Leadership in Healthcare

• Are Leaders born or developed?

Overview of Presentation
• Basic concepts
• Theories of leadership
• Styles of leadership
• Need for leadership in Pakistan
• Framework for leadership
• Levels of leadership in health
• Pre-requisites
• Leadership management
• Evaluation of leadership and leadership networks
• Assumptions about community leadership
• Roles of PH leader
What is Leadership?
• “Leadership is the process of persuasion by which an individual induces a group
to pursue objectives held by leader or shared by the leader and his or her
followers”

• “Leadership is a process by which an individuals influences a group of individuals

to achieve a common goal”
Who is a Leader?

• “Any individual who influences the behaviour of others is regarded as a leader”

Theories of leadership
• Nature theory
1. Great man theory
2. Trait theory
• Nurture theory
• Situation theory
Nature theory
• Great Man Theory

• suggests that some people are born to lead.

• Great leaders can't be made because leadership qualities are innate.

• Characteristics like charisma, intelligence, political skills and wisdom are some of
the natural qualities .

• Based on study of already great leaders , from aristocracy

• In times of need, great man arise by magic

• But no single trait corelate with outcome indicators
• Trait represent tendencies
• Several traits lead to certain behaviour or style
• Trait theory
• Certain traits either born with or acquired in early life
• All effective leaders possess these traits
• Leaders have right combination of traits
• So search and focus on those traits,
• If people had those traits, would become effective leaders

• What are those traits?

• Honest, forward looking, competent, inspiring, intelligent
Traits And Skills Critical For A Leader
• Adaptable • Clever
• Alert to social environment • Creative
• Ambitious • Diplomatic and tactful
• Assertive • Fluent in speaking
• Cooperative • Knowledgeable about group task
• Decisive • Organizes
• Dependable • Persuasive
• Dominant • Socially skilled
• Energetic • Tolerant of stress
• Persistent • Willing to assume responsibilities
• Self confident
Nurture Theory
• Leadership can be learned

• Two dimensions,
1. concern for people
2. Concern for the task to be done

Based on these dimensions, task-people models of leadership deveoped

Leadership grid/managerial grid
 Leadership Grid/Blake and Mouton’s Managerial
Grid
• High concern for people and
• B:Yeld and comply
production
• High concern for people, low for
production • These leaders encourage team
work and
• Comfort and security of employees
commitment
• Friendly environment
• • Make the
Control employees
and dominate feels ,
• They hope friendly environment will
constructive
• High concern for production and low for
increase production
• A: Low concern for people, people
part of the company
•production
Not necessarily v productive • Balanced and compromise • Employees not important
• Preserve job and seniority • Some concern to people and • They get money, performance is
production expected
• Avoid troubles to protect themselves
• Concerned, not to be held • Try balance between company • use rules and punishment to achieve
responsible goals goals

for any mistake and workers needs • Used at the edge of real or perceived
failure
• Less innovative • But needs of neither are met
• Used in crisis management
A- Impoverished/Indifferent Style
• Evade and elude
• Low concern for people, production
• Preserve job and seniority
• Avoid troubles to protect themselves
• Concerned, not to be held responsible
for any mistake
• Less innovative
B- Country Club/Accommodative Style
• Yeld and comply
• High concern for people, low for production
• Comfort and security of employees
• Friendly environment
• They hope friendly environment will
increase production
• Not necessarily v productive
C-Produce or perish/Dictatorial style
• Control and dominate
• High concern for production and low for people
• Employees not important
• They get money, performance is expected
• use rules and punishment to achieve goals
• Used at the edge of real or perceived failure
• Used in crisis management
D-Sound/Team style
• High concern for people and production
• These leaders encourage team work and
commitment
• Make the employees feels , constructive
part of the company
E- status Quo style
• Balanced and compromise
• Some concern to people and production
• Try balance between company goals
and workers needs
• But needs of neither are met
The Opportunistic Style

• Exploit and manipulate

• Do not have a fixed location on grid
• Adopt behaviour which offer greatest
• personal benefit
Paternalistic Style

• Prescribe and guide

• This alternates between A and B
• They praise and support but discourage
challenge to their thinking
The Situation Theory
• Predictor of success is context or situation

• Focus is on characteristics of that situation

• Situations change and are complex
• So no general rule or theory is dominant in this area
• Analyze characteristics of leader, followers and situation
Need For Leadership In Healthcare In Pakistan

• Developing countries
• Doubling burden of diseases
• Increasing environmental health problem
• To secure equity and access
• Balance between public and environmental health measure,
• Balance between primary and secondary health care
• Demand for high technology services of low return
• Financing sources and mechanisms to introduce
• Management of health personnel, numbers, education
Leadership Development
• Health for all leadership development in 1985 by WHO
• Report by institute of medicine

• “Shift from authority focused leadership to collaborative and team oriented

leadership has not been met with adequate leadership education and training”

• To cover gap between policies and plans and their implementation

• WHO developed a framework
Framework by WHO
Ecological Leadership

• To address new perspectives and problems.

• Public health leaders will need training at different times during their
professional career

• Leaders develop constantly skills and integrate these skills into leadership
activities

• Builds the capacity of the public health system

• This capacity building at personal, organizational, professional, community and
overall systems.

• Actively seek training opportunities for the changing needs

• Incorporate new skills into overall approach to healthcare systems

• The 4 set of skills they need for today and tomorrow’s

NLN Leadership Competencies Framework
1. Core transformational competencies

2. Political competencies

3. Trans organizational competencies

4. Team building capacities

Leadership Styles
a. Directive Behaviour
• Tell what , how, where, when to do
• Supervise performance

a. Supportive Behaviour
• Listen, provide support and encourage efforts
• Facilitate involvement in problem solving and decision making
 Styles of Leadership

Continues to direct and

support and facilitates closely supervise
subordinate efforts
But explain decisions and
share responsibility of takes suggestions and
decision making supports progress

turn over responsibility of gives specific instructions

decision making to and closely supervise task
subordinates accomplishment
 Attributes of a Leader
Understanding international health and health
development Having a vision, critical thinking, forecasting,
se of opportunities, resources, collaboration, analysing, how to get and use informations
partnerships, nationally and internationally Vision
Planning and managing change and
Enhancing allocating resources, setting priorities,
enhancing, nurturing and and sharing Enabling
transforming these change identifying resistance, evolving
leadership
attributes in others consensus

Leadership
Peers, colleagues, supervisors,
self-confidence, positive attitude, politicians, communities,
willing to change, maintain values, Changing Working
governments, partners
continuous self development itself with others

Commun
listening to groups, communities, presenting icating
ideas, analysis, proposals, adaptable and
sensitive to cultural values
 Levels of Leadership in Health
• Federal ministry
makes policies and plans, budgets, major programmes
functions at higher level are broader in scope

• Provincial ministry
Policies, Health services delivery, budgets, major programmes

• District level
functions; service delivery, supplies, health care personnel matters
• PHC level
Medical officer, HC personnel, involved n direct contact with people

• Community level
Good relations with members of community

• Physician at BHU
leader for staff and community
Hierarchical frameworks and leadership
support
• Hierarchical structures of authority and responsibility

National Leader

Provincial leader

District Leader

Community
Leader
Prerequisite Education And Knowledge Of
Health System
• Technical requirement
In PHC is well known, endemic, health education, maternal, child, FP,
immunization etc.
• Social requirement
very complex, needs abilities to reach out to communities, other sectors, vertical
components of health system above and below
social aspect of PHC leadership, most deficiencies and difficulties of leadership
observed
Formal Training In Management
• Formal education
complementary, one alone is not sufficient, provides foundations
organization, supervision, external relationship, coordination, evaluation,
most leaders in PH do not have formal training

• Field/work experience
provides learning opportunities, but tells the half story
more enlightening when built upon formal medical education
Situation Of Leadership Training In Medical
Education
• Medical education around individual Dx, and management
• PH Departments at medical colleges weak in terms of staff and students time at
department
• Very little instructions on health care system and management
Evaluation of Leadership
• Evaluation of process
• To understand how and why something works, so how to improve outcomes
• To avoid repeating mistakes
• Transfer best practices

• Evaluation of outcome
• Desired outcome achieved, to what extent
• At the end of programme
Evaluation Of Leadership Networks
1. Peer leadership networks
Peer leaders connected by shared interests
share information, advice, support, collaborate
Leadership programmes catalyze peer leadership networks
To expand leadership networks
2. Organizational leadership networks
• Within organization:
• informal ties among employees
• To get advice, ideas, resources to solve problem quickly
• To enhance performance
• Interorganizational networks
• Organizations with shared interests
• To produce a product or deliver an efficient service
3. Field policy leadership networks
• Shared interest to influence a policy or practice
• They seek to shape environment, framing an issue
• They work around common grounds to mobilize support
• influence policy, allocation of resources
4. Collective leadership networks
• Self-organized, social ties, around common cause or shared goals
• Local groups form networks to expand
• They get a sense of community and purpose
• To achieve a specific goal
• Each member belong to something larger than oneself
Leadership and Community Development
• Communities benefit from improved leadership
• Substantial improvement in communities development , even if not totally
transformed
Assumptions For Developing Community
Leadership
1. Participative decision making is more productive than central decision making

2. Planned and collaborative change more desirable than unplanned or adhoc

change

3. Process of planned change can be learned by most communities

4. Potential leadership in every community can be activated

by knowledge, skill training and leadership experience

 Role Of Public Health Professional In Community
Development
• Following roles are expected from A PH leader;

1. Catalyst
help community to recognize problems and opportunities
generate interest in improvement of local ability
2. Process helper
to assess locals in designing and implementing process
3. Resource-linker
to locate financial, technical resources
to help establish links between local and outside resources
4. Expert
knowledge, skills, expertise applicable to solution of the
communities , realization of opportunities
efficiently assist communities in understanding there abilities
Basic Principles Of Leadership For Community
Development
1. A systems perspective
aware of community, environment, integrated social system
community development more likely to succeed
informal primary groups along formal boards and committees
2. Local perspective
every community ----- unique local factors
structure of community organizations according to the needs/factors
neglect of local members---- programmes unlikely to succeed
3. Community involvement
active involvement of community members
suggestions/advice/proposals outsiders--- final decision by locals
effectively use knowledge and skills of local members
4. Awareness of community culture
values/principles,
ideas and actions aligned with social, political, economic and
ecological systems of community
5. Minimization of conflicts
inherent to any programmes is probability of conflict
resistance to change
computability of programmes wit beliefs, values, attitudes, needs
and expectations of the community
6. Relevance to local needs
strongly felt needs, interests, problems of community
programmes more likely to succeed
 Resources
• Text book of Public health and Community Medicine by Ilyas and
Ansari
Challenges to Public Health Leaders
Participants discussion- activity
• Lack of trained staff> Docs, paramedics
• Lack of resources
• Lack Infrastructure
• Lack of policy
• Lack of public awareness
Challenges to Leadership in Healthcare
Societal and System Wide (Macrolevel)
1. Demographic and epidemiological transition
2. Growing and shifting supply and demand patterns
3. Advances in science and technology
4. Political and economic change
5. Corporatization and privatization
6. Increasing costs
7. Crises in human resources for health
• Demographic and epidemiological transition
• Population growth
• Ageing population
• Rise in chronic, non-communicable disease and lifestyle-related health issue
• High disease burdens and poor health indicators
• Growing and shifting supply and demand patterns
• More patients with complex needs requiring multiple healthcare providers
• Hospital capacity issues
• More knowledgeable and health-literate consumers
• Higher expectations from healthcare organizations (value-for-money)
• Increasing dissatisfaction with healthcare system
• Greater treatment affordability, increased medical tourism, growing
health insurance use, rising incomes
• Inequalities in access to healthcare
• Advances in science and technology
• New Information and communication Technology systems
• Innovations in healthcare services and delivery
(electronic medical records, telemedicine, internet-based care, hospital and ward redesign)
• New categories or specialization of service providers
• Greater integration and interdisciplinary teams
and collaborative healthcare practice
• Political and economic change
• Adapting to changes in government and health sector reforms
• Decentralization of healthcare
• Budget constraints, measures to avoid deficits
• Disconnection between population needs and resource allocation
• Lack of or increasing collaboration between governments, health providers,
community representatives and other stakeholders to address the needs of
healthcare systems
• Shifting to patient-focused care; greater attention to community health and
addressing social determinants of health
• Corporatization and privatization
• Emergence of new business models for healthcare; Public–Private Partnership
(PPP) models
• Move from independent health organisations to large, networked health systems
• High or uneven demand for specialist tertiary care
• Growth of the private sector; competition for
health professionals
1. Increasing costs
Healthcare costs
Managerial costs
Costs associated with developing
new programmes
• Crises in human resources for health
• Shortage of trained health personnel, out-migration of skilled health workers
• Lack of effective retention strategies and poor working conditions
• Challenge to maintain health services with appropriate skill mixes
• Limited resources and health infrastructure and their maintenance
• Deficiencies in health information systems
Organizational (Meso level)
1. Human resource management challenge
2. Changes in organisational structures and measures
3. Intensification of front-line and middle management work
• Human resource management challenge
• Inefficiency and insufficiencies in provision of health services and use of
resources; increased demands for efficiency and cost-cutting
• Barriers to implementing lean healthcare: outsourcing hospital activities,
limited knowledge of lean
• Inadequate planning and performance evaluation systems; poor
talent identification; poor deployment and underutilization of staff
• Lack of support and opportunities in management training and
leadership development within organisations
•Poor quality of services or concerns
of declining quality;
poor culture regarding patient safety
• Changes in organisational structures and measures
• Dominant hierarchical culture
• Selective recruitment into leadership positions; need for robust succession
planning and management
• Excessive bureaucracy or lack of transparency
in organisational rules and processes
• Inadequate systems to prevent and control healthcare associated infections
(HAIs)
• Target-driven approach to performance measurement
• Fee-for-service payment models encouraging volume not quality of care
• Value-based payment models, other new payment models
• Intensification of front-line and middle management work
• Broad responsibility; balancing clinical, teaching, research and
management roles
• Long working hours, unpredictable work patterns, tight deadlines,
stress and reduced productivity
• Difficulties of middle-level and front-line managers to operationalise executive
strategic directions and initiatives
(lack of incentives, lack of support,
resource constraints,
conflict between organisational priorities and employees’ own goals and values)

• Informal and shared leadership in the front-line in the absence of formal

management
Individual level (Micro level)
• Shifting health manager role
• No universal standard definition for a health manager nor defined competency
standards
• Lack of transparency and accountability
• Increasing dual clinician and manager
and leadership roles
• More physicians becoming senior healthcare managers
• More non-physician health managers, new types of professional healthcare
managers
• Figueroa, C.A., Harrison, R., Chauhan, A. et al. Priorities and
challenges for health leadership and workforce management globally:
a rapid review. BMC Health Serv Res 19, 239 (2019).
https://doi.org/10.1186/s12913-019-4080-7
Thank you