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Article
Publication date: 4 July 2016

Erwin Loh, Jennifer Morris, Laura Thomas, Marie Magdaleen Bismark, Grant Phelps and Helen Dickinson

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…

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.

Details

Leadership in Health Services, vol. 29 no. 3
Type: Research Article
ISSN: 1751-1879

Keywords

Article
Publication date: 25 January 2008

John Clark and Kirsten Armit

The purpose of this paper is to provide a summary of a research and consultation project being undertaken by the NHS Institute for Innovation and Improvement and The…

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Abstract

Purpose

The purpose of this paper is to provide a summary of a research and consultation project being undertaken by the NHS Institute for Innovation and Improvement and The Academy of Medical Royal Colleges to develop an integrated medical management and leadership competency framework. This will apply to all doctors in training at undergraduate and postgraduate levels and post‐registration.

Design/methodology/approach

A literature review and consultation approach has been adopted. By interviewing appropriate stakeholders from medical professional, educational, service and regulatory bodies, a high level of awareness and engagement has been realised. This should pay dividends at the implementation phase.

Findings

Whilst some management and leadership is included within current curricula, it is highly variable both in terms of its coverage and relevance. At undergraduate level, it is often covered within professional development modules. At postgraduate level, some exciting initiatives are offered for some doctors but no integrated, systematic and coherent framework exists. Findings from the research are influencing the design and content of the emerging competency framework.

Research limitations/implications

The approach used has provided a good range of information however, neither an exhaustive set of views or a full literature review has been obtained.

Practical implications

Introduction of the Medical Leadership Competency Framework will have a significant impact on how doctors are trained. To be deemed an effective and safe doctor in the future, competence in both clinical and wider non‐clinical competences including management and leadership will be required.

Originality/value

This paper will raise awareness of this important initiative and offer a methodology for other clinical professional groups, nationally and internationally.

Details

Clinical Governance: An International Journal, vol. 13 no. 1
Type: Research Article
ISSN: 1477-7274

Keywords

Article
Publication date: 16 March 2015

Steven J. Agius, Amy Brockbank, Rebecca Baron, Saleem Farook and Jacky Hayden

The purpose of this paper is to determine the impact of an integrated Medical Leadership Programme (MLP) on a cohort of participating specialty doctors and the NHS…

Abstract

Purpose

The purpose of this paper is to determine the impact of an integrated Medical Leadership Programme (MLP) on a cohort of participating specialty doctors and the NHS services with which they were engaged.

Design/methodology/approach

This was a qualitative study designed to obtain rich textual data on a novel training intervention. Semi-structured interviews were conducted with participating MLP trainees at fixed points throughout the programme in order to capture their experiences. Resulting data were triangulated with data from extant documentation, including trainees’ progress reports and summaries of achievements. Recurring discourses and themes were identified using a framework thematic analysis.

Findings

Evidence of the positive impact upon trainees and NHS services was identified, along with challenges. Evidence of impact across all the domains within the national Medical Leadership Competency Framework was also identified, including demonstrating personal qualities, working with others, managing services, improving services and setting direction.

Research limitations/implications

Data were drawn from interviews with a small population of trainees undertaking a pilot MLP in a single deanery, so there are inevitable limitations for generalisability in the quantitative sense. Whilst the pilot trainees were a self-selected group, it was a group of mixed origin and ability.

Practical implications

The study has provided valuable lessons for the design of future leadership programmes aimed at doctors in training.

Originality/value

Identifying the effectiveness of an innovative model of delivery with regard to the Medical Leadership Curriculum may assist with medical staff engagement and support health service improvements to benefit patient care.

Details

Journal of Health Organization and Management, vol. 29 no. 1
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 12 October 2017

Prosenjit Giri, Jill Aylott and Karen Kilner

The purpose of this study was to explore which factors motivate doctors to engage in leadership roles and to frame an inquiry of self-assessment within Self-Determination…

Abstract

Purpose

The purpose of this study was to explore which factors motivate doctors to engage in leadership roles and to frame an inquiry of self-assessment within Self-Determination Theory (SDT) to identify the extent to which a group of occupational health physicians (OHPs) was able to self-determine their leadership needs, using a National Health Service (NHS) England competency approach promoted by the NHS England Leadership Academy as a self-assessment leadership diagnostic. Medical leadership is seen as crucial to the transformation of health-care services, yet leadership programmes are often designed with a top-down and centrally commissioned “one-size-fits-all” approach. In the UK, the Smith Review (2015) concluded that more decentralised and locally designed leadership development programmes were needed to meet the health-care challenges of the future. However, there is an absence of empirical research to inform the design of effective strategies that will engage and motivate doctors to take up leadership roles, while at the same time, health-care organisations continue to develop formal leadership roles as a way to secure medical leadership engagement. The problem is further compounded by a lack of validated leadership qualities assessment instruments which support researching this problem.

Design/Methodology/approach

The analysis draws on a sample of about 25 per cent of the total population size of the Faculty of Occupational Medicine (n = 1,000). The questionnaire used was the Leadership Qualities Framework tool as a form of online self-assessment (NHS Leadership Academy, 2012). The data were analysed using descriptive statistics and simple inferential methods.

Findings

OHPs are open about reporting their leadership strengths and leadership development needs and recognise leadership learning as an ongoing development need regardless of their level of personal competence. This study found that the single most important factor to affect a doctor’s confidence in leadership is their experience in a management role. In multivariate regression, management experience accounted for the usefulness of leadership training, suggesting that doctors learn best through applied “leadership learning” as opposed to theory-driven programmes. Drawing on SDT (Deci and Ryan, 1985; 2000; Ryan and Deci, 2000), this article provides a theoretical framework that helps to understand those doctors who are likely to engage in leadership and management activities in the organisation. More choice and self-determination of medical leadership programmes are likely to result in more relevant leadership learning that builds on doctors’ previous experience in this area.

Research limitations/implications

While this study benefitted from a large sample size, it was limited to the use of purely quantitative methods. Future studies would benefit from the application of a mixed methodology to combine quantitative data with one-to-one interviews or a focus group.

Practical implications

This study suggests that doctors are able to determine their own learning needs reliably and that they are more likely to increase their confidence in leadership and management if they are exposed to leadership and management experience.

Originality/value

This is the first large-scale study of this kind with a large sample within a single medical specialty. The study is considered as insider research, as the first author is an OHP with knowledge of how to engage OHPs in this work.

Details

Leadership in Health Services, vol. 30 no. 4
Type: Research Article
ISSN: 1751-1879

Keywords

Article
Publication date: 6 October 2014

Andi Sebastian, Liz Fulop, Ann Dadich, Anneke Fitzgerald, Louise Kippist and Anne Smyth

The purpose of this paper is to call for strong medical co-leadership in transforming the Australian health system. The paper discusses how Health LEADS Australia, the…

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Abstract

Purpose

The purpose of this paper is to call for strong medical co-leadership in transforming the Australian health system. The paper discusses how Health LEADS Australia, the Australian health leadership framework, offers an opportunity to engage medical clinicians and doctors in the leadership of health services.

Design/methodology/approach

The paper first discusses the nature of medical leadership and its associated challenges. The paper argues that medical leaders have a key role in the design, implementation and evaluation of healthcare reforms, and in translating these reforms for their colleagues. Second, this paper describes the origins and nature of Health LEADS Australia. Third, this paper discusses the importance of the goal of Health LEADS Australia and suggests the evidence-base underpinning the five foci in shaping medical leadership education and professional development. This paper concludes with suggestions on how Health LEADS Australia might be evaluated.

Findings

For the well-being of the Australian health system, doctors need to play an important role in the kind of leadership that makes measurable differences in the retention of clinical professions; improves organisational cultures; enhances the engagement of consumers and their careers; is associated with better patient and public health outcomes; effectively addresses health inequalities; balances cost effectiveness with improved quality and safety; and is sustainable.

Originality/value

This is the first article addressing Health LEADS Australia and medical leadership. Australia is actively engaging in a national approach to health leadership. Discussions about the mechanisms and intentions of this are valuable in both national and global health leadership discourses.

Details

Leadership in Health Services, vol. 27 no. 4
Type: Research Article
ISSN: 1751-1879

Keywords

Article
Publication date: 13 May 2022

David Earl Adams

Medical errors have become the third leading cause of death in the USA. Two million deaths from preventable medical errors will occur annually worldwide each year. The…

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Abstract

Purpose

Medical errors have become the third leading cause of death in the USA. Two million deaths from preventable medical errors will occur annually worldwide each year. The purpose of this paper is to find themes from the literature relating leadership styles – leadership approaches in practice – with success in reducing medical errors and patient safety.

Design/methodology/approach

This review analyzed primary and secondary sources based on a search for the terms leadership OR leadership style AND medical errors OR patient safety using five high-quality health-care-specific databases: Healthcare Administration Database from Proquest, LLC, Emerald Insight from Emerald Publishing Limited, ScienceDirect from Elsevier, Ovid from Ovid Technologies and MEDLINE with Full-Text from Elton B. Stevens Company. After narrowing, the review considered 21 sources that met the criteria.

Findings

The review found three leadership approaches and four leadership actions connected to successfully reducing medical errors and improving patient safety. Transformational, authentic and shared leadership produced successful outcomes. The review also found four leadership actions – regular checks on the front line and promoting teamwork, psychological safety and open communication – associated with successful outcomes. The review concluded that leadership appeared to be the preeminent factor in reducing medical errors and improving patient safety. It also found that positive leadership approaches, regardless of the safety intervention, led to improving results and outcomes.

Research limitations/implications

This review was limited in three ways. First, the review only included sources from the USA, the UK, Canada and Australia. While those countries have similar public-private health-care systems and similar socioeconomics, the problem of medical errors is global (Rodziewicz and Hipskind, 2019). Other leadership approaches or actions may have correlated to reducing medical errors by broadening the geographic selection parameters. Future research could remove geographic restrictions for selection. Second, the author has a bias toward leadership as distinctive from management. There may be additional insights gleaned from expanding the search terms to include management concepts. Third, the author is a management consultant to organizations seeking to improve health-care safety. The author’s bias against limited action as opposed to strategic leadership interventions is profound and significant. This bias may generalize the problem more than necessary.

Practical implications

There are three direct practical implications from this review. The limitations of this review bound these implications. First, organizations might assess strategic and operational leaders to determine their competencies for positive leadership. Second, organizations just beginning to frame or reframe a safety strategy can perhaps combine safety and leadership interventions for better outcomes. Third, organizations could screen applicants to assess team membership and team leadership orientation and competencies.

Originality/value

This review is valuable to practitioners who are interested in conceptual relationships between leadership approaches, safety culture and reducing medical errors. The originality of this research is limited to that of any literature review. It summarizes the main themes in the selected literature. The review provides a basis for future considerations centered on dual organizational interventions for leadership and safety.

Details

Measuring Business Excellence, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1368-3047

Keywords

Article
Publication date: 13 November 2020

Prakash Subedi, Jill Aylott, Naushad Khan, Niki Shrestha, Dayaram Lamsal and Pamela Goff

The purpose of this paper is to outline the “Hybrid” “International” Emergency Medicine (HIEM) programme, which is an ethical pathway for the recruitment, employment and…

Abstract

Purpose

The purpose of this paper is to outline the “Hybrid” “International” Emergency Medicine (HIEM) programme, which is an ethical pathway for the recruitment, employment and training of Emergency Medicine doctors; with a rotation through the NHS on a two-year medical training initiative with a Tier 5 visa, “earn, learn and return” programme. The HIEM programme offers an advantage to the Tier 2 visa by combining training, education and employment resulting in new learning to help improve the health system in Nepal and provide continued cultural support, clinical and leadership development experience in the UK NHS. Finally, this programme also provides a Return on Investment to the NHS.

Design/methodology/approach

A shortage of doctors in the UK, combined with a need to develop Emergency Medicine doctors in Nepal, led to a UK Emergency Medicine Physician (PS) to facilitate collaboration between UK/Nepal partners. A mapping exercise of the Royal College of Emergency Medicine curriculum with the competencies for the health system and quality improvement leaders and partners with patients produced a “HIEM programme”. The HIEM programme aims to develop first-class doctors to study in Emergency Departments in the UK NHS while also building trainee capability to improve the health system in Nepal with a research thesis.

Findings

The HIEM programme has 12 doctors on its programme across years one and two, with the first six doctors working in the UK NHS and progressing well. There are reports of high levels of satisfaction with the trainees in their transition from Nepal to the UK and the hospital is due to save £720,000 (after costs) over two years. Each trainee will earn £79,200 over two years which is enough to pay back the £16,000 cost for the course fees. Nepal as a country will benefit from the HIEM programme as each trainee will submit a health system improvement Thesis.

Research limitations/implications

The HIEM programme is in its infancy as it is two years through a four-year programme. Further evaluation data are required to assess the full impact of this programme. In addition, the HIEM programme has only focussed on the development of one medical speciality which is Emergency Medicine. Further research is required to evaluate the impact of this model across other medical and surgical specialties.

Practical implications

The HIEM programme has exciting potential to support International Medical Graduates undertake a planned programme of development while they study in the UK with a Tier 5 visa. IMGs require continuous support while in the UK and are required to demonstrate continued learning through continuous professional development (CPD). The HIEM programme offers an opportunity for this CPD learning to be structured, meaningful and progressive to enable new learning. There is also specific support to develop academic and research skills to undertake a thesis in an area that requires health system improvement in Nepal.

Originality/value

This is the first time an integrated clinical, leadership, quality improvement and patient partnership model curriculum has been developed. The integrated nature of the curriculum saves precious time, money and resources. The integrated nature of this “hybrid” curriculum supports the development of an evidence-based approach to generating attitudes of collaboration, partnership and facilitation and team building in medical leadership with patient engagement. This “hybrid” model gives hope for the increased added value of the programme at a time of global austerity and challenges in healthcare.

Details

Leadership in Health Services, vol. 34 no. 3
Type: Research Article
ISSN: 1751-1879

Keywords

Article
Publication date: 6 July 2015

Peter Spurgeon, Paul Long, John Clark and Frank Daly

The purpose of this paper is to address issues of medical leadership within health systems and to clarify the associated conceptual issues, for example, leadership versus…

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Abstract

Purpose

The purpose of this paper is to address issues of medical leadership within health systems and to clarify the associated conceptual issues, for example, leadership versus management and medical versus clinical leadership. However, its principle contribution is to raise the issue of the purpose or outcome of medical leadership, and, in this respect, it argues that it is to promote medical engagement.

Design/methodology/approach

The approach is to provide evidence, both from the literature and empirically, to suggest that enhanced medical engagement leads to improved organisational performance and, in doing so, to review the associated concepts.

Findings

Building on current evidence from the UK and Australia, the authors strengthen previous findings that effective medical leadership underpins the effective organisational performance.

Research limitations/implications

There is a current imbalance between the size of the databases on medical engagement between the UK (very large) and Australia (small but developing).

Practical implications

The authors aim to equip medical leaders with the appropriate skill set to promote and enhance greater medical engagement. The focus of leaders in organisations should be in creating a culture that fosters and supports medical engagement.

Social implications

This paper provides empowerment of medical professionals to have greater influence in the running of the organisation in which they deliver care.

Originality/value

The paper contains, for the first time, linked performance data from the Care Quality Commission in the UK and from Australia with the new set of medical engagement findings.

Details

Leadership in Health Services, vol. 28 no. 3
Type: Research Article
ISSN: 1751-1879

Keywords

Article
Publication date: 24 November 2009

Judy McKimm, David Rankin, Phillippa Poole, Tim Swanwick and Mark Barrow

Doctors are seen as key to embedding health improvement and patient safety initiatives and there has been much international debate over how best to engage doctors in…

Abstract

Doctors are seen as key to embedding health improvement and patient safety initiatives and there has been much international debate over how best to engage doctors in healthcare leadership and management. This paper explores the current focus on leadership development programmes for doctors through taking a comparative approach to initiatives in New Zealand and the UK. It also considers the challenges to embedding leadership development programmes at all levels of training, education and continuing professional development and highlights some of the implications arising from the two approaches.

Details

International Journal of Leadership in Public Services, vol. 5 no. 3
Type: Research Article
ISSN: 1747-9886

Keywords

Article
Publication date: 5 September 2018

Ross I. Lamont and Ann L.N. Chapman

There is increasing recognition of the importance of incorporating medical leadership training into undergraduate medical curricula and this is now advocated by the…

Abstract

Purpose

There is increasing recognition of the importance of incorporating medical leadership training into undergraduate medical curricula and this is now advocated by the General Medical Council (GMC) and supported through the development of the Undergraduate Medical Leadership Competency Framework (MLCF). However to date, few medical schools have done so in a systematic way and training/experience in medical leadership at undergraduate level is sporadic and often based on local enthusiasm. The purpose of this paper is to outline a theoretical curriculum to stimulate and support medical leadership development at undergraduate level.

Design/methodology/approach

This study describes a theoretical framework for incorporation of medical leadership training into undergraduate curricula using a spiral curriculum approach, linked to competences outlined in the Undergraduate Medical Leadership Competency Framework. The curriculum includes core training in medical leadership for all students within each year group with additional tiers of learning for students with a particular interest.

Findings

This curriculum includes theoretical and practical learning opportunities and it is designed to be deliverable within the existing teaching and National Health Service (NHS) structures. The engagement with local NHS organisations offers opportunities to broaden the university teaching faculty and also to streamline medical leadership development across undergraduate and postgraduate medical education.

Originality/value

This theoretical curriculum is generic and therefore adaptable to a variety of undergraduate medical courses. The combination of theoretical and practical learning opportunities within a leadership spiral curriculum is a novel and systematic approach to undergraduate medical leadership development.

Details

Leadership in Health Services, vol. 32 no. 3
Type: Research Article
ISSN: 1751-1879

Keywords

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