180° view on general practitioners’ leadership skills: practice-level comparisons of leader and staff assessments using data from the cluster-randomised controlled IMPROVEjob study

OBJECTIVES: Strong primary care leaders are needed to assure high quality services for patient populations. This study analysed general practitioners’ (GP) leadership skills comparing practice-level self and staff assessments based on the full range of leadership model and the leader-member exchange (LMX). SETTING: The questionnaire survey was conducted among German general practice leaders and their staff participating in the IMPROVEjob trial. PARTICIPANTS: The study population comprised 60 German general practices with 366 participants: 84 GP practice leaders and 282 employees (28 physicians and 254 practice assistants). PRIMARY AND SECONDARY OUTCOME MEASURES: Leadership skills of the practice leaders were measured using the Integrative Leadership Questionnaire (German Fragebogen für integrative Führung) and the LMX-7 questionnaire. Leaders rated themselves and practice staff rated their leaders. The data was analysed by paired mean comparisons on the practice level. RESULTS: For most leadership dimensions, practice leaders rated themselves higher than their employees rated them. Differences were found for transformational leadership (p<0.001, d=0.41), especially for the dimensions ‘innovation’ (p<0.001, d=0.69) and ‘individuality focus’ (p<0.001, d=0.50). For transactional leadership, the dimension ‘goal setting’ differed significantly (p<0.01, d=0.30) but not the other dimensions. Scores for negative leadership were low and showed no differences between leaders and employees. Interestingly, employed physicians’ rated their practice leaders higher on the two transformational (‘performance development’, ‘providing a vision’) and all transactional dimensions. The LMX-7 scale showed high quality relationships between leaders and employees. CONCLUSIONS: This 180° analysis of GPs’ leadership skills with self and employee ratings indicated good relationships. There is a potential to improve leadership regarding goal-setting, innovation and focusing on individual team members. These results allow for the development of targeted interventions. TRIAL REGISTRATION NUMBER: German Clinical Trials Register, DRKS00012677. Registered 16 October 2019.