Sally Hanks



This study acknowledges the requirement for leadership in dental training and professional standards to improve patient safety, the quality of care and the shaping of culture. Leadership development requires authentic learning outcomes whose meaning and related constructs of leadership are fully understood. The literature is missing empirical studies at operational level; this study addresses that gap. The innovative blended methodology, embedding case study, recording and observation of dentists, and use of the think aloud technique optimised the co-construction of knowledge via the zones of maximum complexity in Video Reflexive Ethnography (VRE) and proximal development in Activity Theory. This bottom-up, context sensitive approach enabled discovery of three activity systems with associated outcomes: patient care, running the surgery, and running the practice. Further analysis of their integrated, combined outcome supported identification of six metacognitive, higher-order concepts that underpin leadership in dental practice: Organisational level, Community of Practice, Personal Position or Context (dentist as individual, clinician and business person), Identity (personal and professional), Relationships, ‘Capability and Flexibility’. Concepts and their relationships informed the final conceptual framework thus clarifying the fundamental tenets of dentists’ leadership. High levels of emotional intelligence, professional identity formation, stress management, and effective dentist-nurse relationships are pre-requisite. Differences between principal and associate roles, challenges of working in a Dental Body Corporate, and internal conflict between the various personal positions of the dentist were noted. These areas are explored and deliberated, alongside challenges in, and opportunities for, addressing them. The framework aligns with contemporary concepts and approaches to leadership, while not being limited or constrained to a single theory, model or definition. Its use emphasises the oversimplification of outdated approaches through facilitating understanding of leadership while retaining and embedding its complexity. The framework can be applied across all leadership levels and to multiple stakeholders, including dentists, to develop regulatory, education and operational activities.

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