It’s hard for leaders to breathe life into health care these days because the atmosphere is so polluted by frequent restructuring.  Clinical leaders and their teams lose the commitment that made them choose to work in health care in the first place.  Teams are worn down by continual change without seeing any positive benefit. Leaders acquire toxic disinterest and are much more likely to avoid leading than actively pursue it.

Nobody leads from the front anymore.

The avoidant leader has several manifestations. The most common is when a leader uses appeasement. Staff are led to believe that their concerns are valid and will be dealt with appropriately. These leaders are receptive and quite often promise to take some action. As time passes, nothing eventuates and any initial optimism fades. Even when concerns are repeated again and again there is no effect. Noxious cynicism and discontent replace any hope. The current disputes about junior doctors in England are an example of this kind of leadership. All parties involved claim similar objectives, to prevent unsafe clinical practices and not compromise patient care. However, the disputes remain unresolved.

Then there is the hostile avoidant leader who is most dangerous. They counteract any expressions of genuine concern by turning the complaint back on the staff member. The subordinate is made into the problem and accused of having a personal and malicious agenda which is unsupportive and even destructive to a health care system already at crisis. The tables are turned. The leader and the organisation assume the victim role. This type of leadership is most often seen when whistleblowers expose widespread abusive and threatening behaviours within teams.

High workforce turnover may signal another kind of avoidant leadership. The ensuing short term leadership lends itself to equivocation. Ambivalence and ambiguity become safer options for temporary leaders. Where delays in action are expected, such as addressing unsafe levels of patient care, equivocal leadership is common.

The underlying problem with avoidance is that it is linked to management not leadership. Nobody leads anymore, especially not from the front or the top. Today’s healthcare organisations are far too complex. Leaders with vision, competence and commitment are required at all levels.  It is an intrinsic activity. However, effective leaders often get co-opted into management which is a hierarchical activity of checks and balances. Avoidance is a poor management strategy and has nothing to do with effective leadership.