LEADERSHIP IN A TIME OF CHANGE

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LEADERSHIP IN A TIME OF CHANGE

• Steven P. Shelov, M.D., M.S.
• Chairman, Department of Pediatrics
• Vice President, Infants and Childrens Hospital
  of Brooklyn
• Maimonides Medical Center
• Professor of Pediatrics, SUNY DOWNSTATE School of
  Medicine

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Academic Educational Milieu - Past

• No defined ambulatory experiences for residency
• No continuity clinics
• No required adolescent, ER, Developmental
  rotations

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Academic Educational Milieu - Past

• Inpatient pediatrics was the dominant and all
  pervasive training ambience
• NICUs and PICUs and some ER experience were the
  defining curricula
• And of course, being on every other night, with
  no salaries was the norm

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Call to Action on Health Care Quality

• 1998 Committee on Quality of Health Care in
  America Institute of Medicine
• 1999 To Err is Human Building a Safer Health
  Care System For America
• 2001 Crossing the Quality Chasm A New Health
  System for the 21st Century

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• All health care organizations, professional
  groups and private and public purchasers should
  adopt as their explicit purpose to continually
  reduce the burden of illness, injury and
  disability, and to improve the health and
  functioning of the people of the United States.

Recommendation Number One Institute of Medicine
Crossing the Quality Chasm
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• List of performance characteristics to achieve
  that purpose - health care should be
• Safe
• Effective
• Patient Centered
• Timely
• Efficient
• Equitable

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Simple Rules for the 21st Century Health Care
System

• CURRENT APPROACH
• Care is based primarily on visits
• Professional autonomy drives variability
• Professionals control care
• Information is a record
• Decision making is based on training and
  experience

• NEW RULE
• Care is based on continuous healing relationships
• Care is customized according to patient needs and
  values
• The patient is the source of control
• Knowledge is shared and information flows freely
• Decision making is evidence-based

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Simple Rules for the 21st Century Health Care
System

• CURRENT APPROACH
• Do no harm is an individual responsibility
• Secrecy is necessary
• The system reacts to needs
• Cost reduction is sought
• Preference is given to professional roles over
  the system

• NEW RULE
• Safety is a system property
• Transparency is necessary
• Needs are anticipated
• Waste is continuously decreased
• Cooperation among clinicians is a priority

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Types of Silences

• Silences of deed - repeated failure of physician
  and hospital leaders to respond with corrective
  action to studies documenting severe and
  preventable quality problems
• Silence of word the absence of thorough
  discussion of the tragic consequences of that
  lack of response

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VIDEO.
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Strategic Planning Process

• Define your goals, departmentally and
  organizationally
• Know your identity
• Understand your strengths and weaknesses
• What is the desired process?
• What are your desired outcomes? What has been
  achieved and what is there yet to do?
• Begin the circle again with new priorities

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It is important to remember that MANAGEMENT IS
NOT LEADERSHIP
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What are the core processes of modern management?
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Core Processes of Modern Management

• Planning and budgeting
• Organizing and staffing
• Controlling and problem solving

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Processes of Leadership

• Establishing a direction
• Aligning a people
• Motivating and inspiring

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Creating An Agenda

• Management
• Planning and budgeting establishing detailed
  steps and timetables for achieving needed results
  and then allocating the resources necessary to
  make that happen

• Leadership
• Establishing direction developing a vision of
  the future, often the distant future, and
  strategies for producing the changes needed to
  achieve that vision

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Developing a human network for achieving the
agenda

• Management
• Organizing and Staffing establishing some
  structure for accomplishing plan requirements,
  staffing that structure with individuals,
  delegating responsibility and authority for
  carrying out the plan, providing policies and
  procedures to help guide people, and creating
  methods or systems to monitor implementation

• Leadership
• Aligning people communicating the direction by
  words and deeds to all those whose cooperation
  may be needed so as to influence the creation of
  teams and coalitions that understand the vision
  and strategies, and accept their validity

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Execution

• Management
• Controlling and problem solving monitoring
  results vs. plan in some detail, identifying
  deviations, and then planning and organizing to
  solve these problems

• Leadership
• Motivating and inspiring - energizing people to
  overcome major political, bureaucratic, and
  resource barriers to change by satisfying very
  basic, but often unfulfilled, human needs

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Outcomes

• Management - Produces a degree of predictability
  and order and has the potential of consistently
  producing key results expected by various
  stakeholders (e.g. for various customers, always
  being on time for stockholders, being on budget)

• Leadership Produces change, often to a dramatic
  degree, and has the potential of producing
  extremely useful change (e.g., new products that
  customers want, new approaches to labor relations
  that help make a firm more competitive.)

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Changes Over Time In Amount Of Leadership
Required to Move Forward

• When situations are stable, and product
  appropriate
• 5-10 Produce regular periodic reports
• 20-30 Staffing appropriate to optimum
• Implementation
• 40-50 production, budget meetings weekly
• 20-30 all other activities

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Changes in Needs, Priorities with Pressures on
Production, Quality and Competition

• 30-50 types of planning, organizing, more
  delegation, less authoritarian
• 50-60 establish new, clear directions,
  communicate direction to all staffers, workers
  and enlist belief by them
• Energizing motivating to overcome bureaucratic,
  political, resource barriers
• 0-10 all other activities

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Relationship of Change and Complexity to the
Amount of Leadership Required
Amount of Change Needed in the Operation
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Creating an Agenda - Management vs. Leadership
Management Planning and budgeting Leadership Establishing direction
The Primary Function Help produce predictable results on important dimensions Plan for those results Help produce changes needed Establish direction for change
A brief description of the activity Develop a written plan a detailed map, of how to achieve the results currently expected Timetables of what must be done when , by whom, and with the costs involved Identify necessary steps, timetables, and costs. Develop direction a vision which describes key aspects of an organization or activity in the future Develop a strategy for achieving that future state doing so by means of an inductive process of gathering a broad range of information Testing and experimenting alternative directions and options Choosing one
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Establishing Direction Establishing Direction
Direction A description of something in the future (a vision),, and a strategy for getting there. A good vision satisfies two tests desirability, and feasibility. Desirability means the needs of the constituencies that support the business or organization are met. Feasibility means there is a sensible strategy for getting there, accounting for strengths and weaknesses
Creating Direction Gathering a broad range of information Challenging conventional wisdom and analytically looking for patterns that answer very basic questions Generating and then testing alternative directions against this understanding . Experimenting with some options. Finally choosing a good one (i.e., one that is both desirable and feasible.) Doing all this in a dynamic way that never really ends (although the process can go through periods of great activity and periods of relative inactivity.
Potential Impact Clear direction helps produce useful change, especially significant or non-incremental change. Pointing out where a group should move showing how it can get there Providing a message that is potentially motivating/uplifting.
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Aligning People Aligning People Aligning People
Management Organization and Staffing Leadership Aligning People
Primary Function Creating an organization that can implement plans, and thus help produce predictable results on important dimensions Getting people lined up behind a vision and set of strategies so as to help produce the change needed to cope with a changing environment
A Brief Description of the Activity A process of organizational design involving judgments about fit what structure best fits the plan what individual best fits each job in the structure what part of the plan fits each person and thus should be delegated to him or her what compensation system best fits the plan and the people involved A major communications challenge Getting people to understand and believe the vision and strategies by communicating a great deal to all of the individuals whose cooperation or compliance may be needed to make that direction a reality Doing so in as clear and credible a way as possible.
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Quality
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Leadership
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Principle Centered Leadership
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Principle 1 Be continually learning
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Principle 2 Be service oriented
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Principle 3 Radiate Positive Energy
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Principle 4 Believe In Other People
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Principle 5 Lead Balanced Lives
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Principle 6 See life as an adventure
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Principle 7 Be synergistic
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Principle 8 Exercise for self renewal
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10 Rules

1. Care based on continuous healing relationships
2. Customization based on patient needs and values
3. The patient as the source of control
4. Shared knowledge and the free flow of information
5. Evidence based decision making

1. Safety as a system property
2. The need for transparency
3. Anticipation of needs
4. Continuous decrease in waste
5. Cooperation among clinicians

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Learning
Balanced Lives
Adventure
APA
Belief in People
Synergy
Service
Positive Energy
Self Renewal
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To laugh often and much To win the respect of
the intelligent people and the affection of
children To earn the appreciation of honest
critics To appreciate beauty, to find the best
in others To leave the world a bit better
whether by a healthy child, a garden patch, or a
redeemed social condition To know even one life
has breathed easier because you have
lived. This is to have succeeded. Ralph
Waldo Emerson
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Thank you!