Enabling relational leadership in primary healthcare settings

Lessons from the DIALHS collaboration

Bibliographic Data

ID11490505
AuthorsSusan Cleary (0000-0002-9071-7958, University of Cape Town, corresponding author), Alison du Toit (Self Employed Industrial and Organizational Psychologist and Time to Think coach, Cape Town, South Africa), Vera Scott (0000-0003-0675-6047, University of the Western Cape), Lucy Gilson (0000-0002-2775-7703, University of Cape Town)
Year2018
Volume33
Issuesuppl_2
Pagesii65-ii74
Publication date2018-07-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueHealth Policy and Planning (JOURNAL)
Journal identifiersISSN: 0268-1080 • E-ISSN: 1460-2237
PublisherOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czx135
PMID30053037
OpenAlexW2823451388
LanguageEN
Citations received18
References cited39

Strong management and leadership competencies have been identified as critical in enhancing health system performance. While the need for strong health system leadership has been raised, an important undertaking for health policy and systems researchers is to generate lessons about how to support leadership development (LD), particularly within the crisis-prone, resource poor contexts that are characteristic of Low- and Middle-Income health systems. As part of the broader DIALHS (District Innovation and Action Learning for Health Systems Development) collaboration, this article reflects on 5 years of action learning and engagement around leadership and LD within primary healthcare (PHC) services. Working in one sub-district in Cape Town, we co-created LD processes with managers from nine PHC facilities and with the six members of the sub-district management team. Within this article, we seek to provide insights into how leadership is currently practiced and to highlight lessons about whether and how our approach to LD enabled a strengthening of leadership within this setting. Findings suggest that the sub-district is located within a hierarchical governance context, with performance monitored through the use of multiple accountability mechanisms including standard operating procedures, facility audits and target setting processes. This context presents an important constraint to the development of a more distributed, relational leadership. While our data suggest that gains in leadership were emerging, our experience is of a system struggling to shift from a hierarchical to a more relational understanding of how to enable improvements in performance, and to implement these changes in practice.

Accountability · Action learning · Audit · Business · Context (archaeology) · Corporate governance · Health care · Knowledge management · Leadership style · Pedagogy · Political science · Public relations · Shared leadership · Sociology · Computer Science · Global Maternal and Child Health · Healthcare Quality and Management · Primary Care and Health Outcomes