In the realm of health care, one mistake can mean the difference between life and death. In fact, according to a 1999 report from the Institute of Medicine (IOM), between 44,000 and 98,000 Americans die every year due to preventable medical errors in hospitals. The IOM report set a goal to reduce medical errors by 50 percent in the five years following the report’s release. Creating a culture of safety, the report said, includes designing a system that prevents, detects and minimizes hazards and the likelihood of error. The report also stressed the need for effective leadership within health care organizations.
Despite this, health care leaders are facing more and more pressures. In fact, 75 percent of health care leaders said they are feeling the pressure, according to Development Dimensions International’s (DDI’s) Leadership Forecast 2003-2004. DDI is a global HR consulting firm that specializes in leadership and selection. Its most recent Leadership Forecast surveyed more than 1,500 leaders and 1,400 associates. More than 300 health care leaders and staff participated.
According to Greg Nelson, vice president of DDI’s Health Care Practices Group and co-author of “Zapp! Empowerment in Health Care: How to Improve Patient Care, Increase Employee Job Satisfaction and Lower Health Care Costs,” the sheer size of the issues for health care leaders is daunting. “Not only is leadership development a hot topic, but it is a topic that is present from coast to coast,” he said. “In health care specifically, whether you’re in a small rural hospital in Enid, Okla., or if you’re in a major hospital in New York City or Los Angeles or Chicago, the idea behind the need is the same.”
In the survey, more than three-quarters of health care leaders said they feel increased pressure to perform, while 64 percent said they are being judged more stringently. Nelson said this is due to increased demands coming from both consumers and businesses. Because the cost of health care is increasingly shifting to consumers, they are demanding more from medicine. In addition, Nelson said that patients leave the hospitals much sooner than they used to. “Because they’ve got a lot more self-care, they’ve got a lot of questions about their education and their own level of ability to take care of themselves,” he said. “The point is that you have consumers that are really driving a lot more pressure upon leaders in health care to do a better job.”
In addition, Nelson said that businesses are having to pay a large percentage of the cost for health care, and these businesses want to understand what’s driving the double-digit inflation in health care. “They’re looking to the leaders in health care to help mediate not only the cost and the expense, but also to mediate the outcomes,” Nelson explained. “Are we getting significantly better outcomes in health care because we’re paying that much more? And the reality is we’re not.”
These increasing pressures coming from businesses and consumers only add to the existing pressures coming from regulatory agencies, accrediting bodies and organizations that monitor how hospitals and health care leaders are doing, said Nelson. For example, patient safety information from The Leapfrog Group was available to 70 percent of U.S. health care consumers by November 2002. “You have a lot more public scrutiny of what health care is doing. You have groups like The Leapfrog Group that are publishing data of hospitals about their level of performance. You have large cooperatives that are saying, ‘We demand better patient satisfaction ratings from you before we’re going to give you our money.’ You have different groups of people like that, that are really putting the outcomes of health care in very public forums, and that in itself might be creating a lot more pressure,” said Nelson.
With the pressure on leaders from various directions building, ensuring that those leaders get the development they need can literally be a lifesaver. According to the survey, health care leaders have lower competence and more weaknesses relative to their job demands today than they had four years ago. Respondents also indicated that they are strong in only a third of the competencies needed to do their jobs. Top weaknesses include decision making and continuous learning.
The first step in ensuring health care leaders get the development they need is creating a blueprint, Nelson said. “If you don’t take a formal business strategy approach to your leadership development, you’re not going to get the outcomes that you expect.”
He added, “The very first thing to do is to take a step back and say, ‘What have we done in this area before?’ So often, a nurse is a nurse on Friday and then on Monday she’s a nurse manager. And she’s a nurse manager because she had some basic clinical skills that were part of her doing the job well. On the other hand, as a nurse manager she didn’t get all the key leadership training over the weekend. They didn’t teach her how to be a better coach. They didn’t talk to her about gaining commitment. They didn’t give her special instruction over the weekend on how to manage conflict or facilitate change or how to inspire others.”
Health care organizations must take a closer look and determine who their leaders actually are, Nelson said. Just as executives and directors are leaders, so are nurse managers. Once the leaders are identified, the organization must determine which leadership development activities are needed. “At the first-line level, leaders are going to get the basics—the blocking and tackling of good management leadership because remember, in health care most of those first-line supervisors are doing 60 percent on-the-job work, as well as trying to do the management and leadership itself,” said Nelson. “As you get to the director level, they’re doing maybe 40 percent work, 60 percent management, so you have to help articulate what is the leadership requirement as you have a different level of leadership, and then you identify and you create very specific ways of measuring those developmental needs.”
Doing this requires identifying each job role’s competencies for every level of leadership in the organization. “Quite frankly, health care is already familiar with clinical competencies, so what we advocate is your leadership development plan should be built on not just the clinical competencies—nurse on Friday—but the behavioral competencies—manager on Monday,” said Nelson.
One of the most obvious competencies for a health care leader is the ability to facilitate teamwork. “Health care is an extraordinarily team-based environment. No patient gets better just because of one person’s administration; they get better because there’s 30 or 40 people that are touching them. So you have to have a really good grasp of team-based knowledge transfer, aligning team performance for success and building trust within an environment so people feel comfortable communicating with each other.”
According to DDI, work teams that have strong leaders are 37 percent more likely to outperform groups with weak leaders. Depending on the size of the organization, this can contribute millions in productivity dollars. Nelson said, “When people are aligned around specific goals with their leaders, they start contributing to a much better, efficient process, and in health care that means you’re saving lives.”
Nelson added that better retention also results from better leadership development. In the survey, only 38 percent of health care workers said they had a high degree of confidence in the abilities of their front-line leaders. “Most people leave their leader; they don’t leave the organization,” Nelson said. “Seventy percent of people leave the job because of the relationship they have with their first-line supervisor. If that’s the case, you’re going to have a major impact on retention because you have developed not only a leadership development platform, but you’ve made it a business strategy. …You share your strategy, and the leaders who don’t cut the mustard obviously aren’t going to be around too long. And the ones who do well are the ones who will receive the recognition. That has a major impact on retention.”
The third area of impact, Nelson said, is customer service. “It’s long been known that happy employees translate to happy customers,” he said. “When people are engaged and feel like they’re doing meaningful work, when they are getting leadership support for what they do, that translates directly to better patient care.”
One key to successful leadership development in health care is patience, said Nelson. Most workers—leaders and rank-and-file employees alike—in the health care field are in constant crisis-management mode. This can lead them to think of development in terms of quick hits, Nelson said. “Over time, you have to have a dedicated constancy of purpose to get you to where you want to be,” he added.
In addition, you have to work with all levels of leaders in the organization. “It’s not just first-line supervisors,” Nelson explained. “Is this consistent for your directors? Are they participating? Is it consistent for your executives? And even more, is it consistent for all the physicians who you allow to work in your hospital? They’re de facto leaders too, so if you haven’t included them, you haven’t included all your leadership, and that’s a big gap in most hospitals.”
Through dedication to leadership development at all levels of the organization, health care companies can drive up efficiency and customer satisfaction while reducing turnover and, ultimately, saving more lives.