Hack:
Better leaders, Better health

Context The health sector lags behind business and other industries in adopting modern leadership and managerial theories (Gunderman, 2009). The sector is highly structured and driven by decades of standardized practices and values. The remuneration system and leadership style in healthcare still awards individuals for teamwork and attribute success to key players in the sector and less so to the collective effort. The structured and standardized approach to operations fosters a leadership style that stifles creativity and innovation. The healthcare system manpower is composed of frontline staff (doctors and nurses mostly) and the investigative background staff (scientist, technologists, administration staff, and technicians). When members of the public or policy makers measure the performance of the healthcare system, more often public opinions that are gathered for evaluation are based on the frontline staff's relationships with the public. Consequently the whole system is judged on a subcomponent of the whole. The investigative background staff perceives this as lack of acknowledgement of their roles. The skewed view of the healthcare system often leads to attribution and perception errors. Attribution error is the tendency to attribute the behavior of other people more to internal factors than external factors (McShane & Travaglione, 2009). The attribution errors lead to perception of non-frontline staff as obscure, invisible and irrelevant to the whole. For example there are hardly any great stories about medical laboratory scientists successfully screening and finding a rare autoantibody in a patient with a chronic inflammatory disease. The credits often are attributed to the clever doctor or nurse but the reality is that for further testing to be done in a laboratory the frontline staff would have failed to pinpoint the disease using their experiences and knowledge. The lack of teamwork and leadership in the sector starves creativity and innovation and drives the healthcare sector operational costs upwards. Further complications that arise from attribution and perception errors are professional self-serving bias. Self-serving bias is the perceptual error whereby individuals attribute favorable outcomes to internal factors and their failures to external factors (McShane & Travaglione, 2009). For example the pathology services (diagnostic and allied services) are frequently reformed and targeted as costly and none core services. At best they are outsourced to private providers. Often the reforms are disguised as cost cutting measures but the pathology services on the other hand provide the basis for a majority of clinical decisions. The perception error build a strong professional self-serving bias that views success in health as the domain of the intelligent medical doctors with teams of nurses and insignificant or obscure support staff. The costs and medical errors are often viewed as resulting from non-frontline staff or non-core services. Further, the attribution errors also distort how policy makers and administrators tend to attribute success in the healthcare systems. The embedded attribution and perception errors create a biased and perceptively unfair reward and remuneration system. Individual recognition and reward system is used to incentivize frontline staff and very little, if any, incentive is passed on to non-frontline staff. Commercially, productive services are important assets that are worth retaining and protecting but the healthcare remuneration and reward system encourages a view that those that front for the productive services get rewarded. Health is defined as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO, 1948). The definition implies that a diversity of professionals is relevant to the healthcare system and health delivery. Snee (2011) recognises that healthcare services and institutions are not for a particular professional group but the satisfying the needs of the patients. Reduction of professional self-serving interest and organisational structural complications can enable clarification and articulation of organisational goals. Gunderman (2009) defines professional bureaucracy structure as a system that relies on an elaborate system of training and indoctrination to endow individuals with a strong internal compass that allows great deal of control over their own work. Further consequent to attribution and perception errors is the misplaced motivation of doctors and nurses to view command and control leadership styles, with highly bureaucratic administrative structures as appropriate for their practice. Professional bureaucracy and command and control leadership tend to lead to the more-important-than-average effect (MITA) which justifies immoral and unethical behavior. MITA effect is the propensity of individuals, with an astounding aptitude, for self-justifications for engaging in unethical behavior to attain group or individual goals (Hoyt, Price & Emrick, 2010). MITA effect does exist in the healthcare. For example there are media reports of medical doctors and nurses behaving unethical. Recently, a doctor employed his untrained wife to administer medicines and fraudulently inflated enrolled patients (Akuhata, 2011). Problem statement Given the prevailing healthcare context modern leadership and managerial principles are necessary in the healthcare system. Reforming the system to foster creativity and innovation is necessary. Team based remuneration system and removal of attribution and perception errors is necessary to reduce operational costs. Reducing perception and attribution errors in the healthcare imply overhauling the healthcare system structure and practice but addressing the person of the leader has similar effect to healthcare reforms. There is need for systems leadership and a systematic review of the healthcare system. Systems leadership is how to create improve and sustain successful organizations using social process that recognize people (MacDonald, Burke & Stewart, 2006). Although systems leadership creates successful organizations, leaders themselves also need to take care of themselves. Today’s complex, volatile and rapidly changing healthcare environment demand leaders who can cope with both professional and non-professional pressures. There is need for leaders who have skills to cope with competing demands and do not burn-out or run-out of energy. Healthcare system leaders need to give their life and work a sense of meaning that can be communicated openly to others to enhance creativity and innovation in the sector.