Title: Developing Collaborative Leaders in Healthcare
Description: As the delivery and management of healthcare continues to become increasingly complex, confronted by numerous economic, political and public health challenges, it is crucial for healthcare organizations to effectively develop and support their clinical and administrative leaders. A national staffing shortage in healthcare coupled with a global pandemic has increased burnout for healthcare providers. Retaining, engaging, and developing talent has taken on an urgency not seen before in healthcare organizations. The academic healthcare system has additional layers of intricacy with its tripartite clinical, educational, and research missions. Collaboration – and the behaviors and attitudes that enable it – is key for all leaders to negotiate across disciplinary boundaries within the academic health enterprise. Healthcare organizations must carefully consider how to develop and empower leaders capable of both leading teams and leading collaboratively, with peer leaders across the system. This study used a mixed-method case study approach to evaluate an interprofessional, team-based leadership development program in an academic health system to identify the program elements and learning experiences that influenced the participants’ ability to demonstrate the tenets of collaborative leadership and the factors that fostered or inhibited their abilities.

Mid-level level leadership teams were nominated to the 10-month program, which utilized a blended learning approach of in-person days, live virtual sessions and online content and interaction. Teams were also required to complete a capstone project to allow the opportunity for integrating program learning through action while contributing to organizational change and innovation. Historical data from focus groups, evaluations and pre and post self-efficacy assessments from six cohorts were analyzed for this study. Ten semi-structured interviews comprised the new data collected. Focus group and evaluation data was derived from all program participants from six cohorts, consisting of 145 participants, in which 97/145 (67%) were females and 48/145 (33%) were males. Physicians comprised 28% of the group, nurses/other clinical specialists 31%, and 40% were administrators. The pre and post self-efficacy assessment data was limited to 65 participants. It is evident from the findings that leadership development as an interprofessional team, and as part of a larger cohort, is a powerful way to improve team cohesion, build relationships across the healthcare system, and enable boundary crossing – all vital capabilities to collaborative leadership.

Learning as a team revised participants’ mental models by enabling an appreciation of diverse perspectives and self-awareness. The design of the program, particularly the program’s length and the action learning experience, were key factors in allowing the leadership ability of teams to mature. The program gave participants the dedicated time and space to build trust, solve problems, and reflect as individuals and as team. During the program and after, the most prevalent challenge for leaders was finding the time to establish and maintain relationships, which is critical to collaborative leadership. Other limiting factors were leadership turnover, lack of senior leadership support, and barriers to physician engagement. The organization in this study, like other academic health systems, employs a matrixed structure. While the matrixed structure necessitates collaboration, inherent stressors such as ambiguity around roles, decision-making abilities, power, and competing priorities emerged as a challenge to collaborating with peer leaders.

The major recommendations for leadership development in an academic health system derived from this study are to: 1) design leadership development learning experiences within the context of an interprofessional team, 2) consider how participants may be enabled and inhibited in their leadership practice by organizational structures and cultures and, 3) ensure that the program length allows for the adequate time and space to learn, integrate and apply new ways of leading.