Poor Leadership in Healthcare
OBSTACLES AND FACTORS
Barriers to a Successful Leadership Improvement Plan
In a great many cases, major failures in healthcare leadership are hard to discover or surface by themselves for investigation (Walshe & Shortell, 2004). Often, many of them are revealed only by accident or chance and even then, what is discovered may only be part of an entire problem that has escaped notice or been kept from being discovered. Major failures may come out as an accidental result of some very unpleasant event, a staff member or outside may raise this concern, by the perseverance of one or a few motivated individuals or through media exposure. Despite current systems for quality assurance or improvement in most healthcare organizations and in developed countries at that, major failures are not all too easily known. These systems, which include incident reporting, clinical profiling, mortality and morbidity review, credentialing, risk and claims management and external arrangements for regulation, inspection, accreditation...
The importance of disclosure and discovery in detecting and solving these major failures cannot be overstated (Walshe & Shortell).
But barriers prevent both disclosure and discovery (Walshe & Shortell, 2004). The first barrier is the well-entrenched culture of secrecy and protectionism in healthcare facilities in all countries. This is the "club culture" of doctors and fellow professionals who put their self-interest above that of their patients. And organization leaders themselves are defensively more protective of the institution than their patients. The second is that the knowledge of the failure is shared by many people or is fragmented among them but no single individual knows the entire issue nor possess the authority to do anything about it. A third is the capacity or tendency of certain individuals and organization for self-deception and rationalization, which disinclines them from acting on the failure. They find it easier to suspect or disbelieve something unpleasant than to believe…
