Editorial

Citation

Bowerman, J. (2012), "Editorial", Leadership in Health Services, Vol. 25 No. 3. https://doi.org/10.1108/lhs.2012.21125caa.001

Editorial

Article Type: Editorial From: Leadership in Health Services, Volume 25, Issue 3

This past Easter of 2012, the niece of an old college friend from my English university days, has been staying with me. She has just completed her medical exams from the University of Leicester, and has chosen Edmonton as a place to complete a six-week elective in Emergency Room medicine. Alberta is a rich Canadian province, largely because we have reportedly the world’s third largest reserves of oil in the form of oil sands and as a result of this wealth, we are reported to spend more on health care than the other Canadian provinces. Wealth is one thing, isolation is another. Because we are so far away from more densely populated areas, I always wonder why anyone would want to come to this city. After all, we are geographically far north, we have a somewhat intemperate climate, we have no large bodies of water close by, and we have to travel a long way to reach another city even in the same province. It seems curious therefore that someone from the UK would actually want to come here for a training experience.

I was very curious to talk to her after her first shift. I wanted her impressions – to know what could make this a valuable experience for her, and whether we are really different from hospitals in the UK. The healthcare system is always under attack it seems, whatever the country. Wait times, access to elective surgeries, drug access, primary care access, extended care – all these and then some, constantly make the headlines.

Are we different? How so? She has a variety of shifts in various hospitals and a primary care centre, all of which are spread out right across the city, and has to rely on public transportation to make it to work. How did you manage to travel across the city in the wee hours of the morning? Are the patients different? Do we practice medicine differently? Do you notice any difference in medical leadership? Is there any difference in the scope of practice? Are the people in the city different? If you had to take home one observation at this point in terms of emergency wards in Edmonton and those in the UK where you have worked, what would it be?

I have to confess, I was just a little disappointed with her answers. Overall it seemed we are much like the emergency wards in other hospitals she has experienced. The patients have much the same kinds of issues – certainly in an inner city hospital where there is a far greater population of street people – there will be more chronic alcoholism and drug related issues and violence – but generally her shifts have been fairly ordinary. She has had to deal with issues related to scope of practice, there are apparently some differences in how medical students can practice here as opposed to back home in the UK, and also there are different drug names which she has had to adapt to. The drugs that are common to us here with trade names such as Advil, and Tylenol, have different names in the UK, which was confusing – with no cross indexed drug manual that was easily handy. But she survived her first shift, had a kindly mentor/doctor in charge who even allowed her to leave ten minutes early so she could take her midnight bus home. She kept saying how kind people are here – which is something I have not noticed and which is nice to hear about this city, which is home to me.

One of the aspects of my guest’s experience that I find of particular interest is how this short internship will assist her in her future medical experience. At first thought, it seems obvious really – international experience and practicing one’s profession from another cultural perspective will always be valuable career wise – won’t it? When she returns to the UK she is anticipating taking a management and leadership program – both essential items for a medical career in a very complex healthcare system.

To this end, Francesca Garrard’s viewpoint in this issue is quite pertinent. Dr Garrard writes of the growing movement to mentor junior doctors as future NHS leaders, but she suggests that there are several barriers to this happening. Some of these include an emphasis on end-point based incentive systems, where as evidence of job achievement for job applications, a simple audit is selected, that requires little emphasis on change management. As Garrard notes, it really is important to emphasise experiential learning if learning from change management is important in developing future leaders. In addition, short fixed term contracts with rotating posts and varying shift patterns can lead to an undervaluing of the breadth of experience and not allow for alternative perspectives. Positive mentoring from managers to junior doctors is not always provided, and there is a need to lead by example, something that requires awareness and the need for constant feedback. Now that my friend is here, not only experiencing change management but paying for it in the form of student tuition, it would be a waste if the learning is just assumed or written off as an event, with little or no opportunity to expand on it and build it into her career.

The first article for this issue reflects the theme of mentoring – something my guest is experiencing in terms of her relationship to the various doctors to whom she is assigned. The author, Sherry Finney, reports of the effectiveness of a matrix – mentoring pilot project in a healthcare setting in Eastern Canada. The common view of mentoring is usually a one on one relationship between mentor and mentee, but in light of the complexity of the modern health care setting, Finney suggests that a matrix style of mentoring, with a variety of mentors each with a specialty in managerial competency might be more useful individuals wishing to build competency. Her findings, although limited because the pilot project was so small, suggest that this might well be the case, and plans for the future at the facility she studied include a continuation of the mentoring project with an emphasis on teams and action learning.

As Finney notes, the ongoing complexity of medical and health care challenges today requires new kinds of relationships between different parties offering different services. This is particularly true in communities if we wish to build capacity and health and divest ourselves of the disease-oriented sickness model that is so prevalent today. This theme is brought home in our next article written by Heidi Muenchberger et al., about the considerations necessary to build effective community based health coalitions that emphasise preventative programs which respond to the real needs of citizens and which promote wellness. The challenges these kinds of coalitions face include dysfunctional systems, failure to understand communities, and competitive service relationships in the form of turf wars as well as the huge focus on disease rather than health. Muenchberger’s study took place in Southeast Queensland, Australia, and involves a partnership coalition of many diverse agencies all intent on building community capacity. The study brings home the difficulties these various agencies and departments have in working together and the need for action plans to be developed during the early stages of coalition development to overcome barriers and tensions within each key phase of the coalition development.

Bodil Eckholm also writes about those stuck in the middle between competing interests – this time in the form of middle managers working in elderly care in the Swedish healthcare system caught between the competing demands of politicians, officials at the central level, nursing staff persons and persons receiving care and their families. The research is based on a study of eight managers in different socio economic home help service units and sheds light on how they manage the role conflict they experience in terms of their managerial practice. His findings suggest that there are large similarities in how they perceive the demands and expectations placed on them, but there are some broad differences in how they handle them. Those who are most successful are found to combine a professional and organizational perspective in terms of how they manager their work. Eckholm’s findings have considerable implications for both the recruitment of managers and in developing managerial competency training programs.

Finally we have two very different papers – one – a Jordainian study about nurses’ job satisfaction and their intention to quit by Dr Jafar Alasad and colleagues, and the other by Rajabhani Subashini offering a very broad perspective on the need for a robust health insurance system to provide quality health care in India. Alasad’s paper reminds us that good working conditions along with supportive leadership and appropriate incentive and reward programs are essential for nursing retention and to reduce turnover. Subashini’s paper speaks to the need for an Indian National Health Policy based on a health insurance program that emphasises health for all – a difficult subject given India’s huge economic, geographic, social and cultural disparities.

More on India can be found in Jo Lamb-White’s News and Views section, as well as items on initiatives in the UK, Africa, and the US. As someone who has a daughter in the US with no health insurance, I live in fear of what happens if she should get sick and even though “Obamacare” might not be the perfect answer, it does seem better than having no care at all. So I was relieved to read her report on the leadership health initiatives that are ongoing there, independent of how the Supreme Court will rule, to fix, what appears from the outside, to be a very broken system. Health care is not a shopping item, it is an essential item of life, and no one should have to go into bankruptcy and lose their home to access it if they are sick. This is why effective health leadership – to provide universal accessibility at a reasonable cost – is so important.

Jennifer BowermanEditor