Dr. Fathieh-Abu Moghli

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Leadership

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

Power differential

What is leadership?

•Influencing people

•Directing/Commanding people

•Guiding people/ Coordinating activities

•Supervising people

Types of LeadersLeader by the position achievedLeader by personality, charisma Leader by moral exampleLeader by power heldIntellectual leaderLeader because of ability to

accomplish things

Managers vs. LeadersManagersFocus on thingsDo things rightPlanOrganizeDirectControlFollows the rules

LeadersFocus on peopleDo the right thingsInspireInfluenceMotivateBuild Shape entities

Common Activities

Planning OrganizingDirecting Controlling

Planning ManagerPlanningBudgetingSets targetsEstablishes

detailed stepsAllocates

resources

LeaderDevises strategy

Sets direction Creates vision

OrganizingManagerCreates

structureJob descriptionsStaffing HierarchyDelegatesTraining

LeaderGets people on

board for strategy

CommunicationNetworks

Directing WorkManagerSolves problemsNegotiates Brings to

consensus

LeaderEmpowers

peopleCheerleader

ControllingManager Implements

control systems Performance

measuresIdentifies

variancesFixes variances

Leader MotivateInspireGives sense of

accomplishment

The Good Old Days . . .• In the mid 1900’s, 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.

Traditional Leadershipin Medicine

• Hierarchical• Tyrannical• Fear

• Abusive• Malignant• Inflexible• Intolerant

“Never argue with the Chief”

Times Have Changed!• In the 1970’s, 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.

Traditional Leadershipin Medicine

• No longer considered a successful approach

• Not tolerated in clinical settings

Teamwork

Medical Leaders• To practice medicine is to serve in the

capacity of leader or team member on multiple teams simultaneously at any given time.

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

Teams in Medicine(Early Career)

Physician – Patient Team

Groups in Medicine(Mid Career)

• Departmental– Section chief– Division head– Vice chair– Clinic director– Lab director

• Hospital– Partnership leader– Medical Staff Committees

• Educational– Student rotation director– Residency director– Fellowship director

• School– Faculty council– Search committees

• Medical Society – committees– Meeting program chairs

• Academy leadership roles

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.

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.

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.

Teamwork• The members of the team may change from

day to day, depending on the medical situation.

• The team’s 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.

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

individual’s education and expertise.– Team members understand each other’s roles.– Mechanism for communication.– Mechanism for monitoring patient outcome.– Strong sense of team identity.

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

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.

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.

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.

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

Interdisciplinary Teams

• In contrast to:– Disciplinary or independent medical

management approach• in which a practitioner works autonomously

with limited input from other practitioners.

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.

Interdisciplinary Teams

• In contrast to:– Consultative approach

• in which one practitioner retains central responsibility and consults with others as needed.

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Leader’s 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.

Types of power• Reward power• Coercive power

• Legitimate power=position power=Authority• Expert power (Area of specialization)

PATRIARCHAL

• Referent power:

association with the powerful

inspiring admiration

Charisma (personal)

• Informational power:• Self power (feminist power)

PATRIARCHAL

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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.

Leadership TraitsIntelligence

More intelligent than non-leaders

Scholarship Knowledge Being able to

get things donePhysical

Doesn’t see 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:

TaskFollowers

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Goals of the first line manager

safe, effective care to pts through employees Physical & emotional

Wellbeing of employees

1 2

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 leaderTask-oriented

) Structural(Relationship-oriented (Consideration)

Authority by The leader

Freedom for subordinates

AuthoritarianDemocratic

Subordinates are toldOf the leader’s decision

Subordinates are allowed To function within limits

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 subordinatesLeadership should shift from one person

to another during project implementation

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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.

Guidelines for adapting leadership style /activities to the situation

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Life-cycle theory Share ideas & facilitate decisionMaking (participating)Hi Rel.- low task

Explain decisions &Clarify (selling)

Hi task-hi rel.

Lo rel. lo taskGive D-M & action responsibility (delegating)

Hi task ,lo rel.Give specific instruction closely supervise (telling)

Task behavior

Relationship behavior

High

Low

HighLow

R 4R 3R 2R 1

AbleWilling

AbleUnwilling

UnableWilling

Unableunwilling

LowModerateHigh

Leadership StylesDelegating

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 & betteroutcomes,

Less resources

Safe,Supportive

environment Am I a representative of Management or

One of the employees ?

1st line manager

employees

management

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I have to be familiar with goals

&problems of both Management&

employees

I am a Communication

link

I need to beAssertive &

Verbally fluent

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REMEMBER

A leader must be a member of the group BUTSuperior to them in some significant

attribute And must occupy a position of high

potential

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

Leadership Skills

• Endless amount of literature, books, courses, seminars, and institutes dedicated to leadership

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

emphasis on leadership

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 Manager’s Training Program• ACS – Leadership Skills to Overcome Obstacles• etc

Learning Successful Leadership Skills

Leadership texts• Good to Great

by Jim Collins• Dealing with Difficult

Peopleby Harvard Press

• Bargaining for Advantage

By G Richard Shell

Learning Successful Leadership Skills

• Reading– Biographiesof great leaders

Learning Successful Leadership Skills

• Observation– Learn from those around you

Learning Successful Leadership Skills

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

Learning Successful Leadership Skills

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

Get Involved and Practice

• Volunteer for leadership positions– School– Hospital– Medical Specialty Societies

• Local• Regional• National

Learning Successful Leadership Skills

• Learning from experience

“A little experience upsets a lot of theory”.

S. Parkes Cadman, Cleric

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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Leadership Activities

• Directing: Pointing the way…………Difficult

• Supervising: Overseeing…………….Easy

• Coordinating: Synthesizing…………Critical

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Leadership Roles

General Directions, Indirect supervision, Coordination through policies,

meeting, or memos

Director

1st line Manager

Explicit, detailed directions, supervise through working with employees, coordinate by frequent rounds, reports & care plans

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DIRECTING Oral or written commands

by a superior that require an employee to act or refrain from action.

Orders come from position power & acceptance of subordinates & are enforced by hospital polices

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Deciding to give orders orally or in writing depends on the realization that:

• some persons rely on visual sources of information.

• some persons rely on aural perception.• some persons rely on both equally.Oral or written orders should be specific for

clear-cut tasks and general for ambiguous tasks

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Orders should be written when:

Employee need for structure is high.Leader’s span of management is broad.Trust between leader and followers is

lacking.Information is very important.

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Guidelines for effective orders • Indicate by name or title the individual to whom the order

is addressed• Specify the date of issue and expected date of compliance• Use simple sentences with an action verb to describe the

activity to be done• Specify the activity in terms of observable behavior• Set clear time limits of task completion• Quantify the work to be accomplished in measurable terms• Provide the standards against which performance will be

evaluated• Include the name and title of the person issuing the order

& the person to contact for clarification

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In sending orders:Make sure the message is: Clear, complete, & concise.Sent to intended receiver.Is depersonalized.Don’t send too many or too few orders.Don’t hesitate to state the obvious.

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SUPERVISION Inspecting the work of

another, evaluating the adequacy of performance, & approving or correcting it.

Intensity of supervision depends on:

• Subordinates need for structure.

• Requirements of the situation.

• Skill of the supervisor.

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What to do and how to supervise:

• Go and look. This is the only reliable feedback.• Make supervision at the bedside in a non-

threatening manner that will not jeopardize professional-patient relationship.

• Spend more time with subordinate at the bed side.• Maintain privacy.• Be tactful.

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What to do… continued…• Spot-check at regular intervals.• Use the Questioning method for data collection.• Vary the method for supervision.• Remember that the subordinate is there to do a job

not to please you.• Make sure that subordinates know exactly what

they should or should not do.• Avoid frequent correction.• Plan for your supervisory activities.

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COORDINATION• Activity consisting of efforts to cause members of

a work group work together harmoniously effective patient care.• Vary the methods to integrate activities, consider

the difficulty and urgency of the task, the size, sophistication of the workforce, and own communication style.

• Be diplomatic and persuasive.• Exchange information frequently with the staff

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Methods of information exchange.

• Memorandum.• Posters.• Position papers.• Meetings.

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.