Editorial

Citation

Bowerman, J. (2009), "Editorial", Leadership in Health Services, Vol. 22 No. 4. https://doi.org/10.1108/lhs.2009.21122daa.001

Editorial

Article Type: Editorial From: Leadership in Health Services, Volume 22, Issue 4

On a recent trip to New York I happened to pick up a book entitled, A Whole New Mind by Daniel Pink (2006). The thesis behind the mind is that right brainers will rule the future. Just as this era of sustainability and rapid change has turned the traditional bureaucratic leadership paradigm upside down, so it has changed the way we need to think. It is no longer sufficient to rely on the linear logical planned step by step left brained approach to life – the age of accountants, lawyers and software engineers is coming to an end. According to Pink, the future belongs not to these types, but rather the right brained, inventive, design oriented, big picture, more emotional thinkers.

One of the reasons I enjoyed Pink’s thesis is that as a teacher of leadership I think he is right. I believe leadership to be not a quality emphasising left brained military analytical precision, but rather one where right brained, intuitive, relationship savvy, empathic qualities are of equal if not more importance. This is especially true in a health world of unprecedented complexity. In my opinion, the concepts of design, seeing the big picture, striving to make meaning in difficult situations, understanding the significance of relationships and the role of empathy have major implications for the world of health service leadership. We need to be able to see the whole story, blurring the boundaries, much more in tune with our emotions than our logic, so that we can start to design new solutions to the challenging problems we face.

The fact is that we are facing huge health challenges created by the demographic forces of increasing life span, exponential population growth and the rate of technological change. At the same time the world is going through a major economic downturn, which has served to exacerbate all these challenges. Health is no longer a local or national concern; it is a global concern. In every country, health costs are going through the roof. Even though the answer from political leadership all too often is to cut the budget by eliminating middle management positions, reorganizing and consolidating – typical left brained problem solving approaches – the problem of costs is real and continues to get worse. All too often it seems, our politicians act as though they should run the system, instead of making the case for change and then allowing the leadership in the system to act accordingly. In short, their ongoing tinkering with the system fails to produce sustained change, and often seems to compound the problems we face.

Here in my own Western Canadian province, it is reported that our health authority is running a 1.1 billion dollar deficit. It is reported that the NHS in the UK requires another 10 billion pounds in the next three years to survive as a national health service. The costs to reform the American health care system where many people do not have any health care coverage is estimated to be in the trillions of dollars. How many administrative reforms have been foisted on health care systems by well meaning politicians whose main concern is to bring costs down? At the same time, the costs keep going up.

We need to begin to ask ourselves – is this really a paper work problem? Can we bring about health service reform by continuing to shuffle paper, change the administrative systems, pay the managers to leave, lay off staff, recruit more? Or are we facing a health problem? And if it is a health problem, then what can the leaders in the system do about it? Indeed what can we all do to participate in that discussion so that we can finally bring health to the forefront of our discussions. I read somewhere that health is simple, illness is complex. Some would argue that there is much going on in our modern western society – much that we have a vested interest in – that contributes to our sickness including modern food that promotes chronic disease, sedentary life styles, and pharmaceutical drugs that do not cure underlying conditions but merely manage them. These are huge issues and have major implications for our health – or lack thereof – yet our health service delivery systems operate almost independently of them.

On a large scale, to make the change possible requires a focused leadership and will and the imagination to do things differently. On a small scale, local practices often reflect a leadership initiative to do things better and differently. Whether driven by imagination, or necessity, we know that some good things are happening in the health care system – even though the big picture may be disheartening. The question for those who read and contribute to this journal is what can you do to make a difference? Leadership in Health Services needs your stories of leadership that have practical implications for health service – so that others can learn from your practices. If we cannot rely on the left brain actions of our political leaders to make a difference, then the actions of those actually working in the system become ever more important in their capacity to make a difference.

In this issue, Graham Dickson directly articulates this leadership paradox we particularly face. Although directly pertaining to Canada, his paper has much relevance to the entire global world of health leadership. As he analyzes the transformations that are ongoing in the Canadian health system and their theoretical and practical implications for leadership he notes the lag between the old “more administrative and managerial” models and the newer more innovative and transformative approaches to leadership. His paper speaks to the key leadership shifts that are required if leaders are to able to respond to the changes occurring in the health care environment and at the same time be effective and active leaders in shaping the new systems that are required. To this end he describes some of the positive dialogue currently occurring in Canada concerning newer more dynamic and contextually relevant leadership models that may be useful for guiding our health service development.

Other papers here also speak to leadership development and practices that have implications for the wider system. First, Peter Hockey and his co-authors describe a novel leadership competency development program where National Health Service medical professionals provide medical services in partnership with local people through the Maddox-Jolie-Pitt Foundation in Cambodia, to both improve the health of people in a developing country and at the same time build their own leadership competencies. The paper is interesting on a number of levels. First, many of us know little of this foundation and what it does, and the paper does shed some information on this. Second, medical professionals get to interact and work with people entirely outside their own culture – where the stories and the contexts are very different from what they are used to, and then take the new skills and experiences back to the NHS. Leadership through learning, particularly when the learning occurs in such a culturally different context makes for a fascinating and ongoing study of leadership, and we can look forward to more papers in the future that evaluate just exactly what competencies are developed and their contribution toward a better health care system.

In another vein, Janice Sharlow et al. describe a leadership development initiative from the Alberta Cancer Board in Western Canada. Framed conceptually on advanced leadership theories and practices, the paper describes a collaborative cohort approach to leadership development where leaders in all levels of management and administration, including individuals with medical and scientific leadership portfolios, come together in a carefully designed program to promote individual, group and organizational learning. The ultimate aim of the program is to impact organizational culture and promote organizational development and effectiveness against the backdrop of ongoing fiscal and demographic pressure. Given the political reality of the health service in this province, with the emphasis on major cost cutting, this type of program takes on particular importance.

Finally a group of Florida researchers is a pilot study speaking to gender differences in the extent to which male and female health care professionals participate in ongoing professional development activities and the impact this has on their careers. Although preliminary, their finding – that men participate more in ongoing professional development activities than women – suggests that the gap between these two groups in terms of health care career attainment may continue, with more men than women achieving leadership positions.

Also included here is an in-depth book review by Michael Aherne. Entitled Regulating Aged Care: Ritualism and the New Pyramid, published by Edward Elgar, and written by Australian writers, John Braithwaite, Toni Makkai, and Valerie Braithwaite, the book looks at 30 years of regulation and regulatory structures in terms of outcomes in aged care centers in three countries. Are we further ahead by having such regulation built into our health care structures? The authors would suggest not. Could this be more of the left brain thinking that Pink argues is becoming obsolete? Read Michael’s extremely thorough review, then read the book, and then assess for yourselves how leaders can use regulation not to preserve the status quo through ritual, but as a transformative force to bring about real change in our health care services. If you read just one book this year, then this might just be the one to start you thinking about the leadership journey we can start to undertake.

Jennifer Bowerman