Teaching Management Skills to Health Providers

Training medical managers in management: the example of the Geneva University Hospitals

The HUG continuing education programme MicroMBA brings together medical and non-medical managers. Among other things, it has helped to raise their awareness of the economic dimension of their work, develop their managerial abilities, facilitate the roll-out of the hospital’s strategy, stimulate participants’ proactive and entrepreneurial behaviour, encourage them to innovate and improve the management of their unit, lead them to carry out genuinely innovative and cross-functional projects, and develop networking and cross-functional collaboration… The high level of satisfaction shows that appropriate training can lead participants to develop a taste for management and, above all, to become agents of change.

The challenges

Medical managers have to face several challenges that are genuine sources of stress: reducing costs, motivating staff more effectively (who are also increasingly difficult to recruit), improving services to patients, optimising resource management and raising the quality of care. Very few of them have been trained in management, because they work in an environment that places far greater value on medicine than on management. Access to positions of responsibility does not require any specific management training, so doctors prefer to focus on what seems most important to them, namely medicine. They are therefore particularly ill-prepared to deal with these challenges that they encounter despite themselves.

If they are to meet them, medical managers must not only be trained in management, but must also internalise cultural changes capable of promoting innovation and change, two other notions far removed from their main areas of interest.

As for non-medical managers, they are often specialists and not all of them have received business management training that gives them an overall view.

Developing managerial skills is therefore a necessity for all managers, not only medical managers. Bringing these different groups together in training programmes is far from straightforward…

Like most similar institutions, the HUG experience internal compartmentalisation that limits cross-functional collaboration. Reducing this “territorialism” is therefore another important objective. Lastly, facilitating the roll-out of the hospital institution’s strategy further down the hierarchy is another challenge that needs to be incorporated into the issue.

The solution: MicroMBA

Aware of these challenges, the HUG training centre took up the challenge itself by devising an entirely innovative overall concept for management training. This initiative, which breaks new ground, is an example of “intrapreneurship”, that is, entrepreneurial behaviour within large public- and private-sector organisations. One component of this new concept is the continuing education programme MicroMBA. MicroMBA is generalist business management training that complements the HUG’s “catalogue” management training. Aimed at medical and non-medical managers, it also seeks to stimulate interdepartmental collaboration and change. At the end of the programme, participants are required to deliver an innovative or change project within the HUG, enabling the HUG to obtain tangible and measurable results.

The topics covered by MicroMBA include such varied subjects as building interdisciplinary teams, presentation techniques, the “customers” of healthcare providers, innovation in the healthcare sector, legal issues, leadership, accounting and financial management, cost control, human resources management, conflict management, negotiation techniques, communication and public relations, project management and stress management.

Because MicroMBA brings together managers from different parts of the HUG (doctors, administration, logistics and general services), participants have the opportunity to become familiar with “parallel universes”. This rich source of personal development and integration enables them to develop their informal internal network and thus break down silos. Participants all underlined the pleasure and usefulness of the networking they were able to develop in this context.

MicroMBA provides managers with management tools to: - internalise and roll out the institution’s strategy; - raise their awareness of the integrated and holistic management of their department or unit; - encourage them to behave entrepreneurially (intrapreneurship); - increase collaboration with other departments/units and reduce internal compartmentalisation; - give them the desire to complement their training by drawing on the catalogue of training opportunities to explore relevant topics in greater depth; - help them to take better account of human and emotional factors; - develop their ability to work in multidisciplinary groups; - develop their informal collaboration network; - increase their managerial autonomy.

MicroMBA also makes it possible to internalise messages relating to the HUG’s culture, strategic objectives and management philosophy. Spreading the classes over nine months, at a rate of four hours every fortnight, gives participants the opportunity to anchor the training in their practical activity while at the same time being coached by the speakers.

The programme comprises several modules covering the basics of entrepreneurial management. It was designed by an entrepreneur to train both medical and non-medical hospital managers. It is firmly oriented towards practice and concrete results, while incorporating conceptual support.

The teaching approach is based on practical examples, checklists and theoretical concepts relevant to managing a hospital department/unit. It also uses external examples intended to demonstrate similarities with the private sector; this makes it possible to show that the hospital is not a world apart, as many doctors believe, and that methods that have proved successful elsewhere can also be used in the hospital sector. The classes include expert contributions, case studies, group work, debates, role plays and course materials.

Finally, participants have to work on an innovative multidisciplinary group project for the HUG, which is presented before a panel and the other participants and serves as the final assessment. Although it is up to participants to propose them, these innovative projects must lead to practical implementation from which the HUG must benefit. The groups are accordingly coached by the programme director.

MicroMBA also makes it possible to earn credits towards the University of Geneva’s postgraduate diploma training. This validation encourages participants to continue their management training.

MicroMBA is in fact an adaptation, tailored to the specific needs of the HUG, of the entrepreneurship courses at the Swiss Federal Institute of Technology in Lausanne (EPFL) and the Faculty of Science of the University of Geneva. The EPFL concept has been so successful that it is now being rolled out nationally with a budget now funded by the Swiss Confederation.

The success of the MicroMBA model has led many institutions and companies to adopt it (Geneva General Hospital, the City of Geneva, Geneva Industrial Services, Edipresse, Banque Cantonale de Genève, etc.).

Evaluation method

In order to meet the deadline for submitting this paper, an interim survey was carried out when participants had completed three quarters of the planned modules. This survey has already shown overall that participants are very satisfied, since they unanimously recommend MicroMBA and the MicroMBA concept is a genuine driver of change within the HUG.

As this version of MicroMBA was a pilot, it yielded many lessons for planning improvements for future cohorts. We shall return to this later, particularly by analysing participants’ testimonies.

Another survey will be carried out at the end of the programme and after the presentation of the group work aimed at implementing an innovative project within the HUG. As these projects form an integral part of the training and internalisation process, they had not yet been completed and their impact, whether positive or negative, could of course not be highlighted in the survey that was conducted.

Participant profile

The MicroMBA pilot initially brought together twenty-five people. However, three participants dropped out during the year for health or personal reasons unrelated to their degree of satisfaction. Of the remaining twenty-two participants, sixteen returned the completed questionnaire.

- Medical staff: 8 - Administrative staff: 7 - Operations staff: 1 - Total: 16

Departments: - Psychiatry (3) - Medicine (3) - Geriatrics (1) - Surgery (1) - Management and shared services (3) - Paediatrics (2) - Operations (1) - Surgery (1) - Operations (1)

The participants are administrators, human resources managers, heads of administrative or technical departments, associate consultants under department heads, or heads of department.

Measured results

Satisfaction

Analysis of the responses revealed an overall level of satisfaction sufficient to qualify MicroMBA as a success.

It is interesting to note that all participants enjoyed taking this course despite the fact that it included subjects as little “seductive” as accounting… Doctors proportionally derived more enjoyment from it than non-doctors (out of eight doctors, seven enjoyed it greatly, one doctor a little less), which shows that doctors, once exposed to management in a context that stimulates them, are much more receptive to it than had been suspected.

One hundred per cent of respondents recommend MicroMBA to other HUG staff.

Participants are in complete agreement (11), rather agree (5), rather disagree (0), completely disagree (0) with the statement that they enjoyed taking this course.

The quality of MicroMBA is regarded by participants as excellent (3), good (12), adequate (1), inadequate (0).

Participants are in complete agreement (5), rather agree (9), rather disagree (2), completely disagree (0) with the statement that the added value of this programme fully justifies the investment.

Usefulness

The usefulness of MicroMBA is, overall, confirmed by participants.

Participants are in complete agreement (7), rather agree (6), rather disagree (3), completely disagree (0) with the statement that this programme is useful for their professional future.

Participants are in complete agreement (3), rather agree (11), rather disagree (2), completely disagree (0) with the statement that the design of MicroMBA is sound in view of their present and future needs.

It is interesting to note that even those who rather disagree as to its usefulness still recommend the programme to their peers. The nuance expressed by the responses to these two questions seems to indicate that the programme itself is perceived as useful (with two exceptions), but that its design can be improved. The improvements to be made to this programme are set out below.

Impact on motivation

These responses show that MicroMBA had a significant effect on participants’ motivation to become agents of change and to alter their professional outlook.

Although the behavioural impact is more limited, a large majority of participants changed their behaviour or their relationships with colleagues. This impact is particularly remarkable given the limited time devoted to each subject. We can conclude that this intensive mode of training is particularly well suited to an audience subject to severe time constraints but capable of rapidly assimilating concepts.

Internalisation is possible, even if it remains partial. The awareness-raising objective has clearly been achieved if it is translated into practical implementation.

Participants are in complete agreement (5), rather agree (10), rather disagree (1), completely disagree (0) with the statement that this programme increased their desire to become more proactive or created new opportunities.

Participants are in complete agreement (7), rather agree (9), rather disagree (0), completely disagree (0) with the statement that this programme helped change the way they view certain aspects of their work and the relationships maintained with other HUG staff.

Participants are in complete agreement (3), rather agree (8), rather disagree (3), completely disagree (2) with the statement that MicroMBA helped to change their behaviour or certain relationships with HUG staff.

Impact on breaking down silos and managing change

MicroMBA clearly promotes cross-functional collaboration. This probably results from a better understanding of the activity of the other participants as well as of the institution’s challenges.

Because this programme presents matters from a resolutely strategic perspective, participants are encouraged to broaden their outlook so that the tree obscures the forest less. Stepping back from their day-to-day operations and placing them in a broader perspective ultimately leads them to “lift their heads from the handlebars”.

Presenting matters at the strategic level enabled participants to internalise more fully the institution’s strategy, objectives and management orientations. In this way, MicroMBA proved to be an excellent means of rolling out and also explaining the institution’s strategy at a hierarchical level that is generally little involved in its deployment. One of the modules held after the survey had been conducted also gave participants the opportunity to discuss with the chief executive all the issues that had caught their attention. The discussion showed a high level of managerial maturity among participants, who were entirely at ease both with the vocabulary and with the management concepts addressed. This exchange was extremely beneficial in terms of motivation and commitment.

It also appears that MicroMBA makes a significant contribution to “networking” in so far as its operating methods lead participants to develop a network within the institution. Group work, combined with the multiple opportunities for interaction put in place, enables them to weave a network of relationships with people they would otherwise have had little opportunity to meet in the course of their usual work. Participants thus built up a network of contacts and support that should endure after the end of the classes. It will be strengthened by the group work on the innovative projects that will follow the classes.

The variety of participants and of activities represented makes MicroMBA a genuine platform for sharing, exchange and discovery. This richness was not assessed in the questions asked in the questionnaire but emerges clearly from the testimonies as well as from the verbal round table held at the end of the last module. It is therefore not only the speakers who contribute to the programme’s success, but also the participants, who bring their own experience and backgrounds.

Participants also appreciate being able to discuss their concerns openly in an environment without risk of sanctions. MicroMBA can therefore occasionally act as a revealer of the real culture expressed by the men and women in the field; this makes it possible to gauge any gap between that culture and the one desired by management. Each discussion yielded a wealth of lessons. An analysis of the information gathered on these occasions was communicated to management, without breaching confidentiality, so that it could supplement its perception of the experience of those working in the field.

Finally, it emerges that a large majority (fourteen participants) agree that the content of MicroMBA is likely to contribute to the institution’s development. They thus acknowledge the usefulness and practical interest of management training.

With the exception of one participant who did not express a view, participants are in complete agreement (7), rather agree (8), rather disagree (0), completely disagree (0) with the statement that MicroMBA helps break down silos within the HUG.

Participants are in complete agreement (8), rather agree (8), rather disagree (0), completely disagree (0) with the statement that the group dynamic enabled them to get to know better the work and concerns of staff from other HUG units.

With the exception of one participant who did not express a view, participants are in complete agreement (5), rather agree (9), rather disagree (1), completely disagree (0) with the statement that MicroMBA usefully developed their network of contacts within the HUG.

Participants are in complete agreement (3), rather agree (11), rather disagree (1), completely disagree (1) with the statement that this programme provides tools and concepts useful to the development of the HUG (change management).

We will refrain here from discussing the seven other questions put to participants, as they concern the programme’s qualitative aspects (structure, balance between theory and practice, supervision, etc.).

Suggested improvements

The main request for improvement concerns a rebalancing of the relationship between theory and practice. Participants are clearly eager for practical work, even if this involves more work outside class hours. This is surprising inasmuch as the organisers deliberately limited work to be done at home on the assumption that participants would not have time to do it.

The other clearly expressed wish is to increase the number of examples specific to the hospital and to stop illustrating certain concepts with examples drawn from other settings. This reflects participants’ perception that the hospital is “different” and that what is done elsewhere is not necessarily relevant. Despite the fact that, paradoxically, this sense of uniqueness (“here, it’s different”) exists in practically all organisations, public and private alike, those responsible for the programme will take it into account and provide more examples from the hospital world.

These teething troubles are fairly normal and will make it possible to refine the approach and further raise participants’ level of satisfaction.

Testimonials

The following testimonials are fairly representative of participants’ perceptions at this stage of the programme:

- “It is important to situate our managerial activity within the broader perspective of the HUG and to avoid an outlook focused solely on the department in which we work. Knowledge of a modern and up-to-date vision of business and public service management.” - “These classes are an extraordinary opportunity to learn techniques that could constitute the gold standard in work within the HUG.” - “This programme takes a considerable amount of time and energy because its content is dense and condensed. One has to persevere, however, because by the end of the programme we have learnt many new concepts and, above all, acquired a managerial outlook that we sometimes lack.” - “An enriching experience both in terms of the people met and the knowledge acquired.” - “MicroMBA enabled me to grasp certain aspects of management of which I had little or no idea, in a pleasant and motivating working atmosphere. Such a programme makes you want to delve deeper into the most interesting themes.”

In addition to these testimonials, the fact that several participants who completed the programme spontaneously expressed the wish to have additional modules “for pleasure” and, of course, less frequently, shows that the objective has been achieved.

Conclusion

The fact that MicroMBA has a genuine incentive effect by leading participants to become more proactive and to change both their behaviour and their outlook demonstrates that management training is a real driver of change and innovation in hospitals.

What characterises this change is that it starts from the bottom rather than being driven from the top. By training middle managers, both medical and non-medical, they are encouraged to adopt intrapreneurial behaviour. They thus become the true agents of change, which results in a genuine breaking down of silos. When change and performance improvement are initiated by those working in the field, fear of change disappears in favour of a dynamic focused on improving services and efficiency. Naturally, this has a very positive impact on participants’ motivation and professional satisfaction.

Because MicroMBA favoured strategic-level reflection, in addition to the practical tools that were presented, participants were able to take ownership of the HUG’s strategy. This deployment of the strategy helps to focus efforts in the field more effectively.

The fact that participants unanimously recommend this type of training within the institution reflects the fact that they would appreciate seeing other managers, at all levels, also applying some of the concepts developed within the framework of MicroMBA. This view was expressed orally on many occasions during the classes and led the HUG to devise a training programme for senior managers that is on the point of being adopted.

Given that the survey carried out expresses the synthesis of the views of both medical and non-medical managers, it clearly appears that the MicroMBA approach has also succeeded in meeting the challenge of jointly training managers from different backgrounds. Previously, doctors were reluctant to take part in management training that brought together other professional categories, which did nothing to facilitate the breaking down of silos and cooperation.

The result of this survey confirms that the MicroMBA concept, despite the imperfections inherent in a pilot programme, is remarkably successful in that it meets a real need and demonstrates that innovation is possible even in terrain as “mined” as training doctors in management practices.

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