Learning to Lead in Health Care: A Narrative Inquiry of Physician Leadership

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Jolemore, Shawn
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Mount Saint Vincent University
Active physician leadership within health care organizations can shape the way health care is delivered and contribute to improving and strengthening the system. Yet physicians often struggle to be effective in organizational leadership positions due to lack of leadership experience and the preparation that helps develop requisite competencies and skills. Informed by a qualitative narrative approach, this doctoral study explores the question of how physicians who transition into formal leadership positions learn to lead. Twelve physician leaders based in Halifax, Nova Scotia, were interviewed to gain their perspective on this particular adult learning experience. Categorical content analysis was applied in a multi-stage coding process that yielded four main themes: professional identity, organizational culture, workplace context, and leadership learning, along with relevant sub-themes. Communities of practice, organizational learning and transformative learning theories served as a theoretical framework to inform the analysis. Findings illustrate that the reality of formal physician leadership in health care organizations is ill-matched to the core values and professional identities of doctors. Physicians move along a path through a social learning landscape, negotiating a sense of identity that spans multimembership in different practice communities. For some, the product of this cross-boundary learning is the creation of a superordinate leader identity. For others, it seems to be the understanding and appreciation of a dual identity — physician and leader — the relative importance and weight of each varying over time and context This study emphasizes that physician leadership development can be enhanced by attending more explicitly to how people learn and, concomitantly, supports the assertion that adult education theories and practices can make a significant and valuable contribution to enhance leadership development in medical contexts.
Physician leadership, health care, leadership experience