Dr. Fathieh-Abu Moghli

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Dr. Fathieh-Abu Moghli

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Title: Dr. Fathieh-Abu Moghli

1
Management and Leadership For medical staff

Dr. Fathieh-Abu Moghli

Management -
A process of working through other staff
members to provide care, cure, comfort to
patients and their families in the most effective
and efficient manner.
Planning, Organizing
Directing, Controlling
Available Financial, Material,
And Human Resources
Quality Service to Clients
Individual, Family, Community

3
Management

Efficiency
Effectiveness Achieve goals
ends

outputs

inputs
Means
4
The management system
Inputs
Outputs
Patient care
Process / Throughput
Data
controlling leading staffing organizing planning Data gathering
Staff development
personnel
Equipment
Research
Information Agency Clients Employees resources
Objectives Systems Standards Policies Procedures b
udget
Organization Chart Job evaluation Job
description Group work
Power Problem- Solving Change Conflict Communicati
on
Staff needs Recruitment Selection Scheduling Assig
ning Monitoring Staff development
Q.I Performance appraisal Labor relations
supplies
5
Data gathering
planning
organizing
staffing
leading
controlling
The Management Process Interrelated system
components
6
Management - A process of getting work
done through others

Organization structure

Management levels / positions

Middle management level First line
management level First line level
Top management level
Functional base
7
Line and staff relations

Line positions
Staff positions
Solid same level
Dotted frequently used
Dashed Consultation/coordination

Organization chart
8
Delegation- The process by which one person
assigns duties to be performed by another and
grants him the authority to accomplish
them. Authority- The right to act or
command the actions of others. It is delegated
downwards. Responsibility The obligation
involved when a person accepts an assignment. It
can not be delegated. Accountability A
state of being liable to the delegator for the
quality and quantity of an assigned action. It
moves upwards.

Centralization
Decision-making done at top level
Decentralization
Some major decision-making is delegated to
persons in lower position levels
Unity of command
Having one source for authority (orders).
Dual subordination
Having more than one superior

Interdepartmental relations
Relations that exist between different
departments.
Intradepartmental relations
Relations that operate within the same
department.

11
Leadership

A social relationship in which one party
influences the behaviors of others. It involves
power differential
Components
The leader, the led, the situation and a goal

12
Leadership

A social relationship in which one person has
more ability to influence the behavior of others.
Power differential

13
What is leadership?

Influencing people

Directing/Commanding people

Supervising people

Guiding people/ Coordinating activities

14
Types of Leaders

Leader by the position achieved
Leader by personality, charisma
Leader by moral example
Leader by power held
Intellectual leader
Leader because of ability to accomplish things

15
Managers vs. Leaders

Managers
Focus on things
Do things right
Plan
Organize
Direct
Control
Follows the rules

Leaders
Focus on people
Do the right things
Inspire
Influence
Motivate
Build
Shape entities

16
Common Activities

Planning
Organizing
Directing
Controlling

17
Planning

Leader
Devises strategy
Sets direction
Creates vision

Manager
Planning
Budgeting
Sets targets
Establishes detailed steps
Allocates resources

18
Organizing

Leader
Gets people on board for strategy
Communication
Networks

Manager
Creates structure
Job descriptions
Staffing
Hierarchy
Delegates
Training

19
Directing Work

Leader
Empowers people
Cheerleader

Manager
Solves problems
Negotiates
Brings to consensus

20
Controlling

Leader
Motivates
Inspires
Gives sense of accomplishment

Manager
Implements control systems
Performance measures
Identifies variances
Fixes variances

21
The Good Old Days . . .

In the mid 1900s, what was medicine like?
Physician controlled medical care.
Physician prescribed other modalities and told
other professionals exactly what to do and how to
do it.
Physician was autonomous and received little
input from other health professions.

22
Traditional Leadershipin Medicine

Hierarchical
Tyrannical/dictatorial/ cruel
Fear

Abusive
Malignant
Inflexible
Intolerant

Never argue with the Chief
23
Times Have Changed!

In the 1970s, health care began its reform and
physicians began to depend on other health
professionals to assist with patient care
functions.
Managing the care of individuals and populations
often requires participation in team-based
efforts.
Other health professionals have learned how to
maximize their opportunities, and to affect the
direction of health care reform.
Other health professions are now respected
patient care providers with much to contribute to
the health care system.

24
Traditional Leadershipin Medicine

No longer considered a successful approach
Not tolerated in clinical settings

25
Teamwork
26
Medical Leaders

To practice medicine is to serve in the capacity
of leader or team member on multiple teams
simultaneously at any given time.

27
Teams in Medicine(Early Career)

Physician teams
Fellows
Senior residents
Junior residents
Students
Clinic teams
Physicians
Front desk staff
Nursing staff
Ancillary staff

Hospital Teams
Physicians
Nursing staff
Ward staff
Ancillary providers
Operating Room Teams
Surgeons
Anesthesia
Nursing
Scrub Techs
OR desk staff

28
Teams in Medicine(Early Career)
Physician Patient Team
29
Groups in Medicine(Mid Career)

Educational
Student rotation director
Residency director
Fellowship director
School
Faculty council
Search committees
Medical Society
committees
Meeting program chairs
Academy leadership roles

Departmental
Section chief
Division head
Vice chair
Clinic director
Lab director
Hospital
Partnership leader
Medical Staff Committees

30
The New Paradigm

Teams and teamwork represent the basis of a new
paradigm in health care.
Shifts in
Where employees work
What functions they perform
In which disciplines they work
How they interact with each other
Increasing numbers of workers are now expected to
cross-train and function as effective team
members.

31
Teamwork

Quality health care depends on every health care
worker doing his/her part.
Professionals with different backgrounds,
different education, different ideas, different
responsibilities, and different interests all
work together to provide appropriate quality
care.
Well coordinated teamwork across the health
professions can provide effective and
cost-effective patient care.

32
Teamwork

In almost any health care career, you will be a
part of an interdisciplinary health care team
(practitioners from different professions who
share a common patient population and common
patient care goals with responsibility for
complementary tasks).
The team concept was created to provide quality
holistic health care to every patient.
It is essential that you learn to become a team
player and learn to work well with others.

33
Teamwork

The members of the team may change from day to
day, depending on the medical situation.
The teams goal stays the same - - to provide
quality health care for patients that will
Help patients get well and/or stay well.
Contribute to diagnosing diseases or conditions.
Make patients more comfortable or otherwise
improve the quality of their lives.

34
Teamwork Model

Components
Common group of patients.
Common goals for patient outcome and shared
commitment to meeting these goals.
Member functions are appropriate to an
individuals education and expertise.
Team members understand each others roles.
Mechanism for communication.
Mechanism for monitoring patient outcome.
Strong sense of team identity.

35
Teamwork Model

Values/Behaviors
Trust among all parties
Knowledge and trust remove the need for
supervision
Joint decision making
Mutual respect for the expertise of all members
of the team this respect is communicated to the
patient

Communication that is not hierarchic but rather
two-way facilitating sharing of information
knowledge
Cooperation coordination promote the use of the
skills of all team members, prevent duplication,
and enhance the productivity
Optimism that this is the most effective method
of delivery of quality of care

36
Advantages of Teamwork

For Patients
Improves care by increasing coordination of
services, especially for complex problems.
Empowers patients as active partners in care.
Can serve patients of diverse cultural
backgrounds.
Uses time more efficiently.

37
Advantages of Teamwork

For Health Care Professionals
Increases professional satisfaction.
Enables the practitioner to learn new skills and
approaches.
Encourages innovation.
Allows provider to focus on individual
areas of expertise.

38
Advantages of Teamwork

For the Health Care Delivery System
Holds potential for more efficient delivery of
care.
Maximizes resources and facilities.
Decreases burden on acute care facilities
as a result of increased preventive care.

39
Example

Surgical Team
Admitting clerk (admission information)
Insurance representative (approval for surgery)
Nurses or patient care technicians (prep pt)
Surgeons, one or more
Anesthesiologist
Operating room nurses
Surgical technicians

Housekeepers (clean and sanitize OR after
procedure)
Sterile supply techs (clean instruments)
Recovery room personnel
Dietitian
Social worker
Physical therapist
Occupational therapist
Home health personnel

40
Interdisciplinary Teams

In contrast to
Disciplinary or independent medical management
approach
in which a practitioner works autonomously with
limited input from other practitioners.

41
Interdisciplinary Teams

In contrast to
Multidisciplinary approach
which involves various health care professionals
working independently - - not collaboratively - -
with each responsible for a different patient
need.

42
Interdisciplinary Teams

In contrast to
Consultative approach
in which one practitioner retains central
responsibility and consults with others as
needed.

43
Leaders 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.

44
Types of power

Reward power
Coercive power
Legitimate powerposition powerAuthority
Expert power
(Area of specialization)

PATRIARCHAL
45
PATRIARCHAL

Referent power
association
with the powerful
inspiring
admiration
Charisma
(personal)
Informational power
Self power (feminist power)

Most effective leaders rely on several different
forms of power e.g. giving orders (legitimate),
praising (reward), disciplining (coercive).
Power must be used wisely to influence people
e.g. abuse of coercive power may lead to
weakening or loss of referent power.
Effective leaders understand the costs, risks,
and benefits of using each kind of power and are
able to recognize which to draw on in different
situations and with different people.

47
Leadership Traits

Intelligence
More intelligent than non-leaders
Scholarship
Knowledge
Being able to get things done
Physical
Doesnt seem to be correlated

Personality
Verbal facility
Honesty
Initiative
Assertiveness
Self-confident
Ambitious
Originality
Sociability
Adaptability

48
Leadership Styles

The characteristic manner of performing
leadership activities. Leaders need to focus on
two things to achieve leadership goals

Task
Followers
49
Goals of the first line manager
1
2
safe, effective care to pts through employees
Physical emotional Wellbeing of employees
I need Professional knowledge,
knowledge of law, economics, labor relations
leadership skills Making decisions guide
others to make decisions Make minor changes
50

Subordinates are
invited to question
ideas from the leader

Task-oriented (Structural)
Relationship-oriented (Consideration)
Authority by The leader
Freedom for subordinates
Democratic
Authoritarian
Subordinates are allowed To function within
limits
Subordinates are told Of the leaders decision
Tannenbaum Schmidt 1973
51
Contingency or situation theory of leadership

The organization culture, work situation work
group are in constant interaction.
The effective leader is one whose personality and
style satisfy employees need for structure and
consideration.
The leader ( subordinates) is controlled by the
situation, he/she is
Subservient to the task.
At mercy of subordinates
Leadership should shift from one person to
another during project implementation

52
Guidelines for adapting leadership style
/activities to the situation

The leader must
Be an accepted member of the work group.
Be superior to other members in some significant
attribute.
Occupy a powerful position in the group force
field.
He
She
Demonstrate professional, communication,
management political skills
Represent a subject area or functional emphasis
that confers power and prestige on practitioners.

53
Life-cycle theory
High
Explain decisions Clarify (selling) Hi task-hi rel. Share ideas facilitate decision Making (participating) Hi Rel.- low task
Hi task ,lo rel. Give specific instruction closely supervise (telling) Lo rel. lo task Give D-M action responsibility (delegating)
Relationship behavior
Low
Task behavior
High
Low
Moderate
Low
High
R 1 R 2 R 3 R 4
Unable unwilling Unable Willing Able Unwilling Able Willing
54
Leadership Styles

Delegating
Low relationship/ low task
Responsibility
Willing employees
Participating
High relationship/ low task
Facilitate decisions
Able but unwilling

Selling
High task/high relationship
Explain decisions
Willing but unable
Telling
High Task/Low relationship
Provide instruction
Closely supervise

55
Expectations of leadership
More better outcomes, Less resources
1st line manager
management
Safe, Supportive environment
Am I a representative of
Management or One of the
employees?
employees
56
I am a Communication link
I have to be familiar with goals problems of
both Management employees
I need to be Assertive Verbally fluent
57
REMEMBER

A leader must be a member of the group
BUT
Superior to them in some significant attribute
And must occupy a position of high potential

58
Communication skills for doctors

Good communication skills are integral to medical
and other healthcare practice.
Communication is important not only to
professional-patient interaction but also
within the healthcare team.

59
Principles of effective communication

ensures interaction rather than direct
transmission
requires planning and thinking in terms of
outcomes
demonstrates dynamism what is appropriate for
one situation is inappropriate for another.
Achieving this dynamism requires flexibility,
responsiveness and involvement
follows the helical model (what one person says
influences what the other says in a spiral
fashion so that communication gradually evolves
through interaction).
From BMA

60
Factors increasing the need for strong
communication skills in medicine

improving the patients journey, which
requires advanced leadership, team working and
communication skills
cultural and organizational change
the growing need for long-term management of
chronic disease this is believed to require a
shift in doctor-patient interaction and
healthcare team working to a partnership model
complaint handling and increasing litigation.

61
The benefits of good communication skills

Benefits for patients
The doctor-patient relationship is improved.
The doctor is better able to seek the relevant
information and recognise the problems of the
patient by way of interaction and attentive
listening. As a result, the patients problems
may be identified more accurately.
Good communication helps the patient to recall
information and comply with treatment
instructions thereby improving patient
satisfaction.

62
Benefits for patients- continued
Good communication may improve patient health
and outcomes. Better communication and dialogue
by means of reiteration and repetition between
doctor and patient has a beneficial effect in
terms of promoting better emotional health,
resolution of symptoms and pain control. The
overall quality of care may be improved by
ensuring that patients views and wishes are
taken into account as a mutual process in
decision making. Good communication is likely
to reduce the incidence of clinical error.
63
Benefits for doctors

Effective communication skills may relieve
doctors of some of the pressures of dealing with
the difficult situations encountered in this
emotionally demanding profession. Problematic
communication with patients is thought to
contribute to emotional burn-out and low personal
accomplishment in doctors as well as high
psychological morbidity.
Being able to communicate competently may also
enhance job satisfaction.
Patients are less likely to complain if doctors
communicate well. There is, therefore, a reduced
likelihood of doctors being sued.

64
Communication within the healthcare team

Good communication within the healthcare team is
essential in order to ensure continuity of care
and effective treatment for patients.
Good communication can deepen professionals
understanding of others work or how their
role fits in with the rest of the healthcare team
Communication with managers and other
professionals, such as social workers, is equally
relevant. Communication difficulties between
doctors and with their managers is a leading
cause of disciplinary problems.

Good communication skills are essential to ensure
the effective transmission of knowledge and to
medical students and
doctors in training.
The communication skills are needed to publish
research, educate, lead or inspire others
written and presentation skills in addition to
the one-to-one oral communication are required in
patient consultations.

66
Barriers to effective communication

Personal barriers
lack of skill to use language that is tailored to
the patient, giving structured explanations and
listening to patients views to encouraging
two-way communication
inadequate knowledge of, or training in, other
communication skills including body language and
speed of speech.
doctors undervaluing the importance of
communicating (not appreciating the importance of
keeping patients adequately informed).

negative attitudes of doctors towards
communication. For example, giving it a low
priority due to a concern primarily to treat
illness rather than focusing on the patients
holistic needs
a lack of inclination to communicate with
patients. This can be due to lack of time,
uncomfortable topics and lack of confidence.
lack of knowledge about the illness/condition or
treatment.
Doctors need to be honest about the
limitations of their knowledge.
human failings, such as tiredness and stress.
language barriers.

68
Organizational barriers to effective communication

Work constraints including lack of time, pressure
of work, and interruptions.

69
Developing Leadership Skills

All physicians function as a leader on a daily
basis
Most physicians have some baseline skills
Some are naturally better at it than others
Leadership skills can learned, developed and
honed
Endless amount of literature, books, courses,
seminars, and institutes dedicated to leadership

70
Leadership Skills