Transcript Leadership in Healthcare and Financial Responsibility

The 13th Annual PAN EUROPE PACIFIC MEDICAL & LEGAL
CONFERENCE
PARIS, FRANCE
Monday 1 April 2013 - Monday 8 April 2013
Leadership in Healthcare and Financial
Responsibility
Charles P. McCusker
Head of Department of Obstetrics and Gynaecology, Fairfield Hospital
Associate Professor, University of Western Sydney
www.obstetricare.com
Leadership and learning are
indispensable to each other.
•
J o h n F. K e n n e d y ( 1 9 1 7 - 1 9 6 3 ) , s p e e c h p r e p a r e d f o r
delivery in Dallas the day of his assassination, November
22, 1963
Alexandre Auguste Ledru-Rollin
1807 - 1874)
was a French Politician
The following well-known
quote, or some variation of
it, is often attributed to
Ledru-Rollin:
"There go the people. I
must follow them,
for I am their
leader."
The quote is probably
apocryphal
Harvard School of Public Health
Program for Chiefs of Clinical Services
January 2012
Melbourne Business School
Master of Business Administration
Australia’s most trusted Professions
[Reader’s Digest Survey - 2011]
1. Paramedics
2. Firefighters
3. Pilots
4. Rescue volunteers
5. Nurses
6. Pharmacists
7. Farmers
8. Medical specialists
9. GPs
10. Veterinarians
Dopey Sneezy Bashful Sleepy Happy Grumpy Doc
Definition:
Leadership is a very complex multidimensional
concept and has been defined in a number of
different ways.
A common definition is:
The process by which one person
designates “what is to be done” and
influences the efforts of others in order
to accomplish specific purposes.
8
Another important definition is that:
Leaders are agents of change,
persons whose acts affect other
people more than other
people’s acts affect them.
9
Leadership Approach:
Leaders following the proactive approach take
responsible initiatives to change situations
and attitudes through people. This approach
is the essence of modern leadership It
contrasts with the reactive approach where a
leader responds only to events and
instructions from outside.
10
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.
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Styles
Autocratic or authoritarian style
Participative or democratic style
Laissez-faire or free rein style
Narcissistic leadership
Toxic leadership
Autocratic or authoritarian style
Under the Autocratic leadership style, all decision-making
powers are centralized in the leader, as with dictators.
Leaders do not entertain any suggestions or initiatives from
subordinates. The autocratic management has been
successful as it provides strong motivation to the
manager. It permits quick decision-making, as only one
person decides for the whole group and keeps each
decision to him/herself until he/she feels it needs to be
shared with the rest of the group
Participative or democratic style
The democratic leadership style favours decision-making by the
group. Such a leader gives instructions after consulting the
group.
They can win the cooperation of their group and can motivate
them effectively and positively. The decisions of the
democratic leader are not unilateral as with the autocrat
because they arise from consultation with the group members
and participation by them
Laissez-faire or free rein style
A free-rein leader does not lead, but leaves the group entirely to itself.
Such a leader allows maximum freedom to subordinates; they are
given a free hand in deciding their own policies and methods.
Different situations call for different leadership styles. In an emergency
when there is little time to converge on an agreement and where a
designated authority has significantly more experience or expertise
than the rest of the team, an autocratic leadership style may be most
effective; however, in a highly motivated and aligned team with a
homogeneous level of expertise, a more democratic or laissez-faire
style may be more effective. The style adopted should be the one
that most effectively achieves the objectives of the group while
balancing the interests of its individual members.
Narcissistic leadership
The narcissism may be healthy or destructive although there is a
continuum between the two. To critics, "narcissistic
leadership(preferably destructive) is driven by unyielding arrogance,
self-absorption, and a personal egotistic need for power and
admiration.”
Toxic leadership
A toxic leader is someone who has responsibility over a group of
people or an organization, and who abuses the leader-follower
relationship by leaving the group or organization in a worse-off
condition than when he/she first found them.
Emotional Intelligence:
As a result of many researches, Goleman (1998)
concluded that although successful leaders vary in many
ways, yet the most effective ones are alike in one crucial way:
They all have a high degree of what has come to be known as
“emotional intelligence”. It’s not that IQ and technical skills
are irrelevant. They do matter, but mainly as “threshold
capabilities” or entry-level requirements for executive
positions
Recent studies clearly show that without emotional
intelligence a person can have the best training and a brilliant
analytical mind but still won’t make a great leader
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Doctors as Leaders
[No need to identify]
Senator Bob Brown
[Former Leader of the Australian Greens]
Syrian President Bashar Al-Assad
[Maybe should have stuck to Ophthalmology]
Dr Mahathir Mohamad
[Some like the title]
Dr William McBride
He was named Man of the Year (1962), Australian of the Year (1962) Commander of the
Order of the British Empire (1969), Father of the Year (1972) and Officer of the Order of
Australia (1977) – [Source Wikipedia]
Ignaz Philipp Semmelweis
(July 1, 1818 – August 13, 1865) was a Hungarian physician who discovered, by 1847, that the incidence of
puerperal fever, could be drastically cut by use of hand washing standards in obstetrical clinics. Semmelweis’
hypothesis, that there was only one cause, that all that mattered was cleanliness, was extreme at the time,
and was largely ignored, rejected or ridiculed. He was dismissed from the hospital and harassed by the
medical community in Vienna, which eventually forced him to move to Budapest.
Edward Jenner
A cartoon by James Gillray, published in 1801, depicting Edward Jenner at the
Smallpox Inoculation Hospital, St Pancras, London, vaccinating the populace with
cowpox, which (according to the original caption) had ‘wonderful effects!’
Is this item:
•A. a 19th century
coffee percolator?
•B. a 19th century
carbolic-acid
atomiser to sterilise
operating theatres?
•C a 19th century
smelling –salts
dispenser to revive a
person who has
fainted?
B
Joseph Lister
Invented this atomiser in the 1860s to spray a
mist of carbolic acid over the operating theatre
and all those within it. He tested it during his
sister’s mastectomy. She survived – a rare
occurrence. Lister was booed out of the British
Medical Association meeting in Dublin in 1867,
and it took years of lobbying before his and
Pasteur's theories on infection and asepsis were
accepted.
Joseph Lister
[1827-1912]
made the link between lack of cleanliness in hospitals and deaths after operations.
For this reason, he is known as the ‘Father of Antiseptic Surgery’.
In August 1865, Lister applied a piece of lint dipped in carbolic acid solution onto the wound of an
eleven year old boy at Glasgow Infirmary, who had sustained a compound fracture after a cart
wheel had passed over his leg. After four days, he renewed the pad and discovered that no
infection had developed, and after a total of six weeks he was amazed to discover that the boy's
bones had fused back together, without the danger of suppuration.
Florence
Nightingale
Florence Nightingale (12 May 1820 –
13 August 1910) was a celebrated English
Nurse, writer and statistician. She came to
prominence for her pioneering work in
nursing during the Crimean war, where she
tended to wounded soldiers. She was
dubbed "The Lady with the Lamp" after her
habit of making rounds at night. An
Anglican, Nightingale believed that God had
called her to be a nurse.
Nightingale laid the foundation of
professional nursing with the establishment,
in 1860, of her nursing school at St Thomas'
Hospital in London, the first secular nursing
school in the world, now part of King’s
College London. The Nightingale Pledge
taken by new nurses was named in her
honour, and the annual International Nurses
Day is celebrated around the world on her
birthday.
Morris
Fishbein
•Was the most visible public
figure in the American
Medical Association [post
world War II]
•Editor of the Journal of the
American Medical
Association.
•Never engaged in Clinical
Practice.
•An unwavering force
against Medical Insurance
reform and Government
participation in medical
affairs.
•Pointed out that the Nazis
had written compulsory
health insurance into law,
making Medicine a tool of
the State.
Leaders……
 In addition to “operational management” that
is, day to day running of the organization,
have to be able to stand back and view the
future of the organization.
 Need to be able to manage not only those
beneath them, but also those above them.
 Must not just fall back on what gave them
success in their early days when they became
the leader.
Quality assurance
versus
Continuous Quality Improvement
Quality assurance
versus
Continuous Quality Improvement
Eddie the Eel
Usain Bolt
Strategic
planning
Schematically:
Strategic planning

Decision making

Action

Outcomes
Donald M Berwick
“Toyota revolutionized our
expectations of production; Federal
Express revolutionized our
expectations of service. Processes that
once took days or hours to complete
are now measured in minutes or
seconds. The challenge is to
revolutionize our expectations of
Healthcare; to design a continuous
flow of work for clinicians and a
seamless experience for patients”.
Barack Obama appointed Berwick to serve as the
Administrator of Centers of Medicare and
Medicaid Services. On December 2, 2011, he left
the position because it was clear that
Republicans in the Congress would not allow a
vote to confirm him.
Clayton M. Christensen (born April 6, 1952) Professor of Business
Administration at the Harvard Business School. He is best known for his study of
innovation in commercial enterprises. His first book, The Innovator's Dilemma
articulated his theory of ‘disruptive innovation.’
“Many think of management as cutting deals and laying people off and hiring people
and buying and selling companies. That’s not management, that’s deal making.
Management is the opportunity to help people become better people. Practised that
way, it’s a magnificent profession.”
A Culture of Improvement
Geller , ES and Solomon D, The Anatomy of Medical Error . 2007
• From individualism to teamwork
• From fault finding to fact finding
• from reactive to proactive
•From quick fix to continuous improvement
•From piecemeal to systems approach
Being a leader has its highs and its lows, its rewards and
its penalties, - it all depends on one’s perspective.
are
are
The Redback spider - the price of success.
It is one of only two animals known to actively assist the female in sexual cannibalism.
In the process of mating, the much smaller male somersaults to place his abdomen over
the female's mouthparts. In about 2 out of 3 cases, the female consumes the male while
mating continues. Males who are not eaten die soon after mating.Males who sacrifice
themselves during mating present two advantages over males who do not. The first is
that males who are eaten are able to copulate for a longer period and thus fertilise more
eggs. The second is that females who have eaten a male are more likely to reject
subsequent males.
Health care expenditure as a percentage of GDP in 12 OECD countries [source: OECD (2008),
OECD Health Data 2008, Version: December 2008 in NHHRC 2009 A Healthier Future For All
Australians Final Report]
Data released recently by the Australian Institute of
Health and Welfare shows the nation’s health care bill
is rising rapidly, from $77.5 billion in 2000-2001 to
$130 billion in 2010-11. The largest increases were in
public hospital services and medicines, prompting
questions of how we can rein in these costs.
The fact that Australia’s health spend is growing isn’t
surprising – our medical services are offered under an
uncapped fee-for-service system of funding, which
favours activity rather than prevention. In other words,
funding is skewed towards offering procedures rather
than advice
Financial
year
% of GDP
Amount
($ billions)
1981–82
6.3
10.8
2007–08
8.8
103.6
2008–09
9.0
112.8
2009–10
9.4
121.4
Source: Australian Institute of Health and Welfare
Retrieved on 10 July 2012.
According to an international analysis of 2004 health care costs results standardized by GDP price
purchasing parities and reported by the Australian Institute of Health and Welfare (AIHW),
Australia’s health care costs were intermediate between the UK and USA in the proportion of national
GDP (9.6%) and per capita health costs ( $AU 4226 pa ).5
Figure 3. Health expenditures in the USA, UK and Australia in 1994,1999 and 2004, as
percentage of GDP and per person per annum health costs in $AU
(Source: Australian Institute of Health and Welfare Database, 2006, Reference 5)
Mr Gordon Ballantyne
Head of Customer service
TELSTRA
“According to the Australian Bureau of Statistics, annual health
expenditure grew by 45 % between 1997 and 2007 to reach
$4,507 per person.”
“Australia has the highest Hospitalisation rate per capita in the
Western world but as many as 75% don’t need to be in there.”
“Health costs are increasing. By 2020 the underlying costs of
healthcare will be between$120bn and $200bn. We will need
more in-home healthcare as opposed to hospitalisation.”
Over the decade to 2008/9, actual expenditure in Australia grew by 5.4% pa and
as a proportion of GDP by 3.2% pa.
These growing amounts spent on health will affect all other sectors.
Some states, like NSW, estimate that at the current rate, health will consume
100% of the state budget by 2033.
Increasing costs are driven by overall income growth, technological change,
population size, ageing and associated increasing chronic disease prevalence.
Drivers of expenditure:
50% overall income growth - as pc GDP increases, greater amounts are
expended on health
25% technology, drugs, procedures
12.5% population increase
12.5% population ageing
IBM Australia managing director Andrew Stevens
August 2011
“………at the current rate of healthcare spending, and coupled with the ageing population,
healthcare would account for almost half of government expenses if nothing was done to fix
the health system.
"Australia's healthcare sector already costs taxpayers approximately $100 billion per year,
equivalent to 10 per cent of GDP, and health expenditure is growing faster than GDP," he
said.
"Within 20 years, Treasury expects Australia's healthcare bill to top $250 billion as the
population ages and as serious and chronic disease levels increase."
Financial Responsibility in Healthcare
Healthcare as a proportion of GDP: India 1%, UK 6%, USA 16%
Australia 9 % moving to 12% by +/- 2020 .
Thank you– are there any questions