Prescription Leadership:

The 9 Practical Skills Needed for Health Professionals to Thrive in the
21st Century

Harry van Bommel, M.Ad.Ed.


Beverley Powell-Vinden, R.N., B.N.Sc., M.Ed.

Michèle Chaban, M.S.W, DPhil.

Elizabeth Latimer, M.D., C.C.F.P., F.C.F.P.

Larry Lewis, M.A.

Published by:

Resources Supporting Family and Community Legacies Inc.

Scarborough, Ontario2000

© Harry van Bommel 2000

ALL RIGHTS RESERVED. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the author.

Canadian Cataloguing in Publication Data

van Bommel, Harry

Prescription leadership: the 9 practical skills needed for health professionals to thrive in the 21st century

Includes bibliographic references and index.

ISBN 1-55307-004-6

1. Health services administration. 2. Medical personnel—
Professional relationships. 3. Communication in medicine.
4. Leadership.  I. Powell-Vinden, Beverley, 1963-  II. Title.

RA971.V35 2000362.1’068’4C00-901514-0

To contact the authors, write or call:

Resources Supporting Family and Community Legacies Inc.

11 Miniot Circle

Scarborough, Ontario


(416) 264-4665

Dedicated to those health care providers who demonstrate daily the PRACTICAL knowledge and skills required to work together with their colleagues to meet the physical, emotional, spiritual and information needs of their patients and their patients’ families.


Each co-author brings a lifetime of personal and professional education and experiences to their research and work. We have been fortunate to learn and work with some of the best. We gratefully acknowledge our patients and clients, their families, and our colleagues who helped us to learn to practice and teach the PRACTICAL knowledge and skills presented in this book.

Special thanks to Carol Ann Godard for her helpful ideas early on in the project.

Each chapter has a reference section to acknowledge where the generic, practical skills are further explained. The field of management and staff development is rich in literature and we acknowledge the authors of those works for richly enhancing the information available to help readers.

Lastly, we appreciate the support, encouragement and life lessons of our family and friends. Their invaluable help makes our work possible.


There is a general body of leadership knowledge that is the same for everyone. This book is based on a series of management and staff development self-study modules called Learn for yourself. This generic information has been used over the past decade by tens of thousands of managers and front-line staff in various sectors including health care.

This book is unique because it takes the generic information written by Harry van Bommel, an adult educator and management consultant, and adapts it specifically to the health care sector. The co-authors all have extensive, ongoing, practical experience modeling the knowledge and techniques in this book. They are not ivory tower theorists. They are passionate and practiced leaders in their field -- your field. They know that advanced leadership skills are really just practicing the fundamentals of leadership predictably, fairly and firmly with a good dose of humor.

Introduction for Administrators

In the real estate industry, the answer to every question seems to be location, location, location. I think for health care administrators the correct answer is usually communication, communication, communication. And as much as we communicate--we always feel like we are over doing it--it is still not enough.

The complexities of health care and the large number of people involved in most facilities and programs make communication all the more important. Effective communication is time consuming and costly but the consequences of doing it poorly lead to even larger financial and employee morale costs and potential legal liability costs.

The themes in this book and the topics addressed are basic building blocks that are absolutely required for individuals in any kind of organization, whether it be the health care industry or not. The pieces that cannot be covered in a national book on leadership, of course, include any legislation that affects (1) hospital administration (in Ontario, the Public Hospital Act), (2) professional disciplines and their own body of legislation and regulations, and (3) legislation such as human rights, waste management and occupational safety. This detailed information must be learned elsewhere. Such information is up-dated often and each province and territory is different. You may obtain some of that through your workplace and your professional associations and some of it will be part of your professional recertification or licensing.

I think much of our time as administrators is spent receiving data, converting it into information and making decisions about what that can be used for--what we call identifying opportunities and closing the gap between where we are now and where we need to be. That is, forever identifying where things can be improved. So you have some basic information, perhaps you have done something with it, changed something and now see an increase in performance. You actually make something happen, empower individuals, or see that a group is working on a task to raise a performance level. I think a lot of skills sets for administrators revolve around decision making, interpreting information and problem-solving activities.

Leadership skills are generally learned through one’s own professional discipline; in my case psychology. We learn it partly, I think, in taking workshops and courses and in the line of fire. I think you find yourself in the company of some great minds and you see how they work. That’s the model for learning. This book will provide you with some shortcuts to new information and reinforcement of knowledge and skills you already possess.

My work as a hospital administrator is energizing. It might have to do with control, perhaps. Everything is resting on my shoulders if something happens. I have some degree of freedom. I close the door for 2 hours and people know to leave me alone. I have some control. I am the director of decisions rather than the receiver of decisions. I am an old guy, and I can tell you that I have been elsewhere doing other activities but I have never had more excitement than here. If you talk to other hospital administrative folks who have been around a while, they have pretty powerful mandates they are carrying around. They work hard and long hours and so on, but I think they are generally on a high. You see it when you meet with them. The president sometimes doesn’t sit down. He walks around to express his ideas. He’s excited. That is not nervous energy. He is genuinely happy to be doing what he is doing.

There are certainly people who have more control than I do. But I have to make decisions. I have to institute change. I have to turn the corner quickly. Life never seems to unfold here as I planned. I make a presentation about the upcoming priorities. This is how we are going to proceed with a plan. After two months, things have changed. You don’t throw your work out, you adapt it. Making change and decision making affects not only you but you have an impact on much of the organization. That is pretty exciting. You have been given a gift. That gift is going to have impact on a wide variety of areas.

It’s not unusual to meet with a vice-president who asks me, “Are you still having fun?” It’s a check-in thing. Are things reasonably under control? If you are having fun, stress is different. Sometimes I think, “If you mean by having fun, have I had to completely change how I am about to do something, and introduce new methodology, or alter the plan dramatically, and I don’t know if I have the time to present it in the style I would like—if that’s what you mean by having fun, then I am up to my ears in fun!”

I also like encountering our clients and their family members. To actually get involved in a direct client event is for me a ‘wow’, it’s exciting.

The opportunity to be involved in this book is fun, too. I hope you have as much fun as I have in developing and implementing your leadership skills.

Larry Lewis, M.A.

Former Program Director, Community Living

West Park Hospital

Toronto, Ontario

Current Educator

North York Community Care Access Centre

North York, Ontario

Introduction for Nurses

Change is the one constant as we look forward to a new millennium, not only in society as a whole, but in our professional and personal lives as well. Over the last decade, the profession of nursing has undergone tremendous change. Some of the key issues nurses have had to deal with include: increasing patient acuity; constant change; new roles; better informed and more demanding clients and families; cost effectiveness driving decision making, rather than health needs, and last but not least; coping with job loss and the 3 “Rs”—reorganization, restructuring, reengineering.

Staff nurses, in particular, often lament their lack of autonomy and ability to control their work environment. Staff nurses and nurses in other positions, can in fact, have a tremendous impact on clients and families by taking leadership positions in their work settings and organizations.

Nurse leaders are not only in formally recognized leadership roles like nurse manager, clinical nurse specialist or educator but also in the day-to-day practice of providing care to clients. Here are some examples of things you might do on a regular basis but don’t tend to think of as leadership in action: ensuring that your client has enough information to safely care for themselves at home; mentoring a new graduate or student nurse; easing the fears of a patient about to undergo surgery; consistently treating your clients with care and compassion; and providing a staff nurse perspective on a hospital committee or workgroup.

Leadership in action is really caring in action.

Prescription Leadership has been written as a guide for today’s nurse struggling to be a caring leader amidst constant change and workplace turmoil. I encourage every nurse in a leadership role, formal or informal, recognized or not, to spend some time reviewing the information in this book.

All of the skills necessary for leadership in a health care setting have been addressed. You may want to use this book to help you meet some of the quality assurance requirements of your regulatory body. Ask yourself what skills are lacking or need improvement and then review the appropriate section in the book to help you meet this goal. At the same time, congratulate yourself on the leadership skills you already have and those that have improved.

Remember that leadership and care are not exclusive of one another; a successful nurse leader provides compassionate care to clients, regardless of job description.

Beverley Powell-Vinden, R.N., B.N.Sc., M.Ed.

Health Education Consultant

PowerPhrase Communications

Mississauga, Ontario

Introduction for Physicians

Physicians are going to enjoy this book! They have been and continue to be leaders in health care. In these pages they will find new information and ways of developing skills as well as an affirmation of their current skills and ways of functioning in the leadership role.

Physicians, like many health professionals, have been educated to provide patient and family care. While being very skillful in this important area, they have not likely had any education or training in the areas of leadership, management, team work, supervision, communication, life-long learning skills and other subjects that are necessary to manage and lead in the current and future health care climate. The content and exercises will provide physicians with the opportunity of looking at aspects of their leadership and management roles in new and enlightened ways. There are few places where such a scope of subjects relevant to leadership are all brought together between the covers of one book which can be read and utilized in sections that are of use in a problem-based way.

Leadership roles come to physicians in a variety of ways. The setting up of a practice, negotiating for space and services, hiring and managing office staff represent one area where knowledge and skills in communication, negotiation, preparing a budget, dealing with difficult people, working with teams and resolving conflicts can make the whole process not only more understandable and manageable, but also more satisfying all around. Physicians will also find themselves working with interdisciplinary teams in hospitals and, increasingly, in the provision of patient care in the community. Some familiarity with the theory of teams and ways of developing and working in teams will help the physician to feel at home, and to be a more effective and responsive team member.

To paraphrase the song, "the times they are a-changing". Physicians will be involved in change in patterns of health care delivery that will impact their practice in the office and in hospital. The sections on managing change and supervision will provide physicians with some of the tools and knowledge to understand what is happening around them. Such knowledge can enhance a sense of confidence to deal with the attendant stresses of change oneself and also to assist staff and groups to do so. The section on presentation skills will assist physicians who find themselves in new roles of leadership, as well as assisting them to present educational rounds in more dynamic and effective ways. The section titled "Awareness" gives some perspectives on career path planning which can assist the physician in reviewing and affirming or changing one's career path.

Some of the language and perspective of the book will be new to physicians. For example, the word "client" will be used to represent those who are users of service. We, of course, will be more comfortable calling these people our "patients", as has been our tradition and because the word patient is a better word to encompass the fiduciary relationship and covenant that we hold with them. However, the perspective of "client" can be of help if it more fully allows us and our staff to see that we want to provide them with a respectful, timely and effective "service". The physician will, I hope, find that new language provides a new perspective on issues of care delivery for them and for their clinic, hospital and office staff.

Many of the concepts and approaches outlined in the book will also be applicable to effective and mutually satisfying patient and family-care relationships. Skills in communication, negotiation, humor and resolving conflicts have a universal application to our dealings with people in many aspects of our lives. The book encourages self-reflection, which can very helpful in one's personal life and relationships as well as leading to more career satisfaction.

Most physicians have not had the opportunity to gain skills in leadership and management in their medical training. Here is that opportunity. Enjoy!

Dr. Elizabeth Latimer, M.D., C.C.F.P., F.C.F.P.

Professor, Family Medicine, McMaster University

Consultant Physician, Hamilton Health Sciences Cooperation, Hamilton Regional Cancer Centre

Hamilton, Ontario

Introduction for Social Workers

This book is a mosaic of possibilities. Enter it with the imagination of perspective.

Social Work is a profession that has its origins in social reform and social change. Clearly the last decade in health care has seen an ample amount of both these dynamics as we endured human and fiscal cuts. The intent of these strategies was to enhance care and allow for a more equitable distribution of goods and services to other sectors. For those of us in social work, we watched as programs, services and other resources crumbled. For a time we tried to invent new ways to conduct our work. Eventually, we had no choice but to surrender to the inevitable changes. While we may have found fewer of us serving more in a cost effective way, we could not help but ask if we were serving our clients as well as we had in the past.

Social Work’s commitment to equity, process and consensus building has often kept us from taking an overt leadership stance. We can no longer afford to do this. Prescription Leadership can help social workers marshal the best of their skills so that they can contribute to a more stable health care system from which to care for others.

On a personal note--I was 23 years old when a drunk driver ran his car into my body. Over the course of the next 8 years, I began to lose functioning in my arms, hands and legs. Various other systems in my body became progressively compromised. Those years taught me a great deal about attitude, humor, disabilities, public speaking, and coping with stress and time management. Many of those skills are in this book. The material was written for your professional development but, as my experiences have taught me, it can also help you personally.

Dr. Michèle Chaban, M.S.W, DPhil.

Social Worker, Mount Sinai Hospital

Clinical Thanatologist, Educator and Consultant, Private Practice

Toronto, Ontario

Don’t Panic!

There is a lot of information in this book. However, this may be the only book you ever need to learn how: to be a principled leader, to be an effective supervisor, to manage change, to provide excellent client service, to run effective meetings, to build a team of dedicated people, to negotiate your needs, to interview others to join your health care facility/team in its successes, to plan strategically, to resolve conflicts, to solve problems creatively, to manage your stress and time, to increase your use of humor, and to plan your career. This book was written to help different people:

Administrators, nurses, physicians, social workers, other healthcare professionals and volunteers.

Managers and staff in different types of health care organizations.

Students in high school, college, university and other schools.

Other adult learners who want to learn on their own.

The book is divided into separate sections for each major skill area. Some material is repeated or explained further in different chapters. We assume you will not read the book cover to cover but will read those chapters most helpful to you now, which is why it is necessary to be repetitive.

Note: Prescription Leadership is also available on the web site: The web site version of the book includes memory maps to help you preview and summarize the contents of each section. Print the maps directly from the web site; add your own personal notes and ideas to these basic preview-review pages.


When you finish reviewing a new section, it is helpful to take some time to evaluate what you have found most useful and what you would like to do with that information. This process can be very useful whether you write out the answers or just think about them.

1.What general concepts, ideas or techniques have you learned?

2.List at least three techniques from this section that you could use immediately.

3.What other concepts, ideas or techniques do you want to learn?

4.Is there anything you have learned that you could pass on to your colleagues, family members or friends?

5.Do you have any further comments or ideas you want to record based on what you have learned?

Practical Leadership

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Copyright © 2000 Harry van Bommel

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical copying, recording or otherwise, except with the prior written permission of the author or under license from the Canadian Copyright Agency.