Facilitators and barriers to achieving effective hospital-based clinical leadership
Clinical leadership, if it is to be evident and successful, requires broader clinician engagement and forms of citi-zenship behaviors within the clinical context that mediate the realization of this form of leadership. Much has been written in the organizational and health care literature about employee work engagement and the benefits derived through promoting work engagement.5,19 Similarly, organizational citizenship behavior is well rehearsed in the literature. Considerable evidence confirms positive associations between constructs such as job satisfaction, work perfor-mance, improved productivity, and engaged employees.5 Organizational citizenship behavior has been defined as work-related behaviors that are discretionary, not related to the formal reward systems, and which promote the effec-tive functioning of the organization. The types of behaviors commonly seen to form organizational citizenship behavior include altruism, courtesy, conscientiousness, and civic virtue,63 including acts such as helping those with a heavier workload, giving of one’s time to help others, not taking long lunch breaks, and completing tasks on time.64 The focus of attention on work engagement and citizenship behaviors, both within and outside of the health care literature, has largely been upon the general construct of work engagement or disengagement with attention to work roles and tasks.46 The turn toward clinical leadership requires attention to dif-ferent facets of work engagement and citizenship behaviors, in particular the nature of clinical citizenship behavior as opposed to generic forms of these behaviors.