Editorial - Leadership in Health

Welcome to the December edition of Health Care and Informatics Review Online which focuses on leadership in health, both in general terms and more specifically in relation to the development and deployment of information technology (IT) and information management (IM) solutions in the area of health.

Discussion in relation to leadership often implies that the process of leadership can be separated from the organisational context in which it is applied, ie, that "leading" is largely a generic process. Degeling and colleagues have questioned this view of leadership, citing research that argues that, rather than rationally controlling and steering organisations, the role of leaders is to provide "the illusion of controllability".^{[ 1 ]}  Degeling and colleagues extend this critique by considering the importance of context in accomplishing leadership.^{[ 2 ]}

The hypothesis that leadership cannot be separated from the context in which it is applied underpins the concepts presented in the paper "Leadership and Learning: A Review of Leadership Themes in Health Informatics" from Ray Delany, Management Consultant, Auckland, New Zealand. In this paper, Delany considers the argument that the leadership requirements of health care in general and informatics in particular are different.

Delany highlights that advocates of the view that any particular group requires a "special" form of leadership will quickly run up against the pragmatic experience of seasoned, professional leaders who are accustomed to providing differing leadership styles to suit the various circumstances they find themselves in. He notes that the characteristics of effective  leaders are consistent with the generic principles of ethics and good behaviour in society, and are transferable across many areas of human endeavour.

The paper "Leading Health Organisations in New Zealand" from Dr Rod Perkins, Senior Lecturer in Health Management, School of Population Health, The University of Auckland, New Zealand, attempts to examine the elements that have been identified as components of successful leadership and management and place them in the context of a strategy to retain skilled staff in the New Zealand health service.

The paper highlights a number of key points including: that leaders are required at all levels in organisations if they are to change or adapt to the external environment; that the characteristics of effective managers are similar to those of transformational leaders, eg that leaders focus on their people rather than the tasks they perform and; that the workplace can be structured and organised in such a way that it can nurture leaders and leadership.

We are very pleased to include in this edition the posthumous publication of a paper authored by Dr Margaret Tobin in 2002 when she held the position of Director, Mental Health Services, South Australia in 2002. Dr Tobin and co-authors Madeline Richardson (Project Officer, Mental Health Services and Programs, Department of Human Services, South Australia at the time that the paper was authored) and Dr Luxin Chen (Country Project Development Director, Institute for International Health, University of Sydney, New South Wales, Australia at the time that the paper was authored) highlight the expertise required to lead service unit level change and the challenges of using change management strategies to implement local service unit level interpretations of national strategy.

The paper draws on the very substantial breadth of Dr Tobin’s experience of institutional change management, regional service development and state level implementation of a major reform agenda and describes examples of linking national policy with local organisational change.

Publication of this paper was delayed by Dr Tobin’s untimely death in October 2002. We are very pleased to now be able to provide this publication for our readers with kind permission of her co-author Dr Madeline Richardson.

Finally, we present a guest editorial from Mike Rillstone, Chief Advisor (Health Sector, Information & Technology), Corporate & Information Directorate, New Zealand Ministry of Health. Rillstone’s paper applies a seasonal flavour to consideration of what makes effective leadership in the health sector. He reflects on organisations as interdependent partners, each contributing to the success and survival of each other, and highlights that trust and recognition of contributions from all organisational members provide the keystones in this symbiotic leadership.

1. Czarniawska-Joerges B. The Three-Dimensional Organization, Lund: Studentlitteratur; 1993.
2. Degeling P, Iedema R, et al. Accomplishing Leadership in the Context of Health Reform. In: Dopson S, Mark AL (eds). Leading Health Care Organizations. Basingstoke, Palgrave: Macmillan; 2003. pp 113–133.