Misconceiving Medical Leadership

Abstract

Medical leadership and leadership education have recently emerged as subjects of an expanding though as yet uncritical literature. Considerable attention is being given to the development of courses and electives, together with some proposals for generalizing these offerings to all medical students and doctors. This article briefly sketches this development and its derivation from business and corporate leadership models and accompanying literature, and subjects its adoption by medicine to critical scrutiny. Putative motivations for these developments are discussed, and an alternative explanation is offered, tied to the loss of physician status. The nature of leadership as complex, emergent, and unpredictable has been ignored in the promotion of medical leadership and leadership training, and this is reflected in the false assumption that leadership in medicine is something that can be taught. Although the leadership literature is beginning to recognize these complex aspects of leadership, so far their implications have not been acknowledged. This article aims to stimulate further analytic discussion of this under-theorized aspect of medicine.

Physician leadership development at Cleveland Clinic: a brief review

“…21 The design and delivery of the Cleveland Clinic physician leadership development programs aligns with these recommendations. Programs have been uniformly well received, and, though there is clearly a continued need to assess impact based on skepticism and many unanswered questions, 12,13,22 there is already available and growing 22 evidence of important institutional impact and value.…”

“…Indeed, because the nature of leadership and needed competencies have been perceived to be "complex, emergent, and unpredictable"; 12 some have even questioned whether such programs have demonstrable value. 12,13 In defense of the need for developing effective leaders, more than 50% of hospitals report changes in their senior leadership team over the past 2 years, and nearly a quarter plan to add one or more roles to these teams over the next 2 years. 11 Yet, of 10 measurable dimensions of leadership effectiveness, CEOs rated as lowest their teams' abilities to prepare internal candidates for future leadership positions.…”

“…In developing effective leaders, many hospitals and health systems struggle to find consistent strategies. Indeed, because the nature of leadership and needed competencies have been perceived to be “complex, emergent, and unpredictable”; 12 some have even questioned whether such programs have demonstrable value. 12,13…”

The state-of-play in physician health systems leadership research

“…However, questions abound about the nature of physician leadership and its implications for health system reform. Some scholars have expressed concern that renewed attention to "medical leadership" may simply reframe existing parts of physician practice in ways that entrench medical professional dominance rather than drive meaningful reform (Parker, 2013;O'Reilly and Reed, 2011). Moreover, there have been concerns that increasing focus on clinician leadership participation, in general, may promote unduly simplistic prescriptions for reform; these could lead to unrealistic expectations of the impact leaders can have on reform in the face of entrenched institutionaland policy-level barriers that limit leadership discretion (Hewison and Griffiths, 2004).…”

Corporate medical cultures: MD Anderson as a case study in American corporate medical values

“…38. Malcolm Parker, 2013, “Misconceiving Medical Leadership,” Perspectives in Biology and Medicine 56, no. 3 (Summer 2013): 387–406, https://doi.org/10.1353/pbm.2013.0027.…”