Patterns in Clinical Leadership Learning: Understanding the Quality of Learning about Leadership to Support Sustainable Transformation in Healthcare Education
Abstract
:1. Introduction
1.1. Sustainable Healthcare: A Financial, Environmental and Social Sustainability Challenge
1.2. Developing Clinical Leaders: An Educational Sustainability Challenge
1.3. The Processes of Clinical Leadership Learning: A Professional Development Sustainability Challenge
1.4. Concluding Summary and Research Questions
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- RQ1 Can we conceptualise and measure the quality of doctors’ leadership learning through the construct of learning patterns?
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- RQ2 Can a leadership learning measure adapted from the ITL (Inventory of Teacher Learning) capture change in doctors’ leadership learning patterns during CL-PD, to demonstrate progress in leadership learning?
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- RQ3 Are the as-identified leadership learning patterns associated with those clinical leadership competences that are considered central for sustainable healthcare development?
2. Materials and Methods
2.1. Participants and Setting
2.2. Design, Instruments and Data
- (1)
- A conceptually-sound and empirically robust individual clinical leadership learning instrument was developed and validated in earlier research [12] to assess participants’ self-assessed individual clinical leadership competences as a context for understanding their leadership learning processes. These competences (leadership self-efficacy involving knowledge and mindset for clinical leadership; engaging stakeholders, boundary-crossing expertise, change agency and willingness to take risks and learn from failures, [12]) are widely identified in the literature on sustainability as key leadership competences for leading organisational change towards sustainability. This instrument served as the basis for answering RQ3.
- (2)
- A novel self-assessment instrument on leadership learning patterns, adapted from a validated longer instrument on professional learning, the Inventory of Teacher Learning [76], specifically revised for medics for the first time as part of the study at hand, to assess medical doctors’ learning processes in the context of clinical leadership PD. The original instrument consisted of 32 Likert-type items in three scales (meaning-oriented, application-oriented and problematic learning), two containing 9 items and one scale consisting of 14 items. For reasons of usability, we shortened the instrument to 18 items with 6 items in each of the three scales. We selected those items with the highest r-it’s within a scale in the original study [76] and at the same time secured maximum variability in indicators within each scale.
2.3. Data Analysis
- (1)
- Exploratory Factor Analysis (EFA) on the novel instrument (detailed description of EFA in a previous paper, [12]). Both varimax and oblimin rotations were used. The varimax rotation is an orthogonal approach that, when used in factor analysis, creates uncorrelated factors; whilst the oblimin rotation is an oblique approach that takes into consideration the possibility of factors being correlated. Costello and Osborne [99] suggested that although varimax rotation is more commonly used, oblique rotation should produce more accurate results, especially in our field where factors are likely to be correlated based on the intertwined nature of behaviours. Regardless, both methods should produce highly similar results should the factors be indeed uncorrelated. Taking into account Costello and Osborne’s suggestions and the consideration that exploratory factor analysis was run on a novel instrument, both varimax and oblimin rotations were used for theoretical and methodological rigidity purposes;
- (2)
- Multiple linear regressions were run to examine the relationships across the five individual learning outcomes and learning patterns. Little’s MCAR test [100] indicated that the data was missing completely at random, so listwise deletion could be used in handling missing data without creating any biases in the results [101]. All statistical analyses were conducted in R4.2.2.;
- (3)
- Thematic analysis of the qualitative participant interviews: and open responses in the survey: All qualitative data was cross-sectionally coded and systematically compared across the whole dataset [102] by members of the research team experts in qualitative data analysis. The first dataset’s data was coded by Author1, scrutinised by a research assistant with experience in qualitative data analysis, and re-coded by Author1 based on this feedback. In this second round of coding, the themes were probed by repeatedly discussing them and the supporting data with Author4. The coding of the second dataset was conducted by the research associate, who was experienced in qualitative coding (Author3), and Author1. Alongside inductive coding, the data were deductively coded for a talk on meaning-oriented learning and problematic learning, as defined above, using NVivo12 software. It is this latter deductive coding we particularly draw on in this paper. Code content was compared systematically [103] to identify manifestations of learning patterns and their links to clinical leadership. Additional strategies to support validity involved (a) word and coding queries in NVivo12 checking for any missed insights and (b) comparison of the interview findings with findings from the quantitative analyses. Discussing the findings with the programme team and its then-current cohort provided participant validation.
3. Results
3.1. RQ1: Can We Conceptualise and Measure the Quality of Doctors’ Leadership Learning through the Construct of Learning Patterns?
If you’d have asked me six months into the [leadership] project, I’d have probably thought well
what’s the point, but actually at the end of it I realise what the point was.”(CL-PDv1_Int02)
“When you talk to doctors sometimes they feel very disillusioned about management processes because often they feel excluded from those and disempowered, and probably partly because of the course I feel completely the opposite.—I feel quite empowered in changing things that I’m unhappy with and I think that’s from a longevity in your job point of view quite important, if you feel like you have agency.”(CL-PDv1_Int15)
“Unable to implement project [as Chief Resident] as clinical lead did not [support the project]. I have taken this project to another organisation and it is now being implemented there. The skill I learnt on the [PD] course have helped me be more successful the second time round.”(CL-PDv1_OpenResponse_Participant82)
3.2. RQ2: Can the Leadership Learning Inventory Capture Change in Doctors’ Leadership Learning Patterns during CL-PD?
“Being a Chief resident almost changed my way of thinking slightly to understand a lot more, this is the problem and these are the possible answers rather than this is the problem and I’m really mad and angry about it.”(CL-PDv1_Int4)
“Mindset towards leadership and change—I have definitely thought more about that in the last year as a result of the course than I ever have before, consciously. I have been aware vaguely of people around me who are good leaders, or maybe not so good leaders but in leadership roles, but I had not really actively thought as much about why they were good or perhaps not so good, and how that affected their ability to effect change. [Later in interview:] I think I probably try and have a broader perspective on things before I jump in or try and initiate a change in some way.”(CL-PDv2_Int8)
“As a junior doctor you think that 95% of your work is clinical and the more senior you get the more you realise that whilst the clinical side of your job is intrinsic to what your role is as a doctor, that actually the management side is just as important and I think the shame is that a lot of doctors see it as a burden whereas I see it as exciting and I think the [PD] course has helped me to put me in that positive frame of mind so I want to do it as opposed to feeling I have to do it.”(CL-PDv1_Int16)
3.3. RQ3: Are Leadership Learning Patterns Associated with Those Clinical Leadership Competences That Are Considered Central for Sustainable Healthcare Development?
4. Discussion
4.1. Implications
4.2. Strengths and Limitations
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Correction Statement
References
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Item | Meaning | Problematic |
---|---|---|
Dataset1: Course1-PostOnly_AllCohorts | ||
Q49_1. I try to understand why certain leadership methods work. | 0.762 | |
Q49_3. I exchange ideas about new ways of leadership with colleagues. | 0.593 | |
Q49_8. I try to understand new ideas about leadership. | 0.684 | |
Q49_11. I often reflect on my leadership practices. | 0.646 | |
Q49_12. I like to experiment with new ways of leadership. | 0.639 | |
Q49_17. I analyse why my team members/colleagues don’t understand my proposals. | 0.667 | |
Q49_2. I feel disappointed because most of my team members don’t want change. | 0.379 | |
Q49_4. I don’t know how I can improve my leadership. | 0.703 | |
Q49_5. I only want to learn things that I can use immediately in my practice. | 0.673 | |
Q49_10. Knowledge that I cannot apply quickly is useless to me. | 0.674 | |
Q49_14. I have a growing feeling of discontent with my work. | 0.439 | |
Q49_18. New ideas about leadership are naïve most of the time. | 0.446 | |
Dataset2pre: Course2-Pre | ||
Q49_1. I try to understand why certain leadership methods work. | 0.447 | |
Q49_3. I exchange ideas about new ways of leadership with colleagues. | 0.373 | |
Q49_8. I try to understand new ideas about leadership. | 0.580 | |
Q49_11. I often reflect on my leadership practices. | 0.585 | |
Q49_12. I like to experiment with new ways of leadership. | 0.667 | 0.460 |
Q49_17. I analyse why my team members/colleagues don’t understand my proposals. | ||
Q49_2. I feel disappointed because most of my team members don’t want change. | 0.442 | |
Q49_4. I don’t know how I can improve my leadership. | −0.569 | |
Q49_5. I only want to learn things that I can use immediately in my practice. | 0.768 | |
Q49_10. Knowledge that I cannot apply quickly is useless to me. | 0.842 | |
Q49_14. I have a growing feeling of discontent with my work. | −0.366 | 0.344 |
Q49_18. New ideas about leadership are naïve most of the time. | −0.637 | 0.501 |
Dataset2ImmPost: Course2-ImmediatePost | ||
Q49_1. I try to understand why certain leadership methods work. | 0.365 | −0.336 |
Q49_3. I exchange ideas about new ways of leadership with colleagues. | 0.705 | |
Q49_8. I try to understand new ideas about leadership. | 0.427 | −0.367 |
Q49_11. I often reflect on my leadership practices. | 0.585 | |
Q49_12. I like to experiment with new ways of leadership. | 0.434 | |
Q49_17. I analyse why my team members/colleagues don’t understand my proposals. | 0.637 | |
Q49_2. I feel disappointed because most of my team members don’t want change. | 0.410 | 0.773 |
Q49_4. I don’t know how I can improve my leadership. | 0.689 | |
Q49_5. I only want to learn things that I can use immediately in my practice. | 0.655 | |
Q49_10. Knowledge that I cannot apply quickly is useless to me. | 0.567 | |
Q49_14. I have a growing feeling of discontent with my work. | 0.906 | |
Q49_18. New ideas about leadership are naïve most of the time. | 0.774 |
n | Mean (Pre) | SD (Pre) | Mean (Post) | SD (Post) | Df | t | |
---|---|---|---|---|---|---|---|
Meaning | 34 | 3.52 | 0.47 | 3.90 | 0.48 | 66.00 | 3.27 ** |
Problematic | 34 | 2.75 | 0.53 | 2.55 | 0.85 | 55.35 | −1.17 |
Predictors | Unstandardised Coefficients | Standard Error | Standardised Coefficients | 95% Confidence Interval | p-Value | Variance Inflation Factor (VIF) | |
---|---|---|---|---|---|---|---|
Lower Limit | Upper Limit | ||||||
Outcome Variable: Self-Efficacy | |||||||
(Intercept) | 2.62 | 0.40 | - | 1.82 | 3.41 | <0.001 | - |
Meaning | 0.45 | 0.09 | 0.46 | 0.26 | 0.63 | <0.001 | 1.00 |
Problematic | −0.12 | 0.07 | −0.17 | −0.26 | 0.01 | 0.074 | 1.00 |
Outcome Variable: Capacity to Engage Stakeholders | |||||||
(Intercept) | 2.14 | 0.45 | - | 1.25 | 3.03 | <0.001 | - |
Meaning | 0.52 | 0.10 | 0.48 | 0.31 | 0.73 | <0.001 | 1.00 |
Problematic | −0.07 | 0.08 | −0.09 | −0.22 | 0.08 | 0.358 | 1.00 |
Outcome Variable: Boundary Crossing Expertise | |||||||
(Intercept) | 1.82 | 0.36 | - | 1.10 | 2.53 | <0.001 | - |
Meaning | 0.59 | 0.08 | 0.61 | 0.43 | 0.76 | <0.001 | 1.00 |
Problematic | −0.13 | 0.06 | −0.18 | −0.25 | −0.01 | 0.040 | 1.00 |
Outcome Variable: Change Agency | |||||||
(Intercept) | 1.93 | 0.58 | - | 0.77 | 3.09 | 0.001 | - |
Meaning | 0.54 | 0.14 | 0.39 | 0.27 | 0.81 | <0.001 | 1.00 |
Problematic | −0.17 | 0.10 | −0.17 | −0.37 | 0.03 | 0.088 | 1.00 |
Outcome Variable: Willingness to Take Risks and to Learn from Risks and Failures | |||||||
(Intercept) | 0.77 | 0.52 | - | −0.25 | 1.80 | 0.137 | - |
Meaning | 0.66 | 0.12 | 0.50 | 0.42 | 0.90 | <0.001 | 1.00 |
Problematic | 0.16 | 0.09 | 0.17 | −0.01 | 0.34 | 0.066 | 1.00 |
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Hofmann, R.; Chu, C.P.K.; Twiner, A.; Vermunt, J.D. Patterns in Clinical Leadership Learning: Understanding the Quality of Learning about Leadership to Support Sustainable Transformation in Healthcare Education. Sustainability 2024, 16, 4165. https://doi.org/10.3390/su16104165
Hofmann R, Chu CPK, Twiner A, Vermunt JD. Patterns in Clinical Leadership Learning: Understanding the Quality of Learning about Leadership to Support Sustainable Transformation in Healthcare Education. Sustainability. 2024; 16(10):4165. https://doi.org/10.3390/su16104165
Chicago/Turabian StyleHofmann, Riikka, Claudia Pik Ki Chu, Alison Twiner, and Jan D. Vermunt. 2024. "Patterns in Clinical Leadership Learning: Understanding the Quality of Learning about Leadership to Support Sustainable Transformation in Healthcare Education" Sustainability 16, no. 10: 4165. https://doi.org/10.3390/su16104165