Rule 3: For low cost, look inwards

Rule 3: For low cost, look inwards

The six rules of good healthcare management and leadership development.


Full-scale, multi-program development ecosystems like Discovery might be beyond the means of many local health organizations, but that doesn’t mean that an effective management development strategy is out of reach.

While business schools and leadership experts have much to contribute, organizations should never overlook the resources that exist internally – often at low or no cost – to develop their management and leadership cadres. Examples of this include drawing on patient volunteers as experts-by-experience, senior managers as mentors and asking frontline staff to define how they would like to be managed.

Not only are these resources very often free, they also add valuable real-world insight to an intervention and ground content in the daily realities of the organization, as opposed to management theory. So even when externally-run programs can be afforded, it makes sense to think carefully about how to supplement their design using human resources from within.

Everything an effective manager does is sandwiched between action on the ground and reflection in the mind. Stretching practical experiences followed by reflection are the foundation of many of the best development approaches and neither necessarily require buying external support.

Local bodies with links to the organization can also be a well of low-cost resources for management and leadership development. Many healthcare providers have formed ‘buddying’ relationships together to bring in new perspectives and support greater collaboration and system leadership. Some have come together to jointly sponsor programs, while others have formed partnerships with successful non-health businesses nearby to bring in new management expertise and development opportunities.

Symptoms of failure:

  • Internal resistance of management development due to perceptions of low value.
  • Participants that rate development programs highly at first, but the effects are short-lived.
  • A feeling of disconnect between layers of the organization.

Key action for boards:

List your current development activities against a grid of patients, staff, senior leaders and professional trainers. Are the resources you are using to deliver them balanced?

Case study

Community-led public health: Institute of Urban Indigenous Health (Brisbane, Australia).

Is the patient the problem? Often, public health targets are missed because apparently recalcitrant patients don’t make use of the services offered them. But who wants to keep asking for care when one is forever being blamed? So how can beneficiaries take hold of the reigns in public health, to work with clinicians and other professionals in a constructive way? The Institute for Urban Indigenous Health (IUIH) in Brisbane, Australia, has found a way to bring Aboriginal leadership effectively to the center of public health provision.

The IUIH was founded in Brisbane in 2009 by four Aboriginal Community Controlled Health Services, with a mandate to expand service delivery to the 60,000 people identifying as either Aboriginal or Torres Strait Islander. In the beginning IUIH only had five staff members and now employs over 400 people engaged in public health driven programs and clinical service delivery. Critical to the rapid growth and expansion of IUIH was an existing Aboriginal Senior Executive team who resolved that IUIH should enculturate a ‘bottom up’, peer-based approach to leadership development that valued the insights and cultural knowledges of Aboriginal and Torres Strait Islander staff members. The existing leadership also recognized that the development of a culturally reflective and responsive non-Aboriginal workforce necessitated far more than a ‘tick-a-box’ approach to cultural competency. 

Guided by consultant Monica Redden, they adopted CoachingOurselves, a peer-learning approach engaging small groups in structured conversations on pressing topics. Clinical Director Renée Blackman describes it as integral to her leadership of four local clinics: it is a great way for people to conceptualize their managerial predicaments, to hear each other’s perspectives, and to embody a kind of leadership that sets agendas and trusts colleagues to take responsibility for the work that needs doing. As Redden says “The learning curve for the workforce on some of the practical application of management in particular has been very steep; they are leaping from entry as registered nurse to clinic manager to regional manager within the span of two years. Generally I think CO has helped the middle managers and emerging leaders to understand the significance of structured and focused conversation on the management of IUIH. CO has been a powerful scaffolding tool for them to learn and continue to learn.”

CoachingOurselves is a proven approach with 20,000 managers around the world, but uniquely, IUIH has taken this on as a way to work with client-expert relations. Under the heading of a Cultural Integrity Investment Program, Renée Brown and Alison Nelson (responsible for workforce development at IUIH) recognized the great fit between Coaching Ourselves and conversation-oriented or yarn* based learning modeled within Aboriginal cultures. Brown and Nelson developed Yarnin’ Up, with a focus on the socialization of staff and reminding clinical experts that their personal and professional identities are provisional, socially constructed and limited in scope. Like CoachingOurselves, Yarnin’ Up will extend to further topics on societal values, privilege, trans-generational grief and loss, family values and legitimacy. The Yarnin’ Up approach has already proved its ability to raise and facilitate profound discussions. Some staff have even taken Yarnin’ Up topics home to use with their own families; and now there is the possibility that Yarnin’ Up will be used beyond IUIH.

IUIH employs a lot of newly graduated health professionals, and values the way that Yarnin’ Up, like CoachingOurselves provides a scaffolded learning approach. By staff bringing their own story to their connections with others, they can draw on more than their professional identities.

Even if Yarnin’ Up remains specific to its context, Monica Redden is convinced that the original CoachingOurselves approach can be widely applied where shared understanding is necessary to ensure the continued – and properly contested – legitimacy of leadership.

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