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Leadership in Healthcare: Issues and Challenges. Anthea Penny R H Penny Ltd. [email protected] Outline of this presentation. What do we mean by leadership in healthcare? What are the issues and challenges for leadership in healthcare?

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Presentation Transcript
outline of this presentation
Outline of this presentation
  • What do we mean by leadership in healthcare?
  • What are the issues and challenges for leadership in healthcare?
        • Internationally e.g. UK, USA, NZ, Australia, Sweden & Canada
  • Are there solutions ?
leadership
Leadership…….
  • Copes with change
  • Sets the direction, takes ownership and leads it
  • Aligns people to achieve change and/or a vision for the future
  • Motivates people to achieve goals
  • Differs from management
in healthcare previous thinking about leadership
In Healthcare: Previous thinking about leadership
  • Mainly fell into 3 categories:
    • Function of power and influence
    • “Great man” trait and theory
    • Situational theory: situation or context important
  • Problems with these:
    • Focused on task and relationships but didn’t address the nature of the challenge or the complexity and amount of change required
emergence of a new paradigm
Emergence of a new paradigm
  • Leadership is the relationship between the leader and the led that induces followers to act for certain goals that represent the wants and needs of both parties. Burns 1970’s
  • Identified two contrasting leadership styles
    • Transactional – exchange that is mutually beneficial; may be politically, socially or economically valuable.
    • Transformational – based on 4 components
the 4 components of transformational leadership
The 4 components of transformational leadership
  • Influence stems from the ethical and moral stance of the leader
  • The leader behaves and acts as a role model and treats everyone as an individual
  • The relationship is one of intellectual stimulation, encouraging independent thinking, argument, rational thinking & problem solving
  • The leader acts as a mentor, coach advisor to followers
slide7

Leadership involves power and responsibility

  • Power and Responsibility MUSTcome together
  • Transformation will only happen if driven by clinical teams
  • CEO and other change agents support not do

Entrepreneurship not compliance

Liberation not Imprisonment

leadership in healthcare is
Leadership in Healthcare is….
  • Unique in that there are multiple stakeholders:
    • Clinicians – Medicine, Nursing & Allied Health
    • Managers
    • Bureaucrats
    • Politicians
    • Advocacy groups
    • The Media
tensions between different key groups
Tensions between Different Key Groups
  • Politicians – political leaders with a short term focus and usually politically biased
  • Bureaucrats – Responsible for policy development and its implementation but do they lead?
  • Clinicians – Access clinical resources and accountable for delivering quality patient outcomes. Lead clinical innovation and service delivery
  • Managers – Can lead an organisation / service but are accountable for the “bottom line” and organisational performance
  • Patients – leading “advocacy” & self-care
slide10

Leadership and Alignment

  • alignment

Strategy

The Business Direction

Structure

The Organisational

Design

The Character of the

Organisation

Culture

slide12

International Issues and Challenges for Healthcare Leaders

  • Sustainability
  • Community/patient expectations
  • Clinical governance and accountability
  • The way health services are delivered
  • Workforce capacity and sustainability
  • Political influence and intervention
  • Performance improvement & patient safety
main sources of data for the 5 countries are
Main Sources of Data for the 5 countries are:
  • Commonwealth Fund surveys of 5 countries:
    • 2003: Hospital managers
    • 2002: Experiences and attitudes of sicker adults
    • 2001: Experiences of adults
    • 1999: Quality of medical care
  • OECD health data 2003
  • Ministry of Health reports
    • Health and Independence Report 2003
    • Health Expenditure Trends in New Zealand 1990 -2002
  • WHO Report 2001
  • International Masterclasses- anecdotal evidence
slide17

8% growth path

6.3% growth

16

14

5.8% growth

12

10

5.1% growth

% of GDP

8

6

4

2

0

2000

2010

2020

2030

2040

2050

New Zealand’s long-term path is very sensitive to small changes in trend growth…

Health spending track

…so to deliver quality and quantity of health services the sector will need to use every $ even more well

sustainability
Trends and issues:

Population changes

Social determinants of health

Changing burden of disease

Technology advancement

Limits to resources

Aging workforce

Migration

Sustainability
slide19

Sustainability

Leadership Challenges:

  • Leading the debate
  • Determining priorities
  • Technology assessment
  • Providing safe, quality, affordable patient care
community patient expectations21
Issues:

Patients “wants” versus “needs”

Self-care and management of chronic disease

Hospitals are “sacred”

“Doctors know best”

Community / Patient Expectations
slide22

Community / Patient Expectations

Leadership Challenge:

  • Persuading the community to accept change
  • Shifting the emphasis of resources to community care where necessary
  • Leading the move from an “expert” model to a self-care model
clinical accountability and quality
Clinical accountability and quality

Avoidable events

“Worst” country assigned score of 100

clinical governance and accountability
Issues:

Clinical accountability for use of resources, patient safety and quality

Continuing number of adverse events

Blame cultures

Continuous quality improvement systems

Clinical Governance and Accountability
slide26

Clinical Governance and Accountability

Leadership Challenges:

  • Provision of clinical leadership
  • Clinical governance& accountability
  • Leading and creating a non-blame cultures
  • Preventing adverse events through continuous CQI systems
slide29

The Way Healthcare is Delivered

Issues:

  • Fragmentation and duplication of services
  • Lack of integration across the health continuum
  • Emphasis on hospital care
  • Meeting the needs of our increasing older populations
  • The need to develop new

models of care

the way healthcare is delivered30
Leadership Challenges:

Developing new models of care that embrace primary care

Integrating care and how it is delivered across the continuum

Leading organisational change and evolution

The Way Healthcare is Delivered
workforce capacity and sustainability
Workforce Capacity and Sustainability

Issues:

  • Current issue; recruitment, retention and training
  • Aging workforce
  • Workforce shortages
  • Future availability of a skilled workforce
  • Effective team work
workforce capacity and sustainability35
Leadership Challenges:

Creating career frameworks within a learning environment

Training appropriate numbers of health professionals

Using substitution strategies & creating new roles

Development of high functioning inter-professional teams

Workforce Capacity and Sustainability
slide37

Political Influence and Intervention

Issues:

  • Short term /politically expedient “fixes” rather than long term strategies
  • Effect of constant political interference and in some countries continuing structural change
political influence and intervention
Leadership Challenges:

Separating the impact of the political arena from healthcare delivery

Leading and getting political buy-in to long term strategies

Leading the debate with society about the development of priorities for the future

Political Influence and Intervention
slide40

Health status by international standards

(a) Life expectancy

Health Outcomes

New

OECD

United

United

Australia

Canada

Japan

Zealand

Norway

average

Sweden

Kingdom

States

83

82

81

80

79

78

77

76

75

Life expectancy at birth: 1994 data Source: OECD

slide41

New

OECD

United

United

Australia

Canada

Japan

Zealand

Norway

average

Sweden

Kingdom

States

8

7

6

5

4

3

2

1

0

Health status by international standards

(b) Infant mortality

Health Outcomes

Infant mortality: Deaths per 1,000 live births, 2004 or latest available year Source: OECD

slide42

New

OECD

United

United

Australia

Canada

Japan

Zealand

Norway

average

Sweden

Kingdom

States

35

30

25

20

15

10

5

0

Health status by international standards

(c) obesity

Health Outcomes

Obesity: Percentage of population aged 15 and above with a BMI greater than 30, 2004 or latest available year Source: OECD

performance management
Issues:

Improving performance & making it stick

individual

teams

organisational

Having timely information by which to manage clinical and resource decisions

Establishing & measuring outcomes

Performance Management
slide44

Performance Management

Leadership Challenges:

  • Leading and influencing performance improvement
  • Developing a “Learning Organisation”
  • Leading quality improvement initiatives
  • Developing IT systems that work
the need to develop leaders in healthcare

The need to develop leaders in healthcare

Provision of national, professional and organisational initiatives

sustainability47
Sustainability
  • Develop a vision for the future that fits with the environments issues and the resources available
  • Manage change through an evolutionary approach rather than constant restructuring
  • Make “healthcare” the place to work in
sustainability continued
Sustainability continued
  • Improve access and integration
    • Collaboratives – IHI initiatives
    • Mapping patient pathways
    • Continuums of care for population groups
  • Improve organisational performance and use of incentives e.g.

UK target system

Östergötland’s prioritizing & contracting process

Jönköping - pursuing perfection initiatives

leadership and community patient expectations
Leadership and Community/Patient Expectations
  • Lead consumer involvement that:
    • Moves from an expert model to a self-care model
      • Developing the “expert” patient
      • Putting the patient “in the room”
    • Provides patient choice and ease of access
    • Promotes home/community based accessible care
clinical governance and accountability50
Clinical Governance and Accountability
  • Develop and provide clinical leadership and CG systems that work hand in hand with management and that are patient centered
  • Lead and develop a learning organisation and culture that is non-blaming
  • Provide clarity around clinical standards, service and organisational goals, targets and expectations
healthcare delivery
Healthcare Delivery

Develop new models of care that:

  • Promote wellness
  • Provide accessible primary care
  • Manage long term chronic disease efficiently
  • Provide high quality secondary and tertiary care when needed in a way that is affordable
  • Provide palliative care
  • Are equitable and affordable
workforce capacity and sustainability52
Workforce Capacity and Sustainability
  • Plan and develop strategies for the training and development of a future workforce that may be composed of different roles and different ways of working
  • Provide a career framework for the above
  • Develop a multi-disciplinary team approach in training and delivery
  • Support informal caregivers
political influence and intervention53
Political Influence and Intervention
  • Use information, strategies and processes that gain understanding and buy-in from all of the key stakeholders (e.g. Östergötland)
  • Health leaders and professionals: use influence and power appropriately
  • Be proactive in advice
performance management54
Performance Management
  • Pursue perfection! And settle for nothing less
  • Make managers and leaders accountable for the organisations performance – bring the decision making as close to the bedside as possible
  • Develop clinical and management leadership that can lead, influence and manage change
  • Create organisational cultures that are non-blaming and “safe”
what will tomorrow bring
What will tomorrow bring?

Continual change and evolution of healthcare systems and the way it is delivered

  • To survive current and future pressures health care systems will have to change or adapt faster than they have to date
  • In order to survive health systems will need effective leadership
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