Editorial

Citation

Bowerman, J. (2015), "Editorial", Leadership in Health Services, Vol. 28 No. 4. https://doi.org/10.1108/LHS-08-2015-0020

Editorial

Article Type: Editorial From: Leadership in Health Services, Volume 28, Issue 4

In a recent round of interviews of human resource candidates for the management department in my university, one such candidate was asked what he felt was his most valuable competency that he was bringing to the position. His response surprised most of the interview panel. We were all expecting to hear something like effectiveness, management, efficiency or some other business-laden concept. Instead, he told us the most valuable competency he felt he demonstrated that he would be bringing as a professor of human resources was “compassion”. He felt that this benefitted both his students and his peers. He proceeded to provide several examples of how he had demonstrated compassion in the course of his university teaching.

Co-incidentally, the next day, as I was browsing through LinkedIn, I discovered that one of my former doctoral colleagues, Judy Hunter, who is now Chief Human Resources Officer and Not for Profit Director of Holland Bloorview Kids Rehabilitation Hospital, had written a piece on the importance of building compassion into the bottom line (LinkedIn June 19, 2015). To this end, her organization has now formed a new partnership with the Schwartz Centre for Compassionate Healthcare. This is a Canadian first, and her hospital joins 475 international health centres to ensure that all clients receive compassionate care.

Compassion is not usually a concept we associate with healthcare leadership these days. Formally in hospitals, leadership tends to come from the top-down, usually from people outside the institution, either government or agency leaders, who set rules and regulations, and who expect certain outcomes in the form of efficiencies and cost savings. Informally we will find compassion – indeed nursing care is renowned for its compassion – but it is not always institutionalized within the formal structure of the system. Yet, according to Judy, quoting from a white paper (http://theschwartzcenter.org/media/Building-Compassion-into-the-Bottom-line.pdf), hospitals and hospital-based health systems achieve better outcomes following a commitment to compassionate care. She notes:

[…] they benefit from lower staff turnover, higher retention, recruitment of more qualified staff, greater patient loyalty, and reduced costs from shorter lengths of stay, lower rates of re-hospitalization, better health outcomes, and fewer costly procedures.

In short, compassion has a multiplier effect throughout the entire system.

In addition, caregivers expressing compassion for patients, their families and each other experience less stress, a greater sense of teamwork and more work satisfaction. And patients as well benefit from improved quality of care, better health, fewer medical errors and a deeper human connection to their caregivers.

Judy urges healthcare professionals to read the report, especially given the alarming rates of burnout experienced by healthcare professionals. Just imagine if outside agencies such as governments could relinquish their attachment to pecuniary outcomes and healthcare provision could be just what it is supposed to be within an environment of compassion. It does happen. Only recently I heard an interview with a doctor attached to Medecins Sans Frontieres, operating from a ship actually helping refugees in the Mediterranean. His entire work and its raison d’etre was based on compassion, on rescuing and helping those who are desperate, and who want nothing other than the opportunity to better their circumstances.

It is difficult to demonstrate compassion in a world where it seemingly is not valued, and yet for this particular doctor, it was an extraordinarily meaningful and valuable way to exercise his profession. As Judy quotes from the report, “Caregivers can’t control what diseases affect people but they can control the interactions”. Compassion does not often crop up in our rush to assess our bottom lines. Government leaders do not talk about it, auditors do not conduct audits for it, it is not really a subject for business schools, or for leadership classes, yet it matters. We know it does. So this issue’s editorial is a call for compassion and more research demonstrating its value as an important leadership aspect in the increasingly complex health service we are all part of delivering.

Many of the papers we receive for publication, while not necessarily labelling compassion per se, seem to imply that it is a foundation for basic competencies such as communication, the establishment of trust, empowering of others and sharing knowledge. It is perhaps obvious that we all desire better health systems and services, where people obtain the treatment they need, in a timely and compassionate manner. This group of papers reflects some of this insight. Once again they span the globe, three from Sweden, one from the USA and two from the UK, and all provide somewhat differing perspectives into the somewhat ill-defined concept of leadership and its components. But all reflect the rapidly changing environment of the health services world we inhabit.

The three papers from Sweden appear to have a common theme – the complexity of leadership, how to determine it and how it is viewed by others. Thus, Dr Kristina Palm et al. describe employee perceptions of changes in manager’s leadership based on a two-year leadership development programme for first-line healthcare managers in Stockholm, Sweden. The aim is to determine how the changes are perceived by others in their manager’s leadership over the length of time of the programme. Results from interviewees emphasized an increased perception of confidence on the part of managers and a greater ability to handle conflict and make decisions. It is important to note that these results are not necessarily related to the content of the programme itself, they could also be related to the passage of time. Thus, both aspects are useful indicators of the developmental aspect of leadership research.

Anna Cregard and Nomie Eriksson, also of Sweden, examine the perceptions of trust and distrust in those physicians who hold part-time managerial positions. Using a qualitative research approach, the study is based on interviews and focus groups to examine ability, benevolence and integrity as aspects of trust and distrust in physician managers. Physician managers operate within a dual logic of management and medical, and sometimes those logics will be at odds with each other, essentially because of the conflicting paradigms between the two world views, one associated with management, efficiency and cost cutting, and the other with medicine. As they note, “the challenge for the physician-manager is to gain the trust of other medical professionals by balancing cost efficiency with patient quality care”. The paper urges training and support for medical professionals in their managerial roles, because without it, they run the risk of losing the trust of other medical professionals.

Our final contribution from Sweden, from Ursula Reichenpfader and colleagues, comprises a systematic review of published empirical research on leadership as a determinant for the implementation of evidence-based practice. Based on 17 studies using empirical research, referring to both leadership and evidence-based practice, the findings note the variety of ways that leadership is addressed in current implementation studies conducted in healthcare settings. In particular, they note the lack of differentiation between management and leadership. For those of us who have studied leadership for years in a variety of organizational settings, these findings are not surprising. In my experience, leadership is always a contextual phenomenon, and is often overly confused with management. We all too often profess to want leadership, where really we want people to manage better. When our leaders fail to provide vision and direction, we say they lack leadership abilities. The concept of leadership has, as the authors note, a weak conceptual base which is not surprising given the variety of organizations, cultures and people in every organizational field from business to government to health care itself. Perhaps it is possible that more specific evidence-based research can address this dilemma and provide more precise definitions.

Dr Lee Revere and co-authors address the design, deployment and implementation of a specific leadership development programme for academic medical department chairs offered as an alternative to the lengthy and somewhat theoretical MBA or MHA. Written as a case study, the paper addresses the gap between traditional clinical training and the business acumen required to be an effective physician leader. The course which is described was created to meet the local needs as defined within the context of the Texas Medical Center. There is much solid information here which will be of interest to those wishing to prepare physicians for business/leadership positions, and although specific to this particular medical centre, the paper provides some excellent directions to address this need.

Our final papers are from the UK and concern shared or distributive leadership. George Boak et al. examine distributed leadership in the form of a case study of distributed leadership and team working in a single health department over a period of two years. This is a case study which demonstrates how the performance of a physiotherapy service was improved by the introduction of specialist teams, a team working ethos, and the implementation of systems to support it, which included distributing leadership responsibilities more widely within the department.

Stephen Willcock and Gemma Wibberley, in a conceptual analysis, examine a shared leadership perspective for doctors working in the National Health Service (NHS). The authors remind us that with health policy reform, all medical doctors will need to be engaged with leadership in one form or another, perhaps at “different levels and with different degrees of formality”. They see the challenge as avoiding the traditional individualistic approaches to leadership development which tend to concentrate on developing individual capacity, and a move towards group-based, action learning programmes which emphasize the distributed nature of leadership. This is particularly important when the system is moving towards “multi-specialty community providers and vertically integrated primary and acute care systems”. But more than simply a leadership development challenge, the authors remind us that it will also involve a significant cultural change where shared leadership is but one component of the necessary preconditions for transforming the NHS.

This editorial started with a commentary on the possible importance of compassion as an undermining foundation for healthcare delivery systems. The six papers together reflect some of the difficulties in determining exactly what leadership means and how it is viewed by others, its overlap with management, the role confusion medical doctors may experience as they transform to medical managers and, finally, distributed and shared leadership as our more traditional models of professional autonomous medical leadership give way to more inclusive and collaborative models of medical management. These papers are timely reminders that running organizations, particularly those related to health services, is no easy task. Leadership, it would appear, is a complex yet increasingly necessary quality in the messy and ever-changing world of health service. The contributions here help to add clarity to this world.

Jennifer Bowerman

Editor, Department of Commerce, Grant MacEwan University, Edmonton, Canada