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Thoebes GP, Porter TH, Peck JA. Physicians as leaders: a systematic review through the lens of expert leadership. Leadersh Health Serv (Bradf Engl) 2023; ahead-of-print. [PMID: 37470328 DOI: 10.1108/lhs-02-2023-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
PURPOSE The purpose of this paper is to provide a systematic review of the current state of physician leadership. Theory of expert leadership (TEL) was applied to explore the effects of physician inherent knowledge, industry experience and leadership capabilities on leader behaviors and outcomes. DESIGN/METHODOLOGY/APPROACH This review (August 2011-February 2022) applied the preferred reporting items for systematic review and meta-analysis strategy. Our search began with 3,537 studies and a final sample of 12 articles. FINDINGS The findings offer a number of studies that note the relationship between physician leadership and the three dimensions of TEL. How influential these are on leadership behaviors and health-related outcomes varies. We also found a number of studies that described general physician leadership behaviors that were not directly linked to factors of TEL, as well as two additional themes: leader identity and trust. ORIGINALITY/VALUE To the best of the authors' knowledge, this is the first systematic review that has applied a highly cited theory (i.e. TEL) to the data and the first that has focused solely on a U.S. population. These findings offer healthcare organizations insight into the potential strengths and challenges of physician leadership.
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Affiliation(s)
- Gina Phelps Thoebes
- Mandel Global Leadership and Learning Institute, Cleveland Clinic, Cleveland, Ohio, USA and Department of Psychology, University of Akron, Akron, Ohio, USA
| | - Tracy H Porter
- Department of Management, Cleveland State University, Cleveland, Ohio, USA
| | - Jessica A Peck
- Department of Management, Cleveland State University, Cleveland, Ohio, USA
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Savage M, Savage C, Brommels M, Mazzocato P. Medical leadership: boon or barrier to organisational performance? A thematic synthesis of the literature. BMJ Open 2020; 10:e035542. [PMID: 32699130 PMCID: PMC7375428 DOI: 10.1136/bmjopen-2019-035542] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The influx of management ideas into healthcare has triggered considerable debate about if and how managerial and medical logics can coexist. Recent reviews suggest that clinician involvement in hospital management can lead to superior performance. We, therefore, sought to systematically explore conditions that can either facilitate or impede the influence of medical leadership on organisational performance. DESIGN Systematic review using thematic synthesis guided by the Enhancing Transparency in Reporting the synthesis of Qualitative research statement. DATA SOURCES We searched PubMed, Web of Science and PsycINFO from 1 January 2006 to 21 January 2020. ELIGIBILITY CRITERIA We included peer-reviewed, empirical, English language articles and literature reviews that focused on physicians in the leadership and management of healthcare. DATA EXTRACTION AND SYNTHESIS Data extraction and thematic synthesis followed an inductive approach. The results sections of the included studies were subjected to line-by-line coding to identify relevant meaning units. These were organised into descriptive themes and further synthesised into analytic themes presented as a model. RESULTS The search yielded 2176 publications, of which 73 were included. The descriptive themes illustrated a movement from 1. medical protectionism to management through medicine; 2. command and control to participatory leadership practices; and 3. organisational practices that form either incidental or willing leaders. Based on the synthesis, the authors propose a model that describes a virtuous cycle of management through medicine or a vicious cycle of medical protectionism. CONCLUSIONS This review helps individuals, organisations, educators and trainers better understand how medical leadership can be both a boon and a barrier to organisational performance. In contrast to the conventional view of conflicting logics, medical leadership would benefit from a more integrative model of management and medicine. Nurturing medical engagement requires participatory leadership enabled through long-term investments at the individual, organisational and system levels.
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Affiliation(s)
- Mairi Savage
- Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Carl Savage
- Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Mats Brommels
- Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Pamela Mazzocato
- Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Perreira TA, Perrier L, Prokopy M, Neves-Mera L, Persaud DD. Physician engagement: a concept analysis. J Healthc Leadersh 2019; 11:101-113. [PMID: 31440112 PMCID: PMC6666374 DOI: 10.2147/jhl.s214765] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/02/2019] [Indexed: 12/13/2022] Open
Abstract
The term "physician engagement" is used quite frequently, yet it remains poorly defined and measured. The aim of this study is to clarify the term "physician engagement." This study used an eight step-method for conducting concept analyses created by Walker and Avant. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched on February 14, 2019. No limitations were put on the searches with regard to year or language. Results identify that the term "physician engagement" is regular participation of physicians in (1) deciding how their work is done, (2) making suggestions for improvement, (3) goal setting, (4) planning, and (5) monitoring of their performance in activities targeted at the micro (patient), meso (organization), and/or macro (health system) levels. The antecedents of "physician engagement" include accountability, communication, incentives, interpersonal relations, and opportunity. The results include improved outcomes such as data quality, efficiency, innovation, job satisfaction, patient satisfaction, and performance. Defining physician engagement enables physicians and health care administrators to better appreciate and more accurately measure engagement and understand how to better engage physicians.
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Affiliation(s)
- Tyrone A Perreira
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Legal, Policy and Professional Issues, Ontario Hospital Association, Toronto, Ontario, Canada
| | - Laure Perrier
- University of Toronto Libraries, University of Toronto, Toronto, Ontario, Canada
| | - Melissa Prokopy
- Legal, Policy and Professional Issues, Ontario Hospital Association, Toronto, Ontario, Canada
| | - Lina Neves-Mera
- Legal, Policy and Professional Issues, Ontario Hospital Association, Toronto, Ontario, Canada
| | - D David Persaud
- School of Health Administration at Dalhousie University, Dalhousie University, Halifax, Nova Scotia, Canada
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Rabkin SW, Dahl M, Patterson R, Mallek N, Straatman L, Pinfold A, Charles MK, van Gaal S, Wong S, Vaghadia H. Physician engagement: the Vancouver Medical Staff Association engagement charter. Clin Med (Lond) 2019; 19:278-281. [PMID: 31308103 PMCID: PMC6752238 DOI: 10.7861/clinmedicine.19-4-278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Engagement of physicians with their healthcare community or institution should be a central issue in healthcare because it can be translated into improved patient care, enhanced well-being for physicians as well as safer, more effective and less costly healthcare. To accomplish the mission/goal of meaningful physician engagement, we set about to establish a 'charter' for physician engagement. We defined our concept of meaningful physician engagement and customised the engagement spectrum construct for physician relationship with their healthcare community or institution. While recognising the importance of physician leaders within the hierarchical system for efficacy of organisational management, relying only on physicians in formal executive positions is insufficient for developing physician engagement. There is a need for widespread physician engagement across the organisation. The objective is both an improvement in patient care and in physician well-being.
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Affiliation(s)
- Simon W Rabkin
- Vancouver General Hospital, Vancouver, Canada and president of medical staff, Vancouver Medical, Dental and Allied Staff Association, Vancouver, Canada
| | - Marshall Dahl
- University of British Columbia and Vancouver Hospital, Vancouver, Canada and former president of medical staff, Vancouver Medical, Dental and Allied Staff Association, Vancouver, Canada
| | - Ryan Patterson
- Vancouver General Hospital, Vancouver, Canada and vice president of medical staff, Vancouver Medical, Dental and Allied Staff Association, Vancouver, Canada
| | - Noa Mallek
- Vancouver General Hospital, Vancouver, Canada and secretary medical staff, Vancouver Medical, Dental and Allied Staff Association, Vancouver, Canada
| | - Lynn Straatman
- University of British Columbia, medical director cardiac function clinic, Vancouver Hospital, Vancouver, Canada and chair advocacy committee, Vancouver Medical, Dental and Allied Staff Association, Vancouver, Canada
| | | | - Marthe Kenny Charles
- University of British Columbia, medical microbiologist, Vancouver General Hospital, Vancouver, Canada
| | - Stephen van Gaal
- University of British Columbia, staff neurologist, Vancouver General Hospital, Vancouver, Canada
| | - Sophia Wong
- University of British Columbia, medical lead, Vancouver Coastal Health Laboratories, program director, UBC Medical Biochemistry Residency Training Program, Medical Biochemist, Vancouver General Hospital, Vancouver, Canada
| | - Himat Vaghadia
- University of British Columbia, staff anaesthesiologist, Vancouver General Hospital, Vancouver, Canada
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de Jager E, McKenna C, Bartlett L, Gunnarsson R, Ho YH. Postoperative Adverse Events Inconsistently Improved by the World Health Organization Surgical Safety Checklist: A Systematic Literature Review of 25 Studies. World J Surg 2017; 40:1842-58. [PMID: 27125680 PMCID: PMC4943979 DOI: 10.1007/s00268-016-3519-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The World Health Organization Surgical Safety Checklist (SSC) has been widely implemented in an effort to decrease surgical adverse events. METHOD This systematic literature review examined the effects of the SSC on postoperative outcomes. The review included 25 studies: two randomised controlled trials, 13 prospective and ten retrospective cohort trials. A meta-analysis was not conducted as combining observational studies of heterogeneous quality may be highly biased. RESULTS The quality of the studies was largely suboptimal; only four studies had a concurrent control group, many studies were underpowered to examine specific postoperative outcomes and teamwork-training initiatives were often combined with the implementation of the checklist, confounding the results. The effects of the checklist were largely inconsistent. Postoperative complications were examined in 20 studies; complication rates significantly decreased in ten and increased in one. Eighteen studies examined postoperative mortality. Rates significantly decreased in four and increased in one. Postoperative mortality rates were not significantly decreased in any studies in developed nations, whereas they were significantly decreased in 75 % of studies conducted in developing nations. CONCLUSIONS The checklist may be associated with a decrease in surgical adverse events and this effect seems to be greater in developing nations. With the observed incongruence between specific postoperative outcomes and the overall poor study designs, it is possible that many of the positive changes associated with the use of the checklist were due to temporal changes, confounding factors and publication bias.
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Affiliation(s)
- Elzerie de Jager
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4814, Australia.
| | - Chloe McKenna
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4814, Australia
| | - Lynne Bartlett
- College of Public Health, Medical & Veterinary Sciences, The Townsville Hospital, Townsville, QLD, 4814, Australia
| | - Ronny Gunnarsson
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.,Research and Development Unit, Primary Health Care and Dental Care Narhalsan, Southern Älvsborg County, Region Västra Götaland, Sweden.,Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Yik-Hong Ho
- International College of Surgeons, Chicago, IL, USA.,Department of Surgery, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
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Abstract
PURPOSE OF REVIEW This article describes the recent literature on using extrinsic and intrinsic motivators to improve performance on core processes of care, highlighting literature that describes general frameworks for quality improvement work. RECENT FINDINGS The literature supporting the effectiveness of extrinsic motivators to improve quality is generally positive for public reporting of performance, with mixed results for pay-for-performance. A four-element quality improvement framework developed by The Armstrong Institute at Johns Hopkins Medicine was developed with intrinsic motivation in mind. The clear definition and communication of goals are important for quality improvement work. Training clinicians in improvement science, such as lean sigma, teamwork, or culture change provides clinicians with the skills they need to drive the improvement work. Peer learning communities offer the opportunity for clinicians to engage with each other and offer support in their work. The transparent reporting of performance helps ensure accountability of performance ranging from individual clinicians to governance. SUMMARY Quality improvement work that is led by and engages clinicians offers the opportunity for the work to be both meaningful and sustainable. The literature supports approaching quality improvement work in a systematic way, including the key elements of communication, infrastructure building, training, transparency, and accountability.
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