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LEADERSHIP CONCEPTS:

Definitions
• Leadership is the direction, guidance, and example given to others to get quality work
done and achieve intended objectives.
• Leadership is influencing people to make the changes necessary to achieve results.
• Leadership is the ability to take others where they otherwise would not go or to get
others to do what they otherwise would not do (positively or negatively).
• Strategic Leadership is guidance or direction that is essential to meeting stated
objectives or successfully implementing a plan of action.
• Leadership: doing the right thing at the right time to get people to perform in a timely
fashion.

Leadership's Influence
• "Our role as leaders is not to catch people doing things wrong, but to create an
environment in which people can become heroes".

Difference between leader and manager:

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characters of a leader:
- Has consistent and dependable integrity ‫ذو مبدأ ثابت‬
- Cherishes heterogeneity and diversity ‫يدرك التجانس واألختالف‬
- Searches out competence ‫البحث خارج مجال االختصاص‬
- Is open to contrary opinion ‫االنفتاح علي الرأي األخر‬
- Communicates easily at all levels
- Understands the concept of equity and consistently advocates it ‫العدالة واالنصاف‬
- Leads through serving ‫خدمة األخرين‬
- Is vulnerable to the skills and talents of others ‫التعرف علي المواهب والمهارات‬
- Is intimate with the organization and its work ‫قريب من المؤسسة‬
- Is able to see the broad picture (beyond his or her own area of focus) – HELICPTER
VIEW
- Is a spokesperson and diplomat ‫متحدث ودبلوماسي‬
- Can be a tribal storyteller (an important way of transmitting corporate culture)
- Tells why rather than how
- Understands and speaks for:
* The corporate value system (expression of its human and ethical character)
* Good design (in all its facets)
* Participative management

Additional characteristics of a good leader include the

ability to:
- Display independent thought and make decisions;
- Demonstrate self-confidence and emotional stability;
- Bring order out of chaos; ‫تنظيم الفوضي‬
- Demonstrate sensitivity to the needs and feelings of others;
- Give and accept friendship;
- Keep learning and then teaching others, creating both a learning and a teaching
organization ready to both manage and create change
- Act to help groups attain their objectives with maximum application of the group's
capabilities;
- Be responsive to the needs of the organization;
- Use and temper the power vested in him/her by the organization; ‫استخدام السلطات المخولة‬
- Motivate others to produce;
- Demonstrate personal fortitude; ‫اظهار الثبات الشخصي‬
- Never lose his/her own identity ‫التمسك بالهوية الشخصية‬
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The Role of Leadership in Quality Improvement
- Focus on value to the customer;
- Promote constancy of purpose:
*Shared vision with the organization and all involved
* Common interest/passion and commitment: Quality
* Power with rather than power over (exam)
- Develop cross-functional organizational networks:
* Creative-minded
* Empowered employees
* Automated to handle information explosion
* Constant, incremental improvement
- Role by modeling
The Effectiveness of Leaders
• Leaders are effective because of their impact on others 'motivation and on
others' ability to perform effectively and with satisfaction;
• Effective leaders combine the following leadership components:
- Togetherness
- Delegation of authority commensurate with responsibility
- High visibility
- Clear communications
- A feedback system
- A reward and recognition system

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LEADERSHIP STYLES
Effective leadership styles are developed from a keen awareness of the
environment and an understanding of what motivates and satisfies
people. Different situations may call for varied leadership styles. The
"middle-of-the-road" leader/manager has learned to balance the needs of
the organization with those of the employees. He/she uses the leadership
style thought to be most effective at the time, given the job to be done and
the morale level of the employees. Optimal productivity is the goal.
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LEADERSHIP STYLE
Autocratic or - The leader/manager makes decisions and announces
Bureaucratic them to the group with little or no subordinate
participation;
- Rules are strictly enforced;
- This leadership style is most effective in immediate
crisis situations or when Very strict control is
necessary, e.g., budget cuts or confidentiality of data.
Diplomatic or - The leader/manager "sells" the decision and/or
Consultative presents the decision and invites questions;
- Decisions stand unless over whelming reasons dictate
a change;
- This leadership style is effective when employee
acceptance of a decision Already made is important for
its implementation, e.g., redesigning the quality
improvement process as a result of a merger.
- Involving employees in the action plan and responding
to concerns or questions Encourages employee
support.
Participatory - The leader/manager presents a tentative decision,
(The TQM "draft" of an idea, or a problem to staff/team, receives
Leadership/Man suggestions, and then makes the decision, based on
agement Style) what is deemed best for the organization; retains final
decision.
- A powerful motivator for employees whose expertise is
considered valuable to the decision-making process;
- Participatory management is ongoing, systematic, and
generally integrates Organizational goals with
departmental and individual goals;
- Participatory management can optimize the
introduction of change;
- Problems with the process may include:
- The fact that it is more time-consuming;
- Employees may resent participating only at levels that
they consider less important, e.g., procedures but not
policies;
- Decision making is certainly more delayed and may
tend to compromise certain organizational goals.
- Participatory management techniques are linked
closely to Management by Objectives(MBO), the process
sometimes used to set:
- Short range (annual), medium range(1-4years),and
even long range(5 or More years)goals;
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- Objectives and performance measures for meeting
those goals;
- The definitions of results desired;
- Time frames for implementation.
Democratic - The leader/manager details the problem, defines limits,
and asks the group for a decision.
- This leadership style works well:
- With some decisions regarding procedures or
methods;
- When decision-making deadlines are flexible;
- When employee participation is critical for successful
implementation of the
Action plan;
- When working with effective self-directed work groups
or teams.

Laissez- - No limits are set and no decisions made by the

faire("free rein") leader/manager;
- There is little or no interference with the group
process;
- Employees function within limits set by the manager's
own superior, or within those set by informal leaders or
by consensus of the group;
- The manager may be seen as a figurehead, not a
leader; if this is the case,
Generally both productivity and morale suffer;
- The laissez-faire leadership style can work
satisfactorily if the individuals in the group are very self-
motivated, united in purpose, goal-oriented, and
innovative

Immediate crisis >>>> autocratic

Lenghty crisis >>>> participatory

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Role of CPHQ in applying quality in HC organization:
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ORGANIZATIONAL INFRA STRUCTURE
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ORGANIZATIONAL INFRA STRUCTURE
1) "governing body"
- Possible names for the governing body include, but are not
limited to:
• Board of Directors
• Board of Trustees
• Board of Governors
• Governing Board

- the governing body, as the legal authority, carries the ultimate

responsibility for all patient care rendered by all practitioners
within the confines of that organizational structure and authority.

- Governing Body Performance and Contributions:

there are four key factors that most impact governance, a
governing body's ability to perform and make a solid contribution
to the organization's success: structure, composition,
infrastructure, and functioning.
• Structure—the anatomical aspect of governance:
- Board size
- Number and types of boards
- Number of governance layers
- Relationships among boards
- Number and type of board committees
• Composition—the raw material—each board member's:
- Personal characteristics
- Knowledge
- skills
- Experiences
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• Infrastructure—systems and processes, e.g.:
- Leadership
- Objectives
- Work plans
- Information control/confidentiality
- Agenda and meeting management
- Education and development
- Evaluation
• Functioning—the physiological aspect of governance ,i.e., how
and how well the board discharge sits responsibilities and roles
• Responsibilities: The things to which boards must pay attention
in order to fulfill their obligations(the "what"):
- Formulate the organization's vision and strategic goals;
- Ensure effective, efficient executive management performance;
- Ensure the quality and safety of patient care; and
- Ensure the board's own effectiveness and efficiency.

• Roles: The activities required by boards to fulfill their

responsibilities (the "how"):
- Policy formulation—specifying and conveying expectations that
are consistent with the vision and goals;
- Decision making—prioritizing and choosing among alternatives;
and
- Oversight—monitoring and analyzing organizational processes
and outcomes.
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Governing body functions:
• The delivery of appropriate, quality healthcare in a cost-effective
manner at minimized risk;
• The establishment of a constructive relationship with
administration, independent practitioners, employed staff, and
other deliverers of care;
• The accommodation of the needs, expectations, and reasonable
demands of stakeholders: healthcare consumers, regulatory
agencies, providers, and third party payers;
• Appropriate responses to healthcare changes, including
corporate liability ,financial constraints, increased competition,
types and limits of revenue or reimbursements, expansion in the
number and types of providers and practitioners seeking
affiliation, advances in research and technology, patient
demographics and case mix, and public expectations;
• The preservation of quality care and economic viability.
Governing body responsibilities and roles:
• Participate with organization leaders in development of mission,
vision, and values;
• Establish policy in collaboration with other leaders;
• Maintain quality of patient care and safety and promote
performance improvement;
• Provide for organizational management and planning, including
criteria based selection of the CEO and establishing strategic
direction and goals;
• Adopt corporate by laws, addressing legal accountabilities and
responsibilities to patients;
• Provide for appropriate medical staff (hospitals licensed
independent practitioner participation in governance;
• Provide for compliance with applicable law and regulation,
including public reporting;
• Provide for and comply with the organization's ethics policy or
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code;
• Provide for conflict resolution;
• Provide for necessary resources; approve the budget;
• Review GB performance.
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2) MANAGEMENT:
• A chief executive officer (CEO)—at times called:
*administrator,
*executive director,
*president, or
*chief operations officer
appointed or approved by the governing body, is responsible for
the daily operation and management of the organization,
including recruitment and retention of staff, physical and financial
assets, and information and support systems.
• A management and administrative staff develop organizational
goals and objectives; implement appropriate functions and lines of
responsibility and accountability; and establish necessary
departments and services.
• Provisions for all necessary policies/procedures, financial
practices, program planning, internal controls, and communication
mechanisms must be in place.
• The successful management team achieves goals and objectives
with the best possible allocation of human and material resources,
and demonstrates effectiveness, efficiency, and productivity
through concrete and objective methods of evaluation.
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3) (Medical director, CMO, Chief of staff)
Duties of the chief of staff, based on medical staff bylaws:
- Presiding officer at all medical/professional staff meetings.
- Chair of the Medical Executive Committee and ex-officio member
of all medical/professional staff committees;
- Member, either voting or nonvoting, of the governing body;
- Appoints medical/professional staff committee members and
chairpersons not elected by their peers;
- Enforces medical/professional staff bylaws, rules and
regulations; ‫وضع القواعد‬
- Represents the medical/professional staff concerning policies,
needs, views, and grievances to administration and the governing
body;
- Participates as a key organization leader in organization wide
decision making, including the quality strategy
The Medical Director or Chief Medical Officer serves in this
leadership role in medical groups and health plans.
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4) quality council – performance improvement council –
steering committee :
- To establish an oversight body for quality. ‫كيان واحد متكامل‬
- Delegated by Governing Body
- It replaces ALL other quality committees EXCEPT: Peer
review committee
- Composition: The quality council is comprised of leaders
from administration, governing body, medical staff group, key
departmental managers and the quality professional.
- Oversees the quality/performance improvement function
organizationwide, as well as all key processes associated
with successful implementation and outcomes.
1. Develop and approve the QM plan (prior to final approval by
GB).
2. Approve the strategic quality initiatives.
3. Prioritize quality initiatives according to the potential impact
on patient care.
4. Select QI team.
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5. Support teams’ activities.
6. Review aggregated data.
7. Review periodic outcome summaries.
8. Determine the training and educational needs of the
organization. ( exam )
9. Determine budget needs for performance improvement.
10. Evaluate the effectiveness of QI initiatives.
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5)

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bylaws generally specify:
• The role and purpose of the organization;
• The duties and responsibilities of the governing body;
• The process and criteria for selecting governing body members;
• Officers and committees, including selection process,
responsibilities, meeting procedures, and inclusion of medical
staff members as appropriate;
• Relationships and responsibilities between the governing body
and the medical staff (hospitals)/licensed independent
practitioners, chief executive officer, and any authority superior to
the governing body;
• Definition of conflict of interest;
• Requirements for the establishment of a medical staff, auxiliary
organizations, etc., if applicable;
• Mechanisms for adopting, reviewing, and revising the bylaws.
• Quality and safety of patient care;
• Quality/performance improvement mechanisms;
• Review of independent practitioner credentials and delineation of
privileges;
• Selection of the governing body members, chief executive officer
(CEO), and other
• key management staff;
• The planning of services;
• The development and approval of the budget;
• Review of the governing body's performance.
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6)
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imp

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7) LICENSED INDEPENDENT PRACTITIONERS ‫ممارس مرخص‬
• Definition:
A licensed independent practitioner (LIP) is any individual who is
professionally licensed and permitted by the organization to
provide patient care services without direction or supervision,
within the scope of that license.
LIPs include physicians, dentists, and podiatrists, as well as other
practitioners as determined by each state.

Role of LIP:
1. Measurement, assessment and improvement of medical staff
processes.
2. Participate in organization wide PI activities.

MEDICAL STAFF MEMBERSHIP APPOINTMENT:

Any LIP is potentially eligible.
Steps involved:
1) application
2) credentialing
3) Bylaws approval
4) Proctoring
5) Appointment
6) reappointment
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bylaws and organizational charts:

• Authority
• Responsibility
• Accountability
• Communication
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Strategic Planning:
is an organization wide/system wide, ongoing look into the future. It is a
process based on objective internal and external assessments that focus on
current reality and the foreseeable future, and is driven by vision, needs,
priorities, feasibility, capabilities, and available resources.

TRADITIONAL STRATEGIC PLANNING PROCESS:

Step 1: External Analysis
Step 2: Internal Analysis both : Issue Analysis
Step 3: Development/Review/Revision of Mission, Vision, and Values -
guiding statements
Step 4: Implement the strategy
Step 5: Evaluate the strategy
Step 1: External Analysis (opportunities / threats )
External Analysis may include any or all of the following Assessments:
Environmental, Community, and Cultural/Linguistic Competency.
• Purposes:
- Sets the tone for organizational culture and commitment to excellence;
- Defines the "community" for service goals and sets territorial boundaries
for future operations;
- Defines and assesses the actual and potential markets and customers;
- Identifies opportunities and constraints;
- Provides a basis for "benchmarking": Comparing the organization to
neighbors and competitors.
• Data to be collected and assessed ( identification/review/analysis):
- Regulatory environment;
- Competition;
- Customer needs, expectations, preferences, and priorities;
- Demographic forecasting: Determines characteristics of customer groups
to be served, e.g., age, gender, language, and ethnicity;
- Provides information as to types and quantity of products and services
 CHAPTER 2 - STRATEGICLEADERSHIP
needed and demanded.
Step 2: Internal Analysis ( strengths / weakness )
• Purpose: To develop a balanced picture of the organization's
current assets, scope of services, patients served, organization
functions, quality and patient safety status, resources.
• Data to be assessed (identification/review/analysis):
- Types and utilization of services;
- Important organization functions;
- Patient mix;
- Quality management/quality improvement findings;
- Practitioner characteristics, treatment patterns, and performance;
- Financial performance;
- Facilities inventory;
- Organizational assessment (evaluation of the current
effectiveness of infrastructure and culture

Issue Analysis
• Evaluate culture, people, pricing/value, key processes, and ability
to innovate.
• Identify key challenges and opportunities;
• The issue analysis often takes the form of a "S.W.O.T." Analysis,
using the external and internal data collected and analyzed in
Steps 1 and 2:

S Strengths What do we do well? Competitive advantages and why?

[Internal Why do customers come back?
Analysis] Consider high value or performance points, high quality services,
leadership, reputation, workforce skills, finances.
W Weaknesses Where do we not deliver/compete well and why?
[Internal Where are gaps in capabilities and resources?
Analysis] Cash-strapped? Structure, supply, inventory, or service delivery
issues? Employee or practitioner skill needs?
Do our vulnerabilities negatively impact our reputation?
Consider employee/practitioner resistance to change, outmoded
technology/facilities, and inefficiencies.
O Opportunities Where are new customers? Where might we expand our presence?
[External New systems, processes, methods, technologies, products,
Analysis] services?
T Threats Consider competitors; legislation/regulation; shifting demographics;
[External customer behavior, needs, expectations, and choices; economic and
Analysis] financial factors; community press; marketplace.
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Step 3: Development/Review/Revision of Mission,

Vision, and Values
- reflect the corporate commitment to service and the quality
culture espoused by leaders
- must be communicated routinely and continuously by leaders
to each and every individual in the organization and must be
operationalized in policies, procedures, and daily practice.

Mission : broad purpose and role of the organization related

to desired services
Vision: the organization's intent and aspirations for the future.
Core values - value statements - guiding principles:
* how the organization will achieve
* A listing of organizational values that support the mission and
vision statements and guide strategic planning, decision making,
and the provision of all services.
* reflect the organization’s sense of right and wrong
eg : Respect for persons, Quality of care , Patient-centered care,
Acceptability of care , Professional competence , Effectiveness of
care , Employee empowerment and satisfaction , Continuity of
care and service, Safety, Accessibility, Service, Teamwork,
Continuous Learning, and Mutual Respect.
Goals:
* To reflect and operationalize the mission and vision.
* Goals articulate specific strategic end points toward which
activity is directed to accomplish the mission and vision. They
should be focused on improvement of organization performance,
not short-term financial gain, and may be:
- Short-range (annual, 2-3 years, or even 2-4 years) and
- Longer-range (5-10 years).
- In quality improvement mode, goals must be based on and
prioritized by knowledge of those important functions and
processes that are most critical to achieving effective patient
outcomes.
- SMART : specific – measurable – achievable – realistic – time limited.
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Critical Success Factors:

Critical success factors are those things the organization must do
to achieve the goals and vision, e.g., defining roles; improving
quality, technical expertise, access, or customer satisfaction;
securing recognition of value; growing market share; offering new
services; attracting, training, and retaining staff. Once identified,
they are incorporated into the Strategic Plan as strategies,
objectives, or strategic initiatives.

Objectives (strategies):
- Be measurable and explicit;
- Specify a time for completion;
- Identify the person(s) responsible for completion.
- Objectives should incorporate specific quality planning projects
and quality improvement projects, based on input from teams and
other sources.
- In some Strategic Plan formats, objectives are called "strategies."
Whether labeled as objectives or strategies, each should be linked
to a specific goal, offering more detail concerning how the
organization plans to reach the goal.
- In some organizations where quality planning is integrally tied to
strategic planning, strategic initiatives (or strategic quality
initiatives) become the tools to describe the roll-out of strategic
goals, and the objectives component of the Strategic Plan is within
each initiative
- Goals and strategies/objectives must undergo ongoing periodic
evaluation and revision to insure their relevance and successful
fulfillment.

Initiatives: a statement of intent to improve organization

performance.

Step 4: Implement the strategy:

- Review of organizational culture input from past steps , internal
assessment, focusing on barriers to, and leverages for, change;
 CHAPTER 2 - STRATEGICLEADERSHIP
- Leadership commitment to quality concepts and participation in
operationalizing strategic goals through all of management to the
entire organization;
- Involvement of all appropriate entities, departments, and
services, dependent on the corporate and organization
structure(s);
- Establishment and effective use of cross-functional teams;
- Empowerment of employees through Ql training, with emphasis
on service;
- Provision of incentives to foster success.

strategy implementation

deployment or rolldown to departments to develop plans including targets

and means Heart of Hoshin planning process

implementation of department plans plan

regular process review monthly – quarterly act

do

annual review check

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Plan-Do-Check-Act (PDCA) Cycle is four-step problem solving model to

promote continuous improvement.

 Plan: Alignment, identify problem, determine goal, cause analysis.

*Background Information:
- Where do things stand today (current state)?
- What are the perceived symptoms that makes us believe we need to act?
*Problem Statement:
- Write a sentence that defines the problem you are trying to solve.
- The problem is the gap between the current state and the goal.
- Select one problem per PDCA
*Goal:
How will you measure success?
*Cause Analysis:
- What is causing the problem?
- What prevents us from achieving the goal?
- Why does the cause exist?
- Is there a highest priority cause?

 Do: Action plan and execution

- What are the solutions to address the root cause?
- What activities need to take place?
- Who will be responsible? When?

 Check: Progress, target vs. actual

- What is the progress/result in light of your original goal?
- Do the actual results match the planned results?

 Act: Standardize if it worked, adjust if it didn’t work.

- Adjust if it didn’t work, reassess and make changes.
- Standardize if it worked, document standard process if solution solved the problem.
- Expand implementation to other areas as appropriate.
- Ensure ongoing PDCA to sustain results.
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Step 5: Evaluate the strategy

The "Balanced Scorecard": A Strategic Measurement System
- The "balanced scorecard" (also called "strategic scorecard"), is a type
of performance measurement system based on and organized around
the strategic plan.
- It is a translation of mission, vision, and strategy into a set of top-level-
approved operational performance measures (indicators). It is an
integrated report showing current performance in diverse areas most
valued by the organization.
- It becomes a management decision tool driving organizational change
and improvement. A truly balanced scorecard will reflect the priorities
of both the organization and its customers.
- The balanced scorecard of performance measures answers the
questions, "How are we doing?" and "Are we there yet?"
- The key is to select measures that truly are predictive of the leaders'
ability to achieve the organization's vision and goals. They generally
are categorized based on perspectives (views of the organization)
deemed critical to success, e.g. :
• Customer Perspective (patients, employees, other customers expecting all
dimensions of performance )
• Financial Perspective (profit, revenue growth, productivity, asset
utilization)
• Operations/Internal Perspective (those process directly impacting
performance for customers)
• Clinical Outcomes
• Innovation and Growth
- Human capital (employee skills, training, retention, etc.)
- Informational capital (access to information)
- Organizational capital (ability to change and sustain success, e.g., culture,
buyin, teamwork, accountability)
• Community perspective
• Research and Teaching (academic medical center)
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a performance measurement system and a performance management tool that uses key
indicators or performance measures (e.g., clinical quality, patient satisfaction, employee
productivity, financial) to visually as certain the status (or "health") of the organization.
It’s also called (digital dashboard, enterprise dashboard, executive dashboard, or KPls-key
performance indicators),

Dashboards provide a "snapshot" of performance at given points in time, e.g., monthly or

quarterly, and allow leaders to gauge how well the organization is performing overall

https://www.youtube.com/watch?v=AdXt8BfiGJg
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Balanced : one component
the way of thinking of the organization holistically , look for the organization in 4 different
ways

financial How we are looking to our stakeholders?

customers what value needed to provide to customers and

achieve financial
goals ?

what internal processes must be done to provide

internal value to customers , achieve financial goals?

people what skill capabilities we must have in our

organization to provide
value to customers , achieve financial goals?

This is strategy framework to ensure that plan is affected , integrated ,

holistic>>> balanced

This is called strategy maps one of several tools used in balanced scorecards
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Strategic planning, Master planning

Strategic planning Master planning – ( old )

identified customer needs. people to purchase.
external and internal
analysis.

management.
frame (3-5 yrs) to
be modified as changes occur.
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organization culture:
every healthcare organization has collective internal culture :
a basic set of assumptions about people, how people work together and how work gets
done . these assumptions guide decisions and activities and are imparted to new
members of the organization as well as in day to day operational management. The
internal culture determines how the organization deals with people , finances , patient
care, and services , change , ethics , individual diversity, and external community
cultural issues effective…. cultures …. Are marked by high levels of employee
productivity , creativity and commitment . This in turn drive increased quality, innovation
and profitability.

•Effective organizational culture is characterized by these three people-related traits:

1. Clarity of mission, vision and values among employees.
2. Employee understands their individual and inter-dependent roles in achieving the
vision.
3. Strong alignment between employee attitudes and strategic goals and objectives.

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The organization plan for the provision of patient
care services
- Mission, vision, core values.
- Patient rights and responsibilities.
- Confidentiality policies.
- Organizational chart (structure &information flow)
- Organization’s functions
- Scope of services
- Leadership responsibilities
- Prioritized strategic quality initiatives
- Assessment of patient needs and satisfaction.
- Types of patients
- Budget
- Contract services.
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the quality strategy ( the written plan )
* Describes the key management functions (QM/RM/UM) and governs their operation.
 Approved by Governing body and medical staff.
* must be documented because people cannot be asked to commit to what is not written.
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content outline for QM/PI plan

 Purpose – role.
 Guiding statements (mission, vision, core values)
 Quality goals and objectives (should link to the strategic goals)
 List of customers
 List of organization wide functions
 Dimensions of performance
 QM/PI information flowchart
 Roles and responsibilities
 Approaches and methodologies
 Standard formats for documents and forms
 Communication and reporting mechanisms
 Confidentiality and conflict of interest
 Program evaluation
 Appendices
 Approval signatures