The four Cs of physician leadership: A key to academic physician success

Submitted: 13 June 2023
Accepted: 30 May 2024
Published: 17 September 2024
Abstract Views: 27
PDF: 24
Supplementary Materials: 0
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Leadership is increasingly recognized as important in medicine. Physician leadership impacts healthcare delivery and quality. Little work has been done to determine how physician leadership in practice aligns with established models in leadership theory. We conducted 40 semi-structured, 50-minute interviews of physicians who had achieved the rank of professor in our school of medicine and were serving, or had served, in leadership positions. We used an inductive content analysis approach to identify content categories, with leadership emerging as one such category. Subsequently, for the present study, we performed a secondary analysis of the data. To do this, we reviewed all transcripts, seeking to identify if and how participants discussed leadership in relation to success in academic medicine. Following identification of subcategories related to leadership, we performed qualitative content analysis. We then used a deductive content analysis approach to determine how participants’ discussions of leadership aligned with major leadership theories. Then, the principal investigator conducted a secondary inductive content analysis revealing leadership themes that were synthesized into a new model of physician leadership. Twenty-nine participants spontaneously discussed leadership and leadership-related topics as important to their own academic success and comprised the present study cohort. Participants identified contributors to leadership success that aligned with multiple major leadership theories, including leadership traits, skills, behaviors styles, and situational leadership. None of the leadership theories aligned completely with our physician leaders’ discussions, suggesting an alternate leadership framework was operating. Further analysis revealed a new model of leadership comprised of the “Four Cs of Physician Leadership”: character, competence, caring, and communication. Our participant group of academic physicians identified leadership capabilities as being important in their academic success. While they discussed leadership in ways that fit to varying degrees with the major leadership theories, their discussions revealed a novel, more holistic leadership framework. Further work will be beneficial to determine if this model of leadership is specific to physicians or is more generalizable.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Arroliga, A. C., Huber, C., Myers, J. D., Dieckert, J. P., & Wesson, D. (2014). Leadership in health care for the 21st century: challenges and opportunities. The American Journal of Medicine, 127(3), 246–249. DOI: https://doi.org/10.1016/j.amjmed.2013.11.004
Attar, M., & Abdul-Kareem, A. (2020). Agile business leadership methods for industry 4.0. 171–191. DOI: https://doi.org/10.1108/978-1-80043-380-920201011
Berghout, M. A., Fabbricotti, I. N., Buljac-Samardžić, M., & Hilders, C. G. J. M. (2017). Medical leaders or masters?—A systematic review of medical leadership in hospital settings. PLoS ONE, 12(9), e0184522-24. DOI: https://doi.org/10.1371/journal.pone.0184522
Blake, R., & Mouton, J. (1964). The managerial grid. Gulf Publishing.
Blanchard, K. (2007). Leading at a higher level. Prentice-Hall.
Burns, J. M. (1978). Leadership. Harper and Row.
Cochran, A., Elder, W. B., & Neumayer, L. A. (2019). Characteristics of effective mentorship for academic surgeons. Annals of Surgery, 269(2), 269–274. DOI: https://doi.org/10.1097/SLA.0000000000002487
Collins, R. T., Algaze, C., & Posner, B. Z. (2023). The Leadership/Management Concept Scale: differentiating between actions constituting leadership and management. Leadership & Organization Development Journal. 44(5), 657-677. DOI: https://doi.org/10.1108/LODJ-06-2022-0299
Collins, R. T., Purington, N., & Roth, S. J. (2022). Physician understanding of and beliefs about leadership. Journal of Healthcare Management, 67(2), 120–136. DOI: https://doi.org/10.1097/JHM-D-21-00036
DeRue, D. S. (2011). Adaptive leadership theory: Leading and following as a complex adaptive process. Research in Organizational Behavior, 31, 125–150. DOI: https://doi.org/10.1016/j.riob.2011.09.007
Dickerman, J., Sánchez, J., Portela-Martinez, M., & Roldan, E. (2018). Leadership and academic medicine: Preparing medical students and residents to be effective leaders for the 21st century. MedEdPORTAL, 14, 10677. DOI: https://doi.org/10.15766/mep_2374-8265.10677
Ginzburg, S. B., Deutsch, S., Bellissimo, J., Elkowitz, D. E., Stern, J. N., & Lucito, R. (2018). Integration of leadership training into a problem/case-based learning program for first- and second-year medical students. Advances in Medical Education and Practice, 9, 221–226. DOI: https://doi.org/10.2147/AMEP.S155731
Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative success. Transaction Publishers.
Goleman, D. (2000). Leadership that gets results. Harvard Business Review, 78(2), 78–90.
Greenleaf, R. (1977). The servant as leader. Greenleaf Center.
Hersey, P., & Blanchard, K. H. (1969). Life cycle theory of leadership. Training and Development Journal, 23(5), 26–34.
Hersey, P., & Blanchard, K. H. (1977). Management of organizational behavior: Utilizing human resources (3rd ed.). Prentice-Hall.
Jago, A. G. (1982). Leadership: Perspectives in theory and research. Management Science, 28(3), 315–336. DOI: https://doi.org/10.1287/mnsc.28.3.315
Katz, R. L. (1955). Skills of an effective administrator. Harvard Business Review, 33(1), 33–42.
Lewin, K., Lippitt, R., & White, R. K. (1939). Patterns of aggressive behavior in experimentally created social climates. Journal of Social Psychology, 10(2), 271–299. DOI: https://doi.org/10.1080/00224545.1939.9713366
Lucas, R., Goldman, E. F., Scott, A. R., & Dandar, V. (2018). Leadership development programs at academic health centers: Results of a national survey. Academic Medicine, 93(2), 229–236. DOI: https://doi.org/10.1097/ACM.0000000000001813
Martin, S. R., Heyming, T. W., Fortier, M. A., Jenkins, B., Ahn, K., Cappon, J. P., & Kain, Z. N. (2023). Do pediatrician interpersonal and personality characteristics affect patient experience? Academic Pediatrics, 23(2), 336–342. DOI: https://doi.org/10.1016/j.acap.2022.06.010
Mumford, M. D., Zaccaro, S. J., Harding, F. D., Jacobs, T. O., & Fleishman, E. A. (2000). Leadership skills for a changing world: Solving complex social problems. The Leadership Quarterly, 11(1), 11–35. DOI: https://doi.org/10.1016/S1048-9843(99)00041-7
O’Connor, C., & Joffe, H. (2020). Intercoder reliability in qualitative research: Debates and practical guidelines. International Journal of Qualitative Methods, 19, 1609406919899220. DOI: https://doi.org/10.1177/1609406919899220
Porter, M. E., & Teisberg, E. O. (2007). How physicians can change the future of health care. JAMA, 297(10), 1103–1111. DOI: https://doi.org/10.1001/jama.297.10.1103
Quinn, J. F., & Perelli, S. (2016). First and foremost, physicians: The clinical versus leadership identities of physician leaders. Journal of Health Organization and Management, 30(4), 711–728. DOI: https://doi.org/10.1108/JHOM-05-2015-0079
Rath, C. R., Grosskopf, S., & Barmeyer, C. (2021). Leadership in the VUCA world - a systematic literature review and its link to intercultural competencies. European Journal of Cross-Cultural Competence and Management, 5(3), 195–219. DOI: https://doi.org/10.1504/EJCCM.2021.116890
Saxena, A., Desanghere, L., Stobart, K., & Walker, K. (2017). Goleman’s leadership styles at different hierarchical levels in medical education. BMC Medical Education, 17(1), 169–178. DOI: https://doi.org/10.1186/s12909-017-0995-z
Shanafelt, T. D., Gorringe, G., Menaker, R., Storz, K. A., Reeves, D., Buskirk, S. J., Sloan, J. A., & Swensen, S. J. (2015). Impact of organizational leadership on physician burnout and satisfaction. Mayo Clinic Proceedings, 90(4), 432–440. DOI: https://doi.org/10.1016/j.mayocp.2015.01.012
Shanafelt, T. D., Hasan, O., Dyrbye, L. N., Sinsky, C., Satele, D., Sloan, J., & West, C. P. (2015). Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clinic Proceedings, 90(12), 1600–1613. DOI: https://doi.org/10.1016/j.mayocp.2015.08.023
Shanafelt, T. D., & Noseworthy, J. H. (2017). Executive leadership and physician well-being: Nine organizational strategies to promote engagement and reduce burnout. Mayo Clinic Proceedings, 92(1), 129–146. DOI: https://doi.org/10.1016/j.mayocp.2016.10.004
Shubeck, S. P., Kanters, A. E., & Dimick, J. B. (2019). Surgeon leadership style and risk-adjusted patient outcomes. Surgical Endoscopy, 33(2), 471–474. DOI: https://doi.org/10.1007/s00464-018-6320-z
Sier, V. Q., Schmitz, R. F., Putter, H., Schepers, A., & Vorst, J. R. van der. (2022). The big five: Studying the surgical personality. Surgery, 172(5), 1358–1363. DOI: https://doi.org/10.1016/j.surg.2022.08.003
Singh, S., & Estefan, A. (2018). Selecting a grounded theory approach for nursing research. Global Qualitative Nursing Research, 5, 2333393618799571. DOI: https://doi.org/10.1177/2333393618799571
Soenens, G., Marchand, B., Doyen, B., Grantcharov, T., Herzeele, I. V., & Vlerick, P. (2023). Surgeons’ leadership style and team behavior in the hybrid operating room. Annals of Surgery, 278(1), e5–e12. DOI: https://doi.org/10.1097/SLA.0000000000005645
Sonnino, R. E., Reznik, V., Thorndyke, L. A., Chatterjee, A., Ríos-Bedoya, C. F., Mylona, E., Nelson, K. G., Weisman, C. S., Morahan, P. S., & Wadland, W. C. (2013). Evolution of faculty affairs and faculty development offices in U.S. medical schools. Academic Medicine, 88(9), 1368–1375. DOI: https://doi.org/10.1097/ACM.0b013e31829ed496
Souba, W. W. (2004). Building our future: A plea for leadership. World Journal of Surgery, 28(5), 445–450. DOI: https://doi.org/10.1007/s00268-004-7439-8
Stogdill, R. M., & Coons, A. E. (1957). Leader behavior: Its description and measurement. University Bureau of Business Research.
Trastek, V. F., Hamilton, N. W., & Niles, E. E. (2014). Leadership models in health care - a case for servant leadership. Mayo Clinic Proceedings, 89(3), 374–381. DOI: https://doi.org/10.1016/j.mayocp.2013.10.012
Vears, D. F., & Gillam, L. (2022). Inductive content analysis: A guide for beginning qualitative researchers. Focus on Health Professional Education: A Multi-Professional Journal, 23(1), 111–127. DOI: https://doi.org/10.11157/fohpe.v23i1.544
Yeager, D. S., Hanselman, P., Walton, G. M., Murray, J. S., Crosnoe, R., Muller, C., Tipton, E., Schneider, B., Hulleman, C. S., Hinojosa, C. P., Paunesku, D., Romero, C., Flint, K., Roberts, A., Trott, J., Iachan, R., Buontempo, J., Yang, S. M., Carvalho, C. M., … Dweck, C. S. (2019). A national experiment reveals where a growth mindset improves achievement. Nature, 573(7774), 364–369. DOI: https://doi.org/10.1038/s41586-019-1466-y

How to Cite

Collins II, R. Thomas, Neha J. Purkey, Meenu Singh, Alan D. DeSantis, and Rania A. Sanford. 2024. “The Four Cs of Physician Leadership: A Key to Academic Physician Success”. Qualitative Research in Medicine and Healthcare 8 (2). https://doi.org/10.4081/qrmh.2024.11519.