Primary Care Doctors and Leadership in Health Care ... - What is GIS

Primary Care Doctor & 

Leadership In Health Care 

Dr. Tawfik A. M. Khoja 

MBBS, DPHC, FRCGP, FFPH, FRCP (UK) (UK 

Director General – GCC 

Health Ministers’ Ministers Council 

Organization 

Views on Future 

Dr. Ali M. Al Shehri 

MBBS , Ms , FRCGP (UK) 

Former Founding Executive Director 

PHC - NGHA 

Dr. Tawfik A. Khoja, Dr. Ali Al – shehri 1


Establishing the 

Advanced Practice Role : 

Leadership Challenges 


INTRODUCTION: 

INTRODUCTION: 

The new year, indeed 

the new millennium 

and the new age in 

health care are now 

upon us. 


Our Heritage and Roots 

Hold on to your heritage 

as a family physician . 

It may save the health care 

system , or at least save 

your patient from it . 

William R. Phillips, MD, MPH 


Healing is more than health care 

- Health is more than the absence of disease, and 

care is more than the provision of diagnostic and 

treatment services. 

- Comfort, confidence and 

communication contribute to 

improved outcomes and 

higher satisfaction, for both 

the patient ,the doctor and 

PHC team . 


» The greatest challenge we face 

as a nation is to guarantee 

everyone access to health care 

and equity within the 

community. 

» FCM physicians must work to keep 

their intact. 

professionalism and pride 

» Family and Community Medicine is 

well-suited to lead health care reform 

in the 21 century. 

Dr. Tawfik A. Khoja, Dr. Ali Al – shehri 

7

FCM Physicians are able, adaptable, 

accountable professionals, they are 

not the problem, disease is. 


8

VISSION 

I wish every FCM physician 

I wish every 

becomes the master of community 

based services, primary care 

physician, central / focal referral 

point where he / she can acquire a 

niche in the society to help the 

patients and families and live up to 

the definition of “ Friend, 

Philosopher , Guide and Leader ". 


Our vision is that Primary Health Care 

Centers will be GCC’s GCC s first choice for 

health care. 

Our Vision 

Lead the way to quality health care 

providing comprehensive, integrated, 

appropriate & wellness oriented services. 


Our Mission 

Our mission is to promote, maintain 

and improve health & well-being of 

GCC’s and achieve better personal & 

population health outcomes by 

working proactively to provide 

integrated, efficient and effective 

health care services in a caring & 

professional manner, and by 

advancing the ability of individuals & 

communities to effectively respond to 

their health needs. 


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Objectives Objectives of of PHC PHC in in GCC GCC States: 

States 

Is to ensure that essential health 

care is available to everyone in 

the community with high quality 

standard. 

Patient Safety 



13

“ Primary Care seems to offer important 

advantages within health care system in 

terms of cost containment, health status of 

the population, and a range of other related 

outcomes. The value of a strong primary 

care base within national healthcare systems 

is recognized by the WHO ” 

(Campbell Campbell JL, BMJ 2007) 

2007

“More than two decades of accumulated 

evidence reveals that having a primary care 

based health systems matters. matters People 

and countries with adequate access to 

primary care realize a number of health and 

economic benefits, including the following ” : 

(Robert Robert L. Phillips & Barbara Starfield , 

American Family Physician, 

15 October 2003) 

2003

Evidence of Effectiveness 

Reduced the cause mortality and mortality 

caused by cardiovascular and pulmonary 

diseases . 

Less use of emergency departments 

and hospitals 

Better Preventive Care 

Better detection of breast 

cancers and reduced 

incidence and mortality 

caused by colon and 

cervical cancer .

Evidence of Efficiency 

Fewer Tests, higher patient satisfaction, less 

medication use, and lower care related costs. 

Evidence of Equity 

Reduced health disparities, 

more complete immunization, 

better blood pressure control, 

and better oral health”. health .

GPs, FPs, Generalist Clinicians characterized by : 

- Total approach 

- Deal with most of patients / problems 

- Member / leader of a team 

- Provocative for patients’ patients rights 

- Communicator / liaison officer 

for multiple services 

- First point of contact; “gatekeeper 

gatekeeper” 

to the system of specialists 

- Doing more with less resources

Essentials of FAMILY Practice 

Focus on supporting the healing process; 

health promotion 

Focus on the whole person 

Focus on the environment of care 

Coordination of care 

Continuity of care 

Outpatient services across the lifespan 

Emphasis on risk assessment, primary and 

secondary prevention 

Management of common acute and stable 

chronic illnesses 


FCM 

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What is an Advanced FAMILY Practice ? 

Characteristics LEADER 

• Expert knowledge base 

• Complex decision-making decision making skills 

• Clinical competency for advanced practice 

• Shaped by context/country of practice 

• M C recommended 

• Integration of research, education, practice, 

management 

• Autonomy 

• Case management/own case load 

• Consultant services 

• Program planning, implementation, evaluation 

• First point of contact 


Professional bureaucracy 

High degree of control 

Resistible to change 

Strong collegial linkages 

Costly 

Multi - disciplinary 

Customers driven

“Commonality Commonality & interaction 

between medicine & management, 

dictates more involvement of 

doctors” doctors doctors” 

(Al--Shehri, (Al (Al-Shehri, Shehri, Saudi Saudi Medical Medical Journal Journal , , , 2004) 2004) 

WHAT SORT OF INVOLVEMENT ? 

Health Care Provider 

Manager 

Leader

Management & Leadership 

Is 

there 

a 

difference? 

difference

Differences Between a Manager and a Leader 

Manager Leader 

Administers Innovates 

A copy Original 

Maintains Develops 

Focuses on System & Structure Focuses on People 

Asks how and when Asks what and why 

His eye always on the bottom line Eye on the horizon 

Imitates Originates 

Accepts the status quo Challenges the status quo 

Is the good, classic deliver Is his own person 

Does things right Does the right things

Leadership Vs Management 

“ If the ladder is not leaning against the 

right wall , every step we take just gets 

up to the wrong place faster ” (Covey)

Leadership Vs. Vs Vs. . Management 

“ Efficient management without effective 

leadership is ……...…like straightening 

deck chairs on the Titanic ” (Covey)

Leadership Vs. Vs Vs. . Management 

Most , if not all , managers are buried in day-to-day 

management of their organization & have no 

time to survey the horizon to lead . (Covey)

What Do PHC Doctors Need to Know ? 

Management cannot succeed without effective 

leadership. 

If you are the top person in your organization, 

make sure you know how to lead more than 

how to manage.

Definition of Leadership 

Northouse 2004 said: “ As soon as 

we try to define leadership we 

immediately discover that leadership 

has many different meanings ”

Northouse defined leadership as : 

“ A process whereby an individual 

influences a group of individuals 

to achieve a common goal ” .

Effective Leader: Leader Leader: 

Go Go with the flow. 

Capitalize Capitalize on followers . 

Act Act as performers or 

agents of change. 

Promote Promote a unique vision.

Effective Leader 

Lead through assertive behavior, self-confidence, 

expertise, unconventionality, and concern for followers’ 

needs. 

Self-sacrificing to achieve the shared vision. 

Use unconventional or extraordinary means. 

Engage in novel behavior. 

Use personal rather than position power. 

Exert power through elitist, entrepreneurial 

and exemplary behavior rather than through 

consensus-seeking and directive behavior.

Why Is It So Difficult ? 

We’re smart 

We’re knowledgeable 

We’re capable… BUT 

We’re humble 

We’re timid 

We’re not confident 

We’re not respected 


33

Obstacles / Barriers to Role 

Implementation 

Public perception: “just a G P ”: “where’s the 

SPECIALISED doctor?” 

MD perception: “just a G P ”; threat 

A mini-doctor”; fear of responsibility 

Regulations / Laws 

FCP’ self-perception 

Family Physicians’ resistance 

Change is not easy , 

fear of change; 


34

Dr. Tawfik Dr. Dr. A. Khoja, Tawfik Dr. A. Khoja Ali Al – shehri 

35 35 35

Strategies to Change 

Perceptions 

‘The The number one goal in 

LEADERSHIP Strategic Plan is to 

"formulate formulate and influence healthcare 

policy to remove barriers to General 

Practitioner practice". practice". 

It is our 

intent to facilitate a more uniform 

advancement of statutory changes to 

remove barriers to FCP practice in 

all HEALTH CARE FACILITIES .’ . 


36

Changing Laws & Marketing 

Promote demand among constituents (the public) 

Offer a concrete proposal & demonstrate FCP 

value & results through research & implementation 

Understand competing interest groups and 

address their concerns eg (MD organianizations ) 

Making service desirable & necessary 

Provide a concrete cost / benefit analysis 


37

Changing Public Perceptions 

Understand your customer,s need 

Direct patient care services by FCP 

Public relations: media, flyers, 

newsletters 

Community-based activities 

Personal example 

News articles 


38

Changing M.D. Perceptions 

Interdisciplinary activities with active FCP 

participation 

Shared training, research, practice 

Confidence and assertiveness - without 

aggressiveness or arrogance 

Recognize differences and 

articulate mutual strengths 

and interdependence 


39


40

Questions to Help Identify Your Leadership 

What makes me different from other health care 

providers? 

If I cease to exist, why would my customers miss me? 

What do my customers ask for that I don’t have? 

What need do I fill that no one else does? 

Who are my best customers and why? 

Characteristics 


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What is the most important and 

marketable quality of the 

leadership of family practice? 

Being a FCP ! 

It is the “FCP FCP” in “advanced advanced 

family practice” practice that is our 

greatest asset ! Dr. Tawfik A. Khoja, Dr. Ali Al – shehri 

42

How to shape our role? 

We must remember that 

being great LEADER 

will make us great 

advanced FCP. FCP. 


43


The future is now 

- FCM practice has long promoted outcomes, teams , 

accountability & LEADERSHIP in health care facility 


The future is you 

- FCM can lead future reforms in health care if we 

mind the milestones that mark the road that has 

carried us safely so far. 

- Let us remember our heritage: It stood in the 

community; it had a hearth and it was a home. 

- Recall the essence of why you became a FCM 

doctor and treat each patient with a generous 

dose of that special elixir with safety and 

effectiveness. 


Declare your values in what you do. 

Demonstrate the value of what you do. 

BE & FEEL YOU ARE A LEADER 

- Prepare the future for yourself ,for your patients 

and community …. . 


1. Evidence based practice 

2. Political skill 

3. Persistence 

4. Commitment 

5. Inspiration to others 

6. Personal example 

Legacy 

7. Nursing education and 

leadership. 

8. Nursing as a distinct 

profession 

9. Organizational skill 



Challenges: 

Common vision for Healthcare Organizations: 

PHC-Based systems 

Clear vision for doctors regarding their 

involvement as leaders 

Shortage of PHC doctors 

Leaders with general skills at the 

top of healthcare organization 

Role models PHC services 

PHC representing body (e.g. RCGP in UK) 

Changing role of existing top clinical 

managers (from management to leadership)

To change from management to leadership 

is NOT easy: 

“It It is hard. hard I went through withdrawal pains because I stopped 

dealing with a lot of the pressing, urgent matters that were right in 

front of me and which gave me a sense of immediate 

accomplishment. I didn’t receive much satisfaction as I started 

wrestling with the direction issues, the culture building issues, the 

deep analysis of problems, the seizing of new opportunities. 

Others also went through withdrawal pains from their working style 

comfort zones. They missed the easy accessibility I had given 

them before. They still wanted me to be available to them, to 

respond to, to help solve their problems on a day-to-day basis.

“BUT I persisted. persisted I was 

absolutely convinced that I needed 

to provide leadership. leadership And I did. 

Today our whole business is 

different. We’re more in line with 

our environment. We have 

doubled our revenues and 

quadrupled our projects. I’m m into 

leadership.” 

leadership. 

President of an oil company, 

Cited by covey.,

PROMOTING THE Leadership In Health 

Care Organization 

RECOMMENDATIONS 


1. Selective training, further leadership 

development of PHC / FCM Medicine 

staff should be priority. 

2. Health system research within the PHC 

activities 

leadership. 

should be enhanced in 

3. Establishment of CME in leadership with 

involvement of educational institutions. 


LEARNING TOGETHER 

TO WORK TOGETHER 

FOR HEALTH 

Khoja . A . Tawfik . Dr 

57

4. Intensify communicating 

and field visits between 

central level and periphery . 

5. Improve standard of 

selecting staff in leadership 

positions . 

6. Integration , Revise & 

update manuals . 



ﻡﻜﻟﻭ ﻲﻟ ﻪﻨﺎﺤﺒﺴ ﷲﺍ ﹰﺎﻴﻋﺍﺩ 

ﻥﺍﻭﻀﺭﻟﺍﻭ ﺔﻴﻓﺎﻌﻟﺍﻭ ﺔﺤﺼﻟﺍ ﻡﺍﻭﺩﺒ 

Thank you for your 

kind attention

Primary Care Doctors and Leadership in Health Care ... - What is GIS

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