If you want to learn a lot about physician engagement, medical leadership and its competencies, and the effect of those factors on organizational performance and outcomes, then you have to read several outstanding chapters in this book. This second edition has changed considerably from its predecessor, Medical Leadership: From the Dark side to Centre Stage. Although two of the ten chapters pertain to the United Kingdom only, several of the remaining chapters are gems, as they summarize extensive evidence from around the world, including research studies by the authors.
It is evident that fixing the health care system requires radical transformation, moving from a system organized around individual physicians to a team-based approach based on patients. Physicians must be central players in that transformation. After a few chapters covering content from the first edition, Spurgeon and Clark explain some of the root causes of the tension between physicians and managers and why performance management can be perceived as a threat to clinical autonomy. Top
Chapter 4 on roles and models of leadership is one of the best summaries on the topic available today. The description of shared or distributed leadership, essential for successful collaborative and multidisciplinary teams, adds two new dimensions to the construct: formality and leader–follower balance. Chapter 5 gives an outstanding overview of international competency frameworks for physician leadership development, and it is nice to see both Canadian models, CanMEDS 2015 and LEADS, included.
Chapter 6 provides solid evidence of the link between medical engagement and organizational performance. The authors go into detail on what engagement is and should be. They describe extensively how they developed and validated a medical engagement scale. From the literature and from their own studies, Spurgeon and Clark then provide plenty of evidence of how the level of physician engagement correlates with performance and innovation in health care. Briefly, working in an open culture, having purpose and direction, and feeling valued and empowered are, not surprisingly, characteristics of those in organizations with outstanding performance outcomes. Although our gut feeling would tell us that this is to be expected, Spurgeon and Clark provide the evidence to support it. Top
There is also a chapter on leadership in primary care. As in Canada, medical leadership development in the UK started among hospital-based physicians and later expanded to primary care physicians. Canada might learn from the good and bad lessons in the UK and choose a few elements for implementation here. The chapter on engaging residents in medical leadership is of less value for Canada, as the system of training and staff physicians in the UK is quite different from ours.
In summary, even though this book is not for everyone, the quality of the chapters highlighted above is outstanding. Many times, this reviewer paused to reflect on how some of the content could be applied to our health care system. It is clear that health system transformation and organizational performance are no longer about medical leadership alone. Physician engagement with the system is essential, and, without it, our health care system will have difficulty surviving.
Johny Van Aerde, MD, MA, PhD, FRCPC, is editor-in-chief of the Canadian Journal of Physician Leadership and past-president of the Canadian Society of Physician Leaders.
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