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Innovation or Stagnation: Growing Our
Health Leaders for Tomorrow – Together
October 3, 2015 RRU Leadership Conference
Moderator: Chris Eagle Panelists: Graham Dickson and Anita Snell
Agenda
Introduction and objectives
Profile results of key studies, projects
Activity on key findings
Health Leadership Action Plan
Activity on how to accelerate change
to grow health leaders for tomorrow
2
3
CHLNet Grows to 40
3
Government – Alberta Health, BC Ministry of Health, Manitoba Health, Ontario Ministry of Health and Long-Term Care, Public Health Agency of Canada, Saskatchewan Health, Yukon Health and Social Services
Regional Health Authorities – Alberta Health Services, Eastern Health, Health PEI, Nova Scotia Health Authority
National Health Organizations – Accreditation Canada, Academy of Canadian Executive Nurses,
Canadian Blood Services, Canadian Agency for Drugs and Technologies in Health, Canadian Society of Physician Executives, Canadian Patient Safety Institute, Canadian College of Health Leaders, Canadian Medical Association, Canadian Nurses Association, Canadian Institute for Health Information, Canadian Pharmacists Association, College of Family Physicians of Canada, Canadian Federation of Nurses Unions, Canadian Foundation for Healthcare Improvement, Emerging Health Leaders, HealthCareCAN, Mental Health Commission of Canada, Royal College of Physicians and Surgeons of Canada, Société Santé en francais, Victorian Order of Nurses
Provincial Organizations - BC Health Leadership Development Collaborative, Centre for Healthcare Innovation (Manitoba),Ontario Association of Community Care Access Centre, Ontario Hospital Association
Universities - Royal Roads University
Patients – Patients Canada
Private sector - Rx&D Canada, MEDEC, BIOTECanada Partners as of Sept. 2015
System Performance
Commonwealth Fund shows still lagging 10 of 11 countries (June 2014)
Only ahead of US
One of most decentralized systems in developed world
Inconsistent provincial, territorial, national health care insurance plans,
policies, legislation, regulation, priorities, funding models and
accountability instruments
4
Country Rankings
AUS CAN FRA GER NETH NZ NOR SWE SWIZ UK US
5
5
The Patient Interest
UK Research shows that good people
leadership and management practices in
hospitals are associated with decreased
patient mortality.
[Source: West et al., 2012]
6
Benchmarking
Study, 2013:
Size of the
gap
CHLNet 2014
7
Benchmarking Results
61% do not have a formal approach to
succession planning
Want to protect time for leadership
development
Low satisfaction with budgets and
programs
Leadership a key foundational enabler of
system performance and health reform
8
“Leadership is the golden thread that runs
through any discussion of NHS reform and
improvement.” (Ham, 2014)
Key Studies:
2. PHSI Grant (Funded by CIHR and Michael
Smith Foundation)
What is the current
state of health
leadership capacity
in Canada?
9
10 Participatory Action Research Projects
Across Canada
10
Quebec & Ontario (2): New Models of
Primary Care Delivery
Atlantic: Employee (EHR)/
Physician Engagement (CH/IWK)
Prairies: Shared
Services in Saskatchewan
BC Integrated
Primary and Community
Care
National Node Project: Access, Quality & Appropriateness
Total = $817,500 • CIHR Grant ($350,000),
• MSFHR Grant ($100,000)
• In-kind contributions
PHSI Results: What is the current state of
health leadership capacity in Canada?
New capacities required for reform – systems thinking,
strategic thinking, and relationship development
Quality physician leadership – at all levels is required
Too much churn and fragmentation
Alignment of thinking and action: challenges
convention notions of autonomy, accountability, and
collaboration
11
Standards: Putting Patients First
Other countries have national
expectations—UK, Australia.
Canada needs a national
framework. Otherwise we are playing leadership in
Alice’s world...
“...our research supports a
national standard for leadership
competencies”
12
Knowledge Mobilization: Creating a Leadership Culture
Canada is laissez-faire.
A national convener is missing and is needed.
NHS Leadership Academy
“In England they have started
this scheme: the thousand top
leaders. They are trying to train
the thousand top leaders that
are the next generation of
leadership for the NHS. Wow.”
13
Knowledge Mobilization: Supporting Change
“Current leadership culture needs a basic
refresh. There is not a great value placed
on health management and
administration in this country.“
“Canada has a healthcare
succession planning model
called ‘I quit!’"
A coordinated leadership succession planning and talent
management developmental strategy is needed.
It should link to Canada’s reform agenda.
14
Recent Work 15
Key Studies:
3. Physician Leadership
What is the current
capacity for
physician leadership
in Canada?
16
Understanding Canadian
Physician Leadership
17
Baseline demographics including range of formal and
informal roles and skill development
Enabling and deterring factors for physicians to take on
leadership roles
Satisfaction/dissatisfaction with current roles
Ways to increase engagement of physicians in leadership
Objectives and Questions
18
Mixed methods:
Phase 1- Survey:
3943 physicians invited – 689 valid responses
CMA & CHI statisticians assistance
Phase 2 - Semi-structured Interviews
15 physician leaders
NVivo 10
Methodology/Analysis
19
Distribution of Physician Leaders: Age, gender, location
20
< 35
35-44
45-54
55-64
>65
Urban/suburban 75%
Small town/rural 25%
31%
Female 47%
Male 53%
4%
27%
33%
5%
Practice Data
21
Respondents’ Type of Practice % Academic Health Center/non-academic teach hosp 36
Private Office/Clinic 22
Community Hospital/Clinic 22
ER 6
Admin/Corp Office 8
Other 4
Compensation for Formal Leadership Roles
8% of respondents in formal leadership roles not paid; 18% received a stipend only (n=559)
Rural physicians worked more unpaid hours in leadership than urban physicians
Medical specialists spent more paid hours on formal leadership and chose it as a long term career choice more than surgical specialists did
Half the respondents had more than one formal leadership role (n =553)
22
Voluntary/Informal Leadership Activities
On average physician leaders spent from 38 to 81 hours per month on voluntary activities (n=608)
41% received no support
28% education, office and/or admin support
17% received recognition only
14% other
23
What Encouraged You To Take On Physician Leadership Role(s)?
Drawn to leadership from early age
Desire to make a difference
Being mentored
Being asked (by senior leadership)
Learning/courses offered by organization
Satisfying Factors as a Physician Leader
Broad sphere of influence & decision-making
Making a difference – capacity to create change
Skill acquisition to influence people positively
Enabling others; working as team and building
relationships
Understanding how things work
Solving problems effectively
24
What Discouraged You From Taking On Physician Leadership Role(s)?
Negative attitudes
toward medical leaders
throughout entire
medical system
From med school to
practicing colleagues
Lack of preparation
Financial losses
Guilt of lost clinical time
Dissatisfying Factors as a Physician Leader
Managing other physicians (herding cats)
Being ineffective in effecting change
Dealing with bureaucracy
Complex work life
Busy schedule – long hours (without recognition)
20 additional hours/week
Work life balance/integration is a struggle
Financial losses not major cause of dissatisfaction
25
Supportive Organizational Practices
26
Leadership Development
Strategy for organizations to endorse
Partial support or paid for by organization
Talent management – succession plan – onboarding
Invitation to lead by leaders – mentorship
Compensation for time and education
Recognition (for QI accomplishments)
Innovation: Engage physicians in implementing innovative health care improvement (QI)
Conclusion
27
Wealth of information gained
Physician leaders are passionate and dedicated – will tolerate poor to
no compensation and work countless hours with little recognition
AND
Will be satisfied if efforts result in a better-functioning health care system
(i.e. improved patient outcomes)
Health care organizations have a ready pool of physician leader
candidates – now must enable them
Activity: Discuss and report out
Tables 1 and 2: Based on your
experience, what could/should be done
to in order to grow greater physician
leadership capacity in Canada?
Tables 3 and 4: What are our current
notions of autonomy, accountability,
and collaboration in health care? What
“new models” might facilitate our ability
to achieve meaningful change?
28
CHLNet: Health
Leadership
Action Plan
Created by a working
group with extensive
consultation with
network partners
29
30 CHLNet Vision: Better Leadership,
Better Health – Together
30
Government – Alberta Health, BC Ministry of Health, Manitoba Health, Ontario Ministry of Health and Long-Term Care, Public Health Agency of Canada, Saskatchewan Health, Yukon Health and Social Services
Regional Health Authorities – Alberta Health Services, Eastern Health, Health PEI, Nova Scotia Health Authority
National Health Organizations – Accreditation Canada, Academy of Canadian Executive Nurses,
Canadian Blood Services, Canadian Agency for Drugs and Technologies in Health, Canadian Society of Physician Executives, Canadian Patient Safety Institute, Canadian College of Health Leaders, Canadian Medical Association, Canadian Nurses Association, Canadian Institute for Health Information, Canadian Pharmacists Association, College of Family Physicians of Canada, Canadian Federation of Nurses Unions, Canadian Foundation for Healthcare Improvement, Emerging Health Leaders, HealthCareCAN, Mental Health Commission of Canada, Royal College of Physicians and Surgeons of Canada, Société Santé en francais, Victorian Order of Nurses
Provincial Organizations - BC Health Leadership Development Collaborative, Centre for Healthcare Innovation (Manitoba),Ontario Association of Community Care Access Centre, Ontario Hospital Association
Universities - Royal Roads University
Patients – Patients Canada
Private sector - Rx&D Canada, MEDEC, BIOTECanada Partners as of Sept. 2015
Canadian
Health
Leadership
Action Plan
Key Elements
31
Collective vision…
What is our vision and desired outcomes in terms of closing the leadership capacity gap?
100,000 managers with basic skill set?
Patient/community leadership growth?
32
Common leadership platform…
33
Common
language
LEADS, or LEADS
compatible
capabilities
framework
Evidence on Innovations and Leading
Practices
34
Research and Evaluation subcommittee
Knowledge Mobilization subcommittee
CHLNet Top Ten
Webinars
Other?
“Implementation and operation of an
integrated health system requires leadership
with vision as a well as an organizational
culture that is congruent with the vision.”
Enhance Capacity and Capabilities
35
LEADS Collaborative
Support for LEADS Business Unit
LEADS Exchange Days
Community of Practice
Link to university programs?
Certification?
Measurement and Evaluation
36
ROI project with UK and
Australia.
Contribution of LEADS to
institutional change.
Canada’s ranking in 10
years: successful health care
transformation—what will
that look like, in measurable
terms, in 10 years?
Activity: Discuss and Report Out
Do you support the notion of a “national action plan”?
If we buy in to the notion of growing our health leaders for
tomorrow – together, what advice would you give re:
What a collective vision and desired results might be (Table 1)
How to take advantage of a common leadership language (Table
2)
Whether or not it is valuable to pursue some form of professional
certification for leaders/managers in health care (Table 3)
How organizations might collaborate to grow leadership capacity
for 100,000 health managers and/or patients/community (Table 4)
37
Thank you
Dr. Chris Eagle
Anita Snell (PhD)
Graham Dickson (PhD)
38
