After refining our initial model, we conducted a focused literature
review. We drew from literature within health systems leadership,
followership and organizational development, contrasting our own newly
formulated conceptualization with other existing models. We engaged in
iterative rounds of revisions. Ultimately, we coalesced our thinking
into one conceptual model (see results section), which we refined
through persona-driven testing (i.e. cognitive simulations with various
types of simulated characters that were used to elucidate each role in
various scenarios) and stakeholder consultation.22,23
Knowledge user consultations
Similar to knowledge user consultations endorsed by scoping reviews26 and the Canadian Institutes of Health Research Knowledge Exchange process27 and based on a prior published process , we sought formative feedback on our provisional concepts from a range of educators, experts, and frontline practitioners from across North America via a snowball sampling technique, starting with nominations from experienced leadership developers within our team (GD, TC, JS). Our newly proposed model along with associated persona-driven vignettes were submitted to a representative sampling of health system knowledge users (clinicians, administrators, educators and researchers in health care leadership) for review.
Our inclusion criteria were that the individual would meet one of the following criteria:
1) Personal experience in blended leadership roles across two or more organizations/units;
2) Supervised/lead others who bridge across more than one role; or
3) Actively engaged in teaching or scholarship about leadership training and development.
We excluded those who met the above criteria but had no experience within the North American health care context. We constructed a simple survey tool with an embedded video (
https://bit.ly/BridgeLEADsurvey) and requested that each knowledge user help us to identify the strengths, weaknesses, and relevance of the conceptual model to their own leadership-related practice. The quantitative aspects of the survey were analyzed using simple descriptive statistics. The qualitative aspects initially underwent a thematic analysis
28 by the senior author (TMC) and was subsequently checked by the first authors (SR, SL). We subsequently met with each of the leaders for a one-on-one interview led by our senior author (TMC) to gather feedback from those who volunteered to engage with us to provide further feedback. A thirty-minute, one-on-one Zoom interview (Zoom communications, Inc., San Jose, CA) was completed within a one-month span with any knowledge user who sought to provide verbal feedback about our model in addition to their survey responses. Feedback was incorporated into the body of the paper throughout the writing process.