Leadership Healthcare Issues and Challengers

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1 : Leadership in Healthcare: Issues and Challenges Ravi Kumudesh Dip(MLT)/BSc(Mgt)/PG Dip(ExMgt)
2 : Outline of this presentation What do we mean by leadership in healthcare? What are the issues and challenges for leadership in healthcare? Are there solutions ?
3 : Leadership……. Copes with change Sets the direction, takes ownership and leads it Aligns people to achieve change and/or a vision for the future Motivates people to achieve goals Differs from management
4 : In Healthcare: Previous thinking about leadership Mainly fell into 3 categories: Function of power and influence “Great man” trait and theory Situational theory: situation or context important Problems with these: Focused on task and relationships but didn’t address the nature of the challenge or the complexity and amount of change required
5 : Emergence of a new paradigm Leadership is the relationship between the leader and the led that induces followers to act for certain goals that represent the wants and needs of both parties. Burns 1970’s Identified two contrasting leadership styles Transactional – exchange that is mutually beneficial; may be politically, socially or economically valuable. Transformational – based on 4 components
6 : The 4 components of transformational leadership Influence stems from the ethical and moral stance of the leader The leader behaves and acts as a role model and treats everyone as an individual The relationship is one of intellectual stimulation, encouraging independent thinking, argument, rational thinking & problem solving The leader acts as a mentor, coach advisor to followers
7 : Leadership involves power and responsibility Power and Responsibility MUST come together Transformation will only happen if driven by clinical teams CEO and other change agents support not do Entrepreneurship not compliance Liberation not Imprisonment
8 : Leadership in Healthcare is…. Unique in that there are multiple stakeholders: Clinicians – Medicine, Nursing & Allied Health Managers Bureaucrats Politicians Advocacy groups The Media
9 : Tensions between Different Key Groups Politicians – political leaders with a short term focus and usually politically biased Bureaucrats – Responsible for policy development and its implementation but do they lead? Clinicians – Access clinical resources and accountable for delivering quality patient outcomes. Lead clinical innovation and service delivery Managers – Can lead an organisation / service but are accountable for the “bottom line” and organisational performance Patients – leading “advocacy” & self-care
10 : Leadership and Alignment Strategy Structure Culture The Business Direction The Organisational Design The Character of the Organisation alignment
11 : What are issues and challenges in healthcare internationally that leaders are facing?
12 : International Issues and Challenges for Healthcare Leaders Sustainability Community/patient expectations Clinical governance and accountability The way health services are delivered Workforce capacity and sustainability Political influence and intervention Performance improvement & patient safety
13 : Main Sources of Data for the 5 countries are: Commonwealth Fund surveys of 5 countries: 2003: Hospital managers 2002: Experiences and attitudes of sicker adults 2001: Experiences of adults 1999: Quality of medical care OECD health data 2003 Ministry of Health reports Health and Independence Report 2003 Health Expenditure Trends in New Zealand 1990 -2002 WHO Report 2001 International Masterclasses- anecdotal evidence
14 : Source: Commonwealth Fund Survey of Hospital Managers 2003
15 : Health status by international standards - expenditure Health Outcomes
16 : Spending trajectories vary across OECD: small differences matter
17 : …so to deliver quality and quantity of health services the sector will need to use every $ even more well New Zealand’s long-term path is very sensitive to small changes in trend growth… Health spending track
18 : Sustainability Trends and issues: Population changes Social determinants of health Changing burden of disease Technology advancement Limits to resources Aging workforce Migration
19 : Sustainability Leadership Challenges: Leading the debate Determining priorities Technology assessment Providing safe, quality, affordable patient care
20 : Community / patient expectations
21 : Community / Patient Expectations Issues: Patients “wants” versus “needs” Self-care and management of chronic disease Hospitals are “sacred” “Doctors know best”
22 : Community / Patient Expectations Leadership Challenge: Persuading the community to accept change Shifting the emphasis of resources to community care where necessary Leading the move from an “expert” model to a self-care model
23 : Avoidable events “Worst” country assigned score of 100 Clinical accountability and quality
24 :
25 : Clinical Governance and Accountability Issues: Clinical accountability for use of resources, patient safety and quality Continuing number of adverse events Blame cultures Continuous quality improvement systems
26 : Clinical Governance and Accountability Leadership Challenges: Provision of clinical leadership Clinical governance& accountability Leading and creating a non-blame cultures Preventing adverse events through continuous CQI systems
27 : The way healthcare is delivered
28 :
29 : The Way Healthcare is Delivered Issues: Fragmentation and duplication of services Lack of integration across the health continuum Emphasis on hospital care Meeting the needs of our increasing older populations The need to develop new models of care
30 : The Way Healthcare is Delivered Leadership Challenges: Developing new models of care that embrace primary care Integrating care and how it is delivered across the continuum Leading organisational change and evolution
31 : Practicing physicians per 1000
32 : Staffing Shortages
33 : Practicing nurses per 1000
34 : Workforce Capacity and Sustainability Issues: Current issue; recruitment, retention and training Aging workforce Workforce shortages Future availability of a skilled workforce Effective team work
35 : Workforce Capacity and Sustainability Leadership Challenges: Creating career frameworks within a learning environment Training appropriate numbers of health professionals Using substitution strategies & creating new roles Development of high functioning inter-professional teams
36 : The Politics of Health
37 : Political Influence and Intervention Issues: Short term /politically expedient “fixes” rather than long term strategies Effect of constant political interference and in some countries continuing structural change
38 : Political Influence and Intervention Leadership Challenges: Separating the impact of the political arena from healthcare delivery Leading and getting political buy-in to long term strategies Leading the debate with society about the development of priorities for the future
39 : Improving Performance Health Outcomes
40 : Life expectancy at birth: 1994 data Source: OECD Health status by international standards (a) Life expectancy 75 76 77 78 79 80 81 82 83 Australia Canada Japan New Zealand Norway OECD average Sweden United Kingdom United States Health Outcomes
41 : Infant mortality: Deaths per 1,000 live births, 2004 or latest available year Source: OECD Health status by international standards (b) Infant mortality Health Outcomes
42 : Obesity: Percentage of population aged 15 and above with a BMI greater than 30, 2004 or latest available year Source: OECD Health status by international standards (c) obesity Health Outcomes
43 : Performance Management Issues: Improving performance & making it stick individual teams organisational Having timely information by which to manage clinical and resource decisions Establishing & measuring outcomes
44 : Performance Management Leadership Challenges: Leading and influencing performance improvement Developing a “Learning Organisation” Leading quality improvement initiatives Developing IT systems that work
45 : Some International Solutions?
46 : The need to develop leaders in healthcare Provision of national, professional and organisational initiatives
47 : Sustainability Develop a vision for the future that fits with the environments issues and the resources available Manage change through an evolutionary approach rather than constant restructuring Make “healthcare” the place to work in
48 : Sustainability continued Improve access and integration Collaboratives – IHI initiatives Mapping patient pathways Continuums of care for population groups Improve organisational performance and use of incentives e.g. UK target system Östergötland’s prioritizing & contracting process Jönköping - pursuing perfection initiatives
49 : Leadership and Community/Patient Expectations Lead consumer involvement that: Moves from an expert model to a self-care model Developing the “expert” patient Putting the patient “in the room” Provides patient choice and ease of access Promotes home/community based accessible care
50 : Clinical Governance and Accountability Develop and provide clinical leadership and CG systems that work hand in hand with management and that are patient centered Lead and develop a learning organisation and culture that is non-blaming Provide clarity around clinical standards, service and organisational goals, targets and expectations
51 : Healthcare Delivery Develop new models of care that: Promote wellness Provide accessible primary care Manage long term chronic disease efficiently Provide high quality secondary and tertiary care when needed in a way that is affordable Provide palliative care Are equitable and affordable
52 : Workforce Capacity and Sustainability Plan and develop strategies for the training and development of a future workforce that may be composed of different roles and different ways of working Provide a career framework for the above Develop a multi-disciplinary team approach in training and delivery Support informal caregivers
53 : Political Influence and Intervention Use information, strategies and processes that gain understanding and buy-in from all of the key stakeholders (e.g. Östergötland) Health leaders and professionals: use influence and power appropriately Be proactive in advice
54 : Performance Management Pursue perfection! And settle for nothing less Make managers and leaders accountable for the organisations performance – bring the decision making as close to the bedside as possible Develop clinical and management leadership that can lead, influence and manage change Create organisational cultures that are non-blaming and “safe”
55 : What will tomorrow bring? Continual change and evolution of healthcare systems and the way it is delivered To survive current and future pressures health care systems will have to change or adapt faster than they have to date In order to survive health systems will need effective leadership
56 : “To lead is to serve” Adair
57 : Are these leadership issues and challenges relevant to health leaders in Hong Kong?


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