Interplay of clear, demanding, and important goals on project performance in community-academic health partnerships.

BACKGROUND: Community-academic health partnerships (CAHPs) have become increasingly common to bridge the knowledge-to-practice gap in health care. Because working in such partnerships can be excessively challenging, insights into the individual-level enablers of high performance will enable better management of CAHPs. PURPOSE: Steered by the goal-setting theory, this study examined the relations between goal clarity, goal stress, goal importance, and their interactions on perceived project performance among individuals working in CAHPs' constituting projects. METHODOLOGY: Using a convergent mixed-method research design, online survey data were collected from 268 participants working in a variety of CAHP projects in three German-speaking countries. We tested the hypotheses using structural equation modeling, after which thematic analysis was carried out on the 209 open-ended responses. RESULTS: CAHP project performance was positively associated with goal clarity and negatively associated with goal stress. A three-way interaction analysis showed that when goal importance was high, the relationship between goal clarity and project performance remained positive regardless of the level of goal stress. The qualitative data corroborate this finding. CONCLUSION: In CAHP projects, high goal importance offsets the negative effect of goal stress on project performance, indicating that workers who perceive the project goals as important can manage the stress associated with demanding goals better. PRACTICE IMPLICATIONS: To achieve high project performance in CAHPs, organizational and project leaders should (a) set clear project goals, (b) facilitate project workers in dealing with stress resulting from overly demanding goals, and (c) emphasize the importance of the project goals, especially when goal stress is high.

Development of a national medical leadership competency framework: the Dutch approach.

BACKGROUND: The concept of medical leadership (ML) can enhance physicians' inclusion in efforts for higher quality healthcare. Despite ML's spiking popularity, only a few countries have built a national taxonomy to facilitate ML competency education and training. In this paper we discuss the development of the Dutch ML competency framework with two objectives: to account for the framework's making and to complement to known approaches of developing such frameworks. METHODS: We designed a research approach and analyzed data from multiple sources based on Grounded Theory. Facilitated by the Royal Dutch Medical Association, a group of 14 volunteer researchers met over a period of 2.5 years to perform: 1) literature review; 2) individual interviews; 3) focus groups; 4) online surveys; 5) international framework comparison; and 6) comprehensive data synthesis. RESULTS: The developmental processes that led to the framework provided a taxonomic depiction of ML in Dutch perspective. It can be seen as a canonical 'knowledge artefact' created by a community of practice and comprises of a contemporary definition of ML and 12 domains, each entailing four distinct ML competencies. CONCLUSIONS: This paper demonstrates how a new language for ML can be created in a healthcare system. The success of our approach to capture insights, expectations and demands relating leadership by Dutch physicians depended on close involvement of the Dutch national medical associations and a nationally active community of practice; voluntary work of diverse researchers and medical practitioners and an appropriate research design that used multiple methods and strategies to circumvent reverberation of established opinions and conventionalisms. IMPLICATIONS: The experiences reported here may provide inspiration and guidance for those anticipating similar work in other countries to develop a tailored approach to create a ML framework.

Quantifying culture gaps between physicians and managers in Dutch hospitals: a survey.

BACKGROUND: The demands in hospitals for safety and quality, combined with limitations in financing health care require effective cooperation between physicians and managers. The complex relationship between both groups has been described in literature. We aim to add a perspective to literature, by developing a questionnaire which provides an opportunity to quantitatively report and elaborate on the size and content of differences between physicians and managers. Insight gained from use of the questionnaire might enable us to reflect on these differences and could provide practical tools to improve cooperation between physicians and managers, with an aim to enhance hospital performance. METHODS: The CG-Questionnaire was developed by adjusting, pre-testing, and shortening Kralewski's questionnaire, and appeared suitable to measure culture gaps. It was shortened by exploratory factor analysis, using principal-axis factoring extraction with Varimax rotation. The CG-Questionnaire was sent to all physicians and managers within 37 Dutch general hospitals. ANOVA and paired sample T-tests were used to determine significant differences between perceptions of daily work practices based in both professional cultures; culture gaps. The size and content of culture gaps were determined with descriptive statistics. RESULTS: The total response (27%) consisted of 929 physicians and 310 managers. The Cronbachs alpha's were 0.70 - 0.79. Statistical analyses showed many differences; culture gaps were found in the present situation; they were even larger in the preferred situation. Differences between both groups can be classified into three categories: (1) culture gaps in the present situation and not in the preferred, (2) culture gaps in the preferred situation and not in the present, and (3) culture gaps in both situations. CONCLUSIONS: With data from the CG-Questionnaire it is now possible to measure the size and content of culture gaps between physicians and managers in hospitals. Results gained with the CG-Questionnaire enables hospitals to reflect on these differences. Combining the results, we distinguished three categories of increasing complexity. We linked these three categories to three methods from intergroup literature (enhanced information, contact and ultimately meta cognition) which could help to improve the cooperation between physicians and managers.