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MARCH / APRIL 2006

FEATURES

Health care leaders in India convene for leadership and faculty development workshops

In February, Sri Ramachandra Medical College and Research Institute (SRMCRI) welcomed HMI faculty for a pair of programs aimed at enhancing clinical education and health care leadership. This year HMI and SRMCRI expanded the focus of the workshops to include a wider range of institutional and regional professionals in health care and academic medicine. About 90 participants, holding a variety of health care management roles throughout India, attended the two programs in Chennai.

“It is wonderful to see that this institution is now known as a center of excellence in India for education programs of this nature, and is able to attract participants from all over the country,” said Elizabeth Armstrong, PhD, HMI director of education programs.

Armstrong and Tom Aretz, MD, HMI vice president for education, have joined colleagues in Chennai in previous years to deliver these programs. This time, they were joined on the HMI faculty by Harvey Makadon, MD, vice president for health systems, and Elizabeth Brown, RN, MSN, director of clinical services, for the three-day leadership course entitled “Building the Hospital of the Future: Strategy, Vision and Multidisciplinary Leadership.” The HMI team represented expertise in both education and health care management, complementing the diverse group of participants.

Hospital accreditation in India was the subject of a negotiation exercise that formed the centerpiece of the three-day leadership course.

“The discussions were extremely lively, addressing a vast range of ideas and issues,” Brown said. “The program provided a laboratory for discussing the various experiences and expertise that participants brought to the program, and taking theory and seeing how it is applied around the world.”

The course concentrated on approaches to creating health care systems and processes that produce safer outcomes. Discussions focused on how to measure performance in organizations, select a leadership style appropriate to existing organizational culture and context and its anticipated new direction, and understand negotiation skills and the roles of various stakeholders in a system, especially in times of change. The negotiation exercise formed the centerpiece of the three-day course. Hospital accreditation in India, presently a hotly debated topic in Indian health care, was selected as the topic for negotiation. Participants were given some general background information about the pros and cons of accreditation, and were then randomly assigned to various stakeholder roles.

“In designing such an exercise, one wants to choose a topic that is of current interest and creates genuine controversy among the stakeholders,” said Aretz. “The selection of the stakeholders, crafting of the role scenarios, and the subsequent random assignment of the roles to the participants force them to analyze the issues critically and look at them from various angles, a necessary condition of any meaningful negotiation.”

Using this role-play scenario, Aretz then derived general principles of negotiation by comparing and contrasting results and processes in the various groups.

Another key session, “Organizing for Performance Measurement: Managing What You Measure,” highlighted a “balanced scorecard approach” for measuring the performance of an organization, an evaluation tool for patient safety and quality, financial performance and efficiency, and patient satisfaction matching the measurement system with strategic objectives.

HMI’s Elizabeth Brown, pictured with program participants, said the program “provided a laboratory for discussing the various experiences and expertise that participants brought to the program, and taking theory and seeing how it is applied around the world.”

“Participants recognized the need for leadership to play a role, for an organization to have the structure in place to implement and follow up on change,” Makadon said, “and most importantly, that the reality of implementing quality and patient safety programs is quite complex.”

A particularly well received and innovative feature of the program was the “action plan group” held at the end of each day. This session provided participants with an informal, small-group setting in which to discuss the general principles and concepts that emerged in each session and how they might be most useful in helping resolve a key problem at a participant’s institution, thereby creating a viable action plan. Attendees, said Armstrong, “could discuss how the day’s concepts coincided to action they would like to take at home, and helped the participants to clearly define a specific problem and develop a set of tools and a realistic plan to employ.”

Armstrong added that the participants were encouraged to identify a partner from within the group and make a commitment to touch base with regularly to check on progress and evaluate his or her organization’s ability to employ the course concepts.

“The meetings were very beneficial and helped the participants explore what the process would actually look like by creating a tangible plan for how a system would be put in place, whether it was implementing a quality improvement plan, reforming curriculum, or developing a new hospital,” said Brown.

Armstrong and Aretz directed a separate two-day course entitled “Enhancing Effectiveness in Clinical Teaching,” which focused on learning and teaching new clinical skills. A highlight of this program was a two-part session on microteaching featuring a morning session that emphasized clinical teaching and an afternoon session focused on clinical skills. Participants selected a clinical teaching scenario and were then taped giving a 10-minute teaching segment. The “teacher” was then able to review the tape and receive feedback from colleagues. The session reinforced skills in analytical observation and clinical supervision, and allowed the participants to practice giving feedback to a colleague.

Other sessions centered on exploring parallels between quality improvement and feedback principles and analyzing work rounds, attending rounds, and chief resident rounds, staples of clinical bedside teaching in many U.S. institutions.