Search results

Purpose – This paper explores differences in decision-making approaches between physician executives and nonphysician executives in a managerial setting.

Design/Methodology/Approach – Fredrickson and Mitchell's (1984) conceptualization of the construct of comprehensiveness in strategic decision making is the central construct of this paper. Theories of professional identity, socialization, and institutional/dominant logics are applied to illustrate their impact on strategic decision-making approaches of physician and nonphysician executives.

Findings – This paper proposes that high-status professionals, specifically physicians, occupying senior management roles are likely to approach decision making in a way that is consistent with their professional identity, and by extension, that departments led by physician executives are less likely to exhibit comprehensiveness in strategic decision-making processes than departments led by nonphysician executives.

Originality/Value – This paper provides conceptual evidence that physicians and nonphysicians approach management differently, and introduces the utility of comprehensiveness as a construct for strategic decision making in the context of health care management.

Research on strategic decision‐making has emphasized the importance of team decision‐making as it brings the benefits of synergy. Literature on healthcare is silent on the role of professional doctors in the strategic decision‐making process and their impact on decision outcomes. The purpose of the present paper is to empirically examine the outcomes of decisions when physician executives were involved in strategic decision‐making process in healthcare organizations.

Using a structured survey instrument, this paper gathered data from 361 senior executives from 109 hospitals in USA and analyzed the data using regression techniques on whether the presence of physicians in strategic decision‐making processes enhanced decision quality, commitment, and understanding.

Results showed the presence of professional doctors in the decision‐making process enhances commitment and decision quality in healthcare organizations.

Only the healthcare industry was considered. Self‐report measures may have some inherent social desirability bias.

This study contributes to both practicing managers as well as to strategic management literature. This study suggests that healthcare administrators need to engage physician executives in strategic decision‐making to have successful decision outcomes.

To the extent strategic decision‐making process is similar in other industries, the findings can be generalizable across other industries.

The purpose of this paper is to examine the empirical validity of transformational, transactional and laissez‐faire leadership and their sub‐scales among physician managers.

A nation‐wide, anonymous mail survey was carried out in the United States, requesting community health center executive directors to provide ratings of their medical director's leadership behaviors (34 items) and effectiveness (nine items), using the Multifactor Leadership Questionnaire 5X‐Short, on a five‐point Likert scale. The survey response rate was 40.9 percent, for a total 269 responses. Exploratory factor analysis was done, using principal factor extraction, followed by promax rotation).

The data yielded a three‐factor structure, generally aligned with Bass and Avolio's constructs of transformational, transactional and laissez‐faire leadership. Data do not support the factorial independence of their subscales (idealized influence, inspirational motivation, individualized consideration, and intellectual stimulation under transformational leadership; contingent reward, management‐by‐exception active, and management‐by‐exception passive under transactional leadership). Two contingent reward items loaded on transformational leadership, and all items of management‐by‐exception passive loaded on laissez‐faire.

A key limitation is that supervisors were surveyed for ratings of the medical directors' leadership style. Although past research in other fields has shown that supervisor ratings are strongly correlated with subordinate ratings, further research is needed to validate the findings by surveying physician and other clinical subordinates. Such research will also help to develop appropriate content of leadership training for clinical leaders.

This study represents an important step towards establishing the empirical evidence for the full range of leadership constructs among physician leaders.

Medicine is undergoing dramatic changes that will alter its basic organizational structure. The integration of evidence‐based medicine, patient centered care, and the electronic medical record into medical practice will necessitate innovative approaches to management.

A review of the literature was undertaken to assess the current state of leadership coaching for physicians and non‐medical health care leaders. Different models of leadership coaching are described and examined.

Leadership coaching has been an underutilized resource in health care executive training. The use of coaching methods has been of great utility for physician and non‐medical managerial leadership. Health care leaders will need to develop interpersonal and emotional intelligence competencies in order to successfully run increasingly complex organizations.

To encourage further quantitative studies of coaching in the health care field. Such studies would be significantly helpful in elucidating those approaches to coaching that yield the best results. Encouraging the greater use of leadership coaching by medical executives can be of potentially important benefit to the successful operation of their institutions.

The purpose of this paper is to present a case study which details the successful development, design and deployment of a leadership course for academic medical department chairs. The course provides a needed local and contextual alternative to the lengthy and often theoretical MBA/MHA.

Faculty developers used a multi-tiered methodology for developing the physician leadership course. The methodology consisted of literature findings, needs assessment, stakeholder input and structured interviews with administrative leaders.

The research, stakeholder input and interviews revealed an increasing number of physician leaders with a general lack of fundamental administrative leadership skills. These shortfalls are largely because of underexposure to core management competencies during medical school and limited contextual knowledge outside their organization. There is an urgent need for leadership development opportunities aimed at current and future academic medical department chairs.

This research is limited by the assumptions that the curriculum meets the ever-changing needs of health-care leaders, the course’s focus on academic medical department chairs within the Texas Medical Center and the lack of long range follow-up data to substantiate the effectiveness of the curriculum content and course structure.

The Academic Medical Department Leadership course offers valuable management skills training which complements standard medical training. Much of the course structure and content is adaptable to physician administrative and leadership positions in all settings.

Although the Academic Medical Department Leadership course is a response to a local concern, the study offers a generalizable approach to addressing the demand for skilled physician leaders.

This paper aims to present the argument that effective physician leadership is needed to improve the quality and efficiency of healthcare delivery in the USA and around the world.

This paper is based on an in-depth literature review, interviews with physician leaders and a study of the competencies required for physicians to successfully lead healthcare organizations.

The paper finds that a clear need exists for training to improve specific leadership competencies among physicians, regardless of their career stage or career path.

Limited research has been conducted on the value of physician leadership and its impact on quality outcomes and patient safety.

This paper establishes the need for physician leadership in healthcare organizations.

This paper will influence public attitudes within the healthcare sphere on the value that physician leaders can bring to healthcare.

This paper fulfils a need for more study on the impact that physician leadership brings to quality and patient care, and establishes the need for physician leaders to obtain specific leadership competencies.

In this paper, I review the many research contributions that have advanced our knowledge about the role and impact of physician executives during the recent era of managed care. The interpretive framework for this review is guided by Freidson's restructuring thesis, which posits that physician executives — the administrative elite of the medical profession — represent the segments of the profession whose role will be to balance the needs of the organization with the desires of the medical profession. Although substantial research supports the proposition that physician executives are well positioned, prepared, and willing to undertake such boundary-spanning responsibilities, there is only minimal research specifically addressing the effectiveness of this hybrid profession. In this void, I suggest that another approach to assessing effectiveness is to focus on the process of trust building and maintenance, since trust is central to achieving the primary responsibilities of physician executives. A model of the process of trust development is presented as a guide for future research, along with discussion about particular challenges to physician executives in gaining trust from clinicians and non-physicians.

Physicians are commonly promoted into administrative and managerial roles in US hospitals on the basis of clinical expertise and often lack the skills, training or inclination to lead. Several studies have sought to identify factors associated with effective physician leadership, yet we know little about how physician leaders themselves construe their roles. The paper aims to discuss these issues.

Phenomenological interviews were performed with 25 physicians at three organizational levels with physicians affiliated or employed by four hospitals within one health care organization in the USA between August and September 2010. A rigorous comparative methodology of data collection and analysis was employed, including the construction of analytic codes for the data and its categorization based on emergent ideas and themes that are not preconceived and logically deduced hypotheses, which is characteristic of grounded theory.

These interviews reveal differences in how part- vs full-time physician leaders understand and value leadership roles vs clinical roles, claim leadership status, and identify as physician leaders on individual, relational and organizational basis.

Although the physicians in the sample were affiliated with four community hospitals, all of them were part of a single not-for-profit health care system in one geographical locale.

These findings may be of interest to hospital administrators and boards seeking deeper commitment and higher performance from physician leaders, as well as assist physicians in transitioning into a leadership role.

This work points to a broader and more fundamental need – a modified mindset about the nature and value of physician leadership.

This study is unique in the exploration of the nature of physician leadership from the perspective of the physician on an individual, peer and organizational level in the creation of their own leadership identity.

The purpose of this paper is to test and measure the outcome of a community hospital in implementing the Affordable Care Act (ACA) through a co-management arrangement. RQ1: do the benefits of a co-management arrangement outweigh the costs? RQ2: does physician alignment aid in the effective implementation of the ACA directives set for hospitals?

A case study of a 350-bed non-profit community hospital co-management company. The quantitative data are eight quarters of quality metrics prior and eight quarters post establishment of the co-management company. The quality metrics are all based on standardized national requirements from the Joint Commission and Centers for Medicare and Medicaid Services guidelines. These measures directly impact the quality initiatives under the ACA that are applicable to all healthcare facilities. Qualitative data include survey results from hospital employees of the perceived effectiveness of the co-management company. A paired samples difference of means t-test was conducted to compare the timeframe before co-management and post co-management.

The findings indicate that the benefits of a co-management arrangement do outweigh the costs for both the physicians and the hospital (RQ1). The physicians benefit through actual dollar payout, but also with improved communication and greater input in running the service line. The hospital benefits from reduced cost – or reduced penalties under the ACA – as well as better communication and greater physician involvement in administration of the service line. RQ2: does physician alignment aid in the effective implementation of the ACA directives set for hospitals? The hospital improved in every quality metric under the co-management company. A paired sample difference of means t-test showed a statistically significant improvement in five of the six quality metrics in the study.

Previous research indicates the potential effectiveness of co-management companies in improving healthcare delivery and hospital-physician relations (Sowers et al., 2013). The current research takes this a step further to show that the data do in fact support these concepts. The hospital and the physicians carrying out the day-to-day actions have shared goals, better communication, and improved quality metrics under the co-management company. As the number of co-management companies increases across the USA, more research can be directed at determining their overall impact on quality care.

Research on strategic decision making has over‐emphasized the importance of competence‐based trust among the team members. Literature on healthcare is silent on the impact of competence‐based trust between the physicians and administrators on decision outcomes. The purpose of this paper is to empirically investigate whether competence‐based trust between physician executives and administrators is beneficial to the healthcare organizations.

Using a structured instrument, data are collected from top management teams of 109 US hospitals. The participants include both CEOs and administrators and physician executives. The data are analyzed using multiple regression technique to examine the role of competence‐based trust between the physicians and administrative executives in enhancing decision quality, commitment and understanding.

Results show that competence‐based trust is the key to successful strategic decision making while lack of trust may hinder the effectiveness of decision implementation in healthcare organizations.

Only the healthcare industry is considered. Self‐report measures may have some common method bias and social desirability bias.

This study contributes to both practicing managers as well as to strategic management literature. This study suggests that development and retention of competence‐based trust between the administrators and physicians is essential in making decision‐making process effective and successful.

Though the study represents the US hospitals, to the extent the strategic decision process is similar across the world, the findings can be generalized to other healthcare organizations in the world.