Members of this culture emphasize negotiation and compromise, the establishment of solid power bases, the forging of alliances, and the provision of convincing evidence for their points of view. Any organizational strategy that is to be accepted by this culture must address the anxiety associated with social disruption and must take into account politically based strategies. Members of the Advocacy Culture encourage fair bargaining among constituencies with vested interests that are inherently in opposition. These conflicting constituencies might be management and staff, or, at a broader level, the healthcare institution and potential healthcare consumers. Advocates tend to hold assumptions about the ultimate role of power and the frequent need for outside mediation in a viable healthcare system. Most importantly, the Advocacy Culture usually has served as a counterpoint to the Managerial Culture and (to a somewhat lesser extent) the Professional Culture. Fundamentally, the Advocacy Culture and physician activists have served as a critical bulwark against restricted access, inadequate quality of healthcare service, and inequitable treatment of healthcare workers.
Pioneer Leader/ Alternative Culture
The fourth leadership type identified by McKenna and Pugno concerns the role played by physician leaders as “pioneers.” Focusing on medical advances, inventions, and innovations in clinical settings, the pioneer is likely to focus on accelerating discovery in the healthcare world. According to McKenna and Pugno (2006, p. 94):
Physician leaders who serve as pioneers—champions of change, advocates for the adoption of new innovations—are experts in anticipating future implications of present realities, and guiding the discovery, invention, dissemination, and acceptance of new drugs and devices, new practices, and procedures that create new possibilities for professionals to diagnose, treat, and manage the patients they serve.
The interests and activities of pioneer leaders are usually not confined to a specific healthcare system. They like to see new perspectives and practices being diffused throughout the healthcare community. Ideas are not to be kept in organizational or disciplinary silos. The key focus of those serving in this expert role is the achievement of medical advances in their field of specialization—or even in other fields both inside and outside the medical domain. Those physician leaders who serve in the role of pioneer must acquire or generate cutting-edge knowledge in their area of interest and commitment. They must also become skillful change agencies and learn how to effectively intervene in a system to bring about change and improvement.
A broad perspective is required when one is a pioneer exploring a new territory. One must be aware of everything that is moving and acting in this novel environment. Ultimately, the goal of a pioneer is wilderness survival in the midst of discovery. This is certainly the case for physicians who serve as pioneer leaders. They are working on behalf of new healthcare perspectives and practices while seeking to keep their innovation alive and well—on behalf of the life and wellness of the patients they are serving. In alignment with this commitment of physician pioneers, other members of the Alternative Culture similarly tend to view health care as a process that should sustain and enhance life. Unlike members of the Professional Culture, those who are most aligned with the Alternative Culture tend to think of disease in direct contrast with a well-lived life. The alternative perspective concerns not the fact that dis-ease inevitably comes with a life that is out of balance. Members of this culture are most afraid of being seen as quacks or judged to be crazy, wicked, or foolish.
