L 101: Introduction to Health Care Leadership

Caregivers in the US, especially doctors, commonly wear long-sleeved coats at work. You and a fellow medical student have just learned that in many countries, doctors avoid these coats because harmful bacteria can linger on the cuffs, moving from patient to patient as the doctor makes rounds. You and your friend would love to see providers in the US stop wearing the coats — but the problem seems huge and insurmountable. What might a leader say in this situation? (A) "I wish health care workers were more receptive to change." (B) "I've heard that some US hospitals have banned the coats. We should find out how they did it — and if it led to a decrease in hospital-acquired infections." (C) "This is the fault of our apathetic national leadership." (D) "We'll be able to change this situation once we're done with our training."

Correct Answer: "I've heard that some US hospitals have banned the coats. We should find out how they did it — and if it led to a decrease in hospital-acquired infections." A leader avoids complaining and blaming others, instead steering the conversation instead toward action.

Which of the following descriptions best describes "leadership"? (A) A firm, unyielding position on what should be done to solve a problem (B) A set of beliefs based upon principle (C) A positive, "let's do something about it" attitude toward problems (D) A posture of resistance to those in authority

Correct Answer: A positive, "let's do something about it" attitude toward problems A leadership stance is a positive, can-do approach to solving problems. It is not an opinion, a belief, or a reflexive opposition to people in power.

When effective leaders hear others complaining about a serious problem, which action would they most likely take? (A) Change the subject to talk about something interesting. (B) Add their own complaints to the chorus. (C) Acknowledge the problem, and talk about what to do about it. (D) All of the above

Correct Answer: Acknowledge the problem, and talk about what to do about it. Leaders don't ignore problems or complain about them. They try to learn how big a problem really is. Then they work with others to figure out what to do about it.

You and a fellow medical student have learned that in many countries, doctors avoid wearing long-sleeved coats at work because the coats can carry harmful bacteria such as methicillin-resistant Staphylococcus aureus (MRSA). You and your friend would love to see providers in the US stop wearing the coats. A conference of hospital and clinic leaders is coming up. How might you pique their interest in this issue of wearing long-sleeved coats? (A) Tell them the story of one patient who became sick with a health care-acquired infection. (B) Tell them how much money could be saved if long-sleeved coats were banned. (C) Show them data about how American MRSA rates compare with those of other countries. (D) All of the above

Correct Answer: All of the above By telling the story of a patient and talking about cost savings, you are connecting the problems of the powerless to both the hearts and the business interests of the powerful. By using data, you are forming a clearer picture of the problem. These are leadership behaviors.

Which of the following statements might be made in response to a problem by an effective leader? (A) "This is a problem. How often does it happen?" (B) "This is a problem. Who else shares this problem?" (C) "This is a problem. Let's do something about it." (D) All of the above

Correct Answer: All of the above Taking the leadership stance includes collecting information about a problem, tying that problem to the concerns of people in power, and taking responsibility for solving it. It does not involve waiting for someone else to solve it.

Which of the following is an example of a personality or work style profile assessment? (A) Myers-Briggs Type Indicator (B) Strength Deployment Inventory (C) DiSC Profile (D) All of the above

Correct Answer: All of the above The Myers-Briggs Type Indicator, the Strength Deployment Inventory, the DiSC Profile, and the Riso-Hudson Enneagram Type Indicator (RHETI) are all examples of personality or work style profile assessments.

In the lesson, IHI fellow Jana Deen explained that she went back to her roots and focused on patients to start making changes in health care. What other resources might be helpful as you seek to improve health care? (A) Social networking sites like Facebook and Twitter (B) National conferences (C) Listservs (D) All of the above

Correct Answer: All of the above The answer is All of the above. Social networks, conferences, and listservs can all be useful tools to stay in touch with colleagues around the world. If you're using the websites for professional purposes, make sure to avoid sharing any patient information.

According to Peter Drucker, which of the following statements is true? (A) An effective leader knows that a leader is not someone who is loved or admired. (B) An effective leader knows that leaders are highly visible. (C) Effective leaders submit themselves to the "mirror test." (D) All of the above

Correct Answer: All of the above The best answer is all of the above.

Your hospital has recently begun using the World Health Organization (WHO) Surgical Safety Checklist in all of its operating rooms. As chief of surgery, you have been hearing different reports about the use of the checklist; apparently, some surgeons are all for it, while others remain skeptical. You are curious about finding out how well and often the checklist is actually being used. Which of the following might be a good first step to take? (A) Request that an assistant be assigned to the administrative details, so that you can focus on the true work of leadership. (B) Go to the operating rooms and observe the checklist being used a few times. Collect some data about the use of the checklist (C) Talk to surgical nurses about their experience with the checklist. (D) B and C

Correct Answer: B and C Leadership is an action, not a formal position of authority. One of the first actions of leaders is to get a clear picture of the real situation, often by gathering data and finding out what people are experiencing on the front lines of care.

You are working to improve the care of diabetics in your community health clinic, and today you're giving a presentation to the clinic's leadership. You begin by telling the story of Kevin, a diabetic in the clinic who underwent a below-the-knee amputation after years of poorly controlled diabetes. What is the reason for telling this story? (A) Motivate by guilt. (B) Engage the largest possible number of people in the room. (C) Demonstrate that the data that you collected is valid. (D) Expose a possible legal liability.

Correct Answer: Engage the largest possible number of people in the room. The majority of people — in any room — tend to be influenced most powerfully not by logic or formal authority, but by their emotions. Telling the story of a real patient is a way to engage their interest in solving the problem you hope to address.

Reggie takes a look at the time between antibiotic order and administration in the other ICUs in his hospital. He discovers that most of the ICUs have the same problem. This is an example of which of the following actions of leaders discussed in this lesson? (A) Reframing the issue (B) Connecting to a powerful ally (C) Forming a clearer picture of the problem (D) Proving his case

Correct Answer: Forming a clearer picture of the problem Reggie gathered some data and realized that this problem affects nearly all the ICU patients in his hospital. Having formed a clearer picture of the problem, he now is in an excellent position to engage the hospital's leadership

Michael Pugh talks about the distinction between management and leadership. Which of the following is most indicative of leadership? (A) Commanding people (B) Hiring people (C) Influencing people (D) Problem solving

Correct Answer: Influencing people The best answer is influencing people. Michael Pugh says in management, you have to have resources and staff, and you have to problem solve. But ultimately to achieve something bigger than daily operations, you have to actually lead people, which is about influence more than authority.

Which statement about storytelling is most accurate? (A) It persuades a few people in the room, but is difficult to do. (B) It is anecdotal, and therefore should not be used as a tactic for persuasion. (C) It can put a human face on otherwise abstract data. (D) All of the above

Correct Answer: It can put a human face on otherwise abstract data. Most people are influenced most powerfully by their emotions, rather than by logic or formal authority. For these emotional people, a leader must connect his or her issue to their hearts—and storytelling is often a good way to do that.

Which statement about persuasion is most accurate? (A) It is essentially manipulative, and leaders shouldn't manipulate others. (B) It is one of the important tasks of leadership. (C) It doesn't really work, since people don't make changes unless you require them to do so. (D) It requires leaders to be charismatic and eloquent.

Correct Answer: It is one of the important tasks of leadership. The first step in many leadership challenges is to persuade the group that there is a problem and a possible solution.

You've just gotten a job as a pharmacist at your local hospital. You're alarmed when you discover that different concentrations of certain narcotics are labeled almost identically. It seems clear that this is an accident waiting to happen. But when you bring it up with your seasoned coworkers, they don't feel the same urgency. "Things are never going to change around here," they say. "Just double-check and make sure you're dispensing the right concentration." What do you do? (A) Go straight to the person in charge of purchasing and tell him to order differently-labeled concentrations. (B) Offer to dig up statistics about errors related to look-alike medications and bring those figures to the Chief Pharmacist. (C) Focus on dispensing the right concentration — it's unlikely you can make a change here, so vigilance is your best option. (D) Take it upon yourself to put colored stickers on different concentrations. Your coworkers obviously aren't going to help out, so someone's got to do something — and it might as well be you.

Correct Answer: Offer to dig up statistics about errors related to look-alike medications and bring those figures to the Chief Pharmacist. When presented with a problem, leaders can count something — in this case, the likelihood of errors related to look-alike medications — to get a real sense of the magnitude of the problem. It's likely that just talking to the person in charge of purchasing (Answer A) won't be sufficient — he or she will likely seek a strong rationale (as well as approval) for such a change. Just trying to be vigilant (Answer C) is NOT taking a leadership stance to solve the problem. And putting colored stickers on the medications (Answer D) is a temporary fix that neither addresses the larger system problem (what happens when you're out sick?) nor enlists the support of your coworkers (there are no leaders without followers).

You gather some data about the use of a surgical checklist in your operating rooms and have an idea for an improvement. At the next month's meeting, you present the idea to your colleagues. The most likely outcomes will include: (A) Everyone on the team will be immediately inspired by the data to make a change. (B) The initial opinions of each member of the team will be firmly embedded, and nothing you can do will change them. (C) People will have different reactions; some will support you, others will initially resist you. (D) People will naturally reject the validity of the data.

Correct Answer: People will have different reactions; some will support you, others will initially resist you. Good leaders know that their followers may include people who are resistant, people who are enthusiastic, and everything in between.

You are a radiology resident, and you're working to decrease the time it takes to get chest x-rays read in the hospital. You've gathered some data, and you're now discussing your results with the residency director and the chief of radiology. Thus far, you have presented the data to them and reviewed a case of a patient who had a negative outcome because of a delay in the reading of his chest x-rays. During this meeting, it would be a good idea to also: (A) List the reasons a resident might be the best type of leader to address this problem. (B) Ask for this effort to be noted in your evaluation form for the rotation. (C) Relate your goal to national radiology standards. (D) Relate the effort to your personal career goals.

Correct Answer: Relate your goal to national radiology standards. Some members of any group are "formal"—that is, they're more likely to try a new idea if they see that people with power and authority are on board. Connecting the change you want to make to the interests of higher authorities is a key tactic in persuading these types of people.

What can quality improvement teams learn from Renoir, Monet, and Cezanne? (A) Improvement, like artistic work, should be a solo journey. (B) Your personal compass always points the way. (C) Teamwork can lead to creative ideas. (D) All of the above

Correct Answer: Teamwork can lead to creative ideas. The answer is teamwork can lead to creative ideas. Renoir, Monet, and Cezanne, who were all artists in the French Impressionist movement, fed off each other's ideas and energy to create masterpieces. Similarly, members of quality improvement teams should work together to understand systems and make changes to improve patient care. The other choices are incorrect because improvement is not a solo journey and everyone's compass may go off course from time to time.

When effective leaders hear others complaining about a problem, which action would they most likely take? (A) Change the subject to talk about something interesting. (B) Try to learn how big the problem really is. (C) Add their own complaints to the chorus. (D) All of the above

Correct Answer: Try to learn how big the problem really is. Leaders don't ignore problems or complain about them. They try to learn how big a problem really is. Then they work with others to figure out what to do about it.

Which of the following best describes a workable level of unity? (A) When everyone on a team is unanimously in favor of a proposal (B) When a team is unable to reach a consensus and cannot move forward. (C) When a group is willing to try an action together, even if there isn't complete agreement on what to do (D) When an authority figure makes a rule that everyone must follow

Correct Answer: When a group is willing to try an action together, even if there isn't complete agreement on what to do Whatever a leader does is highly unlikely to be applauded by every single one of his or her colleagues — but that shouldn't stop a leader from moving forward. The idea is to create some sort of workable level of unity that allows the group to move beyond dueling opinions and into action.

You are working on decreasing adverse events related to medication errors, a serious problem on your pediatrics unit. After gathering some data, you present it to your colleagues on the unit. The result is several days of heated discussion among various caregivers. As a leader, at this point you should: (A) Meet with the hospital's chief executive and ask her to mandate the changes you have in mind. (B) Work to engage as many individuals on the unit as possible, investigating the source of their worries and responding to their concerns. (C) Recognize the level of anxiety this topic has provoked and back off for a while to allow people to digest the information. (D) Consider trying out your ideas on another unit to avoid causing more anxiety on this one.

Correct Answer: Work to engage as many individuals on the unit as possible, investigating the source of their worries and responding to their concerns. Leadership is about action. It's not about making everyone happy. It's also not about formal authority. It is essential for leaders to recognize that people will respond in a variety of ways when faced with a problem or change; it's also essential to move forward the improvement despite those reactions. Working to engage as many individuals on the unit as possible will help achieve a "workable level of unity."

When a leader aims to achieve something and initially fails, what is his or her most likely response? (A) You should give a really good explanation. (B) You should make sure that people know how hard you worked. (C) You should find a new way to work with people to get it done. (D) You make sure that everyone knows whose fault it is.

Correct Answer: You should find a new way to work with people to get it done. An effective leader takes a leadership stance — that is, takes responsibility for solving a problem and initiates action. He or she also achieves a "workable level of unity" — just enough agreement among his or her followers to move forward. Good leaders do not point the finger at others or complain when things go wrong.

In order to persuade the "logical" individuals in the room, what should you be sure to include in your presentation about improving care for patients with diabetes? (A) Average blood pressure and cholesterol levels (quality of care measures) of the clinic's patients with diabetes (B) A photograph of a patient who suffered unnecessarily from poorly controlled diabetes (C) A list of the providers in the clinic with the worst patient satisfaction measures (D) A reminder of the Board of Trustees' stated goal of improving chronic disease care

Your Answer: Average blood pressure and cholesterol levels (quality of care measures) of the clinic's patients with diabetes "Logical" individuals are persuaded by data, so it would be a good idea to present the clinic's performance on quality of care measures (Answer A). A photograph of a patient (Answer B) would be more persuasive to "emotional" individuals, while a reminder of the Board of Trustees' goals (Answer D) would appeal to "formal" individuals, who are most persuaded by evidence that those with power and authority are on board with the proposed change.

Reggie is a new pharmacist in a surgical intensive care unit. He notices that it is taking an average of three hours from the time an order is placed until a patient receives an antibiotic (the goal is one hour). What might Reggie do if he were to act like a leader? (A) Look into the cause of the problem and research how other ICUs have solved it. (B) Tell his supervisor about the data. (C) Transfer to a different ICU that has improved outcomes. (D) Make sure that patients during his shift get antibiotics faster by paying close attention to orders.

Your Answer: Look into the cause of the problem and research how other ICUs have solved it. One way to take a leadership stance is to seek out strong ideas for solving a problem. By looking at published articles by people who have overcome a similar challenge, Reggie is taking a leadership stance.

In one hospital, the chief of staff is an elected position. Physicians vote every three years, choosing from a pool of candidates nominated by their peers. What can be said of this system and its relation to the types of leaders it will likely create? (A) The leaders are less likely to be effective because they will be motivated by popularity instead of results. (B) The leaders are more likely to be effective because they will be highly visible. (C) The leaders are more likely to be effective because the system encourages diversity. (D) The leaders are less likely to be effective because the system will produce leaders without followers.

Your Answer: The leaders are less likely to be effective because they will be motivated by popularity instead of results. The effectiveness of a leader is determined by her results, not her popularity. However, elections of this kind run the risk of elevating leaders according to their charisma or popularity, rather than their ability to get results.