Perspectives on Hospital Leadership

Transcription

1 Perspectives on Hospital Leadership 62 nd Annual Ontario Anesthesia Meeting Dr. Bert Lauwers Chair, Provincial Physician Leadership Council Ontario Hospital Association 1

2 Physician Leadership A prophet is not without honour except in his own town, amongst his relatives and in his own home. Mark 6:4 2

3 Agenda A personal journey Why physicians should lead in health care Impediments to physician hospital leadership How to engage physicians The Canadian Society for Physician Leader s White Paper, Accepting Our Responsibility. Business basics that will get you there 3

4 1. A Journey 4

5 1. A Journey 5

6 1. A Journey July 1989 February 2002 The dark side Program Management Chief of Staff The glass ceiling Full time physician leadership Education Back to Health Care Why become a physician leader? I wanted to be more than an arm-chair voyeur.. 6

7 2. Why Physicians Should Lead It is easier to teach a physician about the business of health care, than it is to teach a non-physician about the practice of medicine. 7

8 2. Why Physicians Should Lead Dr. Amanda Goodall Cass Business School, London The change towards physician leadership is being driven by research showing that leaders who are experts in the core business, such as doctors, are associated with improved organizational performance. 8

9 2. Why Physicians Should Lead The Theory of Expert Leadership (TEL) supports physician leadership. A leader should have deep knowledge of the core business of the organization that he or she is to lead. The top 100 hospitals in the USA were statistically more likely to be led by physicians than nonmedically trained managers. For hospitals ranked in 2009, leadership by a physician CEO (vs a non-physician manager) was strongly associated with top quartile performance; quality scores were approximately 25% higher. Goodall A, Stoller JK. BMJ Leader 2017;0:1 4. doi: /leader

10 2. Why Physicians Should Lead Professor Goodall s Conclusions Challenges in healthcare (e.g., cost, access, quality) demand great leadership. Physician leadership has been associated with top quality ranking hospitals. Yet, physicians are not usually trained in leadership competencies and traditional selection and training cultivates individualism. Leadership development programs are signature features of successful organizations and are being embraced by frontrunner healthcare organizations. 10

11 2. Why Physicians Should Lead Health care is the most complex industry in society Everybody wants change, but nobody wants to change Health care is a volatile, uncertain, complex and ambiguous world Dr. Graham Dickson, Leadership inaction or Leadership in Action The Change Dilemma 11

12 2. Why Physicians Should Lead in Health We rely on government to lead transformation which is constant and endless Nurses and physicians are amongst the most trusted professions have they been involved in shaping transformation? We cut administration when budgets are tight and demands for change increase Strongest correlate to compassion fatigue in frontline staff changing nurse managers 12

13 2. Why Physicians Should Lead Professor s Dickson s Conclusion There is no national plan or strategy---and rarely provincial ones---to provide a comprehensive developmental opportunity to all health leaders (formal managers, doctors, nurses and patients) who want to participate in reform, and develop the capabilities to be successful at it. 13

14 3. Impediments to Physician Hospital Leadership The OHA consulted with hospitals to better understand the current landscape related to hospitalphysician relationships. Those surveyed included Board Chairs, Chief Executive Officers (CEOs), Chiefs of Staff, Vice- Presidents of Medical Affairs, Department Chiefs and Medical Staff Association (MSA) Presidents. The purpose was to understand how hospitals foster effective hospital-physician relationships. 48% of Ontario hospitals responded to the survey. 14

15 3. Impediments to Physician Hospital Leadership The most common barriers to effective hospitalphysician were: Physician availability and time; Physician payment/income models/status as independent contractors; Tensions between the OMA and the Ministry of Health and Long-Term Care (MOHLTC); Generational barriers/ old school attitudes/slow leadership turnover; and, Challenges with recruiting and retaining physicians who are strong leaders. Effective Working Relations Between Hospitals and Physicians: Part 3 Hospitals and Physicians Share Their Views, OHA, p

16 3. Impediments to Physician Hospital Leadership Hospital-Physician Alignment Dr. Jack Kitts Most physicians do not see themselves as: Part of the system; Leaders in the system; and Are not trained to be system thinkers. 16

17 3. Impediments to Physician Hospital Leadership OHA undertook seven regional sessions across the province from March to May 2017 Barriers identified Physicians view time as currency Communication is critical Generational differences requires attention Team vs. individual priorities Culture drives success Silos between physicians and administrators External Factors Politics, Public Hospitals Act, changing patient expectations 17

18 4. Why Engage Physicians? Informed and engaged physicians working with the management of the hospital is a successful recipe for organizations to remain current, patientcentred and innovative. Dr. Gillian Kernaghan, President and CEO, St. Joseph s Healthcare, London transforming healthcare organizations to improve performance requires effective strategies for engaging doctors and developing medical leadership. Dr. Ross Baker 18

19 4. How to Engage Physicians One factor in developing a successful framework is to recognize the need to strike a balance between: hospitals continued recognition that the physicianpatient relationship is foundational to the provision of high-quality care; and physicians continued recognition that at times, they may have to balance advocacy for their individual patients with the best interests of the broader patient population being served. Effective Working Relations Between Hospitals and Physicians: Part 2: A Practical Approach to Enhancing the Relationship, OHA, p

20 4. How to Engage Physicians Five Principles to Enhance Hospital Physician Relationships A shared commitment to high-quality, patient-centered care including a shared recognition for the need to match available resources to community needs. Mutual respect to build a foundation of trust and understanding. Delineated roles, responsibilities, expectations and lines of accountability which promotes problem solving. Responsive organizational leadership that promotes staff engagement, integration and team building at all levels, and supports physician leaders, by providing opportunities for their leadership development. Clear, open and respectful communication. 20

21 4. How to Engage Physicians Five enablers for an effective relationship between physicians and hospitals 1. Physician Engagement: To engage physicians at all levels and as early as possible in the change process, give them formal roles so they are part of the change process, build trust, have meaningful engagement, transparency and respect. 2. Leadership Development: Provide leadership development, recognizing that strong physician leadership goes a long way to enabling the work of the hospital, provide physicians with the skills and supports for team-based problem solving, and recruit the right individuals. 21

22 4. How to Engage Physicians 3. Interprofessional Team Approach: Provide an interprofessional team approach to patient care and leadership (also called shared leadership), programmatic management, dyad teams and clinical leadership teams. 4. Shared Decision-Making: Ensure physicians have meaningful involvement and influence on process, outcomes and accountability, that they feel listened to and encouraged to suggest innovative ideas. 5. Engaged Hospital Leaders: Promote attendance and involvement of the CEO and hospital leadership at all levels of physician groups, have an open door policy and hospital leadership that is very responsive. 22

23 5. Accepting Our Responsibility A blueprint for physician leadership in transforming Canada s health care system Johny Van Aerde, MD, PhD, and Graham Dickson, PhD As a profession, physicians have a unique and central role to play in service delivery Currently, the processes and methods dedicated to creating and supporting physicians leaders, i.e., education, mentorship, and professional leadership development are disorganized, episodic, and limited in scope, if they exist at all. 23

24 5. Accepting Our Responsibility A 25 page manifesto that describes the leadership role that physicians could play in the reform agenda. Canadian Society of Physician Leaders. Recommendations are directed to physicians, health care organizations, provinces and medical associations, and the government of Canada 24

25 5. Accepting Our Responsibility What physicians should do: 1. Explore and challenge their personal mental models and the world views that restrict them from engaging in the health system and realizing their potential as leaders. 2. Be willing personally to participate in and champion efforts by their colleagues to understand the reform agenda. 3. Take advantage of opportunities to participate in reform initiatives, especially patient safety and quality improvement initiatives. 25

26 6. Business Basics that Will Get You There 1. Join the Canadian Society of Physician Leaders. 2. Go to the Canadian Medical Association, JOULE and review their course offerings. 3. Begin with the Foundational Courses. On line courses are now available this year. 4. If your hospital brings the courses in-house, attend. 5. Let your program area know if you have a leadership interest. 6. Find a mentor. 7. Test the waters. Consider becoming a Medical Staff Officer or Departmental Chief. 8. Have courage. 26

27 A Profound Leadership Thought Rabbi Sacks, The Daily Telegraph, Beyond the Politics of Anger No civilization lasts forever. The first sign of breakdown is that people stop trusting the ruling elite. They are seen as having failed to: Solve the major problems facing the nation Benefiting themselves, not the population as a whole Out of touch and surrounded by people like themselves 27

28 Questions? 28