Management and leadership development in healthcare
Management and leadership development in healthcare
Sound investment or money down the drain?
KPMG’s experience from working with healthcare providers and payers in more than 40 countries is that a typical organization can become around 15 percent more efficient purely through operational, administrative and workforce improvements.1 Scaled up to a global level, this suggests that the prize of better managed healthcare services may be in the order of one trillion dollars. For such a potential payback, it is a wonder that so little research has been done on the impact of different attempts to improve leadership and management on organizations’ quality, efficiency and outcomes. Investing in managers and leaders is a key part of achieving these improvements. Our systematic review identified four areas where returns are clearest:
- Benefits to the wider workforce: These benefits include better teamwork and collaboration2 3 4, increased clarity of communication to staff5, improved morale6 and an increase in ‘enabling others to act’7. For example, after the implementation of a leadership and management development program at several aged care sites in the US, staff reported an increase in transformational (as opposed to transactional) leadership behaviors, as well as a decrease in “passive avoidant” management styles.8
- Improvements in patient experience and satisfaction: Several studies found improved patient satisfaction scores, with better scores for metrics such as “how well pain was controlled”, “nurses took time to listen,” and general satisfaction with services.9 10 Studies also found that various programs were associated with a reduction in patient complaints; improved communication between staff and patients; and improved continuity of care.2 5
- Direct benefits from developmental projects: Many management and leadership programs involve participants completing real-world improvement projects in their organization. These are often themed, such as action learning initiatives on patient safety, or innovation. Such projects can generate direct benefits to the employing organization, and help to target improvement efforts where they are most needed.11 For example, the Management Academy for Public Health in the United States focused on training public health managers to generate entrepreneurial ideas within their organizations and involved an action learning project. Of 73 teams who took part in the program between 2000 and2002, 28 (38 percent) had projects that had generated revenue by 2007 (a total US$4 million across all projects).12
- Increased confidence and use of management/leadership skills: A number of studies identified measurable improvements in good management and leadership behaviors, for example inspiring a shared vision and proactively facilitating others.4 Self-reported impact evaluations also consistently found improvements in the confidence of participants to cope with the demands of their roles.13 14 15
No studies were found showing substantial, quantifiable benefits in terms of health outcomes, financial performance or staff turnover. However, this was more due to few or no studies asking these specific questions rather than a lack of effect. Most of the interventions measured were too small in scale to realistically affect cross organizational indicators on finance or quality.
What we do know is that when organizations are ‘well managed’ this can make a substantial difference to their performance: accounting for up to one third of profitability in all sectors16,and linked to better staff satisfaction and patient reported outcomes in health.17 Conversely, in depth investigations into large-scale failures in care routinely locate root causes in poor leadership, narrow management-by-objectives, disconnect between board-and bedside and a host of poor procedural, operational and administrative behaviors.18
1 Value walks: Successful habits for improving workforce motivation and productivity, KPMG International (2013)
2 Boomer CAM, B. Creating the conditions for growth: a collaborative practice development programme for clinical nurse leaders. Journal of nursing management. 2010; 18(6):633-644.
3 Tumerman MC, L. M. Increasing medical team cohesion and leadership behaviors using a 360-degree evaluation process. WMJ: official publication of the State Medical Society of Wisconsin. 2012; 111(1):33-37.
4 Singer SJ, Hayes J, Cooper JB, et al. A case for safety leadership team training of hospital managers. Health care management review. 2011; 36(2):188-200.
5 Dierckx de Casterle BW, A.; Verschueren, M.; Milisen, K. Impact of clinical leadership development on the clinical leader, nursing team and care-giving process: a case study. Journal of nursing management. 2008; 16(6):753-763.
6 Haseman BCC, M. P. Phillips, J. N. Stafford, P. J. practising inspired leadership: the use of applied theatre “prophetical” in the executive Leadership Development Program for Queensland Health. Australian health review: a publication of the Australian Hospital Association. 2009; 33(3):377-381.
7 Duygulu SK, G. Transformational leadership training programme for charge nurses. Journal of advanced nursing. 2011; 67(3):633-642.
8 Jeon YHS, J. M.; Li, Z.; Cunich, M. M.; Thomas, T. H.; Chenoweth, L.; Kendig, H. L. Cluster Randomized Controlled Trial of An Aged Care Specific Leadership and Management Program to Improve Work Environment, Staff Turnover, and Care Quality. Journal of the American Medical Directors Association. 2015; 16(7):629.e619-628.
9 Hultman CSH, E. G.; Kaye, D.; Helgans, R.; Meyers, M. O.; Rowland, P. A.; Meyer, A. A. Sometimes you can’t make it on your own: the impact of a professionalism curriculum on the attitudes, knowledge, and behaviors of an academic plastic surgery practice. The Journal of surgical research. 2013; 180(1):8-14.
10 Assessment Tool Helps Hospital Conquer Challenges. T + D. 2006; 60(6):68-69.
11 Singer SJ, Hayes JE, Gray GC, Kiang MV. Making time for learning-oriented leadership in multidisciplinary hospital management groups. Health care management review. 2015; 40(4):300-312.
12 Orton SU, K.; Zelt, S.; Porter, J.; Johnson, J. Management academy for public health: creating entrepreneurial managers. American journal of public health. 2007; 97(4):601-605.
13 Porter JJ, J.; Upshaw, V. M.; Orton, S.; Deal, K. M.; Umble, K. The Management Academy for Public Health: a new paradigm for public health management development. Journal of public health management and practice: JPHMP. 2002; 8(2):66-78.
14 Saleh SSW, Dwight; Balougan, Modinat. Evaluating the effectiveness of public health leadership training: the NEPHLI experience. American journal of public health. 2004; 94(7):1245-1249.
15 Dannels SAY, H.; McDade, S. A.; Chuang, Y. C.; Gleason, K. A.; McLaughlin, J. M.; Richman, R. C.; Morahan, P. S. Evaluating a leadership program: a comparative, longitudinal study to assess the impact of the Executive Leadership in Academic Medicine (ELAM) Program for Women. Academic medicine: journal of the Association of American Medical Colleges. 2008; 83(5):488-495.
16 McGahan AM, Porter ME. What do we know about variance in accounting profitability? Management Science. 2002; 48(7):834-851.
17 Dawson et al, NHS staff management and health service quality: Results from the NHS Staff Survey and related data, Department of Health (2011).
18 Walshe K & Shortell S, When things go wrong: How healthcare organizations deal with major failures, Health Affairs 23:3 p103-111 (2004).