement and commitment of individuals to their institution and community, with enhanced motivation and appreciation. These programs also heightened participants’ knowledge of strategy, organizational operations, leadership styles, leadership roles and responsibilities, and developing collaboration through collegial networks. A 2022 study surveyed US dental school deans to explore the influence of LD programs on dental faculty career development.22 Findings showed that most participants agreed that LD promotes strengths and benefits, most notably improving leadership and administrative skills. Results from the current study support the need and demand for LD opportunities for DH program directors.
Data from the current study highlighted the influence of leadership and management, and professional development for participation in LD. Leadership and management, including systematic and operational actions, indicate the level of influence of administrative nuances that may be required for the participants in this study to gain access to LD opportunities. Organizational structures such as where the DH program is located within the educational setting inherently impact LD opportunities. One research study identified the effect of organizational impact on LD training opportunities.14 Responses from this study also identify diverse organizational influences that can serve as barriers, enabling mechanisms, culture, human resources, resource allocation, utilization of resources, and sustainability of support.11-12 Participation in LD was affected by their school’s resource allocation and support for LD.
Results from this study demonstrate variable institutional or program resources to support LD training opportunities. Inconsistencies were also shown in how individuals were identified to participate in LD opportunities. Best practices for successful leadership development should include thoughtful identification of talent to foster growth, completing formal training, leveraging a supportive infrastructure to enhance sustainability, and evaluating program effectiveness.14 Responses from this study demonstrated a dependence on self-advocacy to initiate these opportunities, with little encouragement from institutional supervisors. A lack of systematic approaches for selecting team members with leadership potential provides no clear pathway for consistent opportunities among program directors.
Open-ended comments indicated vulnerability and frustration with institutional barriers, including inadequate funding, planning resource allocation, and administrative prioritization of LD opportunities for DH program directors. In a study of faculty development directors for health care professional programs, findings showed the most significant challenges to participating in LD opportunities included resources of finances and time14 Limited funds for travel and registration fees for costly courses were minimal, and deans or chairs heavily influenced most experiences to determine the feasibility of LD training for program directors. Similar trends were noted in a study examining LD training for dental faculty that identified lack of financial support and protected time as the two most significant barriers for LD participation.22 Similar trends were noted in the current study, indicating that administrative support from program or division deans influenced the institutional support for DH program directors to participate in LD opportunities.
Respondents highlighted organizational bias in allocating funds for DH faculty. Statements revealed longstanding professional barriers that have discouraged DH program directors from pursuing requests for resources to support LD participation. Trends expressed a strong need for self-advocacy to engage in such experiences. If DH program directors share a mindset of being viewed and treated as less valued than other colleagues in the institutional setting, it can lead to a lack of motivation and discourage DH program directors in requesting LD opportunities.
Institutional support may be inconsistent due to insufficient literature supporting successful outcomes for DH program directors who complete LD. Without substantial research demonstrating successful outcomes, administrators may be reluctant to invest in these programs. While current data and historical reports support the need for LD in higher education, there is a lack of studies in the literature to investigate the return on investment in leadership development.11,14 Richard and colleagues23 attempted to measure the return on investments in leadership development using computer simulation modeling. With responses from the current study indicating a positive opinion of LD training, the potential impact is positive in terms of the agreed need, value, and desire for LD for DH program directors. Self-advocacy for LD participation may be essential to gain buy-in and receive administrative support.
Professional development considerations related to LD emphasized the need for networking, mentoring, career support, and professional growth. The current data concurred that encouragement and mentoring were positive influential factors in advancing LD participation. A supportive work environment should be in place to foster the individual and institutional value and rewards of professional growth and development, including LD opportunities and training. Based on the literature, there can be substantial value in investing resources in LD training to support the success of DH program directors.
Limitations and Recommendations
While a larger response rate is ideal, the current demographics from this study indicate consistency and alignment with DH programs in the US, thus providing an accurate reflection of LD in DH program directors. Self-reports created limitations for this research project and included the potential for false reports by participants, the subjectivity of data, and information that is program-specific and not generalizable.
Future research should build upon the current data and include evaluating existing programs and follow-up from those who have participated in leadership development and are in leadership roles. To further support the allocation of resources and continued support of leadership development, the literature must include outcomes data to prove it is successful, is worth the investment, and increases outcomes in DH educational leaders. Additional investigation into the trends and value of succession planning is also essential to better understand sustainability opportunities for future program directors.
CONCLUSION
Study findings support positive perceptions of the need, demand, and value of leadership development programs for DH program directors. Leadership and management, and professional development cultivated driving forces such as networking and mentoring, yet also exposed systematic barriers including lack of financial support and protected time for LD participation. By addressing barriers and capitalizing on driving forces, programs can create systemic approaches to fostering LD for current and future DH program directors.
Footnotes
NDHRA priority area, Professional development: Education (educational models).
DISCLOSURES
The author has no conflicts of interests to disclose. No outside funding was received for this research.
- Received May 3, 2023.
- Accepted August 20, 2023.
- Copyright © 2023 The American Dental Hygienists’ Association
