Editorial

Citation

Bowerman, J. (2015), "Editorial", Leadership in Health Services, Vol. 28 No. 2. https://doi.org/10.1108/LHS-03-2015-0006

Editorial

Article Type: Editorial From: Leadership in Health Services, Volume 28, Issue 2

This issue leads off with an article that we have classified as a viewpoint – about mission statements. As the author, Dr Aamer Sarfraz, points out – mission statements were first incorporated as a management tool some 40 years ago. Likely – when they were first developed – no one ever considered them as a useful tool for a public service such as a hospital. But now with hospitals and the medical and health services within them being considered as businesses and with the business model being applied to the cost and billing essentials they have to provide, they could be considered a useful tool, helping to build a “unity of purpose amongst hospital stakeholders”.

However, they can have negative consequences. Sarfraz notes that although the mission statement may bring about a sense of common purpose, it can also “induce boredom or […] induce emotional resistance that leads to cynical undermining of its purpose”. Certainly, having worked in the public service for many years, this has been my impression of them. The politicians cut the funding yet again, a new initiative is launched and the employees look at the mission statement and sigh. The BOHICA – “Bendover – Here it Comes Again” mentality is sadly all too alive and well in many of our institutions.

Can mission statements be useful – instilling a sense of purpose and leadership, giving stakeholders a sense of involvement? I believe so. But as the author suggests, the introduction of mission statements “should follow an initial phase of involving and educating staff and the local community”. Personally, I believe they should be living statements – the author agrees with this – so that they “[…] are used to focus all future innovations and changes”. Perhaps, the next time we see a mission statement hanging on the wall, we should consider to what extent our experience in that organization or institution aligns with that mission, and if not, what can we do as clients, leaders, stakeholders or employees to ensure that it lives through our actions! Sometimes, all it takes is a personal awareness of the real meaning of such a statement to bring about a real change. In my opinion, a mission statement should always be more than a management platitude or a marketing ploy. It should be a call to action to walk our talk! Perhaps, this calls for more research into the value of mission statements in terms of their impact of the overall organization.

Our next author, Thomas Andersson, from Sweden, uses qualitative research to write about the challenges that occur in medical leadership when physicians hold positions, both as doctors and managers, largely because of the differences in the social identity between a manager and a physician. Physicians see themselves as autonomous individuals within a health context, whereas managers hold subordinate positions within a managerial hierarchy. Because of their professional medical training, the author notes that, physicians who are managers tend to remain first and foremost physicians. Not too often, we in the business world view leadership as a strictly structural component of an organization, whereas really medical leadership incorporates cultural, professional and identity issues which have all kinds of potential for role confusion. Andersson suggests a potential solution of more cooperative relationships between physician and non-physician managers. Certainly, the challenges for physicians who wish to play a managerial leadership role in the organizational hierarchy are great, and the article notes the need for both changes in organizational structure and medical training to support more effective medical leadership.

Our next paper in this issue describes a workplace-based interdisciplinary clinical leadership program designed to increase willingness for participants to take on leadership roles in a large regional health-care centre in Victoria, Australia. Written by Aleece MacPhail, the study uses multi-source feedback to appraise the first two years of the program, based on a five-point Likert scale, follow-up on participants after completion of the program to identify new leadership roles and reflective sessions on the part of senior executive staff. The results are exciting to anyone who supports in-house learning and reflection. The researchers found an increased willingness for people to take on new leadership roles, and an increase in staff confidence, sufficiently so that the recommendations were for the program to continue. External training can be expensive, and, all too often, the impact is such that the content of the training is quickly forgotten. This author notes that this in-house program was low cost by comparison and the results were significant for developing leadership capability and skills so much so, in fact, that the program was continued, with more evaluations and outcomes to be measured as the program grows.

Lean Leadership is the topic of the paper that follows, and is studied here using an ethnographic approach based on experiences, participant observation, interviews and document analysis, in a Dutch University medical centre. The first author of this paper, Dr Kjeld Aij, is the Head of Anaesthesiology and Surgical Care at a large Dutch teaching hospital, and wanted to document his experiences in implementing lean, thus changing the culture of the organization. The article is an interesting read, not least because of the involvement of the author in the lean transformation and in the reflections he describes based on his own experiences as a health-care leader. As he describes, lean leadership requires actual behavioural change. It is not just about lean theory; it is about the actions that contribute to cultural change and the creation of value for patients and clients. This requires a leader who goes to the gemba – in this case, the shop floor to ensure an understanding of the work processes and thus to make the right decisions. In addition, leaders should demonstrate modesty, with an ability to inspire others. I quote from the article:

        […] leaders must be consistent, but at the same time flexible. By not being afraid of going to the workfloor to study hypotheses in practice, by showing themselves to be part of the team and able to empower others, and by combining willpower with modesty, leaders will learn not just how best to implement Lean but also how to become true leaders (Aij, p. 21).

Another study, by Swedish author, Kerstin Nilsson, examines the roles and functions of process managers, involving patient care and treatment, while working in Swedish hierarchically structured hospitals. This was a qualitative research study, based on in-depth interviews with 12 process managers at three hospitals in Sweden, the aim being to explore the extent to which process managers can bring about improvements in processes to improve overall patient care. Much of the difficulty in bringing about changes in hospital processes relate to the “deeply institutionalized organizational routines and inter-disciplinary boundaries”, and rather than focus on the system, Nilsson aims for a deeper understanding based on the experiences of process managers who are actually involved in patient care and treatment. Her findings are not difficult to understand – they point to a lack of clarity in understanding scope of responsibility and work content. Once again – we see a need for role clarity and improved communication – aspects of organizations that should be simple enough to implement and are yet hugely difficult in practice.

The final paper in this collection is based on research conducted by Dr PS Raju and is concerned with perceived service attributes in the development of overall customer satisfaction and customer loyalty in a health-care setting. I believe hospitals provide an essential service for patients, and I personally have never thought of them in terms of patient loyalty. In my Canadian city, there are three main hospitals (aside from the Cancer treatment hospital), each of which provide differentiated services and tend to serve particular areas and respective populations. Raju’s research is from the USA, which has a very different system from Canada, but, in general, I am noticing an increase in these kinds of research papers dealing with customer satisfaction and loyalty in hospital settings. Overall, I find it an interesting trend, reflecting many future implications for the delivery of health service in a world where the numbers of people requiring such services are increasing exponentially and are expecting more and more in terms of the quality of services provided.

On a point of interest, in recent months, I have read a number of articles written by front-line medical staff about the bottle necks and delays experienced by overworked physicians and nurses in hospital emergency departments, as too many patients converge into too-small hospital waiting rooms, with too many chronic conditions and too few medical providers. I am reminded of the essay in our previous issue (28-1) – where the author – a medical student by the name of Shreena Suchak – suggested using a motorway metaphor to provide quicker patient centred routes to separate those who are chronic from acute and ease the bottle necks. I wonder what it takes for us to change our systems – to rely less on our hospitals and more on communities of care. Obviously, I cannot answer the question, but it does seem that, even as the papers in this issue suggest, change is difficult to achieve.

Jennifer Bowerman