Physician leadership development: towards multidisciplinary programs?

Purpose The purpose of this paper is to describe research that examined physician leadership development using complexity science principles. Design/methodology/approach Intensive interviewing of 21 participants and document review provided data regarding physician leadership development in health-care organizations using five principles of complexity science (connectivity, interdependence, feedback, exploration-of-the-space-of-possibilities and co-evolution), which were grouped in three areas of inquiry (relationships between agents, patterns of behaviour and enabling functions). Findings Physician leaders are viewed as critical in the transformation of healthcare and in improving patient outcomes, and yet significant challenges exist that limit their development. Leadership in health care continues to be associated with traditional, linear models, which are incongruent with the behaviour of a complex system, such as health care. Physician leadership development remains a low priority for most health-care organizations, although physicians admit to being limited in their capacity to lead. This research was based on five principles of complexity science and used grounded theory methodology to understand how the behaviours of a complex system can provide data regarding leadership development for physicians. The study demonstrated that there is a strong association between physician leadership and patient outcomes and that organizations play a primary role in supporting the development of physician leaders. Findings indicate that a physician's relationship with their patient and their capacity for innovation can be extended as catalytic behaviours in a complex system. The findings also identified limiting factors that impact physicians who choose to lead, such as reimbursement models that do not place value on leadership and medical education that provides minimal opportunity for leadership skill development. Practical Implications This research provides practical applications for physician leadership development and emphasizes that it is incumbent upon physicians and organizations to focus attention on this to achieve improved patient and organizational outcomes. Originality/value This study pairing complexity science and physician leadership represents a unique way to view the development of physician leaders within the context of the complex system that is health care.

BackgroundOrganizations should strive to function at the highest level possible. One way to foster organizational success is through leadership development (LD), though such education for middle managers was limited. Additionally,...

In this article, we present findings from a retrospective survey of 117 physician leadership development program graduates at the Sauder School of Business at the University of British Columbia in Vancouver. The survey was designed to assess how the program contributed to graduates' leadership development, specifically in terms of behaviour change and work-related changes. The themes resulting from the analysis of the open-ended questions reflected that the program led to changes in graduates' leadership behaviour and their ability to lead change in their respective organizations. The study highlighted the benefits of investment in training for physician leaders to advance transformation and improvement initiatives in a changing world.

Purpose– The aim of this study is to review published articles within the HRD and related fields to identify relationships between disparate streams of research (leadership and innovation and sustainability).Design/methodology/approach– Academic research supports the complex relationships between leadership and innovation and leadership and sustainability. An integrative literature review of published articles is used to gain an understanding about effective leadership as an important link between innovation and sustainability.Findings– The analysis revealed the parallel research streams are rather isolated from one another. Central themes focused around leadership roles, orientations, practices, and influences; leadership capacity building; and (global) leadership development. Emergent themes with respect to sustainability included global mindset and concern for others. Servant leadership was brought forth.Research limitations/implications– The literature review was drawn from the four Academy of Human Resource Development (AHRD) journals, as well as sources from the human resource management (HRM), business and management, and related fields.Practical implications– The study discussed influences of leadership on innovation and sustainability, mindsets and competencies, and leadership development strategies for use in understanding how to foster innovation and sustainable practices. Developmental activities including experiential learning, action learning, and service learning programs were considered.Originality/value– This article is among the first to highlight leadership as a connection between innovation and sustainability and provides a valuable platform for HRD scholars and practitioners interested in enhancing leadership capacity and development in these areas.

Purpose This study aims to explore how medical school deans develop as leaders within their institutional context, focusing on how they acquire decision-making capacity, exercise influence and sustain their roles in administration. Using Self-Determination Theory (SDT) as a lens, the study examines key components of leadership development, including autonomy, competence and relatedness. Design/methodology/approach A qualitative study design was employed using semi-structured interviews with medical school deans in Riyadh, Saudi Arabia. Participants were recruited via e-mail and provided informed consent prior to participation. Interviews were conducted virtually, audio-recorded and transcribed verbatim. Data were analyzed using framework analysis to identify themes aligned with the constructs of SDT. Findings Eight themes were identified across the three SDT domains. Autonomy was reflected in defining autonomy and role negotiation. Competence in leadership emerged through experiences of mastery, the influence of resources, participation in formal leadership programs and achievement of organizational goals. Relatedness was reflected in interpersonal relationships and personal fulfillment. These findings illustrate that leadership development is shaped by both individual experiences and institutional contexts. Research limitations/implications Although, this study sheds light on the complex interplay between leaders’ autonomy, motivation to lead and leaders’ ability to motivate others and how that contributes to organizational culture, a larger sample size, which includes deans from other Saudi Arabian cities, is needed for the findings to be transferable to other contexts. Furthermore, there was a lack of investigator triangulation. Time and access to the resources available for this research were constrained, both in terms of time and funding. As a result, the decision was made to streamline the analysis process to ensure the completion of the study within the specified constraints. Moreover, although the study shows a positive impression of leadership training programs, it does not measure actual outcomes or impact. As a result, the full effect of educational programs formal or informal cannot be determined. Practical implications Despite the methodological limitations of this study, the findings have several implications for educational practice and policy. First, at the individual level, leaders and candidates for administrative positions should be educated in their leadership roles. Leaders need to understand what role autonomy, competency and relatedness play in their development as leaders and how to best cultivate these aspects while practicing leadership. Second, in terms of the organizational level, policies regarding leadership recruitment and development of leaders belonging to the medical school need to be developed. Such policies may foster a better workplace culture that prioritizes leadership development, which may lead to efficient and effective organizations. Social implications This study highlights how leadership development in academic medicine extends beyond individual skill-building to social and organizational transformation. By viewing deans as learners embedded within relational, cultural and institutional contexts, it underscores that autonomy, competence and relatedness are socially constructed and sustained. Supporting these needs can improve workplace culture, reduce burnout and enhance collaboration among academic leaders. The findings suggest that fostering connected, motivated leadership in medical schools contributes not only to individual well-being but also to institutional resilience and the broader societal goal of developing effective, ethical and community-oriented health-care education systems. Originality/value This study contributes to the limited literature on leadership development among medical school deans by applying a theoretical lens to understand their lived experiences. It highlights that leadership development extends beyond technical skill acquisition and involves a dynamic process of negotiation autonomy, building competence and fostering meaningful professional relationships. The findings offer insights for designing contextually relevant leadership development initiatives in medical education.

Purpose– The purpose of this paper is to investigate the responses of employees, who are identified as talents by their multinational enterprises, in regards to leadership development activities. By applying social exchange and expectancy theories, the authors examine the association between talent identification, perceived effectiveness of leadership development activities, willingness to participate in those activities and actual participation in them.Design/methodology/approach– The data were collected through a web-based questionnaire entitled “Leadership2020 Talent Survey”. Eight multinational enterprises joined the survey and delivered a sample based on the target group definition.Findings– The analysis shows that perceived effectiveness of leadership development activities is positively associated with willingness of employees to undertake those activities. The results also reveal that there is no significant association between the employees’ willingness to participate in leadership development activities and their actual participation in those activities.Research limitations/implications– Given its cross-sectional nature, the authors cannot completely exclude the possibility of common method bias having impact on the results of this study. The authors thus call for longitudinal research to examine the nature of causality within the relationships analyzed in this study.Practical implications– Managers and practitioners should keep in mind that willingness to participate in leadership development activities does not always result in actual participation of employees in those activities. Symbolic representations may be very different from representations in real-life situations. Investigations that rely on the willingness as a proxy for actual behaviour must thus be interpreted with caution.Originality/value– The authors found that employees often fail to act in accordance with their stated eagerness. According to the findings, there is a clear discrepancy between expressed willingness to implement certain behaviour and its actual implementation. This study poses a strong bias in overestimating the likelihood that an employee will engage in a desirable behaviour based on his/her willingness to do so.

To the Editor: Calls for increased physician leadership are growing in number and strength.1–3 The recent proliferation of leadership curricula in medical schools and residency programs suggests that educators are beginning to believe that focused leadership development efforts early in medical education could produce more and better-trained physician leaders. Our own experience developing an innovative leadership education and development program in the University of Toronto’s Faculty of Medicine is consistent with study findings at the Mayo Medical School, in which 85% of student leaders felt leadership should be taught in medical school.4 We are convinced that students enter medical school with an interest in leadership and a desire to build their skills. Yet medical curricula have been slow to develop frameworks in support of these interests. To harness this enthusiasm, medical schools must actively strive to facilitate leadership education. Toward this end, we offer five evidence-based suggestions: Leadership development programs should be student focused and flexible, encourage formal mentorship, expose students to disciplines outside of medicine, be rigorously evaluated, and engage accreditation agencies to measure and promote leadership development. Two meta-analyses, covering studies from 1951 to 2001, demonstrated that leadership development programs can be effective across many disciplines, particularly when they are tailored to the needs of the trainee and reflect the objectives of the organization.5,6 These formalized approaches, which mix lessons in theory with practical experiences, should be used to help medical students realize their leadership potential. Amol A. Verma, MD, MPhil Resident in internal medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada; [email protected] Jordan D. Bohnen, MD, MBA Resident in general surgery, Massachusetts General Hospital, Boston, Massachusetts.

Higher education (HE) in the changing context requires leadership training and development as a vital element for university governance and innovation. While there are several theoretical frameworks on leadership development, most of them are outcome evaluation‐oriented. Consequently, there is a lack of a leadership development model which emphasises both design process and expected outcomes. In addition to this, HE leadership development has been gradually transformed toward complexity and flexibility due to the volatile external environment of the 21st century. Thus, instead of having a development programme that simply focuses on individual skill enhancement, a comprehensive leadership development programme that equally fosters leaders' competencies (leader development) and develops collective leadership (leadership development) is increasingly utilised. Unfortunately, previous theoretical frameworks fail to take into consideration these new features. The main aim of this study was to develop a comprehensive theoretical model for academic leadership development (ALD) that promotes both leader development and leadership development. In the present study, 24 academic leaders, lecturers and researchers from five European and six Chinese HE institutions co‐designed the ALD model. The constructed model consists of four main dimensions: theoretical core, types of training and providers, training format and ultimate goals. The results contribute to developing, promoting and enhancing leadership development in academic settings.

DIANE L. DIXON is managing principal of D. Dixon & Associates LLC, specializing in health care leadership and organizational development. She also has taught leadership and organizational behavior for the business of medicine program at Johns Hopkins University and holds a doctorate in human resource development from George Washington University, Washington. Does your long-term care organization need change? For instance, is your nursing home stuck in the old institutional model? Are you thinking about how you might lead that change? Are you pondering what it will take to do so? There is no quick prescription or handy tool kit for making yourself into a leader who can overcome an organization's inertia. But there are useful guidelines for developing the skills required for leading change. To start, the emphasis should be on looking to see if you're ready to be a change leader. Are you ready to lead change? A good place to begin is with introspection about your willingness to embrace new ways of thinking about yourself within the context of your long-term care organization. Before getting much further, it's important to make sense of change semantics. The use of words and phrases related to organizational change can cause confusion. “Leading change,” “change agent,” and “culture change” are not jargon, but they're sometimes misused or overused. Then, they become clichés that lose the power of their meaning. But these terms do have real significance in long-term care and health care delivery overall. Are you a medical director who, as part of the leadership team, feels responsible for improving your organization's care of residents overall? Are you a director of nursing who sees the need to improve care quality at several levels of the organization? Are you a nurse practitioner who wishes to facilitate dialogue among all the people working in your nursing home about how to improve teamwork? Are you an administrator who embraces change and understands that the organizational culture is influenced by your leadership? Are you a department manager or neighborhood coordinator who sees himself or herself continuously working with others to discover new ways to deliver quality care? Are you a consulting pharmacist who wants to be an active participant on an interdisciplinary team? Introspection and reflection are the foundation for leadership development. It's essential that you be willing to engage in these processes and accept that the first thing needing change could well be you. It is important to look through this individual lens to understand your potential leadership role in long-term care. This then can move you to develop your personal capacity to lead and forge the vital relationships required for a collective commitment to change within your organization. Leadership development requires assessments of both your inner capacities and your abilities to lead others. The two sets of self-assessment questions that I've developed are based on the work of David V. Day, PhD (Leadership Quarterly 2000;11:581–613). Your answers to the questions listed on this page may create a framework for getting started on the journey to leading long-term care change. Reflecting on the questions and taking time to answer them honestly is the groundwork for your leadership development plan. As you begin, consider your vision for your organization. The effort will lead you in the right direction for your personal development plan. Focus on your strengths and how you can further enhance them. The areas for growth you identify aren't weaknesses. They're opportunities for learning and development. Start by focusing on a few critical competency areas that will make a significant difference in your ability to lead change. Here are some suggested components of your plan: ▸ Goals: Make them specific, measurable, attainable, realistic, results oriented, and time focused. ▸ Strategies: Action plans, with time frames, used to achieve goals. ▸ Critical relationships: Interactions you'll need with mentors, coaches, partners, and others who can provide support. ▸ Accountability: Details of how you will hold yourself accountable for completing the plan. ▸ Indicators of Success: Methods of determining the impact of achieving the goals. Thinking about leading change in long-term care can be daunting in the midst of competing priorities. But don't let that hold you back at a time when the field needs leadership and change more than ever. Moving forward with your own development as a leader will help make the effort manageable and fulfilling. What's important is getting started.

AimTo identify and describe the impact areas of a newly developed leadership development programme focussed on positioning leaders to improve the student experience of the clinical learning environment.BackgroundThere is a need to consider extending traditional ways of developing leaders within the clinical learning in order to accommodate an increased number of students and ensure their learning experience is fulfilling and developmental. The Florence Nightingale Foundation implemented a bespoke leadership development programme within the clinical learning environment. Identifying the areas of impact will help to inform organisational decision making regarding the benefits of encouraging and supporting emerging leaders to undertake this type of programme.MethodFor this qualitative descriptive study, eight health care professionals who took part in a bespoke leadership development programme were interviewed individually and then collectively. The Florence Nightingale Foundation fellowship/scholarship programme is examined to determine impact.ResultsTwo key themes were described in relation to impact of the programme. These were ‘Personal Development’ and ‘Professional Impact’. The two key themes comprised several subthemes. The notion of time and space to think was subsumed within each theme.ConclusionData highlights that the Florence Nightingale Foundation programme had a distinct impact on participants by transforming thinking and increasing self‐confidence to enable changes to make improvements both within their organisations and at national level.Implications for Nursing ManagementHealth care managers must continue to invest in building leadership capacity and capability through programmes that can help position individuals to realize their potential to positively influence health outcomes and wider society.

This chapter discusses leadership development (LD) of Polish managers during the process of economic transformation since 1989. The first part of the chapter discusses the Polish managers’ leadership capabilities and their characteristic features and behaviours as contrasted with managers from other Central and Eastern European countries (CEE) and from Western European countries. In the second part changes in the approaches to leadership training and development in Poland are analysed. In addition to discussing company-based LD, the second part of the chapter describes the typical features of management and LD programmes at Polish universities. It can be concluded that there was some progress in leadership competence development over the years. LD is based mostly on Western training models; in addition, Polish managers are learning from their Western counterparts while working on global markets and interacting with MNCs operating in Poland.

A GREAT deal of research on effective schools has told us that principal as is one of the most important ingredients of a school that works. Such a principal keeps the school's focus on instruction, sets a constructive tone and high expectations, works to ensure a common curriculum, and provides leadership for teachers. Since the heyday of the effective schools research in the 1980s, however, very little has been done to evaluate whether or not principals are being prepared to be instructional or whether much of their time on the job is spent in this capacity. Layer atop this, then, the concern about the declining pool of building-level leaders and the need for stronger leadership in an age of strict accountability, and one can understand why the national discussion has focused on recruiting strong candidates and setting standards for training and evaluation. The hard part, of course, will be getting beyond the rhetoric of need and quality, so that in another 20 years someone else is not writing about the need for the principal to serve as the leader of a school. The Push and Pull Of Accountability In its new publication, In Pursuit of Quality Teaching: Five Strategies for Policymakers, the Education Commission of the States takes on this issue of leadership. The authors, Robert Palaich and Michael Allen of ECS, note that the conflicting demands of school leadership - coupled with the pressure of high-stakes assessment, shortened average job tenure, and the increasingly small difference in pay between teachers and principals - have led to a growing shortage of school and district leaders, especially principals. The media, too, have frequently reported on the issue over the past year. Moreover, administrators quoted in a Washington Post story in June pointed out that principals are frequently held accountable for test scores but don't have the power to hire and fire teachers. The Public Education & Business Coalition, a Colorado-based partnership of leaders from education, business, and the community, recently put together some Key Learnings from its school-based projects. Here are a few that deal with the matter of leadership: * Leadership development must extend far beyond the principal's office. Teachers and others with a vested interest in the success of the school should participate in leadership development opportunities. * There is a clear distinction between leadership skills and management skills. Leadership training for principals must focus on the former. * Leadership development activities are most effective when they occur concurrently with curriculum, instruction, and assessment reform in a school. * Lasting change in schools is most likely to occur when a complacent staff becomes inspired by a leader or a new pedagogy. An outside party can contribute to this change by providing resources and nurturing relationships within the school. * Barriers to reform are more perceived than real. Finding Good Leaders A survey of 151 students enrolled in principal preparation programs at four universities, published in the spring 2000 issue of ERS Spectrum, found that the top three motivators for becoming a principal were: the chance to make a positive impact (nearly 60%), the chance to make a difference (more than 45%), and the chance to take on a personal challenge (more than 40%). Salary was the fifth reason for becoming a principal (less than 35%). When asked about inhibitors to becoming a principal, the number-one response was and bureaucracy (nearly 50%). Nearly 35% listed the increased time commitment, followed by possible litigation, discipline problems, and standardized tests (all less than 25%). Salary ranked sixth among inhibitors (a bit more than 20%). Considering their findings, the researchers' recommendations for school boards and communities were to increase salaries, reduce paperwork and/or provide assistance, consider ways to shrink the school bureaucracy, support principals through improved legal training, provide greater support for principals on disciplinary issues on their campuses, balance the emphasis on standardized test scores with emphasis on other forms of assessment, and provide for administrative assistants with broader responsibilities in order to decrease the time pressures on principals. …

The development of leaders and building of leadership capacity are central concerns of HRD research and practice, yet the large and high‐impact area of leadership education provided by U.S. universities to undergraduate students is missing from the domain literature. Over the past 20 years, leadership education has become a common feature at universities and colleges in the United States and is experiencing strong demand and institutional support. Leadership development operates in parallel to the traditional curriculum shaping the career trajectories of university graduates and adding to the talent pool of hiring organizations. This article outlines the status of university‐based leadership education in the United States, offers a critical assessment, and highlights areas in need of investigation and scholarship of relevance to HRD.

Improving Value in Healthcare

Purpose The purpose of this study is to contrast how the relationship between career and leadership development and workplace culture is experienced by women in two different countries and the implications this has for human resource development initiatives. Design/methodology/approach The study used a qualitative narrative research design to understand how the lived experiences of Australian and Vietnamese early- to mid-career female academics is engendered. Findings The study identified a number of key barriers and enablers that affected women’s career and leadership development. For the Australian participants, the main barrier included the competing demands of work and life and male dominated organisational cultures that discriminate against women in covert ways. The main enabler was mentoring and the building of professional networks that provided their careers with direction and support. For the Vietnamese participants, the main barriers were overt and included male-dominated organisational and societal cultures that limit their career and leadership development opportunities. The main enabler was having a sponsor or person with power in their respective organisation who would be willing to support their career advancement and gaining recognition from colleagues and peers. Research limitations/implications Gaining a deeper understanding of the barriers and enablers that effect women’s career and leadership development can be used to investigate how culturally appropriate developmental relationships can create ways to overcome the barriers they experience. Originality/value The study analysed the contrasting experiences of barriers and enablers from two cultures. The participants narrated stories that reflected on the gender politics they experienced in their career and leadership development. The narrative comparisons provide a unique lens to analyse the complex cultural experience of gender and work with potential implications for human resource development.