Leadership in a Time of Strife and Change

When Thomas Chapman states, "Today, hospitals have been left scrambling to find their way in the midst of a complex milieu characterized by unprecedented competitive pressures, growing alternatives to traditional care, and the likelihood that reform will accelerate the shift to managed care," I could not agree more. And I concur completely with his assessment that in order to succeed in this environment health care leaders must be able to: * "exploit change for the good of the organization and the community..." * "rally internal and external constituencies, with limited resources, around a common sense of purpose and mission ..." * "articulate and maintain a long-term vision for the organization while tending to short-term realities in their communities." I must part company with Chapman, however, over his assertion that service is the only true source of successful health care leadership. "Tomorrow's leaders," he says, "will succeed not because they are financial wizards or artful negotiators or technological geniuses, but because they manifest true servanthood--and expect others in the organization to do the same." Apparently, he does not believe doctors fulfill the qualifications of this "true servanthood." I found particularly disconcerting his view that "most physicians traditionally have assumed levels of independence, isolation, and separatism." As a result, he believes that an "appeal to community service will not, in itself, generate much support from physicians for reform initiatives." On the contrary, in my experience, most physicians are remarkably inspired by programs that truly benefit the community. In fact, physicians undoubtedly donate more of their time and energy to assisting indigent patients than do salaried hospital executives. One mark of the truly visionary hospital executive these days might very well be that he or she is paying attention to the objections of medical staff to reform initiatives that appear in the form of "managed competition." What that executive might come to realize is that managed care is a euphemism for a system that interposes a third party between practitioner and patient in medical decisions traditionally made by the latter two alone. Moreover, that third party is generally not acting solely in the best interest of the patient, but in an effort to maintain an insurer's profitability. A true health care visionary would realize that our nation's current tilt toward managed care as a means of health care reform is a function of the power of one special interest group--insurers-rather than the result of an informed consensus that managed competition is in fact the best system for our communities. Chapman appears to assume that health care reform will expand the role of managed care. While political realities make this a likely scenario for the immediate future, it is a giant leap of faith to assume that managed competition as a mode of reform will ultimately serve the community and patients better than some other system, or, indeed, that managed care will remain in favor at all. It may well be that ten years from now those recalcitrant physicians who are refusing to get on this particular bandwagon will be viewed as the true visionaries of the '90s. Certainly vision is needed if we are to resolve the problems of our health care system. When Chapman says, "Inspired leadership will take root in our ability to inner inner passions and dreams and to persuade others to join us in realizing them, " I see this as the kind of leadership we want from our policymakers. Hospitals and health care systems, however, require a different kind of leader. The increasing complexity of our health care system has created something akin to a wilderness, an overgrown thicket of regulations and bureaucratic forms. The hospital CEO must have the vision necessary to comprehend the topography of this forest and to navigate a path along which to lead a variety of constituencies. …