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Emerald Group Publishing Limited
Copyright © 2011, Emerald Group Publishing Limited
Article Type: Editorial From: Leadership in Health Services, Volume 24, Issue 3
I always tell my students a story that one of my professors told me – the story of a decaying housing development where people did not know where to start to clean it up. The decision was made – just to cut the grass – that simple easy action step led to another, led to another, and before long, the entire residential complex suddenly resembled a place with a degree of order. Slowly but surely the place was cleaned up.
I believe this story has something to say about the kind of leadership we want in our health services, which are, in their own way, as messy and slummy as a bad housing development. If we look at the big picture in health services, we see huge numbers of people working in vast numbers of medical care and related administrative professions, (indeed, the NHS alone is the second largest employer in the world next to the Indian Railway). Our health care workplaces demonstrate ever-increasing complexity and fragmentation with services always under the threat of funding cuts. As users of health care, we are living longer, yet our nations’ populations grow unevenly as the poor and the underdeveloped populations increase in numbers and the richer modern developed nations face declines in live births. If we put all this in the context of rapid change created by ongoing almost daily breakthroughs in high tech and pharmaceutical medical science, then it is indeed a messy picture.
Despite the messiness, however, in the big picture, there are many pictures of order in this new world of health. Wonderful new medical facilities abound staffed by dedicated and orderly health professionals. Seemingly medical miracles occur on a daily basis.
Today I train triathlon with an individual whose diagnosis of acute multiple myeloma just two years ago was potentially a death sentence. His cancer was actually diagnosed at a sports clinic when his family doctor failed to check out his pain sufficiently. Thanks to an understanding cancer hospital administrator, he was allowed to take his bike into the cancer treatment hospital. Pedalling slowly at first, and then harder and harder, he used the hospital room work outs on his bike to ward off the side effects of the chemo drugs. He is now in full remission and looking to do his next iron man. Somewhere, somehow, a hospital administrator made it possible for him to take his bike into the hospital room, an action decision as simple as cutting grass. And it gave my friend his life back.
Complexity can be paralyzing – but successful initiatives start somewhere – with a decision and then a corresponding action. Such actions are what I call leadership. They imply a thought process of sense making – of just seeing what needs to be done and not being afraid to do it. Sometimes the rules and the messiness of decision making can shut us down. It takes determination, vision and a commitment to learning to take the small steps that create change – to bring order and sense to our messy world. This is why leadership and leadership development are so important in our health world. We cannot look just to the guys at the top to lead the charge and make the sense for us – even though it is tempting to believe that our politicians and paid leaders have the answers. They may have access to the purse strings, but otherwise their world is just as complex and messy as the one we live in. They are overwhelmed as well and their action steps can be just as limiting. In the end, as employees and health users, the more we can take those small action steps and learn from them, the more we are demonstrating our potential leadership and the more we are helping to make our messy world a better one for all of us.
In this vein then, I was really happy to read Anita Snell and Graham Dickson’s article entitled “Optimizing employees’ newly learned leadership behaviours”. For this study Snell interviewed participants from a variety of leadership development programs which ran anywhere from two days to two years, and were delivered through a combination of methods. Her findings were that no matter what kind of program, the participants always took away useful skills and were able to implement leadership behaviours back in workplaces that were largely supportive of their efforts. Snell’s study really emphasizes the value of leadership training, that it does bring value to (health care) organizations, and that these organizations themselves benefit as they integrate the value of such programs into their structures and day to day work practices. She noted that leadership training participants’ respond (most) favourably to those organizations that live their values, but that systemic issues such as hierarchical decision making, competing priorities, turf wars, and the rapid rate of change (will) interfere with effective leadership practices. This note reinforces my own view of the value of small action steps in the leadership journey, especially since the research suggests that systemic organizational obstacles will always be present.
Michael Leibert examines the performance of integrated delivery systems, their quality, service, and cost implications, in the USA. He compares the performance of 50 flagship hospitals participating in the most highly integrated delivery systems in the USA to a representative sample of non system hospitals, taking into account clinical quality of medical care, patient satisfaction and cost efficiency. I found this paper interesting because for me, from the outside looking in, and growing up on a television diet of American hospital dramas, the US health care delivery system at its best has always seemed to be the model of the future. Yet as he points out, health care in America is not provided through integrated and coordinated processes. It is in fact an uncoordinated system which models the US culture and political structure with an emphasis on individual freedoms, and self-reliance to form a cottage industry of sorts of unrelated and financially self-contained business entities. His findings suggest that the implementation of integrated health care delivery systems may have much to offer the future of health care in that country. From the perspective of this external observer, integrated systems simply make sense. It is surprising really that so often what makes sense can be so difficult to translate into effective action.
In another vein, Thanos Papadopoulos provides a study of lean thinking in the UK National Health Service, as a means of demonstrating how continuous improvement (CI) can improve clinical pathways. His is a complex analysis that investigates through a case study, the role of dynamic actor associations in shaCI in a public sector context. For me personally, this paper reminds me of the importance of the ongoing sense making and reflection that needs to happen in the workplace for CI to occur. As the author states, the research reveals that “continuous improvement (CI) is inextricably linked to continuous translation”. The importance of such translation allows for the concept of continuous improvement and thus ongoing change to be accepted and integrated as an ongoing construct.
Simon Albrecht and Manuela Andreetta’s article describes how he tests a model using confirmatory factor analysis to show how empowering leadership influences employee empowerment. His research suggests that when organizations provide managers and leaders with empowering leadership training and development programs, and these behaviours are demonstrated in the workplace, then employees respond by becoming more engaged and committed. In short, he suggests turnover is less and employees are more empowered. This is exciting research that helps to promote training and development initiatives in health care contexts. Engaged employees are the ones who want to be there, and who will understand the value of leadership initiatives through those small yet decisive steps.
We trust that you enjoy this issue with the four articles and the News and views section complied by my co-editor Jo Lamb. Remember that in the workplace, the simplest action steps can have the most effect. This is particularly true in health care. When the complexity of the modern health world overtakes you and threatens to leave you with “paralysis through analysis” – stop, reflect, and then take action. Even something as simple as cutting the grass or as allowing someone to bring their bike into their treatment room can make a huge difference in our world.