차원, 담화, 차이: 피훈련자 입장에서의 리더십과 팔로우십(Med Educ, 2015)

Dimensions, discourses and differences: trainees conceptualising health care leadership and followership

Lisi J Gordon,1 Charlotte E Rees,2 Jean S Ker1 & Jennifer Cleland3






현대의 헬스케어 리더십은 조직의 다양한 레벨에 걸쳐 분배되어야 하며, 지위나 전문성과 무관하게 그 상황에 가장 적합한 사람에 의해서 수행되어야 하는 것으로 인식된다. 이를 통해서 환자 경험을 향상시키고, 실수, 감염, 사망을 줄이고, 직원의 사기를 높이고 직원의 결근과 스트레스를 줄이는 것으로 보고된다 그러나 세계의 다양한 맥락에서의 결과를 보면 헬스케어의 리더십에 근본적인 실패를 보여주며, 이는 전통적인 위계적 리더십과 관련되어 있음을 강조한다. 다른 말로는, 이론과 실천 사이에 갭이 있는 것이다.

Contemporary health care leadership is seen as something that should be distributed across many levels of an organisation and undertaken by those most appropriate to the situation, regardless of position or profession.1–3 This is reported to improve the patient experience, reduce errors, infection and mortality, increase staff morale, and reduce staff absenteeism and stress.4,5 However, reports from different contexts worldwide have illustrated fundamental failures in leadership in health care, highlighting that issues are related to traditional leadership hierarchies (e.g. the 2013 Francis Report1 in the UK and the 2008 Garling Report3 in Australia). In other words, there is a gap between theory and practice in health care leader- ship.


리더십을 개발할 수 있는 가장 효과적인 방법에 대해서 고려하기 전에, 이 주제에 대한 기존 문헌을 살펴볼 필요가 있을 것이다.

Before considering the most effective ways in which leadership can be developed, it is important to con- sider the health care literature on this topic.


우리가 사용한 '담화'라는 단어는 푸코가 '사고의 시스템'에 대해서 가졌던 관점이다. 담화를 이러한 방식으로 바라보는 것은 하나의 개념에 대해서 - 주어진 시간에 다양한 맥락에서 - 생각하고 대화하는 방식을 특징지어준다. 비록 우리가 문헌의 formal discourse analysis를 수행한 것은 아니지만 회색문헌(grey literature)와 학계 문헌에서 네 가지 포괄적인 리더십 담화를 ㄷ출했다.

The word ‘discourse’ is used here to describe discourse accord- ing to the Foucauldian view of discourse as a system of thought that is historically situated.6–8 Using dis- course in this way characterises a way of thinking and talking about a concept (such as leadership) that appears in a range of contexts (e.g. in research litera- ture or policy documents) at a given time.9 Although we did not conduct a formal discourse analysis of the literature, we identified four broad discourses of leadership in the grey and academic literature: indi- vidualist, contextual, relational and complexity dis- courses.


의학교육에서 리더십은 종종 배워야 하는 스킬이나 개발해야 하는 행동의 집합체로 정의된다.

In medical education, leadership is often defined as a skill to be learned or a set of behaviours to be developed.


예를 들어 영국에서 'Medical Leadership Competency Framework'가 2010년 개발되었고, 더 최근에는 'Healthcare Leadership Model'이 만들어졌다. 추가로 UK GMC는 모든 의사에게 있어서 '리더십과 관리'를 도달해야 하는 리더십 역량으로 지적하였다. 아마 이러한 역량의 관점에서 최근의 리더십 교육 프로그램에 관한 systematic review는 단지 지식/스킬/태도/행도의 교육훈련이 중등도(modest)의 효과만을 가짐을 보여주었다.

For example, within the UK context, a ‘Medical Leadership Competency Framework’ was developed in 2010 and more recently a ‘Healthcare Leadership Model’ has been created.24,27 In addition, the UK General Medical Council (GMC) document Leadership and Management for all Doctors pinpoints ways in which leadership ‘competencies’ can be met.28 Perhaps related to this competency focus, a recent systematic review of leadership education programmes described only a ‘modest’ impact of training on knowledge, skills, attitudes and behaviours.29


전통적으로 팔로워들은 리더십을 '받는 사람'으로 여겨지며, 리더십의 비전과 목표에 따라 행동하고 이를 조절(moderate)하는 사람으로 여겨졌다. 광범위한 리더십 문헌에서 팔로워십에 대한 구체적 논의는 없다.

Traditionally, followers are understood to be the ‘re- cipients’ of leadership who act on and ‘moderate’ the leader’s vision or goals.30 Within the wider lead- ership literature there is an acknowledged lack of specific discussion about followership, which is reflected in health care education research.31,32


헬스케어의 회색문헌은 공유된/전파된 리더십을 관계적 담화의 차원에 둔다. 그러나 경험적 연구를 보면 리더십 특성, 행동, 스타일 등을 만드는 것은 개인주의자적 담화와 잘 들어맞는다. 다른 연구 역시 이러한 개인주의를 관통하는데, 이 경우 좋은 리더를 만드는 것은 무엇인지, 어떤 사람에게 어떤 것이 필요한지 등에 초점을 둔다. 그러나 Fairhrst와 Uhl-Bein은 리더십 연구를 '개인에 기반을 둔 이론이나 설문을 넘어서 관계적 프로세스를 리더십의 핵심에 두어야 한다'라고 주장했다. 다른 사람들은 리더십의 정의를 보다 분명하게 할 것을 요구하면서, 맥락과 조직 시스템의 역할이 중요함을 인정했다.

The health care grey literature commonly argues for shared and distributed leadership, mapping to a relational discourse.33,34 However, empirical studies in health care have focused on establishing leader traits, behaviours and styles, aligned with an individ- ualist discourse (e.g.35,36). Other research perpetu- ates this individualism by focusing on defining what makes a good leader or what attributes belong to whom (e.g.37–39). However, Fairhurst and Uhl-Bein argue for leadership research approaches that ‘go beyond individual based theorising and survey approaches to the interactional processes at the heart of leadership’.40 Others have called for more distinct articulation of the definitions of leadership, recognising the important roles of context and organisational systems.41,42


종종 참가자들의 인터뷰로 헬스케어나 의학계에서 리더십 역할에 대해 다룬 적이 있다. 예를 들어 16명의 의학교육 리더를 인터뷰하여 Leiff와 Albert는 네 개의 핵심 리더십 수행 영역을 찾았으며, 리더들이 리더십 개발을 근무지와 연결시키는 것을 선호함을 밝혔다.

Often, participants of interview studies have already attained leadership roles within health care or academic medicine.43–45 For example, in interviews of 16 medical education leaders, Leiff and Albert45 found four key areas of leadership practice (intrap- ersonal, interpersonal, organisational and systemic) and reported that leaders preferred to link leader- ship development to the workplace.


Souba 등은 리더십이 어떤 맥락에서 개념화되는 방식이 그 리더십에 관한 대화와 그것이 시행되는 것에 영향을 준다고 했다.

Souba53 argues that the way in which leadership is conceptualised in a context affects how it is talked about and, indeed, enacted.




방법

METHODS


의미가 사회적 상호작용에 의해서 구성된다는 전데를 두고, 이 연구는 인식론적으로는 사회적 구성주의에 토대를 두고 있다. 이러한 인식론적 관점은 리더십이 사회적으로 구성되는 과정이며, 관계적이고 맥락적이라는 우리의 이론적 관점과 잘 맞는다. 현실에 대한 다양한 인식과 해석을 이해하는데 목적을 둔 연구질문에 대답하기 위해서 그룹 인터뷰와 개별 인터뷰의 thematic framework analysis 를 사용한 해석적 접은을 했다.

In line with the premise that meaning is con- structed through social interaction, this research is epistemologically grounded in social construction- ism.54 This epistemological stance aligns with our theoretical viewpoint that leadership is a socially constructed process that is both relational and contextual.40 In order to answer research questions aimed at understanding multiple perspectives and interpretations of reality, an interpretive approach using thematic framework analysis of group and individual interviews was employed.54,55


자료 수집

Data collection


A series of group and individual interviews were carried out at times and places convenient for par- ticipants. Individual interviews were offered when group interviews were not possible (e.g. as a result of work schedules). After they had provided written consent, participants were asked to complete an individual written data sheet, which included demo- graphic questions, plus space to provide free-text answers to the questions: ‘What is leadership?’ and ‘What is followership?’ 


An interview schedule was designed to provide guidance to the interviewers as to the structure of the interview for consistency in approach. Relevant to this paper, participants were asked about how they defined leadership and followership, and to explore their experiences of health care leadership and followership (at this point narrative interview techniques were used and are reported elsewhere [L.J. Gordon, C.E. Rees, J.S. Ker, J. Cleland. Exploring medical trainees’ experi- ences of leadership and followership through narratives of the health care workplace; unpublished paper 2015]). All interviews were audio-recorded (with permission) and along with the written answers to the free-text items, transcribed.



자료 분석

Data analysis


Thematic framework analysis was undertaken.55,57 Familiarisation with the data was achieved by listening to audio-recordings while reading transcripts. At this point, all transcripts were checked for accuracy, and paralinguistic features (e.g. pauses, laughter) were added and data were anonymised. The research team then developed a thematic framework through dis- cussion and negotiation of key themes. An initial cod- ing framework was drafted which included both what participants said and how they said it (this was done by listening to the interviews whilst reading tran- scripts). All data pertaining to trainees’ definitions of leadership and followership were coded as dimen- sions of leadership and followership (‘dimensions’ being akin to the ‘themes’ of the definitions) using ATLAS.ti Version 7.0 (Scientific Software Development GmbH, Berlin, Germany). New dimensions were added as and when identified (and agreed through further discussion within the research team).



In addition, we coded these definitions as either solicited (when participants were specifically asked to define leadership or followership) or unsolicited (when participants volunteered a definition of lead- ership or followership as part of the general discus- sion or within narratives). Differentiating between solicited and unsolicited definitions allowed us to make comparisons between structured and unstruc- tured parts of the interviews and perhaps identify differences in explicit/conscious and tacit/uncon- scious understandings of leadership and follower- ship.58 These definitions were then mapped to the discourses of leadership common in the literature: individualist, contextual, relational and complexity discourses (Table 1).



ATLAS.ti software allowed us to explore patterns in the data in terms of differences between trainee groups. It is increasingly common within qualita- tive research to numerically explore such patterns through the use of computer-assisted qualitative data analysis software (CAQDAS).59 We interro- gated the data according to four specialty groupings: 

    • (i) surgical (including trauma and orthopaedics, general surgery, ear, nose and throat [ENT], obstetrics and gynaecology); 
    • (ii) medical (including general medicine, emergency medicine, psychiatry, cardiology, renal medicine, acute medi- cine, paediatrics and core medical training); 
    • (iii) general practice (GP), and 
    • (iv) service specialties (including anaesthesiology, radiology and pathology). 


We also explored patterns in the data according to training stage: 

    • (i) early-stage (Foundation Programme [FP] trainees, core trainees and specialty trainees at or prior to the half-way point of specialty training), and 
    • (ii) higher-stage (trainees beyond the half-way point of specialty training up to certificate of completion of training).




결과


리더십 차원: (행동)으로서의 리더십

Leadership dimension: leadership as behaviour 


리더십은 다음의 행동을 포함하는 것으로 정의된다: 효과적 의사소통, 효과적 위윔, 자신감, 조화, 사례 제시, 의사 결정 등

Leadership is defined as behaviour including: effective communication; effective delegation; confidence; coordination; setting example; decision making, etc.


리더십 차원: (역할)로서의 리더십

Leadership dimension: leadership as role


피훈련자들은 직군간 업무가 있는 상황에서, 의사로서 그들 자신을 리더로 기대했다. 피훈련자들은 또한 리더를 명명된 역할 혹은 단계-특이적인 것(GP혹은 컨설턴트가 리더이다)으로 말했다.

Trainees describe the expectation by themselves and others in the interprofessional workplace that as doctors, they are the leader. Trainees also talk about leader as a named role or described as stage-specific (e.g. GP or consultant equals leader)


리더십 차원: (위계)으로서의 리더십

Leadership dimension: leadership as hierarchy


리더십은 의료 혹은 직군간 위계의 한 부분이었다. 여기에는 주니어 피훈련자도, 만약 그 맥락에서 가장 시니어라면, 자동적으로 의사가 되는 상황도 포함한다.

Leadership is talked about as something that is part of the medical or interprofessional hierarchy. This includes when a junior trainee, as the most senior person within a context, will automatically be the leader


리더십 차원: (그룹 프로세스)으로서의 리더십

Leadership dimension: leadership as group process


이 영역은 팀워크와 관련된 것이며, 단직군, 다직군 상황에 모두 관련된 것이다. 피훈련자들은 리더십을 팀의 한 부분이 되는 프로세스라고 언급했으며, 소속감과 그룹의 목표에 초점을 두는 것을 통해 팀 수행능력과 긴밀히 연관된다고 했다.

This dimension is focused around team working that is both uni- and interprofessional. Trainees talk about leadership as a process that is part of team working and closely related to team performance through a sense of belonging and with a focus on group goals


리더십 차원: (인성)으로서의 리더십

Leadership dimension: leadership as personality


여기에 해당하는 사례는 인성 혹은 어떤 개인이 '타고난' 리더인 것이다. 다른 것으로는 리더 위치에 있기를 좋아하는 사람에 대한 것도 있다. 종종 이 영역에서 리더가 만들어지는 것인지 타고난 것인지에 대한 논의가 있었다.

Examples of this include trainees’ talk about dominant personalities or individuals being ‘natural’ leaders. Other data talks about people who prefer to be in leadership positions. Often within this dimension there was discussion about whether leaders were ‘born’ or ‘made’


리더십 차원: (원칙과 가치)으로서의 리더십

Leadership dimension: leadership as principles and values


피훈련자는 리더는 공정하고, 다가갈 수 있고, 코치해주고 지지해주며, 팔로워들이 개발과 학습할 수 있게 해주는 것이라고 했다.

Trainees talked about a leader being fair, approachable, coaching and supportive, and allowing followers to develop and learn


리더십 차원: (책임)으로서의 리더십

Leadership dimension: leadership as responsibility


피훈련자들은 리더십이 어떻게 임상적 책임과 동등한지 설명했다. 주어진 상황에서 궁극적인 임상적 책임을 갖는 사람이 리더였다.

Trainees describe how leadership equates to clinical responsibility. The person who has ultimate clinical responsibility within a given situation was perceived to be the leader


리더십 차원: (스킬)으로서의 리더십

Leadership dimension: leadership as skills


리더십을 협상기술, 위임기술이라고 묘사했다. 이는 구체적으로 어떤 스킬을 언급했다는 것에서 '행동'과는 차이가 있는데, 또한 구체적 임상 스킬 역시 한 개인을 리더로 규정하는 것이라 했다.

Trainees describe leadership as skills such as negotiation skills, delegation skills. This differs from behaviours in that there is specific mention of skills. Trainees also describe specific clinical skills that identify a person as the clinical leader







팔로워십 차원: (행동)으로서의 팔로워십

Followership dimension: followership as behaviours


이 영역은 팔로워십을 피훈련자가 임상 현장에서 일반적으로 지녀야 할 행동의 집합으로 보았다.

This dimension focuses on followership being a set of individual behaviours which trainees perceive to be typical within the health care workplace


팔로워십 차원: (능동적 참여자)으로서의 팔로워십

Followership dimension: followership as active participant


팔로워십을 주어진 상황에서 리더가 누군지 선택하거나 능동적으로 리더를 지지하는(혹은 지지하지 않는) 것이라 했음.

Trainees described followers choosing who the leaders are in a given situation or through actively supporting (or not supporting) the leader


팔로워십 차원: (프로세스)으로서의 팔로워십

Followership dimension: followership as group process


피훈련자는 팔로워들이 팀 내에서 행해야 하는 역할로 이해하였다. 여기서 팔로워는 팀 구성원 또는 팀 플레이어로 여겨졌다. 일부 피훈련자들은 '팔로워'를 '팀멤버'와 상호교환적으로 사용했다.

This dimension describes trainees’ understandings of the role that followers have to play within a team. Within this, followers are seen to be team members and team players. Some trainees used the terms ‘follower’ and ‘team member’ interchangeably


팔로워십 차원: (모르는 단어)으로서의 팔로워십

Followership dimension: followership as unknown term


피훈련자들은 팔로워십을 몰랐던, 혹은 새로운 단어라고 했다. 일부 피훈련자들은 이 연구를 위해 만든 단어가 아니냐고 물었다.

Here, trainees explicitly state that ‘followership’ is an unknown or new term. Some trainees questioned whether the term had been made up for the purpose of this study


팔로위섬 차원: (수동성)으로서의 팔로워십

Followership dimension: followership as passive


수동적인 것으로 보았다. 어떤 지시를 맹목적으로 따르거나 그룹 목표를 설정하는 데 참여하지 않는 것이다.

Here, trainees see followership as passive. Trainees describe following instructions ‘blindly’ and with no participation in decision making about group goals


팔로워십 차원: (위계)으로서의 팔로워십

Followership dimension: followership as hierarchy


만약 어떤 시니어가 존재하는 상황이 있다면, 그를 따라야 하며, 그래서 팔로워십이라고 하기도 함.

Trainees link followership talk about the clear- cut assumption that if there is someone more senior present, trainees will defer to them and are therefore followers


팔로워십 차원: (인성)으로서의 팔로워십

Followership dimension: followership as personality


한 사람의 인성과 관계된 것. 리더십 특성이 없거나, 그래서 기본적으로 팔로워가 될 수밖에 없는 것

Trainees talk about followership as something relating to someone’s personality. They were often seen to be lacking leadership traits and therefore by default they become a follower


팔로워십 차원: (역할)으로서의 팔로워십

Followership dimension: followership as role


다직군간 근무환경에서 주니어 의사를 팔로워가 되어야 한다고 기대했다. 이 영역은 피훈련자들의 다직군간 상황에서 누가 리드하고 누가 따르는지에 대한 역할과 기대에 대한 것이었다.

Trainees expect junior doctors to be the followers within the interprofessional health care workplace. This dimension is also relevant when trainees are talking about interprofessional roles and expectations of who should lead and who should follow (e.g. doctors as leaders and nurses as followers)




리더십과 팔로워십에 대한 담화

Discourses of leadership and followership



개인주의적 담화

Individualist discourse

 

가장 흔하게 드러난 것으로서 피훈련자들은 근무지에서 '한 명의 리더'를 특정해냈다. 리더십을 정의하는 데 있어서 개인주의적 아이디어는 개인의 행동, 인성, 리더십 스타일의 묘사로부터 드러난다. 피훈련자들은 또한 리더를 임명되는 것 혹은 직위와 같은 개인차원의 것으로 보면서, 한 개인이 가진 지식이나 전문성에 따라 어느 개인을 리더로 정의했다.

As the most commonly identified discourse mapped to talk across the dataset (Table 4), trainees would single out ‘the leader’ within their workplace. Individualist ideas about defining leadership were articulated through descriptions of individual behaviours, personality and leader- ship style. Trainees also described leaders individualistically with relation to designation and role, defining individuals as leaders as a result of their knowledge and expertise (Table 3, Quote 16).


맥락적 담화

Contextual discourse


어떤 것에 있어서 어떤 사람을 리더로 보고, 다른 것에 대해서는 다른 사람을 리더로 본다는 식의 접근이 있었다. 또한 어떻게 한 맥락에서 맥락 내에서의 지위와 책임의 적절성에 따라서 서로 다른 개인들이 리더십을 맡게 되는지를 설명했다. 리더는 상황에 따라서 리더십 스타일을 적용해야 하며, 예컨대 일상적 임상상황과 급성 심장마비 상황에서 달라야 한다고 했다.

Trainees explained that they might approach cer- tain leaders for certain things (e.g. to resolve con- flict) and others for different issues (e.g. career planning). Trainees also described how in certain contexts (e.g. surgical theatre), different individuals would take on leadership as it was appropriate to their position and responsibilities within that con- text (Table 2, Quote 7). Leaders were also seen to adapt their leadership style according to the situa- tion, for example, as they moved from routine clini- cal care to an acute cardiac arrest.



관계적 담화
Relational discourse


토론의 많은 부분에서 효과적인 팀워크와 어떻게 리더가 팀워크를 조절하고 촉진하는지가 언급되었으며, 특히 solicited definition에서 그러했다. 피훈련자들은 팀 구성원(팔로워)를 리더의 결정에 영향을 주는 핵심으로 보았다. 피훈련자들은 의료에서의 위계를 언급할 때 관계적 담화와 연결시켰으며, 이는 특히 그 위계에서 스스로의 위치를 정의하는 관점에서 그러하였다.

Effective team working and how leaders coordinated and facilitated this represented the focus of much discussion, particularly within solicited definitions. Trainees saw team members (or followers) as key to influencing a leader’s decisions; who the leaders and followers were in their workplaces were thought to remain static (Table 3, Quote 11). Trainees also aligned with a relational discourse when discussing the medical hierarchy, in particular from the per- spective of defining their own position within that hierarchy (Table 3, Quote 14).



복잡성 담화

Complexity discourse


피훈련자들은 리더십과 팔로워십을 개인에게 부여된 특성이라기보다는 프로세스로 보았다. 리더십은 헬스케어 팀에서 늘 움직이는 역동적인 것이며 상황에 따라 협상해야 하는 것이다. 여러 개인과 관계, 맥락의 복잡한 상호작용에 대해 언급하면서 그 즉각적 상황의 요구에 따라 '한 발 나아가기' '한 발 후퇴하기'를 하는 것이 리더십과 팔로워십이라고 했다. 복잡성 담화는 가장 적게 언급된 것이었다.

Trainees talked about leadership and followership as representing a process rather than as characteristics attributed to an individual. Leadership was seen as a dynamic entity that moved around the health care team and was negotiated according to the situation. Trainees talked about the complex interplay among individuals, relationships and context, and described ‘stepping forward’ or ‘stepping back’ into leadership or followership roles according to the needs of the immediate situation. Complexity was the discourse least mapped to talk across the dataset.

 

 



DISCUSSION


우리는 우리의 질문을 이전 리더십 연구에서 사용된 것과는 다르게 구성하였다. 개인의 행동, 특성, 기술에 초점을 두기 보다는 '무엇이 리더십이고' 무엇이 팔로워십이냐'를 물었고, '무엇' 혹은 '누구'가 좋은 리더냐고 묻지 않았다. 이러한 접근을 통해서 리더십과 팔로워십을 정의하는 다양한 방식을 찾았다. 여기서 드러난 영역의 폭이 넓지만 리더십을 이해할 때 보다 덜 복잡한 방식의 선호가 두드러졌다(행동, 위계, 인성). 특히 unsolicited talk에서 개인주의적 관점이 피훈련자의 이해를 지배하고 있었음을 강조한다.

We framed our questions differently from those used in previous leadership research. Rather than focus- ing on an individual’s behaviour, traits and skills,40 we asked participants to discuss ‘what is leadership’ and ‘what is followership’ rather than ‘what’ or ‘who’ makes a good leader. Through this approach, we explored the multiple ways in which leadership and followership can be defined. Despite the breadth of dimensions identified, the preference was for more unsophisticated ways of understanding leadership (such as behaviours, hierarchy and per- sonality), particularly in unsolicited talk, highlight- ing that an individualist focus dominates medical trainees’ understandings.


피훈련자들이 초반에 팔로워십의 정의에서 어려워했던 부분은 현대 문헌에서 리더-팔로워 관계의 묘사와도 echo한다. 예컨대 팔로워는 종종 리더십 과정에서의 능동적 참여자로 구성되어진다. 그러나 이 대화의 많은 부분은 본질적으로 가설적이고, 인터뷰가 unsolicited talk로 갈수록 팔로워십에 대한 설명은 줄어들었다. 이는 팔로워 혹은 팔로워십이라는 용어와 관련한 우리의 관찰결과가, 비록 현대의 리더십 문헌에서는 흔한 것이더라도, 헬스케어 영역에서는 많이 사용되는 것이 아님을 보여준다. 주자하건대, 팔로워 혹은 팔로워십이라는 용어는 '팀'이라는 용어로 대체된다.

Initial difficulties in getting trainees to define fol- lowership gave way to descriptions echoing contem- porary definitions of leader–follower relationships in the literature; for example, followers were some- times constructed as active participants in the lead- ership process.61 However, much of this talk was hypothetical in nature and as discussion moved on to unsolicited talk, explanations of followership became scarce. This may be related to our observa- tion that the terms ‘follower’ and ‘followership’, although commonplace within the contemporary leadership literature, are not widely utilised within health care spheres. Arguably, the terms ‘follower’ and ‘followership’ in health care are replaced by terms referring to ‘teams’.4,24,26


수련 단계에 따라 개념적 차이가 있는 것을 보면, 낮은 수련단계의 경우 높은 단계인 경우보다 리더십을 덜 복잡하게 개념화하고 있었다. 이는 리더십에 대한 직무 경험이 적고 formal 리더십 개발 프로그램에서 끌어낼 능력이 적은 것이 이유일 것이다.

Exploring differences in conceptualisations between training stages revealed that early-stage trainees held less sophisticated conceptualisations of leadership than higher-stage trainees. This may reflect their limited workplace experiences of leadership and their inability to yet draw on any formal leadership development programmes (these being typically reserved for higher-stage trainees in the UK).63


 

우리 연구는 피훈련자가 리더십을 개념화하는데 맥락의 영향 (전공 유형에 따라) 이 있음을 강조한다. Willcocks는 서로 다른 의료 전공 내에서 문화적 맥락에 영향을 주는 여섯 개 요인을 찾았다.

Our research also highlighted the influence of con- text (in terms of specialty grouping) on trainees’ conceptualisations of leadership. Willcocks identi- fied six factors that influence cultural context within different medical specialties, including

  • 역사적 배경 historical background,
  • 직무의 특성과 기술의 활용 the nature of the work and use of tech- nology,
  • 내적-외적 관계 internal and external relationships,
  • 개인주의와 동기 individu- alism and motivation,
  • 전공-간 상호작용과 의사소통 inter-specialty interaction and communication, and
  • 가치와 사회화 values and socialisation, and

그러면서 서로 다른 전공문화가 '매니지먼트'를 서로 다른 방식으로 경험한다고 했다.

argued that different specialty cultures experience ‘management’ (and thus possibly leadership) in dif- ferent ways.50

 

예를 들면 수술관련 전공

For example, surgery is well known for its traditional hierarchical practices. The use of various tools to rate surgeons’ leadership beha- viours, including example setting and individual performance indicators, might, for example, perpet- uate an individualist discourse with respect to surgi- cal leadership.51,52,64

 

각 전공 내에서 교육활동도 영향을 줄 것이다. 예를 들면 마취과에서 리더십은 non-technical skill이다. 이러한 요인을 고려하면, 전공 간 리더십을 서로 다르게 개념화하는 것은 놀랍지 않다. 다시 한 번, 전공 사이의 차이는 맥락과 교육이 리더십과 팔로워십을 개념화하는데 있어서 중요한 역할을 함을 강조한다.

Educational practices within specialties may also influence conceptualisations of leadership and followership; for example, within anaesthesia, leadership is seen as a non-technical skill to be learned.65 Given these factors, it is per- haps unsurprising that differences in conceptualisa- tions were identified across specialties.50 Again, the differences among specialty groups highlight the important roles that context and educational influence can play in how leadership and follower- ship are conceptualised.




24 National Health Service Leadership Academy. Healthcare Leadership Model: The Nine Dimensions of Leadership Behaviour. Leeds: NHS Leadership Academy 2013. 


25 Stoller JK. Commentary: recommendations and remaining questions for health care leadership training programmes. Acad Med 2013;88:12–5. 


26 Royal College of Physicians Canada. CanMEDs 2015: Stepping up emphasis on leadership competencies. Dialogue. http://www.royalcollege.ca/portal/page/ portal/rc/resources/publications/dialogue/vol13_10 /canmeds2015_leadership. [Accessed 8 October 2015.]












 








 2015 Dec;49(12):1248-62. doi: 10.1111/medu.12832.

Dimensionsdiscourses and differencestrainees conceptualising health care leadership and followership.

Author information

  • 1Medical Education Institute, School of Medicine, University of Dundee, Dundee, UK.
  • 2Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia.
  • 3Division of Medical and Dental Education, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK.

Abstract

CONTEXT:

As doctors in all specialties are expected to undertake leadership within health care organisations, leadership development has become an inherent part of medical education. Whereas the leadership literature within medical education remains mostly focused on individual, hierarchicalleadership, contemporary theory posits leadership as a group process, which should be distributed across all levels of health care organisation. This gap between theory and practice indicates that there is a need to understand what leadership and followership mean to medical trainees working in today's interprofessional health care workplace.

METHODS:

Epistemologically grounded in social constructionism, this research involved 19 individual and 11 group interviews with 65 UK medicaltrainees across all stages of training and a range of specialties. Semi-structured interviewing techniques were employed to capture medical trainees' conceptualisations of leadership and followership. Interviews were audiotaped, transcribed verbatim and analysed using thematic framework analysis to identify leadership and followership dimensions which were subsequently mapped onto leadership discourses found in the literature.

RESULTS:

Although diversity existed in terms of medical trainees' understandings of leadership and followership, unsophisticated conceptualisations focusing on individual behaviours, hierarchy and personality were commonplace in trainees' understandings. This indicated the dominance of an individualist discourse. Patterns in understandings across all stages of training and specialties, and whether definitions were solicited or unsolicited, illustrated that context heavily influenced trainees' conceptualisations of leadership and followership.

CONCLUSIONS:

Our findings suggest that UK trainees typically hold traditional understandings of leadership and followership, which are clearly influenced by the organisational structures in which they work. Although education may change these understandings to some extent, changes inleadership practices to reflect contemporary theory are unlikely to be sustained if leadership experiences in the workplace continue to be based on individualist models.

© 2015 John Wiley & Sons Ltd.

PMID:
 
26611190
 
[PubMed - in process]


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