Leadership in Health Services

ISSN: 1751-1879

Article publication date: 28 January 2014



Bowerman, J.K. (2014), "Editorial", Leadership in Health Services, Vol. 27 No. 1. https://doi.org/10.1108/LHS-11-2013-0039



Emerald Group Publishing Limited


Article Type: Editorial From: Leadership in Health Services, Volume 27, Issue 1

Being an editor means that one edits more than writes. Writing becomes something that other people do! It can be quite a challenge therefore when one is requested to present at a conference based on a past paper – especially when one has not actually written a paper recently. In this case the paper I am referring to was about the design of a community health centre being built right in my front yard, and published in this very journal in 2006 (LHS, 19/4, pp. xvi-xxiii). An interested reader and LHS contributor wrote to me from Quebec in July of 2013, commented on this article and asked me if I would be a guest speaker at an annual conference on research and aging to be held at the University of Laval, in October.

Obviously I was loath to turn down such an invitation, though I did wonder what I would have to say that would be of interest to an enthusiastic bunch of aging researchers, when, even if I do write, my work is rarely based on hands-on research. I am very much an ideas person, quick to consider theories and critical perspectives which are not always well received. With some trepidation, I therefore accepted the invitation, and after a number of false starts, developed a presentation on health service within two paradigms, the sickness paradigm and the health paradigm.

My thesis was about how aging, as much as we see it within the sickness paradigm inasmuch as we fear the projected medical costs of a rapidly aging population, can be just as easily viewed within the health paradigm. The medical one is associated with increasing costs, it views the aging population from the perspective of fear and costs usually in consideration of pharmaceutical requirements. Certainly in Canada, seniors, per capita, use many more drugs than the rest of the population (Simpson, 2012) with most of those drugs being for chronic conditions usually associated with aging such as cancer, dementia, diabetes, cardiac arrest, and plain old loneliness and depression. Many of these conditions also of course often disproportionately impact the poor.

On the other hand, the wellness paradigm views the elderly as dynamic contributors to our society, working well past retirement age because they want to, participating in programs that promote health and community, refusing drugs recommended by family doctors because of their unknown and long term side effects, and effectively managing their own health. They do this with assistance from professionals and community representatives and leaders who do not see them as patients but as active participants in their own life.

Sooner or later, if we are lucky enough, we will all grow old. My wish is for us to do it on our terms. The fact is that illness can strike us down at any time. We need help when that happens. But such help can come from a number of quarters, and not just from the medical quarter. We know there are increasing numbers of health centres and community programs in our Canadian cities aimed at promoting wellness. We also know that we need more scientific research – especially on the conditions that most debilitate us mentally and physically –such as Parkinsons disease, or dementia. Overall, the provision of health services is expensive and no-one wants to pay for it. It is built around a model of sickness and puts us at the mercy of specialized providers on whom we come to depend. Wellness on the other hand is a personal responsibility where we can utilize self- knowledge and effective partnerships. This is the paradigm that will in my opinion lead us gently into the twilight of our years and ensure that all of those years are as productive as possible.

Many thanks to Melanie Levasseur and the other organizers of the Conference for inviting me to the Annual Research Days of the Quebec Network for Research on Aging. I learned lots from the many presentations. In particular I was very impressed with the student presentations on their research. I am grateful to have been able to present my somewhat challenging ideas to such a warm and receptive crowd.

Perhaps an outstanding question from my presentation is exactly how to engage more people in consideration of their own health. Indeed how to engage more people generally in terms of health priority determination. It is therefore with some particular interest that the first paper for consideration in this issue is by Dr Iestyn Williams and concerns a novel approach to citizen engagement in health priority setting. Four deliberative events were held involving the participation of 139 citizens whereby elements of the twenty-first century town meeting, the World Café and a specially designed set of dice-games were used to elicit both quantitative and qualitative responses to certain issues concerning health care priority setting. In some ways, the authors’ findings were a bit disappointing in that the study showed very little influence on Primary Care Trust resource allocation. However, they do suggest that the tools are a useful means of introducing the topic of health care resource allocation to the general public in terms of some of the challenges it poses, thus having an educational effect that could have long term implications for bringing about more citizen involvement in decision making.

Some years ago at a conference in Toronto on health care services, I happened to see a group of actors role playing a scene out of a hospital where a nurse challenges a doctor for not washing his hands. According to the audience, this is a very current subject. We have never had a paper on this topic submitted before. So it is with pleasure that this issue contains a paper about clinical leadership style and hand hygiene compliance, by Stella Stevens from Australia. True her research sample was small-only 53 medical and dental staff members were interviewed about their perceptions of leadership style as it related to hand hygiene. What stands out from this study is that although much of the leadership style literature focuses on transformational, engaging or authentic leadership style, these styles are not considered to be highly motivating when it comes to hand washing. Instead, more directive approaches to leadership, using clear statements backed up by role modelling appear to be more effective in bringing about greater compliance. As a once mother of a young child who was always reluctant to wash her hands, I understand!

Dr. Stavros Bekas writes about a way to develop medical leadership among trainee doctors, by drawing on a theoretical basis for the evaluation of leadership development in postgraduate medical education. He has developed four frames for evaluating programmes, their pedagogical content, how leadership is conceptualized and achieved, the contribution in quality improvement, and those practical aspects that increase engagement and participation. His research is essentially theoretical drawing on literature in the field, as well as his own personal experience. For me one of the key observations of Dr Bekas is his emphasis on the development of a "collective capacity for change." As he notes, "leadership is necessary but not sufficient for change in complex organizations." I believe this is an important point. If leadership programmes do not develop the capacity to challenge the existing status quo, and bring about improvements, then they may be failing. Methods therefore to establish this are going to be very important as we continue to deliver leadership development programmes.

Finally the last two papers in this issue deal with quite different aspects of leadership. The first by Doohee Lee explores consideration leadership as a factor in improving the performance of, and reducing injury in Home Health Aides. As the author notes, previous studies have suggested that preventive training diminishes employee injury, but no studies have explored how consideration leadership can interact with training to reduce them even further. Maximizing training effectiveness requires leaders to "understand the importance of their own role in training transfer processes, as well as demonstrating their own adequate influence behaviours such as consideration."

Second, Billie Kell writes from a very pragmatic perspective about the development, delivery, and evaluation of a customized team building project on a Paediatric Unit of a London Hospital. I am familiar with this kind of project delivery since I spent a couple of years implementing these same kinds of programs in organizations. For anyone wanting "hands on know-how" on how to create and implement similar programs, this paper has much practical information. Do such programs offer long term value for work teams, are the skills transferable to different teams, do they build resilience in the face of continuing organizational change? These are long term questions that perhaps merit going back and talking to participants on a regular basis. This experience however demonstrates the immediate value of such programmes in terms of the investment of money and time on the part of the organization and the participants.

Jennifer K. Bowerman
Editor LHS

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