Followership: A review of the literature in healthcare and beyond.

INTRODUCTION: Research in healthcare leadership has focused on leaders. In contrast, organizational success may be more influenced by followers. Kelley described five followership styles based on two characteristics: active engagement and independent critical thinking. We examined the literature on the association between followership style and workplace outcomes.

METHODS: Articles from MEDLINE, CINAHL, and EMBASE were searched. Given the paucity of studies, we expanded our search to non-healthcare databases. Two reviewers identified all studies examining followership styles and their association with job satisfaction and/or performance outcomes. Included studies were evaluated using the GRADE approach.

RESULTS: We identified one article on followership for every sixty articles on leadership in the medical literature. Fourteen observational studies on followership were included in our analysis. Outcomes ranged from the individual to the organizational level. No synthesized analysis was possible due to heterogeneity. Followership styles with greater active engagement and independent critical thinking were associated with increased job satisfaction, decreased burnout, and workplace performance metrics.

CONCLUSIONS: There is a dearth of studies on followership. The literature suggests that followership characterized by greater independence is associated with positive outcomes. Given the importance of teamwork in the critical care environment, we should prioritize understanding of this important variable.