– The purpose of this paper is to re-examine the challenges facing leaders in health care, to explore the impact of these on the choices available to healthcare leaders, and to re-visit the nature of leadership in general. It identifies a distinction between care that is a set of auditable transactions and care that is also a covenant, and suggests that leadership too can be practised in these distinctively different ways. It draws on a three year learning set of senior practitioners in the NHS in England.
– This paper draws on the authors own observations over 25 years of educating and developing clinical leaders, and also on the insights of a learning set of senior NHS practitioners over a three period.
– The paper provides empirical insights about how both health care and leadership have changed over the last 30 years, and proposes that treating either of them as a set of auditable transactions in a market place results in dissatisfied leaders as well as practitioners, and that a covenant of both care and leadership needs to be understood and established.
– Observations have been limited to the NHS in the UK although there are indications that the issues are of wider applicability.
– The paper includes implications for the behaviours of those leading health care organisations, those being led, and those influencing the context.
– This paper challenges prevailing definitions of leadership and prevailing explanations for difficulties in health care organisations.
