Historically, leadership has played a significant role in organisations. Leadership is viewed as a process that involves influence as a party leads followers towards the accomplishment of predetermined objectives. Given the importance of healthcare in the society, having a strong leadership is crucial for the attainment of goals of the system. The following paper reviews leadership based on the UAE healthcare experience.
Leadership as a Dispersed and Engaged Process
There are various forms of leadership. Heroic and dispersed leaderships are among them. Heroic leadership is thought to help in the running of healthcare organisations. The leadership is of greater significance when it replaces an ineffective one. However, the presence of professional hierarchy undermines the extent to which leadership influences performance. For instance, in hospitals, physicians are more responsive to their professional ranking rather than managerial authorities. The implication is that heroic leadership might be effective within healthcare facilities. In my experience, I have encountered instances when heroic leadership has jumpstarted the performance of organisations but failed to sustain such efforts. Thus, heroic leadership must be complemented with other forms of leadership if success is to be attained in the long run.
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Focusing on the role of leadership in strategy formation also raises concerns. Instead of looking at the top to identify strategic planning, Mintzberb (2012) opines that focusing on the base is critical. From personal experience, I have realised that within a hospital set-up, services are delivered at the base as opposed to from the top.
According to Bennett, Wise, Woods & Harvey (2003), dispersed leadership provides the potential for ensuring that leadership does not fall into two opposing groups where one sees it as a result of individual agency and others view it as a consequence of systems design and role arrangements. For the above reason and others, dispersed leadership has assumed popularity beyond heroic leadership. One of the most notable developments is the shift in focus from behaviours and attributes of an individual (as outlined in trait, situational and transformational leadership theories) to a systematic viewpoint that portrays leadership as a cooperative social engagement which emerges out of the interaction a multiplicity of actors (Fenberg, Ostroff, & Burke, 2005).
Dispersed leadership is not engaged by a given person or executed against other persons. On the contrary, Bennett et al. (2003) view the leadership as a collective activity which works on the basis of relationships as opposed to individual action. Gronn (2002) felt that leadership could be understood using a holistic dimension rather than an aggregation of personal contributions. Such leadership is a ‘concertive engagement’ as opposed to a numeral one. The author illustrated his observations using three forms of engagement: intuitive working associations, institutionalised practices and spontaneous collaboration.
Taking a dispersed perspective of leadership implies that assessors shift from generic leanings to actions/ attributes of leaders/ individuals to situated leadership practices (Spillane 2006). For Spillane (2006), a dispersed leadership perspective entails two attributes: the leader-plus and practice aspects. Whereas the former recognises, and accounts for the work that an individual does, the latter relates to the management/ leadership practice.
Leadership Perspectives
Based on the WHO (2007), the organisation of health services in the UAE is decentralised. As already observed, delegation or decentralisation is an aspect that espouses the dispersion of leadership. By its nature, decentralisation enables various individuals to contribute to leadership by allowing for the delegation of a certain degree of power. The WHO (2007) indicates that within the UAE, six federated authorities alongside nine regional medical districts are in charge of health care delivery. In particular, primary care services are handled by regions that have relative autonomy. In total, twenty-six hospitals and one hundred six primary care centres cater for the health of the UAE people.
Based on the account of the WHO (2007), it is apparent that the UAE’s top leadership has fully committed to the improvement of health care services owing to its large-scale investments in the industry. The organisation also affirms that health decision-makers at the national level and professionals at the health sector work with a strong conviction with a view to enhancing the quality of services and leading reforms in the industry. It is an important aspect of leadership, which aligns with the need to embrace change.
Leaders’ Pursuit of Strategy as Emergent Process
According to Mintzberg (2012), leadership dispersion is critical to overcoming problems associated with power centrality especially in case when more than two centres of power are likely to prevail. For instance, in the health care sector, managers may be drawn from different fields other than health-related. As Mintzberg (2012) observes physicians have a power arrangement that is different from the managerial one. Consequently, the two centres of power might pull apart if a cooperative working structure is not devised.
Mintzberg (2012) also underscores the need to distribute management/ leadership such that the base is covered. As opposed to leadership revolving on the top management, involving other stakeholders, such as professionals, decision-makers, and beneficiaries, is important in diffusing power from the top to the bottom. For instance, when buying hospital equipment, the management is obliged to involve medical professionals to ensure tranquillity. In the UAE, the top leadership is committed to working alongside other stakeholders to improve healthcare services.
Internationalisation and Leadership in the UAE
Organisations are always seeking to expand internationally in order to improve their competitiveness. Diversification of product/ service offering, improving market share and financial results, as well as reducing business risk are also critical objectives that organisations pursue through internationalisation (Beamish, Morrison, Inkpen, & Rosenzwig, 2003). Leadership intersects with internationalisation, as organizations are required to predict and prevent adverse effects associated with excessive internationalization. There is also a link between the two given that entities are obliged to devise methods to take advantages that emerge from the globalisation of operations. In developing solutions, organisational leaderships need to look for avenues of acquiring resources and allocating them judiciously. One of the solutions that leaderships employ is to postpone global activities or find funding for them (Beamish et al., 2003).
Under ideal circumstances, leadership has the responsibility of creating an environment that facilitates the acquisition of information on the basis of internal or market data (Beamish et al., 2003). As a result, it allows for the arrival at informed decisions. Through the above dealings, organisations are able to handle unforeseen circumstances in a bid to move forward. Similarly, such leadership allows entities to plan for change through preparations that ensure emergent technologies or ways of doing things are adopted. At the international arena, leadership must be ethical, relational and sustainable.
The UAE Case
Based on statistics, the UAE has fifteen hospitals operating with urban centres (World Health Organization, 2006). The figure is 57.7% of the entire hospital facilities in the country. In the rural areas, 11 hospitals are in operation. Additionally, 106 primary care facilities are located in the country. It is also noted that the ministry has received a constant budgetary allocation for healthcare services from 1982 to 2001.
The state has revised the delivery of care with a specific focus on replacing existing fees-for-services arrangement to an insurance-based mode (World Health Organization, 2006). It is in line with global trends. As a result, the leadership of the healthcare system in the country seems to be cognizant with international changes. Consequently, it is observed that the leadership of the sector influences the internationalisation of health in the UAE. Alternatively, it is arguable that the global trends in the industry have influenced the leadership of the healthcare industry.
Decentralisation is an eminent feature of the leadership of the UAE. Given that the UAE is a federation, it is not surprising that state power is modelled along power sharing. Within the healthcare system, the health ministry looks at power sharing as primary health care (Kazi, 2013). The Primary Health Care Services Promotion Committee (PHCSPC) viewed decentralisation as the assignment of powers or some autonomy to areas. However, supervision, assessments and follow-up are carried out by the central government. One of the positive outcomes of the approach is the expansion in the quality of the services advanced in the health sector. The approach to leadership in the country enables regional care centres to use the same model. Such an approach allows for dispersed leadership which involves situated practices that facilitate the adoption of methods suitable for the region.
Apart from the delegation of power, regionalisation has also been employed effectively within the UAE. The approach also helps to achieve goals of dispersed leadership given that each region has some powers on financial matters involving primary and secondary care services. Based on the report by the World Health Organization (2006), the structuring of the health services sector follows a decentralised approach. The WHO (2006) indicates that the country is organised along six federal authorities and nine regional medical facilities. Primary care services are addressed by regions that have a certain degree of independence. Decentralisation has helped in improving the delivery of services greatly. Previously, it was noted that dispersed leadership involves the dispersion or spread of power. Understood differently, power is not centred at one point. Hence, the case of the UAE demonstrates that the healthcare system allows for decentralised service delivery, an aspect that has led to the increase in quality of the services delivered.
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From personal experience, I acknowledge that decentralising power allows locals to factor in their different approaches to care delivery leading to satisfactory outcomes. When locals are given an opportunity to contribute to the services delivered, the level of ownership increases leading to positive results.
The WHO (2006) has also observed that the UAE government has fully committed to supporting investments in the healthcare sector. In addition, the world body indicated that there is a strong belief among decision-makers at the national level and professionals regarding reforms in the healthcare industry. In particular, the stakeholders are convicted on reforming health financing and quality assurance. Commitment is a characteristic of astute leadership. For an organisation or a system to succeed, its leadership must commit to the objectives being pursued. Similarly, other stakeholders need to play a role by giving support to the efforts. In the case of the UAE, the back-up from top decision-makers and professionals is an indicator of a high level of cooperation, which is a significant attribute of dispersed leadership.
