The Evidence for clinical Leadership: Why, what, how · Summary • There is evidence that there is...
Transcript of The Evidence for clinical Leadership: Why, what, how · Summary • There is evidence that there is...
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JamiuBusari(MD,MHPE,PhD)Associate Professor,Medical EducationDept.Chair&ProgramDirectorofPediatrics31stOctober,2016@jobusar
TheEvidenceforclinicalLeadership:Why,what,how
AgentsforChange,2016,Liverpool
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DIS
CLO
SUR
E ST
ATEM
ENT
Noconflictsofinterest
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Academic:Educationaldevelopment&research
MaastrichtUniversity,Maastricht,Netherlands
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ClinicalWork:DepartmentofPediatrics
Zuyderland MedicalCenter,Heerlen,Netherlands
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Theleadershipdilemmainhealthcare
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Understandingtheproblem
Mentalmodelsinhealthcare
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HealthCareOrganization:regularmentalmodel….
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Butinreality,theorganizationofcarelookslikethis..
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Leadership
Aprocessofsocialinfluencethatmaximizestheeffortsofothers,towardstheachievementofagoal
Kevin Kruse Forbes.com What is Leadership April 9, 2013
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Whatwereadintheliterature….
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Theimportanceofclinicalleadership
• “…….theemphasisuponcompetency-basedleaderdevelopmenthasdonelittletofostereffectiveclinicalleadership…,despiteitspotentialusefulness,andinformativeandsummativeevaluationofleaderdevelopment.
• Althoughconsiderablediscussionhasoccurredontheneedforclinicalleadership,andlargescalepubicinquiriesevidencetheconsiderablepatientharmthathasoccurredintheabsenceofsuchleadership,therecontinuestobeamajordisconnectbetweencliniciansandmanagers,andclinicalandbureaucraticimperatives
• Thedebateoverwhoisbestpositionedtoleadservicedeliveryandtheplaceofcliniciansingovernancecontinues”
Daly et al. J Healthc Leadersh. 2014(6). 75-83
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• “…….theemphasisuponcompetency-basedleaderdevelopmenthasdonelittletofostereffectiveclinicalleadership….
• ,therecontinuestobeamajordisconnectbetweencliniciansandmanagers,andclinicalandbureaucraticimperatives
• Thedebateoverwhoisbestpositionedtoleadservicedeliveryandtheplaceofcliniciansingovernancecontinues”
Daly et al. J Healthc Leadersh. 2014(6). 75-83
Theimportanceofclinicalleadership
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The evidence
Thefactorsdefiningtheneedforleadership
Needsassessment
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Curricularreform
The evidence 1 - Why
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QualityinHealthcare–buildingwiththeendinmind
IHITripleAim
Theevidence2- Why
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Valuebasedhealthcaredelivery(M.Porter,HBS,2006)
1. Howefficientapatientfeelshis/herailmenthasbeenhandled
2. Howtheprovidersofcareperceivethattheprocessworksforthem;
3. Howtheprovisionoftrainingandresearchcontributestoinnovationandimprovementofservicesprovidedin1.aboveanddoesnothinder2.
4. Howeffectivethehospitaladministrationmanagescostsandgeneratesrevenuewhileachievingandsustainingpoints1.to3.
The evidence 3 - Why
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The evidence 4- Why
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The evidence - Why
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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%
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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)
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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)
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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
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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%
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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%
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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%
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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%
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Discussion• Previousmanagementexperienceseemedimportant
• Mandatorymanagementcoursesimprovedperceivedcompetency
• Unclearwhetherlengthofimplementationinfluencesperceivedcompetency- Yearssincegraduation
• Clearneedformanagementtraining- Specificpreferences
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Limitations• Responserate
• Differencesinhealthsystems
• Subjectivemeasurements
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The evidence for why - Summary
Thefactorsdefiningtheneedforleadership
IncreasedHCcosts
Sociopoliticalchangesinhealthcare
Needsassessment
Increaseddemands/changingexpectations
Curricularchanges
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Theevidence1- What
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Theevidence2- What
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Theevidence3- What
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Summary• Thereisevidencethatthereisaunwaveringneedfortrainingand
developmentinalldomainsofmedicalleadership(Brouns etal,.2011,Berkenbosch etal.,2011)
• Physicianleadersneedtotakeresponsibilityandbeaccountableforprovidingandmanaginghealthcaredelivery(Busarietal.,2011)
• Thereisaneedformoreparticipationofphysiciansinleadinghealthcareorganizations(Goodall,2011)
• Weshouldremainwaryofgettingcaughtintheillusionthatformalleadershipandmanagementtrainingisenoughforhealthcaretransformation(Busari,2012)
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Finalthoughts…
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Weshouldbeclearaboutwhatwemean…
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Leaderslightupthepathforotherstofollow
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They(always)leapfirst
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Theyleadbyexample
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Theyareresponsivetotheirteams