Leadership in healthcare

It is time to step up; we’ve all got to become leaders. A topic that makes a lot of people very passionate, but particularly me. This is written from a perspective of a clinician with an awareness of the inadequacies of the healthcare system but also the profession in general.

Physiotherapy, as a profession, is in a wonderful position to truly lead the health system out of the curative, illness-sustaining model and into a new preventative, wellness-promoting model. This system, that is designed to keep people unhealthy, is also designed to keep people in pain; and until things change chronic pain will continue to be a massive burden on today’s society. I think allied health, in general, can become a leading field to change the public’s perception about musculoskeletal pain but I can focus on physiotherapy as it is my field of knowledge; if you can extend this to your own practice in another field, let me know!

A good definition of leadership is (Ref),

‘a social influence process through which emergent coordination (involving social order) and change (i.e. new values, attitudes, approaches, behaviours, etc) are constructed and produced’

Traditional leadership theories are underpinned by the explicit and implicit qualities of leaders. The issue with this approach is it tends to undervalue a few things and overvalues the power of the ‘position’ of being a leader (Ref). Some of the things that traditional theory undervalue are:

The process of leadership; it is a fluid, interactive process.The complex dynamics between parties; in complex systems like healthcare, unfortunately reductionist thinking leads to missed opportunities for progress. If taken for what it is, healthcare needs to learn from all parties to stimulate change and growth.Innovation; traditional leadership, is concerned with values and position, by virtue of being concrete do not align with innovation and change.

The position of leadership that we find ourselves, as clinicians, is the ultimate leverage to influence change. I think there is a world of untapped potential and the intricacies of leadership should be demonstrated more in clinical interactions to produce better outcomes. This means the position of leadership is taken for what it is, but also the process of leadership is promoted amongst the profession (and allied health in general), in order to effect change. So I’ve listed 5 key areas for enhancing leadership in every clinical scenario, which, in my opinion should become the basis for driving outcomes towards a better system and healthier population.

1. Every encounter is an opportunity to show leadership. As may be evident from the introduction, every single time you interact with a patient, you are being given opportunities to lead. No one else is going to lead the ship, and the patient has given you implicit permission to lead them through their injury/rehabilitation/psychosocial issues/unhelpful beliefs, so step up and lead, it is that simple.

There are enough great resources out there to enhance your skills for treatment, and it is the duty of every health professional to stay abreast of the evidence. But clinical treatment is about more than evidence-based or evidence-informed decision making; leadership, in my view is a massive missing element.

2.  Leadership is a two-way process, so take your cues from the patient. Traditional theory explains leadership as a dyadic relationship, and for the most part, when referring to clinical management this is true. It is mostly a relationship between two people looking to effect change. But it is not a one-way street; effective leadership is understanding the nuances of promoting intrinsic motivation. This means listening to the patient and responding to their cues; sometimes they want to demonstrate leadership, and sometimes they will be asking for leadership from you. Take these and ‘guide the ship to the destination’.

3. Communication is key. A good friend/mentor of mine is known to say, ‘everything in life rises and falls on leadership and leadership rises and falls on communication.’ It is pretty evident that communication is key in our professions, but in some scenarios if we really listen and take cues from both the verbal and non-verbal communication we are receiving, we can have the biggest influence.

4. Great expectations… it’s about challenging, not just meeting, expectations. Meeting patient expectations has been extensively written about in this and other blogs. Part of the reason the Western world finds itself in a position where musculoskeletal pain has become one of the most burdensome conditions is that expectations have simply been met. Too many clinicians have foregone a leadership role and public expectations are met and not challenged. For me, the best clinicians, challenge expectations and demonstrate leadership in everything they do. If more of us are willing to do this, then maybe there is a way out of this mess. If we are taking cues from the patient and remaining aligned with their values then these challenges can result in permanent and important change.

5. Bring everyone into your leadership circle. In clinical scenarios sometimes this may involve asking other professionals around you to show more leadership. In a complex system like the healthcare system, too much focus has been placed on individual leadership for too long, to the detriment of the public (Ref). We need to make it our mission to raise those around us to change outcomes, not just perpetuate the same outcomes. Importantly, this involves the biggest stakeholder; the patients themselves!

Asking our patients to become leaders and continue to challenge the system around them, will develop more resilient humans, who are ready to forge new paths out of pain and into health and wellbeing.

Our ultimate aim, as health professionals, is to obtain better outcomes for all patients and create social value by enhancing quality of life, promoting health and returning patients back to wellbeing. So to me, this means we all need to step up and begin to develop our own individual leadership capacity and demonstrate this with each and every patient. On top of this, asking those around you to do the same, and asking the patient to demonstrate some leadership of their own will be an important step to reversing health trends that have continued unabated for the last 20 years (Ref).

If you have any thoughts, please share them, and thanks for reading.

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