Dr. Fathieh-Abu Moghli

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Management and Leadership For medical staff

• Dr. Fathieh-Abu Moghli

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• Management -
• A process of working through other staff
  members to provide care, cure, comfort to
  patients and their families in the most effective
  and efficient manner.
• Planning, Organizing
• Directing, Controlling
• Available Financial, Material,
• And Human Resources
• Quality Service to Clients
• Individual, Family, Community

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Management

• Efficiency
• Effectiveness Achieve goals
• ends

outputs

inputs
Means
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The management system
Inputs
Outputs
Patient care
Process / Throughput
Data
controlling leading staffing organizing planning Data gathering
Staff development
personnel
Equipment
Research
Information Agency Clients Employees resources
Objectives Systems Standards Policies Procedures b
udget
Organization Chart Job evaluation Job
description Group work
Power Problem- Solving Change Conflict Communicati
on
Staff needs Recruitment Selection Scheduling Assig
ning Monitoring Staff development
Q.I Performance appraisal Labor relations
supplies
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Data gathering
planning
organizing
staffing
leading
controlling
The Management Process Interrelated system
components
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Management - A process of getting work
done through others

Organization structure

• Management levels / positions
• 
  
• 
  

Middle management level First line
management level First line level
Top management level
Functional base
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Line and staff relations

• Line positions
• Staff positions
• Solid same level
• Dotted frequently used
• Dashed Consultation/coordination

Organization chart
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Delegation- The process by which one person
assigns duties to be performed by another and
grants him the authority to accomplish
them. Authority- The right to act or
command the actions of others. It is delegated
downwards. Responsibility The obligation
involved when a person accepts an assignment. It
can not be delegated. Accountability A
state of being liable to the delegator for the
quality and quantity of an assigned action. It
moves upwards.

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• Centralization
• Decision-making done at top level
• Decentralization
• Some major decision-making is delegated to
  persons in lower position levels
• Unity of command
• Having one source for authority (orders).
• Dual subordination
• Having more than one superior

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• Interdepartmental relations
• Relations that exist between different
  departments.
• Intradepartmental relations
• Relations that operate within the same
  department.

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Leadership

• A social relationship in which one party
  influences the behaviors of others. It involves
  power differential
• Components
• The leader, the led, the situation and a goal

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Leadership

• A social relationship in which one person has
  more ability to influence the behavior of others.
• Power differential

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What is leadership?

• Influencing people

• Directing/Commanding people

• Supervising people

• Guiding people/ Coordinating activities

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Types of Leaders

• Leader by the position achieved
• Leader by personality, charisma
• Leader by moral example
• Leader by power held
• Intellectual leader
• Leader because of ability to accomplish things

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Managers vs. Leaders

• Managers
• Focus on things
• Do things right
• Plan
• Organize
• Direct
• Control
• Follows the rules

• Leaders
• Focus on people
• Do the right things
• Inspire
• Influence
• Motivate
• Build
• Shape entities

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Common Activities

• Planning
• Organizing
• Directing
• Controlling

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Planning

• Leader
• Devises strategy
• Sets direction
• Creates vision

• Manager
• Planning
• Budgeting
• Sets targets
• Establishes detailed steps
• Allocates resources

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Organizing

• Leader
• Gets people on board for strategy
• Communication
• Networks

• Manager
• Creates structure
• Job descriptions
• Staffing
• Hierarchy
• Delegates
• Training

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Directing Work

• Leader
• Empowers people
• Cheerleader

• Manager
• Solves problems
• Negotiates
• Brings to consensus

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Controlling

• Leader
• Motivates
• Inspires
• Gives sense of accomplishment

• Manager
• Implements control systems
• Performance measures
• Identifies variances
• Fixes variances

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The Good Old Days . . .

• In the mid 1900s, what was medicine like?
• Physician controlled medical care.
• Physician prescribed other modalities and told
  other professionals exactly what to do and how to
  do it.
• Physician was autonomous and received little
  input from other health professions.

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Traditional Leadershipin Medicine

• Hierarchical
• Tyrannical/dictatorial/ cruel
• Fear

• Abusive
• Malignant
• Inflexible
• Intolerant

Never argue with the Chief
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Times Have Changed!

• In the 1970s, health care began its reform and
  physicians began to depend on other health
  professionals to assist with patient care
  functions.
• Managing the care of individuals and populations
  often requires participation in team-based
  efforts.
• Other health professionals have learned how to
  maximize their opportunities, and to affect the
  direction of health care reform.
• Other health professions are now respected
  patient care providers with much to contribute to
  the health care system.

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Traditional Leadershipin Medicine

• No longer considered a successful approach
• Not tolerated in clinical settings

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Teamwork
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Medical Leaders

• To practice medicine is to serve in the capacity
  of leader or team member on multiple teams
  simultaneously at any given time.

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Teams in Medicine(Early Career)

• Physician teams
• Fellows
• Senior residents
• Junior residents
• Students
• Clinic teams
• Physicians
• Front desk staff
• Nursing staff
• Ancillary staff

• Hospital Teams
• Physicians
• Nursing staff
• Ward staff
• Ancillary providers
• Operating Room Teams
• Surgeons
• Anesthesia
• Nursing
• Scrub Techs
• OR desk staff

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Teams in Medicine(Early Career)
Physician Patient Team
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Groups in Medicine(Mid Career)

• Educational
• Student rotation director
• Residency director
• Fellowship director
• School
• Faculty council
• Search committees
• Medical Society
• committees
• Meeting program chairs
• Academy leadership roles

• Departmental
• Section chief
• Division head
• Vice chair
• Clinic director
• Lab director
• Hospital
• Partnership leader
• Medical Staff Committees

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The New Paradigm

• Teams and teamwork represent the basis of a new
  paradigm in health care.
• Shifts in
• Where employees work
• What functions they perform
• In which disciplines they work
• How they interact with each other
• Increasing numbers of workers are now expected to
  cross-train and function as effective team
  members.

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Teamwork

• Quality health care depends on every health care
  worker doing his/her part.
• Professionals with different backgrounds,
  different education, different ideas, different
  responsibilities, and different interests all
  work together to provide appropriate quality
  care.
• Well coordinated teamwork across the health
  professions can provide effective and
  cost-effective patient care.

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Teamwork

• In almost any health care career, you will be a
  part of an interdisciplinary health care team
  (practitioners from different professions who
  share a common patient population and common
  patient care goals with responsibility for
  complementary tasks).
• The team concept was created to provide quality
  holistic health care to every patient.
• It is essential that you learn to become a team
  player and learn to work well with others.

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Teamwork

• The members of the team may change from day to
  day, depending on the medical situation.
• The teams goal stays the same - - to provide
  quality health care for patients that will
• Help patients get well and/or stay well.
• Contribute to diagnosing diseases or conditions.
• Make patients more comfortable or otherwise
  improve the quality of their lives.

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Teamwork Model

• Components
• Common group of patients.
• Common goals for patient outcome and shared
  commitment to meeting these goals.
• Member functions are appropriate to an
  individuals education and expertise.
• Team members understand each others roles.
• Mechanism for communication.
• Mechanism for monitoring patient outcome.
• Strong sense of team identity.

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Teamwork Model

• Values/Behaviors
• Trust among all parties
• Knowledge and trust remove the need for
  supervision
• Joint decision making
• Mutual respect for the expertise of all members
  of the team this respect is communicated to the
  patient

• Communication that is not hierarchic but rather
  two-way facilitating sharing of information
  knowledge
• Cooperation coordination promote the use of the
  skills of all team members, prevent duplication,
  and enhance the productivity
• Optimism that this is the most effective method
  of delivery of quality of care

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Advantages of Teamwork

• For Patients
• Improves care by increasing coordination of
  services, especially for complex problems.
• Empowers patients as active partners in care.
• Can serve patients of diverse cultural
  backgrounds.
• Uses time more efficiently.

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Advantages of Teamwork

• For Health Care Professionals
• Increases professional satisfaction.
• Enables the practitioner to learn new skills and
  approaches.
• Encourages innovation.
• Allows provider to focus on individual
• areas of expertise.

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Advantages of Teamwork

• For the Health Care Delivery System
• Holds potential for more efficient delivery of
  care.
• Maximizes resources and facilities.
• Decreases burden on acute care facilities
• as a result of increased preventive care.

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Example

• Surgical Team
• Admitting clerk (admission information)
• Insurance representative (approval for surgery)
• Nurses or patient care technicians (prep pt)
• Surgeons, one or more
• Anesthesiologist
• Operating room nurses
• Surgical technicians

• Housekeepers (clean and sanitize OR after
  procedure)
• Sterile supply techs (clean instruments)
• Recovery room personnel
• Dietitian
• Social worker
• Physical therapist
• Occupational therapist
• Home health personnel

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Interdisciplinary Teams

• In contrast to
• Disciplinary or independent medical management
  approach
• in which a practitioner works autonomously with
  limited input from other practitioners.

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Interdisciplinary Teams

• In contrast to
• Multidisciplinary approach
• which involves various health care professionals
  working independently - - not collaboratively - -
  with each responsible for a different patient
  need.

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Interdisciplinary Teams

• In contrast to
• Consultative approach
• in which one practitioner retains central
  responsibility and consults with others as
  needed.

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Leaders Power and Influence

• Influence is important to the leadership process
  because it is the means by which leaders
  successfully persuade others to follow their
  advice, suggestion or order. The essence of
  leadership is the ability to influence others. To
  have influence, however, one also must have power.

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Types of power

• Reward power
• Coercive power
• Legitimate powerposition powerAuthority
• Expert power
• (Area of specialization)

PATRIARCHAL
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PATRIARCHAL

• Referent power
• association
  with the powerful
• inspiring
  admiration
• Charisma
  (personal)
• Informational power
• Self power (feminist power)
• 
  

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• Most effective leaders rely on several different
  forms of power e.g. giving orders (legitimate),
  praising (reward), disciplining (coercive).
• Power must be used wisely to influence people
  e.g. abuse of coercive power may lead to
  weakening or loss of referent power.
• Effective leaders understand the costs, risks,
  and benefits of using each kind of power and are
  able to recognize which to draw on in different
  situations and with different people.

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Leadership Traits

• Intelligence
• More intelligent than non-leaders
• Scholarship
• Knowledge
• Being able to get things done
• Physical
• Doesnt seem to be correlated

• Personality
• Verbal facility
• Honesty
• Initiative
• Assertiveness
• Self-confident
• Ambitious
• Originality
• Sociability
• Adaptability

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Leadership Styles

• The characteristic manner of performing
  leadership activities. Leaders need to focus on
  two things to achieve leadership goals

Task
Followers
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Goals of the first line manager
1
2
safe, effective care to pts through employees
Physical emotional Wellbeing of employees
I need Professional knowledge,
knowledge of law, economics, labor relations
leadership skills Making decisions guide
others to make decisions Make minor changes
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• Subordinates are
• invited to question
• ideas from the leader

Task-oriented (Structural)
Relationship-oriented (Consideration)
Authority by The leader
Freedom for subordinates
Democratic
Authoritarian
Subordinates are allowed To function within
limits
Subordinates are told Of the leaders decision
Tannenbaum Schmidt 1973
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Contingency or situation theory of leadership

• The organization culture, work situation work
  group are in constant interaction.
• The effective leader is one whose personality and
  style satisfy employees need for structure and
  consideration.
• The leader ( subordinates) is controlled by the
  situation, he/she is
• Subservient to the task.
• At mercy of subordinates
• Leadership should shift from one person to
  another during project implementation

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Guidelines for adapting leadership style
/activities to the situation

• The leader must
• Be an accepted member of the work group.
• Be superior to other members in some significant
  attribute.
• Occupy a powerful position in the group force
  field.
• He
  She
• Demonstrate professional, communication,
  management political skills
• Represent a subject area or functional emphasis
  that confers power and prestige on practitioners.

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Life-cycle theory
High
Explain decisions Clarify (selling) Hi task-hi rel. Share ideas facilitate decision Making (participating) Hi Rel.- low task
Hi task ,lo rel. Give specific instruction closely supervise (telling) Lo rel. lo task Give D-M action responsibility (delegating)
Relationship behavior
Low
Task behavior
High
Low
Moderate
Low
High
R 1 R 2 R 3 R 4
Unable unwilling Unable Willing Able Unwilling Able Willing
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Leadership Styles

• Delegating
• Low relationship/ low task
• Responsibility
• Willing employees
• Participating
• High relationship/ low task
• Facilitate decisions
• Able but unwilling

• Selling
• High task/high relationship
• Explain decisions
• Willing but unable
• Telling
• High Task/Low relationship
• Provide instruction
• Closely supervise

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Expectations of leadership
More better outcomes, Less resources
1st line manager
management
Safe, Supportive environment
Am I a representative of
Management or One of the
employees?
employees
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I am a Communication link
I have to be familiar with goals problems of
both Management employees
I need to be Assertive Verbally fluent
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REMEMBER

• A leader must be a member of the group
• BUT
• Superior to them in some significant attribute
• And must occupy a position of high potential

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Communication skills for doctors

• Good communication skills are integral to medical
  and other healthcare practice.
• Communication is important not only to
  professional-patient interaction but also
• within the healthcare team.

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Principles of effective communication

• ensures interaction rather than direct
  transmission
• requires planning and thinking in terms of
  outcomes
• demonstrates dynamism what is appropriate for
  one situation is inappropriate for another.
  Achieving this dynamism requires flexibility,
  responsiveness and involvement
• follows the helical model (what one person says
  influences what the other says in a spiral
  fashion so that communication gradually evolves
  through interaction).
• From BMA

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Factors increasing the need for strong
communication skills in medicine

• improving the patients journey, which
  requires advanced leadership, team working and
  communication skills
• cultural and organizational change
• the growing need for long-term management of
  chronic disease this is believed to require a
  shift in doctor-patient interaction and
  healthcare team working to a partnership model
• complaint handling and increasing litigation.

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The benefits of good communication skills

• Benefits for patients
• The doctor-patient relationship is improved.
  The doctor is better able to seek the relevant
  information and recognise the problems of the
  patient by way of interaction and attentive
  listening. As a result, the patients problems
  may be identified more accurately.
• Good communication helps the patient to recall
  information and comply with treatment
  instructions thereby improving patient
  satisfaction.

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Benefits for patients- continued
Good communication may improve patient health
and outcomes. Better communication and dialogue
by means of reiteration and repetition between
doctor and patient has a beneficial effect in
terms of promoting better emotional health,
resolution of symptoms and pain control. The
overall quality of care may be improved by
ensuring that patients views and wishes are
taken into account as a mutual process in
decision making. Good communication is likely
to reduce the incidence of clinical error.
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Benefits for doctors

• Effective communication skills may relieve
  doctors of some of the pressures of dealing with
  the difficult situations encountered in this
  emotionally demanding profession. Problematic
  communication with patients is thought to
  contribute to emotional burn-out and low personal
  accomplishment in doctors as well as high
  psychological morbidity.
• Being able to communicate competently may also
  enhance job satisfaction.
• Patients are less likely to complain if doctors
  communicate well. There is, therefore, a reduced
  likelihood of doctors being sued.

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Communication within the healthcare team

• Good communication within the healthcare team is
  essential in order to ensure continuity of care
  and effective treatment for patients.
• Good communication can deepen professionals
• understanding of others work or how their
  role fits in with the rest of the healthcare team
• Communication with managers and other
  professionals, such as social workers, is equally
  relevant. Communication difficulties between
  doctors and with their managers is a leading
  cause of disciplinary problems.

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• Good communication skills are essential to ensure
  the effective transmission of knowledge and to
  medical students and
• doctors in training.
• The communication skills are needed to publish
  research, educate, lead or inspire others
• written and presentation skills in addition to
  the one-to-one oral communication are required in
  patient consultations.

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Barriers to effective communication

• Personal barriers
• lack of skill to use language that is tailored to
  the patient, giving structured explanations and
  listening to patients views to encouraging
  two-way communication
• inadequate knowledge of, or training in, other
  communication skills including body language and
  speed of speech.
• doctors undervaluing the importance of
  communicating (not appreciating the importance of
  keeping patients adequately informed).

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• negative attitudes of doctors towards
  communication. For example, giving it a low
  priority due to a concern primarily to treat
  illness rather than focusing on the patients
  holistic needs
• a lack of inclination to communicate with
  patients. This can be due to lack of time,
  uncomfortable topics and lack of confidence.
• lack of knowledge about the illness/condition or
  treatment.
• Doctors need to be honest about the
  limitations of their knowledge.
• human failings, such as tiredness and stress.
• language barriers.

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Organizational barriers to effective communication

• Work constraints including lack of time, pressure
  of work, and interruptions.

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Developing Leadership Skills

• All physicians function as a leader on a daily
  basis
• Most physicians have some baseline skills
• Some are naturally better at it than others
• Leadership skills can learned, developed and
  honed
• Endless amount of literature, books, courses,
  seminars, and institutes dedicated to leadership

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Leadership Skills

• Inadequate time to study leadership skills
• Medical curricula do not include an emphasis on
  leadership

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Learning Successful Leadership Skills

• Formal training
• Leadership series
• University/School courses
• Seminars
• Edwards Campus
• Non-medical
• Formal Leadership Courses
• Harvard Course Leadership Development for
  Physicians in Academic Health Centers
• AAMC New Managers Training Program
• ACS Leadership Skills to Overcome Obstacles
• etc

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Learning Successful Leadership Skills

• Leadership texts
• Good to Great
• by Jim Collins
• Dealing with Difficult People
• by Harvard Press
• Bargaining for Advantage
• By G Richard Shell

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Learning Successful Leadership Skills

• Reading
• Biographies
• of great leaders

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Learning Successful Leadership Skills

• Observation
• Learn from those around you

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Learning Successful Leadership Skills

• Endless supply of role models in medicine (good
  and bad)

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Learning Successful Leadership Skills

• Can learn as much from a poor leader as from a
  good one

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Get Involved and Practice

• Volunteer for leadership positions
• School
• Hospital
• Medical Specialty Societies
• Local
• Regional
• National

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Learning Successful Leadership Skills

• Learning from experience

A little experience upsets a lot of
theory. S. Parkes Cadman, Cleric
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Learning Successful Leadership Skills

• Find a mentor
• Someone you respect
• Someone you can approach repeatedly and in a
  crisis
• Ask if they will consent to being your mentor
• Recognize your mentors efforts
• Expect to do the same for others (be a mentor)

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Conclusion

• You must become a leader to practice medicine
  successfully.
• Mid Career requires more complex and
  sophisticated leadership skills
• Make leadership development a part of your daily
  routine.
• Learn from those around you.
• Seek out opportunities for skill development
• Practice at every opportunity.