Do we expect too much from our leaders

Much of what Bruce Vladeck says about health care is irrefutable, and his article provides an unusually thorough assessment of the issues facing leaders as they grope with conflicting priorities. Since I agree with so much of Vladeck's assessment, I will focus my comments on the key point of difference. This difference lies in what we expect of leaders. We have a propensity for attributing to leaders qualities and expectations that, depending on environmental conditions, may be totally unrealistic. We call for leaders to change systems but sometimes we forget to be pragmatic and patient. I differ with Vladeck's suggestion that health care leaders are running for cover and ignoring their community and social responsibilities. A very strong argument can be made that if the health care leader will not confront the issues, who will? An assumption is made that the leader must accomplish all these strategic assignments in the public interest personally or it represents a professional failure. What is missing is an explanation of the circumstances as to why leadership is perceived by some to be lacking. Vladeck states that "as enormous and powerful forces of change have swirled all around them, leaders in the health care community have too often been preoccupied with narrow and parochial interests, misunderstanding the significance to their organization's long-term well-being of efforts to change the broader environment." He goes on to say, "In fact, it is probably not unfair to say that, over the last number of years, we have had too many reactors and followers, and a serious shortage of leaders--in our society as a whole, certainly, but surely in health care as well. The very importance of the health care enterprise requires that that change. A new generation of real leadership is essential. The health of our communities requires it." This "clarion call to arms," in my opinion, needs to be examined in the light of what leadership today is all about. First of all, leaders today are dealing with entirely different circumstances than leaders of the past. The world is a much more complex place. The state of communications technology is a good example. Events worldwide are televised "live." The very latest in government or corporate misbehavior appears instantly in the morning newspaper. The competition for "air time" for any leader in any field is judged by its news worthiness not necessarily its social worthiness. The role, function, and visibility of leadership is being blurred by the speed of change in society as a whole, not just the health field. Because solid leadership activity (in marshalling the forces of change in the health field) is not readily visibile it does not mean that leaders are not working to solve the problems and address the issues. It is important to remember that leaders have to be highly adaptive, as emphasized so well by Vladeck, and a good part of this adaptability relates to how leaders organize their activities to achieve their organization's mission. Let me suggest that the era of the self-sufficient, high-profile and highly visible type of leader who prefers to "go it alone" has disappeared and is being replaced by an army of leaders, most striving toward goals of high community purpose. I base this on my contacts with the present and future generation of health service executives who are indeed preparing for massive changes in health care. I also have a bias that I suspect is shared by Vladeck--that leading a health care organization these days requires special skills, political savvy, and more than a little luck. Let's examine the management team--without which the organizational train is derailed. Today's leader is much more dependent on members of the management team simply because of organizational complexity. For example, governing boards have become much more involved in policy decision-making, and properly so. This demands more of the executive responsible for helping the board cope with very complicated issues. …