Leadership in Health Services

ISSN: 1751-1879

Article publication date: 2 May 2011



Bowerman, J. (2011), "Editorial", Leadership in Health Services, Vol. 24 No. 2. https://doi.org/10.1108/lhs.2011.21124baa.001



Emerald Group Publishing Limited

Copyright © 2011, Emerald Group Publishing Limited


Article Type: Editorial From: Leadership in Health Services, Volume 24, Issue 2

Writing an editorial is always a bit of a challenge – because one never knows for sure who reads it or, indeed, if it is read at all. One presumes the articles will be perused but the editorial is always a bit of a risky enterprise. Editorials are usually not scholarly referenced nor do they have a specific format. They represent an essentially somewhat subjective opinion related to the main themes of the subject at hand by an individual who has some degree of familiarity with the overall content and subject-matter.

Imagine my surprise therefore when, this past quarter, I heard from two individuals about past editorials I had written. Both indicated an interest in my views and both recommended new publications they felt I should read to deepen my knowledge of the subjects I had written about.

The first came from a Swedish author, Thomas Sewerin, who had written for LHS back in 2009 (Vol. 22 No. 3) about the need for a contingency approach to HR development, using action learning approaches based on play and art. This approach challenges the normative and prescriptive approach to organizational development and is designed to encourage participants to look forward and imagine that the organization could be using a technique that encourages self-reflection and sensemaking. Sewerin has expanded this thesis considerably in a new book he has written entitled Teams, Leadership and Coaching, published by Tertulia Books in 2009, and, as result of my earlier editorial, sent me a complimentary copy.

The seeds of Sewerin’s thesis about coaching, leadership and learning arise in part from his work with MiL Leadership Institute – one of Sweden’s renowned institutes of leadership development, whence the term Action Reflection Learning was originally coined. I first came across this institute as a result of my work with Victoria Marsick when I originally discovered action learning, and attended a few fascinating conferences in Toronto with representatives of the school from Sweden.

The book is an amazing representation of Thomas’s work as a coach and leadership development expert. Full of simple colourful graphics, pictures of famous works of art, and themes from literature, the book demonstrates the power of metaphors and play. They are resources in a tool box which serve through reflective questions, and self-assessment to unlock “emotions, tensions, images of self and others, alliances and threats” (p. 13), as individuals struggle with change and their roles in organizations. In the complex, ever changing and often politically charged world of health, I cannot think of a more useful resource to develop leadership capacity at all levels of the organization than this book, and I am indebted to Thomas for sending it to me.

The other correspondence came from one of our own EAB members who referenced my editorial in Vol. 23 No. 4 where I had made the comment that, as “yesterday’s institutions no longer serve us … (with reference of health care), we must look to ongoing innovation” (p. 290). He recommended a book he had just come across which described just such a form of innovation. The book entitled Humanizing the Economy, written by John Restakis, and published by New Society Publishers in 2010, is about a global cooperative movement that could provide an alternative to the profit-driven model of health and social care we are all too familiar with today. He notes how co-op models that provide health and social services have a “remarkable capacity to provide new types of care at a cost, and in a manner that blends the benefits of a public good with the choice and responsiveness usually associated with a private sector service” (p. 105). To this end, he describes social co-ops in Italy and health co-ops in Japan as examples of how members of a community can care for one another on the basis of common humanity, free from the “dehumanizing mechanisms of commerce” (p. 115).

Restakis’s book gave me hope for a healthcare system which so often operates at the edge of chaos and which too many people love to say needs to operate more like a business! A common response to the problems we so often hear about – lack of hospital beds, access to care, waiting times for surgeries, and spiralling costs – is for politicians, playing to the public will, to introduce yet more top down reorganizations. At best these serve as temporary band aids to what is all too often a dysfunctional system. In this type of system we can assume that the participants, health, medical, and administrative, want to do their best but they are stymied by the limitations of the bureaucracy in which they operate. We have much to learn about alternative methods of care, and innovations that take the profit out of the system and focus on wellbeing. The book by Restakis is a great teaching tool in this regard.

Our papers for this issue represent a mixed bag of truly global research on very different aspects of health services. From Taiwan and, Iran, Southern Thailand to Sweden to, and finally a viewpoint from, the UK – they tell the story of just how international our journal is becoming.

Increasingly, it has been my observation that we are receiving an increase in the number of papers about service quality and how it relates to behaviours. In this case, the research paper submitted by researcher Yu-Ying Huang examines whether service quality has a moderating effect on behavioural intentions in the context of the competitive health care system in Taiwan where patients spend considerable time doctor shopping for treatment directly from hospitals. This results in much direct competition between hospitals for patients, resulting in managers becoming increasingly interested in how patients perceive their care quality, how they determine their satisfaction levels and how they generate their behavioural intentions. The research has a number of implications for quality service and how these can relate to future patient actions.

Dr Masoumeh Simbar has contributed a very useful study from Iran about the health beliefs of midwives around HIV/AIDS protection and the barriers to reducing the risk of infection. Using a health belief research model, the study aimed to assess the knowledge and practice of Iranian midwives toward the transmission of infection and propensity for action to avoid infection. The study has two important findings which have relevance for many other areas of the world – the need for managers to support avoidance of transmission of infection by providing adequate personnel in emergencies and sufficient protective equipment – something we likely take for granted in the more developed world – and the provision of educational interventions to increase the knowledge of midwives around the perceived risk of infection transmission.

Next Nirachon Chutipattana takes us to Southern Thailand to research the impact of organizational culture on managerial competency of primary care managers. Comparing a high prescriptive culture with one emphasizing leadership and humanistic values, the study demonstrates that the highest level of competencies around partnerships and collaboration are found in low prescriptive cultures emphasizing visionary values. In short, managers, who are highly conscientious to begin with, can demonstrate the competencies of building partnerships and collaborating with others when they work in a culture that supports these values. Highly prescriptive organizational cultures are not able to support these competencies. The study suggests that, once we are able to identify and build highly humanistic cultures, then we are better able to develop highly visionary leadership on the part of primary care managers.

In somewhat similar vein, Gunilla Johansson from Sweden provides us with a research study, which demonstrates the importance of congruent leadership in palliative care as a buffer against stress. When the leadership is visionary, understands what good palliative care is, and acts in congruence with these values, then the resulting work environment will not only provide the best possible care for patients, but will also support a good environment for staff. Johansson’s study demonstrates the importance of leadership in reinforcing professional values resulting in better care and less stress.

Finally, we are very happy to include Christine Bamford’s excellent piece about an e-mentoring approach to developing leadership competencies based on double loop learning. This social networking approach to leadership development pairing e-mentors with e-mentees not only builds leadership competencies so that individuals can better withstand the challenges of work complexity but also improves performance. The authors of this program have now presented it at a couple of European conferences, and the program is proving to be both popular and successful – being accredited by Strathclyde Business School. This is an approach to leadership which has a solid foundation in Kolb’s learning theory, and which takes advantage of increasingly popular social networking technology. It surely has much relevance for other workplaces in our search to develop learning technologies that are popular, inexpensive, take advantage of people’s propensity for reflection and social networking, and that also produce results. Facebook and Twitter are not all bad in the workplace if people can use them as a tool for self-development and learning.

Jennifer BowermanCo-Editor of LHS

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