Health LEADS Australia and implications for medical leadership

Power and politics of leading change in emergency departments: A qualitative study of Australasian emergency physicians

OBJECTIVE

The ability to lead change is well recognised as a core leadership competency for clinicians, including emergency physicians. However, little is known about how emergency physicians' think about change leadership. The present study explores Australasian emergency physicians' beliefs about the factors that help and hinder efforts to lead change in Australasian EDs.

METHODS

An online modified Delphi study was conducted with 19 Fellows of the Australasian College for Emergency Medicine. To structure the process, participants were sorted into four panels. Using a three-phase Delphi process, participants were guided through a process of brainstorming, narrowing down and ranking the factors that help and hinder attempts to lead change. Reflexive thematic analysis was used to code and interpret the qualitative data set emerging from participants' responses through the final ranking phase.

RESULTS

A wide array of self-, ED- and hospital-related enablers and barriers of leading change were identified, the relative importance of which varied as a function of panel. Five core themes characterised emergency physicians' conceptions of change leadership in hospitals: challenging environments of competing interests and tribalism; need for trust and psychological safety to sustain collaboration; challenges of navigating complex hierarchies; need to garner executive leadership support and; need to maintain a growth mindset and motivation to practice change leadership.

CONCLUSION

The findings of our study provide new insight into emergency physicians' conceptions of the nature, barriers to and enablers of change and point to new directions in leadership development to support emergency physicians' aspirations in the context of quality, organisation and health systems improvement.

Leadership curricula and assessment in Australian and New Zealand medical schools

BACKGROUND

The Australian Medical Council, which accredits Australian medical schools, recommends medical leadership graduate outcomes be taught, assessed and accredited. In Australia and New Zealand (Australasia) there is a significant research gap and no national consensus on how to educate, assess, and evaluate leadership skills in medical professional entry degree/programs. This study aims to investigate the current curricula, assessment and evaluation of medical leadership in Australasian medical degrees, with particular focus on the roles and responsibilities of medical leadership teachers, frameworks used and competencies taught, methods of delivery, and barriers to teaching leadership.

METHODS

A self-administered cross-sectional survey was distributed to senior academics and/or heads or Deans of Australasian medical schools. Data for closed questions and ordinal data of each Likert scale response were described via frequency analysis. Content analysis was undertaken on free text responses and coded manually.

RESULTS

Sixteen of the 22 eligible (73%) medical degrees completed the full survey and 100% of those indicate that leadership is taught in their degree. In most degrees (11, 69%) leadership is taught as a common theme integrated throughout the curricula across several subjects. There is a variety of leadership competencies taught, with strengths being communication (100%), evidence based practice (100%), critical reflective practice (94%), self-management (81%), ethical decision making (81%), critical thinking and decision making (81%). Major gaps in teaching were financial management (20%), strategic planning (31%) and workforce planning (31%). The teaching methods used to deliver medical leadership within the curricula are diverse, with many degrees providing opportunities for leadership teaching for students outside the curricula. Most degrees (10, 59%) assess the leadership education, with one-third (6, 35%) evaluating it.

CONCLUSIONS

Medical leadership competencies are taught in most degrees, but key leadership competencies are not being taught and there appears to be no continuous quality improvement process for leadership education. There is much more we can do as medical educators, academics and leaders to shape professional development of academics to teach medical leadership, and to agree on required leadership skills set for our students so they can proactively shape the future of the health care system.

Collaborative leadership: organisational structure and institutional investment to multiply innovative educational efforts among trainees

Background

Trainees comprise a substantial employee population worldwide and there is increasing perspective of leadership as a foundational skill of physician development. In the USA, the Accreditation Council for Graduate Medical Education mandates a ‘Resident/Fellow Forum’ to facilitate cross-institutional engagement and communication with the Graduate Medical Education Committee.

Interventions

To increase effectiveness, we conceived a ‘Senate’ in place of a forum, incorporating broader housestaff representation and partnerships with faculty and hospital executive leadership. The ‘Yale-New Haven Hospital Resident and Fellow Senate’ was supported by hospital financial resources and faculty mentorship. It provided leadership development, enhanced interdepartmental, connected multiple medical specialties, and improved housestaff engagement with institutional leaders. The Senate comprised an elected Executive Board and five councils in areas of common interest with appointed Chairs and members at large.

Conclusions

We summarise the Senate’s conception, structure, election process, lessons learnt and associated impact. We conclude that the creation of an institutionally supported Senate with interest-specific councils and faculty mentorship leads to qualitatively positive downstream effects on housestaff social interactions, institutional engagement and leadership opportunities.

Unlocking medical leadership’s potential: a multilevel virtuous circle?

Background and aimMedical leadership (ML) has been introduced in many countries, promising to support healthcare services improvement and help further system reform through effective leadership behaviours. Despite some evidence of its success, such lofty promises remain unfulfilled.

MethodCouched in extant international literature, this paper provides a conceptual framework to analyse ML’s potential in the context of healthcare’s complex, multifaceted setting.

ResultsWe identify four interrelated levels of analysis, or domains, that influence ML’s potential to transform healthcare delivery. These are the healthcare ecosystem domain, the professional domain, the organisational domain and the individual doctor domain. We discuss the tensions between the various actors working in and across these domains and argue that greater multilevel and multistakeholder collaborative working in healthcare is necessary to reprofessionalise and transform healthcare ecosystems.

Development of a national medical leadership competency framework: the Dutch approach

BACKGROUND

The concept of medical leadership (ML) can enhance physicians' inclusion in efforts for higher quality healthcare. Despite ML's spiking popularity, only a few countries have built a national taxonomy to facilitate ML competency education and training. In this paper we discuss the development of the Dutch ML competency framework with two objectives: to account for the framework's making and to complement to known approaches of developing such frameworks.

METHODS

We designed a research approach and analyzed data from multiple sources based on Grounded Theory. Facilitated by the Royal Dutch Medical Association, a group of 14 volunteer researchers met over a period of 2.5 years to perform: 1) literature review; 2) individual interviews; 3) focus groups; 4) online surveys; 5) international framework comparison; and 6) comprehensive data synthesis.

RESULTS

The developmental processes that led to the framework provided a taxonomic depiction of ML in Dutch perspective. It can be seen as a canonical 'knowledge artefact' created by a community of practice and comprises of a contemporary definition of ML and 12 domains, each entailing four distinct ML competencies.

CONCLUSIONS

This paper demonstrates how a new language for ML can be created in a healthcare system. The success of our approach to capture insights, expectations and demands relating leadership by Dutch physicians depended on close involvement of the Dutch national medical associations and a nationally active community of practice; voluntary work of diverse researchers and medical practitioners and an appropriate research design that used multiple methods and strategies to circumvent reverberation of established opinions and conventionalisms.

IMPLICATIONS

The experiences reported here may provide inspiration and guidance for those anticipating similar work in other countries to develop a tailored approach to create a ML framework.

Why we need to teach leadership skills to medical students: a call to action

Health system reform models since the early 1990s have recommended leadership training for medical students, graduates and health workers. Clinicians often have leadership roles thrust on them early in their postgraduate career. Those who are not well trained in leadership and the knowledge that comes with leadership skills may struggle with the role, which can impact patient safety and create unhealthy working environments. While there is some literature published in this area, there appears to be little formal evaluation of the teaching of leadership, with scarcely any discussion about the need to do so in the future. There are clear gaps in the research evidence of how to teach and assess medical leadership teaching. In this paper, three leadership frameworks from Australia, Canada and the UK are compared in terms of leadership capabilities for a global view of medical leadership training opportunities. A literature review of the teaching, assessment and evaluation of leadership education in medical schools in Australia, the UK and America is also discussed and gaps are identified. This paper calls for an education shift to consider practical health system challenges, citing the mounting evidence that health system reform will require the teaching and rigorous evaluation of leadership methods. Opportunities for teaching leadership in the curricula are identified, as well as how to transform leadership education to include knowledge and practice so that students have leadership skills they can use from the time they graduate.

Developing health leadership with Health LEADS Australia

Purpose Leadership, and leadership development, in health and human services is essential. This review aims to draw conclusions from practice within the Australian context. Design/methodology/approach This review is an overview of health leadership development in Australia, with a particular focus on the implementation of the national health leadership framework, Health LEADS Australia (HLA). Findings Since its inception, the HLA has influenced the development of health leadership frameworks across the Australian states and territories. Both the National Health Leadership Collaboration and individuals with "boundary-spanning" roles across state government and the university sector have contributed to the development of collaborative online communities of practice and professional networks. Innovation has also been evident as the HLA has been incorporated into existing academic curricula and new professional development offerings. Ideas associated with distributed leadership, integral to the HLA, underpin both sets of actions. Practical implications The concept of a national health leadership framework has been implemented in different ways across jurisdictions. The range of alternative strategies (both collaborative and innovative) undertaken by Australian practitioners provide lessons for practice elsewhere. Originality/value This article adds to the body of knowledge associated with policy implementation and provides practical recommendations for the development and promotion of health leadership development programmes.

Untangling approaches to management and leadership across systems of medical education

Aims

How future doctors might be educated and trained in order to meet the population and system needs of countries is currently being debated. Incorporation of a broad range of capabilities, encompassed within categories of management and, increasingly, leadership, form part of this discussion. The purpose of this paper is to outline a framework by which countries’ progress in this area might be assessed and compared.

Methods

Key databases and journals related to this area were reviewed. From relevant articles potential factors impacting on the incorporation of aspects of management and leadership within medical education and training were identified. These factors were tested via an online survey during 2013 with six members of a European Association of doctors who promote medical involvement in hospital management, including members from countries less represented in the health management literature.

Results

A framework for analysing how management and leadership education is being approached within different systems of healthcare is developed and presented.

Conclusions

More systematic work across a wider range of countries is needed if we are to have a better understanding of how countries within and beyond Europe are approaching and progressing the education of doctors in management and leadership.

Prioritizing health leadership capabilities in Canada: Testing LEADS in a Caring Environment

This article is the first major empirical test of LEADS in a Caring Environment, the principal leadership capability framework in Canada. The results rank the perceived salience of leadership attributes, given time and budget constraints, while implementing a major organization reform in the Saskatchewan health system. The results also indicate important differences between self-assessed leadership behaviours versus observed behaviours in other leaders that may reflect participants' expectations of managers with designated authority.

Perceptions of trust in physician-managers

PURPOSE

The purpose of this paper is to explore the dual role of physician-managers through an examination of perceptions of trust and distrust in physician-managers. The healthcare sector needs physicians to lead. Physicians in part-time managerial positions who continue their medical practice are called part-time physician-managers. This paper explores this dual role through an examination of perceptions of trust and distrust in physician-managers.

DESIGN/METHODOLOGY/APPROACH

The study takes a qualitative research approach in which interviews and focus group discussions with physician-managers and nurse-managers provide the empirical data. An analytical model, with the three elements of ability, benevolence and integrity, was used in the analysis of trust and distrust in physician-managers.

FINDINGS

The respondents (physician-managers and nurse-managers) perceived both an increase and a decrease in physicians' trust in the physician-managers. Because elements of distrust were more numerous and more severe than elements of trust, the physician-managers received negative perceptions of their role.

RESEARCH LIMITATIONS/IMPLICATIONS

This paper's findings are based on perceptions of perceptions. The physicians were not interviewed on their trust and distrust of physician-managers.

PRACTICAL IMPLICATIONS

The healthcare sector must pay attention to the diverse expectations of the physician-manager role that is based on both managerial and medical logics. Hospital management should provide proper support to physician-managers in their dual role to ensure their willingness to continue to assume managerial responsibilities.

ORIGINALITY/VALUE

The paper takes an original approach in its research into the dual role of physician-managers who work under two conflicting logics: the medical logic and the managerial logic. The focus on perceived trust and distrust in physician-managers is a new perspective on this complicated role.