Leadership Styles and Challenges in Healthcare

1. On Leadership……… J. Ricardo Loret de Mola, MD, FACOG, FACS Professor and Chair, Department of Obstetrics and Gynecology Southern Illinois University School of MedicineSpringfield, Illinois USA

3. What I want to talk about • Examine leadership and leadership styles • Why leadership is problematic for people in Healthcare (especially for Doctors!) • An example of an outstanding Healthcare leader

4. On Amazon there are: >100,000 books on Leadership >5,000 Audiobooks on Leadership On Ebay there are: 80,309 items for sale on Leadership WHY?

5. In other words we should run as fast as we can away from a bad leader!

6. We do know what a Leader is NOT! • A manager • A boss • A foreman • A person in charge • A director • An executive • A supervisor • A chief • A superior • A commander

7. Who is a leader then? • There is no simple definition • My working premise is that leaders have two main characteristics: • Their ability to set a path, goal, or vision for the people who are being led. • And their capacity to motivate them to pursue and eventually achieve the goal. • (But I must admit…..I am not defining one!)

8. What sort of goal do I mean? • To put a man on the moon • To defeat Germany in the Second World War • To create a national health service in the US • To improve the management of pregnant patients with hypertension in an Ob/Gyn clinic • To reduce waiting times in triage at L&D • All of these tasks have to be done with others - and that is true of most important tasks (A leader is not a leader without people to lead!)

9. Trends In Leadership Development Leadership surveys of U.S. workers report: • 39% believe leaders most often act in best interest of organization. • 22% see leaders as ready to admit mistakes. • 46% believe their organizations give them freedom to do their jobs. • 25% of women and 16% of men believe their organizations pick the best people for leadership. • 33% of managers are perceived as “strong leaders.”

10. Studies of Leadership • Until the late 40s the belief was that leaders were born not made and had particular traits: intelligence, money, extraversion, etc. • From the late 40s until the late 60s the central belief was that it was how leaders behave that mattered. It was a question of style. As such it could be learned.

11. Studies of Leadership • From the late 60s until the early 80s the idea was that leadership depended on the situation in which leaders found themselves. Some would be good for some circumstances but not for others. • Since the early 80s the central idea has been that leaders need vision and charisma and that leading and managing are different.

12. Characteristics of Charismatic Leaders • Charismatic leaders through role modelling "represent the values and beliefs to which they want followers to subscribe" • They build positive images and express ideas that appeal to followers ideologically • They set high expectations and are confident that followers can reach them • They install emotional responses in followers relative to achieving the goals

13. Managers and leaders are different • “Power is potentially dangerous, and so large organisations have developed a collective managerial ethic that stifles imagination and creativity.” Abraham Zaleznik, Harvard Business Review

14. Difference Between all others and a true Leader Leader • Wants to create the future • Needs to make change • Thinks ideal • Welcomes risks • Sees problems as opportunities • Is patient • Substance is KING • Your best college professor • High emotional intelligence Manager, Boss, etc. etc. • Overseas the current process well • Must achieve Balance • Thinks Execution • Comfortable with control • Problems are just that & need resolution ASAP • Procedure is KING • Instructs as to technique & process • Impersonal, Remote

15. Empirical studies on Leadership • Vision • Communicating the vision. • Empowerment - giving and sharing power not restricting it • Trust • Working with others

16. Foundations For Effective Leadership Leadership is one of the four functions of management…. ….that does not mean that all managers are effective leaders

17. Leadership

18. Types of Leadership Style

19. Styles of Leadership • There are four major styles of Leadership Laissez faire (free reign) Autocratic The Perfect Leader • Paternalistic or Autocratic • Paternalistic or Democratic • Paternalistic or Free Reign • Autocratic or Free Reign • Autocratic or Democratic • Democratic or Free Reign Participative (Democratic) Paternalistic

20. Types of Leadership Style • Autocratic: • Leader makes decisions without reference to anyone else • High degree of dependency on the leader • Can create de-motivation and alienation of staff • May be valuable in some types of healthcare environments where decisions need to be made quickly and decisively (Emergency Department)

21. Types of Leadership Style • Democratic: • Encourages decision making from different perspectives – leadership may be emphasised throughout the organisation • Consultative: process of consultation before decisions are taken • Persuasive: Leader takes decision and seeks to persuade others that the decision is correct

22. Types of Leadership Style • Democratic: • May help motivation and involvement • Staff feels ownership of the enterprise and its goals • Improves the sharing of ideas and experiences within healthcare • Can delay decision making • Perhaps a more effective way of running an academic Ob/Gyn department

23. Types of Leadership Style • Laissez-Faire: • ‘Let it be’ – the leadership responsibilities are shared by all • Can be very useful in areas where creative ideas are important (Academic Research) • Can be highly motivational, as people have control over their working life • Can make coordination and decision making time-consuming and lacking in overall direction • Relies on good team work • Relies on good interpersonal relations and communication

24. Types of Leadership Style • Paternalistic: • Leader acts as a ‘father figure’ • Paternalistic leader makes decision but may consult • Believes in the need to support staff (Academic Chairs tend to be like this….perhaps the mentor or teacher inside of us) • Can be perceived as condescending

25. Doctors' problems with leadership • Doctors are used to working primarily as individuals. Guard their independence jealously. They value autonomy highly - but leadership is about working with others.

26. Doctors' problems with leadership • Doctors and power: when I use the word power who do think you of?

29. Doctors' problems with leadership • Doctors feel uneasy about power. Think of it negatively. • At the same time they are often unwilling to cede power - something that is important in empowering and leading. • They are wary of abandoning control to others - yet that is what leadership is often about

30. Doctors' problems with Leadership • Think as “presumptuous” to set a vision for an organisation • Are not used to systems or organisations anyway, more like “Lone Rangers” • Have little experience in setting strategy. • Have difficulty seeing the broader picture • Are awkward with teams. Too inclined to try and dominate them rather than lead them.

31. Doctors' problems with Leadership • Too used to telling people (patients) what to do rather than inspiring or empowering them • Are driven by science and suffer from tactical behaviour and react rather than think strategically • Are too fond of hierarchies • They are wary of expressing emotion in themselves

32. Doctors' problems with Leadership • Are inclined to be analytic rather than creative, imaginative, and sympathetic • Poor at manipulating symbols and creating organisational excitement • Are often poor communicators • They are happier with puzzles rather than problems

33. Doctors' problems with Leadership • Doctors for these reasons have problems being leaders and being led • "Leading doctors is like herding cats." Warren Bennis • The University of Hell • “There is no kingdom too small for a doctor to be king of.” John Green

34. Do doctors’ problems with Leadership matter? • Doctors have created organisations that are hard to lead and have a tendency to elect compromise candidates and deliberately avoid those who might display leadership. • This is important because--worldwide--they are too often reacting, usually negatively, to the ideas of others rather than taking the lead, helping to move things forward

35. Successful Leader in Healthcare

36. Iain Chalmers

37. Iain Chalmers • Founder of the Cochrane Collaboration, now a worldwide movement that is transforming healthcare • As a young doctor, worked in Palestine • Once an Obstetrician in Wales; became worried that much of what he was doing might be harmful • Learned epidemiology • Founded National Perinatal Epidemiology Unit, the forerunner of Cochrane • Now moving into criminal justice, education, and medical history

38. Iain Chalmers: vision • A vision of medical interventions being based firmly on evidence, particularly to avoid harm • A vision of how this might be achieved, through a worldwide collaboration

39. Iain Chalmers: communication and trust • A relentless communicator--both through journals and the like and with individuals • Trusted absolutely: will tell you what you don’t want to hear, in the nicest but most persistent way

40. Iain Chalmers: empowerment and working with others The original “Tom Sawyer”--get others painting the fence and then sleep

41. Iain Chalmers: empowerment and working with others • “If you don’t mind who gets the credit there is no limit to what you can achieve.” Mark Twain • Has created a worldwide network • An unequalled ability to expect and get the best from people and to make sure they get the credit for what they have done

42. Conclusions • Leadership is important to effect change • Leadership is primarily about setting a vision and motivating people to want to achieve the vision • Communicating the vision, building trust, empowering people, and working in teams are all very important • Leadership and management are different

43. Conclusions • In healthcare we have problems with leadership, both leading and being led • But there have been and are outstanding examples of leaders • Leadership is not entirely inborn but nor can everybody learn to lead. • As a profession we need to think more about leadership and encourage people who can lead - or at least not stand in their way.

44. Southern Illinois University School of Medicine Springfield Illinois