Leadership across Danish hospitals

Abstract

Healthcare organizations are challenged by complexity in structure and knowledge, and heterogeneity in deliveries and patient demands. Reductionist managerial approaches fall short in resolving the quality issues of healthcare, but Scientific Management and New Public Management (NPM) nevertheless has a strong hold on leadership thinking in hospitals. Increasing demand for adaptive and collaborative capacity emphazises the need to rethink the way we organize and lead these organisations. We conducted semi-structured interviews, examining the organizational and leadership thinking of 14 key decision makers, hospital directors and ward leaders, holding a key role in planning and implementing new organisational structures in the Region of Southern Denmark. Informants stress the organizational complexity, and the need for better coordination and collaboration across boundaries. In contrast, they present leadership discourses that are grounded on hierarchical positions and individual agency. Hospitals are complex organisations characterised by extensive bureaucracy, struggling with quality issues, attributable to rigid organisational boundaries and the dominant SM and NPM thinking. We show that an organisational change meant to address this problem is not accompanied by a similar change in leadership constructs, and we offer ideas of complexity leadership, enhancing relational coordination, adaptability and flexibility.