Structure of health-care dyad leadership: an organization's experience.

Purpose This study aims to explore the structural aspects (roles, responsibilities and reporting) of dyad leadership in one health-care organization (HCO). Design/methodology/approach The perceptions of 32 leaders (17 physician leaders and 15 dyad co-leaders) in formal leadership positions (six first-level with formal authority limited to teams or divisions, 23 middle-level with wider departmental or program responsibility and three senior-level with institution-wide authority) were obtained through focus groups and surveys. In addition, five senior leaders were interviewed. Descriptive statistics was used for quantitative data, and qualitative data were analyzed for themes by coding and categorization. Findings There are a large number of shared responsibilities in the hybrid model, as most activities in HCOs bridge administrative and professional spheres. These span the leadership (e.g. global performance and quality improvement) and management (e.g. human resources, budgets and education delivery) domains. The individual responsibilities, except for staff and physician engagement are in the management domain (e.g. operations and patient care). Both partners are responsible for joint decision-making, projecting a united front and joint reporting through a quadrat format. The mutual relationship and joint accountability are key characteristics and are critical to addressing potential conflicts and contradictions and achieving coherence. Practical implications Clarity of role will assist development of standardized job descriptions and required competencies, recruitment and leadership development. Originality/value This is an original empirical study presenting an integrated view of dyad leaders and senior leadership, meaningful expansion of shared responsibilities including academic functions and developing mutual relationship and emphasizing the central role of stability generating management functions.

Leading patient-centred change in the Swedish health system: lessons from the 2009 Sweden Study Tour.

In May 2009, 17 senior health leaders from Canada travelled to Sweden as part of a Canadian College of Health Service Executives study tour. This paper provides an overview of the tour, outlines a number of health service reform practices in Sweden and proposes five "lessons learned" with regard to the practice of leading reform. Knowledge of the current Swedish practices of "leading change" based on the itinerary shows that a patient-centred vision, when combined with effective leadership practice, can bring about significant change. Ongoing dialogue between the Swedish and Canadian leaders provided the substance for this paper.