Interest in leadership development in healthcare is substantial. Yet it remains unclear which interventions are most reliably associated with positive outcomes. We focus on the important area of physician leadership development in a systematic literature review of the latest research from 2007 -2016. The paper applies a validated instrument used for medical education, MERSQI, to the included studies. Ours is the first review in this research area to create a tiered rating system to assess the best available evidence. We concentrate on findings from papers in the highly-rated categories. First, our review concludes that improvements in individual-level outcomes can be achieved (e.g. knowledge, motivation, skills, and behavior change). Second, development programs can substantially improve organizational and clinical outcomes. Third, some of the most effective interventions include: workshops, videotaped simulations, multisource feedback (MSF), coaching, action learning, and mentoring. Fourth, the evidence suggests that objective outcome data should be collected at baseline, end of program, and retrospectively. An outcomes-based approach appears to be the most effective design of programs. We also make recommendations for future research and practice.

Health systems invest significant resources in leadership development for physicians and other health professionals. Competent leadership is considered vital for maintaining and improving quality and patient safety. We carried out this systematic review to synthesise new empirical evidence regarding medical leadership development programme factors which are associated with outcomes at the clinical and organisational levels. Using Ovid MEDLINE, we conducted a database search using both free text and Medical Subject Headings. We then conducted an extensive hand-search of references and of citations in known healthcare leadership development reviews. We applied the Medical Education Research Study Quality Indicator (MERSQI) and the Joanna Briggs Institute (JBI) Critical Appraisal Tool to determine study reliability, and synthesised results using a meta-aggregation approach. 117 studies were included in this systematic review. 28 studies met criteria for higher reliability studies. The median critical appraisal score according to the MERSQI was 8.5/18 and the median critical appraisal score according to the JBI was 3/10. There were recurring causes of low study quality scores related to study design, data analysis and reporting. There was considerable heterogeneity in intervention design and evaluation design. Programmes with internal or mixed faculty were significantly more likely to report organisational outcomes than programmes with external faculty only (p=0.049). Project work and mentoring increased the likelihood of organisational outcomes. No leadership development content area was particularly associated with organisational outcomes. In leadership development programmes in healthcare, external faculty should be used to supplement in-house faculty and not be a replacement for in-house expertise. To facilitate organisational outcomes, interventions should include project work and mentoring. Educational methods appear to be more important for organisational outcomes than specific curriculum content. Improving evaluation design will allow educators and evaluators to more effectively understand factors which are reliably associated with organisational outcomes of leadership development.

IMPORTANCEThe COVID-19 pandemic is the greatest global test of health leadership of our generation. There is an urgent need to provide guidance for leaders at all levels during the unprecedented preresolution recovery stage. OBJECTIVETo create an evidence-and expertise-informed framework of leadership imperatives to serve as a resource to guide health and public health leaders during the postemergency stage of the pandemic. EVIDENCE REVIEWA literature search in PubMed, MEDLINE, and Embase revealed 10 910 articles published between 2000 and 2021 that included the terms leadership and variations of emergency, crisis, disaster, pandemic, COVID-19, or public health. Using the Standards for Quality Improvement Reporting Excellence reporting guideline for consensus statement development, this assessment adopted a 6-round modified Delphi approach involving 32 expert coauthors from 17 countries who participated in creating and validating a framework outlining essential leadership imperatives. FINDINGS The 10 imperatives in the framework are: (1) acknowledge staff and celebrate successes;(2) provide support for staff well-being; (3) develop a clear understanding of the current local and global context, along with informed projections; (4) prepare for future emergencies (personnel, resources, protocols, contingency plans, coalitions, and training); (5) reassess priorities explicitly and regularly and provide purpose, meaning, and direction; (6) maximize team, organizational, and system performance and discuss enhancements; (7) manage the backlog of paused services and consider improvements while avoiding burnout and moral distress; (8) sustain learning, innovations, and collaborations, and imagine future possibilities; (9) provide regular communication and engender trust; and (10) in consultation with public health and fellow leaders, provide safety information and recommendations to government, other organizations, staff, and the community to improve equitable and integrated care and emergency preparedness systemwide. CONCLUSIONS AND RELEVANCELeaders who most effectively implement these imperatives are ideally positioned to address urgent needs and inequalities in health systems and to cocreate with their organizations a future that best serves stakeholders and communities.

PurposeCalls for doctors to enter management are louder as the benefits of medical leadership become clearer. However, supply is not meeting demand. This study asks doctors (physicians): what might encourage you to go into leadership, and what are the disincentives? The same was asked about leadership training. First, the paper tries to understand doctors’ motivation to lead, specifically, to explore the job characteristics that act as incentives and disincentives. Second, the study points to organisational obstacles that further shrink the medical leadership pipeline.MethodDoctors were surveyed through the Organization of Danish Medical Societies. Our key variables included: (1) the incentives and disincentives for doctors of going into leadership and management and (2) the motivation to participate in leadership training. Our sample of 3534 doctors (17% response) is representative of the population of doctors in Denmark.FindingsThe main reason why doctors are motivated towards leadership is to make a difference. They are put off by fears of extra administration, longer hours, burnout, lack of resources and by organisational cultures resistant to change. However, doctors are aware of their need for leadership development prior to entering management.Practical implicationsTo improve succession planning, health systems should adapt to reflect the incentives of their potential medical leaders. Leadership training is also essential. These changes are especially important now; medical leaders are linked positively to organisational and patient outcomes and have been central in responding to COVID-19, stress and burnout among clinical staff continues to rise, and health systems face recruitment and retention challenges.

ObjectiveThe COVID-19 pandemic exposed significant gaps in Iran’s and other health systems’ risk communication. The accompanying infodemic undermined policy responses, amplified distrust in government and reduced adherence to public health recommendations among the Iranian population. This study aimed to develop a conceptual framework for health risk communication and infodemic management (RCIM) during epidemics and health emergencies in Iran that could have potential applications in other contexts.DesignThis study was designed in two phases. Phase 1 involved semistructured qualitative interviews with key informants to explore effective RCIM strategies across public health settings in Iran and to develop a conceptual framework. Phase 2 involved revising the framework based on feedback from an online expert panel regarding its comprehensiveness and validity.SettingProvincial/national public health settings in Iran.ParticipantsTwenty key informants from provincial and national public health authorities who contributed to COVID-19 response programmes participated in interviews. Nine experts from diverse academic disciplines, provincial and national settings, and geographical locations participated in an online expert panel.ResultsThe conceptual model was created based on qualitative interviews and expert panel discussions and was structured according to six pillars of the WHO health system framework: leadership and governance, information, health workforce and financial resources, along with media and community. Leadership and governance, including trustworthy leaders, were recommended as the foundation for developing RCIM in Iran. Developing an official strategy with information infrastructures, including high-quality surveillance systems, identified personnel and training for specialists among the health workforce, financial resources, communication channels and community engagement were recognised as other dimensions for developing health risk communication in Iran.ConclusionThe proposed framework represents a step toward establishing a national RCIM strategy in Iran. Further validation of the conceptual framework and experiments on how it could potentially influence policy and practice is recommended. This model has the potential to be applied in other contexts in its current form or as the foundation for customised local versions.

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