1
|
Debets M, Jansen I, Lombarts K, Kuijer-Siebelink W, Kruijthof K, Steinert Y, Daams J, Silkens M. Linking leadership development programs for physicians with organization-level outcomes: a realist review. BMC Health Serv Res 2023; 23:783. [PMID: 37480101 PMCID: PMC10362722 DOI: 10.1186/s12913-023-09811-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Hospitals invest in Leadership Development Programs (LDPs) for physicians, assuming they benefit the organization's performance. Researchers have listed the advantages of LDPs, but knowledge of how and why organization-level outcomes are achieved is missing. OBJECTIVE To investigate how, why and under which circumstances LDPs for physicians can impact organization-level outcomes. METHODS We conducted a realist review, following the RAMESES guidelines. Scientific articles and grey literature published between January 2010 and March 2021 evaluating a leadership intervention for physicians in the hospital setting were considered for inclusion. The following databases were searched: Medline, PsycInfo, ERIC, Web of Science, and Academic Search Premier. Based on the included documents, we developed a LDP middle-range program theory (MRPT) consisting of Context-Mechanism-Outcome configurations (CMOs) describing how specific contexts (C) trigger certain mechanisms (M) to generate organization-level outcomes (O). RESULTS In total, 3904 titles and abstracts and, subsequently, 100 full-text documents were inspected; 38 documents with LDPs from multiple countries informed our MRPT. The MRPT includes five CMOs that describe how LDPs can impact the organization-level outcomes categories 'culture', 'quality improvement', and 'the leadership pipeline': 'Acquiring self-insight and people skills (CMO1)', 'Intentionally building professional networks (CMO2)', 'Supporting quality improvement projects (CMO3)', 'Tailored LDP content prepares physicians (CMO4)', and 'Valuing physician leaders and organizational commitment (CMO5)'. Culture was the outcome of CMO1 and CMO2, quality improvement of CMO2 and CMO3, and the leadership pipeline of CMO2, CMO4, and CMO5. These CMOs operated within an overarching context, the leadership ecosystem, that determined realizing and sustaining organization-level outcomes. CONCLUSIONS LDPs benefit organization-level outcomes through multiple mechanisms. Creating the contexts to trigger these mechanisms depends on the resources invested in LDPs and adequately supporting physicians. LDP providers can use the presented MRPT to guide the development of LDPs when aiming for specific organization-level outcomes.
Collapse
Affiliation(s)
- Maarten Debets
- Amsterdam UMC, Medical Psychology, Univ of Amsterdam, Amsterdam Public Health, AMC, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
| | - Iris Jansen
- Amsterdam UMC, Medical Psychology, Univ of Amsterdam, Amsterdam Public Health, AMC, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands
| | - Kiki Lombarts
- Amsterdam UMC, Medical Psychology, Univ of Amsterdam, Amsterdam Public Health, AMC, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands
| | - Wietske Kuijer-Siebelink
- School of Education, Research On Responsive Vocational and Professional Education, HAN University of Applied Sciences, Nijmegen, Netherlands
- Research On Learning and Education, Radboud University Medical Centre, Radboudumc Health Academy, Nijmegen, Netherlands
| | - Karen Kruijthof
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, De Boelelaan 1117, Amsterdam, Netherlands
| | - Yvonne Steinert
- Faculty of Medicine and Health Sciences, Institute of Health Sciences Education, McGill University, Montreal, Canada
| | - Joost Daams
- Medical Library, Amsterdam University Medical Centers, Amsterdam, Noord-Holland, Netherlands
| | - Milou Silkens
- Department of Health Services Research & Management, City University of London, London, UK
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, Netherlands
| |
Collapse
|
2
|
Naehrig D, Schokman A, Hughes JK, Epstein R, Hickie IB, Glozier N. Effect of interventions for the well-being, satisfaction and flourishing of general practitioners-a systematic review. BMJ Open 2021; 11:e046599. [PMID: 34408036 PMCID: PMC8375719 DOI: 10.1136/bmjopen-2020-046599] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Clinician well-being has been recognised as an important pillar of healthcare. However, research mainly addresses mitigating the negative aspects of stress or burnout, rather than enabling positive aspects. With the added strain of a pandemic, identifying how best to maintain and support the well-being, satisfaction and flourishing of general practitioners (GPs) is now more important than ever. DESIGN Systematic review. DATA SOURCES We searched MEDLINE, PsycINFO, Embase, CINAHL and Scopus from 2000 to 2020. STUDY SELECTION Intervention studies with more than 50% GPs in the sample evaluating self-reported well-being, satisfaction and related positive outcomes were included. The Cochrane Risk of Bias 2 tool was applied. RESULTS We retrieved 14 792 records, 94 studies underwent full-text review. We included 19 studies in total. Six randomised controlled trials, three non-randomised, controlled trials, eight non-controlled studies of individual or organisational interventions with a total of 1141 participants. There were two quasi-experimental articles evaluating health system policy change. Quantitative and qualitative positive outcomes were extracted and analysed. Individual mindfulness interventions were the most common (k=9) with medium to large within-group (0.37-1.05) and between-group (0.5-1.5) effect sizes for mindfulness outcomes, and small-to-medium effect sizes for other positive outcomes including resilience, compassion and empathy. Studies assessing other intervention foci or other positive outcomes (including well-being, satisfaction) were of limited size and quality. CONCLUSIONS There is remarkably little evidence on how to improve GPs well-being beyond using mindfulness interventions, particularly for interventions addressing organisational or system factors. This was further undermined by inconsistent reporting, and overall high risk of bias. We need to conduct research in this space with the same rigour with which we approach clinical intervention studies in patients. PROSPERO REGISTRATION NUMBER CRD42020164699. FUNDING SOURCE Dr Diana Naehrig is funded through the Raymond Seidler PhD scholarship.
Collapse
Affiliation(s)
- Diana Naehrig
- The Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Aaron Schokman
- The Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | | | - Ronald Epstein
- Family Medicine Research Programs, University of Rochester School of Medicine, Rochester, New York, USA
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Nick Glozier
- The Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| |
Collapse
|
3
|
Urrila LI. From personal wellbeing to relationships: A systematic review on the impact of mindfulness interventions and practices on leaders. HUMAN RESOURCE MANAGEMENT REVIEW 2021. [DOI: 10.1016/j.hrmr.2021.100837] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
4
|
Aeschbach VM, Fendel JC, Schmidt S, Göritz AS. A tailored mindfulness-based program for resident physicians: A qualitative study. Complement Ther Clin Pract 2021; 43:101333. [PMID: 33601285 DOI: 10.1016/j.ctcp.2021.101333] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 01/14/2021] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Diminished well-being is prevalent in resident physicians. This qualitative study explored the effects of a tailored mindfulness-based program (MBP) aimed at increasing resident physicians' well-being. A second goal was to compare the MBP with an active control group. MATERIALS AND METHODS We conducted interviews with 35 resident physicians: 21 physicians attended an eight-week MBP (intervention group) and 14 physicians received text-based information about mindfulness for self-study (control group). The interviews were analyzed using thematic analysis. RESULTS Participants in the intervention group reported that the MBP helped them integrate mindfulness into their everyday life, increased their self-awareness, equanimity and well-being, and had positive effects on their self-care and interactions with patients. In the control group, the perceived effects were minor. CONCLUSION A tailored mindfulness-based program can help resident physicians care for their own well-being during medical residency and can have positive effects on their interactions with patients.
Collapse
Affiliation(s)
- Vanessa M Aeschbach
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstraße 8, 79104, Freiburg, Germany; Department of Occupational and Consumer Psychology, Institute of Psychology, University of Freiburg, Engelbergerstraße 41, 79106, Freiburg, Germany.
| | - Johannes C Fendel
- Department of Occupational and Consumer Psychology, Institute of Psychology, University of Freiburg, Engelbergerstraße 41, 79106, Freiburg, Germany
| | - Stefan Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstraße 8, 79104, Freiburg, Germany
| | - Anja S Göritz
- Department of Occupational and Consumer Psychology, Institute of Psychology, University of Freiburg, Engelbergerstraße 41, 79106, Freiburg, Germany
| |
Collapse
|
5
|
Kersemaekers WM, Vreeling K, Verweij H, van der Drift M, Cillessen L, van Dierendonck D, Speckens AEM. Effectiveness and feasibility of a mindful leadership course for medical specialists: a pilot study. BMC MEDICAL EDUCATION 2020; 20:34. [PMID: 32019524 PMCID: PMC7001198 DOI: 10.1186/s12909-020-1948-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 01/24/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Medical specialists experience high levels of stress. This has an impact on their well-being, but also on quality of their leadership. In the current mixed method study, the feasibility and effectiveness of a course Mindful Leadership on burnout, well-being and leadership skills of medical specialists were evaluated. METHODS This is a non-randomized controlled pre-post evaluation using self-report questionnaires administered at 3 months before (control period), start and end of the training (intervention period). Burn-out symptoms, well-being and leadership skills were assessed with self-report questionnaires. Semi-structured interviews were used to qualitatively evaluate barriers and facilitators for completion of the course. RESULTS From September 2014 to June 2016, 52 medical specialists participated in the study. Of these, 48 (92%) completed the course. Compared to the control period, the intervention period resulted in greater reductions of depersonalization (mean difference = - 1.2, p = 0.06), worry (mean difference = - 4.3, p = 0.04) and negative work-home interference (mean difference = - 0.2, p = 0.03), and greater improvements of mindfulness (mean difference = 0.5, p = 0.04), life satisfaction (mean difference = 0.4, p = 0.01) and self-reported ethical leadership (mean difference = 0.1, p = 0.02). Effect sizes were generally small to medium (0.3 to 0.6) and large for life satisfaction (0.8). Appreciation of course elements was a major facilitator and the difficulty of finding time a major barrier for participating. CONCLUSIONS A 'Mindful Leadership' course was feasible and not only effective in reducing burnout symptoms and improving well-being, but also appeared to have potential for improving leadership skills. Mindful leadership courses could be a valuable part of ongoing professional development programs for medical specialists.
Collapse
Affiliation(s)
- Wendy M. Kersemaekers
- Radboudumc Center for Mindfulness, Department of Psychiatry, Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Kiki Vreeling
- Radboudumc Center for Mindfulness, Department of Psychiatry, Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Hanne Verweij
- Radboudumc Center for Mindfulness, Department of Psychiatry, Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Miep van der Drift
- Department of Respiratory Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Linda Cillessen
- Radboudumc Center for Mindfulness, Department of Psychiatry, Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Dirk van Dierendonck
- Department of Organisation and Personnel Management, Rotterdam School of Management, Erasmus University, Rotterdam, The Netherlands
| | - Anne E. M. Speckens
- Radboudumc Center for Mindfulness, Department of Psychiatry, Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| |
Collapse
|