Book: The Business of Healthcare

Kenneth H. Cohn, Douglas E. Hough Greenwood Publishing Group, 2008

Characteristics of Leaders Harsdorff and colleagues evaluated approximately 800 acknowledged leaders from different U.S. business sectors, including healthcare. 31 The universal finding or traits that correlate with successful leaders are: Absolute personal integrity, including the ability to keep confidences. The ability to innovate. The ability to build partnerships in times of limited resources. Superior intelligence. The ability to hire and develop the best talent available.

National Health and Medical Research Council (1991) National Statement on Ethical Conduct in Research Involving Humans. Canberra. p.6.

Quality ASSURANCE ?
An activity where the primary purpose is to monitor, evaluate or improve the quality of health care delivered by a health care provider (an individual, a service or an organisation) is a quality assurance study. QA should be an integral part of all health care delivery.

Guideline on Implementation Of Quality Assurance System in Health Facilities Ministry of Health, Thimphu Bhutan, First Edition: 2007

Quality: means developing statements regarding the input, processes and outcome standards that the health care delivery system must meet for its population in order to achieve optimum health gains.

QUALITY MANAGEMENT FOR HEALTH CARE DELIVERY By Brent C. James, M.D.

Quality Management for Health Care Delivery provides a

framework to help hospitals organize for, communicate about , monitor, and continuously improve all aspects of health care delivery. It also presents evidence to support the proposition that an organized system to achieve high quality care can lead to lower health care costs. In the present national environment a highly structured approach to the pursuit of quality is essential.

MANAGING CHANGE IN ORGANIZATIONS NILANJAN SENGUPTAMOUSUMI S. BHATTACHARYAR. N. SENGUPTA

Explain the change process?

Change may be initiated by a crisis in the organization, new demands placed on the organization, or innovation proposed by someone in the organization. The old ways are opened to questions, and the climate for change exists. Change occurs through a random process of looking for new solutions, or a planned approach to solving a problem. members accept the new situation.
The following steps will help you successfully introduce and implement a change in your organization:

I. Preparation: Anticipating key elements II. Planning: Getting people together to plan the response III. Transition Structures: Establishing special ways of working together and temporary organizational structures IV. Implementation: Activating a flexible response and learning cycle V. Reward: Acknowledging the people who made it work

I. PREPARATION:
1. 2. 3. 4. 5. Prepare your employees. Describe the change as completely as you can. Research what happened during the last change. Assess the organizational readiness of your team. Don't make additional changes that aren't critical.

II. PLANNING:
1. Make contingency plans. 2. Allow for the impact of change on personal performance and productivity. 3. Encourage employee input. 4. Anticipate the skills and knowledge that will be needed to master the change. 5. Set a time table and objectives so you can measure your progress.

III. TRANSITION STRUCTURES:

1. 2. 3. 4. Create a transition management group to oversee the change. Develop temporary policies and procedures during the change. Create new communication channels. Meet frequently to monitor the unforeseen, to give feedback or to check on what is happening.

IV.IMPLEMENTATION
1. Provide appropriate training in new skills and coaching in new values and behaviors. 2. Encourage self-management. 3. Give more feedback than usual to ensure that people always know where they
stand.

4. Allow for resistance. 5. Give people a chance to step back and take a look at what is going on. 6. Encourage people to think and act creatively. 7. Look for any opportunity created by the change. 8. Allow for withdrawal and return of people who are temporarily resistant. 9. Collaborate. Build bridges from your work group to other work groups. 10. Monitor the change process.

V. REWARD:
1. Share the gains. 2. Create incentives for special effort.
3. Celebrate by creating public displays that acknowledge groups and individuals
who have helped make things happen.

Guideline on Implementation Of Quality Assurance System in Health Facilities Ministry of Health, Thimphu Bhutan, First Edition: 2007

The Quality Assurance Process The main common assumption behind national and international QA initiatives is that QA activities are good for the system; they help to increase effectiveness and efficiency and to control costs. The essence of any QA approach involves the measurement of actual performanceand its comparison with expected performance and the implementation of changes to improve the delivery of health services and, consequently of health status. These would further guide and aid in setting standards, measuring and improving quality. This process also focuses its attention to internally caused and solvable problems. This mechanism can now be used to initiate the QA process .

The most crucial part of this is that staffs acquire confidence and necessary knowledge and tools to initiate the QA process in their work place. At the end of each stage staff will be able to commence the following activities: 1. establish a multi-disciplinary Quality Action Team in their institution 2. increase staff awareness about the importance of Quality Assurance 3. initiate the process of monitoring patient defined indicators, including data collection, analysis and interpretation 4. use this information as a QA tool to aid local decision making and encourage a multidisciplinary, teamwork approach in solving problems relating to quality of health service delivery. 5. assess progress made since the initial implementation of the quality checklists 6. incorporate lessons learnt into developing more effective strategies and improve plans for next quality initiatives 7. strengthen skills in problem identification, analysis and solution 8. stimulate QA awareness in other areas of the hospitals and clinics by considering professional quality factors After the implementation process, health facilities will have reached a state whereby the QA system will have become part of the routine health care delivery system. Monitoring and Evaluation will be carried out periodically to improve and sustain the QA activities

Leadership Styles and Their Consequences D. D. Warrick University of Colorado

Leadership Styles
The 5 styles of leadership summarized here are: Autocratic, Democratic, Evaluative, Participative, and Laissez-Faire. Each has its strengths and challenges.
AUTOCRATIC

An autocratic leader dictates tasks and timelines to a group and imparts a strong focus on an objective. At best, the autocratic leader leads a team to success under tight timelines and can be especially functional for a team with inexperienced and/or unskilled members. At worst, the autocratic leader denies input from all others and can dominate both task strategy and credit for success. What situations in your community might benefit from the autocratic leaders approach?
1- DEMOCRATIC

The democratic leader involves team members in planning and decision-making, often through a formal information gathering and/or voting process. At best the democratic leader encourages ideas and input from all team members and motivates teams toward success. At worst, the democratic leader can leave out

input from less aggressive team members and override feedback from members once a decision is made. Democratic leaders should be skilled in conflict resolution techniques to illicit the optimum performance of a team.
What situations in your community might benefit from the democratic leaders approach?
2- EVALUATIVE

An evaluative leader focuses on information gathering and research from team members and external sources in order to reach the best decision with a rationale to support it. At best, the evaluative leader seeks expertise from within their team to form decisions and shares an appreciation for inquiry and competence with the team. At worst, evaluative leaders may disregard some members input. Evaluative leadership requires flexible and open cooperation to be effective. What situations in your community might
benefit from the evaluative leaders approach?
3- LAISSEZ-FAIRE

A Laissez-Faire leader gives little or no direction while providing feedback when prompted by team members. At best, the laissezfaire leader promotes an acute sense of competence and expertise in team members and allows others to rise to their performance potential. At worst, this style can lack accountability for team failures and not adequately coach members to success who may be uncomfortable in a self-directed environment by appearing to not care or be too busy to properly lead.
What situations in your community might benefit from the LaissezFaire leaders approach?

4- COLLABORATIVE

The collaborative leader uses consensus building and other group process to arrive at mutually beneficial decisions to maintain team motivation and buy-in. At best, participative and collaborative leaders are viewed as endeared colleagues by their team and maintain individual team members sense of value and contribution. At worst, participative leadership can botch the consensus process and fail to manage conflict among the group, thereby failing to reach a decision or a task objective.

5- Collaborative leadership requires the ability to unite groups of

interested and capable people around a common need or vision and to facilitate the formulation of solutions and actions as determined by the group.

Differences Between Being a Manager and Leader

Leaders and managers http://www.lesaffaires.com/uploads/references/743_managersleaders-different_Zaleznik.pdf Managers and administrators have strong organizational, time management, interpersonal, and financial skills. Summary of Warren Bennis view on the difference between leaders and managers.

The manager administers; the leader innovates. The manager is a copy; the leader is an original. The manager maintains; the leader develops. The manager focuses on systems and structure; the leader focuses on people. The manager relies on control; the leader inspires trust. The manager has a short-range view; the leader has a long-range perspective. The manager asks how and when; the leader asks what and why. The manager has his eye on the bottom line; the leader has his eye on the horizon. The manager imitates, the leader originates. The manager accepts the status quo; the leader challenges it. The manager is the classic good soldier; the leader is his own person. The manager does things right; the leader does the right thing.