In this reflective paper, it is about the contemplation about leadership with two themes; teamwork and co-production. Firstly, what I learnt and what I felt from learning will be shown in this paper. From the learning, stressing importance of patient involvement in part of co-production which emphasise co-existence of patient involvement and staff involvement in healthcare system might lead to fadedness of importance in staff involvement compared to the past. This is starting point of building personal concept. In stage of conceptualisation, I support why I regard the staff involvement more important than the patient involvement with literature review. After this, as I state the staff involvement is important, I will define how to effectively involve the staff in hospital with specific type of leadership with example. Furthermore, the limitation of using this type of leadership to be cautious in healthcare system will be suggested with example. In last part of conceptualisation, this paper will examine applicability of this concept toward other business context. Lastly, It will summarize what I have been reflected and show the ways to build the concept more solid as a future plan. To efficiently reflect what I have learnt and build my own concept with further information, I refer to the Bassot’s reflective method (2017); Composing of description, feelings and evaluation, analysis, Conclusion and action plan.
Team needs characteristics to differentiate with a group; having a perception of belongings in members, sharing vision, goal, responsibility thereby participating in the decision making (Katzenbach and Smith, 1993). To have these characteristics, the appropriate leadership is must-have item to teamwork. In the case of poor leadership generated in team, the teamwork is exposed to the problems of social loafing and group thinking. The social loafing indicates that if the evaluation about the teamwork is not assessed individually, individuals put less effort on team assignment. In other word, moral hazard being lack of personal accountability and biased thinking of effort inequality among team is the reason for provoking social loafing. According to Irving Janis (1972), group thinking generates the irrational decision making and it is easily happened in the highly cohesive team with possessing autocratic leader. In case of team endangered to group think, the debate toward the opinion from leader is regarded as an attempt to corrupt team. Thus, this culture makes team member to ignore consideration from different perspective which can dispute the leader’s opinion.
Specifically, when it comes to health care system, doctor’s position in health care system is too powerful to interrupt their opinion thereby determining the power of participant through the acknowledgement of degree which the doctor has the highest among the service provider in health care system (Lee, 2019). Likewise, under the bureaucratic system which has highly strict hierarchy, teamwork is highly endangered to be fallen to group thinking. These are the possible problems from inappropriate leadership method applied toward the team. To avoid the problems mentioned above, the lecturer suggests the leadership needs to transform from the current situation which is command and control (Commission on dignity in care for older people, 2012). With my further research about the type of teamwork in health care system, there are two major types of teamwork; Interdisciplinary teamwork and intra-disciplinary teamwork. Interdisciplinary teamwork is working as a team which composed with the members from all different disciplinary and intra-disciplinary teamwork is a team of same discipline such as team of surgical doctor (Lee, 2019). Under the command and control leadership method, in case of interdisciplinary teamwork, the nurses are stressful about lack of empowerment to voice rather than the doctor and it affects badly to job satisfaction (Timmins, 2011).
Job dissatisfaction fails to motivate the workers to serve better quality of service and finally it negatively affects to patients as the low quality of service has given. This case indicates that active involvement in staff is important. Co-production in the lecture states that the patient involvement is important as the staff involvement (Vennik et al, 2016). In terms of patient involvement, through the reflection about patient experience from survey, the health care system could identify the lack ability in current healthcare system situation. Therefore, the patient involvement is important to develop the quality of service, the aftermath of low quality of service being served. To get the patients experience without any omission, through the right leadership the hospital hopes to actively engage the service receivers (Vennik et al, 2016). Therefore, the lecturer stresses both patient involvement and staff involvement to improve the quality of service and in the procedure during improvement, leadership acts an important factor to reach the result that hospital anticipated. Reflection and questions with the experience In general sense, treating each other with respect and interacting freely is important factors to be successful team. In case of social loafing and group thinking, it is much easier to understand with my group assignment experience during university life. When the group had assigned, in all case of my experience, there was the person who has powerful voice and tries to be the leader in the group.
To empower with getting confidence from the group member, the person like this act they have much more knowledge and ignore what other say about the question we needed to deal with. At the beginning of the forming the role in group, there was some friction to voice individual idea. However the friction continuously occurred and the result repeated, the group understand this as their culture of the group and naturally accept the leader’s point of view even if it is wrong. As the by-product of this, each member lost the will to do and shifted the workload to other. Likewise, what I troubled in the university life is same as the problems in health care system. From this point, I started to question to myself that the things happen in health care system can also apply to the other general business context. In health care, the lecturer denied the command and control leadership method and I am now curious about what is the best leadership for the healthcare system and also for the general business context. Furthermore, I could not understand even after the lecture why the patient involvement is important as the staff involvement in health care system. My mother suffered from lumbar herniated intervertebral disc, so it makes my mom to hospitalise. To ensure my mother’s condition better, we look for the best hospital in South Korea. As this hospital is popular to this illness, the number of patients per doctor is relatively bigger than any other hospital in this case.
The higher burden of work toward the doctor leads to carelessness such as reduction in number of consultation to patient and delays decision making during surgery because of highly stressful environment. I think, through the patient’s centred care, they could identify what the problem is, but it cannot generate the remedy to develop the quality of service. However, I think the staff involvement could do. Therefore, the first question that I have from the lecture is which is more important between staff involvement and patient involvement. From the first question, I develop the sub-question. If the staff involvement is more important, what type of leadership will be needed to maximise staff involvement? Is there any failure to adopt specific leadership suggested in health care system? Furthermore, is this type of leadership could be applied to other business context? These are what I felt after the lecture from this course and what I want to know through further research. Analysis (Conceptualisation) Which is more important between staff involvement and patient involvement? Engagement of the stakeholder is a factor in performance. In healthcare system, there are two main participants; staff and patient. In case of patient, patients generate their experience and send their emotion to healthcare institution through participating survey which gives general feedback that the hospital needs to change (NHS, 2018). If the patient’s involvement is actively held and the result of involvement is fully reflected to the hospital’s consideration of giving better service, the patient involvement is done its work fully. However, this involvement is generated after the service is given.
Even if the good patient involvement is done, the date of fixing current situation is not underpinned. By the way, in terms of staffs, they have to serve the right service with right methodology applied in right time. When the staffs are not fully engaged in their work, the negative result is made in decrease in patient satisfaction, staff turnover, and annual health check rating or increase in patient mortality, staff absenteeism, and MRSA infection rate (West and Dawson, 2012). To conclude, the patient feedback which is one of the products from patient involvement is a factor affected to staff participation. Even if the hospital identifies what the problem is from feedback, there is no big change from the initiatives by hospital when the staffs have no willingness to change and enthusiasm in work (Coulter, 2013). In other words, it would be better to consider the patient involvement as a sub-criterion of involving staff. Therefore, in this perspective, I rather consider that the staff involvement is much important than patient involvement in healthcare system. If the staff involvement is more important, what type of leadership will be needed to maximise staff involvement? In terms of maximising staff involvement which is important than any other stakeholders in healthcare system, according to Dickinson and Ham (2008), they states that ‘staff’s individual values and perceptions, team and micro-system cultures and wider systemic factors must be aligned in order to produce effective engagement in medical leadership.’ For setting the appropriate organisation, the leadership must unify individual shared value and perception to team’s without any isolation. In this case, the leadership in health care has to transform from command and control method to facilitative method (West et al, 2015).
The Facilitative leadership focuses on the interaction between the participants and facilitates the shared goal achievement by relational process such as building team culture and shared accountability (Smith, 2003). In other words, having horizontal relationship between workers creates frequent and free interaction and this interaction provides continuous debates on their projects with developing self-critique in decision making and avoiding group thinking. Through the case of Beaumont Hospital in Dublin, Ireland, this example will show specific methods to build free-interaction environment and the anticipated result thereby applying facilitative leadership method. According to Ward et al (2017), Surgical and Medical Assessment & Rehabilitation team (SMART) is formed from 2016. This interdisciplinary team, at the infant period of forming team, was not accepted to the hospital workers. However, the two methods that they introduced were efficiently building the belongings to team; common assessment tool to identify patient condition and strict rule in interaction. Firstly, the development of interdisciplinary common assessment tool enables to make reduction in duplicating various professional estimations held by different disciplines and collect data about patient’s general information. As a result of this, belief among different disciplines is generated as the result of medical action is constantly positive by using common assessment tool identifying problem from one specific ward and informing to others. Furthermore, the strict rule of meeting twice daily allows for more chances to be in face to face interactions.
It might cause negative result in early stage of forming team as members do not equip the interaction method with respect, but as the time passes and the interaction experiences are among workers piled up, the workers improve communication method regarding processing patient care. Enhancement of hospital worker’s job and morale satisfaction are the results from improved interaction skill between service providers and introduction of common assessment tool. The importance of facilitative leadership is well-known to management context but the case of Beaumont hospital is the rare case of constructing good condition for facilitative leadership in healthcare system. Is there any failure to adopt specific leadership suggested in health care system? Importance of facilitative leadership to engage staff in healthcare industry is widely known, but there are difficulties in creation of horizontal relationship for amicable conversation between staff. In other words, kinds of wicked problem blocks to actualise facilitative leadership in health service sector. It is more obviously seen in South Korea’s case. According to Korean ministry of health and welfare (2010), at the stage of choosing specialty, in terms of doctor, the main criterion for choice is based on monetary perspective. As an evidence of this, in 2010, the proportion of dentist and physiotherapists is increased as 4 times as bigger than the 2000 while there is no clear increase in surgical discipline. Biased choice leads to lack of human resources in specific ward and it affects to doctors from less preferred department putting in bigger burden of work during teamwork.
If the doctor acknowledge that they have inequality work burden compared to their colleagues, there is a danger of social loafing. Furthermore, the situation named as ‘specialty bashing’ might empower the limited number of doctors to decide what to do as the other part of doctor has no deep knowledge about what they do not choose (Holmes et al, 2008). Therefore, through the specific example of staff recruitment and retention problem, which is one of wicked problems, it produces the isolation in decision making procedure and blocks to adopt facilitative leadership. Therefore, knowing what the obstacles are in building horizontal relation and how to solve these are much significant issues in recently. Is this type of leadership could be applied to other business context? When it comes to the general business context, which I mainly learnt from the courses in university, the horizontal leadership is also needed to actualise. Actually, I thought that the command and control method is faster to make decision than debate from facilitative leadership, so, at the first time, I regard this bureaucratic leadership method is productive and ideal. On the other hand, in case of business, similar to healthcare system, there are different kinds of stakeholders with different needs. The shareholders have a goal of share price maximisation, while the manager has a goal of maximising their income (Ayuso and Argandona, 2007). The problem happens because manager has a power to control the company without any intervention by shareholders in short term as general meeting of stakeholders is not frequently held compared the number of manager making decision (ICSA, 2017).
The decision made for their private income maximisation does not always bring share price maximisation. If the manager’s income is assessed on the size of the firm, the manager may strive to practise hostile take-over to increase the size of the firm. However, in marking share price, the anticipation about the firm determines the share price. Hence, if the analysts criticise this hostile take-over which might cause the firm’s unstable financial condition in long term, the share price which shows opposite result compared to manager’s situation will fall. Therefore, to avoid the manager’s misbehaviour conducting only for their short term profit maximisation, there are two methods have been usually adopted. First method is introduction of corporate governance which is costly to shareholders to monitor the manager’s moral hazard and adverse selection (Jensen and Meckling, 1976). The second method is engaging the managers with making them to feel belongings. The main effects of facilitative leadership are clearly sharing goals and roles in team with productivity and building belongings in a team (Smith, 2003). By using this method, the manager does not look for the profit from short term and pursue the sustainable growth of company as the belongings stamp manager’s mind on one’s success led from firm’s success.
In another perspective, Most of managers are receiving higher income, so according to Maslow (2017), the giving managers well structured appraisal to build belongings, satisfaction and self actualisation which is higher level of needs rather than monetary needs is much better method to involve in organisation. Building belongings with interaction which is main part of facilitative leadership is still needed in the outside of healthcare industry. Conclusion with future plan Through the learning from courses, I have deeper information about the teamwork and co-production in healthcare system. In case of procedure of processing the data, I generate the questions with new information from the lecture with my experience and knowledge for helping understanding and reflecting what I have learnt. Through the four questions related to teamwork and co-production in health service system linking with leadership, I organise the thing I have learnt from this course and my curiosity which creates from the crashes between new information and my pre-existed information. After solving all the questions that I made during the course, I conclude that in healthcare system, still the staff involvement is much more important than patient involvement and to maximise staff involvement, constructing horizontal relations between stakeholders is important. While, the many knew about importance of building this relationship, there are obstacles to adopt the facilitative leadership method in healthcare system.
Supporting with case of the South Korea, to make staff involvement efficiently, knowing what the obstacles are and how to overcome these hurdles is now the most important thing. Furthermore, this paper shows that relational leadership method similarly needs to apply in general business context thereby possessing the difference in needs between stakeholders which also happens in health care system. This is what I have learnt from my further reflection about this course. Still, there are defects on my own concept such as the way to deal with the obstacles to build free-interaction environment in healthcare system for full engagement of workers. In additionally, the research needs to be held about facilitative leadership disadvantage of using in healthcare system and in more general business context. For the part of solution of obstacles happening during building horizontal relationship, I will do further research from the literature named ‘Changing the culture of a hospital: from hierarchy to networked community’ written by Bate in 2000. For the part of poor effect from facilitative leadership, I will look closely on ‘Tackling Wicked Problems: The Case for Facilitative Leadership’ generated by Carcasson, in 2016.
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