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How medical specialists experience the effects of a mindful leadership course on their leadership capabilities: A qualitative interview study in the Netherlands

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Objectives Medical leaders are facing leadership challenges that ask for a leadership style that takes care of both themselves and their coworkers. Mindfulness may support this leadership style. We explored how a ‘Mindful leadership for medical specialists’ course affected medical specialists’ leadership. Design We conducted a qualitative study based on in-depth interviews. The grounded theory method was used to analyse the data. Setting A university medical centre in the Netherlands. Participants Seventeen medical specialists (six male) with an average age of 51 years (ranging from 40 to 66 years). Interventions The mindful leadership course consisted of 10-weekly 5-hour sessions that focused on cultivating mindfulness and compassion. In addition, sessions included didactic and interactional teaching about leadership theories. Results Four categories emerged from the data: (A) Self - Attitude: psychological attitude towards self, (B) Self - Behaviour: behaviour towards self, (C) Other - Attitude: psychological attitude towards others, and (D) Other - Behaviour: behaviour towards others. Themes were defined within these categories: awareness of self, open mind, insight and appreciation of self (A), emotional and cognitive self-regulation, letting go of unhelpful behaviour and developing helpful behaviour (B), differences in attitude to others such as awareness of (impact on) others, keeping an open mind about others, allowing difficult emotions associated with others, appreciating of others (C), and communicating more effectively, providing direction, empowering and caring for others (D). Conclusions The results help us understand the core elements of mindful leadership, both with respect to one’s psychological attitude and behaviour towards oneself and others. More research on mindful leadership and the effects on self and others is needed. Mindful leadership courses could be a valuable part of clinical training and might contribute to more sustainable healthcare organisations.
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VreelingK, etal. BMJ Open 2019;9:e031643. doi:10.1136/bmjopen-2019-031643
Open access
How medical specialists experience the
effects of a mindful leadership course
on their leadership capabilities: a
qualitative interview study in
the Netherlands
Kiki Vreeling,1 Wendy Kersemaekers,1 Linda Cillessen ,1,2 Dirk van Dierendonck,3
Anne Speckens1,2
To cite: VreelingK,
KersemaekersW, CillessenL,
etal. How medical specialists
experience the effects of a
mindful leadership course on
their leadership capabilities:
a qualitative interview study
in the Netherlands. BMJ Open
2019;9:e031643. doi:10.1136/
bmjopen-2019-031643
Prepublication history and
additional material for this
paper are available online. To
view these les, please visit
the journal online (http:// dx. doi.
org/ 10. 1136/ bmjopen- 2019-
031643).
Received 13 May 2019
Revised 14 November 2019
Accepted 18 November 2019
1Psychiatry, Center for
Mindfulness, Radboudumc,
Nijmegen, Netherlands
2Donders Institute for Brain,
Cognition and Behavior,
Radboud Universiteit, Nijmegen,
Netherlands
3School of Management,
Erasmus Universiteit Rotterdam,
Rotterdam, Netherlands
Correspondence to
Ms Linda Cillessen;
linda. cillessen@ radboudumc. nl
Original research
© Author(s) (or their
employer(s)) 2019. Re- use
permitted under CC BY- NC. No
commercial re- use. See rights
and permissions. Published by
BMJ.
Strengths and limitations of this study
Qualitative interviews with medical specialists with
enormous workload.
Purposive sampling for age, gender, specialty,
leadership role and completion of the mindfulness
course.
Interviews were conducted at least 12 months after
participants completed the mindfulness course.
Emerging categories are not always as clearly delin-
eated as the grouping suggests.
There might be a self- selection bias in our partici-
pants, due to the intense programme of the mind-
fulness course
ABSTRACT
Objectives Medical leaders are facing leadership challenges
that ask for a leadership style that takes care of both
themselves and their coworkers. Mindfulness may support
this leadership style. We explored how a ‘Mindful leadership
for medical specialists’ course affected medical specialists’
leadership.
Design We conducted a qualitative study based on in-
depth interviews. The grounded theory method was used
to analyse the data.
Setting A university medical centre in the Netherlands.
Participants Seventeen medical specialists (six male)
with an average age of 51 years (ranging from 40 to 66
years).
Interventions The mindful leadership course consisted
of 10- weekly 5- hour sessions that focused on cultivating
mindfulness and compassion. In addition, sessions
included didactic and interactional teaching about
leadership theories.
Results Four categories emerged from the data: (A)
Self - Attitude: psychological attitude towards self, (B)
Self - Behaviour: behaviour towards self, (C) Other -
Attitude: psychological attitude towards others, and (D)
Other - Behaviour: behaviour towards others. Themes were
dened within these categories: awareness of self, open
mind, insight and appreciation of self (A), emotional and
cognitive self- regulation, letting go of unhelpful behaviour
and developing helpful behaviour (B), differences in
attitude to others such as awareness of (impact on)
others, keeping an open mind about others, allowing
difcult emotions associated with others, appreciating of
others (C), and communicating more effectively, providing
direction, empowering and caring for others (D).
Conclusions The results help us understand the core
elements of mindful leadership, both with respect to one’s
psychological attitude and behaviour towards oneself
and others. More research on mindful leadership and the
effects on self and others is needed. Mindful leadership
courses could be a valuable part of clinical training
and might contribute to more sustainable healthcare
organisations.
INTRODUCTION
Healthcare professionals across America and
Europe face pressing challenges. Healthcare
institutions must balance limited resources
with continuous changes in healthcare
systems (eg, insurance), increased produc-
tion pressure, more administrative tasks and
greater amounts of knowledge to digest.1 2
Furthermore, patients have a stronger voice
and are more involved in medical decision
making.3 All these developments have led
to high levels of work- related stress among
healthcare workers,4–7 more dropout than
in other sectors8 and strong increases in
burnout.9 10
Combatting work- related stress requires
good leadership in healthcare organisa-
tions, not only for workers themselves, but
also for patients and the organisation as a
whole.11 12 According to WHO, high- quality
leadership can help support employees (eg,
by providing feedback, being available to
help with questions or problems or creating
a healthy work environment,12 which may
ultimately reduce the risk of burnout).13
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Furthermore, variations in the quality of medical leader-
ship can result in compromised patient care, sometimes
with catastrophic consequences.14 Despite the impor-
tance of good leadership, it is difficult to provide a single
definition of it because it depends on the context.11 In
medical settings, healthcare leaders are asked to create
an environment that is caring and healthy for patients,
staff and the organisation, and to create a strong and
engaged culture.12 That requires leaders to deploy a
range of leadership styles and behaviours that are helpful
for themselves as well as their teams and the healthcare
environment.15
Medical specialists are increasingly in the lead
and ultimately responsible for their units’ perfor-
mance.16 17 However, their medical education rarely
equips them to successfully perform leadership tasks
in the rapidly changing and demanding healthcare
system.2 16 Therefore, it is increasingly recognised that
the current context of healthcare and its requirements
ask for education on effective leadership.11 It is important
that medical specialists receive evidence- based education
to equip them with tools for effective leadership.6
Mindfulness might be a potent way to support medical
specialists in clinical leadership. Mindfulness is defined as
intentionally paying attention to the present moment in a
non- judgemental way18 and it helps practitioners uncover
habitual behavioural patterns and their attitudes towards
themselves, others and experiences. A recent meta-
analysis on determinants of effective leadership training
found that programmes focused on self- awareness and
intrapersonal content, which are inherent to mindful-
ness, are among the most effective in terms of results.19
However, these interventions are also least studied,19 and
therefore a mindful leadership course is the focus of the
current study.
Research has found that mindfulness may improve
leadership via two pathways. First, mindfulness has been
demonstrated to reduce perceived stress, depression
and anxiety, and to improve well- being and quality of
life in healthy individuals.20 Furthermore, there is some
evidence that mindfulness may help medical specialists in
their professional settings.21–23 Given that medical special-
ists are experiencing burnout symptoms at epidemic
levels,9 addressing their personal health is important.
When medical specialists are less absorbed by their own
complaints and symptoms, their leadership skills may
improve automatically.
Second, mindfulness may directly target leadership
skills. Cross- sectional research among a diverse sample
with leaders from different work fields found positive
associations between leaders’ trait mindfulness and
employees’ well- being, job per formance and satisfaction.24
Employees with a mindful leader feel they are treated
with greater respect and experience less stress.25 Finally,
research has shown that mindfulness improves various
areas relevant to leadership,26 such as self- regulation
(including attention regulation, emotion regulation and
self- awareness).27 This may lead to improved relationships
with employees,24 28 improved communication29 30 and
increased compassion and empathy.31–33
Most empirical studies operationalise mindfulness
within the leadership context by asking leaders to fill out
a mindfulness measure, which neglects its integration
and explication in their leadership behaviour and atti-
tudes.e.g.34 35 To advance the field, this qualitative study
addresses the perceived impact of mindfulness training
on leadership among medical specialists. The Radboud
Centre for Mindfulness developed a course, ‘Mindful
leadership for medical specialists’, which addressed mind-
fulness and leadership centring on mindfulness leader-
ship components added as a bridge to daily practice. In
addition to studying the perceived effects of the course,
we used our data to build a theoretical framework for the
concept of mindful leadership.
METHODS
We conducted this qualitative study among a subsample of
participants in a non- randomised waitlist- controlled pre-
post study on the effects of a mindful leadership course
on medical specialists’ burnout symptoms, psychological
well- being and leadership skills.36 According to Dutch
law, the non- medical and non- experimental nature of the
study, combined with the minimal risks and burdens for
participants, meant that this study did not require review
by the Medical Ethical Committee Arnhem/Nijmegen,
the Netherlands. All study participants provided informed
consent. We followed the COREQ37 and SRQR38 check-
lists for reporting qualitative research.
Participants
We recruited medical specialists from various hospitals in
the eastern part of the Netherlands for the parent study
on the mindful leadership course. Participation in the
course was voluntary. In total, five cohorts attended the
mindful leadership course, totalling 52 medical special-
ists overall. Of those 52 medical specialists, we emailed 25
to ask for their participation in this study. Seventeen of
the 25 invitees agreed to participate.
We used purposive sampling to equally represent
characteristics such as age, gender, specialty, leadership
role and completion of the course. All 17 participants
completed the interviews. Six (35%) of them were men
and their average age was 51 years (varying from 40
to 66 year). Eight (47%) participants had an internal
specialty, five (29%) had a supportive specialty (ie, anaes-
thesiology, pathology, medical microbiology, radiology,
or radiotherapy) and four (24%) had a surgical specialty
(table 1). Participants held various leadership roles:
managing departments or teams, role- modelling and
teaching medical residents and students.
Course description
The ‘Mindful leadership for medical specialists’ course
consisted of 10- weekly 5- hour sessions in the afternoon
and evening with a dinner break in between. The group
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Table 1 Participant characteristics
Identification number Gender Specialty (category)
1 Male Supportive
2 Male Internal
3 Female Internal
4 Female Supportive
5 Male Surgical
6 Female Supportive
7 Male Internal
8 Female Internal
9 Female Supportive
10 Female Surgical
11 Male Surgical
12 Female Surgical
13 Female Internal
14 Male Internal
15 Female Internal
16 Female Supportive
17 Female Internal
size varied from eight to sixteen participants. The course
included the original Mindfulness- Based Stress Reduc-
tion (MBSR) programme developed by Jon Kabat- Zinn.18
The original 8- week programme consists of weekly
group sessions that include mindfulness meditation (eg,
body scan, sitting meditation, gentle movement exer-
cises), psychoeducation about stress and group discus-
sions. Home meditation practice (45 min per day) is an
important aspect of the programme. Furthermore, one
session consisted of a silent retreat. Participants learnt
to focus their attention on the present moment and
observe their own thoughts, feelings and behaviour in a
kind and non- judgemental way rather than identifying
with them (meta- awareness). They were encouraged
to become aware of their own automatic behavioural
patterns and consider replacing them with more helpful
behaviour. In addition to the MBSR, the course consisted
of experiential teaching sessions on cognitive behavioural
therapy, compassion39 40 and three frameworks relevant to
becoming a better leader.
The three leadership frameworks presented were
Covey’s habits for leadership success,41 Hersey’s situa-
tional leadership42 and Scharmer’s Theory U.43 Covey
presents the seven habits of highly effective people,
progressing from independence to interdependence.41
Hersey describes effective leaders as those who adapt
their leadership style to the performance readiness
(ability and willingness) of the individual or group they
are attempting to lead.42 Scharmer’s Theory U describes
a process of letting- go (of our old ego and self) and
letting- come (our highest future possibility: our self) in
which the bottom of the U is ‘presencing’, where these
two selves meet and begin to listen to and resonate with
each other.43 These theories were chosen because of their
relatedness to mindfulness. Each introduces overlapping
themes of becoming more aware of self and others, being
more in the present (instead of in the past or future),
being more in the being- mode (vs the doing- mode), prac-
tising more conscious (instead of automatic) decision
making, listening more carefully and becoming more
sensitive to employees’ needs. After being trained in each
of these frameworks, participants learnt and planned how
to apply their new knowledge to their daily leadership
activities in the weeks between sessions.
Procedure
Two of us (WK and KV) interviewed the medical specialists
12 to 18 months after their participation in the mindful
leadership course (which occurred between September
2014 and June 2016). We used a semistructured style for
the interviews. The topic guide (see online supplementary
material 1) focused on the perceived impact of the course
with follow- up questions about impacts on their leader-
ship skills and the facilitators and barriers to participating
in the course. If not mentioned by the interviewees, the
interviewers asked specific questions related to planning
and organising work, managing people and developing
vision and strategies. The interviewers asked partici-
pants whether they attributed the perceived impacts on
their leadership to the course. Fifteen of the interviews
were conducted in person, the other two were done by
telephone. All interviews were conducted in Dutch and
recorded. The average interview time was up to an hour.
Interviews took place at a location chosen by the partici-
pant, which was usually their workplace.
Data analysis
All interviews were recorded and transcribed verbatim.
Data were anonymised and unique research codes were
added to the interviews and transcripts. We analysed the
data using Atlas.TI7,44 a software package for qualitative
analysis.
We used the grounded theory approach to analyse the
data.45 We chose that approach so we could generate a
theorical framework of the perceived impact of mindful
leadership in practice. Furthermore, the grounded
theory approach is an excellent tool for analysing a
social phenomenon like mindful leadership, which is an
under- researched area.45 46 It is a data- driven method in
which the data forms the only input for the theory, which
reduces bias from researchers’ perspectives and previous
theorising about mindful leadership.47 However, this
approach is vulnerable to relativism (ie, researcher inter-
pretation),47 which stresses the importance of a diverse
research group.
The grounded theory approach uses data coding
(labelling and categorising). Codes that are derived
from the data are used to create categories in a theo-
retical framework with three phases of coding, namely
open coding, axial coding and selective coding.48 Data
analysis begins when the first interview is conducted, and
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Figure 1 Two- dimensional model of mindful leadership.
continuous adaptations in the codes and topic guide are
an integral part of this method. Three researchers (HvR,
WK, KV) coded independently to minimise subjectivity.
After every two or three interviews, they compared
and discussed codes and reached consensus. In each
meeting, the researchers updated the coding scheme,
added new codes and combined similar codes. In this
phase, open coding was mostly used, which consists of
reading and re- reading the interviews and developing a
coding three.
After eight interviews, a different group of researchers
(AS, WK, KV) began dividing the codes into themes
with axial coding, in which a list of categories and (sub)
themes is made from the list of codes. Based on discus-
sion in research team, the topic guide was adjusted for
subsequent interviews to collect more detailed informa-
tion about leadership roles. After 14 interviews, no new
codes were emerging from the data. This indicated that
saturation had been reached, as all new data fitted into
the existing codes.45 We still conducted and coded three
more planned interviews to confirm this.
After the 17 interviews were transcribed and coded,
two researchers (WK and KV) grouped the codes again
with axial coding. In two group discussions, the research
team (except LC) grouped the codes into themes and
categories derived from the themes, to find the core cate-
gories (selective coding). We discussed the themes and
categories until we reached consensus. The categories
originated naturally from the data and showed familiarity
with mindfulness theory and practice. During and after
the process of defining themes, we continuously checked
with the original data to make sure themes fitted. Finally,
we selected illustrative quotes for each of the selected
themes and translated them into English. Translations
were checked by a native English professional translator.
Credibility of the data
The research group had different backgrounds and
knowledge, which facilitated a broad view due to different
perspectives. The group consisted of a professor in psychi-
atry/mindfulness trainer (AS), a business researcher/
professor in leadership (DvD), a senior researcher/mind-
fulness trainer (WK), a PhD student/psychologist (LC)
and a business consultant/mindfulness trainer (KV).
The interviewers (WK and KV) did not have any rela-
tionship with the participants prior to the study, which
increases credibility by reducing the chance of socially
desirable responses. WK and KV expected the mindful-
ness training to have positive effects on leadership skills.
Participants were given the rationale for the study (so they
could provide informed consent), but they did not know
the interviewers’ personal goals, which may also reduce
socially desirable responses. Only the interviewer and
participant were present for each interview. The partici-
pants did not receive interview transcripts, but transcripts
were carefully created and checked with the audio files of
the interviews. Participants did not provide feedback on
the study findings.
Patient and public involvement
There were no patients involved in this study, which
focused on medical specialists. Results will be communi-
cated to the participating medical specialists.
RESULTS
One participant (no. 11) said that the intervention did
not have any perceptible effects on his leadership or
personal life. However, the other participants did report
effects, of which results are described below.
Four categories originated naturally from the data and
resulted in a model with two dimensions: attitude versus
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behaviour and self versus others (see figure 1). Through
an iterative process, we reduced the 200 codes to 15
themes describing a process. These themes describe the
four categories with the underlying two dimensions. They
are described below. Quotes for each theme can be found
in table 2.
The core dimensions of our model are ’Self’ versus
‘Other’ and ‘Attitude’ versus ‘Behaviour’. ‘Self’ in our
model refers to the attitude and behaviour towards
oneself. ‘Other’ refers to the attitude and behaviour
towards others. The Attitude versus Behaviour dimension
aligns with the being versus doing dimension that can be
found in mindfulness literature.49 One has a tendency
to constantly do as a habitual behaviour on automatic
pilot as opposed to simply being and experiencing the
moment. In a mindfulness course, participants experi-
ence the difference between ‘doing’ and ‘being’.
In our model ‘Attitude’ describes different attitudes in
being towards self and others. ‘Behaviour’ describes inten-
tional behaviour: a chosen action, internal or external,
done deliberately and with awareness. Combining these
two dimensions creates the following four categories:
A. Self - Attitude: Psychological attitude towards self.
B. Self - Behaviour: Behaviour towards self.
C. Other - Attitude: Psychological attitude towards oth-
ers.
D. Other - Behaviour: Behaviour towards others.
Within these categories, we identified different themes
(figure 1).
The responses from the participants described a process
from attitude to behaviour. Categories were often interre-
lated and could strengthen each other. This can be seen
in the quotes (table 2), which often contain themes from
different categories.
Self - Attitude
The first category in which the participants mentioned
an impact of the training is their psychological attitude
towards themselves as leaders. It is a development in
which awareness and an open mind lead to insight and
an appreciation of self. We gathered four themes.
Awareness of self
Participants described an awareness of their internal
processes like their emotions, the coming and fading
away of emotions like stress or tension, physical reactions
to their emotions and their own behaviour in situations.
Open mind
Participants described how mindfulness helped them see
the bigger picture and notice what is there. They reported
an ability to observe from a distance, take a wider perspec-
tive and look at what is happening. They described having
a fresh view and being contemplative.
Insight
Participants mentioned having more insight into what
triggers them to exhibit certain behaviour or make a deci-
sion. They reported enhanced self- reflection.
Appreciation of self
Participants described being more accepting of who they
are and noticed more confidence in their own capacities.
They reported being more at ease, less self- critical and
more relaxed. They described realising and accepting
that they are good at what they do. Two participants
described how they now value their own opinions on
matters and are aware of what they find important in their
lives. Furthermore, they described being or feeling more
confident.
Self - Behaviour
The second category involves behaviour of leaders
directed towards themselves in their role as a leader.
Cognitive and emotional self-regulation
Participants indicated regulating their emotions by recog-
nising their thoughts and behaviour. They described how
they regulate their thoughts and emotions by intention-
ally seeing thoughts as just thoughts, taking time for their
emotions, keeping a distance from them, exploring their
behaviour and using their breath to calm down.
Letting go of unhelpful behaviours
Participants described letting go of unhelpful behaviour:
consciously ‘not- doing’ such as not or not continuously
checking emails, not uncritically accepting requests
from colleagues, not doing things that are not priorities
for themselves, not getting involved, not multitasking
or not reacting to a situation. They described choosing
to step out of the habitual act of doing and deliberately
refraining from it.
Developing new helpful behaviours
Participants described acknowledging and allowing their
needs, standing up for themselves and acting accordingly.
For example, they described expressing their opinion,
blocking time in their agenda for themselves, planning
and taking a rest and making choices that suit them.
Other - Attitude
The third category is the psychological attitude towards
others. It consists of four subcategories:
Being aware of one’s (impact on) others
Participants described being more aware of others. They
mentioned paying more attention to others and being
really present with them. They also reported being more
aware of the positive or negative impact of their commu-
nication (verbal or nonverbal) or their behaviour on
others. For example, participants noticed the impact of
an inconsiderate remark or tone of voice.
Keeping an open mind towards others
Participants mentioned not having a fixed mindset
and described a more open, accepting and explor-
atory attitude towards others. They reported being less
judgemental, omitting judgements in situations or recon-
sidering judgements when they noticed they had them.
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Table 2 Categories, themes and illustrative quotes derived from the qualitative interviews
Category and Themes Illustrative quotes
Self – Attitude 1. Awareness of
self No. 3 – “…what I then notice is that I start breathing faster, I also start talking louder, start
interrupting others…”
2. Open mind No. 17 – “That you’re not so caught up in yourself or the everyday hustle. You can view
things from a distance and that gives you a broader perspective.”
3. Insight No. 14 – “…you can (…) denitely also see that as an outcome of the course, that I think
'well you need to watch out now, look at what’s happening, what is it that triggers you?’.”
4. Appreciation of self No. 13 – “That as a tutor too I stick to my own qualities more, and am more condent about
those, and can more easily say 'I simply want to know this or that' and 'that’s my style of
training.' And that’s made me more condent.”
Self – Behaviour
1. Cognitive and emotional
regulation
No. 14 – “…to then focus on your breathing, take deep breaths, and, pull yourself back
together in a physical sense…”
2. Letting go of unhelpful
behaviour
No. 12 – “We’ve talked about that, about how much we let our phones and email run our
lives. And us constantly checking. You don’t need to at all, of course. People can easily wait
a day. They don’t need an answer within ve minutes.”
3. Developing new helpful
behaviours
No. 9 – “(…) dealing with pressure in a different way (…), taking a moment for myself more
often, taking a break when it’s break time and going outside for a walk and thinking ‘bye
guys, I’m just popping out to get some fresh air’. And taking more moments in between just
to rest for a moment.”
Other – Attitude
1. Being aware of one’s impact
on others
No. 9 – “In conversations with others too (….). I think you start looking at it from a different
perspective, you become more empathetic I think and more sensitive to ‘how does the other
person feel about what I’m saying?’ and ‘how would I feel about it?’.”
2. Keeping an open mind
towards others
No. 14 – “Especially by separating the content from the person talking, and so listening
to the story from a very neutral perspective. What is the message? Where is the conict?
Depending on what presents itself, and then keeping the judgement as focused on the
content as possible, as factual as possible and not letting it be coloured by the way the
story is told or any undertones you might be hearing.” No. 3 – “I judge less. And I’m actually
very happy with that. Especially if you then look back at yourself, that I thought ‘you know.
Everyone is different of course.’ And I often had an opinion about that or was quick to judge.”
3. Allowing difcult emotions
associated with others
No. 8 – “We had just come out of a very hectic period, and (…) a sensitive and serious
conict (…) and as the manager I was right in the middle of that, and it wasn’t easily resolved
(…) A great deal of investment was needed for many of the relationships that had been
seriously damaged, so that was quite a challenge too and at times when it didn’t go as
quickly as I’d hoped, I simply needed to grin and bear it.”
4. Appreciating others No. 16 –“He’s a bit neurotic and very particular and deals with people in a very different
way that I do. And very dedicated to his work, but I put a kind of negative spin on that (…)
Whereas now (…) I look at things differently (…) when I look at him now, I see a man who has
truly dedicated his life to his work.”
Other - Behaviour
1. Communicating more
effectively
No. 14 – “…then it’s listening, isn’t it, really just listening and nothing else, just listening.” No.
16 – “…being more open towards that and asking more questions. Asking ‘why’, ‘can you
pinpoint why exactly you aren’t doing well?’ ‘Can you articulate what you want, what you
need?’ That I guess, asking more questions and more, well that means not drawing your own
conclusions, but getting more to the bottom of things.” No. 3 – “(…) then I just show there’s
nothing wrong with admitting you don’t know something. Or that you’d like to use someone
else’s expertise.”
2. Providing direction No. 10 – “I think now that I’ve given myself more direction and I can more clearly outline the
direction for the people I manage.”
Continued
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Category and Themes Illustrative quotes
3. Empowering No. 5 – “But experience by now has taught me that the less I interfere (…) the more people
start to develop talents (…) That helps people develop and the product may actually be
better, especially for those people themselves, because there’s a greater sense of them
having done it themselves. So taking more distance, not interfering too much.” No. 3
–“Putting someone down, because that would then feed my ego. That is not at all benecial
to what we need to do, to delivering good patient care. (…) I think well, then I’ll take myself
as an example, and they picked up on that, that I said something along the lines of ‘I don’t
know this’, ‘Can you contribute any thoughts on this?’ Or ‘I did it for this or that reason, but
maybe you have other ideas, or maybe I overlooked something’?”
4. Caring for others No. 9 – “I also noticed with the colleague who’s had a burnout, that I was the rst to notice
that he was burning out and that it started being an issue and that I see it in other colleagues
(…) You’re much more aware, not only of yourself, but also of other people around you.” No.
16 – “And then I try to put them at ease a bit that way, by saying ‘You can’t do everything at
once, so try to take it one step at a time.’ You hope it helps someone a bit.”
Table 2 Continued
Focusing on facts and content rather than the emotions
associated with a person helped them separate emotions
from facts.
Allowing difcult emotions associated with others
This involves being open to difficult things. Participants
mentioned how they allowed and tolerated difficult situa-
tions and behaviour. They mentioned being patient with
others who exhibited difficult behaviour.
Appreciating others
Apart from having a nonjudgemental attitude towards
others, participants described how they now see others’
value more. They realise that people are different and do
not necessarily have the same ideas and ambitions. They
have a greater understanding of other people’s situations.
One participant described seeing people as more equal.
Other - Behaviour
The fourth category involves changes in observable
behaviour towards others. It includes four subcategories:
Communicating more effectively
As part of communicating openly, the participants
mentioned listening, asking for clarification and
connecting with others by sharing expectations, the expe-
rienced workload or their own vulnerability. This theme
was overwhelmingly present in the data.
Most participants mentioned listening with more atten-
tion as a direct effect of the training. They described an
ability to let go of control during communication and
really listen to the other person with attention and focus.
They mentioned refraining from interrupting or finishing
other people’s sentences. They mentioned having more
in- depth discussions and more effective conversations.
Participants reported feeling confident in their ability to
capture essential information, understand key points and
understand another person.
Furthermore, participants not only reported listening
more, but also asking more questions to get clarification.
They asked questions like “What do you mean by that?”
or “Can you tell me what you need?” They also invited
so- called ‘difficult people’ to join in conversations and
engage with decisions.
Participants mentioned connecting and aligning more
with their colleagues. They reported working together
and sharing their experiences, such as workload, expec-
tations towards one another and their own vulnerability.
Providing direction
Participants described an ability to express more clearly
how they see things, what they want and how they want
it. They described expressing a vision towards others and
acting on it. They mentioned formulating their ideas
more clearly towards others.
Empowering
Participants described how they consciously refrained
from responding to emails to tell others what to do
and developed behaviour that facilitated others. They
described how they now give their employees more
responsibility and trust that what they do is right. That
allows employees to develop, and the participants did not
intervene with their learning process. Instead of telling
employees what to do, the participants coached them and
discussed their personal development with them.
Caring for others
Participants described a certain care for their colleagues.
They mentioned actions like devoting more time to their
colleagues, paying more attention to their well- being and
keeping in contact with them when they were on sick
leave. One participant described how he fired someone
with compassion.
Participants also mentioned encouraging others to take
care of themselves. They described advising others to
practice mindfulness or transmitting to others what they
had learnt in the course (eg, being less judgemental and
kinder towards yourself). They mentioned being milder
towards others and encouraging others to do so.
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Apart from effects on their leadership, participants also
mentioned results of the process of practising mindful-
ness in their leadership. The answers can be divided in
two subcategories:
1. Greater satisfaction in work
They described having a more pleasant and productive
contact with their colleagues and the patients.
2. Efficiency
Participants described that the effort they put in the
organisation had a bigger return on investment and
that they received more appreciation from their
employees.
DISCUSSION
This qualitative study addressed the perceived impact of
mindfulness training on leadership by medical specialists.
In addition to the dimension of self versus other, we iden-
tified a dimension of attitude versus behaviour, which can
also be described as ‘being’ versus ‘doing’.49 The psycho-
logical attitude towards oneself was characterised by more
awareness, an open mind, insight and an appreciation of
self. In terms of behaviour towards oneself, participants
reported better emotional and cognitive self- regulation,
which involved letting go of unhelpful behaviours and
developing new helpful behaviours. The change of atti-
tude towards others was characterised by having more
awareness of others and one’s own impact on others,
keeping an open mind towards others, allowing diffi-
cult emotions associated with others and appreciating
others. Changes in behaviours towards others consisted
of communicating more effectively, providing directions,
empowering and caring for others.
The data also showed that the four categories are inter-
related. For example, when people appreciate themselves
more, this can result in better self- care (B), a more appre-
ciative attitude towards others (C) and more caring for
others (D). Insight seems to precede behavioural changes,
although not all insights lead to behavioural change. It is
possible that resources for behavioural change (eg, time
and energy) are not (yet) available but will be in future.
Therefore, some effects of the intervention may become
visible long after the intervention has ended.
Contribution to previous research
Our model is in line with findings from previous research.
Another study that involved healthcare workers after a
mindfulness intervention described an increased open
mind, awareness of self, insight, self- acceptance, letting
go of unhelpful behaviour and developing helpful
behaviour.32 It also reported perceived effects in the inter-
personal domain, like listening, empathy and acceptance of
others.32 Irving et al described an influence of mindfulness
on leaders’ emotional regulation and self- awareness.50
Furthermore, previous research showed that leaders’
mindfulness is related to employees’ well- being.24 Our
study revealed some potential pathways to explain
this relationship. Leaders said that awareness of their
leadership style helps them communicate more effec-
tively and provide clearer instructions. Furthermore, they
are more aware of their employees’ mental and physical
states, which helps leaders empower and care for them;
this is in line with a previous qualitative study on mind-
fulness and leadership.51 However, other pathways may
exist, especially those that appear unconsciously and
are difficult to reflect on in interviews. Interviews with
employees or observation studies may help to elucidate
these pathways. Furthermore, personal relationships may
also improve, although that is beyond the scope of this
study.52 These improved personal relationships may also
have a positive effect on performance at work and as a
leader.
Good et al28 suggested that mindfulness may enhance
the effects of a leadership course. Our study, although
qualitative, found that medical specialists report benefi-
cial outcomes from a combined course, which provides
some support for that idea. Rigorous randomised
controlled trials of leadership courses with and without
mindfulness would be necessary to truly test this idea.
However, previous research did find that a mindfulness
communication course had beneficial effects on conver-
sations with patients,30 while another study of a mindful
leadership course reported benefits to communication
with colleagues and employees.33
One participant in our study reported that the course
had no perceived benefits on their leadership skills or
personal life. Mindfulness- based interventions like the
leadership course may not be equally beneficial for all
participants. for example,53 Therefore, it is important
that future research address the question of who is likely
to benefit and who is not, and raise awareness of alterna-
tive leadership courses that might be a better match for
certain medical specialists.
Relation to different leadership styles
Studying the perceived effects of a mindful leadership
course gave us insight into the nature of mindful lead-
ership. Our model builds on and extends current theo-
rising on positive leadership grounded in ethical and
moral values. Some themes correspond with aspects of
other leadership styles, most notably authentic leadership
and servant leadership. Authentic leadership focuses on
greater self- awareness, an internalised moral perspective,
balanced information processing and transparency in
behaviour towards others.54 In our results, we also see the
aspect of self- awareness that is also an element of authentic
leadership has and, like authentic leadership, mindful
leadership involves behaviour that promotes greater
psychological capacity through cognitive and emotional
self- regulation. A unique quality of mindful leadership is
the more explicit incorporation of a behavioural compo-
nent with a broader behavioural spectrum, going beyond
transparent authentic behaviour and the strong attitu-
dinal focus of authentic leadership.
We also see a link with servant leadership, which has
been described as having six characteristics: empowering
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and developing people, humility, authenticity, interper-
sonal acceptance, providing direction and stewardship.55
The characteristics of empowerment and interpersonal
acceptance overlap with mindful leadership. Empower-
ment describes a leader’s focus on employees’ autonomy,
enhancing their personal growth and having a general
coaching attitude. All these elements are part of mindful
leadership to greater or lesser degrees. We also see a link
with the interpersonal acceptance dimension of servant
leadership: the themes ‘awareness of others’, ‘open mind
to others’ and ‘appreciating others’ from our results dove-
tail with this characteristic of servant leadership. Mindful
leadership differs in that the focus is both on self and
others. Servant leadership is grounded in serving others,
the six characteristics are all defined in terms of the rela-
tion between leader and follower. Mindful leadership
describes more explicitly and in deeper detail the intrap-
ersonal aspect of being a leader through different helpful
attitudes and behaviour. Thus, mindful leadership offers
components not present in authentic or servant leadership.
Although our data are qualitative and require further quan-
titative research, they suggest that mindful leadership adds
components that are relevant to leadership in a medical
setting.
Strengths and limitations
One strength of this research is that we were in the unique
position to conduct interviews about the application of
mindful leadership in real life with a group of partici-
pants who have enormous workloads. These interviews
and real- life examples gave us the insights we needed. We
applied purposive sampling that considered age, gender,
specialty, leadership role and completion of the course,
to make sure a large variety of perspectives was included,
which is a strength in qualitative research. All the inter-
views were conducted by researchers who were not the
teachers, which made the responses less prone to subjec-
tivity. The research group that analysed the data consisted
of researchers with a variety of expertise, to avoid bias
from particular perspectives. A final strength is that the
interviews were conducted no less than 12 months after
the course ended, which made it possible to say some-
thing about how the lessons from the course were inte-
grated into daily work practice.
Despite its strengths, this research also has some limita-
tions. First, categorising was helpful when analysing the
results, but it sometimes felt forced and artificial. In reality,
the distinction between the different categories were not
always very sharp. For example, being aware of your judge-
ment about a colleague was categorised as an awareness
related to others. But a case could also be made for label-
ling it as awareness of self. Clearly the categories influence
each other, and the reality is not static. The same applies
for the themes within categories. Second, our mindful
leadership course was an intense programme. Therefore,
it is possible that self- selection for participation created a
bias in the participants, which may compromise the study’s
generalisability. Finally, we only focused on the perspective
of the medical specialists themselves, which can be seen as
limitation. The perspective of their employees could also
be informative, which is an interesting avenue for future
research. Despite these limitations, we feel that this study
adds to the research on mindful leadership in general, and
leadership among medical specialists in particular.
Implications
Our results reflect changes in psychological attitudes and
observable behaviours and are a first attempt to define
mindful leadership and its components. Furthermore, they
suggest that a mindful leadership course may be a valu-
able training option for medical specialists. More research
on mindful leadership and the effects on self and others
is needed. Future research may address the effects of the
course from the perspective of employees, and randomised
controlled trials with large samples are needed to address
effectiveness. Furthermore, it may be valuable to study
beforehand who will benefit from the course.
Acknowledgements The authors wish to thank Dr Hiske van Ravensteijn for her
contribution to the coding of the data.
Contributors KV contributed to the conception and design, acquiring data,
analysing and interpreting data, drafting and revising the article, and approving
the nal version. WK contributed to the conception and design, acquiring data,
analysing and interpreting data, drafting and revising the article, and approving the
nal version. LC contributed to drafting and revising the article and approving and
submitting the nal version. DvD contributed to analysing and interpreting data,
drafting and revising the article, and approving the nal version. AS contributed to
the conception and design, acquiring data, analysing and interpreting data, drafting
and revising the article, and approving the nal version.
Funding The authors have not declared a specic grant for this research from any
funding agency in the public, commercial or not- for- prot sectors.
Competing interests AS is the director of the Radboudumc Center for Mindfulness
and WK, LC and KV were employed by the Radboudumc Center for Mindfulness at
the time of this study.
Patient consent for publication Not required.
Ethics approval According to Dutch law, the non- medical and non- experimental
nature of the study, combined with the minimal risks and burdens for participants,
meant that this study did not require review by the Medical Ethical Committee
Arnhem/Nijmegen, the Netherlands. The principles of the Declaration of Helsinki
were followed wherever applicable. In addition, participants agreed to participate by
signing an informed consent. Data were treated condentially and according to the
Dutch ‘Protection of personal data’ law.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available.
Open access This is an open access article distributed in accordance with the
Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license, which
permits others to distribute, remix, adapt, build upon this work non- commercially,
and license their derivative works on different terms, provided the original work is
properly cited, appropriate credit is given, any changes made indicated, and the use
is non- commercial. See:http:// creativecommons. org/ licenses/ by- nc/ 4. 0/.
ORCID iD
LindaCillessen http:// orcid. org/ 0000- 0003- 2030- 8646
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... Continued open questioning was used to deeply understand the provided answers. Perceived effects of the course on personal and professional functioning and leadership skills were also explored, and are reported in a separate publication [42]. However, if responses to these questions were considered to be facilitators or barriers to participating in the course, they were included in the qualitative analysis of the feasibility. ...
... However, if responses to these questions were considered to be facilitators or barriers to participating in the course, they were included in the qualitative analysis of the feasibility. Saturation was reached for perceived effects of the course (see 42). The interview questions were not pilot tested. ...
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Background: Medical specialists experience high levels of stress. This has an impact on their well-being, but also on quality of their leadership. In the current mixed method study, the feasibility and effectiveness of a course Mindful Leadership on burnout, well-being and leadership skills of medical specialists were evaluated. Methods: This is a non-randomized controlled pre-post evaluation using self-report questionnaires administered at 3 months before (control period), start and end of the training (intervention period). Burn-out symptoms, well-being and leadership skills were assessed with self-report questionnaires. Semi-structured interviews were used to qualitatively evaluate barriers and facilitators for completion of the course. Results: From September 2014 to June 2016, 52 medical specialists participated in the study. Of these, 48 (92%) completed the course. Compared to the control period, the intervention period resulted in greater reductions of depersonalization (mean difference = - 1.2, p = 0.06), worry (mean difference = - 4.3, p = 0.04) and negative work-home interference (mean difference = - 0.2, p = 0.03), and greater improvements of mindfulness (mean difference = 0.5, p = 0.04), life satisfaction (mean difference = 0.4, p = 0.01) and self-reported ethical leadership (mean difference = 0.1, p = 0.02). Effect sizes were generally small to medium (0.3 to 0.6) and large for life satisfaction (0.8). Appreciation of course elements was a major facilitator and the difficulty of finding time a major barrier for participating. Conclusions: A 'Mindful Leadership' course was feasible and not only effective in reducing burnout symptoms and improving well-being, but also appeared to have potential for improving leadership skills. Mindful leadership courses could be a valuable part of ongoing professional development programs for medical specialists.
... These studies were supported by additional research(Schuh et al., 2019).Schuh et al. (2019) concluded that the positive relationship between mindful leadership and employee performance was a result of the leader creating an environment of high procedural justice and low employee emotional exhaustion.Reb et al. (2019) also found mindful leaders create environments with less employee stress.Other researchers have found that mindful leadership has improved the quality of employee relationships at work and helped employees to connect to the organizational purpose(Levey & Levey, 2019).Reb et al. (2019) also studied work relationships and found mindful leaders develop higher-quality relationships with their followers. Further,Vreeling et al. (2019) found that mindful leader relationships with followers enabled leaders to more effectively empower and assist their employees since they had a better awareness of the employees' physical and mental states.Servant Leadership.Research in servant leadership, another component of HCSL, has included studies of teams as well as individuals across many disciplines. ...
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This study provides a systematic review of prior empirical research on the impact of mindfulness interventions and practices on leaders. The aim is to integrate existing knowledge and identify future research needs. Mindfulness as a leader-specific practice is defined and discussed to provide conceptual clarity and to highlight the importance of understanding the phenomenon and its value in the context of leadership and individual leader development. A conceptual framework is presented which synthesizes findings from prior works and shows that leaders' mindfulness practices affect various developmental outcomes viewed as important for leaders and leadership. A comprehensive future research agenda for theoretical and empirical advancement is proposed that recommends looking beyond the essential wellbeing and work productivity outcomes and exploring the transformative outcomes of mindfulness interventions and practices related to leaders' relationships and inner growth that involve enhanced self-awareness and social/contextual awareness.
... Previous qualitative studies on MBPs for physicians and resident physicians have reported similar themes, such as increased awareness, changes in attitudes towards the self, increased self-care and well-being, and impacts on social interactions [20,23,[45][46][47][48]. Moreover, a contextual factor that was identified by Beckman and others [45] and Irving and others [46] was the importance of sharing experiences from medical practice with colleagues. ...
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Background and purpose: Diminished well-being is prevalent in resident physicians. This qualitative study explored the effects of a tailored mindfulness-based program (MBP) aimed at increasing resident physicians’ well-being. A second goal was to compare the MBP with an active control group. Materials and methods We conducted interviews with 35 resident physicians: 21 physicians attended an eight-week MBP (intervention group) and 14 physicians received text-based information about mindfulness for self-study (control group). The interviews were analyzed using thematic analysis. Results Participants in the intervention group reported that the MBP helped them integrate mindfulness into their everyday life, increased their self-awareness, equanimity and well-being, and had positive effects on their self-care and interactions with patients. In the control group, the perceived effects were minor. Conclusion A tailored mindfulness-based program can help resident physicians care for their own well-being during medical residency and can have positive effects on their interactions with patients.
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Objectives Clinician well-being has been recognised as an important pillar of healthcare. However, research mainly addresses mitigating the negative aspects of stress or burnout, rather than enabling positive aspects. With the added strain of a pandemic, identifying how best to maintain and support the well-being, satisfaction and flourishing of general practitioners (GPs) is now more important than ever. Design Systematic review. Data sources We searched MEDLINE, PsycINFO, Embase, CINAHL and Scopus from 2000 to 2020. Study selection Intervention studies with more than 50% GPs in the sample evaluating self-reported well-being, satisfaction and related positive outcomes were included. The Cochrane Risk of Bias 2 tool was applied. Results We retrieved 14 792 records, 94 studies underwent full-text review. We included 19 studies in total. Six randomised controlled trials, three non-randomised, controlled trials, eight non-controlled studies of individual or organisational interventions with a total of 1141 participants. There were two quasi-experimental articles evaluating health system policy change. Quantitative and qualitative positive outcomes were extracted and analysed. Individual mindfulness interventions were the most common (k=9) with medium to large within-group (0.37–1.05) and between-group (0.5–1.5) effect sizes for mindfulness outcomes, and small-to-medium effect sizes for other positive outcomes including resilience, compassion and empathy. Studies assessing other intervention foci or other positive outcomes (including well-being, satisfaction) were of limited size and quality. Conclusions There is remarkably little evidence on how to improve GPs well-being beyond using mindfulness interventions, particularly for interventions addressing organisational or system factors. This was further undermined by inconsistent reporting, and overall high risk of bias. We need to conduct research in this space with the same rigour with which we approach clinical intervention studies in patients. PROSPERO registration number CRD42020164699. Funding source Dr Diana Naehrig is funded through the Raymond Seidler PhD scholarship.
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Background: Medical specialists experience high levels of stress. This has an impact on their well-being, but also on quality of their leadership. In the current mixed method study, the feasibility and effectiveness of a course Mindful Leadership on burnout, well-being and leadership skills of medical specialists were evaluated. Methods: This is a non-randomized controlled pre-post evaluation using self-report questionnaires administered at 3 months before (control period), start and end of the training (intervention period). Burn-out symptoms, well-being and leadership skills were assessed with self-report questionnaires. Semi-structured interviews were used to qualitatively evaluate barriers and facilitators for completion of the course. Results: From September 2014 to June 2016, 52 medical specialists participated in the study. Of these, 48 (92%) completed the course. Compared to the control period, the intervention period resulted in greater reductions of depersonalization (mean difference = - 1.2, p = 0.06), worry (mean difference = - 4.3, p = 0.04) and negative work-home interference (mean difference = - 0.2, p = 0.03), and greater improvements of mindfulness (mean difference = 0.5, p = 0.04), life satisfaction (mean difference = 0.4, p = 0.01) and self-reported ethical leadership (mean difference = 0.1, p = 0.02). Effect sizes were generally small to medium (0.3 to 0.6) and large for life satisfaction (0.8). Appreciation of course elements was a major facilitator and the difficulty of finding time a major barrier for participating. Conclusions: A 'Mindful Leadership' course was feasible and not only effective in reducing burnout symptoms and improving well-being, but also appeared to have potential for improving leadership skills. Mindful leadership courses could be a valuable part of ongoing professional development programs for medical specialists.
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Mindfulness training is a novel method of leader development but contrary to its rising popularity, there is a scarcity of research investigating how mindfulness training may affect leader capabilities. To gain a better understanding of the potential of a new research field, qualitative research is advantageous. We sought to understand how senior leaders experience the impact of mindfulness training in their work lives and leadership ability. The sample comprised 13 leaders (n = 11 male) working in six organizations that completed a 10-week workplace mindfulness training (WMT). We conducted semi-structured interviews 6 to 12 months following course completion. We analyzed the data following thematic analysis steps and based on these findings, we devised a framework of the perceived impact of mindfulness training on self-leadership and leadership capabilities. We show that WMT exhibited impact on three self-leadership capacities: mindful task management, self-care and self-reflection and two leadership capacities: relating to others and adapting to change. Participants’ recounts additionally suggested effects may expand to the level of the team and the organization. We show that WMT may be a promising tool for self-directed leadership development and outline avenues for future research.
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Objectives Value-based healthcare implies that healthcare issues are addressed most effectively with the ‘physicians in the lead' (PIL) strategy. This study explores whether PIL also supports a holistic care approach that patients are increasingly demanding. Design A qualitative research design was used. Setting This study was conducted in a general hospital in the Netherlands with an integrated PIL strategy. Participants Semistructured interviews were conducted with 14 hospital stakeholders: 13 stakeholders of an Obstetrics and Gynaecology department (the hospital’s Patient Council (n=1), nurses (n=2), midwives (n=2), physicians (n=2), residents (n=2), the non-medical business managers of the Obstetrics and Gynaecology department (n=2) the Board of Directors (n=2)) and a member of the Dutch National Healthcare Institute’s Innovative Healthcare Professions programme. Results According to diverse stakeholders, PIL does not support a holistic healthcare delivery approach, primarily because of the strong biomedical focus of the physicians. Although physicians can be educated to place more emphasis on the holistic outcome, holistic care delivery requires greater integration and teamwork in the care chain. As different healthcare professions are complementary to each other, a new strategy of a ‘team in the lead' was suggested to meet the holistic healthcare demands. Besides this new strategy, there is a need for an extramural care management coordination centre where patients are able to receive support in managing their own care. This centre should also facilitate services similar to the core function of a church or community centre. These services should help patients to deal with different holistic dimensions that are important for their well-being. Conclusions The PIL strategy appears to be insufficient for holistic healthcare delivery. A ‘team in the lead’ approach should be considered to meet the holistic healthcare demands. Further research should focus on observing PIL in different cultures and exploring the effectiveness of the strategy ‘team in the lead’.
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In the present research, we examine the relation between leader mindfulness and employee performance through the lenses of organizational justice and leader-member relations. We hypothesize that employees of more mindful leaders view their relations as being of higher leader-member exchange (LMX) quality. We further hypothesize two mediating mechanisms of this relation: increased interpersonal justice and reduced employee stress. In other words, we posit that employees of more mindful leaders feel treated with greater respect and experience less stress. Finally, we predict that LMX quality serves as a mediator linking leader mindfulness to employee performance—defined in terms of both in-role and extra-role performance. Across two field studies of triadic leader-employee-peer data (Study 1) and dyadic leader-employee data (Study 2), we find support for this sequential mediation model. We discuss implications for theorizing on leadership, organizational justice, business ethics, LMX, and mindfulness, as well as practical implications.
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Purpose: In addition to developing diagnostic and clinical skills, postgraduate medical education should stimulate residents' professional development. Teaching medical professionalism is challenging and is often left largely to the informal and hidden curricula. An intervention that might be beneficial for medical residents is Mindfulness-Based Stress Reduction (MBSR). The authors implemented MBSR as an optional course for residents and qualitatively explored how it influenced residents professionally. Method: Between 2014 and 2016, the authors conducted 19 in-depth, face-to-face interviews with residents who had participated in an MBSR course at Radboud university medical center, the Netherlands. Medical and surgical residents, across a range of disciplines, participated. The authors used the constant comparison method to analyze the data. Results: The analysis of the data resulted in five themes: awareness of thoughts, emotions, bodily sensations, and behavior; increased self-reflection; acceptance and nonjudgment; increased resilience; and relating to others. Residents indicated that the MBSR training increased their awareness and self-reflection at work, and they were more accepting toward themselves and toward their limitations. Furthermore, they mentioned being more resilient and better at setting priorities and limits. They improved their self-care and work-life balance. In addition, residents indicated that the training made them more aware of how they communicated. They asked for help more often and seemed to be more open toward feedback. Lastly, they indicated an increased sense of compassion for others. Conclusions: This study indicated that mindfulness training can serve as a tool to cultivate important professional competencies for residents.
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Background: Burnout is highly prevalent in residents. No randomized controlled trials have been conducted measuring the effects of Mindfulness-Based Stress Reduction (MBSR) on burnout in residents. Objective: To determine the effectiveness of MBSR in reducing burnout in residents. Design: A randomized controlled trial comparing MBSR with a waitlist control group. Participants: Residents from all medical, surgical and primary care disciplines were eligible to participate. Participants were self-referred. Intervention: The MBSR consisted of eight weekly 2.5-h sessions and one 6-h silent day. Main measures: The primary outcome was the emotional exhaustion subscale of the Dutch version of the Maslach Burnout Inventory-Human Service Survey. Secondary outcomes included the depersonalization and reduced personal accomplishment subscales of burnout, worry, work-home interference, mindfulness skills, self-compassion, positive mental health, empathy and medical errors. Assessment took place at baseline and post-intervention approximately 3 months later. Key results: Of the 148 residents participating, 138 (93%) completed the post-intervention assessment. No significant difference in emotional exhaustion was found between the two groups. However, the MBSR group reported significantly greater improvements than the control group in personal accomplishment (p = 0.028, d = 0.24), worry (p = 0.036, d = 0.23), mindfulness skills (p = 0.010, d = 0.33), self-compassion (p = 0.010, d = 0.35) and perspective-taking (empathy) (p = 0.025, d = 0.33). No effects were found for the other measures. Exploratory moderation analysis showed that the intervention outcome was moderated by baseline severity of emotional exhaustion; those with greater emotional exhaustion did seem to benefit. Conclusions: The results of our primary outcome analysis did not support the effectiveness of MBSR for reducing emotional exhaustion in residents. However, residents with high baseline levels of emotional exhaustion did appear to benefit from MBSR. Furthermore, they demonstrated modest improvements in personal accomplishment, worry, mindfulness skills, self-compassion and perspective-taking. More research is needed to confirm these results.
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Most writing on sociological method has been concerned with how accurate facts can be obtained and how theory can thereby be more rigorously tested. In The Discovery of Grounded Theory, Barney Glaser and Anselm Strauss address the equally Important enterprise of how the discovery of theory from data-systematically obtained and analyzed in social research-can be furthered. The discovery of theory from data-grounded theory-is a major task confronting sociology, for such a theory fits empirical situations, and is understandable to sociologists and laymen alike. Most important, it provides relevant predictions, explanations, interpretations, and applications. In Part I of the book, "Generation Theory by Comparative Analysis," the authors present a strategy whereby sociologists can facilitate the discovery of grounded theory, both substantive and formal. This strategy involves the systematic choice and study of several comparison groups. In Part II, The Flexible Use of Data," the generation of theory from qualitative, especially documentary, and quantitative data Is considered. In Part III, "Implications of Grounded Theory," Glaser and Strauss examine the credibility of grounded theory. The Discovery of Grounded Theory is directed toward improving social scientists' capacity for generating theory that will be relevant to their research. While aimed primarily at sociologists, it will be useful to anyone Interested In studying social phenomena-political, educational, economic, industrial- especially If their studies are based on qualitative data. © 1999 by Barney G. Glaser and Frances Strauss. All rights reserved.
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Although self-leadership and mindfulness comprise the same self-regulatory core (observation) regarding attention in relation to mental states and have similar outcomes (e.g., stress reduction, increased performance), the relationships between self-leadership and mindfulness have not yet been examined. In this study, 174 participants completed self-report measures of self-leadership and mindfulness. Results showed that self-leadership was positively related to the observing facet of mindfulness. The importance of observation and the role of openness to experience in self-leadership and mindfulness are discussed. © 2018 Scientific Journal Publishers Limited. All Rights Reserved.