Identifying Leadership Competencies in Medical and Dental Healthcare Professionals in Pakistan

Leadership competencies in Medical and Dental Education and Profession

The literature related to medical education leadership is still in its beginning and developing phase. Bland, et al. [9] were among the pioneers to empirically study particular educational leadership competencies for effective university- community partnership in bringing about the change in curriculum. In an ever-changing medical education system, leaders need to have a shared vision with their followers and by good communication and role modeling, they can facilitate change that can be applied both to education and health care services.

Effective leadership is linked with improvement in teaching effectiveness and enhancing educational quality and excellence [10]. Leithwood, et al. [11] discovered that effective school leaders exhibit four main competencies: developing people and teams, setting direction for the future, reforming the organization and supervising the educational program. Bordage, et al. [12] conducted a study to identify skills and qualities of educational directors and they found five significant personal traits which were open- mindedness, vision, flexibility, trustworthiness and led by values. McKimm’s study results also identified the same qualities but added a few more including self-awareness, self- management, strategic skills, analytical thinking, tolerance and being willing to take risks.

In order to manage the challenges in the new health care systems, specialists and organizations feel the need to improve doctors’/dentists’ leadership abilities. As a result, physician leadership programs are developing and growing, appealing to all levels of experience and training. Leadership is an important aspect of physicians’ specialized job regardless of field and setting. It is considered necessary for all physicians as mentioned in the General Medical Council’s (GMC) publications, Good Medical Practice and Tomorrow’s Doctors [8].

Doctors need to develop leadership skills like emotional intelligence, conflict resolution, negotiation, situational sensitivity and style flexibility, strategic planning, stress management, communication skills, team building, solving problems, managing change and acting with integrity. As effective physician leaders, they must have strong morals, ethical values and take responsibility of the public health [13]. Physician leaders have responsibility for training their students and trainees by role modeling, coaching and mentoring [14]. A change in traditional educational methods in healthcare is extremely important to fulfill the requirements of an updated medical service and community expectancy. Academic change cannot be achieved without competent leadership, and the lack of leadership in the past has actually hindered change [15]. It is very important for the leadership to create a favorable educational atmosphere/culture, which not only emphasizes learning but also assessment, analysis and improving education. Hence leadership is critical to bringing about improvement in educational outcomes.

Leadership can be learned, however, identifying, and defining the central competencies of leadership remain elusive. There is an abundance of literature written about leadership, but significant research in area of medical education is lacking. The study done by Citaku, et al. is one of the few which has provided empirical evidence for the most important leadership competencies in medical education [1]. These researchers have developed a leadership competencies model, empirically investigating the core leadership competencies.

This model comprises 63 leadership competencies within five domains:

1. Social responsibility;
2. Innovation;
3. Self-management;
4. Task Management;
5. Justice orientation.

This empirical model of leadership competencies offers a foundation for developing curricula of training programs to teach and develop leadership competencies in any domain, including medical and dental healthcare professions.

Survey Procedures

Survey participants were from four private and public medical colleges, dental colleges and teaching hospitals of Rawalpindi and Islamabad. A 63-item questionnaire measuring leadership competencies designed by Fadil Citaku, et al. [1] was administered in person to all participants. Four institutes were visited, ethical review committee approval was obtained and the questionnaire about leadership was distributed among the faculty members. The data collected was entered in SPSS version 23 for further analysis.

Data Analysis

SPSS version 23 was used for statistical analysis. Reliability of the survey scores was evaluated by using Cronbach’s α and sampling adequacy test by K-M-O test. Descriptive statistics of the survey items was done. Evidence of factorial validity was evaluated by using exploratory factor analysis. Principal component analysis (PCA with 63 items) was done.

One-way ANOVA for 5 extracted factors was conducted. It was performed separately for females and males, doctors and dentists, and finally for assistant professors, associate professors and professors. The mean Likert score and SD (standard deviation) for each item were calculated. This was used to calculate the mean Likert score and SD for each scale by taking the mean of all the items that comprise the scale. Correlation coefficient for each scale and its items was calculated using Pearson’s test.

Descriptive Statistics of the Survey Items

Descriptive statistics of the items are summarized in Table 1. A large number of respondents rated each item as important (4) or very important (5). For remaining items, the whole scale was used. The calculated means of the items ranged from 3.57 (#18 honesty and integrity) to 4.30 (#3 personal decision quality). The SDs are either less than or equal to 1 for five-point items, showing that data points are gathered closely around the mean.

Principal Component Analysis and Reliability

Numerous explanatory principal component analyses were conducted. It was established that the best solution was five factors as they rated for more than 50% of the variance, were consistent and logical. The five factors identified as leadership competencies were social responsibility, innovation, self-management, task management and leading others.

After analyzing the values of factor loadings, communalities, and cross-loadings, 20 out of 63 variables were removed based on the following criteria: Low communalities (i.e. having a value less than 0.3), such as LOC6_SP (0.252), SMC9_SR (0.294) and SRC10_FE (0.312) Low factor loading (having a value less than 0.4).

Cross loadings having a difference of less than 0.2. The questions were removed from the following competency domains: four from Task Management, two from Social Responsibility, four from Self-Management, nine from Leading Others and one from Innovation.

To measure the reliability and internal consistency of each factor, Cronbach’s coefficient alpha values were calculated for each extracted factor and for the complete data set. A value less than 0.7 is questionable, 0.7–0.8 is marginal, and 0.8–1 is acceptable [16]. Cronbach’s alpha values of all five domains of competency model were found reliable to be used in our setting. All values of five domains were above

0.7 indicating scale’s reliability. A reliable scale is internally consistent and stable overtime.

The results summarized in Table 2, also show very high reliability of items within each factor. Cronbach’s a was 0.78 for Task management, 0.87 for Social Responsibility and Innovation, 0.86 for Self-Management, 0.90 for Leading others and 0.88 for Factor 5 Innovation. All five factors were correlated with each other. The high internal consistency of each factor’s items, the overall pattern of factor loadings indicates the coherence of the factors. The items having the highest loadings on Social Responsibility, for example, are honesty and integrity (0.81) and accountability (0.81). All the other loadings on social responsibility were moderate (eg, >0.40) to large (>0.80). Other four factors also showed a same pattern of loadings.

Results indicate that there is agreement between the findings of the original study done by Citaku, et al. and the current study.

Differences between Men and Women

Further descriptive analysis of the scales was done according to the gender (Table 3). In the subscale 1, “Task management” the mean scale was 29.06 ± 3.25 for males and 29.44 ± 4.47 for females. In the subscale 2, “Self-regulation” the mean scale was 45.44 ± 8.21 for males and 46.09 ± 9.06 for females. For subscale 3, “Self-management” the mean scale was 43.30 ± 7.39 for males and 44.52 ± 7.72 for females. For subscale 4, “Leading others”, males had mean scale of 73.80 ± 11.45 and females had 75.40 ± 11.76. The last subscale 5, “Innovation” males had mean scale of 56.22 ± 8.09 and females had 57.63 ± 8.91. There were no significant differences for leadership experience between men and women.

Differences According to Professional Seniority

Descriptive analysis of the scales relative to professional seniority was completed revealing the following results. In the subscale 1, “Task management” the mean scale was 29.32± 4.01 for Assistant Professors, 29.14 ± 4.46 for Associate Professors and 29.43± 3.62 for Professors. In the subscale 2, “Self-regulation” the mean scale was 46.33 ± 8.64 for Assistant.

Limitations

Only a cross-sectional study was conducted due to time constraint. This study only represents doctors and dentists, not including other healthcare professionals like nurses and physiotherapists. The survey reply rate was high (91%), and it was done in four institutions of Rawalpindi and Islamabad only. This study should be replicated with more representative samples from other major cities of Pakistan to further explore leadership in healthcare professions.