“Who knew that getting into health-care management and health-care leadership would be such a blood sport?”
You might expect this quote to have emanated from the Centres for Disease Control and Prevention (CDC) in the United States or in response to its proposed massive government cuts to the federal government’s Medicaid program. But no: it is from Canada.
The comment was in response to the abrupt dismissal of the Chief Information Officer in Alberta, the shutting down of that organization, and the transfer of all 425 staff to the Alberta Health Service (AHS) Acute Care Department.
Bloodsport leadership refers to leadership practices characterized by combat, hunting, and violence; glorified in the movie, Gladiator II. There is a winner – armed and powerful – and a loser; defenceless and defeated. These notions seem to be alive and well in today’s world; both in Canada and in the U.S., modelled in its purest form by President Donald Trump.
For those who study leadership, this is jarring. After all, isn’t one of the most powerful ways of learning leadership observing role models? Health leaders across Canada may well be asking the question: Is this the kind of leadership we want? And for those who embrace the LEADS in a Caring Environment capabilities framework, can LEADS still work in an increasingly uncaring context?
Good health leadership is defined as “the collective capacity of an individual or group to influence people to work together to achieve a common constructive purpose: the health and wellness of the people we serve.” In Canada, this definition has taken the form of the LEADS framework, used in most jurisdictions across Canada.
Contrary to bloodsport leadership, the raison d’être for LEADS-based health leadership is CARING – for patients, families, communities, caregivers and citizens. This caring identity does not necessarily fit into politics or business. Pre-Trump, there were articles making the case for more caring and compassionate leadership in politics and business. Good leaders in health care are driven by service to others, not dominating them to serve their own needs. Effective health leaders are guided by ethical principles of which health and wellness is itself one. Living LEADS means denouncing leadership that uses the force of firings, imprisonment, economic sanctions and, in extreme cases, corruption.
Yet, bloodsport leadership is increasingly becoming the norm. For some, a niggling question lingers. Is practicing LEADS realistic? Accurate? Relevant, in today’s health system? Why not just acquiesce to a new order and stay beneath the radar to survive?
A simple answer has already been given. LEADS reflects the ethos of health care as a social enterprise. Therefore, leadership for health must reflect its essence.
Another answer is derived from polarity management or managing contradictions. Polarities are interdependent pairs of opposing values and beliefs and managing them means having them work together to achieve a greater common purpose that neither can achieve on its own. Or, as is prevalent in today’s discourse, polarities can present binary either/or choices, such as win/lose. Often those narratives treat challenges as “problems to be solved” rather than as contradictions to be held and balanced in a dynamic tension that needs to be managed to achieve a greater purpose.
In dealing with polarities or contradictions, Roger Martin challenged leaders to practice integrative thinking; a form of reasoning that allows them to constructively face the tensions of opposing models and find either a new resolution or a tension point realizing the best of both poles.
Bloodsport leadership embraces a singular, win-lose worldview. Effective leaders, in contrast, avoid being drawn into this mindset. They manage polarities to look for mutual gains. In doing so, they retain compassion and caring as elements of effective leadership. In a world where such qualities are considered “woke” or frivolous, LEADS balances the poles of results and relationships, modeling leadership aimed at advancing or achieving the common good.
Today, two polarities are emerging that need to be managed in Canada if health leadership is not to become a bloodsport. They are competition and cooperation; and publicly funded and privately funded health care. The challenge for Canadian health leaders is to identify the early warning signs of over-focusing on one pole to the neglect of the other and to create the optimal balance between them, rather than indulge one of the two opposing forces. The pendulum swinging between the two poles needs to find an orbit of dynamic tension, prescribing the space for solutions, as opposed to indulging “either/or,” which destroys social harmony.
The metaphor of bloodsport leadership embraces the competition pole exclusively. But if the pendulum swings to endorse competition only, caring leadership is shattered. It speaks directly to the notion of dominance rather than partnership in society.
The LEADS framework balances the demands of caring for patients within limited fiscal boundaries, otherwise known as a polarity of “cost and quality.” It asks leaders to focus on tasks that can lead to achieving health and well-being, and building relationships amongst people.
Another polarity in the Canadian context is represented by one pole of publicly funded health care (referred to as universal) and the other of “privately financed” health care. Canada’s health system is deemed universal, but is it? In the Canadian context, universal health coverage means that all people have access to the range of medically required hospital and medical care services at the time and to the extent of need on a “where and as available” basis without financial hardship.
With more than 6 million Canadians without access to primary care and with only hospital and medical services covered, we are seeing the limitations of only endorsing the “publicly funded” pole and narrowly defining the comprehensiveness of insured services. So, while the publicly funded system is “universal,” it is increasingly inaccessible. Consequently, more Canadians are opting out of publicly financed care in favour of privately financed care.
From a polarity management perspective, to retain publicly funded health delivery at the expense of privately financed care is neither desirable nor achievable. As Canada continues to lag well behind other industrialized countries in terms of health-system performance, it is becoming increasingly clear that Canadian health policy needs to find a better balance involving both private and tax-financed services.
To endorse one pole over another is to invite bloodsport leadership in defence of that decision. LEADS leaders cannot see different professions, interest groups, patients, community members or citizens as competitors or enemies as the term bloodsport metaphor suggests. Rather, we must see them as community colleagues, each of whom has a role in making the system (itself a holistic concept)) work (hence the Develop Coalitions and Systems Transformation domains of the LEADS framework).
In addition, there is a third reason we might be susceptible to bloodsport leadership – and doubting LEADS – and it may be the most troublesome of all: Do we believe in science and research, or don’t we?
That factor is the narrative that experts are self-serving, and that scientific research itself is not reliable. This narrative, being championed by far-right populist discourses and increasingly prevalent in the form of conspiracy theories and social media posts, puts science at risk. It questions the social capital and moral authority vested in our government and health institutions.
These attacks are eroding confidence and trust in experts and scientific findings. For example, the Edelman Trust Index profiles the growing fear that government leaders, business leaders and journalists/reporters “lie to us.” Respondents saying yes to each hit all-time highs, respectively, of 69 per cent, 68 per cent and 70 per cent. And, in keeping with our bloodsport analogy, 40 per cent of respondents indicate they approve of hostile activism – attacking people online or intentionally spreading disinformation, threatening or committing violence and damaging public or private property – as a viable means to drive change.
This divides people into two camps: those who trust experts and academics and those, like President Trump, who embrace “common sense” at the expense of expertise. This creates a win-lose dynamic. The loser is the underpinnings of good science and research and the winner ignorance, populism and its associated belief systems. In populist belief, leadership standards are often determined by those who gain power and those who do not: the former being “leaders,” whether ethical or not. Indeed, the result may well be the denigration of evidence-informed leadership (LEADS); the kind of leadership needed in health care.
Health leaders cannot let the narrative of bloodsport leadership stand. Public narrative influences change. Changing public narrative is a leadership skill. We, as health leaders, need to share our own stories, stories of others, and stories of today’s world of health care showing both the practical and emotional power of research and expertise in action; and how science, married with ethics, gives us a foundation for hope and some direction for creating a positive future.
The credibility of LEADS derives from what the research tells us works in health leadership, at all levels of responsibility. And, because the framework’s contents are derived from leaders and followers giving their input into the research it is a “common sense” articulation of what people see good leadership in health care to be.
Yet, LEADS cannot rest on its laurels. It was developed 20 years in a different socio-political context. Currently there is a national project to refresh the LEADS framework.
Bloodsport leadership is here. We are being challenged by a prevailing need not just to lead in an existing system (i.e., leadership in the system), but to change the system (leadership on the system).
For Elon Musk, “The fundamental weakness of Western society is empathy.” LEADS leaders align more the words of Hanah Arendt: “The death of human empathy is one of the earliest and most telling signs of a culture about to fall into barbarism.”
