A testable agenda
Research propositions and empirical design
The next step is to test leader-context episodes directly rather than continue using years served or outsider status as crude proxies.
Career variety will be positively associated with portable performance after controlling for total experience.
Broader cognitive and behavioral repertoire.The association will be stronger when assignments permit outcome maturity and consequence ownership.
Depth converts exposure into accountable learning.Institutional tenure will be curvilinear under high environmental dynamism.
Local capital may later be offset by obsolete assumptions.Local institutional capital will favor insiders in early implementation.
Tacit knowledge and trust reduce transition friction.External calibration and dissent will weaken tenure-related rigidity.
Renewal mechanisms counter entrenchment.Repeated trust formation will mediate variety and portable performance.
Legitimacy is rebuilt without inherited status.Durable succession will distinguish productive variety from churn.
Portable leaders leave stronger systems.Recommended design
Multi-system longitudinal cohort
Compare senior healthcare leaders with high and low contextual variety. Match or weight on career length, role level, system size, baseline condition, domain, market structure, and prior performance.
Proposed data dictionary
Outcome families and sources
| Family | Illustrative measures | Source |
|---|---|---|
| Leader history | Institutional and role tenure, employer count, functional breadth | Verified CV, credentialing, employer records |
| Context | Ownership, mission, scale, rurality, market, baseline distress | AHA, CMS, audited reports |
| Quality and safety | Mortality, harm, infections, readmissions, reliability | CMS, state and internal quality systems |
| Workforce | Turnover, vacancy, engagement, safety climate | HRIS, surveys, finance |
| Access | Wait time, referrals, utilization, disparity | EHR, scheduling, claims |
| Durability | Persistence, readiness, process ownership | Longitudinal outcomes and succession records |
Interpretive discipline
Material limitations
- Rapid integrative review, not a preregistered systematic review.
- Direct hospital comparisons of career-variety profiles are limited.
- Corporate studies do not fully represent healthcare quality, access, and community obligations.
- Longevity and mobility are selected rather than randomized.
- The survey instrument, sample, effect estimate, and tests require formal reproduction.
- The model, matrix, curves, and PLEI remain original and unvalidated.