This first chapter provides an introduction to the book as well as outlining some of its major themes and issues. It provides a general outline of the theory of conscience defended in the book.

Allison Hoffman (University of Pennsylvania Carey Law), an expert on health care regulation, focuses on tectonic changes to health care in recent decades. She offers a bracing account of these shifts, arguing that American doctors may have overreached in their efforts at influencing health care regulation. In so doing, physicians created profit pools that corporate interests proved all too adept at capturing, leaving doctors with lower professional status than they might have otherwise enjoyed. Hoffman suggests that lawyers, and legal reformers more generally, might learn from physicians’ cautionary tale of protectionism and profit.

Critical to successful engagement in any organisation is an understanding of the important elements affecting good communication. There are many dimensions to the study of communication in the 21st century, both generally and in health service settings, in the 21st century. This chapter considers the foundational concepts, with references to help students discover more about communication in organisational, social and cultural settings. Many believe that even the definition of communication is worth questioning. As a notion it is so discursive and diverse that any definition other than the simplest becomes so complex as to cease being useful.

The complexities inherent in healthcare organisations highlight the multifaceted nature of their operations. Regardless of role, scale, procedural intricacies or governance structures, these organisations need to deal with the complexities of both internal dynamics and external landscapes. The diversity of stakeholders involved adds layers of challenge to effectively managing clinical and social processes, optimising outcomes, allocating resources equitably, developing and retaining a skilled workforce, making informed decisions and upholding ethical standards.

Managers and leaders need to critically analyse their own thinking and decision-making processes so they can objectively evaluate the problems and issues they face every day. To do this they need to understand their personal preferences, prejudices, values and cultural beliefs, and their motivations and desires. It is also important for them to understand how these factors shape the biases managers and leaders take to decision-making. To achieve success, they require the ability to analyse, synthesise and evaluate material, and to assemble their thoughts in a logical argument.

The financial management of healthcare organisations is a key management responsibility for both public and private facilities. While this responsibility has always been important, it is becoming increasingly more so, with the rising costs of healthcare provision due to advances in technology and rising rates of chronic disease and ageing populations. The responsible use and management of scarce healthcare resources requires knowledge and information. The accounting process provides the necessary information to develop and monitor a budget. However, it is the financial management of the budget and associated activity levels that provide the necessary framework to ensure budget integrity and financial governance.

Effective strategic planning, implementation and management drive organisational performance. Healthcare managers have recognised the increasing importance of strategic planning and management as the healthcare industry has become more dynamic and complex. However, development of feasible strategy can be difficult, and implementation of even well-developed strategy is often challenging. This has become increasingly complex as healthcare organisations aim to implement triple bottom-line (TBL) reporting to better ensure sustainability. This chapter provides advice on leading and improving strategic planning and management for sustainability in health-service organisations.

Values permeate every aspect of our lives, shaping individual actions and giving meaning, direction and scope to our work environments and organisational cultures. Defining positive behaviours and identifying unprofessional, disrespectful or negative behaviours shape and define every aspect of our work and personal lives. Values also have an emotional component: when we act in accordance with our values, we experience positive emotions; conversely, when we act against our values or are placed in situations that compromise our values, we experience emotional dissonance. It is this emotional component that drives us to seek values alignment in our personal and professional lives.

Reflection is an action in which we step back and take another look. It is not a new concept in the health sciences. Contemporary conceptions of reflective practice are underpinned by the classic works of John Dewey, Carl Rogers and Donald Schön. Nowadays, reflection is considered one of the core components of healthcare education and is evident in the governing codes and guidelines underpinning professional practice in many health disciplines in Australasia. References to reflection appear in the health disciplines’ code of professional practice or code of conduct. Effective and purposeful reflection is seen to be a core component of proficiency and continuing professional development. Despite this, students, practitioners and healthcare leaders often find reflection – and critical reflective practice – challenging.

In the evolving landscape of healthcare, quality and service improvement are the forefront, driving the shift towards more efficient, effective and patient-centred care. Quality in healthcare includes not only the excellence of medical interventions but also extends to the patient experience and ensuring safe, effective care. The importance of quality is highlighted by the Institute of Medicine’s (IOM) six dimensions: safety, effectiveness, patient-centredness, timeliness, efficiency and equity. These dimensions provide a comprehensive framework for evaluating and enhancing healthcare quality and services. This chapter seeks to broaden the comprehensiveness of the healthcare quality and service improvement model suggested by the IOM and provides real-life case studies in which each of the 12 dimensions is examined and discussed.

Intense debate surrounds the differences between the roles, functions and even the differences between leaders and managers. Leadership is not wholly different from management; indeed, it is a component of management and a responsibility of management, especially of senior managers. Effective managers need to be effective leaders, and the most effective leaders are also good managers.

Negotiation is important for healthcare managers. In the past, negotiation was largely conducted face-to-face but that changed during the COVID-19 pandemic. Many negotiations are now conducted virtually over videoconferencing platforms such as MS Teams. This chapter introduces negotiating that can assist readers to develop their skills for use in personal and professional negotiations.

Leadership is an elusive concept. Key authors cannot agree on the characteristics of leaders, but all agree that leadership is about relationships and evolves over time. For example, Rost and Barker state that ‘leadership is an influence relationship among leaders and followers who intend real changes and outcomes that reflect a shared purpose’. Meanwhile, Landsdale suggests that ‘effective leaders enable people to move in the same direction, toward the same destinations, at the same speed, but not because they have been forced to, but because they want to’. This raises the question of how we get people to want to go in the same direction and at the same pace. In the health services, this is particularly challenging because of the multidisciplinary nature of the key stakeholders. It requires appropriate leadership of interprofessional teams.

Understanding, managing and building positive culture within a workplace are key responsibilities of leadership and management. This chapter outlines what workplace culture is, the effects of poor culture on an organisation and what managers can do to improve workplace culture. the Austrian American management theorist Peter Drucker once famously said, ‘Culture eats strategy over breakfast’. This might seem implausible, because there is an expectation that healthcare managers plan, set out, implement and then evaluate strategy. Drucker’s point is that unless there is a positive workplace culture, seeing a strategy move to successful implementation and adoption is very difficult, sometimes impossible.

Workforce planning in the healthcare system continues to be a politically charged issue in many countries due to the continuing shortage of various health professional groups and the subsequent costs and liabilities to governments hoping to generate improvements and efficiencies. In 2016, the World Health Organization (WHO) released the Global strategy on human resources for health: Workforce 2030, whose overall goal was to improve health, social and economic development outcomes by ensuring universal availability, accessibility, acceptability, coverage and quality of the health workforce, through adequate investment to strengthen health systems and the implementation of effective policies at national, regional and global levels. The Strategy reaffirms the importance of the WHO Global Code of Practice on the International Recruitment of Health Personnel, which recommends countries, including Australia and Aotearoa New Zealand, aim for workforce self-sufficiency with regard to workforce-planning.

This chapter outlines the importance of partnering with stakeholders for quality health service management and delivery, and highlights common patterns driving partnership-based public policy. It introduces concepts associated with partnering in health services, defines key terms and discusses necessary managerial skills or competencies needed to engage with stakeholders and implement partnership-based policy. The interests of key health-sector stakeholders are discussed and important steps are outlined for managers undertaking stakeholder analyses. Finally, the chapter explores essential factors for successful partnerships and the competencies managers need to successfully develop and maintain stakeholder partnerships.

Lack of compassion among health service staff has been identified as a concern around the world. High-profile scandals and inquiries in the United Kingdom have suggested that health systems and services ‘are struggling to provide safe, timely, and compassionate care’. In the United States, only half of patients and staff surveyed believed the health system provides compassionate care. Similarly, a recent study in Australia identified a gap between the intentions of organisational leadership to provide consistently high-quality care and the ability of staff to do so at point of care. Healthcare managers are looking for proven ways to support staff to recognise and provide compassionate care.

A 2021 report on a study of workplace conflict in the United Kingdom concludes that, in 2018–19, more than 35 per cent of respondents reported workplace conflict, with an estimated 485 000 employees resigning as a result. Managers need to understand that conflict does not resolve itself; rather, it tends to gather intensity and energy. Gupta, Boyd and Kuzmits have found that ‘employees spend as much as 42 percent of their time engaging in or attempting to resolve conflict and 20 percent of managers’ time is taken up by conflict-related issues’. Managing conflict is one of the primary responsibilities of managing staff and teams, particularly in multicultural work environments. Understanding what is ‘culturally normative in terms of self-worth, confrontation, emotional expression, and managerial intervention can help [staff] involved in workplace conflict understand what they are experiencing’. Additionally, it can help managers intervene appropriately. In this chapter, different types and origins of conflict are discussed, as well as approaches to managing and resolving conflict.