The Value of APP Leadership in Hospital Administration: A Scoping Review

Authors

• Crystal Poole, University of LynchburgFollow

Specialty

Nephrology

Advisor

Dr. Blake Rogers

Abstract

ABSTRACT

This review evaluated the role of advanced practice providers (APPs), including physician associates (PAs) and nurse practitioners (NPs), in hospital administration and leadership, with a focus on onboarding, utilization, retention, and cost outcomes. Despite their central role in inpatient care, APP integration into hospital leadership has lagged, with implications for workforce stability and organizational performance. A structured scoping review of the literature (2019–2025) identified and summarized studies reporting APP leadership roles and associated onboarding, retention, utilization, and cost outcomes.

Across included studies, structured onboarding, clear role delineation, and ongoing professional development were consistently linked to improved APP retention and operational efficiencies. High turnover generated substantial recruitment and training costs and disrupted continuity of care and team cohesion. In contrast, APP-led leadership initiatives were associated with reduced turnover, lower reliance on temporary staff, and reported cost savings. APP leaders frequently served as bridges between clinical teams and administration, strengthening communication, improving operational efficiency, and supporting alignment with institutional priorities. However, most evidence came from single institutions and consisted of observational reports with limited comparisons to physician-, nurse-, or manager-led models.

Hospitals should formalize APP leadership pathways and align them with governance, credentialing, and evaluation processes; invest in structured onboarding and advancement programs; and consider dyad- or team-based leadership models that incorporate APPs alongside physicians or administrators. These strategies may improve workforce stability, reduce costs, enhance patient access and continuity of care, and better align with value-based care priorities. Future research should include multicenter evaluations, prospective cost analyses, and comparative studies of leadership structures to clarify the long-term organizational impact of APP leadership.

Recommended Citation

Poole C. The Value of APP Leadership in Hospital Administration: A Scoping Review. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).