Leading change in health care: the challenge of anxiety

PURPOSE

The purpose of this paper is to identify the centrality of anxiety in health care, especially in the context of leading change. It identifies the importance of emotional labour for clinical professionals and the resultant development of defensive routines. The idea of containment is central to addressing anxiety.

DESIGN/METHODOLOGY/APPROACH

The approach involves identification of anxiety as a key factor in leading change in health care, but one which is often ignored.

FINDINGS

Anxiety is the elephant in the room vis-a-vis leading change in health care. To address the use of defensive routines, a range of activities can act as "containers" for anxiety and help with leading change.

PRACTICAL IMPLICATIONS

To lead change in health care implies addressing the existence and importance of anxiety and the emotional labour which health-care professionals undertake.

ORIGINALITY/VALUE

The existence of anxiety and the profound impact it has on leading change in health care has typically been under-estimated or avoided. The paper aims to remedy this.

Beyond healthcare leadership? The imperative for health and social care systems

PURPOSE

This paper aims to make the case that there is a need to move beyond a focus on an approach to leadership development which is confined to health care only. It argues that, given the economic, financial, social and organisational context within which health and social care organisations in the UK operate, there is a need to develop leadership within health and social care systems, rather than within the existing "siloed" sectors.

DESIGN/METHODOLOGY/APPROACH

The paper considers the context within which health and social care organisations in the UK operate; examines the nature of those organisations; makes the case for focusing on the health and social car system through systems leadership; and identifies the need for leadership, rather than leader development.

FINDINGS

There is a danger of health and social care organisations "walking backwards into the future" with eyes fixed on the past. The future lies with treating health and social care as a system, rather than focusing on organisations. The current model is individual leader focused, but the emerging model is one of collective multi-agency teams.

ORIGINALITY/VALUE

The paper seeks to go beyond a health-care-only focus, by asserting that there is a need to regard health and social care as a single system, delivered by a multiplicity of different organisations. This has implications for the kind of leadership involved and for how this might be developed.

Organisational learning

Purpose The understanding of "organisations" has changed fundamentally from seeing them as concrete entities to viewing them as communities of meaning. Mature adults in healthcare learn best when addressing pressing problems in company of their peers. Healthcare is unlike other sectors because of the emotional labour which is part of the experience of clinical staff. Absorptive capacity offers a conceptual model for viewing organisational learning and the encouragement of systemic eloquence can be enabled through a variety of approaches, provided they are designed and delivered as part of a well-thought-through approach to developing local absorptive capacity. Design/methodology/approach This is a viewpoint paper. Findings Healthcare differs from other sectors. Organisational learning can be enabled by a range of approaches, but these need to be sensitive to local circumstances. Originality/value The paper asserts that healthcare is unlike other sectors because of emotional labour on the part of clinical staff. It maintains that organisations are communities of meaning, rather than concrete entities. Systemic eloquence can be enhanced by the concept of absorptive capacity, applied in local contexts.

Escaping the healthcare leadership cul-de-sac

Purpose This paper aims to propose that healthcare is dominated by a managerialist ideology, powerfully shaped by business schools and embodied in the Masters in Business Administration. It suggests that there may be unconscious collusion between universities, healthcare employers and student leaders and managers. Design/methodology/approach Based on a review of relevant literature, the paper examines critiques of managerialism generally and explores the assumptions behind leadership development. It draws upon work which suggests that leading in healthcare organisations is fundamentally different and proposes that leadership development should be more practice-based. Findings The way forward for higher education institutions is to include work- or practice-based approaches alongside academic approaches. Practical implications The paper suggests that there is a challenge for higher education institutions to adopt and integrate practice-based development methods into their programme designs. Originality/value The paper provides a challenge to the future role of higher education institutions in developing leadership in healthcare.

Leadership metaphors

Purpose

This paper aims to suggest that the language typically used about leadership in healthcare tells us something important about how we see it.

Design/methodology/approach

Three main metaphors currently adopted for healthcare leadership purposes are explored – military, sporting and finance.

Findings

The language used about leadership sustains the way the world is seen. A more life-affirming use of language is possible, which more accurately reflects what healthcare is about.

Originality/value

The paper builds on the work of Gareth Morgan in applying the use of metaphors to healthcare leadership.

Whither the elephant?: the continuing development of clinical leadership in the UK National Health Services

The paper revisits the theme of clinical leadership in UK countries, following an earlier (2009) review. It examines the competency-based approach; considers the emerging voices of clinical leaders; explores the results of evaluation research studies; identifies learning from intra-UK and international comparisons and considers the issue of leader development versus leadership development. It concludes that there is little conceptual clarity; that there continues to be a major disconnect between clinicians and managers; that different approaches to developing clinical leaders are emerging in different parts of the UK and that the major challenge remains to develop leadership, rather than leaders.