Developing individual leaders is not enough

Western health care systems face a common set of challenges. These include issues of quality and safety, workplace reform, a shortage of health care professionals and a growing inability to meet the needs of those with chronic illness. As a result, a  urry of reform initiatives has been launched. At the same time, it is increasingly recognized that implementation of these initiatives will require stronger, more effective leadership than has existed to date. Partly re ecting this need, the UK has established a Centre for Health Care Leadership, Australia and New Zealand have established a joint Health Leaders Network, and the USA has recently established a Robert Wood Johnson Foundation funded Advanced Health Care Executive Leadership Development Institute. Although the above initiatives are well-intentioned, it is my premise that these efforts will have little impact unless they go beyond efforts aimed at the career development of individual leaders alone. The underlying assumption appears to be that developing the leadership knowledge and skills of individuals will enable these individuals more effectively to change their organizations to improve quality, enhance safety, change workforce conditions more easily, recruit health care professionals and better meet the needs of the chronically ill. This is an overly simplistic view of how organizations change. Leadership development programs based on the individual alone may well assist these people in their own career development but will leave the organizations with which they are af liated fundamentally unchanged. In brief, the goal of leadership development programs should be organizational change not, primarily, individual career development. This requires a multi-level approach to change that recognizes the interacting effects of the external environment, the organization, the team or group and the individual.1 If the above is true, how might such programs be designed? The most promising approach is to recognize that organizations are composed of complex, interdependent, interacting parts best captured in a total system approach that builds in the capacity for learning on the part of all components of the organization.2 This suggests the need to work with teams of individuals throughout the organization using real problems and challenges that are preventing the organization from achieving its improvement objectives. These teams may be single or multi-disciplinary and either at the same level of the organization or multiple levels depending on the nature of the problem being addressed and the development needs of the team. For example, the implementation of a quality improvement and performance accountability system to meet clinical audit requirements might most appropriately focus on the governance and top management team – both clinical and non-clinical – of the health care organization. In contrast, improving the quality and outcomes of care for diabetes patients would focus on the micro-system or team involved in the care of diabetic patients.3,4 In both cases, however, the focus is primarily on organizational leadership development for change and not on individual career leadership development. In such an approach, individuals do develop leadership skills, knowledge and experiences that bene t them in their careers but this occurs under the dominant objective of developing and improving the performance of the organization. This approach to leadership development, of course, is extremely demanding and time-consuming and, therefore, difcult to implement on a wide scale. It also requires that organizations be at a threshold state of readiness to enter into such a relationship. Thus, the approach is subject to the political criticism that attention is given to those best able to make improvements rather than to those most in need of such improvements. These drawbacks, however, can be mitigated to some extent by developing a focused framework for organizational leadership development. One departure point for such a framework is to consider the six aims for any health system, as articulated in the recent Institute of Medicine (IOM) report Crossing the quality chasm: a new health system for the 21st century.5 These aims include being: