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Differential effects of professional leaders on health care teams in chronic disease management groups

Wholey, Douglas R.; Disch, Joanne; White, Katie M.; Powell, Adam; Rector, Thomas S.; Sahay, Anju; Heidenreich, Paul A.

doi: 10.1097/HMR.0b013e3182993b7f
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Background: Leadership by health care professionals is likely to vary because of differences in the social contexts within which they are situated, socialization processes and societal expectations, education and training, and the way their professions define and operationalize key concepts such as teamwork, collaboration, and partnership. This research examines the effect of the nurse and physician leaders on interdependence and encounter preparedness in chronic disease management practice groups.

Purpose: The aim of this study was to examine the effect of complementary leadership by nurses and physicians involved in jointly producing a health care service on care team functioning.

Methodology: The design is a retrospective observational study based on survey data. The unit of analysis is heart failure care groups in U.S. Veterans Health Administration medical centers. Survey and administrative data were collected in 2009 from 68 Veterans Health Administration medical centers. Key variables include nurse and physician leadership, interdependence, psychological safety, coordination, and encounter preparedness. Reliability and validity of survey measures were assessed with exploratory factor analysis and Cronbach alphas. Multivariate analyses tested hypotheses.

Findings: Professional leadership by nurses and physicians is related to encounter preparedness by different paths. Nurse leadership is associated with greater team interdependence, and interdependence is positively associated with respect. Physician leadership is positively associated with greater psychological safety, respect, and shared goals but is not associated with interdependence. Respect is associated with involvement in learning activities, and shared goals are associated with coordination. Coordination and involvement in learning activities are positively associated with encounter preparedness.

Practice Implications: By focusing on increasing interdependence and a constructive climate, nurse and physician leaders have the opportunity to increase care coordination and involvement in learning activities.

Douglas R. Wholey, PhD, is Professor, Center for Care Organization Research & Development, Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis. E-mail: whole001@umn.edu.

Joanne Disch, PhD, RN, FAAN, is Clinical Professor, School of Nursing, University of Minnesota, Minneapolis. E-mail: disch003@umn.edu.

Katie M. White, EdD, is Assistant Professor, Center for Care Organization Research & Development, Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis. E-mail:kmwhite@umn.edu.

Adam Powell, PhD, is Research Investigator, The Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minnesota, and Assistant Professor, Department of Medicine, University of Minnesota, Minneapolis.E-mail:Adam.Powell@va.gov.

Thomas S. Rector, PhD, is Health Research Specialist, The Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minnesota, and Professor, Department of Medicine, University of Minnesota, Minneapolis.E-mail:Thomas.Rector@va.gov.

Anju Sahay, PhD, is Research Health Science Specialist, Chronic Heart Failure Quality Enhancement Research Initiative, VA Medical Center, Palo Alto, California. E-mail:Anju.Sahay@va.gov.

Paul A. Heidenreich, MD, is Professor of Medicine, VA Palo Alto Health Care System and Stanford University, California. E-mail:Paul.Heidenreich@va.gov

This work was funded by the Interdisciplinary Nursing Quality Research Initiative, Robert Wood Johnson Foundation.

The views expressed herein do not necessarily represent those of the Department of Veterans Affairs.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins