Brian Golden, Professor of Strategic Management at the Rotman School of Management and the founding Academic Director of Rotman’s Global Executive MBA for Healthcare and the Life Sciences, discusses the capabilities required for effective healthcare leadership.
From his years of experience Professor Golden is emphatic about what makes a successful healthcare leader, “I've never seen a high performing health system that didn't have significant clinical leadership,” he says. Whereas 30 years ago clinicians who transferred to management roles might be accused of moving to the ‘dark side’, today doctors and other clinicians know that the system is driven by multiple stakeholders and complex dynamics—finance, regulation, human resources, etc. So as a leader “they need someone who can speak their language, who is on their side.”
“There is a bit of trust edge when clinicians are in leadership roles, because they have been socialized to the end purpose, to the meta purpose—which is to use resources as effectively as they can to care for patients,” asserts Golden. It’s not so much that clinicians, who convert to management roles, have special medical knowledge, but more that they have the credibility as people who understand the nature of the profession. Leaders with clinical credibility, not always the most renowned clinicians, are more able to be influential in healthcare organizations and as system leaders, than those coming from outside—though there will be notable exceptions.
Otherwise, the characteristics that make a successful healthcare leader are in many ways similar to those any leader in a complex, multi-stakeholder environment must possess—critically the ability to lead through persuasion, networking and influence, rather than through exercising top-down power. (The latter is contrary to the traditional medical hierarchy). Healthcare leaders must have the ability to actively listen, see alternatives, negotiate, and resolve conflict.
One of the aims of a program led by Professor Golden, the Rotman Health Leadership: Achieving Your Potential program, is to help doctors who were previously used to having power and who have moved to clinical leadership roles operate effectively where they will have very little real power. As Golden observes, “You survive and prosper as a leader by being able to influence and persuade, and that's a different skillset a different mental frame, and it takes practice.”
Leadership priorities: technical vs culture
Much recent thinking around leadership focuses on organizational culture and the need to prioritize values and purpose. Leadership at all levels with space given for individualism, creativity and innovation are seen as de rigueur in progressive organizations today. But do healthcare leaders have time for all of these things, when they are consumed with technical issues and concerns—operations, finance, and risk management?
Golden has a clear view on this: “We tell our healthcare participants, that we're not training you to be the Chief Financial Officer, or the Chief Risk Officer, or the Chief Information Officer, what we're training you to do is to first understand what they do, to ask them tough questions, and not get the wool pulled over your eyes.” It’s the leader’s role to set the strategy, to establish the mission and the values of the organization, and to select trusted people who have the technical expertise and ensure that the job they do is aligned with the organization’s goals.
He sees it as a three-tier pyramid. The broad base represents technical skills—finance, accounting, etc. The next smaller tier up, where the Rotman Health Leadership: Achieving Your Potential is directed, is for interpersonal skills and this is critical. The final peak of the pyramid in conceptual—the ability to see the system as a whole and influence its design and progression. As Golden puts it, “having the ability to not only see all of the moving parts, but to see ways of reconfiguring them. That’s a rare skillset.” This level is covered by Rotman’s Advanced Health Leadership Program.
Leading innovation in healthcare
In a busy, highly regulated healthcare environment innovation, creativity and critical thinking may be somewhat constrained, but to meet the demands of a fast-changing world they are really important and a key leadership priority. There are hurdles to be crossed and innovation may be slow, but it’s essential. “Healthcare, for the right reasons, is risk averse,” says Golden. “If our system is designed and currently saving lives, we don't want to put that at risk when we make changes. However, unless we innovate, we're going to save fewer lives, because the demand is getting greater.”
State funded healthcare systems, whether in Canada or the UK, have been very paternalistic for many years. The typical approach, observes Golden, was historically "as long as we get you better, we don't have conversations about the quality of your life, the quality of your experiences, what you really hoped for, whether you would be willing to give up three years of uncomfortable life for a shorter, comfortable life.” Today greater focus on patients has prompted the real innovation of appreciating multiple dimensions of success in healthcare. Design thinking and integrative thinking—methodologies championed by Rotman—can play an important part in the innovation process.
In a world characterized by rapid technological, demographic and social change, healthcare organizations, as with those in other sectors, are in a constant process of managing change. The bad news is that most change efforts fail across the globe—in all industries. Yet as Golden emphasizes, “The good news is that the probability of success is very high if you follow an empirically validated model of change and don't act relying on your gut.”
Leading change depends on the kinds of change. The most common changes are planned change—"where we have sequential models for trying to understand what we're aiming to accomplish and the gap between where we are and where we want to be. Then it's about formulating a vision that aligns with people's values. And then it's a combination of selling your idea and creating the incentives, motivating people, but also giving people the capabilities to support you.” It is important to note that if you want new results, you not only have to excite people to get on your side, but you have to create a supportive environment and this means ensuring people have the necessary capabilities, that they've been trained, and they have the right technology—that they are not relying on old knowledge, ideas and technology.
It takes a very different kind of leadership to lead through unplanned change—where, as during the pandemic, there is no rule book. “This is more about a leader first, keeping people together, pushing decisions back to people closer to the problem,” suggests Golden, “managing their stress level, allowing them to be sufficiently stressed that they are willing to change, not so stressed that they get frozen in position.” It is then about providing resources and then ultimately it is making decisions based on experimentation. Here the approach is, “we've never done this before; we're going to try it on a smaller scale and then if it works go through rapid cycles of innovation.” As with planned change, Golden says, “we know how to do this, but it's a very different change leadership model.”
AI in healthcare
Artificial intelligence is already and will in future offer huge benefits for healthcare delivery. Golden is an enthusiast and Rotman is “massively invested in its development,” he says. “Not everyone—the clinicians, the care givers—in the health system can be in the top 1%. What AI is trying to do is harness the expertise of the best and provide decision support. AI may not be better than the best neurosurgeon but will be better than the average neurosurgeon. It’s not going to do the surgery, yet, but will develop the path.”
The first use of AI was in image matching and diagnostics. More recently, during the COVID pandemic, it was used to help governments make policy decisions about who were the highest risk cases. There is clearly a long way still to go before the technology fulfills its potential.
Looking to the future, Golden’s team at Rotman benefit greatly from access to world-renowned AI thought-leaders at the University. Golden references the thinking of Avi Goldfarb and colleagues, in their 2022 book Power and Prediction, where they emphasize how the successful application of AI will depend not so much on the technology but on how well it is integrated into each system, infrastructure and environment—with an appreciation of the organizational and infrastructure changes it will necessitate. This is clearly an area where effective leadership is critical, and one covered in the two Rotman programs.
Rotman’s health leadership programs
Professor Golden runs two professional development programs—Rotman Health Leadership: Achieving Your Potential and the Advanced Health Leadership Program. The first runs twice annually: once online and once face-to-face. The second runs in-person once a year. The in-person sessions at Rotman allow participants to focus on the people-centred aspect of leadership and of course to network with peers, while the online sessions concentrate on the technical components—statistics, finance, accounting, etc.—and can be completed from anywhere in the world in the participants’ own time.
Rotman’s Global Executive MBA for Healthcare and the Life Sciences is also led by Golden: an 18-month journey across five countries that helps healthcare and life sciences professionals build expertise, reshape their organizations, and explore opportunities at home and abroad.
“We do believe the in-person learning and interaction and relationship building is absolutely critical, for the vast majority of learning opportunities, whether it's site visits to Kaiser Permanente, or IDEO in California, or the NHS in the UK,” states Golden. “But we take the view that we don't need you to travel from all over the world, in order to sit in a class where those interactions aren't important. The time of our program participants is precious, so here online is best.”
Networking through and beyond the programs has been critical. “I couldn't appreciate how important it would be when we started the program,” recalls Golden. “But it’s become central to the success. Because we bring in public sector, private sector and participants from all over the world, it exposes people to new roles, new organizations, new health systems, that they would never know existed if they were only engaged with their classmates on a Zoom call.”
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Over the years Golden has seen enormous changes in both the way healthcare systems work and in the medical treatments that have become available as well as what research-based concepts of leadership are taught to students—all of which continue to be constantly changing.
“I started out in the mid-80s, working in this field,” remembers Golden. “It was a very simple world, though we didn’t think so then. Now, there's so much more we can do for patients, which means the choices are tougher and our responsibilities are greater from every perspective.”
Healthcare is the biggest industry in the world, at eight trillion dollars annually, yet, surprisingly, very few business schools provide programs related to the sector. Rotman is at the forefront.
Professor Brian Golden is the Sandra Rotman Chair in Health Sector Strategy at the University of Toronto’s Rotman School of Management and the University Health Network. He previously served as Vice-Dean, MBA Programs. Professor Golden is the founding Academic Director of The Sandra Rotman Centre for Health Sector Strategy. He is the Rotman School’s National Director for Health Care Leadership Programs.