Distinguishing competencies of effective physician leaders

Development of a leadership and management module for the undergraduate medical curriculum

BACKGROUND

Physicians play an important role in management and governance of healthcare systems, yet many lack formal leadership training and skills. Despite leadership training through placements in wards at a graduate level, this should take place early on (undergraduate level), to lay the foundations for future physicians to consider a career choice in leadership positions long before entering practice. The fundamentals of leadership and management should be incorporated in the medical curriculum, with input from experts in the area such that relevant concepts are appropriately adapted with a healthcare context.

METHODS

We developed a pilot leadership and management module for undergraduate medical students, drawing from sources such as the UK National Health System and General Medical Council, primary literature, and undergraduate business school curricula. Students in their clinical years (4-6) of an undergraduate, six-year medical degree, were invited to participate in five 2-hour online sessions. Participants completed a questionnaire before and after module completion to assess whether individual perspectives on 22 skills relevant to leadership knowledge, and their self-rated competence in each one, changed following module attendance.

RESULTS

Sixteen medical students participated in the study. Module attendance resulted in mean self-reported competence increase in 18 of the 22 skills, with "inspire others", "public speaking", "coding and billing", "risk management" and "conflict resolution" displaying the largest positive change. Free-text comments provided encouraging feedback regarding the module and its contents, and the teaching method of such skills (case-studies or more applied scenarios, as opposed to taught lectures).

CONCLUSIONS

The positive changes in student perceptions and self-reported competence in leadership skills that are not traditionally included in the undergraduate medical curriculum, but are part of the business curriculum, further support the importance of inter-professional learning. Our findings are expected to inform the development of a module that could be incorporated in undergraduate medical curricula as part of future research with larger sample size and objective measures of skill competence.

Narratives of Actionable Medical Leadership From Senior Leaders for Aspiring Leaders in Academic Medicine

Background

Physicians understand that certain personal attributes are essential in medical leaders, but they often do not know what actions are expected of them as leaders or what they should do to be more effective leaders.

Purpose

We sought to compile, through interviews with senior leaders at an academic institution, real leadership scenarios for a series of case-based examples to be used during group mentoring sessions for aspiring medical leaders.

Methods

We conducted one-to-one interviews using open-ended questions with 11 current and emeritus chairpersons or chiefs of major departments or divisions at our academic medical center. Questions were designed to elicit anecdotes and examples of actions that demonstrate effective and ineffective leadership. Responses were analyzed with qualitative techniques to generate topics of leadership behaviors, which then were compiled into a collection of illustrative examples.

Results

The leaders interviewed discussed challenges they encountered in daily routines and described how they addressed certain dilemmas. Topics included making decisions without complete information, winning over reluctant administrators, building alliances with peers, involving subordinates in initiatives, and using knowledge to defend one's position. Actions requiring interpersonal skills also were discussed, including varying modes of communication, avoiding adversity, displaying gratitude toward subordinates, and safeguarding one's professional image. The leaders' insights and recommendations were compiled into a themed collection of topics to be used during group mentoring sessions to enhance leadership skills.

Conclusions

This qualitative study suggests that the wisdom and experience of senior leaders may be gleaned for a collection of case-based topics that could complement other formal training programs for aspiring medical leaders.

Physicians as leaders: a systematic review through the lens of expert leadership

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.

We know but we hope: A qualitative study of the opinions and experiences on the inclusion of management, health economics and research in the medical curriculum

The achievement of global and national health goals requires a health workforce that is sufficient and trained. Despite considerable steps in medical education, the teaching of management, health economics and research skills for medical doctors are often neglected in medical curricula. This study explored the opinions and experiences of medical doctors and academic educationalists on the inclusion of management, health economics and research in the medical curriculum. A qualitative study was undertaken at four medical schools in Southern Africa (February to April 2021). The study population was medical doctors and academic educationalists. Semi-structured interviews with purposively sampled participants were conducted. All interviews were recorded and professionally transcribed. Constructivist grounded theory guided the analysis with the use of ATLAS.ti version 9.1.7.0 software. In total, 21 academic educationalists and 28 medical doctors were interviewed. In the first theme We know, participants acknowledged the constraints of medical schools but were adamant that management needed to be taught intentionally and explicitly. The teaching and assessment of management and health economics was generally reported to be ad hoc and unstructured. There was a desire that graduates are able to use, but not necessarily do research. In comparison to management and research, support for the inclusion of health economics in the curriculum was insignificant. Under We hope, educationalists hoped that the formal clinical teaching will somehow instil values and best practices of management and that medical doctors would become health advocates. Most participants wished that research training could be optimised, especially in relation to the duration of allocated time; the timing in the curriculum and the learning outcomes. Despite acknowledgement that management and research are topics that need to be taught, educationalists appeared to rely on chance to teach and assess management in particular. These qualitative study findings will be used to develop a discrete choice experiment to inform optimal curricula design.

Developing a Dedicated Leadership Curriculum for Radiation Oncology Residents

The increasing complexity of healthcare emphasizes the need for continued physician leadership and leadership training. This study aims to determine baseline attitudes toward the perceptions and utility of a leadership development curriculum (LDC) for radiation oncology (RO) residents. A novel longitudinal LDC was implemented for RO residents at our institution from 2018 to 2019. Prior to the curriculum, current and past residents in our institution's RO residency program were surveyed on their attitudes towards leadership in healthcare, emotional intelligence competencies, and leadership training interests. After the completion of the LDC, a post-curriculum survey was forwarded to current residents. The response rate was 84% (21 of 24) for the baseline survey and 90% (9 of 10) for the post-curriculum survey. Having a leadership training curriculum during residency was rated as extremely useful, with top training interests involving leading clinical teams, effective communication strategies, and conflict management. After the LDC, the residents reported high satisfaction with the curriculum and utilization of leadership training into their daily work. Our LDC demonstrates significant potential to engage trainees and improve their leadership skills at the graduate medical education level.

Toward a universalistic behavioural model of perceived managerial and leadership effectiveness for the health services sector

Much management and leadership development provision for healthcare professionals has been the subject of considerable criticism, and there have been numerous calls for training programmes explicitly focused on the specific managerial (manager/leader) behaviours healthcare managers, physician leaders and nurse managers need to exhibit to be perceived effective. The aim of our multiple cross-case/cross-nation comparative study has been to: i) identify similarities and differences between the findings of published qualitative critical incident studies of effective and ineffective managerial behaviour observed within British, Egyptian, Mexican and Romanian public hospitals, respectively, and ii) if possible, deduce from the identified commonalities a healthcare-related behavioural model of perceived managerial and leadership effectiveness. Adopting a philosophical stance informed by pragmatism, epistemological instrumentalism and abduction, we used realist qualitative analytic methods to code and classify into a maximum number of discrete behavioural categories empirical source data obtained from five previous studies. We found high degrees of empirical generalization which resulted in the identification of five positive (effective) and four negative (ineffective) behavioural dimensions (BDs) derived, respectively, from 14 positive and 9 negative deduced behavioural categories (BCs). These BDs and underpinning BCs are expressed in the form of an emergent two-factor universalistic behavioural model of perceived managerial and leadership effectiveness. We suggest the model could be used to critically evaluate the relevance and appropriateness of existing training provision for physician leaders, nurse managers and other healthcare managers/leaders in public hospitals or to design new explicit training programmes informed and shaped by healthcare-specific management research, as called for in the literature.

Empathic organizational culture and leadership: conceptualizing the framework

Purpose

This paper aims to conceptualize and discuss empathic organizational culture and leadership along with organizational implications.

Design/methodology/approach

The authors reviewed literature to conceptualize empathic organizational culture and leadership. They referred to Hofstede’s organizational culture concept and studies on empathy to explore how leader–follower relationships are influenced by a leader’s empathic disposition.

Findings

Organizational leadership is instrumental in shaping employee performance. While work design, culture, peer support and resource accessibility are discernible, leadership style, control and others are covert. Leaders’ empathic attitudes and dispositions can positively influence organizational functions for improved performance. This review suggests that organizational culture should support growth, proper functioning and effective coordination between employees for improved organizational effectiveness.

Research limitations/implications

The authors conducted searches in leadership and management journals to help conceptualize leaders’ empathic disposition. Future researchers may explore other bodies of literature and the cultural demographic differences in exhibiting empathic leadership and its effectiveness. Researchers can explore how empathic culture relates to job motivation, satisfaction and commitment. The authors suggest that future research may explore how employees’ and supervisors’ behaviors and interactions can create an empathic organizational culture.

Practical implications

The authors identify the characteristics in an empathic leader to articulate the role of empathy in leadership. Alignment between person, group norms and organizational values is more important than the existence of culture.

Originality/value

Empathy is studied by researchers from various disciplines. Similarly, employee well-being has received attention from organizational researchers from many fields. However, researchers have given inadequate attention to conceptualizing an empathic organizational culture and its interrelationship with leadership. The authors offer a more positive perspective to the leader-member exchange (LMX) research by describing how leaders can sustain positive relationships with employees rather than the purely transactional exchanges that characterize LMX.

Physician leadership during the COVID-19 pandemic: an emphasis on the team, well-being and leadership reasoning

Background

The COVID-19 pandemic impacted many aspects of normal operations in academic medicine. While effective leadership is always important, the intensity and urgency of COVID-19 challenged academic medicine leaders to find new ways to lead their institutions and manage their own experiences of the pandemic.

Methods

Sixteen physician leaders from Michigan Medicine took part in semistructured interviews during April and May 2020. Participants were asked open-ended questions about the attributes and techniques that were important to effectively lead during a crisis. The authors analysed the interviews using thematic analysis.

Results

Participants described three overarching themes of leadership during the COVID-19 pandemic: (1) bringing together a diverse team with clear, shared goals; (2) using a range of strategies to tend to their teams’—as well as their own—well-being; and (3) engaging in leadership reasoning as a way of learning from others and reflecting on their own actions to inform their future leadership practice.

Conclusion

The results of this study reveal several salient themes of crisis leadership during the COVID-19 pandemic. The findings also highlight the role of leadership reasoning, a reflective practice employed by leaders to understand and improve their leadership skills. This finding presents leadership skill development as part of lifelong learning in medicine. Findings may be incorporated into best practices and preparations to inform future healthcare leaders.

Predicting Leadership Competency Development and Promotion Among High-Potential Executives: Role of Leader Identity

We propose that distinct leadership competencies differ in their development over time. Extending the integrative model of leader development (Day et al., 2009), we further propose that leader identity will form complex relationships with leadership competencies over time. To test these propositions, we use longitudinal data (i.e., 5 months, four measurement points) of the 80 in total high-potential executives in a corporate leadership development program. We find a significant difference in the initial levels and the changes of eight distinct leadership competencies. We also find that leader identity relates to the development of certain – but not all – leadership competencies. Finally, we demonstrate the importance of developing leadership competencies by linking them to career advancement (i.e., job promotion). These findings are discussed in light of their theoretical and practical implications.

Leadership development trends and challenges in the twenty-first century: rethinking the priorities

Purpose

The purpose of this paper is to understand challenges facing organizations in the twenty-first century and address these challenges through suggesting future leadership development based on relevant leadership theories, which would motivate and guide future research directions in a streamlined manner.

Design/methodology/approach

The present study adopted the exploratory literature review, using the integrative method, to review the theoretical and empirical literature on leadership development published since the 2000s, primarily focusing on research published in the Journal of Management Development.

Findings

The findings of the current review confirmed that leadership theories are the base for leadership development theories, particularly if the purpose is to address and overcome the current challenges facing organizations. The authors suggest that leadership theories and leadership development theories do not exist in isolation from one another, nor do they exist in isolation from challenges facing organizations.

Research limitations/implications

This review does not cover all studies before the 2000s nor other journals in the field of leadership.

Originality/value

Given that most organizations are suffering from one or more of the following issues: sexual scandals, unethical behaviors, individualism, crises and a low level of performance or productivity, the development of particular leadership skills has become a priority. This study is one of few studies guiding both future leadership development research directions and leadership development initiatives.

The Expression of Social and Emotional Competencies of Leadership in Lithuanian Organizations: The Gender Approach

The phenomenon of gender leadership is a controversial object in contemporary leadership studies. These days, the possibilities of traditional leadership have been limited by the ongoing dynamic, global changes, which have influenced the emergence of female leadership as an independent phenomenon and its separation from the male leadership. Presently, possibilities exist to form new insights about gender leadership. Scholars have begun an intense scientific discussion on the advantages and disadvantages of male and female leadership. The goal of this paper is to disclose the social and emotional leadership competencies of different gender employees. The employed research methods are as follows: an analysis and synthesis of scientific literature with the aim of revealing the peculiarities of gender leadership and defining leadership as a set of social and emotional competencies; quantitative research conducted using a questionnaire-based survey with the aim of empirically determining the manifestation of social and emotional leadership competencies in terms of gender leadership. The theoretical analysis allows us to identify the fundamental trends of gender leadership research. The empirical basis of this article comprises the results of empirical research carried out in 2018. The paper includes an abstract of the theoretical research of gender leadership and the social and emotional leadership competencies based on the research methodology and the results received. According to the results of the empirical research, it is possible to find matching assessments of social and emotional leadership competencies in men and women; certain significant differences exist as well. These results revealed which of the advantages possessed by female leaders tend to lie in their soft management skills: interaction, trust, as well as relationships and skills in working with people.

What makes an ideal hospital-based medical leader? Three views of healthcare professionals and managers: A case study

Medical leadership is an increasingly important aspect of hospital management. By engaging physicians in leadership roles, hospitals aim to improve their clinical and financial performances. Research has revealed numerous factors that are regarded as necessary for ‘medical leaders’ to master, however we lack insights into their relative importance. This study investigates the views of healthcare professionals and managers on what they consider the most important factors for medical leadership. Physicians (n = 11), nurses (n = 10), laboratory technicians (n = 4) and managers (n = 14) were interviewed using Q methodology. Participants ranked 34 statements on factors elicited from the scientific literature, including personal features, context-specific features, activities and roles. By-person factor analysis revealed three distinct views of medical leadership. The first view represents a strategic leader who prioritizes the interests of the hospital by participating in hospital strategy and decision making. The second view describes a social leader with strong collaboration and communication skills. The third view reflects an accepted leader among peers that is guided by a clear job description. Despite these differences, all respondents agreed upon the importance of personal skills in collaboration and communication, and having integrity and a clear vision. We find no differences in views related to particular healthcare professionals, managers, or departments as all views were defined by a mixture of departments and participants. The findings contribute to increased calls from both practice and literature to increase conceptual clarity by eliciting the relative importance of medical leadership-related factors. Hospitals that wish to increase the engagement of physicians in improving clinical and financial performances through medical leadership should focus on selecting and developing leaders who are strong strategists, socially skilled and accepted by clinical peers.

A Model for Sustaining Health at the Primary Care Level

As the healthcare industry in USA is changing from a fee-for-service to a value-based system, the need for a shift in how patients are treated is evident. Healthcare organizations are reimbursed based on value and quality of service. The system shift recognizes that each patient possesses differing medical needs moving care from generalized medical treatments to individualistic care. To deal with this change and attempt to increase quality and value, many healthcare organizations are adopting a team care approach through the development of Patient-Centered Medical Homes (PCMH). In many examples of the team approach, the Primary Care Practitioner (PCP) is viewed as the main coordinator of care. Having this responsibility can create added stress for practitioners, which can lead to a decrease in the quality of care. The proposed model, in this article, outlines an example of how individualistic care can be achieved and assembled in the PCMH with the PCP as the main coordinator of care to sustain patient health.

Effective physician leaders: an appreciative inquiry into their qualities, capabilities and learning approaches

Purpose

The aim of this study was to explore the qualities and capabilities effective physician leaders attribute to their success in leading change and how they developed these.

Method

The authors interviewed 20 emerging and senior leaders using a semistructured interview guide informed by appreciative inquiry. Data were subjected to an inductive qualitative content analysis to identify themes related to qualities, capabilities and learning approaches.

Results

The qualities identified were clarity of purpose to improve care, endurance, a positive outlook and authenticity. They were considered innate or developed during participants’ upbringing. Capabilities were to ground management in medicine, engage others, catalyse systems by acting on interdependencies and employ a scientific approach to understand problems and measure progress. Capabilities were developed through cross-pollination from a diversity of work experiences, reflection, when education was integrated with practice and when their organisational environment nurtured ambition and learning.

Conclusions

This study reframes current leadership thinking by empirically identifying qualities, capabilities, and learning approaches that can contribute to effective physician leadership. Instead of merely adapting leadership development programmes from other domains, this study suggests there are capabilities unique to effective physician leadership: ground management in medicine and employ a scientific approach to problem identification and solution development. The authors outline practical implications for individuals and organisations to support leader development as a cohesive organisational strategy for learning and change.

Competencies physicians need to lead - a Canadian case

Purpose Emerging evidence correlates increased physician leadership effectiveness with improved patient and healthcare system outcomes. To maximize this benefit, it is critical to understand current physician leadership needs. The purpose of this study is to understand, through physicians' self-reporting, their own and others' most effective and weakest leadership skills in relation to the LEADS leadership capabilities framework. Design/methodology/approach The authors surveyed 209 Canadian physician leaders about their perceptions of their own and other physicians' leadership abilities. Thematic analysis was used, and the results were coded deductively into the five LEADS categories, and new categories emerging from inductive coding were added. Findings The authors found that leaders need more skills in the areas of Engage Others and Lead Self, and an emergent category of Business Skills, which includes financial competency, budgeting, facilitation, etc. Further, Achieve Results, Develop Coalitions and Systems Transformation are skills least reported as needed in both self and others. Originality/value The authors conclude that LEADS, in its current form, has a gap in the competencies prescribed, namely, "Business Skills". They recommend the development of a more comprehensive LEADS framework that includes such skills as financial literacy/competency, budgeting, facilitation, etc. The authors also found that certain dimensions of LEADS are being overlooked by physicians in terms of importance (Systems Transformation, Achieve Results, Develop Coalitions), and this warrants greater investigation into the reasons why these skills are not as important as the others (Engage Others and Lead Self).

Medical leaders or masters?-A systematic review of medical leadership in hospital settings

Medical leadership is increasingly considered as crucial for improving the quality of care and the sustainability of healthcare. However, conceptual clarity is lacking in the literature and in practice. Therefore, a systematic review of the scientific literature was conducted to reveal the different conceptualizations of medical leadership in terms of definitions, roles and activities, and personal-and context-specific features. Eight databases were systematically searched for eligible studies, including empirical studies published in peer-reviewed journals that included physicians carrying out a manager or leadership role in a hospital setting. Finally, 34 articles were included and their findings were synthesized and analyzed narratively. Medical leadership is conceptualized in literature either as physicians with formal managerial roles or physicians who act as informal 'leaders' in daily practices. In both forms, medical leaders must carry out general management and leadership activities and acts to balance between management and medicine, because these physicians must accomplish both organizational and medical staff objectives. To perform effectively, credibility among medical peers appeared to be the most important factor, followed by a scattered list of fields of knowledge, skills and attitudes. Competing logics, role ambiguity and a lack of time and support were perceived as barriers. However, the extent to which physicians must master all elicited features, remains ambiguous. Furthermore, the extent to which medical leadership entails a shift or a reallocation of tasks that are at the core of medical professional work remains unclear. Future studies should implement stronger research designs in which more theory is used to study the effect of medical leadership on professional work, medical staff governance, and subsequently, the quality and efficiency of care.