Article Text

Download PDFPDF

Do ‘physicians in the lead’ support a holistic healthcare delivery approach? A qualitative analysis of stakeholders’ perspectives
  1. Romana Fattimah Malik1,2,
  2. Carina G J M Hilders3,
  3. Fedde Scheele1,2,4
  1. 1 Department of Research and Education, OLVG Hospital, Amsterdam, The Netherlands
  2. 2 Athena Institute, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands
  3. 3 Erasmus School of Health Policy and Management, Rotterdam, The Netherlands
  4. 4 School of Medical Sciences, Institute of education and training, VU University Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Dr Romana Fattimah Malik; romana_malik{at}


Objectives Value-based healthcare implies that healthcare issues are addressed most effectively with the ‘physicians in the lead' (PIL) strategy. This study explores whether PIL also supports a holistic care approach that patients are increasingly demanding.

Design A qualitative research design was used.

Setting This study was conducted in a general hospital in the Netherlands with an integrated PIL strategy.

Participants Semistructured interviews were conducted with 14 hospital stakeholders: 13 stakeholders of an Obstetrics and Gynaecology department (the hospital’s Patient Council (n=1), nurses (n=2), midwives (n=2), physicians (n=2), residents (n=2), the non-medical business managers of the Obstetrics and Gynaecology department (n=2) the Board of Directors (n=2)) and a member of the Dutch National Healthcare Institute’s Innovative Healthcare Professions programme.

Results According to diverse stakeholders, PIL does not support a holistic healthcare delivery approach, primarily because of the strong biomedical focus of the physicians. Although physicians can be educated to place more emphasis on the holistic outcome, holistic care delivery requires greater integration and teamwork in the care chain. As different healthcare professions are complementary to each other, a new strategy of a ‘team in the lead' was suggested to meet the holistic healthcare demands. Besides this new strategy, there is a need for an extramural care management coordination centre where patients are able to receive support in managing their own care. This centre should also facilitate services similar to the core function of a church or community centre. These services should help patients to deal with different holistic dimensions that are important for their well-being.

Conclusions The PIL strategy appears to be insufficient for holistic healthcare delivery. A ‘team in the lead’ approach should be considered to meet the holistic healthcare demands. Further research should focus on observing PIL in different cultures and exploring the effectiveness of the strategy ‘team in the lead’.

  • medical leadership
  • physicians
  • holistic care
  • value-based healthcare
  • healthcare delivery

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from


  • Contributors RFM, CGJH and FS contributed to the conception and development of the study, project management, reporting and publication. RFM, CGJH and FS developed the topic list for the semi-structured interviews. RFM and FS participated in participant recruitment and RM in the data collection. RFM performed all interviews. RFM, CGJH, and FS developed and refined the coding framework, and RFM and NA performed the data analysis. RFM prepared the first draft of the manuscript. RFM, CGJH and FS were involved in drafting and revising the manuscript and have given final approval of the version to be published. RM takes responsibility for the manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The Ethical Review Board of the hospital waived ethical approval for this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement De-identified transcribed interviews and the code set can be made available by request to the corresponding author.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.