The Australian health system, like most, is facing increasing demand to deliver higher quality of care within ever tighter fiscal constraints through Activity Based Funding. What a challenge for health leaders!

A few years ago, when I asked a group of health executives to outline the main aspects of their role, the key challenges seemed to be financial balance, workforce control and planning. While these are still important management functions, hopefully the days of the economic rationalist and heroic leader are history.

Poor management and leadership cause more needless harm, including deaths, than clinical mistakes or incompetence. Health systems and entities need leadership of the highest standard at all levels to meet the increasing expectations of patients and communities. Leaders need to focus on improving the health of the population served and on the way care is delivered.  This is the REAL challenge for health leaders and where value can be added.

It is this thinking that has made distributed and collective leadership key principles of the NSW Health Leadership Framework. The King’s Fund, in the United Kingdom and the Center for Creative Leadership, in the United States of America, have recently reinforced the case for collective leadership. Leaders must create cultures where all staff take individual and collective responsibility for delivery of safe, effective and high quality care. In their report Developing collective leadership for health published in May, 2014 ( the authors argue that such a strategy should begin with boards and executive teams but involve all staff and patient leads.

The report recommends that organisations create cultures that:

  • reinforce and sustain visions of continually improving, high quality and compassionate care
  • establish clear, challenging, measurable priorities for all staff
  • ensure staff are respected, valued and supported
  • build team, inter-team and inter-organisational working
  • ensure continual learning and quality improvement at every level and in every area
  • encourage people to accept responsibility for outcomes and to view errors or failures as opportunities for learning and innovation
  • encourage high levels of staff engagement and ensure collaboration across professional and organisational boundaries

The Health Research and Educational Trust in the USA has also published an important contribution to the discussion. Their report, Building a Leadership Team for the Health Care Organization of the Future (April, 2014) stresses the importance of leaders focusing on quality, safety, efficiency, population health engagement and seamless delivery across the continuum, along with the need for physicians and other clinical professionals to play a more significant role. (

The challenges facing our system require leaders to develop strategies that promote collective leadership through a focus on continuous improvement, staff engagement and empowerment and learning.
This requires the development of very different organisational cultures to many current ones. It is no longer an optional extra.