#MedEd and #Leadership: A Synopsis of a New Dutch Framework

By Jamiu Busari (@jobusar)

A joint collaboration between the Platform for Medical Leadership and the University of Twente, the Netherlands

©2015, Platform Medisch Leiderschap / Universiteit Twente

In recent years, the landscape of health care delivery has undergone significant change;  this has required extensive reforms to physician training programs  because of increasing public expectations of the medical profession (1).  Simultaneously, the curricula of many physician training programs have been modified to include managerial and leadership competencies for physicians (2,3,4,5).

Similar to the medical leadership initiatives in the UK, Canada and Australia, a new competency framework for medical leadership has recently been developed in the Netherlands – the Dutch framework for medical leadership (DFML) (6).

The DFML was formally unveiled in July 2015 and is a product of a collaborative initiative between the Platform for Medical Leadership (PML) and the University of Twente (UT). The framework was developed using a mixed method qualitative approach. In addition to in-depth interviews (with a diverse group of doctors and non-medical stakeholders), a systematic review of the Dutch medical leadership literature, online surveys and focus group meetings with physicians from different sectors of the Dutch health care system were performed. Additional resources on leadership initiatives from other countries were also reviewed, including the medical leadership competency framework (MLCF) and LEADS framework (3-5, 7,8).

The DFML Framework

The DFML was intended primarily for physicians and physicians-in-training. However, the framework is applicable and useful for other health care professionals. Its objective is to provide the necessary knowledge, skills and attitudes needed for leadership in healthcare.

The content of the DFML aligns with the CanMEDS 2015 framework, and in particular with the new Leader Role (previously called the Manager Role). (7,8)  The competencies described in the DFML are considered to be unique for health care leaders, both within and outside the clinical workplace.

The DFML consists of twelve competencies that have been clustered into three overlapping themes. These themes represent leadership capabilities that focus on 1) the individual 2) others within the healthcare system and 3) the society as a whole.  These 12 items include:

  1. Leading with vision: having both a personal and shared vision within the healthcare team and the organization
  2. Personal development: continuous personal development and optimal development of own knowledge and conduct
  3. Exemplary behavior/role modeling: awareness of attitudes and behaviors that have an impact on others
  4. Presence/visibility: being aware of the visibility of a health professional in different functions and roles
  5. Taking Responsibility: taking on shared responsibility for the care process and the the outcome of care
  6. Exerting Influence: the ability to exert influence at different levels of care for the benefit of patients, professionals, organization and society as a whole.
  7. Coaching and leading others: informal and formal methods of coaching and managing others regardless of the stage of training, discipline or work experience
  8. Bridging connections/building networks: working with patients, colleagues and others, including multidisciplinary teams.
  9. Organizing/managing healthcare: exerting influence on the efficient organization and process of care
  10. Improve quality of care: maintaining and enhancing the quality of care and health policy
  11. Sustainable use of resources: coordinating the responsible funding and budgeting of health care services
  12. Entrepreneurship and Innovation: providing oversight for the relevant changes and developments both within and outside the domain of medical practice

As societal expectations of health care delivery change, all health care professionals (doctors especially) have a leadership obligation. The traditional view of leadership being linked to a title or position must be broadened to a conceptualization of  leadership as a catalyst for change within the health care system.

RML-Figuur-3 (1).png


  1. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010; 376(9756): 1923-1958.
  2. Warren OJ, Carnall R. Medical leadership: why it’s important, what is required, and how we develop it. Postgrad Med J. 2011;87:27-32.
  3. NHS Institute for Innovation and Improvement and Academy of Medical Royal Colleges. Medical leadership competency framework: enhancing engagement in medical leadership. 3rd ed. Coventry: NHS Institute for Innovation and Improvement and Academy of Medical Royal Colleges 2010 July.
  4. LEADS in a caring environment framework, Canadian college of health leaders
  5. Health Workforce Australia [2013]: Health LEADS Australia: the Australian Health Leadership Framework 
  6. Raamwerk Medisch Leiderschap (Dutch Framework for medical leadership)
  7. Dath D, Chan M-K, Abbott C. CanMEDS 2015: From Manager to Leader, Ottawa: The Royal College of Physicians and Surgeons of Canada; 2015 March
  8. Frank JR, Snell L, Sherbino J, editors. The CanMEDS 2015 Milestones Guide. Ottawa: Royal College of Physicians and Surgeons of Canada; 2014 September