Will They Come?

Subtitle:  The Importance of Leadership Among Health Changes

Article’s Category: Theme Event Articles

Authors: Ana Carolina Guimarães Cerbino¹; Lorena Hayashida Carneiro do Prado²; Lucas Tadeu Gonzaga Diniz²; Mercielle Ferreira Silva Martinelle²

¹Universidade Federal de Goiás; ²Pontifícia Universidade Católica de Goiás | IFMSA Brazil

E-mail: [email protected]

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The late 16th century’s Henry IV, Part 1 by Shakespeare reminds  us of a fundamental question about leadership in a conversation between the rebellious Glendower and Henry Percy. They conspire against the king, mocking each other. Glendower says: “I can call spirits from the vast deep”, to which Percy replies: “Why, so can I, or so can any man; but will they come when you do call for them?”¹. Shakespeare asks: “Will they come?”; Leaders must ask the same question: Why do others follow them? They could answer that to lead is to have a good reason. Good leadership is a meaningful leadership, at the service of a cause, at the service of others and the world. It is a long-term vision around which professional life is based. It can change the lives of others and bring special meanings to their lives. However, it must be also recognized that, today, the growing scale and complexity of health service creates challenges for communication, mission alignment, system-level planning, and monitoring –  obstacles that can become major flaws in their good reasons.

         Understanding that the whole world is facing many changes is not big news; it is well known that the planet is experiencing waves of scientific, technological and cultural advances that influence the health environment. Furthermore, diseases are seen in different perspectives and the patients have more access to health information and different lifestyles. The clinical practice and the medical abilities need to keep up with these changes to improve healthcare. As a result, medical students who develop leadership skills and know how to manage problems are needed².

However, the need for leadership in medical practice is often confused with the concept of leadership associated with important positions of authority, when, in fact, every physician is a leader and leadership is included in their daily life³. Thus, the question arises: how to become a leader without the appropriate training?

Therefore, the importance of extending this knowledge to universities and medical residency is recognized. Only few medical education schools include teaching leadership in their curriculum. Although training in finance, business planning, and personnel management is central to the professional development of health system executives, these topics are not generally emphasized in schools. Furthermore, the workload of the medical course can be exhaustive, and some students tend to be discouraged from participating in extracurricular activities and end up having no contact with the concepts of health leadership and management. This very important issue for the development and continuity of health systems can go unnoticed during graduation and be neglected by countless curricula and may get in the way of trying to lead for “good reasons”. Leadership is, beyond a big dream “at the service of a cause”, the ability to identify priorities, set a vision, and mobilize the actors and resources needed to achieve them. Therefore, it must be acknowledged the need for interactive leadership in health, empower managers and implementers to assert themselves as leaders, enable patients, families, and community groups to participate in health leadership; and advance research in the field of health leadership.

The contemporary health systems operate through networks organized by levels of responsibilities. As a result, in order to guarantee a cohesive, effective, accessible, patient-centered, equitable, and safe care, these networks require cooperation and coordination through effective health leadership and workforce management⁴, but there is still a lack of leadership and management skills between medical students and medical professionals and this is a serious health emergency. This sometimes can be a neglected topic which creates a negative patient care experience, delays the health system flow and causes serious problems to the interpersonal relationships between health professionals. Therefore, this context impairs all the health system’s dynamics causing mis-diagnostics, unsatisfied patients, abandonment of treatment, students’ and medical providers’ distress, and damaged patient care. This scenario needs to be urgently changed and leadership skills must be taught in medical schools so it is possible to improve clinical practice, to manage population’s needs and drive innovations. 

This can be achieved through many and different ways and one of them is being part of a students’ organization which provides a lot of opportunities to participate in committees, sections and projects, determining potential contributions to the organization. When a student is a part of an organization, they have  the responsibility to ensure the organization is meaningful to its members and to encourage, inspire, nurture, and support others in completing projects. Besides that, the student who is a leader needs to communicate expectations clearly, be flexible whenever possible, delegate tasks and make sure they are completed, and ensure the continuity of the organization through identifying future leaders and fostering their development⁵.

When a student takes part in  an organization, they accept  new responsibilities that go  beyond the school’s tasks and demonstrate qualities such as motivation, initiative, and commitment leading to his personal growth⁵. Being part of IFMSA Brazil ensures  that medical students develop their abilities, become leaders in their local environments and expand their knowledge. This opportunity definitely contributes to their professional formation and develops their ability to manage problems and find solutions – it prepares them to deal with the diversity of health problems as well as prepares them for  everyday life as a doctor. These skills help in connection  with the multidisciplinary health teams, especially with regard to the process of empowerment and openness for dialogue in problem solving, proactivity, transparency and responsibility in the action plan, based on a true participatory model, in which the “social being” is democratically valued and everyone is equally committed to making decisions and constantly acquiring critical and multidimensional knowledge.

Initially, it is necessary to understand that health systems could begin by distinguishing possible leaders and engaging them in task forces, committees, retreats, and formal training programs. Every one of these exercises requires devoted time and institutional help for leadership development. Giving continuous, organized input to developing leaders offers open doors for progressing appraisal of initiative potential, mentoring, and succession planning through the handover tool⁶. 

In addition, health systems must also recognize the fact that the most encouraging leaders are the individuals who have an understanding and a convincing vision as well as epitomize the basic beliefs of the organization and can engage and motivate others to unite behind a common vision. Physicians are naturally energetic about their own clinical specialties and research territories, yet pioneers need to understand, respect, and support the diverse interests of their teams and the institution in a balanced way. Physician leaders also need to accomplice successfully with non-physician partners, including business leaders, executives, and health professionals, such as nurses, psychologists, nutritionists, pharmacists, social workers, physical educators, physiotherapists, among others, in the dynamics of multi professionalism.

Health systems could also execute organized procedures for “onboarding” and strategies for gathering feedback. For instance, shadowing  visits that permit new leaders to demand perspectives from current leaders, personnel, and staff are important for learning the social standards and vital needs for the new job. This procedure likewise serves to set up new community organizations and fabricate believability for the new leaders ought to have a realistic comprehension of what’s anticipated from them and be allowed to create connections that support effective planning.

Finally, regarding the work of medical schools to create a spirit of leadership and willingness to undertake changes, it is known that Health System Science (HSS) includes the study of population health, health care, finance, communication skills and patient safety. For this reason, it is important to study the HSS in order to improve the quality of healthcare. Therefore, the medical school must modify its curriculum incorporating HSS as one of its pillars alongside basic and clinical Science⁷.

In conclusion, we understand leadership as a phenomenon with multiple faces, always at the service of a cause, of other people and of the world, which can change the lives of other people and bring special meanings to their lives. Much more than that, leadership also represents, in medical practice, multiprofessional involvement, skills in communication, administration and decision making; it represents the construction of action plans through a participatory model that considers different specialties in a democratic and responsible system. Given this, teaching the phenomenon in classrooms and taking it to the corridors of hospitals and conference rooms is a necessity and one day will mitigate communication challenges, alignment of missions, planning and monitoring at the system level. Finally, medical leaders will be able to understand why others follow them and how their skills can be used in favor of patients, family members, staff and the health system. Yes, this day will come.

References

¹ Shakespeare, W., & Bevington, D. M. (1994). Henry IV, Part 1. Oxford: Oxford University Press.

² Mokshagundam, S., Pitkin, J., Dekhtyar, M., Santen, S., Hammoud, M., & Skochelak, S. E. (2019). Engaging Medical Students in Leadership Development. Medical Science Educator, 29(3), 849–853. https://doi.org/10.1007/s40670-019-00754-w

³True MW, Folaron I, Colburn JA, Wardian JL, Hawley-Molloy JS, Hartzell JD. Leadership Training in Graduate Medical Education: Time for a Requirement?. Mil Med. 2020;185(1-2):e11-e16. doi:10.1093/milmed/usz140

⁴Figueroa, C. A., Harrison, R., Chauhan, A., & Meyer, L. (2019). Priorities and challenges for health leadership and workforce management globally: A rapid review. BMC Health Services Research, 19(1), 1–11. https://doi.org/10.1186/s12913-019-4080-7

⁵ Shanahan, R., Rosen, B., Schofer, J., Fisher, A. S., Wald, D., Weiner, S., … Kazzi, A. (2020). Medical Student Leadership in Emergency Medicine. Journal of Emergency Medicine, (February), 1–3. https://doi.org/10.1016/j.jemermed.2020.02.023

⁶ Lerman, C., & Larry Jameson, J. (2018). Leadership development in medicine. 

New England Journal of Medicine, 378(20), 1862–1863. https://doi.org/10.1056/NEJMp1801610

⁷ Lawson L, Lake D, Lazorick S, Reeder T, Garris J, Baxley EG. Developing Tomorrow’s Leaders: A Medical Student Distinction Track in Health System Transformation and Leadership. Acad Med. 2019;94(3):358-363. doi:10.1097/ACM.0000000000002509