Management

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Dr. Fathieh-Abu Moghli
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
2
Management
Efficiency:
=
inputs
outputs
Means
Effectiveness: Achieve goals
“ends”
3
The management system
Inputs
Outputs
Process / Throughput
Data
personnel
Data
gathering
planning
Information
Agency
Clients
Employees
resources
Objectives
Systems
Standards
Policies
Procedures
budget
organizing
staffing
leading
controlling
Staff
development
Equipment
supplies
Organizatio Staff needs
n Chart
Recruitment
Job
Selection
evaluation Scheduling
Job
Assigning
description Monitoring
Group work Staff
Power
Q.I
ProblemPerformance
Solving
appraisal
Change
Labor
Conflict
relations
Communication
development
4
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
O
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a
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Management levels / positions:
Top management level
Middle management level
First line management level
Functional
base
First line level
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s
t
r
u
c
t
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e
Line and staff relations
Organization
chart
Line positions:
Staff positions
• Solid: same level
• Dotted: frequently used
• Dashed: Consultation/coordination
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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. 8
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
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
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
Common Activities
•
•
•
•
Planning
Organizing
Directing
Controlling
Planning
Manager
• Planning
• Budgeting
• Sets targets
• Establishes
detailed steps
• Allocates
resources
Leader
• Devises strategy
• Sets direction
• Creates vision
Organizing
Manager
Creates structure
Job descriptions
Staffing
Hierarchy
Delegates
Training
Leader
Gets people on board
for strategy
Communication
Networks
Directing Work
Manager
Solves problems
Negotiates
Brings to consensus
Leader
Empowers
people
Cheerleader
Controlling
Manager
Implements
control systems
 Performance
measures
Identifies
variances
Fixes variances
Leader
 Motivates
Inspires
Gives 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 Leadership
in Medicine
• Hierarchical
• Tyrannical/dictatorial/
cruel
• 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 Leadership
in 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 twoway 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.
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.
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Types of power
P
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C
H
A
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• Reward power
• Coercive power
• Legitimate power=position power=Authority
• Expert power
(Area of specialization)
P
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I
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C
H
A
L
• Referent power:
association with the powerful
inspiring admiration
Charisma (personal)
• Informational power:
• Self power (feminist power)
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
– Doesn’t seem to be
correlated
• Personality
– Verbal facility
– Honesty
– Initiative
– Assertiveness
– Self-confident
– Ambitious
– Originality
– Sociability
– Adaptability
Leadership Styles
The characteristic manner of
performing leadership
activities. Leaders need to
focus on two things to
achieve leadership goals:
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Followers
Task
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Goals of the first line manager
1
safe, effective care to pts
through employees
2
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)
Freedom for
subordinates
Authority by
The leader
Democratic
Authoritarian
Subordinates are allowed
To function within limits
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Subordinates are told
Of the leader’s 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
Relationship
behavior
Share ideas &
facilitate decision
Making (participating)
Hi Rel.- low task
Explain decisions&
Clarify (selling)
Lo rel. lo task
Give D-M & action
responsibility
(delegating)
Hi task ,lo rel.
Give specific
instruction closely
supervise (telling)
Hi task-hi rel.
Low
Task behavior
Low
Moderate
High
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High
Low
R4
R3
R2
R1
Able
Willing
Able
Unwilling
Unable
Willing
Unable
unwilling
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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
Expectations of leadership
More & better
outcomes,
Less resources
1st line manager
Safe,
Supportive
environment
employees
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management
Am I a representative of
Management or
One of the 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 patient’s ‘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 patient’s 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 patient’s 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
Leadership Skills
• 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
People
by Harvard Press
• Bargaining for
Advantage
By G Richard Shell
Learning Successful Leadership
Skills
• Reading
– Biographies
of 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)
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.
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