Medisch leiderschap ontrafeld

Medical leadership is a popular topic in the Netherlands, and several interest groups now incorporate medical leadership into postgraduate medical education. However, there is no consensus on what this concept entails. By conducting a discourse analysis, a qualitative method which uses language and text to reveal existing viewpoints, this article reveals three perspectives on medical leadership: administrative leadership, leadership within organisations and leadership within each doctor's daily practice. Text analysis shows that the first two perspectives refer to medical leadership mainly in a defensive manner: by demonstrating medical leadership doctors could 'take the lead' once again; patient care only seems to play a small part in the process. These perspectives are not free of consequences, they will determine how the medical profession is constructed. For this reason, it is argued that there should be more emphasis on the third perspective, in which the quality of care for patients is of primary importance

Building bridges : engaging medical residents in quality improvement and medical leadership

OBJECTIVE: To develop an educational intervention that targets residents' beliefs and attitudes to quality Improvement (QI) and leadership in order to demonstrate proactive behaviour. DESIGN: Theory-driven, mixed methods study including document analysis, interviews, observations and open-ended questionnaires. SETTING: Six Dutch teaching hospitals. INTERVENTION: Using expertise from medicine, psychology, organizational and educational sciences we developed a situated learning programme named Ponder and IMProve (PIMP). The acronym PIMP reflects the original upbeat name in Dutch, Verwonder & Verbeter. It has a modern, positive meaning that relates to improving your current circumstances. In quarterly 1-h sessions residents are challenged to identify daily workplace frustrations and translate them into small-scale QI activities. MAIN OUTCOME MEASURES: Organizational awareness, beliefs and attitudes to QI and organizational responsibilities, resident behaviour, barriers and facilitators to successful learning and the programme's potential impact on the organization. RESULTS: Overall, 19 PIMP meetings were held over a period of 3 years. Residents defined 119 PIMP goals, resolved 37 projects and are currently working on another 39 projects. Interviews show that PIMP sessions make residents more aware of the organizational aspects of their daily work. Moreover, residents feel empowered to take up the role of change agent. Facilitators for success include a positive cost-benefit trade-off, a valuable group process and a safe learning environment. CONCLUSION: This article demonstrates the added value of multidisciplinary theory-driven research for the design, development and evaluation of educational programmes. Residents can be encouraged to develop organizational awareness and reshape their daily frustrations in QI work

Why Medical Residents Do (and Don't) Speak Up About Organizational Barriers and Opportunities to Improve the Quality of Care

PURPOSE: Medical residents are valuable sources of information about the quality of frontline service delivery, but if they do not speak up, their ideas, opinions, and suggestions for improving their work practices cannot be considered. However, speaking up can be difficult for residents. Therefore, the authors have explored both what helps residents speak up about organizational barriers and opportunities to improve the quality of their work and what hinders them from doing so. METHOD: The authors conducted an exploratory qualitative interview study with 27 Dutch medical residents in the Netherlands in 2016. They used the critical incident technique for data collection and the constant comparison method of the Qualitative Analysis Guide of Leuven for data analysis. RESULTS: Three types of incidents in which residents considered speaking up are described. The authors identified 2 main considerations that influenced residents' decisions about speaking up: Is it safe to speak up, and is speaking up likely to be effective? Residents' decisions were influenced by personal, team, and organizational aspects of their situations, such as supervisors' open attitudes, hierarchy, duration of clinical rotations, organization size, and experiences (either vicarious or their own). CONCLUSIONS: Findings from this study indicate that residents tend to be silent when they encounter organizational barriers or opportunities to improve the quality of their work. Perceived effectiveness and safety are important forces that drive and constrain speaking up. The authors provide important starting points to empower medical residents to speak up about their suggestions for change

Why Medical Residents Do (and Don't) Speak Up About Organizational Barriers and Opportunities to Improve the Quality of Care

PURPOSE: Medical residents are valuable sources of information about the quality of frontline service delivery, but if they do not speak up, their ideas, opinions, and suggestions for improving their work practices cannot be considered. However, speaking up can be difficult for residents. Therefore, the authors have explored both what helps residents speak up about organizational barriers and opportunities to improve the quality of their work and what hinders them from doing so. METHOD: The authors conducted an exploratory qualitative interview study with 27 Dutch medical residents in the Netherlands in 2016. They used the critical incident technique for data collection and the constant comparison method of the Qualitative Analysis Guide of Leuven for data analysis. RESULTS: Three types of incidents in which residents considered speaking up are described. The authors identified 2 main considerations that influenced residents' decisions about speaking up: Is it safe to speak up, and is speaking up likely to be effective? Residents' decisions were influenced by personal, team, and organizational aspects of their situations, such as supervisors' open attitudes, hierarchy, duration of clinical rotations, organization size, and experiences (either vicarious or their own). CONCLUSIONS: Findings from this study indicate that residents tend to be silent when they encounter organizational barriers or opportunities to improve the quality of their work. Perceived effectiveness and safety are important forces that drive and constrain speaking up. The authors provide important starting points to empower medical residents to speak up about their suggestions for change

Why Medical Residents Do (and Don’t) Speak Up About Organizational Barriers and Opportunities to Improve the Quality of Care

Purpose Medical residents are valuable sources of information about the quality of frontline service delivery, but if they do not speak up, their ideas, opinions, and suggestions for improving their work practices cannot be considered. However, speaking up can be difficult for residents. Therefore, the authors have explored both what helps residents speak up about organizational barriers and opportunities to improve the quality of their work and what hinders them from doing so. Method The authors conducted an exploratory qualitative interview study with 27 Dutch medical residents in the Netherlands in 2016. They used the critical incident technique for data collection and the constant comparison method of the Qualitative Analysis Guide of Leuven for data analysis. Results Three types of incidents in which residents considered speaking up are described. The authors identified 2 main considerations that influenced residents’ decisions about speaking up: Is it safe to speak up, and is speaking up likely to be effective? Residents’ decisions were influenced by personal, team, and organizational aspects of their situations, such as supervisors’ open attitudes, hierarchy, duration of clinical rotations, organization size, and experiences (either vicarious or their own). Conclusions Findings from this study indicate that residents tend to be silent when they encounter organizational barriers or opportunities to improve the quality of their work. Perceived effectiveness and safety are important forces that drive and constrain speaking up. The authors provide important starting points to empower medical residents to speak up about their suggestions for change