Dr. Fathieh-Abu Moghli

1. Management and Leadership For medical staff Dr. Fathieh-Abu Moghli

2. 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 Staff development personnel Equipment Research Information Agency Clients Employees resources Objectives Systems Standards Policies Procedures budget Organization Chart Job evaluation Job description Group work Power Problem- Solving Change Conflict Communication Staffneeds Recruitment Selection Scheduling Assigning 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 Middle management level First line management level First line level Management levels / positions: Top management level Functional base

7. Line and staff relations Organization chart Line positions: Staff positions • Solid: same level • Dotted: frequently used • Dashed: Consultation/coordination

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 movesupwards.

9. 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

10. 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 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 Managers vs. Leaders

16. Common Activities • Planning • Organizing • Directing • Controlling

17. Manager Planning Budgeting Sets targets Establishes detailed steps Allocates resources Leader Devises strategy Sets direction Creates vision Planning

18. Manager Creates structure Job descriptions Staffing Hierarchy Delegates Training Leader Gets people on board for strategy Communication Networks Organizing

19. Manager Solves problems Negotiates Brings to consensus Leader Empowers people Cheerleader Directing Work

20. Manager Implements control systems Performance measures Identifies variances Fixes variances Leader Motivates Inspires Gives sense of accomplishment Controlling

21. The Good Old Days . . . • In the mid 1900’s, 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. Hierarchical Tyrannical/dictatorial/ cruel Fear Abusive Malignant Inflexible Intolerant Traditional Leadershipin Medicine “Never argue with the Chief”

23. Times Have Changed! • In the 1970’s, 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. 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 Teams in Medicine(Early Career)

28. Teams in Medicine(Early Career) Physician – Patient Team

29. Departmental Section chief Division head Vice chair Clinic director Lab director Hospital Partnership leader Medical Staff Committees Educational Student rotation director Residency director Fellowship director School Faculty council Search committees Medical Society committees Meeting program chairs Academy leadership roles Groups in Medicine(Mid Career)

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 team’s 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 individual’s education and expertise. • Team members understand each other’s roles. • Mechanism for communication. • Mechanism for monitoring patient outcome. • Strong sense of team identity.

35. 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 Teamwork Model

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. 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 Example

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. Leader’s 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 PATRIARCHAL • Reward power • Coercive power • Legitimate power=position power=Authority • Expert power (Area of specialization)

45. PATRIARCHAL • Referent power: association with the powerful inspiring admiration Charisma (personal) • Informational power: • Self power (feminist power)

46. 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. Intelligence More intelligent than non-leaders Scholarship Knowledge Being able to get things done Physical Doesn’t seem to be correlated Personality Verbal facility Honesty Initiative Assertiveness Self-confident Ambitious Originality Sociability Adaptability Leadership Traits

48. Leadership Styles The characteristic manner of performing leadership activities. Leaders need to focus on two things to achieve leadership goals: Followers Task

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) Freedom for subordinates Authority by The leader Democratic Authoritarian Subordinates are allowed To function within limits Subordinates are told Of the leader’s decision Tannenbaum & Schmidt 1973