Clinical leadership and integrated primary care: A systematic literature review

Nieuwboer,; Sande, Rob van der; Marck, Marjolein A. van der; Rikkert, Marcel G M Olde; Perry, Marieke

doi:10.1080/13814788.2018.1515907

Cited by 55 publications

(67 citation statements)

References 49 publications

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“… 2 On a systems level, clinical leadership increases physician engagement and results in advances in healthcare reform, regulation, and patient safety policies. 3 Although there is literature that suggests that clinical leadership empowers physicians and improves patient care, 2 - 6 the process by which clinical leadership is learned is less clear, as there have been no standardized residency curricula or competency-based assessments for leadership development in physicians. 6 - 9 While physicians invest the majority of time during their residency to the acquisition and application of clinical knowledge, their exposure to leadership training is generally lacking; they primarily report learning these critical skills through trial-and-error or observation of faculty in higher positions of power.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Clinical Leadership Training Needs in Senior Pediatric Residents

Daniel

Newton

Farrell

et al. 2021

Journal of Medical Education and Curricular Development

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Introduction: Although clinical leadership in physicians is associated with improved healthcare, leadership training is rarely integrated into residency training. Our objective was to perform a comprehensive needs assessment of our pediatric residents’ existing leadership experiences and knowledge and to identify training gaps within our program. Methods: First, we held focus groups with senior pediatric residents to understand their clinical leadership experiences and identify training needs. Notes were transcribed and independently coded by 2 researchers, with thematic saturation achieved. Next, we focused each session on 1 leadership content area identified from the aforementioned themes to better understand the specific training needs for each topic. Results: Four major themes were identified: (1) Effective and timely communication with supervisors, learners, ancillary staff, and patients is indispensable in promoting safe patient care, avoiding conflict, and preventing misunderstanding. (2) Training in teaching methods is desired, especially gaining the skills needed to teach various levels of learners, in different settings and under time constraints. (3) Time management, availability of resources, and team logistics were often learned through trial-and-error. (4) Self-care, self-acceptance, emotional regulation, and peer debriefing are relied upon to manage negative emotions; rarely are resilience and wellness strategies employed in “real-time.” Conclusion: Senior residents currently face gaps in clinical leadership training and may benefit from additional instruction in content areas related to these 4 themes. Our next steps are to utilize the identified themes to develop a longitudinal and skills-based clinical leadership curriculum to address the gap in graduate medical education.

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Section: Introductionmentioning

confidence: 99%

Assessment of Clinical Leadership Training Needs in Senior Pediatric Residents

Daniel

Newton

Farrell

et al. 2021

Journal of Medical Education and Curricular Development

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“…In a recent study that explored the role of Norwegian municipalities in managing the GP scheme [1], Bjørnhaug and Skyvulstad concluded that GPs should be led by someone with 'a medical background, good knowledge of GPs' work, and an ability to build good relationships with the GPs'. Nieuwboer et al [17] echo some of these statements in a systematic literature review on the role of leadership in facilitating integrated primary care, which concluded that physicians appear to be the most adequate leaders, because of their hierarchical position in relation to other physicians.…”

Section: Challenges Facing Municipalities' Involvement In Quality Impmentioning

confidence: 98%

“…Nieuwboer et al. [ 17 ] echo some of these statements in a systematic literature review on the role of leadership in facilitating integrated primary care, which concluded that physicians appear to be the most adequate leaders, because of their hierarchical position in relation to other physicians.…”

Section: Challenges Facing Municipalities’ Involvement In Quality Impmentioning

confidence: 99%

Quality improvement and antimicrobial stewardship in general practice – the role of the municipality chief medical officer. A qualitative study

Høye

Brænd

Spehar

2020

Scandinavian Journal of Primary Health Care

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Aims: This study aimed to explore the conditions for the Municipal Chief Medical Officers' (MCMOs) involvement in quality improvement in general practice, specifically concerning antibiotic prescribing practices. Methods: This qualitative study consisted of semi-structured in-depth telephone interviews and group interviews with MCMOs (n ¼ 12). The interview guide aimed to explore the MCMOs' views on their role and responsibilities regarding the quality of care in general practice. The data were analysed using systematic text condensation. Results: Three main themes were identified: 1) the relationship between the municipality and the general practitioner (GP), with the MCMO acting as an intermediary, 2) influencing the GPs' work and 3) antibiotic use and infection control. The MCMOs perceived themselves as liaisons between the municipalities and the GPs. They emphasized building trust, showing respect and sharing common values in their interactions with the GPs, upholding the GPs' professional autonomy. Working for quality improvement was considered a priority; however, MCMOs expressed a need for external support to establish a permanent quality improvement framework. The informants were positive about engaging in improving antibiotic prescribing practices because this combined the municipality's responsibilities for quality improvement and communicable disease control. Conclusions: The MCMOs considered themselves as well-suited agents for quality improvement in general practice, as liaisons between the municipalities and the GPs. Quality improvement in general practice would benefit from a clearer structure in terms of the MCMOs' roles and responsibilities. Within communicable diseases control, the MCMOs have a clear mandate, which places antimicrobial stewardship initiatives in a favourable position amongst other areas of quality improvement.

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“…Leadership recognition of the importance of integration and provision of tangible support and resources are in uential in adoption and implementation of care integration [19][20][21][22][23][24]. Program and clinic partner factors supporting integrated implementation…”

Section: Leadership Supportmentioning

confidence: 99%

Integrated implementation of evidence-based interventions to increase colorectal cancer screening through public health-primary care partnerships

Soloe¹,

Arena²,

Schlueter³

et al. 2020

Preprint

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Background In 2015, the Centers for Disease Control and Prevention funded the Colorectal Cancer Control Program (CRCCP), which partners with health systems and primary care clinics to increase CRC screening uptake. We interviewed CRCCP stakeholders to explore factors that support an integrated implementation of evidence-based interventions and supporting activities to promote CRC screening with other screening and chronic disease management activities in primary care clinics. Methods Using the Consolidated Framework for Implementation Research, we conducted a literature review and identified constructs to guide data collection and analysis. We purposively selected four CRCCP awardees that demonstrated ongoing engagement with clinic partner sites, willingness to collaborate with CDC and other stakeholders, and availability of high-quality data. We gathered background information on the selected program sites and conducted primary data collection interviews with program staff and partners. We used NVivo QSR 11.0 to systematically pilot-code interview data, achieving a Kappa coefficient of 0.8 or higher, and then implemented a stepwise process to identify site-specific and cross-cutting emergent themes. Results Programs reported that they support clinic partners’ integrated implementation by providing coordinated application processes and braided funding streams, and by funding partner organizations to provide technical assistance to support efficient implementation of evidence-based interventions and supporting activities into existing clinic workflows. These actions, in turn, support clinics in implementing evidence-based interventions and supporting activities that promote both CRC screening and other chronic disease screening and management. Discussion The selected CRCCP programs and their partners implement activities to support the integration of evidence-based interventions and supporting activities with other clinic efforts. These integrated efforts support increased efficiency of clinic workflow, improved coordination of patient care, increased uptake of screening and improved patient outcomes. Conclusions The findings provide insights into how public health programs can support primary care clinics in integrating interventions and activities into existing workflows to support efficient, coordinated delivery of quality patient-centered care.

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Clinical leadership and integrated primary care: A systematic literature review

Cited by 55 publications

References 49 publications

Assessment of Clinical Leadership Training Needs in Senior Pediatric Residents

Assessment of Clinical Leadership Training Needs in Senior Pediatric Residents

Quality improvement and antimicrobial stewardship in general practice – the role of the municipality chief medical officer. A qualitative study

Integrated implementation of evidence-based interventions to increase colorectal cancer screening through public health-primary care partnerships

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