TY - JOUR T1 - Enacting medical leadership to address wicked problems JF - BMJ Leader JO - BMJ Leader SP - 12 LP - 17 DO - 10.1136/leader-2019-000137 VL - 4 IS - 1 AU - Wouter Keijser AU - Jo-Louise Huq AU - Trish Reay Y1 - 2020/03/01 UR - http://bmjleader.bmj.com/content/4/1/12.abstract N2 - 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 leadershipPhysicians 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, … ER -