1. Issue 2 July 2014
Welcome to When Doctors Lead
The Newsletter of the World Federation of Medical Managers
WFMM Vision: To establish a recognized international network for the discussion of
issues, research, and development of standards and performance benchmarks in
effective physician leadership.
1. NHS (England) hosts WFMM Members at the 2014 International
Medical Leaders Forum (IMLF)
The 2014 IMLF was held in conjunction with NHS Medical Directors at the Hilton
Brighton Metropole Hotel, Brighton, England. NHS medical directors/responsible officers
held a one day conference on 4 June titled Ahead of the Curve. This was opened by
Professor Sir Bruce Keogh, the National Medical Director of NHS England. There were
informative discussions and insights about the UK revalidation program for international
delegates
Professor Jenny Simpson and Dr Mike Bewick from the NHS, generously hosted the
WFMM International Leaders Forum (IMLF) on 5 June with invited WFMM members and
guests. The program outline is below.
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2. IMLF Program at a glance
Welcome: Dr Roger Boyd (Australia), Chair WFMM Steering Committee
Session 1: Chair: Prof. Walter Riccardi (WFMM Member: Italy)
Providing the vision, leadership and know-how to drive change and quality
improvement
Professor Nick Black, London School of Hygiene and Tropical Medicine
Do leaders’ personal values make them victims or saviours?
Dr Peter Brambleby, Public Health Consultant and past Director of Public Health in
NHS Primary Care Trusts
Session 2: Chair: Dr Peter Angood (WFMM Member: USA)
How can skilled medical leaders create value for health care?
Workshop:
International perspectives on UK
Revalidation
Professor Jenny Simpson (UK) and
Dr Mike Bewick (Medical Director of
Primary Care NHS England, UK)
Workshop:
Partnering for performance to drive
reform
Professor Graham Dickson (Canada) and
Professor Peter Spurgeon (UK)
Session 3: International Policy Dialogue: a relational approach to support
medical leadership development in health care
Study visits were organised for international delegates over two days:
On Monday June 2, 2014 delegates visited the offices of International SOS where Dr Dick
Hooper, the Responsible Officer and Regional Director for global clinical governance
International SOS, Dr Ray Field, the Revalidation Lead for the NHS, Dr Henrietta Hughes, Medical
Director of North East London NHS, and other SOS staff led discussions around revalidation.
International SOS is an organisation of 11,000 employees, 3600 of whom are doctors; they
provide services in remote places, such as advice, retrievals and related services.
In the afternoon delegates had the opportunity to visit the Riverside Medical Practice in
Vauxhall. Dr Clare Gerada (immediate past Chairperson of the Royal College of GPs) and Dr Lucy
Warner (the Chief Executive of the Practitioner Health Program) hosted the visit.
In the morning of June 3, 2014 a visit was made to the St Thomas's campus of the Guys and St
Thomas Foundation Trust. A tour was made of the new Evelina London Children's Hospital, with
the medical director, Dr Sara Hanna. A wide ranging discussion with Dr Ian Abbs, the Medical
Director of the entire Trust, was included in the tour. This Trust has some 1200 - 1400 beds
across two campuses; about 850 consultants and 1500 – 1750 doctors in training and some 2
million patient contacts per year.
In the afternoon delegates visited the UK Department of Health where Dr Jenny Simpson
(Clinical Director of Revalidation), Dr Mike Berwick (Deputy Medical Director of NHS England)
and Dr Celia Ingham-Clarke (the National Director for Reducing Premature Deaths) responded in
depth to questions across a broad range of significant issues.
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3. 2. WFMM Steering Committee Meeting
The WFMM Steering Committee held its annual meeting on Friday 6 June, hosted by the Faculty
of Medical Leadership and Management at its offices in London. Dr Roger Boyd retired as Chair
of the WFMM Steering Committee with significant thanks from members. As the inaugural Chair
Dr Boyd has been a significant supporter and founding leader in establishing the WFMM. Dr Lee
Gruner, current President of The Royal Australasian College of Medical Administrators took over
as the Chair and will steer the WFMM through a review and into development of a new
Memorandum of Understanding for WFMM members.
3. Physician Leadership: Development and Practice
In collaboration with Emerald publishing the World Federation of Medical Managers
member organisations and others have contributed new research and papers to a soon
to be published “special edition” journal about health services management and
leadership.
Journal contributions have been received from authors across the spectrum of medical
leadership, covering the following topics:
• What is medical leadership and what do medical leaders do?
o What are its core components and how does it differ from other types of
leadership in health systems?
o Does medical leadership differ from medical management, and if so,
how?
• Is there a unique perspective or world view that informs and shapes how doctors
manage and lead? If so, how does this differ from other health system leaders?
• What exemplar programs are used to help physicians learn the capabilities of
modern leadership?
o How effective are these programs?
o What competency models or curriculum models are used as a foundation
for medical leadership development?
o What instructional practices enhance physician leadership development?
o How do different jurisdictions recognize doctors who have taken formal
programs and who move from clinical practice to full-time medical
leadership roles?
o Are there re-certification expectations of physicians in medical leadership
roles?
o What models exist to assess leadership capability? Is accountability for
performance of medical leadership conducted? If so, how, and how
effective are these models?
• What processes do health systems and health organizations use to ‘create an
environment in which excellence in medical leadership will flourish’? Do they
differ from conditions that enhance physician engagement? If so how?
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4. • Should physician-led healthcare settings be differentiated from non physician-led
healthcare settings in terms of patient outcomes?
Selected papers have been reviewed and the Special Issue of the Leadership in Health
Services journal will be published by Emerald in late 2014.
We are interested in further empirical research articles and conceptual pieces using
either quantitative, qualitative or mixed-method studies. If you are interested please
contact the Guest Editors of this Special Issue as we hope to stimulate further
publication.
Guest Editors:
Professor Emeritus Graham Dickson
Leadership Studies
Faculty of Social and Applied Sciences
Royal Roads University
gdickson@royalroads.ca
Dr Karen Owen
Chief Executive
The Royal Australasian College of Medical
Administrators
KOwen@racma.edu.au
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5. 4. Member Profiles
WFMM Member Profile 1 : The Hong Kong College of Community
Medicine (HKCCM)
The Hong Kong College of Community Medicine (HKCCM) is a member of the Hong Kong
Academy of Medicine (AM). HKCCM now has 67 Fellows in Administrative Medicine. The
College currently has 13 Basic Specialist Trainees (BST) and 6 Higher Specialist Trainees
(HST). Examinations are held annually.
An in-depth review of the training outcomes in the AM training has been conducted in
2013/2014 comparing these with those promulgated in RACMA’s training program. It
has been agreed to retain the current College training competencies but to further
contextualise each competency domain.
HKCCM has initiated discussions on medical leadership on 2 occasions in the past year—
at the College’s own Annual Scientific meeting held in September 2013 with the theme
of Medical Leadership and Management (Global Outlook and Local Landscape), when
the keynote speaker was RACMA’S Dr Roger Boyd. The second occasion was a session at
the HKAM’s 20th Anniversary Congress, held in December 2013, when the role of
simulation in building leaders for global humanitarian assistance was reviewed.
HKCCM (AM) works in close collaboration with The Royal Australasian College of Medical
Administrators (RACMA). Currently 30 HKCCM (AM) Fellows are also RACMA Fellows. In
the past year, 2 RACMA Accelerated Pathway candidates based in Hong Kong have
presented for the RACMA Fellowship examination. The two Colleges have reciprocal
professional development arrangements in place. RACMA’s CEP Coordinator in Hong
Kong participates in RACMA’s CEP Committee meetings and is also a member of the
2014 RACMA Annual Scientific Conference programme committee. This year the
conference will be held in Sydney in September 2014. Dr Fung Hong, President of
HKCCM, is an invited speaker. There is commitment to reciprocal Fellow attendance at
respective annual meetings.
Hong Kong Hospital Authority (HKHA) is a major employer of medical managers in Hong Kong
and holds a 2 day annual convention, usually in May. In 2014 there were > 5000
registrants. One of the plenary sessions focused on medical leadership and teamwork.
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6. WFMM Member Profile 2: The Canadian Society of Physician Executives
(CSPE)
The Canadian Society of Physicians Executives (CSPE) remains the organization where
physicians in the leadership arena find a home. The CSPE is exploring new directions by
embarking on research around leadership and by developing a firm and established
publication forum for physician leaders. Because it has been claimed that every
physician is a leader, not just executives, our organization, in partnership with the
Canadian Medical Association, tries to offer something for all physicians in general and
for physicians with specific leadership roles in particular. Our three main areas of focus
for the coming year are:
The 2014 conference “Courage: Bringing Authenticity to Action” took place in Toronto
on April 11-12th. The conference was well attended by over 400 physician participants
and the overall energy and enthusiasm was quite high. Plans for the 2015 conference
are now underway. The theme “Thriving in Complexity: Physicians Enabling
Transformational Change” will be held in Vancouver on April 24-25, 2015.
Leadership Survey
The CSPE will launch a large “Canadian physician leadership” survey in early June. The
survey in partnership with the Canadian Medical Association and the University of
Manitoba will be sent to physician leaders across Canada. Currently, there is limited
Canadian data on physician leadership. The results from this survey will be the first is
quite limited and this survey will hopefully provide us with new data that will help to
build future leaders.
Canadian Journal of Physician Leadership
It has been long awaited, but we will finally launch the Canadian Journal of Physician
Leadership electronically this summer. The journal will be published quarterly and
mailed to all members.
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7. WFMM Member Profile 3: The Royal Australasian College of Medical
Administrators (RACMA)
RACMA is the recognised medical speciality college which sets the standards for
doctors in medical management. The College awards the fellowship in medical
administration which permits the medical practitioner to join the College in the
membership class of Fellow and to apply for registration as a specialist medical
administrator.
2013 Census Executive Summary
The College monitors its specialist medical management workforce on a regular basis.
The most recent Census survey was conducted in late 2013. While there was a
relatively low response rate (34.2%), the results show some indicative patterns:
1. 68.4% of respondents work in public sector health services, 15.2% in private
sector health services with others working in a variety of settings, including
Defence and self-employment.
2. As the health service bed capacity increases so does the number of RACMA
trained specialist medical managers employed increase
3. RACMA specialist medical managers working in hospitals have Physician
managers reporting directly to them. Depending on the size of the hospital, the
variation is from less than five clinicians up to over 45 clinicians in hospitals with
over 500 beds.
4. The RACMA specialist medical manager workforce is ageing: 54.4% of the 2013
survey respondents were aged 55-59 years or older.
5. 72 respondents indicated they might retire within the next 5 years and 69 in 5-9
years’ time. Most of those who propose retirement within the next 10 years,
plan to take up alternative work e.g. locum physician management work,
consulting and advisory, academic work.
6. Junior medical staff continues to be managed across the entire hospital spectrum
by all classes of College membership; the major proportion of junior doctor
management is in the larger hospitals.
7. Mobility is high among RACMA specialist medical managers with 25% of 2013
survey respondents changing jobs in the last 12 months: 90% of these did so
because of job opportunities.
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8. Physician leaders at work
The following table shows how a sample of medical managers in Australia reported
how they spent their time at work (hours) over a recent 4 week period. Using a
notional average for the ranges (measured in hours), calculations were completed
on the total hours worked on the profile of tasks and for each task the percent of
total time worked.
Calculations were made to gauge relativities in the proportion of medical
management work tasks spent as part of the total work performed.
Source: RACMA Surveys of Membership June 2012, and October, 2013
The significant leadership of quality improvement in health services/patient
outcomes is clear. Between 2012 and 2013 Australian hospitals have been impacted
by new national quality standards. The role of medical leaders is evidenced.
Who does this compare with what happens in your country?
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9. 5. What is the WFMM?
WFMM Mission: To develop leadership skills in clinicians and demonstrate the value
proposition for doctors and physicians in leadership and management of health services
worldwide.
The WFMM was formed at a meeting in Hong Kong in September 2010, when a group of
doctors in senior management and leadership of health services in eight countries came
together to discuss the potential value of international actions to promote clinical
(medical) leadership in advancing the quality of care and performance of health services.
Since that time like minded organisations have signed a Memorandum of Understanding
to collaborate and support each other to promote physician leadership and
engagement.
WFMM signatories and member organisations are:
• American College of Physician Executives (ACPE) – USA
• College of Medical Administrators of Sri Lanka (CMASL) – Sri Lanka
• Canadian Society of Physician Executives (CSPE) – Canada
• Danish Association of Medical Directors (DAMD) – Denmark
• Faculty of Medical Leadership and Management (FMLM) – UK
• Hong Kong College of Community Medicine (HKCCM) – Hong Kong
• Israeli Society of Medical Management (ISMM) – Israel
• Italian Society of Medical Managers (SIMM) – Italy – including European Alliance of
Medical Managers (EAMM) – Europe
• The Royal Australasian College of Medical Administrators (RACMA) – Australia & New
Zealand
• South African Society of Medical Managers (SASMM) - South Africa
Since 2011, WFMM has held annual International Medical Leaders Forums in association
with one of its member organisation’s annual conferences. These have been held in
Rome in 2011, hosted by SIMM; in San Francisco in 2012, hosted by ACPE, and in
Vancouver in 2013, hosted by CSPE and the Canadian Medical Association, in 2014
hosted by the NHS (England). In 2015 the International Medical Leaders Forum (IMLF)
will be held in Hong Kong on 20 May. Watch for details at www.wfmm/org/
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