Taken together, the articles by Alan Hudson, "The First 200 Days: Cancer Leadership in Ontario," and Shamian-Ellen/Leatt, "Emotional Intelligence," (Eds. note: See Hospital Quarterly, Fall 2002) touch on issues of culture, relationships, communications, responsibility, accountability, appreciation, learning, and foundational values. These are never-ending challenges to people who wish to lead organizations.

The observations made in the articles are offered in the spirit of progress - that is, they represent an acknowledgement that a new attitude to leadership and management is required in our dramatically shifting environment and arena of public expectations that affects healthcare in Canada today. There is a growing appetite in public service today for a more decisive and action-oriented form of leadership; but also for a deeper commitment to justice, equality and citizen engagement. In order to survive, leaders must respond to this prevailing public sentiment while focusing unwaveringly on the purpose and reasons for them to be leading in the first place.

The articles also explore the need to create new conversations about what we value, about how healthcare-consumer focused we are, and about the quality of our work life. New conversation leads to new relationships, which are the arena of action for leadership. To quote R. Shortt, "What goes on between people defines what an organization is." I would add to this and "what it can become." Creating new conversations through healthy relationships is also a fundamental underpinning of accountability.

In the healthcare sector, with its traditional command-and-control systems, structures and processes, "accountability" is often about "who is to blame?" Real accountability is about keeping agreements and performing jobs in a respectful atmosphere. It is about learning, truth, change and growth. It is not about fear and punishment. We need to learn from our "best mistakes" and continuously improve the system for which we assume stewardship. Accountability is often a misunderstood word. It is regularly confused with the concept of responsibility. To be responsible means to do what one has committed oneself to do, through the simple act of accepting one's job or position. Accountability, on the other hand, refers to the process of accounting for the achievement of one's responsibility. It is the process by which one demonstrates fidelity to that obligation or purpose. Leaders must be able to account to others for appropriate exercises of responsibility if they are to retain credibility in their leadership role.

The articles suggest that to be open to large-scale change, leaders must create literal openings and emptyings that ensure the emergence of a new vision that articulates new-shared values. This opening requires discipline and courage - discipline to resist knee-jerk reactions and courage to separate from old patterns, structures and processes that are no longer useful to the evolving organization. Finally, the articles underscore the need for leaders to ask the right questions at the right time. Framing the question, and timing it in a manner that creates commitment to learning, is vital to an organization's continual improvement.

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