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Shifting the Paradigm for Health Care Leadership

In his article, Bruce Vladeck maintains that health care leaders have fallen short of the demands placed on them over recent years--often responding in reactive and self-protective ways to their environment. Vladeck calls for "a new generation of health care leaders" who would recognize the qualitative difference between health care leadership and leadership in other fields; would adopt a long view creating within their organizations a purpose and culture that attempts to identify and fulfill important and continually changing community needs; would communicate effectively to both internal and external constituencies; and would inspire others to follow their leadership. His call for a new generation of leaders implies a gap between the demands placed on today's health care leaders and the skills and values they currently possess. This gap, however, may be even greater than Vladeck has led us to believe and will undoubtedly widen. Not only must health care executives in the '90s lead organizations of today, they bear the responsibility for preparing their organizations for a new century. Throughout his article, Vladeck assumes that the current system will prevail during the coming decade. Our research indicates a paradigm shift for the delivery of health care and the demands placed on health care leaders. In the next century, we expect to see health care moving away from its present fragmentation toward a seamless, continuum of services. Executives must begin to design and steward these new organizations, rather than continue to search for better ways to manage health care organizations as we know them today. The culture, structure, and systems of tomorrow's health care organizations demand a new type of leader--a transformational leader whose responsibilities are organizational in nature. Leaders will focus less on accomplishing tasks and more on developing people and managing processes. Traditionally, we have viewed leaders as heroes--those special individuals who rise to the top during a crisis, setting the direction, making all the decisions, and energizing the troops. This myth, however, reinforces a short-term focus, neglecting the benefits of learning, thinking, and acting on all levels of complex organizations. The leader's new work, according to management expert Peter Senge, is to build "learning organizations," organizations that are creative and can adapt readily to change. The rate at which organizations learn may become the only sustainable source of competitive advantage. Rather than charismatic decision makers, tomorrow's leaders are designers of organizations where people are continually expanding their capability to shape the future. A transformational leader has the capability to shift the focus from problem solving to creating new visions that challenge the prevailing mental models. Creating organizational purpose is not enough. Leaders must promote a shared vision of the future that permeates throughout the organization and provides the guiding focus for current and future activities. They must communicate a personal passion and conviction that flows from a fundamental belief in that vision. TEAM LEADERSHIP Leaders must recognize their personal strengths and weaknesses--using their time and skills for high-leverage activities and orchestrating others to accomplish objectives and realize organizational vision. The health care leader's ability to build and manage teams becomes one of his or her most critical competencies. Health care organizations are so complex and the demands on leaders so varied that it is impossible for one individual to fulfill all expectations. No single individual can operate today's complex internal organization, work effectively within the community, and direct the future of the total health care system. Leaders must possess the ability to choose and inspire a team of people with the diverse skills to accomplish the job. …