Leadership in Health Care: A European Perspective

Paul Joyce (Nottingham Trent University, Nottingham, UK)

International Journal of Public Sector Management

ISSN: 0951-3558

Article publication date: 4 April 2008



Joyce, P. (2008), "Leadership in Health Care: A European Perspective", International Journal of Public Sector Management, Vol. 21 No. 3, pp. 315-316. https://doi.org/10.1108/09513550810863222



Emerald Group Publishing Limited

Copyright © 2008, Emerald Group Publishing Limited

This book is mainly about local leadership in the public health care sector and aims to provide a bridge between the academic and practical worlds. In this review first the content of the book is outlined and then some of its analysis and arguments are considered.

Chapters 1 and 2 introduce leadership and leadership models. Chapter 2 contains a well written and very easy to read tour of the main academic theories of leadership. In Chapter 3 Goodwin stresses the pressures faced by health care services in European countries, including the pressures created by increasing consumer demand and the need to manage chronic diseases, and the drive for efficiency and cost control. Chapter 4 goes into more detail about the behaviour of leaders in relation to network and inter‐organisational activities. Chapter 5 deals with the topic of emotional intelligence. Chapter 6 lays out some of the evidence on leadership in the NHS collected and analysed by Goodwin himself. Chapter 7 begins by looking at leadership and learning from failure. The last part of Chapter 7 focuses on the development of leaders, giving some attention, for example, to mentoring and coaching. Goodwin approaches this in line with the current mood to focus on developing leadership talent through approaches that encourage individuals to reflect on their ways of leading and how well their ways are working. The topic of gender and leadership, which is first raised in Chapter 1, is also touched on again at the end of Chapter 7.

Goodwin's book offers a coherent account of leadership, and it begins to offer a framework of ideas and concepts for analysing leadership processes at the local level of the UK NHS.

He relates the leadership process to the phenomenon of change. He suggests (2006, p. 72):

… successful leadership is dependent on understanding context and developing successful interpersonal in inter‐organisational relationships in order to move forward with change. As such, change is not a series of single actions but a process of continual interaction with others in order to create networks of other leaders and followers who are prepared to support an implementation agenda for change.

There are at least three implications in this statement. First, leaders need to be good at analysing context. Secondly, leaders need to be good at mobilising their followers and others. Goodwin tells the reader that leaders cannot exist without followers and that leaders work essentially through their ability to communicate a vision. He makes reference to the importance of inspiration. Leaders inspire others with their vision. Thirdly, leaders need to be good at creating new leaders. Goodwin suggests that the top leaders of an organisation encourage people to lead themselves.

Goodwin argues that the leadership process is the same in the public and private sectors. The difference between the sectors is due to context rather than any fundamental difference in the leadership process. One specific difference between the public health sector and the private sector concerns the degree of clarity in the nature of managerial accountability. He says that managers in the public health care sector face more ambiguous accountability. Public services managers, he says, have a relatively large number of internal and external stakeholders. In contrast, private sector managers have a clear accountability for the financial bottom line.

Goodwin suggests health service leaders need skills in relating to politicians, consumers and patients' rights groups, consumers, and professional health care staff. These stakeholders are important in different ways. Politicians set policies and control financial and other resources. Consumers have ideas about the services they require and have shown signs of being less passive in relation to professional and managerial judgements. Professional health care employees are important in successful realisation of plans to implement change.

Goodwin reports that there is relatively little evidence from studies of how public services leaders work. His own research (Goodwin, 2002) on chief executives in the UK NHS is used to make a number of interesting arguments about leadership in health care. Five of these arguments are as follows.

First, successful implementation of major change follows the creation of a local leadership culture. Secondly, the creation of a local leadership culture is the result of the successful management of big local issues. (This particular point may reflect the need of a new strategic leadership to build its credibility with followers and local partners which may depend on success in solving local issues.)

Thirdly, Goodwin argues (2006, p. 74) that chief executives in the NHS can influence how external actors perceive the quality of their executive team and that this has a bearing on the creation of a local leadership culture. Fourthly, Goodwin argues that chief executives can influence the creation of interpersonal and inter‐organisational networks and the extent to which they are used to create inter‐organisational power sharing, alliances and partnerships. This also has a bearing on local leadership culture. Finally, Goodwin says that the emergence of a local leadership culture requires the chief executive handle and account for the relationship between objectives defined nationally and locally.

This book may be of interest to different types of readers. Generally speaking, it may be of interest to chief executives in the NHS. It may be of some interest to NHS leaders at service levels, who might find the material in Chapter 5 on emotional intelligence helpful as they confront their personal challenges and risks of leadership. The material in Chapter 6 is probably of more interest to university academics and doctoral and Masters' students on public sector management programmes.


Goodwin, N. (2002), “Determining the leadership role of chief executives in the English NHS”, unpublished PhD thesis, Manchester Business School, University of Manchester, Manchester.

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