Healthcare today is a high pressure, complex and very competitive industry – even in countries with universal, publicly funded systems. In a business that lives at the increasingly intricate intersection of individually complex issues such as patient experience, value-based reimbursement, information privacy, digital health, employee/physician engagement, social determinants of health and evidence based medicine, we seem to have forgotten about the one critically important resource that brings it all together.
This week’s blog is about how we’ve lost our way in healthcare, always searching for that silver bullet that will fix our problems – and why we should consciously focus on looking inward and mending the leadership gap that exists widely in healthcare organizations…especially in hospitals.
The search for the silver bullet
Running a successful healthcare organization is complicated. There are so many stakeholders, often with conflicting goals and perspectives. While many people insist that, if we’d only be stronger, wiser and more determined, there would be sufficient money – the truth is that the conflicting priorities of the many stakeholders are such that we’ll never be able to please them all. The array of treatments and technologies that are available these days is virtually limitless – while ability to pay (either publicly or privately) certainly isn’t.
For decades, healthcare administrators have searched for the silver bullet that would “fix” healthcare. Lean, six sigma, reengineering, big data, analytics…hospitals have spent millions on implementing such initiatives with very little long term proven ROI. In 2008, close to the peak of the Lean wave sweeping healthcare, the province of Saskatchewan moved to a province-wide implementation of Lean …promising to improve efficiency, eliminate waste and improve employee engagement. By 2015 it became clear that, once again, this latest program wasn’t the silver bullet. A new study “showed that Lean doesn’t help patient satisfaction, health outcomes, and hurts worker satisfaction.” It also cost the system more than it saved.
Just as many people think that more things, more stuff, will make them happy, healthcare is renowned for buying into new programs and chasing after the next shiny object. Any one of hundreds of companies or programs can help you drive efficiency, patient experience etc. in the short run…but rarely do these initiatives result in long term, sustainable change, simply because there’s no fundamental change in leadership behaviour.
Healthcare needs great leadership
Peter Drucker notoriously said that healthcare organizations are the most complex organizations to manage ever devised. Hospitals have been described as complex adaptive systems with multiple agents and conflicting agendas. While consultants and individual projects may help address some specific organizational gaps, such as implementing a new IT system, the only way to long term, organization-wide improvement is with strong, competent leadership at the top – leadership that also listens to and makes use of strong, competent leadership from middle managers and clinicians.
A few people get it. Most don’t.
Getting your MBA doesn’t make you a good leader
Leadership has been defined as “…a process of social influence, which maximizes the efforts of others, towards the achievement of a goal.”
At the heart of our leadership drought in healthcare is the reality that leadership itself is barely seen as a profession/discipline at all. There’s broad perception that you can take anyone, give them a few leadership courses and they can be a decent leader. But…
- Taking a leadership course doesn’t make you a good leader
- Getting your MBA doesn’t make you a good leader
- Having a CEO/manager/director/VP title doesn’t make you a good leader
- Being a good clinician, doesn’t necessarily make you a good leader
- Being successful in a single high profile project or initiative doesn’t necessarily make you a good leader
While leadership courses certainly help, becoming an effective leader takes experience and ongoing commitment to being a good leader – as well as continuous learning, personal reflection, listening well and hard work.
Unfortunately, in healthcare, we rarely promote based on previous leadership effectiveness. Mostly, we take good clinicians and “promote” them into leadership roles with a sink or swim mentality. Most organizations provide some basic leadership courses, but there’s little in the way of leadership evaluation or coaching going on.
There’s even a disturbing trend in Canada whereby physicians or politicians are appointed to CEO roles in hospitals with little or no proven leadership skills or experience. While they may connect well with their colleagues and patients…leadership is missing. Increasingly the CEO role in Canadian hospitals has become a political role. Their focus is often on political connections, individual tasks, systems, interventions, programs and endless restructuring – not sustained, evidence based leadership and management.
“Wellness” isn’t a program you buy
As an example, consider “wellness.” Employee/physician wellness is one of the hottest topics in healthcare organizations these days is– particularly since statistics on provider sick time and burnout are alarming. Most organizations have quickly jumped on the wellness bandwagon by buying/implementing some sort of employee & physician wellness program. Some have even gone as far as hiring a Chief Wellness Officer…to work alongside the Chief Innovation Officer, the Chief Strategy Officer, the Chief Patient Experience officer, the Chief Privacy Officer….OK, I’ll stop there; my cynicism is showing.
Organizational wellness isn’t a program you buy, it’s a way of thinking and behaving. Successful companies with great leadership have come to grips with the fact that it’s more about organizational culture…and have made efforts to build a culture of wellness, engagement and mental health well-being in the workplace. They address critical factors such as hours of work, perverse incentives, worker frustration and inability to disconnect from work – as well as focusing on building connections and meaning into the work itself.
We need to find our way back to good leadership
The leadership problems in healthcare aren’t just a matter of inference from our current state of affairs, they’re actually well documented.
As an example, consider the scandal associated with the NHS and severe failings in care in Mid Staffordshire hospitals in 2012/2013. A comprehensive investigation and report attributed the problems to a culture of poor communication, blame, lack of engagement and a litany of other operational shortcomings…summarized simply as bad leadership at all levels.
Unfortunately, it’s unlikely that we’re going to change the thinking of the senior leaders in government and healthcare today. Many of their views are just too entrenched and they have too much invested in the status quo.
My hope rests with the next wave of leaders. Many of the newer and developing leaders I’ve encountered in my business and on social media are highly interested in developing themselves as leaders, not just pointing to what others should do. They’re interested in listening and learning. Millennials, in particular, seem less influenced by titles than previous generations and more interested in evidence and balance.
So…to all the new and developing leaders out there (and the really committed and reflective senior leaders), keep the conversation going and let’s work to bridge the leadership gap in healthcare.
This article was written by Renate Ilse and published on the leadership blog at Ilse Zorn & Associates.