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Enacting medical leadership to address wicked problems
  1. Wouter Keijser1,2,
  2. Jo-Louise Huq3,
  3. Trish Reay4
  1. 1 Faculty of Behavioral, Management and Social Sciences (BMS) Change Management and Organizational Behaviour (CMOB), Universiteit Twente, Utrecht, The Netherlands
  2. 2 DIRMI Institute, Utrecht, The Netherlands
  3. 3 Haskayne School of Business University of Calgary, Calgary, Alberta, Canada
  4. 4 Strategic Management and Organization, University of Alberta, Alberta School of Business, Edmonton, Alberta, Canada
  1. Correspondence to Wouter Keijser, Faculty of Behavioral, Management and Social Sciences (BMS) Change Management and Organizational Behaviour (CMOB), Universiteit Twente, Utrecht, The Netherlands; wouter{at}

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This paper argues that although physicians’ established ways of working make them excellent clinicians, their education and experience make it difficult for them to address wicked problems. After defining wicked problems and illustrating them within healthcare contexts, we explain why physicians’ institutionalised and professionalised ways of working leave them underprepared to address wicked problems. We then describe the emerging concept and frameworks of medical leadership (ML) and show how ML training could provide physicians with the skills and abilities they need to enact leadership in collaborative environments. We also explain how ML could help physicians become more comfortable in ‘grey-zone decision-making’ that is needed to address current challenging problems. Finally, we draw attention to changes that are warranted outside of ML training to bolster its potential: incentivise training and reregulate top–down, empower the professional pipeline and create bottom–up opportunities.

Physicians and leadership

Physicians face many challenges as part of their day-to-day professional work. Their clinical skills serve them well in many ways. But when faced with wicked problems they are generally ill-prepared. Moreover, physicians’ training and established ways of working can result in physicians unwittingly becoming part of the problem when addressing wicked problems.

Wicked problems are those fundamental, challenging problems that exist within and between social sectors, are not solvable through linear planning or the application of causal models and tools, have no definitive problem formulations or solutions, and are impacted and changed when their intended solutions are implemented.1–3 Wicked problems are ‘complex, intractable, open-ended and unpredictable’ such as ‘global warming, drug abuse, child protection or natural disasters, … (the) safety of nanotechnology or growing numbers of refugees’ (see Head and Alford, p397).3 In healthcare, problems related to mental illness, palliative care, healthy ageing, sexual health and cancer care have all been classified as wicked.4–7

Because of their nature, …

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  • Contributors WK provided the concept and idea of the article. WK and J-LH contributed equally to consecutive drafts, which were reviewed and edited by TR for important intellectual content, with continued input from WK and J-LH. All authors approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.