International Journal of Health Policy and Management

International Journal of Health Policy and Management

Balancing Management and Leadership in Complex Health Systems; Comment on “Management Matters: A Leverage Point for Health Systems Strengthening in Global Health”

Document Type : Commentary

Author
Aku Kwamie 1, 2
1 Department of Health Policy, Planning and Management, University of Ghana School of Public Health, Accra, Ghana
2 Sociology and Development of Change Group, Wageningen University, Wageningen, The Netherlands
10.15171/ijhpm.2015.152
Abstract
Health systems, particularly those in low- and middle-income countries (LMICs), need stronger management and leadership capacities. Management and leadership are not synonymous, yet should be considered together as there can be too much of one and not enough of the other. In complex adaptive health systems, the multiple interactions and relationships between people and elements of the system mean that management and leadership, so often treated as domains of the individual, are additionally systemic phenomena, emerging from these relational interactions. This brief commentary notes some significant implications for how we can support capacity strengthening interventions for complex management and leadership. These would necessarily move away from competency-based models focused on training for individuals, and would rather encompass longer-term initiatives explicitly focused on systemic goals of accountability, innovation, and learning.
Keywords
Management
Leadership
Complexity
Health Systems
Subjects
  1. Kotter J. What Leaders Really Do. Harvard Business Review. 2001(December 2001).
  2. World Health Organisation (WHO). Strengthening Management in Low-Income Countries. Geneva, Switzerland: WHO; 2005.
  3. Bradley EH, Taylor LA, Cuellar CJ. Management matters: a leverage point for health systems strengthening in global health. Int J Health Policy Manag. 2015;4(7):411-415. doi:10.15171/ijhpm.2015.101
  4. Chinitz D, Rodwin VG. On Health Policy and Management (HPAM): mind the theory-policy-practice gap. Int J Health Policy Manag. 2014;3(7):361-363. doi:10.15171/ijhpm.2014.122
  5. McDonald R. Leadership and leadership development in healthcare settings – a simplistic solution to complex problems? Int J Health Policy Manag. 2014;3(5):227-229. doi:10.15171/ijhpm.2014.101
  6. Sheikh K, George A, Gilson L. People-centred science: strengthening the practice of health policy and systems research. Health Res Policy Syst. 2014;12(1):19.
  7. Olivier de Sardan J. The bureaucratic mode of governance and practical norms in West Africa and beyond. In: Bouziane M, Harders C, Hoffman A, eds. Local Politics and Contemporary Transformations in the Arab World: Governance Beyond the Centre. London, UK: Palgrave MacMillan; 2013.
  8. Stacey R, Griffin D, Shaw P. Complexity and management: fad or radical challenge to systems thinking? London: Routledge; 2000.
  9. Osborn RN, Hunt JG, Jauch LR. Toward a contextual theory of leadership. Leaders Q. 2002;13(6):797-837.
  10. Kwamie A, Agyepong IA, Van Dijk H. What governs district manager decision-making? A case study of complex leadership in Dangme West district, Ghana. Health Systems and Reform. 2015;1(2):1-11. doi:10.1080/23288604.2015.1032475
  11. World Health Organisation (WHO). Towards better leadership and management in health: report on an international consultation on strengthening leadership and management in low-incomes countries, 29 January - 1 February 2007, Accra, Ghana. Geneva, Switzerland: WHO; 2007.
  12. Currie G. The influence of middle managers in the business planning process: a case study in the UK NHS. British Journal of Management. 1999;10(2):141-155. doi:10.1111/1467-8551.00116
  13. Swanson R, Atun R, Best A, et al. Strengthening health systems in low-income countries by enhancing organizational capacities and improving institutions. Global Health. 2015;11(1):5.
  14. Rouleau L, Balogun J. Middle Managers, Strategic Sensemaking, and Discursive Competence. Journal of Management Studies. 2011;48(5):953-983. doi:10.1111/j.1467-6486.2010.00941.x
  15. Blaise P, Kegels G. Quality management in health care systems in Africa: one concept, many faces, contrasted results. An analysis of three case studies from Africa. Quality in Higher Education, Health Care, Local Government. 5th 'Toulon-Verona' Conference, ISEG; September 19-20, 2002; Lisbon.
  16. Newell P, Bellour S. Mapping accountability: origins, contexts and implications for development. Institute of Development Studies; 2002.
  17. Cleary S, Molyneux S, Gilson L. Resources, attitudes and culture: an understanding of the factors that influence the functioning of accountability mechanisms in primary health care settings. BMC Health Serv Res. 2013;13(1):320.
  18. Kiggundu MN. Integrating strategic management tasks into implementing agencies: from firefighting to prevention. World Dev. 1996;24(9):1417-1430. doi:10.1016/0305-750X(96)00055-1
  19. Ortiz Aragon A, Giles Macedo JC. A 'Systemic Theories of Change' Approach for Purposeful Capacity Development. Institute of Development Studies; 2010.
  20. Ortiz Aragon A. A Case for Surfacing Theories of Change for Purposeful Organisational Capacity Development. Institute of Development Studies; 2010.
  21. Woodhill J. Capacities for institutional innovation: a complexity perspective. Institution of Development Studies; 2010.
  22. Kwamie A, van Dijk H, Agyepong IA. Advancing the application of systems thinking in health: realist evaluation of the leadership development programme for district manager decision-making in Ghana. Health Res Policy Syst. 2014;12(1):29.
  23. World Health Organisation (WHO). Systems thinking for health systems strengthening. Geneva, Switzerland: Alliance for Health Policy and Systems Research; 2009.
  24. Birken S, Lee S-Y, Weiner B. Uncovering middle managers' role in healthcare innovation implementation. Implement Sci. 2012;7:28. doi:10.1186/1748-5908-7-28

  • Received Date 28 July 2015
  • Revised Date 11 August 2015
  • Accepted Date 11 August 2015
  • First Published Date 01 December 2015
  • Published Date 01 December 2015