Handle with care: A multidisciplinary analysis of frontline medical leadership in medical residents

Abstract

This thesis examined medical leadership from several perspectives using a theory-driven, mixed methods and multi-disciplinary approach. We showed that medical leadership is a loosely defined concept that is susceptible to many different interpretations. It is considered a panacea for various problems in health care and is currently implemented throughout the health care system, competency based medical education in particular. There are several institutional, educational, occupational and organizational forces at play which may constrain medical leadership development that are currently partly overlooked. The second part of this thesis focused on ‘speaking up’. To increase the quality of care for patients, it is important that medical residents are able to speak up and share their valuable frontline experiences. However, the results showed that residents do not automatically speak up or proactively engage in the organization of health care. They could feel that speaking up is risky and believe that it will not make a difference. This thesis shows that it is important to realize that a hesitance to speak up is not merely a flaw of individual health care workers who are not able to behave proactively, but an outcome of several social, regulatory and educational processes that cause employees to feel that speaking up is not always welcomed and fostered. It is therefore important to proactively engage residents in proactive behavior while remaining aware of the pitfalls of medical leadership development as described in this thesis.