How Leaders Can Meet These Challenges

The bureaucratic system guiding health care delivery has allowed health care quality to diminish and costs to rise every year for the last several decades. These quality and cost issues have occurred despite a great deal of attention from health care managers to containing costs over the last few decades. These cost increases and the diminished quality of health care services are not sustainable for our businesses, people, and economy for the long term. In the past thirty years the federal government, one of the largest payers of health care bills, has focused a great deal of attention on reforming the system of health care delivery. The end of bureaucracy in health care organizations does not mean an end to management in health care services delivery. We will always need management in health care because we will always require efficiency. However, it has become increasingly clear that our system of health care delivery requires a complete reorganization of the way these services are delivered to the consumers of health care. The only way to meet and survive the many challenges is through the development of leadership skills in every person who works for the health care organization.

According to Rubino, Esparza, and Chassiakos (2014), managers spend the bulk of their time looking internally, with a major concentration on organizational processes. Leaders, in contrast, attempt to influence followers and spend their time monitoring external forces. This improves the leader's ability to predict changing environmental trends and to assist his or her followers in dealing with impending change. However, the leader can influence others only if these individuals allow themselves to be influenced. They are more likely to be willing to do this when they have respect for the leader and trust in him or her to do the right thing, for both the organization and the individuals who work for the organization.

In order for health care leaders to be successful in goal accomplishment, they will have to rely on their empowered staff to become creative in their approach to the delivery of health care services to customers in a transparent environment. This, in turn, will require the development of a positive culture in which employees can work in a collaborative manner to deliver appropriate and quality services to what will be very demanding customers. To be successful, health care organizations should be taking an outcome' oriented approach, supplemented with attention to the amenities that can and should be part of excellent health care.

The improvement of health care services is obviously a very difficult challenge that will require trial and error by both those in charge and those who follow. Harford (2011) argues that this trial-and-error process will most likely result in some failures, and this is why health care organizations must learn to adapt. His advice for successful adaptation is to experience three essential steps along the way: “to try new things, with the expectation that some will fail; to make failure survivable, because it will be common; and to make sure that you know when you've failed” (p. 36). The key here is to attempt to keep the failures to a minimum but also to learn from them. Failure can be a powerful tool in the process of leadership development. The development of leadership skills takes years, a great deal of experimentation, and a tolerance for some mistakes in the process.

This advice to help leaders and followers to successfully adapt to the changing health care environment sounds simple enough, but there are numerous barriers to successful implementation of the entire process. The greatest barrier will be overcome when the organization develops the ability to admit failure in the delivery of efficient and effective health services. Then leaders and followers can look at other potential solutions. In order to make this happen in health care, we need two things: leadership must emerge and followers must become aligned with the leadership.

Leaders and followers who are capable of becoming future leaders must face and eventually find solutions to very difficult challenges.

According to Andersen (2012) leaders require special characteristics if they are to gain followers who will support them in their current task or vision. These characteristics include being “farsighted, passionate, courageous, wise, generous and trustworthy” (p. 8). The most important characteristic the health care leader can exhibit is the ability to take a farsighted approach to confronting challenges. The leader needs to provide an honest vision of where he or she wants to take the health care organization in the long term. In order to get the followers on board in fulfilling this vision, the leader needs to be able to explain why it is the correct vision to follow at this point in time. In order to gain the trust of followers, a leader must be confident not only in the vision but in the method chosen to accomplish this vision.

Andersen (2012) points out that individuals are attracted to leaders who provide a farsighted approach to challenges and who see potential solutions for these challenges that will involve the followers.

Leaders Who Are Farsighted . . .

• See possible futures that are good for the enterprise

• Articulate their vision in a compelling and inclusive way

• Model their vision

• See past obstacles

• Invite others to participate in their vision [Andersen, 2012, p. 25].

These five important behaviors act like guideposts that point to a possible solution to the challenges faced by the health care industry. For example, individuals in positions of power need an articulated long-term vision and the ability to model this vision for their followers. These individuals need to be aware of obstacles in the way to achieving their vision and then work past the obstacles.

According to Kouzes and Posner (2010), the ability to imagine a future and then attract followers to share that future is one of the most important competencies of successful leaders. These leaders have the ability not only to see a future but also to convince others that this future is a real possibility. In fact Kouzes and Posner (2010) also discovered in their research that being forward looking is second only to being honest as the most admired aspect of leaders. It seems that followers desire leaders who have a strong vision of where they want to take their followers in the long run. These desired leaders are also honest with their followers about just how difficult it is to achieve the vision but are charismatic enough to gain followers' acceptance in their attempt to beat the odds.

There is no question that an important factor in the ability to lead an organization is the accuracy of the vision put forth by the leader. Reynolds (2013), in her book Prescription for Lasting Success: Leadership Strategies to Diagnose Problems and Transform Your Organization, argues that in order to build a dynamic organization the leader needs to apply the 4 P's model – Purpose, Passion, Planning, People – and also have the ability to Persevere. This model can be used to improve the way each health care facility diagnoses its problems and develops a plan to correct them. Reynolds, a physician, argues that health care facilities need to make a diagnosis of their major problems from the outside in and then deal with the real problems, not the symptoms of these problems.

Leaders are responsible for getting things done through their people; that is, through the professionals who actually deliver the care to the patient or consumer. Spiegelman and Berrett (2013) point out that if organizations do not treat their employees properly they shouldn't expect these employees to treat customers any better. In their book Patients Come Second: Leading Change by Changing the Way You Lead, these authors point out that if health care organizations treat their employees with respect these employees will, in turn, most likely do the same with patients, creating a culture of excellent service. This is the same philosophy that has been followed by a large number of businesses in the private for-profit sector of our economy. The former CEO for Southwest Airlines, Herb Kelleher, practiced this philosophy, resulting in a profit for his company in every year of his tenure.

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