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Emerald Group Publishing Limited
Copyright © 2010, Emerald Group Publishing Limited
Article Type: Editorial From: Leadership in Health Services, Volume 23, Issue 4
In 2006, I wrote a paper for this journal entitled “Designing the primary health care centre of the future: a community experience” (Leadership in Health Services (LHS), Vol. 19 No. 4, pp. xvi-xxiii, 2006). The paper described the planning and developing of a new primary care centre in an older, urban and demographically mixed neighbourhood in my home city, Edmonton, Alberta, Canada, paying particular attention to the intense two-way dialogue that had to occur between the health authority and the community for the centre to meet the requirements of a new inner city vision for primary health care, and at the same time satisfies the established community where it was to be located. In this editorial, I provide an update on the clinic journey and demonstrate what I believe are some important lessons about the nature of leadership required for today’s health care services.
The clinic was intended to be very much a futuristic and leading model for primary care – both structurally and visually, having the capacity to help people live healthier, longer lives (from cradle to grave) through the provision of care for every day needs and the management of chronic conditions. All together, the clinic in a single location would provide home care, social services, dental, speech and language programs, communicable disease prevention programs and addiction services. In addition, a plaster clinic and urgent care centre were intended to take the load off the nearby hospital emergency department, thus allowing more acute needs to be treated in a timely and more cost-effective manner.
Originally scheduled to be open in October 2009, the clinic’s official opening was delayed until just last week (June 24, 2010). Reasons for the delay were cited as the H1N1 vaccination drive. In addition, political health funding restrictions have meant that the urgent care centre, along with six family physicians, has yet to be added with no official timetable in sight. (They are to be phased in.) To date, official figures show that the clinic cost $42 million. An estimated $8.4 million are required to make the facility fully functioning.
It can be argued that the political failure to fund the physician and urgent care aspects points to a failure of leadership at the highest level. The clinic remains a great vision for primary health care, led by a very capable project manager who skillfully developed ongoing collaborate relationships with the community through to the physical completion of the building. Yet in spite of her efforts, the elected leaders, the politicians have failed us with their failure to fund. Small wonder people tend regard political leadership with a degree of cynicism these days.
Undoubtedly, from a community perspective, despite the delay in provision of family physicians and urgent care, the clinic is a wonderful addition. The project manager, architects and designers deserve much credit for their attention to the community requirements – which included preservation and inclusion of an old architecturally significant former school into the overall design, pleasant landscaped green space surrounded by original elm trees and underground parking to help take the load off the local communities which are close to fairgrounds and sports arenas.
This is an inner city neighbourhood. A recent article in the local paper describes this as one of the “most culturally and socio-economically diverse and challenging areas of the city. The area has a child mortality rate as twice that of […] (other areas), while the infant mortality rate is on par with Russia or Thailand” (Paula Simons, Edmonton Journal, May 22, 2010). Such an outstanding design and location is a real leadership coup in terms of building bringing health and wellness and support for young families to the area. At the same time, those of us living in the community have had to recognize that the clinic is merely located here. It is of no help and will provide no leadership when other influences that feed off the poor and exacerbate their living conditions, such as liquor outlets want to locate here as well. Just recently, it was the community which had to band together to fight off the inclusion of a liquor store in the nearby strip mall, pointing to the obvious fact that public health is everyone’s business. The fact that an alcohol counseling unit is located in the clinic made no difference to our fight, and we were unable to call on them for support.
A new book entitled Leadership for Health Care by Jean Hartley and John Benington (Policy Press, 2010) asks us to understand the leadership in the health field as “part of a wider frame of organizational issues”. The authors demonstrate that the very complexity of the field and the speed of change render the more simplistic one-dimensional theories as no longer sufficient. Just as my clinic story demonstrates, today’s health field is a minefield of change; and different types of leaders are required at any one time. As yesterday’s institutions no longer serve us; and communities, patients and carers demand to be involved in the systems of health and the processes of healing, increasingly we must look to ongoing innovation. We are forced to recognize that step-by-step continual improvements in existing institutions no longer work. Although circumstances such as budgets may persuade us to make do in structures and systems that we already recognize as obsolescent, these are in the end backward steps. Learning to read context, therefore, is a key leadership requirement, involving knowing how to balance conflicting interests, and move forward appropriately, especially when others hold the purse strings and have different agendas.
Context and complexity perhaps describe best the variety of papers that have been submitted for this issue. At any one time, there are ongoing innovations in health care institutions that can help bring about improvements. In this regard, Kerry Walsh, Calvin Burns and Jiju Antony assess the effectiveness of an electronic adverse incident reporting system in four hospitals within a National Health Service Scottish-based board area as a means of improving patient safety. They note the possibility of using such a system to build organizational learning but recognize the need for strong hospital leadership for its effectiveness. Whatever system is available to report adverse incidents, whether the traditional paper system or a new electronic one, for effective learning to occur, it is important to build and develop a culture that helps to counter some of the traditional constraints to the reporting of adverse incidents within the various and differing medical disciplines.
Keith A. Willoughby, Benjamin T.B. Chan and Marlene Strenger’s paper provide details on a study to determine the wait time for various patient care processes in various Saskatchewan Hospital Emergency Departments, using the science of Planning, Doing Studying and Acting (PDSA) to improve patient flow and reduce patient wait times. Learning Organization specialists will quickly recognize the similarity between PDSA and Kolb’s and Revan’s learning cycles. Patient wait times are always a major political health issue and at any one time are used to judge the effectiveness of the health care system. The authors’ findings demonstrate how simple and relatively inexpensive tools can effectively cut physician reassessment times. Although they point out that their findings might not be generalizable to other health care systems in different geographic locations, it does appear to have useful findings in terms of system change. Questions remaining are the need for leadership support for such initiatives and how to build the changes into the culture of the organization.
Michael Schroeter, Igor Savitsky, Maria A. Rueger, Ludwig Kuntz, Verena Pick and Gereon R. Fink explain a study of a new organizational structure – the Cologne Consultancy Concept which was implemented in a Cologne hospital and involves the assignment of patients to a ward – to be treated by a team of physicians who are offered incentives for case-oriented and efficient medical treatment. The system is in contrast with the Anglo-American ward and physician system of treatment, which the authors describe, and is intended to match the political and social demands of the German health care system while at the same time meeting the needs of patients more effectively and significantly reducing the admissions process. This paper really does address a major organizational change having serious implications for medical professionals who appear to have adapted to the system very well. The system would appear to have positive implications for other specialized hospital settings and is worthy of study and replication in other countries.
Finally, Marie Boltz, Elizabeth Capezuti and Nina Shabbat describe a mixed methods study of concept mapping to define the core components of system-wide acute care program designed to meet the need of older adults. The information was obtained using a worldwide web interface, supplemented with consumer interviews, and input from 306 stakeholders. Her findings are important allowing for eight clusters that not only describe the essential components for geriatric acute care but also provide useful directions for future research. These clusters include guiding principles (values), leadership, organizational structures, age-sensitive practices and geriatric staff competence amongst others. This is a timely and important study especially given the anticipated future demand for geriatric care, and it provides important information for policy makers and acute care providers.
We trust that as readers, you will find these papers along with our Talking Heads Interview, and the information found in the news and views section, timely additions to your leadership knowledge, at the same time having very practical implications for your own leadership scope of practice. Thanks to everyone for their contributions. LHS continues to demonstrate growth as an important journal in the health field, serving as a major vehicle for knowledge sharing around leadership innovation and ideas to improve health services. We urge you to check out our web site via www.emeraldinsight.com noting the author and paper requirements for submissions. It is indeed encouraging that so many of you wish to share their leadership research innovations and practices with us.