Leadership Imperatives in Healthcare

Introduction

Leadership is an integral part in healthcare today, particularly in relation to the attainment of a transformed healthcare system as envisioned by most healthcare organizations. The significance of leadership in healthcare is further brought about due to the multiplicity of the complex challenges that the healthcare systems face regarding their ability to provide safe, affordable, and quality care to service users (Porter-O’Grady and Malloch, 2011). In order to address these challenges, which would in turn notably influence (improve) the quality of healthcare provided and enhance the present healthcare models and the roles played by each healthcare organization member, it is imperative that public healthcare practitioners and professionals should demonstrate knowledge of leadership as well as possess leadership skills (ACN, 2015). It is thus, important that healthcare leaders are available in the various healthcare system levels, to utilize the leadership skills and knowledge they possess to tackle the many challenges that they routinely encounter, a majority of which require critical thinking.

The aim of this essay is therefore to discuss the various aspects of leadership, including leadership concept, leadership and organizational models, and the manner in which leadership and change models can be employed in delivering public health promotion programmes. This essay will critically define, analyze and discuss the key concepts of leadership, change and change leadership. Additionally, it will critically analyze tow leadership models and two change models, followed by a discussion on the role that leadership and leading change plays in public health.

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Background

Leadership has been described in various ways by different scholars. According to Northouse (2017), for instance, leadership entails a process through which one influences others in order to realize a shared goal. Northouse’s (2017) definition of leadership is almost similar to that by Kouzes and Posner (1995, p.30) who define it as “the art of mobilizing others to desire to struggle for the achievement of shared goals.” Ledlow and Colppols (2014, p.13), on the other hand, describe it as “the ability to assess, develop, maintain, and change the organizational culture and strategic system in order to meet the external environment’s needs and expectations.” These definitions are highly applicable to the healthcare organizations and professionals given that healthcare leadership mainly entails the development of a vision, promotion of healthcare system members’ ability to work in a manner that achieves change, addressing the diverse organizational, resource and other barriers, as well as motivating and encouraging other healthcare professionals (Kotter, 2012).

Change, on the other hand, refers to the process of evolving into something or someone different (from one state of affairs to the other). According to Wensing, Grol and Grimshaw (2020) change in the health sector implies the movement from currently employed healthcare systems and processes to new ones, which are perceived as better. The implementation of change in healthcare, just like in any other profession or industry, requires healthcare leaders to demonstrate strong leadership and skills- change leadership. However, despite the importance of change, the glorification of leaders who are able to effectively communicate vision and succeed in their change efforts, and the large body of research into how change can be effected, studies still show that while most organizations are immune or reluctant to change, two thirds of change initiatives by organizations that undertake change fail. This signifies the difficulty of managing change as well as the lack of total agreement on the factors that are core to change initiatives. The difficulty of change has also been argued by Karr (1849) (cited in Sirkin, Keenan and Jackson, 2005); “the more things change, the more they remain the same”. Change leadership refers to the use of strategies such as drive vision, access of the resources and personal advocacy to influence and encourage others required to develop a strong foundation necessary for the realization of change (Higgs and Rowland, 2000). However, the effective communication of a vision that promotes change has been a challenge for most change leaders. Change leadership goes beyond merely communicating intended changes- it should also take into account the various strategies, including top-down change and participatory approaches, so as to incorporate change campaigns that appeal to all organizational members. If this is not done, change leadership would be ineffective as it would merely result in change that does not affect reality on a deeper level, but rather cements the status quo.

Therefore, given that change necessitates the creation of a new system, which requires leadership, the realization of successful and sustainable change is highly dependent on the availability of effective change leaders who can establish and share a vision, and manage change resistance as well as conflict (Issah, 2018). This makes working together to establish a common understanding of the strategy needed to execute change and how best to implement it the core of change leadership.

Leadership Models

This section will describe and critically analyze the Healthcare Leadership Model and Covey’s 7 Habits Model.

The Healthcare Leadership Model, developed by the National Health Service (NHS), aims at helping healthcare professionals become better leaders. This leadership model outlines the things health system members can see their leaders doing at the workplace and is designed such that it helps all members, irrespective of the roles they play or type of care settings where they work, to identify ways of developing into/as leaders (Healthcare Leadership Model – Leadership Academy, 2021). The Healthcare Leadership Model comprises nine leadership dimensions, each of which includes the expected leadership behaviors that are highlighted on a four-part continuum (essential, proficient, strong, exemplary). The leadership behaviors in these scales are presented in a series of questions that briefly describe what the leadership dimension is like at each section of the scale, and which also directs how a leader should interact with others, and they with him/her (Healthcare Leadership Model – Leadership Academy, 2021). Behaving the way a good leader does would in turn directly impact on healthcare professionals’ colleagues, the teams they work in and with, and the overall team and organizational culture and climate (Healthcare Leadership Model – Leadership Academy, 2021). Additionally, this can impact on their care experience, whether or not they work directly with service users/patients, as improving the identified qualities would cause them to focus on providing patients, their caregivers and families with high quality care and services. The nine leadership dimensions outlined by the model include: inspiring shared purpose; leading with care; evaluating information; connecting our service; sharing the vision; engaging the team; holding to account; developing capability; and influencing for results (Healthcare Leadership Model – Leadership Academy, 2021).

Authentic leadership refers to a leadership model in which leaders are expected to demonstrate behavior or leadership that can be described as transparent, honest and genuine with the aim of developing trust and inspiring others to follow them (Qiu et al., 2019). This model’s key components are: internalized moral perspective, self-awareness, relational processing and moral processing (Alilyyani, Wong and Cummings, 2018). However, the authentic leadership model is limited since it lays stress on the health organization members as opposed to the service users, who should ordinarily be central to the healthcare system. According to Francis (2013), strictly following this model would result in healthcare organizations and practitioners; looking inwards rather than outwards, lacking consideration for patients, being defensive and develop misplaced assumptions regarding the actions and judgements of other people, and failing to prioritize service users. Therefore, whereas the model impacts on the way the organization and organizational members behave, it has limited impact on the organization’s outputs- patients’ expectations of care and their health outcomes (Ellis and Abbott, 2010). Therefore, Ellis and Abbott (2013) suggest that the NHS Healthcare Leadership Model should, following the Francis (2013) report, put patients first, give frontline staff the responsibility and freedom in order to empower them to act in the patients’ interest, as well as support for leadership and offer leadership that is strong.

Covey’s 7 Habits Model is premised on the philosophy that change starts from inside an individual and works its way outwards. According to Covey, an individual’s character is a collection of their habits, including skill, knowledge and desire, and effective people demonstrate 7 key habits: “proactivity; beginning with the end in mind; putting first things first; seeking first to understand and then be understood; thinking ‘win-win’; synergizing; and sharpening the saw”. The three foremost habits enable leaders to develop from dependence to independence. Therefore, leaders must take charge of their environment by being proactive rather than reactive, think about the future with the sought-after outcome in mind, and manage themselves by implementing activities that influence the second habit’s attainment. After the achievement of independence following the three foremost habits, the three successive habits facilitate managers’ interdependence, whereby they rely on their subordinates more or less to the degree which the subordinated depend on them. Effective leaders must therefore think of ways of developing win-win situations (by, for example, developing positive relationships through effective communication), try to understand others before others can understand them, and develop synergies through which they work with others to achieve common goals. The seventh habit, sharpening the saw, enables leaders to become better by continuously learning from their experiences.

However, while the model contributes to improving leaders’ fundamental effectiveness, It is limited in the sense that each leader’s values and beliefs regarding what is important vary. Therefore, what one leader may perceive as useful may not be as important to another, resulting in the various habits having different degrees of importance among different leaders.

Change Models

Kurt Lewin developed the three-step change process in 1947 as a way of implementing organizational change. The three steps of the change process as identified by Lewin (1947) are: unfreezing, changing and refreezing. This change model is preferred given that it effectively facilitates leadership interventions and the management of employees’ attitudes/perceptions (Burnes, 2014). The unfreezing step, given that people are naturally bound to resist change, is important as it involves creating awareness on how the current status quo or acceptability level is prohibitive (Lewin, 1947). Unfreezing follows a careful examination of old ways thinking, behaviours, processes, and organizational structures so as to demonstrate to the organizational members the necessity of change in order to develop or maintain competitiveness. Communication is important in this stage as it mainly involves informing employees of imminent change, the rationale for it, and its benefits, with the aim of motivating them to embrace the change (Hussain et al., 2017).

The second step, changing, is where the change is implemented. It is a period marked with uncertainty and fear, as people struggle with the new reality of the need to learn new behaviors, ways of thinking and processes (Lewin, 1947). This is the hardest step, but which can be easily accomplished with adequate preparation. Cummings, Bridgman and Brown (2016) assert that it is therefore important that employees are educated, informed and supported sufficiently in order to get them accustomed to the change, and to be constantly reminded why the change is being implemented and its benefits.

Refreezing is the third step, and which involves reinforcing or solidifying the new state whereby the changes made are endorsed and cemented as the new way of doing things/thinking. This step is essential as it helps ensure that people do not revert to former behavior or ways of thinking, thereby change is not lost (Lewin, 1947). This can be done through acknowledgements and positive rewards which could promote the repetition of positively reinforced behavior.

The 8-step process for leading change, developed by John Kotter in 1996 involves 8 steps of implementing change, which include: “creating a sense of urgency, building a guiding coalition, forming a strategic vision, enlisting a volunteer army, enabling action by removing barriers, generating short-term wins, consolidating gains, and instituting change” (Kotter, 2012). Regarding the creation of urgency, people are unlikely to change if they do not identify the need to do so. It is therefore important to create urgency by demonstrating possible threats that may arise in future due to failure to change, initiating dialogues and broadly communicating the need for change to motivate change readiness and acceptance (Lv and Zhang, 2017). Forming guiding coalitions involves assembling a team of influential/powerful individuals within the organization to lead the change and drum up support for it. The third step, developing a vision and strategy, involves developing a vision of what the change entails and telling people its importance and how to attain it. The achievement of this can be done by relying on the organization’s core values and using change leaders (enlisting a volunteer army) that can effectively communicate the vision to others to enable them understand and accept it (step 4) (Kotter, 2012). Enabling action- the fifth step- involves engaging people and encouraging them to reflect on the change process, including how best the change can be accomplished, and implement strategies that will remove barriers to the process. Generating short-term wins involves acknowledging the changes happening, and recognizing people’s efforts towards the attainment of change, while the seventh step (consolidating gains) enables the organization to involve people as change agents, in order to gain momentum and build upon the already realized successes (Kotter, 2012). The final step, instituting/anchoring change, enables the changes achieved to be cemented into the organization’s culture, failure to which the organization will lose the change, and members go back to the old ways.

The Role of Leadership and Leading Change in the Field of Public Health

Leadership plays a key role in public health. Through leadership, there have been increased calls for change that have resulted in a shift of focus from individual to community-wide approaches aimed at the improvement of public health (Frieden, 2015). This is a vision whose realization is critically dependent on leadership, which significantly determines the effectiveness or success of change initiatives. Leadership generates essential attributes that are necessary in leading change in public health, including vision, influence, values, and competencies (Yphantides, Escoboza and Macchione, 2015). Leaders are able to envision a future that is different from the current status quo; leadership promotes health organizations’ ability to envision a new system, which Berwick, Nolan and Whittington (2008), define as being aimed the provision of improved health for the populace and better care for individuals at affordable (the lowest) rates. On the account of this vision and its conciseness, leaders are more effectively facilitated to communicate it to other people (healthcare professionals), build consensus, involve all stakeholders, and promote collaboration in order to enhance its acceptability throughout the health system.

Leadership, owing to the knowledge, skills, expertise, and contribution of leaders to the healthcare system, bestows upon leaders the influence they require to promote wide-spread change (Yphantides, Escoboza and Macchione, 2015). Influence enables leaders to get others to see and accept their point of view and the need for change. Through their influence, health leaders have interacted and expanded their relationships with other health professionals beyond their conventional disciplines or departments, thereby improving, interprofessional, interdisciplinary, interagency and inter-organizational collaboration in healthcare, which significantly contributes to the promotion of public health and safety (Yphantides, Escoboza and Macchione, 2015).

Leaders’ possession of certain values (including collaboration, teamwork, and servant leadership) and competencies (knowledge, skills and attitudes) have enhanced their effectiveness in driving change (Rowitz, 2014). These values and competencies improve their understanding of the developments that the sector has undergone and continues to undergo, and therefore their ability to develop and implement changes that contribute to the improvement of the health system.

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Conclusion

Leadership is a key aspect in healthcare given the crucial role it plays in transforming the healthcare system to provide service users with affordable, safe and quality care. It is therefore important that healthcare professionals at all levels develop their leadership knowledge and skills so as to better carry out their roles, one of which is leading change, which can be implemented using various methods including Lewin’s (1947) 3-step change process and Kotter’s (1996) 8-step process for leading change.

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