Academic Health Care: Leadership in Time of Change

Article excerpt

Executive Summary

Health care today is between paradigms. This state of fluctuation places extraordinary challenges on leaders of academic health care facilities. New leadership skills are needed to overcome this dilemma. Communicating a vision and persuading others to work toward this ideal is the responsibility of an effective leader. Prevailing over adversities unique to academic medical centers requires strong leadership and stakeholder support.

Introduction

Health care in the United States today differs vastly from its model a decade ago. The traditional health care environment values individual autonomy and rewards individual achievement.

The evolving system supports a larger community interest. Technological advances, delivery system innovations and changes in demographics as well as disease states themselves have dissolved the old rules, obscured the boundaries and nullified the anticipated success from former behaviors. Health care is between paradigms.

However, the overall mission of academic health centers endures: to improve the health of the public through education, research and service. The educational aspect of preparing health care professionals for practice remains constant in a shifting environment. (Chapman, 1998)

The relationship between the health of the academic organization and effective leadership is strong (r=.97). (Dudek-Shriber, 1997) Therefore, it is not surprising that academic medical center leaders must also adapt to this relentlessly fluctuating and often conflicting pressure. (Klauer Triolo, 1997)

Such times require stable leadership with new leadership skills. This paper addresses the critical issue of leadership in academic health care centers. It will review current thought on leadership skills and its application to academic health centers. The intertwined challenges of establishing a productive and creative climate with shrinking resources in an unstable environment is not unique. The academic triad of education, research and service and the traditional hierarchical leadership style in academic health centers present distinctive nuances to leadership in the public sector.

Current Leadership Status

There is an increasing instability of medical school administrative leadership in recent decades. (Banaszak-Holl, 1994) Department chair people also exhibit rapid turnover. (Green, 1991) Petersdorf (1997) cited fiscal distress, unrealistically high expectations, an unwieldy constituency, stunted intellectual life, unreasonable boundaries, incompatibility between level of authority and responsibility and faculty prone to second-guessing as masons for the high turnover in leadership at academic health care centers. Yedidia (1998) added unprecedented competition in the clinical arena as another cause.

The vitality of an academic institutions is defined by its ability to control costs, promote learning and provide access and equity. Recent changes most important to higher education have been external to it: diminished resources, rising demand for alternate services, emergence of technology and new reliance on market-like mechanisms for public services. (Policy Perspectives 1994 Pew Higher Education Roundtable) These changes threaten the conventional educational process.

Leaders in academic institutions are removed from core activities. Very few, if any, of the daily activities of a dean directly relate to the educational programs of the school. (Machen, 1995) Dean's spend 90% of their time on five major issues: excessive traditionalism, isolation and division of activity within an institution, poor management, too few resources and too few people with too much to do. (Chapman, 1998)

The dean's attitude however has an enormous impact on what happens to an educational institution and its programs. (Chapman, 1998) A rekindling and engaging of the spirit of those supporting the academic mission requires sensitivity and continual nurturing. …