Health organisations are large complex entities
Many health organisations are complex and substantial organisations with significant budgets, employing large number of highly qualified staff, operating and owning substantial facilities and assets. Leading these organisations at the best of times has always been challenging. Increasing and mounting pressure are triggering another round of major "reforms, reviews, transformation" in a number of First world countries (UK, Canada, South Africa and New Zealand)
Reforms to-date have not addressed the pressures faced by First world countries health system. They are and will be temporary band aid because:
they focused on individual elements like funding, structure, workforce, facilities, integration, technology, etc rather than taking a whole of system approach.
lack of a robust dual transformation agenda
there is little or no focus on “leaders we need”.
Any reform agenda should have three foundation pillars. First the scope should not only cover comprehensively the whole of system but take a systems thinking approach (as suggested by David Stroh in his book System Thinking for Social Change) . Secondly it needs to have a dual transformation agenda (as set out in the book Dual Transformation by Scott D. Anthony, Clark G. Gilbert, Mark W. Johnson) that re-positioning of traditional core business and concurrently creating a separate new future. Thirdly, it needs look at the “leaders we need” for implementation. There is no point having a system thinking and comprehensive reform agenda and a dual transformation focus if we do not have leaders needed for implementation.
Lesson from a case study in health system reform
One of the great experiences in my career was to be part of a Ministerial Review Group (MRG) tasked with making recommendations (within existing legislative framework) to improve the sustainability of the whole health system. Most of the recommendations were accepted by the government of the day. However during implementation some initiatives made progress while others got bogged down.
Recommendations that struggled with implementation were largely due to the fact that “we did not have the leaders we need to do the job”. MRG made a fundamental assumption that the system had the “leaders we need” for implementation. So as I look at several First world countries going through another round of major “reviews, transformation and reforms” I cannot help but feel that the same flawed assumption is being made.
Styles of leadership
Today’s leadership model as described by author Michael McCoby is largely “master craftsman and industrial style leaders”. In today’s knowledge economy characterized by rapid and constant changing environment fueled by a digital revolution these models of leadership are no longer appropriate. Today’s challenges and opportunities are far too complex for traditional master craftsman and industrial style leaders to cope with. Their response to today’s environment is too linear, slow, top-down and autocratic. What is needed is a knowledge based network leadership model. This model focuses on having a network of leaders capable of working as a team to provide the width, depth, agility and speed in their responses. This model de-emphasizes big personality, and big ego mentality type of leadership.
Complex and complicated challenges
Complex and complicated challenges require very different responses. Often these two words are used interchangeably. The Cynefin framework clearly highlights a seismic difference between the two. Complicated challenges for example can be solved by good solutions developed with the help of experts and data analytics. However, for complex challenges searching for best or good practices or solution is the wrong response. The response for complex challenges is a discovery mind-set implementing a portfolio of safe to fail initiatives.
Therefore these two very different responses need two very different types of leaders with different talent, temperament, skill, knowledge, capability and capacity.
Talent, temperament, skill, knowledge, capability and capacity
Comprehensive reform agenda with a dual transformation focus needs to carefully also look at the different talent, temperament, skill, knowledge, capability and capacity needed for implementation .Often these terms are used interchangeably and there is either confusion or lack of clarity of what they mean. For the purpose of this article let’s put some definition around what they mean.
Talent is a natural ability that we were born with and stays with us. Temperament refers to our in-born behaviors and emotions we tend to exhibit that remain stable throughout our lifetime. Skills are the proficiency developed through training and practice. Knowledge is the theoretical understanding of a topic or subject. Knowledge can be acquired and learned through multiple channels including discussions, workshops, conferences, seminars and academic qualifications. Capability refers to the skills and knowledge required for a particular task for example “change management”. Capacity refers to our ability to absorb change or undertake multiple concurrent complex interrelated projects effectively.
For example the team leader and team members leading complex initiatives with high level of fluidity, ambiguity and tight time-frames should have:
talent for thinking outside the box,self- directing and decisive
calm and positive temperament,
knowledge of system and agile thinking,
skillful in navigating changing priorities and
capacity to drop, change and add new areas of work on short notice
Suggestion for your reform agenda – leaders you need!
Make sure there are two distinct teams: one to focus on re-positioning current system and the second to focus on creating the new future. A common mistake is assuming that the same team can do both.
The leaders and team members of these two distinctly separate teams need to have the right talent, temperament, skill, knowledge, capability and capacity for the task at hand.
Within each team ensure that there is alignment of talent, temperament, skill, knowledge, capability and capacity is also a recipe for disaster. For example, there is no point having a team with the right talent and temperament but with insufficient and inappropriate skill, knowledge and capacity.
Final word
Not too long ago I listened to a talk on “the leaders we need”. The speaker outlined an asymmetry gap between the leaders we need and the leaders we have and want. I took four points from his talk:
Leaders need to be able to check their egos in the interest of greater good
Leaders need to have a shared purpose of greater good beyond their own agenda
Leaders need to value team more than any individual especially themselves
Leaders need to have courage to take responsibility, learn and act
Any reform agenda where their leaders do not meet the above 4 characteristics no matter how talented, skillful, knowledgeable and capable will not be successful.