Gottfried Weilharter

Hospitals are very complex expert organizations. While to the outside world, hospitals are buzzing with activities aimed at achieving excellent medical solutions and caring patients in an atmosphere of tension between life and death, the real issues and problems within a hospital revolve around the challenges of increasing developments in medicine and quality of the organization and it's personnel.

The development of Leadership Competence in a hospital depends on several criteria, like training programs (cf. Chapter 20 in this volume by Brock, Garbsch, & Wilhelmer) collaboration structures between leaders on different hierarchical levels and between different professions. Besides all that a consulting concept put forward to the managers in different hierarchical levels is of crucial importance.

This report describes a complex structure of consulting and support for leadership. This consulting structure is build up in a public regional hospital owner in the province of Upper Austria. Owning a market share of approximately 45%, the Upper Austrian Health and Hospital Corporation (gespag) is Upper Austria's major hospital owner, operating 10 hospitals. The gespag employs about 10.000 people, of which about 500 are leaders in different hierarchical levels. The legal form of the Upper Austrian gespag is a public limited company. The province of Upper Austria is the sole owner. The top management consists of the supervisory board, 3 executive directors and 5 departmental directors. The gespag management center embraces about 60 people. Each of the 10 hospitals of the gespag is managed by three directors: medical director, director of nursing and director of finance and administration. Each department in a hospital, for example the department of surgery, is managed by two persons, one member of the medical staff and one of the nursing staff.


Management, leaders, and employees in hospitals have to deal with complex personal and organizational problems and challenges.

Hospitals are as expert organizations permanently confronted with conflicting expectations of action and performance based on their environment: politics, economy, science and citizens as patients. Understanding the intrinsic logic of these four subsystems of society becomes a central condition for the planning and implementation of change processes in health-care organizations.... [Leaders] have to prove their capability to understand the different sub-systems of health organizations and to meet the specific needs of all key players involved. Acting as reliable role models for trust-based dialogues, being an "alien equal" among equals as well as keeping professional distance from all different stakeholders of the health-care organizations turn out to be success factors for managers. (cf. Chapter 20 in this volume by Brock, Garbsch, & Wilhelmer)

Hospitals need professional organizational development (OD) support, which has to be created by successful cooperation between management, internal and external consulting competences.

My main experiences in 13 years consulting in hospitals are: first it's necessary to solve problems in communication and cooperation there, where they arise, to be specific, between directly involved participants— "stakeholder of the problems." Moreover it's important, that all participants of troubles in communication and cooperation are supported to solve their problems at the right time, not too early and not too late. In most cases participants ask too late for support and consulting, so that problems and conflicts are already escalated on a high level. And at least it's necessary to underscore, that problems in communication and cooperation are basically not interpreted as personal troubles of employees, but rather are well-founded in deficient leadership competence, low quality of communication in team-meetings, ambiguous responsibilities within the teams and unclear assignments of tasks between the different professions.

Leaders are confronted again and again with difficult situations and decisions, which can have drastic consequences for teams or individuals. As experts in medical treatment, therapy and care, leaders in hospitals are focused on their specialized knowledge of their profession. Particularly relevant for professional change in hospitals seems to be the social competence of leaders, which helps to steer the boat of change through storms of uncertainty. Team leaders in hospitals need support from their own superiors, that is, leaders in middle and executive boards. They ask for trust, honesty and for professional support such as coaching.

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