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Robertson C, Manners R, Bingham K, French H, Porteous KY, Oliver S. An evaluation of the West of Scotland in-programme Chief Resident role. Future Healthc J 2024; 11:100131. [PMID: 38751491 PMCID: PMC11090895 DOI: 10.1016/j.fhj.2024.100131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Background Postgraduate leadership education is an evolving field. Locally we have an established 'Chief Residency' programme where centres have two to four senior trainees completing leadership duties alongside clinical workload, supported by local directors of medical education. This is twinned with a 4-day central training programme and peer-support network. Methods To assess perspectives of the CR role, we adopted a qualitative case-study design using an electronic questionnaire delivered to previous chief residents between 2020 and 2023. Results were analysed using thematic analysis. Results Trainees valued involvement within quality improvement and trainee support, demonstrating successful multi-departmental projects. Leadership education was viewed ubiquitously positively but participants felt further work is needed to address role legitimacy locally. A proposed solution was junior doctor leadership teams to address workload and emotional challenges. Conclusion This model provides further evidence of the value in investing in trainee leadership positions, demonstrating organisational impact. Future work will research hospital peer leadership teams.
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Affiliation(s)
- Callum Robertson
- NHS Lanarkshire & University Hospital Monklands, Monkscourt Avenue, Airdrie, ML6 0JS, United Kingdom
- University of Glasgow Medical School, Wolfson Medical School Building, University Avenue, Glasgow, G12 8QQ, United Kingdom
| | - Rachel Manners
- NHS Lanarkshire & University Hospital Monklands, Monkscourt Avenue, Airdrie, ML6 0JS, United Kingdom
| | - Katharine Bingham
- NHS Lanarkshire & University Hospital Monklands, Monkscourt Avenue, Airdrie, ML6 0JS, United Kingdom
| | - Helen French
- NHS Lanarkshire & University Hospital Monklands, Monkscourt Avenue, Airdrie, ML6 0JS, United Kingdom
| | - Kelly Yvonne Porteous
- NHS Lanarkshire & University Hospital Monklands, Monkscourt Avenue, Airdrie, ML6 0JS, United Kingdom
- University of the West of Scotland (UWS), Paisley Campus, High Street, Paisley, PA1 2BE, United Kingdom
| | - Scott Oliver
- NHS Lanarkshire & University Hospital Monklands, Monkscourt Avenue, Airdrie, ML6 0JS, United Kingdom
- University of Glasgow Medical School, Wolfson Medical School Building, University Avenue, Glasgow, G12 8QQ, United Kingdom
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Long PW, Loh E, Luong K, Worsley K, Tobin A. Factors that influence and change medical engagement in Australian not for profit hospitals. J Health Organ Manag 2022; ahead-of-print. [PMID: 35604304 DOI: 10.1108/jhom-08-2021-0318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The study aims to assess medical engagement levels at two teaching hospitals and a 500 bed private hospital in two states operated by the same health care provider and to describe individual and organisational factors that influence and change medical engagement. DESIGN/METHODOLOGY/APPROACH A survey was emailed to all junior and senior medical staff, seeking responses to 30 pre-determined items. The survey used a valid and reliable instrument which provided an overall index of medical engagement. Qualitative data were also collected by including an open ended question. FINDINGS Doctors (n = 810) working at all sites are in the top 20-40 percentile when compared to Australia and the United Kingdom. Two sites in one state were in the highest relative engagement band with the other being in the high relative range when compared to the (UK) and the medium relative band when compared to sites in Australia. Senior doctors working at all three were less engaged on feeling valued and empowered, when compared to having purpose and direction or working in a collaborative culture. This appears to be related to work satisfaction and whether they feel encouraged to develop their skills and progress their careers. Junior doctors at 1 site are much less engaged than colleagues working at another. Since their formal training pathways are identical the informal training experience appears to be an engagement factor. ORIGINALITY/VALUE Despite medical engagement being recognised as crucial, little is known about individual and organisational factors that support doctors to be engaged, particularly for juniors and in the private sector.
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Affiliation(s)
- Paul W Long
- Research, Australian Institute of Business Pty Ltd, Adelaide, Australia.,CHL, Centre for Health Leadership, Surry Hills, Australia
| | - Erwin Loh
- Centre for Health Research and Implementation, Monash University, Melbourne, Australia
| | - Kevin Luong
- Royal Australasian College of Medical Administrators, Hawthorn East, Australia
| | - Katherine Worsley
- Royal Australasian College of Medical Administrators, Hawthorn East, Australia
| | - Antony Tobin
- Faculty of Medicine, Dentistry and Health Sciences, VCCC, University of Melbourne, Parkville, Australia
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Ross SJ, Sen Gupta T, Johnson P. Leadership curricula and assessment in Australian and New Zealand medical schools. BMC Med Educ 2021; 21:28. [PMID: 33413349 PMCID: PMC7792303 DOI: 10.1186/s12909-020-02456-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/13/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The Australian Medical Council, which accredits Australian medical schools, recommends medical leadership graduate outcomes be taught, assessed and accredited. In Australia and New Zealand (Australasia) there is a significant research gap and no national consensus on how to educate, assess, and evaluate leadership skills in medical professional entry degree/programs. This study aims to investigate the current curricula, assessment and evaluation of medical leadership in Australasian medical degrees, with particular focus on the roles and responsibilities of medical leadership teachers, frameworks used and competencies taught, methods of delivery, and barriers to teaching leadership. METHODS A self-administered cross-sectional survey was distributed to senior academics and/or heads or Deans of Australasian medical schools. Data for closed questions and ordinal data of each Likert scale response were described via frequency analysis. Content analysis was undertaken on free text responses and coded manually. RESULTS Sixteen of the 22 eligible (73%) medical degrees completed the full survey and 100% of those indicate that leadership is taught in their degree. In most degrees (11, 69%) leadership is taught as a common theme integrated throughout the curricula across several subjects. There is a variety of leadership competencies taught, with strengths being communication (100%), evidence based practice (100%), critical reflective practice (94%), self-management (81%), ethical decision making (81%), critical thinking and decision making (81%). Major gaps in teaching were financial management (20%), strategic planning (31%) and workforce planning (31%). The teaching methods used to deliver medical leadership within the curricula are diverse, with many degrees providing opportunities for leadership teaching for students outside the curricula. Most degrees (10, 59%) assess the leadership education, with one-third (6, 35%) evaluating it. CONCLUSIONS Medical leadership competencies are taught in most degrees, but key leadership competencies are not being taught and there appears to be no continuous quality improvement process for leadership education. There is much more we can do as medical educators, academics and leaders to shape professional development of academics to teach medical leadership, and to agree on required leadership skills set for our students so they can proactively shape the future of the health care system.
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Affiliation(s)
- Simone Jacquelyn Ross
- College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia.
| | - Tarun Sen Gupta
- College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia
| | - Peter Johnson
- College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia
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Tavabie S, Bass S, Minton O. Emotional intelligence in palliative medical education. Br J Hosp Med (Lond) 2020; 81:1-5. [PMID: 33377833 DOI: 10.12968/hmed.2020.0573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The death of a patient is one of the most stressful situations a healthcare professional can face for the first time at work or during training. Palliative and end of life care education aims to impart appropriate awareness and understanding of key issues arising at the end of life, but also to develop learners' interpersonal skills in leadership, communication and management of their own emotional load. There is a pressing need to be explicit around death, dying and care at the end of life and to equip clinical staff with the ability to manage the emotions that are experienced by their patients, their teams and themselves. Emotional intelligence is considered as a framework for medical educators to use in this setting with presentation of a simulated patient vignette to contextualise this.
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Affiliation(s)
- Simon Tavabie
- Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Steve Bass
- Specialist Palliative Care Team, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Ollie Minton
- Specialist Palliative Care Team, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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Mikkola L, Parviainen H. Identity and relationship frames in medical leadership communication. Leadersh Health Serv (Bradf Engl) 2020; 33:429-443. [PMID: 33635023 DOI: 10.1108/lhs-05-2020-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE A frame is an interpretive scheme of meanings that guide participants' interpretations of social interaction and their actions in social situations (Goffman, 1974). By identifying early-career physicians' identity and relationship frames, this study aims to produce information about socially constructed ways to interpret leadership communication in a medical context. DESIGN/METHODOLOGY/APPROACH The data consist of essays written by young physicians (n = 225) during their specialization training and workplace learning period. The analysis was conducted applying constructive grounded theory. FINDINGS Three identity and relationship frames were identified: the expertise frame, the collegial frame and the system frame. These frames arranged the meanings of being a physician in a leader-follower relationship differently. ORIGINALITY/VALUE The findings suggest that identity questions discussed recently in medical leadership studies can be partly answered with being aware of and understanding socially constructed and somewhat contradictory frames.
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Affiliation(s)
- Leena Mikkola
- Department of Language and Communication Studies, University of Jyväskylä, Jyväskylä, Finland
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Leng C, Challoner T, Hausien O, Filobbos G, Baden J. From chaos to a new norm: The Birmingham experience of restructuring the largest plastics department in the UK in response to the COVID-19 pandemic. J Plast Reconstr Aesthet Surg 2020; 73:2136-2141. [PMID: 33039307 PMCID: PMC7502238 DOI: 10.1016/j.bjps.2020.08.127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/18/2020] [Indexed: 12/03/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic presented unprecedented challenges for healthcare systems worldwide. The Queen Elizabeth Hospital, Birmingham, has one of the largest burns, hands and plastics department in the UK, totalling 83 doctors. Our response to the COVID-19 response was uniquely far reaching, with our department being given responsibility of an entire 36 bed medical COVID-19 ward in addition to our commitment to specialty-specific work, and saw half of our work force re-deployed to Intensive Treatment Unit (ITU). Our aim was to exploit the high calibre of doctors found in plastic surgery, and to demonstrate, we were able to support the COVID-19 effort beyond our normal scope of practice. In order to achieve this aim, the department underwent significant structural and leadership changes. Factors considered included: rota and shift pattern changes to implement depth and resilience to sudden fluctuations in staffing levels; a preparatory phase for focussed upskilling and relevant training packages to be delivered; managing the COVID-19 ward cover and ITU deployment; adjustments to our front of house and elective specialty-specific service, including developing alternative and streamlined patient pathways; mitigating the effects on plastic surgical training during the pandemic; the importance of communications for patient care and physician wellbeing; and leadership techniques and styles we considered important. By sharing our experience during this pandemic, we hope to reflect on and share lessons learned, as well as to demonstrate that it is possible to rapidly mobilise and retrain plastic surgeons at all levels to contribute safely and productively beyond a specialty-specific scope of care.
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Affiliation(s)
- C Leng
- Burns, Hands and Plastics Department, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, United Kingdom.
| | - T Challoner
- Burns, Hands and Plastics Department, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, United Kingdom
| | - O Hausien
- Burns, Hands and Plastics Department, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, United Kingdom
| | - G Filobbos
- Burns, Hands and Plastics Department, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, United Kingdom
| | - J Baden
- Burns, Hands and Plastics Department, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, United Kingdom
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Keijser WA, Handgraaf HJM, Isfordink LM, Janmaat VT, Vergroesen PPA, Verkade JMJS, Wieringa S, Wilderom CPM. Development of a national medical leadership competency framework: the Dutch approach. BMC Med Educ 2019; 19:441. [PMID: 31779632 PMCID: PMC6883542 DOI: 10.1186/s12909-019-1800-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 09/09/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The concept of medical leadership (ML) can enhance physicians' inclusion in efforts for higher quality healthcare. Despite ML's spiking popularity, only a few countries have built a national taxonomy to facilitate ML competency education and training. In this paper we discuss the development of the Dutch ML competency framework with two objectives: to account for the framework's making and to complement to known approaches of developing such frameworks. METHODS We designed a research approach and analyzed data from multiple sources based on Grounded Theory. Facilitated by the Royal Dutch Medical Association, a group of 14 volunteer researchers met over a period of 2.5 years to perform: 1) literature review; 2) individual interviews; 3) focus groups; 4) online surveys; 5) international framework comparison; and 6) comprehensive data synthesis. RESULTS The developmental processes that led to the framework provided a taxonomic depiction of ML in Dutch perspective. It can be seen as a canonical 'knowledge artefact' created by a community of practice and comprises of a contemporary definition of ML and 12 domains, each entailing four distinct ML competencies. CONCLUSIONS This paper demonstrates how a new language for ML can be created in a healthcare system. The success of our approach to capture insights, expectations and demands relating leadership by Dutch physicians depended on close involvement of the Dutch national medical associations and a nationally active community of practice; voluntary work of diverse researchers and medical practitioners and an appropriate research design that used multiple methods and strategies to circumvent reverberation of established opinions and conventionalisms. IMPLICATIONS The experiences reported here may provide inspiration and guidance for those anticipating similar work in other countries to develop a tailored approach to create a ML framework.
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Affiliation(s)
- Wouter A. Keijser
- Faculty of Behavioural, Management and Social Sciences (BMS) Change, Management and Organizational Behavior (CMOB), University Twente, Enschede, The Netherlands
- DIRMI Foundation, Utrecht, The Netherlands
| | | | - Liz M. Isfordink
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Vincent T. Janmaat
- Erasmus Medical Center, Wytemaweg 80, 3015 CP Rotterdam, The Netherlands
| | - Pieter-Paul A. Vergroesen
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | | | - Sietse Wieringa
- Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Continuing Education, University of Oxford, Oxford, OX1 2JD UK
| | - Celeste P. M. Wilderom
- Faculty of Behavioural, Management and Social Sciences (BMS) Change, Management and Organizational Behavior (CMOB), University Twente, Enschede, The Netherlands
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Arnold L, Cuddy P, Hathaway SB, Quaintance JL, Kanter SL. Medical Leaders Identify Personal Characteristics and Experiences that Contribute to Leadership Success in Medicine. MedEdPublish (2016) 2019; 8:206. [PMID: 38089351 PMCID: PMC10712527 DOI: 10.15694/mep.2019.000206.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Introduction: The approach of medical educators to preparing learners for leadership reflects the emphasis leadership theories once placed on experiential learning. But, contemporary theories now also show a renewed interest in the role of personal characteristics in effective leadership. This shift raises questions explored here: What characteristics mark top medical leaders? What experiences nurture those characteristics? Method: In a 2015 qualitative study, 48 University of Missouri-Kansas City (UMKC) medical graduates who met criteria for outstanding leadership participated in semi-structured interviews. Investigators applied directed content-analysis to their responses. Then, using iterative open-coding, investigators identified personal characteristics leaders said contributed to their leadership, clustered them into types, and counted the number of leaders who spoke to each type. Next, they coded and categorized experiences leaders discussed and counted the number of leaders who mentioned each type of experience. Finally, they identified leaders' comments about which types of experiences helped develop which types of characteristics. Results: Most leadersmentioned four types of characteristics: openness to new ideas/opportunities/astute risk-taking; intense motivation/active involvement/commitment; people-orientation; and capability/competence/ intelligence. Many discussed two additional types: self-awareness and service-orientation. Leaders said these types of experiences nurtured their characteristics: family traditions, high-school co-curricular activities, participation in medical school learning communities plus interaction with role models/mentors and authentic opportunities to practice leadership, innovation, and excellence throughout their education and in the workplace. Conclusions: Medical leaders' views of the role of personal characteristics in outstanding leadership and the power of educational and workplace experiences, especially informal ones, to mold those characteristics have enriched understanding how to prepare tomorrow's leaders.
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Affiliation(s)
- Louise Arnold
- The University of Missouri-Kansas City School of Medicine
| | - Paul Cuddy
- The University of Missouri-Kansas City School of Medicine
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Kuhlmann E, Shishkin S, Richardson E, Ivanov I, Shvabskii O, Minulin I, Shcheblykina A, Kontsevaya A, Bates K, McKee M. Understanding the role of physicians within the managerial structure of Russian hospitals. Health Policy 2019; 123:773-781. [PMID: 31200948 DOI: 10.1016/j.healthpol.2019.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 02/18/2019] [Accepted: 05/29/2019] [Indexed: 10/26/2022]
Abstract
This article examines the role of physicians within the managerial structure of Russian hospitals. A comparative qualitative methodology with a structured assessment framework is used to conduct case studies that allow for international comparison. The research is exploratory in nature and comprises 63 individual interviews and 49 focus groups with key informants in 15 hospitals, complemented by document analysis. The material was collected between February and April 2017 in five different regions of the Russian Federation. The results reveal three major problems of hospital management in the Russian Federation. First, hospitals exhibit a leaky system of coordination with a lack of structures for horizontal exchange of information within the hospitals (meso-level). Second, at the macro-level, the governance system includes implementation gaps, lacking mechanisms for coordination between hospitals that may reinforce existing inequalities in service provision. Third, there is little evidence of a learning culture, and consequently, a risk that the same mistakes could be made repeatedly. We argue for a new approach to governing hospitals that can guide implementation of structures and processes that allow systematic and coherent coordination within and among Russian hospitals, based on modern approaches to accountability and organisational learning.
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Affiliation(s)
- Ellen Kuhlmann
- Institute of Epidemiology, Social Medicine and Health Systems Research, Medical School Hannover, OE 5410, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Sergey Shishkin
- National Research University - Higher School of Economics, Myasnitskaya street, 20, of. 221, 101000 Moscow, Russia.
| | - Erica Richardson
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
| | - Igor Ivanov
- Center for Monitoring and Clinical and Economic Expertise of the Federal Service for Surveillance in Healthcare, Slavyanskaya Square, 4, building 1, entrance 4, 109074 Moscow, Russia.
| | - Oleg Shvabskii
- Center for Monitoring and Clinical and Economic Expertise of the Federal Service for Surveillance in Healthcare, Slavyanskaya Square, 4, building 1, entrance 4, 109074 Moscow, Russia.
| | - Ildar Minulin
- Center for Monitoring and Clinical and Economic Expertise of the Federal Service for Surveillance in Healthcare, Slavyanskaya Square, 4, building 1, entrance 4, 109074 Moscow, Russia.
| | - Aleksandra Shcheblykina
- Center for Monitoring and Clinical and Economic Expertise of the Federal Service for Surveillance in Healthcare, Slavyanskaya Square, 4, building 1, entrance 4, 109074 Moscow, Russia.
| | - Anna Kontsevaya
- Department of Non-communicable Disease Epidemiology, National Research Center for Preventive Medicine, Moscow, Russian Federation.
| | - Katie Bates
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
| | - Martin McKee
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK; Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
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Berghout MA, Oldenhof L, Fabbricotti IN, Hilders CGJM. Discursively framing physicians as leaders: Institutional work to reconfigure medical professionalism. Soc Sci Med 2018; 212:68-75. [PMID: 30014983 DOI: 10.1016/j.socscimed.2018.07.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 07/03/2018] [Accepted: 07/06/2018] [Indexed: 11/22/2022]
Abstract
Physicians are well-known for safeguarding medical professionalism by performing institutional work in their daily practices. However, this study shows how opinion-making physicians in strategic arenas (i.e. national professional bodies, conferences and high-impact journals) advocate to reform medical professionalism by discursively framing physicians as leaders. The aim of this article is to critically investigate the use of leadership discourse by these opinion-making physicians. By performing a discursive analysis of key documents produced in these strategic arenas and additional observations of national conferences, this article investigates how leadership discourse is used and to what purpose. The following key uses of medical leadership discourses were identified: (1) regaining the lead in medical professionalism, (2) disrupting 'old' professional values, and (3) constructing the 'modern' physician. The analysis reveals that physicians as 'leaders' are expected to become team-players that work across disciplinary and organizational boundaries to improve the quality and affordability of care. In comparison to management that is negatively associated with NPM reform, leadership discourse is linked to positive institutional change, such as decentralization and integration of care. Yet, it is unclear to what extent leadership discourses are actually incorporated on the work floor and to what effect. Future studies could therefore investigate the uptake of leadership discourses by rank and file physicians to investigate whether leadership discourses are used in restricting or empowering ways.
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Dickinson H, Snelling I, Ham C, Spurgeon PC. Are we nearly there yet? A study of the English National Health Service as professional bureaucracies. J Health Organ Manag 2018; 31:430-444. [PMID: 28877622 DOI: 10.1108/jhom-01-2017-0023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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 issues of medical engagement in the management and leadership of health services in the English National Health Service (NHS). The literature suggests that this is an important component of high performing health systems, although the NHS has traditionally struggled to engage doctors and has been characterised as a professional bureaucracy. This study explored the ways in which health care organisations structure and operate medical leadership processes to assess the degree to which professional bureaucracies still exist in the English NHS. Design/methodology/approach Drawing on the qualitative component of a research into medical leadership in nine case study sites, this paper reports on findings from over 150 interviews with doctors, general managers and nurses. In doing so, the authors focus specifically on the operation of medical leadership in nine different NHS hospitals. Findings Concerted attention has been focussed on medical leadership and this has led to significant changes to organisational structures and the recruitment and training processes of doctors for leadership roles. There is a cadre of doctors that are substantially more engaged in the leadership of their organisations than previous research has found. Yet, this engagement has tended to only involve a small section of the overall medical workforce in practice, raising questions about the nature of medical engagement more broadly. Originality/value There are only a limited number of studies that have sought to explore issues of medical leadership on this scale in the English context. This represents the first significant study of this kind in over a decade.
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Affiliation(s)
- Helen Dickinson
- Public Service Research Group, University of New South Wales , Canberra, Australia
| | - Iain Snelling
- Health Service Management Centre, University of Birmingham , Birmingham, UK
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Abstract
Purpose This paper aims to systematically review the literature on roles of physicians in virtual teams (VTs) delivering healthcare for effective "physician e-leadership" (PeL) and implementation of e-health. Design/methodology/approach The analyzed studies were retrieved with explicit keywords and criteria, including snowball sampling. They were synthesized with existing theoretical models on VT research, healthcare team competencies and medical leadership. Findings Six domains for further PeL inquiry are delineated: resources, task processes, socio-emotional processes, leadership in VTs, virtual physician-patient relationship and change management. We show that, to date, PeL studies on socio-technical dynamics and their consequences on e-health are found underrepresented in the health literature; i.e. no single empirical, theoretic or conceptual study with a focus on PeL in virtual healthcare work was identified. Research limitations/implications E-health practices could benefit from organization-behavioral type of research for discerning effective physicians' roles and inter-professional relations and their (so far) seemingly modest but potent impact on e-health developments. Practical implications Although best practices in e-health care have already been identified, this paper shows that physicians' roles in e-health initiatives have not yet received any in-depth study. This raises questions such as are physicians not yet sufficiently involved in e-health? If so, what (dis)advantages may this have for current e-health investments and how can they best become involved in (leading) e-health applications' design and implementation in the field? Originality/value If effective medical leadership is being deployed, e-health effectiveness may be enhanced; this new proposition needs urgent empirical scrutiny.
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Affiliation(s)
- Wouter Keijser
- Faculty of Behavioral, Management and Social Sciences, University of Twente , Enschede, The Netherlands
| | - Jacco Smits
- Faculty of Behavioral, Management and Social Sciences, University of Twente , Enschede, The Netherlands
| | - Lisanne Penterman
- Faculty of Behavioral, Management and Social Sciences, University of Twente , Enschede, The Netherlands
| | - Celeste Wilderom
- Faculty of Behavioral, Management and Social Sciences, University of Twente , Enschede, The Netherlands
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Loh E, Morris J, Thomas L, Bismark MM, Phelps G, Dickinson H. Shining the light on the dark side of medical leadership - a qualitative study in Australia. Leadersh Health Serv (Bradf Engl) 2018; 29:313-30. [PMID: 27397752 DOI: 10.1108/lhs-12-2015-0044] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The paper aims to explore the beliefs of doctors in leadership roles of the concept of "the dark side", using data collected from interviews carried out with 45 doctors in medical leadership roles across Australia. The paper looks at the beliefs from the perspectives of doctors who are already in leadership roles themselves; to identify potential barriers they might have encountered and to arrive at better-informed strategies to engage more doctors in the leadership of the Australian health system. The research question is: "What are the beliefs of medical leaders that form the key themes or dimensions of the negative perception of the 'dark side'?". Design/methodology/approach The paper analysed data from two similar qualitative studies examining medical leadership and engagement in Australia by the same author, in collaboration with other researchers, which used in-depth semi-structured interviews with 45 purposively sampled senior medical leaders in leadership roles across Australia in health services, private and public hospitals, professional associations and health departments. The data were analysed using deductive and inductive approaches through a coding framework based on the interview data and literature review, with all sections of coded data grouped into themes. Findings Medical leaders had four key beliefs about the "dark side" as perceived through the eyes of their own past clinical experience and/or their clinical colleagues. These four beliefs or dimensions of the negative perception colloquially known as "the dark side" are the belief that they lack both managerial and clinical credibility, they have confused identities, they may be in conflict with clinicians, their clinical colleagues lack insight into the complexities of medical leadership and, as a result, doctors are actively discouraged from making the transition from clinical practice to medical leadership roles in the first place. Research limitations/implications This research was conducted within the Western developed-nation setting of Australia and only involved interviews with doctors in medical leadership roles. The findings are therefore limited to the doctors' own perceptions of themselves based on their past experiences and beliefs. Future research involving doctors who have not chosen to transition to leadership roles, or other health practitioners in other settings, may provide a broader perspective. Also, this research was exploratory and descriptive in nature using qualitative methods, and quantitative research can be carried out in the future to extend this research for statistical generalisation. Practical implications The paper includes implications for health organisations, training providers, medical employers and health departments and describes a multi-prong strategy to address this important issue. Originality/value This paper fulfils an identified need to study the concept of "moving to the dark side" as a negative perception of medical leadership and contributes to the evidence in this under-researched area. This paper has used data from two similar studies, combined together for the first time, with new analysis and coding, looking at the concept of the "dark side" to discover new emergent findings.
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Affiliation(s)
- Erwin Loh
- Monash Health, Clayton, Australia and Monash University , Clayton, Australia
| | - Jennifer Morris
- Melbourne School of Population and Global Health, University of Melbourne , Melbourne, Australia
| | - Laura Thomas
- Melbourne School of Population and Global Health, University of Melbourne , Melbourne, Australia
| | | | - Grant Phelps
- School of Medicine, Deakin University , Victoria, Australia
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Abstract
As has often been the case in its nearly 70-year history, the NHS finds itself in difficult times with very real clinical and financial sustainability challenges and a need to transform itself. The vision has been laid out in the Five Year Forward View, but if there was a 'how-to' manual for delivery it could be argued that it isn't always completely clear and some chapters are incomplete. In the context of change in the modern NHS, medical leadership is often spoken about as being key and yet what this means varies between different people and at different times and on a whole spectrum of scale, from small projects to whole health-economy redesign. This article consists of some personal reflections on what it feels like to be in the midst of both.
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Affiliation(s)
- Simon Constable
- Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK and visiting professor, Institute of Medicine, University of Chester, Chester, UK
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15
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Abstract
Medical leadership is a global policy priority worldwide as it aims at answering some of the greatest challenges of healthcare, including changing patient needs, budget cuts, increasing citizen demand for accountability and rising service expectations. However, the introduction of doctors in management roles is not easy, and the actual practice of medical management greatly varies across countries and within each country. In order to favour its development, policymakers and executives should have the courage to give autonomy to medical managers and to support them, and should acknowledge the specificities of such hybrid roles when selecting, training and appraising future medical leaders. At the same time, professionals and their associations should understand that clinical leadership is not about dismantling professionalism, but rather about reconfiguring it, incorporating new values and logics into the traditional medical culture.
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Affiliation(s)
- Federico Lega
- Bocconi University, Centre for Research on Healthcare Management, Milan, Italy
| | - Marco Sartirana
- Centre for Research on Healthcare Management, Bocconi University, Milan, Italy, and Utrecht School of Governance, Utrecht University, Utrecht, The Netherlands
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16
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Abstract
The modern patient safety movement began around 2000, when attention was drawn to error-related hospital mortality by the Institute of Medicine. Several years later the American College of Obstetricians and Gynecologists addressed safety issues in office practice, in recognition of the migration of increasingly complex surgical procedures to the office setting. Efforts begun in 2008 resulted in development of a program for safety certification of ob/gyn offices. Elements of the program are described, with recommendations on how they can be incorporated into standard office practice to reduce the chances of patient harm caused by errors or other adverse events.
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Affiliation(s)
- John P Keats
- Department of Obstetrics and Gynecology, The David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.
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17
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Abstract
At its core, the purpose of healthcare is simple: to maximise quality and quantity of life. To achieve this vision, doctors have assumed an array of roles across a number of domains beyond the one-to-one patient-doctor interaction. Such domains include; teaching, research, leadership, management and clinical governance to name but a few. These roles and the healthcare systems in which they operate, have evolved over time to meet demand from patients, the profession, government and regulators. Further evolution is needed as we move into the 21st century to deal with the “perfect storm” of expensive technological advances, economic challenges and epidemiological changes.1 It is the trainees and students of today who will drive this progress in the future. Journals are a gateway to scientific progress and we believe there is a need for a journal to educate and develop the knowledge, skills and attitudes of trainees and students. Furthermore, over the past few years, the very nature of scientific journal publication has come under scrutiny.2 Hence we seek to establish a modern journal that deals with the challenges and opportunities of the 21st century.
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