Effect of a novel healthcare leadership program on leadership and emotional intelligence

Abstract

The purpose of this study was to assess the effectiveness of the Feagin Leadership Program (FLP) in teaching leadership domains and emotional intelligence. An anonymous survey of 178 graduates of FLP (2011–2019) including the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF) was used to assess emotional intelligence and program views. ANOVA was used to compare the difference in emotional intelligence domains between groups. Respondents reported the FLP most improved skills in communication, emotional intelligence, and team building. Medical students (18, 38.3%) and faculty/staff (5/14, 35.7%) reported the most relevant domain was emotional intelligence; residents/fellows reported the most relevant domain was teamwork (8/37, 21.6%). Respondents in residency/fellowship had the highest score in emotionality (P = .01). These results suggest that a healthcare leadership program tailored to medical trainees was effective in improving their competency in various leadership domains, and that emotional intelligence and teamwork were the most relevant components of the program.

Introduction

Leadership is an essential quality needed in medical providers. Our current healthcare system in the United States places a premium on teamwork to effectively deliver medical care, requiring not only clinical knowledge but certain skills like conflict management to optimize patient care.^1-3 In addition to the leadership needed to manage daily clinical activities, many physicians will be thrust into a leadership role at some point in their careers to help manage increasingly complex systems of care.⁴

Despite the need for leadership, traditional medical training does not teach many of the leadership skills necessary for physicians in the current healthcare environment.⁴ In the past, medical students and residents have been expected to primarily acquire leadership through the observation of others due to a lack of formalized leadership training in many medical education programs.^5-7 Although some programs exist, interventions in leadership education, particularly in residents, often show poor effectiveness and may focus too much on cognitive domains as opposed to conceptual frameworks.⁸ Thus, there is a need for programs that provide an evidence-based framework for leadership education in the context of current training programs.⁷

The content and structure of an effective leadership development program within medical education continues to be a significant focus of research. Over the last 20 years, different institutions have developed healthcare leadership education programs, with varying methodology and focus.⁹ In a systematic review assessing type of leadership, environment, and educational impact, Careau et al. were unable to definitively assess the effectiveness of these programs due to the heterogeneity of educational methods.¹⁰ In practice, development of certain competencies such as emotional intelligence has been shown to improve physician resiliency, decrease burnout, improve communication and confliction resolution, improve productivity, and decrease errors.^3,11-14 With regards to structure, team-based approaches, active learning in the form of role play and practice of skills, and 360° assessment have been found to be effective strategies in sustainable development in clinical leadership.¹⁵

With these factors in mind, the Feagin Leadership Program (FLP) was created at Duke University School of Medicine. The FLP was created to serve as a foundation upon which to build a leadership curriculum to teach learners leadership skills useful not only in healthcare but generalizable to many different facets of life.^16,17 The program curriculum is based around the Duke Healthcare Leadership Model, a model developed from literature review and a concept mapping approach as previously published by Hargett et al.¹⁶ The program is a nine-month immersive program for medical students, residents, and fellows that uses didactic sessions, small group discussions, simulations, role play, and project based learning to intentionally promote leadership development in medicine. The curriculum accomplishes this through focusing on the core principle of patient centredness with core competencies of integrity, teamwork, critical thinking, emotional intelligence, and selfless service.^16,17

Our objective was to assess the effectiveness of the Feagin Leadership Program to develop leaders in the healthcare field through self-reported activity and perceived improvement in emphasized leadership domains. Additionally, we sought to assess the relevance of the provided tools and education to leadership activity after the program and asses the overall emotional intelligence of previous program participants.

Methods

An anonymous confidential electronic survey was developed using the Research Electronic Data Capture (REDCap, Nashville, TN, https://projectredcap.org). Participants were asked to describe prior leadership training experience, current leadership positions, and the degree to which the FLP helped them improve competency in targeted leadership domains. Using a 5-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, and 5 = strongly agree), participants were asked to self-assess their growth in these domains, the domain’s relevance to their current leadership activities, their comfort in assuming further leadership opportunities, and to what extent they believed the FLP had facilitated their successful leadership. Answers were stratified based on current level of training or position.

The survey and an electronic version of Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF) were sent to the 178 participants who had completed the FLP from 2011 to 2019 through REDCap.^18-20 Different evaluations of emotional intelligence have been utilized in existing literature; we chose to utilize the TEIQue-SF due to its ease of use and validity evidence.^12,21,22 Previous research has shown similarities in scoring between the TEIQue-SF and the original, 153-item TEIQue survey; thus, the short form was used to avoid survey fatigue.²² Other core competencies were not assessed with objective measures to limit survey burden. A secondary e-mail was sent to participants who had not responded to the survey after one month to encourage participation in the anonymous survey.

The TEIQue-SF is a 30-item tool that yields an overall emotional intelligence score, and sub domain scores for: well-being, self-control, emotionality, and sociability.²³ The TEIQue-SF asks participants to rate questions on a scale of 1 to 7, 1 = completely disagree and 7 = completely agree. Z-scores from this tool were stratified by level of training; mean scores were calculated for each of the four subdomains of emotional intelligence. The inter-subject reliability of each of these domain scores were assessed with Cronbach alphas. Mean scores were compared to each other through analysis of variance (ANOVA) testing.

The Duke University School of Medicine Institutional Review Board determined the current study to be exempt on November 25, 2019.

Results

A total of 101 previous participants responded to the survey (56.7% response rate). The mean age of respondents was 34.1 years (range 25–55, standard deviation 7.36 years) with 70 men and 31 women. Fifty-two respondents (51%) were still in medical school, residency, or fellowship programs. Of the respondents who had finished medical training, 27 (26.7%) were faculty at an academic medical centre, 13 (12.9%) were in private practice, 7 (6.9%) were a hospital employee, and 2 (2.0%) were in a position outside of medicine.

Thirty-nine (38.6%) respondents reported prior formal leadership training/education with the most common source being a degree program or formal coursework (18.8%, Figure 1). Ninety-two (91%) respondents reported involvement in leadership activities after the FLP (Figure 2).

Figure 1.

Sources and prevalence of prior leadership experience.

Figure 2.

Leadership activities since program completion.

Of the leadership skills promoted by the program—communication, empathy, provided a framework for a leadership model, team building, coaching, emotional intelligence, mindfulness, professional etiquette, leadership philosophy, resilience, and time management—respondents were most likely to report the program helped with communication (83, 82.2%), emotional intelligence (65, 64.4%), and team building (64, 64.6%) (Figure 3).

Figure 3.

Leadership domains helped by the program as reported by respondents.

Additionally, respondents were asked to rank the five core competencies of the Duke Healthcare Leadership Model based on their relevance for their current leadership activities. Out of 100 respondents to this section, 32 ranked emotional intelligence as the most relevant competency while only five ranked selfless service as the most relevant. Medical students (18, 38.3%) and faculty/staff (5/14, 35.7%) reported that the most relevant domain was emotional intelligence; residents/fellows reported the most relevant domain was teamwork (8/37, 21.6%).

With regard to current leadership activities, 90.5% agreed/strongly agreed that the program improved their overall comfortable in assuming leadership. 76.2% agreed/strongly agreed that the program was a substantial factor in their success. Thirty-one respondents recommended additional skills for the FLP to include to enhance its effectiveness, including 13 who specifically mentioned negotiation or conflict management.

Seventy-eight participants completed the TEIQue-SF survey (43% response rate). The highest level of emotional intelligence was in the domain of well-being (6.24), followed by emotionality (5.67), self-control (5.31), and sociability (5.3) (Figure 4). There were significant differences among the faculty, resident/fellow, and medical student groups in the domain of emotionality (p=.01) with medical students recording the highest level. Well-being (P = .23), self-control (P = .20), and sociability (P = .29) scores were not statistically different. The inter-subject reliability assessment of the different domains was assessed via Cronbach’s alpha scores which were found to be acceptable (0.7–0.8) or questionable (0.6–0.7) for all domains (well-being = 0.77, self-control = 0.65, emotionality = 0.78, and sociability = 0.66).

Figure 4.

Results of the Trait Emotional Intelligence Questionnaire Short form (TEIQue-SF) Based on Current Level of Training.

Discussion

Leadership is an increasingly important competency within the healthcare workforce with continued research seeking to better understand the necessary domains of that competency as well as how to develop and assess it.^{7,14,16,24-28} An increasing number of programs at various levels of training are being developed to meet both the need for leadership training and the desire of leadership training by many medical trainees.^3,7,15,29,30 Almost 40% of respondents reported previous leadership training prior to participating in the FLP, with the largest source being previous coursework. Since elective courses in leadership are not typically available within medical education, programs must find unique ways to integrate into training environments. The FLP seeks to include medical students, residents and fellows in a team-based program outside of clinical training with the goal of developing effective, ethical leaders in healthcare.¹⁷

In evaluating overall leadership activity, over 90% of respondents had a current leadership position, 91% felt the program made them feel more comfortable to assume leadership opportunities and 76% felt the program contributed to their success. Although many factors may affect one’s ultimate participation in leadership activities including previous leadership experience, our results suggest that such a program can provide education, experience, and skills that allow interested leaders to be more prepared and, likely as a result, more comfortable being active in leadership.

The FLP showed varying ability to improve individual leadership skills. Over 80% of respondents reported improvement in communication and 50% reported improvement in leadership philosophy, providing a framework for a leadership model, team building, and emotional intelligence. However, fewer than 20% of people reported improved time management and less than 30% reported improved empathy. We believe this is likely secondary to the structure of the program, which is in addition to current responsibilities of participants’ respective roles, likely adding to their respective workload without specific time management content. Also, except for teams who pursue projects directly involving patients, no new direct patient care is included in the program, perhaps limiting the ability of discussions on empathy to be actualized in immediate experience. Thus, limitations of structure in addition to content should be considered when deciding what skills or domains should be a source of emphasis.

Additionally, this study noted that the value of different domains may differ based on one’s current position or activities. While residents/fellows noted teamwork as the most important domain of the model in their current work, medical students and faculty identified emotional intelligence. Emphasis on teamwork and managing team members is consistent with other studies looking at leadership needs in particularly in residents, as is respondents request for more emphasis on conflict management, something we will emphasize in future programs.²⁴ However, other studies focused on physician-leaders have noted the importance of more practical skills (such as finance and human resources) and industry knowledge.²⁶ Given that all respondents were in medical training programs at the time of FLP participation, our data show that the perceived value of certain domains may differ based on current activities or positions. Thus, any leadership program must understand and adapt to their target audience.

Emotional intelligence has also been noted to be a necessary domain for effective leadership and leadership training in healthcare.³¹ Although higher emotional intelligence has not necessarily correlated with overall performance metrics, it has been associated with other factors, such as well-being and job satisfaction.^12,13,21,32 Our data demonstrated minimal but statistically significant difference among different groups with regards to emotionality (0.81 between current medical students and faculty and 0.68 between current medical students and current residents or fellows) and no significant difference with other factors. With medical students being found to have the highest levels of emotionality, our data suggest that level of training does not itself imply a certain level of emotional intelligence. This is important in that it implies that other factors besides training level or experience level play a significant role in determining emotionality. Alternatively, this may show that the program’s training results in a similar level of emotional intelligence among all participants. Further research is needed to explore the determinants of emotionality and emotional intelligence.

Limitations

Our study has several important limitations. First, it was conducted at a single, highly ranked institution with a curriculum that changed somewhat over time. Thus, our demographic makeup of participants may not be representative of medical trainees undergoing leadership education around the country and may make our findings less generalizable. Our small sample size precluded our ability to analyze each cohort separately to see if self-reported outcomes changed as the program itself matured. Additionally, the required application and high rate of previous leadership training (40%) implies a certain level of motivation for leadership within the studied cohort that may not apply generally to all trainees. Our response rate of 56.7% is slightly above the average response rate reported for organizational research but may still provide a source of bias due to the number of non-respondents.³³

Evaluation of our curriculum was limited as it was retrospective and lacked objective data for participants prior to the program for comparison. Although we could not directly measure pre- and post-participation changes, we included components of reaction, learning and behavior within our assessment and utilized self-assessment as commonly seen in other program evaluations.^34,35 Though the lack of data before and after participation limits our ability to control for confounding influence and directly correlate the results to program participation, we did try to ask questions about the respondents’ leadership activity and skills specifically in relation to past program participation when possible.

Finally, we ensured that collected information was anonymous to limit reporter bias. However, the accuracy of the data is obviously contingent on the accuracy and completeness of the information provided by the respondents.

Conclusion

The results of this study suggest that a health leadership program tailored to medical students, residents, and fellows was effective in supporting their future leadership roles improving their competency in various leadership domains. Emotional intelligence and teamwork were identified as the most relevant components of the program. Participants identified important enhancements to our curriculum, such as negation or conflict management. Medical students were found to have the highest level of emotionality via the TEIQue-SF.

Footnotes

Declaration of conflicting interests

Dean Taylor is the chairman of the Feagin Leadership Program.

ORCID iD

Grant H. Cabell

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