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Instilling Clinical Leadership, Ownership and Accountability

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History tells us….

• Tripartite management– Based around the hospital– Separation of personal and public health care

services– Professions developed power bases– Professional leadership was strong

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Along came General Management

• Healthcare services desperately needed the models and skills of management

• Mind over mind set…manage the nurses not the nursing

• Functional divisions – mostly based on medical specialties

• Integration of primary, secondary, tertiary

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Management is management!

• Leadership through formal authority

• Structures needed designing from scratch

• Some lacked healthcare service experience

• Decision-making influenced by the need to retain power rather than good leadership

• Poor understanding of the operations; bad understanding of the culture

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Logic of managerialism is blind..

• Passion for care giving

• Value of professional practice

• Lacked authority in within own working environments

• Feeling value and connectedness supports leadership

• Values of caring and vocation are essential to practice

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Mapping the social topology

• The role of leadership in exercising power

• The profession as point of reference

• The role and use of symbolic power

• Change management and managing people

• Sharing the leadership role

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Leadership, the exercising of cultural, social and symbolic power• Reproduce those behaviours which are

seen as successful

• Reproduction through experiential role modeling

• Recognition

• Behaviour is meaningful

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Culture

• Familiar and comfortable with the doxa

• Social stability based on shared norms

• Cultural and social capital such as higher education and social recognition enables reproduction of standards

• Culture recognised as the norm and gives authority

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New paradigm

• Professions challenged by the need for utility

• Skills to recognise and include the economic imperatives placed on an organisation

• Challenge of economic utility underlies much of the tension between corporate and clinical decision-making.

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The profession as point of reference for leadership

• No matter what the context of decisions

• Professional maturity encompasses metaliteracy - valuing the opinions, values and ideas of others

• Can not be separated without considerable experience and engagement in other decision-making processes

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Professionhood

• A commonality of characteristics which circumvent the formality of operational structure

• Leadership characteristics can not be formalised

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Role and Use of symbolic power

• Generalising behaviour

• Education as the bridge

• Don’t change the underlying values of the profession

• Rules of play in the healthcare services environment

• Leadership demonstrated through skills in getting others to follow

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Change Management

• Inherent in the leadership role is change manager

• Change is integral to the survival of organisations

• Setting direction

• Establishing standards

• Communicating the change

• Envisioning the future

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Values based Leadership

• Regular testing of morality and ethics

• How we behave toward and influence each other

• Aligned to the establishment of ethical boundaries inside which subordinates make decisions

• Emotional intelligence is the mark of a good leader

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Managing People

• Key leadership role

• Embedded in change process

• Embedded in organisational culture

• Developing staff, plans, board relationship

• Culture of “Stepping up” to leadership

• Not clinical direction but leadership

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Sharing the leadership role

• Sharing of power

• Involvement in executive decision-making

• Involvement in strategy

• Determination of organisational priorities

• Allocation of resources and funds

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Sharing of leadership

• Collaboration Hesselbein

• Individuals do nothing alone

• Individual motivating capabilities and

• Large group/organisational motivation Shortell

• Leaders as change agents Pfeffer

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Value of Sharing

• Confidence to delegate

• Reinforce the power

• Opportunities for collective decision-making

• Familiarity with the “practical sense” of the organisation; understanding the game

• “Pull the team together” and “get people up to the game”

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Mintzberg

“….about leadership based on mutual respect rooted in common experience and understanding.”

Musings on management (1996)

• Establishing credibility• Being alert to the qualities of others• Creating an environment in which others

can flourish

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Clinical Leadership

• Set direction

• Establish standards

• Integrate agreed values

• Setting ethical boundaries

• Change agent

• Transformational and situational

• Establish trust

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Obligation

Having the skills to lead is an obligation of leadership in public healthcare organisations

Assuring the public’s confidence in the services provided

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Accountability

Accountability is demonstrated through professional maturity in the forms of:

• Leadership

• Credibility

• Education

• Experience, including life experience

• Metaliteracy – many perspectives

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Professional maturity

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Leadership in the context of governance

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Creating a culture of Accountability

• Establish credibility – expertise and outcomes

• Demonstrate education through qualifications and experience

• Demonstrate experience through practice and achievement of outcomes

• Stepping up to leadership

• Sharing the lead role

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Creating a culture of Accountability

• Using power to balance tension

• Managing and meeting targets for change

• Understand and use the opinions and values of others – metaliteracy- being literate in the perspectives of others

• Having the skills to get the job done as well as clinical skills

• Embed in practice