Development of a National Medical Leadership Competency Framework: Syrian Approach

Development of a National Medical Leadership Competency Framework: Syrian Approach | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Development of a National Medical Leadership Competency Framework: Syrian Approach Abla Shaddoud, Mohamad Kusai Al-Munajed, Mayssoon Dashash This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5413549/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background and Objectives: As team-based practices and integrated care approaches become more prevalent, it is essential for physicians to be skilled practitioners capable of functioning efficiently and effectively within complex health systems. In addition to clinical expertise, they should also develop management and leadership competencies. This study aimed to identify the medical leadership competencies among healthcare professionals in the Syrian Arab Republic. Methods: The study involved 86 participants. The Self-assessment tool NHS Leadership test was applied, comprising 40 questions. Data was collected through a Google Form which was distributed online. The results were analysed using statistical software SPSS version 24. Results: Findings showed that the perceptions of resident doctors in Syrian government hospitals regarding the medical leadership competencies were moderate overall, with some items ranked low. The responses revealed that “Demonstrating personal qualities” was the most consistently recognized leadership competencies, with a mean score of (3.42). There were no statistically significant differences at the 0.05 level in medical leadership competencies based on residency year and specialization, although significant differences were observed favoring male participants . Conclusions: There is a critical need to enhance leadership effectiveness among healthcare professionals in the Syrian Arab Republic, especially in the areas of Setting Direction and Managing services, which received the lowest rankings. This improvement should begin at the undergraduate level through targeted courses during academic semesters, followed by continuous training and exposure to systematic rehabilitation programs during residency. Medical Leadership Competences NHS Leadership Academy Demonstrating personal qualities Working with others Managing services Improving services Setting direction. Figures Figure 1 Introduction Leadership plays a crucial role in managing organizations that strive to enhance the well-being of individuals across various fields. It is essential not only for the implementation and achievement of goals, but also for setting those goals, and fostering group’s loyalty. Consequently, a leader is viewed as the heart of the organization, not merely as a figurehead. Leadership is fundamental to effective public administration, as it ensures the organization’s health, oversees business management, and inspires employees to work with enthusiasm and efficiency. Thus, selecting and preparing leaders of organizations and institutions has become a top priority for modern countries [ 1 – 3 ]. Leadership can be defined as the art of influencing people to willingly devote their efforts toward achieving shared goals [ 4 ]. Cuban characterized leaders as "people who shape the goals, motives, and actions of others. They often initiate change to reach both existing and new objectives [ 5 ]." Kotter distinguished between leadership and management, noting that management focuses on planning, budgeting, outlining implementation steps, and allocating necessary resources. In contrast, leadership is centered on envisioning the future, setting the vision, and developing strategies required to achieve it. Management employs and organizes human resources by setting a structure, defining responsibilities, delegating authority and establishing a system for monitoring implementation and correcting errors. Leadership, however, aligns teams by; communicating the new direction and forming a coalition that can understand the vision and work toward achieving it. Kotter also points out that management is concerned with executing plans through supervision and problem-solving, while leadership motivates individuals to overcome obstacles and achieve fundamental and beneficial changes. Therefore, leadership complements management rather than replacing it [ 6 ]. The need for integration between administrative and leadership roles becomes clear. Strong leaders are not only exceptional managers; their credibility is significantly enhanced by administrative experience. It is important to recognize that the distinction between management and leadership is not a binary one; rather it involves a combination or balance of both, as today’s leaders require knowledge grounded in the realities of their organizations [ 7 , 8 ]. Historically, medical training has concentrated primarily on clinical skills. However, with the rise of team-based practice, it has become evident that physicians should not only be proficient in their clinical abilities, but also demonstrate the necessary to be safe skills to work effectively within complex healthcare-systems. In recent years, medical policy-makers have emphasized that all physicians must develop management and leadership competencies in addition to their clinical knowledge and skills to ensure they are effective and safe practitioners [ 9 , 10 ]. . For this study, a conceptual framework centered on medical leadership and engagement has been established. The framework outlines the leadership competencies that all doctors should develop and that must be integrated into curricula and assessment processes. The goal is to ensure that all doctors, throughout their careers, attain a standardized set of leadership competencies essential for being effective practitioners. It is based on the belief that all medical professionals should take on leadership roles to enhance the quality of the service within their specialty, practice or unit [ 11 ]. A Medical Leadership Competency Framework has been developed (Fig. 1 ) to enable assessing the leadership behaviors across five domains depending on their operational context, with the goal of providing high-quality services to patients. It is crucial for all doctors to be competent in each of the five leadership domains: demonstrating personal qualities, working with others, managing services, improving services and setting direction [ 11 , 12 ]. In countries with limited resources medical involvement in planning, the competency of medical leadership is often overlooked in practice. There remains a lack of interest in this area, which is frequently regarded as a luxury or merely a personal talent, despite numerous studies highlighting its importance. Additionally, it is confirmed that leadership skills can be both learned and taught. The ongoing war in Syria has exacerbated the situation as many experienced doctors have left the country; while the existing hierarchical system fails to support the development of new doctors in integrity, character strength, and administrative competency that would qualify them for leadership. Consequently, this study was conducted as an initial attempt to make a meaningful impact in this crucial aspect of medical practice, with the hope that it will pave the way for further research aimed at implementing a comprehensive approach to developing medical leadership. This study aimed to identify the medical leadership competencies among healthcare professionals in the Syrian Arab Republic by addressing the question how do they perceive their medical leadership competencies?. Additionally, the study aimed to analyze significant differences in these competencies based on gender, year of residency and specialization among health care professionals. Methods This study has a cross-sectional design with a descriptive and analytical approach, conducted among resident doctors in government hospitals in the Syrian Arab Republic from September 19 2023 to January 1 2024. With the study adhered to the Declaration of Helsinki and was obtained ethical approval from the research committee of the Syrian Virtual University, on19/9/2023. Data collection was carried out using Google Forms, an online survey platform. The link to the questionnaire, which is the Self-assessment tool (NHS Leadership), was distributed online across various Syrian health websites and social media platforms. Informed consent was taken to ensure the anonymity and confidentiality of the participants’ responses. . That The Self-assessment tool (NHS Leadership) : This measurement instrument consists of, 40 items that cover areas of medical leadership competences: [11, 12] 1. Demonstrating personal qualities (PQ): This area includes eight items that require doctors to demonstrate competencies in self-awareness, self-management, personal development and integrity. 2. Working with others (WO): This section contains eight items that assess doctors' abilities to develop networks, build and maintain relationships, encourage contributions and work effectively in teams. 3. Managing services (MS): This area consists of eight items that requires doctors’ competencies in planning, resources management, personal management and performance management. 4. Improving services (IS): This section includes eight items that require doctors to demonstrate competencies in ensuring patient safety, critical evaluation, encouraging improvement and innovation, and facilitating transformation. 5. Setting direction (SD): This area comprises eight items that assess doctors abilities to identify contexts for change, apply knowledge and evidence, make informed decisions and evaluate impacts. Participants were asked to rate their responses on a Likert-type scale of 1to 5, ranging from ‘strongly disagree’ to ‘strongly agree’, allowing for the quantification of their agreement with each statement.. To interpret the results of this study, specific cut points were defined to assess participants’ total scores related to their perception of medical leadership competencies. The cut points were determined using the response scale of each item, as follows: 1–2.33 = low, 2.34 ­– 3.67 = moderate, and 3.68–5.00 = high levels. A pilot study involving 15 participants led to modifications in the wording of some questions for improved clarity and understanding Reliability :;The internal consistency reliability of the subscales was deemed acceptable, with alpha coefficients exceeding the generally accepted reliability value of 0.70. The internal consistency reliability values for the subscales and components were 0.82, 0.80, 0.76, 0.73 and 0.75 for the first, second, third, fourth and fifth areas, respectively. These values indicate a satisfactory level of reliability to support the objectives of the current study, and suggest that the tool is a valid and reliable measure for use within the Syrian population. Statistical analyses were performed using SPSS version 27. Baseline characteristics were presented as the mean ± standard deviation. Construct validity was assessed using Pearson Correlation, while and reliability was tested through Cronbach’s alpha. Multiple ANOVA was conducted to determine whether significant mean differences exist in the level of medical leadership competencies based on the study variables with P < 0.05 considered statistically significant . Results The final sample was composed of 86 participants. There were 35 females (40.7%) and 51 males (59.3%), from first and second year (19), third and fourth year (35) and they distributed as follows: (22.1%), (40.7%) respectively. Fifth and sixth year 32 as (37.2). Internists 56, Surgeon 30, they distributed as (56.1%) and (34.9%) respectively. To answer the question related to the degree of effectiveness of administrative leadership among medical personnel in the Syrian Arab Republic, the means and standard deviations of the responses of the study sample members on the administrative leadership scale were extracted, according to each level of the five areas of the study. Table (1) shows that, the mean of the ‘Demonstrating personal qualities’ dimension is higher than all other means (3.42), followed by ‘Working with others’ (3.04), followed by ‘Managing services’ (2.86), followed by ‘Improving services’ (2.57) and ‘Setting direction’ (2.54), all of these competencies were in moderate level: Table(1) Means and standard deviations of medical leadership competences Dimensiones Rank Mean SD Level PQ 1 3.42 0.98 Moderate WO 2 3.04 0.91 Moderate MS 3 2.86 0.97 Moderate IS 4 2.75 1.08 Moderate SD 5 2.54 1.07 Moderate Regarding the Demonstrating personal qualities, table (2) shows the general average of the ratings at the level of items in the same area, as follows: Table (2) Means and standard deviations of the medical leadership in demonstrating personal qualities Items Rank Mean SD Level I reflect on how my own values and principles influence my behaviour and impact on others 1 3.70 0.93 High I seek feedback from others on my strengths and limitations and modify my behaviour accordingly 5 3.38 1.10 Moderate I remain calm and focused under pressure 7 3.34 0.98 Moderate I plan my workload and deliver on my commitments to consistently high standards demonstrating flexibility to service requirements 2 3.46 0.89 Moderate I actively seek opportunities to learn and develop 4 3.40 0.94 Moderate I apply my learning to practical work 6 3.36 1.02 Moderate I act in an open, honest and inclusive manner - respecting other people’s culture, beliefs and abilities 3 3.45 0.96 Moderate I speak out when I see that ethics or values are being compromised 8 3.25 1.07 Moderate Table (3) shows the general average of the ratings at the level of items in the area ”Working with Others”: Table (3) Means and standard deviations of the medical leadership in Working with Others Items Rank Mean SD Level I identify opportunities where working collaboratively with others will bring added value to patient care 3 3.12 0.82 Moderate I share information and resources across networks 5 3.01 0.98 Moderate I communicate clearly and effectively with others 2 3.18 0.91 Moderate I listen to and take into account the needs and feelings of others 8 2.82 0.88 Moderate I actively seek contributions and views from others 7 2.94 0.92 Moderate I am comfortable managing conflicts of interests or differences of opinion 4 3.03 0.94 Moderate I put myself forward to lead teams, whilst always ensuring I involve the right people at the right time 6 2.99 0.87 Moderate I acknowledge and appreciate the efforts of others within the team and respect the team’s decision 1 3.23 0.92 Moderate Table (4) shows the general average of the ratings at the level of items in the area ”Managing Service”: Table (4) Means and standard deviations of the medical leadership in Managing service Items Rank Mean SD Level I use feedback from patients, service users and colleagues when developing plans 4 2.99 1.01 Moderate I assess the available options in terms of benefits and risks 2 3.08 0.925 Moderate I deliver safe and effective services within the allocated resource 1 3.11 0.887 Moderate I take action when resources are not being used efficiently and effectively 5 2.92 1.02 Moderate I support team members in developing their roles and responsibilities 3 3.07 0.919 Moderate I provide others with clear purpose and direction 7 2.50 0.971 Moderate I analyse information from a range of sources about performance 6 2.87 1.00 Moderate I take action to improve performance 8 2.34 1.10 Moderate Table (5) shows the general average of the ratings at the level of items in the area ”Improving Services”: Table (5) Means and standard deviations of the medical leadership in Improving service Items Rank Mean SD Level I take action when I notice shortfalls in patient safety 1 3.62 0.83 Moderate I review practice to improve patient safety and minimize risk 2 2.75 0.89 Moderate I use feedback from patients, carers and service users to contribute to improvements in service delivery 6 2.28 1.25 Low I work with others to constructively evaluate our services 7 2.17 0.92 Low I put forward ideas to improve the quality of services 4 2.48 1.07 Moderate I encourage debate about new ideas with a wide range of people 6 2.28 1.33 Low I articulate the need for change and its impact on people and services 5 2.32 1.42 Low I focus myself and motivate others to ensure change happens 3 2.65 0.94 Moderate Table (6) shows the general average of the ratings at the level of items in the area ”Setting Direction”: Table (6) Means and standard deviations of the medical leadership in Setting Direction Items Rank Mean SD level I identify the drivers of change (e.g. political, social, technical, economic, organisational, professional environment) 2 2.91 1.11 Moderate I anticipate future challenges that will create the need for change and communicate these to others 4 2.51 1.00 Moderate I use data and information to suggest improvements to services 6 2.34 1.08 Moderate I influence others to use knowledge and evidence to achieve best practice 1 2.94 1.21 Moderate I consult with key people and groups when making decisions taking into account the values and priorities of the service 7 2.23 1.09 Low I actively engage in formal and informal decision-making processes about the future of services 8 2.15 1.04 Low I take responsibility for embedding new approaches into working practices 3 2.84 1.06 Moderate I evaluate the impact of changes on patients and service delivery 5 2.45 1.01 Moderate To answer the second question, means and standard deviations were extracted to estimate medical leadership competency among medical according to the study variables as shown in the table (7): Table (7) means and standard deviations for Medical leadership competency according to the study variables variable Variable classes µ SD Gender Male 3.08 0.68 Female 2.36 0.79 Year of residence 1st &2nd 2.91 0.73 3rd & 4th 2.73 0.82 5th & 6th 2.81 0.69 Specialization Surgeon 2.67 0.76 Internist 2.95 0.92 Multiple ANOVA were conducted to determine whether there are significant mean differences in the level of medical leadership competencies based on the study variables, Table (8): Table (8) means and standard deviations for Medical leadership competency according to the study variables Variable Sum of Square Mean Square F Sig Gender 0.109 0.109 9.442 *0.003 Year of residence 0.026 0.013 1.137 0.326 Specialization 0.140 0.014 1.254 0.266 **P<0.05 Discussion Leadership competencies are extremely crucial in business management and health organizations. Today, leaders increasingly work across national and international borders and in multicultural environments. Thus, they may be colleagues in healthcare institutions abroad, or on an international assignment. They may be members of a global online community, or workers in the field of development aid cooperating with an international network of partner organizations, especially with the spread of this type of health organizations in all of these contexts given the poor health conditions as a result of wars and conflicts in our region in particular. A leader's competency depends on his or her understanding and ability to manage individual and group behaviors in a cross-cultural context. Therefore, the importance of the results of this study at the national level for Syrian medical personnel. The results revealed that the overall was at a moderate level, as the mean of (2.88). Top dimension was Demonstrating personal qualities, with a mean of (3.42). The field of “working with others” ranked second with a mean (3.04), then the field of “services management” came in third place, with a mean of (2.86), followed by the dimension of “improving services” with a mean of (2.57), and in final place came the area of “setting direction” with a mean of (2.54). It can be indicated by the previous results that the medical leadership competency among Syrian medical personnel isn’t effective enough. They are unable to achieve their goals with the resources and capabilities available to them. This may be attributed to not granting authority to them in the correct manner and in the appropriate position. In addition to that they do not have the flexibility to change and develop plans in a timely manner, and lack of the ability to convey their ideas to improve and manage services. It can be inferred from the results in its entirety the importance to accelerate a strategic plan and the initiative of training programs to reduce this gab. However, the results of this study revealed that the ‘Demonstrating personal qualities’ dimension is higher than all other dimensions. Item that reflects how their own values and principles influence their behavior and impact on others, ranked first with a mean of (3.70). This may be attributed to the nature of relationships in our societies in general, which pays a lot of attention to the religious and moral aspects. While the item about speaking out when ethics or values are being compromised came in last place, with a mean of (3.25). This could be an indication of the gap between them and senior management, their inability to intervene, or there is fear of expressing an opinion in administrative business affairs. The second highest dimension mean total is ‘working with others’, the item in this dimension "I acknowledge and appreciate the efforts of others within the team and respect the team’s decision" was as high level with a mean of (3.23). In this dimension, the ability to communicate clearly and effectively with others is noted. This may be attributed to the conviction of the importance of relationships and working cooperatively with others in order to achieve the desired goals and bring added value to patient care. As for the "management Service' items, the statement that reflects the provision of safe and effective services within the allocated resources ranked first with a mean of (3.11), this corresponds to the field of personal qualities, which reflects how their values and principles affect their behavior. While the statement "I take action to improve performance" came in last place, with a low rank and a mean of (2.34), and this may be due to inability to communicate effectively with departments officials, and this leads that they do not enable to exploit their capabilities in the field of service management. The fourth dimension is ‘Improving services’ with the item "I take action when I notice shortfalls in patient safety" was in high level with a mean (3.62), while the statement 'I work with others to constructively evaluate our services' came in the last place with a low rank and a mean of (2.17). This result indicates the need to guide medical personnel towards more efficient discussion in administrative affairs, and enhance the culture of holding meetings to effectively convey and express their ideas without fear of any consequences. The fifth dimension is ‘Setting direction’ with the item "I influence others to use knowledge and evidence to achieve best practice" was at a high level with a mean (2.94), while the statement 'I actively engage in formal and informal decision-making processes about the future of services' came in last place with a low rank and a mean of (2.15). This result shows that plans are developed almost in isolation from the working medical staff. Which may lead to it not being submitted in a timely manner, and thus a lack of flexibility in implementation to serve the public interest. The results related to the second question reported a significant difference between males and females in the effectiveness of medical leadership competency mean score and higher scores among males, with the means are (3.08) and (2.36). This may be due to the ease with which males join activities, and this may be due to changing circumstances as a result of the war conditions that lead to a change in the nature of the society. The findings of the present study reported about decline in leadership competence score as the year of the residence increased, with a mean of (2.91) for the first and second years, (2.73) for the third and fourth years, and (2.81) for the fifth and sixth years. Although this difference is not significant, many factors can be attributed to this finding. The drive among new doctors to prove their potential, the stress of academic performance, long working hours, lack of quality sleep, increasing responsibilities with age and paying more attention to practical medical skills are some of the factors that contribute to this result. This may indicate that there is no plan or clear curriculum that encourages doctors to be medical leaders. The present study revealed that medical leadership competency score rated the highest by internists (2.95), followed by surgeons (2.67). Even though this difference was not significant at P = 0.05, the finding can be attributed to qualitative variance in cooperating with different departments, the importance of flexibility in decision making to achieve the desired outcome between internists and surgeons. The results of the present study differed from the study, Al-Omari & Bani Hani [ 13 ] as all items of the identified dimensions were as high levels. The study revealed that academic year and gender had no significant differences on the combined dependent variable of medical leadership competences of medical students’ at Hashemite University. The difference may be due to the difference in environment, sample members, time and place in which these studies were conducted. That study explain that the study plan for Medicine College at Hashemite University encourage undergraduate students to be medical leaders, which totally agree with Pascarella and Terenzini [ 14 ], Plsek and Wilson [ 15 ] that indicate the crucial role during the college years to increase leadership skills during, and enhance the self-efficacy, civic engagement, character development, academic performance and personal development of students. Similarly, Çitaku et al,. was conducted to identify the dimensions of leadership in medical education and healthcare professions. Exploratory principal component analyses yielded five factors: social responsibility, innovation, self-management, task management and justice orientation. The results of this study also differed from the present study thus there was no main effect for sex. There were no significant differences for age or for leadership experience. There were significant differences between physicians and other health professionals on some factors, the results revealed that Social Responsibility was rated the highest by nurses, followed by internists, general practitioners rated this leadership competency the lowest. Similar findings were reported about the significant differences across specialties, by internists rated the highest [ 16 ]. This can be inferred the need to enroll Syrian medical students through academic semesters in some courses such as: Health Policies, Health economic, and medical technology. It is obvious that the leadership competencies should be developed and incorporated into undergraduate and postgraduate in that case doctors can and do increase their leadership skills during the college years, and enhance the self-efficacy, civic engagement, character development, academic performance and personal development. Ultimately, this ongoing process of understanding of leadership and concreted efforts with various parties, including Faculty members and curricula should prompt all medical students and practitioners to engage in and expect effective leadership that results in people and groups achieving more. Further qualitative and quantitative research can be conducted to find out: Why that, gender had a significant differences on the combined dependent variable of medical leadership competences of medical practitioners’. A longitudinal study can be conducted to find any trends or changes in the medical leadership competences over time in the continuing practice. Conclusion Syrian doctors should appreciate that leadership provides opportunities for change for the better, this understanding of leadership should prompt all medical professionals to engage in and expect effective leadership that results in people and groups achieving more. The skills needed to be developed are the ability to anticipate while getting work done; to able to be flexible, agile and respond to the changes required at the same time, look forward and understand where we’re likely to be headed. Faculty members and curricula should assist students in developing an appreciation for the need for leadership through some courses enrolled through academic semesters and continuing training throughout the career. . Declarations Acknowledgment: We would thank all the participants in this study and the Syrian Virtual University. Funding : “Not applicable”. Declarations: Conflicts of interest: The authors declare that they have no conflict of interest. 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Volume 2: ERIC; 2005. Plsek PE, Wilson T. Complexity, leadership, and management in healthcare organisations. Bmj. 2001;323(7315):746-9 . Çitaku F, Violato C, Beran T, Donnon T, Hecker K, Cawthorpe D. Leadership competencies for medical education and healthcare professions: population-based study. BMJ open. 2012;2(2):e000812 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5413549","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":377206558,"identity":"ca884069-97ab-45cc-83b6-04f2ba5d57d4","order_by":0,"name":"Abla Shaddoud","email":"data:image/png;base64,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","orcid":"","institution":"Syrian Virtual University","correspondingAuthor":true,"prefix":"","firstName":"Abla","middleName":"","lastName":"Shaddoud","suffix":""},{"id":377206559,"identity":"110b91c0-47bf-42ac-bcda-b333d15edbe6","order_by":1,"name":"Mohamad Kusai Al-Munajed","email":"","orcid":"","institution":"Syrian Virtual University","correspondingAuthor":false,"prefix":"","firstName":"Mohamad","middleName":"Kusai","lastName":"Al-Munajed","suffix":""},{"id":377206560,"identity":"dd22cbfa-e92c-4c92-8419-48686ade0894","order_by":2,"name":"Mayssoon Dashash","email":"","orcid":"","institution":"Syrian Virtual University","correspondingAuthor":false,"prefix":"","firstName":"Mayssoon","middleName":"","lastName":"Dashash","suffix":""}],"badges":[],"createdAt":"2024-11-08 04:38:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5413549/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5413549/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":71513316,"identity":"4fd4904f-38ed-4bf6-b7a0-b09a8bf8b303","added_by":"auto","created_at":"2024-12-16 10:44:27","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":275366,"visible":true,"origin":"","legend":"\u003cp\u003eThe medical leadership competency framework\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5413549/v1/c06091810a6cbb6431e6c35e.png"},{"id":101483920,"identity":"47fd7f19-f201-4b0e-b0dd-9e26540fa7e7","added_by":"auto","created_at":"2026-01-30 08:42:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1258905,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5413549/v1/a581802c-1811-476f-93b2-9440fd1dc3d2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Development of a National Medical Leadership Competency Framework: Syrian Approach","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLeadership plays a crucial role in managing organizations that strive to enhance the well-being of individuals across various fields. It is essential not only for the implementation and achievement of goals, but also for setting those goals, and fostering group\u0026rsquo;s loyalty. Consequently, a leader is viewed as the heart of the organization, not merely as a figurehead. Leadership is fundamental to effective public administration, as it ensures the organization\u0026rsquo;s health, oversees business management, and inspires employees to work with enthusiasm and efficiency. Thus, selecting and preparing leaders of organizations and institutions has become a top priority for modern countries [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eLeadership can be defined as the art of influencing people to willingly devote their efforts toward achieving shared goals [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e]. Cuban characterized leaders as \u0026quot;people who shape the goals, motives, and actions of others. They often initiate change to reach both existing and new objectives [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e].\u0026quot; Kotter distinguished between leadership and management, noting that management focuses on planning, budgeting, outlining implementation steps, and allocating necessary resources. In contrast, leadership is centered on envisioning the future, setting the vision, and developing strategies required to achieve it. Management employs and organizes human resources by setting a structure, defining responsibilities, delegating authority and establishing a system for monitoring implementation and correcting errors. Leadership, however, aligns teams by; communicating the new direction and forming a coalition that can understand the vision and work toward achieving it. Kotter also points out that management is concerned with executing plans through supervision and problem-solving, while leadership motivates individuals to overcome obstacles and achieve fundamental and beneficial changes. Therefore, leadership complements management rather than replacing it [\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eThe need for integration between administrative and leadership roles becomes clear. Strong leaders are not only exceptional managers; their credibility is significantly enhanced by administrative experience. It is important to recognize that the distinction between management and leadership is not a binary one; rather it involves a combination or balance of both, as today\u0026rsquo;s leaders require knowledge grounded in the realities of their organizations [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eHistorically, medical training has concentrated primarily on clinical skills. However, with the rise of team-based practice, it has become evident that physicians should not only be proficient in their clinical abilities, but also demonstrate the necessary to be safe skills to work effectively within complex healthcare-systems.\u003c/p\u003e\n\u003cp\u003eIn recent years, medical policy-makers have emphasized that all physicians must develop management and leadership competencies in addition to their clinical knowledge and skills to ensure they are effective and safe practitioners [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e]. .\u003c/p\u003e\n\u003cp\u003eFor this study, a conceptual framework centered on medical leadership and engagement has been established. The framework outlines the leadership competencies that all doctors should develop and that must be integrated into curricula and assessment processes. The goal is to ensure that all doctors, throughout their careers, attain a standardized set of leadership competencies essential for being effective practitioners. It is based on the belief that all medical professionals should take on leadership roles to enhance the quality of the service within their specialty, practice or unit [\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eA Medical Leadership Competency Framework has been developed (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e) to enable assessing the leadership behaviors across five domains depending on their operational context, with the goal of providing high-quality services to patients. It is crucial for all doctors to be competent in each of the five leadership domains: demonstrating personal qualities, working with others, managing services, improving services and setting direction [\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eIn countries with limited resources medical involvement in planning, the competency of medical leadership is often overlooked in practice. There remains a lack of interest in this area, which is frequently regarded as a luxury or merely a personal talent, despite numerous studies highlighting its importance. Additionally, it is confirmed that leadership skills can be both learned and taught.\u003c/p\u003e\n\u003cp\u003eThe ongoing war in Syria has exacerbated the situation as many experienced doctors have left the country; while the existing hierarchical system fails to support the development of new doctors in integrity, character strength, and administrative competency that would qualify them for leadership. Consequently, this study was conducted as an initial attempt to make a meaningful impact in this crucial aspect of medical practice, with the hope that it will pave the way for further research aimed at implementing a comprehensive approach to developing medical leadership.\u003c/p\u003e\n\u003cp\u003eThis study aimed to identify the medical leadership competencies among healthcare professionals in the Syrian Arab Republic by addressing the question how do they perceive their medical leadership competencies?. Additionally, the study aimed to analyze significant differences in these competencies based on gender, year of residency and specialization among health care professionals.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study has a cross-sectional design with a descriptive and analytical approach, conducted among resident doctors in government hospitals in the Syrian Arab Republic from September 19 2023 to January 1 2024. With the study adhered to the Declaration of Helsinki and was obtained ethical approval from the research committee of the Syrian Virtual University, on19/9/2023. Data collection was carried out using Google Forms, an online survey platform. The link to the questionnaire, which is the Self-assessment tool (NHS Leadership), was distributed online across various Syrian health websites and social media platforms. Informed consent was taken to ensure the anonymity and confidentiality of the participants’ responses. . That \u003c/p\u003e\n\u003cp dir=\"LTR\"\u003e\u003cstrong\u003eThe Self-assessment tool (NHS Leadership)\u003c/strong\u003e: This measurement instrument consists of, 40 items that cover areas of medical leadership competences: [11, 12] \u003c/p\u003e\n\u003cp dir=\"LTR\"\u003e1. Demonstrating personal qualities (PQ): This area includes eight items that require doctors to demonstrate competencies in self-awareness, self-management, personal development and integrity. \u003c/p\u003e\n\u003cp dir=\"LTR\"\u003e2. Working with others (WO): This section contains eight items that assess doctors' abilities to develop networks, build and maintain relationships, encourage contributions and work effectively in teams. \u003c/p\u003e\n\u003cp\u003e3. Managing services (MS): This area consists of eight items that requires doctors’ competencies in planning, resources management, personal management and performance management. \u003c/p\u003e\n\u003cp\u003e4. Improving services (IS): This section includes eight items that require doctors to demonstrate competencies in ensuring patient safety, critical evaluation, encouraging improvement and innovation, and facilitating transformation.\u003c/p\u003e\n\u003cp\u003e5. Setting direction (SD): This area comprises eight items that assess doctors abilities to identify contexts for change, apply knowledge and evidence, make informed decisions and evaluate impacts. \u003c/p\u003e\n\u003cp\u003eParticipants were asked to rate their responses on a Likert-type scale of 1to 5, ranging from ‘strongly disagree’ to ‘strongly agree’, allowing for the quantification of their agreement with each statement.. \u003c/p\u003e\n\u003cp\u003eTo interpret the results of this study, specific cut points were defined to assess participants’ total scores related to their perception of medical leadership competencies. The cut points were determined using the response scale of each item, as follows: 1–2.33 = low, 2.34 ­– 3.67 = moderate, and 3.68–5.00 = high levels. \u003c/p\u003e\n\u003cp\u003eA pilot study involving 15 participants led to modifications in the wording of some questions for improved clarity and understanding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReliability\u003c/strong\u003e:;The internal consistency reliability of the subscales was deemed acceptable, with alpha coefficients exceeding the generally accepted reliability value of 0.70. \u003c/p\u003e\n\u003cp\u003eThe internal consistency reliability values for the subscales and components were 0.82, 0.80, 0.76, 0.73 and 0.75 for the first, second, third, fourth and fifth areas, respectively. These values indicate a satisfactory level of reliability to support the objectives of the current study, and suggest that the tool is a valid and reliable measure for use within the Syrian population. \u003c/p\u003e\n\u003cp\u003eStatistical analyses were performed using SPSS version 27. Baseline characteristics were presented as the mean ± standard deviation. Construct validity was assessed using Pearson Correlation, while and reliability was tested through Cronbach’s alpha. Multiple ANOVA was conducted to determine whether significant mean differences exist in the level of medical leadership competencies based on the study variables with P \u0026lt; 0.05 considered statistically significant . \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe final sample was composed of 86 participants. There were 35 females (40.7%) and 51 males (59.3%), from first and second year (19), third and fourth year (35) and they distributed as follows: (22.1%), (40.7%) respectively. Fifth and sixth year 32 as (37.2). Internists 56, Surgeon 30, they distributed as (56.1%) and (34.9%) respectively.\u003c/p\u003e \u003cp\u003eTo answer the question related to the degree of effectiveness of administrative leadership among medical personnel in the Syrian Arab Republic, the means and standard deviations of the responses of the study sample members on the administrative leadership scale were extracted, according to each level of the five areas of the study. Table\u0026nbsp;(1) shows that, the mean of the \u0026lsquo;Demonstrating personal qualities\u0026rsquo; dimension is higher than all other means (3.42), followed by \u0026lsquo;Working with others\u0026rsquo; (3.04), followed by \u0026lsquo;Managing services\u0026rsquo; (2.86), followed by \u0026lsquo;Improving services\u0026rsquo; (2.57) and \u0026lsquo;Setting direction\u0026rsquo; (2.54), all of these competencies were in moderate level:\u003c/p\u003e \u003cp\u003e \u003csub\u003e \u003cb\u003eTable(1) Means and standard deviations of medical leadership\u003c/b\u003e \u003cb\u003ecompetences\u003c/b\u003e\u003c/sub\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDimensiones\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLevel\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePQ\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWO\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRegarding the Demonstrating personal qualities, table (2) shows the general average of the ratings at the level of items in the same area, as follows:\u003c/p\u003e \u003cp\u003e \u003csub\u003e \u003cb\u003eTable (2) Means and standard deviations of the medical leadership in demonstrating personal qualities\u003c/b\u003e \u003c/sub\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLevel\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI reflect on how my own values and principles influence my behaviour and impact on others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI seek feedback from others on my strengths and limitations and modify my behaviour accordingly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI remain calm and focused under pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI plan my workload and deliver on my commitments to consistently high standards demonstrating flexibility to service requirements\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI actively seek opportunities to learn and develop\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI apply my learning to practical work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI act in an open, honest and inclusive manner - respecting other people\u0026rsquo;s culture, beliefs and abilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI speak out when I see that ethics or values are being compromised\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;(3) shows the general average of the ratings at the level of items in the area \u0026rdquo;Working with Others\u0026rdquo;:\u003c/p\u003e \u003cp\u003e \u003csub\u003e \u003cb\u003eTable (3) Means and standard deviations of the medical leadership in Working with Others\u003c/b\u003e \u003c/sub\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLevel\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI identify opportunities where working collaboratively with others will bring added value to patient care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI share information and resources across networks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI communicate clearly and effectively with others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI listen to and take into account the needs and feelings of others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI actively seek contributions and views from others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am comfortable managing conflicts of interests or differences of opinion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI put myself forward to lead teams, whilst always ensuring I involve the right people at the right time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI acknowledge and appreciate the efforts of others within the team and respect the team\u0026rsquo;s decision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;(4) shows the general average of the ratings at the level of items in the area \u0026rdquo;Managing Service\u0026rdquo;:\u003c/p\u003e \u003cp\u003e \u003csub\u003e \u003cb\u003eTable (4) Means and standard deviations of the medical leadership in Managing service\u003c/b\u003e \u003c/sub\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLevel\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI use feedback from patients, service users and colleagues when developing plans\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI assess the available options in terms of benefits and risks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.925\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI deliver safe and effective services within the allocated resource\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.887\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI take action when resources are not being used efficiently and effectively\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI support team members in developing their roles and responsibilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.919\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI provide others with clear purpose and direction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.971\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI analyse information from a range of sources about performance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI take action to improve performance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;(5) shows the general average of the ratings at the level of items in the area \u0026rdquo;Improving Services\u0026rdquo;:\u003c/p\u003e \u003cp\u003e \u003csub\u003e \u003cb\u003eTable (5) Means and standard deviations of the medical leadership in Improving service\u003c/b\u003e \u003c/sub\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabe\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLevel\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI take action when I notice shortfalls in patient safety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI review practice to improve patient safety and minimize risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI use feedback from patients, carers and service users to contribute to improvements in service delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI work with others to constructively evaluate our services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI put forward ideas to improve the quality of services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI encourage debate about new ideas with a wide range of people\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI articulate the need for change and its impact on people and services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI focus myself and motivate others to ensure change happens\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;(6) shows the general average of the ratings at the level of items in the area \u0026rdquo;Setting Direction\u0026rdquo;:\u003c/p\u003e \u003cp\u003e \u003csub\u003e \u003cb\u003eTable (6) Means and standard deviations of the medical leadership in Setting Direction\u003c/b\u003e \u003c/sub\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabf\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003elevel\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI identify the drivers of change (e.g. political, social, technical, economic, organisational, professional environment)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI anticipate future challenges that will create the need for change and communicate these to others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI use data and information to suggest improvements to services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI influence others to use knowledge and evidence to achieve best practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI consult with key people and groups when making decisions taking into account the values and priorities of the service\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI actively engage in formal and informal decision-making processes about the future of services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI take responsibility for embedding new approaches into working practices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI evaluate the impact of changes on patients and service delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTo answer the second question, means and standard deviations were extracted to estimate medical leadership competency among medical according to the study variables as shown in the table (7):\u003c/p\u003e \u003cp\u003e \u003csub\u003e \u003cb\u003eTable (7) means and standard deviations for Medical leadership competency according to the study variables\u003c/b\u003e \u003c/sub\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabg\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003evariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVariable classes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026micro;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eYear of residence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1st \u0026amp;2nd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3rd \u0026amp; 4th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5th \u0026amp; 6th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSpecialization\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgeon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMultiple ANOVA were conducted to determine whether there are significant mean differences in the level of medical leadership competencies based on the study variables, Table\u0026nbsp;(8):\u003c/p\u003e \u003cp\u003e \u003csub\u003e \u003cb\u003eTable (8) means and standard deviations for Medical leadership competency according to the study variables\u003c/b\u003e \u003c/sub\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabh\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSum of Square\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean Square\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSig\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.442\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e*0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.326\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecialization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.266\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e**P\u0026lt;0.05\u003c/sup\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eLeadership competencies are extremely crucial in business management and health organizations. Today, leaders increasingly work across national and international borders and in multicultural environments. Thus, they may be colleagues in healthcare institutions abroad, or on an international assignment. They may be members of a global online community, or workers in the field of development aid cooperating with an international network of partner organizations, especially with the spread of this type of health organizations in all of these contexts given the poor health conditions as a result of wars and conflicts in our region in particular. A leader's competency depends on his or her understanding and ability to manage individual and group behaviors in a cross-cultural context. Therefore, the importance of the results of this study at the national level for Syrian medical personnel.\u003c/p\u003e \u003cp\u003eThe results revealed that the overall was at a moderate level, as the mean of (2.88). Top dimension was Demonstrating personal qualities, with a mean of (3.42). The field of \u0026ldquo;working with others\u0026rdquo; ranked second with a mean (3.04), then the field of \u0026ldquo;services management\u0026rdquo; came in third place, with a mean of (2.86), followed by the dimension of \u0026ldquo;improving services\u0026rdquo; with a mean of (2.57), and in final place came the area of \u0026ldquo;setting direction\u0026rdquo; with a mean of (2.54). It can be indicated by the previous results that the medical leadership competency among Syrian medical personnel isn\u0026rsquo;t effective enough. They are unable to achieve their goals with the resources and capabilities available to them. This may be attributed to not granting authority to them in the correct manner and in the appropriate position. In addition to that they do not have the flexibility to change and develop plans in a timely manner, and lack of the ability to convey their ideas to improve and manage services. It can be inferred from the results in its entirety the importance to accelerate a strategic plan and the initiative of training programs to reduce this gab.\u003c/p\u003e \u003cp\u003eHowever, the results of this study revealed that the \u0026lsquo;Demonstrating personal qualities\u0026rsquo; dimension is higher than all other dimensions. Item that reflects how their own values and principles influence their behavior and impact on others, ranked first with a mean of (3.70). This may be attributed to the nature of relationships in our societies in general, which pays a lot of attention to the religious and moral aspects. While the item about speaking out when ethics or values are being compromised came in last place, with a mean of (3.25). This could be an indication of the gap between them and senior management, their inability to intervene, or there is fear of expressing an opinion in administrative business affairs.\u003c/p\u003e \u003cp\u003eThe second highest dimension mean total is \u0026lsquo;working with others\u0026rsquo;, the item in this dimension \"I acknowledge and appreciate the efforts of others within the team and respect the team\u0026rsquo;s decision\" was as high level with a mean of (3.23). In this dimension, the ability to communicate clearly and effectively with others is noted. This may be attributed to the conviction of the importance of relationships and working cooperatively with others in order to achieve the desired goals and bring added value to patient care.\u003c/p\u003e \u003cp\u003eAs for the \"management Service' items, the statement that reflects the provision of safe and effective services within the allocated resources ranked first with a mean of (3.11), this corresponds to the field of personal qualities, which reflects how their values and principles affect their behavior. While the statement \"I take action to improve performance\" came in last place, with a low rank and a mean of (2.34), and this may be due to inability to communicate effectively with departments officials, and this leads that they do not enable to exploit their capabilities in the field of service management.\u003c/p\u003e \u003cp\u003eThe fourth dimension is \u0026lsquo;Improving services\u0026rsquo; with the item \"I take action when I notice shortfalls in patient safety\" was in high level with a mean (3.62), while the statement 'I work with others to constructively evaluate our services' came in the last place with a low rank and a mean of (2.17). This result indicates the need to guide medical personnel towards more efficient discussion in administrative affairs, and enhance the culture of holding meetings to effectively convey and express their ideas without fear of any consequences.\u003c/p\u003e \u003cp\u003eThe fifth dimension is \u0026lsquo;Setting direction\u0026rsquo; with the item \"I influence others to use knowledge and evidence to achieve best practice\" was at a high level with a mean (2.94), while the statement 'I actively engage in formal and informal decision-making processes about the future of services' came in last place with a low rank and a mean of (2.15). This result shows that plans are developed almost in isolation from the working medical staff. Which may lead to it not being submitted in a timely manner, and thus a lack of flexibility in implementation to serve the public interest.\u003c/p\u003e \u003cp\u003eThe results related to the second question reported a significant difference between males and females in the effectiveness of medical leadership competency mean score and higher scores among males, with the means are (3.08) and (2.36). This may be due to the ease with which males join activities, and this may be due to changing circumstances as a result of the war conditions that lead to a change in the nature of the society.\u003c/p\u003e \u003cp\u003eThe findings of the present study reported about decline in leadership competence score as the year of the residence increased, with a mean of (2.91) for the first and second years, (2.73) for the third and fourth years, and (2.81) for the fifth and sixth years. Although this difference is not significant, many factors can be attributed to this finding. The drive among new doctors to prove their potential, the stress of academic performance, long working hours, lack of quality sleep, increasing responsibilities with age and paying more attention to practical medical skills are some of the factors that contribute to this result. This may indicate that there is no plan or clear curriculum that encourages doctors to be medical leaders.\u003c/p\u003e \u003cp\u003eThe present study revealed that medical leadership competency score rated the highest by internists (2.95), followed by surgeons (2.67). Even though this difference was not significant at P\u0026thinsp;=\u0026thinsp;0.05, the finding can be attributed to qualitative variance in cooperating with different departments, the importance of flexibility in decision making to achieve the desired outcome between internists and surgeons.\u003c/p\u003e \u003cp\u003eThe results of the present study differed from the study, Al-Omari \u0026amp; Bani Hani [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] as all items of the identified dimensions were as high levels. The study revealed that academic year and gender had no significant differences on the combined dependent variable of medical leadership competences of medical students\u0026rsquo; at Hashemite University. The difference may be due to the difference in environment, sample members, time and place in which these studies were conducted. That study explain that the study plan for Medicine College at Hashemite University encourage undergraduate students to be medical leaders, which totally agree with Pascarella and Terenzini [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], Plsek and Wilson [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] that indicate the crucial role during the college years to increase leadership skills during, and enhance the self-efficacy, civic engagement, character development, academic performance and personal development of students.\u003c/p\u003e \u003cp\u003eSimilarly, \u0026Ccedil;itaku et al,. was conducted to identify the dimensions of leadership in medical education and healthcare professions. Exploratory principal component analyses yielded five factors: social responsibility, innovation, self-management, task management and justice orientation. The results of this study also differed from the present study thus there was no main effect for sex. There were no significant differences for age or for leadership experience. There were significant differences between physicians and other health professionals on some factors, the results revealed that Social Responsibility was rated the highest by nurses, followed by internists, general practitioners rated this leadership competency the lowest. Similar findings were reported about the significant differences across specialties, by internists rated the highest [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis can be inferred the need to enroll Syrian medical students through academic semesters in some courses such as: Health Policies, Health economic, and medical technology. It is obvious that the leadership competencies should be developed and incorporated into undergraduate and postgraduate in that case doctors can and do increase their leadership skills during the college years, and enhance the self-efficacy, civic engagement, character development, academic performance and personal development.\u003c/p\u003e \u003cp\u003eUltimately, this ongoing process of understanding of leadership and concreted efforts with various parties, including Faculty members and curricula should prompt all medical students and practitioners to engage in and expect effective leadership that results in people and groups achieving more. Further qualitative and quantitative research can be conducted to find out: Why that, gender had a significant differences on the combined dependent variable of medical leadership competences of medical practitioners\u0026rsquo;. A longitudinal study can be conducted to find any trends or changes in the medical leadership competences over time in the continuing practice.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSyrian doctors should appreciate that leadership provides opportunities for change for the better, this understanding of leadership should prompt all medical professionals to engage in and expect effective leadership that results in people and groups achieving more. The skills needed to be developed are the ability to anticipate while getting work done; to able to be flexible, agile and respond to the changes required at the same time, look forward and understand where we\u0026rsquo;re likely to be headed. Faculty members and curricula should assist students in developing an appreciation for the need for leadership through some courses enrolled through academic semesters and continuing training throughout the career. .\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment:\u0026nbsp;\u003c/strong\u003eWe would thank all the participants in this study and the Syrian Virtual University. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: “Not applicable”.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclarations:\u0026nbsp;\u003c/strong\u003eConflicts of interest: The authors declare that they have no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number: “\u003c/strong\u003eNot applicable”. \u0026nbsp; \u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eClark J, Armit K. Leadership competency for doctors: a framework. Leadership in Health Services. 2010;23(2):115-29.\u003c/li\u003e\n\u003cli\u003eIgbaekemen GO. Impact of leadership style on organisation performance: A strategic literature review. Public Policy and Administration Research. 2014;4(9):126-35.\u003c/li\u003e\n\u003cli\u003eBolden R, Gosling J, Marturano A, Dennison P. A review of leadership theory and competency frameworks. 2003.\u003c/li\u003e\n\u003cli\u003eKoontz H, O\u0026apos;Donnell C. Management: principes et m\u0026eacute;thodes de gestion: McGraw-Hill; 1980.\u003c/li\u003e\n\u003cli\u003eCuban L. The managerial imperative and the practice of leadership in schools: State University of New York Press; 1988.\u003c/li\u003e\n\u003cli\u003eKotter JP, Cohen D. Change leadership: The Kotter collection (5 Books): Harvard Business Review Press; 2014.\u003c/li\u003e\n\u003cli\u003eHeibert M, Klatt B. The encyclopedia of leadership. New York, McGraw-Hill; 2001.\u003c/li\u003e\n\u003cli\u003eMalik MA, Azmat S. Leader and leadership: Historical development of the terms and critical review of literature. Annals of the University of\u003cspan dir=\"RTL\"\u003e \u003c/span\u003eCraiova for Journalism, Communication and Management. 2019;5(1):16-32.\u003c/li\u003e\n\u003cli\u003eNaylor CD. Leadership in academic medicine: reflections from administrative exile. Clinical medicine. 2006;6(5):488.\u003c/li\u003e\n\u003cli\u003eNicol ED. Improving clinical leadership and management in the NHS. Journal of Healthcare Leadership. 2012:59-69.\u003c/li\u003e\n\u003cli\u003eNHS Leadership Academy. The clinical leadership competency framework. Coventry: NHS Institute for Innovation and Improvement, Coventry House, University of Warwick Campus. 2011.\u003c/li\u003e\n\u003cli\u003eNHS Leadership Academy. Leadership framework: Self-assessment tool. Retrieved from: http://www.leadershipacademy.nhs.uk/wpcontent/uploads/2012/11/NHSLeadershipFrameworkLeadership NHSLeadershipFrameworkLeade.pdf. 2012.\u003c/li\u003e\n\u003cli\u003eAl-Omari AA, Bani-Hani KE. Medical leadership competences among medical students at Hashemite University in Jordan. International Journal of Leadership in Education. 2020;23(3):315-29.\u003c/li\u003e\n\u003cli\u003ePascarella ET, Terenzini PT. How College Affects Students: A Third Decade of Research. Volume 2: ERIC; 2005.\u003c/li\u003e\n\u003cli\u003ePlsek PE, Wilson T. Complexity, leadership, and management in healthcare organisations. Bmj. 2001;323(7315):746-9\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003e\u0026Ccedil;itaku F, Violato C, Beran T, Donnon T, Hecker K, Cawthorpe D. Leadership competencies for medical education and healthcare professions: population-based study. BMJ open. 2012;2(2):e000812\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Medical Leadership Competences, NHS Leadership Academy, Demonstrating personal qualities, Working with others, Managing services, Improving services, Setting direction. ","lastPublishedDoi":"10.21203/rs.3.rs-5413549/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5413549/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground and Objectives:\u003c/strong\u003e As team-based practices and integrated care approaches become more prevalent, it is essential for physicians to be skilled practitioners capable of functioning efficiently and effectively within complex health systems. In addition to clinical expertise, they should also develop management and leadership competencies. This study aimed to identify the medical leadership competencies among healthcare professionals in the Syrian Arab Republic.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThe study involved 86 participants. The Self-assessment tool NHS Leadership test was applied, comprising 40 questions. Data was collected through a Google Form which was distributed online. The results were analysed using statistical software SPSS version 24.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eFindings showed that the perceptions of resident doctors in Syrian government hospitals regarding the medical leadership competencies were moderate overall, with some items ranked low. The responses revealed that “Demonstrating personal qualities” was the most consistently recognized leadership competencies, with a mean score of (3.42). There were no statistically significant differences at the 0.05 level in medical leadership competencies based on residency year and specialization, although significant differences were observed favoring male participants\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThere is a critical need\u003cstrong\u003e \u003c/strong\u003eto enhance leadership effectiveness among healthcare professionals in the Syrian Arab Republic, especially in the areas of \u0026nbsp;Setting Direction and Managing services, which received the lowest rankings. This improvement should begin at the undergraduate level through targeted courses during academic semesters, followed by continuous training and exposure to systematic rehabilitation programs during residency.\u003c/p\u003e","manuscriptTitle":"Development of a National Medical Leadership Competency Framework: Syrian Approach","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-16 10:44:22","doi":"10.21203/rs.3.rs-5413549/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b8842247-4de7-4c31-abae-43fc4e90452f","owner":[],"postedDate":"December 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-30T08:41:55+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-16 10:44:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5413549","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5413549","identity":"rs-5413549","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}