Posted by: Tony Shannon | September 30, 2014

Medical Leadership – moving from the dark side towards the age of enlightenment

Medical Leadership – moving from the dark side towards the age of enlightenment

As medical, management and technical fields collide in 21st Century Healthcare… a common language and framework is required for medical leaders to steer the way forward.

1200- Establishment of the first Medical School Faculty in University of Bologna, Italy
1908- Establishment of the first MBA programme in Harvard University, USA
1987- Establishment of first Software Engineering degree in Imperial College London, England

As the world’s economies continue their tumultuous ride through the early 21st Century, the many varied healthcare systems of the world are exhibiting strain in many forms. Yet a look across the globe makes clear that a simple increase in percentage spending on healthcare is not the simple solution it might appear (note costs versus outcomes alone in the US versus Singaporean system alone as an illustration). If so… where is the future of healthcare, where are we heading?
Medicine has rapidly evolved in recent years from the age-old profession it once was, pursued by our forefathers as single handled practitioners that served their communities from cradles to graves. Delivering Quality & Affordable Healthcare in the 21st Century is acknowledged to be amongst the most complex of human endeavours on the planet, a multi-disciplinary team sport that requires medical, management and technological expertise and so is one of the grand challenges of our age. Given that context, is there any surprise that with such complexity comes a cultural and cognitive challenge across such diverse teams? Though our human species has thrived on earth thanks to our innate problem solving skills, over the course of the 20th Century the specialisation of our labour has resulted in so many camps, cultures and codes that collaboration can be difficult. We need to regroup and regain our common purpose.

So why don’t clinicians understand/appreciate the field of management?
Raised in a medical family where medical matters often came up over dinner, the world of management was mentioned, though more in passing than in a way we really understood. With no mention of the management field on my medical school curriculum it wasn’t until I entered the field of Emergency Medicine and met informed mentors and colleagues that my training and understanding of Leadership and Management began. Thankfully leaders within my College of Emergency Medicine had the foresight to make this educational element key to our curriculum , a useful precursor to the transformation that has been seen across Emergency Medicine over the last decade in the NHS. Even internationally the movement to drive forward medical leadership and education took until 1975 to see the important landmark of the establishment of the  American Association for Physician Leadership (previously named the AAMD and just recently the American College of Physician Executives) and in the UK the Faculty of Medical Leadership and Management  has only just recently been founded in 2011. So considering the age of medicine as a profession we must recognise that these are still relatively “early days” in the field of medical leadership and management as a movement for change. As we emerge from the “dark ages” where the majority of our profession have not understood the vital role of leadership and management in healthcare, but rather seen such moves as towards the “dark side”… so we now need to educate our all colleagues, demystify the science and art involved and offer a related lexicon that enters the everyday medical vernacular.

Have you ever attended a management meeting with some perplexing vocabulary in the room?

The challenge with communicating and broadening the appeal of leadership and management to our medical colleagues can be at least in part explained by recognising the differing culture and languages across the clinical and management worlds.
Our medical school education imparted long established fields of anatomy, physiology and pathology to us based on well-established tomes that underpin their scientific basis with a robust vocabulary that can be universally understood (e.g. left, radial, arterial, capillary refill, etc, etc).
Yet the relatively young field of management, our understanding of management science and related MBA curricula are changing at a considerable rate, with a related vocabulary that is still on the move. Management disciplines as business strategy, organisational management and economics are still evolving as scientific disciplines. Lest that is in doubt consider the globes most recent economic crisis and ask yourself can the field of economics be considered as a solid science yet?
In terms of culture, for some of our medical colleagues this implicit lack of scientific rigour suggests an alien culture. Of course most of us recognise that doctors blend a mix of science and art across our work. We might like to consider that medicine is more science than art , that management appears more art than science but few would argue that good health care requires a mix of both.
In terms of language, given the different disciplines involved.. depending on those attendees in the room, there is often an early mismatch in vocabulary between clinicians and managers, i.e. while clinicians can quickly relate using the vocabulary we were all taught at medical school, another language is needed to communicate to management colleagues which the MBAs of this world have not managed to standardise yet.
So in consequence we have separate cultures and languages that are holding us back.

Why do health IT projects run aground when your smartphone could power Apollo 11 to the moon?
As time moves on, it is increasingly clear that healthcare is an “information intensive” discipline yet the science of information systems and software engineering yield yet another discordant vocabulary that clinicians also struggle to comprehend.
If Medicine is an age-old profession and management a relatively new discipline, then information systems and software engineering are in their very early formative days. Of course it is clear from the world around us that these technical fields are in the midst of dramatic change, with transformative potential, yet this speed of innovation yields a rapidly evolving culture and language that seems a world apart from the medical domain.
As health IT projects require clinicians, managers and technologists to work together… yet each bring their own vocabulary to the table, so a related “lost in translation” challenge is commonly seen. The good news is that in the midst these complex technologies .. common patterns can be found and if team members work together they can be harnessed effectively…
Effective Health IT projects need teams that harness these key patterns…combining informed clinical leadership, agile project management and process improvement methodologies along with technical competencies towards a clear vision.
Ineffective Health IT projects mishandle these key patterns at play. They may involve well meaning clinical engagement, but often demonstrate a mismatch between process improvement efforts and naive technical choices .. without a clear vision in sight chaos can quickly result.
The root cause here isn’t simply underpowered computers, but a broader and deeper issue. Deep down, the lack of a common language/framework to harness those key patterns at play between clinicians/management/technologists contributes to the problematic health IT implementations that are all too commonplace and globally speaking a health IT market that awaits positive disruption.

The way forward; towards a common framework for progressing 21st Century Healthcare
How then, can the grand challenge of 21st Century Healthcare be delivered if these disparate medical, management and technical disciplines must work together, yet their education, culture and vocabulary all remain in isolation? To lead healthcare forward in the 21st Century, someone needs to lead that change. Those of us who understand the value of leadership & management as central to the future know and understand this, but how are we to engage every clinician, every manager, every technologist in common conversations?
Surely if we are to really lead the future of healthcare we must believe that our own generic problem solving skills, grounded in the scientific method but tempered in the art of medicine are key to the future. The contention therefore is that if /when medical leaders are to lead the way forward in this century towards the transformation and improvement of healthcare across the globe then we must work between us towards a simple yet clear vocabulary that we can share with our clinical, management and technical colleagues around at every meeting and every report. Does such a framework exists? Are common patterns to be found across our challenges? I believe the answer is yes.
The key to understanding 21st Century Healthcare is that this is not just a complicated challenge, but a complex systems challenge. Complex adaptive systems sit on the edge of chaos and coexist with both complicated and simple systems, an outlook which can help understanding medicine, management and technology fields and aligning efforts. For now that is just a taste … we will look in more detail at the key to this understanding (aka Cynefin) in a later blog..
So there is light ahead… if/when we move forward to enlighten the sciences and arts of Medicine/Management/Technology around a common framework with a common purpose ….we will be much better equipped to deliver 21st Century Healthcare.


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