#KeyLIMEPodcast 302: Leaders (born or made)

Reference

Riikka Hofmann, Jan D. Vermunt. Professional learning, organisational change and clinical leadership development outcomes. Medical Education. 2021;55:252–265.

Reviewer

Linda Snell (@LindaSMedEd)

Background

We need clinical leaders to address  health  systems challenges globally,  addressing complexity of clinical problems,  financing, organization and quality of health care.

There are debates about what clinical leadership means. Clinical leadership = leadership of clinicians in the context of their clinical roles (vs. replacing clinical practice with formal management positions) is touted as a solution, and CLs need to be trained, with new roles and competencies. Leadership is a core competency in most competency frameworks.

There is a lack of evidence-based best-practice models for clinical leadership development. Few robust outcome models or evidence of effectiveness to evaluate the impact of clinical leadership professional development programs, or theories supporting these models. The few studies done studies commonly evaluate immediate individual impact, with little attention to organisational benefits, which hinders valid evaluations of programme effectiveness.

Purpose

“to conceptualise and operationalise clinical leadership in ways that will enable us to identify and evaluate its development;  to develop a conceptually sound outcome model for CL development in healthcare, linking individual professional learning and organisational change.”

• RQ1: What should ‘clinical leadership’ achieve in a healthcare system like the NHS?
• RQ2: How can we depict and conceptualise the professional learning outcomes of clinical leadership development?
• RQ3: How are the individual clinical leadership development outcomes linked with the desired organisational outcomes?

Key Points on the Methods

“review existing models and theories of clinical leadership, a range of evaluations, empirical studies and systematic reviews of clinical leadership development to establish what is known about its effectiveness and outcomes, and to identify patterns and gaps in evidence.”  A mini-scoping review??  (RQ1)

Multi-source, sequential integrated mixed-methods study with 3 analyses
(a) systematic content analysis of NHS policy documents (RQ1) Thematic analysis well described.
(b) data from a CL programme evaluation study: factor analysis (EFA) of 142 participants’ survey responses (RQ2-3); questions informed by a&c. 7 cohorts, 293 people, who had participated in a leadership program: 10 day long modules, a 10 month project, and a leadership role (senior registrars, early career doctors). Analysis – descriptive stats and factor analysis.
(c) thematic qualitative analysis of 30 in-depth participant interviews across six cohorts. (RQ2-3) Benefits and outcomes of program; challenges, barriers and enablers of leadership; suggestions for improvement. “systematic steps were taken to improve the validity of the interview data and counteract common forms of bias, such as social desirability was well described.

->integrating findings from the above 3 to examine:

• expected organisational outcomes of CL,
• individual learning outcomes of CL development,
• mechanisms linking the two. (“To evaluate clinical leadership development, we need a conceptually integrated model that links competences and behaviours with organisational outcomes and has operational specificity that enables empirical studies”)

Key Outcomes

Lit review:

“overcoming resistance to engagement in leadership/ management and difficulties of inter-professional collaboration
may require a focus on clinicians’ self-efficacy and sense of agency, engaging with and understanding the perspectives and motives of others, and addressing risk.”

Document review:
5 documents challenges and solutions: Across documents, CL is seen as a solution to organisational needs via “ increasing inter-professional collaboration, speeding up the scaling up of good practice and genuine change and transformation of practice, instead of further organizational re-structuring.”

Survey: 5 themes / factors emerged
• Knowledge/Understanding and Mindset – An understanding of how the organisation works; positive about, and wanting to
contribute to, this area of work
• Capability to engage stakeholders – to support change
• Willingness and capability for working across boundaries – Confidently expressing own viewpoints; supporting
collaborative cultures; crossdept networks; feeling on the same side with non-clinical management
• Effecting change – & ability to influence decision-making
• Willingness to take risks to effect change – take personal and reputational risks to achieve change in clinical practice

Interviews:
Linked to 5 factors above – ‘revisioned’ to: self efficacy, engaging stakeholders, boundary crossing expertise, agency, willingness to take risks and to learn from risks and failures rather than trying to define what clinical leadership ‘is’, evaluations should aim to answer what is expected to be achieved in a healthcare system.

Key Conclusions

The authors believe their study contributes by proposing an alternative conceptualization of leadership development outcomes; by showing relationship between individual learning outcomes and organisational outcomes; by linking the clinical domain and the professional learning literature through introducing constructs like boundary-crossing, self-efficacy and agency.

Spare Keys – other take home points for clinician educators

Nicely explained methods re interview methods to increase validity, and description of thematic analysis.

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