However, before exploring ways in which the insights of Sandstrom, McKenna and Pugno might be brought together, there is one other important frame that needs to be introduced. This frame sets up important distinctions to be drawn between the collective values, perspectives, and practices to be found in specific healthcare departments, divisions or an entire organization. These values, perspectives, and practices converge in what can be considered the “cultures” or “subcultures” of a healthcare system. Differing competencies and styles of leadership are required in each culture and subculture.
Leadership Competencies and Health Care Culture
Up to this point, I have focused on what McKenna and Pugno have considered the generic competencies required of all healthcare leaders. However, the leadership portrait becomes more complex. Specific competencies are aligned with specific leadership preferences. These preferences might be grounded in the leader’s personal history or the specific role they play in the organization. I turn in the next essay in this series to personal preferences and roles when bringing in the concepts offered by Jeannine Sandstrom regarding the five best practices of leadership and related them to concepts offered by McKenna and Pugno.
However, there is a third determinant of the competencies on which a healthcare leader will focus. It requires that I provide not only a complex portrait but also a landscape rendering. This determinant is the dominant culture operating in the department, division, or overall organization in which the leader is operating. No leader is immune from the powerful cultural forces swirling all around them. There are values (enforceable norms), perspectives (dominant viewpoints), and practices (repetitive behaviors) that inform what is “proper” to think and do as a leader operating in a specific culture.
I have proposed elsewhere that four dominant cultures exist in all human service organizations (Bergquist, 1993; Bergquist and Brock, 2008; Bergquist and Pawlak, 2008)—including health care (Bergquist, Guest and Rooney, 2002). These are the professional culture, the managerial culture, the advocacy culture, and the alternative culture. I find it informative to see how these four cultures align with McKenna and Pugno’s (2006, p. 67) description of four types of healthcare leaders. Perhaps specific types of leadership styles in healthcare systems relate to specific healthcare cultures.
Two of McKenna and Pugno’s types are identified as being related to administrative duties—much as is the case with the Managerial and Advocacy Cultures. The other two types are related to clinical duties—which is also the case with the Professional and Alternative cultures that I have identified. McKenna and Pugno also distinguish between leadership roles that are engaged in a specific healthcare organization – such is the case with the Managerial and Professional Cultures—and those that are not confined to one healthcare organization—such as in the role played by the Advocacy and Alternative Cultures.
Given the close alignment between my four cultures and the four healthcare leadership types identified by McKenna and Pugno, I will consider how these models of leadership-type and culture play out together.
Expert Leader/ Professional Culture
McKenna and Pugno identify the key leadership role played by physicians as “experts” in the clinical setting of a healthcare system. This role is played by physician leaders within the confines of a specific healthcare system. The key focus of those serving in this expert role is the achievement of clinical excellence. Those physicians who serve in the role often teach and train clinicians. They might also publish and speak in their specific field of expertise. Competencies are required that relate specifically to patient care. Medical knowledge is particularly important.
