Distributed leadership in health care teams

Chreim, Samia; MacNaughton, Kate

doi:10.1097/hmr.0000000000000073

Cited by 28 publications

(12 citation statements)

References 32 publications

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“…These challenges may be mitigated by developing an integrated inter professional model of teamwork that is based on trust, effective communication, clearly defined professional roles, and continuing inter professional development. [26,[35][36][37] If successfully implemented, inter professional teamwork can improve the quality of patient care, as well as increase patient and provider satisfaction.…”

Section: Discussionmentioning

confidence: 99%

Interprofessional care of patients with type 2 diabetes mellitus in primary care: family physicians’ perspectives

et al. 2022

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Background There is a lack of understanding of the team processes and factors that influence teamwork and medication management practices in the care of patients with type 2 diabetes mellitus (T2DM). The purpose of the study was to explore physicians’ perspectives of barriers and facilitators to interprofessional care of patients with T2DM within team-based family practice settings. Methods This was a qualitative, descriptive study. Participants included physicians affiliated with a primary care network providing care to patients with T2DM in an interprofessional team-based primary care setting in Edmonton, Alberta, Canada. Participants’ contact information was obtained from the publicly available College of Physicians and Surgeons of Alberta and respective primary care network websites. Interview questions addressed physicians’ perspectives on factors or processes that facilitated and hindered the care and medication management of adult patients with T2DM in primary care team-based clinical practice. Interviews were audio-recorded, transcribed, and analyzed using qualitative content analysis and a constant comparative approach. Results A total of 15 family physicians participated in individual interviews. Family physicians identified facilitators of interprofessional team-based care and medication management of patients with T2DM in three theme areas—access to team members and programs, knowledgeable and skilled health professionals, and provision of patient education by other health professionals. Two themes emerged as barriers to interprofessional care – lack of provider continuity and the loss of skills from delegation of tasks. Conclusion Family physicians perceive both benefits and risks to interprofessional team-based care in caring for patients with T2DM. Successful functioning of team-based care in family practice will require overcoming traditional professional roles.

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Section: Discussionmentioning

confidence: 99%

Interprofessional care of patients with type 2 diabetes mellitus in primary care: family physicians’ perspectives

et al. 2022

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“…Although interprofessional collaboration was comparatively greater among family physicians who worked as part of a team than those who did not, in absolute terms the degree of collaboration did not appear to be very high. Many factors contribute to the extent to which health care professionals work together including the development of trust, effective communication, and clear role definitions [38]. Some combination of these factors (facilitators and barriers) may account for the reported percentage of interprofessional collaboration not being higher.…”

Section: Discussionmentioning

confidence: 99%

Interprofessional collaboration in diabetes care: perceptions of family physicians practicing in or not in a primary health care team

et al. 2019

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BackgroundIn Canada, most patients with type 2 diabetes mellitus (T2DM) are cared for in the primary care setting in the practices of family physicians. This care is delivered through a variety of practice models ranging from a single practitioner to interprofessional team models of care. This study examined the extent to which family physicians collaborate with other health professionals in the care of patients with T2DM, comparing those who are part of an interprofessional health care team called a Primary Care Network (PCN) to those who are not part of a PCN.MethodsFamily physicians in Alberta, Canada were surveyed to ascertain: which health professionals they refer to or have collaborative arrangements with when caring for T2DM patients; satisfaction and confidence with other professionals’ involvement in diabetes care; and perceived effects of having other professionals involved in diabetes care. Chi-squared and Fishers Exact tests were used to test for differences between PCN and non-PCN physicians.Results170 (34%) family physicians responded to the survey, of whom 127 were PCN physicians and 41 were non-PCN physicians (2 not recorded). A significantly greater proportion of PCN physicians vs non-PCN physicians referred patients to pharmacists (23.6% vs 2.6%) or had collaborative working arrangements with diabetes educators (55.3% vs 18.4%), dietitians (54.5% vs 21.1%), or pharmacists (43.1% vs 21.1%), respectively. Regardless of PCN status, family physicians expressed greater satisfaction and confidence in specialists than in other family physicians or health professionals in medication management of patients with T2DM. Physicians who were affiliated with a PCN perceived that interprofessional collaboration enabled them to delegate diabetes education and monitoring and/or adjustment of medications to other health professionals and resulted in improved patient care.ConclusionsThis study sheds new insight on the influence that being part of a primary care team has on physicians’ practice. Specifically, supporting physicians’ access to other health professionals in the primary care setting is perceived to facilitate interprofessional collaboration in the care of patients with T2DM and improve patient care.

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“…For instance, a QIC can include both administrative and clinical leaders together with different clinical specialists, all of whom partake in coordinating team activities, ensuring progress and desired quality achievements by simultaneously exerting horizontal and vertical influence in the QI work. In this sense, “the distribution of clinical and administrative responsibilities across individuals in the leadership constellation may not stem entirely from a formal description of the division of labor, but come about with the influence of circumstances such as team requirements” (Chreim & MacNaughton, 2016, p. 201). Challenging the leader–follower dyad as the dominant leadership model, distributed leadership has at its core the conception of leadership as a collective phenomenon arising across individuals, positions, and levels (Gronn, 2002, 2009).…”

Section: Literature Review and Theoretical Frameworkmentioning

confidence: 99%

“…Previous distributed leadership research shows positive effects on, for instance, patient satisfaction and innovative behavior (cf. systematic reviews by Bolden, 2011; Tian et al, 2016); however, very few studies have examined distributed leadership practices in interorganizational and cross-professional settings (Boak et al, 2015; Chreim & MacNaughton, 2016; McKee et al, 2013). Here, an important condition for expecting positive outcomes of distributed leadership is whether the leadership practices in regard to the aims, roles, and scope of the collaborative work are aligned within and across organizational entities (Harris et al, 2007; Jakobsen et al, 2021; Leithwood et al, 2007; Thorpe et al, 2011).…”

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confidence: 99%

Distributed leadership in health quality improvement collaboratives

Carstensen,

Kjeldsen,

Nielsen

2023

Health Care Manage Rev

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Background and Purpose Distributed leadership has been suggested for describing patterns of influence in collaborative settings where public services are performed across professions and organizations. This study explores how leadership in health quality improvement collaboratives (QICs) is characterized by aligned distributed leadership practices, and how these practices relate with experienced progress and achievements in the quality improvement (QI) work. Methods The analysis relied on a qualitative, multicase study of two nationwide Danish QICs. Data consisted of 12 single-person and 21 group interviews with local QI teams and local and regional QIC coordinators (85 informants in total), participant observations of 34 meetings within the QICs, and a collection of documentary material. The collected data were analyzed thematically with NVivo. Results Leadership practices in local QI teams are characterized by aligned distributed leadership, with leadership activities being widely distributed based on negotiated, emergent practices regarding the aims, roles, and scope of the QI work. However, local quality coordinators play a pivotal role in driving the QI activities, and hierarchical support from hospital/municipal management is a precondition for the contribution of aligned distributed leadership to experienced progress and QIs. Practice Implications Emergent distributed leadership should be balanced by thorough consolidation of the practices to provide the best circumstances for robust QI. The active participation of formal managers and local coordinators plays a pivotal role in this consolidation and is decisive for the increased potential for long-term success and sustainability of the QI work, particularly within complex QICs.

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Distributed leadership in health care teams

Cited by 28 publications

References 32 publications

Interprofessional care of patients with type 2 diabetes mellitus in primary care: family physicians’ perspectives

Interprofessional care of patients with type 2 diabetes mellitus in primary care: family physicians’ perspectives

Interprofessional collaboration in diabetes care: perceptions of family physicians practicing in or not in a primary health care team

Distributed leadership in health quality improvement collaboratives

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