Physician leadership: influence on practice-based learning and improvement.
In response to the technology and information explosion, practice-based learning and improvement is emerging within the medical field to deliver systematic practice-linked improvements. However, its emergence has been inhibited by the slow acceptance of evidence-based medicine among physicians, who are reluctant to embrace proven high-performance leadership principles long established in other high-risk fields. This reluctance may be attributable to traditional medical training, which encourages controlling leadership styles that magnify the resistance common to all change efforts. To overcome this resistance, physicians must develop the same leadership skills that have proven to be critical to success in other service and high-performance industries. Skills such as self-awareness, shared authority, conflict resolution, and nonpunitive critique can emerge in practice only if they are taught. A dramatic shift away from control and blame has become a requirement for achieving success in other industries based on complex group process. This approach is so mainstream that the burden of proof that cooperative leadership is not a requirement for medical improvement falls to those institutions perpetuating the outmoded paradigm of the past. Cooperative leadership skills that have proven central to implementing change in the information era are suggested as a core cultural support for practice-based learning and improvement. Complex adaptive systems theory, long used as a way to understand evolutionary biology, and more recently computer science and economics, predicts that behavior emerging among some groups of providers will be selected for duplication by the competitive environment. A curriculum framework needed to teach leadership skills to expand the influence of practice-based learning and improvement is offered as a guide to accelerate change.