Leadership in Healthcare: Issues and Challenges

1. Leadership in Healthcare: Issues and Challenges Anthea Penny R H Penny Ltd. anthea.penny@xtra.co.nz

2. 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 ?

3. 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

4. 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

5. 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

6. 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

7. 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

8. Leadership in Healthcare is…. • Unique in that there are multiple stakeholders: • Clinicians – Medicine, Nursing & Allied Health • Managers • Bureaucrats • Politicians • Advocacy groups • The Media

9. 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

10. Leadership and Alignment • alignment Strategy The Business Direction Structure The Organisational Design The Character of the Organisation Culture

11. What are issues and challenges in healthcare internationally that leaders are facing?

12. 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

13. 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

14. Source: Commonwealth Fund Survey of Hospital Managers 2003

15. Health status by international standards- expenditure Health Outcomes

16. Spending trajectories vary across OECD: small differences matter

17. 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

18. Trends and issues: Population changes Social determinants of health Changing burden of disease Technology advancement Limits to resources Aging workforce Migration Sustainability

19. Sustainability Leadership Challenges: • Leading the debate • Determining priorities • Technology assessment • Providing safe, quality, affordable patient care

20. Community / patient expectations

21. Issues: Patients “wants” versus “needs” Self-care and management of chronic disease Hospitals are “sacred” “Doctors know best” Community / Patient Expectations

22. 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

23. Clinical accountability and quality Avoidable events “Worst” country assigned score of 100

25. 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

26. 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

27. The way healthcare is delivered

29. 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

30. 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

31. Practicing physicians per 1000

32. Staffing Shortages

33. Practicing nurses per 1000

34. Workforce Capacity and Sustainability Issues: • Current issue; recruitment, retention and training • Aging workforce • Workforce shortages • Future availability of a skilled workforce • Effective team work

35. 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

36. The Politics of Health

37. 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

38. 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

39. Improving PerformanceHealth Outcomes

40. 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

41. 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

42. 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

43. 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

44. Performance Management Leadership Challenges: • Leading and influencing performance improvement • Developing a “Learning Organisation” • Leading quality improvement initiatives • Developing IT systems that work

45. Some International Solutions?

46. The need to develop leaders in healthcare Provision of national, professional and organisational initiatives

47. 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

48. 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

49. 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

50. 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