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Bland A, Waal AD, Grzybowski S. Lessons learned from the COVID-19 pandemic: The importance of physician leadership in responding to rural community ecosystem disruptions. CANADIAN JOURNAL OF RURAL MEDICINE 2024; 29:71-79. [PMID: 38709017 DOI: 10.4103/cjrm.cjrm_27_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/01/2023] [Indexed: 05/07/2024]
Abstract
INTRODUCTION The COVID-19 pandemic presented an unprecedented challenge for rural family physicians. The lessons learned over the course of 2 years have potential to help guide responses to future ecosystem disruption. This qualitative study aims to explore the leadership experiences of rural Canadian family physicians during the COVID-19 pandemic as both local care providers and community health leaders and to identify potential supports and barriers to physician leadership. METHODS Semi-structured, virtual, qualitative interviews were completed with participants from rural communities in Canada from December 2021 to February 2022 inclusive. Participant recruitment involved identifying seed contacts and conducting snowball sampling. Participants were asked about their experiences during the COVID-19 pandemic, including the role of physician leadership in building community resilience. Data collection was completed on theoretical saturation. Data were thematically analysed using NVivo 12. RESULTS Sixty-four participants took part from 22 rural communities in 4 provinces. Four key factors were identified that supported physician leadership towards rural resilience during ecosystem disruption: (1) continuity of care, (2) team-based care models, (3) physician well-being and (4) openness to innovative care models. CONCLUSION Healthcare policy and practice transformation should prioritise developing opportunities to strengthen physician leadership, particularly in rural areas that will be adversely affected by ecosystem disruption. INTRODUCTION La pandémie de COVID-19 a représenté un défi sans précédent pour les médecins de famille en milieu rural. Les leçons tirées au cours des deux années écoulées peuvent aider à orienter les réponses aux futures perturbations de l'écosystème. Cette étude qualitative vise à explorer les expériences de leadership des médecins de famille ruraux canadiens pendant la pandémie de COVID-19, en tant que prestataires de soins locaux et chefs de file de la santé communautaire, et à identifier les soutiens et les obstacles potentiels au leadership des médecins. MTHODES Des entretiens qualitatifs virtuels semi-structurés ont été réalisés avec des participants issus de communautés rurales du Canada entre décembre 2021 et février 2022 inclus. Le recrutement des participants a consisté à identifier des contacts de base et à procéder à un échantillonnage boule de neige. Les participants ont été interrogés sur leurs expériences durant la pandémie de COVID-19, notamment sur le rôle du leadership des médecins dans le renforcement de la résilience des communautés. La collecte des données s'est achevée après saturation théorique. Les données ont été analysées thématiquement à l'aide de NVivo 12. RSULTATS Soixante-quatre participants provenant de 22 communautés rurales de quatre provinces ont pris part à l'étude. Quatre facteurs clés ont été identifiés pour soutenir le leadership des médecins en faveur de la résilience rurale en cas de perturbation de l'écosystème: (1) la continuité des soins, (2) les modèles de soins en équipe, (3) le bien-être des médecins et (4) l'ouverture à des modèles de soins novateurs. CONCLUSION La politique de santé et la transformation des pratiques devraient donner la priorité au développement d'opportunités pour renforcer le leadership des médecins, en particulier dans les zones rurales qui seront négativement affectées par la perturbation de l'écosystème.
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Affiliation(s)
- Alexandra Bland
- Department of Family Medicine, Centre for Rural Health Research, University of British Columbia, Vancouver, BC, Canada
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Stempien J, Gibson M, Harrison A. "We want to change the system": a qualitative study on emergency medicine physician leadership. CAN J EMERG MED 2024; 26:266-270. [PMID: 38520497 DOI: 10.1007/s43678-024-00667-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 01/31/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE The significance of physician leadership to help transform the healthcare system has been increasingly discussed. This study looked at the qualities of emergency medicine (EM) physicians that support or inhibit their work as healthcare leaders. METHODS Through an iterative process of semi-structured interviews and then focus groups, we examined why EM physicians pursue leadership roles, the strengths they bring and the frustrations they encounter. Thematic analysis identified factors that facilitate and inhibit the work of EM physicians as they enter leadership roles. RESULTS These findings can be summarized in four key themes. (1) A desire to improve the wider health system was often a prime motivator for entering a leadership role. (2) EM physicians' clinical skills such as confident decision-making, relationship building through communication, and comfort with uncertainty supported their successful transition to leadership. (3) EM physician leaders perceived shiftwork as both a potential benefit and a challenge in their leadership role and felt it needed to be carefully managed to ensure personal wellness and success. And (4) participants were not driven to take on leadership positions by financial remuneration but stated that the discrepancy between EM clinical and leadership compensation was a point of stress. CONCLUSION As physician leadership is explored as a mechanism to support the healthcare system's success, this project provides insights into the realities experiences by EM physicians and considerations for healthcare professionals as they encourage physicians into leadership positions.
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Affiliation(s)
- J Stempien
- University of Saskatchewan College of Medicine, Saskatoon, SK, Canada.
| | - M Gibson
- Department of Sociology, University of Saskatchewan, Saskatoon, SK, Canada
| | - A Harrison
- Royal Roads University, Vancouver, BC, Canada
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Luo OD, Razvi Y, Kaur G, Lim M, Smith K, Carson JJK, Petrin-Desrosiers C, Haldane V, Simms N, Miller FA. A qualitative study of what motivates and enables climate-engaged physicians in Canada to engage in health-care sustainability, advocacy, and action. Lancet Planet Health 2023; 7:e164-e171. [PMID: 36754472 DOI: 10.1016/s2542-5196(22)00311-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 06/18/2023]
Abstract
Increasing numbers of health-care professionals are aware of the need to deliver low-carbon sustainable health systems. We aimed to explore how physicians can be motivated and supported to pursue this ambition by conducting an exploratory qualitative descriptive study that involved individual in-depth interviews with climate-engaged Canadian physicians participating in health-care sustainability advocacy and action. Interview transcripts were analysed to identify themes related to the actions that physicians can take to promote sustainable health care, and the motivators and enablers of physician engagement in sustainable health care. Participants (n=19) engaged in a spectrum of health-care sustainability initiatives ranging from reducing health-care waste to lobbying and political action. They were motivated to advance health-care sustainability by their concern about the health implications of climate change, frustration with health-care waste, and recognition of their locus of influence as physicians. Participants articulated that policy and system, organisational and team, and knowledge generation and translation supports are required to strengthen their capacity to advance health-care sustainability. These findings can provide inspiration for engagement opportunities in health-care sustainability, guide service delivery and educational innovations to promote health-care professionals' interest in becoming sustainability champions, and extend the capacity of health-care professionals to reduce the climate impact of health care.
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Affiliation(s)
- Owen Dan Luo
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, QC, Canada
| | - Yasmeen Razvi
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Gurleen Kaur
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michelle Lim
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kelti Smith
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jacob Joel Kirsh Carson
- Department of Pediatrics, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Claudel Petrin-Desrosiers
- Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Nicole Simms
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Centre for Sustainable Health Systems, University of Toronto, Toronto, ON, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Centre for Sustainable Health Systems, University of Toronto, Toronto, ON, Canada.
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Lang M, Keenan L. Canadian medical faculty senior leaders: what skills do they need? Leadersh Health Serv (Bradf Engl) 2022; ahead-of-print. [PMID: 36000765 DOI: 10.1108/lhs-03-2022-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Many academic leaders have little formal leadership training, which can result in challenges to effective leadership, succession planning and burnout. This paper aims to explore the leadership skills needed to be an effective senior academic leader in a Canadian medical faculty. DESIGN/METHODOLOGY/APPROACH An anonymous voluntary survey of needed leadership skills and supports was sent to 60 senior academic leaders at the University of Alberta. This was followed by interviewing a purposive sample, using open-ended questions based on a multimodal needs assessment of senior academic leaders. The authors used an iterative process to analyze the data; anonymized transcripts were coded and categorized separately by two researchers, and themes were created. FINDINGS The "ability to influence" was the highest rated needed leadership skill in the survey. The interviewed leaders (n = 12) were unanimous that they felt unprepared at the start of the leadership role. The survey and interviews identified five major themes for leadership skills: Mentoring, Finances, Human Resources, Building Relationships and Protected Time. Networking and leadership courses were identified as major sources of support. RESEARCH LIMITATIONS/IMPLICATIONS Although a single site study, the results were similar to another large Canadian medical faculty (University of Toronto, Lieff et al., 2013). While the survey had a 42% response rate (25/60), the survey responses were echoed in the interviews. Although the purposive sample was small, the interviewed leaders were a representative sample of the larger leadership group. ORIGINALITY/VALUE Academic leaders may benefit from a mentorship team/community of leaders and specific university governance knowledge which may help their ability to influence and advance their strategic initiatives.
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Affiliation(s)
- Mia Lang
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Louanne Keenan
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Mathews M, Ryan D, Hedden L, Lukewich J, Marshall EG, Brown JB, Gill PS, McKay M, Wong E, Wetmore SJ, Buote R, Meredith L, Moritz L, Spencer S, Alexiadis M, Freeman TR, Letto A, Ryan BL, Sibbald SL, Terry AL. Family physician leadership during the COVID-19 pandemic: roles, functions and key supports. Leadersh Health Serv (Bradf Engl) 2022; ahead-of-print. [PMID: 35877594 DOI: 10.1108/lhs-03-2022-0030] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Strong leadership in primary care is necessary to coordinate an effective pandemic response; however, descriptions of leadership roles for family physicians are absent from previous pandemic plans. This study aims to describe the leadership roles and functions family physicians played during the COVID-19 pandemic in Canada and identify supports and barriers to formalizing these roles in future pandemic plans. DESIGN/METHODOLOGY/APPROACH This study conducted semi-structured qualitative interviews with family physicians across four regions in Canada as part of a multiple case study. During the interviews, participants were asked about their roles during each pandemic stage and the facilitators and barriers they experienced. Interviews were transcribed and a thematic analysis approach was used to identify recurring themes. FINDINGS Sixty-eight family physicians completed interviews. Three key functions of family physician leadership during the pandemic were identified: conveying knowledge, developing and adapting protocols for primary care practices and advocacy. Each function involved curating and synthesizing information, tailoring communications based on individual needs and building upon established relationships. PRACTICAL IMPLICATIONS Findings demonstrate the need for future pandemic plans to incorporate formal family physician leadership appointments, as well as supports such as training, communication aides and compensation to allow family physicians to enact these key roles. ORIGINALITY/VALUE The COVID-19 pandemic presents a unique opportunity to examine the leadership roles of family physicians, which have been largely overlooked in past pandemic plans. This study's findings highlight the importance of these roles toward delivering an effective and coordinated pandemic response with uninterrupted and safe access to primary care.
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Affiliation(s)
- Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Dana Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, St. John's, Canada
| | - Emily Gard Marshall
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, Halifax, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Paul S Gill
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | | | - Eric Wong
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Stephen J Wetmore
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Richard Buote
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, Halifax, Canada
| | - Leslie Meredith
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Lauren Moritz
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, Halifax, Canada
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Maria Alexiadis
- Department of Family Practice, Nova Scotia Health Authority, Halifax, Canada
| | - Thomas R Freeman
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Aimee Letto
- Newfoundland and Labrador Medical Association, St. John's, Canada
| | - Bridget L Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Shannon L Sibbald
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Amanda Lee Terry
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University London, Canada, and Department of Epidemiology and Biostatistics, Schulich School of Western University Medicine and Dentistry, Western University, London, Canada
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Hamlin RG, Ruiz CE, Jones J, Patel T. Toward a universalistic behavioural model of perceived managerial and leadership effectiveness for the health services sector. Health Serv Manage Res 2022; 36:89-101. [PMID: 35485323 DOI: 10.1177/09514848211065462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Much management and leadership development provision for healthcare professionals has been the subject of considerable criticism, and there have been numerous calls for training programmes explicitly focused on the specific managerial (manager/leader) behaviours healthcare managers, physician leaders and nurse managers need to exhibit to be perceived effective. The aim of our multiple cross-case/cross-nation comparative study has been to: i) identify similarities and differences between the findings of published qualitative critical incident studies of effective and ineffective managerial behaviour observed within British, Egyptian, Mexican and Romanian public hospitals, respectively, and ii) if possible, deduce from the identified commonalities a healthcare-related behavioural model of perceived managerial and leadership effectiveness. Adopting a philosophical stance informed by pragmatism, epistemological instrumentalism and abduction, we used realist qualitative analytic methods to code and classify into a maximum number of discrete behavioural categories empirical source data obtained from five previous studies. We found high degrees of empirical generalization which resulted in the identification of five positive (effective) and four negative (ineffective) behavioural dimensions (BDs) derived, respectively, from 14 positive and 9 negative deduced behavioural categories (BCs). These BDs and underpinning BCs are expressed in the form of an emergent two-factor universalistic behavioural model of perceived managerial and leadership effectiveness. We suggest the model could be used to critically evaluate the relevance and appropriateness of existing training provision for physician leaders, nurse managers and other healthcare managers/leaders in public hospitals or to design new explicit training programmes informed and shaped by healthcare-specific management research, as called for in the literature.
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Affiliation(s)
- Robert G Hamlin
- Management & Leadership, 66130University of Wolverhampton Business School, Wolverhampton, UK
| | - Carlos E Ruiz
- Georgia Gwinnett College, 216179School of Business Administration, Lawrenceville, GA, USA
| | - Jenni Jones
- Management & Leadership, 66130University of Wolverhampton Business School, Wolverhampton, UK
| | - Taran Patel
- 52837Grenoble Ecole de Management, Grenoble, France
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Snadden D, Reay T, Hanlon N, MacLeod M. Engaging primary care physicians in system change - an interpretive qualitative study in a remote and rural health region in Northern British Columbia, Canada. BMJ Open 2019; 9:e028395. [PMID: 31142534 PMCID: PMC6549631 DOI: 10.1136/bmjopen-2018-028395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe how physicians were engaged in primary healthcare system change in a remote and rural Canadian health authority. DESIGN A qualitative interpretive study based on a hermeneutic approach. METHODS 34 transcribed in-depth interviews with physicians and administrators relevant to physician engagement were purposively sampled from a larger data set of 239 interviews gathered over a 3-year period from seven communities engaged in primary healthcare transformation. Interviews were coded and analysed interpretively to develop common themes. SETTING This research is part of a larger study, Partnering for Change I, which investigated the efforts of Northern Health, a rural regional health authority in British Columbia, to transform its healthcare system to one grounded in primary care with a focus on interdisciplinary teams. It reports how physician engagement was accomplished during the first 3 years of the study. PARTICIPANTS Interviews with 34 individuals with direct involvement and experience in the processes of physician engagement. These included 10 physicians, three Regional Executives, 18 Primary Healthcare coordinators and three Division of Family Practice leads. RESULTS Three major interconnected themes that depicted the process of engagement were identified: working through tensions constructively, drawing on structures for engagement and facilitating relationships. CONCLUSIONS Physician engagement was recognised as a priority by Northern Health in its efforts to create system change. This was facilitated by the creation of Divisions of Family Practice that provided a structure for dialogue and facilitated a common voice for physicians. Divisions helped to build trust between various groups through allowing constructive conversations to surface and deal with tensions. Local context mattered. Flexibility in working from local priorities was a critical part of developing relationships that facilitated the design and implementation of system reform.
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Affiliation(s)
- David Snadden
- Department of Family Practice, University of British Columbia, Faculty of Medicine, Northern Medical Program, Prince George, British Columbia, Canada
| | - Trish Reay
- School of Business, University of Alberta, Edmonton, Alberta, Canada
| | - Neil Hanlon
- Geography, University of Northern British Columbia, Prince George, Canada
| | - Martha MacLeod
- Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada
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Sonnenberg LK, Pritchard-Wiart L, Busari J. The resident physician as leader within the healthcare team. Leadersh Health Serv (Bradf Engl) 2018; 31:167-182. [PMID: 29771225 DOI: 10.1108/lhs-08-2017-0046] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study was to explore inter-professional clinicians' perspectives on resident leadership in the context of inter-professional teams and to identify a definition for leadership in the clinical context. In 2015, CanMEDS changed the title of one of the core competencies from manager to leader. The shift in language was perceived by some as returning to traditional hierarchical and physician-dominant structures. The resulting uncertainty has resulted in a call to action to not only determine what physician leadership is but to also determine how to teach and assess it. Design/methodology/approach Focus groups and follow-up individual interviews were conducted with 23 inter-professional clinicians from three pediatric clinical service teams at a large, Canadian tertiary-level rehabilitation hospital. Qualitative thematic analysis was used to inductively analyze the data. Findings Data analysis resulted in one overarching theme: leadership is collaborative - and three related subthemes: leadership is shared; leadership is summative; and conceptualizations of leadership are shifting. Research limitations/implications Not all members of the three inter-professional teams were able to attend the focus group sessions because of scheduling conflicts. Participation of additional clinicians could have, therefore, affected the results of this study. The study was conducted locally at a single rehabilitation hospital, among Canadian pediatric clinicians, which highlights the need to explore conceptualization of leadership across different contexts. Practical implications There is an evident need to prepare physicians to be leaders in both their daily clinical and academic practices. Therefore, more concerted efforts are required to develop leadership skills among residents. The authors postulate that continued integration of various inter-professional disciplines during the early phases of training is essential to foster collaborative leadership and trust. Originality/value The results of this study suggest that inter-professional clinicians view clinical leadership as collaborative and fluid and determined by the fit between tasks and team member expertise. Mentorship is important for increasing the ability of resident physicians to develop collaborative leadership roles within teams. The authors propose a collaborative definition of clinical leadership based on the results of this study: a shared responsibility that involves facilitation of dialog; the integration of perspectives and expertise; and collaborative planning for the purpose of exceptional patient care.
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Affiliation(s)
- Lyn Kathryn Sonnenberg
- Department of Paediatrics, University of Alberta , Edmonton, Canada and Glenrose Rehabilitation Hospital, Edmonton, Canada
| | - Lesley Pritchard-Wiart
- Department of Physical Therapy, University of Alberta , Edmonton, Canada and Glenrose Rehabilitation Hospital, Edmonton, Canada
| | - Jamiu Busari
- Department of Pediatrics, Zuyderland Medical Center, Heerlen, The Netherlands and Department of Educational Development and Research, Maastricht University , Maastricht, The Netherlands
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