Performance

Clinical leadership in HA and other healthcare providers
Like many professions, physicians are keenly aware if a colleague is not performing to standard.
We learned through the interviews that instead of reporting them, physicians may choose not to
refer their patients to a poor-performing physician. It is difficult to define the cause for this
finding. There are many reasons why a lack of challenge could exist, including payment
mechanisms, mutual trust and empathy. Whatever the reason, our interviews found that doctors
may be less likely to whistleblow and many clinical leaders, themselves doctors, do not feel that
it is their place or role to judge a colleague, let alone actively manage poor performance.
This situation is magnified in organizations where clinical leadership roles are filled on a rotational
basis, that is to say where a leader is chosen not through ability but because it ‘is their turn’.
Leading practice
In response to this challenge of supporting clinical
leadership, PHSA has developed a pilot program to train
and support Department Heads. The approach will include:
Clarifying the role, the requirements, and the
expectations from a Department Head.
Developing and implementing an orientation program.
Developing and implementing a professional
development program for medical administrators.
In these cases, management can be seen to be a burden, a task that administrators may deem
necessary but certainly one that does not motivate the clinical leader to perform anything other
than a preemptory function.
Remunerating the position considering its importance
in managing and directing medical staff and the impact
that this has on the quality and safety for patients.
Our interviews found that clinical leaders are seldom provided with the necessary training or support to fulfill these roles effectively.
Issues around clinical leadership are further compounded by the professional barrier that sometimes exists between physicians and management, where the
feedback from administrators was that they understand that they are not necessarily equipped to challenge doctors professionally and/or clinically and look to
clinicians to self-regulate and manage themselves more effectively.
During our interviews we were advised many times that one of the main difficulties is that the Chief of Staff role is oftem either not recognized by some local
physicians or perceived to be valued by HAs themselves as an integral part of the management of physicians within the system. This observation appears to go
further than simply a request for greater remuneration, more that those interviewed believe that the clinical leadership role needs to be better understood and
reviewed by the system.
Who the clinical leaders are is usually clear; the fact that they are not motivated to lead is due to a combination of lack of remuneration, status, levers to create
change and management support.
As many physicians are exclusively contracted to perform services through the MSP system rather than having contracts of employment, it may not be in the
interests of the physician to disclose relevant information. A combination of regulation and this inherent conflict in the system has potential to form a major barrier
to open and honest dialogue on performance issues that is not present in other jurisdictions such as the UK where physicians have contracts with the hospitals in
which they work. That system may have greater potential to develop dialogue, because, as employees, doctors may be far less at risk of losing their livelihoods.
Employers also may have a greater duty of care, and provide structured assistance programs to support individuals through any personal and professional
difficulties and performance issues.
Ministry of Health 44
Provincial Review of Physician Licensing, Credentialing, Privileging & Performance Management
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