Leadership in Healthcare PDF
Preview Leadership in Healthcare
Leadership in Healthcare Richard B. Gunderman Leadership in Healthcare 1 3 RichardB.Gunderman,BA,PHD,MD(Hons),MPH IndianaUniversityMedicalCenter Indianapolis,IN USA [email protected] ISBN:978-1-84800-942-4 e-ISBN:978-1-84800-943-1 DOI10.1007/978-1-84800-943-1 BritishLibraryCataloguinginPublicationData AcataloguerecordforthisbookisavailablefromtheBritishLibrary LibraryofCongressControlNumber:2008937458 #Springer-VerlagLondonLimited2009 Apartfromanyfairdealingforthepurposesofresearchorprivatestudy,or criticismorreview,aspermittedundertheCopyright,DesignsandPatentsAct 1988,thispublicationmayonlybereproduced,storedortransmitted,inany formorbyanymeans,withthepriorpermissioninwritingofthepublishers,or in the case of reprographic reproduction in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproductionoutsidethosetermsshouldbesenttothepublishers. Theuseofregisterednames,trademarks,etc.inthispublicationdoesnotimply, evenintheabsenceofaspecificstatement,thatsuchnamesareexemptfromthe relevantlawsandregulationsandthereforefreeforgeneraluse. Productliability:Thepublishercangivenoguaranteeforinformationabout drugdosageandapplicationthereofcontainedinthisbook.Ineveryindividual case the respective user must check its accuracy by consulting other pharmaceuticalliterature. Printedonacid-freepaper SpringerScience+BusinessMedia springer.com Foreword Leadership in Healthcare by Richard Gunderman is a marve- lousandmuchneededbookthatexaminestheessentialroleof leadership in the future of the medical profession. As Gunderman notes in the first chapter: ‘‘To think outside the box,weneedtoreadandconverseoutsidetheconfinesofour discipline.’’Dr.Gundermaniseminentlywellqualifiedforthe challengeofthinkingoutsideofhisdiscipline.Inadditiontohis M.D. from the University of Chicago, Dr. Gunderman also earned a Ph.D. in Social Thought from the University of Chicago.Thiscombinationofmedicalandphilosophicaltrain- inggives Dr. Gunderman a unique perspectivefrom which to explorethefieldofLeadershipinHealthcare.Withhisunusual preparation and wide-ranging intellect, Dr. Gunderman has alreadyhadaprofoundimpactonmanyfields,includingphi- lanthropy, ethics, bioethics and medicine. With this book he willextendhisinfluenceintothefieldofleadershipstudies. Dr.Gunderman’sabilitytoweavetogethertheinsightsfrom the fields of medicine and philosophy and add perspectives from literature and film makes this treatise essential reading notonlyforthoseinterestedinmedicalleadershipbutalsofor the broad area of leadership studies. In Leadership in HealthcareDr.Gundermandrawsfromsuchdisparatesources as Aristotle, William Harvey, Jane Austen, AndreasVesalius, Søren Kierkegaard and Akira Kurosawa to craft a powerful argument on the role of leadership in the profession of medicine. v vi Foreword Inhisfamousessay,theHedgehogandtheFox,IsaiahBerlin suggested that all great thinkers could be divided into one of twocamps:hedgehogsorfoxes.Thehedgehogs‘‘knowonebig thing.’’Theyhaveasingleintegratingparadigmthroughwhich theyviewtheentireworld.Theyseetheworldthroughasingle integrating lens. According to Berlin, thinkers such as Dante, LucretiusandPascalwerehedgehogs.Ontheotherhand,foxes ‘‘know many things.’’ They view reality from a multitude of different perspectives. Famous foxes include Herodotus, ShakespeareandPushkin.AsIreadLeadershipinHealthcare, IseeDr.Gundermanasafoxlamentingthefactthatmedicine hasbecomedominatedbyhedgehogs. Thisbookislongoverdue.Anin-depthunderstandingofthe roleofLeadershipinHealthcareiscriticalbothforthefieldof medicine and for the larger society. As citizens of developed societies age and become wealthier, the role of medicine will inevitablybecomelargerandmoreimportant.Healthcarecur- rentlyconsumesover16%oftheGDPoftheUnitedStatesand isprojectedtogrowtoatleast20%oftheGDPwithin10years. At the same time medical training has become increasingly morespecialized.Althoughspecializationisvitallyimportant, it is also crucial to have generalists, people who span the narrow and artificial boundaries and are concerned with the organic nature of the enterprise. If too few professionals are concerned about the ‘‘big picture’’ of their profession, it can enter into a death spiral in which specialization begets more specialization. The net result is that the overall health of the largersystemcansufferandevenfail. Dr.Gundermanhasaveryinsightfulchapterontheroleof organizations in the future of medicine. Organizational struc- turesthatmayhavebeenappropriateinearlierdecadesmaybe wholly inappropriate today and for the future. Just a few decades ago, the modern business corporation had literally dozens of layers of bureaucracy. Today, those organizations thathavesurvivedtendtobeconsiderablyflatterwithfarfewer layers of bureaucracy. At one time most of corporate power was concentrated in a single leader. Today power tends to be dispersed to multiple leaders. Some of the more successful LeadershipinHealthcare vii organizations now include external stakeholders in decisions that, at one time, were purely internal. Overall, developed societieshaveseenadramaticshiftfromauthoritarianorgani- zationalsystemstodemocraticsystems. The issue of appropriately aligning incentives and rewards for physicians can be generalized to many other professions. Forexample,therearethosewhoarguethatthe2008economic downturn was in large part caused by the decoupling of the traditionalrelationshipsbetweenbankersandhomebuyers.As recentlyastwodecadesago,manyhomeloanswereoriginated by local banks who loaned to local homebuyers. The bankers hadaverystrongincentivetoloanonlytoqualifiedborrowers and to carefully monitor such loans. This decoupling of the local banks from local home buying led to new lending prac- tices that have threatened the world economy. The increasing specializationofmedicalprofessionalsmightleadtoaparallel crisisinmedicine. PerhapsoneofthemostpowerfulargumentsthatDr.Gun- dermanmakesistheneedformedicalschoolstolookbeyond accumulatedknowledgeandIQwhentheyselectnewstudents. If medical schoolsignore the emotional intelligence as well as theleadershipcharacteristicsoffuturedoctors,theywillcreate amedicalprofessionthat consistsofbrillianttechnicianswho don’tunderstandandperhapscannotevencopewiththelarger humanisticissuesthatarevitaltothefutureoftheprofession. Letmebeclearthatthiscriticismisnotspecifictomedicine.All theprofessionssufferfromthissamemalady.Businessschools and law schools are equally guilty of admitting technicians at theexpense ofgeneralistsandneedtotakethesame prescrip- tionsthatDr.Gundermanrecommends. The concept of ‘‘ecotones’’ as discussed in his book is anotherinterestingmetaphorwherethefieldofmedicalleader- shipcaninformthefieldofleadershipstudies.Infact,thisbook itself represents an ecotone. Dr. Gunderman contends that ‘‘there are many ecotones in academic medicine.’’ The same canbesaid ofvirtuallyall professions andorganizations. For example,theleadersoftheautomobileindustrywouldbewell advised to consider the concept of ecotones in examining the viii Foreword rapidlyevolvingnatureoftheirindustry.Failuretodosocould leadtofailureofanumberofthemajorautomotivefirms. In his chapter on searching for a leader Dr. Gunderman makes the important, and typically overlooked, observation thattherecruitingphaseisperhapsthemostcriticalphasefor anewleader.Itisduringrecruitingthattheprospectiveleader has the power and flexibility to negotiate for the resources necessary to ensure the ongoing success of the organization. Infact,thefailuretosecuresuchresourcesduringnegotiations may be the single best signal that the position is potentially dangerous. In sum, Leadership in Healthcare is a powerful treatise on thecriticalroleofeffectiveandenlightenedleadershipforone of society’s most important professions. This is a book that shouldbereadnotonlybyleadersandaspiringleadersofthe medicalprofessionbutalsobyscholarsofleadershipingeneral. The former will discover key insights from a wide range of disciplinesthat willinformtheir leadershippracticeand style. The latter will find a range of sometimes unique perspectives thatcanenlightenexistingtheoriesofleadership. PhilipL.Cochran Acknowledgements Numerousfriendspastandpresentcontributedtomyongoing educationinleadershipanddeservethanksforhelpingtomake this volume possible. I cannot catalog all the coaches and teammates,colleaguesinfraternal,governmental,professional andcivicorganizations,coworkersinphilanthropicinitiatives, andmembersoffaithcommunitieswhosharedvaluableleader- shiplessons.Ifirstencounteredleadershipasasubjectofstudy andpracticethroughtheLillyEndowment YouthLeadership Program,underthefar-sightedleadershipofH.DeanEvans. Manyteachershaveprovideddeepinsightsintoleadership, mostofwhichIonlydimlyrecognizedassuchwhileundertheir tutelage.Thesehaveincluded,atWabashCollege:EricDean, William Placher, Hall Peebles, Lewis Salter, and Raymond Williams;intheCommittee onSocialThoughtattheUniver- sity of Chicago:James Gustafson, Leon Kass, David Greene, LeszekKolakowski,andKarlWeintraub;andintheSchoolof Medicine at University of Chicago: John Fennessey, Thomas Krizek,MarkSiegler,NormaWagoner,andLawrenceWood. More recently at Indiana University, Mervyn Cohen entrusted me with two leadership responsibilities that ignited a passion to begin studying leadership in earnest. Philip CochranandCarolMadisonintheTobiasCenterforLeader- shipExcellencehavepermittedmetoparticipateinanumberof valuableleadershipdiscussionsandprojects.IntheCenteron Philanthropy,EugeneTempel,DwightBurlingame,andLeslie Lenkowsky have done the same. Several people have made ix x Acknowledgements particularly important contributions to the School of Medi- cine’s ongoing Leadership in Healthcare elective course, includingBrandonBrown,EmilyBeckman,andWilliamPro- vince. I also want to thank my regular conversation partners, William Enright, Paul Nagy, and Robert Payton, as well as NancyGoldfarbandRichardKlopp.ThanksforRuthPatter- sonandRhondaGerdingforhelpinorganizingmyleadership teachingandpreparingthemanuscript. Students and colleagues who have collaborated on prior work reflected in this volume include Shanaree Brown, Emily Burdick, Kenneth Buckwalter, Steve Chan, Nathan Erdel, JoshuaFarber,StevenKanter,AndrewKoerber,andMarsha Snyder.Iwouldalsoliketothankseveraljournaleditorswho havepublishedsomeofmypriorwritingsinthisarea,including Stanley Baum, Edmund Franken, Bruce Hillman, Anthony Proto, and Robert Stanley. Van Moore, Harvey Nieman, James Thrall and Christoph Wald have provided recent valu- ableopportunitiestocontinueexploringleadership. I would especially like to thank the many learners at the University of Chicago and Indiana University with whom it hasbeenadelighttoexploreleadershipovertheyears.Above all, my parents, James and Marilyn Gunderman, my beloved wife, Laura, and our children, Rebecca, Peter, David, and John,havetaughtmemorethanIcansayaboutwhataleader needstobeanddo.Theirloveprovidesawellspringofdevotion andmeaningonwhichitisablessingtobeabletodraw each day.
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