So……what is going on?
• Pakistani healthcare workers demand govt. help
• Police & security forces fighting Covid-19 (public service messages / guns??), lucky to
have PPE, training workshops on precautionary measures
• Pakistan’s population 225 mil. Expenditure on health <1% of GDP
• Hospitals ill-equipped & over-crowded, at best
• As Covid-19 spreads desperate attempts are being made to prepare health facilities
to cope with the rising number of infected people
• Dr. Asfandyar Khan (Spokesperson Pakistan Healthcare Association) healthcare
workers at frontlines of the pandemic fighting battle without PPE suicidal mission
without kits
• Dr. Usama Riaz 1st medical doctor victim of Covid-19 many like him but unknown
number self-isolation / self-treatment
• Kausar Naz (Chairperson Young Nurses Association) Govt. Least concerned about
safety, well-being, duty hrs. of nurses vital role for healthcare 1 nurse / 99 pts.
what if situation out of control hire more nurses
• “Primarily, it is the
responsibility of the
federal government to
take the lead and
formulate a national
response to the crisis.
Despite the sharp
increase in the
number of cases,
there is still no
effective coordination
between the federal
and provincial
governments. Surely,
this has contributed to
the failure to contain
the problem. Nothing
could be more pitiable
at this stage than the
lack of consensus
between the federal
and provincial
governments over the
severity of the crisis.
https://www.dawn.com/news/1541750
Even the figures are
disputed.”
*Emphasis added by presenter
Leadership in Health
Dr. Saira Mansoor
Dept. of Community Medicine
Liaquat National Medical College & Hospital
Session objectives
At the end of this 35 minute session, the learners shall be
able to:
• Discuss the importance of leadership in the health
system of Pakistan
• Describe the concept of leadership
• Explain the qualities of a leader
The Pakistani Healthcare System briefly
• Federal / provincial / local govt. structure 18th amendment in 2010
• 3 tiers of care Primary (BHU/RHC) / Secondary (THQ/ DHQ) / Tertiary (teaching
hospitals, specialty hospitals)
• Governance framework, national health goals & indicators, policies & programs,
infrastructure, healthcare workforce, medical technologies & pharmaceuticals,
health economics
• Goals Service delivery / education / research
• Patient care values Equity, Quality, Relevance, Cost-effectiveness
• Environment Political, social, economical, religious, cultural
• Stakeholders
Health problems of Pakistan
• Lack of awareness
• Poor diet
• Water & air pollution
• hygiene problems leading to communicable and non-communicable diseases
• Weak political will & poor / corrupt governance
• Fragmented healthcare system
• Poor health infrastructure
• Poor spending on healthcare A
• Outdated medical facilities & technologies
“Health System”
• Shortage of doctors, nurses & other healthcare staff
• Lacking / Sub-standard training in crisis
• Lack of life-saving treatments & medicines
• Poverty, illiteracy
• Health deterioration of underprivileged people of Pakistan
Shortcomings in healthcare
Health Governance:
The wide range of functions carried out
• Inverse care: under the stewardship of governments
• Mismatch of personal means and health needs as they seek to achieve national health
policy objectives
• Impoverishing care
• Catastrophic expenses for the poor It is a political process that involves
balancing competing influences and
• Fragmented & fragmenting care demands, including:
• Non-holistic specialization, many sub-systems • Maintaining strategic direction of
• Unsafe care policy development &
implementation
• HAIs, medical errors, adverse effects • Detecting & correcting undesirable
trends & distortions
• Misdirected care: • Articulating the case for health in
• Resource allocation to curative vs. preventive national development
• Regulating the behavior of a wide
range of actors
• Establishing effective accountability
mechanisms
Concept of Leadership
“If you want to go fast, go alone. If you want to go far, go with
others.”
AFRICAN PROVERB
Definition
“Leadership is a process of persuasion or example, by which an
individual (or a leadership team) induces a group to pursue
objectives held y the leader or shared by the leader & his or her
followers”
• Leadership is a process
• Leadership involves influence
• Leadership occurs in a group context
• Leadership involves group attainment
Theories of Leadership
• The “nature” theory Born to lead
• Great man theory – charismatic
• Trait theory – specific traits shared by all leaders
• The “nurture” theory Learn to lead
• Skills theory – certain competencies / capabilities can be
learnt
Situated Leadership theory
• The most important predictor of success is the situation or context
• Different contexts and situations require different styles
Hersey-Blanchard Situational Leadership Theory • The Hersey-Blanchard Situational Leadership
Theory has two pillars:
• Leadership style
• Maturity level of those being led
• 4 behaviors
• S-1 Directing (Telling)
• S-2 Coaching (Selling)
• S-3 Supporting (Participating)
• S-4 Delegating (Distributing)
• Four maturity levels of the group are posited by
Hersey and Blanchard with letter designations:
• M-1: basic incompetence or unwillingness in doing the task
• M-2: inability to do the task but willing to do so
• M-3: competent to do the task but do not think they can
• M-4: the group is ready, willing, and able to do the task.
Leadership Styles
• x axis Concern for Production
• y axis Concern for People
• Scale 1 (low) – 9 (high)
• Styles:
• (1,1) indifferent style – evade & elude
• (1,9) accommodating style – yield & comply
• (9,1) dictatorial style – control & dominate
• (9,9) sound style – teamwork & commitment
• (5,5) status quo style – balance & compromise
• Seven key behavior elements for leaders
Element Description
Initiative Taking action, driving & supporting
Inquiry Questioning, researching & verifying
understanding
Advocacy Expressing convictions and championing ideas
Decision-making Evaluating resources
Blake & Mouton’s Leadership Dilemmas
Conflict Confronting & resolving
– Grid Solutions (1999)
resolution
Resilience Dealing with problems, setbacks & failures
Leaders & Managers
Skills Model Mumford et al, 2000
COMPETENCIES INDIVIDUAL LEADERSHIP CAREER ENVIRONME
ATTRIBUTES OUTCOMES EXPERIENCES NT
INFLUENCES
Problem-solving General cog. Ability Effect. Prob.- • Develop w/ time Internal:
• Define problem • Intel./ reason./ Mem. solving • Challenging job • Technical
• Gather Information • Percept./info. process • Keystone sk. assign., • Facilities
• Formulate new • Creative/ divergent thinking mod. • Mentoring • Experience of
understanding capacities • Sol. Log.; Effect.; • Approp. training subordinate
• Generate best solution • Fluid Intelligence Unique; out-side- • Hands-on exp. • Communication
Social Judgement Crystallized cog. Ability box Solve new prob. External:
• Perspective taking • Intel. abil. > w/ time • Problem-solution / • Economic
• Social perceptiveness • Comp. complex info / learn social judge. • Political
• Behavioral flexibility new sk. / info increase • Social
• Social performance • Oral/ written comm. experience • Nat. disasters
Knowledge Motivation willing to: Performance Outside leader’s
• Apply/ implement prob.- • Tackle complex org. prob. • Stand. ext. criteria control
solving sk. in orgs. • Express dominance • + Eval. Perf. rev.
• Accurate info complex • Social good of org. • Perf. assign duties
schema Expert Personality Openness,
Deal w/ ambig., Curiosity
Qualities of a Leader
“If I could teach you 3 things, they would be Compassion, Simplicity & Honesty”
Lao Tzu in Tao Te Qing
Leadership qualities
Traits Skills
• Adaptable to situations • Clever (intelligent)
• Alert to social environment • Conceptually skilled
• Ambitious & achievement-oriented • Creative
• Assertive, decisive • Diplomatic & tactful
• Cooperative
• Having a vision
• Dependable • Enabling change
• Influencer (dominant) • Working with others
• Communicating
• Energetic
• Understanding international health & development
• Persistent • Changing self
• Self-confident • Enhancing & sharing leadership
• Tolerant to stress
• Responsible
Levels of healthcare leadership
• Individual
• Organizational
• Community
• Local
• Provincial
• National
• International
Health leadership as a competency
• Leadership is a highly-desired competency for all healthcare
workers
• Leadership training is mandated at all levels of healthcare and
for all kinds of workers
• Pakistan Medical & Dental Council – 7 star doctor
• College of Physicians & Surgeons – CPSP competency framework
• ACGME, LCME, GMC, CANMedics, AMC
• World Health Organization, CDC
The World Health Organization’s framework
for attaining leadership and management
strengthening of healthcare systems
https://www.who.int/management/strengthen/en/
