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February 2017 -
Volume 15, Issue 2
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From the Editor

 
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Original Contribution / Clinical Investigation










<-- Saudi Arabia-->
Pattern of current tobacco use among the Saudi adult population: results of the national Survey of Risk Factors of Non-Communicable Diseases
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Abdelshakour M. Abdalla, Lamiaa Z. Abuzaid, Waleed S. Al-Hussain, Nasser A. Al-Hamdan, Abdalla A. Saeed, Ahmed A. Bahnassy

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Concentrations of Azithromycin and Amoxicillin-Clavulanic acid in patients undergoing tonsillectomy
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Nidhal AK Mohammed Ali, Rasha G. Thanoon

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International Health Affairs


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Influence of Elderly parent on family dynamics: results of a survey from Karachi, Pakistan
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Waris Qidwai, Imdad Ali Khushk, Sabrina Allauddin, Kashmira Nanji

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Education and Training



<-- Saudi Arabia-->
Leadership in Postgraduate Family Medicine Training Programs: A “Steps-Model” Implementation in Eastern Province-MOH, Saudi Arabia
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Abdullah Dukhail AL-Khathami

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Case Study


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Evaluation of the Child with Short Stature
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Abdulrazak Abyad



Middle East Quality Improvement Program
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February 2017 - Volume 15, Issue 2

Leadership in Postgraduate Family Medicine Training Programs:
A "Steps-Model" Implementation in Eastern Province-MOH
Saudi Arabia


Abdullah Dukhail AL-Khathami


Correspondence:
Dr. Abdullah Dukhail AL-Khathami,
MBBS, ABFM, FFCM, MSc Med Edu (Cardiff-UK), DTQM, Diploma/MSc PMHC (Nova-Lisbon)

Consultant Family and Community Medicine-Medical Education
Director, Postgradute Family Medicine Program in Eastern Province-MOH
Chairman, Primary Mental Health Care Programs-MOH
CBAHI - Primary Care Surveyor
Vice-Chair, WONCA- Working Party on Mental Health-EMRO
Email: mabna@yahoo.com

Abstract


Leadership in Family Medicine/ Primary Health Care, including training of postgraduates in this discipline, is essential to favorably impact training, as well as patient related health care outcomes.

In the Eastern province of Saudi Arabia, a step model leadership approach has been utilized to achieve targets set for training of postgraduates in Family Medicine training program, in same time it also has been utilized in the primary mental health program in Eastern Province-MOH.

Step model leadership initiative is a transformational leadership that involves three steps.
Step one essentially is based on a managerial role where tasks are assigned for the team and desired outcomes agreed at the start of the program. Step two is role model stage that ensures progression of the task. Step three is essentially an evaluator type of leadership role that tries to establish and mentain the continiuouty of achieving the desired outcomes, it utilizes advocacy as one of its main strategies.

It is important that one in a leadership position in this step model understands their role and contributes effectively in line with the expectations of the step model for leadership initiative.

This Step Model for leadership has been successfully applied in the training of postgraduates in Family Medicine Program in Eastern province, MOH of Saudi Arabia. It is proposed that it should be applied throughout Saudi Arabia and in other countries of the region.

Key words: Leadership, Step model, Family Medicine Program, Post graduate training, Saudi Arabia


INTRODUCTION

In one's role as Director of the postgraduates in Family Medicine training program,MOH, effective leadership is important to influence the performance and postgraduate training related and patient care outcomes(1). A new initiative called "Step model" leadership could be considered as a kind of transformational leadership for implantation in Family Medicine programs/Primary Health Care. Transformational leadership was introduced by James McGregor Burns, in 1978. He defined transformational leadership as a process where "leaders and their followers raise one another to higher levels of morality and motivation."(2)

Transformational leadership style demonstrates as a positive contributor to safety environment(3), and is effective in improving care staff's perception of management support(4). Also, it contributes positively to job satisfaction in healthcare institutions, and in enhancing the empowerment influences among work staff(5). Transformational style generates greater commitment from followers than other leadership styles(1).

Step-model is based on the the leader goal, the nature of the task, and the age of the institution. It has been applied in the Primary Mental Health Program since 2003, and in the Saudi Postgraduate Family Medicine Program in the Eastern Province, MOH since 2010. It has proved to be very effective in building a competent motivated team.

Step-model is based on transformation effectively through 3 levels: manager, leader, and internal evaluator. The person in charge should recognize these levels when he/she transfers from one step into another according to determined factors. These factors are:

(1) The task nature and complexity
(2) Age of the task, is it new, in progression, or already established?
(3) The maturity level of the team members.
(4) Ability of the person to modify his performance according to each level.
(5) Assigned person's competencies in leadership, motivation, and building a work-team.

For any new work or assigned task, the person who is assigned as responsible for a team to accomplish a task, should consider these three steps. This person should be able to play these roles correctly and transfer from one step to the next in the correct time according to the maturity of the team and the achievement level.

Step ONE "Manager":
When task is starting.
Manager's goal is "Coaching" to establish an effective and efficient process for the work.

The manager is concerned with setting the rules in order to accomplish a task. So, in this role, the rules must be clear for every team member. The manager is responsible for directing and coaching his/her team within clear and defined rules.

Manager's tasks:
1.
Establish the framework of the work and its outcomes
2. Responsible for selection of the team members who could work in a familiar and safe environment.
3. Choice with the team an efficient process to achieve the proposed outcomes
4. Create the ground rules for the work in the view of the organization system
5. Assess team members' performance
6. Be sure the work is in the planned process
7. Work is on progression
8. Motivate the team members
9. Select a appropriate task-leader and members for a defined task
10. Work in solving the obstacles facing the team work
11. Create proposed work leaders

Manager should assured that, everyone in his/her team fully understand what they're responsible for, and know how one will measure success. Next, help the team to achieve the goal and stay motivated. This type of management links short-term achievement to the organization's longer-term goals(6). In this step clear communication and regular feedback are essential for the successful passing of this step.

Step TWO "Leader": when task is in progression.
Leader's goal "Model" is guiding work-team for achieving the proposed outcomes.

The leader leads the team by redirecting them toward the goal. The leader delegates the task to the team members. However, he/she follows the task progression as well as facilitates the teamwork in order to achieve the set goals.

Leader's tasks:
1.
Guide the team for acheiving the task goals
2. Be a lived model for the team members
3. Support the team members to achieve their tasks
4. Work with team to modify the process, as needed, according to the work needs
5. Share with his/her team the performance assessment
6. Motivate his/her team members
7. Create and maintain a safe work environment

As cited in Bernard M. Bass's book, 1985, this type of leader who is a model of integrity and fairness; sets clear goals; has high expectations; encourages others; provides support and recognition; stirs the emotions of people; gets people to look beyond their self-interest; inspires them to achieve their goals(7).

This step may be the longest period till it is sure that the proposed leaders become competent enough to carry the responsibilities as effective leaders.

Step THREE "Internal Evaluator": when task is almost or fully achieving the proposed outcome.
Evaluator's goal "Advocator" is to maintain work in effective progression.

The internal evaluator supports team leaders as well as the team members to accomplish the task. Internal evaluator plays also the role of the counsellor for the team.

Internal Evaluator's tasks:
1.
Evaluate the leader's performance
2. Be sure the work outcomes are desirable
3. Work as an advocator and counsellor for the team members
4. Work as mentor and adviser for the team leaders and members.
5. Supervise the whole work and maintain it in the desired process.
6. Interfere and correct any mistake that can deviate the work.
7. Protect the work from outside distraction

The following Table shows Step-model and the factors that influence transformation from one step to another :




Designed by Dr. Nada Bounian

Acknowledgement
I am thanking Allah for all support, guidance, and help for achieving a safe environment and succeed through my career as a director of a postgraduate family medicine (FM) program and a primary mental health care (PMHC) program in Eastern Province-MOH, Saudi Arabia.

My respect and thanks go to my colleagues in both programs, PMHC and postgraduate FM for their collabprations, contributations, and all affection and care which they have provided me during my work.

Deep thanks to my colleague and advisor Professor Waris Qidwai for his advice and review.


REFERENCES

1. Spano-Szekely L, Quinn Griffin MT, Clavelle J, Fitzpatrick JJ. Emotional Intelligence and Transformational Leadership in Nurse Managers. J Nurs Adm. 2016 Feb;46(2):101-8.
2. Burns, J.M. (1978) 'Leadership,' New York: Harper and Row.
3. Merrill KC. Leadership style and patient safety: implications for nurse managers. J Nurs Adm. 2015 Jun;45(6):319-24.
4. Jeon YH, Simpson JM, Li Z, Cunich MM, Thomas TH, Chenoweth L, Kendig HL. Cluster Randomized Controlled Trial of An Aged Care Specific Leadership and Management Program to Improve Work Environment, Staff Turnover, and Care Quality. J Am Med Dir Assoc. 2015 Jul 1;16(7):629.e19-28.
5. Choi SL, Goh CF, Adam MB, Tan OK. Transformational leadership, empowerment, and job satisfaction: the mediating role of employee empowerment. Hum Resour Health. 2016 Dec 1;14(1):73.
6. Manktelow, J.N., Brodbeck, F., and Anand, N. (2005) 'How to Lead: Discover the Leader Within You,' Swindon: Mind Tools.
7. Bass, B.M. 'Leadership and Performance Beyond Expectations,' 1985. New York: Free Press.

 

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