Exploring the Dynamics of Physician Engagement and Leadership for Health System Improvement: Prospects for Canadian Healthcare Systems

by Jean-Louis Denis et al. | Apr 16, 2013

Jean-Louis Denis, Full Professor, École nationale d'administration publique

G. Ross Baker, Full Professor, Institute of Health Policy, Management and Evaluation, University of Toronto

Charlyn Black, Professor, School of Population and Public Health, University of British Columbia

Ann Langley, Professor, Department of Management, HEC Montréal

Bernard Lawless, Physician, St. Michael‘s Hospital, University of Toronto

Diane Leblanc, Organizational Psychologist, Capital District Health Authority, Halifax, Nova Scotia

Maria Lusiani, Postdoctoral Fellow, HEC Montréal

Charlotte Moore Hepburn, Assistant Professor, Department of Paediatrics, University of Toronto School of Medicine

Marie-Pascale Pomey, Associate Professor, Université de Montréal

Ghislaine Tré, Postdoctoral Fellow, St. Mary‘s Hospital, Montréal


  • Physician leadership and physician engagement are essential elements of high-performing healthcare systems, contributing to higher scores on many quality indicators. Likewise, physician participation in hospital governance can improve quality and safety.
  • Although much of the literature on healthcare reforms suggests the importance of physician engagement and leadership, this literature is less explicit about the processes by which health systems and organizations can convert physicians‘ autonomy, knowledge and power into resources for health system performance and improvement.
  • Physician leadership is important at the apex of the organization, but leadership occurs at all levels of the system. Increasing attention is being paid to high-performing clinical microsystems as well as new leadership modalities (e.g. dyads of physician and manager leaders and other forms of distributed leadership) and processes (e.g. physician ―compacts) that are fostering what some refer to as ―organized professionalism.
  • Physician engagement does not happen on its own. Organizations must use diverse strategies and initiatives to strengthen physician engagement and leadership, including (but not limited to):
    • physician compacts as mechanisms that help clarify roles, expectations and accountabilities between physicians and other system leaders
    • leadership that is linked to broader improvement strategies to create a receptive context for physician engagement in improving clinical outcomes
    • leadership development—especially for collective and distributive leadership—to support physician engagement
    • teams and team leadership—especially inclusive leadership—as a favourable context for physician engagement and leadership and performance improvement
  • A key variable for success in these approaches to physician involvement is trust between physicians and organizations, which can develop around these elements: open communication, willingness to share relevant data, creating a shared vision and accumulating evidence of successful collaboration.
  • True physician engagement and leadership begins with understanding and addressing the underlying characteristics and values of the engaged physicians.
  • Organizationally, physician engagement depends on a mosaic of factors and can therefore be difficult to achieve. Physician leaders may experience obstacles in assuming leadership roles in organizations and systems. Such obstacles may be partly attenuated with purposeful changes to shape the organizational culture (called ―cultural work).
  • Successful strategies to engage physicians need to go beyond, but not ignore, appeals to their economic motives. In the same vein, formalized strategic leadership positions are important but are insufficient to effect high performance. Because of the major ―cultural problems posed by management–professional tensions, economic and symbolic solutions do not necessarily translate into greater physician engagement. The main challenge is to bridge and integrate cultures, not buy commitment.
  • Developing physicians‘ skills and competencies to support improvements in health systems means targeting a full range of physicians rather than only individual physicians. Key core competencies for engaging and fostering physician leadership include leadership, strategic planning, ―systems thinking, change management, project management, persuasive communication and team building.