The art of leader maintenance

Abstract

[Extract] Contemporary public health facilities seem unable to meet the expectations of either the communities they serve or the governments that operate them. Those expectations include a high standard of care with continually improving practice and outcomes; that is, what we might regard as practice development. The inability to satisfy these expectations is currently attributed, at least in part and somewhat simplistically, to a perceived failure of leadership. The immediate response to remedy this perceived failure has been a proliferation of leadership development and support programmes. Not surprisingly, these programmes are yet to have any significant effect on complex problems deeply rooted in the structures and cultures of the health systems. Clinical leadership is fundamental to practice development, and practice development teams have been characterized by high profile leaders who tend to move onwards and upwards so there is a high turnover of leaders among these teams. A re-examination of the notion of leadership development and maintenance is both timely and necessary, as is some consideration of the place of leadership in the dynamics of clinical teams. The creation of transformational leaders can be highly effective in changing culture and performance but the task of doing this in a context that is hostile to its principles may be more than most leaders can endure and still survive intact. There is a great need for leadership maintenance practices but there is little evidence that this maintenance exists in contemporary health facilities.