Why we Need Effective Leadership and Management in Public Health

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  • 4 years ago
  • Posted: February 9, 2015 at 2:08 pm

Public Health will always be a defining agenda in the affairs of men. It will be one of the most decisive key factors in the Post-2015 global development agenda. I watched the Health feature about Cancer patients on KTN and to be quite frank I was disheartened by the troubling thought of how thousands of people go through miserable times in a bid to acquire a place at a shot of radiotherapy. This got me thinking again about the state of the Kenya Healthcare system, especially with regard to its management. I chose to focus on the technical engagement of leadership in the management of Public Health at the risk of sounding too academic, but it is from the point of knowledge that we develop sound critical action. I also venture to state the Public Health system with a global connotation, like I always say, think Global, but act Local.

The idea of public health features prominently in global health politics, especially in the health-related millennium development goals, MDGs. Additionally, the World Health Organization (WHO) (2007) identified lack of good leadership and management as a major constraint to the achievement of the Millennium Development Goals (MDGs) in most public health sectors.

In the 21st century, PH is to be faced with new challenging frontiers such as inequalities in population health. These frontiers will be necessary in fulfilling quantum leaps in the field, not only in access to public health, but importantly in global public health leadership and management. Public health (PH) focuses on protecting and improving the health of individuals and communities through activities such as disease prevention, detection and control, health promotion and development of healthy public policies. The world is in the throes of multiple crises, from food security to fiscal threats, and this affects and will continue, public health. Consequently, sober and wise leadership and management in public health have never been this crucial. Thus, the question What Are the Benefits of Studying Business Administration? attains greater significance in this rapidly evolving scenario. An education in business administration offers detailed understanding of diverse leadership and management issues, many of which can be applied to public health management.

Defining the global public health agenda within the basket of issues facing the world, will be the paramount regard of the leadership. However, before stipulating the contents of the global public health agenda, it is wise to understand what entails exemplary leadership. The elements in this reality must be regarded within the light of sound leadership and management. Critical consideration now comes on the platform of identifying the theories and models in leadership and management and their public health application.

Leadership has many theories surrounding it and how they best apply for its effectiveness. Leadership definitions entail the process of influence; however what matters is whether the influence is one directional only or bi-directional. Notably, apart from the influence shared between the leader and followers another important factor in the leadership process is the situation that the group encounters which affects the leadership style There are among them core theories that offer a closer understanding of the idea of leadership. Dating back to the twentieth century, four main theory groups on leadership have emerged. The first among these four groups is trait theories. It supposes that efficient leaders have a common pool of characteristics or traits of personality. Implicit leadership theory says that people develop their concepts of leadership at an early age. This group focuses on such things as empathy, assertiveness, excellent decision making skills, charisma, and the like. They help in effective leadership; however, possessing such traits and qualities does not necessarily a leader make or combination of either. Historically, claims were made by experts and laymen that leadership is innate, whatever the case, effective leadership can be learned by developing praiseworthy traits. Traits are the expression of the content of the mind, the inner workings that develop outstanding leadership in a person.

The second of these groups is behavioral theories. The first group focuses on the person, and this one is concerned with what actions a leader would take. It is self-evident; focus is on how the leaders behave. They are either authoritative or inclusionary. Kurt Lewin in the 1930s devised a framework detailing different leadership styles. According to Lewin, there are three types of styles based on behavior, especially tied to decision-making. First, there is the autocratic, which involves sole decision making. The nature of which is that there is no top-bottom consultation on matters. Nonetheless, this would not affect the cohesiveness of the team as their input would not affect the quality of the outcome. It is necessary specifically when decisions need to be taken quickly. Second is the democratic style which is as it implies, inclusive and participatory.

Participatory type of leadership is especially useful during times of change when individuals are hesitant to it. The leader involves the team in decision-making, but it varies when the leader has to take it solely, or the team facilitates the decision. While it is appreciated by people, problems arise when they are too many voices, which create dissention that might prove inefficient. Third, laissez-faire type is where leaders do not entirely interfere and leave the team to their own wiles making most of the decisions. This takes place where the team is highly motivated, diligent, and sometimes when the boss takes to sloth in terms of the vital matters of the firm.

Third of the core leadership theories is contingency. Over the years, people realized that the best style of leadership predicated on circumstance. Contingency leadership theories try to predict which style of leadership best fits the situation. If a decision need to be taken quickly, perhaps a leader requires the full support of the team, these among many factor in the selection process. Instances of well-known contingency theories include the Hersey-Blanchard Situational Leadership Theory that allies the maturity of individual members of the team with leadership style. Others include House’s Path-Goal Theory and Fielder’s Contingency Model, all of which involve understanding how situations affect other factors in effective leadership. In turn, this influences how a leader conducts their leadership affairs.

Fourth are power and influence theories which focus on how leaders use their leadership position to accomplish affairs, how they exert their power and influence. Examples of well- known models of this nature include the French and Raven’s Five Forms of Power as well as the transactional leadership. The former involves three types of positional power that is reward, legitimate, and coercive; not to mention two sources of power, referent and expert. The former refers to charm while the other is personal appeal. This model further implies that the most decisive aspect is the development of personal power, and the best way to go about this is expert power. In this way, the leader gets legitimacy by being an expert in his affairs which is the most suitable source of power. Transactional leadership presupposes that people will do nothing else but for their own reward. Consequently, activities designed in a way that to be pegged to reward structures. Introspectively, this might not be the best leadership strategy in building relations or developing a proper highly motivated team, but it works in many organizations on a daily basis. Emphatically, the best of the leadership styles is transformative leadership. The leader shows a remarkable capacity of vision, purpose, possessing the necessary depth for its achievement. Motivating the subordinates to adopt the vision and run with it to its logical end, demanding the precise best from everyone. However, the only downside to this style is that the leader might need the support of pedantry- inclined fellows who share in the enthusiasm of the visionary leader. Whatever style of leadership adopted the principle remains, leadership has and always will be at the front-line of efficient running of affairs.

Equally prominent in Public Health, PH is the concept of management. There are theories that exist to describe the various functionalities and how they apply to public health. A manager ensures that resources have the maximum effect towards achievement of set goal. Nevertheless, the manager does not go about this haphazardly, rather applies method and purpose to an end. One of the key functions of a manager is managing change. Public health is undergoing a lot of change, inexorably. Therefore, a manager becomes crucial in navigating this constant reality. It is in understanding the importance of vision and strategy that aids in the realization of set objectives. The leader creates a vision; the manager fulfills the vision. Some people believe that public health program beneficiaries and staff who work these programs have no need of management. Many of the students of public health only wish to complete their studies in a speedy fashion and become competent professionals. They wish to be involved in promoting efficient healthcare programs and awareness campaigns in population-based medicine. These are all noble goals, but one thing that is missing and most importantly is the knowledge, understanding, and application of public health management. Nobly, this becomes the goal of any student or professional in public health, studying management in and of itself, not to mention how it applies to PH. Vitally, all public health depends on teamwork, and it is this idea that all constructs of management apply.

Management, essentially, can be divided into two broad categories, classical and post-modernist management theories. A point of moot over the years has been the fact that attempts in laying distinctions between management and leadership is prominent. Interestingly, these distinctions have not been clear particularly because there was quibble over terminology. Claims concerning distinctions are rather academic than practical. Clearly, a certain set of tasks fall under the title of management and others under leadership. Furthermore, some affairs in health systems and organizations have fallen under the category of leadership actually belong to management. It is necessary to note that some actions by public health practitioner can only be defined as management. The crux of the matter is that management skills fall under transactional leadership while leadership skills are under transformational leadership. This is the main distinction between management and leadership and all other differences subscribe to this one idea. Despite these apparent oppositions, the unity of the two leadership forms creates total quality in public health.

According to management theory, there are four elements to it. First, it is a procedure that contains social and technical functionalities; second, it accomplishes the set out organizational objectives. Third, it achieves the objectives through use human and other resources. Fourth, all the activities tend to be accomplished in a formal organizational setting. Notably, managers at all levels play a highly significant in molding organizational culture and values by their actions and modeling. They are the best representatives of an organization’s performance. Managers by the actions have description they take based on the competencies they use fulfilling organizational objectives. Managers have five functions that must be seen through for any positive forward movement.

According to Burke & Friedman (2011) these include planning, organizing, controlling, directing, and staffing. Classically, three key figures stand out in management theory and include Max Weber, Henri Fayol, and Frederick Taylor. Taylor was responsible for the scientific theory of management which extolled the virtues of organizing work and the workplace scientifically, and the selecting and training of employees. Taylorism, as it came to be known emphasized on collaboration and specialization between managers and workers respectively. Taylorism presupposed that if employees could be recruited and trained to fit the demands of a job then their efficiency and output would grow if conditions of work became altered. In spite of the claims by Taylor on the scientific merit of his postulation, it was an engineering model. This led Taylor and cohorts to develop a variety of tool and some of their innovations like the Gantt charts and time management studies are still in use to this very day. Fayol’s impact lies in the development of goal-oriented management and the elaboration of its fourteen principles. Being a Frenchman, the experience of managers in Europe was quite the inspiration for proposals such as effective communication, centrality, training, equity in remuneration, and encouragement of initiative.

The main idea of Fayol’s work was the development of organizational harmony and cohesion. Weber focused on the legalistic and rational aspects of an organization, bypassing the prevalent notions of authority in the 19th century. The idea was that the structure of hierarchy could be revolutionary social phenomenon in modern society. At the close of the nineteenth century, the main concept was that of bureaucracy, ordered, impartial, and rational flow of affairs that was free of vested interests. The rationality of Weber’s Bureaucracy was to avoid the irrationality of humans. Mary Parker Follet developed the integrationalist approach that postulated organizations were integrative units where each person played a role in the whole which created a totally new entity. This work focuses more on the people and not the office, the psychologic and not the logic of firms or organizations, not a surprise from a social worker. Chester Barnard in 1938 explained in a book, The Functions of the Executive that productivity lay in such things as motivation, leadership, and teamwork. It was a far cry from Taylor’s work that was too rationalistic. Others whose work focused on interpersonal relations aside from Follet and Barnard were Simon and Selznick, both 1957 and 1949 respectively.

The modernist approach developed in the last half of the twentieth century. This was a period of social, economic, and political change, especially post-second world war. Theories advanced in such times include the systems theory, enunciated by Talcott Parsons in mid-1940s, but developed by Hungarian Ludwig von Bertalanffy. It involved applying general systems theory to organizational theory. This was the unification of social, scientific, and other systems in a bid to explain society and restructuring of organizational theory. Additionally, other theories include the functional rationality approach which treats that organizations have a way of behaving that is free of human intervention. March, Simons and Thompson all played a role in the advancement of theory. In the mid-60s, two theorists attempted to consolidate all the conceptual frameworks that developed at the time. Consequently, they developed the Etzioni’s four models and Scott’s three perspectives. The models included the rational, interactionist, structural, and compliance. Scott’s perspectives consisted of the rational systems, natural systems, and open systems. The post-modernist approach focuses more on specific organizational narratives, as opposed to the empirically based quantitative analyses. It gained prominence in the 1990s and still continues to do so. Post-modernists believe in the relativity of truth, and that reality is a function of change.

There is a spectrum of issues that make up public health. Public health presupposes the determinants of health to be broad beyond healthcare alone and takes a sociological approach to exploring them. The weighty task becomes how the dual concepts of leadership and management, combined in a delicate balance work for the good of public health from sound policy development to application especially in project phases. For instance, traits theory can be applied to project management. Consideration placed in several factors that determine a streamline in the PH process. Factors like strategy, the development of effective partnerships, performance indicators, the economics of programs, social impact variables, ethics, and the changing face of PH, among many. Also, effective communication, cultural management, ensuring that the informatics of PH utilized have maximum purpose and effect and conflict resolution in healthcare management. Too often than not, it has been the norm in PH to avoid the sensitive balance between capitalism and efficiency. Peter Drucker arguably one of the best management thinkers of the twentieth century declares that nonprofits require management more because they lack the discipline of the bottom-line. Initially, and most importantly, the leadership and management determine what health efficiency is and what it means to them.

In fact, the most vital thing to understand efficiency and its difference from other terms is that it is a quantitative term expressed as a ratio .More so when it used in health, the term must include a numerator and a denominator which are variables that relative each other to determine action towards an end. Comprehensively, the creation of resource optimization and innovation is ever the burden of every professional and student in public health because they all fall under the broad category Public Health Leadership and Management.

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Stefan Wolf
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