Health leadership and health system change


Leadership in Health Services

ISSN: 1751-1879

Article publication date: 4 October 2011



Dickson, G. and Philippon, D.J. (2011), "Health leadership and health system change", Leadership in Health Services, Vol. 24 No. 4.



Emerald Group Publishing Limited

Copyright © 2011, Emerald Group Publishing Limited

Health leadership and health system change

Article Type: Guest editorial From: Leadership in Health Services, Volume 24, Issue 4

About the Guest Editors

Graham Dickson Principal investigator in the cross-Canada research project that created the LEADS in a Caring Environment framework, which is being used to define the standards of effective health systems leadership in Canada. The LEADS framework has been endorsed by Health Leaders Association of BC, the Canadian College of Health Service Executives and the Canadian Health Leadership Network (which is comprised of over 30 national and provincial health organizations). Dr Dickson’s specialty is leadership development and succession planning within the health and education sectors.

Donald J. PhilipponProfessor Emeritus at the University of Alberta with appointments in the School of Public Health and the School of Business, He has served as Co-Chair of the Canadian Health Leadership Network (CHLNet), and as Special Advisor to the Saskatchewan Academic Health Sciences Network. He previously has held senior administrative positions in the Canadian health system, including Deputy Minister of Health in Alberta. Don holds B.A., B.Ed., and M.A from the University of Saskatchewan (Regina Campus) and a PhD in Educational Administration from the University of Alberta. He is a Fellow with the Canadian College of Health Leaders. His academic interest and publications are in the fields of comparative health systems, health leadership and interprofessional health sciences education.

The call for abstracts for this special edition was a result of a growing interest in large scale leadership development across the globe. Contributing to that interest is a burgeoning consciousness of the distinction between leadership as opposed to management as a fundamental set of skills needed in rapidly changing environments. This is reflected in many recent articles in this journal.

Another contributing factor is the growing discourse on global systems, spurred on of course by instantaneous web-based communication, and a growing global consciousness.

This special edition contains articles that profile large-scale leadership development initiatives from several countries around the world. Each of these articles was chosen because of a unique perspective, or challenge re large-scale leadership development, that is informative and illuminating. The New Zealand article in the Viewpoint section was included because at this point it is largely a practice based initiative that is intended to lead to a broader national initiative with greater research underpinning.

We were very pleased to be asked to serve as guest editors for this special edition. We are appreciative of the response we received to our call for papers, and respectfully acknowledge the hard work of those authors (included in this edition and not included in this edition), and the many peer reviewers who assisted in getting us to this stage of publication.

Both co-editors are deeply involved in major leadership development initiatives in Canada. Don Philippon has served as the co-chair of the founding Board for the Canadian Health Leadership Network (CHLNet). Graham Dickson was the principal research leader and developer for the “LEADS in a Caring Environment” (LEADS) framework that has been adopted for leadership development by CHLNet and many other health organizations in Canada.

Both the CHLNet and LEADS initiatives involved many partners. The challenge of developing strategic alliances relative to these projects are profiled in the article by Monique Cikaliuk. Important lessons for individuals in other countries, who are experiencing the same need, are found in this article.

Given our background, and the need for an “organizer” for the journal, we have chosen to use the LEADS in a Caring Environment framework (LEADS) to organize and guide our editorial comments. The framework reflects an in-depth analysis of the literature around health leadership and also, the contents of leadership frameworks drawn from many international jurisdictions. Consequently, our editorial reflects an analysis of the seven contributions to this edition and what elements of the LEADS in a Caring Environment framework they illustrate.

LEADS places emphasis on the essential contribution of self to effective health leadership (Leads Self [L]) which consists of four capabilities: Self awareness, self-management, self-development and demonstration of character. While several articles touch upon the importance of this dimension the “Obamacare” article by Lamar Odom stands out. The statement that, “President Obama’s leadership style is consistent with someone of high emotional intelligence. He appears to possess a high degree of self awareness as evidenced by his holding true to his personal values and his deontological conviction of universal healthcare.” The Queensland article by Crethar, Phillips and Brown emphasizes self-development by showcasing innovative ways to create experiential learning that involves self reflection based on personal experience relevant to each of the participants.

Engage others (E) is the second domain of the LEADS in a Caring Environment Framework. The capabilities leaders need to engage others are: foster the development of others; contribute to the creation of health organizations; communicate effectively and build teams. The Portugal article on PACES by Luis Lapao that deals with primary care reform incorporates a very clear strategy to engage practitioners and staff across three regions to increase stronger networks to facilitate the change process.

Achieve results (A) is the third domain of the LEADS framework Achieve results includes the capabilities of setting direction; strategically aligning decisions with vision, values and evidence; taking action to implement decisions; and assess and evaluate outcomes. All of the articles demonstrate how important achieving results is to an effective leadership strategy. Ironically, the Borkowski article emphasizes the point that although one can show a relationship between improved organizational productivity and leadership development efforts, it is very difficult to find specific evidence of that connection This is a challenge for all of us that promote leadership development as fundamentally important to organization change and success; and one that should be taken up by researchers in the future.

Develop Coalitions (D) is the fourth domain of the LEADS in a Caring Environment framework. It consists of the capabilities of purposely build partnerships and networks to create results; demonstrate commitment to customers and service; mobilize knowledge; and navigate the socio-political environments. As noted above the Canada article by Monique Cikaliuk provides a key focus on this area. The Portugal article provides a very interesting twist on this domain in that it shows building coalitions can have both positive and negative consequences. For example the group spirit improved the working between front line managers and regional leaders. However the greater transparency between different groups exposed differences in organizational culture and heightened perceived threats to existing power brokers. The result was that the process left program participants less positive about the potential of the reform process.

Systems Transformation (S) is the fifth domain of LEADS. Leaders who can achieve systems transformation have the capability to: demonstrate systems/critical thinking: encourage and support innovation; orient themselves strategically to the future; and champion and orchestrate change. The vision of system transformation is an end goal of all the leadership development articles included in this edition. For example, the Scotland article by John Edmonstone directly ties leadership developments to the policy agenda of transforming the Scottish health system. Likewise, the two American articles, Lamar Odom’s article on “Obamacare” and Nancy Borkowski’s article on the Memorial Healthcare System are both clearly rooted in making overall system transformation, and point out the complexity of taking on major transformation challenges.

In conclusion, all articles show that leadership – regardless of country or issue – is about creating change. Health systems around the world are facing dramatic and significant change, and are relying on modern, sophisticated leadership skill to create that change. They also point out that the dynamics of creating change in large systems is very demanding. Part of that demand is occasioned by the complexity of large systems, but part of it too is the innate difficulty of exercising effective leadership: going first (as many of these authors demonstrated); stepping into the unknown; and living in an environment of ambiguity and confusion. It is hoped that the reader, by comparing the experiences of these authors to the context in which they work, can find some insights that will assist them in their change process.

Graham Dickson, Donald J. Philippon

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