Leadership challenges in Canadian health care: exploring exemplary professionalism under the malaise of modernity

This thesis explores the nature of leadership within the health professions and the influences upon them of the "malaise of modernity." In order to address this question, significant aspects of the following are dealt with: moral and political philosophy, the influences of modernity, professionalism, the moral community, the communitarian ethic, leadership theories and organizational culture. Primarily a theoretical essay, this project uses a broad range of writings from classical and contemporary scholars. The objective of the thesis is to develop a model for contemporary health care leadership. Philosophical political frameworks and sociological images are examined to understand the complex multidimensional concept of modernity as it significantly affects all areas of society, not the least of which is health care. The predicaments that arise from the "malaise," such as bureaucratization, alienation, commodification and commercialization, provide a significant backdrop for further discussions of implications for professions and leadership. An exploration of moral philosophy demonstrates that the work of Plato and Aristotle still informs contemporary scholarship on health care values and professional practice. Discussions of the quest for the good, virtue and ethical theories relate to views of professionalism and current challenges. A critique of leadership theories concludes that there is a need for further development of an alternative framework to support the practice of ethical leadership within health care. Documentary cases, the Report of the Royal Commission, Building on Values: The Future of Health Care in Canada, and the Dr. Nancy Olivieri case illustrate these current issues of leadership, professionalism and policy development. Throughout the thesis, the discussion of the foundations and challenges of educational leadership draws upon personal interviews with exemplary leaders. They join the dialogue with classical philosophers and such contemporary scholars as Charles Taylor, Alasdair Maclntyre and James MacGregor Burns. The thesis concludes with a model for leadership, in response to the central inquiry of this project. The model establishes elements necessary for developing excellence in leadership in the 21'' century to guide professional practice and health care reform in the midst of the malaise.