title: Paradigm shifts: using a participatory leadership process to redesign health systems.
abstract: OBJECTIVE
  Physicians have increasingly given up private practices to become members of, and key stakeholders in, large healthcare systems. These systems are currently transforming to meet the Triple Aim: guaranteeing the equitable provision of high-quality, evidence-based care at a reasonable cost. Participatory leadership is an organizational change theory that engages key stakeholders as architects in the transformation process. This review highlights the utility of this leadership strategy in designing care for women's health.
  
  
  RESULTS
  Our blueprint describing participatory leadership theory in women's health systems change is discussed in three case studies, highlighting what we call the six Ps of participatory leadership: participants, principles, purpose, process, and power. The 'sixth P', product, can then be substantially influential in changing the paradigm of care.
  
  
  CONCLUSIONS
  Obstetrics and gynecology is increasingly practiced in large health systems responsible for the health of populations. Innovations in clinical practice impact care at the level of the individual. In order for advances in clinical practice to reach broad populations of women, they must be integrated into a delivery system. Physician engagement in leadership during this time of system transformation is of critical importance.
authors.affiliation: aLos Angeles County Department of Health Services bDepartment of Obstetrics and Gynecology, Harbor UCLA Medical Center cDepartment of Obstetrics and Gynecology, Olive View-UCLA Medical Center, David Geffen School of Medicine at UCLA dOffice of Women's Health, Los Angeles County Department of Public Health, Los Angeles, California, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Saleeby
authors.forename: Christine H
authors.initials: CH
authors.lastname: Holschneider
authors.forename: Rita
authors.initials: R
authors.lastname: Singhal
mesh_terms: D019033:Delivery of Health Care, Integrated; D019317:Evidence-Based Medicine; D005260:Female; D006176:Gynecology / Q000458:organization & administration; D018166:Health Care Reform; D006801:Humans; D007857:Leadership; D015141:Los Angeles; D009774:Obstetrics / Q000458:organization & administration; D009936:Organizational Innovation; D011247:Pregnancy; D011582:Psychological Theory; D011787:Quality of Health Care; D014932:Women's Health Services / Q000458:organization & administration*; D000078329:Workforce