title: Consensus on the leadership of hospital CEOs and its impact on the participation of physicians in improvement projects.
abstract: OBJECTIVE
  The success of a Dutch program to disseminate quality improvement projects depends on the participation of physicians working in program hospitals. The leadership of hospital executives (CEOs) is considered an important explanation. This study aims to determine whether the relation, between the extent to which physicians notice their CEOs stimulate improvement initiatives and the number of projects joined by physicians, is moderated by the consensus among physicians working in the same hospital.
  
  
  METHODS
  Multilevel analyses are applied on data of 286 physicians from eight hospitals to: (1) estimate whether participation depends on noticing if CEOs stimulate improvement, (2) test if an individual's participation differs when more colleagues have the same opinion (effect modification).
  
  
  RESULTS
  Significant moderator effects are found. The participation of physicians, noticing that CEOs stimulate improvement is higher when more colleagues share this opinion. For physicians not knowing whether improvement is encouraged, higher consensus coincides with lower participation.
  
  
  CONCLUSIONS
  Project involvement of physicians depends on their consensus about encouragement by CEOs. This confirms the importance of strategic leaders in dissemination programs. Further research is recommended into causes of CEO leadership visibility and methods to strengthen leadership climate.
authors.affiliation: NIVEL - Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands. m.duckers@nivel.nl
authors.forename: Michel L A
authors.initials: ML
authors.lastname: Dückers
authors.forename: Inge
authors.initials: I
authors.lastname: Stegeman
authors.forename: Peter
authors.initials: P
authors.lastname: Spreeuwenberg
authors.forename: Cordula
authors.initials: C
authors.lastname: Wagner
authors.forename: Karin
authors.initials: K
authors.lastname: Sanders
authors.forename: Peter P
authors.initials: PP
authors.lastname: Groenewegen
mesh_terms: D016542:Chief Executive Officers, Hospital; D032921:Consensus; D003299:Cooperative Behavior; D006801:Humans; D007857:Leadership; D009426:Netherlands; D010820:Physicians; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires