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Courage and leadership in healthcare: a critical analysis



Rebecca Myers and I have been writing a book together for some time.

It’s called “Courage and leadership in healthcare: a critical analysis”. We are honoured that Sage Publications (Books), highly celebrated in this field, have agreed to publish our book in 2018.

Sage, of course, publish the journal “Dementia: the International Journal of Social Research and Practice.”

We hope that our book will find relevance to all health and social care professionals with a particular interest in management and leadership. We are actively looking for people who wish to volunteer to give a clear account of their experiences (such as – and this list is not exclusive and complete – difficulties in ‘speaking out’ against the system for example clinically in safe staffing or “blowing the whistle”, courage in raising issues about bad policy or conflicts of interest, courage in coping with public failure, courage in facing terrible standards in healthcare directly or as a close relative or friend, courage in scientific research, courage in dealing with personal loss of a loved one, courage in dealing with the illness of someone close).

We anticipate that the book will have a number of important aspects – and we want people who use the health and social care services, as well as people who work for and run services, to tell us what they think is important about what is being done right (and wrong).

Moral courage is the courage to take action for moral reasons despite the risk of adverse consequences.

Courage is required to take action when one has doubts or fears about the consequences. Moral courage therefore involves deliberation or careful thought.

The concept of moral distress is not new. Jameton (1984) offered the first definition of moral distress in the nursing literature. He stated that moral distress is the stress that occurs “when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action” (p. 6).

Courage is also critical to people who run the NHS and social services. Lessons can be drawn from the leadership styles of people who have brought about exhibited great courage and brought about change, such as Gandhi or Martin Luther King.

Change is a powerful force in healthcare systems, and essential for healthcare systems to match provision to meet needs of patients and users.

Courage can be extremely personal too. Courage historically has been couched in the language of adversarial combat, and this runs in parallel with media messaging of conditions such as cancer or dementia. We will consider whether it is appropriate to consider cancer or dementia as a ‘fight’ – in that there are some cancers, for example, where complete remission is a possibility.

While anything can happen to anyone at any time, the preparation of death is important, for example, in palliative approaches; and has implications for individual reactions to life-changing illnesses and the lives of close carers.

Professionals and practitioners, and students, working in health and social care can get ill themselves too. Courage is needed to have to deal with multiple demands, such as the threats to health and illness themselves, the regulator, the media, impact on friends and family, and intense stigma and exclusion from peers and colleagues. (I hope to write about this from personal experience.)

The term “blow the whistle” has long been felt to be a strong phraseology for the courage to speak up against cultures which have gone wrong. Problems have still remained pursuant to the Public Interest Disclosure Act (1998) which is supposed to protect public sector employees. And yet speaking up courageously is often needed to promote patient safety, a key duty of all registrants in healthcare.

We will give an account of the individual experiences of people who have spoken out against the system, including misdiagnosis of important conditions, criticising poor clinical care, and speaking out against child abuse. Often people who speak out find themselves emotionally and intellectually ‘burnt out’ too, and the chapter will consider the pivotal need to protect staff wellbeing too.

Our book is a timely look at an important professional strand for all practitioners and professionals, patients and service users, and all other members of the general public. We hope you will help us get the content and style of the book right – and we hope especially you can directly contribute.




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