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Instilling Clinical Leadership, Ownership and Accountability

Instilling Clinical Leadership, Ownership and Accountability

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Instilling Clinical Leadership, Ownership and Accountability

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  1. Instilling Clinical Leadership, Ownership and Accountability

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. Culture • Familiar and comfortable with the doxa • Socialstability 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

  9. 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.

  10. 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

  11. Professionhood • A commonality of characteristics which circumvent the formality of operational structure • Leadership characteristics can not be formalised

  12. 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

  13. 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

  14. 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

  15. 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

  16. Sharing the leadership role • Sharing of power • Involvement in executive decision-making • Involvement in strategy • Determination of organisational priorities • Allocation of resources and funds

  17. Sharing of leadership • Collaboration Hesselbein • Individuals do nothing alone • Individual motivating capabilities and • Large group/organisational motivation Shortell • Leaders as change agents Pfeffer

  18. 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”

  19. 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

  20. Clinical Leadership • Set direction • Establish standards • Integrate agreed values • Setting ethical boundaries • Change agent • Transformational and situational • Establish trust

  21. Obligation Having the skills to lead is an obligation of leadership in public healthcare organisations Assuring the public’s confidence in the services provided

  22. Accountability Accountability is demonstrated through professional maturity in the forms of: • Leadership • Credibility • Education • Experience, including life experience • Metaliteracy – many perspectives

  23. Professional maturity

  24. Leadership in the context of governance

  25. 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

  26. 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