Instilling Clinical Leadership, Ownership and Accountability

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

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

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

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

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

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

Culture Familiar and comfortable with the doxa Social stability 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

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.

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

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

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

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

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

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

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

Sharing of leadership CollaborationHesselbein Individuals do nothing alone Individual motivating capabilities and Large group/organisational motivation Shortell Leaders as change agentsPfeffer

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”

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

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

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

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

Professional maturity

Leadership in the context of governance

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

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