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JamiuBusari(MD,MHPE,PhD)Associate Professor,Medical EducationDept.Chair&ProgramDirectorofPediatrics31stOctober,2016@jobusar
TheEvidenceforclinicalLeadership:Why,what,how
AgentsforChange,2016,Liverpool
DIS
CLO
SUR
E ST
ATEM
ENT
Noconflictsofinterest
Academic:Educationaldevelopment&research
MaastrichtUniversity,Maastricht,Netherlands
ClinicalWork:DepartmentofPediatrics
Zuyderland MedicalCenter,Heerlen,Netherlands
Theleadershipdilemmainhealthcare
Understandingtheproblem
Mentalmodelsinhealthcare
HealthCareOrganization:regularmentalmodel….
Butinreality,theorganizationofcarelookslikethis..
Leadership
Aprocessofsocialinfluencethatmaximizestheeffortsofothers,towardstheachievementofagoal
Kevin Kruse Forbes.com What is Leadership April 9, 2013
Whatwereadintheliterature….
Theimportanceofclinicalleadership
• “…….theemphasisuponcompetency-basedleaderdevelopmenthasdonelittletofostereffectiveclinicalleadership…,despiteitspotentialusefulness,andinformativeandsummativeevaluationofleaderdevelopment.
• Althoughconsiderablediscussionhasoccurredontheneedforclinicalleadership,andlargescalepubicinquiriesevidencetheconsiderablepatientharmthathasoccurredintheabsenceofsuchleadership,therecontinuestobeamajordisconnectbetweencliniciansandmanagers,andclinicalandbureaucraticimperatives
• Thedebateoverwhoisbestpositionedtoleadservicedeliveryandtheplaceofcliniciansingovernancecontinues”
Daly et al. J Healthc Leadersh. 2014(6). 75-83
• “…….theemphasisuponcompetency-basedleaderdevelopmenthasdonelittletofostereffectiveclinicalleadership….
• ,therecontinuestobeamajordisconnectbetweencliniciansandmanagers,andclinicalandbureaucraticimperatives
• Thedebateoverwhoisbestpositionedtoleadservicedeliveryandtheplaceofcliniciansingovernancecontinues”
Daly et al. J Healthc Leadersh. 2014(6). 75-83
Theimportanceofclinicalleadership
The evidence
Thefactorsdefiningtheneedforleadership
Needsassessment
Curricularreform
The evidence 1 - Why
QualityinHealthcare–buildingwiththeendinmind
IHITripleAim
Theevidence2- Why
Valuebasedhealthcaredelivery(M.Porter,HBS,2006)
1. Howefficientapatientfeelshis/herailmenthasbeenhandled
2. Howtheprovidersofcareperceivethattheprocessworksforthem;
3. Howtheprovisionoftrainingandresearchcontributestoinnovationandimprovementofservicesprovidedin1.aboveanddoesnothinder2.
4. Howeffectivethehospitaladministrationmanagescostsandgeneratesrevenuewhileachievingandsustainingpoints1.to3.
The evidence 3 - Why
The evidence 4- Why
The evidence - Why
Characteristics
Country Netherlands Denmark Australia Canada
Response rate 177/506(35%)
719/2105 (34%)
194/1213 (16%)
177/500 (35%)
Gender MaleFemale
33%67%
36%64%
43%57%
50%50%
Age (SD) 30.3 (3.0) 34.2 (4.3) 27.2 (3.8) 29.2 (3.9)Top 3 specialty Pediatrics
Ob&gynInternal
GeneralInternal
Psychiatry
EmergencySurgeryGeneral
GeneralInternalSurgery
Years since graduation (SD)
4.9 (2.8) 6.0 (4.2) 2.5 (2.5) 3.2 (2.7)
Previous Training YesNo
15%85%
87%13%
15%85%
14%86%
Previous experience YesNo
58%42%
38%62%
44%56%
56%44%
Perceivedcompetencies
Netherlands Denmark Australia Canada
Average 3.39 (0.37) 3.54 (0.40) 3.45 (0.42) 3.35 (0.51)
Highest perceivedHandling received feedback 3.92 (0.55) 3.88 (0.65) 3.98 (0.61)
Managing a ward 3.88 (0.64) 3.92 (0.55) 3.93 (0.72)
Using information technology 3.94 (0.87) 4.11 (0.69) 4.23 (0.64) 4.01 (0.83)
Advocating for patients 4.03 (0.60) 3.95 (0.81)
Lowestperceivedcompetencies
Netherlands Denmark Australia Canada
Organisation healthcare system 2.86 (0.97)
Organisation specialist department 2.11 (0.77) 2.59 (0.92) 2.66 (0.97)
Requirements as specialist 2.53 (0.81)
Improving quality processes 3.25 (0.94)
Negotiating personal ambitions 3.10 (0.98) 2.58 (1.00)
Negotiate working conditions 2.45 (0.87) 2.51 (0.97) 2.75 (0.93) 2.23 (0.91)
Multipleregression
Gender Management experience
Graduation Management course
B p B p B p B p
Netherlands .172 .003
Denmark -.108 .001 .181 .000 .082 .001
Australia .178 .007
Canada .292 .000 .201 .037
Needsassessment
Country Netherlands Denmark Australia Canada
Needs training YesNo
85%15%
85%15%
77%23%
84%16%
Preferred topics Leadership skillsNegotiation skillsCost-effectivenessCareer planningFinancial planningSpecialist departmentHealthcare system
*
**
***
****
*
**
Method Case basedWorkshop +
++ +
Timing Medical schoolResidencyAs a specialist
25%95%19%
32%87%54%
51%76%24%
30%85%18%
Needsassessment
Country Netherlands Denmark Australia Canada
Needs training YesNo
85%15%
85%15%
77%23%
84%16%
Preferred topics Leadership skillsNegotiation skillsCost-effectivenessCareer planningFinancial planningSpecialist departmentHealthcare system
*
**
***
****
*
**
Method Case basedWorkshop +
++ +
Timing Medical schoolResidencyAs a specialist
25%95%19%
32%87%54%
51%76%24%
30%85%18%
Needsassessment
Country Netherlands Denmark Australia Canada
Needs training YesNo
85%15%
85%15%
77%23%
84%16%
Preferred topics Leadership skillsNegotiation skillsCost-effectivenessCareer planningFinancial planningSpecialist departmentHealthcare system
*
**
***
****
*
**
Method Case basedWorkshop +
++ +
Timing Medical schoolResidencyAs a specialist
25%95%19%
32%87%54%
51%76%24%
30%85%18%
Needsassessment
Country Netherlands Denmark Australia Canada
Needs training YesNo
85%15%
85%15%
77%23%
84%16%
Preferred topics Leadership skillsNegotiation skillsCost-effectivenessCareer planningFinancial planningSpecialist departmentHealthcare system
*
**
***
****
*
**
Method Case basedWorkshop +
++ +
Timing Medical schoolResidencyAs a specialist
25%95%19%
32%87%54%
51%76%24%
30%85%18%
Discussion• Previousmanagementexperienceseemedimportant
• Mandatorymanagementcoursesimprovedperceivedcompetency
• Unclearwhetherlengthofimplementationinfluencesperceivedcompetency- Yearssincegraduation
• Clearneedformanagementtraining- Specificpreferences
Limitations• Responserate
• Differencesinhealthsystems
• Subjectivemeasurements
The evidence for why - Summary
Thefactorsdefiningtheneedforleadership
IncreasedHCcosts
Sociopoliticalchangesinhealthcare
Needsassessment
Increaseddemands/changingexpectations
Curricularchanges
Theevidence1- What
Theevidence2- What
Theevidence3- What
Summary• Thereisevidencethatthereisaunwaveringneedfortrainingand
developmentinalldomainsofmedicalleadership(Brouns etal,.2011,Berkenbosch etal.,2011)
• Physicianleadersneedtotakeresponsibilityandbeaccountableforprovidingandmanaginghealthcaredelivery(Busarietal.,2011)
• Thereisaneedformoreparticipationofphysiciansinleadinghealthcareorganizations(Goodall,2011)
• Weshouldremainwaryofgettingcaughtintheillusionthatformalleadershipandmanagementtrainingisenoughforhealthcaretransformation(Busari,2012)
Finalthoughts…
Weshouldbeclearaboutwhatwemean…
Leaderslightupthepathforotherstofollow
They(always)leapfirst
Theyleadbyexample
Theyareresponsivetotheirteams