Need for leadership in primary healthcare

A family physician-led primary healthcare system can serve as a good model

Need for leadership in primary healthcare

Leadership is a crucial component of a doctor’s training. An effective leader in healthcare is one who not only leads and drives changes at various levels of the health system but also strives to achieve safe and good quality of care with a higher patient satisfaction. Clinicians are trained to make difficult decisions. At times these decisions have to be taken on-the-spot.

How often do we reflect on our own leadership skills in clinical practice? In order to become a reflective leader, one has to be a reflective thinker first. Reflective leadership begins with self-awareness, reflecting and learning from one’s own experiences and experience of others. A conflict can be an opportunity to learn something new about one’s self and another person.

Team work is important in clinical practice, even more important when faced with a complex and challenging task. Poor team communication, particularly when dealing with unknown or considerable amount of uncertainty may compromise a patient’s safety.

Leadership and management skills are required to build teams. Besides self-awareness and learning from experiences, a leader requires strategic thinking, resilience and integrity.

Lack of leadership and management capacity at all levels of healthcare system has been exacerbated by a high disease burden and undersupply of resources in low middle-income countries. It has been cited as a major barrier in improving and expanding healthcare services [Int J Health Plann Mgmt 2018 (Wiley)].

Changing a culture requires a collective effort and collective action. There is a need to establish leadership development programmes in primary care with a focus on trainings addressing acquisition of skills required to deal with unstable conditions, identifying what is meant by bad behaviour, speaking up when things are not right and accepting that things can go wrong.

Despite the need, there is not much focus on developing leadership skills in the medical curriculum at both undergraduate and postgraduate levels. Leadership development and execution in the medical profession has not significantly progressed as in other disciplines.

The existing weakness in our profession requires focusing on the much-needed leadership development. To improve health-related outcomes, a significant development in leadership is required to effectively mobilise health resources and bring a quality change (Qidwai, W 2014).

Understanding what leadership means and how it is practised requires formal training in a leadership role. In general practice (GP), balancing the clinical and leadership roles can be challenging, many GPs prioritise clinical work, this combined with inadequate management training and preparedness to acquire leadership role can be a barrier in their participation.

Integrating medical leadership competencies in undergraduate and postgraduate curricula and learning experience of practicing physicians will help doctors not only in their personal development planning but also in their career progression. 

Low motivation to lead, lack of self-confidence in taking up a leadership role and the fear of mishandling the situation were some of the factors among GPs which were identified in a Norwegian study (Scandinavian J of Prim H Care 2017).

The key objective of primary care leadership development is to improve the health and well-being of the population. Primary care is the first point of contact with the healthcare system. There is certainly a need for improved leadership development in primary care in Pakistan.

With participation of multiple stakeholders, the leadership model in primary care can be complex and needs cultivation of essential leadership qualities.

Integrating medical leadership competencies in undergraduate and postgraduate curricula and learning experience of practicing physicians will help doctors not only in their personal development planning (PDP) but also in their career progression.

The PDP or self-development cycle tells an individual where he/ she is in terms of academic skills and experience, personal or social skills and experience and work experience and how they can improve through means like workshops, courses, self-study, etc.

The PDPs guide us in identifying our strengths and weaknesses and prioritises areas of improvement. Obtaining feedback from colleagues and patients is another way of demonstrating personal quality (Med Ldrship Competency Framework, NHS, UK 2010)

In conclusion, an effective leadership positively impacts organisations. Engaging family physicians in the senior management teams of primary healthcare can be a way forward to bring reforms in the healthcare system.

In a family physician-led primary healthcare system, a family physician not only inspires but also motivates his/ her team members like LHVs, nurses, medical technicians, EPI team, etc.

By creating a non-hostile environment, where team members can share their views without being underestimated, by providing opportunities for team members to grow and develop their capabilities, they can serve as a good role model. A true leader is always ready to face new challenges and make change happen.

Dr Hina Jawaid, is an assistant professor in family medicine at the University of Health Sciences, Lahore

Dr Abdul Jalil Khan is an assistant professor in family medicine at Khyber Medical University, Peshawar

Need for leadership in primary healthcare