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.

Consolidation of pathology services in England: have savings been achieved?

BACKGROUND: During the last decade, pathology services in England have undergone profound changes with an extensive consolidation of laboratories. This has been driven by some national reviews forecasting a national reduction of costs by £250-£500 million ($315-$630 million) a year as a result. The main aim of this paper is to describe the financial impact of such consolidation, with a specific focus on the forecasted savings. A secondary aim is to describe the development of private sector involvement in laboratory services in a traditionally publicly funded healthcare system and the development of pathology staff size. METHODS: In the English scenario, the majority of hospitals and laboratories are publicly funded and a survey was sent as Freedom of Information request to all directors of pathology. A descriptive comparison of savings among consolidated and non-consolidated pathology services was made by using the pathology budgets in two different periods (2015 versus 2010), adjusted by inflation and increased activity. RESULTS: The hub-and-spoke model has been implemented as part of the consolidation process of pathology services in England. Consolidated pathology networks have achieved higher savings compared to non-consolidated single laboratories. There has been an increased role of private providers and savings were achieved with negligible personnel redundancies. CONCLUSIONS: Consolidated units have on average achieved larger cost savings than non-consolidated units but further analysis with stronger research design is required to independently evaluate the impact of pathology consolidation on both savings and quality.

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.

Leadership development in health care in low and middle-income countries: Is there another way?

Leadership and management capacity is an important factor in the health care systems of low and middle-income countries (LMICs) due to resource scarcity and a high burden of disease. The paper identifies the key concerns of health care policy-makers and health care leaders and managers in LMICs and, in the case of the latter, what is led and managed. It examines the two major education and training approaches adopted to develop such capacity and the cultural context against which development takes place, noting that leadership and management development in LMICs needs to reflect local cultures. From this consideration, it is proposed that action learning (which already has a track-record of application in LMICs) would be a practical way forward.

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.

Effective medical leadership development for a complex NHS.

The NHS Leadership Academy in England is investing £46 million in a standardized model of development, with academic qualifications becoming essential in future NHS leadership roles. This represents a cul-de-sac for medical leaders because it is based on a series of misplaced assumptions about health-care leadership and its development.

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.

Clinical leadership: the challenge of making the most of doctors in management.

The need to develop the leadership and management capability of clinicians is deemed fundamental to address the cost and quality issues associated with health-care provision. The challenge facing the NHS is how best to bring this about.

Clinical leadership: the elephant in the room.

The article explores the concept of clinical leadership in the National Health Service in the UK by seeking to establish a workable definition and by contrasting it with managerial leadership, focussing on the 'disconnected hierarchy' in professional organizations. It proposes that the problems faced by clinical leadership relate to the current nature of general management in the NHS and concludes by suggesting that clinical leadership is the 'elephant in the room'-often ignored or unaddressed.

"Feel the fear and do it anyway": the hard business of developing Shared Governance.

The article provides an overview of recent lessons from the Shared Governance literature, a description of a 4-year evaluation study and a highlighting of important issues which emerge from this. Early UK Shared Governance implementation relied heavily on North American experience, but there is now a growing body of UK experience. The literature review draws upon evaluation research to date, provides a contextual description of the Shared Governance site and the approach adopted, together with a description of the quantitative and qualitative evaluation design used. The findings indicate that early problems had the most profound impact, that there were continuing chronic difficulties and that a number of important issues have subsequently emerged. The article concludes that there are some significant successes, but that Shared Governance implies cultural change, is subject to "fashion swings" and that there are practical limits to what can be achieved. Implementation means hard work but can produce worthwhile results.

Leadership development in health care: what do we know?

The NHS in England has developed a strong focus on clinical and managerial leadership. The article describes both emerging ideas on leadership models and approaches to developing leaders as a background to the description of two evaluation studies of leadership programmes for executive directors and the lessons learned for the future.

Learning to lead.

Effective clinical leadership has been central to the last government's modernisation agenda ( DoH 2000a ) and nursing has been one of the key groups targeted for development. Calls for the 'modern matron', for example, reflect the public desire for a named and accountable individual who will take responsibility for the quality of patients' experience and will intervene to make improvements where necessary.

Developing middle managers.

BOTH THE NURSING strategy for the NHS in England (DoH 1999 ) and the NHS Plan (DoH 2000 ) identify the importance of clinical and managerial leadership to the success of the government's modernisation agenda.