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PhD Defence Wouter Keijser

Opening up Medicine: Physicians and Leadership in Times of Transformation

Wouter Keijser is a PhD student in the research group Change Management & Organization Behaviour. His supervisor is prof.dr. C.P.M. Wilderom from the Faculty of Behavioural, Management and Social Sciences.

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This dissertation focusses on the phenomenon of ‘medical leadership’ (ML) that has recently emerged, exemplified by increasing international attention within the academic as well as wider healthcare community. While an abundance of ML trainings has flooded physicians’ post-graduate training programs and various medical schools gradually integrate ML education in their curricula, much ambiguity about this novel concept exists. This thesis has two objectives: a) to establish more understanding about ML and b) to further its discourse in related research, practice and education. From a distinct set of study perspectives, qualitative as well as quantitative approaches were employed and data is analyzed from various sources, ranging from literature reviews, interviews, surveys and through other measures.

International literature is scrutinized, deriving from various fields, including social sciences, ML and leadership studies as well as national archives in six Western countries. Scaffolded by interviews with national experts on ML in these nations, this resulted in detailed analysis of ML’s institutional origins. Also, ML’s prime dimensions were identified, comprising: ‘interconnectedness’; ‘openness and reciprocity’; and ‘adaptively organizing for inclusive change’. Jointly, these reflect physicians’ new orientation in the studied healthcare systems.

Featuring the Netherlands as case study, the development process of a national ML competency framework is also portrayed. One of the processes this thesis describes is how a community of practice, in collaboration with the Dutch Royal Medical Association, and applying a mixed methods approach, can provide to the medical community a national taxonomical language on ML.

Placing ML in the multi-faceted perspective of the healthcare system and society-at-large, an analytic model is developed in this thesis furthermore, that assists unwrapping and, ultimately, deployment of ML’s potential, taking into account the variety of stakeholders and levels at which ML is operated and influenced. This is accompanied by a comprehensive analysis of how physicians are challenged in addressing healthcare’s wicked problems that convoy healthcare transformation processes. Recommendations for further actions at educational, organizational and governance levels are specified, that will enable the medical profession in better preparing for governing wicked problem.

Aspiring the advancement of ML development, this thesis provides two more originalities. A conceptual framework is presented that stipulates the guiding principles for effective design and deployment of ML training. In a similar way utilizing international academic literature and cross-pollinating relevant theories, a new approach is developed to enable ML development in clinical settings, significantly aided by the input of non-medical staff. Rooted in theories of communities of practice, professional medical (leadership) identity formation, and interprofessional education this novel method provides interdisciplinary teams with a tool to endeavor their higher levels of effective collaboration.

Also from a practical perspective, a longitudinal 4.5-year intervention-effect study, employing a blended use of the comprehensive TeamSTEPPS curriculum and ML coaching of cardiothoracic surgeons and anesthesiologist in an academic multidisciplinary setting, is described, while applying the new guideline for reporting complex multi-professional healthcare teamwork training, which development as part of this thesis.

The thesis concludes with a set of reflections on the future perspective of ML development, comprising a literature review on physician ‘e-leadership’ and an overview of a recent multi-program and -national European study on e-health implementation, involving profound integration of social and healthcare services for the elderly.

Apparently, contemporary physicians in various Western countries are incorporating new nonclinical behaviors and competencies in their professional repertoire, that increasingly promotes as well as furthers continuous and inclusive innovation and change. This thesis finds evidence that ML is not a lofty trend: it is here to stay. However, as is described in various chapters, merely scheduling ML training for physicians will not suffice. In order to harvest the potential effects of physicians’ new leadership, a network approach is needed that musters all parties that are to be involved. Besides individual physicians’ engagement in profound self-reflection and training relating their new non-clinical competencies, much remains in the hands of various stakeholders to support these professionals in their highly responsible work and life-long education.