Editorial

Citation

Bowerman, J. (2010), "Editorial", Leadership in Health Services, Vol. 23 No. 1. https://doi.org/10.1108/lhs.2010.21123aaa.001

Editorial

Article Type: Editorial From: Leadership in Health Services, Volume 23, Issue 1

I wonder how many of you who read this journal and the editorials are aware of the Westminster Health Forum – comprising a series of seminars or hearings – developed around major health issues, held in Westminster for the benefit of policy makers to engage with key stakeholders? This past September, I was finally able to attend one such hearing on “The Future of the National Health Service”, a topic of increasing global relevance given the raucous debate in the USA around their health care system, how health care should be funded and how it should be delivered.

Before I actually discuss the session I attended, I want to use this editorial as a means of commending the organisers of the Forum in putting together this series, which has been ongoing now for at least two years. Comprising a whole gamut of topics of major importance in health care, including diabetes, obesity, dementia, palliative care, aged care, alcohol, life style strategies, dental care, nutrition and the elderly, childhood obesity, mental health, cancer care, primary care, infant health, and many more, the Forum allows people who know and who care to come together to learn about, discuss, understand, and reflect on the major health issues we face in today’s society. I cannot commend the Forum organisers enough, including Michael Ryan and his team for the leadership they have demonstrated in pulling together this series. In doing so, they have helped to deepen our understanding that health matters cannot be dealt with in isolation from one another. That together – all these topics discussed in the Forum help to make up the background canvas, the total health environment in which we live. Instead of just seeing our own item of concern, we can share our experiences and begin to understand how one small part impacts every other part in the multi-dimensional canvas we call health care.

I felt privileged to finally be able to attend at least one of the sessions in the series, “The Future of the National Health Service”. If I lived in London, or close to, I would be attending many more sessions in the Forum. I believe this kind of cross-communication to be so important if we are to start solving our health care issues. My personal wish, as someone living in the Western Canadian province of Alberta, is that Canada could organise something similar. I understand that the huge distances and provincial and federal politics may be barriers to such communication, but given that the health issues being discussed in London are endemic to most, if not all, developed countries, then similar kinds of forums would have considerable significance in encouraging people to finally understand and perhaps make progress on the commonality of the health issues confronting us.

What did I learn from the session I attended? Mostly perhaps it was the awareness that monopoly professions, big contractors and big government are the three main forces dominating health care worldwide. That was something I had always been aware of, but to actually hear it from Professor Nick Bosanquet – Professor of Health Policy at Imperial College London – in those words, was quite striking. To me that means that real change in the health care system will always be difficult. Large corporations do not move easily, monopoly professions represent many vested interests, and government comes and goes but it is always big, and always able to be manipulated by the other two forces. Within this context, we will always be up against a reluctance to create real change as obsolescence continually creeps up on us. Professor Bosanquet (and other speakers) all emphasised the need to support individuals and authorities at the local level to develop more and different kinds of partnerships with local providers to help bring down costs and drive innovation. One of the problems with top-down sweeping policies from big government is that in their attempts to control or cut costs, they tend to paint everyone with the same brush – a kind of “one size fits most” approach with little or no reference to outcomes and value of service.

If there was a leadership message at the conference, then this was it. The need to put power in the hands of local health teams to solve their own problems – to empower local managers and clinicians to get results, so that quality problems can be resolved quickly and smoothly. It is this kind of approach that will reduce costs and bring about long term improvements in outcomes. One of the speakers noted how models like lean show the effectiveness of streamlining and improving productivity without tearing the whole thing apart. This approach calls for a new kind of leadership – one that can provide and create the appropriate kind of culture for the emergence of leaders who understand the issues at the local level and who can engage staff and stakeholders at all levels to work to preserve and build improvements. Thus, rather than the traditional and usually political emphasis on cost, there is a need to focus on value, in particular supporting those who work at the local level.

Is the training and development necessary for this kind of leadership available at this time? One of the speakers at the Forum – Steve Barnett – accepted that “the necessary investment in the development and training of talent at the middle management level across our health care systems has been neglected”. Clearly, if the health system is to be made up of the kinds of people envisioned by the speakers, then this will have to be corrected. Leadership in Health Services is well aware of this dearth of leadership development programs, and indeed it is our raison d’être for the journal – to share when these kinds of programs are developed, and their effectiveness in creating this new kind of leadership that our health systems so desperately need. Many of our papers in past issues have included papers that describe some of these leadership development programs, the difficulties they encounter, and their effectiveness in developing change agents. In particular, just in recent issues, I am reminded of John Edmonstone’s and Mervyn Conroy’s papers in Volume 22, No. 3 of 2009, and the paper on learning together as an approach to leadership development by Janice Sharlow, Paula Langenhoff, Aslam Bhatti, Jude Spiers, Greta Cummings in No. 4 of 2009. These are just a few of the published papers that deal specifically with the issue of leadership development. But as Steve Barnett noted above, this has been a neglected area of investment. Our recent call for papers for an upcoming Special Issue describing initiatives that deal with this vital area of health leadership at the system or national level is going to hopefully going to spark a renewed interest in this area. It is too easy, when health care costs are going through the roof, to neglect or cut back in areas of training and development, particularly around “fuzzy” areas such as leadership, yet these costs are a real investment in people and systems that can only multiply in value.

Finally – just a word or two about the papers in this issue. As editors, we are all thrilled to include a truly inspiring interview a great medical leader of our times, Dr Ernest Madu, and his work at the Heart Institute of the Caribbean in Jamaica. I first read of Dr Madu’s work in Ode Magazine, and am so happy that Alistair Craven of Emerald was able to interview Dr Madu for our own Leadership in Health Services. Read this interview and share it with your friends and colleagues. Dr Madu’s work shows us what is possible if we just have the vision, the critical thinking, the skill, and the drive to make a difference. This is leadership at its very best.

Other papers include a fascinating case study from a medical services company in Montreal, a paper from Sweden on age care managers, a paper on knowledge management in Spain, and a paper on the responsiveness of health boards in Nova Scotia to the needs of the black minority population – written by one of our Editorial Board members based on his doctoral dissertation. The final paper is a research study about how perceptions of institutional culture in four Nigerian hospitals, reflected through the dimensions of character and leadership, can positively impact health sector reform in this country.

Thanks to all our contributors for this issue. We urge you to keep thinking about the vital leadership issues our health care systems are facing, and to keep sharing your knowledge with us in the form of articles and research papers. When I was in the UK, people kept telling me that leadership in health is a “niche” area. In my opinion, leadership, particularly in an area as important as health should never be niche: it should be mainstream. Please do what you can to help everyone see it in this light so that Leadership in Health Services can develop the readership it deserves, and begin to make a real impact on our health systems through the research it shares and the practical ideas it generates for change.

Jennifer Bowerman