Charles P. McCuskerHead of Department of Obstetrics and Gynaecology, Fairfield Hospital

Associate Professor, University of Western Sydneywww.obstetricare.com

The 13th Annual PAN EUROPE PACIFIC MEDICAL & LEGAL CONFERENCE

PARIS, FRANCE Monday 1 April 2013 - Monday 8 April 2013

Leadership in Healthcare and Financial Responsibility

Leadership and learning are indispensable to each other.

• J o h n F. K e n n e d y ( 1 9 1 7 - 1 9 6 3 ) , s p e e c h p r e p a r e d f o r d e l i v e r y i n D a l l a s t h e d a y o f h i s a s s a s s i n a t i o n , N o v e m b e r 2 2 , 1 9 6 3

             

Alexandre Auguste Ledru-Rollin 1807 - 1874)

was a French Politician

The following well-known quote, or some variation of it, is often attributed to Ledru-Rollin:

"There go the people. I must follow them, for I am their leader."

The quote is probably apocryphal

Harvard School of Public HealthProgram for Chiefs of Clinical Services

January 2012

Melbourne Business SchoolMaster of Business Administration

Australia’s most trusted Professions[Reader’s Digest Survey - 2011]

1. Paramedics 2. Firefighters

3. Pilots 4. Rescue volunteers

5. Nurses 6. Pharmacists

  7. Farmers 8. Medical specialists

9. GPs 10. Veterinarians

Dopey Sneezy Bashful Sleepy Happy Grumpy Doc

8

Definition:Leadership is a very complex multidimensional concept and has been defined in a number of different ways. A common definition is:

The process by which one person designates “what is to be done” and

influences the efforts of others in order to accomplish specific purposes.

9

Another important definition is that:

Leaders are agents of change, persons whose acts affect other

people more than other people’s acts affect them.

10

Leadership Approach:

Leaders following the proactive approach take responsible initiatives to change situations and attitudes through people. This approach is the essence of modern leadership It contrasts with the reactive approach where a leader responds only to events and instructions from outside.

11

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.

Styles

Autocratic or authoritarian styleParticipative or democratic styleLaissez-faire or free rein style

Narcissistic leadership Toxic leadership

Autocratic or authoritarian style

Under the Autocratic leadership style, all decision-making powers are centralized in the leader, as with dictators.

Leaders do not entertain any suggestions or initiatives from subordinates. The autocratic management has been successful as it provides strong motivation to the manager. It permits quick decision-making, as only one person decides for the whole group and keeps each decision to him/herself until he/she feels it needs to be shared with the rest of the group

Participative or democratic style

The democratic leadership style favours decision-making by the group. Such a leader gives instructions after consulting the group.

They can win the cooperation of their group and can motivate them effectively and positively. The decisions of the democratic leader are not unilateral as with the autocrat because they arise from consultation with the group members and participation by them

Laissez-faire or free rein style

A free-rein leader does not lead, but leaves the group entirely to itself. Such a leader allows maximum freedom to subordinates; they are given a free hand in deciding their own policies and methods.

Different situations call for different leadership styles. In an emergency when there is little time to converge on an agreement and where a designated authority has significantly more experience or expertise than the rest of the team, an autocratic leadership style may be most effective; however, in a highly motivated and aligned team with a homogeneous level of expertise, a more democratic or laissez-faire style may be more effective. The style adopted should be the one that most effectively achieves the objectives of the group while balancing the interests of its individual members.

Narcissistic leadership

The narcissism may be healthy or destructive although there is a continuum between the two. To critics, "narcissistic leadership(preferably destructive) is driven by unyielding arrogance, self-absorption, and a personal egotistic need for power and admiration.”

Toxic leadership

A toxic leader is someone who has responsibility over a group of people or an organization, and who abuses the leader-follower relationship by leaving the group or organization in a worse-off condition than when he/she first found them.

18

Emotional Intelligence:

As a result of many researches, Goleman (1998) concluded that although successful leaders vary in many ways, yet the most effective ones are alike in one crucial way:They all have a high degree of what has come to be known as “emotional intelligence”. It’s not that IQ and technical skills are irrelevant. They do matter, but mainly as “threshold capabilities” or entry-level requirements for executive positionsRecent studies clearly show that without emotional intelligence a person can have the best training and a brilliant analytical mind but still won’t make a great leader

Doctors as Leaders[No need to identify]

Senator Bob Brown[Former Leader of the Australian Greens]

Syrian President Bashar Al-Assad[Maybe should have stuck to Ophthalmology]

Dr Mahathir Mohamad[Some like the title]

Dr William McBrideHe was named Man of the Year (1962), Australian of the Year (1962)

Commander of the Order of the British Empire (1969), Father of the Year (1972) and Officer of the Order of Australia (1977) – [Source

Wikipedia]

Ignaz Philipp Semmelweis (July 1, 1818 – August 13, 1865) was a Hungarian physician who discovered, by 1847, that the incidence of

puerperal fever, could be drastically cut by use of hand washing standards in obstetrical clinics. Semmelweis’ hypothesis, that there was only one cause, that all that mattered was cleanliness, was extreme at the time,

and was largely ignored, rejected or ridiculed. He was dismissed from the hospital and harassed by the medical community in Vienna, which eventually forced him to move to Budapest.

Edward JennerA cartoon by James Gillray, published in 1801, depicting Edward Jenner at the Smallpox Inoculation

Hospital, St Pancras, London, vaccinating the populace with cowpox, which (according to the original caption) had ‘wonderful effects!’

Is this item:

•A. a 19th century coffee percolator?•B. a 19th century carbolic-acid atomiser to sterilise operating theatres?•C a 19th century smelling –salts dispenser to revive a person who has fainted?

BJoseph Lister

Invented this atomiser in the 1860s to spray a mist of carbolic acid over the operating theatre and all

those within it. He tested it during his sister’s mastectomy. She survived – a rare occurrence.

Lister was booed out of the British Medical Association meeting in Dublin in 1867, and it took years of lobbying before his and Pasteur's theories

on infection and asepsis were accepted.

Joseph Lister [1827-1912]

made the link between lack of cleanliness in hospitals and deaths after operations. For this reason, he is known as the ‘Father of Antiseptic Surgery’.

In August 1865, Lister applied a piece of lint dipped in carbolic acid solution onto the wound of an eleven year old boy at Glasgow Infirmary, who had sustained a compound fracture after a cart

wheel had passed over his leg. After four days, he renewed the pad and discovered that no infection had developed, and after a total of six weeks he was amazed to discover that the boy's

bones had fused back together, without the danger of suppuration.

Florence Nightingale

Florence Nightingale (12 May 1820 – 13 August 1910) was a celebrated English Nurse, writer and statistician. She came to prominence for her pioneering work in nursing during the Crimean war, where she tended to wounded soldiers. She was dubbed "The Lady with the Lamp" after her habit of making rounds at night. An Anglican, Nightingale believed that God had called her to be a nurse.Nightingale laid the foundation of professional nursing with the establishment, in 1860, of her nursing school at St Thomas' Hospital in London, the first secular nursing school in the world, now part of King’s College London. The Nightingale Pledge taken by new nurses was named in her honour, and the annual International Nurses Day is celebrated around the world on her birthday.

Morris Fishbein

•Was the most visible public figure in the American Medical Association [post world War II]•Editor of the Journal of the American Medical Association.•Never engaged in Clinical Practice.•An unwavering force against Medical Insurance reform and Government participation in medical affairs.•Pointed out that the Nazis had written compulsory health insurance into law, making Medicine a tool of the State.

Leaders……

In addition to “operational management” that is, day to day running of the organization, have to be able to stand back and view the future of the organization.

Need to be able to manage not only those beneath them, but also those above them.

Must not just fall back on what gave them success in their early days when they became the leader.

Quality assurance versus

Continuous Quality Improvement

Quality assurance versus

Continuous Quality ImprovementEddie the Eel Usain Bolt

Strategic planning Schematically:

Strategic planning

Decision making

Action

Outcomes

Donald M Berwick “Toyota revolutionized our expectations of production; Federal Express revolutionized our expectations of service. Processes that once took days or hours to complete are now measured in minutes or seconds. The challenge is to revolutionize our expectations of Healthcare; to design a continuous flow of work for clinicians and a seamless experience for patients”.

Barack Obama appointed Berwick to serve as the Administrator of Centers of Medicare and

Medicaid Services. On December 2, 2011, he left the position because it was clear that Republicans in the Congress would not allow a vote to confirm him.

Clayton M. Christensen (born April 6, 1952) Professor of Business Administration at the Harvard Business School. He is best known for his study of innovation in commercial enterprises. His first book, The Innovator's Dilemma articulated his theory of ‘disruptive innovation.’

“Many think of management as cutting deals and laying people off and hiring people and buying and selling companies. That’s not management, that’s deal making. Management is the opportunity to help people become better people. Practised that way, it’s a magnificent profession.”

A Culture of ImprovementGeller , ES and Solomon D, The Anatomy of Medical Error . 2007

• From individualism to teamwork

• From fault finding to fact finding

• from reactive to proactive

•From quick fix to continuous improvement

•From piecemeal to systems approach

Being a leader has its highs and its lows, its rewards and its penalties, - it all depends on one’s perspective.

are

are

The Redback spider - the price of success.It is one of only two animals known to actively assist the female in sexual

cannibalism.

In the process of mating, the much smaller male somersaults to place his abdomen over the female's mouthparts. In about 2 out of 3 cases, the female consumes the male while mating continues. Males who are not eaten die soon after mating.Males who sacrifice themselves during mating present two advantages over males who do not. The first is that males who are eaten are able to copulate for a longer period and thus fertilise more eggs. The second is that females who have eaten a male are more likely to reject subsequent males.

Health care expenditure as a percentage of GDP in 12 OECD countries [source: OECD (2008), OECD Health Data 2008, Version: December 2008 in NHHRC 2009 A Healthier Future For All

Australians Final Report]

Data released recently by the Australian Institute of Health and Welfare shows the nation’s health care bill is rising rapidly, from $77.5 billion in 2000-2001 to $130 billion in 2010-11. The largest increases were in public hospital services and medicines, prompting questions of how we can rein in these costs.The fact that Australia’s health spend is growing isn’t surprising – our medical services are offered under an uncapped fee-for-service system of funding, which favours activity rather than prevention. In other words, funding is skewed towards offering procedures rather than advice

Financialyear % of GDP Amount

($ billions)

1981–82 6.3 10.8

2007–08 8.8 103.6

2008–09 9.0 112.8

2009–10 9.4 121.4

Source: Australian Institute of Health and Welfare Retrieved on 10 July 2012.

According to an international analysis of 2004 health care costs results standardized by GDP price purchasing parities and reported by the Australian Institute of Health and Welfare (AIHW), Australia’s health care costs were intermediate between the UK and USA in the proportion of national GDP  (9.6%) and per capita health costs ( $AU 4226 pa ).5 Figure 3. Health expenditures in the USA, UK and Australia in 1994,1999 and 2004, as percentage of GDP and per person per annum health costs in $AU (Source: Australian Institute of Health and Welfare Database, 2006, Reference 5)

Mr Gordon BallantyneHead of Customer service

TELSTRA

“According to the Australian Bureau of Statistics, annual health expenditure grew by 45 % between 1997 and 2007 to reach

$4,507 per person.”“Australia has the highest Hospitalisation rate per capita in the Western world but as many as 75% don’t need to be in there.”“Health costs are increasing. By 2020 the underlying costs of healthcare will be between$120bn and $200bn. We will need

more in-home healthcare as opposed to hospitalisation.”

Over the decade to 2008/9, actual expenditure in Australia grew by 5.4% pa and as a proportion of GDP by 3.2% pa.These growing amounts spent on health will affect all other sectors.

Some states, like NSW, estimate that at the current rate, health will consume 100% of the state budget by 2033.

Increasing costs are driven by overall income growth, technological change, population size, ageing and associated increasing chronic disease prevalence.Drivers of expenditure:50% overall income growth - as pc GDP increases, greater amounts are expended on health25% technology, drugs, procedures12.5% population increase12.5% population ageing

IBM Australia managing director Andrew StevensAugust 2011

“………at the current rate of healthcare spending, and coupled with the ageing population, healthcare would account for almost half of government expenses if nothing was done to fix the health system."Australia's healthcare sector already costs taxpayers approximately $100 billion per year, equivalent to 10 per cent of GDP, and health expenditure is growing faster than GDP," he said."Within 20 years, Treasury expects Australia's healthcare bill to top $250 billion as the population ages and as serious and chronic disease levels increase."

http://drdork.blogspot.com/

Financial Responsibility in HealthcareHealthcare as a proportion of GDP: India 1%, UK 6%, USA 16%

Australia 9 % moving to 12% by +/- 2020 .

Thank you– are there any questions