The importance of clinical leadership in service redesign

Purpose – The way change occurred at a strategic level and in four clinical services in three hospitals was examined. The purpose of this paper is to report how the hospitals designed and delivered change at organisational and clinical service level to improve services for patients, and the role of clinical leadership in this process. Design/methodology/approach – A comparative case study involving semi-structured interviews was undertaken. These involved a range of senior managers in 2009 (n=77), 2011 (n=21) and 2012 (n=29). Interviews with staff involved directly in service delivery were also carried out in 2011 (n=92). The interviews were recorded digitally, transcribed verbatim, and analysed thematically using the Framework Method. Findings – The value of, and approach taken to clinical leadership varied across the hospitals and over time. This was affected by the culture and priorities of the organisation. Some strategies for developing clinical leadership were developed, however they were limited. It was expected that capable clinical leaders would emerge, and be supported. Effective clinical leadership during organisational and service change required direct executive or managerial support and relied on clinical “champions”. Originality/value – The paper demonstrates that despite the importance of clinical leadership being widely recognized in policy and research, there were no established programmes in place at the hospitals that were studied to support it. Rather there was a reliance on clinical staff coming forward to take on leadership roles as part of organizational efforts to bring about change.

Polyphonous leadership and middle managers

Purpose – The middle manager's role in an organization is important. The purpose of this paper is to determine how middle managers understand their roles in managing changes from the perspective of polyphonous leadership. Polyphonous leadership can be described as something that inspires decisions by listening to multiple voices within the organization. Design/methodology/approach – The empirical data were collected from focus groups in the City of Tampere. Participants were middle managers (n=5) at an organization providing services for young narcotic/alcoholic families and pregnant mothers. The interviewees were selected due to their assumed ability to discuss management issues and their awareness concerning the factors affecting their workers’ capacities. The second focus group was organized for May 2010 (n=5) and the third later on in May 2010 (n=7). Findings – In the Finnish context, middle managers understand polyphonous leadership as a process with a beginning and an end. The authors call this process the dominant narrative of polyphonous leadership, because there is a strong consensus amongst middle managers regarding it. In the first step, middle managers have to work as leaders of interaction. Second, they work as utilizers of diversity. In the third step, they act as decision makers and interpreters of polyphony. The final step gives them a role as conciliators of operating plans and personnel operations. Originality/value – There is not much discussion in the extant literature of how middle managers try to act as linking persons in public services infrastructures. The model of the dominant narrative on polyphonous leadership is new in the literature.

Implementing the citizen focus agenda: a case study in police leadership

Purpose – Although the private sector has long understood that a customer-focused service is synonymous with success, the concept is less embedded in public agencies such as the Police. Cultural studies consistently argue that police practitioners perceive “citizen focused” or “quality of service” approaches as distant to “real policing”, making the concept difficult to implement. The purpose of this paper is to explore the complex infrastructure required for the implementation of this approach, specifically focusing on senior police leadership. Design/methodology/approach – Using semi-structured interviews across a diversity of police officers and staff it provides a case study of a city Police Force in England, who attempted to introduce a citizen focused approach between 2006-2010. Findings – Senior police leaders were reported to exhibit distinct and consistent leadership styles with a “transformational” style more positively associated with the implementation of this agenda. Practical implications – The study argues specific leadership styles are critical to the delivery of “quality” approaches. Originality/value – No other case studies currently exist that have explored the role of police leadership in the field of quality service/citizen focused approaches.

Building resiliency and supporting distributive leadership post-disaster

Purpose – The purpose of this paper is to describe leadership, decision making and other community characteristics that support community resiliency following disasters. Design/methodology/approach – Literature review and case study based on participant observation in nine years post-Hurricane Katrina in New Orleans. Findings – Effective leaders promote community resiliency using democratic, diffused decision making, stressing intra-dependence and promoting individual agency and locally-informed decisions. They build upon local networks and cultural bonds – not waiting for disaster but continuously, with flexible readiness framework infused in all efforts. Research limitations/implications – The paper uses New Orleans’ experiences following Hurricane Katrina to explore how leadership, decision making and other community characteristics can promote resiliency post-disaster – case study extrapolating from one disaster and relevant literature to understand role of leaders in community recovery/re-design. Practical implications – Changes in global economic and environmental conditions, population growth and urban migration challenge capacity of communities to thrive. Leadership and decision making are hub of wheel in crises, so understanding how leaders promote community resiliency is essential. Social implications – Disasters create breakdowns as functioning of all systems that maintain community are overwhelmed and increased demands exceed wounded capacity. Eventually, immediate struggle to limit impact gives way to longer process of re-designing key systems for improved functionality. What contributes to differing abilities of communities to reboot? How can we use understanding of what contributes to that differential ability to prepare and respond more effectively to disasters? Originality/value – Hurricane Katrina was a uniquely devastating urban event – causing re-design and re-building of every major system. Almost ten years post-hurricane, rebuilding process has provided key lessons about effective leadership and community resiliency post-disaster.

Knowledge based governance, governance as learning: the leadership implications

Purpose – The purpose of this paper is to argue that effective and ethical governance and government can and should benefit from many influences and inputs. These influences and inputs, in the form of evidence, information, knowledge and informed public participation contribute to the quality and legitimacy of government analysis and action. Design/methodology/approach – The approach in this viewpoint is to use persuasive communication in an advocacy and illustrative way to introduce learning governance as an approach to governance. Findings – The viewpoint states the case for the usefulness and relevance of evidence and ideas based learning governance linked to learning leadership in governance for effective and ethical leadership in governance. Originality/value – The value of the viewpoint is to stimulate and elicit discussion and debate on learning governance and leadership as approach to governance leadership.