Editorial

Citation

Bowerman, J. (2012), "Editorial", Leadership in Health Services, Vol. 25 No. 4. https://doi.org/10.1108/lhs.2012.21125daa.001

Editorial

Article Type: Editorial From: Leadership in Health Services, Volume 25, Issue 4

What should the relationship be between leadership and governance? It is a fascinating question and one that leads off this issue with the article by John Storey and Keith Grint on the role of general practitioners (GPs) in the clinical commissioning groups (CCGs) recently introduced in the UK. Storey and Grint are not questioning the policy of introducing such groups into the healthcare system. Rather they are asking what kind of leadership can be anticipated as GPs are grouped into consortia operating at dual or even multiple levels – all reflecting a need for different kinds of leadership and governance simultaneously. Thus, their question – what will be the precise nature of the functions of GPs in these new bodies and will they be leaders or governors?

Storey’s and Grint’s discussion of these two concepts – governance and leadership- made me start to question my own views and beliefs around these two concepts – which I would like to think are different from each other and worthy of distinction. For me personally, governance is much more about management – about administration, about institutional structure. Whereas leadership is about visioning – about bringing people forward into that vision – about ultimately transformation. As I pondered the difference and as I viewed Storey’s and Grint’s table showing the complementarities and tensions between the concepts, I was reminded of the famous quote usually attributed to Warren Bennis, management is doing things right, leadership is doing the right things. When I have discussed these differences in workshops with managers, and emphasised my own belief that doing the right things is different from doing things right, some of my audience have become very defensive, acting as though I am questioning the value of their administrative duties and therefore throwing doubt on their leadership ability. For these individuals, good managers (although not defined) are the same as good leaders, and the concept of managing the status quo as opposed to driving it, are one and the same.

Storey and Grint resolve the differences between leadership and governance by demonstrating how they both complement each other, yet are also in tension with each other, and their article explores these complementary functions in some detail. When aspects of leadership go off the rails, i.e. when it goes in the wrong direction, or cannot mobilize the necessary support, then governance is required to provide legitimacy, guidance and regulation. The discussion makes sense. When all else fails and there is great uncertainty, we fall back on what we know and feel comfortable with – structure and rules. Their analysis suggests therefore that context is vital and ultimately will determine which aspects of which are required. Therefore, based on the author analysis, we can assume that GPs in their new consortia roles, will be expected to undertake some selected elements of both governance and leadership, resulting in considerable role challenges, and scrutiny from other levels of government. Certainly, as they note, there will be huge implications for the amount of training and development necessary for GPs to meet these challenges. Having recently enjoyed the visit of a recently graduated MD from the UK, who was here in my city taking an Internship in Emergency Medicine, I realized just how much governance and leadership development would be valued. Learning medicine alone is a huge endeavour, but then having to engage in using that knowledge to oversee the running of a large consortia is something else again.

Some 16 years ago, I was privileged to attend an action learning conference at Salford University, where the guest of honour was Reg Revans himself. This was my first formal introduction to the power of action learning and how it helps people tackle complex and real work problems. At the time, our problem was how to merge two major area hospitals – Withington and Wythenshaw – a merger which to the best of my knowledge never did take place. However, the experience of learning from the master, Reg Revans himself, has left me with the certain knowledge that action learning has to be the best way of addressing the complex leadership problems within our health care system. I hope that these new clinical commissioning groups discussed by Storey and Grint will be able to use the tools that action learning provides so that their leaders can learn and grow in their new roles. For as much as the GPs working to provide clinical leadership will need training and development, they will also require learning to be actually built into the experiences they encounter. The tension between leadership and governance will be best managed by people learning as they juggle their roles. This requires space and time – something those who manage the purse strings do not necessarily want to provide. But only if people slow down and learn, can they effectively speed up. For this reason, my own wish is that action learning can be built into the process – in an ongoing way- so that the necessary learning and growth occur, and so that the new consortia do not become just another flash in the pan fad of the government of the day.

The importance of learning and development support at work – in a multiple case study with first line managers working in eldercare – is explored by Eva Ellström in the second paper of this issue. Her findings emphasise a need for what she calls a need for “dialogue oriented” leadership where managers listen and provide ways of working that engage employees and promote interest. In short, paying managerial attention to issues of learning and development is an important precondition for a productive workplace. As a university teacher, I always try to engage students in the business of learning, of recognising those light bulb moments where some of the theory we discuss actually meets the real world the students live in. It is difficult – just saying the words learning and development – does not necessarily make it happen. I therefore recognise the importance of Ellström’s findings and the importance of developing managers who can make learning come alive for others.

The final three papers in this issue are concerned with business models and their application to health settings. In one case, Luu Trong Tuau discusses the balanced scorecard and its application to a Vietnamese Hospital. In another, Somsri Sumet, Nawarat Suwannapong, Nopporn Howteerakul and Chuthipat Thammarat discuss a knowledge management model for quality improvement in the hemodialysis unit of a non-profit hospital in Bangkok, Thailand. In the third, Andrea Chiarini writes about risk management and cost reduction of cancer drugs using lean six-sigma tools, in an Italian public hospital.

All of these papers show the value of these kinds of tools to the health care settings with significant benefits. The implementation of the balanced scorecard requires greater knowledge sharing, and even suggests scenario planning as a new pathway for research. The knowledge management implementation resulted in both greater staff and patient satisfaction and more significantly a reduction in complications per hemodialysis episode. And finally using the tools of six sigma led to a significant decrease in waste and a reduction of inventory costs related to the preparation, handling and administration of highly toxic and very expensive drugs.

It is comforting to know that tools, originally developed from the business world, to build profitability and increase quality in global production processes can also play significant roles in our health care services. While my own personal belief is that medicine and health and its organisation should not be judged solely by the capacity for profitability, the tools that enhance profitability can also be used to improve health care delivery services, which not only makes things better for the sick, it also makes things better for the staff involved in the health care system itself.

Concluding this issue is News and views written by my co-editor, Jo Lamb-White. As usual, Jo provides us with a timely snapshot of what is happening around the world in the field of health services, continuing to add to our global knowledge in this ever expanding and changing field.

Jennifer Bowerman