Rutgers Robert Wood Johnson Medical School.
Lehigh Valley Health Network.
Milbank Q. 2020 Jun;98(2):399-445. doi: 10.1111/1468-0009.12456. Epub 2020 May 13.
Policy Points An onslaught of policies from the federal government, states, the insurance industry, and professional organizations continually requires primary care practices to make substantial changes; however, ineffective leadership at the practice level can impede the dissemination and scale-up of these policies. The inability of primary care practice leadership to respond to ongoing policy demands has resulted in moral distress and clinician burnout. Investments are needed to develop interventions and educational opportunities that target a broad array of leadership attributes.
Over the past several decades, health care in the United States has undergone substantial and rapid change. At the heart of this change is an assumption that a more robust primary care infrastructure helps achieve the quadruple aim of improved care, better patient experience, reduced cost, and improved work life of health care providers. Practice-level leadership is essential to succeed in this rapidly changing environment. Complex adaptive systems theory offers a lens for understanding important leadership attributes.
A review of the literature on leadership from a complex adaptive system perspective identified nine leadership attributes hypothesized to support practice change: motivating others to engage in change, managing abuse of power and social influence, assuring psychological safety, enhancing communication and information sharing, generating a learning organization, instilling a collective mind, cultivating teamwork, fostering emergent leaders, and encouraging boundary spanning. Through a secondary qualitative analysis, we applied these attributes to nine practices ranking high on both a practice learning and leadership scale from the Learning from Effective Ambulatory Practice (LEAP) project to see if and how these attributes manifest in high-performing innovative practices.
We found all nine attributes identified from the literature were evident and seemed important during a time of change and innovation. We identified two additional attributes-anticipating the future and developing formal processes-that we found to be important. Complexity science suggests a hypothesized developmental model in which some attributes are foundational and necessary for the emergence of others.
Successful primary care practices exhibit a diversity of strong local leadership attributes. To meet the realities of a rapidly changing health care environment, training of current and future primary care leaders needs to be more comprehensive and move beyond motivating others and developing effective teams.
政策要点 联邦政府、州政府、保险业和专业组织的一系列政策要求不断要求基层医疗实践做出重大改变；然而，实践层面领导力的不足可能会阻碍这些政策的传播和推广。基层医疗实践领导层无法应对持续的政策需求，导致了道德困境和临床医生倦怠。需要投资开发针对广泛领导力属性的干预措施和教育机会。
在过去几十年中，美国的医疗保健发生了巨大而快速的变化。这种变化的核心是假设更强大的初级保健基础设施有助于实现改善护理、改善患者体验、降低成本和改善医疗保健提供者工作生活的四重目标。实践层面的领导力对于在这个快速变化的环境中取得成功至关重要。复杂适应系统理论为理解重要的领导力属性提供了一个视角。
从复杂适应系统的角度对领导力文献进行回顾，确定了九个假设支持实践变革的领导力属性：激励他人参与变革、管理权力滥用和社会影响力、确保心理安全、增强沟通和信息共享、培养学习型组织、灌输集体思维、培养团队合作、培养新兴领导者、鼓励跨越边界。通过二次定性分析，我们将这些属性应用于 LEAP 项目中学习有效门诊实践 (Learning from Effective Ambulatory Practice，LEAP) 排名较高的九个实践，以了解这些属性是否以及如何在表现出色的创新实践中表现出来。
我们发现文献中确定的所有九个属性都存在，并且在变革和创新时期似乎很重要。我们还发现了另外两个属性——预测未来和开发正式流程——我们认为这两个属性很重要。复杂性科学提出了一个假设的发展模型，其中一些属性是基础的，是其他属性出现的必要条件。
成功的初级保健实践表现出多样化的强大的本地领导力属性。为了应对快速变化的医疗保健环境的现实，当前和未来的初级保健领导者的培训需要更加全面，并超越激励他人和发展高效团队。
