Book Reviews
Leading Health Care Organizations
Sue Dopson and Annabelle Mark (eds)
ISBN: 1-403902-70-4 2003 265 pages Palgrave Macmillan
Beverly Sibthorpe
I confess to having been ill-disposed towards this volume a few sentences into the preface. Here Keith Grint justified its publication by arguing that even though there have been over 12,000 books written about leadership, we do not really know if it makes any difference or how. This seemed at once indefensible (if true, a monstrous waste of scholarly and other effort that should not continue) and patently untrue (as the papers in the volume went on to demonstrate). Suppressing the urge to read no further, I went on to find this collection a good demonstration of the fact that we do know quite a lot about leading health care organisations.
This is the third volume arising from the Third International Conference on Organisational Behaviour and Health Care held at the Said Business School, University of Oxford, in 2002. The conference theme was leadership in health care and the 15 papers selected for this volume are organised into three sections reflecting areas of focus at the conference:
- the nature of leadership in health care
- leading health care organisations; and
- taking health care forward in the 21st Century.
The section devoted to the nature of leadership in health care has five chapters covering medical leadership in primary health care networks (UK), ‘cognitive sculpting' in nursing leadership development (UK), leading multi-disciplinary teams (USA), clinical governance through effective leadership (UK) and an ethnographic study of clinical leadership in an ICU (UK). One of the more interesting is Sheaff and colleagues' analysis of the tensions between managerial and professional leadership in UK primary health care networks. Such analyses serve to remind us what an anomalous industry primary care health is in some countries (the UK and Australia amongst them): one where private business professionals are providing, for profit, a publicly funded public good. Not surprisingly this throws up major challenges for management, quality and accountability. Wells and colleagues' paper on how to empower workers of differing social and professional standing in multi-disciplinary teams offers some important lessons for effective leadership in this greatly expanded facet of contemporary primary health care. And Carmel's ethnography of leadership in an ICU, which highlights the importance of leaders being able to manage uncertainty, has relevance well beyond the bounds of this narrow clinical setting.
The section devoted to leading health care organisations has four chapters that address knowledge management and communities of practice (UK), inter-agency multi-disciplinary teams (USA), the conceptual and practical validity of contemporary constructions of ‘organisational leadership' (Australia), and the application of Programme Budgeting and Marginal Analysis as a tool to support resource distribution decision-making (Canada). Bate and Robert's knowledge management paper picks up on the National Health Service's (NHS) explicit interest in drawing on private sector know-how to inform knowledge management in the NHS. They sound a warning about NHS reliance on the Breakthrough Collaboratives method which, they argue, lacks some of the important characteristics of effective systems for knowledge management. Degeling and colleagues construe leadership as a ‘modality of authority' and highlight the importance of followership as a condition for leading. Their Australian case studies of clinical reform identify different underlying conceptions of work organisation and accountability which impact on followership.
The six chapters in the third section examine nursing role innovation in the NHS (UK), evidence-based medicine (US and UK), scenario planning for alternative futures (Canada), organisational mergers (UK), radical learning in health care organisations (USA) and a summing up chapter. Redfern and co-authors' study of nursing role innovation suggests that nurse consultant is a genuinely new role with scope therefore for innovation, but it also highlights threats to its potential from work overload and role ambiguity. Chambers and Dopson adopt a context-content-process model of evidence-based medicine (EBM) change to interrogate and summarise the US and UK literatures on EBM change projects. Not surprisingly, they show that EBM change is not the simple, rational process it is often portrayed to be. And Murray reports on scenario planning used by the Ontario Hospital Association. Participants came up with five hospital futures - reformed cathedral, focus factory, mall, broker and fire station - based on consideration of different social, health and health care scenarios. Each has different consequences for hospital planning.
Dopson and Mark's summing up is something of a surprise; it seems very much focused on the NHS and refers at length to material presented at the conference which is not included in the volume. They do however, neatly summarise the commonalities in health care organisations that have effective leadership:
Typically, leadership is distributed within the organisation, professional power is understood, the complexity of social relationships within the organisation is acknowledged and discussed, efforts are made to harness talent, and the contribution of different sorts of perspectives are valued and utilised.
All in all, there is much in this volume that would interest both researchers and practitioners. As the editors hoped, there is a good interweaving of theory and research to inform practice. I was struck though, by the lack of reference to Complex Adaptive Systems (CAS) theory, given the extent to which some of the authors draw indirectly or directly on its concepts (eg leadership as an ‘emergent property'). CAS theory is very useful for helping understand what health care organisations need in order to thrive in the face of ongoing change and uncertainty.
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