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Emerald Group Publishing Limited
Copyright © 2008, Emerald Group Publishing Limited
Article Type: Editorial From: Leadership in Health Services, Volume 21, Issue 3
Pulling together the subjects of the papers for this issue reminded me that they fit within three major themes – all of which are becoming increasingly important in health care service delivery.
The first deals with the application of streamlined and effective private sector management practices to the health care system, the purpose of which is to improve service, and reduce cost. Our governments seem to have an unspoken belief that if our publicly funded institutions can just adopt a private model practice, they will be more efficient and effective. At the same time their centrally driven policy directives often have the exact opposite effects to the ones intended.
These themes are explored in this issue in the papers of Professor Towill, who comments further on the Gerry Robinson BBC television series. His first paper, printed in our previous issue, asked what hospitals can learn from the series. This second paper asks what the Department of Health can learn. As Towill reminds us, government health initiatives are often overly ambitious, tend to come with large chunks of money, along with significant strings, and include little or no involvement from the local skill pool. In this mix there is little room for visible leadership and organisational learning, and so inefficiencies will tend to dominate.
Dr Stephen Willcocks in his article in this issue also reminds us of the role of private sector orientation of government in the delivery of health care, and promotes a marketing approach. The UK policy of having the money for services follow the users means that health care institutions must operate as profit-driven centres. The more patients treated, the more money received to fund the services. In this context, Willcocks argues that a marketing model may well be useful. Present government policy is based on the provision of maximum choice for patient consumers, as they are attracted to those clinical departments that provide faster and more effective patient care. Thus the policy serves as motivation for clinical leaders to organise services and improve quality in the interests of increasing revenue through maximising the customer usage income streams. In this environment, just as in the private market economy, marketing can play a useful role in guiding more intelligent customer behaviour through more effective health care consumer choice.
Gerry Robinson looked at the hospital service with an eye to reducing bottlenecks, reducing waste and increasing internal efficiency; Willcocks argues that a marketing perspective has every place in the health care system with an end result of a more effective and focused clinical leadership. Both Towill and Willcocks offer us a modern business perspective on the delivery of health care, and implications of centrally driven policies, which are, after all, intended to improve health services and reduce costs.
The second theme in this issue deals with the type of leadership style that is most effective in a treatment setting. Holmberg, Fridell, Arnesson, and Bäckvall, writing from Sweden, remind us of the ultimate importance of leadership behaviour in human service organisations – that of getting (human service) results. Their paper is also critical of top-down directives, arguing that all too often their daily demands for cost reduction and rule adherence inhibit risk taking and reduce the effectiveness of new evidence-based treatment programmes. Their research demonstrates that the most effective leadership and managerial behaviours are those that protect staff from the impact of bureaucratic organisational reality, and at the same time provide relevant space, support and learning for the introduction and ongoing provision of new evidence-based clinical treatment practices. In other words, an effective treatment programme – to be effective – requires the right kind of leadership behaviour in the unit or department delivering the programme.
This perhaps brings us to the final theme in this issue – that of leadership training. Dr Rosemary Duda’s paper describes how formal training in leadership skills early in an academic career is professionally and personally beneficial to faculty members in terms of career enhancement in a medical institution. Although her paper fails to provide any details on the type of training provided, it supports the idea that leadership-training initiatives can often have a positive benefit long after the programme has ended.
Pedler and Abbott’s paper provides us with a different insight into leadership training programmes – the increasing relevance of action learning programmes and the importance of skilled facilitation for their effective delivery. Today’s health delivery services are messy and complex. There are no simple solutions to the problems we all face. So it is not surprising that there are an increasing number of health leadership programmes being offered, and that on occasions they may become contentious. Sometimes participants become “stroppy”, taking ownership of the programme into their own hands and resulting in events that may be difficult to resolve by the programme organisers. Such a situation is described by Mike Pedler and Christine Abbott in this issue, in the second of two their two papers about a leadership development programme organised for the East Midlands Region of the National Health Service in the UK by the Centre for Health Improvement and Leadership from the University of Lincoln.
What led to this particular deliberation was the “unprecedented” firing of three of the facilitators from the service improvement programme by the members of an action learning group. As a result of the process implemented by Pedler and Abbott and to explore these events, they have developed a model for the facilitator that has three possible orientations: initiator, coach, and leader. With this in mind, therefore, they suggest more attention needs to be paid to the development of action learning facilitators where the guiding question always needs to be “Am I doing it right?”
As action learning programmes become more important mainstays for leadership development, this paper really reminds us that too often trainers emphasise content at the expense of process or vice versa, and fail to take into account their own particular facilitation orientations – even if they are aware of them. If we are to guide action learning programmes more effectively toward the development of leadership skills in others, then we need to pay much more attention to the role of the facilitator along with the needs of the group.
I hope you enjoy reading this issue and exploring some of the themes visited here. If you have a research perspective on leadership as it pertains to health, we encourage you to share it with us. Health leadership is a vast topic. Indeed, in my own province here in Canada, more people are employed in the health sector than in any other. Only by exploring our perspectives and practices – which go way beyond the delivery of medicine – can we hope to develop more effective leadership practices, and start to resolve some of the common health care problems we as nations all share.