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Unlocking medical leadership’s potential: a multilevel virtuous circle?
  1. Wouter Keijser1,2,
  2. Graeme Martin3
  1. 1 Faculty of Behavioral, Management and Social Sciences (BMS) Change Management and Organizational Behaviour (CMOB), Universiteit Twente, Utrecht, The Netherlands
  2. 2 DIRMI Institution Foundation, Utrecht, The Netherlands
  3. 3 School of Business, University of Dundee, Dundee, UK
  1. Correspondence to Mr Wouter Keijser,Faculty of Behavioral, Management and Social Sciences (BMS) Change Management and Organizational Behaviour (CMOB), Universiteit Twente, Utrecht, Netherlands; wouter{at}


Background and aim Medical leadership (ML) has been introduced in many countries, promising to support healthcare services improvement and help further system reform through effective leadership behaviours. Despite some evidence of its success, such lofty promises remain unfulfilled.

Method Couched in extant international literature, this paper provides a conceptual framework to analyse ML’s potential in the context of healthcare’s complex, multifaceted setting.

Results We identify four interrelated levels of analysis, or domains, that influence ML’s potential to transform healthcare delivery. These are the healthcare ecosystem domain, the professional domain, the organisational domain and the individual doctor domain. We discuss the tensions between the various actors working in and across these domains and argue that greater multilevel and multistakeholder collaborative working in healthcare is necessary to reprofessionalise and transform healthcare ecosystems.

  • medical leadership
  • professionalism
  • learning organisation
  • effectiveness
  • health system

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  • Contributors WK and GM both conceptualised the framework and drafted the manuscript. Both authors have approved the final version to be published and are accountable for all aspects of the work.

  • 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.

  • Data availability statement There are no data in this work.

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