de Zulueta Paquita C
Department of Primary Care and Public Health, Imperial College London, UK.
J Healthc Leadersh. 2015 Dec 18;8:1-10. doi: 10.2147/JHL.S93724. eCollection 2016.
Compassionate health care is universally valued as a social and moral good to be upheld and sustained. Leadership is considered pivotal for enabling the development and preservation of compassionate health care organizations. Strategies for developing compassionate health care leadership in the complex, fast-moving world of today will require a paradigm shift from the prevalent dehumanizing model of the organization as machine to one of the organizations as a living complex adaptive system. It will also require the abandonment of individualistic, heroic models of leadership to one of shared, distributive, and adaptive leadership. "Command and control" leadership, accompanied by stifling regulation, rigid prescriptions, coercive punishments, and/or extrinsic rewards, infuses fear into the system with consequent disempowerment and disunity within the workforce, and the attrition of innovation and compassion. It must be eschewed. Instead, leadership should be developed throughout the organization with collective holistic learning strategies combined with high levels of staff support and engagement. Culture and leadership are interdependent and synergistic; their codevelopment needs to be grounded in a sophisticated, scientifically based account of human nature held within a coherent philosophical framework reflected by modern organizational and leadership theories. Developing leadership for compassionate care requires acknowledging and making provision for the difficulties and challenges of working in an anxiety-laden context. This means providing appropriate training and well-being programs, sustaining high levels of trust and mutually supportive interpersonal connections, and fostering the sharing of knowledge, skills, and workload across silos. It requires enabling people to experiment without fear of reprisal, to reflect on their work, and to view errors as opportunities for learning and improvement. Tasks and relational care need to be integrated into a coherent unity, creating space for real dialog between patients, clinicians, and managers, so that together they can cocreate ways to flourish in the context of illness and dying.
富有同情心的医疗保健被普遍视为一种应予以维护和持续的社会及道德福祉。领导力被认为对于促进富有同情心的医疗保健组织的发展和维护至关重要。在当今复杂多变的世界中，培养富有同情心的医疗保健领导力的策略将需要从将组织视为机器的普遍的非人性化模式转向将组织视为一个有生命的复杂适应系统的模式。这还需要摒弃个人主义、英雄式的领导模式，转向共享、分布式和适应性领导模式。“命令与控制”式领导，伴随着令人窒息的规章制度、严格的规定、强制性惩罚和/或外在奖励，会在系统中注入恐惧，从而导致员工失去权力、团队不团结，以及创新和同情心的消磨。必须避免这种领导方式。相反，应该通过集体整体学习策略以及高水平的员工支持和参与，在整个组织中培养领导力。文化和领导力相互依存且相互促进；它们的共同发展需要基于现代组织和领导理论所反映的连贯哲学框架内对人性的复杂、科学的理解。培养富有同情心护理的领导力需要认识到并应对在充满焦虑的环境中工作的困难和挑战。这意味着提供适当的培训和福利项目，维持高度的信任和相互支持的人际关系，并促进跨部门的知识、技能和工作量的共享。这需要让人们能够在不担心报复的情况下进行试验，反思自己的工作，并将错误视为学习和改进的机会。任务护理和关系护理需要整合为一个连贯的整体，为患者、临床医生和管理人员之间的真正对话创造空间，以便他们共同创造在疾病和死亡背景下蓬勃发展的方法。
