The tradition of mentoring Part II: leadership and mentoring in the culture of healthcare.

Author:Gabriele, Edward


In the second half of this afternoons presentation, I would like to discuss with you the complex yet fascinating interplay of leadership and mentoring in the culture of healthcare. Healthcare providers, regardless of role, inevitably exercise some form of leadership. Effective leadership requires equally effective mentoring. Contrary to some misconceptions, mentoring is a lifetime process. It never ends. It is also far deeper than simply the acquisition of technical skills and behaviors. True leadership, especially in the extremely sensitive arena of healthcare as a human service, requires a never-ending quest for personal as well as professional improvement. What makes this even more complex is that this leadership comes about not just in any ordinary context, but in the highly charged and extremely critical context of healthcare. Unlike many other realities, healthcare gathers human beings at the most sensitive moments of life. Therefore, the exercise of leadership and the mentoring required for leaders have a special and intricate value.

To understand this complexity, I will reflect with you upon five specific areas. First, we will explore the culture that is healthcare and the role of leadership and mentoring within. Second, we will review the basic principles of healthcare ethics that give shape to healthcare leadership and mentoring. Third, we will consider briefly four areas of responsibility in healthcare. Fourth, we will reflect upon four signature pedagogies of the Carnegie Foundation that can be valuable approaches for establishing long-lasting, positive experiences of leadership mentoring. Finally, I will reflect upon an image for sustaining and advancing the meaning and mission of healthcare leadership for the future. It is my firm belief that my final comments provide a critically needed re-imagining of the fundamental goals and content for the continuing education and ongoing mentoring of leaders in healthcare.

Mentored Leadership in a Zone of Cultural Contest

Leadership is a multifaceted construct. In organizations, we can identify leaders, managers, and technicians. While their relative areas of responsibility necessarily overlap, technicians are generally responsible for carrying out operations. Managers provide tactical direction for those operations. Leaders are those who strategically oversee all areas of the organization's tactical delivery. At an even higher level, leaders are those persons and groups who coalesce and integrate all tactical directions and operations with the general mission, purpose, and strategic or long-range plan of the organization itself. From another perspective, leaders are responsible for calling a group to its ultimate purpose, its Being.

I would not say that leaders are necessarily born. Leadership is not necessarily genetic. However, it does draw upon personality traits and innate skills and abilities. It does require significant nurturing and education. It also requires personal and professional mentoring. I do not think it would surprise any of us, when we think about historical circumstances, that it is too easy for the authority of leaders to devolve into tyranny and authoritarianism. This is one reason why the ongoing formation of leadership is as important as is continuing education in leadership skills. Leadership affects and is influenced to its very root experience by one's psychology, community background, values system, experience, and personal goals.

Within this context, it is easy for us to see why mentoring is critical. Just as it is true in any of the professions or in academics, mentoring is the means by which knowledge, skills, and abilities become grafted and integrated into the values formation of the individual leader. The "what" is married with the "who." This is a lifelong-task and it is filled with deep and abiding challenges.

In ancient Greece, philosophers said that society and each person are guided by one's "telos," one's end-point. We might surmise that a telos is one's personal North Star guiding the vessel of our lives. Mentoring is that critical and deeply important lifelong formative experience that continues to draw one's attention to one's North Star--and to evaluate how well or how poorly one is following the North Star. The mentor will call attention to the motivations and inner workings of the self that keep one aligned with one's telos, with the path that is best and surest.

Concomitantly, it is critical to remember that leadership in healthcare has its own beauty and challenges. At this juncture, it is important that we recall that, from a particular perspective, healthcare is a culture. It has many constitutive parts. Like other cultures, healthcare organizations and communities have shared language, patterns of communication, abilities, vision, behaviors and approaches. As a culture, healthcare itself has shared meanings.

At this point, it is likely important for me that I share with you a personal reflection. Over the last half-century in particular, our healthcare institutions have been looking for ways to reduce costs, to improve benefits, and to ensure efficient delivery of services. In short, healthcare organizations and their professional leaders have tried to enact sound business practices. Yet when we observe a variety of examples, we wonder whether the proverbial carriage has gotten in front of the horse. Healthcare seems to have been made into a business.

But is this a worthy or appropriate equation? Healthcare always must make use of the best business practices and models. But healthcare must never be allowed to become a business in the ordinary sense of that word. It is a human service. It is not a business transaction or a commodity. It is not just what civilized people do for those citizens who are sick. As an ethicist, I contend that healthcare is an absolute human right because it defends, protects, preserves, and increases the dignity and worth of each human being.

To be caught up in the complexus that we call healthcare, we need to recognize that it is fundamentally a community partnership among patients, families, communities, providers, and organizational leaders. To accomplish the goals of healthcare and the quality improvement of human life, one can never approach any aspect of healthcare as simple or easy to enact. Healthcare is not a set of clear operations that require occasional maintenance like a software upgrade. Walk through an emergency room and hear the cries of those who are suffering. There is no upgrade that can take away their pain. Look into the eyes of those who are present to a dying family member in the intensive care unit. There is no technical improvement that can erase the ambiguity and loss that makes white the knuckles of those grasping the guardrail on a bedside. Perhaps we prefer to make healthcare into a business because it is easier to handle. Yet for those of who know in ourselves the depth of suffering that comes with human illness, we understand that the caring for those who are sick is far from easy. It costs us in ways that can never be captured on a spreadsheet or ledger. Hence, educating and forming those who would be healthcare leaders requires a very different, in fact a very ancient, form of mentoring. Mentoring is not about academic advisement. It is not about performance appraisal or laboratory supervision. Mentoring, real mentoring, is about entering into companionship in what is the inevitable vortex of human relationships at those junctures of human life that are most vulnerable. Such an experience can never be a business. In fact, its reality is beyond words. It is much like the image of Virgil who accompanies Dante throughout his journey into the Inferno.

This image of entering into a vortex came home most powerfully to me when I was in doctoral studies. My doctoral area involved ritual studies and the social sciences. One of the nearing graduates eventually published on a concept of rituals that spoke of them as "zones of cultural contest." As she theorized, ritual is a zone in which cultures and individuals engage in a heated wrestling, an "acting out" of sorts, of values, goals, beliefs, and fundamental meanings to human life. The image she portrayed has stayed with me through the years.

In fact, based upon my initial reading of my former colleague's work, I have come today to believe that healthcare itself, just as other cultural processes, is a zone of cultural contest. In it, the various partners collide over needs, expectations, assumptions, resources, ethics, belief systems, and values. As a zone of cultural contest, healthcare is a place of volatile change agency. Underneath the often-frantic activity of healthcare, there is an ever-changing sea of paradigms always shifting. It is an...

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