Leading Healthcare Organisations

Citation

Allen, S. (2005), "Leading Healthcare Organisations", Journal of Management Development, Vol. 24 No. 10, pp. 944-945. https://doi.org/10.1108/02621710510627073

This book represents a collection of papers presented at the Third International Conference on Organisational Behaviour and Health care.

The book is divided in to three parts, with an interesting forward that challenges models of leadership that purport to be the most effective in leading change in healthcare. Followership and the effect of systems policies and culture are identified as being key variables in either the success or failure of developing effective services for recipients of health and social care.

Part 1 explores the nature of leadership and chapters relate to differing professional groups. The first chapter focuses on medical leadership in Primary Care Groups and identifies the advantages (or disadvantages!) of the predominance of the medical voice in the development and delivery of primary health care systems. In the second chapter the emotional labour of nursing work within the leadership context is explored through a methodology referred to as “cognitive sculpting”. This enables difference to be identified in the socialisation and power structures that have emerged as characteristics within and between the professional groups. This difference enables taken for granted assumptions to be channelled into effective communication strategies to emerge to move forward with the multiprofessional agenda, which is at the political core of the development of healthcare services. This is effectively illustrated in the multiprofessional context of a mental health service in US Psychiatric teams and precedes the chapter around clinical governance and the joined up thinking that is necessary to achieve effective outcomes. The final chapter in this section applies some of the thinking to an intensive care unit.

The second part of the book takes examples from a range of settings, which build on the first part by applying some of the application of various styles of leadership. This incorporates the notions of communities of practice as a powerful contribution to the arena of knowledge management and challenges some of the narrower views of knowledge management as relating to sources of information from a technological perspective. This chapter highlights the immense resource within people and demonstrates within a qualitative research framework how this intrinsic knowledge can be tapped to develop and deliver effective healthcare. Case studies from across the globe, illustrate that reform of health services is not just a British phenomena and examples of how the dynamics of decision making affect the resource outcomes of health care delivery is an important dimensions in the leadership arena.

Part 3 explores initiatives that are aimed at taking healthcare forward in the twenty‐first century. The first chapter reports an evaluation study that enquired into the actual activity of the newly implemented nurse, midwife and health visitor consultant nurse posts. The findings of the study demonstrated that consultants were able to cope with the complexity of the work and that professional rewards were high, but work overload and role ambiguity were challenges that needed careful handling to avoid the job becoming unmanageable.

This issue is very pertinent as new roles emerge to deliver healthcare as it is perceived to be effective in the twenty‐first century. This is a key challenge for leadership to ensure clarity is achieved at all levels within the organisation, and meta system as healthcare delivery becomes more complex and professional roles become more and more blurred.

This chapter leads the way forward to explore some of the key issues to be grasped to take health care forward. The challenges of evidence based medicine in both the USA and UK is explored within the context of a model of change which recognises the complexity and time frame in implementing strategic change, and this chapter is one of several which makes reference to the perspective of government which expects the change process to happen in very short time scales. This research refutes the popular comment on both sides of the Atlantic that research and practice in either country cannot inform the other. The authors found that difference in influences on evidence‐based change are far more likely to be those of intensity rather than type.

The latter chapters of this part of the book focus more on organisational change through the lens of a merger study of NHS Trusts in London. After discussing the politics of the perceived benefits of mergers the authors found that little attention was paid to the perceived cultural difference in the merging trusts. The outcome form this study challenges the NHS to acknowledge the unintended negative consequences that mergers have on the management and organisation of work, service provision and staff morale.

The final chapter touched on issues that can promote or prevent institutional learning by illuminating the complex pressures that influence chain effects in the learning and doing processes. In summing up the contributions within the book the editors took this further by suggesting the “leadership” should be a verb rather than a “noun” in the context of the NHS.

This book is not within the leadership genre of “how to” books, and as such celebrated difference in approaches to leadership. Within the opening paragraphs of the “foreword” Keith Grint from Templeton College stated that “First there is very little consensus amongst leadership researchers as to whether leadership does make a difference. Second if it does there is very little agreement amongst the authors how that difference may be more tractable.” I would suggest that through the pages of this book the effects of what is assumed to be leadership can make a difference to healthcare delivery and experience. Overall, the editors have drawn together different points of view ensuring that this book adds to a body of knowledge that would appeal to managers and students who have a strategic responsibility and interest in the development of healthcare services. The methodologies for the different studies enhanced the overall value of the book that resulted in an eclectic view of the main challenges facing leaders within today's health service. Through the interpretation of these studies and the implications for action as a means to managing change this book provided food for thought and as a springboard for effective action.