Core Competencies

4.12 Healthcare Systems: Leadership in Healthcare

Introduction

Healthcare is complex and dynamic. As such, it requires leaders who understand its multiple components, including highly technical professions, longstanding institutions of care and education, third-party payers, and large supporting industries. Regulatory frameworks, fragmented incentives, and multidimensional determinants of health serve to further complicate healthcare processes. Leadership is a broad construct that involves individuals, interactions, and change. Leaders motivate and influence others using a combination of virtuous behavior and process-oriented management of change. Pediatric hospitalists are required to be leaders on a daily basis, in communication, interprofessional practice, high-performing teams, operational efficiency, quality improvement efforts, and family centered care. They often are involved in administration, where additional competencies in business and strategy are also useful. Pediatric hospitalists work in the most complex and expensive part of the healthcare system and are therefore well positioned to lead at the bedside, in programs, and in the larger healthcare system.

Knowledge

Pediatric hospitalists should be able to:

  • Identify some common models or styles of leadership, such as transformational, transactional, autocratic, laissez-faire, task-oriented, and relationship-oriented leadership.
  • Review the impact that differing leadership styles may have on quality improvement and patient safety efforts.
  • Compare and contrast leadership styles with communication styles.
  • Illustrate how utilizing leadership skills enhances performance when working clinically at the bedside, as well as when leading projects, programs, or other larger efforts.
  • Identify the key aspects of a high-performing healthcare system, attending to continuous learning, equity, cost, patient experience, access, clinical quality, and patient safety.
  • Identify the key aspects of a high-performing team, attending to mutual respect, recognition, communication, cohesion, mutual support, and situational awareness.
  • Describe the importance of task and role clarity in team performance.
  • List factors that impact team dynamics.
  • Explain how respecting dignity and embracing cultural diversity in the context of family centered and interprofessional health care is central to effective leadership.
  • Compare and contrast between leadership and management.
  • Explain the importance of setting vision and strategy in leadership.
  • List examples of commonly used group decision-making techniques, such as brainstorming, nominal group, Delphi, and dialectical inquiry.
  • Define “change management” and review the role of leaders as change agents for projects and quality improvement processes.
  • Discuss the impact of effective leadership of interprofessional teams on hospital daily operational efficiency and throughput.
  • Describe the impact of effective leadership on quality improvement efforts, patient safety, high value care, hospital business, and population health outcomes.

Skills

Pediatric hospitalists should be able to:

  • Demonstrate effective leadership skills in communication, de-escalation and conflict resolution and management of team dynamic problems.
  • Lead family centered rounds with an interprofessional team.
  • Execute efficient operations, such as hospital throughput, in collaboration with hospital administrative initiatives.
  • Collaborate in interprofessional improvement initiatives.
  • Demonstrate basic skills in leading an effective meeting that results in a specific outcome, decision, or action.

Attitudes

Pediatric hospitalists should be able to:

  • Realize the value of cultural and professional diversity in interprofessional practice and family centered care.
  • Model self-awareness, ethical behavior, integrity, and inclusiveness.
  • Reflect on the importance of leadership as a journey of self-development.
  • Exemplify effective delivery and receipt of constructive feedback.
  • Recognize the interaction between business performance, healthcare delivery, and clinical outcomes in an evolving health care landscape.

Systems Organization and Improvement

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

  • Lead, coordinate or participate in efforts to expand education and mentorship in leadership skills in pediatric hospital medicine.
  • Participate and lead where appropriate in division, department or group, and hospital level committees to advocate for care of hospitalized children.
  • Collaborate with and actively participate and lead where appropriate in medical staff related activities.

References

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