Development of a national medical leadership competency framework: The Dutch approach

Wouter A. Keijser*, Henricus J.M. Handgraaf, Liz M. Isfordink, Vincent T. Janmaat, Pieter Paul A. Vergroesen, Julia M.J.S. Verkade, Sietse Wieringa, Celeste P.M. Wilderom

*Corresponding author for this work

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Background: The concept of medical leadership (ML) can enhance physicians' inclusion in efforts for higher quality healthcare. Despite ML's spiking popularity, only a few countries have built a national taxonomy to facilitate ML competency education and training. In this paper we discuss the development of the Dutch ML competency framework with two objectives: to account for the framework's making and to complement to known approaches of developing such frameworks. Methods: We designed a research approach and analyzed data from multiple sources based on Grounded Theory. Facilitated by the Royal Dutch Medical Association, a group of 14 volunteer researchers met over a period of 2.5 years to perform: 1) literature review; 2) individual interviews; 3) focus groups; 4) online surveys; 5) international framework comparison; and 6) comprehensive data synthesis. Results: The developmental processes that led to the framework provided a taxonomic depiction of ML in Dutch perspective. It can be seen as a canonical 'knowledge artefact' created by a community of practice and comprises of a contemporary definition of ML and 12 domains, each entailing four distinct ML competencies. Conclusions: This paper demonstrates how a new language for ML can be created in a healthcare system. The success of our approach to capture insights, expectations and demands relating leadership by Dutch physicians depended on close involvement of the Dutch national medical associations and a nationally active community of practice; voluntary work of diverse researchers and medical practitioners and an appropriate research design that used multiple methods and strategies to circumvent reverberation of established opinions and conventionalisms. Implications: The experiences reported here may provide inspiration and guidance for those anticipating similar work in other countries to develop a tailored approach to create a ML framework.

Original languageEnglish
Article number441
JournalBMC Medical Education
Issue number1
Publication statusPublished - 28 Nov 2019


  • Design research
  • Medical education
  • Medical leadership
  • National competency framework
  • Qualitative

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    Keijser, W. A., Handgraaf, H. J. M., Isfordink, L. M., Janmaat, V. T., Vergroesen, P. P. A., Verkade, J. M. J. S., ... Wilderom, C. P. M. (2019). Development of a national medical leadership competency framework: The Dutch approach. BMC Medical Education, 19(1), [441].