Orvill Adams, Orvill Adams & Associates Incorporated
Orvill Adams and
Leanne Idzerda
Orvill Adams & Associates Incorporated
Managing doctors and nurses: do we
know what works?
Pressures for change
Health sector reform
change in health care financing decentralization
emphasis on primary care
emphasis on health promotion and disease prevention
Greater accountability
Improved performance
Greater efficiency
Improved quality
Orvill Adams, Orvill Adams & Associates Incorporated
3
Trends in demand for management
Management identified as a key strategy in Poverty Reduction
Strategy Papers
Donors assisting countries by providing technical support for the
strengthening of management
Emphasis on the development of support systems for
management
Evidence that improved management is a key factor in system
Key issues in management
Call for doctors to play a greater role in management and
leadership
In the majority of countries the senior managers are clinicians
with little training in management techniques
There is still a view among some doctors that the profession
should not be involved in management and instead should protect their autonomy
Physician managers are often not rewarded for management
and do not have good career opportunities
Nurses have a role to play as front line managers Imbalance of power between doctors and nurses
Orvill Adams, Orvill Adams & Associates Incorporated
5
Relationships in management: Tensions
Cultures – Medical and Managerial
Clinicians and Physicians in Management
Physicians in Management and Administration
Doctors and Nurses
Command – Team
Conflicting cultures
Medical Culture:
Autonomous decision making
Reactive approach to problem solving
Focus on individuals within the context of their biological,
psychosocial and sociological environments
Managerial Culture:
More collaborative and attempts to be proactive about problem
solving
A broad focus on needs of the institution or overall health care
system
Responsible for maximizing results across multiple stakeholders
Orvill Adams, Orvill Adams & Associates Incorporated
7
Management Process
“An ongoing series of activities concerned with
strategic goal setting, operational decision making
and resource allocation” (Buchanan, 1997)
The doctor as manager
Four key competencies:
1.
To participate in activities and contribute to the
effectiveness of their health care organization and
system;
2.
To manage their practice and careers effectively;
3.
To allocate finite health care resources appropriately;
4.To participate in administrative and leadership roles.
Orvill Adams, Orvill Adams & Associates Incorporated
9
Content of management
Management of medical staff relations
Efficiency practices
Quality management
Legal and regulatory issues
Liaison functions
Cost management
Decision making in uncertain situations
Clinical medicine
Organizational issues
Models of Physician Management
Medical Director
Consultant Manager
Consultant Coordinator
Clinical Triumvirate
Clinical Service
Divisional Directorate
Orvill Adams, Orvill Adams & Associates Incorporated
11
Comparative management practice
Literature suggests that in the UK and Canada the majority of
physician managers work part-time –up to 50% of their time in Canada
Clinical Directorate in UK vs. Dyad in Canada (a doctor and a
nurse or paramedic manager)
Dyad is less hierarchical works well in times of change
Doctors in the UK have a less collegial relationship with their
professional colleagues
Doctors in both countries have accepted that performance
management and quality of care are important aspects of their role (Fitzgerald and Dufour, 2008)
Developing skills and competencies
Modalities of training and education
One – on – one mentoring
Workshops
Seminars
Community service experiences Masters degree
Internal and external programs Trend towards internal programs
Internal programs reflect the values and culture of the
Orvill Adams, Orvill Adams & Associates Incorporated
13
Training and education programs
Certificate of Medical Management
Executive Graduate Certificate
Master of Medical Management
Master of Administrative Medicine
Health Executive MBA
Management capacity building
Successful programs:
Self-assess and critically analyze the context in which
change is planned
Simultaneously address organizational structures, systems
and processes together with training of individuals and
teams
Simultaneously build new systems while learning new roles
and competencies
Emphasize practical application of knowledge for building
Orvill Adams, Orvill Adams & Associates Incorporated
15
Factors affecting management
Insufficient coordination among managers
Inadequate support of senior management
Lack of timely information
Reward for mangers
Shortage of appropriately trained physician and
nurse managers
Role of Nurse Managers
Nursing management aims to ensure that a vibrant
and skilled nursing workforce can flourish and
respond effectively to the diversity needs of health
care recipients and the general public
Nurse managers are directly responsible for
managing nursing services
Orvill Adams, Orvill Adams & Associates Incorporated
17
Strengthening nurse manager satisfaction
Role development support Compensation systems Communication systems Education systems
Organizational climate
Providing nurse managers with autonomy over decisions that
work at the unit level
Building relationships, sharing decision making, sharing
knowledge
Building supportive teams
Lessons
1. Management is not about giving orders, but rather about finding
areas of agreement so that you can move forward
2. They must understand that managerial and professional
accountability are different
3. Responsibility and authority must be commensurate with each
other and they must be delegated as much as possible
4. Scheduling and keeping regular meetings with managers is
important
5. Involving nurse managers in planning and decision making for
the entire nursing organization provides them with executive role modeling
Orvill Adams, Orvill Adams & Associates Incorporated 19
Principles of Management
Selflessness
Integrity
Objectivity
Accountability
Openness
Honesty
Leadership
Competencies and standards that define a good
manager (1).
1.
Lead a team effectively
2.
Identify and set objectives
3.Communicate clearly
4.
Manage resources and work to achieve maximum
benefits, both day to day and in the longer term
5.
Make sound decisions in difficult situations
6.Know when to seek help and do so when
appropriate
Orvill Adams, Orvill Adams & Associates Incorporated
21
Competencies and standards that define a good
manager (2)
7.
Offer help to those you manage when they need it
8.Demonstrate leadership qualities through your own
example
9.
Manage projects
10.Manage change
11.
Delegate appropriately to empower others to improve
services and develop skills of the people you manage
without giving up your own responsibilities
12.
Consider and act upon constructive feedback from
References
Birrer, R. B. 2003. Becoming a physician executive. to be effective leaders, clinicians must first
adopt a new mind-set. Health Progress 84, (1) (57; Jan-Feb): 29-32.
Buchanan, D., S. Jordan, D. Preston, and A. Smith. 1997. Doctor in the process. the
engagement of clinical directors in hospital management. Journal of Management in Medicine 11, (2-3): 132-56.
Fitzgerald, L., and Y. Dufour. 1998. Clinical management as boundary management. A
comparative analysis of canadian and UK health-care institutions. Journal of Management in Medicine 12, (4-5).
General Medical Council. 2006. Management for Doctors. Guidance Document.
McAlearney, A. S., D. Fisher, K. Heiser, D. Robbins, and K. Kelleher. 2005. Developing effective
physician leaders: Changing cultures and transforming organizations. Hospital Topics 83, (2): 11-8.
Parsons and Stonestreet 2003. Factors that contribute to nurse retention. Nurs Econ.;21(3). Schwartz, R. W., Pogge, C., Gillis, S., Holsinger, J. 2000. Academic Medicine, Vol. 75. No 2. Smith, R., Grabham, A. Chantler, C. A conversation among, BMJ. Volume 298, 1989
Stergiopoulos, V., Maggi, J., Sockalingam, S., Teaching the Physician Manager Role to