ATHABASCA UNIVERSITY Exploring Physician Leadership ... ATHABASCA UNIVERSITY Exploring Physician Leadership

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  • ATHABASCA UNIVERSITY

    Exploring Physician Leadership Development in Health-Care

    Organizations through the Lens of Complexity Science

    By

    Colleen Marie Grady

    A Dissertation

    Submitted to the Faculty of Graduate Studies

    In Partial Fulfillment of the Requirement for the

    Degree of Doctor of Business Administration

    Faculty of Business

    Athabasca, Alberta

    November, 2015

    © Colleen Marie Grady

  • EXPLORING PHYSICIAN LEADERSHIP DEVELOPMENT

    i

    Approval of Dissertation

    The undersigned certify that they have read the dissertation entitled

    “Exploring Physician Leadership Development in Health-Care

    Organizations Through the Lens of Complexity Science”

    Submitted by

    Colleen Grady

    In partial fulfillment of the requirements for the degree of

    Doctor of Business Administration

    The dissertation examination committee certifies that the dissertation

    (and the oral examination) is approved.

    Co-Supervisors

    Dr. Deborah Hurst (Internal)

    Athabasca University

    Dr. Bob Hinings (External)

    University of Alberta

    Committee members

    Dr. Chad Saunders

    University of Calgary

    Dr. Leonard Friedman

    George Washingon University

    November 9, 2015

  • EXPLORING PHYSICIAN LEADERSHIP DEVELOPMENT

    ii

    Epigraph

    “The greatest danger in times of turbulence is not the turbulence....

    .....it is to act with yesterday’s logic”

    Peter Drucker

    Dedication

    To my father, Francis Grady, whom I owe lifelong

    gratitude for his encouragement to strive for more.

    His belief in me drives me every single day.

    To my children; Katrina, Justin, Marisa and McKenzie

    who put up with me and cheered me on throughout the journey.

    And to my friend Kerri, without whom this ride would

    not have been nearly as much fun.

  • EXPLORING PHYSICIAN LEADERSHIP DEVELOPMENT

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    Acknowledgements

    The first and most important person to acknowledge is Bob Hinings, University of

    Alberta, who gave so much of his time to support my goal of making a scholarly

    contribution to the world of health-care. Without his guidance and support this

    dissertation would not have seen its completion. I will remain eternally grateful to

    have enjoyed the benefit of his wisdom and wealth of experience as a well-

    respected scholar.

    I would also like to thank Dr. Chad Saunders, University of Calgary, as well as

    Dr. Deborah Hurst, my co-supervisor with Athabasca University for the valuable

    guidance they provided along the way.

    Thanks also to my external examiner, Dr. Leonard Friedman, George Washington

    University, for his ability to make me reach a bit higher and challenge my

    assertions through his valuable lens of health-care administration.

    Thanks to all my friends and colleagues in the Athabasca University DBA

    program, and beyond, who supported and encouraged me every step of my

    journey.

  • EXPLORING PHYSICIAN LEADERSHIP DEVELOPMENT

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    Abstract

    Physician leaders are viewed as critical in the transformation of health care and in

    improving patient outcomes and yet significant challenges exist that limit their

    development. Leadership in health care continues to be associated with

    traditional, linear models, which are incongruent with the behaviour of a complex

    system such as health care. Physician leadership development remains a low

    priority for most health-care organizations although physicians admit to being

    limited in their capacity to lead. This research was intended to provide conceptual

    and practical considerations to both physician leaders and health-care

    organizations that recognize the importance of developing them.

    This study was based on five principles of complexity science and used grounded

    theory methodology to understand how the behaviours of a complex system can

    inform leadership development for physicians. These principles include;

    connectivity, interdependency, feedback, exploration-of-the-space-of-possibilities,

    and co-evolution and were associated with either behaviour of agents within a

    system, or patterns of behaviour. Semi-structured interviews and documents

    provided the basis for data collection. Twenty-one experts in areas of health-care

    management, physician leadership, or leadership development participated.

    Participants included authors, academics, advisors, physicians and non-

    physicians, at both middle and senior operational levels.

    The study demonstrated that there is a strong association between physician

    leadership and patient outcomes and that organizations play a primary role in

    supporting the development of physician leaders. Findings indicate that a

  • EXPLORING PHYSICIAN LEADERSHIP DEVELOPMENT

    v

    physician’s relationship with their patient and their capacity for innovation can be

    extended as catalytic behaviours in a complex system. The findings also identified

    limiting factors that impact physicians who choose to lead, such as reimbursement

    models that do not place value on leadership, and medical education that provides

    minimal opportunity for leadership skill development.

    This study presents convincing evidence that organizations play a primary role in

    developing physician leaders, giving them a competitive advantage and an

    increased ability to affect patient outcomes. The participation of highly

    knowledgeable and experienced participants strengthens the value of the results of

    this study and is likely to provide further research opportunities in health-care

    organizations that prioritize physician leadership development.

  • EXPLORING PHYSICIAN LEADERSHIP DEVELOPMENT

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    Table of Contents Approval Page.......................................................................................................i

    Dedication............................................................................................................ ii

    Acknowledgements.............................................................................................. iii

    Abstract................................................................................................................. iv

    Table of Contents ................................................................................................... vi

    List of Tables .......................................................................................................... x

    Chapter 1: Introduction .......................................................................................... 1

    1.1 Setting the context .................................................................................... 1

    1.1.1 The research question ............................................................................ 5

    1.2 Why does it matter? .................................................................................. 5

    1.3 Theoretical relevance ............................................................................... 8

    1.4 Practical relevance .................................................................................. 11

    1.5 Importance/benefits of the study ............................................................ 12

    1.6 Why now? .............................................................................................. 14

    1.7 Chapter summary ....................................................................................... 17

    Chapter 2: Review of the Literature ..................................................................... 19

    2.1 Introduction ................................................................................................. 19

    2.2 Complexity in health care............................................................................ 21

    2.3 Health-care leadership ................................................................................. 25

    2.3.1 Human capital or social capital? .......................................................... 27

    2.3.2 Shared leadership .................................................................................. 31

    2.4 Physicians as stakeholders (or shareholders) .............................................. 35

    2.4.1 Competitive advantage ........................................................................ 37

    2.4.2 The need for physician leaders ............................................................. 38

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    2.5 Physician leadership development: the known and the unknown .............. 44

    2.5.1 How prepared are physicians to lead? .