Why Leadership Training and Support is Critical for Care Settings

Team-based care is critical for improved patient outcomes, reduced staff turnover, reduced provider burnout, improved patient access, increased efficiency, higher patient satisfaction, and reduced healthcare costs in primary care settings (1, 8, 11, 14). This is important, as all these factors individually and collectively contribute to the high cost of healthcare and reduced patient access (6, 9). As discussed in the article Overview of Coleman’s Learning Collaborative in Supporting Team-Based Care in Primary Care Settings, the estimate of attributable cost of physician burnout in the United States in 2019 was (conservatively) approximately “$4.6 billion in costs related to physician turnover and reduced clinical hours” attributable to physician burnout (6, 9). It’s been estimated that as much as 60% of physicians experience burnout in their careers (5).

When looking at systematic changes within a healthcare setting, it is shown that team-based care optimizes for both patients and providers (7). Involving system-wide team and cultural redesign and clarification, this approach can be challenging to adopt within a complex healthcare system (2). Within a complex and highly variable care environment, change can be challenging to adopt long-term, and takes time (1, 2, 14). Team based care requires a systematic, supportive leadership approach to implement change over time. It has been shown that leadership support is critical to improvement across the care setting (14). Leadership “is an influence relationship among leaders and followers who intend real changes that reflect their shared purposes” (4).

In considering leadership support, it is important to note that these individuals lead within a “continuous dynamic environment [… and] leaders’ development should also be continuous and adjusting to environmental changes and demands” (11). One strategy to support this continuous adjusting is to support leaders is self-directed development, which utilizes a self-reflective and self-management practice for leadership personnel (11). Leadership “draws from numerous academic fields (e.g., psychology, sociology and history) and real-life sources (e.g., work, family, and social experiences) and therefore requires integration of knowledge with experience…critical reflection can assist leadership to play a vital role” (4).

In this scenario, critical reflection is considered “a commitment to questioning assumptions and taken-for-granteds embodied in both theory and professional practice” (4) and leans on the idea that the capacity to self-reflect (critically) relates to how effectively an individual can learn from their personal experiences (upon reflection; 4). The ability to self-reflect in a critical way, is distinct from other types of thought as it “involves a state of doubt, hesitation, perplexity, mental difficulty in which thinking originates, and… and act of searching, hunting, inquiring to find material that will resolve the doubt, to settle and dispose of the perplexity” (4). Furthermore, where reflection is absent, there has been shown to be risk for higher occurrences of poor decision making and bad judgements (4).

If the intent is to increase efficiency in a healthcare setting, reduce redundancies, decrease provider burnout, decrease provider turnover, improve patient outcomes, improve healthcare access, increase patient satisfaction, and decrease cost, then supporting team-based care and leadership becomes critical. Utilizing learning collaboratives to support this change can provide a scaffold as healthcare teams work to redesign and clarify staff roles and care delivery processes (8). As leadership support is imperative to the long-term adoption of change (2, 8, 14), implementing leadership-specific support during the overall scaffolding process of learning collaborative training and support can facilitate long-term change.

It has been said that in leadership training, one cannot rely singularly on the idea of good leadership, but that it needs to be practiced; the implicit needs to be transformed to the explicit (4). Supporting leadership in acquiring critical reflection skills becomes important for this transformation. One such leadership-specific collaborative is the High-Impact Management Program (HIMP) is a leadership development training for the management team, alongside the Dramatic Performance Improvement™ (DPI™) collaborative, offered by Coleman Associates. This management program allows the leadership team (who are so critical in championing other clinicians, leadership, and support staff) to have additional support. Leadership is provided with additional knowledge and skills to facilitate implementing team-based care. Coleman Associates has seen better outcomes in clinics where leadership is more supportive (and supported) than in those without leadership buy-in. This observation is supported by studies with similar trainings and approaches (14).

The HIMP collaborative specifically supports:

• Goal setting and progress monitoring
• Data-driven decision making (including using/understanding data)
• Ownership and empowerment of managers
• Candor in discussions
• Leadership team building
• Honest reflection and self-awareness
• Understanding and correcting dysfunctional teams
• Growing and developing staff
• Leading with emotional intelligence
• Attracting and retaining talent

The approach to leadership support is multi-faceted in HIMP, with an emphasis on teaching (and practicing) honest and often difficult conversations and practicing self-awareness and self-reflection in both small and large group discussions. These sessions are supported didactically, utilizing readings, non-traditional trust exercises, and reflections that support leadership to understand more about management, while also learning how to approach accountability for self and staff. This program is intended to lay the foundation for leadership to continue to have hard conversations, accountability awareness, and to dig into the nuts and bolts of following up when change isn’t going as they wished it were.

While this additional scaffolded support training can support leadership in helping staff implement consistent and long-term adoption of change to a team-based care model, it an also facilitate deep and positive change within the leadership team itself. It has been shown that activities to promote critical reflection and self-awareness can increase resilience and reduce provider burnout (10).

Supporting change of systemic issues (often rooted in leadership and management) has a trickle-down impact on the clinical team, as miscommunication, consistency in accountability and expectations, and team dysfunction can negatively impact patient care processes and team-based care (3, 8). The ability for leadership to self-reflect and hold difficult but necessary conversations and accountability deeply impacts the ability for the team and organization to make forward progress and lasting change (11, 13).

Healthcare organizations are complex and variable environments that require strong and collaborative team-based care and leadership to be a high-performing facility (13, 14). Common elements of effective leadership development programs, “include reinforcing or building a supportive culture, ensuring high-level involvement and mentorship, offering extended learning periods with sustained support, and committing to continuous improvement” (7). Developing leadership abilities through scaffolded support and training can facilitate change for the entire team, as leadership buy-in and support is critical to the health and success of the team in implementing team-based care across the care model (1, 14). Ensuring leadership is supported long-term, by training and supporting self-reflective and communication skills is important for the long-term possibility of positive change (11, 13).