Editorial

Citation

Bowerman, J. (2010), "Editorial", Leadership in Health Services, Vol. 23 No. 2. https://doi.org/10.1108/lhs.2010.21123baa.001

Editorial

Article Type: Editorial From: Leadership in Health Services, Volume 23, Issue 2

How should health policy leaders and managers make decisions about sometimes what appear to be life and death matters? Should they listen solely to those who provide the funding – in many cases politicians or insurance companies, both of whom claim to be interested in operating in the public interest? And just how much input should the public have in making these decisions. After all, it is the public that is the end recipient of health care decisions.

The reason I am asking these questions is that I recently completed a form and returned it to Professor Dev Menon, Professor of Public Health at the University of Alberta – in pursuit of his research – to randomly select 16 Albertans and have them act as a jury – to consider questions concerning the allocation of health care funds toward health care priorities. Interestingly enough, no sooner had I completed my application form and mailed it off, than there was an article in the local paper (Edmonton Journal, February 11, 2010), announcing the project and describing its aims.

The idea of selecting a jury to participate in decision making around health care spending priorities is fascinating. Taking the emphasis away from huge companies with vested financial interests and government policy makers, Dr Dev Menon’s research potentially provides a model for allowing more public input into the complexities of funding, and just how the priorities should be decided. Using different scenarios – deliberately designed to pit groups against each other – young children and seniors, the chronically ill versus the terminally ill, caregivers versus people in marginalized communities, a randomly selected jury that people will be able to determine their true values for decision making, based on information from the expert witnesses, and then by assessing the dilemmas to make their decisions.

This kind of research has a number of implications. Does it indeed provide the government with a new model of public decision making? Part of the answer to this question depends on the selection of the jury, the criteria for selection, whether it is indeed random, and whether decisions are really made. And just what are the leadership implications of this kind of jury decision making process? As a teacher of leadership, I have occasionally used the most famous jury movie of all times, 12 Angry Men, in the classroom, to demonstrate how minds can be changed and core values identified. It uncovers the layers of social rationalization we tend to use thoughtlessly, in our attempts to make things easy. A jury type process, if it is deep, can change people’s values, thus by definition, also changing people. Not only does this research therefore potentially provide a model for public policy input into health care decision making, and where the priorities should be, it also provides a model for personal change and the development of personal leadership capability Watch this space for further announcements about Dr Menon’s research and its results. It could be very important in terms of its implications for providing another player at the table when it comes to important health service delivery decisions as well as helping to build more health service awareness on the part of the general public.

From public input research to the contents of this issue – once again we have five articles truly representing our global reach. Our first article by Dr John Clark and Dr Kirsten Armit explores how leadership and management competencies are increasingly being used in medical education to help build leadership development on the part of medical practitioners. The authors emphasizes that both Canada and Denmark stand out in their approach to the much broader definition of of doctor, than just a medical practitioner. As they explain, medical doctors no longer need just clinical knowledge and skills to be effective in their chosen profession; they also need management and leadership competencies to help them deal with the increasing complexities of the modern world, and also to inspire them to seek more formal leadership positions. It is comforting to know that part of the decision making process for healthcare services includes increasing numbers of medical professionals with leadership and management training.

The next article by Barbara Trerise is a case study describing what is necessary to build a culture in a health care facility in British Columbia, Canada, that focuses on quality, safety, and innovation. One aspect I found appealing about Trerise’s article is her emphasis on the importance of leadership and governance structures to enable the development of the culture. All too often we point to the culture as if in a vacuum, whilst forgetting the necessary leadership support for its creation and maintenance.

Armenia features in our next article, which describes a performance assessment on the impact of the US Agency for International Development funding on a primary health care reform project in a number of Armenian facilities. Because internal monitoring of progress was not available, the article describes the value of internally administered performance assessments to obtain data across the project sites and ascertains the value of the project. It is vitally important to be able to determine the extent to which externally funded interventions add value, and achieve intended outcomes which adds to the importance of this kind of research, especially in countries as underdeveloped as Armenia.

The difficulties faced by district levels in Ghana in communicating about health care decentralization are described by Sakyi. Using in-depth interviews, the researchers demonstrate how ineffective top down communication with healthcare workforces, and relevant stakeholders has affected health sector decentralization. Reform objectives were limited to the top hierarchy, the process of transferring information downwards was limited – all of which negatively affected commitment, ownership, and overall program reform. Anyone who has worked in an organization will understand these findings – I read somewhere that bureaucracy is hardwired into our brains. Until we are able to shake off the trappings of vertical communication, understanding what collaboration, involvement and ownership truly mean, then these kinds of findings are likely to be replicated.

Finally, Dr Iain Snelling encourages us to consider the implications of some of the issues related to the upcoming development of regulations for acute hospitals in England. This Care Quality Commission – a new regulator – is being created from three predecessors, and will be implementing new systems for registering providers and monitoring regulation compliance. The upcoming UK election means that the levels of public and political scrutiny will be high so that leaders will have to ensure that the processes they develop to support the new system are well grounded in research and practice. This original paper, intended as information and discussion is an important contribution to the new regulatory framework being developed. It deserves our attention so that unanticipated matters do not slide by the wayside and then turn up to bite us – so to speak – after the fact.

Jennifer Bowerman