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Article citation: Jennifer Bowerman, (2012) "Editorial", Leadership in Health Services, Vol. 25 Iss: 1, pp. -
At one of the London conferences on healthcare I attended in 2010, I was most impressed to hear a British family doctor describe his primary care clinic. As he talked about the yoga courses, nutritional counseling, exercise classes, and general social well being programs, it was as though the strictly medical aspects of his clinic came second to the more holistic and wellness programs that he was describing with such enthusiasm. Indeed, what he was telling us at the conference, and I believe this is something we as a general public are beginning to grasp, is that health is more than a hospital and often more than the services of a medical specialist.
In short, the world of health services is changing, almost as fast as our global political and economic environment – and just as visibly. As I write this Editorial, I have on my desk a newspaper article about an exciting local primary care health network, incorporating eight family practices, representing 68 family physicians, and serving 72,000 patients in the particular geographic area (Edmonton Journal, September 30, 2011). The office uses POETS (not the kind who write poetry) but rather Proactive Office Encounter Technicians who track the patients and call to remind them when necessary services are due. Working as team members with nurse practitioners, licensed practical nurses, pharmacists, mental health therapists, and chronic disease educators, they handle the care aspects of patient work, leaving the MDs to focus on the more strictly medical aspects of health service. Certainly, the clinic may not be offering yoga, or meditation techniques like the British clinic, but nonetheless it seems to me to a very good way to spend tax payers’ money. Good primary care centers, staffed by multi-skilled teams of healthcare professionals, offering a variety of services that both educate and minister, can help people to live much more healthy lives, even with chronic health conditions, and can thus alleviate much of the pressure on the more expensive health alternatives, such as emergency wards and hospitals.
I have a particular axe to grind when it comes to primary care centers. I happen to live next door to one – built at great cost a few years ago – which has never really been operationalized, except as a well baby clinic, a vaccination clinic, and a birth control clinic. Many parts of the clinic, despite being fully equipped for complex medical services, have just lain vacant. However, as I write this Editorial, there is some movement, and the first MD is just about to arrive some two years after the clinic first opened. True, the plaster clinic, built as a means of taking pressure off the local hospital emergency ward for dealing with sprains and fractures, will still not be operational. In the end, however, as residents, we will take what we can get. A partially staffed clinic is better than no clinic at all.
At a recent political meeting I attended, I asked one our provincially elected politicians why more was not being done to support primary care in our province and recounted my experience with the local clinic. This seemed to me to be a key political and health leadership issue, especially at a time when my province was in the process of electing a new leader for our present governing party.
The politician gave his answer to my question from a political perspective. First, the province does not have enough doctors. He recounted his experience recruiting medical specialists from elsewhere in Canada and other countries. Second, he emphasized the need for professional scopes of practice to be changed so that such clinics do not have to be so heavily dependent on highly paid doctors. It is interesting that in the room of about 50 people, the only person he encountered some resistance from on this particular point was a medical doctor.
But it is disappointing that every time we poach a medical specialist from another part of the world, we are depriving that world of his or her medical expertise. Is this really the way to handle health care? And the area of scope of practice really does raise seriousissues about how we handle change in this increasingly complex professional arena.
As primary care centers continue to be emphasized as a key mechanism in delivering cradle to grave health services, it is obvious that they will require additional funding. Is the money there? Our political leaders and financial portfolios would tell us it is not. But in the end it will have to be. If we are to stave off the upcoming medical and health crises related to life style obesity and its accompanying conditions, then we need to change the way we are addressing societal health. Primary care centers delivering education and services using skilled teams of multi trained professionals and practitioners are one way of doing this. And I believe they will allow us to save money – albeit in the long term. There is likely no short-term fix to escalating costs.
We know that change is not linear; all the evidence suggests that it is accelerating, affecting every aspect of our life. Health is no exception – it is but one wave of change hitting us simultaneously along with all the other waves, In my opinion, we can fix some of the situation, if we are willing to, let go of our traditional paradigms of viewing the world, (and medicine) and can practically start to address health as a wellness issue. This is difficult to do. Being ahead of the change wave may seem dangerous and insecure, but it is better to be ahead than behind. Reg Revans, the father of action, told us that to be ahead, we have to keep learning. I believe we are living in learning times. Today we are inundated with knowledge, especially related to health. It comes at us from many directions, especially through social media, through health mavericks, and other people determined to make a difference. Conservative medical and political establishments may shun them, but they are part of the change wave and cannot be ignored. Traditional paradigms are under attack, and one of the advantages of social media is that everyone knows it.
And what of Leadership in Health Services? How can we be a better part of the change wave? I believe that today innovation and leadership do not just have to come from the top – from the trained professionals and researchers. I believe it can come from anyone and everyone who has a passion for what they do and a desire to make a difference. Leadership in Health Services is more than a name – it is an important subject in today’s world, and it is both my hope and belief that our journal can make a positive difference in this increasingly important arena of our society.
Our articles in this issue reflect many of these themes – building teams and engaging professionals more in the development of their own practice –developing leadership qualities to more effectively work in clinical teams, the importance of learning and an approach that emphasizes better using complex adaptive systems to help change our mental models. They are all written from the perspective of change and increasing workplace complexity.
We commence with a viewpoint – how to improve the effective engagement of doctors in clinical leadership. The author, Jayne Greening, as a Consultant Psychiatrist, and junior Doctor Training Program Director, uses her own experience and related literature, to assess the importance of physicians being actively engaged in the planning, delivery and transformation of the services they provide. She notes that such programs, designed to build leadership and engagement, mean a change in working culture for clinical staff in general, and for senior doctors in particular, a transformation to managerial and relationship engagement. Such programs are so important she believes because of the demonstrated link between active engagement of medical professionals and becoming a high performing organization. She strongly believes that a more effective health care delivery system will be one where the traditional gap between management and professionalism is bridged.
Authors, Jill Peltzer et al. are also interested in the leadership qualities that help to create high performing health care initiatives. Using a qualitative case study methodology, the authors identify the themes that have helped to make a holistic health care center located in an American mid-west State so successful. For this particular health center – which they note is primarily Caucasion and rural, and thus possibly a limitation to the overall significance of their research – they cite the quality of servant leadership in particular, that has been transformational in helping to build a successful workplace culture built around the mission of the Center. Through the work of the Center, and its dynamic culture, they have helped to promote both the growth of staff and of clients.
Steven Willcocks takes us on a literature review of the various theoretical approaches to leadership to explore those models that may be best for nurses, as they contribute increasingly to shared leadership roles within clinical teams. As he notes, every leadership model has something to offer, from trait theory to those emphasizing contingencies and circumstance, but the most effective ones will be those that can best meet the needs of nurses working in clinical teams. To this end, after comparing classroom based development programs to those that are work-based, he comes down on the side of an action learning experiential approach to leadership learning. Such programs, which are of necessity work-based, encourage all the working variables, from situation, leadership, and followership, to be assessed in light of the day-to-day problems encountered in the workplace. In this way, learning programs are developed which are organizationally specific, grounded in the practicalities of the working environment, thus enhancing both team and working development simultaneously.
Lars Edgren’s conceptual paper discusses complex adaptive systems; how understanding and applying this approach can be used to bring about better integration between different health care providers, and thus achieve improved results for the end user. He explains that the advantage of understanding, promoting complex adaptive systems principles to health and social care is that they provide an alternative mindset for those working in environments of ever increasing health and social complexity. This complexity is underscored by the increasing knowledge of end users of our health care systems via the internet, who suffer from a multitude of medical needs, and the tendency of treatment centers to operate independently, often in competition with each other based on a flawed business model of competition.
In our final paper, health researcher, Noorhazilah Abd Manaf’s introduces us to an instrument to measure patient satisfaction as a means of measuring the quality of health care provided by healthcare organizations. As he too notes, the ongoing escalation of healthcare costs, and rising consumer demands and expectations bring to the forefront the paradox between providing quality care alongside the need to implement ongoing cost cutting measures. Insights into patient satisfaction can provide guidance for healthcare managers around how better to allocate limited resources.
Many of the themes in this Editorial and reflected in these contributions are reflected in the News and Views section, written by my co-editor Jo Lamb-White. This is a very timely collection of happenings around the world, covering political leadership to changing scopes of medical practice. Jo and I hope that you find our journal touches your professional interests, and that as readers and researchers, you can continue to contribute and build our efforts to share new and exciting health leadership knowledge and practice.