How to make a job more than just a paycheck: Understanding physician disengagement

Yanchus, Nancy J.; Carameli, Kelley A.; Ramsel, Dee; Osatuke, Katerine

doi:10.1097/hmr.0000000000000218

Cited by 11 publications

(13 citation statements)

References 25 publications

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“…Senior leadership teams, particularly Chief Executive Officers (CEO), manage physicians by nagging, arguing and reminding them of their responsibilities, that is, they fail to meaningfully engage medical leaders. 50 77 78 CEOs and senior leadership teams tend to crowd medical leaders’ agendas with numerous committees or ‘strategic’ meetings that are filled with operational, not strategic matters. 34 40 51 …”

Section: Resultsmentioning

confidence: 99%

Medical leadership: boon or barrier to organisational performance? A thematic synthesis of the literature

Savage

Brommels

et al. 2020

BMJ Open

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ObjectiveThe influx of management ideas into healthcare has triggered considerable debate about if and how managerial and medical logics can coexist. Recent reviews suggest that clinician involvement in hospital management can lead to superior performance. We, therefore, sought to systematically explore conditions that can either facilitate or impede the influence of medical leadership on organisational performance.DesignSystematic review using thematic synthesis guided by the Enhancing Transparency in Reporting the synthesis of Qualitative research statement.Data sourcesWe searched PubMed, Web of Science and PsycINFO from 1 January 2006 to 21 January 2020.Eligibility criteriaWe included peer-reviewed, empirical, English language articles and literature reviews that focused on physicians in the leadership and management of healthcare.Data extraction and synthesisData extraction and thematic synthesis followed an inductive approach. The results sections of the included studies were subjected to line-by-line coding to identify relevant meaning units. These were organised into descriptive themes and further synthesised into analytic themes presented as a model.ResultsThe search yielded 2176 publications, of which 73 were included. The descriptive themes illustrated a movement from 1. medical protectionism to management through medicine; 2. command and control to participatory leadership practices; and 3. organisational practices that form either incidental or willing leaders. Based on the synthesis, the authors propose a model that describes a virtuous cycle of management through medicine or a vicious cycle of medical protectionism.ConclusionsThis review helps individuals, organisations, educators and trainers better understand how medical leadership can be both a boon and a barrier to organisational performance. In contrast to the conventional view of conflicting logics, medical leadership would benefit from a more integrative model of management and medicine. Nurturing medical engagement requires participatory leadership enabled through long-term investments at the individual, organisational and system levels.

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Section: Resultsmentioning

confidence: 99%

Medical leadership: boon or barrier to organisational performance? A thematic synthesis of the literature

Savage

Brommels

et al. 2020

BMJ Open

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show abstract

“…they fail to meaningfully engage medical leaders. [43,64,65] CEOs and senior leadership teams tend to crowd medical leaders’ agendas with numerous committees or “strategic” meetings that are filled with operational, not strategic matters. [21,41,44]…”

Section: Resultsmentioning

confidence: 99%

Physicians in the management and leadership of health care: A systematic review of the conditions conducive to organizational performance

Savage

Brommels

et al. 2019

Preprint

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Introduction: The influx of management ideas into health care has triggered considerable debate about if and how managerial and medical logics can co-exist. Recent reviews suggest that clinician involvement in hospital leadership can lead to superior performance. Objective: To systematically explore the conditions instrumental for medical leadership to have an impact on organizational performance. Methods: We searched PubMed, Web of Science, and Psychinfo for peer-reviewed, empirical, English language articles and reviews published between January 1, 2006 and August 12, 2018. We performed a thematic synthesis through inductive line-by-line coding of the included studies. Results: The search yielded 1447 publications, of which 62 were included. Three major themes were identified that described a movement 1. From medical protectionism to management through medicine, 2. From command and control to participatory leadership practices, and 3. Organizational practices to support incidental versus willing leaders. Based on these themes, the authors developed a model to depict conditions that facilitate or impede the influence of medical leadership through a virtuous cycle of management through medicine or a vicious cycle of medical protectionism. Conclusions: This review helps individuals, organizations, educators, and trainers better understand how medical leadership can be both a boon and a barrier to the performance of health care organizations. In contrast to the conventional view of conflicting logics, medical leadership would benefit from a more integrative mental model of management and medicine. Nurturing medical engagement requires participatory leadership enabled through long-term investments at the individual, organizational, and system levels. These combined efforts will enable a shift to new leadership paradigms suitable to the complexity of health care, and establish conditions favorable for large-system transformation and health care reform. Key words: medical leadership; literature review; hospital performance; physician executive

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“…Barriers and facilitators of psychological safety emerged at an individual level, with personality influencing team dynamics significantly. Whilst the literature reporting on healthcare teams highlights how the behaviour and personality of a leader specifically can be a barrier to psychological safety [4,[41][42][43], the impacts of dominating personalities amongst other team members is less explored. A shy personality was reported as a barrier, and whilst this may be viewed as an innate characteristic, the influence of the team in negating this should be considered.…”

Section: Discussionmentioning

confidence: 99%

“…This enables focus on providing high quality care, as opposed to managing the expectations around voicing dissent and disagreement. It has also been shown that psychological safety increases physician engagement [ 4 ], reduces burnout [ 5 ] and promotes creativity [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Exploring the barriers and facilitators of psychological safety in primary care teams: a qualitative study

Remtulla

Hagana

Houbby

et al. 2021

BMC Health Serv Res

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Background Psychological safety is the concept by which individuals feel comfortable expressing themselves in a work environment, without fear of embarrassment or criticism from others. Psychological safety in healthcare is associated with improved patient safety outcomes, enhanced physician engagement and fostering a creative learning environment. Therefore, it is important to establish the key levers which can act as facilitators or barriers to establishing psychological safety. Existing literature on psychological safety in healthcare teams has focused on secondary care, primarily from an individual profession perspective. In light of the increased focus on multidisciplinary work in primary care and the need for team-based studies, given that psychological safety is a team-based construct, this study sought to investigate the facilitators and barriers to psychological safety in primary care multidisciplinary teams. Methods A mono-method qualitative research design was chosen for this study. Healthcare professionals from four primary care teams (n = 20) were recruited using snowball sampling. Data collection was through semi-structured interviews. Thematic analysis was used to generate findings. Results Three meta themes surfaced: shared beliefs, facilitators and barriers to psychological safety. The shared beliefs offered insights into the teams’ background functioning, providing important context to the facilitators and barriers of psychological safety specific to each team. Four barriers to psychological safety were identified: hierarchy, perceived lack of knowledge, personality and authoritarian leadership. Eight facilitators surfaced: leader and leader inclusiveness, open culture, vocal personality, support in silos, boundary spanner, chairing meetings, strong interpersonal relationships and small groups. Conclusion This study emphasises that factors influencing psychological safety can be individualistic, team-based or organisational. Although previous literature has largely focused on the role of leaders in promoting psychological safety, safe environments can be created by all team members. Members can facilitate psychological safety in instances where positive leadership behaviours are lacking - for example, strengthening interpersonal relationships, finding support in silos or rotating the chairperson in team meetings. It is anticipated that these findings will encourage practices to reflect on their team dynamics and adopt strategies to ensure every member’s voice is heard.

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How to make a job more than just a paycheck: Understanding physician disengagement

Cited by 11 publications

References 25 publications

Medical leadership: boon or barrier to organisational performance? A thematic synthesis of the literature

Medical leadership: boon or barrier to organisational performance? A thematic synthesis of the literature

Physicians in the management and leadership of health care: A systematic review of the conditions conducive to organizational performance

Exploring the barriers and facilitators of psychological safety in primary care teams: a qualitative study

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