Review of determinants of national medical leadership development

Abstract

Increasingly, physician engagement in management, quality and innovation is being recognised as vital, requiring ‘medical leadership’ (ML) competencies. Besides numerous local institutional efforts and despite the high level of autonomy of the medical profession and the education of its members, in some countries, national level activities are focusing on developing ML competencies to guide physicians in more effectively engaging in these non-medical activities. Up to this date, little is known about effective strategies and tactics for developing ML on a national level. This study investigates existing literature on determinants and interventions for national ML development. We performed a scoping review and subsequent systematic literature review of published reviews, using PubMed, Scopus, Web of Science, Ovid MEDLINE and Science Direct in search for eligible papers between 2011 and 2016. Full-text versions of 43 papers were studied, and a snowballing method was deployed. Data extraction included grounded theory coding, and synthesis of data was done iteratively during data clinics. Analysis of the seven included papers resulted in five discrete categories of determinants of and 10 distinct interventions relevant to national development of ML approaches. None of the papers reported on any specific phasing of national ML development. Our data suggest that local and national level activities in ML development should consider multifaceted and multilevel approaches, taking into account resistance to change and redesign of institutionalised logics that accompany changing positions and reconstruction of professional identities of physicians.

<p>The Importance of Leadership Development in Medical Curricula: A UK Perspective (Stars are Aligning)</p>

“…Fellowships exist at national, regional and local levels across the four UK nations, are highly competitive and while still relatively novel, emerging evaluations highlight their impact on individuals, organizations and the wider health service. [46][47][48][49][50][51] Most fellowships include a funded formal "taught" component (some of which are award bearing programs such as a postgraduate certificate), an internship with one or more senior healthcare leaders, and a range of experiential learning including visits to other organizations, networking events and conference attendance. 52 Fellowships often require taking one or more years out of program however, and can negatively impact on the Fellows' return to training, with a significant mind-set adjustment required after working out of program with senior leaders in non-clinical environments, and then going back to being simply "one of many" trainees.…”

“…While the task of leading change and improvement in healthcare is not getting any easier, the impetus to embed leadership and management in every clinician's repertoire has gained serious momentum, and collaborative efforts have had ripple effects throughout the system. 51 Structures for developing and measuring leadership competence have been established, medical leadership (in the UK at least) has developed a professional "home", and whilst serious questions remain about how to develop clinical leadership and the extent of its impact on patient care, the general consensus is that "leadership is everyone"s responsibility' with medical leadership (and its development) integral within healthcare.…”

Enacting medical leadership to address wicked problems

“…Recently, the medical profession has started to incorporate leadership competencies aimed at enabling physicians’ to become leaders in health system transformation and change 41. Several countries now have national-level ML competency frameworks that describe new non-clinical skill sets recommended for physicians including interpersonal and teamwork skills; organisation and management skills; quality and innovation skills; and skills that encourage cocreation and entrepreneurship 42. ML training programme endeavour to bolster physicians to become more proficient professionals, beyond their roles as healers,40 enacting leadership qualities that foster engagement between multidisciplinary professionals in collaborative practice and transformation 42–45.…”

“…Several countries now have national-level ML competency frameworks that describe new non-clinical skill sets recommended for physicians including interpersonal and teamwork skills; organisation and management skills; quality and innovation skills; and skills that encourage cocreation and entrepreneurship 42. ML training programme endeavour to bolster physicians to become more proficient professionals, beyond their roles as healers,40 enacting leadership qualities that foster engagement between multidisciplinary professionals in collaborative practice and transformation 42–45. The swelling number of ML training opportunities (in preclinical and postgraduate education) indicates a growing interest among physicians and their associations, as well as among administrators, policy-makers and educators 44 46 47.…”

Unlocking medical leadership’s potential: a multilevel virtuous circle?

“…Present-day healthcare ecosystems are the product of different combinations of local actors and local political, economic and cultural factors established over many decades, and in some cases, centuries. Thus, the promise of ML in contributing to healthcare ecosystem reform necessitates a multifaceted, historically and contextually sensitive approach at various levels to enable sustainable change and shifts in professionals’ position and identities 23. Such reform is also contingent on intersystem and intrasystem differences, which suggest that one-size-fits-all practices are unlikely to be universally effective.…”