Leadership in Health Care - Essay Example

Leadership in health care Introduction Health care institutions are undergoing gradual transformation in light of the current changes in global economics, finance and politics. Within the industry, rapid technological changes coupled with developments in scientific discoveries and knowledge have characterised the health care institutions in the present time. The specific source, impact and future implications of these changes remain a question of research. This paper explores three aspects of leadership in health care institutions: current realities in the sector and their effect on leadership in the organisations, how health care managers lead in the health care environment and general theories of leadership and their application in the health care sector. Overview of terms The terms leadership, management and quality in health care have an extensive and multidisciplinary use. Their wide usage, however, means a wide variation in their meanings. An elaborate definition of the terms as used in this paper is, therefore, necessary. Leadership According to Dawson (1993, cited by Goodwin 2006), leadership is created when a person exercises influence over others in a group or organisation. The influence on others may either be wide-ranging or narrowly focused but is always within the confines of a formal organisation. The influence focuses on organisational values, directions for development and accomplishments of daily tasks. This means that leadership has three distinct characteristics: dependence on social interaction between the leader and the others, it can exist in multiple dimensions within the same organisation, and it does not necessarily adhere to the confines of hierarchical formations within an organisation. Management Management refers to the process by which the management of an organisation efficiently utilises resources to achieve the overall goals of the organisation at a minimum cost and to achieve maximum profit (Lorenzana 1993). The management team of an organisation is therefore charged with the responsibility of directing the workforce and ensuring that the organisation achieves the stated objectives. It does this through performing its main functions of staffing, planning, organizing, motivating and controlling all processes in the organisation. Healthcare quality It has been difficult to construct an accurate definition of the term quality in health care since all definitions tend to emphasise specific aspects at the expense of equally competing others (Legido-Quigley et al. 2008). A practical definition of healthcare quality can, therefore, be given focusing on important dimensions that a system should adequately satisfy in order to be labelled as having quality. According to the World Health Organisation (2006), quality management must incorporate the following dimensions: effectiveness in delivery, efficiency in practice, accessibility to the population, patient-focused approach, equitable in access and adherence to safety standards. Quality remains a serious concern even in well developed and resourced heath care systems like that of the United Kingdom. This is because there are wide variations in standards of health care delivery within and between health care systems. Leadership in healthcare: Overview on styles Leadership is identified as the essential role within the different health care professions. Leadership entails the ability to manage the motives of an organisation in achieving a change or perceived vision of success. Leaders, in the process of achieving the said objectives, need to “critically appraise the team process and outcomes on the path to achieving a shared goal” (Goodwin, 2006, p. 10). All clinicians require leadership expertise in all settings in order to implement changes based upon sound ethical decision making processes and a patient-oriented approach to health care. A good leader should have not only the basic individual attributes or styles needed for effective leadership but also the organisational skills required to manage the process of change in the organisation. This is necessary particularly in the present day institutions in the health care sector which are regarded as complex and dynamic systems rather than the traditional static organisations (Oliver, 2006). Several management styles have been identified and in the course of the history of management; this has been as a result of the interaction between the personalities of different personality types in managers and their utilisation of different approaches in performing their responsibilities towards the achievement of the goals of their organisations or in the course of transforming various resources available to the organisation into a desired output (Dwivedi, 2005). In the early times, Likert and Likert (1976) developed four approaches of management. These approaches constituted a continuum of different styles as follows: participative, paternalistic, autocratic, exploitative and consultative. Burn and Stalker (1961, cited by Nwadukwe & Timinepere 2012), in their study, identified two major styles of management: organic and mechanistic styles of management. Separately, Mintzberg (1973) identified different forms of management styles adopted by managers in their organisations, of which two major styles were notable: entrepreneurial and strategic planning. In recent times, research in different managerial styles has been varied. Different management styles which are commonly practiced in modern organisations have been identified. For instance, (Oliver, 2006) examined basic management styles as practiced in the healthcare industry and came up with the following styles: charismatic, persuasive, consultative, transactional, transformational and delegating. Furthermore, it has been hypothesised that the majority of managers are bureaucratic and restrictive in their management styles, and these attitudes stifle high performance cultures which are necessary for creativity and innovation to flourish in the organisations (Worrall, 2013). In the health care industry, leaders have four major goals to accomplish in the institutions. These are as follows: improving the quality of health care offered to patients, promoting the health care system by offering quality management practice, and participating in strategies aimed to improve the health care system and influence improvements on the health of the general population. Leadership in healthcare: responsibilities and practice Further, Oliver (2006) observes that the National Health Service (NHS) has undergone drastic organisational change in the recent past. These changes have led healthcare institutions to realise the importance of incorporating other healthcare professionals like nurses in their management processes. This has been underscored by the implementation of programmes such as Leading an Empowered Organization (LEO) which are aimed at equipping healthcare workers with sound leadership skills so that they actively participate in decision making processes within their work environment (Cooper, 2003, cited by Oliver, 2006). Leaders in the healthcare institutions are faced with four major responsibilities. They have to address the needs of individuals, the needs of working teams, the needs of the organisation and the requirements for particular tasks (Oliver, 2006). Of these, addressing the needs of the organisation or the group remains of great significance. Healthcare leaders need to demonstrate a shared philosophy of learning with their organisations, and organisations on the other hand have the responsibility of organising and stimulating change within their operations. Aldair (1997 cited by Oliver, 2006), opines that healthcare leaders, in effectively addressing change within their organisations, should incorporate evaluation, motivation, planning and demonstration skills. In handling the needs of specific tasks in the healthcare environment, Dale et al. (2002, cited by Oliver, 2006), state that leaders require self-confidence, trust, respect and the ability to collaborate with others in accomplishing designated tasks. Apart from these skills, healthcare leaders are required to fully understand the nature and needs of a task before tackling it. In planning for such tasks, leaders may either involve the whole team or a select number of key people who will be directly involved – depending on the nature of change desired (Oliver, 2006). Leadership in healthcare: Present realities To a large extent, the reality of health care institutions in the United Kingdom has been described as one in need of radical change. Gillies (2003), states that the United Kingdom NHS is one of the most centrally managed and financed health care systems in the world. This is in stark contrast to the reality in other European countries such as Sweden and Germany where, “the responsibility for health care is shared between different levels of government” (Gillies, 2003, p. 56). The present poor coordination between local governments, social services departments and the NHS is as a result of the central government being heavily involved in both financing of health services and management and delivery of services (Gillies, 2003). Porter-O'Grady and Malloch (2010), state that the current health care sector is faced with a number of challenges and realities in leadership approach and practice. There has been an increased focus on the healthcare systems, coupled with the current realisations of the different needs of knowledge workers and the different professions to which they hold membership. These realities have drastically altered the basic approach to leadership and the way leadership is practised within the health care systems. These realities have led to a gradual shift from the traditional leadership practice to new innovative ways of leadership within the systems. There has been radical expansion of the knowledge foundation for particular clinical practices. This has created a wide range of knowledge-based practices which were not previously conceived in early practice. New areas of clinical focus have emerged to compete with the traditional roles of nursing and pharmacy. These new areas of speciality include diagnostics, technology and clinical therapeutics. Increased realisation of speciality areas has had an effect of shifting the decision making process within organisations in the healthcare sector from strict hierarchical orders to one based on involvement of speciality knowledge workers. This, in effect, has created a shift towards innovative and non-traditional approaches to leadership (Porter-O'Grady & Malloch, 2010). In addition, hierarchical and unilateral locus of control and decision making has become less viable in the current setting of healthcare institutions (Coombs & Ersser 2004, cited by Porter-O'Grady & Malloch, 2010). In agreeing with this observation, Porter-O'Grady and Malloch (2010), argue that although the locus of control within organisations in the health care sector has remained controlled by the top leadership, the increased independence of areas of speciality practice together with interdependence of all decision making process within the clinical set up have created significant challenges within the healthcare institutions. It has become necessary to link decision making across the health service spectrum at all times. This in turn has created the need for adopting emergent leadership as opposed to the traditional formal leadership. Moreover, the need to support, integrate and facilitate the complex mixture of disparate yet interdependent health professions has enabled new thinking about leadership and complex systems to emerge. Gratton and Erickson (2007, cited by Porter-O'Grady & Malloch, 2010), note that this new thinking which is based on the premise that organisations in the health care sector are currently complex adaptive systems. It is imperative, therefore, that leadership in these new complex systems be based on new concepts as opposed to the traditional leadership concepts of power, authority and directing work, which are associated with the traditionally held foundations of exercising leadership roles. Further, there has been complete transformation in the health care industry as a result of universal access to knowledge, changes in global economic and social trends, broad-based technological innovations and the development of new scientific knowledge and discoveries. These factors have enabled leadership in health care institutions to drive unprecedented change and research in a complex system of patterns and networks. This has created the need for leadership to progress from the fixed and bureaucratic hierarchies which work to stifle creativity, growth and innovation in the current dispensation. Lastly, there is a shift from formal to informal leadership structures within the healthcare sector. The traditional and well defined leadership within the health care institutions has lost its place in current practice. This approach was characterised by tightly controlled structural approaches to managing the healthcare environment, rigidity, employer-directed roles for specific disciplines (like nursing) and power legitimacy in healthcare organisations (Porter-O'Grady & Malloch, 2010). On the contrary, the current healthcare environment is characterised by more mutual relationships between professionals, less rigid structures of leadership within organisations, more involvement of key personalities in decision making processes and a strong focus on sustainability in all management actions. Whereas formal leadership is characterised as being positional, hierarchical and controlling; informal leadership is described as being emergent, networked, locational and situational (Porter-O'Grady & Malloch, 2010). This means that leadership in the healthcare industry is far removed from the “hero” notions of formal and traditional leadership. Conclusion In conclusion, leadership in health care is about ensuring that the quality of healthcare services offered to patients is improved, offering quality management practice, participating in strategies to improve healthcare and influencing general improvements if the healthcare system. To achieve this, leaders in health care need to have self-confidence, trust, respect, and be able to collaborate with others in carrying out designated tasks. Because of the need for collaboration, the health care system is progressively being characterised by adoption of emergent leadership, as opposed to the traditional and highly structured model of leadership. This form of leadership has the advantages of being interactive, less structured and participatory. References Dwivedi, R. K. (2005). Organizational Culture and Performance. New Delhi: MD Publications. Gillies, A. (2003). What Makes a Good Health Care System? Comparisons, Values and Drivers. Oxon: Radcliffe Medical Press. Goodwin, N. (2006). Leadership in Healthcare: A European Perspective. New York: Routledge. Legido-Quigley, H., M. McKee, E., Nolte & I., Glinos (2008). Assuring the Quality of Health Care in the European Union: A Case for Action. World Health Organization. Observatory Studies Series No. 12, p. 2 – 6. 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London: Chartered Management Institute. Article 1, pp. 7-12. Retrieved 7 April 2013, from http://www.mbsportal.bl.uk/taster/subjareas/mgmt/cmi/142362articles13.pdf Read More