SECOND OPINION:Future is uncertain, so bosses go in different directions
THE IRISH health service does not know where it is going, so what is the point of leadership training? Minister for Health James Reilly recently launched a new Diploma in Leadership and Quality in Health Care, which will be delivered by the Royal College of Physicians of Ireland (RCPI). Recruitment commenced in April and the programme, funded by the Special Delivery Unit of the Department of Health, will roll out over the next year.
According to Dr Reilly, all health service leaders will have an opportunity to participate in this “critical” training as “for a long time we have complained that health management didn’t get the training required”.
I don’t know what planet the Minister is living on, but there must be thousands of HSE managers and staff who have completed leadership courses. The Institute of Public Administration, Institute of Public Health in Ireland, university business schools and other organisations have been running leadership programmes for at least 30 or 40 years. Hundreds of inhouse courses are offered by the HSE, even though these have been severely curtailed because of cutbacks.
A recent OECD report found that effective leaders are thin on the ground, so are leadership courses of any value and why is the learning not applied to deliver better health services? Do we really need another new course using “international expertise”? I tried to get a copy of the syllabus for the diploma announced by the Minister but, unfortunately, it is not available yet. This seems strange as recruitment was to commence in April. The information on the RCPI website does not inspire confidence that this course is any different to those being offered by other organisations, none of which seems to have increased the actual numbers of effective leaders.
I attended several of these courses and they had many common components: an over-reliance on Powerpoint presentations, not enough experiential learning, and an emphasis on “command and control”-type leadership. The language used is teamwork but, in reality, models are based on leaders who others are expected to follow. This is particularly true of the HSE which is run on authoritarian lines. This model may do for an army – it will not do for a 2012 health service.
There are as many leadership theories as there are leaders and it is sometimes worthwhile to review one of the classics. About 20 years ago, the “buffalo and geese” metaphor illustrated the leadership paradigm shift needed in organisations such as the HSE. Buffalo follow one leader, geese travel in V-formation where the leader goose constantly changes. The theory is that buffalo leadership is hierarchical – one leader, one voice, and the leader is boss. Geese or collaborative leadership, on the other hand, is based on a network of teams – everyone is a leader, many voices, and the citizen is boss. Collaborative leadership is extremely rare in the Irish public sector although it is recommended by the OECD.
Most, if not all, health problems need intra-disciplinary solutions. Collaborative leaders with boundary-spanning skills, such as building trust and power-sharing, are needed to make this integration happen. Do the current leadership courses teach these skills? No. In fact, most research suggests that boundary-spanning skills can only be learnt on the job.
Even if some leadership courses are worthwhile, there are problems applying the learning when the participant returns to work. A 2011 review of public sector management found that leadership behaviours are often stifled and discouraged.
Developing future leaders involves mapping the skills and abilities of staff to the leadership needs of the HSE and actively encouraging leadership behaviour as part of everyday work.
Since no one knows what these needs are, this almost never happens. Leadership skills end up in a kind of limbo between the course and the job.
The new public health policy due later this year will need collaborative leadership skills. The health sector should stop wasting money on training until it identifies the thousands of workers who have attended leadership courses and find out why they have not used the learning.
The truth is that the Irish health service, unlike buffalo or geese, does not know where its future lies, so “trained” leaders go off in different directions depending on their discipline.
Unless the HSE starts working as a network of integrated teams, which can only be brought about by collaborative leadership, the direction of health services will continue to be determined by each discipline and not citizen health.
Dr JACKY JONESis a former regional manager of health promotion with the HSE