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RE: Transactional and Transformational Leadership in Performance Management and Appraisal: Do the Queensland contracts allow an opportunity to apply both?

This letter proposes to add another viewpoint to Dr Michael Clements’ article “Transactional and Transformational Leadership in performance management and appraisal: Do the Queensland Health contracts allow an opportunity to apply both?” published in The Quarterly 2015.
There is no question about the burdens on health services to continually perform in the presence of resource crunch. This has possibly been worsened when revenue was linked to performance targets. One perceived way out was to utilise the same metrics of KPI linked pay for Senior Medical Officers (SMO), reviewed annually. The intent was also to align the SMO with the organisational goals and thus have an engaged senior workforce, expected to deliver high standard care.
While the use of both transactional and / or transformational leadership may have their roles in such an annual review process, I suggest the continual use of Adaptive Leadership (AL) (Heifetz, Grashow and Linsky, 2009) may be better suited to the task of creating engaged clinicians in this context. This engagement is crucial as it leads to improved safety and quality in patient care (Rana, 2015). The issues around job demands and resource mismatch (as described in the JD-R model (Bailey et al., 2015) for SMOs is also real and cannot be neglected either as that would lead to burnout while seriously eroding clinician engagement.
Healthcare is a complex adaptive system (Anderson and McDaniel, 2000) where there are innumerable ‘adaptive’ challenges (as distinct from ‘technical’ problems). While technical problems have clear, well defined solutions, adaptive challenges don’t. Since improving clinician engagement is an adaptive problem, without clear modular solutions, it therefore needs the AL approach.  AL does not proclaim to deliver ‘answers’ and most certainly do not equate leadership with expertise. AL works on the premise that a level of disquiet and disequilibrium is necessary to sustain an adaptive change (Ronald A. Heifetz, 2009). AL does not aim to minimise conflict or discomfort, rather uses that to evolve into a newer heightened state of comraderies.
Clinicians are one of the most valuable resources available to the health sector, not only by the dollar value but more so by the expertise they bring to the core business. They also have the most influence on variation in health care outcomes (Taitz, Lee and Sequist, 2011). Constraining clinicians to KPIs, especially with potential financial disincentives, can hardly help in garnering their engagement. Furthermore, the spectre of uncertainty should be addressed over the continuum of the year and not relegated to a year-end annualised process. 
Dr Kaushik Banerjea
Anderson, R. and McDaniel, R. (2000). Managing Health Care Organizations: Where Professionalism Meets Complexity Science. Health Care Management Review, 25(1), pp.83-92.
Bailey, C., Madden, A., Alfes, K. and Fletcher, L. (2015). The Meaning, Antecedents and Outcomes of Employee Engagement: A Narrative Synthesis. International Journal of Management Reviews, 19(1), pp.31-53.
Heifetz, R., Grashow, A. and Linsky, M. (2009). The practice of adaptive leadership. 1st ed. Boston: Harvard Business Press
Rana, S. (2015). High-involvement work practices and employee engagement. Human Resource Development International, 18(3), pp.308-316.
Ronald A. Heifetz, M. (2009). The practice of adaptive leadership: tools and tactics for changing your organization and the world. 1st ed.
Taitz, J., Lee, T. and Sequist, T. (2011). A framework for engaging physicians in quality and safety. BMJ Quality & Safety, 21(9), pp.722-728.

Last Updated on Thursday, 29 June 2017 11:16