In a recent whitepaper[1] the Center for Creative Leadership (CCL) reported that healthcare leaders are aware they work in an environment of near constant change and need to adapt. CCL and others are still debating what would be the most appropriate healthcare leadership training to develop and nurture the necessary leadership in healthcare. Are there specific healthcare leadership courses to help healthcare leaders adapt and thrive in the complex environment of healthcare, or is the crucial need of healthcare leadership development more about developing leadership capacity? What is the difference between leadership development and leadership capacity? This article explores the unique context of healthcare and how it affects leadership skills development. The Unique Context of Healthcare We can all agree that healthcare is a complex system of hospitals, clinics, pharmaceutical and medical device firms, insurance, operations support, and policy organizations. Stakeholders within the healthcare system are all the people employed in those firms including providers, administrators, policy specialists, and other employees who are focused on safe, quality, affordable care for all patients. Perhaps we can also agree that if there were ever an argument for the value of collaboration, healthcare might be the ideal example with so many moving parts, shifting regulatory landscapes, and diverse stakeholders. No one stakeholder group can possibly have all the answers, and all of us are interested beneficiaries of comprehensive, integrated, high-quality patient care. One of CCL’s top findings was the importance of creating an attitude of collaboration within the organizational culture of healthcare organizations. CCL’s recommendations included developing skills within the organization regarding participative management, relationship and team building, and dealing with performance issues. Recommendations further supported the need for experiential learning through broad functional experiences that cross healthcare domains (e.g., clinical practice, education, research, healthcare support functions). Similar to leadership training in other industries, healthcare leaders benefit from healthcare leadership training with a focus on communication, interpersonal, coaching, and mentoring skills. Leadership in Healthcare Most “leadership” training is better described as “leader” training. That is, the leadership training is focused on the individual leader. There is great value in individuals being self-aware of strengths and weaknesses, especially regarding communication, handling of conflict, and emotional intelligence. Just as medical tests help healthcare providers diagnose and develop treatment plans, personal leadership assessments such as MBTI, DiSC, and various 360° instruments provide feedback to leaders and their supervisors on self-awareness and behavioral tendencies. With this feedback a leader can develop a personal leadership development plan, which may include healthcare leadership training and specific skills development courses. The National Center for Healthcare Leadership (NCHL) created an Advanced Leadership Development Program (ALDP) to move toward “leadership” development which it defined as “a focus on building the capacity of an existing team of leaders” (p. 2).[2] Sending an entire leadership team through developmental training activities in the same session can be problematic, yet beneficial in assuring shared learning of new concepts and cohesive implementation of new initiatives. The reality is that most leadership development training continues to focus on the individual leader, and leadership team cohesiveness relies on leadership group discussions, reflection, and experiential on-the-job activities. A culture of collaboration and mutual learning requires movement away from traditional top-down, autocratic management to a more participative management style and acknowledgement of leadership as continuous learning.[3] There are hundreds of management and leadership theories. Sonnino[4] (2015) contrasted three leadership types prevalent in healthcare:

• Transactional leaders – focused on efficiency, control, stability, and predictability within existing standard operating procedures; generally not risk-takers.
• Transformational leaders – focused on making changes and shaping the unknown future through motivation of colleagues; comfortable with risk.
• Servant leaders – focused on service and helping others; comfortable with risk.

Transactional leaders are valuable for maintaining the status quo. However, organizations grow and advance with the guidance of transformational and servant leaders. Organizations can nurture the development of transformational and servant leaders through skills training, coaching, and mentoring. Healthcare Leadership Training Healthcare organizations conduct career development while also ensuring leadership capacity by carefully planning and implementing healthcare leadership training. Leadership capacity refers to not only current leadership talent, but also a pipeline of talent ready to assume leadership responsibilities. Leadership capacity is nurtured by preparing workers to practice shared leadership within teams in which individual workers do not have formal management authority. Specific healthcare leadership courses include topics such as listening, empathy, awareness of self and others, conflict management, negotiation, problem-solving skills, communication skills, emotional intelligence, and financial skills. Through collaborative learning, healthcare providers can help administrators and other support workers learn more about patient care issues, and administrators and support workers can help healthcare providers learn more about the financial side of healthcare including cost control and patient cost-sharing. Experiential learning is crucial to reinforcing concepts learned in formal or online healthcare leadership courses. Follow up coaching and mentoring, including peer coaching and peer mentoring, are impactful and allow colleagues to learn with each other, which helps build strong patient-centric service teams. With any fast-changing environment, acceptance of lifelong learning is essential. Research by Cocowitch et al, Garman & Lemak, and Sonnino provided several best practices in healthcare leadership training including the following:

• Diverse learning formats such as classroom, online courses, informational databases, peer-to-peer learning (also known as situational, on-the-job, or apprenticeship learning)
• Healthcare leadership courses adaptable for different personality types and learning styles
• Training and reinforcement spread out over time to allow for learning transfer; mastery of new skills and competencies should build upon each other and allow for application in actual work situations.

Healthcare Leadership Adapting for an Unknown Future One modern leadership theory which focuses on complexity and change is adaptive leadership.[5] Adaptive leadership involves personal (individual), team (work colleagues), and system (organization) dimensions. Learning and practice of adaptive leadership is often assisted through action learning where key stakeholders focus on a current issue, determining as a team what they know, what they don’t know, and developing a research plan to find out more about what they don’t know. Stakeholders work together to learn about the issue, create possible solutions, and become champions for implementing change in the organization. Action learning and other customized healthcare leadership training can help healthcare firms ensure a pipeline of leadership talent ready to meet tomorrow’s technology advancements, higher standards of care, and the need for continuous learning, resiliency, and change management. What trends have you seen in healthcare leadership training? [1] “Addressing the Leadership Gap in Healthcare: What’s Needed When It Comes to Leader Talent?”, 2016. Center for Creative Leadership. https://cclorg-wpengine.netdna-ssl.com/wp-content/uploads/2016/09/addressing-leadership-gap-healthcare-center-for-creative-leadership.pdf [2] Garman, A. N., & Lemak, C. H. (2011). Developing Healthcare Leaders: What We Have Learned, and What is Next. National Center for Healthcare Leadership Whitepaper. http://www.nchl.org/Documents/Ctrl_Hyperlink/doccopy6816_uid2202015927061.pdf [3] Cocowitch, V., Orton, S., Daniels, J., and Kiser, D. (2013). Reframing Leadership Development in Healthcare: An OD Approach.” OD Practitioner, 45(3). http://c.ymcdn.com/sites/www.odnetwork.org/resource/resmgr/odp45_3/vol45no3-cocowitch_et_al.pdf [4] Sonnino, R.E. (2015). Health Care Leadership Development and Training: Progress and Pitfalls. Dovepress.com. https://www.dovepress.com/health-care-leadership-development-and-training-progress-and-pitfalls-peer-reviewed-article-JHL [5] Heifetz, R., Grashow, A., & Linsky, M. (2009). The Practice of Adaptive Leadership: Tools and Tactics for Changing Your Organization and the World. Boston, MA: Harvard Business School Publishing.

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