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Barry ES, Teunissen P, Varpio L. Followership in interprofessional healthcare teams: a state-of-the-art narrative review. BMJ LEADER 2023:leader-2023-000773. [PMID: 37696538 DOI: 10.1136/leader-2023-000773] [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: 02/24/2023] [Accepted: 08/22/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE A state-of-the-art (SotA) literature review-a type of narrative review- was conducted to answer: What historical developments led to current conceptualisations of followership in interprofessional healthcare teams (IHTs)? DESIGN Working from a constructivist orientation, SotA literature reviews generate a chronological overview of how knowledge evolved and presents this summary in three parts: (1) this is where we are now, (2) this is how we got here and (3) this is where we should go next. Using the SotA six-stage methodology, a total of 48 articles focused on followership in IHTs were used in this study. RESULTS Articles about followership within IHTs first appeared in 1993. Until 2011, followership was framed as leader-centric; leaders used their position to influence followers to uphold their dictums. This perspective was challenged when scholars outside of healthcare emphasised the importance of team members for achieving goals, rejecting a myopic focus on physicians as leaders. Today, followership is an important focus of IHT research but two contradictory views are present: (1) followers are described as active team members in IHTs where shared leadership models prevail and (2) conceptually and practically, old ways of thinking about followership (ie, followers are passive team members) still occur. This incongruity has generated a variable set of qualities associated with good followership. CONCLUSIONS Leadership and followership are closely linked concepts. For leaders and followers in today's IHTs to flourish, the focus must be on followers being active members of the team instead of passive members. Since theories are increasingly encouraging distributed leadership, shared leadership and/or situational leadership, then we must understand the followership work that all team members need to harness. We need to be cognizant of team dynamics that work within different contexts and use leadership and followership conceptualisations that are congruent with those contexts.
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Affiliation(s)
- Erin S Barry
- Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Pim Teunissen
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Lara Varpio
- Department of Pediatrics, Perelman School of Medicine at the University, Philadelphia, Pennsylvania, USA
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McKimm J, Ramani S, Forrest K, Bishop J, Findyartini A, Mills C, Hassanien M, Al-Hayani A, Jones P, Nadarajah VD, Radu G. Adaptive leadership during challenging times: Effective strategies for health professions educators: AMEE Guide No. 148. MEDICAL TEACHER 2023; 45:128-138. [PMID: 35543323 DOI: 10.1080/0142159x.2022.2057288] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Leadership and management are becoming increasingly recognised as vital for high-performing organisations and teams in health professions education. It is often difficult for those embarking on leadership activities (as well as more experienced leaders) to find their way through the volume of literature and generic information on the topic. This guide aims to provide a framework for developing educators' understanding of leadership, management, and followership in the context of health professions education. It explains many relevant approaches to leadership and suggests various strategies through which educators can develop their practice to become more effective.
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Affiliation(s)
- Judy McKimm
- Swansea University Medical School, Wales, UK
- Department of Internal Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Subha Ramani
- Harvard Medical School, Boston, USA
- Massachusetts General Hospital Institute for Health Professions Education, Boston, USE
- Honorary Professor of Medical Education, University of Manchester, Manchester, UK
| | - Kirsty Forrest
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Jo Bishop
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Ardi Findyartini
- Head of Medical Education Unit and Head of Cluster, Centre for Medical Education, Indonesia Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Chloe Mills
- Department of Applied Linguistics, Swansea University, Swansea, UK
| | - Mohammed Hassanien
- Department of Clinical Biochemistry & Medicasl Education, College of Pharmacy Practice, King Abdulaziz University, Jeddah, Saudi Arabia
- College of Medicine, Tanta University, Tanta, Egypt
| | - Abdulmonem Al-Hayani
- Anatomy, Department of Anatomy, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Paul Jones
- Faculty of Medicine & Health Sciences, Swansea University, Swansea, UK
| | - Vishna Devi Nadarajah
- Institutional Development at the International Medical University, Kuala Lumpur, Malaysia
| | - Greg Radu
- Departement of Psychiatry, Memorial University, St. Clare's Hospital, St. John's, Canada
- Department of Health and Community Services, Government of Newfoundland and Labrador, St John's, Canada
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Akamine Y, Imafuku R, Saiki T, Lee-Jayaram J, Berg BW, Suzuki Y. Physicians' perceptions of followership in resuscitation in Japan and the USA: a qualitative study. BMJ Open 2021; 11:e047860. [PMID: 34373302 PMCID: PMC8354256 DOI: 10.1136/bmjopen-2020-047860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES While leadership is accepted as a crucial aspect of a successful resuscitation team, the role of followership has not been sufficiently explored. This study aims to explore physicians' perceptions of common favourable followership in resuscitation teams in two different countries. DESIGN A qualitative study with interviews and a reflexive thematic analysis. SETTING The authors individually interviewed critical care and emergency physicians whose clinical experience exceeded 6 years in Japan and the USA. PARTICIPANTS A total of 18 physicians participated in a face-to-face, semistructured and in-depth interviews. RESULTS Five themes and nine subthemes related to followership in resuscitation were identified. Under technical skills, two themes (being knowledgeable and skilled) and three subthemes (understanding guidelines/algorithms, clinical course and being competent with procedural skills), were generated. Under non-technical skills, three themes (assuming roles, team communication and flattening hierarchy) and six subthemes (taking roles spontaneously, calm tone of voice, sharing information, closed-loop communication, respectful attitude and speaking up), were generated. Each generated theme involved commonly perceived favourable attributes of followership in resuscitation teams by experienced critical care and emergency physicians in both countries. CONCLUSIONS This study clarified physicians' perception of common favourable followership attributes in resuscitation teams, both in Japan and in the USA. The results of this study shed light on followership-focused resuscitation education, where followership skills are generally underestimated.
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Affiliation(s)
- Yoko Akamine
- Division of Medical Education, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Rintaro Imafuku
- Division of Medical Education, Graduate School of Medicine, Gifu University, Gifu, Japan
- Medical Education Development Center, Gifu University, Gifu, Japan
| | - Takuya Saiki
- Division of Medical Education, Graduate School of Medicine, Gifu University, Gifu, Japan
- Medical Education Development Center, Gifu University, Gifu, Japan
| | - Jannet Lee-Jayaram
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
| | - Benjamin W Berg
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
| | - Yasuyuki Suzuki
- Division of Medical Education, Graduate School of Medicine, Gifu University, Gifu, Japan
- Medical Education Development Center, Gifu University, Gifu, Japan
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Boardman N, Munro-Berry J, McKimm J. The leadership and followership challenges of doctors in training during the COVID-19 pandemic. Br J Hosp Med (Lond) 2021; 82:1-9. [PMID: 33646028 DOI: 10.12968/hmed.2021.0021] [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] [Indexed: 12/16/2022]
Abstract
Research carried out in 2016 by the authors investigated the challenges that doctors in training experience around leadership and followership in the NHS. The study explored contemporary healthcare leadership culture and the role of followership from the perspective of early career doctors. It found that the leadership and followership challenges for these doctors in training were associated with issues of social and professional identity, communication, the medical hierarchy, and relationships with senior colleagues (support and trust). These challenges were exacerbated by the busy and turbulent clinical environment in which they worked. To cope with various clinical situations and forms of leadership, doctors in training engage in a range of different followership behaviours and strategies. The study raised implications for medical education and training and suggested that followership should be included as part of formal training in communication and team working skills. The importance of both leadership and followership in the delivery of safe and effective patient care has been brought sharply into focus by the COVID-19 pandemic. This article revisits these challenges in light of the pandemic and its impact on the experiences of doctors in training.
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Affiliation(s)
- Nathan Boardman
- Department of General Internal Medicine, Sandwell and West Birmingham Hospitals, Birmingham, UK
| | | | - Judy McKimm
- Department of Medical Education, Swansea University, Swansea, UK
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Kumar B, Swee ML, Suneja M. The ecology of program director leadership: power relationships and characteristics of effective program directors. BMC MEDICAL EDUCATION 2019; 19:436. [PMID: 31752808 PMCID: PMC6873656 DOI: 10.1186/s12909-019-1869-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 11/08/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Program directors are often perceived as strong and independent leaders within the academic medical environment. However, they are not as omnipotent as they initially appear. Indeed, PDs are beholden to a variety of different agents, including trainees (current residents, residency applicants, residency alumni), internal influencers (departmental faculty, hospital administration, institutional graduate medical education), and external influencers (the Accreditation Council for Graduate Medical Education (ACGME), medical education community, and society-at-large). Altogether, these agents form a complex ecosystem whose dynamics and relationships shape the effectiveness of program directors. MAIN BODY This perspective uses management theory to examine the characteristics of effective PD leadership. We underline the importance of authority, accessibility, adaptability, authenticity, accountability, and autonomy as core features of successful program directors. Additionally, we review how program directors can use the six power bases (legitimacy, referent, informational, expert, reward, and coercive) to achieve positive and constructive change within the complexity of the academic medical ecosystem. Lastly, we describe how local and national institutions can better structure power relationships within the ecosystem so that PD leadership can be most effective. CONCLUSION Keen leadership skills are required by program directors to face a variety of challenges within their educational environments. Understanding power structures and relationships may aid program directors to exercise leadership judiciously towards fulfilling the educational missions of their departments.
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Affiliation(s)
- Bharat Kumar
- Division of Immunology, Department of Internal Medicine, University of Iowa, Iowa City, Iowa USA
| | - Melissa L. Swee
- Division of Immunology, Department of Internal Medicine, University of Iowa, Iowa City, Iowa USA
| | - Manish Suneja
- Division of Immunology, Department of Internal Medicine, University of Iowa, Iowa City, Iowa USA
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Maile E, McKimm J, Till A. Exploring medical leader identity and its formation. Leadersh Health Serv (Bradf Engl) 2019; 32:584-599. [PMID: 31612786 DOI: 10.1108/lhs-12-2018-0066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE "Becoming" a doctor involves the acquisition of medical knowledge, skills and professional identity. Medical professional identity formation (MPIF) is complex, multi-factorial and closely linked to societal expectations, personal and social identity. Increasingly, doctors are required to engage in leadership/management involving significant identity shift. This paper aims to explore medical professional identity (MPI) and MPIF in relation to doctors as leaders. Selected identity theories are used to enrich the understanding of challenges facing doctors in leadership situations and two concepts are introduced: medical leader identity (MLI) and medical leader identity formation (MLIF) and consideration given to how they can be nurtured within medical practice. DESIGN/METHODOLOGY/APPROACH A rapid conceptual review of relevant literature was carried out to identify a set of relevant concepts and theories that could be used to develop a new conceptual framework for MLI and MLIF. FINDINGS MLIF is crucial for doctors to develop as medical leaders, and, like MPIF, the process begins before medical school with both identities influenced, shaped and challenged throughout doctors' careers. Individuals require support in developing awareness that their identities are multiple, nested, interconnected and change over time. ORIGINALITY/VALUE This paper draws on concepts from wider literature on professional identity, in relation to how doctors might develop their MLI alongside their MPI. It offers a new perspective on MPI in the light of calls on doctors to "become and be healthcare leaders" and introduces the new concepts of MLI and MLIF.
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Affiliation(s)
- Emily Maile
- Health Education England East Midlands, Nottingham, UK
| | - Judy McKimm
- School of Medicine, Swansea University , Swansea, UK
| | - Alex Till
- Health Education England North West, Manchester, UK and School of Medicine, Swansea University , Swansea, UK
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Till A, McKimm J, Swanwick T. Twelve tips for integrating leadership development into undergraduate medical education. MEDICAL TEACHER 2018; 40:1214-1220. [PMID: 29073824 DOI: 10.1080/0142159x.2017.1392009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Healthcare systems need effective leadership. All healthcare professionals can and should "learn to lead" and this requires a clear focus on leadership development from the earliest stages of a career. Within medicine, undergraduate students should be provided with opportunities to thrive and develop their skills in terms of leadership, management and followership. Drawing from the existing evidence base, the authors' expertise and the latest "thought leadership", these 12 tips provide practical guidance to universities and associated provider organizations, and to academic and clinical faculty, on how to integrate leadership development into their undergraduate medical programs. These 12 tips will help educators provide medical education that incorporates leadership as a core part of a professional's identity, and help students gain a deeper understanding of themselves and the teams, organizations and system they work within.
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Affiliation(s)
- Alex Till
- a School of Psychiatry , Health Education North West (Mersey) , Liverpool , UK
| | - Judy McKimm
- b Strategic Educational Development , Swansea University Medical School , Swansea , UK
| | - Tim Swanwick
- c Faculty of Medical Leadership and Management , Health Education England , London , UK
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Willcocks SG. Exploring team working and shared leadership in multi-disciplinary cancer care. Leadersh Health Serv (Bradf Engl) 2017; 31:98-109. [PMID: 29412097 DOI: 10.1108/lhs-02-2017-0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to explore the relevance of shared leadership to multi-disciplinary cancer care. It examines the policy background and applies concepts from shared leadership to this context. It includes discussion of the implications and recommendations. Design/methodology/approach This is a conceptual paper examining policy documents and secondary literature on the topic. While it focuses on the UK National Health Services, it is also relevant to other countries given they follow a broadly similar path with regard to multi-disciplinary working. Findings The paper suggests that shared leadership is a possible way forward for multi-disciplinary cancer care, particularly as policy developments are supportive of this. It shows that a shared perspective is likely to be beneficial to the further development of multi-disciplinary working. Research limitations/implications Adopting shared leadership needs to be explored further using appropriate empirical research. Practical implications The paper offers comments on the implications of introducing shared leadership and makes recommendations including being aware of the barriers to its implementation. Originality/value The paper offers an alternative view on leadership in the health-care context.
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Till A, Dutta N, McKimm J. Vertical leadership in highly complex and unpredictable health systems. Br J Hosp Med (Lond) 2017; 77:471-5. [PMID: 27487058 DOI: 10.12968/hmed.2016.77.8.471] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article explores how the concept of vertical leadership development might help health organizations cope with and thrive within highly complex and unpredictable health systems, looking at concepts of VUCA (volatility, uncertainty, complexity and ambiguity) and RUPT (rapid, unpredictable, paradoxical and tangled).
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Affiliation(s)
- Alex Till
- Psychiatric Core Trainee, North West School of Psychiatry, Health Education North West (Mersey), Liverpool L3 4BL
| | - Nina Dutta
- General Practice Trainee, London Deanery, London
| | - Judy McKimm
- Professor of Medical Education and Director of Strategic Educational Development, Swansea University, Swansea
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McKimm J, O'Sullivan H. When I say … leadership. MEDICAL EDUCATION 2016; 50:896-897. [PMID: 27562889 DOI: 10.1111/medu.13119] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 10/19/2015] [Accepted: 05/04/2016] [Indexed: 06/06/2023]
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Affiliation(s)
- Judy McKimm
- College of Medicine, Swansea University, Swansea SA2 8PP, UK.
| | - Hester Mannion
- College of Medicine, Swansea University, Swansea SA2 8PP, UK
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McKimm J, Wilkinson T. "Doctors on the move": Exploring professionalism in the light of cultural transitions. MEDICAL TEACHER 2015; 37:837-43. [PMID: 26030381 DOI: 10.3109/0142159x.2015.1044953] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
As the world becomes "flattened" and travel is easier, doctors and other health professionals move and live around the world in large numbers: some for short periods (such as student electives) others on a longer-term or permanent basis. Similarly, as wider migration patterns play out, all doctors need to learn to work in multi-cultural environments, whether they move countries or work in their "home country". We consider cross-cultural aspects of "professionalism" in terms of medical students' and graduates' assimilation into different cultures and some of the aspects of professional practice that may be problematic where cultural expectations and practices may differ. Specifically we explore professional socialization, identity formation, acculturation and cultural competency as related concepts that help our understanding of challenges for individuals and strategies for curriculum development or support mechanisms.
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