Power and physician leadership

Abstract

Power and leadership are intimately related. While physician leadership is widely discussed in healthcare, power has received less attention. Formal organisational leadership by physicians is increasingly common even though the evidence for the effectiveness of physician leadership is still evolving. There is an expectation of leadership by all physicians for resource stewardship. The impact of power on interprofessional education and practice needs further study. Power also shapes the profession’s attempts to address physician and learner well-being with its implications for patient care. Unfortunately, the profession is not exempt from inappropriate use of power. These observations led the authors to explore the concept and impact of power in physician leadership. Drawing from a range of conceptualisations including structuralist (French and Raven), feminist (Allen) and poststructuralist (Foucault) conceptualisations of power, we explore how power is acquired and exercised in healthcare systems and enacted in leadership praxis by individual physician leaders (PL). Judicious use of power will benefit from consideration and application of a range of concepts including liminality, power mediation, power distance, inter-related use of power bases, intergroup and shared leadership, inclusive leadership, empowerment, transformational leadership and discourse for meaning-making. Avoiding abuse of power requires moral courage, and those who seek to become accountable leaders may benefit from adaptive reflection. Reframing ‘followers’ as ‘constituents or citizens’ is one way to interrupt discourses and narratives that reinforce traditional power imbalances. Applying these concepts can enhance creativity, cocreation and citizenship-strengthening commitment to improved healthcare. PLs can contribute greatly in this regard to further transform healthcare.

Challenges and success strategies for dyad leadership model in healthcare

“…Individual and joint leadership development, in addition to being informed by relevant theoretical perspectives, needs to take into account demographic variations (eg, gender and leadership level) and systemic issues. As in our study, more women are in DCL roles 45 and face different challenges and utilize different strategies for success-partially attributable to physician power structures in healthcare 46,47 and the hierarchical relationship between physicians and nurses. 48 It is important the organizations be deliberate in identifying the appropriate talent suitable for dyad leadership based upon underlying motivations and aptitudes.…”

Conceptualisations of Leadership and Relevance to Health and Human Service Workforce Development: A Scoping Review

“…Leadership is characterised by the ability to influence outcomes, not authority or power. 43,44,49,[116][117][118][120][121][122] 3. Leadership is not management, but they are complementary processes.…”

“…Exploration of the use of power and leadership in the H&HS sector reveals again that the medical profession and hospitals dominate the research. 116,117 Gabel 117 identifies the bases of power available to medical professionals and discusses the application in medical practice but fails to consider the broader system or other professions. A quantitative study undertaken by Havold and Havold 144 found that legitimate, referent and reward power had a positive influence on trust whilst coercive power had a negative influence in hospitals.…”

“…A quantitative study undertaken by Havold and Havold 144 found that legitimate, referent and reward power had a positive influence on trust whilst coercive power had a negative influence in hospitals. Saxena et al 116 acknowledge that healthcare requires collaborative leadership but still sees physician leaders as those who will lead diverse groups of healthcare workers.…”

“…Another approach to conceptualizing leadership is to examine the concept of power and its relationship to leadership and organizational outcomes. [116][117][118] Early definitions of leadership focused on power "over" people, whereas later definitions focused on the ability to influence others. The "Five Forms of Power" research conducted by French and Raven in 1959 is one of the most influential theories of power that has been used to explain many of the phenomena of social influence and determine the sources of power that leaders use to influence others.…”