What we say vs. What we do
Conflicting messages: Examining the dynamics of team leadership on interprofessional teams. Lingard L. et al. Academic Medicine 2012;87:1762-1767.
Reviewed by Rebecca Tenney-Soeiro
What was the study question?
To better understand the role of "physician leadership" in the evolving world of collaborative health care and interprofessional team work.
How was the study done?
A multi-instrument case study research design was used. Five different teams in Canadian institutions were involved. Research assistants observed during team meetings, team rounds, consults, and shadowed individual team members. Individuals were interviewed and focus groups were also held. Iterative data analysis was performed using a constant comparative thematic approach.
What were the results?
A tension remains between the ways in which teams discuss leadership with the researchers and the ways in which they actually enacted leadership in daily practice or talked amongst themselves. Physicians often described the teams as equal while non-physicians described an ongoing medical hierarchy, even if the physicians worked against the hierarchy. On all teams, physicians had more decision-making authority than non-physicians and this was linked to the perception that physicians had a higher level of medical-legal accountability for patient care.
What are the implications of these findings?
Physicians experience a tension between two values: they embrace the philosophy of clinical democracy but often act on a philosophy of hierarchical leadership. Our current professional socialization and educational systems condition physicians to envision themselves as leaders of health care teams. Non-physicians' educational systems also reinforce the perceptions of medical dominance. A broad approach, including dialogue across professions, as well as with patients and families, and with regulatory, governmental, insurance, and academic institutions will be required to make real changes.
Editor's note: This well-done study highlights key issues in interprofessional team leadership. It is good background reading as we try to integrate interprofessional education into our clerkship programs (SLB).