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Subject Area: Health Care Management/Healthcare
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Article citation: , (2011) "Editorial", Leadership in Health Services, Vol. 24 Iss: 1, pp. -
The distinction between leadership and management is still with us, a kind of a hangover from the days of more formally bureaucratic organizations when the emphasis was on managers whose roles were to control. Leaders were viewed more as those special individuals, with traits or personality characteristics whose direction provided the way for organizational success. Rapid change however, particularly in communications and technology, has led to a questioning of the old industrial bureaucratic model of leadership. Today we recognize that leadership is required throughout an organization. We have moved from hierarchies to matrixes. It is a different paradigm where we need speed – speed to move and speed to act, speed in decision-making, ongoing learning, collaborative work groups, and structures and forums to make these possible. True, there is still an expectation that leaders will lead, and managers will manage, but in today’s world we acknowledge, that rather than management, it is the idea of leadership diffused throughout an organization which will play the important role in both maintaining sufficient organizational stability to both lead and deal with ongoing change.
This distinction between management and leadership points to a difficult tension in organizational literature and human resource practice. Management, it is acknowledged, plays more the transactional role in an organization, leadership plays more of the transformational role. We acknowledge we need both, yet the paradox is a difficult one in terms of practice. We say we want leadership, yet all too often, in my research experience, fail to provide support for managers and those further down the line who would act as leaders. It is as though we are afraid to give up our leadership and management control.
This leads to a distinction I noted in my own doctoral research, between leaders of organizations and leaders in organizations. In my experience, too many organizational leaders only play lip service to the idea of leadership diffused throughout their organization. These are leaders of organizations who state that they want their employees to take on leadership roles, take initiative, become part of the vision, yet in the end fail to support these things when they happen. Afraid to give up their sense of control, they stifle the initiatives they see. Such individuals in my opinion are leaders of organizations who have failed to really understand leadership in organizations.
There is nothing new in this analysis. Chris Argyris explains it in his distinction of espoused theory and theory in use. Put simply it means that the theories we believe we have about the world are not always the theories that we demonstrate in practice. The closer the alignment between the two, which Argyris believes is only possible through double loop reflective learning, then the greater our ability to embrace and lead change.
How do these observations play out in practice? For my research, this was most evident in the behaviours of the leaders of the organization whose personal training programs and positional perks and benefits placed much emphasis on their individual leadership positions. While they recognized they were in a crazy health care insurance environment that required enormous change, and they espoused bottom up leadership, the programs they allowed to be implemented to build such diffused leadership all failed, mostly because of lack of support from them. Too many top down meetings involving a rigid management structure, and too many people with vested interests in their positions led to an atmosphere where genuine bottom up leadership initiatives failed. Not only did they fail, but, talented individuals were turned off, de-motivated, and many actually left the organization. Clearly, individuals may have benefited in terms of job mobility, but the organization itself was left bereft of their talent.
In this issue, John Edmonstone picks up this theme in his article “Developing leaders and leadership in health care: a case for rebalancing?”. He notes that leadership development is fast becoming an industry concentrating on those individuals in positions from the middle to the top of an organization. The implications are that leaders, participating in such programs, develop a sense of being special and continue their positions of hierarchical control. In short, Edmonstone argues, such leaders become a form of human capital, not well suited to the modern health care environment which is both complex and volatile and requires a different type of development – one that impacts the culture of the organization and has at its heart the need for double loop reflective learning espoused by Argyris. Edmonstone calls this Social Capital.
In contrast to Human Capital, Social Capital focuses on the development of leaders as process i.e. to build leaders in organizations. Thus, development programs include building interpersonal relationships, using social influence, developing collectives, and building new behaviours and values in the context of the real work environment. Built around the opportunities for real work reflection, they include action learning programs where people, through the opportunities to relate to others, help build leadership around real problems.
Edmonstone’s final point is that the emphasis on leadership programs that develop human capital may have created an imbalance, where Human Capital is emphasized at the expense of social capital. Certainly my own experience with organizations would suggest that Edmonstone makes a valid point. If organizations are serious about their need to develop different kinds of leadership to withstand the pressures of change they face – especially health care – which is the second largest employer in the world today, then there is a need to seriously reconsider our existing paradigms around the kind of leadership they require, and just how we are going to go about developing it.
Other articles in this issue also reflect the importance of training and development programs and the impact they can have on leadership and effective organizational outcomes. The importance of group training comes to the fore with Halbesleben’s article entitled “Transfer of crew resource management training”, where he assesses crew resource management training (originally from the aviation industry) as a means building teamwork and improving patient safety. In particular he assesses the communication and decision necessary for improved patient outcomes by examining two health care teams and their behaviours in two different intensive care units both of which had received different degrees of the aviation equivalent of crew resource management training. His finding’s – that higher levels of training are associated with much greater participative decision making and open communications between team members, – speaks to the fact that being open in our communication, sharing leadership, and working together, does not come naturally to us. If we desire blame free and collaborative work environments, we have to work at them through intensive team training such as that developed in the aviation industry.
Bernice Skytt’s research study assesses two different research programs designed to prepare nurses and nurse managers for roles as leaders and managers, and asks whether in fact they make a difference. One program was designed around the need to provide specific training in administrative practices, and the other was designed to provide more of a self-development emphasis oriented on personal growth. As would have been expected, both programs had expressed benefits – the one made people more competent in their technical roles, the other gave people more confidence to express their demands in the workplace, and have a greater sense of their interpersonal skills. Skytt’s study speaks to the need for organizations to make space for learning, it would appear that all learning programs are valuable. In terms of Edmonstone’s previous analysis however, they will be even more valuable if we determine whether we want to build human or social capital. Posing this question makes it possible for learning programs to have a more strategic outcome for the overall organization.
The final two papers for this issue reflect on very different issues facing organizations. Jerry VanVactor provides us with a case study of collaborative communication within healthcare logistics, specifically as they relate to the US Army. In the complex environment of the healthcare supply chain, he presents five emerging themes. These include synergy among organizations, stakeholders working together, enhancements in supply chain operations, continued training for supply chain leaders and commonalities among the various levels of management. In a health care world dominated by cost, Van Vactor’s findings suggest a means of increasing both efficiency and effectiveness in the supply chain by providing a model of enhanced communications. It has enormous implications for leaders of the various supply chains, and those in the supply chain who recognize where increased efficiencies are possible.
Our final paper presents a research study on patient satisfaction in a hospital in Chandigarh, India by Raman Sharma. As the authors point out, patient satisfaction is of not only of increasing importance, it is increasingly a prerequisite of quality health care. The paper provides an interesting insight into an Indian health care facility and provides a good comparison for those of us who live in more Westernized parts of the world where facilities may be more sophisticated. Nonetheless, the authors’ findings are perhaps universal. Their recommendations include an improved design of certain architectural features to enhance patient comfort as well as clear communication on the part of clinicians in their communications with patients.
Once again thank you for your continued support of Leadership in Health Services. Along with “News and views” written by my Co Editor, Jo-Lamb White, we anticipate that you will find this issue a valuable contribution to your health leadership collection.