Linking leadership development programs for physicians with organization-level outcomes: a realist review

Abstract

Background Hospitals invest in Leadership Development Programs (LDPs) for physicians, assuming they benefit the organization’s performance. Researchers have listed the advantages of LDPs, but knowledge of how and why organization-level outcomes are achieved is missing. Objective To investigate how, why and under which circumstances LDPs for physicians can impact organization-level outcomes. Methods We conducted a realist review, following the RAMESES guidelines. Scientific articles and grey literature published between January 2010 and March 2021 evaluating a leadership intervention for physicians in the hospital setting were considered for inclusion. The following databases were searched: Medline, PsycInfo, ERIC, Web of Science, and Academic Search Premier. Based on the included documents, we developed a LDP middle-range program theory (MRPT) consisting of Context-Mechanism-Outcome configurations (CMOs) describing how specific contexts (C) trigger certain mechanisms (M) to generate organization-level outcomes (O). Results In total, 3904 titles and abstracts and, subsequently, 100 full-text documents were inspected; 38 documents with LDPs from multiple countries informed our MRPT. The MRPT includes five CMOs that describe how LDPs can impact the organization-level outcomes categories ‘culture’, ‘quality improvement’, and ‘the leadership pipeline’: 'Acquiring self-insight and people skills (CMO1)', 'Intentionally building professional networks (CMO2)', 'Supporting quality improvement projects (CMO3)', 'Tailored LDP content prepares physicians (CMO4)', and 'Valuing physician leaders and organizational commitment (CMO5)'. Culture was the outcome of CMO1 and CMO2, quality improvement of CMO2 and CMO3, and the leadership pipeline of CMO2, CMO4, and CMO5. These CMOs operated within an overarching context, the leadership ecosystem, that determined realizing and sustaining organization-level outcomes. Conclusions LDPs benefit organization-level outcomes through multiple mechanisms. Creating the contexts to trigger these mechanisms depends on the resources invested in LDPs and adequately supporting physicians. LDP providers can use the presented MRPT to guide the development of LDPs when aiming for specific organization-level outcomes.

Patterns in Clinical Leadership Learning: Understanding the Quality of Learning about Leadership to Support Sustainable Transformation in Healthcare Education

“…However, the literature review also showed that while CL is learnable, few clinicians have the conceptual or practical skills for continuous improvement of services [11]. Vast amounts of CL-PD are offered to address this need, but in the literature, there is a paucity of high-quality evidence of CL-PD's effectiveness on healthcare sustainability [56,[59][60][61], which is in itself not educationally or financially sustainable [53,57]. A deeper gap was found to underlie this challenge: despite CL being widely identified as a central factor for sustainable healthcare, there is no consensus understanding of how CL is learned [54] and a discussion of CL-education/training has only recently emerged in the sustainability literature [34], with a call for more research.…”

“…This study addresses this gap in the literature through a novel approach, informed by theoretical literature on professional learning of sustained innovation and continuous improvement. Acknowledging the challenges in identifying causal pathways from PD-courses to organisational effects on sustainability, and a lack of extant conceptual and methodological tools of evaluation [7,57,59,60], we proposed that a constitutive step of theorising and empirically analysing how leadership is learned during CL-PD is needed first. While many evaluations focus on and compare the content and features of CL-PD interventions, evidence has suggested that learning processes during CL-PD are more important [61,[63][64][65][76][77][78].…”

“…Despite numerous publications, research on outcomes and impact of CL-PD (the 'whether') is in its infancy, and few indicators of change towards sustainability exist [7,9]. While the ultimate goal of CL-PD is improving the sustainability of healthcare processes and outcomes [12], there is, in existing research, a paucity of methodologically robust models and tools to analyse such causal pathways [59][60][61]. A recent methodological review highlights fundamental unresolved challenges involved in establishing causal relationships between leadership-PD and organisational outcomes [57].…”