Date Published: June 11, 2019
Publisher: Public Library of Science
Author(s): Merlijn C. P. van de Riet, Mathilde A. Berghout, Martina Buljac-Samardžić, Job van Exel, Carina G. J. M. Hilders, Mojtaba Vaismoradi.
Medical leadership is an increasingly important aspect of hospital management. By engaging physicians in leadership roles, hospitals aim to improve their clinical and financial performances. Research has revealed numerous factors that are regarded as necessary for ‘medical leaders’ to master, however we lack insights into their relative importance. This study investigates the views of healthcare professionals and managers on what they consider the most important factors for medical leadership. Physicians (n = 11), nurses (n = 10), laboratory technicians (n = 4) and managers (n = 14) were interviewed using Q methodology. Participants ranked 34 statements on factors elicited from the scientific literature, including personal features, context-specific features, activities and roles. By-person factor analysis revealed three distinct views of medical leadership. The first view represents a strategic leader who prioritizes the interests of the hospital by participating in hospital strategy and decision making. The second view describes a social leader with strong collaboration and communication skills. The third view reflects an accepted leader among peers that is guided by a clear job description. Despite these differences, all respondents agreed upon the importance of personal skills in collaboration and communication, and having integrity and a clear vision. We find no differences in views related to particular healthcare professionals, managers, or departments as all views were defined by a mixture of departments and participants. The findings contribute to increased calls from both practice and literature to increase conceptual clarity by eliciting the relative importance of medical leadership-related factors. Hospitals that wish to increase the engagement of physicians in improving clinical and financial performances through medical leadership should focus on selecting and developing leaders who are strong strategists, socially skilled and accepted by clinical peers.
Medical leadership is an increasingly important topic in both literature and practice, because of the anticipated positive effect that physicians in leadership positions have on quality of care, patient safety and cost efficiency [1–4]. Research shows that hospitals perform better when led by physicians [5–8]. Moreover, physicians are said to have more influence over clinical peers in contrast to non-clinical hospital professionals [4, 9–12]. By engaging in leadership roles, physicians could play an important role in encouraging fellow clinicians in achieving contemporary clinical and organizational objectives.
Q methodology was used to explore healthcare professionals and managers’ views on factors in the areas of personal features, context-specific features, and activities and roles that are thought of as most important for effective medical leadership in a hospital setting. Q methodology combines qualitative and quantitative research techniques to provide a foundation for the systematic study of subjectivity, such as a person’s view or opinion [31, 32]. In conducting a Q-study, researchers present respondents with a comprehensive set of statements about the subject of study, which they are asked to rank according to their view on the subject, and to explain their ranking. By-person factor analysis is used to identify subgroups of respondents who rank the statements in a similar way, resulting in a limited number of distinct composite rankings that can be interpreted and described as the principal shared views on the subject of study. Finally, the qualitative data elicited from the interviews, during which respondents explain their ranking of the most and least important statements, is used to check and refine the interpretation of the quantitative data, and to enrich the description with citations.
Thirty-nine respondents participated in the study, 13 from each of the departments (Table 2). The analysis revealed three main shared views on what is important for effective medical leadership in a hospital setting, with 36 (92%) respondents associating statistically significantly with one of the factors. The views are described below with reference to the placement of statements in the idealized ranking of the factor (Table 3).
This study distinguished three views of healthcare professionals and managers on what is most important for medical leadership in a hospital. The first view represents a strategic leader who prioritizes the interests of the hospital by participating in hospital strategy and decision making. Holders of this view argue that this type of leadership is needed in hospitals to create more unity between clinicians and non-clinicians in favor of quality and efficiency of care. The second view describes a social leader who has strong collaborative and communication skills. Respondents holding this view state that social skills are a premise for efficiently leading a clinical department and engaging all staff in creating a shared vision. The third view reflects an accepted leader who is guided by a clear job description. Peer acceptance and clarity concerning the responsibilities of a medical leader were considered necessary to engage fellow staff in decision making and change processes. Despite their differences, all participants agreed upon the importance of personal skills, specifically communication skills, collaboration skills, integrity and having a vision and being able to convey this to others. All interviewees perceived being held in high esteem by fellow physicians, leadership experience, considering yourself primarily a physician and mastering specific managerial knowledge the least important factors for medical leadership.