leadership perspectives on driving transformation

Question 1

what are the key forces for change

Answer 1

[patient demographic and social factors]
- ageing population
- increased caregiving needs
- changing expectations of young generations

[workforce demographic and social factors]
- ageing population
- younger generation entering workforce
- shrinking workforce
- tightening of foreign manpower
- increased caregiving needs
- child-bearing female workforce
- changing attractiveness of profession
- workforce psychological well being (burnout)

[new therapy, regulatory landscape, pandemic]
- new therapy
- covid
- changing regulatory landscape

[economic factors]
- increase in healthcare expnediture
- changing healthcare financing models (bundled payments, pay for performance, capitation model, value driven care)
- aligning with singapore’s economic priorities

Question 2

what are SG’s economic priorities

Answer 2

1. changing global order (staying relevant)
2. accelerating industry consolidation and churn (more productive)
3. rebalance between efficiency and resilience in supply chain and production (robust supply chain, connectivity to the world, enhance production capabilities and strengthen business ecosystem)
4. accelerating digital transformation and innovation (digitalise business model, access new markets, R&D)
5. changes in consumer preferences (online, more conscious about health and environmental sustanility)
6. increased focus on sustainability (opportunities in green economy, economic growth should be sustainable and inclusive for singaporeans)

Question 3

what changes to work towards regarding work

Answer 3

[services to include]
- patient centered care
- patient empowered care
- value-based care
- changing regulatory landscape

[where]
- shift less acute cases out of services
- care closer to home
- hospital or care at home (medication delivery, primary or preventive care, emergency services at home, hospital or surgery at home)

[how to deliver services]
- increased focus on productivity
- 7 day service
- always on health care (automated activation of care, MDS etc)
- capacity sharing or one-cluster approach
- collaborative work practices across disciplines
strategic partnering

Question 4

what are the types of leadership style

Answer 4

1. visionary
2. transformational
3. commanding
4. autocratic/bureaucratic
5. pacesetting
6. transactional
7. democratic
8. laissez-faire
9. coaching
10. affiliative
11. servant
12. adaptive

Question 5

what are the levels of leadership in pharmacy

Answer 5

1. foundational
   - entry members of pharmacy workforce (newly registered pharmacists, PTs, PAs)
   - self development
   - goal is to (i) develop self-awareness and professionalism and (ii) promote leadership and commitment towards self development
2. emerging
   - taking a leadership position role for the first time (senior pharmacist/ PT, team lead, QI/ research project supervisors, PI)
   - early identification: invest in training and provide opportunity to quantify potential
   - new manager: equip with tools to further extend leadership skills
   - goals include (i) communicate to influence (ii) develop others (iii) foster team learning (iv) coaching for performance (v) build positive r/s
3. evolving
   - leaders who are managing progressively larger teams (practice managers, HOD, dept lead, PT supervisors)
   - leadership development and organisational leadership: continue development in higher order leadership skills
   - goals include (i) deepen understanding of the complexity of healthcare system (ii) self mastery through reflection on personal leadership practice (iii) build leadership commitment and passion towards organisational vision and
   mission
4. established
   - leaders of organised or specialised functions (chief pharmacists or AHP, cluster leads, CEO, COO)
   - executive leadership development: focus on inspiration and role-modelling
   - goals include (i) provide stewardship (ii) master complexity (iii) foster organisational learning (iv) lead organisation change
5. exemplary
   - senior leaders in MOH or cluster level (chief pharmacist, group chief pharmacist, group AHP director, GCEO and GCOO)
   - executive leadership development: focus on inspiration and role-modelling
   - goals include (i) provide stewardship (ii) master complexity (iii) foster organisational learning (iv) lead organisational change

Question 6

what are the components of the MOHH one healthcare leadership framework

Answer 6

1. outward focus
   - driving transformation (inspire and energise followers in making sense of change)
   - visionary leadership (build a shared purpose, clearly set out direction, strategy and priorities)
   - holistic systems thinking (think beyond own area of expertise, understand the needs of the wider system)
2. nurturing r/s
   - developing others (nurture commitment, create opportunities for growth, provide support and encouragement)
   - collaborative working (forming supportive and respectful r/s that drive collaboration)
3. empowered working
   - brave decision making (take responsibility for actions and decisions, calculated risks)
   - courageous communication (courage to speak out for what is right, able to galvanise people to take action)
   - collective leadership (harnessing the skills of all)

[personal qualities]
- learning agility (always intensely curious to learn about oneself, the world and others, having a strong drive to seek opportunities to learn)

• resilience (cope effectively with stressors, positively adapt to changes, perform and grow through times of challenge)
• emotional intelligence (self awareness, ability to manage own strengths, weaknesses and motivations, sensitive to others, able to manage interpersonal r/s)

[values]
- compassion (personal interest in people, generosity)

• humility (viewing oneself accurately in relation to others, respect and treat others as equal, willingness to admit mistakes and seeking help)
• integrity (honest and consistent in one’s words, actions and beliefs, taking responsibility and having the moral courage to do the right thing for the right reason)
• public service purpose (driven by the larger mission and vision of the public healthcare)

Question 7

what is Kotter’s eight steps to accelerating change

Answer 7

1. create a sense of urgency (bring people together to guide where their energy should be directed)
2. build a guiding coalition
   *nerve center of the 8-step process (assemble a team that is diverse and influential to lead based on trust and credibility; four cores of credibility are integrity, capability, results, intent)
3. form a strategic vision and initiatives (imaginable, desirable, feasible, focused, flexible, communicable, simple)
4. enlist a volunteer army (~15% of the organisation is sufficient to generate momentum)
5. enable action by removing barriers
6. generate short term wins (wins can happen between 6-18m, helps build momentum and can help to fine tune the vision and strategies, boost morale and motivation)
7. sustain acceleration (press harder after first success, expand the volunteer army, use wins as momentum to fuel change, not to lose sight of ultimate goal)
8. institute change (new practices must be deeply rooted and anchored)

Question 8

what are the change principles

Answer 8

1. leadership + management
   - strong management to handle the day-to-day
   - strong leadership to capitalise on opportunities
2. head + heart
   - change efforts should appeal to both the rational and emotional aspects
   - moved by the desire to contribute to a larger case
3. select few + diverse many
   - begins with a select group of influential individuals to champion change effort and drive momentum forward
   - for change to be sustainable and widespread, will eventually engage and involve individuals from different levels, departments etc
4. have to + want to
   - change is often driven by both external pressures and internal motivations
   - ‘have to’ being regulatory requirements, market forces, competitive pressures that necessitate change to remain relevancy
   - ‘want to’ refers to shared goals, values or aspirations