Title: When Clinicians Lead The McKinsey QuarterlyJames Mountford and Caroline Webb
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2Physician Leadership and Engagement
- Chris Carruthers MD
- Geriatric Medicine for the Practicing Physician
- Ontario Long Term Care Physicians
- Long Term Care Medical Directors Association of
Canada - November 7, 2009
3My Goal
- Encourage you to enhance your LTC Medical
Directors role both locally and nationally
4Question
- What is Common with the following 13
Organizations ?
5The Ottawa HospitalSt Michaels Hospital, Toronto
Sunnybrook Hospital, Toronto The Toronto
Hospital Hotel Dieu Hospital, Kingston
6Humber Hospital, Toronto Winnipeg Health
AuthorityChamplain LHIN, OntarioVancouver
Coastal Health Authority Centre for Addiction
and Mental HealthThe Scarborough
HospitalMontfort HospitalMcGill University
Health Centre
7 8Why Physician CEOs and Leaders ?Physicians (You
!) bring -
- Integrity
- System knowledge
- Management by working around
- Physicians colleagues on side
9- Why do we need (more) physician leaders in all
areas of health care ?
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11Good Outcomes if
- Physicians are involved in planning improvement
as team members - Opportunities for physician and clinical
leadership of improvement - Clinicians own improvement
12When Clinicians Lead
- The McKinsey Quarterly
- James Mountford and Caroline Webb
13- Health care systems that are serious about
transforming themselves must harness the energies
of their clinicians as organizational leaders
14- Effective Clinical Leadership Lifts the
performance of health care organizations - Common Goal -Delivering excellent care
efficiently - LTC Medical Directors must take the lead in
enhancing Long Term Care - If you do not become involved who will ?
15Distributive Physician Leadership
- Institutional Leader
- Service or Department Leader
- Frontline Leader or Clinician
16Barriers to be addressed
- Recognition of roles is important
- Contract with position description
- Appropriate incentives e.g. pay
- Access to education
- Address -Reluctance of physicians to participate
17Long Term Care Medical Directors Role
- Leadership
- Administrative
- Quality improvement
- Medical staff management
- Resident service functions
18Leadership and its challenges
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20What are these lessons on Leadership for LTC
Medical Directors ?
21- Are leaders made or born ?
- Passion to change
- Mentors
- Education
- Clinical practice
- Today's Leadership traits
- Headhunters
- Family
- Acting
- Sabbatical ?
22Leadership and Management
- Leaders lead and managers manage
- Leadership involves the ability to communicate a
clear vision and destination and to provide the
means to reach it - Lines are blurring between managers and leaders
23Leaders and Leadership
- Leaders can be made with some added natural
talent or family history - Quest for knowledge
- Accidentally take on a role
- Opportunities outside of the plan-seized the day
-
24Leadership Demands
- Life long pursuit
- Learning from mistakes
- Following your interests
- Worthwhile but will be demanding
25Passion
- Need to strongly believe in a vision
- Unsatisfied in the way things are
- Advocate for the system not just your patient
- Alternate Level of Care Issue
26Do not buy into what others say cannot be changed
- Want to make a difference
- Recognize always conflicting interests
- Need to take a risk- gamble
27 Mentorship
- Most leaders identified a mentor
- Could be one or many
- Who inspires you ?
- Colleague, boss, or someone in a different
business - Opens doors and provides career advice
- See one, do one,
- teach one
28Management Education
- Scientific background provides significant
advantage - Additional business education is needed
- Not necessarily a MBA
- Provides credibility
- Need to know the skills to address organizational
issues
29Clinical Practice
- Provides credibility
- Out of sight means out of touch
- Can be done by restricting or narrowing your
practice
30Leadership Traits of Medical Directors
- Ability
- Availability
- Affability
- Team Sport
31Availability
- Open door policy
- Approachable
- Not intimidating
- Good times and bad times
- Younger physician access is important
32Affable
- Being pleasant, polite and at ease talking to
others - Laughter is good medicine
- Optimistic
- People person
- Good communicator
33Challenge Dogma
- Management of ulcers
- Arthroscopy
- Private care vs all public
- Only doctors or nurses can do that !
- Challenge traditional geriatric practices e.g
over use of anti-psychotics, Rx of asymptomatic
bacteriuria, care planning that is uniform and
inflexible , euthanasia - Quit complaining and do something about it !
34Team Effort
- Shared Vision
- Put team ahead of your aspirations
- Will not succeed alone
- Others compensate your weaknesses
- Your success is others being recognized
35Family and Colleagues
- Key
- Supportive
- Accommodating
- Keep the family dynamics working
- Balance
- Juggling two careers
36Head Hunters
- Park your ego at the door
- Be prepared for the interview
- Its not a coronation
37Acting Head ?
- Not always a good idea
- Fritz, who expressed enthusiasm for his proposed
promotion but asked that he not be called
"interim" CEO. "You can fire me anytime you want,
but at least give me a better chance to succeed,"
38Sabbatical
- Great idea
- Needs lots of planning
- Part of your contract ??
39Risks
- Ambition is part of ego and narcissism-manage it
- Solitude and isolation
40Disparity between our hopes and reality
- Cant stay on the top of the mountain long
- Old friends maybe ex friends
41- The toes you tread on today maybe in a position
to kick you tomorrow - If you burn your bridges you better be a good
swimmer
42There will be set backs and doors shut
- Moving around can learn more
- Can leave medical practice not the medical
profession - Reach out to the broader community
43- by virtue of their power and position, doctors
are able to block or confound the efforts of
managers or politicians to impose change via
top-down mechanisms. However, by engaging doctors
with change processes, improvements in
performance may be achieved. Chris Ham
44Engaging PhysiciansWhat Administration must do
- Involve them from the beginning
- Bring them to the table for mutual benefit
- Build trust - deliver
- Respect their time
45Recognize their input
- Communicate
- Value their time with your time
- Promote system and individual responsibility for
quality and efficiency
46Shared Decision Making
- The challenge is for those who now are making the
decisions to share the process with physicians in
the future - Token sharing will not work
47Medical Directors should expand and participate
more in
- Administration- participate in decision making
not just be consulted - Quality Improvement ( access, appropriate,
safety, satisfaction)- Lead quality monitoring
and improvement.
48- Medical Staff Management- ensure quality and
participate in clinical activities ( team member)
- Resident Service Functions- Speak for the
residents on quality issues (integrity) - Resident Rights Functions- Participate locally
and nationally in these critical issues e.g end
of life -ADVOCATE - Becoming part of a system -Not there yet
- Avoid being lost as the system is challenged
going forward
49- There are significant opportunities and a need
for LTC Medical Directors involvement
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53Thank You