Different Perspectives and Approaches in Leadership and Management in Healthcare Organisations - Case Study Example

Different Perspectives and Approaches in Leadership and Management in Healthcare Organisations Name: Course: Abstract Healthcare organisations are complex adaptive systems. They are made up of different units that are interrelated and connected in a complex web of interactions. This means that their administration is undertaken in a layered form of bureaucratic chains of command. On the other hand, clinical leadership has been advanced as a solution to the complex problems that face these organisations. By equipping different medical practitioners with leadership skills, it is believed that this will reduce the degree of poor decision-making frameworks in these organisations. Although this is a viable option, the problems of tensions in terms of the use of teams and the process of making decisions still exist. This means that there is need for a new approach in the leadership of healthcare organisations. This paper examines different perspectives of clinical leadership in terms of managerial versus clinical leadership. It also explores different approaches to management of healthcare in the current environment. Table of Contents Introduction 1 Different Perspectives of Leadership in Healthcare Organisations 1 Approaches to Management in Healthcare Organisations 6 Conclusion 9 Different Perspectives and Approaches in Leadership and Management in Healthcare Organizations Introduction The subject of management is a highly debatable issue that is open to a lot of interpretations. These interpretations vary in terms of the industry involved, the approaches adopted and the practical implications of the management practice adopted on the complex systems that define particular organisations. This is demonstrated in the management of health services in several ways. For instance, whereas leadership is seen as the answer to the many disparate problems facing healthcare organisations, research indicates that each of the professionals involved in the organisations bring different perspectives to the management of the organisations. Also, the fact that health organisations bring together different professionals who have to work together in teams so as to achieve results means that success in healthcare organisations is a product of many complex factors. This paper examines the relevance of these statements in light of management theory and recommends the most appropriate approaches that organisations can adopt. Different Perspectives of Leadership in Healthcare Organisations The question of the need for leadership in healthcare organisations has received much attention in management literature. The focus has been on two main areas: increasing involvement and quality of clinical leadership and different perspectives on leadership as practiced by clinician leaders and general managers working in healthcare organisations (Begun, 2003, p. 254). In current practice, clinical leadership is carried out in two broad ways; either as a partnership between an individual with general management training in conjunction with a clinician or as a team or executive group providing leadership functions with input from clinical practitioners (Robertson, 2010, p. 6). Both these approaches present different perspectives and dimensions in leadership. Clinical leadership is seen as an integral part of transforming the healthcare system (Carruthers, Ashill, & Rod, 2006, p. 93; Willcocks, 2008, p. 159). This is because of its ability to address core problems that are facing many healthcare organisations. Clinical leadership is a recent development of different management models that have been applied in the healthcare sector – beginning with general managers and free market models (Stanley, 2006, p. 110). Carruthers, Ashill, and Rod (2006) observe that the essence of reforms in the healthcare services in the United Kingdom stems from the need to transform healthcare services from a state of being fragmented, inefficient and driven by competing professional interests, to one that is market-oriented and centred upon addressing the needs of the customers (p. 96). In order to achieve this, healthcare organisations have to address issues to do with the precise needs of their customers, the relative strengths and weaknesses of their competitors, the nature of customer demand for their services and the structure of the market in which they operate (Jonas, McCay & Keogh, 2011, p. 3; Willcocks, 2008, p. 160). Such an approach will enable healthcare organisations to not only reconfigure their operations around the needs of the patients but also enhance their overall service delivery in terms of offering their patients freedom of choice in service delivery. Additionally, healthcare organizations will be able to address the need for quality improvement in their services, which is measured in terms of how effective, accessible, efficient and satisfying their services are to the customers (Scott, 2010, p. 84). Clinician managers and general managers hold different perspectives concerning clinical leadership. Whereas clinical managers pay much attention to system improvement, customer orientation and the welfare of patients, in general, general managers tend to lay much emphasis on the traditional functions of management which include planning, controlling and allocating resources for different areas of the organisation (Hartman & Crow, 2002, p. 365; Jonas, McCay & Keogh, 2011, p.10). Although many clinical practitioners view the essence of appointing professional medical practitioners as managers in the healthcare institutions, the process of their appointment is viewed with much scepticism (Gillam, 2011, p. 109). This is reflected in the findings of Stanley (2006) who, in a study, observes that although the need to equip, train and use clinical nurses as frontline leaders in healthcare organisations is an important part of clinical leadership, conflicting professional interests and prevailing negative attitudes towards the nursing profession remain major obstacles to the process (p. 108). Further, since healthcare itself is a collection of different professional incorporating doctors at one level and nurses together with other professionals at the other, each of these professionals bringing different perspectives to clinical leadership, there is constant tension between management and the entire members of the organization in terms of teamwork and decision-making processes (Robertson, 2010, p. 53). According to the British Medical Association (2012), doctors who move into management positions in healthcare organizations have different perspectives in the meaning, essence and practice of clinical leadership within the healthcare environment. In essence, doctors who hold management positions aspire to offer expert leadership to the health service, being driven by their clinical skills, deep knowledge and the need to meet the interests of the patients (pp. 13-15). Professional doctors who have been appointed into managerial positions take a unique approach to management which is characterised by several aspects (British Medical Association 2012, p. 23; Robertson 2010, p. 56). These include the following: one, the need to lay much emphasis on the interests of patients in the process of service delivery; two, the ability to provide innovative solutions in service design that transcend hierarchical relationships within the organisations; three, the need to balance management responsibilities while remaining active in clinical practice; and lastly, the ability to address the shortcomings of the health systems and communicating their vision with the colleagues (Robertson, 2010, p. 57). These views correspond to the findings by Stanley (2006), who in a study, identified different perspectives that define clinical leadership by nurses, which include clinical competence and knowledge (p. 109). For nurses to be identified as effective clinical leaders, they have to be skilled, competent and credible in a particular area of the profession. Also, since the healthcare environment is characterised by complex teams of professionals and constant interactions, nurse leaders are required to demonstrate a high degree of knowledge about managing teams and relationships (Stanley, 2006, p. 110). Both professional leaders share different aspects in their approach to clinical leadership, for instance, both doctors and nurses who hold managerial positions in healthcare organisations focus on building consensus among colleagues as a primary method of influencing and implementing decisions (Robertson 2010, p. 24). Also, there is the need for clinical leaders to possess clinical credibility. This applies for both doctors and nurses who, after being appointed to leadership positions, are required to maintain a strong commitment to the welfare of patients (Jonas, McCay & Keogh, 2011, p. 12). This is critical for the clinical leaders to effectively manage and influence their colleagues. Apart from developing general physicians to take up leadership roles in healthcare organisations, focusing on leadership from clinical nurses varies not only in terms of approach but also in its form of practice (Stanley, 2006, p. 111). The essence of developing nurses as leaders in healthcare organisations focuses on equipping them with the requisite skills and resources needed in order to enable them make sound and rapid decisions (Gillam 2011, p. 113). Unlike the traditional approach, such programmes do not prepare individuals for organisational leadership as such but rather seek to empower them to take up leadership roles in their capacity as frontline healthcare givers (Scott 2010, p. 91). Although increasing the number of clinical leaders is one of the methods aimed at reducing the imbalance between clinical forces on one hand (represented by competing professional interests) and the need to administer managerial principles (represented by professional management approaches on the other), in healthcare decision-making, the approach is faced by a common challenge of high level of professional autonomy with relative lack of hierarchy in healthcare organisations (Scott, 2010, p. 86). Approaches to Management in Healthcare Organisations Leadership in healthcare is a complex interaction of different systems and interests. It has already been pointed out that healthcare organizations entail a complex interaction of different professional interests and the need to meet public expectations, deliver adequate and acceptable services to the clients and manage other strategic and organisational processes that define a modern organisation (Garcarz, Chambers & Ellis, 2003, p. 24; Hartman & Crow, 2002, p. 365). This complexity is enhanced by the complex nature of interaction between administrative functions and the need to focus on the welfare of patients (Hartman & Crow, 2002, p. 356). On the other hand, management thought has moved progressively from the initial theories that emphasised on the quality of individual leaders in a top-down approach to present theories that focus on managing organisations as complex entities (Garcarz, Chambers & Ellis, 2003, p. 35). Whereas the general approach of introducing managerial practices in healthcare organisations was aimed at improving efficiency and output of healthcare organisations by breaking the barriers of decision-making, the process has resulted in new challenges. For instance, leadership in healthcare is still seen in terms of being a role that is executed by individuals within the hierarchical setup of administration (Fitzsimons, 2011, 318; Fulop, 2012, p. 10). This means that the conditions in which clinical leaders operate do not favour development of new approaches to management that can foster improvements in the overall performance of healthcare organisations. Also, whereas many general managers and clinical leaders support the standardisation of clinical systems and working in teams to address the issues of safety and outcome of clinical practice, the use and effectiveness of teams in healthcare has generally been underutilised (Fitzsimons, 2011, 320). This is because of the increasing conflict between physician leaders and their colleagues with regard to the use of teamwork, decision-making processes and professional interests (Gillam 2011, p. 112). Different approaches to management have been proposed as a solution to the issues that have been mentioned before. Many of these approaches focus on transforming leadership from a single actor approach to a scenario where multiple actors share in executing leadership responsibilities. In such an approach, leadership is interpreted in terms of organisational effectiveness as opposed to leader-follower relationships (Bolden, Gosling, Marturano & Dennison 2003, p. 24). This means that leadership duties are distributed across the entire organization at different levels. One viable approach that can be a solution to the current problems in healthcare organisations is post-heroic leadership (James, 2011, p. 4). Such an approach is rooted in the need to develop leadership within organisations as a process that focuses on different individuals as opposed to the heroic models of leadership that focused on the attributes of individual leaders and how they influence others (Bolden, et al., 2003, p. 27). Under this approach, leadership is defined in terms of the following key functions: one, providing direction in terms of widespread agreement on objectives; two, aligning the entire organisation in terms of developing coordination in all processes; and lastly, inspiring commitment within individuals by helping them share collectively the objectives of the organisation (Fulop, 2012, p. 12). In essence, post-heroic leadership seeks to include multiple actors in leadership who act at different levels within an organisation but work collaboratively and both formally and informally (James, 2011, p. 14). Also, under this approach, leadership is distributed away from the top levels of an organisation to different ones where many individuals take up leadership responsibilities within the organisation (James, 2011, p.15). This approach takes into account the essence of healthcare organisations as complex adaptive systems (Begun, 2003, p. 263). Scott (2010) observes that healthcare organisations are complex adaptive systems which are characterised by a network of interacting and interdependent agents who are connected in a dynamic and cooperative way by common objectives (pp. 98-99). Because of this, this approach can transform leadership in healthcare organisations from the traditional individual-based approaches to new multi-level leadership approaches. Conclusion This paper has discussed the complexity of managing healthcare organisations in light of the need role and quality of clinical leadership. It can be concluded that the best approach to managing healthcare organisations lies in adopting a system that incorporates administrative leadership and adaptive processes. Since healthcare organisations are complex adaptive systems that are made up of many administrative units linked in complex hierarchical patterns, adapting an approach that develops leadership levels that operate away from a central authority while at the same time maximising the use of administrative units can be a viable option. References Begun, J. W. (2003). Healthcare organisations as complex adaptive systems. Retrieved 23 August 2013, from http://change-ability.ca/files/Complex_Adaptive.pdf Bolden, R., Gosling, J., Marturano, A. & Dennison, P. (2003). A review of leadership theory and competency frameworks. Retrieved 23 August 2013, from http://www2.fcsh.unl.pt/docentes/luisrodrigues/textos/Lideran%C3%A7a.pdf British Medical Association. (2012). Doctors’ perspectives on clinical leadership. 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