Strategic Leadership in Healthcare

– Dr Guido Prato Previde

I studied a large organisation in the field of Health Care where major strategic and organisational changes have been carried out during the past 5 years by a top team. These changes created a pilot experience for the whole country (the solutions they adopted have now become the policies for all other similar organisations in other regions) and are really significant both culturally and operationally. In fact, the team was able to introduce two major radical changes which have characterised the vision of services and of management systems since the early 90s.

The first change was the new emergency that moved to a “stay and play” solution from the traditional “load and go”. This meant that the patient was not simply loaded on the ambulance and hurried off, but all possible treatment was given in the place where the accident had occurred. Only then was the patient brought to the nearest Health Care centre, where professional medical staff were available.

This radical change represents a new vision of the “service”and is a structural and operational breakthrough. The chief”novelty” was the substitution of a hierarchical structure for a co-ordinated matrix. Functional management employees and volunteers, coming both from the public and the private sector, were grouped together and focused on a common objective. This led to a more effective and integrated service where different institutions were collaborating with each other. To do so, communications, for instance, also had to be made more integrated and effective in the territory, and change which became possible because a unique emergency telephone number over the local territory was adopted. From the very first call, a trained operator was able to make an immediate assessment and to decide from the operating centre what was necessary and how to carry out the intervention within the network.

The second fundamental change was the institution of budgeting for the organisational unit. This change of procedure also represented a remarkably revolutionary change because the existing practice in the Italian NHS was wholly centralised and authoritarian in regard to financial accounting.

The two consultants dealt with various aspects of the management of this service, and used KAI to understand and measure better the cognitive culture of the leading establishment in a changing environment. One of the aspects studied was the relationship between the leadership’s cognitive styles and their impact on change. The Adaption-Innovation dimension and measure were applied to the five members of the planning top team and to the 20 members of the operating team; the results are amazing: the radical planning (first) group was found to be strongly innovative (mean: 111.75; stand. dev.: 18.37), while the operating team’s scores were found to be clearly adaptive (mean: 86.42; 15.39). The cognitive profile of the leaders of this organisation clearly reflects the kind of vision, mission and managerial decisions they were able to take; moreover, the change occurred successfully also because of the fact it was really put into practice by the implementing team.

In particular, there were two co-ordinators of the operating team, peers functionally invested with more responsibility, who showed KAI scores which bridged the mean of the two teams (Planning and Operating); it was amazing to see that their individual KAI scores (and their KAI sub-scale scores too!) reflected quite exactly the specific tasks they were expected to do: the more adaptive was in charge of the internal human resources management, and the more innovative particularly dealt with the external environment of the operating team (the Directors included). This makes us suggest that the successful cognitive and communication (team system requirements) patterns were achieved through the two collaborating co-ordinators’ contrasting styles.

Moreover, in a more established phase, a few years later, but still in the middle of final implementation, the profile of the top team had changed: some were still in there, some had left (the team leader included), resulting in a more adaptive profile. However, the change went on because of the differences (in cognitive style) between the Planners and the Operators remained wide enough and because the intuitive high ability of the leader and his successor enabled them to manage the strengths of both styles as well as the possible conflicts.

It seems clear that when leading change, cognitive style is a strategical weapon, and therefore for innovative changes, one might need innovative (cognitive) profile of the Managing Director and for most of the team. Conversely, when more adaptive styles and strategies for change now or later needed, adaptors will be better for leading such change within the organisation. The management of change is assumed to be, by us, a mixture of magic and scientific ability that can deal with the whole range of cognitive style within departments, units and offices, in order to keep both adaptive and innovative strategies alive and effective.

Dr. Guido Prato Previde is the translator-validator of the Italian KAI and founder-director of Decathlon Consulting, Milan.

Originally published in KAI News, 1994