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Medical Leadership’s Inclusivity Promise to Institutions and Professions towards Western Healthcare
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Author: Wouter A. Keijser, U. of Twente
Author: Celeste P.M. Wilderom, U. of Twente, the Netherlands
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Medical Leadership (ML) propagates physicians’ use of organizing-type competencies. Drawing on Institutional Theory, the present abductive study: a) explains ML’s emergence in Western healthcare systems, b) scrutinizes ML’s inclusivity potential to contribute to healthcare transformation, and c) distills a model for interdisciplinary (re)professionalization of physicians during stages of institutional change. We studied ML’s discourse empirically in six Western nations, through: 1) analyzing archival materials, 2) interviewing topical experts, and 3) comparing national ML competency frameworks. Fifteen institutional shifts were found that jointly triggered ML’s emergence, implying fundamental -and possibly irreversible- changes in physicians’ 1) roles and positions; 2) openness and reciprocity; and 3) adaptiveness to healthcare’s increasing complexity. Thus, ML implies physicians should embrace a professional identity that includes innovation, change management and a profound inclusive attitude towards allied professionals. A three-dimensional research model is proposed to gain a better understanding of the current interprofessional dynamics at play since healthcare is increasingly engaged in wicked problems. At the intersection of institutional change and professionalization, further scholarly work is outlined, geared at cost-effective and high-quality patient-centered healthcare in which physicians not only co-lead the patients but, at the same time, span the healthcare’s ancient interdisciplinary, yet often siloed, boundaries.
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Paper is No Longer Available Online: Please contact the author(s).
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The Perception of Not-Profit Hospital Directors on Board Dynamics in the Governance Implementation
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Author: Agota Szabo, Vrije U. Amsterdam
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This study contributes to the current research into board processes and the influence of board dynamics in the perception of hospital directors. It explores the application of governance theories to hospital boards, with a special focus on board dynamics and their influence on the implementation of governance practices as perceived by board members. This study is based on 32 in-depth interviews with not-for-profit hospital trustees and executives in the United States and The Netherlands. Our emerging framework provides an overview of influencing factors both at individual and group level which could have an impact on group dynamics in the boardroom and consequently influence the governance implementation process in the perception of the hospital directors. We contribute to the board governance literature by focusing attention on the influence of group dynamics in the governance implementation process and by showing the individuals’ perspective on interpreting institutional pressure in a complex public environment.
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Paper is No Longer Available Online: Please contact the author(s).
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Strategic Collaboration Between Management and Medical Professionals
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Author: Simon Jan Schrader, Leibniz U. Hannover
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This article investigates the collaboration between management and medical professionals in strategy formation. Specifically, the empirical study focuses on how intended and unintended strategic issues emerge in hospitals, how they are processed and, finally, how they are integrated into the strategic agenda. It is a sequential replication of a previous case study in order to elaborate the nascent theory of strategy formation in hospitals in a comparable setting. This study makes several contributions to the literature: First, it validates the interplay between structure and interaction, a tentative relationship found in the previous study. Furthermore, the study refines the construct of interaction by elaborating the transparency in decision-making and the use of informal procedures as supportive factors in strategy formation. Second, this study extends the nascent theory of strategy formation by identifying the organizational spirit as another relevant construct in the strategy formation process. Third, this study contributes by a specification of the mechanism of strategy formation. More precisely, the interplay of structure, interaction, and organizational spirit determines how strategy formation unfolds and is conceptualized as the strategy making capability of a hospital.
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Paper is No Longer Available Online: Please contact the author(s).
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The Making of Practice Guidelines: Endogenous Dynamics of Policy Formation in Population Screening
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Author: Ozge Karanfil, Koç U.
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Tests to screen for diseases, for example mammography and PSA testing for breast and prostate cancer, are increasingly common in medical practice. However, guidelines for routine screening are contentious and often fluctuate over time. Some tests are over- or underused, with clinical practice persistently deviating from evidence-based guidelines. We develop the first integrated, broad boundary feedback theory and a novel formal model to explain the dynamics of routine population screening including fluctuations and inappropriate use. We present a behaviorally realistic, boundedly-rational model of detection and selection for routine screening that explains oscillations in screening guidelines as decision makers—including consumers, epidemiologists, doctors and patients, perceive harms and benefits from outcomes and make tradeoffs between sensitivity and specificity by altering both the existing guidelines and actual clinical practice. The model endogenously generates fluctuations in screening indications, test thresholds and the target screening population, leading to long periods during which practice guidelines are suboptimal even if the underlying evidence-base is constant. We use cancer screening as a motivating example, but the model is generic and applicable to other diseases or nonmedical contexts such as airport screening, background checks, tax audits, automotive emission tests, or to any other consumer decision where the consumer decides whether or not to acquire information.
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Paper is No Longer Available Online: Please contact the author(s).
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