CitationDownload as .RIS
Emerald Group Publishing Limited
Copyright © 2008, Emerald Group Publishing Limited
After the special issue on lean – things have returned to normal. The journal continues to grab attention and the contributions are increasing in number. We are beginning to realize our goal of having a bank of suitable articles for upcoming issues which is a wonderful feeling. This situation allows us as editors the opportunity to relax a little, and spend more time assessing and reviewing the contributions, without the constant pressure of tight deadlines. The growing popularity of the journal also benefits you as contributors, and helps to build ongoing quality in terms of its content as we are able to work more closely with our peer reviewers, and then once again in turn with you as you assess the feedback. In addition, we notice that we are becoming more global, with many of the contributions coming from around the world – another sign that we are meeting one of our main objectives, that of being a forum for international knowledge sharing. The fact is that leadership and leadership styles are cultural. The more we learn from other people about how leadership issues are addressed in their countries, the more we can open our perspective on what leadership really means to us. Thanks to everyone for helping to make it happen.
As someone who teaches leadership to up-and-coming leaders in the classroom, the subject is always close to my immediate awareness. Thus I constantly ask myself questions related to my own leadership. If I was an effective leader, how would I live my life differently? What decisions would I make and what actions would I take to really live my leadership ideals? As I reflect on the managers and leaders I have worked under in the past, I find myself assessing their actions in terms of my leadership ideals. I am sad to say that many of them fail my test – too busy maintaining stability, they failed to grab onto opportunities for fresh thinking and new directions.
This is a major theme picked up by Dr Jeffrey Braithwaite who is the Director of the Centre for Clinical Governance Research for the Faculty of Medicine in the University of New South Wales, Sydney, Australia. In his paper entitled L(H) ≠ Σ(m1, m2 … mn), Braithwaite argues that the increasing top down political pressures on health care systems may have led to an emphasis on good management, but that such management is not necessarily synonymous with effective leadership. As the mathematical formula of his title suggests, leadership in health services is not the equivalent of good management. Leadership is rather a style of being that is prepared to stand up against the “micro-management” imposed by centrally-leaning private health provider organizations and by governments and bureaucrats of public health care services. He calls for us to research much more deeply than we have in the past under what conditions good leadership roles might be encouraged, and how good leaders who are “prepared to stand and be counted” can contribute to better health systems.
My own thoughts are that often lack of leadership can lead to appalling and tragic results. Take for example Canada’s tainted blood scandal – a tragedy of unprecedented proportions for this country – where, in the 1980s and 1990s, as a result of receiving contaminated blood in the form of transfusions from the Red Cross, more than 3,000 people have died. Just this past month (September 2007), there has been a major Ontario legal decision exonerating four of the Red Cross executives from charges of criminal action, brought by victims and families who received the infected blood. In my opinion, good leaders must be recognized as human, as having the capacity to make mistakes – and learn from them. Indeed in matters of public health, such as the blood supply of a country, we all need to know what went wrong, and how such disasters can be prevented from ever happening again. But good leaders need to take action free from the pressures of political appeasement. They need to be strong enough to take necessary actions based on their assessment of the situation, and strong enough to explain their actions. Would good and strong leadership have made a difference in the case of the blood supply? We would certainly like to think so. It is a study worth waiting for. The trouble with good leadership is that we all know when it is missing but it is too easy to put it down and disagree with it when we see it. Braithwaite’s call to study and develop those conditions under which good leadership can emerge is therefore certainly timely, and part of the urgent challenge for effective health service delivery.
Perhaps one way of developing better leaders is to provide managers (hopefully in training to be leaders) with more effective supervision. Seija Olila documents her findings, based on empirical interviews with public and private health care managers in Finland, demonstrating that supervisory management practices that encourage dialogue and reflective thinking work to clarify and develop competence based management. In doing so, they not only help to build leadership but at the same time provide managers with the opportunity to feel better in their jobs.
Anne Konu, also from Finland, assesses how much managers in health care fields are willing to share leadership practices where the goal is to increase participation in decision-making and develop more collaborative human relations. Her findings suggest that the elements of shared leadership are found in non hierarchical social and health care organizations mostly staffed by women. Those medical institutions that are smaller and staffed by(mostly male) medical practitioners who represent distinct areas of medical specialty with differing levels of seniority are not amenable to shared decision making practices. As Konu points out, this is more than just a gender difference. It is also indicative of the differences in the types of professions found in the medical and health fields and how their work is structured. Her research suggests that shared leadership practices do lead to better outcomes. Thus the creation of such work environments is a goal worth striving for.
In quite a different vein, Dr David Birnbaum’s paper offers us a market survey of infectious control professionals to assess the potential for a new distance learning program in this field – the purpose of which is to build the profession from undergraduate to masters level credentialing. Infection control is under ever increasing scrutiny in today’s world. Indeed in my own province here in Canada, two hospitals were shut down this summer because of lack of appropriate infection control procedures. Change is happening rapidly. How do professionals keep abreast of all they need to know and do? Dr Birnbaum’s initiative in this regard is most timely therefore, and is well deserving of university and professional support.
Finally, Dr Joshua Abor and colleagues provide us with an examination of governance structures in Ghanaian hospitals by comparing private with public systems. Many of us know very little about health care structures in African countries. This article assesses whether the fact that health care is delivered somewhat unevenly could be related to the different types of governance in the two systems, and suggests some useful areas for further study.
So there we have it – five articles each very different – but each covering some aspect related to leadership in health delivery. Plans for future issues include giving successful leaders the spotlight for a series of interviews. Please keep your submissions coming. Leadership and health services are vast topics. There is so much happening and so much to say, so whether you are a researcher or a practitioner in the field, we want to hear from you.
Until the next issue,