leadership in the use of research-based evidence ... pdfs/june 12/dockside … · engaging...

Executive Training for Research Application

Formation en utilisation de la recherche pour cadres qui exercent dans la santé

The EXTRA program was set up with a grant from Health Canada. The views expressed herein do not necessarily represent the views of Health Canada.

© Canadian Health Services Research Foundation

2007-02-11

Title

Leadership in the use of research-based evidence:Physician Leadership Stories from EXTRA

Terrence Sullivan PhDPresident and CEO

Cancer Care Ontario

Academic Program LeaderEXTRA

Exective Training for Research

Application (EXTRA) is a fellowship

program designed to train health

services leaders to become even

better decision makers by learning

how to find, assess and interpret

evidence from research.

Program Partners

� Canadian Health Services Research Foundation

� Canadian College of Health Service Executives

� Canadian Medical Association

� Canadian Nurses Association

� Consortium of 13 Quebec partners represented by

Agence des technologies et des modes d’intervention en santé (AETMIS)

EXTRA Curriculum

6 modules spread over 4 residency sessions

� Promoting the use of research

� Appraising quality and relevance of research

� Becoming a leader in the use of research

� Using research to create and inform change

� Sustaining change in organizations

� Synthesis: IP presentations and building a CoP

� Health information management topics integrated across all

modules

“It is not the critic who counts; not the one who points out how the strong stumbled or where the doer of deeds could have done better. The credit belongs to those in the arena; who strive valiantly; who fail and come up short again and again…”

Theodore Roosevelt

Evidence-based management

� Evidence-based management is affected by ORGANIZATIONAL CONTEXT

� What constitutes GOOD EVIDENCE (enlightenment, tactical, political, instrumental?)

� Complex problems transcend professional and organizational boundaries

Stewart, R.S. 2002. Evidence-Based Management: A Practical Guide

for Health Professionals. Oxford: Radcliffe Medical Press.

6. leadership and managing organizational politics

4. dyadic leadership: coaching and mentoring

2. capacity to initiate and exploit strategic moments

5. leadership in groups: peer assessment in leading people

3. clinical and collaborative leadership

1. leadership and effective communication

EXECUTIONPEOPLETRANSFORMATIONS

STRATEGY

Health Leadership Competencies in the EXTRA

Program





National Health Care Leadership Conference

June 12, 2007

Dylan A. Taylor MD FRCPC FACC CHESite Medical Director

University of Alberta & Stollery Children’s HospitalsCapital Health

Edmonton Area

Physician Integration in a Multi-Specialty Ambulatory Care

Project

Problem:

– Physicians may not perceive their interests to

be aligned with the health system

– Physicians may not perceive themselves to be

part of the decision-making process

• They have been alienated

• They function independently from other members of the health care team

The Four Worlds of the General HospitalAdapted from Glouberman & Mintzberg

Care

Nurses

Cure

Doctors

Control

Managers

Community

Board

Managing the Care of Health and the Cure of Disease - Part I: Differentiation. Health Care Management Review 26(1):54, Winter 2001

Project Challenge

Engaging physicians

– Commitment

– Participation

– Contribution

Leadership Challenge

To model leadership that will successfully engage physicians

Communication

Effective communication

Strategic moments

Collaboration

Dyadic structures

Cooperation

Group leadership

Organizational politics





2007-02-11

2007-02-112007-June 12

Title

Leadership Collaboration: Applying the Co-management Model for evidence-based change

John Knoch PhD

Executive Director, Clinical Support Services

David Thompson Health Region

Alberta

Introduction

� Context: Change through regionalization

� Intervention Project purpose

� Clinical and Collaborative Leadership

� What we’ve done

� Challenges

� Lessons learned

� What EXTRA is doing for me

Context:Change through regionalization

� First regionalization in 1995

� Second major restructuring in 2003

� Operational Reviews in 2004 for regional Laboratory Services, regional Diagnostic Imaging and Medicine Programs

� Recommendation: implement Co-Management dyad model

Intervention Project purpose

� Regionalization resulted in a conflict of cultures

� Establish a new structure that brings physicians

into the decision-making process

� Outline a clear decision-making model that

complements organizational values

� Ensure physician and non-physician leaders are

engaged in appropriate decisions

� Influence physician and non-physician behaviour

Clinical and Collaborative Leadership

� Team must have a clear purpose

� Culture – common goals and values

� Mechanisms to overcome resistance

� Strong communication protocols

� Mentor and coach leaders

� Persuasion and Perseverance

What we’ve done

� Senior Management commitment

� Researched similar models

� Coalition of formal and informal leaders

� Job Description and Competencies

� Implemented New Bylaws and Committees

� New structure began January 2007

� Survey of Medical and Admin Director

Challenges

� Focused and clear purpose

� Culture shift -- anchor change throughout organization

� Role clarity between and within Administration and Physicians

� Evaluation to ensure desired outcomes in Quality and direct care

� Overcome passive and active resistance

Lessons learned

� Clinical and Collaborative Leadership competency

� Seize the strategic moment

� Organizations need to learn from each other

� Components of co-management: complementary leaders, communication, collaboration, competencies and control

What EXTRA is doing for me

� Excellent Faculty, Guest speakers and support staff

� Network with executives across Canada, in both official languages

� Assisting my organization to think through a problem

� Desktop and Research tools

� Develop skills in research, critical analysis and leadership

� Community of Practice





HOW TO INVOLVE PHYSICIANSIN YOUR ORGANIZATION’S CHANGE STRATEGIES

Presented by Carl Taillon, M.D.

Vice-President – Medical Affairs

Centre hospitalier universitaire de Québec

Healthcare Leadership Conference

Toronto – June 2007

INTRODUCTION

� January 2004 : Clinical practice � Health

management

� April 2005 : Vice President Medical Affairs

� June 2005 : FORCES / EXTRA Program :

� 2005-2007 : Intervention project :

« How to address medical

demobilization ? »

PLAN

� Strategies to improve physician’sinvolvement.

� Favourable conditions for implementingchange.

� Behavioural attitudes to consider with

physicians.

STRATEGIES TO IMPROVE PHYSICIAN’S INVOLVEMENT

CÔTÉ A. Gestion. Vol. 32, # 1, Spring 2007

� Compulsion (contrainte)

� Resources to train physician (structure

d’encadrement)

� Link a change process with a symbolicobjective (doter la démarche de

changement d’un objectif symbolique

rassembleur)

STRATEGIES TO IMPROVE PHYSICIAN’S INVOLVEMENT

CÔTÉ A. Gestion. Vol. 32, # 1, Spring 2007

� Address any particular expectations (répondre à certaines attentes particulières)

� Persuade (recourir à la persuasion)

� Pilot studies (utiliser des projets pilotes)

FAVOURABLE CONDITIONS FOR CHANGE

� « Social cohesion »

� Stable environment

� Confidence

WILS (mobilisation collective)

PoliticalMutual

understandingCognitive

TechnicalCo-operationConative

SymbolicSocializationAffective

ChangeComportmentDimensions

TO COME …

� Leadership…

One application. A two-year fellowship. A lifetime of benefits.

For more information about EXTRA and for details on how to apply:

www.chsrf.ca/extra

CURRENT CALL FOR APPLICATIONS: October 1, 2007

CLOSE OF COMPETITION: February 29, 2008

leadership in the use of research-based evidence ... pdfs/june 12/dockside … · engaging...

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