Networks - a briefing paper for the Health Foundation - Centre for ...

3.5 LeadershipHealthcare leaders face unparalleled challenges: The leadership required to establish anetwork is often different from the leadership needed to sustain a network. In contrast tohierarchies and markets, networks organise through cooperative means (Thompson et al.,1991) based on trust.Leaders connect members, and leaders emerge within the networks based on thespecified task/issue. Leadership is more fluid – it passes from person to persondependant on what’s needed over time (CIHM, 2012).Dearth of professional leaders: Evidence suggests that formal leaders deliver lessthan informal leaders (leading change and improvement in health and social care)and the health field has not fully embraced a culture of leadership development(Rosen et al., 2011). Research (Ghosh et al., 2010) is starting to explore relationsbetween developmental networks and leadership (Dobrow et al., 2011).Much resource is available to develop the leadership skills and competencies in GPsand other professionals, although they fail to adequately promote professionalleadership of integration work (Rosen et al., 2011).The message from the US medical groups is however unequivocal: without arelentless focus on securing and sustaining high quality leadership andmanagement of local services and clinicians, many of these GP consortiacould struggle. This would not only be a failure for the clinicians committingtime and energy to GP commissioning but, more importantly, a lostopportunity for both clinically-led service improvement and a reduction inavoidable hospital admissions. (Thorlby et al., 2011: p.17)In the NHS, whilst the policy drive is towards integration, Rosen argues that actuallywhat is needed for senior clinical leaders is the ability to integrateIn the NHS there are, as yet, very few clinicians leading such networks ororganisations, although the introduction of clinical commissioning groups mayhelp to develop a new generation of leaders. Leaders’ attention should befocused on developing a full set of integrative processes, with mutuallysupportive links between clinical, organisational, informational and financialprocesses, in order to enable the delivery of integrated care for patients(Rosen et al., 2011: p.39).3.5.1 Leadership Behaviour in Networks and Structural BarriersLeadership in networks differs from that of traditional organisations because it requires adynamic and innovative approach to instigating and realising change in complex interoperablecontexts (Huxham and Vangen, 2000). Network leadership is widely seen ascollective, emergent, distributed and facilitative. Umble and colleagues concluded thatnetworks provide the ‘collective creativity and broad support needed to enact system andinfrastructure changes’ (Umble et al., 2011). Research has found that that individual networkleadership does not automatically emerge without embeddedness in significant andcooperative processes of dialogue and discourse (Weibler and Rohn-Endres, 2010). Thosetasked with leading networked collaborations must concentrate on membership (coalition)infrastructure and its functioning, and concurrently understand both the immediate contextwithin which they are working and the wider context of the external environment(Wandersman et al., 2005). Health care networks help to address ‘wicked’ problems (or49