Leadership Lessons for Health Care Providers

Frank James Lexa

• Publisher: Academic Press
• Year: 2016
• Print ISBN: 9780128018668
• eBook ISBN: 9780128019115
• Topic: Business
• Subtopic: Leadership
• Index: Business

The rapid changes in health care including novel technologies as well as the changing economic, political, and social landscapes are all forcing physicians as well as most types of health care practitioners to re-think their role in leadership. This is particularly true in the US in recent years, but the same issues are widely prevalent affecting health care workers around the globe. Developing capable medical leaders who can navigate these challenges will be essential. Physicians and other health care practitioners usually receive little or no leadership training in the course of their education. At the next steps in their training: internship, residency and fellowship, gaining clinical acumen takes precedence over developing other skills that are at the core of leadership training. Leadership Lessons for Health Care Providers will allow all types of health professionals to gain a better understanding of what leadership is, how to develop their skills while still early in their careers, how to understand and handle common leadership conundrums and chart a path towards increasing their leadership capabilities as they reach mid-career and beyond. This book will provide a great start for those who are interested in learning more about leadership and includes recommendations for next steps at all stages in leadership work. - Discusses and offers practical advice on a number of leadership development topics including levels of leadership, different styles and techniques, dealing with conflict, making hard decisions, and setting priorities - Includes valuable insight from leaders and specialists in the health care field - Directs readers to additional leadership resources as next steps

Chapter 1

Leadership and its Challenges

Abstract

This chapter discusses what leadership is and why we often have too small a definition of what a leader really does. It explores why it does matter and why healthcare professionals, such as physicians, nurses, nurse practitioners, technologists and healthcare administrators should consider taking on greater leadership roles in their institutions. This chapter also discusses why healthcare is different than other sectors and why the 21st century in the US medical system is a particularly challenging time for would be leaders

Keywords

challenges to leadership

change in US healthcare

definition of leadership

“The task of the leader is to get his people from where they are to where they have not been”

—Henry A. Kissinger, political scientist, 1923-present

Image credit: Illustration of human evolution ending with smart phone. © Frank Fiedler/Shutterstock

Leadership in time

When we think of leadership, it often invokes a mental image of a highly visible successful alpha individual in government, the military, business, or sports. In some sense at least, leadership is a widely distributed behavioral trait present in a broad variety of pack and herd species beyond just Homo sapiens. In fact, some important facets of primate leadership were probably already quite ancient when a great leader or leaders led the first modern humans out of Africa on an expedition that has gone on to encompass the globe. The idea of leadership as a journey and an effort to overcome challenges is still important today. Except for some rare instances where a hospital or a campus is being relocated most healthcare leaders aren’t going to take us on a spatial voyage; rather, they take us on a temporal one, into an uncertain and often unknown land: the future. The success of leaders in healthcare and also that of their followers will depend on how well they can read the horizon, anticipate the future of medicine, and make decisions that succeed in taking their groups and institutions into that future.

Challenges to healthcare leadership and leaders

Great leadership has never been more important or more critical to the mission of healthcare. I had considered having a separate chapter or even section of the book to discuss the challenging times that we are living in. However, that topic is so big, so polemical, and so likely to change rapidly that I thought that a separate chapter or chapters would have distracted from our focus on our core mission in this volume. I decided instead to use this space to keep the focus on leadership, so the subsequent chapters will contain material about how healthcare leaders need to rise to these challenges. Today, healthcare faces severe threats and challenges on many fronts. In particular, declining reimbursement and rivalry with both traditional and nontraditional competitors in healthcare are eroding the political and economic fortunes of our fields. As this book goes to press, health care competition from nonhumans, from machines that can learn is evolving from science fiction to science fact. I interviewed many healthcare professionals for this book. As I talked with a wide spectrum of practitioners from cardiologists to nurses to psychologists and nurses there were several common themes. First and foremost was one of rapid change and even disruption of traditional practice in their fields. The second was that the future is far more uncertain than it had ever been in their careers, and a third was that the risks for us in healthcare practice have never been higher.

Many of the challenges start with the fact that healthcare is different than most other endeavors. To start with, the stakes are higher—people’s lives, their bodies, and their emotional well being are all at stake. I have worked with successful leaders in a variety of fields outside of healthcare. While what they do is important, the risks of a mistake in selling clothes usually come down just to money—poor sales, failed marketing, etc. The mistakes in healthcare can be far more serious and far more damaging and have dimensions that are absent from some other types of leadership—the consequences are severe: pain, loss of health, and even loss of life itself are at risk. It is important to remember that the problems for healthcare leaders may also include both those of commission—a serious error—and those of omission—the services we can’t provide to people because of waste, inefficiency, poor performance, etc.

Changing healthcare

While change is difficult for many sectors of our society, it can be more difficult for healthcare leaders. When we consider change in healthcare, we are constrained on many sides by the degree to which healthcare is highly regulated. It isn’t easy to get a new product or service approved quickly. A second challenge is that healthcare is often fragmented rather than integrated. While that type of environment creates some opportunities for change, it not only limits others but also limits the positive impact of change. For example, an improvement in care in the cardiac intensive care unit is an improvement, but if it is not combined with improvements that enhance care for patients elsewhere in the hospital and/or in outpatient experience, then the overall impact will be small. This will be just an isolated element with little impact on the patient and the larger society. Another challenge to change is that of costs. The pressures to reduce those costs have been discussed for decades, but are now coming to a head both on the private and public sides. The appetite in the public and private sectors to pay more for healthcare is very limited. The detailed discussion of medical costs and their impact on healthcare and society are beyond the scope of this book, but a few points should be made as they are directly germane to medical leadership.

Healthcare costs and change

The costs of medicine are a function of many variables including those that are both intrinsic and extrinsic to the current medical system as we know it. Hospitals may be very good at taking care of gunshot victims. They may have good leaders who can effectively and efficiently mend bodies that are wounded by ballistic injuries. Effective leadership may keep the intrinsic costs under control. However, the total cost of that type of healthcare will still likely depend more on the level of gun violence in the hospital’s referral area, which is an extrinsic cost to the hospital than it does on the intrinsic factors noted previously. A high level of gun violence leads to higher total costs to the system. Even an intrinsically efficient hospital would appear expensive if the extrinsic costs (ie., number of severely injured gunshot patients arriving each day) were high. This notion relates to many other aspects of extrinsic health costs, such as levels of cigarette smoking, obesity, recreational drug use, seatbelts, bike helmets, etc. As cost pressures increase and societal limits on spending are imposed, medical leaders will need to pay much greater attention to cost, quality, effectiveness, and related factors as they make decisions about how resources are used in medical practice.

The current challenges for leaders in healthcare however are about much more than cost. The structure of healthcare in the US is also being challenged. As this book goes to press there are pressures coming from several conflicting directions to change the current practice of medicine. One is a greater role of the Federal government in healthcare. While the states have historically had a lead role in regulating most aspects of medical practice in the United States, in recent decades the national government has had growing presence and influence through the expansion of Medicare, Medicaid, and the Veteran’s Administration system with no sign that that those pressures will abate in the near future. Furthermore, Federalization of healthcare in this manner took a major step forward with the passage of the ACA in 2010.

The focus on changes in the public sector has led some leaders to miss the changes on the private side of the US healthcare sector. Change has also come from that side, as corporate involvement in healthcare has expanded in recent years with national companies moving into many kinds of medical practice. Simultaneously (and not coincidentally), many mid and late career physicians are giving up private practice for hospital employment. Meanwhile, many of the freshly minted physicians in the US are now going directly to employed positions in much greater numbers than in years past. Independent private practice is becoming a less available and perhaps for some a less desirable or realistic choice. This is creating a shift of both power and focus to the hospital rather than the physician practice or other entities as the core industrial unit of US healthcare. The implications of this transition for healthcare leadership are critical. If this trend continues it will affect who will be the leaders—will health care practitioners be led by their own or by nonphysicians. Furthermore it will also change the ways that they will lead and be led.

How to get started

So if I haven’t scared you away from leadership in the first chapter, the next step is how you should get started in leadership. Before you do that, let’s look at the interesting question of whether leadership is your work or someone else’s. This is not a stupid question—in fact it is one that I hear being debated at medical meetings, business meetings, as well as in the hallways of hospitals. It has at least two elements: (1) should healthcare professionals lead in healthcare and (2) what should the structure of a healthcare organization look like, for example, how many leaders and what kind of leaders will it take for the institution to succeed. To answer the second one first, a recurring theme in this book will be that leadership means more than just the work of the top leader in a healthcare organization. It is not only a job for an executive at the top of a division or whole institution, but also the responsibility (and an opportunity) for many additional people, especially those of us who serve at the leading edge of the medical arts. In the broader sense, it is a set of tasks that is the responsibility of many of us who are healthcare professionals: physicians, nurses, dentists, technologists, pharmacists, therapists, administrators, and the many others who make the complex system of health run. That is also my answer to the first debate, you as a healthcare expert should be the kind of person who leads other healthcare experts. This is a polemical topic, but you can learn to be a leader, while many non-healthcare people who understand leadership could never learn to do your job. They can’t really understand what it means to be a family physician, a nurse, or neurosurgeon or understand what really makes you a good dentist or psychiatrist.

I hope that inspires you to continue, but understand that you have some work to do. While you are probably an expert in your field, just being good at what we do in our area of expertise doesn’t guarantee that we will be good leaders in healthcare enterprises. That experience, no matter how detailed or how many years you have been doing it, is by itself probably not enough for you to step directly into a high impact leadership role. Good leadership takes additional skills, extra work, and for many of us some extra training and education. Once you have made the effort to gain those newfound abilities, you will be in a position to make a real difference for yourself, for your organization, and for your career. Without sounding too prejudiced and at the risk of being a bit repetitious, you as a top tier health pracitioner have insights into medical care and into the needs of patients that a top business school graduate is unlikely to ever acquire. The lessons in this book are designed to both teach these points and to inspire you to pursue a career that includes leadership.

At this point you may be asking what is leadership and what do leaders do? Don’t worry, we will cover these topics and more in subsequent chapters. To get started, at the core, leadership is about helping to get a group of individuals to perform well in their mission as they move into the future. It isn’t just about how smart you are (but smart is certainly good!). It isn’t just about how good your medical and nursing and dental skills are (although good is important also). It isn’t about how charismatic you are (but personability and charisma often help and it is safe to acknowledge that their lack can be problematic). It is about how well you can bring out the best in your group, whether that is a handful of people in a small practice or at the other end of the spectrum a large national medical organization with tens of thousands of employees. This book is about a journey, about both the decision to take it and the tools that you need to do it successfully.

Practical points. Each chapter will close with a series of key takeaway points. These will summarize the key points covered in the chapter and will focus on actionable points as well as those you should ponder prior to moving on to the next chapter.

Key points

1. Being a leader is more than a title or a job, it is an activity.

2. Leadership is not about an individual, it is about rallying a group and bringing out the best in them.

3. Leaders take their groups on a journey. For us in healthcare, this is usually not a journey through space, rather it is through time, into the future.

4. Within the memory of those of us who currently work in healthcare, ther...

Table of contents

• Cover
• Title page
• Table of Contents
• Copyright
• Dedication
• Acknowledgments
• Introduction
• Chapter 1: Leadership and its Challenges
• Chapter 2: Profiles in Leadership: What Does it Mean to Be a Great Leader
• Chapter 3: Deciding to Lead: When and Why to Begin to Take on Leadership Roles
• Chapter 4: Your First 100 Days: Facing the Challenge of Becoming a New Leader
• Chapter 5: The Unexpected Leader: Challenges of Having Leadership Thrust Upon You
• Chapter 6: Leading From Below
• Chapter 7: Qualities of Great Leadership
• Chapter 8: Delegation: Getting It Right to Lead Successfully
• Chapter 9: Making the Grade: Levels of Leadership
• Chapter 10: Educating Leaders: A Foundation Curriculum for HealthCare Professionals
• Chapter 11: Learning to Lead: Best Practices for Getting Started
• Chapter 12: Leadership—Organizational Styles and Types
• Chapter 13: Strategic Leadership: Setting Priorities
• Chapter 14: Time to Lead
• Chapter 15: Leading Change in an Organization
• Chapter 16: Leadership in Conflict
• Chapter 17: Leading in a Crisis
• Chapter 18: Tough Choices: How Leaders Make the Hard Decisions
• Chapter 19: Leadership and Mistakes
• Chapter 20: Thinking About Failures in Leadership
• Chapter 21: Becoming a Level 5 Leader
• Chapter 22: Choosing Greatness in Leadership
• Chapter 23: Winning in a Crisis
• Chapter 24: Leading in Serious Conflicts
• Chapter 25: Leadership and Trust
• Chapter 26: Principled Leadership
• Chapter 27: Motivation and Leadership
• Chapter 28: Succession Leadership
• Chapter 29: Leadership: The Last 100 Days
• Chapter 30: Conclusions and Next Steps
• Bibliography
• Index