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Health care practice / quality Primary care Original Scholarship
Benjamin F. Crabtree
William L. Miller
Brian T. Austin
Edward H. Wagner
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• An onslaught of policies from the federal government, states, the insurance industry, and professional organizations continually requires primary care practices to make substantial changes; however, ineffective leadership at the practice level can impede the dissemination and scale-up of these policies. • The inability of primary care practice leadership to respond to ongoing policy demands has resulted in moral distress and clinician burnout. • Investments are needed to develop interventions and educational opportunities that target a broad array of leadership attributes.
Context: Over the past several decades, health care in the United States has undergone substantial and rapid change. At the heart of this change is an assumption that a more robust primary care infrastructure helps achieve the quadruple aim of improved care, better patient experience, reduced cost, and improved work life of health care providers. Practice-level leadership is essential to succeed in this rapidly changing environment. Complex adaptive systems theory offers a lens for understanding important leadership attributes.
Methods: A review of the literature on leadership from a complex adaptive system perspective identified nine leadership attributes hypothesized to support practice change: motivating others to engage in change, managing abuse of power and social influence, assuring psychological safety, enhancing communication and information sharing, generating a learning organization, instilling a collective mind, cultivating teamwork, fostering emergent leaders, and encouraging boundary spanning. Through a secondary qualitative analysis, we applied these attributes to nine practices ranking high on both a practice learning and leadership scale from the Learning from Effective Ambulatory Practice (LEAP) project to see if and how these attributes manifest in high-performing innovative practices.
Findings: We found all nine attributes identified from the literature were evident and seemed important during a time of change and innovation. We identified two additional attributes—anticipating the future and developing formal processes—that we found to be important. Complexity science suggests a hypothesized developmental model in which some attributes are foundational and necessary for the emergence of others.
Conclusions: Successful primary care practices exhibit a diversity of strong local leadership attributes. To meet the realities of a rapidly changing health care environment, training of current and future primary care leaders needs to be more comprehensive and move beyond motivating others and developing effective teams.
Keywords: leadership, primary care, complex adaptive system theory, qualitative research.
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Published May 2020 DOI: 10.1111/1468-0009.12456
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