Cultural differences in clinical leadership: a qualitative study comparing the attitudes of general dental practitioners from Greater Manchester and Tokyo

Leadership in Dental Practice: a Three Stage Systematic Review and Narrative Synthesis

Objectives

To review leadership for dentists in patient facing, primary care dental practice.

Methods

A three stage systematic review with narrative synthesis included stage 1: a scoping overview of management and leadership policy context; stage 2: systematic review of review of leadership in healthcare; and stage 3: systematic focused review of leadership in patient-facing dental practice.

Results

The healthcare literature mirrors the generic literature in relation to the temporal evolution of leadership theories. Policy papers influence healthcare literature, though these are generally written by independent bodies, link solely to medical publications, and are often commissioned from the grand strategic level thereby grounding them in a politicised system. The healthcare leadership literature offers few studies at the operational (patient care) level of leadership, with none of these focused explicitly on dentistry and dental practice.

Numerous aims, definitions, models, conceptualisations, and links to theories of leadership are reported. The stage 1 literature demonstrates more contemporaneous ideas of leadership, while the dental practice literature is too often grounded in outdated concepts and theories.

Conclusions

The overarching trend is from leaders to leadership; with no unified definition, model, theory, concept nor aim recognised. The fundamental importance of specific context and the reaction of others to leadership is reinforced. Leadership theories aligned to healthcare include Engaging, Authentic, Collective and the Transformational-Transactional continuum.

Leadership is a dynamic, socially constructed process, only occurring in a group setting. Consisting of multiple moderating variables that demonstrate reciprocal influence on one another, these influences are neither equal nor stable. (246 words)

Clinical significance

Leadership is embedded in regulatory guidance and standards relating to general dental practice. It is therefore crucial to have an evidenced based understanding of what leadership means in this context, and what further work is necessary to support clinicians in the leadership domain.

A qualitative evaluation of a pilot leadership programme for dentists

PURPOSE

The purpose of this paper was to evaluate a pilot training programme run by Health Education North West to promote clinical leadership amongst general dental practitioners (GDPs). New powers and responsibilities for clinicians have caused a fundamental shift in the way that local services are planned and delivered in England. GDPs are being appointed onto the boards of local professional networks (LPNs) to influence the way that services are delivered at a local level. Analogous to clinical commissioning groups in medicine, the role of LPNs is to ensure that GDPs lead change and drive up the quality of service provision. Clinical leadership has been argued to be fundamentally important in these new structures, but has received little attention in the dental literature.

DESIGN/METHODOLOGY/APPROACH

Semi-structured interviews and a focus group were held with participants of the pilot to explore their understanding and experience of clinical leadership. These were recorded, transcribed verbatim and underwent thematic analysis.

FINDINGS

Nineteen codes were identified and organized into four themes: nature of clinical leadership, challenges for clinical leaders in dentistry, Leadership Exploration and Discovery programme evaluation and future direction.

PRACTICAL IMPLICATIONS

The research provides an understanding of how GDPs conceptualise clinical leadership and provides recommendations for future leadership training programmes.

ORIGINALITY/VALUE

This is the first evaluation of a leadership programme for GDPs and so helps address the paucity of evidence in the dental literature.

The development and piloting of a leadership questionnaire for general dental practitioners: preliminary results from the North West of England and Tokyo

OBJECTIVES

Key reforms in England and Japan have called for greater clinical leadership from general dental practitioners to deliver improvements in the quality of care for patients. In England, the reorganisation of the National Health Service has led to the development of Local Professional Networks to ensure services are clinically led, patient and outcome focused. In Japan, the rapidly changing demographics have led to calls for general dental practitioners to become more active in meeting the emerging population health challenges. Both require engagement at a strategic and a local level. However, little is known about what is meant by clinical leadership in dentistry or what training needs exist. The aim of this study was to develop and pilot a questionnaire to understand what general dental practitioners feel is important about clinical leadership and how they rate themselves.

METHODS

A 61-item questionnaire was developed from the literature, an earlier qualitative study and refined through cognitive interviews. Questionnaires were distributed to general dental practitioners across the North West of England and Tokyo, using random sequence generation. For each item, the participant had to record whether they thought the statement was an important component of clinical leadership and how they rated themselves. Both were rated using a seven-point Likert scale. Data reduction was undertaken using principal component analysis to examine for factor loadings within the questionnaire. Differences in mean scores were also used to highlight substantive differences in how general dental practitioners rated the different components of leadership and how they rated themselves.

RESULTS

The response rate for the pilot was low (22.9% and 7.5% for North West and Tokyo respectively). The items that were considered to be important in leadership reduced to two components in the North West (accounting for 62.1% of the total variance): 'How to lead' and 'How not to lead'. In Tokyo, 56.4% of the total variance was explained by three components: 'Demonstrating personal qualities', 'Working with others' and 'How not to lead'. When the self-rated items were reduced, three factors were found to be important in the North West: 'Working with others', 'Setting direction' and 'Managing services' (55.1% of the variance). 'Working with others', 'Demonstrating personal qualities', 'Pragmatism', 'Setting direction' and 'Improving services' were found to be important in Tokyo (52.8% of the variance). The questionnaire items relating to integrity, team-working and having a positive attitude during difficult times were rated highly by both groups. Items relating to providing vision for team, being assertive and having a positive attitude had the greatest mean difference, suggesting possible areas of training need.

CONCLUSION

The nature of the pilot study and the poor response rate makes any conclusion difficult to infer. Among those that participated, leadership was understood to be more important at a practice level rather than at a strategic level. The questionnaire should be refined further based on the results of the pilot and the data reduction.

Leadership in dentistry: findings from new tool to measure clinical leadership

Background

In England, the recent reorganization of the National Health Service has led to the development of local dental networks and an emerging narrative on the importance of clinical leadership in dentistry. Analogous to clinical commissioning groups, local dental networks ensure general dental practitioners (GDPs) influence the delivery of local services. However, little is known about what GDPs think clinical leadership is and whether the construct has meaning. The aim of this study was to explore the structure of a pilot questionnaire to determine the qualities that GDPs deem are important and to use a data reduction methodology to produce a tool to measure clinical leadership.

Methods

A 61-item questionnaire was distributed to GDPs across the North West of England. GDPs were asked to rate the level of importance of each item using a 7-point Likert scale. Principal component analysis and direct oblimin rotation was used to examine for factor loadings within the questionnaire. Internal validity was tested by Cronbach’s alpha.

Results

Two principle factors emerged: “how to lead” and “how not to lead”. Individually, the item “I think it is important to have integrity” was rated as the most important.

Conclusion

The study developed a refined questionnaire that captures the important qualities of clinical leadership in dentistry. This is the first questionnaire that has been developed to capture important leadership attributes for GDPs.