Leadership for the systemization of health care: the unaddressed issue in health care reform

Abstract

The case literature strongly suggests that both in England and in Australia health care reforms have had very little impact in terms of "improved performance". It is in the context of a perceived failure in the implementation of the reforms that an interest has arisen in leadership at the level of individual clinical units (e.g an orthopaedics unit or birth unit), as the possible "fix" for bridging the promise-performance gap. Drawing upon extensive case studies that highlight the problem and context for appropriate forms of leadership, this paper argues that the appropriate discourse, in terms of leadership in health reform, needs to focus upon the issue of authorization. In making this argument, addresses the current conceptions of leadership that have been advanced in the discourse before offering some case study material that is suggestive of why attention should be focused on the issue of authorization. Illustrates how and why the processes of leading, central to implementing reform, cannot be construed as socially disembodied processes. Rather, leading and following are partial and partisan processes whose potential is circumscribed by participants' position-takings and what is authorized in the institutional settings in which they are located Argues that the "following" that clinical unit managers could command was shaped by the sub-cultures and "regulatory ideals" with which staff of each profession are involved In the interests of reform, policy players in health should not be focusing attention solely upon the performative qualities and potential leadership abilities of middle level management, but also on their own performance. They should consider how their actions affect what is authorized institutionally and which sets the scope and limits of the leadership-followership dialectic in clinical settings.

Health managers and health reform

“…According to Lewis (2004) health management is situated in particular being appointed to managerial roles without clarity of purpose or management training whilst there was cynicism within organisation about the capability of managers appointed from outside the health system and without health system contextual knowledge (Bloor & Dawson, 1994;T. O. Davies & Harrison, 2003;Degeling & Carr, 2004;Edmonstone, 1997;Forbes & Prime, 1999;Harding, 2005;Hewison, 2001;Law & Boyce, 2003;Reedy & Learmonth, 2000;Sutherland & Dawson, 1998).…”

Senior management leadership, social support, job design and stressor‐to‐strain relationships in hospital practice

“…The responsibility that falls under senior management leadership is viewed as an integral part of continuous quality improvement and as pivotal in health care reforms (Goodwin, 2003;Degeling and Carr, 2004). In the UK, for example, the NHS (National Health Service) has focused on the development of leadership qualities framework as a skills-focused approach (NHS, 2009).…”

Follow the leader

“…24 The dynamics of leadership closely relate to followership, and society is in need of strong, efficient leaders to integrate the essentials of effective and successful followers. 24 The dynamics of leadership closely relate to followership, and society is in need of strong, efficient leaders to integrate the essentials of effective and successful followers.…”