JamiuBusari(MD,MHPE,PhD)Associate Professor,Medical EducationDept.Chair&ProgramDirectorofPediatrics31stOctober,2016@jobusar

TheEvidenceforclinicalLeadership:Why,what,how

AgentsforChange,2016,Liverpool

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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

Contact

• Email:jamiu.busari@maastrichtuniversity.nl• Twitter:@jobusar

JOBusari/LHC/2016