From context to contexting: professional identity un/doing in a medical leadership development programme.

Physicians are known for safeguarding their professional identities against organisational influences. However, this study shows how a medical leadership programme enables the reconstruction of professional identities that work with rather than against organisational and institutional contexts to improve quality and efficiency of care. Based on an ethnographic study, the results illustrate how physicians initially construct conflicting leadership narratives - heroic (pioneer), clinical (patient's guardian) and collaborative (linking pin) leader - in reaction to changing organisational and clinical demands. Each narrative contains a particular relational-agentic view of physicians regarding the contexts of hospitals: respectively as individually shapeable; disconnected or collectively adjustable. Interactions between teachers, participants, group discussions and in-hospital experiences led to the gradual deconstruction of the heroic -and clinical leader narrative. Collaborative leadership emerged as the desirable new professional identity. We contribute to the professional identity literature by illustrating how physicians make a gradual transition from viewing organisational and institutional contexts as pre-given to contexting, that is, continuously adjusting the context with others. When engaged in contexting, physicians increasingly consider managers and directors as necessary partners and colleague-physicians who do not wish to change as the new 'anti-identity'.

What makes an ideal hospital-based medical leader? Three views of healthcare professionals and managers: A case study.

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.

Discursively framing physicians as leaders: Institutional work to reconfigure medical professionalism.

Physicians are well-known for safeguarding medical professionalism by performing institutional work in their daily practices. However, this study shows how opinion-making physicians in strategic arenas (i.e. national professional bodies, conferences and high-impact journals) advocate to reform medical professionalism by discursively framing physicians as leaders. The aim of this article is to critically investigate the use of leadership discourse by these opinion-making physicians. By performing a discursive analysis of key documents produced in these strategic arenas and additional observations of national conferences, this article investigates how leadership discourse is used and to what purpose. The following key uses of medical leadership discourses were identified: (1) regaining the lead in medical professionalism, (2) disrupting 'old' professional values, and (3) constructing the 'modern' physician. The analysis reveals that physicians as 'leaders' are expected to become team-players that work across disciplinary and organizational boundaries to improve the quality and affordability of care. In comparison to management that is negatively associated with NPM reform, leadership discourse is linked to positive institutional change, such as decentralization and integration of care. Yet, it is unclear to what extent leadership discourses are actually incorporated on the work floor and to what effect. Future studies could therefore investigate the uptake of leadership discourses by rank and file physicians to investigate whether leadership discourses are used in restricting or empowering ways.

Medical leaders or masters?-A systematic review of medical leadership in hospital settings.

Medical leadership is increasingly considered as crucial for improving the quality of care and the sustainability of healthcare. However, conceptual clarity is lacking in the literature and in practice. Therefore, a systematic review of the scientific literature was conducted to reveal the different conceptualizations of medical leadership in terms of definitions, roles and activities, and personal-and context-specific features. Eight databases were systematically searched for eligible studies, including empirical studies published in peer-reviewed journals that included physicians carrying out a manager or leadership role in a hospital setting. Finally, 34 articles were included and their findings were synthesized and analyzed narratively. Medical leadership is conceptualized in literature either as physicians with formal managerial roles or physicians who act as informal 'leaders' in daily practices. In both forms, medical leaders must carry out general management and leadership activities and acts to balance between management and medicine, because these physicians must accomplish both organizational and medical staff objectives. To perform effectively, credibility among medical peers appeared to be the most important factor, followed by a scattered list of fields of knowledge, skills and attitudes. Competing logics, role ambiguity and a lack of time and support were perceived as barriers. However, the extent to which physicians must master all elicited features, remains ambiguous. Furthermore, the extent to which medical leadership entails a shift or a reallocation of tasks that are at the core of medical professional work remains unclear. Future studies should implement stronger research designs in which more theory is used to study the effect of medical leadership on professional work, medical staff governance, and subsequently, the quality and efficiency of care.

Physical activity types and life expectancy with and without cardiovascular disease: the Rotterdam Study.

Background: We aimed to determine the contribution of specific physical activity (PA) types (i.e. walking, cycling, domestic work, sports and gardening) on total life expectancy (LE) and LE with and without cardiovascular disease (CVD). Methods: We constructed multistate life tables to calculate the effects of total PA and PA types on LE, among individuals older than 55 years from the Rotterdam Study. For the life table calculations, we used sex-specific prevalences, incident rates and hazard ratios for three transitions (healthy-to-CVD, healthy-to-death and CVD-to-death) by levels of PA and adjusted for confounders. Results: High total PA was associated with gains in total and CVD-free LE. High cycling contributed to higher total LE in men (3.7 years) and women (2.1 years) and higher LE without CVD in men (3.1 years) and women (2.4 years). Total and CVD-free LE were increased by high domestic work in women (2.6 and 2.4 years, respectively) and high gardening in men (2.7 and 2.0 years, respectively). Conclusions: Higher PA levels are associated with increased LE and more years lived without CVD. Of the different PA types, cycling provided high effects in both men and women. Cycling could be more strongly encouraged in activity guidelines to maximize the population benefits of PA.