This blog post by Daryl Sadgrove, CEO of the Australasian College of Health Service Management, first appeared on the ACHSM’s website and is reprinted with permission. It looks at the concept of ‘engaging leadership’ and what it means for Australia’s health reform agenda. Daryl also challenges health care managers to get behind a ‘social media revolution’ in health care and discusses why hospital registrars shouldn’t have to run out of consulting rooms onto main roads waving their blackberries in the air to check their online MIMS for potential drug interactions…
The latest release of the King’s Fund tilted Leadership and Engagement for Improvement in the NHS- Together we can explores the role of engaging leadership styles in driving healthcare improvement. The evidence outlined in the paper demonstrates a direct relationship between staff engagement and organisational performance.
Although the paper draws primarily on existing knowledge and evidence in this area, I commend the King’s Fund for drawing attention to this issue in such a profound way. For anyone who is passionate about open, transparent and collaborative styles of leadership, this paper is likely to resonate with you. Those that regularly read my blog would also know that I am on a personal mission to share any ideas, innovations or breakthroughs that have the potential to transform healthcare, and I believe that engaging leadership is one of them.
Engaging leadership is not a new concept, it has been previously described by Alimo-Metcalfe (2008) and arguably by others (albeit under different banners), however I believe this paper by the Kings Fund makes a bold and significant declaration for Engaging Leadership styles
to be embraced. Members of the ACHSM would know that ACHSM has also been a thought leader in this area for a number of years, including working alongside the internationally reknowned Prof. Beverly Alimo-Metcalfe to champion engaging leadership in our region. Beverly who has been at the forefront of this movement, and who was also an author on the King’s Fund paper, has in fact conducted numerous workshops, seminars and keynote presentations for ACHSM over the last few years.
The lack of engagement between managers, clinicians and patients is harming people, creating waste and undermining reform measures – and I reckon enough is enough. We need to move away from an obsession with ‘pace-setting’ leadership styles characterised by laying down demanding targets, leading from the front, often being reluctant to delegate and resistant to collaborate. That is not to say that ‘pace-setting’ leadership styles don’t work, in fact there have been numerous improvements driven by process targets for example which have resulted in reduced ED wait times and the like. The problem is that ‘pace setting’ has become the predominant discourse in too many situations, settings and organisations and has led to disengaged workforces, poorer quality care, serious errors, and untold waste. We must develop more high performing leaders who have the ability to deploy a range of leadership styles, depending on the situation.
As a general rule pace-setting, as a leadership style, works best when the system being influenced is relatively stable and has all of the inputs required to achieve the desired outcome. Pace setting is derived from the practice of coaching elite athletes who are already highly skilled, have an intimate understanding of the task at hand and how to achieve the desired outcome. Pace setting works when the workforce is engaged, the desired skills and behaviours are present, and the outcome is predictable. The state of our current health system couldn’t be further from this. The healthcare system is being confronted by a multitude of challenges including unsustainable growth in healthcare expenditure, a doubling
of demand in two decades, the social and economic effects of an ageing population, and unprecedented workforce shortages; essentially, the system is anything but stable.
After sitting through over a hundred health reform meetings and consultations over the last 18 months, the only thing I am sure about is that we don’t have all the answers. Although there is an enormous amount of great work being done, some of the big questions still remain unanswered. No one seems to know where we are going to put our ageing patients/ customers in 20 years time, no one has convinced me they know how we are going to transform models of care quickly enough to keep pace with demand, we still don’t have a unanimously supported model for governing and coordinating our disparate sectors, and no one knows how we are going to do all of this with a backdrop of unprecedented fiscal constraints.
Based on this what we need are solutions which, are cheap, promote innovation, enable us to distribute innovation quickly, encourage engagement (at all levels), create an open and transparent operating environment, promote knowledge-building (rather than continuously reinventing the wheel), and is characterised by leaders who are both courageous and caring. But guess what… other industries have been doing this stuff for years! Lets get with it!
A couple of months ago I proposed my first idea that I believe could transform healthcare in the ways described above, it was to create a social media revolution in healthcare. In this article I laid down the challenge to all healthcare leaders and organisations to start using social media in 2012. The norm across all industries is for 50% of businesses to have a social media presence, in healthcare we are pushing 10%. However 70% of Australians now use social media to communicate, although clearly not in regards to their healthcare.
I was extremely disappointed the other day when my wife and I saw for a registrar for an antenatal appointment at a NSW hospital, and he was not provided internet access on ANY of the computers in the department, he said “We can apply for it, but it’s all too hard, there so many forms, and in the end our manager won’t support it”. So when he needed to look up a drug reaction on MIMS he had to use his personal blackberry, however as there was no 3G in the office he had to leave the room with a well-rehearsed explanation to walk out on to the main road to search for the answer he needed. I wonder how many times he does that each day? While the rest of the world is embracing the power of social communication, this place still hadn’t got its head around the internet yet!!! COME ON!!!
I believe that Engaging Leadership can transform the way we deliver healthcare. It complements perfectly our first proposal and also creates the ideal culture for a social media revolution to take place. Both concepts seek to embrace the worldwide revolutions taking place in the way we connect, learn, share, lead and collaborate. These revolutions have led to more extraordinary advancements in the last 20 years than in the last 200 and will continue to define the ways in which we work.
I admit that after sitting in over a hundred health reform meetings, I too am guilty of not having the answers to the big questions. But if we create an environment conducive to innovation and engagement, I believe they will come.