Managing Public Ophthalmology
Team building and business skills help make a successful department.
Published: Monday, May 1, 2023
By Howard Larkin
Keeping up with rapidly advancing patient needs, technology, and evolving public-private medical service delivery partnerships can be a challenge for public ophthalmology departments. Cultivating team building and business skills is essential for success, said presenters in the Leadership and Business Innovation Programme at the 40th Congress of the ESCRS in Milan.
Public and private systems share many goals and needs, said Dr Sorcha Ní Dhubhghaill. Both aim for high clinical quality, efficiency, and patient service. And both require high individual and team performance to achieve these.
Yet surgeons are an independent lot and notoriously difficult to manage, and the surgeon elevated to department head in a public system is not always the best manager. They are more likely a high-performing and ambitious clinician, scientist, or teacher. Now, suddenly they need leadership, team building, and change management skills.
Building a sustainable team
Dr Ní Dhubhghaill reviewed four steps for building an effective team and creating a trusting environment that facilitates teamwork, honest communication, and change based on the pioneering work in group dynamics of psychologist Dr Bruce Tuckman, first published in 1965.
“We are not unique in getting people to work together,” she said.
First comes transitioning individuals to a team, which requires establishing norms and behaviours and determining individual roles and responsibilities. Dr Ní Dhubhghaill advised picking a discrete goal of high importance, such as building a retinal unit. Then work with team members to specify the process and define roles. Creating open communication channels to identify and balance competing goals, such as promoting efficiency versus teaching and building trust by being fair, are essential building blocks for future functioning.
The second step is storming, which begins when team members realise the task is more difficult than they imagined. Ensuring to address all issues identified in the forming stage and clarifying or modifying the ground rules, roles, and responsibilities, as needed, are critical.
“This is the stage where everyone complains,” Dr Ní Dhubhghaill explained.
Transparency and fairness in compensation are essential, as are honestly navigating conflicts and listening. Perceived unfairness in compensation or perks erodes team cohesion and degrades individual performance.
“If you are providing incentives, you also have to provide information and a pathway so other colleagues can get there, too,” she said.
Third is norming, which occurs when members accept the team, their roles, and the individual members. The team can then focus on detailed planning and developing goal-completing criteria. Building on positive norms and changing unhealthy norms are important, as is encouraging continued team spirit.
“You have to be a bit of a cheerleader at this stage,” Dr Ní Dhubhghaill noted.
Last is performing, when team members see the results they have been working for and recognise they are worth the effort, Dr Ní Dhubhghaill said. At this stage, the team can better understand its strengths and weaknesses and focus on improving quality and taking the greatest advantage of each member ’s skills to improve outcomes. Setting deadlines for every task is critical to ensure they are accomplished.
Business training needed
While the relationship between public and private ophthalmic services is shifting toward more services performed under contract by private clinics in much of Europe, public hospitals still provide about half of cataract services and greater shares of specialised glaucoma, vitreoretinal and other secondary and tertiary care, said Dr Paul Rosen.
Barriers to effectively managing performance in the public sphere include a lack of incentive payments for increased production and efficiency and a lack of understanding of procedure and process costs, Dr Rosen said. And while shortening patient waiting lists is a key driver of public health system performance, patient satisfaction is much further down the list of priorities.
“What you should be offering in the private and public service is the same sort of patient service.”
To help individuals develop, Dr Rosen said it’s important to deter - mine key incentives through listening and responding to problems identified.
“Individuals know exactly what is going on and how to change it.” Departments will find ensuring services keep up with population needs and emerging technology and improving productivity and cost-effectiveness critical.
Clinical managers need skills not taught in medical school to address these issues, Dr Rosen said. These include an awareness of the need for visibility, excellent communication skills, consensus building, policy development, defining key performance indicators, and working with non-medical managers.
“We should be teaching business and financial skills in medical schools or during residency,” he emphasised. “The idea is clinical managers should be masters of their own and their departments’ destinies.”
Paul Rosen BSc, MB ChB, FRCS, FRCOphth, MBA is Consultant Ophthalmic Surgeon at the Oxford Eye Hospital, Oxford University Hospital Foundation Trust, UK, Head of Department from 1998 to 2004, and Clinical Director of the Specialist Surgery group from 2010 to 2016. firstname.lastname@example.org