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We engaged in multiple rounds of discussions via videoconferencing with memo-generation and collaborative conceptual development using cloud-based, real-time interactive documents, each session lasting approximately one-hour in length.
Literature Review & Synthesis
After refining our initial model, we conducted a focused literature review. We drew from literature within health systems leadership, followership and organizational development, contrasting our own newly formulated conceptualization with other existing models. We engaged in iterative rounds of revisions. Ultimately, we coalesced our thinking into one conceptual model (see results section), which we refined through persona-driven testing (i.e. cognitive simulations with various types of simulated characters that were used to elucidate each role in various scenarios) and stakeholder consultation.22,23
Prototype and Persona-based testing of the model
Next, we simulated personas and stories to test and prototype our model.22–24 The resulting model with associated persona-driven vignettes were submitted to a representative sampling of health system stakeholders (clinicians, administrators, educators and researchers in healthcare leadership) for review. Feedback from stakeholder consultation was used to refine the model.
Stakeholder consultations
Similar to stakeholder consultations endorsed by scoping reviews25 and the Canadian Institutes of Health Research Knowledge Exchange process26, we sought formative feedback on our provisional concepts from a range of educators, experts, and frontline practitioners. This process has been used previously20. Our inclusion criteria were that the individual would meet one of the following criteria:
  1. Personal experience in blended leadership roles across two or more organizations/units;
  2. Supervised/led others who bridge across more than one role; or
  3. Actively engaged in teaching or scholarship about leadership training and development.
We excluded those who met the above criteria but had no experience within the North American leadership context. We constructed a simple survey tool with an embedded video (https://bit.ly/BridgeLEADsurvey) and requested that each stakeholder help us to identify the strengths, weaknesses, and relevance of the conceptual model to their own leadership-related practice. We subsequently met with each of the leaders for a one-on-one interview led by our senior author (TC) to gather feedback from those who volunteered to engage with us to provide further feedback. A thirty-minute, one-on-one Zoom interview (Zoom communications, Inc., San Jose, CA) was completed within a one-month span with any stakeholder who sought to provide verbal feedback about our model in addition to their survey responses.