The Challenges of a Relational Leadership and the Implications for Efficacious Decision-Making in Healthcare.

Objective: To demonstrate how decision-making can be made more efficacious in healthcare contexts, such as cancer care networks, by adopting relational leadership practices. Design: Empirical material was collected through video-recordings over a 12-month period of fifty-three meetings of seven cancer networks in Australia. Using an interpretive approach, analysis was conducted on the meeting conversations of service improvement subcommittees of the networks. Only one sub-committee was described as 'narrative rich' meaning, personal narratives or stories were evident in their conversations. The sub-committee is characterised as displaying elements of multi-ontology sense making. Drawing on the Cynefin framework, conversations were classified as simple, complicated, complex or crisis-based depending on the nature of their decisions and the contextual constraints. This allowed conversations to be tagged as examples of either single or multi-ontology sense making. Setting: Cancer networks in Australia tasked with the dilemma of enhancing multi-disciplinary cancer care. Main outcome: Relational leadership practices can generate narrative rich conversations in decisionmaking through enabling multi-ontology sense making. Results: Sufficient evidence was found to demonstrate that narrative rich conversations offered potentially new and innovative ideas for service improvement but lacking relational leadership practices, networks simply produced interventions that amounted to 'more of the same'. Conclusions: The ability to skilfully relate helps create contexts in which multi-ontology sense making can flourish. Skilful relating, as a leadership practice, is essential to making healthcare professionals more innovative and creative in how they deal with organisational dilemmas, allowing them to engage in robust, informed and inclusive decision-making processes. [ABSTRACT FROM AUTHOR]