MEDICAL LEADERSHIP
By
SENATOR MIRIAM DEFENSOR SANTIAGO

(Keynote address at the opening ceremonies of the Annual Convention of the Philippine Psychiatric Association, Inc., at Edsa Shangri-la Hotel on 21 January 2014)

Psychiatrists Should Lead Hospitals

Let me name some of the most famous medical centers in the world: Harvard Partners System, Mt. Sinai in New York, UCLA System, Georgetown/Medstar, and New York Presbyterian Hospital. All these medical centers have a common feature, in that their CEOs are all psychiatrists. This "new normal" indicates that psychiatrists make good leaders, and therefore psychiatric residence programs in our country should now provide the training necessary for the next generation of medical directors and CEOs.

According to a paper published only last November by the American Psychiatric Association, medical residents should be more exposed to leadership roles. This exposure should consist of three components: specialized curriculum, experiential learning in the form of a project, and mentorship by a physician leader.

Thus, medical schools should cultivate leadership skills as an important component of the psychiatric profession. According to an assistant professor of psychiatry at Yale University School of Medicine, the mood of the leader should be characterized by what is called "resonance." The mood of the psychiatrist affects his patient. For this reason, medical schools should promote the process of self-awareness and mood management. Medical schools should start training residents to become clinician leaders.

To understand this new call for psychiatric doctors to take the helm of change, we have to look back to how medicine has evolved. At first, doctors practiced so-called bedside medicine, and then progressed to so-called hospital medicine. After the 20th century, we are now faced with hospital service complexes with complicated hierarchical structures. The Philippines as a developing country faces problems within our healthcare system concerning economics and efficiency.

The strong movement toward medicalization has given rise to the rising costs of our national healthcare coverage. To help solve this problem, increased importance is now being given to such practices as: preventive medicine, surveillance medicine, and homecare treatments. We are besieged with numerous problems such as "funding constraints and demands for greater accountability for the safety, quality, and efficacy of healthcare."

In the face of this ascending spiral of healthcare spending, the medical profession is compelled to pay proper attention to the task of developing individual leaders and new models of leadership within the profession. If we could properly train healthcare professionals in the area of medical leadership, we could eliminate hospital inefficiency. Thus, in the Philippines as in most other countries worldwide, we see and accept the need to develop leadership skills in medical students.

Medical Leadership is not Management

Medical leadership is defined as leadership roles in the practice of medicine which are assumed by fully trained physicians. This physician leadership includes: resource managing, decision-making, recruiting, medical consulting, information implementing, changes and improvements in hospitals and clinical settings. Physicians stand in the center of clinical service and delivery. Thus, these physicians have been described as "the ideal leaders for healthcare in the 21st century."

The term physician leadership implies qualities such as "a vision, ability to sacrifice, and courage." While a corporate leader aims for profit and time efficiency, a physician leader should aim for empathy and care for his patients. Of course, this represents a major dilemma between, on the one hand, time saving and on the other hand, quality of care. This dilemma could be resolved if adequate leadership training is integrated into the medical curricula.

It is said that a physician leader should possess the three main qualities of medical leadership: "the capacity to work in teams; the ability to personify essential leadership skills; and possession of a strong emotional capacity."

The first quality for leadership is the capacity to work in teams. Therefore, hospitals must provide adequate training workshops. The second quality is personification of essential leadership skills. In Canada, the National Health Service has produced a Medical Leadership Competency Framework. This document suggests that all doctors should be able to excel in five different domains: "personal qualities and professionalism, working with others, managing business, transforming services, and setting directions."

The third quality is possession of a strong emotional quality, meaning that doctors should master emotional intelligence, also known as EQ. This means the cultivation of aspects like self-awareness, self-management, and social awareness.

In contrast to medical leadership, hospital management involves strategic planning, financial controls, human resources, and marketing. Management is mundane; leadership is a trained skill. In a 2010 edition of the Harvard Business Review, we get this definition: "Leadership is about taking people to a place they would not go on their own. It is about disrupting the core and upsetting the status quo." Today, we need to go beyond being management-focused and to truly commit to the training of strategic leaders from within the medical profession. The present medical education continuum should add the following points of leadership studies: "strategic foresight, thinking, and design; visioneering; change; global integration; creativity; innovation; and human capital development."

In more specific terms, the Royal College of Psychiatry has drawn distinct lines between leadership and management, although both are complementary. I quote:

Modern leadership emphasizes the importance of relationships and may be defined as 'a process whereby an individual (the leader) influence others to achieve a common goal.'. . . Management may be defined as 'getting things done well through and with people, creating an environment in which people can perform as individuals, and yet collaborate towards achieving group goals and removing obstacles to such performance. . . . Training in management and leadership should be part of the continuing professional development of all psychiatrists.

Political Leadership after PDAF and DAP

The 2016 presidential elections are now within sight of the political horizon. This will explain the increasing number of self-serving press releases from those who hope to run for president or vice-president. I dare to hope and predict that any incumbent public official who runs for national public office in 2016, will lose in the elections, if the Ombudsman charges him with plunder or malversation, in connection with the pork barrel scam, and/or in connection with what appears to be the impeachment scam. Charges filed in the Sandigan in connection with the PDAF and DAP should disqualify any candidate in the view of irate voters. It is time to prove the power of righteous indignation.

Both in the psychiatric profession and in presidential politics, leadership is crucial, as a product of both culture and vision. We are looking for a leader to provide a blueprint for Filipinos to follow. In the 2013 book Leadership in Psychiatry, the editors emphasized that leadership can be transformational if it involves the management of change and if the leader has the skills set to influence individuals, events, and processes.

Leadership requires skills that are technical, human, and conceptual. Technical skill in psychiatry requires that the leader should understand technical aspects, but should also be able to communicate to the key stakeholders. Human skills are concerned with dealing, negotiating, and working with people. Conceptual skills deal with ability to work with ideas and concepts.

To find a new leader, we have to look for a person with the important attributes of leadership, such as individual style and competencies; problem solving; effective communication, passion; and courage. At an individual level, the candidate should possess: "general cognitive ability, crystallized cognitive ability; modification; and personality."

Since leadership involves both personal and organizational use of power, caution should be exercised in assigning roles of clinicians, particularly psychiatrists. I make this point because psychiatrists have the legal power to deprive patients of their liberty and the organizational power to medicate patients against his will.

In both the medical and political fields, individual personal traits will allow each person to develop certain skills. As a result, voters should ensure that our next leader should be able to manage change effectively and should not insist on maintaining the status quo.

For the next presidential elections, the Filipino people shall not look for a manager but should probe more deeply and look for a leader. I repeat the distinction. On the one hand, management is about coping with complexity. Its practice and procedure are in general a response to the development of large and complex organizations. On the other hand, leadership is about coping with change. While the manager identifies results, a leader sets the direction.

In our modern life, Filipino children, in the attempt to find an individual identity, tend to identify external figures as role models. If their role model is a leader or a teacher, well and good. However, if the role model is a pop star, a film star, or other celebrity, the result, as we have seen in Philippine politics, is that these unqualified people assume leadership roles even if they are not true leaders.

Between 2014 and 2016 lie two potentially seismic political years. In my humble view, leadership requires first of all a mass base, which I define as approval by a major sector of the electorate, such as: university students; the economic lower class; the social media; or even just the regional constituency of the candidate. If there is no mass base, then there is no realistic basis for the ambition to become president or vice-president. Of course, every candidate succeeds in deluding himself that he has a mass base. If so, he has a mental health problem.

If the candidate proves to be popular in initial surveys, he or she should be able to attract contributions from the rich in society, which can go higher or lower, or even dry up, depending on the results of the periodic popular surveys.

Once invested with sufficient funds, the candidate can then build his organization and take out the expensive media advertisement that make elections so noisy and clutter the airwaves. In this three-stage cycle of political candidacy, I ask: Where is the role of leadership? Let us look for the reliable signs.

I do not necessarily believe that the key qualities of successful political leaders are the necessary qualities for true and genuine leadership. But in the context of Philippine political reality, the first key quality is communication. A charismatic leader should communicate and listen with others. He should be able to convey his message in a straightforward way so that their followers will understand their roles and tasks clearly.

The second key quality is problem-solving, which is also part of the role of a clinical leader. To solve a national problem, the leader should be able to correctly identify the problem and gather the right information and data. Thereafter, the leader should explore the range of alternative solutions, select the right action, implement it, evaluate the success, and communicate it effectively. Inevitably, some matters will have to be delegated, but the leader should retain authority, responsibility, and a certain degree of accountability.

In the final analysis, I humbly submit that the next president and vice-president should possess three non-negotiable traits: honesty, competence, and efficiency.

By honesty, I mean that this trait should not be self-proclaimed, particularly by rascals who try to advertise their integrity, mostly by attacking those of others. Honesty is best proved, not by self-paid propaganda in the media, but by awards from respectable awards-giving organizations. This is most notable when a Filipino, in a search covering the whole of Asia, is chosen to be the laureate of the Magsaysay Award for Government Service. Of course, as you have seen, even a laureate should expect mudslinging from political Nazis, whose manicured toes have been stepped upon. Metro Manila knows who these people are, because they are universally condemned as selfish, greedy, and mean, mean, mean.

By competence, I mean that although there is no constitutional requirement, any candidate for president or vice-president should have finished at least a college degree, and at best a graduate degree. Premium should be placed on graduation with honors from a prestigious university. Based on experience, I venture the observation that the best trained leaders come from law, public administration, business administration, and political science. To keep the process democratic, we should allow candidates without these degrees to compensate by attending, perhaps, a three-month seminar at the U.P. national college of public administration.

By efficiency, I mean a person known to be hardworking. He or she should manifest a working belief in management by results. The president or vice-president should stop presiding at inaugural ceremonies such as ribbon-cutting or delivering quotidian speeches, but should instead stay inside their office to get full information and develop his or her decision-making skills.

In recent months, I have gone out of my way, despite my Chronic Fatigue Syndrome, to expose at least two senators, who are sorely lacking in these three traits. As partners in crime, neither one deserve to be president or vice-president. The Filipino people have seen through their masks, and these clowns should stop current efforts at further pretense, such as being called "czar," when the person is only a presidential assistant. Unlike a presidential adviser, who has cabinet rank without portfolio, a presidential assistant is merely part of an entire staff meant to carry out the president's bidding.

Proposals

To strengthen the mental health system, I humbly propose that the Philippine Psychiatric Association should adopt the 2007 assessment instrument for mental health systems published by the World Health Organization. Among the steps recommended are the following:

1. Push for legislation of a Mental Health Act. If you can submit the draft to me, I shall file it immediately.

2. Institute surveillance for specific mental disorders in the community, in collaboration with the National Epidemiology Center and the Department of Health.

3. Provide technical assistance to projects that would integrate mental healthcare in a general hospital, which are usually called the Acute Psychiatric Unit.

4. Decongest outpatient services in mental hospitals by referring patients for follow up consultations with the Acute Psychiatric Unit in a general hospital or medical center. We have talked about leadership, on both the medical and political levels. I can make no better conclusion than to quote a "Psalm of Life" by Henry Wadworth Longfellow:

Lives of great men all remind us
We can make our lives sublime,
And, departing, leave behind us
Footprints on the sands of time;

Footprints, that perhaps another,
Sailing o'er life's solemn main,
A forlorn and shipwrecked brother,
Seeing, shall take heart again.

Let us, then, be up and doing,
With a heart for any fate;
Still achieving, still pursing,
Learn to labor and to wait.