Leadership for the Sustainability of the Health System: Part 2 - Key ...

The solutions of the past, the demarcations among and between the professions, and the way theiraccountabilities have been defined (facility and profession based) are proving inadequate.In this context the priority of leadership and leadership development tasks involve focusing on thesystem from the patient journey perspective across the full continuum of care and dramaticallyincreasing the level of consumer engagement in policy, planning, facility and patientmanagement.Providing leadership that focuses services and providers on consumer andcommunity needDespite recent national and international effort, the deep culture of health services (and theprofessions that work in them) remains facility, disease and profession focused. The financial andnon-financial incentives in the system, while changing, still mainly support traditional role andpractice demarcations. These traditional demarcations no longer always match the pattern andlevel of need or the reality that the bulk of the management of chronic illness and aged carehappens away from service providers and, in fact, is ‘self-management’ facilitated or supported bythe health system. Unlike other innovative and successful industries, the use of ‘customer’ orconsumer views in the design of individual care plans, health services, facilities and systems is verylow. Health leaders themselves are most often a product of the formal and informal education thathas permitted this lack of deep interest in the consumer experience of health, ill health and healthcare.Building appreciation of, and capacity and confidence in, consumer engagement was seen as amajor determinant of health leaders’ influence with their colleagues and a key to successful culturechange with health professionals who are patient rather than corporately focused.The distinctive nature of the health workforce: leading leaders and autonomoushealth professionalsThe nature of the work in health services and the enculturation of health professionals result in aworkforce most focused on individual or group clinical outcomes, research and teaching.Corporate loyalties, where they exist, are to professions and the protection of professionalautonomy rather than to the achievement of organisational goals such as cost containment.Where organisational loyalties exist, they are often to the facilities in which people train and workbut not to the broader health system and even less to health departments. Leading system-widechange that requires the sustained buy-in of autonomous health professionals or healthprofessionals intent on the preservation of their alma mater or their role takes different skills fromthose that might be successful in other industries. It requires the ability to lead leaders andindividuals who are often enormously self-confident, independent and not trained for, orcomfortable in, follower roles.Leadership for the Sustainability of the Health System: Part 2 – Key Informant Interview Report Page 12