Who will lead the physicians unwilling to lead? Institutional logics and double-bind situations in health care leadership

2016 ◽  
Vol 37 (3) ◽  
pp. 325-340 ◽  
Author(s):  
Alexander Styhre ◽  
Adam Roth ◽  
Jonas Roth
Keyword(s):  
Health Care ◽  
Health Care Organizations ◽  
Clinical Work ◽  
Institutional Logics ◽  
Leadership Roles ◽  
Organizational Setting ◽  
Leadership Positions ◽  
Case Study Methodology ◽  
Content Type ◽  
Swedish Health Care

Purpose – Health care organizations are increasingly demanded to balance the institutional logic of “medical professionalism” and “business-like health care,” that is, to both recognize physicians’ professional expertise while locating it in a wider social, economic, and political organizational setting. The purpose of this paper is to examine the implications from this shift in terms of leadership work in health care organizations. Design/methodology/approach – Case study methodology including interviews with 15 residents in Swedish health care organizations. Findings – A study of the willingness of residents to take on leadership positions show that leadership roles are treated as what is potentially hindering the acquisition of the know-how, skills, and expertise demanded to excel in the clinical work. Consequently, taking on leadership positions in the future was relatively unattractive for the residents. In order to overcome such perceived conflict between professional skill development and leadership roles, top management of health care organizations must help residents overcome such beliefs, or other professional groups may increasingly populate leadership positions, a scenario not fully endorsed by the community of physicians. Originality/value – The paper demonstrates how complementary or completing institutional logics are influencing debates and identities on the “shop floors” of organizations.

In their own words: describing Canadian physician leadership

2016 ◽  
Vol 29 (3) ◽  
pp. 264-281 ◽  
Author(s):  
Anita J. Snell ◽  
Graham Dickson ◽  
Debrah Wirtzfeld ◽  
John Van Aerde
Keyword(s):  
Health Care ◽  
Health Care Organizations ◽  
Structured Interview ◽  
Baseline Data ◽  
Leadership Roles ◽  
Personal Factors ◽  
Physician Leadership ◽  
Content Type ◽  
Canadian Physician ◽  
Physician Leaders

Purpose This is the first study to compile statistical data to describe the functions and responsibilities of physicians in formal and informal leadership roles in the Canadian health system. This mixed-methods research study offers baseline data relative to this purpose, and also describes physician leaders’ views on fundamental aspects of their leadership responsibility. Design/methodology/approach A survey with both quantitative and qualitative fields yielded 689 valid responses from physician leaders. Data from the survey were utilized in the development of a semi-structured interview guide; 15 physician leaders were interviewed. Findings A profile of Canadian physician leadership has been compiled, including demographics; an outline of roles, responsibilities, time commitments and related compensation; and personal factors that support, engage and deter physicians when considering taking on leadership roles. The role of health-care organizations in encouraging and supporting physician leadership is explicated. Practical implications The baseline data on Canadian physician leaders create the opportunity to determine potential steps for improving the state of physician leadership in Canada; and health-care organizations are provided with a wealth of information on how to encourage and support physician leaders. Using the data as a benchmark, comparisons can also be made with physician leadership as practiced in other nations. Originality/value There are no other research studies available that provide the depth and breadth of detail on Canadian physician leadership, and the embedded recommendations to health-care organizations are informed by this in-depth knowledge.

Workplace-based clinical leadership training increases willingness to lead

2015 ◽  
Vol 28 (2) ◽  
pp. 100-118 ◽  
Author(s):  
Aleece MacPhail ◽  
Carmel Young ◽  
Joseph Elias Ibrahim
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Leadership Training ◽  
Low Cost ◽  
Leadership Role ◽  
Leadership Roles ◽  
Senior Executive ◽  
Clinical Leadership ◽  
Content Type

Purpose – The purpose of this paper is to reflect upon a workplace-based, interdisciplinary clinical leadership training programme (CLP) to increase willingness to take on leadership roles in a large regional health-care centre in Victoria, Australia. Strengthening the leadership capacity of clinical staff is an advocated strategy for improving patient safety and quality of care. An interdisciplinary approach to leadership is increasingly emphasised in the literature; however, externally sourced training programmes are expensive and tend to target a single discipline. Design/methodology/approach – Appraisal of the first two years of CLP using multiple sourced feedback. A structured survey questionnaire with closed-ended questions graded using a five-point Likert scale was completed by participants of the 2012 programme. Participants from the 2011 programme were followed up for 18 months after completion of the programme to identify the uptake of new leadership roles. A reflective session was also completed by a senior executive staff that supported the implementation of the programme. Findings – Workplace-based CLP is a low-cost and multidisciplinary alternative to externally sourced leadership courses. The CLP significantly increased willingness to take on leadership roles. Most participants (93 per cent) reported that they were more willing to take on a leadership role within their team. Fewer were willing to lead at the level of department (79 per cent) or organisation (64 per cent). Five of the 11 participants from the 2011 programme had taken on a new leadership role 18 months later. Senior executive feedback was positive especially around the engagement and building of staff confidence. They considered that the CLP had sufficient merit to support continuation for at least another two years. Originality/value – Integrating health-care professionals into formal and informal leadership roles is essential to implement organisational change as part of the drive to improve the safety and quality of care for patients and service users. This is the first interdisciplinary, workplace-based leadership programme to be described in the literature, and demonstrates that it is possible to deliver low-cost, sustainable and productive training that increases the willingness to take on leadership roles.

Imprecise DEA framework for evaluating health-care performance of districts

Kybernetes ◽  
2017 ◽  
Vol 46 (4) ◽  
pp. 706-727 ◽  
Author(s):  
E. Ertugrul Karsak ◽  
Melis Almula Karadayi
Keyword(s):  
Health Care ◽  
Performance Evaluation ◽  
Health Care Organizations ◽  
Health Sector ◽  
Evaluation Methodology ◽  
Policy Makers ◽  
Content Type ◽  
Relative Evaluation ◽  
Health Care Performance ◽  
Care Performance

Purpose This paper aims to address performance measurement in the health-care sector, which gains increasing importance for most countries because growing health expenditures and increased quality and competition in the health sector require hospitals to use their resources efficiently. Health policy-makers and health-care managers stress the need for developing a robust performance evaluation methodology for health-care organizations. Design/methodology/approach This paper presents an imprecise data envelopment analysis (DEA) framework for evaluating the health-care performance of 26 districts in Istanbul, a metropolis with nearly 15 million inhabitants. The proposed methodology takes into account both quantitative and qualitative data represented as linguistic variables for performance evaluation. Moreover, this study reckons that weight flexibility in DEA assessments can lead to unrealistic weighting schemes for some inputs and outputs, which are likely to result in overstated efficiency scores for a number of decision-making units (in here, districts). To overcome this problem, a weight restricted imprecise DEA model that constrains weight flexibility in DEA is proposed. Findings The proposed imprecise DEA approach sets forth a more realistic decision methodology for evaluating the relative health-care performance and also enables to determine the best district in terms of health-care performance in Istanbul. Originality/value This paper includes the quality dimension, which has been overlooked in previous studies, into the health-care performance evaluation of districts. Moreover, it circumvents unrealistic weight flexibility which may distort the relative evaluation of health-care performance.

Strategic leadership and management factors driving sustainability in health-care organizations in Thailand

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Suparak Suriyankietkaew ◽  
Pavinee Kungwanpongpun
Keyword(s):  
Health Care ◽  
Health Care Organizations ◽  
Performance Outcomes ◽  
Equation Modeling ◽  
Strategic Leadership ◽  
Sustainable Leadership ◽  
Leadership And Management ◽  
Content Type ◽  
Positive Effects ◽  
Management Factors

Purpose This empirical study aims to identify the essential strategic leadership and management factors underlying sustainability in healthcare. It also examines which factors drive sustainability performance outcomes (SPO) in health-care organizations, an analysis lacking to date. It provides a strategic leadership and management perspective toward sustainable healthcare, responding to the United Nations Sustainable Development Goals.Design/methodology/approachThe investigation adopted Sustainable Leadership as its research framework. Using a cross-sectional survey, 543 employees working in health-care and pharmaceutical companies in Thailand voluntarily provided responses. Factor analyses and structural equation modeling were employed.Findings The results revealed an emergent research model and identified 20 unidimensional strategic leadership and management factors toward sustainability in healthcare. The findings indicate significant positive effects on SPO in health-care organizations. Significant factors include human resource management/development, ethics, quality, environment and social responsibility, and stakeholder considerations.Research limitations/implicationsThe study was conducted in one country. Future studies should examine these relationships in diverse contexts. In practice, health-care firms should foster significant strategic leadership and management practices to improve performance outcomes for sustainability in healthcare.Originality/value This paper is the first empirical, multidisciplinary study with a focus on strategic leadership, health-care management and organizational sustainability. It identifies a proxy for measuring the effects of essential strategic leadership and managerial factors for sustainability in pharmaceutical health-care companies. It advances our currently limited knowledge and provides managerial implications for improving performance outcomes toward sustainable healthcare.

Measuring change attitudes in health care organizations

2019 ◽  
Vol 33 (3) ◽  
pp. 266-285
Author(s):  
Kira Isabel Hower ◽  
Holger Pfaff ◽  
Christoph Kowalski ◽  
Michel Wensing ◽  
Lena Ansmann
Keyword(s):  
Health Care ◽  
Health Care Organizations ◽  
Healthcare Providers ◽  
Attitude Scale ◽  
Equation Modeling ◽  
Cancer Center ◽  
Successful Implementation ◽  
Content Type ◽  
Attitudes Toward Change ◽  
Change Attitude

Purpose Measuring attitudes of healthcare providers and managers toward change in health care organizations (HCOs) has been of widespread interest. The purpose of this paper is to evaluate the psychometric characteristics and usability of an abbreviated German version of the Change Attitude Scale. Design/methodology/approach The Change Attitude Scale was used in a survey of healthcare providers and managers in German hospitals after the implementation of a breast cancer center concept. Reliability analysis, confirmatory factor analysis, structural equation modeling and bivariate analysis were conducted. Findings Data from 191 key persons in 82 hospitals were analyzed. The item-scale structure produced an acceptable model fit. Convergent validity was shown by significant correlations with measures of individuals’ general opinions of the breast center concept. A non-significant correlation with a scale measuring the hospital’s hierarchical structure of leadership verified discriminant validity. The interaction of key persons’ change attitude and hospitals’ change performance through change culture as a mediator supported the predictive validity. Research limitations/implications The study found general support for the validity and usability of a short version of the German Change Attitude Scale. Practical implications Since attitudes toward change influence successful implementation, the survey may be used to tailor the design of implementation programs and to create a sustainable culture of high readiness for change. Originality/value This is the first study finding that a short instrument can be used to measure attitudes toward change among healthcare providers and managers in HCOs.

Can complexity science inform physician leadership development?

2016 ◽  
Vol 29 (3) ◽  
pp. 251-263 ◽  
Author(s):  
Colleen Marie Grady
Keyword(s):  
Complex System ◽  
Health Care ◽  
Leadership Development ◽  
Patient Outcomes ◽  
Health Care Organizations ◽  
Complexity Science ◽  
Primary Role ◽  
Physician Leadership ◽  
Content Type ◽  
Physician Leaders

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.

Bridging competing demands through co-leadership? Potential and limitations

2019 ◽  
Vol 73 (4) ◽  
pp. 464-489 ◽  
Author(s):  
Émilie Gibeau ◽  
Ann Langley ◽  
Jean-Louis Denis ◽  
Nicolas van Schendel
Keyword(s):  
Health Care ◽  
Shared Leadership ◽  
Health Care Organizations ◽  
Institutional Logics ◽  
Leadership Role ◽  
The Other ◽  
Collective Leadership ◽  
Leadership Potential ◽  
Competing Demands ◽  
Multiple Leaders

Collective leadership arrangements in which two people jointly occupy a shared leadership role space are often thought to enable the bridging of competing demands and sources of expertise and legitimacy in pluralistic settings where multiple institutional logics coexist. This research investigates 20 co-leadership dyads in health care organizations to examine whether, when, and how co-leadership arrangements can enable the bridging of institutional logics. Empirical findings suggest that the potential for bridging through co-leadership arrangements is present, but that it may often be achieved through the assimilation of one side by the other rather than balanced integration of competing demands. We conclude that the challenge of collective leadership (and of co-leadership, in particular) may lie not only in developing smooth relations among multiple leaders and their followers, but also in maintaining and mobilizing the tensions that can make their collaboration most fruitful. We suggest that the collective leadership literature has often missed the significance of this central paradox: that collective leadership may be most needed where it is most difficult to achieve. When it seems to operate most smoothly, it is possible that it may not always be fulfilling its mission.

Country-of-origin and brand positioning for health care services

2019 ◽  
Vol 13 (2) ◽  
pp. 183-199 ◽  
Author(s):  
Katherine A. Meese ◽  
Thomas L. Powers ◽  
Andrew N. Garman ◽  
Seongwon Choi ◽  
S. Robert Hernandez
Keyword(s):  
Health Care ◽  
Consumer Culture ◽  
Health Care Organizations ◽  
Country Of Origin ◽  
Eastern Health ◽  
Unique Contribution ◽  
Brand Positioning ◽  
High Involvement ◽  
Content Type ◽  
Chi Square Analysis

PurposeThe purpose of this paper is to examine the relationship between country-of-origin (COO) and brand positioning in the context of the high-involvement service of health care. This paper compares and analyzes different positioning strategies used in Europe, North America and the Middle East.Design/methodology/approachThis paper uses content analysis of promotional materials for a sample of 168 health-care organizations located in 14 countries to identify brand positioning strategies used, such as foreign, local and global consumer culture positioning. A chi-square analysis and post hoc testing is used to examine how positioning strategies differ among regions.FindingsThe findings indicate that European and Middle Eastern health-care organizations most frequently use foreign consumer culture positioning, while North American institutions tend to use global consumer culture positioning. The findings indicate that health-care organizations in countries with a better reputation for care use different positioning strategies than in countries with a lesser reputation for quality care.Practical implicationsThe findings are of value to international advertising and marketing professionals and hospitals seeking to attract patients globally in a competitive marketplace. Hospitals must consider their positioning relative to both domestic and international competitors and the COO of their target audience.Originality/valueCOO is important in high-involvement service industries because consumers lack the information needed to evaluate service quality. Consumers may rely on COO and brand positioning signals more heavily relative to goods or low-involvement services. However, little prior research exists examining COO effects and brand positioning for high involvement services and for health care specifically. This paper makes a unique contribution by filling this gap.

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