Strategies for Clinical Leadership

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Strategies for Clinical Leadership

• Karl J. Krumm, Ph.D.
• krumm4002_at_aol.com

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Healthcare is changing in very fundamental and
important ways

• Technological advances
• Expanding knowledge base
• Customized care
• Refocus on managing chronic care
• Integrated Care models
• Renewed interest in self-management
• Increasing costs

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Changing Healthcare

• Traditional separation of clinical and management
  arenas fading.
• Boundaries of practice areas and professional
  practices shifting
• The importance of leadership is becoming
  increasing important at all levels of the
  healthcare system.
• Working as teams to improve care systems
• Clinical Leadership matters!

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Leaders at all Levels

• Positions of Leadership
• Assigned roles of authority
• Emerging Leaders
• Self selected and short term
• Opinion leaders
• Informal and long term

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Transactional Leader Style

• Traditional use of power and authority
• Directive
• Use of rewards and power
• Controlling
• Tends to be experienced as
• Arrogant
• Boastful
• Hostile
• Pressured

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Transformational Leader Style

• Enrolling and engaging others in the work
• Uses influence and personal power
• Appeals to internal motivation of others
• Invites input
• Tends to be experienced as
• Open
• Encouraging
• Warm
• Inviting
• Confident
• Handles pressure

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What do we know about Clinical Leadership

• Style and impact on Patient care
• Level of care
• Level of errors
• Style and impact on Staff Stress
• Level of staff stress
• Level of reported errors

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Leadership and Change

• Leadership needs to provide followers
• Something to believe in.
• Someone to believe in.
• Someone who believes in them.

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Something to believe in.

• Vision compelling picture to the future
• Mission a path to achieve that future
• Contribution a clear sense of what they are
  doing that makes a difference

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Someone to believe in

• Able to articulate a clear vision
• Has integrity
• Can be trusted

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Someone who believes in them

• Recognizes the effort and contribution of others
• Encourages others to act
• Rewards outcomes
• Provides Opportunities
• Delegates assignments

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Level Five Leadership
Level
Description
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Sustainable Change

• Understanding the Responses to Change
• Sustaining Change Efforts
• Making change stick

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Change Starts with a Ending

• Change begins with an ending
• A sense of loss
• Dis-Orientation
• De-Identification
• Dis- Illusionment
• Dis-Enchantment
• Neutral Zone
• New Beginning

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Challenge of Change

• Learn
• Promotes Change

OK Now What
Resist Promotes Status Quo
Maintain Promotes Caution
Change
So What?
Oh NO
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Resist Oh No!
Posture of Defensiveness or Posture of Healthy
Opponent

• Defensive, resentment
• Passive aggressive
• Grudgingly Compliant to Sabotage
• Im right, this is wrong.
• Reactive (over reactive)
• Angerblame

• Has an alternative point of view
• Change lacks alignment with personal values
• Sees faulty logic or assumptions
• Unconvinced that this is the right direction
• Keeps us honest

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Maintain So What?
Posture of Doubt/Uncertainty or Posture of Quiet
Support

• Skeptical
• Play it safe (Both sides)
• Head Down, wait and see
• Inactive, maybe helplessness
• Avoid and Deny and Hide
• In the Fox Hole
• Seen them come, seen them go
• This too shall pass

• Willing to play along, quietly
• Give change a chance
• Not active, but will support the change
• Suspend final decision on the decision or effort
• Remain open
• Often a late adopter

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Learn Ok, now what?
Posture of Driving Change vs. Posture of
Change Willingness

• I can do this.
• Innovator
• Committed
• Driving Change
• Proactive, feeling of power/influence
• Purposeful, outcome oriented
• Lets make this work
• Charge

• Some anxiety, but Lets go for it!
• Willful compliance
• Count me in
• Willing to get it my best shot
• Responsive
• Early Adopter
• Im behind you

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Choice

• We all can be in one of these places at some
  time.
• Remember that resistance is a natural response
  to any perceived threat.
• Threat is based on our underlying beliefs
• We can choose differently.
• There is no safe path in life, just different
  risks!

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Where do you spend your time?

• Focus on the people that are resisting change?
• Focus on the people who are in maintenancemode?
• Focus on those willing to make the changes?

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Where are the Leverage Points of Change?

• Why do change efforts fail to live up to
  expectations?
• Where are the real leverage point for lasting
  change?
• Where do leaders focus their efforts for creating
  lasting change?

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Creating Sustainable Change
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Sustainable Change

• Environment External influences, opportunities
  and constraints where things appear and occur
  outside of the systems chosen boundaries. In
  business, this includes the marketplace.
• Culture How things get done around here. The
  environment created within a systems chosen
  boundaries
• Capabilities Skills, experiences, aptitudes,
  patterns, and strategies that equip the systems
  members to act, respond, and perform.

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Sustainable Change

• Beliefs Deeply held (often unconscious)
  convictions about how things really work and why
  mental maps that prompt and motivate decisions,
  behaviors, and our relationships with others, our
  culture, and our larger environment
• Identity Core level of being how we
  envision, think about, and approach our unique
  sense of self and meaning. The template by which
  our beliefs are sorted and organized.

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Coaching for Change

• Establish rapport
• Posture of understanding
• Use Empathetic assertions
• Acknowledgment of their position
• Asserting the change
• Being unapologetic and insistence of making
  changes.
• Resilience and courage

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Making a Difference

• Given what you heard and experienced here, what
  do you want to commit to in your personal
  leadership to make a difference?
• ____________________________
• ____________________________
• ____________________________
• ____________________________