Www.leemathias.com Instilling Clinical Leadership, Ownership and Accountability.
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Transcript of Www.leemathias.com Instilling Clinical Leadership, Ownership and Accountability.
www.leemathias.com
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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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