Leadership in healthcare

Student Number: 3226029

AHP_6_011 Leadership for Allied Health Professionals

At the opening ceremony of the Singapore Healthcare Management Congress 2013, Singapore Health Minister Gan Kim Yong said that strong management capabilities and leadership quality in the healthcare sector are extremely crucial to lead the growing healthcare needs of an ageing population, constant threat of global pandemics and rising non-communicable diseases. There is a need to constantly innovate and find ways to keep the population healthy and deliver the healthcare services more effectively (Gan, 2013).

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“One of the things that a leader needs to learn is that the traditional models of leading change are not very effective.” (Kent, 2014). The context for healthcare is changing due to changing expectations, changing disease profile and greater emphasis on ‘predict and prevent’ (Hartley, et al., 2008).

Definition of Leadership

Leadership in healthcare can be viewed in many different ways. Clinical leadership can come from hands-on care, from maintaining clinical expertise and may sometimes be separated from management with the goal of leading staff through transformational change to develop better services for the local community (Bishop, 2009). In the recent years, leadership is seen as something to be used by all but at different levels (National Leadership Council (NLC) Clinical Leadership workstream, 2011). It can be described to be a team effort (The King’s Fund, 2012) or also known as “sharedness” of leadership processes (Wang, et al., 2013) in an organisation. Shared leadership is displayed in terms of mutual influence, shared responsibility among the staff and leading each other towards the goal achievements. Shared leadership expands the extent of leader prototypicality (Wang, et al., 2013) as team members are given a chance to take on decision-making process and leadership role.

“Gone is the heroic individual with a monopoly on the vision; it is replaced by a commitment to building shared visions with a range of stakeholders.” (The King’s Fund, 2012).

Wang, et al., (2013) divided shared leadership into 3 categories which are shared traditional leadership, shared new-genre leadership and cumulative, overall shared leadership. The subgroups on the types of leadership under each category such as

transactional, visionary and transformational leadership can be seen in Appendix A.

Shared traditional leadership is where the leader uses methods such as contingent rewards towards staff to achieve team goals and satisfy staff’s needs (Wang, et al., 2013). Shared new-genre leadership emphasizes transformational, visionary and charismatic leadership which empowers the staff towards development and change (Wang, et al., 2013). Cumulative, overall shared leadership is displayed within the team level, in which each individual team member demonstrate a degree of leadership.

Importance of leadership

Leadership is important as it can determine the functionality of a basic team unit as it strongly influences key team processes. It can determine and clarify the objectives of the team, giving the team a clear view on the goals and the pathways to take to achieve the goals (Hartley, et al., 2008) such as improving patient experience and outcome (NHS Institute for Innovation and Improvement, 2011). Having leadership can encourage participation from the staff, allowing the staff to contribute and pool great ideas, supporting innovation in the team. It also enhances the commitment to quality, as having a leader ensures primary quality objectives are met in the day to day workings within the staff (Hartley, et al., 2008).

Guidance to the changes in the healthcare in many aspects

There are many aspects of healthcare that are constantly changing such as new techniques and technologies in healthcare. As such, there is a constant need to find new ways of working within and across teams, and with patients (Hartley, et al., 2008). Therefore, strong leadership that support a vision for change with a clear articulation of what needs to be achieved, by whom and with what, would likely to succeed in healthcare organisations (Gifford, et al., 2013).

Leadership is also crucial when it comes to finding new approaches to continuous improvement which rely a lot on ‘people management’ (Hartley, et al., 2008). Bishop, (2009, p. 83) stated that leadership in Allied Health is no longer just about ‘managing’ the service and being a ‘therapy lead’, it is about leading the staff and the service to a new position. To achieve this, clinical leaders such as nurse educators, clinical nurse specialist and practice developers are to influence research use through their roles in mentoring, providing information and assisting in the development of policies and procedures to support professional practice (Gifford, et al., 2013). Leaders have to constantly think of methods to support staff so as to make and sustain improvement efforts in order to improve service to the patient. This is important because patient’s expectations have increased as the healthcare industry develops over the years.

Future-looking system

There are new challenges in healthcare such as the kinds of illnesses or even trends are changing (Hartley, et al., 2008). Leadership is important to anticipate rather than just react to changes in demographic and disease profiles (Hartley, et al., 2008). Leaders have to anticipate the multiple diseases associated with a larger elderly population and chronic diseases due to lifestyle choices such as obesity. For example, the rising numbers of cancer cases in Singapore as reported in The Straits Times (Lai, 2014) was made known to awareness among the public.

Networking

Gantz, et al., (2012) stated that collective leadership complements healthcare globalisation. They recognised healthcare globalisation as a way to close disparity gaps and improve public health on a global scale through resource and information sharing. There are new health goals where ‘treatment’ is not the only goal now but also ‘predict and prevent’ illnesses for the public health (Hartley, et al., 2008). As such, there are more hospitals that network with each other and disseminate evidence-based practices throughout their regional and local communities (MacPhee, et al., 2013). Therefore, leadership is important to shape these new goals and to ensure that there is a close link between ideas and practice on the front-line and between different partners.

Clinical decision making

According to Hartley, et al., (2008), leadership clarity is associated with better team processes, and with actual innovation – and ambiguity about leadership was associated with low levels of innovation. This corroborates the view of the role of leadership in helping to create compelling direction and ensure participation of team members in decision-making (Hartley, et al., 2008).

One of the thing that a leader needs to do is to make good decision based on in-depth understanding of all the constituent parts, all the tradition and cultures that accompany the existing professional structures and values (Bishop, 2009, p. 83). Therefore, it is important for a leader to have good decision-making skill so as to have a smooth efficient workflow and quality service.

In Singapore’s healthcare setting, although the decisions made are largely based on the patients’ choice, their family members still exercise significant influence over the level of revelation of prognosis information and final action taken (Foo, et al., 2012). Familial-centred approach is common in Asian setting especially if it involves poor prognosis. As such, a leader in this situation has to consider the various views and make a final decision that gives the best outcomes for the patient and family, even if it means that they have to withhold information about patient’s expected poor clinical outcomes to the patients (Foo, et al., 2012). Good decision-making is achieved based on the good understanding of the culture and tradition of the context. The need for decision-making may arise at any one point while in a clinical setting.

For example, the below anecdotal incident (see Appendix B) about clinical decision-making is analysed using Gibb’s reflective cycle (Waugh, 2013) (see Appendix C). The incident is about a disagreement I had with a senior colleague about him deviating from the treatment protocol regarding the verification of the treatment area. I felt frustrated that I was the only one wanting to do the right thing and find a solution despite voicing out my concerns. After the incident, I felt sad and unjust that my colleague was angry at me for refusing to proceed with the treatment.

The positive experience was that my decision prevented an incident report and an inaccurate delivery of radiation dose. I stepped out of my comfort zone and voiced out my concerns to the oncologists. Conversely, my long decision-making time resulted in a queue of patients and delayed appointments.

According to the Fielder’s contingency model (see Appendix D), I am a task-oriented leader, and the incident calls for a leader with a low Least-Preferred Co-Worker (LPC). As such, I’m a fitting leader for the task as I handled the situation which prevented errors from being made in the treatment.

On the whole, I took a long time to make my decision waiting for my colleague to share his opinions, which turned out to be fruitless. Such disagreements can be avoided if there are mutual understanding and better treatment protocol knowledge. I should have sought assistance from the other seniors right away. After the incident, we had a discussion on the treatment protocols, directing more focus on the importance of protocols and the adherence to them should any similar incidents occur in the future.

Future leadership

Nobody stays stagnant in the workforce. For example, a radiation therapist from North Carolina realised that he needed more leadership skills when he progressed from the treatment aspect to administration and then managing (Robert Wood Johnson Foundation, 2013). The King’s Fund (2012) refers to leadership as a ‘cognitive catalyst’, where the leader’s choice of actions and ideas are focused on as learning points in order to spur learning in the work place by the other team members.

In order to change an organisation, leaders need to change themselves first and be open to changes. “If our leaders grow and help others to grow, our organisation will not only succeed in their changes efforts- they will be an example for other leaders and organisations around the world.” (Kent, 2014).

More leaders are required in Singapore because the healthcare service is expanding rapidly so as to cater for the aging population (Bishop, 2009). As such, the Ministry Of Health Singapore has launched a SingHealth Graduate Diploma in Healthcare Management and Leadership programme in Singapore Management University. It aims to groom a new generation of healthcare professionals who excel in both healthcare management and business leadership which is a skill that is high in demand in today’s evolving healthcare industry (Gan, 2013). Additionally, the Ministry Of Healthcare has also provide sponsorships such as the Healthcare Administration Scholarship (HAS) where outstanding scholars will be given opportunities to be developed for top leadership position within the public healthcare sector (MOH Holdings Pte Ltd, 2013).

Competency frameworks have also become a widely used approach to thinking about the skills of leadership. For example, the healthcare in UK are using the NHS Leadership Qualities Framework (see Appendix E) (National Leadership Council (NLC) Clinical Leadership workstream, 2011). It sets out the key skills or competencies for leaders in healthcare (Hartley, et al., 2008).

Leadership skills are seen to be very important in the healthcare industry worldwide so much so there are many studies and programmes to train future leaders to meet the demands of the ever changing and growing industry.

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