Graham Dickson

From the Inside Out: The Engagement of Physicians as Leaders in Health Care Settings

Health care delivery must be transformed to manage spiraling costs and preserve quality care. Transforming complex health systems will require the engagement of physicians as leaders in their health care settings, in both formal and informal roles. In this article we explore the experience of physician leader engagement and identify factors operating at the individual, team, and organizational levels related to increased or decreased physician leader engagement. Using an inductive approach, our analysis of the transcribed interviews yielded a rich understanding of what motivates physicians to be engaged as leaders, how they experience engagement, the role of the physician leader, how physicians understand other physicians’ engagement, what encourages and discourages their engagement efforts, and the role that education and training has in physician engagement. We conclude by offering strategies that physicians, health care organizations, and educational institutions can implement to increase the engagement of physician leaders.

Transformations in Canadian health systems leadership: an analytical perspective

Purpose – The purpose of this paper is to articulate the shifts in the theoretical conceptualization of, and the practice of leadership in health care in Canada that are happening as a response to challenges of system transformation; and the implications of those shifts for individual leaders, for health services delivery, for research into health system leadership, and for leadership development approaches in university and health agencies.Design/methodology/approach – The paper begins with an analysis of the historical, contemporary, and futuristic context that shapes the conceptualization and practice of leadership now and into the future. The context consists of two parts. First, the need for leadership in health systems in Canada will be established. Second, a conceptual and practical exploration of leadership in health care, beginning with a review of the literature and moving on to exploration of two key projects pertaining to health leadership and health leadership development in Canada, commissio...

Health reform in Canada: Enabling perspectives for health leadership.

Canadian healthcare leaders are experiencing unprecedented change. In Canada and worldwide, efforts are being made to create patient-centred service delivery models. In order to participate fully in that transformation, leaders must embrace the new leadership responsibilities vital to patient-centred change. To fail to do so will marginalize their role or render them irrelevant. This article reviews literature in the past 5 years to outline the change context for leaders and what they can do to enhance their effectiveness. Leaders are encouraged to redouble their efforts to develop their leadership capacity, engage physicians as partners, embrace complexity, engage the patient and public in reform efforts, and embrace appropriate technological trends within the consumer community. To reinvent leadership supportive of patient-centred change, healthcare leaders need to act individually to grow their own capacity and collectively to take control of the leadership needed in order to fulfill their role in change.

Doing Participatory Action Research in a Multicase Study A Methodological Example

In this article, we describe an approach for conducting participatory action research (PAR) in a longitudinal multicase study, with particular focus on cross-case analysis. Existing literature has documented the practice of PAR in single-case studies, but far less has been written on how to conduct PAR across multiple cases. There is also a need for instructional examples of multicase study application, particularly methods of cross-case analysis. In PAR, research methods—including data analysis methods—have the power to shape participant inclusion or exclusion, involvement or attrition, and mobilization of knowledge in real time. In response to these challenges, we discuss the analysis methods used in a PAR study of health leadership in Canada. The project, which consisted of six case studies of leadership in major health system change, involved health leaders as collaborators. We address the challenges of doing PAR with collaborators facing time limitations and suggest a project structure for involving collaborators at critical junctures. We present a detailed, two-part method for conducting cross-case data analysis. Our method involved targeted collaborator involvement in data interpretation while also ensuring faithfulness to the coded data. We describe our process for mobilizing study findings through a deliberative dialogue with health leaders.

Enabling physicians to lead: Canada’s LEADS framework

Purpose The purpose of this paper is to provide a case study demonstrating that LEADS in a Caring Environment Capabilities Framework in Canada can assist physicians to be partners in leading health reform. Design/methodology/approach A descriptive case-based approach was followed, relying on existing documents, research papers and peer-reviewed articles, to substantiate the effect of LEADS on physician leadership in Canada. Findings The Canadian LEADS framework enables physicians to lead by providing them with access to best practices of leadership, acting as an antidote to fragmented leadership practice, setting standards for development and accountability and providing opportunities for efficient and effective system-wide leadership development and change. Research limitations/implications A formal systematic review of the literature was not conducted. Findings can only be generalized to other cases if the reader sees contextual similarities between the present study context and the other cases context. Practical implications This case demonstrates that national leadership frameworks have a role in facilitating physician leadership. Other national jurisdictions may wish to explore the Canadian case to determine how to use a common leadership language to engage physicians in health reform. Social implications Leadership is a key component of health reform. A common language and set of standards (LEADS) that can engage physicians will benefit patients and citizens in Canada. Originality/value This national case study shows how a nationally endorsed leadership framework such as LEADS can facilitate better physician leadership for health reform.

LEADS Learning: Epilogue

When we embarked on the LEADS journey in late 2004, leadership was not part of the policy landscape. Generally, it was taken for granted, assumed to be part of the package that came in a boss, with little distinction made between good management and good leadership. If there was any leadership development, it was top down, with the focus on high flyers. Discussing the quality of leadership in an organization, individual or collective, was confined to whispers in hallways and cafeterias. The idea that the discipline of leadership was important to the social enterprise that is health and health care was just beginning to take root.

The LEADS in a Caring Environment Framework: Systems Transformation

This quote from the Book of Changes [1] shows the complexity of change is nothing new. Confucius was not thinking of health care, but nevertheless shows us the interconnectedness among systems transformation (large scale change), smaller scale change (unit and organization) and personal change.

Putting LEADS in Context

There is a rich literature on leadership going back some 2,500 years. Ancient Greece and Rome are famous for their leaders.

Learning LEADS: A Lifelong Journey

The old adage “leaders are born, not made” is misguided. Our premise in developing the LEADS framework and writing this book is quite the opposite: we contend leadership can be learnt and developed. As Malcolm Gladwell points out in his book Outliers (above) an individual must be nurtured in an environment that creates the conditions for success. In this chapter, we outline an approach where it’s up to you, the leader, to create that nurturing environment for yourself. You are, after all, CEO of self!

LEADS: A New Perspective on Leadership in Health

The LEADS in a Caring Environment framework defines health leadership through five domains: