A prescription for efficient healthcare adminsitration
A modern health care organisation is a complex entity with numerous stakeholders having divergent interests. Managing these complex organisations requires individuals with a variety of skills and prime among them is effective leadership with a positive attitude, stated President of the College of Medical Administrators of Sri Lanka, Surgeon Rear Admiral NELW Jayasekera in his presidential address, on the occasion of the inauguration ceremony of the 20th Annual Scientific Sessions, held on March 15 at the Cinnamon Lakeside Hotel in Colombo.
The chief guest on the occasion was Defence Secretary Gotabaya Rajapaksa.
Explaining the programme for the scientific session, Dr Jayasekera said: "The theme for this year's scientific sessions is 'Towards better performing health care institutions'. This morning we had a workshop on 'Role of the Medical Administrators in delivering safe, effective and patient centered healthcare'. Tomorrow we will be having a full seminar with nine paper presentations and two symposia, followed by a post-scientific session on eHealth. Hence in essence, this year we will be having three full days, a first in the history of our College sessions".
He explained six performance dimensions of a health care organization as follows: Clinical effectiveness, customer orientation, staff orientation, safety, production efficiency and governance which includes leadership.
Dr. Jayasekera said his address was based on this last dimension titled, Medical Leadership in Sri Lanka: the achievements so far and a way forward"
In defining the concept of Medical Leadership, he said:
"Permit me to define leadership, before I discuss what Medical Leadership is. Among the many, Peter Northouse (2010) defines leadership as 'a process whereby an individual influences a group of individuals to achieve a common goal'. Medical Leadership is using the technical knowledge in medicine leading a health care organisation towards its common goal. However, I have realised that medical personnel particularly doctors with so many specialisations and sub-specialisations and divergent individual objectives are some of the most difficult groups to be led towards a common goal.
"I am confident that we all agree that effective leadership is essential for a high performing health system. However, Medical Administration, the specialty required to provide the leadership is less popular among doctors for a variety of reasons including remuneration. Further, military medicine is even more unpopular as evidenced by the number of doctors opting to join the military, even after the war is over. Hence, I guess that I being a military health administrator, I am a rare breed that no one wants to follow. However, with three decades of military medicine service, two decades of medical administrative service and over a decade of association with our college, I believe that I have sufficient expertise to discuss the progress so far and suggest a way forward". Our Acheivements
Describing the development of the discipline since the pre-independence period he said: "A landmark year in the annals of medical administration was in the year 1856 when the Principal Civil Medical Officer was appointed to lead the Civil Medical Department established to provide medical care for the general population.
"Hence, for almost 140 years since the creation of the first medical administrative post there was no formal management training given to doctors taking up administration. At the time, management skills had not been prominent in either the curricula or the appraisal systems of courses for medical undergraduate and post graduate students. During this period most doc- tors ended up in administrative positions as they became senior without any formal management training.
"Today we have 138 MO's who have successfully completed the master's degree, of which 18 have completed the doctorate in Medical Administration. Despite these developments only about 20% of the state sector health care institutions are manned by medical leaders who have had a formal training in Medical Administration.
"Hence, it is evident that the importance of developing management skills in doctors has been realised, and the demand by doctors to pursue a career in leading health care organisations is growing. However, a key question discussed in many circles is whether we are producing the desired type of leaders for optimum performance at all levels in health care. When considering the multitude of issues related to both patients as well as providers, my answer is that there is much room for improvement". A way forward
In proposing a way forward, Dr Jayasekera said: "What we need is a paradigm shift from developing knowledge and skills to developing attitudes. We have to move away from individual, self-centered learning that has been created as a result of fierce competition both in school and in the medical school. We need to move towards a collective effort, building an environment of understanding and compromise. To do this we need to change the way we think, feel and behave towards others developing positive attitudes through social learning. As Prof William James from the Harvard business School aptly said 'Knowledge and skills aren't enough, it is the attitude that matters'.
"We are aware that genes play only a minor role, while the major role in developing attitude is through social learning relatively early in life. Hence, family, school and medical school environments contribute very significantly to the development of attitude. We also know that unlike knowledge and skills, right attitudes are difficult to develop.
"Though developing positive attitudes appears to be easier said than done, it can be achieved. Hence, permit me to make two broad proposals.
"The first and long term proposal is to place attitude and leadership development high on the agenda of all school, undergraduate and post graduate curricula. As a majority of these skills are learnt, all of us here have a social responsibility to lead by example so that our juniors may learn. In this regard let me quote Albert Einstein who said 'Setting an example is not the main means of influencing another, it is the only means'.
" As a prescription for developing attitude let me quote two publications. The first is ' Working with Emotional Intelligence' by Danel Goleman who defines Emotional Intelligence ( EI) as ' Capacity for understanding our own feelings and those of others, to motivate ourselves and manage emotions in ourselves and in our relationships'. In developing EI we need to understand self, by self- awareness, self- regulation and motivation and we need to understand others by empathy and build relationships. " The other publication which is linked to the relationship dimension of the first, is ' The Speed of Trust' by Steven Covey who argues that trust by increasing speed and reducing cost is an essential ingredient for building relationships and effective leadership. In essence we need to develop our EQ or emotional intelligence equally well as our cognitive intelligence or IQ, which we already have. In this regard, there is an urgent need for an exhaustive curricula review in all learning institutions.
" The second and short term proposal, until we achieve the above in the long term, is to recruit for attitudes and train for skills. Traditionally our recruitment and advancement criteria have been based on knowledge and skills. We need to move away from this mindset, and give adequate weight to positive attitudes, particularly at recruitment. I am aware that identifying an individual's attitudes is no easy task, but it must and can be done."