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 5 *Management: A process of getting work done through others O r g a n i z a t i o n Management levels / positions: Top management level Middle management level First line management level Functional base First line level 6 s t r u c t u r e Line and staff relations Organization chart Line positions: Staff positions • Solid: same level • Dotted: frequently used • Dashed: Consultation/coordination 7 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 9 Interdepartmental relations: Relations that exist between different departments. Intradepartmental relations: Relations that operate within the same department. 10 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 11 Leadership A social relationship in which one person has more ability to influence the behavior of others. Power differential 16 ، آذار22 12 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. 43 Types of power P A T R I A R C H A L • Reward power • Coercive power • Legitimate power=position power=Authority • Expert power (Area of specialization) P A T R I A R 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. 46 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: 16 ، آذار22 Followers Task 48 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 16 ، آذار22 49 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 16 ، آذار22 Subordinates are told Of the leader’s decision Tannenbaum & Schmidt 1973 50 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 16 ، آذار22 51 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. 16 ، آذار22 52 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 16 ، آذار22 High Low R4 R3 R2 R1 Able Willing Able Unwilling Unable Willing Unable unwilling 53 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 16 ، آذار22 management Am I a representative of Management or One of the employees? 55 I am a Communication link I have to be familiar with goals & problems of both Management & employees I need to be Assertive & Verbally fluent 16 ، آذار22 56 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 16 ، آذار22 57 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. 16 ، آذار22 58 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 16 ، آذار22 59 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. 16 ، آذار22 60 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. 16 ، آذار22 61 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. 16 ، آذار22 62 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. 16 ، آذار22 63 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. 16 ، آذار22 64 • 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. 16 ، آذار22 65 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). 16 ، آذار22 66 • 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. 16 ، آذار22 67 Organizational barriers to effective communication • Work constraints including lack of time, pressure of work, and interruptions. 16 ، آذار22 68 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.