Leaders of Contemporary Public Health Promotion Services - Essay Example

Leaders of contemporary public health and health promotion services have considerable challenges to manage over the next few years. Date I. Introduction: the issue of obesity and narcissism Leadership and Management in the public health sector is fast becoming more important considering the increasing number of epidemics it has to effectively respond. Epidemics which has been negligible decades ago is fast increasing at an alarming rate that public health providers must not only rethink its approach in addressing these epidemics but also on how can it more effectively respond as an organization. There are two epedemics which were negligible decades ago that is now becoming an issue of concern due to its pervasiveness-obesity and narcissism. The issue with obesity is already in the public consciousness. Yet, despite of the multitude of proposed solution on how to curb obesity, its incidence still continue to rise at an alarming rate. Clearly, the present approach proves to be ineffective because the epidemic still pervades and this poses a challenge to public health sector leadership in years ahead on how to effectively respond to this epidemic that poses serious health risk. Narcissism can be said as a silent epidemic because its symptoms are not obvious unlike obesity where we can readily see that a person is overweight. We can feel its ill effects such as overconfidence that leads to self-destruction but having difficulty on determining if such personality trait is already a disorder. Only until recently in a study made by Twenge and Campbell that they found out that the prevalence of Narcissistic Personality Disorder (NPD) is already as pervasive as obesity. This is a unique epidemic among the younger and present generation because this is not pervasive among the older generation. People over the age of 65 had only three percent incidence of narcissm while it is 10 percent among people who are in their twenties (2009). What is more alarming with this epidemic is that it has not yet entered into the consciousness of the public mind and maybe even among health care practitioners. This poses as a greater problem because it is not recognized as an issue when it is already as pervasive as obesity. When NPD is not yet recognized as a problem, we would not know how to address the disorder that it will continue to affect unnoticed. This combined issues poses a challenge for the leaders and managers of the public health care sector over the next few years considering that they also have to address another type of epidemic that is as pervasive as obesity which is narcissism. II. The current state of the public health sector in England In a study conducted by Hunter on where the problem of the public health sector in England lies, respondents articulated the inadequacy of leadership and its misplaced priorities (2010). One of the respondents elaborated that “I think we’ve lacked public health leadership. Public health got too focused on standards of practice and all sorts of inward-looking things” (Hunter 2010:66). The leadership problem in the public health sector is not only present at random but is pervasive “throughout the public health system from the top down” (Hunter 2010:67). It lacked a clear and widely shared goal, visions that should reflect in the desired outcomes (Hunter 2010). The National Health System itself as an institution is already known as a dysfunctional organization which has a very myopic vision and inward looking nearsightedness (Hunter 2010). It approaches health issues in a very medical sense when the issue requires a holistic approach such as the issue of obesity and narcissism. It focuses solely on the curative aspect of public health intervention than prevention that should involve the larger social and civic environment (Hunter 2010). Moreso with the issue about Narcissism Personality Disorder which requires a thorough assessment before the symptom can be detected. As a matter of policy, England’s public health system adapts the perspective of treating public health care like a mechanized factory evident with the idea of Sir Varney with his Public Service Factories (PSF) where public service are done on scale and procedures are standardized including the public health care sector (Seddon 2008). The Prime Minister and Barber introduced the idea of “deliverology” in the public health where activities are measured to indicate performance and result. These two dominant public policies set the precedence why England’s public health system is problematic because of its misdirected health care policy that breeds poor leadership and inadequate management. III. Meeting the challenges of the public health sector With how the respondents of Hunter’s study reported their discontent about England’s National Health Service (2010), leaders over the coming years have a considerable challenge to surmount considering the discontent of the public about the present health care system. The criticism is not only confined among the general public but also among scholars like Seddon who pinpointed that government invested and believed in the wrong things. This resulted in an inadequate health care sector whose leadership and organizational practices are found to be unresponsive. It also became very doubtful whether the current public health care system can respond to the pervasive epidemic of obesity and narcissism. Clearly, there are considerable challenges that leaders have to manage over the next few years. What needs to be done? Meeting the challenge of the public health care sector requires a multifaceted approach considering the nature of its organization and the peculiarity of the industry it operates. Unlike private corporations where change can be decided at the top management, implementing change or rehabilitating the public health sector also involves policy reorientation. Being such, the challenges that the leadership in the public sector has to manage includes the thrust of its policy direction. The issue of the present public policy on health care As Seddon pointed out in his study about encouraging Systems Thinking in the public sector, it has to “start at the start” in implementing any systems improvement in an organization. This is not only limited to determining what the demands in the organization are, but also includes the policy that determines its direction (2008). Seddon best described the cause of inadequacy of the public health sector that made it ineffective in addressing epidemics (such as obesity and narcissism) because governments invested in wrong things such setting targets, incentives and inspection, employing economies of scale, deliverology and shared back-office service instead of knowing and catering to the client’s demands (2008). This approach likened rendering public health care to a factory where outputs are measured in terms of predetermined deliverables which explains why it is ineffective because a responsive health care delivery cannot be determined through compliance to certain codified procedures. Public health care sector involves not only curing human beings of their disease but also on how to prevent them. When the policy that sets the direction of the public health care system is hedged on a “wrong belief”, it follows that there will be something wrong with the efficacy and responsiveness of its service delivery. The discontent on England’s National Health Care System was evident with the study of Hunter (2010) where respondents reported the inadequacy of the present system. Preventing and addressing epidemics such as obesity and narcissism is such a multifaceted endeavor that requires creative thinking. Codifying methods which is the offspring of a misguided public health policy impedes creative thinking which could have addressed that epidemic (Seddon 2008). Also, when the government’s reform policy takes a dim view of people (Seddon 2008), it defeats the initiative of its employees which could have been harnessed by a good leadership. Instead of seeing people as the route to performance (Tamkin et al 2010) they are being distrusted with the exercise of restrictive control which is a characteristic of the leadership of the present health care system. As a result, the potential of health care providers to really address epidemics such as obesity and narcissism is not optimized even if they know how to address them as reported in the study of Hunter (2010). The current public policy of cutting cost through subcontracting health care is also problematic. While the upfront cost is minimal, it can prove to be costly in the long-run because there is no incentive from subcontractors to reduce the amount of care (Seddon 2008) not to mention that it entails more cost in monitoring its performance. It also feeds the dim perspective of people because it is posited on the assumption that subcontractors cannot be trusted hence is the need to institute controlling mechanisms such as inspection which could add costs. Such, no teamwork is developed that could develop creative solutions in arresting epidemics such as obesity and narcissism because subcontractors only does what is specified in their contracts. The imperative of changing the kind of leadership in the public sector To improve the quality of care in the public health care sector, leadership must be changed in addition to the policy reorientation. Improving the leadership in the health care sector is imperative because high-quality leadership is regarded as vital in bringing success to any group activity (Al Mailam 2004) because it contributes significantly to success and failure of any organization (Lok and Crawford 2004). At present, the leadership of the public health sector employs the traditional transactional method of leading people. Transactional leadership is contingent upon making the subordinates follow its leaders by the expectancy of reward or exchange either by remuneration or punishment (Jamaludin et al., 2011). This is evident with the carrot and yardstick leadership employed in the public health care sector where employees are being lured of incentives to follow the procedures that is suppose to encourage performance among public health care employees. Given the dismal and unresponsive performance of the public health care sector, this kind of leadership obviously needs to be changed. There are other leadership styles that can be adopted in the public health sector such as Level 5 type of leadership which is characterized by leader’s humility, discipline and strong will (Babou 2008) but this could not be appropriate with the westernized cultural context of England. Leaders in the public health sector can also adopt a visionary leadership which ““articulate, express and share the organizational missions and goals in a simple, easily understood and tangible vision statement. . . [it] develops clarity, focus and flexibility” in an organization (: Dwivedi, 2006). But this type of leadership could be a stretch in the present state of leadership in the public health care sector because this type of leadership requires “charisma” from the leader. With how Hunter reported the skepticism of the employees and the public on the leadership of the public health care sector, this type of leadership might not just work. What is applicable with the present state of the public health care sector is the transformational leadership because this type of leadership elevates the followers to achieve better than their current performance. Transformational leadership … involves the mutual ”rising” of both sides to higher levels of motivation and morality (Jamaludin, et al, 2011, pg. 76) and it brings the best out of people which is currently lacking in the public health care sector. This type of leadership is particularly applicable in public service especially the health care sector because transformational leadership’s paradigm motivates the followers beyond their own self-interest for the good of the organization and society (Bass (1997). Transformational leadership elicits followership not on the expectation of reward or punishment but by enhancing the role of followers, motivating them to take more responsibilities and enhancing their self worth (Bass 1997). Addressing the unresponsive public policy on health care According to Seddon, the key solution in improving public health care from the standpoint of public policy is to improve the system and smarten the frontliners. This meant delivering health care services that is important to the patient (2008). Seddon’s study also coincided with Hunter and Semler that to improve delivery, there should be an increased independence and volunteer involvement among workers. At present, this is non-existent because functions are broken down into parts such as separation of back-office from frontliners where the flow of the system is difficult to monitor. The solution can be best gleaned in the Semco model where Team Units can see the final product of their work. There is no separation of functions where one team unit only does one specific function and another unit does the other function until the product is completed. Instead, teams are responsible from planning to execution until the product is completed. The result was dramatic because there was a 600% increase in productivity (Semler 1993). This can be replicated in the public health care sector where one Team Unit is responsible for addressing the entire need of a patient. For example, in responding the epidemic of narcissism and obesity, health care providers are empowered to address the disease or disorder by also attending to other factors that caused the disorder or disease. Obesity and narcissism often involves social and psychological issue that led them to indulge. To effectively address the need of the patient, such patient does not have to be passed on to other departments or other health care providers and run the risk of losing pertinent information about the patient’s case in the process. This way, health care providers are more responsive to the needs of their patients not to mention that they are able to cut the bureaucracy. This is also a better method of addressing the epidemic of obesity and narcissism because the root cause of the disorder is also addressed. The danger of not having a specialize practitioner of certain disease or disorder can be addressed by having a composite of specialists in each Team Units. This was done at Semco where business units have engineers and other specialists to adequately complete a work. The role of leadership in instituting the right organizational culture public health care For the public health sector in England to become more responsive to the ever increasing epidemic of obesity and the silent epidemic of narcissism, its culture must be dramatically changed. At present, the public health sector of England typifies a bureaucratic monolith where it is slow in responding to the needs and demands of its patients/clients employing obsolete management methods. What it can do to respond to the present and future challenges is to mimic Semco, the Brazilian company where it made a turnaround from its old and traditional leadership resulting in higher productivity and better pay among its employees. To achieve this, the leadership of the public health sector must shed away the negativist perspective of its people and develop a healthier assumption about its employees (Seddon 2008). True, a certain degree of power and control must be exercised to influence outcome (Zalenik 1992) but it should not come to a point of stunting creative thinking and defeating motivation. It should realize that people are more motivated to work when it enhances their self-esteem and to serve others especially in a public health sector where it caters to the general public (Seddon 2008). It should treat its employees as adults and emphasize less on codifying rules because it stunts and prevents creative thinking on how to improve the performance of the organization (Semler 1998). It should do away with the breaking of functions such as separating back office jobs that bloats the bureaucracy not to mention that it increases the unnecessary paper works which makes the operation costly and unresponsive. Instead, it can make the public health sector more responsive by reducing the hierarchy where communication can flow more freely with lesser organizational layers. It should develop thinking and learning organizational culture where employees are real partners and are empowered to make a real difference in the organization just like what Semco did under the leadership of Semler (2008). Instead of concentrating the power on the executives in a pyramid structure, employees are given the leeway to devise and develop procedures without consulting the top management for implementation. This is applicable in public health sector because each patient has a unique need where the frontliners are better informed on how to adequately respond to this need. This can prove effective in responding the epidemic of obesity because the treatment of the disease varies with each individual as there is no single approach in treating the epidemic that is applicable to all. Each approach is customized and is dependent on each patient’s condition and can even transcend beyond the curative approach towards prevention that can prove to effective in combating the epidemic in the long run. This is not only beneficial among the patients but also on the employees as well. Both Semler and Seddon agreed in their studies that people are not really that motivated to work in a carrot and yardstick environment. Employees tend to work better when they find fulfillment with their jobs which they have a greater control of the outcome. At Semco, employees are even voluntarily extending overtimes just to achieve the goals which the employees have set for themselves. Quite surprisingly, employees tend to be more effective when the controlling tendency of the management is removed (Semler 1993). This kind of culture, when developed in public health sector will be very beneficial to the patients because healthcare providers are more preoccupied in giving a more responsive care even beyond what is required. Developing teamwork in the public health sector The public health sector in England is a typical example of a government bureaucracy where it is big and unresponsive (Hunter 2010). As a result, it is uncoordinated where teamwork is almost non-existent because functions are broken into pieces where each activity is measured. Epidemics such as obesity continue to rise and narcissism still goes unnoticed because the public health sector in England as an organization cannot adequately respond with equal dispatch of the epedimic’s increase. Given this kind of organizational structure, it will be a tremendous challenge of any leader in the public health sector to develop motivated teams. This can be achieve however If the public health sector in England will imitate Semco where teams are deliberately kept small (150 individuals per team at most) for easier management and freer movement of communication. It can develop confidence t trust its own people (Tamkin et al 2010) by giving them independence such as what is done at Semco to devise its own system on how to do things either for manufacturing or selling (employees are even trusted to set their own quotas). It does not have to seek approval from management everytime it makes decision making it more responsive to any issues encountered at hand (Semler 1993). This kind of set up is highly applicable in public health sector where teams can be kept small and able to decide on its operation. In addressing obesity and narcissism, medical practitioner will be able to respond better because their hands are not tied to the prescribed procedures. Instead, their team can customize their response based on the actual need of the patient. Addressing obesity and narcissism through a motivated team The current medical model employed by the public health sector in England in addressing the epidemic of obesity proves to be ineffective evident with the continued rise of the epidemic of obesity and its failure to detect the rising cases of narcissism. With regard to the epidemic of narcissism, it is very doubtful if the public health sector is even aware that the disorder has already reached a proportion of an epidemic as there is no public health literature available that discusses on how to arrest its continued rise. Given the ineffectiveness of the current approach in curbing the prevalence of obesity, it is imperative that a new model of approach should be developed and adapted to met the challenge of the epidemic. Addressing the epidemia of obesity solely from medical approach is inadequate. Health care providers are already aware that for the prevalence of the disease to be arrested, it has to include the social and civic environment (Seddon 2010). Obesity is such a complex disease that it could be a result of other factors that is not only limited to medical causes. It can be a product of social and psychological factors such as “ the pervasive insecurity, and novel opportunities for consumption [that] produce tendencies towards individualism, narcissism, hedonism and disorientation. The health consequences include. . . the current epidemic of obesity (Liffe 2008:69). This can be however adequately responded to when teams are given the latitude to devise its own approach (Belbin 1981) to arrest the epidemic because it can include other methodology of addressing the issue. This can include counseling prevention and determining the root cause of indulgence that led to obesity. This way, the health care sector is more responsive in combating the rise of the epidemic of obesity. Narcissism Personality Disorder (NPD) is a multi-faceted epidemic and its root cause is not often medical but is rather caused by social and psychological factors. It will only be considered as a medical issue when the disorder has already aggravated. At present, health care providers are unable to effectively address the epidemic because it does not include the social and psychological factors in the consideration of its treatment. It focuses solely on the medical aspect and fails to see the social and civic environment that caused the disorder (Seddon 2008). If only health sector teams are empowered to really address epidemics, they will be given the latitude to address the epidemic of narcissism and can include other methodologies such as counseling and better parenting which could prove to be effective in combating the epidemic of obesity and narcissism IV. Conclusion The public health sector is subordinate to the government’s health care policy. To address its current inadequacy, it will not be enough to solve it from the level of the management. Unlike corporations where changes can readily be implemented by a decision from the top management, public health is dependent on the policy thrust of the government. Seddon articulated that there is a need to rethink the government’s reform agenda because it proves to be inadequate. The idea of Prime Minister and Barber about deliverology misses the mark on how to improve public health care system (2008). It is flawed because it relies on the bureaucracy of measurement that cannot tell whether there is a real improvement or none. It likened the sector of public health care to a factory where activities are measured to indicate performance and result. Providing health care is such a multifaceted endeavor and getting a patient well just cannot be predicted by complying to a set of codified measurement tools. It may work in a factory where the processes of production are simple but not on providing healthcare to human beings. The issue of mechanization public health care was even pronounced with the idea of Sir Varney where Seddon criticized his gloomy idea to be avoided at all costs. The idea was to institute Public Service Factories (PSF) and that includes the public health sector (2008). This policy was tantamount to giving a uniform cure to certain type of diseases or disorder without regard to the peculiarity or need of a patient. Given this kind of public policy, it is no longer surprising that England’s public health care system is problematic. The very policy that directs it is already misplaced. The breaking up of functions such as separation of back offices, belief in targets, incentives and inspection; belief in economies of scale and shared back-office services; belief in deliverology., are only a product of such policy of factorization of public service (Seddon 2008). The mechanization of the public health care sector is likened to Taylor’s Scientific Management (1911) which is an obsolete management style and only works in the factory but not in dealing with human beings. To improve the public health care system of England, it would first require a rethinking of public health policy among its political leaders. Instead of the mechanization of health care, it should seek to improve its system and smarten its frontliners to become more responsive in addressing epidemics. This is particularly applicable in addressing the epidemic of obesity and narcissism because these epidemics do not only require medical attention but also social and psychological attention and other therapies as well. At present, the current health care system of England cannot effectively respond to complex epidemics such as obesity and narcissism due to its mechanized nature. If England has to arrest the epidemic of obesity and narcissism, it has to “start at the start” (Seddon 2008) which is redirecting its public health care policy to become more responsive. But redirecting public health care policy is not enough to address the inadequate public health service in England. Its leadership has also to rethink itself. Its leadership has to change its locus of control to stress more on innovative thinking that will allow people to meet real demand and become more responsive as a health care provider than complying with instituted measurement tools (Seddon 2008). It should do away with its present transactional leadership style and should begin adopting a transformational type of leadership where it motivates people to be perform better not through the expectancy of reward but by the intrinsic desire to perform. Instead of breaking functions where responsibility and accountability are difficult to account, organizations should instead smarten its frontliners to be more responsive to the real need of its patients. This change is consistent with a transformational leadership context where it betters organizational performance by making its people perform better. A cultural shift within the organization should be initiated where health care providers are more empowered to have a “real say” on how things can be improved and done (Semler 1993). Treating employees as responsible adults that fosters volunteerism and greater fulfillment proved to be a better motivator than offering incentives and punishment (Semler 1993). The need to arrest obesity among the population of England is imperative because obesity is linked to other chronic diseases such as diabetes and heart disease and is known to lower life expectancy (Bhattacharya and Sood, 2011:140). If the epidemic is curbed, other chronic diseases such as diabetes and heart diseases will be lessened as well. If left unchecked, then the general population of England is threatened with lower life expectancy and higher medical costs associated in treating diabetes and heart diseases. The imperative of improving the public health care system is not only a matter of improving the service delivery of a particular institution or organization but involves public interest and such should be treated as urgent. Bibliography Al-Mailam, F.F. (2004). Transactional versus transformational style of leadership-employee perception of leadership efficacy in public and private hospital in Kuwait. Quality Management in Health Care. 13(4): 278-284. Babou (2008). 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