Appendix
Developing and Engaging Clinical Leaders in the “New Normal” of Hospitals
ISBN: 978-1-80382-934-0, eISBN: 978-1-80382-931-9
Publication date: 14 September 2022
Citation
Lega, F. and Pirino, A. (2022), "Appendix", Developing and Engaging Clinical Leaders in the “New Normal” of Hospitals (European Health Management in Transition), Emerald Publishing Limited, Leeds, pp. 107-129. https://doi.org/10.1108/978-1-80382-931-920221013
Publisher
:Emerald Publishing Limited
Copyright © 2022 Federico Lega and Angela Pirino. Published under exclusive licence by Emerald Publishing Limited
Prisma Eligibility Criteria
| Criteria | Inclusion | Exclusion | Records |
|---|---|---|---|
| Abstract | Abstract available | No abstract available | 12,259 |
| Free full text | Full text available | Text partially available | 4,411 |
| Humans | Studies involving human subjects | Studies involving non-human subjects | 2,997 |
| Complementary medicine | Studies in general medicine | Studies in specific diseases | 671 |
| Systematic review | Systematic reviews | Studies involving healthcare worker categories, such as head nurses | 736 |
Hospital Sample
| #1 Policlinico Universitario A. Gemelli – Rome |
| #2 Policlinico Sant’Orsola-Malpighi – Bologna |
| #3 Grande Ospedale Metropolitano Niguarda – Milan |
| #4 Istituto Clinico Humanitas – Rozzano (Milan) |
| #5 Ospedale San Raffaele – Gruppo San Donato – Milan |
| #6 IRCCS Arcispedale Santa Maria Nuova – Reggio Emilia |
| #7 Azienda Ospedaliera di Padua |
| #8 Ospedale Papa Giovanni XXIII – Bergamo |
| #9 Ospedale Policlinico San Matteo – Pavia |
| #10 Ospedale Borgo Trento – Verona |
| #11 Presidio Ospedaliero Spedali Civili di Brescia |
| #12 Ospedale Luigi Sacco – Milan |
| #13 Ospedale San Raffaele Turro – Gruppo San Donato – Milan |
| #14 Ospedale San Gerardo – Monza |
| #15 Presidio Ospedaliero Molinette – A.O.U. Città della Salute e della Scienza – Turin |
| #16 Azienda Ospedaliera Ordine Mauriziano – Turin |
| #17 Ospedale San Martino di Genoa |
| #18 Azienda Ospedaliera Universitaria Sant'Andrea – Rome |
| #19 Ospedale di Parma |
| #20 Azienda Ospedaliero Universitaria Pisana – Pisa |
Table 3. Survey
Q0 – For this survey, the term ‘clinical engagement’ means a situation in which physicians are motivated to be involved in management decisions and practices. The term ‘clinical leader’ indicates health professionals with a degree in medicine or the sciences who could take on a leading managerial role.
Please indicate if you work in a private or public hospital.
- ○
Public hospital
- ○
Private hospital
Q1 – In which area do you work?
- ○
General management
- ○
Medical area
- ○
Surgical area
- ○
Diagnostic area
Q2 – In your opinion, what prompts clinicians to become engaged as leaders in their hospital (more than one answer is possible)?
- ○
Organisational commitment defined as psychological attachment to the hospital where they work
- ○
Clarity of the responsibilities of the position they hold
- ○
Managerial knowledge
- ○
Mentoring
- ○
Balance between clinical work and managerial work
- ○
Recognition and acknowledgment of the value of the role
- ○
Confidence, pride and passion for the job
- ○
Age
- ○
Experience
- ○
Other__________________________________
Q3 – Please rate from 0 (not useful at all) to 10 (absolutely essential) the routines, activities and tasks of hospital management regarding the effectiveness of enhancing the engagement of clinical leaders.
| 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | ||
| Meritocratic career advancement and opportunities |
|
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| Providing extensive and systematised data about performance and/or quality of services |
|
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| Providing financial resources to better perform in their role |
|
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| Selecting appropriate human resources to support them in performing their role |
|
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| Mentoring programs |
|
|||||||||||
| Financial incentives such as higher benefits or bonuses |
|
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| A better balance of hours spent on managerial and clinicians tasks |
|
|||||||||||
| Workload reduction |
|
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| Other |
|
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Q4 – Please rate the statements about clinical engagement in your hospital.
| Totally Disagree | Disagree | Unsure | Agree | Totally Agree | |
|---|---|---|---|---|---|
| Clinical engagement is sufficient | ⃝ | ⃝ | ⃝ | ⃝ | ⃝ |
| Hospital management effectively promotes clinical engagement | ⃝ | ⃝ | ⃝ | ⃝ | ⃝ |
| Clinical engagement is essential for achieving our goals | ⃝ | ⃝ | ⃝ | ⃝ | ⃝ |
| Clinical engagement is stimulated | ⃝ | ⃝ | ⃝ | ⃝ | ⃝ |
| Most clinicians are interested in managerial positions | ⃝ | ⃝ | ⃝ | ⃝ | ⃝ |
Q5 – Please order the following managerial competences from the most (= 1) to the least important (= 5) according to which ones you think are most relevant for clinical leaders to effectively perform in their role.
____ Working with others, by developing networks, building and maintaining relationships, encouraging contribution and working in teams.
____ Managing services by planning, managing resources, people and performance.
____ Improving services by ensuring patient safety, critical evaluation, encouraging innovation and facilitating change.
____ Setting direction by identifying the context for change, applying knowledge and evidence, making decisions and evaluating their impact.
____ Fostering the adoption and development of innovation.
Q6 – Please order the following soft skills from the most (= 1) to the least important (= 6) according to which ones you think are most relevant for clinical leaders to effectively perform in their role.
____ Motivating colleagues
____ Communication abilities
____ Collaborative spirit
____ Empathy
____ Tolerance for debate and disagreement
____ Persuasion and negotiation
Q7 – Please order the following personal qualities from the most (= 1) to the least important (= 5) according to which ones you think are most relevant for clinical leaders to effectively perform in their role.
____ Self-awareness, i.e. being aware of one's own principles and learning from experience.
____ Self-management, i.e. organising oneself while taking into account the priorities of others.
____ Self-development, i.e. continuous professional development; learning from experience, feedback and discussion with others.
____ Acting with integrity, i.e. behaving in a transparent and ethical manner.
____ Be a role model able to inspire confidence in all that one performs.
Q8 – In your opinion, how important are the following training initiatives in supporting the development of engagement and capabilities in a clinical leader?
| Not at All Important | Not Important | Quite Important | Very Important | Extremely Important | |
|---|---|---|---|---|---|
| Managerial training programmes | ⃝ | ⃝ | ⃝ | ⃝ | ⃝ |
| Managerial training programmes with final assessment | ⃝ | ⃝ | ⃝ | ⃝ | ⃝ |
| Theoretical soft skills training programmes | ⃝ | ⃝ | ⃝ | ⃝ | ⃝ |
| Practical soft skills training programmes that have been tested and assessed | ⃝ | ⃝ | ⃝ | ⃝ | ⃝ |
| Psychological training programmes to enhance personal qualities | ⃝ | ⃝ | ⃝ | ⃝ | ⃝ |
| Others | ⃝ | ⃝ | ⃝ | ⃝ | ⃝ |
Q9 – Are there mandatory training initiatives that clinical leaders must attend and/or pass in order to be appointed to a managerial position in your hospital?
- ○
Yes
- ○
No
Q10 – If there are mandatory training programmes, what do they entail? Who are they addressed to?
| Offered Free of Charge by the Hospital, the University or a Public Agency | Offered Free of Charge by the University or a Private Agency Without the Direct Involvement of the Hospital | Offered for a Fee by the Hospitals or a Private Agency | |
|---|---|---|---|
| Training programmes in management knowledge | ⃝ | ⃝ | ⃝ |
| Soft skills training programmes | ⃝ | ⃝ | ⃝ |
| Psychological training programmes | ⃝ | ⃝ | ⃝ |
| Soft skills and management training programmes | ⃝ | ⃝ | ⃝ |
| Others | ⃝ | ⃝ | ⃝ |
Q11 – Do you feel that the current training programmes offered by your hospital promote the development of managerial competences, soft skills and personal qualities you believe to be relevant?
| Not at All | Only Some Aspects, But Not Sufficiently | Only in Part, But Sufficiently | Totally | ||
| 0 1 2 3 4 5 6 7 8 9 10 | |||||
| Managerial competences |
|
||||
| Soft skills |
|
||||
| Personal qualities |
|
||||
Q12 – This is the final item in this survey. We thank you for participating. Would you be interested in being interviewed?
- ○
Yes, please enter your email and we will contact you to setanappointment. ________________________________________
- ○
No
Table 4. Report on Clinical Engagement Survey
Q0 – For this survey, the term ‘clinical engagement’ means a situation in which physicians are motivated to be involved in management decisions and practices. The term ‘clinical leader’ indicates health professionals with a degree in medicine or the sciences who could take on a leading managerial role.
| Answer | Percentage -% | Count |
|---|---|---|
| Public | 60.00 | 3 |
| Private | 40.00 | 2 |
| Total | 100% | 5 |
Q1 – Which area is related to the role you hold in the hospital?
| Answer | % | Count |
|---|---|---|
| General management | 100.00 | 5 |
| Medical area | 0.00 | 0 |
| Chirurgical area | 0.00 | 0 |
| Diagnostic area | 0.00 | 0 |
| Total | 100 | 5 |
Q2 – In your experience, what prompts clinicians to engage as leaders in their hospital (more than one answer is possible)?
| Answer | % | Count |
|---|---|---|
| Organisational commitment defined as a psychological attachment to the hospital where they work | 60 | 3 |
| Clarity of the responsibilities of the role | 60 | 3 |
| Managerial knowledge | 20 | 1 |
| Mentoring | 0 | 0 |
| Balance between clinical and managerial duties | 20 | 1 |
| Recognition and acknowledgment of the value of the role | 80 | 4 |
| Confidence, pride and passion in the job they do | 20 | 1 |
| Age | 0 | 0 |
| Experience | 60 | 3 |
| Other | 20 | 1 |
| Total | 100 | 5 |
Q3 – Please rate from 0 (= not useful at all) to 10 (absolutely critical) the routines, activities and tasks done by hospital management regarding the effectiveness of enhancing the engagement of clinical leaders.
| Field | Min | Max | Mean | S.D. | Variance | Count |
|---|---|---|---|---|---|---|
| Meritocratic career advancement and opportunities | 2.00 | 10.00 | 6.80 | 2.64 | 6.96 | 5 |
| Providing extensive and systematic data about performance and/or quality of services | 1.00 | 9.00 | 6.20 | 2.99 | 8.96 | 5 |
| Providing financial resources to better perform in their role | 5.00 | 9.00 | 6.60 | 1.62 | 2.64 | 5 |
| Selecting appropriate human resources to support them in performing in their role | 1.00 | 9.00 | 6.60 | 2.87 | 8.24 | 5 |
| Mentoring programmes | 6.00 | 8.00 | 7.00 | 0.63 | 0.40 | 5 |
| Financial incentives such as higher benefits or bonuses | 6.00 | 8.00 | 7.20 | 0.98 | 0.96 | 5 |
| A better balance of hours spent on managerial and clinician tasks | 4.00 | 8.00 | 6.20 | 1.60 | 2.56 | 5 |
| Workload reduction | 2.00 | 6.00 | 3.60 | 1.50 | 2.24 | 5 |
| Other | 0.00 | 10.00 | 3.80 | 3.82 | 14.56 | 5 |
Other – text.
Possibility to influence decisions (investments, research, …).
Q4 – Please evaluate the following statements on clinical engagement in your hospital.
| Field | Totally Disagree (%) | Disagree (%) | Unsure (%) | Agree (%) | Totally Agree (%) | Total (No.) | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Clinical engagement is sufficient | 0.00 | 0 | 20.00 | 1 | 0.00 | 0 | 80.00 | 4 | 0.00 | 0 | 5 |
| Hospital management effectively promotes clinical engagement | 0.00 | 0 | 0.00 | 0 | 0.00 | 0 | 60.00 | 3 | 40.00 | 2 | 5 |
| Clinical engagement is essential for achieving our goals | 0.00 | 0 | 0.00 | 0 | 0.00 | 0 | 20.00 | 1 | 80.00 | 4 | 5 |
| Clinical engagement is stimulated | 0.00 | 0 | 20.00 | 1 | 0.00 | 0 | 60.00 | 3 | 20.00 | 1 | 5 |
| Most clinicians are interested in managerial positions | 0.00 | 0 | 20.00 | 1 | 40.00 | 2 | 20.00 | 1 | 20.00 | 1 | 5 |
Q5 – Please order the following managerial competences from the most (= 1) to the least important (= 5) according to which ones you think are most relevant for clinical leaders to effectively perform in their role.
| Field | 1 (%) | 2 (%) | 3 (%) | 4 (%) | 5 (%) | Total | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Working with others, developing networks, building and maintaining relationships, encouraging feedback and working on teams | 20.00 | 1 | 40.00 | 2 | 20.00 | 1 | 20.00 | 1 | 0.00 | 0 | 5 |
| Managing services by planning, managing resources, people and performance | 20.00 | 1 | 20.00 | 1 | 0.00 | 0 | 40.00 | 2 | 20.00 | 1 | 5 |
| Improving services by ensuring patient safety, critically evaluating, encouraging innovation and facilitating transformation | 40.00 | 2 | 20.00 | 1 | 0.00 | 0 | 20.00 | 1 | 20.00 | 1 | 5 |
| Setting direction by identifying the context for change, applying knowledge and evidence, making decisions and evaluating their impact | 20.00 | 1 | 0.00 | 0 | 20.00 | 1 | 20.00 | 1 | 40.00 | 2 | 5 |
| Fostering the adoption and development of innovation | 0.00 | 0 | 20.00 | 1 | 60.00 | 3 | 0.00 | 0 | 20.00 | 1 | 5 |
Q6 – Please order the following soft skills from the most (= 1) to the least important (= 6) according to which ones you think are most relevant for clinical leaders to effectively perform in their role.
| Field | 1 (%) | 2 (%) | 3 (%) | 4 (%) | 5 (%) | 6 (%) | Total | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Motivating colleagues | 20.00 | 1 | 40.00 | 2 | 0.00 | 0 | 20.00 | 1 | 0.00 | 0 | 20.00 | 1 | 5 |
| Communication abilities | 20.00 | 1 | 20.00 | 1 | 40.00 | 2 | 20.00 | 1 | 0.00 | 0 | 0.00 | 0 | 5 |
| Collaborative spirit | 0.00 | 0 | 0.00 | 0 | 0.00 | 0 | 40.00 | 2 | 60.00 | 3 | 0.00 | 0 | 5 |
| Empathy | 20.00 | 1 | 20.00 | 1 | 20.00 | 1 | 20.00 | 1 | 20.00 | 1 | 0.00 | 0 | 5 |
| Tolerance of debate and disagreement | 0.00 | 0 | 20.00 | 1 | 40.00 | 2 | 0.00 | 0 | 20.00 | 1 | 20.00 | 1 | 5 |
| Degree of persuasion and negotiation | 40.00 | 2 | 0.00 | 0 | 0.00 | 0 | 0.00 | 0 | 0.00 | 0 | 60.00 | 3 | 5 |
Q7 – Please order the following personal qualities from the most (= 1) to the least important (= 5) according to which ones you think are most relevant for clinical leaders to effectively perform in their role.
| Field | 1 (%) | 2 (%) | 3 (%) | 4 (%) | 5 (%) | Total | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Self-awareness, i.e. being aware of one's own principles and learning from experience | 20.00 | 1 | 20.00 | 1 | 20.00 | 1 | 40.00 | 2 | 0.00 | 0 | 5 |
| Self-management, i.e. organising oneself while taking into account of the priorities of others | 0.00 | 0 | 0.00 | 0 | 20.00 | 1 | 20.00 | 1 | 60.00 | 3 | 5 |
| Self-development, i.e. continuous professional development; learning from experience, feedback, and discussion with others | 0.00 | 0 | 0.00 | 0 | 20.00 | 1 | 40.00 | 2 | 40.00 | 2 | 5 |
| Acting with integrity, i.e. behaving in a transparent and ethical manner | 20.00 | 1 | 40.00 | 2 | 40.00 | 2 | 0.00 | 0 | 0.00 | 0 | 5 |
| Be a role model, able to inspire confidence in what one does | 60.00 | 3 | 40.00 | 2 | 0.00 | 0 | 0.00 | 0 | 0.00 | 0 | 5 |
Q8 – In your opinion, how important are the following training initiatives in supporting the development of engagement and capabilities in a clinical leader?
| Field | Not at All Important (%) | Not Important (%) | Quite Important (%) | Very Important (%) | Extremely Important (%) | Total (No.) | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Managerial training programmes | 0.00 | 0 | 20.00 | 1 | 20.00 | 1 | 60.00 | 3 | 0.00 | 0 | 5 |
| Managerial training programmes with final assessment | 0.00 | 0 | 20.00 | 1 | 20.00 | 1 | 60.00 | 3 | 0.00 | 0 | 5 |
| Theoretical soft skills training programmes | 0.00 | 0 | 40.00 | 2 | 40.00 | 2 | 20.00 | 1 | 0.00 | 0 | 5 |
| Practical soft skills training programmes that have been tested and assessed | 0.00 | 0 | 0.00 | 0 | 0.00 | 0 | 80.00 | 4 | 20.00 | 1 | 5 |
| Psychological training programmes to enhance personal qualities | 0.00 | 0 | 20.00 | 1 | 20.00 | 1 | 40.00 | 2 | 20.00 | 1 | 5 |
| Other | 20.00 | 1 | 20.00 | 1 | 40.00 | 2 | 0.00 | 0 | 20.00 | 1 | 5 |
Q9 – Are there mandatory training initiatives that clinical leaders must attend and/or pass in order to be appointed to a manager position in your hospital?
| Answer | % | Count |
|---|---|---|
| Yes | 40.00 | 2 |
| No | 60.00 | 3 |
| Total | 100 | 5 |
Q10 – If there are mandatory training programmes, what do they entail? Who are they addressed to?
| Field | Offered Free of Charge by the Hospital, the University or a Public Agency | Offered Free of Charge by the University or a Private Agency Without the Direct Involvement of the Hospital | Offered for a Fee by the Hospital or a Private Agency | Total | |||
|---|---|---|---|---|---|---|---|
| Training programmes in management knowledge | 66.67 | 2 | 33.33 | 1 | 0.00 | 0 | 3 |
| Soft skills training programmes | 33.33 | 1 | 33.33 | 1 | 33.33 | 1 | 3 |
| Psychological training programmes | 0.00 | 0 | 50.00 | 1 | 50.00 | 1 | 2 |
| Soft skills and management training programmes | 50.00 | 1 | 50.00 | 1 | 0.00 | 0 | 2 |
| Other | 0.00 | 0 | 0.00 | 0 | 0.00 | 0 | 0 |
Q11 – Do you feel that the current training programmes offered by your hospital promote the development of managerial competences, soft skills and personal qualities you believe to be relevant? (from 0 to 10).
| Field | Min | Max | Mean | S.D. | Variance | Count |
|---|---|---|---|---|---|---|
| Managerial competences | 2.00 | 7.00 | 5.60 | 1.85 | 3.44 | 5 |
| Soft skills | 3.00 | 7.00 | 5.00 | 1.26 | 1.60 | 5 |
| Personal qualities | 3.00 | 9.00 | 5.20 | 2.71 | 7.36 | 5 |
Q12 – This is the final item in this survey. We thank you for participating. Would you be interested in being interviewed?
| Answer | % | Count |
|---|---|---|
| Yes, enter your email and we will contact you to set an appointment | 0.00 | 0 |
| No | 100.00 | 5 |
| Total | 100 | 5 |
Table 5. Reference Model Timetable
- Prelims
- 1 Clinical Leadership in Context: New Public Management, Horizons of the ‘New Normal’, and Corporatisation of Health Organisations
- 2 Remarks on the COVID-19 Pandemic and Clinical Leadership's Pivotal Role
- 3 Background: 30 Years of Transition From Doctor-Managers to Clinical Leaders
- 4 What We Know About Clinical Leadership
- 5 What We Should Take Into Consideration: Perspectives, Expectations and Advice From Top Hospital Managers
- 6 A Reference Model
- 7 Comparative Country Analysis: How Are Clinicians and Health Professionals Supported and Trained to Take on Leadership Roles?
- 8 Implications for Policymaking and Practitioners in an International Context
- 9 Conclusion
- Appendix
- References
- Index