Gordon Lisi, Rees Charlotte, Ker Jean, Cleland Jennifer
School of Management, University of St Andrews, The Gateway, North Haugh, St Andrews, KY16 9RJ, Scotland, UK.
Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
Adv Health Sci Educ Theory Pract. 2017 Dec;22(5):1101-1121. doi: 10.1007/s10459-016-9744-z. Epub 2016 Dec 30.
Current theoretical thinking asserts that leadership should be distributed across many levels of healthcare organisations to improve the patient experience and staff morale. However, much healthcare leadership education focusses on the training and competence of individuals and little attention is paid to the interprofessional workplace and how its inherent complexities might contribute to the emergence of leadership. Underpinned by complexity theory, this research aimed to explore how interprofessional healthcare teams enact leadership at a micro-level through influential acts of organising. A whole (interprofessional) team workplace-based study utilising video-reflexive ethnography occurred in two UK clinical sites. Thematic framework analyses of the video data (video-observation and video-reflexivity sessions) were undertaken, followed by in-depth analyses of human-human and human-material interactions. Data analysis revealed a complex interprofessional environment where leadership is a dynamic process, negotiated and renegotiated in various ways throughout interactions (both formal and informal). Being able to "see" themselves at work gave participants the opportunity to discuss and analyse their everyday leadership practices and challenge some of their sometimes deeply entrenched values, beliefs, practices and assumptions about healthcare leadership. These study findings therefore indicate a need to redefine the way that medical and healthcare educators facilitate leadership development and argue for new approaches to research which shifts the focus from leaders to leadership.
当前的理论认为，领导力应分散在医疗保健组织的多个层面，以改善患者体验和员工士气。然而，许多医疗保健领导力教育侧重于个人的培训和能力，很少关注跨专业的工作场所及其内在复杂性如何促进领导力的产生。在复杂性理论的支撑下，本研究旨在探讨跨专业医疗团队如何通过有影响力的组织行为在微观层面发挥领导力。在英国的两个临床地点开展了一项基于整个（跨专业）团队工作场所的视频反思民族志研究。对视频数据（视频观察和视频反思环节）进行了主题框架分析，随后对人际互动和人机互动进行了深入分析。数据分析揭示了一个复杂的跨专业环境，其中领导力是一个动态过程，在各种互动（正式和非正式）中以各种方式进行协商和重新协商。能够在工作中“看到”自己，让参与者有机会讨论和分析他们日常的领导实践，并挑战他们一些有时根深蒂固的关于医疗保健领导力的价值观、信念、实践和假设。因此，这些研究结果表明需要重新定义医学和医疗保健教育工作者促进领导力发展的方式，并主张采用新的研究方法，将重点从领导者转向领导力。
