Essays

Essays March 2016

Why Build Health Leadership Capacity Across Canada?

Hugh MacLeod, Dr. Gillian Kernaghan and Kelly Grimes

Canada has historically led the world in thinking about health, in measuring health and, until relatively recently, in delivering on healthcare. However, reports from a variety of organizations indicate that Canada has been gradually drifting down the international league tables in terms of health system performance. There is a growing consensus that Canada’s 14 separate health systems need to move away from “innovation by accident to innovation by design” and that leadership is the number one enabler of health system innovation. The previous federal government's withdrawal from its traditional “convener” role has also compounded the challenge of growing leadership capacity, and new hope abounds with a potential new health accord.  Widespread innovative practices and concepts such as such as Triple Aim, Lean, or Ontario-based Ideas and Community Health Links need leadership to succeed. Yet evidence shows that the majority of these improvement initiatives will fail, with poor leadership being a key ingredient in the lack of sustained success. 

Healthcare transformation demands that leaders (wherever they are in their leadership journey) change their behaviour and become better at: systems thinking, strategy, communication, coalition building, information sharing and informatics, team-building and servant leadership. Each behaviour change is a discrete act of both will and corresponding action. It takes discipline to build the reflection and practice time into a very demanding healthcare environment in which demands are insatiable, and an “emergency room identity” that mitigates against these very actions.

Given this circumstance, just how much behaviour change can any individual take on? Leaders find themselves in a place where their intellect tells them that they have to create significant reform to be relevant, and that they also have to master a whole new array of leadership skills to be successful at doing so. Yet their emotions may tell them that to take the time to learn new skills, or unlearn behaviours that are no longer desirable, but which got them to a pre-eminent position, leaves them vulnerable and perhaps threatened.

Over time, we all develop and accumulate our own unique personal and human hard drives, software (mental models) that shape and influence our perspectives, perceptions, reactions, and expectations. As our human hard drive gets filled, we also accumulate various coping mechanisms, biases and habits, firewalls, anti-virus 'software' and security programs to survive. Some of us become jaded, some cynical, or just "too long in the tooth," and some develop egos that drive us one way or another. Yet some of us still retain that child gleam in our eyes, that thirst and search for greater leadership learning and understanding that drives us.  That gleam, the yearning to learn, is at the heart of leadership.

We believe leadership sits in every chair. Evidence is also showing that, while leadership is certainly a function of time, place and circumstance which generates the imperative to learn, there are some common capabilities that are shared among high impact leaders. Inherent in those capabilities is the ability to adapt, adjust and learn. There is also a growing body of knowledge suggesting that in a system as complex as healthcare, “heroic” leadership models are at best time limited.  A new view of leadership (at least for the health sector) is emerging, one that believes that experiential learning that is constructed from exploring and analyzing one’s experiences throughout a personal leadership journey is key to leadership development and capacity enhancement. With this new lens, comes the recognition of new models of leadership such as distributed or shared leadership as not one person can have all the requisite expertise to effect major changes in a system as complex as healthcare. 

It is hard to envisage a true distributed leadership system without a common language around leadership.  It can provide a foundation or set of standards facilitating sharing of both leadership practices and leadership development programs. LEADS in A Caring Environment capabilities framework can be that common language. Although LEADS is just one of many frameworks that can create opportunities to have this conversation and create shared purpose, it has potential to be common because of its endorsement by numerous health organizations and professions in Canada. It is a “by health, for health” leadership capabilities framework built upon five key elements:  Lead Self, Engage Others, Achieve Results, Develop Coalitions, and System Transformation. In fact, no other country in the world has achieved such a widespread adoption of a set of standards for health leadership in a decentralized system. LEADS provides a tool and process for leaders to reboot that child’s gleam in them, through a thirst for knowledge and understanding, and enthusiasm for harnessing that for the greater good. 

Healthcare leaders hard drives are far from full, indeed, they are continuously being expanded and reformatted. We all can be challenged on our own “Balcony of Personal Reflection.” Time to invite others  - metaphorically speaking, onto our balconies, and engage in meaningful dialogue. No doubt, we will all have our own egos that haunt us, perhaps some skeletons in the closet, and some demons that need to be exorcised. 

If we are able to build a “balcony” where people feel safe and secure in sharing personal reflections and the testing of assumptions held, we will have helped individuals grow and evolve. It’s not a time to play it safe, it’s a time to take some calculated risks in attempting to move healthcare, arguably the single most important societal agenda, forward. If we are to grow and act as a cohesive team, our balconies have to be strong places where we can congregate and learn.

Healthcare leadership change/development like healthcare transformation takes time and may take years to show tangible outcomes results.  This is the same challenge that health promotion and health prevention has had as an upstream intervention...we know it’s the right thing to do, however, day in day out we look for quick fixes. Quick fixes keep folks focused and rewarded for repair solutions.  Leadership is like living in a fish bowl of tinkering and bandaids to cover up wounds, old mindsets and behaviours, elitism, outdated processes, silo mentality, ego vs altruism, self-interest vs interdependence, competition vs collaboration, and uncertainty and threat. In the meantime, the health leadership gap and disengagement continues to grow. Like a fish in water, leaders often can’t distinguish themselves from the context around them making it difficult to see the impact of their actions on the culture and functioning of an organization.  Yet we must try if we are part of the problem, and want to be part of the solution.

Canada needs a more coherent, concerted and distributed approach to support the emergence of the next generation of high impact health leaders.  We need to keep the conversation about leadership development constantly alive, front and centre. But even more than a conversation, it must become a deliberate and regular part of the health system’s business, policy and research. A decade ago, health leadership was not on policy or research landscapes.  However, with declining relative performance, leaders as a cadre and leadership capabilities are now seen as the source code to move to our desired future. Without collaboration by governments and other health system partners around health leadership, Canada will not be able to regain its status as a world leader in healthcare thinking, innovation and performance.  Like health promotion and prevention, we know it is the right thing to do and now we must make the time to do it, together.

To this end, the Canadian Health Leadership Network (CHLNet) and its 40 network partners propose a five pillar action plan to ensure high quality leadership that would be applied at any level of the health system: create a collective vision; endorse a common leadership language; gather more evidence on innovation and leading practices; enhance capacity and capabilities; and measure and evaluate success.

About the Author

Hugh MacLeod (former CEO of Canadian Patient Safety Institute), Dr. Gillian Kernaghan (CEO of St. Joseph's Health Care, London) and Kelly Grimes (Executive Director, CHLNet) are all members of CHLNet’s working group who have created a national health leadership action plan. The group’s purpose is through collective efforts that cut across jurisdictions and health disciplines and over the life cycle of leadership (from emerging health leadership to senior executive leaders), to stimulate and grow health leadership capacity to better address the leadership gap emerging across the country and its impact on system performance and sustainability. CHLNet is also embarking on a landmark study on return on investment to provide further evidence on the impact of health leadership.

References

Advisory Panel on Healthcare Innovation. (2015). Unleashing Innovation: Excellent Healthcare for Canada. Health Canada: Ottawa. Available online at http://www.healthycanadians.gc.ca/publications/health-system-systeme-sante/report-healthcare-innovation-rapport-soins/alt/report-healthcare-innovation-rapport-soins-eng.pdf

CHLNet. (2014). Final Report: Canadian health leadership benchmarking survey report. Canadian Health Leadership Network: Ottawa. Available online at http://chlnet.ca/tools-resources/research

MacLeod H. (2015) A Last Word From The Balcony of Personal Reflection With Healthcare Ghosts of Despair, Consciousness and Hope, Longwoods Essay Series.

CHLNet. (2014). Closing the Gap: A Canadian Health Leadership Action Plan. http://chlnet.ca/wp-content/uploads/Canadian-Health-Leadership-Action-Plan.pdf

Dickson, G. & Tholl, B. (2014). Bringing Leadership to Life in Health: LEADS in a Caring Environment. Springer Publishing: London UK.

Lavis JN, Moat KA, Tapp C, Young C. (2015). Evidence Brief: Improving Leadership Capacity in Primary and Community Care in Ontario. Hamilton, Canada: McMaster Health Forum. Available online@ https://www.mcmasterhealthforum.org/docs/default-source/Product-Documents/stakeholder-dialogue-summary/leadership-capacity-in-ontario-sds.pdf?sfvrsn=2

The LEADS Collaborative. (2015). Health Leadership Capabilities Framework. http://leadscollaborative.ca/uploaded/web/Resources/LEADS_Brochure_2015.pdf

Van Aerde, J. (2015). Understanding physician leadership in Canada: overview of a CSPE/CMA/CHI study. Canadian Journal of Physician Leadership. Available online@ http://physicianleaders.ca/assets/leadershiparticle.pdf

West, M. (2015). Leadership and Leadership Development in Health Care: The Evidence Base. King’s Fund: London, UK. Available online at http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/leadership-leadership-development-health-care-feb-2015.pdf  

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