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Table of Contents
ORIGINAL RESEARCH
Year : 2019  |  Volume : 2  |  Issue : 1  |  Page : 19-26

Interprofessional leadership development for health professions learners: A program and outcomes review


1 Center for Interprofessional Health Education, University of Kentucky, Kentucky, USA
2 Department of Clinical Sciences, College of Health Sciences, University of Kentucky, Kentucky, USA
3 Inpatient Rehabilitation Unit, Children's Hospital of Michigan, Detroit, MI, USA
4 Department of Educational Leadership and Policy Studies, College of Education, Florida State University, Florida, USA

Date of Web Publication30-May-2019

Correspondence Address:
Dr. Leslie N Woltenberg
207C Charles T. Wethington, Jr. Building, 900 South Limestone Street, Lexington, KY 40536
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/EHP.EHP_1_19

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  Abstract 


Background: Interprofessional collaborative care has become a preferred model for patient-centered health care, and effective participation in interprofessional teams has emerged as a core expectation of all providers. In response to this change in the healthcare landscape, Leadership Legacy was designed as an extracurricular enrichment opportunity to complement the formal curriculum by enhancing participants' collaboration, leadership, and teamwork skills. This cohort-based interprofessional leadership development program for health profession learners was built on a foundation of leadership theory, specifically emotional intelligence, and the interprofessional education collaborative competencies. Methods: A longitudinal cohort study with a pre- and post-test mixed method design was used to determine changes in students' attitudes, beliefs, and knowledge that resulted from participation in Leadership Legacy. Results: Results of the 2-year study indicate that participation in the program produced learners who reported statistically significant gains in knowledge of educational requirements and scope of practice of other healthcare professionals, satisfaction measures of the experience, interprofessional competencies, and attitudes toward healthcare team and team understanding measures. Conclusions: Together the elements of Leadership Legacy, when viewed through the lens of leadership theory, provide an opportunity whereby interprofessional learners engage in activities designed to increase emotional intelligence and stimulate social change. These same activities also enable future practitioners to develop skills directly related to critical leadership competencies such as conflict management and resolution, effective communication, feedback agility, and project management.

Keywords: Emotional intelligence, interprofessional, leadership, teamwork


How to cite this article:
Aulisio MC, Woltenberg LN, Erlandson EF, Lorensen ME. Interprofessional leadership development for health professions learners: A program and outcomes review. Educ Health Prof 2019;2:19-26

How to cite this URL:
Aulisio MC, Woltenberg LN, Erlandson EF, Lorensen ME. Interprofessional leadership development for health professions learners: A program and outcomes review. Educ Health Prof [serial online] 2019 [cited 2019 Oct 16];2:19-26. Available from: http://www.ehpjournal.com/text.asp?2019/2/1/19/259381




  Background Top


It has been demonstrated in multiple studies across disciplines that patients are more likely to receive safe, quality care when health professionals work together.[1],[2],[3] In response to this, interprofessional collaborative care has become the preferred model for patient- and community-centered health care. Further, within the evolving context of healthcare reform, effective participation in interprofessional teams has emerged as a core expectation of all healthcare providers.[3],[4],[5],[6],[7] The interprofessional education collaborative (IPEC),[8] consisting of leaders from 15 different health education programs, updated the core interprofessional collaborative practice competencies to provide ongoing formal guidance and practice standards related to interprofessional practice in four content areas: values/ethics, roles and responsibilities, interprofessional communication, and teamwork.[8] These standards guide not only the practice of professionals but also influence the interprofessional education and training of future practitioners to prepare them to collaborate later in their careers.

Interprofessional education provides important preparation for future practitioners, but they also require preparation for the leadership roles they will invariably assume within those teams.[9] The practice of leadership relies on both technical ability and social competence. What are today sometimes referred to as “soft” skills, people skills, and interpersonal skills have been referred to in research as human skills, relationship behavior, concern for people, and supportive behavior.[10] These skills are organized within Goleman's concept of emotional intelligence that refers to the human tendencies, interactions, relationships, and nuances that can significantly impact a leader's success or failure.[11],[12] These social aspects of leadership all share the common cornerstone of self-awareness and social perspective taking or the ability to empathize with others.[13],[14] Goleman's idea of emotional intelligence also addresses the ability to inspire and influence others, initiative and organizational awareness or political skills, and collaboration and conflict management.[15] Research supports the link between emotionally intelligent leaders, performance at work, and the achievement of work-related goals and further suggests that while intellect may be necessary for professional success, emotional intelligence is an equally important requirement.[11] Rarely visualized together, [Figure 1] provides one demonstration of the ways in which these competencies, knowledge, attitudes, and beliefs may inform high-quality patient-centered care.
Figure 1: Intersectionality of Core Elements for Patient-Centered Care

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Given these insights, many prospective employers within health care seek to hire practitioners who not only possess knowledge and technical expertise but also leadership ability and an ability to work effectively within a team.[16] The way in which employers articulate their understanding of the term “leadership” may vary somewhat, but their desire for emotional intelligence in their workforce is clear. Unfortunately, few collegiate education programs' curricula answer this call and address emotionally intelligent leadership competencies such as communication, negotiation, conflict and project management, and team building. In response to this, the University of Kentucky (UK) conceptualized and established Leadership Legacy in 2009, one of the few cohort-based interprofessional leadership development programs in the nation. The purpose of this study was to examine changes in health professions learners' beliefs, knowledge, and attitudes that resulted from participation in an interprofessional leadership development program.


  Methods Top


Program overview

Leadership Legacy is a semester-long interprofessional cocurricular experience offered at the University of Kentucky for health professions learners. Managed by the University's Center for Interprofessional Health Education, the program receives nominations for student participants by administrators and faculty within the respective health profession programs. Each spring, the Center admits a cohort of 20–25 interprofessional learners. The explicit goal of Leadership Legacy is to provide health profession learners with the opportunity to understand and develop an array of emotionally intelligent leadership competencies within an interprofessional context as informed by four of the core IPEC competencies.[17] The four core IPEC Competencies are: (1) applying leadership practices that support collaborative practice and team effectiveness, (2) listening actively and encouraging ideas and options of other team members, (3) giving timely, sensitive, instructive feedback to others about their performance on the team, responding respectfully as a team member to feedback from others, and (4) respecting the unique cultures, values, roles/responsibilities, and expertise of other health professions and the impact these factors can have on health outcomes.[8] Given that emotional intelligence begins with emotional self-awareness and accurate self-assessment, the leadership development activities within Leadership Legacy are geared toward building those capacities.[15] As described in [Table 1] with the corresponding leadership competencies, the program consists of five active learning sessions and one final project centered on community outreach presented during a graduation ceremony. These activities are designed to provide participants with ample opportunity to practice what Kouzes and Posner reported in their model of transformational leadership as the most important emotional intelligence attribute: the ability to build rapport with others.[18],[19] As an example, the DISC assessment is integrated early in the program to provide learners with an opportunity to explore personality and behavioral attributes and discuss implication such attributes in team collaboration and leadership. All Leadership Legacy activities are designed to help students develop leadership skills that will be transferable to the clinical setting.
Table 1: Leadership Legacy - contemporary session descriptions and competencies

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Participants

A total of 42 students from seven health profession programs participated in Leadership Legacy in the period of this 2-year study (spring 2015 and 2016 semesters.) The academic programs represented in this study population include dentistry, nursing, medicine, pharmacy, physical therapy, communication sciences and disorders, and public health.

Methodology/research design

Before data collection, a study protocol was reviewed by the University of Kentucky's Institutional Review Board who declared the study “Exempt.” Evaluation in Leadership Legacy took place in the form of self-assessment. A pre- and post-test mixed-method design was utilized, which included a combination of rating scale items (quantitative) and open response items (qualitative). Data were gathered from student participants at both the beginning and the conclusion of the course in the form of an anonymous electronic survey linked only by a unique identifier. Participants were permitted to skip any statement and could opt out at any time.

Instrumentation

Three instruments were employed for data collection and subsequent analysis of beliefs, knowledge, and attitudes in this study. The Program Evaluation (PE) quantitatively measured beliefs (competencies and overall experience) and knowledge (education and scope of practice of other professions). The PE included two open response prompts: “Please share what you valued most from participation in Leadership Legacy” and “Please share any further comments about Leadership Legacy and/or your experience.” Further, the PE included open response items for collection of qualitative data from participants regarding perceived value from the experience and general comments. The Team Understanding Scale (TUS) was developed and piloted as a measure assessing beliefs in relation to interprofessional competencies.[20] The TUS uses a semantic differential scale (0 = “Not at all” to 4 = “Very much”) and is comprised of eight items focused on beliefs related to interprofessional competencies. Further tests and validation of the TUS instrument are ongoing. Finally, the widely used and validated instrument, The Attitudes Toward Health Care Teams Scale (ATHCTS) uses a six-point Likert-type scale (0 = “Strongly Disagree” to 5 = “Strongly Agree”) for evaluation of twenty items to quantitatively measure attitudes regarding the quality of care that can be enhanced by interprofessional collaboration.[21] Previous research demonstrated the construct validity of the ATHCTS.[22]

Data analysis

Pretest and posttest responses were matched based on a unique identifier. All quantitative data were exported from the electronic survey system and imported into SPSS for statistical analysis (IBM Corp; Armonk, NY, USA).[23] In addition to calculating reliability estimates (e.g., Cronbach's alpha for TUS and ATCHTS items) and producing descriptive statistics, a number of inferential tests (e.g., independent samples t-tests and paired-samples t-tests) were utilized. A Bonferroni adjustment was applied to mitigate the risk for a type 1 error as a result of compounding error due to multiple comparisons. Markers used for success included a positive shift in pretest to posttest mean scores. To determine practical significance, Cohen's d effect size estimates were calculated for TUS and ATCHTS items.[24] Effect size estimates of 0.2 were considered small, 0.5 were considered medium, and 0.8 were considered large in magnitude.[24] Thematic analysis was employed for qualitative data to identify themes with 25% or greater saturation per cohort.


  Results Top


A total of 42 students from seven academic programs participated in the evaluations for the spring 2015 and 2016 cohorts representing a 100% response rate. A breakdown of demographic information for the students is presented in [Table 2].
Table 2: Participant demographics

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Cronbach's alpha reliability estimates for TUS and ATCHTS items exhibited moderate-high internal consistency. More specifically, α = 0.866 for the TUS spring 2015 and α = 0.774 for the TUS spring 2016 and α = 0.756 for the ATHCTS spring 2015 and α = 0.767 for the ATHCTS spring 2016.

Beliefs regarding interprofessional competencies were assessed through the PE, as outlined in [Table 3]. Although statistically significant mean improvements did not occur between the cohorts examined, responses remained on the positive end of the scale in both years. Overall means included in [Table 3] reflect the average ratings across both cohorts.
Table 3: Program evaluation results for beliefs regarding overall experience and competencies

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In addition, learners were asked to rate the extent of their knowledge for other health professions' educational requirements and scope of practice through the PE. A paired-sample t-test compared pretest to posttest means [Table 4]. Statistically significant changes in pretest to posttest knowledge of various professions are noted with an asterisk (*) in [Table 4].
Table 4: Program evaluation results for knowledge/awareness of other professions

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Emergent themes across both cohorts from the PE open response regarding “value of the experience” item included learning about one's own leadership style, learning how to adapt one's style to team/patient needs, and enhancing collaboration skills with interprofessional peers. Themes from the “further comments” PE open response item included positive regard for the experience (”great,” “wonderful,” “fantastic”), desire for more team building time with the other participants, and more preparation for the legislative session.

The TUS items were examined for both cohorts as displayed in [Table 5]. Statistical significance emerged in both spring 2015 and 2016 cohorts for ability to envision the big picture of health care (P = 0.005 and P = 0.004, respectively) and effectiveness in facilitating consensus (P < 0.0001, P = 0.004, respectively). Spring 2016 participant responses were statistically significant for awareness of personal strengths and weaknesses (P = 0.005).
Table 5: Team understanding scale results

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Finally, pre- and post-test paired sample t-tests were conducted for ATHCTS items for each cohort. Statistically significant differences emerged for three items across both cohorts with asterisks (*) in [Table 6].
Table 6: Attitudes toward healthcare teams scale results

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With regard to practical significance, Cohen's d effect size values were calculated. Among the fifteen items [Table 3], four were “small” in magnitude, three “small-medium,” four “medium,” two “medium-large,” and two “large.” The ten items evaluated for educational requirements across both years [Table 4] included a total of two “small,” three “small-medium,” three “medium,” four “medium-large,” and eight “large” effect sizes. The ten items evaluated for scope of practice across both years [Table 4] included a total of five “small,” five “small-medium,” two “medium,” five “medium-large,” and three “large” effect sizes. For the eight items examined across both years [Table 5], there were two “small,” three “small-medium,” two “medium,” four “medium-large,” and five “large” effect sizes. For the twenty items examined across both years [Table 6], there were 17 “small,” 10 “small-medium,” four “medium,” six “medium-large,” and two “large” effect sizes.


  Discussion Top


This longitudinal cohort study employed a pre- and post-test mixed method design to examine changes in students' beliefs, knowledge, and attitudes as a result of participation in an interprofessional leadership development program. Results of the 2-year study indicated positive gains across all categories and confirmed participants' value of the activities designed to increase emotional intelligence [Table 3]. Qualitative and quantitative data from the PE affirmed high degree of satisfaction with the program (overall and individual elements) and beliefs that align with interprofessional competencies. The DISC assessment activity was the highest rated element across the 2-year study and was underscored in the qualitative theme whereby participants indicated value in learning how their DISC profile interfaces and can best engage with others. Personal growth in self-awareness compliments the reported gains in knowledge of other professions' educational requirements and scopes of practice [Table 4]. The statistical and practice significance demonstrated in [Table 4] underscores the knowledge acquisition of other health professions among participants. Dedicated time to learn with, from, and about other health professionals was highly valued by participants especially given that most education and training programs are largely uniprofessional.[25]

The TUS provided insight regarding participant beliefs and gains related to interprofessional competencies. These positive shifts in means, statistically significant and otherwise, warrant acknowledgment as they demonstrate growth in key competency areas such as communication, motivation, and awareness of one's strengths and weaknesses among other important leadership [Table 5]. These meaningful differences in the scores indicate that despite not being statistically significant (even before the Bonferroni correction), practical significance is exemplified through numerous medium to large effect sizes. An example of this type of occurrence and particularly important to this study is participants' ability to work as part of a team with other healthcare professions through this opportunity [Table 5], spring 2015].

Consistent with results from the other instruments, the ATHCTS indicated that participants made numerous positive shifts in mean with statistically significant gains in the following categories: teams are responsive to the needs of patients, the team approach helps meet the needs of family caregivers and patients, and team dynamics positively impact patient care decisions [Table 6]. The practical difference in these mean shifts is demonstrated through notable effect sizes, further emphasizing this program as an effective means of positively influencing attitudes toward interprofessional teams. Attitudes conducive with effective team functioning, such as those measured by the ATHCTS, have positive implications for high-quality patient-centered health care. Further, following the rule of George and Mallery, the internal consistency is at an acceptable level.[26]

Leadership Legacy participants demonstrated growth and knowledge acquisition, understanding and application of interprofessional competencies, and engaged emotional intelligence attributes. Developing emotional intelligence not only provides solid, transferrable skills for future employment but also fosters academic success among students during their education.[27] There is increasing evidence that healthcare professionals' emotional intelligence influences their ability to deliver safe and compassionate health care.[28] Together the elements of Leadership Legacy, when viewed through the lens of leadership theory, provide an opportunity whereby interprofessional learners gain beliefs, knowledge, and attitudes that will positively inform their future health care and leadership practices.

Limitations of this study warrant acknowledgment. The nature of this program is application based and/or nomination for application; thus, a preexisting interest in leadership and/or interprofessional education is likely to create some selection bias. Further, the study was conducted at a single institution; thus, we cannot speak to the generalizability of the findings. However, because of a 100% participation rate, we are optimistic that findings will hold across samples as sampling error was not an issue in this study. Since the completion of this 2-year study, the Physician Centrality subscale items within the ATHCTS have been omitted from evaluation due to the singular profession emphasis. Further, the Hawthorne effect cannot be ruled out especially for the ATHCTS items where learners may inadvertently overrate their interprofessional competencies in the pretest. Although the design of this study may have inherent limitations, the program format and assessment methodology may be replicated for the development of interprofessional leadership programs at other institutions.


  Conclusions Top


The purpose of this study was to examine changes in health profession learners' beliefs, knowledge, and attitudes that resulted from participation in an interprofessional leadership development program. Results of the 2-year study indicate that participation in the program produced emotionally intelligent learners who reported knowledge gains of other professions and positive beliefs regarding interprofessional competencies and made significant gains in attitudes toward effective healthcare teams. Interprofessional leadership development programs such as Leadership Legacy address critical leadership competencies that may otherwise be absent from healthcare professions' curricula, improve attitudes toward interprofessional collaborative care, and prepare learners for team-based practice.

Acknowledgment

The authors wish to acknowledge the University of Kentucky Center for Interprofessional Health Education for support of this project and continued promotion of interprofessional opportunities at the institution.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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