Task poster

https://elp.northumbria.ac.uk/bbcswebdav/pid-12858778-dt-content-rid- 26143346_2/xid-26143346_2

This module has a two-part summative assessment. The first element is the production of an electronic academic poster that will focus on collaborative and partnership working in public health / healthcare. The second is a 2500 essay that critically discusses and evaluates the importance of management and leadership theory within a public health and /or healthcare management context. The two elements are not directly linked. The weighting of each component of the assessment is 50%.

Formative assessment

To support your summative assessments, we also provide support via two formative assessments.

1. You will produce an electronic academic poster on one PowerPoint slide which will critically analyse collaborative / partnership working issues in an existing collaborative / partnership public health and / or healthcare management project of your choice. In particular there should be a critical discussion of the effectiveness of the collaborative work/ partnership. Examples of projects will be available on the e-learning portal or you can find your own. This will be presented to your peers and module tutor(s) for review and feedback. This peer and tutor feedback will help you to develop your final electronic academic poster which is one element of the summative assessment.

The electronic academic poster will provide the opportunity for you to present a visual representation of key issues relating to the rationale and effectiveness of an example of public health or healthcare management collaborative / partnership working. (MLO’s 1,2)

2. You will be asked to provide your allocated tutor with an outline plan of your essay via email. This should be no more than one page in length. You will also receive a small group tutorial with your module tutor, which will be an opportunity to ask specific questions about the assignment.

Summative assessment

Part 1 (50%)

You will produce the final version of your academic poster, which critically analyses collaborative / partnership working issues within an existing collaborative / partnership public health and / or healthcare management project. (MLO’s 1, 2).

Part 2 (50%)

You will submit a 2,500 word essay which critically discusses and evaluates the importance of management and leadership theory and its application within a public health and/or healthcare context. You are encouraged to identify and write about a single public health or healthcare topic.

https://elp.northumbria.ac.uk/bbcswebdav/pid-12858778-dt-content-rid- 35448131_2/xid-35448131_2

THE ROLE OF MANAGEMENT & LEADERSHIP IN PUBLIC HEALTH

AC7029:

LEADERSHIP AND COLLABORATIVE WORKING IN PUBLIC HEALTH AND HEALTHCARE

[name]

[student number]

May 2019

Word Count: 2336

Module: AC7029 Emma Shields

1

The Role of Management and Leadership in Public Health

The issues affecting population health are extremely complex and require action

against a wide range of determinants to make lasting improvements, therefore it is

fundamental that public health services are managed effectively and efficiently. It is

therefore essential that those in charge of protecting population health not only have

the knowledge and skills identified as essential for effective management but are

able to lead others in their field. Theories of management and leadership play a

pivotal role in determining how interventions and services aimed at improving

population health should be implemented, both nationally and locally. There are a

wide range of perspectives on the principles and practices of management and

leadership, including the Contingency Approach to Management and Participative

Leadership, which will be critically discussed in relation to public health practice.

Public health agencies across the world play a key role in protecting the health of the

population through disease control, health promotion and overall reducing morbidity

and mortality rates to ensure people live long and healthy lives (World Health

Organization, 2019a). This is achieved through research; the development of public

health policy, law and regulations (Burke, 2011); collaboration with a wide range of

public, private and voluntary organisations; service provision; and, developing

effective management and leadership strategies (World Health Organization, 2019b).

A wide range of determinants affecting population health exist, such as social,

environmental, political, educational, cultural, economic and genetic factors (Marmot

and Wilkinson, 2005). These include the prevalence and spread of disease, access

to health services, living and working conditions, household income and individual

behaviours, all which collectively determine a person’s health outcomes (Baum,

2016). The complexity of public health and the issues affecting it therefore requires

Module: AC7029 Emma Shields

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an understanding of management and leadership principles which underpin the work

carried out in the field of public health (Brownson et al, 2018).

Managers are people appointed the role of overseeing the daily functions of an

organisation and are given the authority to make important decisions which can

affect the provision of whatever product or service is offered by the company (Darr,

2011). Leaders are employees within the organisation, working at any level or in any

role, who can influence and impact positive change to improve organisational

outcomes (Rowitz, 2018). A clear distinction between managers and leaders is that

whilst a leader may possess the ideas and strategies needed for success, only those

in a managerial position have the power to implement and enforce them (Barr and

Dowding, 2012). Johnson and Breckon (2007) suggest that the level of authority a

manager is given should be synonymous to the level of responsibility they have to

ensure successful outcomes. However, it is argued that the relationship between the

management and leadership are interrelated and both equally as important,

particularly in public health (Burke, 2011). It is also argued that building a competent

public health workforce which demonstrates excellent management and leadership

qualities is equally, if not more important, than simply being experts in contemporary

health issues (Fraser et al, 2017). There are a range of perspectives which

conceptualise the importance of both management and leadership. Management

theories include the Scientific, Systems, Human Relations and Contingency

approaches, whilst leadership theories include Authoritarian, Transactional and

Transformational.

The Contingency approach to management combines aspects of several other

theories: the Scientific approach, which is evidence-based and systematic to ensure

maximum productivity; the Systems approach, which considers how all parts of an

Module: AC7029 Emma Shields

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organisation work together co-ordinately, each function equally as important; and the

Humanistic approach, which focuses on the people within the organisation and how

they interact with each other (Johnson and Breckon, 2007). Developed by Lawrence

and Lorsch (1967) whose research into the organisational structures of several

organisations concluded that no single method of management was superior. The

theoretic emphasis of this approach is that management is situational: it is essential

that managers adapt their management styles to both the needs of the organisation

and the service or intervention they are overseeing, and if the managerial structure

adopted fails to cohere with the goals of the organisation, it must be changed to a

more appropriate style (Barrett, 2011). However, it is argued that adapting

management style to suit the situation is futile; if managers must change the way

they operate due to situations they cannot manage, they consequently cannot

successfully manage the situation at all (Kreitner, 2008).

Despite this, the Contingency Approach is considered relevant to public health

practice due to its strong focus on integration, which is a fundamental principle

underpinning the work of various organisations in the delivery of services,

collaborative research, and resource sharing, to achieve common public health goals

(Redwood et al, 2016). The field of public health consists of multiple stakeholders,

such as government agencies, educational institutions, private and voluntary sector

organisations, and local communities (Freidman, 2011a). Integration is particularly

important within private-public partnerships due to differences in organisational

structures, collaborating workforces and strategy sharing, which requires effective

management, delegation, negotiation and communication (Waring et al, 2013). This

approach is particularly useful within the area of health promotion, as understanding

the consequences of processes and behaviours is fundamental to developing

Module: AC7029 Emma Shields

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behaviour change-based policies and interventions (Elder, 2001). Therefore, how

public health challenges are approached is dependent on various situational factors

such as the targeted population, the resources available, how and where the

intervention will be implemented, and the overall aims of the intervention (Sheeran et

al, 2016). The complexity of behaviour-change interventions therefore requires a

contingent management strategy, which is essential to the continually changing

organisational structures of public health agencies.

Managing organisational change can be challenging for those in charge of protecting

and promoting the health of the population due to the political ideologies which

impact the way health services are operated and delivered. In 2013, the

responsibility of public health in the United Kingdom (UK) was decentralised from the

Central Government to local authorities as a result of the Localism Act (2011) giving

local authorities additional decision-making powers. Additionally, many health

services were privatised to improve efficiency as part of the Health and Social Care

Act (2012). These changes were enforced under the Coalition Government, whose

political agenda was influenced by the New Localism ideology which promotes local

service provision to meet the needs of local communities (Tait and Inch, 2015).

However, the Central Government primarily retained financial control, which

therefore limits what can be achieved by local authorities, providing managers of

public health services at a local level with additional challenges to contend with

(McKenna and Dunn, 2015). Bureaucratic management styles which consist of multi-

level hierarchies are therefore unsuitable for fractured and unstable environments

which require flexibility and fluidity to ensure organisational change is as disruptive

as possible (Barrett, 2012). It is also argued that the outcomes of an organisation

can vary depending on whether they are operated publicly or privately, with public

Module: AC7029 Emma Shields

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sector agencies under constant scrutiny from the general public due to way they are

funded (Pollitt, 2003).This not only highlights the importance of effective contingent

management strategies in public health, but also adds pressure to public health

managers, enforcing the ideology that the employment of competent leaders is

equally important for organisational success. Due to the situational-based theory

which underpins the Contingency approach to management, the need for effective

leadership is also a key aspect of this perspective, considering the relationships

between those working at a managerial level and the rest of the employees within

the organisation to achieve desired outcomes (Freidman, 2011b).

Leadership plays an integral role in the field of public health. Whilst managers are

important in overseeing the functions of an organisation through solving problems,

distributing finances and resources, and planning effective strategies, leaders are

those who influence, motivate and empower others to ensure the organisation

operates effectively and continually strives to improve and progress (Stanfield,

2009). It is suggested that leaders have innate characteristics which make them

effective at their job, but these skills and principles can also be learnt by others

(Rowitz, 2018). Leadership is recognised as essential to the provision of health care

services in the UK, as it is believed that mortality rates can be reduced if all staff

actively participate in the improvement of the services they are employed in (NHS

Leadership Academy, 2014). Theories conceptualising the importance of leadership

include the Trait Approach, which suggests leaders are born with the inherent

characteristic needed for effective leadership (Burke and Freidman. 2011); The Style

approach, which favours emphasis on individual behaviours; and, Transformational

Leadership, which builds on the concept of working together to achieve common

goals (Healey and Lesneski, 2011).

Module: AC7029 Emma Shields

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Transformational leadership is a theory which values mutual respect, empowerment,

trustworthiness and motivation in which those in a managerial position highly regard

the contributions of those at a lower level in the organisation (Shelton, 2012).

Transformational leadership was conceptualised by Burns (1978), who suggested

leaders where either Transactional, in which people lead others in exchange for a

favourable reward, or Transformational, who inspire others for the good of the

organisation. Transformational leadership is made up of four components: Idealized

Influence, which is they behaviours which inspire others to follow; Inspirational

Motivation, the optimistic and enthusiastic exchange between leaders and others in

order to motivate and inspire ; Individualised Consideration, in which leaders value

others’ aspirations and achievements; and, Intellectual Stimulation, which involves

addressing and challenging issues to develop effective solutions (Bass and Riggio,

2008). Forming good relationships is a key attribute needed to fulfil these roles, as

influence and empowerment is only possible if others within the organisation trust

and respect those they are following (Barling, 2014). Novick et al (2008) suggests

that empowerment for all employees within a public health organisation can be

chaotic, particularly if employees don’t agree with the political agendas which

influence the aims of the organisation they are working for. Healey and Lesneski

(2011) argue that the influential impact leaders can have on others improves the

outcomes of services and interventions, resulting in Transformational leadership

being well established in the public health field.

There are many different styles of leadership, such as Transactional, Autocratic and

Participative, all which differ in terms of how leadership is implemented within an

organisation. Participative leadership, also known as Democratic leadership,

provides employees with the opportunity to make important decisions regarding the

Module: AC7029 Emma Shields

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service they provide (Ricketts and Ricketts, 2011). A systematic review of leadership

styles during disease outbreaks by Arifah and colleagues (2018) found that

participative leadership qualities such as encouragement, effective communication

and partnership working, were considered essential components in controlling and

managing outbreaks. Participative leadership styles coincide with the perspectives of

Transformational Leadership theorists, and the World Health Organization (2016)

regards Participative leadership styles as fundamental to improving population

health, as all employees invested in working towards this aim should be treated

equally and decisions made collaboratively. Research shows that utilising this style

of leadership can improve job satisfaction which leads to an improvement in

productivity, particularly in public sector organisations (Kim, 2002). However, this

approach to leadership relies on the assumption that all members of the

organisation, both managerial and frontline staff, have similar interests and visions,

however this scenario is idealistic and may not always be the case (Ricketts and

Ricketts, 2011).

Some of the challenges faced by public health managers and leaders include

outbreaks of disease, new trends in unhealthy behaviours and policy reform (Rhodes

et al, 2010). One of the key functions of a public health manager is to make rational

and evidence-based decisions to overcome such challenges (Brownson et al, 2018).

This requires technical skills such as planning and budgeting; Interpersonal skills

such as effective listening and cooperating; and conceptual skills such as analysing

complex situations, commitment and visualising success (Healey and Lesneski,

2011). Public health managers are required to effectively plan both short- and long-

term goals in addition to planning for unknown events which can affect the outcomes

of those goals. Contingency planning allows for disasters to be averted and is of

Module: AC7029 Emma Shields

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particularly important in public health, for example during disease outbreaks (Darr,

2011) Similar skills are identified as essential leadership qualities, with the addition

of emotional intelligence, influence and self-awareness (Moodie, 2016). It is argued

that attempting to teach leaders in the field of public health the skills needed to excel

in the workplace is difficult due to those in managerial positions lack leadership skills

themselves and therefore cannot inspire others (Yphantides et al, 2016). However,

the similarity of skills needed for both management and leadership provides an

insight into the resemblance of both concepts.

A systematic review by Neinbar (2010) provides an insight how the concepts

management and leadership concepts are defined. The study synthesises that the

terms are often used in existing literature synonymously, with the responsibilities of

both managers and leaders often described the same. With the tasks carried out by

both managers and leaders and skills required for effective management and

leadership similarly described in both Moodie and Neinbars studies, neither concepts

are distinctive, and both are required for the operations of an organisation to be

successful. Freidman (2011b) also concludes that public health requires both the

operational functions of managers and the influence of leaders to overcome the

many challenges that arise due to changes in organisational structures, cuts to

funding and resources, and ongoing threats to the health of the population.

To conclude, the terms management and leadership are interchangeable, and it is

often difficult to differentiate between the two. Despite this, there are many different

theories of how management and leadership can be applied within public health

organisations. The Contingency approach to management displays relevance to

overcoming public health challenges such as organisational change and the

implementation of new policies. This is due to its flexibility and situational theoretic,

Module: AC7029 Emma Shields

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whilst Transformational leadership is regarded as an important concept in achieving

the overall aims of public health, such as prompting healthy behaviours and effective

and efficient service provision, by developing a value and goal orientated workforce.

The skills needed to effectively manage, and lead have been revealed through

research to be similar, synthesising that both are of as equal importance.

Word Count: 2336

Module: AC7029 Emma Shields

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References

Arifah A.R., Mohd, T., Mohd F.R., Syahira, S., Rosliza. A.M., and Juni, M.A. (2018)

‘Leadership Theories in Disease Outbreak Management’, International Journal of

Public Health and Clinical Service, 5 (2), pp. 1-16.

Barling, J. (2014) The Science of Leadership: Lessons from Research for

Organizational Leaders. New York: Oxford University Press.

Barr, J. and Dowding, L. (2012) Leadership in Health Care. 2nd edition. London:

Sage Publications Ltd.

Barrett, I.R. (2012) Administration and Management Theory and Techniques: A

Guide for Practising Managers. Bloomington: Author House.

Bass, B.M. and Riggio, R.E. (2008) Transformational Leadership. 2nd edition. New

Jersey: Taylor and Francis Publishing.

Baum, F. (2016) The New Public Health. 4th edition. Oxford: Oxford University

Press.

Brownson, R., Baker, E.A., Deshpande, A.D., and Gillespie, K.N. (2018) Evidence-

Based Public Health. 3rd edition. New York: Oxford University Press.

Burke, R.E. (2011) ‘Introduction’, in Burke, R.E. and Friedman, L.J., (eds), Essentials

of Management and Leadership in Public Health, Burlington: Jones and Bartlett

Learning, pp. 1-5.

Darr, K. (2011) ‘Introduction to Management and Leadership Concepts, Principles

and Practices’, in Burke, R.E. and Friedman, L.J., (eds), Essentials of Management

and Leadership in Public Health, Burlington: Jones and Bartlett Learning, pp. 7-24.

Elder, J.P. (2001) Behavior Change and Public Health in the Developing World.

California: Sage Publications Ltd.

Fraser, M., Castrucci, B., and Harper, E. (2017) ‘Public Health Leadership and

Management in the Era of Public Health 3.0’, Journal of Public Health Management

and Practice, 23 (1), pp. 90-92.

Freidman, L.H. (2011a) ‘Strategic Planning and marketing for Public Health

Managers’, in Burke, R.E. and Friedman, L.J., (eds), Essentials of Management and

Leadership in Public Health, Burlington: Jones and Bartlett Learning, pp. 39-52.

Freidman, L.H. (2011b) ‘Changing Role of Public Health Managers and Leaders’, in

Burke, R.E. and Friedman, L.J., (eds), Essentials of Management and Leadership in

Public Health, Burlington: Jones and Bartlett Learning, pp. 149-158.

Health and Social Care Act. (2012). Arrangements for Provision of Health Services.

(Online). Available at:

http://www.legislation.gov.uk/ukpga/2012/7/part/1/crossheading/arrangements-for-

provision-of-health-services/enacted. (Accessed: 7 May 2019).

Module: AC7029 Emma Shields

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Johnson, J. and Breckon, D. (2007) Managing Health Education and Promotion

Programs: Leadership Skills for the 21st Century. 2nd edition. Sudbury: Jones and

Bartlett Publishers.

Kim, S. (2002) ‘Participative Management and Job Satisfaction: Lessons for

Management Leadership’, Public Administrative Review, 62 (2), pp. 231-241.

Kreitner, R. (2009) Principles of Management. 11th edition. Boston: Houghton Mifflin

Harcourt Publishing Company.

Lawrence, P.R. and Lorsch, J.W. (1967) ‘Differentiation and Integration in Complex

Organizations’, Administrative Science Quarterly, 12 (1), pp. 1-47.

Localism Act. (2011) Chapter 1: General Powers of Authorities. (Online). Available

at: http://www.legislation.gov.uk/ukpga/2011/20/part/1/chapter/1/enacted. (Accessed:

7 May 2019).

Marmot, M. and Wilkinson, R. (2005) Social Determinants of Health. 2nd edition.

Oxford: Oxford University Press.

Moodie, R. (2016) ‘Learning About Self: Leadership Skills for Public Health’, Journal

of Public Health Research, 5 (1), doi: 10.4081/jphr.2016.679.

Neinbar, H. (2010) ‘Conceptualisation of Management and Leadership’,

Management Decision, 48 (5), pp. 661-675.

NHS Leadership Academy. (2014) NHS Leadership Academy: An Overview.

(Online). Available at: https://www.leadershipacademy.nhs.uk/wp-

content/uploads/2014/11/NHS-Leadership-Academy-full-pack.pdf. (Accessed: 11

May 2019).

Novick, L.F., Morrow, C.B., and Mays, G.P. (2008) Public Health Administration:

Principles for Practice Based Management. 2nd edition. Massachusetts: Jones and

Bartlett Learning.

Pollitt, C. (2003) The Essential Public Manager. Buckingham: Open University Press

Redwood, S., Brangan, E., Leach, V., Horwood, J., and Donovan, J.L. (2016)

‘Integration of Research and Practice to Improve Public Health and Healthcare

Delivery Through a Collaborative 'Health Integration Team' Model – a Qualitative

Investigation’, BMC Health Services Research, 16 (201), doi: 10.1186/s12913-016-

1445-z.

Rhodes, M.L., Murphy, J., Muir, J., and Murray, J.A. (2010) Public Management and

Complexity Theory: Richer Decision-Making in Public Services. New York:

Routledge.

Ricketts, C. and Ricketts, J. (2011) Leadership: Personal Development and Career

Success. 3rd edition. New York: Cengage Learning.

Rowitz, L. (2018) Essentials of Leadership in Public Health. Burlington: Jones and

Bartlett Learning.

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Sheeran, P., Maki, A., Montanaro, E., Avishai-Yitshak, A., Bryan, A., Klein, W., Miles,

E., and Rothman, A.J. (2016) ‘The Impact of Changing Attitudes, Norms, and Self-

Efficacy on Health-Related Intentions and Behavior: A Meta-Analysis’, Health

Psychology, 35 (11), pp. 1178-1188.

Shelton, E.J. (2012) Transformational Leadership: Trust, Motivation and

Engagement. Canada: Trafford Publishing.

Stansfield, A.W. (2009) Defining Effective Leadership: Lead in Whatever You Do.

Oklahoma: Tate Publishing.

Tait, M. and Inch, A. (2016) ‘Putting Localism in Place: Conservative Images of the

Good Community and the Contradictions of Planning Reform in England’, Planning

Practice and Research, 31 (2), pp. 174-194.

Waring, J., Currie, G., and Bishop, S. (2013) ‘A Contingent Approach to the

Organization and Management of Public–Private Partnerships: An Empirical Study of

English Health Care’, Public Administration Review, 73 (2), pp. 313-326.

World Health Organization. (2016) Participatory Leadership for Health. (Online).

Available at:

https://apps.who.int/iris/bitstream/handle/10665/251458/9789241511360-

eng.pdf;jsessionid=89DD84BD64C87470D686C387E9C4AB8F?sequence=1.

(Accessed: 12 May 2019).

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http://www.euro.who.int/en/health-topics/Health-systems/public-health-services.

(Accessed: 11 May 2019).

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Available at: https://www.who.int/about/role/en/. (Accessed: 11 May 2019).

Yphantides, N., Escoboza, S., and Macchione, N. (2016) ‘Leadership in Public

Health: New Competencies for the Future’, Front Public Health, 3 (24), doi:

10.3389/fpubh.2015.00024.

Leadership and

collaborative working in

Public Health and

Healthcare

Analysis of Leadership and Management applied to Healthcare By: [Name]

Analysis of Leadership and Management applied to Healthcare

1

Introduction

Healthcare organisations are developed in a complex system that is hard to predict

due to their changing nature (Weberg, 2012). Understanding the complexity of the context

has been important to raising awareness on how Healthcare organisations must be

understood in order to improve their performance (Ghiasipour et al., 2017; Belrhiti, Nebot

Giralt, and Marchal, 2018). For instance, these arguments have been used in the literature

to justify that the success of the performance of Healthcare settings is subject to different

interconnected and complex components, like an adequate level of skills, knowledge,

competencies, and a high level of motivation among the workforce (Mosadeghrad, 2014).

Interestingly, the components mentioned before have a common element, the members

of the staff, who show all those characteristics through their performance. According to

this, Plsek and Wilson (2001) understood that the focus on delivering good practice

should be shifted to developing appropriate knowledge about the individuals who are in

charge of leading those members of the staff, and as a consequence exploring how

leadership and management play an important role in the interactions that are produced

within the complexity of Healthcare organisations. In the United Kingdom, the relevance

of strong leadership and management has also been stated as a core element for the

success of the Healthcare system, the NHS England (2014) has settled a 5 years forward

view scenario where leadership and management, in conjunction with the promotion of a

positive culture, are key elements for achieving a high-quality care, and it is not surprising

that they are investing in training people with strong leadership skills to ensure that they

will deliver a good service (NHS England, 2018). Therefore, this essay has the aim to

critically discuss what are leadership and management and how the different models can

play a fundamental role in the success of Healthcare organisations.

Discussing leadership and management, are they the same thing?

Leadership and management started to be conceptualised as two different things more

than 40 years ago, thanks to the work of Abraham Zaleznik (1977), who considered that

these two concepts had different roles in the organisation. In the following years, a very

broad range of authors developed an extensive literature of knowledge regarding these

two concepts (Bennis and Nanus, 1985; Gardner, 1990; Kotter, 1990), and interestingly

today it is still easy to find a debate on how the differences among management and

leadership can be used to achieve the success of the organisation (Toor and Ofori, 2008;

Bass, 2010; Algahtani, 2014) . In this aspect, Kotter´s (1991) conclusions about

Analysis of Leadership and Management applied to Healthcare

2

leadership and management are very remarkable for analysing how these two elements

can be linked to deliver high-quality standards in a complex Healthcare system, saying

that ´Managing is about coping with complexity, leadership is about coping with change´

(Kotter, 1991, p.32). Then, it is possible to affirm that, even though they are two different

things, both, managers and leaders are needed for any effective organisation (Kotter,

1991). An interesting interpretation to Kotter´s (1991) statement can also lead to thinking

that managers are people in charge of confronting the chaos of the organisations with the

aim of bringing consistency to them (Kotterman, 2006). However, if manager is about

efficiency and leadership is about bringing change, and successful change is about

motivating people to work towards the same vision in an active way while creating a

positive culture (Hechanova, Caringal-Go and Magsaysay, 2018), then using Gill (2011)

definition of leadership can be useful to understand how effective leadership can be linked

to success.

Leadership is showing the way and helping others to pursue it. This entails

envisioning a desirable future, promoting a clear purpose or mission, supportive

values and intelligent strategies, and empowering and engaging all those concerned.

(Gill, 2011,p.9).

When analysing and comparing these two concepts it seems that there is a general trend

to assume that managers apply solutions to problems following the procedures of the

organisations, while leadership plays a fundamental role in bringing innovative solutions

when the situation is unpredictable (Weberg, 2012). Therefore, leadership is associated

with words like visionary or with strong statements like doing the right thing, while

managers are more focused on the task and doing the things right (Azad et al., 2017),

Kotterman (2006) uses the terminology unimaginative cold to illustrate the general

perception of managers work in the organisations. However, a perfect example of how

this conceptualisation might affect the effectiveness of a Healthcare organisation can be

found in the United Kingdom with the case of Mid Staffordshire Hospital, where the basic

principles of care were ignored, resulting in catastrophic results for both, the organisation

and the patients, due to the lack of effective leadership and management (Francis, 2013),

this means that both roles share a responsibility on the results of the organisation (Azad

et al., 2017). Then, affirming that management and leadership focus on different things

might be right depending on the context, but it is also important to understand that in

Healthcare, managers and leaders have the same moral duties and obligations towards the

Analysis of Leadership and Management applied to Healthcare

3

costumers to deliver a high quality of care (Parand et al., 2014). For this reason, the

differences between those two components might not be as clear as Zaleznik (1977) or

Kotter (1990) identified in their work. In conclusion, not just leadership and management

is needed for the success of the organisations, it is also important to understand that both

can share similar skills and they are not two completely different elements, in

contraposition, it is essential that they are both integrated, in any successful Healthcare

organisation (Parand et al., 2014).

Theories of management and leadership, skills and application to practice

There is a very broad literature in leadership and management theories, however, since

Healthcare is a complex system which is constantly changing, it seems that traditional

models about leadership are not appropriate for describing which behaviors are the best

ones for the success of Healthcare organisations (Weberg, 2012). When analysing the

traditional leadership theories it is possible to understand that leadership is mainly based

on the individual capacities of influencing the staff trough elements like motivation, the

use of rewards and punishment or even manipulation (Bass, 2010), however the main

problem of this statement, when it is applied to Healthcare, is how it draws an individual

who holds a role, rather than an individual who has a set of behaviours to influence people

(Plowman & Duchon, 2008). Therefore, it is fundamental to use a model of leadership

and management in Healthcare suitable for facing the challenges of working in an

innovative system (Weberg, 2012).

In management, the system approach has been broadly applied in Healthcare systems

(Waterson, 2009), this is not surprising considering that patient safety has been one of the

focus of improvement in the last few years (Edworthy et al., 2006; Benning et al., 2011;

Weaver et al., 2013). The most extensive model in patient Safety was developed by

Reason´s (2000) and is called the Swiss Cheese Model of safety. From the broad spectrum

of models that can be applied to management in Healthcare, the Swiss Cheese Model

stands out from others because Reason (2000) understood that due to the complexity of

care, human errors were going to be made, and those errors won´t be avoided by using

punishment, instead there was a need to prevent the mistakes and therefore avoid the

potential harm that they could produce. Collins (2014) uses the example of avoiding

wrong-site surgeries during operations for understanding how this model can suit the

demands of the Healthcare system. Every slice of the Swiss cheese represents a way to

prevent errors, in the case of avoiding wrong-site surgery three are the slices that can be

Analysis of Leadership and Management applied to Healthcare

4

used, key stakeholder support, surgical safety checklist, and the communication among

the team and their collaborative work (Collins et al., 2014). Each slice has holes, and

when they line up, they represent possible errors, which can be latent errors or active

errors (Reason, 2000). From this particular situation, the latent errors are product of the

organisation structure or design, then this could go from failure in administering antibiotic

medication because of the lack of reviewing allergies before administering, to aspects of

the Healthcare organisation that interfere with the members of the staff producing them

distress or a lack of concentration (Collins et al., 2014). On the other hand, active errors

are easy to spot because they are produced by the staff mistakes usually at the time of

performing tasks in the system, for example, following the previous example an active

errors would be giving the wrong medication, or conducting a surgery in the wrong limb

(Collins, et al., 2014). The application of this model in Healthcare not just avoids giving

the responsibility of outcomes to just one individual, it gives a broader view that helps

analysing the situation from a nonlinear perspective, where relationships among the

components are important, and therefore it allows a space of analysis where errors can be

fixed (Collins, et al. 2014).

Another relevant approach of management is the contingency approach, which states that

there is not a right path for managing, due to the diversity and complexity of the

organisations, not all methods can work the same way for the different organisations

(Engelseth and Kritchanchai, 2018). One of the characteristic aspects of this theory is the

differentiation between internal factors, which includes the climate and the culture of the

organisation, and external factors like healthcare policies when analysing which strategy

should be adopted (Mintzberg,1979). Contrary to The Swiss Model, the application of

this approach to the decision-making process hasn´t been clearly defined (Lamminen et

al; 2015). However, it makes sense to affirm that having awareness of both, internal, and

external factors, is fundamental in order to follow a strategy that suits the demands of

competitive and complex Healthcare system, and therefore it has a direct implication in

the decision-making process (Lamminen et al; 2015). In the particular setting of

Healthcare, this approach can be useful when applied to situations where change is needed

because there is a need to follow a strategy where changing the culture and paying

attention to structural processes of the organisations is fundamental for success (Mackian

and Simons, 2013). A personal example where this approach can be useful is in the setting

of a care home for people with learning disabilities, where the staff wasn´t engaging

Analysis of Leadership and Management applied to Healthcare

5

appropriately with basic tasks, like signing for medication or following the support plans.

In this kind of situation, there is a need for a deep restructuration of the workplace, then

for conducting successful change, it requires a manager that can control the different

variables around them (Engelseth and Kritchanchai, 2018).

As it has been mentioned before, there is also a broad set of leadership theories, in this

essay it is argued that two are the most suitable for facing the demands of the complex

system. The first one is transformational leadership, which has been linked with a positive

culture in Healthcare organisation and patient’s safety (Page, 2004). The strongest aspects

of this theory rely on the skills that a transformational leader has, like charisma, effective

communication, creativity or innovation, which are linked to the capacity of creating

followers who are motivated to work towards a vision (Burke and Friedman, 2011; Al-

Sawai, 2013). In the context of the NHS applying transformational leadership could be

useful for the improvement of the Children and Young People Mental Health Services

(CAMHS), which are facing a process of change due to a need for improving the services

delivered, in fact in Future in Mind (2015) it is specified the need of leaders to supervise

that change is efficiently integrated across the Mental Health Services. Transformational

leadership has been proved to be linked to positive attitudes among teams and improving

the quality of service and care (Saravo, Netzel and Kiesewetter, 2017; Sfantou et al.,

2017). Therefore, it is argued that transformational leadership is suitable for modern

healthcare environments because they facilitate change, trough the transmission of the

vision to the staff while motivating them to pursue the goals (Kumar and Khiljee, 2016).

Even though transformational leadership has been mentioned in the literature as the ideal

model of leadership (Mackian and Simons, 2013) it can be criticised by saying that it

glorifies the figure of the leader as an individual (Bolden, 2011). For this reason, it is

argued that distributed leadership is a good alternative to this approach (Bolden, 2011).

Considering this approach over others might result surprisingly at the beginning,

nonetheless, when paying attention to the massive number of variables inside the settings

of Healthcare, it results interesting to adopt an approach where leadership relies on many

members rather than one (Mackian and Simons, 2013). In the past, Healthcare systems

like the NHS have prompted the application of leadership to small groups of senior staff

(Miller and Sitton-Kent, 2016), however, improvements might be needed at any level of

the organisation, for this reason in order to improve the quality of care it makes sense to

use a theory where leadership can be used in specific settings without needing a senior

Analysis of Leadership and Management applied to Healthcare

6

member of the staff (Boak et al., 2015). A perfect example on how the lack of distributive

leadership can affect the quality of the service delivered by the Healthcare system can be

seen in the example of Mid -Staffordshire mentioned before, Francis (2013) stated that

part of the lack of a professional service was due the poor management and leadership,

and due to this they ignored the needs of different levels of the organisations. Therefore,

it can be concluded that distributed leadership could have been useful for spotting these

issues at an early stage (Beirne, 2017). Moreover, there is increasing investment in

innovating in specialised services such as cancer services that will need the work of staff

with a background from different disciplines at a multi-level, which at the same time will

require the use of multiple leaders to handle those situations (Beirne, 2017).

Effective leadership and management are the key pieces for successful Healthcare

organisations (Sfantou et al., 2017), for this reason it is not surprising that the NHS offers

wide range of programs that aim to help staff to get trained in leadership and management

skills, for example, the Mary Seacole Programme or the Edward Jenner Programme (NHS

England, 2018). When looking at the content of this programmes it is possible to observe

that they include skills that have been traditionally attributed to management, like

technical skills to organise the tasks, do the planning and budgeting and organise,

conceptual skills that help managers to understand what they need to do and to make

decisions, and interpersonal skills useful for motivating and manage people (Burke and

Friedman, 2011). One skill that is not frequently mentioned in the programs but results

very useful in Healthcare is proactiveness, because the hierarchical distribution of

management can limit those managers who are in the lower and high positions of the

organization (Mackian and Simons, 2013), for this reason, successful Healthcare

organizations need proactive managers with self-awareness who understand themselves,

their values and their motivations, and managers able to use this knowledge to influence

their performance at work in difficult situations (Mackian and Simons, 2013). On the

other hand, when it comes to leadership, the Leadership programs seems to agree that the

skills that need to be taught are identified in nine different dimensions (NHS Leadership

Academy, 2013). Those dimensions are prioritising care and being able to be aware of

the needs of others, understand the vision and communicate it to the staff, being able to

create good relationships with the team, create followers through the influence power,

being creative and critical when evaluating and considering the information, being

influential with the results, being trustable, aware of the context and finally being

Analysis of Leadership and Management applied to Healthcare

7

innovative (NHS Leadership Academy, 2013). These dimensions are particularly

important in Healthcare because they have been designed to avoid situations where

mistakes were made in the past, like Mid Staffordshire (NHS England, 2018). Based on

this, it can be concluded that a fundamental skill for success in Healthcare is empathy,

just as Francis (2013) highlighted in his report, having empathy for others and listening

to people’s feelings is fundamental for guaranteeing patient´s safety and therefore the

success of the organisation.

In conclusion, just by the cooperation of the staff, and the use of their skills in the

performance, Healthcare organisation will be able to survive to the big challenges that

will have to face due to the complex nature of the system (NHS England 2014)

Analysis of Leadership and Management applied to Healthcare

8

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The Prison Health Partnership Improving the Health & Wellbeing of the Prison Population in

England through Multi-Agency Cohesiveness & Shared Responsibility (1)

 Partnership between NHS England, Public Health England and HM Prison & Probation Service established in

2012, joined by Ministry of Justice & Department of Health & Social Care in 2018 (1).  The collaboration coincided with the passing of the Health and Social Care Act (2012) which increased focus on

partnership working and integrated care (2) despite claims that the UK Government’s reliance on partnerships are ineffective at reducing health inequalities (3).

 The partnership was developed due to high death rates amongst prisoners and recently released offenders,

many of which were preventable & often the result of suicide, substance use, or poor prison conditions which

lead to those at risk of premature death remaining unidentified by both prison staff and health professionals (4).

Public Health England: Surveillance & Quality Assurance

HM Prison & Probation Service: Prison Service Provision

NHS England: Commissioning of Prison Health Services

Ministry of Justice: Justice & Prison Reform Policy

Department of Health & Social Care: Health Policy

Conclusion: Since the Prison Health Partnership was established, prison mortality rates have decreased. This suggests that the partnership has worked effectively towards achieving its aims, however mortality rates are still considered to be at an unacceptable level (4). Therefore, there is room for improvement, which could include expansion to include relevant private & voluntary sector agencies fundamental to the provision of various prison services to eliminate missed opportunities for improvement and enhance quality of care.

1) To reduce health inequalities and improve the health &

wellbeing of prisoners

2) To identify and address health- related factors which contribute to

offending and re-offending

3) To improve access to health care services for prisoners both during

and after incarceration

Clear & Robust Partnership Arrangements: linked governance structures enable the partnership to work

towards 10 agreed priorities set out in the National Prison

Healthcare Board’s Partnership Agreement 2018/2021 (1)

Clarity & Realism of Purpose: a shared vision of reducing health inequalities with realistic

expectations & acknowledgment of the complexity

of factors affecting the health of prisoners and the

difficulties of overcoming identified issues

Developing & Maintaining Trust: Recognition of organisational independence with individual

resources, strategies and specific roles (above,

right) within the partnership valued and respected.

Recognizing the Need for Partnership: the complexity of health needs amongst prisoners is acknowledged as a

rationale for the partnership. However, government policy at

the time influenced the alliance of various government

agencies, suggesting partnership involvement is involuntary

Monitoring, Measuring & Learning: Internal & independent monitoring boards continually

evaluating the effectiveness of service delivery to

improve staff training and enhance quality of care (4)

Commitment & Ownership: Expansion of the partnership in 2018 to further strengthen the collaboration and increase

efficiency, however a lack of involvement from private and

voluntary sector agencies limits possibilities for improvement

Enabling Factors:





Disabling Factors:

X

X

All 5 partners are government agencies working towards similar

political agendas and influenced by the same political ideologies

Issues regarding prison health is widely publicised leading to

the partnership being scrutinised and under increased pressure (6 )

Effectiveness of The Prison Health Partnership: Evaluated using the Partnership Assessment Tool (5)

Underfunding and overcrowding in prisons limits what the can be

achieved, reducing the impact on prisoner health outcomes

(1)

A whole system approach- from sentencing to release- provides

opportunity for improvement across the whole prison population

References (1) HM Government. (2018) National Partnership Agreement for Prison Healthcare in England 2018-2021. (Online). Available at:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/767832/6.4289_MoJ_National_hea lth_partnership_A4-L_v10_web.pdf. (Accessed: 20 February 2019).

(2) HM Government. (2012) Health and Social Care Act 2012- Part 5: Chapter 2. (Online). Available at: http://www.legislation.gov.uk/ukpga/2012/7/part/5/chapter/2/crossheading/health-and-wellbeing-boards-functions/enacted. (Accessed: 20 February 2019).

(3) Perkins, N., Smith, K., Hunter, D.J., Bambra, C., and Joyce, K. (2010) ‘What Counts is What Works? New Labour and Partnerships in Public Health’, Policy and Politics, 38 (1), pp. 101-117.

(4) House of Commons Health and Social Care Committee. (2019) Prison Health: Twelfth Report of Session 2017–19. (Online). Available at: https://publications.parliament.uk/pa/cm201719/cmselect/cmhealth/963/963.pdf. (Accessed: 24 February 2019).

(5) Hardy, B., Hudson, B., and Waddington, E. (2003) Assessing Strategic Partnership: The Partnership Assessment Tool. Leeds: Nuffield Institute for Health.

(6) HM Government. (2019) Government Response to the Health and Social Care Committee's Inquiry into Prison Health. (Online). Available at: https://www.parliament.uk/documents/commons-committees/Health/Correspondence/2017-19/Government-Response-to-twelfth- report-into-prison-health-cp4.pdf. (Accessed: 21 February 2019).

Equality Act

2010: to help

protect those with

mental health

disability not be

discriminated

against within the

work place and

when applying for

jobs1.

Future In Mind

Department of Health

want to aim to improve

mental health across

young people via

promotion, prevention by

2020. One of the main

focus of the document is

to tackle stigma and

improve attitudes

around mental illness2.What has time for change done?

They have used several

strategies:

– Local hubs with professionals to

give advise and promote anti

stigma and discrimination, inter- professional trust& respect.

– Social Marketing campaigns to

engage people who haven’t

experienced mental health illness

relevant to them and changing

attitudes and behaviours about mental health.

– Working alongside schools and

organisations to improve

knowledge, educating young

people about mental health. Also

carrying out workshops with

teachers to help create time for

change workshops within the schools.

– Provide resources for

professionals in the work place4.

What is time for change? A partnership lead by Mind and

Rethink Mental Health funded

by the Department of Health

and Social Care, Comic Relief

and National Lottery. It’s a

growing social movement

with the aim to change the

way that people think and act

about mental health problems

by working within communities,

work places and with young

people with the aim of trying to

change attitudes. The

partnership therefore showing

cultural continuity3 .

Outcomes Critical Evaluation

Unequal power relationships between service users and staff, reducing role clarity.

Staff burnout and structural discrimination affecting resources, no shared commitment.

Participation rate to gain figures not reliable

Study found an increase in discrimination towards those on welfare benefits

Have met the aims the partnership has set out to do so far, displaying successful independence of outcomes6

Conclusion Overall time for change has been slowly making a difference in educating about mental health. However, as a partnership it’s not working so well. It could be improve the negatives found in the study across staff and discrimination towards welfare benefits.

5

References 1.Illness, R. and Illness, R. (2019). The Equality Act 2010. [online] Rethink.org. Available at: https://www.rethink.org/living-with-mental-illness/mental-health-laws/discrimination [Accessed 12 May 2019].

2.Future In Mind. (2013). England: gov.uk.

3.Time To Change. (2019). Time To Change: About Us. [online] Available at: https://www.time-to- change.org.uk/about-us [Accessed 12 May 2019].

4.Time To Change. (2019). Time To Change: What we do. [online] Available at: https://www.time-to- change.org.uk/about-us/what-we-do [Accessed 12 May 2019].

5.Time To Change. (2019). Our impact. [online] Available at: https://www.time-to- change.org.uk/home/about-us/our-impact [Accessed 12 May 2019].

6.Corker, E., Henderson, C. and Thornicroft, G. (2011). The Viewpoint discrimination survey – the extent of discrimination faced by mental health service users in England. Psychiatrische Praxis, 38(S 01).