Leadership: Based on Relationships

As secretariat to the South Pacific Chief Nursing and Midwifery Officers Alliance (SPCNMOA), the World Health Organization Collaborating Centre for Nursing, Midwifery and Health Development at University of Technology Sydney(WHO CC UTS) works in close partnership to support leaders in nursing and midwifery, directly assisting the governments in 14 South Pacific Island Nations.  This partnership has been in place since 2004, when at the first SPCNMOA meeting a request was made to UTS Faculty of Health to take the lead on establishing a WHO Collaborating Centre for the region. As secretariat, the WHO CC UTS is the bridge to provide national, regional and global policy to strengthen health systems for our sometimes isolated colleagues in the Pacific.

To strengthen the partnership and create practical and positive health system strengthening outcomes for the South Pacific Island Nations the WHO CC UTS engages with SPCNMOA not only through constant communication but activities that have a direct impact. A leadership program has been developed and funded by the Australian Department of Foreign Affairs which has, so far, been implemented annually since 2009.

As 105 emerging ‘leaders’ from the Pacific have now participated in this program we have continually reviewed the program with the SPCNMOA to focus on leadership as a process which includes interpersonal relationships (between leaders and colleagues) and also reinforcing that leadership is not about individuals but about collectives. From this perspective, leadership development does not ask “How do we make better leaders?” but instead “How do we improve leadership in the system?” (Edmonstone, 2011). The success of this program has been documented through many past participants enacting changes in their countries and some becoming chief nurses. Many lessons have been learned that we would like to share with others interested in healthcare leadership models, particularly in developing countries.

In brief, the successful leadership program consists of a Country team of potential leaders in nursing and midwifery mentored by the Chief Nursing /Midwifery Officer in the Ministry of Health of their country. The teams, in collaboration with key stakeholders recognise a problem and devise an Action Plan to help solve it. A Reference group overseas the teams through constant communication, this not only ensures the program is running the way our partners want it to, but enables them to meet in a trusting environment to share problems with Action Plan development and progress.

The skills they have gained has enabled them to strategically plan with key stakeholders, such as Ministries of Finance and Ministries of Health, projects in their countries which are still ongoing and having beneficial impacts today.

The keys to this partnership’s success have been clear and are outlined here:

Trusting relationships – This is the foundation of how any work done in partnership succeeds. This idea often seems to get lost in the struggle to find funding and the need for measurable outcomes.

True country ownership – The health system strengthening initiatives that seem obvious  aren’t actually context driven. So in true country ownership, and by working in their context, some of the projects need to fail so they can learn and rebuild in their own way to succeed the next time.

Being there for the long haul – we’ve had a relationship with the SPCNMOA since 2004. Because of our long standing relationship, we understand the issues facing our colleagues and can support ongoing issues connected with project development.

Without the trusting, open and equal partnership built between WHO CC UTS and SPCNMOA this model for enhancing leadership in nursing and midwifery in the South Pacific would not have had the impact on health systems that it has had. We believe a strong relationship is built on trust, allows true country ownership and grows and strengthens over time. The worrying trend in reduction of development dollars means increased pressure for efficiency and a decrease in ‘soft’ development projects such as these that deal with organisational change. There is a need to apply rigorous research methods to look at the success factors of such a leadership program to provide evidence to funding bodies.