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. 2021 Feb 1;4(2):e2035622.
doi: 10.1001/jamanetworkopen.2020.35622.

Assessment of the Association of Leadership Behaviors of Supervising Physicians With Personal-Organizational Values Alignment Among Staff Physicians

Tait D Shanafelt  1 , Hanhan Wang  2 , Mary Leonard  3 , Mary Hawn  4 , Quinn McKenna  5 , Rick Majzun  6 , Lloyd Minor  7 , Mickey Trockel  8
Affiliations

Assessment of the Association of Leadership Behaviors of Supervising Physicians With Personal-Organizational Values Alignment Among Staff Physicians

Tait D Shanafelt et al. JAMA Netw Open. .

Abstract

Importance: Although misalignment of values between physicians and their organization is associated with increased risk of burnout, actionable organizational factors that contribute to perceived values alignment are poorly understood.

Objective: To evaluate the association between the leadership behaviors of immediate supervisors and physicians' perception of personal-organizational values alignment.

Design, setting, and participants: This survey study of faculty physicians and physician leaders at Stanford University School of Medicine was conducted from April 1 to May 13, 2019. The survey included assessments of perceived personal-organizational values alignment, professional fulfillment, and burnout. Physicians also evaluated the leadership behaviors of their immediate supervisor (eg, division chief) using a standardized assessment. Data analysis was performed from May to December 2020.

Main outcomes and measures: Association between mean leadership behavior score (range, 0-10) of each supervisor and the mean personal-organizational values alignment scores (range, 0-12) for the physicians in their work unit.

Results: Of 1924 physicians eligible to participate, 1285 (67%) returned surveys. Among these, 651 (51%) were women and 729 (57%) were aged 40 years or older. Among the 117 physician leaders evaluated, 66 (56%) had their leadership behavior independently evaluated by at least 5 physicians and were included in analyses. The mean (SD) personal-organizational values alignment score on the 0 to 12 scale was 6.19 (3.21). As the proportion of work effort devoted to clinical care increased, values alignment scores decreased. Personal-organizational values alignment scores demonstrated an inverse correlation with burnout (r = -0.39; P < .001) and a positive correlation with professional fulfillment (r = 0.52; P < .001). The aggregate leader behavior score of the 66 leaders evaluated correlated with the mean values alignment score for physicians in their work unit (r = 0.53; P < .001). Aggregate leader behavior score was associated with 21.6% of the variation in personal-organizational values alignment scores between work units. After adjusting for age, gender, academic rank, work hours, physician-leader gender concordance, and time devoted to clinical care, each 1-point increase in leadership score of immediate supervisor was associated with a 0.56-point (95% CI, 0.46-0.66; P < .001) increase in personal-organizational values alignment score.

Conclusions and relevance: This survey study's results suggest that physicians experience their organization through the prism of their work unit leader. Organizational efforts to improve values alignment should attend to the development of first-line physician leaders.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Shanafelt reported being coinventor of the Mayo Clinic Participatory Management Leadership Index and Well-being Index Instruments (Physician Well-being Index, Medical Student Well-being Index, Nurse Well-being Index, Well-being Index). Mayo Clinic holds the copyright to these instruments and has licensed them for use outside of Mayo Clinic. Dr Shanafelt receives a portion of any royalties paid to Mayo Clinic. Dr Shanafelt also reported receiving honoraria from grand rounds or keynote lecture presentations and advising for health care organizations outside the submitted work. Dr Minor reported receiving personal fees from General Atlantic as senior advisor, from Sensyne Health as a member of the Scientific Advisory Board, from Ancestry.com as a member of the Advisory Board, from Mission Bio as a member of the Scientific Advisory Board, from Mammoth Biosciences as a member of the Scientific Advisory Board, from aMoon as an advisor, from Change Healthcare as a member of the Advisory Board; and is a limited partner with the Slow Ventures Fund III-A and the Menlo Ventures XV Innovators Fund outside the submitted work; and is a member of the External Advisory Board for Digital Health at Novartis, and a member of the Thrive Global Scientific Advisory Board. Dr Trockel reported receiving honoraria for grand rounds or other professional presentations on physician well-being for various health care organizations outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Association of Personal-Organizational Values Alignment Scores With Occupational Burnout and Professional Fulfillment
In panels B and C, circles denote medians, and error bars denote 95% CIs.
Figure 2.
Figure 2.. Association of Personal-Organizational Values Alignment With Aggregate Leadership Score of Work Unit Supervisor
A, Mean values alignment score of individuals in work unit on the y-axis with the mean aggregate leadership score of that work unit’s supervisor on the x-axis. B, Partial residual plot showing values alignment score of individual physician on the y-axis and leadership score of immediate work unit supervisor on the x-axis after controlling for age, gender, faculty track, academic rank, physician-leader gender concordance, percentage clinical work, and work hours.
See this image and copyright information in PMC

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