Physician leadership and quality improvement in the acute child and adolescent psychiatric care setting

The Affordable Care Act and Its Effects on Physician Leadership: A Qualitative Systematic Review

OBJECTIVES

The Affordable Care Act (ACA) shifted the focus in medical care from quantity to quality. This qualitative systematic review aimed to determine the key skills necessary for effective physician leaders after the implementation of the ACA, and to compare them with key skills identified prior to its implementation.

METHODS

A qualitative systematic review was conducted. A systematic literature search on leadership skills for physicians returned 26 articles published between 2009 and 2016. Thematic analysis was used to categorize the data presented in each article. The results from the thematic analysis were then compared with a similar article published before the implementation of the ACA.

RESULTS

Teamwork and team-building, communication, and self-awareness skills were mentioned most often. The percentage of articles mentioning teamwork and team-building skills (61.5%) was significantly greater than the percentage (25%) reported before the implementation of the ACA (P ≤ .04).

CONCLUSION

With the shift toward quality of patient care, health care workers at all levels should strive to work as a team to provide the best quality of care at all stages of patient care.

Discipline-specific competency-based curricula for leadership learning in medical specialty training

Purpose Doctors play a central role in leading improvements to healthcare systems. Leadership knowledge and skills are not inherent, however, and need to be learned. General frameworks for medical leadership guide curriculum development in this area. Explicit discipline-linked competency sets and programmes provide context for learning and likely enhance specialty trainees' capability for leadership at all levels. The aim of this review was to summarise the scholarly literature available around medical specialty-specific competency-based curricula for leadership in the post-graduate training space. Design/methodology/approach A systematic literature search method was applied using the Medline, EMBASE and ERIC (education) online databases. Documents were reviewed for a complete match to the research question. Partial matches to the study topic were noted for comparison. Findings In this study, 39 articles were retrieved in full text for detailed examination, of which 32 did not comply with the full inclusion criteria. Seven articles defining discipline-linked competencies/curricula specific to medical leadership training were identified. These related to the areas of emergency medicine, general practice, maternal and child health, obstetrics and gynaecology, pathology, radiology and radiation oncology. Leadership interventions were critiqued in relation to key features of their design, development and content, with reference to modern leadership concepts. Practical implications There is limited discipline-specific guidance for the learning and teaching of leadership within medical specialty training programmes. The competency sets identified through this review may aid the development of learning interventions and tools for other medical disciplines. Originality/value The findings of this study provide a baseline for the further development, implementation and evaluation work required to embed leadership learning across all medical specialty training programmes.

Leadership mindset in mental health

OBJECTIVES

The objective of this study was to explore the concept of mindset for psychiatrists who are considering stepping into the leadership arena.

METHODS

Qualitative themes were extracted from dialogue on leadership development at a Royal Australian and New Zealand College of Psychiatrists forum for early career psychiatrists.

RESULTS

Three key themes were identified: adapting to a professional identity as psychiatrists; developing a mindset for leadership; and acting intentionally to seek opportunities for leadership.

CONCLUSIONS

Shifts in professional identity occur in the transition from trainee to specialist as early career psychiatrists become increasingly aware of broad systemic factors in clinical care. The concept of a mindset, distinct from a skillset of knowledge and expertise, may be an emergent quality for psychiatrists who are seeking to develop their leadership potential.

Are psychiatrists trained to be leaders in mental health? A survey of early career psychiatrists

OBJECTIVE

The aim of this study was to investigate how early career psychiatrists in 2014 valued the leadership skill education in their training to become psychiatrists.

METHOD

All psychiatrists who gained Fellowship since 2009 after training in New Zealand or Australia were invited to take part in a survey.

RESULTS

Respondents considered themselves not adequately prepared for the leadership, management and administrative tasks and roles they have as psychiatrists, with preparedness for management tasks scoring the lowest. They valued as most useful to have opportunity to practice with a leadership role, to be able to observe 'leaders at work', to have a supervisor with special interests and skills in leadership and management and to have a formal teaching program on leadership and management. They advised teaching to be given throughout the entire 5 years of the training program by experienced leaders.

CONCLUSIONS

Leadership skills training in the education of psychiatrists should contain both practical experience with leadership and management roles and formal teaching sessions on leadership and management skills development. Suggestions for improvement of the leadership and management skills education in the training of psychiatrists have been formulated.

Unit-based interprofessional leadership models in six US hospitals

The landscape of hospital-based care has shifted to place greater emphasis on improving quality and delivering value. In response, hospitals and healthcare organizations must reassess their strategies to improve care delivery in their facilities and beyond. Although these institutional goals may be defined at the executive level, implementation takes place at local sites of care. To lead these efforts, hospitals need to appoint effective leaders at the frontlines. Hospitalists are well poised to take on the role of the local clinical care improvement leader based on their experiences as direct frontline caregivers and their integral roles in hospital-wide quality and safety initiatives. A unit-based leadership model consisting of a medical director paired with a nurse manager has been implemented in several hospitals to function as an effector arm in response to the changing landscape of inpatient care. We provide an overview of this new model of leadership and describe the experiences of 6 hospitals that have implemented it.