Leadership development : a comparative evaluation of short-term and long-term programmes in Swedish health care

Health care systems in Sweden and many other industrialised countries have undergone major technological, organisational, and financial changes during the last decades. Health care leaders and doctors are all key persons in the development of a good work environment and a well-functioning health care organisation. The overall aim of this thesis was to evaluate interventions aimed at developing health care managers, doctors, and medical students' leadership. All four studies were conducted at Södersjukhuset, one of the main hospitals in Stockholm, Sweden, which serves 600 000 inhabitants. Studies I and II assessed the impact of eight long-term dialogue groups, which involved 60 doctors at the children s clinic. Psychosocial work environment measures were collected through a validated instrument sent to all doctors (n=68) in 1999, 2001 and 2003. Follow-up data was collected in 2004 and five focus group interviews were performed after the termination of the dialogue groups. In Study III, two questionnaires were sent to 160 medical students, before and after their participation in a short-term intensive leadership course. In Study IV, 53 managers participated in two different leadership programmes, one short-term and one long-term. The Wheel Questionnaire was used for evaluation both immediately prior to and six months after the end of their respective leadership programmes. Eight focus group interviews were conducted after the programmes to explore the managers' experiences from their participation in the programmes.

It seems useful to offer a short-term leadership course based on experiential learning to medical students on a compulsory basis in order to change participants' attitudes towards more openness in their role, support learning about group dynamics, and facilitate further leadership development. Those participants, who would be least likely to voluntarily attend such a course, are the ones who appear to learn the most. A short-term leadership course for managers supports learning about group dynamics, group development, communication, and enhances self-awareness and strengthens participants in their leadership role. However, our findings indicate that the effects of a short-term course for managers are limited in time. Hierarchy among doctors seems to influence many aspects of the doctors' role, the health care organisation, and the work environment. Long-term leadership development groups can support leadership development in context, decrease hierarchy, visualize gender inequities, facilitate building of a learning organisation and improve the work environment.

This evaluation of two different approaches to leadership development used in Swedish health care indicates that both short-term intensive courses and long-term leadership development groups are useful methods for leadership development in health care. Although the content and methods used in the programmes differ significantly, the interventions seem to complement each other. A practical implication of this thesis is to initially offer short-term leadership orientation courses to present and future health care leaders followed by long-term leadership development groups in order to further develop participants' leadership competencies.

List of scientific papers

I. Bergman D, Arnetz B, Wahlström R, Sandahl C. (2007). Effects of dialogue groups on physicians work environment. J Health Organ Manag. 21(1):27-38.
https://doi.org/10.1108/14777260710732240

II. Bergman D, Stotzer E, Wahlström R, Sandahl C. (2008). Learning from dialogue groups physicians perceptions of role. Journal of Health Organization and Management. [Accepted]
https://doi.org/10.1108/14777260910960957

III. Bergman D, Savage C, Wahlstrom R, Sandahl C. (2008). Teaching group dynamics--do we know what we are doing? An approach to evaluation. Med Teach. 30(1):55-61.
https://doi.org/10.1080/01421590701758624

IV. Bergman D, Fransson Sellgren S, Wahlström R, Sandahl C. (2008). Leadership impact of short-term intensive and long-term less intensive training programmes. Leadership in Health Services. [Accepted]
https://doi.org/10.1108/17511870910953805