Self-determining medical leadership needs of occupational health physicians

The purpose of this study was to explore which factors motivate doctors to engage in leadership roles and to frame an inquiry of self-assessment within Self-Determination Theory (SDT) to identify the extent to which a group of occupational health physicians (OHPs) was able to self-determine their leadership needs, using a National Health Service (NHS) England competency approach promoted by the NHS England Leadership Academy as a self-assessment leadership diagnostic. Medical leadership is seen as crucial to the transformation of health-care services, yet leadership programmes are often designed with a top-down and centrally commissioned “one-size-fits-all” approach. In the UK, the Smith Review (2015) concluded that more decentralised and locally designed leadership development programmes were needed to meet the health-care challenges of the future. However, there is an absence of empirical research to inform the design of effective strategies that will engage and motivate doctors to take up leadership roles, while at the same time, health-care organisations continue to develop formal leadership roles as a way to secure medical leadership engagement. The problem is further compounded by a lack of validated leadership qualities assessment instruments which support researching this problem.

The analysis draws on a sample of about 25 per cent of the total population size of the Faculty of Occupational Medicine (n = 1,000). The questionnaire used was the Leadership Qualities Framework tool as a form of online self-assessment (NHS Leadership Academy, 2012). The data were analysed using descriptive statistics and simple inferential methods.

OHPs are open about reporting their leadership strengths and leadership development needs and recognise leadership learning as an ongoing development need regardless of their level of personal competence. This study found that the single most important factor to affect a doctor’s confidence in leadership is their experience in a management role. In multivariate regression, management experience accounted for the usefulness of leadership training, suggesting that doctors learn best through applied “leadership learning” as opposed to theory-driven programmes. Drawing on SDT (Deci and Ryan, 1985; 2000; Ryan and Deci, 2000), this article provides a theoretical framework that helps to understand those doctors who are likely to engage in leadership and management activities in the organisation. More choice and self-determination of medical leadership programmes are likely to result in more relevant leadership learning that builds on doctors’ previous experience in this area.

While this study benefitted from a large sample size, it was limited to the use of purely quantitative methods. Future studies would benefit from the application of a mixed methodology to combine quantitative data with one-to-one interviews or a focus group.

This study suggests that doctors are able to determine their own learning needs reliably and that they are more likely to increase their confidence in leadership and management if they are exposed to leadership and management experience.

This is the first large-scale study of this kind with a large sample within a single medical specialty. The study is considered as insider research, as the first author is an OHP with knowledge of how to engage OHPs in this work.