Editorial

Citation

Bowerman, J. (2014), "Editorial", Leadership in Health Services, Vol. 27 No. 3. https://doi.org/10.1108/LHS-05-2014-0046

Editorial

Article Type: Editorial From: Leadership in Health Services, Volume 27, Issue 3

This issue begins with a viewpoint. Written by Dr Gordon Caldwell, a Consultant Physician in the UK, he critically assesses the nature of medical health care from the perspective of the particular leadership characteristics required by leaders in this new world of health care and ever increasing complexity. Instead of the traditional command and control model of leadership which we tend to carry around in our heads, and, all too often, experience in practice, he reflects that complex medical organizations require a particular kind of leadership, one where a leader surrounds her/himself with competent and capable people and actively encourages and inspires them to get on with their work as opposed to using the command and control model to order, bully and cajole using proverbial sticks and carrots. Instead of having followers who simply obey, when leaders create the appropriate conditions for followers, then they can be challenging and supportive and can do their work “swiftly, effectively and enjoyably”. He concludes his essay with a list of words and phrases which we often associate with organizational leadership, and which he defines according to his definitions of what medical leadership should be.

I like this viewpoint. It is written with a degree of passion and really points to the paradoxical nature of organizations and leadership we experience, and profess to support. As he notes, the traditional clinical leadership model tends to produce leaders who are skilled in clinical leadership practice which has, as its foundation, a battle field analysis where the enemy is the disease. This may work for a medical field, but when we take it into our organizational context as our leadership model, we create a culture of command and control where our medical staff (troops) are expected to demonstrate unquestioning obedience to authority. Such a leadership culture is inadequate in this new world of complexity. These newer organizations require a different leadership paradigm where leaders walk their talk, and where their actions are consistent with their professed philosophies. What we, all too often, witness is leaders who may profess such philosophies, but, in fact, tend to fall back on the only authoritarian style they know, even when it plainly does not work. My own personal experience tells me that conscious and aware leaders who do understand the new requirements of organizations and act accordingly are hard to find. No matter how much we espouse lateral and organic models of organizations, whenever the going gets tough, as it does in a field such as health care which is increasingly bottom-line influenced, the dominant model of leadership falls back to control and efficiency, (rather than empowerment and caring); telling rather than inspiring. It is as though Max Weber’s theories of bureaucracy are in some way hardwired into our brain, and changing them, despite our rhetoric about change, is very difficult.

A similar theme is raised by William Howieson who discusses how the Scottish government intends to strengthen the public ownership of the National Health Service in Scotland based on its 2007 paper Better Health, Better Care. He asks us to consider whether we really understand the leadership implications of a more mutual health service which would involve much more involvement of the public, patients and clinicians in its decision-making and health care delivery. This, he suggests, is a transformational endeavour requiring an inspired leadership to bring it to fruition. Reiterating the above theme, we may advocate integration, sharing, harmonization and mutual involvement, but we not are not very good at doing them. We prefer control to mutuality. In my opinion, when all is said and done, I believe that part of the human psyche is that people do not like to share. They are reluctant to give away aspects of their jobs which have traditionally been theirs and theirs alone to allow others onto their turf. How to deal with this is perhaps one of the major organizational leadership questions of our time.

Social and health issues are inextricably intertwined in my experience. Howieson’s paper reminded me of how difficult it really is for individuals to really involve themselves in the system without alienating those who are in it, want to control it and who would protect it. As the guardian of an aging autistic adult male, I have discovered that there are not a lot of resources out there for such individuals. An aging male with a mental disability has none of the cuteness of a young child. In addition, because he is an aging adult, he will be regarded as a liability.

Much of the responsibility for building and maintaining the structure around my autistic ward’s life has fallen to me. In my role as guardian, I have discovered the incredible value of social workers. I am truly grateful for the amazing resources in his life in the form Catholic Social Service Workers who spend time with him, take him grocery shopping and take responsibility for his medical appointments. I never thought I would say this but thank goodness for a kind general practitioner (GP) and prozac which has indeed allowed my ward a life which is less stressed and calmer. His experience with GPs has not always been good and one in fact refused him as her patient.

In fact, medical issues are the least of our concerns. It is the social issues which dominate. The day-to-day responsibility for managing his finances, paying his bills, ensuring his home is well maintained, calling the shots when his behaviour is antisocial, renewing his passport, his leisure pass and just ensuring there is a safety net in place for him to live independently all fall to me. Do I do it out of love? Hell no! Just out of duty!

What my experience has taught me is to be thankful for the government support which makes most of this possible. The government department funds the social work agency that provides the weekly support and the day programme which he attends. But other than that I am on my own. And the government department raises its head just enough that I am suspicious of its motives. My fear is that this government department wishes to cut back on his funding, and that the safety net I have so carefully constructed, will crumble in the interests of austerity.

My story is all too common. We live in a paradoxical world. More and more of us are living longer and longer, many of us – like my autistic (yet high functioning) ward – are disabled as well as aging. We know we have to do something about the situation, yet the drivers of our economic system are profit and individualism – the dominant organizational models – bureaucracy and control. How we age, whether we do it well and with health intact depends on many factors, not least of which is a supportive government and a supportive community.

I was reminded of this when I attended the Annual Research Days of the Quebec Network for Research on Ageing last October. Many of the research papers at that conference were about what can be done to improve the lives of the elderly. One of that conference’s organizers, Dr Melanie Levasseur, along with a number of co-authors has written our next paper in this issue, that speaks to the kinds of simple yet meaningful interventions to improve the participation of frail older adults in their own lives. We know that maintaining older adults in their own homes is in the end, much cheaper on the system than hospitalizing them, and this paper emphasizes how social and health interventions can help to promote autonomy and independence. What Melanie’s research does, I believe, is to demonstrate how to bring back the role of the village into the caring model.

Our final three papers demonstrate the increasingly global nature of our journal. Professor Mosadeghrad writes about occupational stress experienced by hospital employees in Iran. Burnout, and job-related stress are huge topics for all occupations, especially health care workers, and cause all kinds of problems from illness to increased turnover. Dr Manima Ghosh has written about patient satisfaction in India and calls for better interpersonal communication skills on the part of hospital employees to help alleviate some of the problems encountered in those hospitals. India is a complicated country. It is big with many cultures, languages and dialects. The difficulties encountered and Dr Ghosh’s work point to the many difficulties of extending satisfactory health care to populations in a large and economically and culturally diverse country. Finally, Abdelhadi Abdelhakim writes about efficiencies in an outpatient pharmacy in a government hospital in Saudi Arabia, using lean manufacturing. Comparing two pharmacies in the same hospital, his research demonstrates how the adoption of lean methods could eliminate some waste, and bring about improved efficiency.

We are up to six papers in this issue. Each paper is, in its own way, reflective of major issues in leadership and the global nature of health. We are happy that our increased volume has allowed us to considerably reduce the wait time that authors experience in having their articles published. We are also grateful that the number of submissions for our journal is increasing, and that we are able to publish them in an increasingly timely manner.

Jennifer Bowerman