Leadership in the clinical workplace: Evidence for why, what and how
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Keynote speech delivered at the annual conference of the Dutch Association for Gastroenterology (NVMDL), 2017
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Leadership in the clinical workplace: Evidence for why, what and how
- 5. • A biblical story • My personal views about leadership • A Clinical syndrome • Reflections
- 7. 1. Biblical Story • Philistines • Valley of Elah • Ancient warfare • Mighty Warrior vs Shepherd boy • Underdog?
- 9. David was not an Underdog • David’s sling was an incredibly devastating weapon. • The stones in the Valley of Elah were not normal rocks. They were barium sulphate, which are rocks twice the density of normal stones. • Experienced and accurate slinger (Accuracy)
- 10. David was not an Underdog • He knew his strength and weaknesses • Courage • Focussed • Did not let his current condition stop him
- 11. 2. My Personal view on Leadership • Why is it important • What needs to be done • How do we do it
- 12. Leadership A process of social influence that maximizes the efforts of others, towards the achievement of a goal Kevin Kruse Forbes.com What is Leadership April 9, 2013
- 14. • Organizational structures – Vertical vs. Horizontal, Bureacracy vs. Adhocracy • Mental Models – Complex adaptive systems • Communication - Suboptimal between frontline care providers & back office hospital administrators • Value definition in Health care - the delivery of ‘reliable, cost effective, state-of-the-art, evidence-based and patient-centered healthcare practice’. • Alignment among stakeholders – Cycle of Non alignment in health care Challenges facing leadership (development) in health care delivery
- 19. The importance of clinical leadership • “…….the emphasis upon competency-based leader development has done little to foster effective clinical leadership…, despite its potential usefulness, and informative and summative evaluation of leader development. • Although considerable discussion has occurred on the need for clinical leadership, and large scale pubic inquiries evidence the considerable patient harm that has occurred in the absence of such leadership, there continues to be a major disconnect between clinicians and managers, and clinical and bureaucratic imperatives • The debate over who is best positioned to lead service delivery and the place of clinicians in governance continues” Daly et al. J Healthc Leadersh. 2014(6). 75-83
- 20. • “…….the emphasis upon competency-based leader development has done little to foster effective clinical leadership…. • , there continues to be a major disconnect between clinicians and managers, and clinical and bureaucratic imperatives • The debate over who is best positioned to lead service delivery and the place of clinicians in governance continues” Daly et al. J Healthc Leadersh. 2014(6). 75-83 The importance of clinical leadership
- 22. Curricular reform The evidence 1 - Why
- 24. Value based health care delivery (M. Porter, HBS, 2006) 1. How efficient a patient feels his/her ailment has been handled 2. How the providers of care perceive that the process works for them; 3. How the provision of training and research contributes to innovation and improvement of services provided in 1. above and does not hinder 2. 4. How effective the hospital administration manages costs and generates revenue while achieving and sustaining points 1. to 3. The evidence 3 - Why
- 25. The evidence 4- Why
- 26. The evidence for why - Summary The factors defining the need for leadership Increased HC costs Sociopolitical changes in healthcare Needs assessment Increased demands/changing expectations Curricular changes
- 27. The evidence 1 - What Vision • All health professionals in worldwide should be educated to mobilize knowledge and to engage in critical reasoning and ethical conduct so that they are competent to participate in patient and population-centred health systems as members of locally responsive and globally connected teams. Method: Expert opinion (review) Requirements for realizing this vision • Instructional and institutional reforms, guided by two proposed outcomes i.e. transformative learning and interdependence in education. Instructional reform: • Informative learning = acquiring knowledge and skills to produce experts • Formative Learning = socializing students around values • Transformative learning = about developing leadership attributes; its purpose is to produce enlightened change agents.
- 28. The evidence 2 - What Hypothesis • Physicians in leadership positions are valuable for hospital performance Method 1. Cross-sectional study 2. Top-100 U.S. hospitals in 2009, as identified IHQ rankings (Structure, Outcomes, Process) 3. Three specialties: Cancer, Digestive Disorders, and Heart and Heart Surgery. 4. Personal histories of 300 chief executive officers of these hospitals traced by hand. 5. The CEOs were classified into physicians and non-physician managers. Results 1.Strong positive association between the ranked quality of a hospital and Physician CEO (p < 0.001). 2.Evidence did not establish that physician- leaders outperformed professional managers, but was consistent with such claims
- 29. Hypothesis • Number of clinicians in strategic governance of hospital trusts is relatively low, but may have an impact on overall performance. Method 1. Retrospective data analysis 2. Pooled regressions via an ordered logit model 3. Published data from annual reports of 169 (acute care) hospital trusts, publicly available performance measures from the Healthcare Commission and 3 year HSMR data (2006-9), Result 1. Significant and positive association between a higher % of clinicians on boards and the quality ratings of service providers 2. Explanation: larger group of clinicians on boards collectively contributing to decision making 3. A small increase in the number of doctors on boards (10%) can have marked consequences for hospital level outputs and outcomes. The evidence 3 - what
- 31. The evidence - how • Zuyderland MC (3 tranches) • Erasmus iBMG : Imagine2 • Academie voor Medisch Specialisten: Klinische Leiderschap • NASKHO/UM: Clinical Leadership & Health Systems Improvement, Curacao • Sanokondu.com
- 33. Some strange things about Goliath • He was led to the battle field • He moved slowly • His reaction was slow for a combat man • “Am I a dog that you should come with stick(s)”
- 34. Some strange things about Goliath • Research suggest he had acromegaly • Secondary to a Pituitary gland tumor • Double vision - Donnelly DE, Morrison PJ. Hereditary Gigantism-the biblical giant Goliath and his brothers. The Ulster Medical Journal. 2014;83(2):86-88.
- 36. 6 features of Clinical Leaders 1. They always go first: People who lead, enter new territory first. Leaders experience things first meaning that they go first and face the unknown alone: at least, initially. 2. They face uncertainty and danger: Going first also means taking risks. Leaders are often oblivious to the problems they will face, but they have the courage to meet them, and confidence in their ability to overcome them. 3. They have vision: Having foresight suggests leaders see things others do not and have knowledge, information or understanding others lack.
- 37. 4. They are capable and credible: Leaders have substance and focus. They are professional and know their business. 5. They possess inherent quality: Regardless of what the product is—a car, a service or health care—leaders are the best in the business. Others will follow because leaders personify quality, which people want to emulate. 6. They have followers: leaders differentiate themselves from others implicitly. These others are followers, who seek leadership because someone else will shoulder the risk, initiate action or find a solution. Quality will emerge. 6 features of Clinical Leaders
- 38. In Summary • The system is Goliath • The professional is David • Clinical Leadership is the sling
- 47. Trust
- 49. Summary • There is evidence that there is a unwavering need for training and development in all domains of medical leadership (Brouns et al,. 2011, Berkenbosch et al., 2011) • Physician leaders need to take responsibility and be accountable for providing and managing health care delivery (Busari et al., 2011) • There is a need for more participation of physicians in leading health care organizations (Goodall, 2011) • We should remain wary of getting caught in the illusion that formal leadership and management training is enough for health care transformation (Busari, 2012)