Creation of high-performing medical department

Background: Transforming dysfunctional medical groups into high-performing departments is a process that physician leaders are not typically trained to enact. Multiple issues challenge the ability to successfully create a financially sound department that offers high-quality care along with impactful academic deliverables.Methods: We present an example of a critical care group that was highly dysfunctional that was transformed into a highperforming medical department. It underwent a change that was achieved through three stages: (1) Defining Purpose; (2) Relationship Building and Problem Solving; and (3) Group Development. The later stage is approached in a three-phase cycle.Results: Success was achieved on all deliverables including clinical care, academics and finances as validated by external measures. The department was awarded best practice for delivery of clinical care by an international accreditation group. It was twice recognized as their hospital’s highest engaged medical group. Academic deliverables increased to become a high performer all while financial stability was achieved. The importance of health and wellness is highlighted.Conclusions: The process for transforming departments is suggested in a step-wise approach for other groups to achieving similar success.

Elements of perceived good physician leadership and their relation to leadership theory

Purpose This research paper aims to discover the elements of good physician leadership as perceived by physicians and to find out how the findings connect to the leadership theory. Design/methodology/approach The subjects (n = 50) of this qualitative study are physicians from four hierarchical levels (residents/specialising physicians, specialists, heads of departments and chief physicians). Content analysis with a constructivist-interpretative approach by thematisation was the chosen method, and it was also analysed how major leadership theories relate to good physician leadership. Findings Physician leaders are expected to possess the professional skills of physicians, understand how the work affects physicians’ lives and be competent in applying suitable leadership approaches following different situations and people. Trust, fairness, empathy, social skills, two-way communication skills, regular feedback, collegial respect and emotional intelligence are expected. As medical expertise connects leaders and followers, success in medical leadership comes from credibility in medical expertise, making medical leadership an inseparable part of good physician leadership. Subordinates are physician colleagues, who have their informal leadership roles on their hierarchical levels, making physician leadership a multidimensional leadership setting wherein formal leaders lead informal leaders, which blurs the traditional leader–follower boundary. In summary, good physician leadership is leadership through medical expertise combined with good manners, collegiality and traits from different kinds of leadership theories. Originality/value This study discovers elements of good physician leadership in a Finnish health-care context in which no similar prior empirical research has been carried out.

Value based care in nephrology: the Kidney Care Choices Model and other Reforms

The Advancing American Kidney Health (AAKH) initiative has reinvigorated the focus on improving the care of patients with advanced chronic kidney disease. Multiple interventions have been planned, with focus on education campaigns for both clinicians and patients, delaying the progression of kidney disease and improving utilization of home dialysis modalities and kidney transplantation. Value-based care models for patients with advanced kidney disease are being rolled out, with the ESRD treatment choices model starting in January 2021, and the Kidney Care choices model planned to start in January 2022. There is increasing emphasis on the role of the nephrologist as the "captain of the ship", leading efforts in care coordination as physician leaders. The transplant reforms have focused on changes to organ procurement organizations aiming to increase availability of organs, as well as transplants performed, both deceased donor as well as living donor, and removing financial disincentives from live organ donation. The American Society of Nephrology (ASN) and the National Kidney Foundation (NKF) are partnering with the Department of Health and Human Services to develop educational material for clinicians and patients. In this review, we discuss these reforms, as well as potential challenges that have risen, and potential solutions, with emphasis on the Kidney Care Choices model.

We need to work differently in a crisis: peer-professional leadership to redesign physicians’ work

BackgroundUnderstanding physician leadership is critical during pandemics and other health crises when formal organisational leaders may be unable to respond expeditiously. This study examined how physician leaders managed to quickly design a new model for acute-care physicians’ work, adopted across four large hospitals in a public health authority in Canada during the COVID-19 pandemic.MethodsThe research employed a qualitative case study methodology, with inductive analysis of interview transcripts and documents. Shortly after a physician work model redesign, we interviewed key informants: the physician leaders and others who participated in or supported the model’s development. Participants were chosen based on their leadership role and through snowballing. All those who were approached agreed to participate.ResultsA process model describes leadership actions during four phases of work model development (priming, early planning, readying for operations and transition). These actions were: (1) recognising the threat, (2) committing to action, (3) forming and organising, (4) building and relying on relationships, (5) developing supporting processes and (6) designing functions and structure. We offer three additional contributions to knowledge about leadership in a time of crisis: (1) leveraging peer-professional leadership to initiate, formalise and organise change processes, (2) designing a new work model on existing and emerging evidence and (3) building and relying on relationships to unify various actors.ConclusionsThe model of peer-professional leadership can deepen understanding of how to lead professionals. Our findings could assist peer-professional and organisational leaders to encourage quick redesign of professionals’ work in response to new phases of the COVID-19 pandemic or other crises.

Physician leaders’ cross-boundary use of social media: what are the implications in the current COVID-19 environment?

Purpose The purpose of this study is to better understand social media (SM) factors that physician leaders need to consider, as they adapt their cross-boundary practices to engage with colleagues and patients. Firstly, this study explores why SM is being used by physicians to cross horizontal (physician to physician) and stakeholder (physician to patient) boundaries prior to COVID-19. Secondly, based on the studies reviewed, this study provides insights on the practical SM implications for physician leaders working in the COVID-19 environment to actively enhance their practices, reduce public confusion and improve patient care, thus informing health-care practices. Design/methodology/approach A systematic literature review was used to conduct a structured transparent overview of peer reviewed articles that describe physicians’ use of cross-boundary SM across several disciplines (e.g. health, information science). As a baseline assessment prior to COVID-19, the review synthesized 47 articles, identified and selected from six databases and Novanet. This study used NVivo 12 to thematical code the articles, leading to the emergence of four broad factors that influence SM use. Findings A key reason noted in the literature for physicians use of SM to cross horizontal boundaries is to share knowledge. Regarding stakeholder boundaries, the most cited reasons are to improve patient’s health and encourage behavioural changes. Insights garnered on the practical SM implications include the need for physicians to be stronger leaders in presenting trustworthy and consistent facts about health information to the public and fellow peers. As role models for the effective use of SM tools, physician leaders can mentor and coach their colleagues and counterparts. Research limitations/implications As this was a literature review, the authors did not collect primary data to further explore this rapidly changing and dynamic SM world. Next steps could include a survey to determine firstly, how physicians currently use SM in this COVID-19 environment, and secondly, how they could leverage it for their work. Findings from this survey will help us better understand the role of physician leaders as health-care influencers and how they could better create trust and inform the Canadian public in the health information that is being conveyed. Practical implications Physician leaders can play a key role in positively influencing institutional support for ethical and safe SM use and engagement practices. Physicians need to participate in developing regulations and guidelines that are fundamentally to physician leader’s SM use. Central to this research would be the need to understand how physicians cross-boundary practices have changed during and potentially post COVID-19. Physician leaders also need to monitor information sources for credibility and ensure that these sources are protected. As role models for the effective use of SM tools, physician leaders can mentor and coach their colleagues and counterparts in this area. Originality/value Although there have been studies of how physicians use SM, fewer studies explore why physician leaders’ cross boundaries (horizontal and stakeholder) using SM. Important insights are gained in physician leaders practical use of SM. Key themes that emerged included: organizational and individual, information, professional and regulations and guideline factors. These factors strengthen physician leaders understanding of areas of foci to enhance their cross-boundary interactions. There is an urgency to study the complexity of SM and the effectiveness of regulations and guidelines for physicians, who are being required, at an accelerated rate, to strengthen and increase their cross-boundary practices.

COVID-19 Crisis: The Pandemic Highlights the Unique Training and Skills of Military Physicians Afforded by Military-Specific Graduate Medical Education

ABSTRACT Military physicians trained in military Graduate Medical Education programs are uniquely prepared to lead in austere and chaotic environments based on formal and informal curricula taught in military treatment facilities. The coronavirus disease-2019 pandemic highlighted this reality when military-trained physician leaders were challenged to lead change directly from the front.

Building community during the COVID-19 pandemic: a system level approach to physician well-being

Before the COVID-19 pandemic, physician burnout was identified as reaching crisis proportions, and the pandemic is expected to worsen the already perilous state of physician wellness. It has affected physicians’ emotional health, not only by increasing workload demands, but also by eroding resilience under increasing pressures. The mental health consequences are expected to persist long after the pandemic subsides. With physician wellness increasingly recognized as a shared responsibility between individual physicians and the health care system, system-level approaches have been identified as important interventions for addressing physician well-being. In this article, we describe two evidence-guided initiatives implemented in our hospitalist network during the current pandemic: a trained peer-support team and facilitated physician online group discussions. These initiatives acknowledge the emotional strain of physicians’ work and challenge the “iron doc” culture of medicine. Our efforts build community and shift culture toward improved physician wellness. We suggest that the pandemic might be an opportunity for our profession to strengthen our support networks and for physician leaders to advance physician wellness in their work environments.

Understanding attention deficit/hyperactivity disorder in physicians: workplace implications and management strategies

Physicians with attention deficit/hyperactivity disorder (ADHD) may have unrecognized workplace difficulties because of inattention and impulsivity. If these behaviours interfere with patient care or organizational functioning, leaders may erroneously attribute the physician’s actions to unprofessionalism. As such, corrective efforts with punitive measures may be ineffective. ADHD is a neurodevelopmental disorder that responds to evidence-based treatments, including medications, accommodations, and supports. Physician leaders who understand the unique presentations of ADHD in physicians may better identify when this condition may be contributing to workplace behaviour. Furthermore, physician leaders may have a professional or legal duty to accommodate or support physicians with underlying medical and/or psychiatric conditions, such as ADHD. Using our own clinical experience, we provide a general overview of ADHD in physicians and guide physician leaders on how to help physicians who may be struggling with ADHD in the workplace. We hope that our clinical experience and observations of this hidden problem will spur discussion, awareness, and action for further research and support.

Just a leader? Leadership work challenges and identity contradiction experienced by Finnish physician leaders

PurposeThis study seeks to improve the understanding of physician leaders' leadership work challenges.Design/methodology/approachThe subjects of the empirical study were physician leaders (n = 23) in the largest central hospital in Finland.FindingsA total of five largely identity-related, partially paradoxical dilemmas appeared regarding why working as “just a leader” is challenging for physician leaders. First, the dilemma of identity ambiguity between being a physician and a leader. Second, the dilemma of balancing the expected commitment to clinical patient work by various stakeholders and that of physician leadership work. Third, the dilemma of being able to compensate for leadership skill shortcomings by excelling in clinical skills, encouraging physician leaders to commit to patient work. Fourth, the dilemma of “medic discourse”, that is, downplaying leadership work as “non-patient work”, making it inferior to patient work. Fifth, the dilemma of a perceived ethical obligation to commit to patient work even if the physician leadership work would be a full-time job. The first two issues support the findings of earlier research, while the remaining three emerging from the authors’ analysis are novel.Practical implicationsThe authors list some of the practical implications that follow from this study and which could help solve some of the challenges.Originality/valueThis study explores physician leaders' leadership work challenges using authentic physician leader data in a context where no prior empirical research has been carried out.