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

Julia Gauly; Rachel Court; Graeme Currie; Kate Seers; Aileen Clarke; Andy Metcalfe; Anna Wilson; Matthew Hazell; Amy Louise Grove

doi:10.1186/s13012-023-01274-3

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

Implement Sci. 2023 May 13;18(1):15. doi: 10.1186/s13012-023-01274-3.

Authors

Julia Gauly¹, Rachel Court¹, Graeme Currie², Kate Seers¹, Aileen Clarke¹, Andy Metcalfe³, Anna Wilson¹, Matthew Hazell¹, Amy Louise Grove⁴

Affiliations

¹ Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7HL, UK.
² Warwick Business School, University of Warwick, Scarman Rd, Coventry, CV4 7AL, UK.
³ Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK.
⁴ Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7HL, UK. A.L.Grove@warwick.ac.uk.

Abstract

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).

Keywords: Leadership; Organisational leadership interventions; Reaslist review; Surgery.

Publication types

Systematic Review
Review
Research Support, Non-U.S. Gov't

MeSH terms

Delivery of Health Care*
Health Facilities
Humans
Leadership*
Learning