Leaderitis

It's time to do away with another obsession that prevents meaningful improvements in health care.

Who doesn't love a good leader? Someone that (assuming he or she is not a alleged sex offender, racist, pedophile, or bully, that is) can parachute into any beleaguered institution - hospital, medical association, Ministry - and sow so many innovative, integrated, visionary ideas, that through the sheer force of personality, can't help but streamline processes, save money, improve outcomes, reduce burnout, generate enthusiasm, reinvigorate a culture, inspire through example, communicate audacious goals, and disrupt, disrupt, disrupt!! Yes, we have an instinctive, magnetic attraction to visionary leaders, and are always looking to train more and more of them in health care.

So, much like our preoccupation with data metrics, and our twenty-year sinkhole of money investment into electronic health records, health care can't seem to get enough leadership. Not surprisingly, the tally of leadership skills prized among health care professionals, doctors in particular, now meets or exceeds the number of basic Biblical commandments. Whether any of these skills matter to the patients being cared for, or the vast expenditures of time it takes to acquire them, doesn't seem to enter much into the discussion.

The persoalan in health care these days, at least as I see it, has little to do with a lack of leadership. People in health care still do their damnedest to get the job done, even if they don't play nicely with one another. And for all the blame dumped on "entrenched interests" that "refuse to change their old ways", there is just as much, if not more, misplaced faith in management schemes and computer systems that have become the bane of health care practitioners.

Instead, the persoalan is three-fold. First, no matter how hard we try to apply management and systems thinking to health care, it is ultimately about a single caregiver, or small team of caregivers, engaging in real human interactions with real human patients. No guidebook or business-school fad or mathematical model can account for human emotions and human relationships.

Second, the declared need for "better leaders" has become just another stock excuse to deflect criticism from the mishandling of real system-wide problems. Can anybody say with a straight face that "better leaders" will fix critical overcrowding in hospitals? Or work magic on mental health patients with resources hopelessly inadequate to meet demand?

Finally, and most importantly, the essential contract at the heart of leadership - the exchange of authority for accountability - is moribund in modern health care systems. Forget politicians, who as a profession are conditioned not to take responsibility for their decisions...what about the executives and bureaucrats hired to make sure the systems run as designed and intended?

With shortages of family doctors set to reach crisis levels, are administrative leaders acting with any sense of urgency? Have any of them lost their jobs?

If regional health authorities fail to make the grade after ten years, are the executives held accountable? Are the respective Boards dissolved and replaced? Does anyone admit the idea in both design and execution was a failure, and scraps the authorities completely?

When home care agency executives give themselves raises at the expense of front-line care, are the Boards taken to task? What about the senior bureaucrats in charge of oversight?

When hospitals face unprecedented gridlock, forcing the cancellation of surgeries and acutely sick people to languish in hallways, are the regional health authorities held responsible? What about the Ministry Directors or Assistant Deputy Ministers? Or the Deputy Minister him- or herself? Or the Minister of Health?

These questions are naturally rhetorical. Nobody in a position of authority takes ownership of any problems in health care, nor admits fault for failures that result from a bad idea or a willful lapse in governance. Instead, there's allege they - and not the people they were hired to serve - were wronged, or just the collection of a pension and a ride off into the sunset.

Good leaders are an asset, not a panacea. They can boost morale, iron out group dysfunction, and streamline operations. But it's the people on the ground and the front lines that do the work, whether in health care, education, or the military. Those are the people that need respect and appreciation, not the ones standing in the back, basking in the view. Leaders are quite often simply in the right place at the right time, and even the most effective in world history - Pericles, Winston Churchill, Napoleon - can run out of luck and wear out their welcome.

So the next time people with real power - politicians, senior administrators, Board directors - harp on and on about the need for "strong, innovative" leadership in health care, ask one question: if they aren't the ones to provide the accountable leadership the system so desperately needs, why aren't they stepping aside?

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Ditulis Unknown — Saturday, February 3, 2018 — Add Comment — accountability, burnout, capacity, collaboration, health policy, hospitals, leadership, medical associations, politics