Six Principles for Developing Leadership Training Ecosystems in Health Care

Perspectives on leadership for medical educators: a qualitative study of leadership qualities identified by US medical school deans

INTRODUCTION

Leaders in medical education face unique challenges and carry the immense responsibility of training the next generation of healthcare professionals. Highly effective leaders are critical in medical education, and degree programmes in health professions education aim to produce these needed academic leaders. This study aims to identify the leadership qualities deemed important by established leaders in medical education to guide the development of health professions education leadership curricula.

METHODS

From September 2023 to March 2024, the authors conducted semistructured interviews with 23 US medical school deans or recommended members of their staff (eg, Associate Dean for Medical Education) regarding the leadership qualities they deemed important for leading in medical education. The authors then applied reflexive thematic analysis to the interview transcripts to identify themes representing leadership qualities.

RESULTS

Transcript analysis demonstrated 12 themes that represent leadership qualities thought to be essential in medical education. These themes included a leader who is driven by values, humble, resilient, emotionally intelligent, puts people first, fosters psychological safety, is collaborative, communicates effectively, makes decisions, acts strategically, drives innovation and is adaptable.

CONCLUSION

This study identified twelve key leadership qualities that US medical school deans perceive as essential for leadership in medical education. These qualities can be organised into personal, interpersonal and system-level qualities, but they are interconnected in practice with qualities being relevant on multiple levels. These findings align with several healthcare leadership models but emphasise resilience and adaptability more distinctly, highlighting unique challenges in medical education. These insights could help refine existing leadership theories and frameworks within the context of medical education and enhance leadership development programmes in medical education and potentially related fields.

The Military Medicine Leadership Life Cycle: A Model for Longitudinal Leadership Development for Staff Physicians

Leadership development is a challenge for all health care systems. Military Medicine has unique challenges with increased frequency of physician turnover and more junior leaders taking on positions of leadership earlier in their careers. Military medical corps officers are also challenged with leading in clinical, academic, and operational settings. Effective leadership within the Military Healthcare System requires an intentional and ongoing leadership development process across the careers of military medical corps officers. This article describes the leadership lifecycle of military medical corps officers, highlighting existing leadership development opportunities and providing an example of a leadership lifecycle from junior staff to senior executive for other organizations. The article concludes with specific recommendations that will allow military medicine to continue to strengthen the leadership skills of its officers to meet ever growing challenges.

Teaching health systems leadership and innovation to physicians

BACKGROUND

A master's programme in Health Systems Leadership and Innovation was launched in 2016 to integrate health systems science and innovation management within the medical education continuum.

OBJECTIVES

To identify faculty and staff perceptions of tailoring the programme to accommodate potential future learning needs as a continuous quality improvement initiative of the programme.

METHODS

A combination of two qualitative research methodologies was used: (1) a situational analysis to explain context and (2) a collaborative autoethnographic approach to understand the evolution of the programme and future directions. Faculty and staff involved with the programme were invited to participate after obtaining institutional research ethics approval. In conducting a collaborative autoethnography, all authors are participants who narrate, analyse and theorise about their individual and or collective experiences.

RESULTS

Nine faculty and three staff members narrated their perceptions of the programme. The situational analysis identified major internal and external actors, major processes and external actants relevant to the programme. It also outlined the multiple overlapping social arenas where the students, faculty and staff were situated through a social world map and differing positions of the authors with respect to the programme's future learners. The master narrative identified an urgent need for internal and external communications about the programme and to revisit course delivery methods. The authors were divided in their opinion as to whether the programme should continue to cater to undergraduate medical students or focus on physicians or have learners from multiple educational levels in the same class.

CONCLUSIONS

The programme needs marketing, continuous course assessments and revisions to ensure visibility and relevance. The programme offers a flexible pathway for students at different stages in the career path from novice medical students to consultant physicians, and tensions related to the level of medical education hierarchy in the class are being managed by the faculty.

Multi Professional Consultant Practice-What Is it and How Does the Role Contribute Systems Transformation?

Healthcare systems are facing unprecedented need to respond to an ever-evolving context of providing safe person-centred care to its citizens and staff. This transformation requires a rethink of healthcare leadership. Systems leaders are critical for culture change; to support safe patient care, facilitate innovation, build person-centred teams, and develop a collaborative workforce. Education has been considered the panacea for leadership growth with current models closely connected to qualifications, distinct courses and micro-credentialing. Yet systems leaders need skills, capacities and experience which augment interprofessional teams to work and innovate in ways which are creative, satisfying and sustaining. These leaders facilitate interprofessional partnerships vertically and horizontally within an organisation. One such role is the Multi Professional Consultant Practitioner, who are expert practitioners and embedded researchers, with a strategic whole system approach, and value all voices toward improving patient and staff experience. This role has been predominantly developed within the United Kingdom. However, a global model would translate this role within health systems more broadly. Potential exists for integrated expertise to enable quality care across the system to meet the needs of their local communities. With this in mind, this scoping review aimed at exploring the Multi Professional Consultant Practitioner role-what it is and how it contributes to system transformation.

Sustained Leadership Practices and Behaviours Following Postgraduate Leadership Education: A Qualitative Study

AIM

To explore how postgraduate leadership education is translated into practice and how leadership practices and behaviours are sustained following completion of a leadership program.

DESIGN

A qualitative exploratory study using an appreciative inquiry approach.

METHODS

A single Health District, partnered with a regional university, offering a 12-month leadership program, the Effective Leadership in Health Program. Four semi-structured group interviews were undertaken with 11 registered nurses (RNs) and allied health professionals. Data were audio-recorded and transcribed before being analysed using thematic analysis.

RESULTS

Four themes were revealed relating to how the learning was translated and sustained in clinical practice, namely, within (1) self, (2) others, (3) relationships and (4) sustained leadership. All participants agreed that their participation in the leadership program impacted on their subsequent approach to leadership in multiple contexts, relationships and interactions.

Exploring leadership in health professionals following an industry-based leadership program: A cross-sectional survey

AIM

To evaluate the self-reported leadership practices and behaviours of health professionals following a leadership program and explore factors that impacted leadership style.

DESIGN

An online cross-sectional survey was conducted from August to October 2022.

METHODS

The survey was disseminated via email to leadership program graduates. The Multifactor Leadership Questionnaire Form-6S was used to measure leadership style.

RESULTS

Eighty completed surveys were included in the analysis. Participants scored highest on transformational leadership and lowest on passive/avoidant leadership style. Participants with higher qualifications scored significantly higher in the inspirational motivation scores (p = 0.03). As years in their profession increased, there was a significant decrease in contingent reward scores (p = 0.04). The younger participants scored significantly higher on the management-by-exception than older participants (p = 0.05). There were no significant associations with the year the leadership program was completed, gender or profession and Multifactor Leadership Questionnaire Form - 6S scores. Most participants (72.5%) strongly agreed that the program enhanced their leadership development and 91.3% strongly agreed or agreed that they routinely apply the skills and knowledge learnt in the program in their workplace.

CONCLUSION

Formal leadership education is important in developing a transformational nursing workforce. This study found that program graduates had adopted a transformational leadership style. Education, years of experience and age impacted the specific leadership elements. Future work needs to incorporate longitudinal follow-up to relate changes in leadership with impact on clinical practice.

IMPLICATIONS FOR THE PROFESSION

Transformational leadership as a dominant style can contribute to nurses and other disciplines positively contributing to innovative and person-centred approaches to health service delivery.

SUMMARY STATEMENT

What already is known-Leadership amongst nurses and other health professionals impacts patients, staff, organizations and ultimately healthcare culture. What this paper adds-Formal leadership education is important in developing a transformational healthcare workforce. Implications for practice/policy-Transformational leadership can enhance nurses and other disciplines commitment to innovative and person-centred approaches.

IMPACT STATEMENT

This research identifies that lessons learnt from formal leadership education are retained over time by healthcare providers. This is important for nursing staff, and other healthcare providers, who are leading teams and overseeing care delivery, can ensure leadership behaviours and practices are enacted to influence a transformational workforce and culture.

REPORTING METHOD

This study adhered to STROBE guidelines. No Patient or Public Contribution.

LEADS+ Developmental Model: Proposing a new model based on an integrative conceptual review

BACKGROUND

Leaders in academic health sciences centres (AHCs) must navigate multiple roles as an inherent component of their positions. Changing accountabilities, varying expectations, differing leadership capabilities required of multiple leadership roles can be exacerbated by health system disruption, such as during the COVID-19 pandemic. We need improved models that support leaders in navigating the complexity of multiple leadership roles.

METHOD

This integrative conceptual review sought to examine leadership and followership constructs and how they intersect with current leadership practices in AHCs. The goal was to develop a refined model of healthcare leadership development. The authors used iterative cycles of divergent and convergent thinking to explore and synthesise various literature and existing leadership frameworks. The authors used simulated personas and stories to test the model and, finally, the approach sought feedback from knowledge users (including healthcare leaders, medical educators and leadership developers) to offer refinements.

RESULTS

After five rounds of discussion and reformulation, the authors arrived at a refined model: the LEADS+ Developmental Model. The model describes four nested stages, organising progressive capabilities, as an individual toggles between followership and leadership. During the consultation stage, feedback from 29 out of 65 recruited knowledge users (44.6% response rate) was acquired. More than a quarter of respondents served as a senior leader in a healthcare network or national society (27.5%, n = 8). Consulted knowledge users were invited to indicate their endorsement for the refined model using a 10-point scale (10 = highest level of endorsement). There was a high level of endorsement: 7.93 (SD 1.7) out of 10.

CONCLUSION

The LEADS+ Developmental Model may help foster development of academic health centre leaders. In addition to clarifying the synergistic dynamic between leadership and followership, this model describes the paradigms adopted by leaders within health systems throughout their development journey.

Linking leadership development programs for physicians with organization-level outcomes: a realist review

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.

Blueprints for Connection: A Meta-Organizational Framework for Layering Theory, Philosophy, and Praxis Within Continuing Education in the Health Professions

ABSTRACT

As a field, Continuing Professional Development (CPD) lies at the intersection of many disciplines. Tensions can occur as scholars from fields ranging from education to quality improvement seek to advance the practices and workplaces of health care professionals. Owing to the diversity of people working to affect change within the field of CPD, it remains a very challenging space to collaborate and understand the various philosophies, epistemologies, and practice of all those within the field.In this article, the authors have proposed a meta-organizational framework for how we might re-examine theory, application, and practice within the field of CPD. It is their belief that this proposal might inspire others to reflect on how we can cultivate and invite diverse scientists and scholars using a range of theories to add to the fabric of the field of CPD.

Leadership behaviours in interprofessional student teamwork

BACKGROUND

Effective leaders support high-quality patient care and improve patient safety by embodying a collective leadership style. Training in leadership skills needs to be integrated longitudinally throughout a clinician's career. Models of leadership drawn from organisational theories can provide a conceptual framework for cultivating student leadership qualities during teamwork and the evaluation of emergent outcomes. Using the conceptual framework of Situational Leadership Theory, we sought to explore the leadership qualities identified by students of their team members, during a large scale interprofessional learning activity.

METHODS

In 2018, 1674 students from 11 health disciplines were required to participate in the "Health Collaboration Challenge" (HCC). The HCC required students to work in small interprofessional teams of five or six students. Following team activities, students were required to provide constructive written feedback to their team members. Peer feedback data were coded and categorised into themes using the conceptual framework of Situational Leadership Theory. Data were then quantified within each theme.

RESULTS

A total of 1282 comments were analysed. The most frequent comments related to 'delegating' (456/1282, 36%) and 'supporting' (402/1282, 31%). This was followed by comments categorised as 'directing' (244/1282, 19%), and 'coaching' (180/1282, 14%) leadership styles. Notably, a total of 1112/2597 (43%) of comments were unconstructive. A total of 298 comments provided by students informed their peers of areas for self-improvement. The most frequent comments were recommendations relating to 'active team member contribution' (111/298; 37%), followed by 'communication' (83/298; 28%), 'interprofessional practice' (77/298; 26%), and 'disciplinary knowledge' (27/298; 9%).

CONCLUSION

Although most students demonstrated a reasonable ability to display leadership behaviours appropriate to teamwork, further development is needed through training. Leadership skills are an expectation of health professional graduates, and should be explicitly taught and vertically integrated within interprofessional education curricula. Further research is warranted in how students contribute to and understand the requirements of leadership within interprofessional teams.