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Emerald Group Publishing Limited
Copyright © 2009, Emerald Group Publishing Limited
Article Type: Editorial From: Leadership in Health Services, Volume 22, Issue 2
Toronto’s Health Achieve Conference has been branded as the largest and most important healthcare show in North America. This past year in November, I was fortunate enough to attend as a representative of this journal Leadership in Health Services. For me personally, as I browsed, chatted and listened, the conference brought home to me the true complexity of the health service today, and how much we both expect and require from our health care leaders. Writing this editorial gives me the opportunity to explore some of my observations in more detail, so that we can perhaps begin to extend the scope of this journal and encourage many more contributions from a much broader perspective around health leadership and its requirements. Much more than a theoretical journal, we want one that speaks to the ever-expanding numbers of practitioners in the field and the ever-expanding requirements of their roles.
First – the big picture! This was really brought home to me as I explored the exhibition floor – with something in the order of 300 exhibitors featured – all promoting a myriad of health related services, from sterilizing techniques to schools of health services, human resources and management, from communication aids to green anesthesia products, from linen services to healthy food services, from specialized software to rapid response programs, from wellness to pharmaceutical monitoring, from equipment to laboratory services,- the list goes on and on. If ever one really wanted to understand the rate of change in the healthcare field then just attend one of these symposiums – the variety of interests and services are totally overwhelming. And it occurred to me as I reflected that these myriads of services all of which are reflected in modern healthcare institutions together help to make up the face of modern health care. Some years ago at Salford University, I heard Reg Revans – pioneer of action learning – lecturing on how learning has to keep ahead of the rate of change if we are to survive as a society. The exhibitors’ hall brought home to me Revans’s words – in health care alone, the rate of change is huge within an enormously complex organizational and institutional environment. For our leaders to keep up, they need to learn – at a rate more rapid than the change that is happening. This is truly our greatest challenge as both as learners and educators - to ensure the space, the supports and the resources for our health care personnel for maximum learning. I believe this is necessary if we are to develop the leadership necessary to both manage our health care systems effectively and take them to where they need to be. The dangers in times of declining tax revenues and pressure from politicians is that we will ignore our learning needs and concentrate just on the management piece – plugging the holes as it were rather than recreating the dyke.
Next, I attended two leadership forums – one for physicians, and one for nurses. Both were fascinating particularly when considering the totally different perspectives from which they approached the subject of leadership. For the physicians, the main focus was the consideration of personal leadership behaviour and how to engage physicians in work practices within a team model as opposed to a hierarchical model. This was obviously a pretty important subject – at least for two physicians who were chatting to each other behind me – about fellow physicians who refused to work appropriately or who refused to visit patients in the hospital because their white coats no longer commanded the kind of respect that they felt their roles were due.
Their comments were brought home once the session started when a small troop of actors role played two hospital scenes in which diva medical consultants flatly refused to work as part of a team with the other healthcare workers demonstrating both supreme arrogance and in one of the scenarios, actual violence. I hoped perhaps that the behaviour I was viewing was a little exaggerated, deliberately so to generate discussion. But when asked by the session chair, most of the audience acknowledged that they had actually witnessed this type of behaviour at some time in their careers. The discussion that followed was about the types of programs within medical institutions to help physicians deal with the changing aspects of their roles and the resulting stresses associated with it.
In interesting contrast, the main focus of the nursing leadership session was integration. The context for the discussion was Ontario’s 2006 Local Health Care Integration Act, the main purpose of which is to build integration in health care services as a means to improving the health care of Ontarians. This legislation recognizes that today’s health services can no longer operate in silos. It means moving services out of hospitals into communities and then reinvesting those savings back into hospital care for those who desperately need it. At its best integration reflects a totally seamless system of care where one access point may mean dealing with six or seven services at any particular time. As the speaker pointed out, there is no evidence for fragmented care, but there is much evidence for integrated care. In such a context, nursing leadership has a responsibility to actively advocate for integration, and for the removal of barriers and silos within the system. Such advocacy can be both difficult and risky. Old role models do not die out overnight. But if the discourse can focus on the best needs of the client, and not on the needs of the system, then integration can be a major stepping-stone to new types of leadership roles.
Finally, the next topic to mention briefly is the speech by Dr Mehmet Oz MD, (America’s favourite doctor and a popular speaker on the Oprah Winfrey Show) speaking about innovation and the things we can do to age with vitality. Dr Oz and his partner Michael Roizen have written a number of books in the You series, all of which have been best sellers and are now globally available. In his usual light hearted and engaging manner he began from the premise that “aging is a side effect of life not a natural part of it” His most important point is that we need to change our way of thinking about health. It is health that prevents us from aging. We cannot fix health through legislation. Health cannot just be about prevention, it must be transformational. Health is what we do in our communities, and in our homes. Ultimately, all health is personal. This is a new paradigm where health is our individual responsibility and a much broader concept than merely absence of illness.
Increasingly, of course, the key aspect of health care is economics – it is after all the largest growing business in the world. Thus, the questions of who pays and who gets coverage are always forefront of our political systems, No matter how much we profess to want “free” health care for all there are always those who believe that health care must be based on a “for profit basis” and should be paid for by those who can afford it.
When asked from the floor how he felt about the American system of privatized medicine, Dr Oz spoke quite movingly about how those of us with health care systems providing universal coverage (such as Canada and the UK) should do all we can to keep them. And he assured us of his belief that we would indeed see a change in the American health care system within a very few years (he happened to be speaking on American Election Day and most of us in the audience were buoyed with the anticipation of change – both medical and political - for that country). How and when that leadership appears and who it will come from will be interesting to watch.
The conference of course touched on many other leadership issues, but as I reflect on what I learned and I think about the papers contributed for this issue, I am pleased that we are on track. Dennis Towill provides us with his fourth and final summing up of the BBC series with Sir Gerry Robinson asking us what we learned. When I speak to people in North America about this series, many of them have never heard of it – yet the issues Sir Gerry dealt with at that British hospital are the same all over the world. This series has enormous educational potential and deserves to be seen by all medical managers and leaders. The question is how do we make it happen?
We hope you will enjoy the papers in this issue – as we follow up from past themes – such as lean, and explore new ones such as leadership conversations. Thank you all for your contributions. There was a great deal of interest shown in our journal at the Ontario conference. Leadership is an increasingly important concept in the field of health service delivery and the more you are able to share your experiences through your contributions, the more valuable our journal becomes.