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Advancing leadership in surgery: a realist review of interventions and strategies to promote evidence-based leadership in healthcare

BACKGROUND: Healthcare systems invest in leadership development of surgeons, surgical trainees, and teams. However, there is no agreement on how interventions should be designed, or what components they must contain to be successful. The objective of this realist review was to generate a programme t...

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Autores principales: Gauly, Julia, Court, Rachel, Currie, Graeme, Seers, Kate, Clarke, Aileen, Metcalfe, Andy, Wilson, Anna, Hazell, Matthew, Grove, Amy Louise
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10182608/
https://www.ncbi.nlm.nih.gov/pubmed/37179327
http://dx.doi.org/10.1186/s13012-023-01274-3
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author Gauly, Julia
Court, Rachel
Currie, Graeme
Seers, Kate
Clarke, Aileen
Metcalfe, Andy
Wilson, Anna
Hazell, Matthew
Grove, Amy Louise
author_facet Gauly, Julia
Court, Rachel
Currie, Graeme
Seers, Kate
Clarke, Aileen
Metcalfe, Andy
Wilson, Anna
Hazell, Matthew
Grove, Amy Louise
author_sort Gauly, Julia
collection PubMed
description BACKGROUND: Healthcare systems invest in leadership development of surgeons, surgical trainees, and teams. However, there is no agreement on how interventions should be designed, or what components they must contain to be successful. The objective of this realist review was to generate a programme theory explaining in which context and for whom surgical leadership interventions work and why. METHODS: Five databases were systematically searched, and articles screened against inclusion considering their relevance. Context-mechanism-outcome configurations (CMOCs) and fragments of CMOCs were identified. Gaps in the CMOCs were filled through deliberation with the research team and stakeholder feedback. We identified patterns between CMOCs and causal relationships to create a programme theory. RESULTS: Thirty-three studies were included and 19 CMOCs were developed. Findings suggests that interventions for surgeons and surgical teams improve leadership if timely feedback is delivered on multiple occasions and by trusted and respected people. Negative feedback is best provided privately. Feedback from senior-to-junior or peer-to-peer should be delivered directly, whereas feedback from junior-to-senior is preferred when delivered anonymously. Leadership interventions were shown to be most effective for those with awareness of the importance of leadership, those with confidence in their technical surgical skills, and those with identified leadership deficits. For interventions to improve leadership in surgery, they need to be delivered in an intimate learning environment, consider implementing a speak-up culture, provide a variety of interactive learning activities, show a genuine investment in the intervention, and be customised to the needs of surgeons. Leadership of surgical teams can be best developed by enabling surgical teams to train together. CONCLUSIONS: The programme theory provides evidence-based guidance for those who are designing, developing and implementing leadership interventions in surgery. Adopting the recommendations will help to ensure interventions are acceptable to the surgical community and successful in improving surgical leadership. TRIAL REGISTRATION: The review protocol is registered with PROSPERO (CRD42021230709). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13012-023-01274-3.
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spelling pubmed-101826082023-05-14 Advancing leadership in surgery: a realist review of interventions and strategies to promote evidence-based leadership in healthcare Gauly, Julia Court, Rachel Currie, Graeme Seers, Kate Clarke, Aileen Metcalfe, Andy Wilson, Anna Hazell, Matthew Grove, Amy Louise Implement Sci Systematic Review BACKGROUND: Healthcare systems invest in leadership development of surgeons, surgical trainees, and teams. However, there is no agreement on how interventions should be designed, or what components they must contain to be successful. The objective of this realist review was to generate a programme theory explaining in which context and for whom surgical leadership interventions work and why. METHODS: Five databases were systematically searched, and articles screened against inclusion considering their relevance. Context-mechanism-outcome configurations (CMOCs) and fragments of CMOCs were identified. Gaps in the CMOCs were filled through deliberation with the research team and stakeholder feedback. We identified patterns between CMOCs and causal relationships to create a programme theory. RESULTS: Thirty-three studies were included and 19 CMOCs were developed. Findings suggests that interventions for surgeons and surgical teams improve leadership if timely feedback is delivered on multiple occasions and by trusted and respected people. Negative feedback is best provided privately. Feedback from senior-to-junior or peer-to-peer should be delivered directly, whereas feedback from junior-to-senior is preferred when delivered anonymously. Leadership interventions were shown to be most effective for those with awareness of the importance of leadership, those with confidence in their technical surgical skills, and those with identified leadership deficits. For interventions to improve leadership in surgery, they need to be delivered in an intimate learning environment, consider implementing a speak-up culture, provide a variety of interactive learning activities, show a genuine investment in the intervention, and be customised to the needs of surgeons. Leadership of surgical teams can be best developed by enabling surgical teams to train together. CONCLUSIONS: The programme theory provides evidence-based guidance for those who are designing, developing and implementing leadership interventions in surgery. Adopting the recommendations will help to ensure interventions are acceptable to the surgical community and successful in improving surgical leadership. TRIAL REGISTRATION: The review protocol is registered with PROSPERO (CRD42021230709). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13012-023-01274-3. BioMed Central 2023-05-13 /pmc/articles/PMC10182608/ /pubmed/37179327 http://dx.doi.org/10.1186/s13012-023-01274-3 Text en © Crown 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Systematic Review
Gauly, Julia
Court, Rachel
Currie, Graeme
Seers, Kate
Clarke, Aileen
Metcalfe, Andy
Wilson, Anna
Hazell, Matthew
Grove, Amy Louise
Advancing leadership in surgery: a realist review of interventions and strategies to promote evidence-based leadership in healthcare
title Advancing leadership in surgery: a realist review of interventions and strategies to promote evidence-based leadership in healthcare
title_full Advancing leadership in surgery: a realist review of interventions and strategies to promote evidence-based leadership in healthcare
title_fullStr Advancing leadership in surgery: a realist review of interventions and strategies to promote evidence-based leadership in healthcare
title_full_unstemmed Advancing leadership in surgery: a realist review of interventions and strategies to promote evidence-based leadership in healthcare
title_short Advancing leadership in surgery: a realist review of interventions and strategies to promote evidence-based leadership in healthcare
title_sort advancing leadership in surgery: a realist review of interventions and strategies to promote evidence-based leadership in healthcare
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10182608/
https://www.ncbi.nlm.nih.gov/pubmed/37179327
http://dx.doi.org/10.1186/s13012-023-01274-3
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