When Clinicians Lead The McKinsey QuarterlyJames Mountford and Caroline Webb

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Physician Leadership and Engagement

• Chris Carruthers MD
• Geriatric Medicine for the Practicing Physician
• Ontario Long Term Care Physicians
• Long Term Care Medical Directors Association of
  Canada
• November 7, 2009

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My Goal

• Encourage you to enhance your LTC Medical
  Directors role both locally and nationally

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Question

• What is Common with the following 13
  Organizations ?

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The Ottawa HospitalSt Michaels Hospital, Toronto
Sunnybrook Hospital, Toronto The Toronto
Hospital Hotel Dieu Hospital, Kingston
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Humber Hospital, Toronto Winnipeg Health
AuthorityChamplain LHIN, OntarioVancouver
Coastal Health Authority Centre for Addiction
and Mental HealthThe Scarborough
HospitalMontfort HospitalMcGill University
Health Centre
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• All Have Physician CEOs

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Why Physician CEOs and Leaders ?Physicians (You
!) bring -

• Integrity
• System knowledge
• Management by working around
• Physicians colleagues on side

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• Why do we need (more) physician leaders in all
  areas of health care ?

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Good Outcomes if

• Physicians are involved in planning improvement
  as team members
• Opportunities for physician and clinical
  leadership of improvement
• Clinicians own improvement

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When Clinicians Lead

• The McKinsey Quarterly
• James Mountford and Caroline Webb

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• Health care systems that are serious about
  transforming themselves must harness the energies
  of their clinicians as organizational leaders

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• Effective Clinical Leadership Lifts the
  performance of health care organizations
• Common Goal -Delivering excellent care
  efficiently
• LTC Medical Directors must take the lead in
  enhancing Long Term Care
• If you do not become involved who will ?

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Distributive Physician Leadership

• Institutional Leader
• Service or Department Leader
• Frontline Leader or Clinician

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Barriers to be addressed

• Recognition of roles is important
• Contract with position description
• Appropriate incentives e.g. pay
• Access to education
• Address -Reluctance of physicians to participate

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Long Term Care Medical Directors Role

• Leadership
• Administrative
• Quality improvement
• Medical staff management
• Resident service functions

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Leadership and its challenges
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What are these lessons on Leadership for LTC
Medical Directors ?
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• Are leaders made or born ?
• Passion to change
• Mentors
• Education
• Clinical practice
• Today's Leadership traits
• Headhunters
• Family
• Acting
• Sabbatical ?

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Leadership and Management

• Leaders lead and managers manage
• Leadership involves the ability to communicate a
  clear vision and destination and to provide the
  means to reach it
• Lines are blurring between managers and leaders

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Leaders and Leadership

• Leaders can be made with some added natural
  talent or family history
• Quest for knowledge
• Accidentally take on a role
• Opportunities outside of the plan-seized the day

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Leadership Demands

• Life long pursuit
• Learning from mistakes
• Following your interests
• Worthwhile but will be demanding

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Passion

• Need to strongly believe in a vision
• Unsatisfied in the way things are
• Advocate for the system not just your patient
• Alternate Level of Care Issue

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Do not buy into what others say cannot be changed

• Want to make a difference
• Recognize always conflicting interests
• Need to take a risk- gamble

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Mentorship

• Most leaders identified a mentor
• Could be one or many
• Who inspires you ?
• Colleague, boss, or someone in a different
  business
• Opens doors and provides career advice
• See one, do one,
• teach one

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Management Education

• Scientific background provides significant
  advantage
• Additional business education is needed
• Not necessarily a MBA
• Provides credibility
• Need to know the skills to address organizational
  issues

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Clinical Practice

• Provides credibility
• Out of sight means out of touch
• Can be done by restricting or narrowing your
  practice

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Leadership Traits of Medical Directors

• Ability
• Availability
• Affability
• Team Sport

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Availability

• Open door policy
• Approachable
• Not intimidating
• Good times and bad times
• Younger physician access is important

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Affable

• Being pleasant, polite and at ease talking to
  others
• Laughter is good medicine
• Optimistic
• People person
• Good communicator

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Challenge Dogma

• Management of ulcers
• Arthroscopy
• Private care vs all public
• Only doctors or nurses can do that !
• Challenge traditional geriatric practices e.g
  over use of anti-psychotics, Rx of asymptomatic
  bacteriuria, care planning that is uniform and
  inflexible , euthanasia
• Quit complaining and do something about it !

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Team Effort

• Shared Vision
• Put team ahead of your aspirations
• Will not succeed alone
• Others compensate your weaknesses
• Your success is others being recognized

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Family and Colleagues

• Key
• Supportive
• Accommodating
• Keep the family dynamics working
• Balance
• Juggling two careers

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Head Hunters

• Park your ego at the door
• Be prepared for the interview
• Its not a coronation

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Acting Head ?

• Not always a good idea
• Fritz, who expressed enthusiasm for his proposed
  promotion but asked that he not be called
  "interim" CEO. "You can fire me anytime you want,
  but at least give me a better chance to succeed,"

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Sabbatical

• Great idea
• Needs lots of planning
• Part of your contract ??

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Risks

• Ambition is part of ego and narcissism-manage it
• Solitude and isolation

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Disparity between our hopes and reality

• Cant stay on the top of the mountain long
• Old friends maybe ex friends

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• The toes you tread on today maybe in a position
  to kick you tomorrow
• If you burn your bridges you better be a good
  swimmer

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There will be set backs and doors shut

• Moving around can learn more
• Can leave medical practice not the medical
  profession
• Reach out to the broader community

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• by virtue of their power and position, doctors
  are able to block or confound the efforts of
  managers or politicians to impose change via
  top-down mechanisms. However, by engaging doctors
  with change processes, improvements in
  performance may be achieved. Chris Ham

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Engaging PhysiciansWhat Administration must do

• Involve them from the beginning
• Bring them to the table for mutual benefit
• Build trust - deliver
• Respect their time

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Recognize their input

• Communicate
• Value their time with your time
• Promote system and individual responsibility for
  quality and efficiency

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Shared Decision Making

• The challenge is for those who now are making the
  decisions to share the process with physicians in
  the future
• Token sharing will not work

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Medical Directors should expand and participate
more in

• Administration- participate in decision making
  not just be consulted
• Quality Improvement ( access, appropriate,
  safety, satisfaction)- Lead quality monitoring
  and improvement.

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• Medical Staff Management- ensure quality and
  participate in clinical activities ( team member)
  
• Resident Service Functions- Speak for the
  residents on quality issues (integrity)
• Resident Rights Functions- Participate locally
  and nationally in these critical issues e.g end
  of life -ADVOCATE
• Becoming part of a system -Not there yet
• Avoid being lost as the system is challenged
  going forward

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• There are significant opportunities and a need
  for LTC Medical Directors involvement

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Thank You