The role of the physician in transforming the culture of healthcare

Complexity Leadership: Constructing 21st-Century Health Care

In this 21st-century postdigital age, deeper and more relevant understandings of both structure and process are critical in laying the foundations for the success of human enterprises and systems for the foreseeable future. Leadership of these complex, networked initiatives and environments will require a fundamentally different understanding and tool sets essential to the well-designed, linked, and integrated undertaking of the human enterprise. This is no less true of the unfolding health care networks now becoming the substantive framework for the delivery of health care services in the foreseeable future. This article explicates the essentials of this new model for leadership.

Experts' perceptions of management and leadership competence in Finnish hospitals in 2030

PURPOSE

The purpose of this study is to elicit and analyze experts' perceptions of management and leadership competence (MLC) and likely MLC developments and requirements in hospital contexts by 2030.

DESIGN/METHODOLOGY/APPROACH

A three-round, web-based Argument Delphi process was used to gather critically discussed opposing perceptions of 33 Finnish experts, which were subjected to inductive content analysis to identify themes.

FINDINGS

Current deficiencies in MLC and several trends (e.g. an ongoing shift towards collaborative management) and required improvements (e.g. a need to adopt more holistic approaches) were identified. However, there were some conflicting perceptions, regarding for example the desirability of fixed-term positions for managers.

RESEARCH LIMITATIONS/IMPLICATIONS

The findings provide qualitative indications of a group of Finnish experts' perceptions of MLC and requirements for its development, elicited using the Argument Delphi Method. Thus, they are subject to the usual limitations of the applied methodology and should be generalized to other contexts cautiously.

PRACTICAL IMPLICATIONS

The identification of current deficiencies and future requirements for MLC may facilitate the formulation of robust approaches for improving it in hospital contexts.

SOCIAL IMPLICATIONS

The findings may be useful for improving MLC in hospitals, thereby enhancing efficiency, teamwork, safety and client satisfaction in healthcare settings.

ORIGINALITY/VALUE

The Argument Delphi Method has been rarely used in health management science studies and healthcare context. It is intended to develop relevant arguments and reveal reasons for differing views about focal issues, thereby providing deeper understanding of experts' perceptions of MLC and its likely development.

A Change-Management Approach to Closing Care Gaps in a Federally Qualified Health Center: A Rural Kentucky Case Study

Effective organizational change requires intentional planning. We applied Kotter’s 8-Step Process for Leading Change model in understanding and evaluating how a federally qualified health center in rural Kentucky implemented a significant organizational change — a proactive office encounter (POE) model — to improve preventive care service delivery, close care gaps, and reduce health disparities among its patients. We completed qualitative interviews with 21 clinic personnel (eg, administrators, physicians, support staff, care coordinators) who were directly involved with POE implementation. We found evidence of steps 1 through 7 of Kotter’s 8 steps of change in the POE implementation process. Step 8, anchoring new approaches in the organizational culture, was an area for improvement. Change-management models, such as Kotter’s 8-Step Process for Leading Change, provide a systematic guide for health clinics to implement sustainable organizational change aimed at improving patient health outcomes.

Millennial managers: exploring the next generation of talent

PURPOSE

While considerable scholarly attention has been given to "millennials" (those born between 1981 and 1997), little is known of this generation's ability to influence healthcare organizations and managerial roles in particular. This paper aims to clarify why millennials enter the healthcare management field and how their motivations correlate with preferences for working in various healthcare sectors and with various patient populations.

DESIGN/METHODOLOGY/APPROACH

Survey data were collected from 107 millennials pursuing bachelor degrees in healthcare management by using a modified version of the multidimensional work motivation scale. Further data were collected on millennials' preferences for working in various healthcare sectors and with various patient populations. Correlational analyses were conducted to examine the relationship between types of motivation and workplace preferences. Cross-cultural differences were also examined within this generational set.

FINDINGS

Results indicate a significant positive relationship between intrinsic motivation and preferences for working on the payer side of the industry and within finance and IT functions. Findings also reveal a significant positive relationship between prosocial motivation and preferences for working with more vulnerable patient populations. Variance in work motivation among cultural sub-sets of millennials suggests different upbringings, or alternatively, cultural relativity of the motivational constructs themselves.

RESEARCH LIMITATIONS/IMPLICATIONS

Despite offering key insights into the next generation of healthcare managers, this study is limited by a sample of millennials from one large, metropolitan university in the USA and thus may not represent the views of all millennials.

PRACTICAL IMPLICATIONS

To select, retain and develop the next generation of healthcare managers, it is incumbent upon organizations to better understanding millennials' motivations and preferences.

ORIGINALITY/VALUE

This study is the first of its kind to illuminate the motivations and preferences that underpin a key and growing segment of the healthcare workforce. Millennials, now the largest and most diverse generation on the planet, are poised to change the landscape of health care.

Dream or reality? A recipe for sustainable and innovative health care ecosystems

Purpose

Service ecosystems are gaining credence among management scholars. However, there is still little agreement about the distinguishing attributes of service ecosystems in both the public and the private sectors. The purpose of this paper is to focus on the health care service system, suggesting a “recipe” for the implementation of a sustainable and innovative health care service ecosystem.

Design/methodology/approach

A mixed methodology was used. First, a critical literature review was conducted to lay the conceptual foundations of this study. Then a theory about the institutional, organizational and managerial requisites for the implementation of a health care service ecosystem was developed.

Findings

The health care sector is appropriate for the core tenets of the service ecosystem perspective. Tailored interventions aimed at improving the functioning of the health care service ecosystem should be implemented at the micro, meso, macro and mega levels. Patient empowerment, patient-centered care and integrated care are the fundamental ingredients of the recipe for effective health care service ecosystems.

Practical implications

The ecosystem approach provides health policy makers with interesting insights to help shape the health care service system of the future. The paper also contributes to the innovation of managerial practices emphasizing the role of patient involvement in the design and delivery of health care.

Originality/value

This is one of the first attempts to systematize scientific knowledge about service ecosystems in the health care sector. An agenda for further research is suggested, in order to further advance the establishment of an effective and innovative health care service ecosystem.

Medical leadership, a systematic narrative review: do hospitals and healthcare organisations perform better when led by doctors?

INTRODUCTION

Despite common assumptions that doctors are well placed to lead hospitals and healthcare organisations, the peer-reviewed literature contains little evidence on the performance of doctors in leadership roles in comparison with that of non-medical managers.

OBJECTIVES

To determine whether there is an association between the leader's medical background and management performance in terms of organisational performance or patient outcomes.

METHODS

We searched for peer-reviewed, English language studies using Medline, Embase and Emerald Management between 2005 and 2017. We included quantitative, qualitative and mixed method empirical studies on the performance of senior healthcare managers where participants were described as doctors or leaders and where comparative performance data were provided on non-medical leaders. Studies without full text available, or no organisational, leadership behaviour or patient measures, were excluded.

RESULTS

The search, conducted in Medline (n=3395), Embase (n=1913) and Emerald Management (n=454) databases, yielded 3926 entries. After the application of inclusion and exclusion criteria, 16 studies remained. Twelve studies found that there were positive differences between medical and non-medical leaders, and eight studies correlated those findings with hospital performance or patient outcomes. Six studies examined the composition of boards of directors; otherwise, there were few common areas of investigation. Five inter-related themes emerged from a narrative analysis: the impact of medical leadership on outcomes; doctors on boards; contribution of qualifications and experience; the medical leader as an individual or part of a team and doctors transitioning into the medical leadership role.

DISCUSSION AND CONCLUSION

A modest body of evidence supports the importance of including doctors on organisational governing boards. Despite many published articles on the topic of whether hospitals and healthcare organisations perform better when led by doctors, there were few empirical studies that directly compared the performance of medical and non-medical managers. This is an under-researched area that requires further funding and focus.