Physicians in the management and leadership of health care: A systematic review of the conditions conducive to organizational performance

Abstract

AbstractIntroductionThe influx of management ideas into health care has triggered considerable debate about if and how managerial and medical logics can co-exist. Recent reviews suggest that clinician involvement in hospital leadership can lead to superior performance.ObjectiveTo systematically explore the conditions instrumental for medical leadership to have an impact on organizational performance.MethodsWe searched PubMed, Web of Science, and Psychinfo for peer-reviewed, empirical, English language articles and reviews published between January 1, 2006 and August 12, 2018. We performed a thematic synthesis through inductive line-by-line coding of the included studies.ResultsThe search yielded 1447 publications, of which 62 were included. Three major themes were identified that described a movement 1. From medical protectionism to management through medicine, 2. From command and control to participatory leadership practices, and 3. Organizational practices to support incidental versus willing leaders. Based on these themes, the authors developed a model to depict conditions that facilitate or impede the influence of medical leadership through a virtuous cycle of management through medicine or a vicious cycle of medical protectionism.ConclusionsThis review helps individuals, organizations, educators, and trainers better understand how medical leadership can be both a boon and a barrier to the performance of health care organizations. In contrast to the conventional view of conflicting logics, medical leadership would benefit from a more integrative mental model of management and medicine. Nurturing medical engagement requires participatory leadership enabled through long-term investments at the individual, organizational, and system levels. These combined efforts will enable a shift to new leadership paradigms suitable to the complexity of health care, and establish conditions favorable for large-system transformation and health care reform.Strengths and limitations of this studyWhile previous literature reviews have established a correlation between physicians in leadership roles and organizational performance, this is to our knowledge the first review that seeks to explore what contributes to that link.The review expands on the typically quantitative focus of systematic reviews by providing a thematic synthesis of fifty-five empirical studies and seven literature reviews.A model is presented that depicts a virtuous cycle of management through medicine and a vicious cycle of medical protectionism.This review is limited by the quality and heterogeneity of the included studies.While plausible correlations between conditions and performance outcomes are explored, to establish causality requires study designs that can determine the strength of the relationships.