Hleb, Ka ja K.; Scha a, Tomaž; Mi is, Philip H.
A icle
Responsible leade ship: S a egic e sus in eg a i e
p ac ices in complex sys em ans o ma ion
Adminis a i e Sciences
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Sugges ed Ci a ion: Hleb, Ka ja K.; Scha a, Tomaž; Mi is, Philip H. (2025) : Responsible leade ship:
S a egic e sus in eg a i e p ac ices in complex sys em ans o ma ion, Adminis a i e Sciences,
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Ci a ion: Hleb, K. K., Scha a, T., &
Mi is, P. H. (2025). Responsible
Leade ship: S a egic Ve sus
In eg a i e P ac ices in Complex
Sys em T ans o ma ion. Adminis a i e
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A icle
Responsible Leade ship: S a egic Ve sus In eg a i e P ac ices in
Complex Sys em T ans o ma ion
Ka ja K. Hleb 1,* , Tomaž Scha a 2and Philip H. Mi is 3
1School o Business and Economics, Uni e si y o Ljubljana, 1000 Ljubljana, Slo enia
2IEDC Bled School o Managemen , 4260 Bled, Slo enia
3Babson College, Pa k, MA 02457, USA
*Co espondence: [email p o ec ed]
Abs ac : Sys ems o na ional impo ance like na ional heal h ca e sys ems, e en i his-
o ically and cul u ally di e se, a e oday acing simila p oblems. One way o add ess
hem is h ough esponsible leade ship o ien a ions and p ac ices ha p omo e complex
p oblem sol ing and mul iple s akeholde ela ions. He e, we ocus on challenges acing
leade s in wo his o ically dis inc public heal h ca e sys ems, ha o he UK (NHS) and he
Republic o Slo enia (JZS), in e ms o (a) cos s e sus ca e; (b) na iga ing egula ions and
bu eauc acy; and (c) mee ing he needs o s a e sus pa ien s. Then, we compa e how
esponsible leade ship, exp essed in he o m o he s a egis e sus in eg a o o ien a ion
o leade , could help o mi iga e hese p oblems. Analysing hese wo o ms o esponsi-
ble leade ship, which successi ely exp ess mo e men al ma u i y and p ac ical acumen,
illus a es hei ela i e s eng hs in econciling mul iple economic and social in e es s,
ope a ional challenges, and public conce ns in di e en na ional heal h sys em con ex s.
This highligh s esponsible leade ship as a means o in o m policy making and p ac ice in
public heal h ca e sys ems and opens up a i al discussion on he impo ance o leade ship
o ensu e he human igh o a heal hy and ul illing li e.
Keywo ds: na ional heal h ca e sys em; complex sys em leade ship; esponsible leade ship;
cons uc i e de elopmen o mind; heal h ca e; public sys em; policy making
1. In oduc ion
Add essing he p oblems acing na ional heal h ca e sys ems calls o highly esponsi-
ble leade ship. Na ional heal h ca e sys ems in di e en na ions a e acing simila p oblems
in he pos -COVID-19 e a, including ageing popula ions, c i ical sho ages o heal h ca e
p o essionals, gaps in in es men ha a ec quali y and a ailabili y, hie a chical and bu-
eauc a ic go e nance, and s uc u es ha yield dispa i ies in ca e, long wai ing pe iods
o appoin men s, and less access o men al heal h se ices. Commonly u ilised solu ions
o hese p oblems, like inc easing he pool o pe sonnel, imp o ing coo dina ion be ween
segmen ed heal h ca e unc ions and p o essionals, and implemen ing inancial, legal,
and poli ical e o ms, a e all necessa y, bu no su icien ; hey do no ully add ess he
leade ’s e e yday dilemmas in ol ing he ollowing: (a) cos s e sus ca e; (b) na iga ing
egula ions and bu eauc acy; and (c) mee ing he needs o s a e sus pa ien s. Could new
ypes o heal h ca e sys em leade ship make a di e ence?
Theo is s ha e u ned hei a en ions o he pos -bu eauc a ic leade ship mindse s
and p ac ices needed o add ess he complex mul i-s akeholde p oblems acing la ge
s a e and p i a e o ganisa ions oday (Mi is,2020b;Pless,2023;Waldman e al.,2020).
In bo h business school class ooms and execu i e o ices, he e a e calls o au hen ic,
Adm. Sci. 2025,15, 145 h ps://doi.o g/10.3390/admsci15040145
Adm. Sci. 2025,15, 145 2 o 18
se an , e hical, and/o ans o ma ional leade ship (A olio & Ga dne ,2005;B own &
T e ino,2006;Bass & Riggio,2005). Especially impo an is esponsible leade ship, since i
akes a ela ional iew o leade ship and conce ns a en ion and accoun abili y o mul iple
s akeholde s (Maak & Pless,2006;Waldman & Siegel,2008;Waldman e al.,2020). Recen
esea ch has highligh ed wo o ien a ions o esponsible leade ship: ha o he s a egis
and he in eg a o , who demons a e di e en ways o leading an en e p ise (Waldman
e al.,2020;Voeg lin e al.,2020;Pless e al.,2012).
He e, we examine concep ually how esponsible leade ship, as p ac iced by he s a e-
gis e sus he in eg a o , would be ope a ionalised in na ional heal h ca e sys ems. On
a mac o scale, heal h ca e sys ems a y in di e en na ional, o ganisa ional, and socio-
poli ical con ex s (Min zbe g,2017;Johnson e al.,2017), bu we ha e ound ha leade s
o na ional sys ems in he UK and Slo enia ace some common p oblems and ope a ional
dilemmas. Ou analyses highligh how a esponsible leade as a s a egis e sus an in e-
g a o would likely see and app oach hese challenges di e en ly and engage in di e en
kinds o p oblem sol ing.
We close wi h ecommenda ions o na ional heal h sys ems wi h ega d o leade ship
selec ion and de elopmen , sys em assessmen s and measu emen , changing managemen ,
paying a en ion o quali y, p e en a i e main enance and s ess es ing, and es ablishing
humble, esponsible leade ship as a sys em no m.
2. Compa a i e Desc ip ion o Na ional Heal h Ca e Sys ems in he
Uni ed Kingdom and Republic o Slo enia
The Na ional heal h ca e se ice (NHS) in he Uni ed Kingdom (UK) and Ja ni
zd a s eni sis em (JZS), (in English: Public Heal hca e Sys em) in he Republic o Slo enija
(RS) we e es ablished in cul u ally and economically di e en socie ies. The NHS was
o med in 1946 in a democ a ic mona chy wi h a libe al economy. JZS was o med a he
same ime a e he second wo ld wa , bu in a one poli ical pa y epublic wi h a cen ally
planned economy. JZS has u he de eloped a e he ansi ion o he Republic o Slo enia
in o a democ a ic, social s a e wi h a libe al economy in he nine ies o he p e ious cen u y,
becoming a pa o he Eu opean Union in 2004.
In he NHS, e e y UK ci izen makes a compulso y mon hly con ibu ion in o public
heal h ca e insu ance, while in JZS, con ibu ions a e paid in by all employees, oge he
wi h hei employe s. Compa ing inancial s a is ics and o he s a is ics shows di e ences
and simila i ies in he dis ibu ion o esou ces, bu no majo di e ences (Eu os a ,2024;
OECD,2023).
In he NHS, he e a e h ee g oups o se ices: (a) gene al p ac i ione and den al,
(b) hospi al and specialis , and (c) local heal h au ho i y. Gene al p ac i ione s gi e p ima y
medical ca e o egis e ed pe sons and a e paid by he go e nmen on a pe capi a basis,
in addi ion o ha ing p i a e pa ien s. Hospi al and specialis se ices a e p o ided in
go e nmen -owned hospi als and o he acili ies by p o essionals on go e nmen sala ies.
These a e di ec ed by egional au ho i ies’ hospi al boa ds (B i annica,2024). In JZS, by
con as , p ima y heal h ca e is o ganised in o a ne wo k o communi y heal h ca e cen es
in 54 communi ies ha secu e unds and go e n hese cen es. These a e supplemen ed
wi h wen y- i e hospi als and wo uni e si y clinical cen es ounded by he go e nmen .
Funding o bo h le els comes om one public insu ance company, ZZZS. The e is p o ision
o p i a e p ac ices and hospi als.
Adm. Sci. 2025,15, 145 3 o 18
3. Challenges Facing Na ional Heal h Ca e Sys ems in he Uni ed
Kingdom and Republic o Slo enia
NHS ounding p inciples a e s ill app op ia e oday and p o ide a s ong ounda ion
o he u u e (C isp e al.,2024). JZS ounding p inciples a e decla ed in he documen
Resolucija o nacionalnem planu zd a s enega a s a 2016–2025 »Skupaj za d užbo
zd a ja« (Vlada Republike Slo enije,2016; ReNPZV16–25). The NHS and JZS a e acing
a mul i ude o challenges ha a e pu ing signi ican s ain on he wo sys ems. Despi e
di e ences in hei unding and o ganisa ion, bo h he NHS and JZS ace common p oblems
ha s ain each sys em:
a.
Wo k o ce sho ages esul in high le els o s ess and bu nou and hampe pa-
ien ca e.
b.
Funding and in es men ace signi ican gaps, pa icula ly in in as uc u e and
equipmen ha a ec he quali y and a ailabili y o ca e.
c.
Long wai ing pe iods o appoin men s, ea men s, and su ge ies, wo sened by
COVID-19, leading o delays in ca e and inc eased pa ien su e ing.
d.
Ageing popula ions wi h complex heal h needs pu addi ional p essu e on he na-
ional heal h ca e sys ems and equi e mo e esou ces and specialised ca e.
e.
Men al heal h se ices a e ising in demand wi h he a ailabili y o hese se ices
no keeping pace. Many people a e unable o access he suppo hey need in a
imely manne .
.
Weal h inequali ies esul in signi ican dispa i ies in heal h ou comes be ween di -
e en egions and socioeconomic g oups and a e a c ucial add ess o imp o ing
o e all public heal h.
g.
Hie a chical and bu eauc a ic na ional heal h ca e sys ems hampe inno a ion and
educe e iciency, esponsi eness, and adap abili y.
The o e a ching p oblem acing heal h ca e leade s is how o bes deli e app op ia e
se ices o pa ien s wi h a p omised quan i y and quali y, wi hin he planned o and
a ailable budge s. Wha does esponsible leade ship heo y ha e o o e na ional heal h
ca e sys ems?1
4. Responsible Leade ship
Responsible leade ship (RL) has been ad anced o add ess c i ical issues in guiding
complex, mul i- ela ional, and mul ile el o ganisa ions (Maak & Pless,2006;Pless & Maak,
2022;Waldman & Gal in,2008;Kemps e & Ca oll,2021;Waldman e al.,2020;Mi is,
2020a). Resea ch (Ma ques e al.,2018;Shi & Ye,2016;Ja ed e al.,2024) on he opic
inds ha oughly hal he academic li e a u e conce ns i s heo e ical o mula ion (Maak
& Pless,2006;Waldman e al.,2020) and he es is di ided among empi ical s udies wi h
CEOs (Pless & Maak,2022) and me hodological and measu emen issues (Voeg lin e al.,
2012,2020).
Maak and Pless (2006) pionee ed he de ini ion o RL: “ esponsible leade ship is alue
based and ho oughly e hical p inciple d i en ela ionship be ween leade s and s akeholde s who a e
connec ed h ough a sha ed sense o meaning and pu pose h ough which hey aise one ano he
o highe le els o mo i a ion and commi men o achie ing sus ainable alue c ea ion and social
change”. The ela ional aspec s o esponsible leade ship a e emphasised. The co e ask o
esponsible leade ship is o build and main ain us ul ela ionship wi h he e ogenous,
o en global s akeholde s. A leade ’s emo ional in elligence and e hics a e key. Emo ional
in elligence includes s ong sel - egula ing capabili ies and all o ms o empa hy (cogni i e,
beha iou al, and emo ional). Social abili ies, skills, and us building a e he equisi es o
a esponsible leade (A del & Fe a i,2014).
Adm. Sci. 2025,15, 145 4 o 18
While many au ho s connec esponsible leade ship di ec ly wi h co po a e social e-
sponsibili y, o he s ake a mo e independen posi ion. In Waldman e al. (2020), “ esponsible
leade ship is an o ien a ion o mindse aken by people in execu i e le el posi ions owa ds mee ing
he needs o a i m’s s akeholde (s). As such, i deals wi h de ining hose s akeholde (s), assessing
he legi imacy o hei claims, and de e mining how hose needs, expec a ions o in e es s can and
should be bes se ed”.
Academic deba es cen e a ound he philosophical oo s o co e concep s o RL (Ciulla,
2022, p. 21), wi h a ela i e emphasis on esponsibili y, cha ac e , i ue, e hics, mo ali y
(Pless & Maak,2022), and i s link o sup a-o ganisa ional ela ionali y (Maak & Pless,
2006;Waldman & Gal in,2008). Mi is e al. (2022, pp. 350–354) di ide i in o ou
ypes: adi ional (co e ed in classical leade ship li e a u e like Ba na d), sha eholde -
cen ed, s akeholde -cen ed, and con e ging o co- esponsibili y. Fu he deba e conce ns
i s cons i uen p ope ies o he mind (Waldman e al.,2017,2020;Waldman & Gal in,2008;
Pless,2023;Smi h & Lewis,2011) and i s a ious poli ical and social implica ions (Pless &
Maak,2022;Kemps e e al.,2019;S ahl & Sully de Luque,2014).
On he p ac ical side, schola s and esea ch ha e conside ed he applica ions o RL
o a se ies o compe ing ensions: (a) esponsibili y o he s akeholde s. sha eholde ,
(b) economic s. social alue, and (c) iducia y du y s. social impac , and aised ques ions
abou i s o mula ion as being (d) oman ic s. ealis ic and i s use o (e) pseudo s.
au hen ic p ope ies.
4.1. Responsible Leade ship in Heal h Ca e-Rela ed Li e a u e
Responsible leade ship heo y has been widely adop ed by schola s and p ac i ione s
alike (Pless,2023). Many ha e employed a esponsible leade ship lens o heal h ca e
sys ems go e nance (Ba ool e al.,2024;Haque,2021;Molná e al.,2021;Ogunyemi &
Onaga,2023;Khanam e al.,2024;Se ay Özkan e al.,2024;Z. X. Zhang e al.,2023).
Fo ins ance, Haque (2021) sugges s how o ganisa ions should u ilise esponsible lead-
e ship o p o ec and main ain employee well-being and o ganisa ional sus ainabili y, wi h
bo h ha ing implica ions o heal h ca e policymake s’ ini ia i es. Z. X. Zhang e al. (2023)
demons a e how a esponsible leade in China manages he p ocess o balancing social
and economic goals o con ibu e o he unde s anding o how a socially esponsible i m
can imp o e he heal h ca e indus y, and con ibu e o he e o m o China’s heal h ca e. In
u n, Khanam e al. (2024) demons a e a signi ican posi i e associa ion be ween esponsi-
ble leade ship and o ganisa ional jus ice and a nega i e associa ion be ween o ganisa ional
jus ice and employee u no e in en ion in he heal h ca e sec o . Resul s addi ionally
con i m he media ing ole o o ganisa ional jus ice be ween esponsible leade ship and
employee u no e in en ion.
4.2. Two Va ian s o Responsible Leade ship
Schola s ha e emphasised o a ious deg ees ha ad anced de elopmen o he mind
and he capaci y o engage in complex hinking, “pe o m” o ackle pa adoxes, ope a e
ela ionally, beha e mo ally, and ake esponsibili y a e all ounda ional cha ac e is ics o
esponsible leade ship (Waldman e al.,2006,2019,2020;Maak & Pless,2006;Y. Zhang
e al.,2015;Mi on-Spek o e al.,2018;Waldman & Bowen,2016;Smi h & Lewis,2011).
Waldman e al. (2020) ame esponsible leade ship in wo o i s p ima y mani es-
a ions in he “ eal” wo ld: he s a egis and he in eg a o . S a egis and in eg a o
o ien a ions a e p oposed ou le s o esponsible leade ship a di e en le els o sophis ica-
ion and pe sonal in ol emen . They di e in hei ype and quali y o hinking, how hey
handle esponsibili ies and accoun abili y o sha eholde s (o go e ning bodies) e sus
o he s akeholde s, in hei pe sonal in ol emen and commi men s o social esponsibili y,
Adm. Sci. 2025,15, 145 5 o 18
and in he ela i e emphasis hey gi e o au hen ici y s. image building. The wo ypes
also seem bes sui ed in di e en con ex s.
B ie ly, leade s wi h a s a egic o ien a ion a e mo e ap o be linea hinke s who see
hemsel es as esponsible p ima ily o sha e owne s (o go e ning bodies in he public
sec o ). Faced wi h a pa adox o dilemma, hey u n o he op ion ha is a ou ed by hose
in powe , causes he leas dis up ion, and/o p o ec s hei own in e es s and posi ion. They
will se le o comp omise a he han engage wi h o he s deeply o ind a supe o dina e
solu ion. They a e o en “ins i u ionalis s” whose sense o e hics and mo als a e ancho ed
in exis ing ules and egula ions and who espec he “sys em”. When i comes o CSR
o o he p osocial ac i i ies, hey will a ou wha e e enhances hei own image and
hei ins i u ion’s epu a ion bu o he wise lack pe sonal in ol emen and do no make
hese ac i i ies a high p io i y. When i comes o ela ionali y, hei emphases and social
ne wo ks a e based mo e so on ins umen ali y: who has he powe , esou ces, and/o
poli ical connec ions needed o bes help me ul il my esponsibili ies o sha e owne s (o
go e ning bodies).
Leade s wi h an in eg a i e o ien a ion a e mo e ap o ha e a bo h/and mindse and
o see hemsel es as esponsible o he ull ange o s akeholde s inside and ex e nal o
hei o ganisa ion. Faced wi h a pa adox o a dilemma, hey look o a c ea i e solu ion
and o o he ’s ideas and in luence o do so. As o e hics and mo als, hey ope a e in
line wi h uni e sal p inciples and will “buck he sys em” o he g ea e good. They also
end o pe sonally lead CSR and o he p osocial e o s o hei o ganisa ion and s i e
o be au hen ic in hei leade ship o e all. As o ela ionali y, hei emphases and social
ne wo ks a e mo e inclusi e o all s akeholde s and connec o hose who will help o
de elop “win-win” solu ions o all conce ned.
In sum, bo h s a egis s and in eg a o s ha e a commi men o and demons a e
esponsibili y and accoun abili y in hei leade ship, bu how hey ame esponsible
leade ship and implemen i a e decidedly di e en (see Table 1). How would hese wo
ypes handle leade ship in na ional heal h sys ems?
Table 1. Summa y o ounda ional cha ac e is ics o s a egis and in eg a o mindse s.
S a egis Founda ional Cha ac e is ic In eg a o
Linea ei he /o mindse
S a egis -speci ic meaning making Mind Bo h/and mindse
In eg a o -speci ic meaning making
Uncom o able wi h pa adoxes and gi es
p ecedence o pas p ac ice o expediency Handling Pa adoxes
Emb aces pa adoxes and collabo a es
as needed o a “win-win” esolu ion
Fa ou s sha eholde (o go e ning body) s.
ull ange o s akeholde s Accoun abili y Conside s bo h sha eholde s and
s akeholde s
Ancho ed in acknowledged
sys em o ins i u ion o law and go e nance
E hics
Mo als Ancho ed in uni e sal law
No pe sonal in ol emen in CSR e o s,
delega es o o he s Pe sonal Responsibili y
Se es as a ole model o CSR and is
likely o be pe sonally in ol ed
Lowe conce n o au hen ici y,
highe conce n o image building
Au hen ici y s. Image
Building
Highe conce n o he au hen ici y,
no conce n o image building
Ins umen al—Whome e se es he
p e ailing in e es s Rela ionali y Inclusi e—Whome e is needed o
se e he common good
Libe al ma ke economies Con ex Coo dina ed economy
Sou ce: own wo k based on Waldman e al. (2020) and Maak and Pless (2006).
4.3. Applying Responsible Leade ship o Na ional Heal h Ca e Sys em Leade ship
To apply esponsible leade ship o na ional heal h ca e sys ems, we look a he oun-
da ional cha ac e is ics o RL in he con ex o hei co e applica ion o leade ship and hei
Adm. Sci. 2025,15, 145 6 o 18
ope a ional applica ion in a sample o h ee selec ed heal h ca e challenges in he na ional
heal h ca e sys ems o he UK and RS.
We de ine an umb ella issue and h ee sub-issues as being cumula i e lis ed p oblems
o bo h na ional heal h ca e sys ems (a–g). In summa y, a co e pending issue o go e nance
and esponsibili y in bo h na ional heal h ca e sys ems is ha he wo sys ems as a whole
do no unc ion adequa ely. Mos o he u gen sub-pending issues o go e nance and
esponsibili y, in bo h he NHS and JZS alike, a e summa ised as ollows:
Sub-Issue 1: cos s. ca e
Despi e ecen inc eases in unding in he NHS and a cons an subs an ial p opo ion
o GDP dedica ed o heal h ca e in JZS, he e a e s ill gaps in in es men , pa icula ly in
in as uc u e and medical equipmen . JZS also does no co e all he needs o he sys em.
The quali y and a ailabili y o ca e a e a ec ed.
Sub-Issue 2: dealing wi h ules, egula ions, and bu eauc acy
(A) Ageing popula ions wi h complex heal h needs and co-mo bidi ies, (B) inequali ies
and dispa i ies in heal h ou comes be ween di e en egions and socioeconomic g oups,
and (C) he hie a chical and bu eauc a ic na u e o he espec i e na ional heal h ca e
sys ems and obs acles o inno a ion, e iciency, esponsi eness, and adap abili y a e key
egula o y and bu eauc a ic issues.
Sub-Issue 3: mee ing he needs o s a s. pa ien s
(A) The c i ical sho age o heal h ca e p o essionals is exace ba ed by high le els
o bu nou and s ess among exis ing s a . The expensi e, libe alised labou ma ke o
doc o s and medical s a in he EU is mo e o an RS p oblem. (B) Long wai ing pe iods
o appoin men s, ea men s, and su ge ies esul in delays in ca e and p olonged pa ien
su e ing o e en he wo sening o he condi ion. Backlog is wo sened a e COVID-19.
(C) Men al heal h ca e se ices a e in high demand, and a e insu icien in supply.
In wha ollows, we app oach and add ess each o he h ee summa ised sub-issues
sepa a ely h ough he lens o esponsible leade ship. We o e examples ha wo k wi h he
h ee sepa a e sub-issues and illus a e he akes o bo h esponsible leade ship o ien a ions,
he s a egis and he in eg a o , on hem.
4.4. The Responsible Leade ship Mindse
The s a egis mindse app oaches complex p oblems in a pa ial ashion. As such, i
ocuses on a limi ed numbe o p oblems and hei p obable ela edness and ies o add ess
hose in linea ashion, while no add essing he issue as a whole o sys emically. Such a
mindse is ocused on a na owed, sel -au ho ed iew and is in o med p edominan ly by a
singula domain and/o singula s ance.
Sub-issue 1. Focuses, o example, on unding and in es men s and ies o mi iga e
he wo o he pu poses o sol en inancial managemen , isola ed om he ealis ic
heal h- ela ed needs o he popula ion.
Sub-issue 2. Has singula iews which a e adminis a ion-d i en and lea e behind he
assumed co e pu pose o he heal h ca e sys em, ha is, he heal h o people subsc ibing o
ha gi en sys em. I is capaci y-d i en and no pa ien - equi emen -d i en (ma ke -d i en
s. pa ien -d i en).
Sub-issue 3. Focuses on wo k o ce sho ages and ageing popula ions and ies o
mi iga e his one ou come, isola ed om o ganisa ional p ope ies, poli ics, o inancial
ag eemen s.
By con as , he in eg a o mindse app oaches p oblems in a complex manne . I
b ings oge he and ha monises he needs o di e se s akeholde s ha seemingly con adic .
I can deal wi h pa adoxical ensions. As such, i ocuses on me a p oblems and sys emic
iews. Such a mindse applies a widened, (sel ) ans o ma i e iew. Any comp ehensi e
Adm. Sci. 2025,15, 145 7 o 18
numbe o issues a e unde s ood in line wi h complexi y heo y. The nonlinea dependency
be ween bounda y condi ions and con en is acknowledged. Such a iew ep esen s an
in eg a o mindse .
Sub-issue 1. Focuses on unding and in es men s and ies o mi iga e he wo o he
pu poses o sol en inancial managemen while i s and o emos se ing he ealis ic
heal h- ela ed needs o he popula ion.
Sub-issue 2. Views he sys em as a whole, and is d i en and led by an assumed co e
pu pose o a heal h ca e sys em— ha being he heal h o he people subsc ibing o ha
gi en sys em. Sys emic solu ions become a cane o a go e ning policy ha is in se ice o
ac ual heal h equi emen s in indi idual pa ien s.
Sub-issue 3. Wo k o ce sho ages and he ageing popula ion a e jux aposed in spi e o
high le els o discom o and ension, un il a me a solu ion is ound, accep ed, and applied.
Such a solu ion dis ibu es igh s and esponsibili ies, in a manne which makes sense and
is wise, among all s akeholde s and adjus s o “wha is” s. “wha should be”. As such, he
in eg al app oach does no isola e i sel om o ganisa ional demands, poli ics, o inancial
ag eemen s, bu o e s i sel as a solu ion-seeking pa ne .
4.5. Pe o ming Pa adox
S a egis s seek o esol e pa adoxes by a ou ing he “side” mos in line wi h pas
p eceden and ins i u ional adi ions and in e es s. The s akeholde map is no de eloped.
One o wo s akeholde s a e picked in line wi h pe sonal in e es s, p oximi y, p essu e,
o unde s anding. All he es o he s akeholde s a e le ou , delibe a ely o due o a
lack o sys emic knowledge, o a e e en seen as con adic o y bene icia ies. The chosen
s akeholde s’ posi ion is exagge a ed and hei possibly biassed app oach ende s hese
mo e p ominen han hey would be in a wholesome mapping.
Sub-issue 1. Indus y-speci ic p essu es o he posi ion on heal h ca e unding and
budge , like digi al, pha maceu ical, o he medical ma e ial and equipmen , educa ion,
ood and be e ages, e c., wi h a low ROI o basic uni s o ca e, hence, he pa ien . The
s a egis on-look can inco po a e he in e es s o one g oup, while igno ing o opposing
he in e es s o ano he equally impo an g oup.
Sub-issue 2. In e gene a ional con lic , based on su i al ins inc , is le o be mi iga ed
and shoulde ed by public policy and egula ion. The s a egic o ien a ion leans in a ou o
one o he o he and is sho o he capaci y o look o and e en ually ind a me a solu ion.
Sub-issue 3. The main cha ac e s o he heal h ca e s o y, he pa ien and he heal h ca e
p o essional exhaus ed by he demands o he sys em in gene al, a e bo h i on cu ed wi hin
i . The sys em is in olun a ily co-dependen and in coali ion wi h o he go e nmen al
s uc u es. A powe play be ween basic wo uni s is igge ed due o he lack o p e en i e
managemen . The s a us quo in ol es u ning away, in hopes o he issue o sol e i sel .
In eg a o s a e mo e com o able wi h pa adoxes o a dilemma and ace hem head
on. No s akeholde ’s posi ion is exagge a ed, and biases a e ac i ely b ough o ligh
and add essed. The s akeholde map is de eloped and all alid s akeholde s a e named,
ega dless o pe sonal in e es , p oximi y, p essu e, unde s anding, o po en ial bene i s
(wholesome mapping). A bo h/and iew is adop ed. These esponsible leade s look o
c ea i e “win-win” solu ions.
Sub-issue 1. Indus y-speci ic p ess o a posi ion on heal h ca e unding and budge ,
like digi al, pha maceu ical, o he medical ma e ial and equipmen , educa ion, ood and
be e ages, e c., wi h a low ROI o he basic uni o ca e, hence, he pa ien is add essed
and wi hs ood. The in e es s o all impo an g oups a e c oss-nego ia ed o achie e a high
ROI o he basic uni o ca e, hence, he pa ien ou come.
Adm. Sci. 2025,15, 145 8 o 18
Sub-issue 2. In e gene a ional con lic based on su i al ins inc s is sha ed and shoul-
de ed by all ele an s akeholde s, i s and o emos , he jux aposed in e es s o you h
s. age. Public policy and egula ion is a media ing pa ne and a ca ie o his p ocess.
An in eg a i e o ien a ion e uses o lean in a ou o one o he o he bu leans in o he
p ocess un il a me a solu ion is ound. In e gene a ional cohabi a ion is he aim.
Sub-issue 3. The main cha ac e s o he heal h ca e s o y, he pa ien and he heal h
ca e p o essional, a e cen e s age in an independen , alue-d i en sub-sys em o socie y.
All in olun a y co-dependency wi h o he sub-sys ems is denied and as such enjoys he
ull suppo o go e nmen al s uc u es.
4.6. Accoun abili y
S a egis s end o a ou adi ional in e es s (sha e owne s o go e ning bodies and
enlis ed o he s) when in line wi h hei ins i u ional in e es s, p essu e, o s a egic ad an-
ages.
Sub-issue 1. A s a egic on-look a ails i sel o ce ain s akeholde s and no o o he s.
Fo example, some echnology p o ide s ha e leeway in o a pa ne ing con e sa ion and
can coun on ag eemen s being made; howe e , ano he bene icia y, o example, a new
uni builde con ac o , canno ely on ag eemen s being made. Bo h a e a he expense o
be e ca e o a inal use .
Sub-issue 2. Some a eas wi h be e local managemen achie e be e ca e, and o he s
lacking quali y in local managemen a e lagging behind. Me a managemen , a he le el o
he s a e, is accoun able o some bu no equally o o he s.
Sub-issue 3. Physical illness is a ended o and men al ca e is lagging behind due o
less asse i eness o he lack o a comp ehensi e p esen a ion o needs in he sys em as
a whole.
Con a iwise, all ele an s akeholde s can coun on an in eg a o being accoun able.
S akeholde s a e en eloped in a holis ic poin o iew.
Sub-issue 1. An in eg al on-look en isions he sys emic collabo a ion o all needed
s akeholde s o he sys em o be sus ainable and in se ice o i s main pu pose— ha being
op imal ca e o a inal use , hence a pa ien .
Sub-issue 2. Me a managemen , a he le el o he s a e, is accoun able o all.
Sub-issue 3. Men al heal h ca e is ecognised as an a ea equi ing a en ion in he
wholesome design o heal h managemen and is seen as po en ially ende ing le e age in
mi iga ing physical illness o ha m, and as such, is a po en ial inal cos cu e .
4.7. Pe sonal Responsibili y
Pe sonal esponsibili y is no assumed by s a egis s; ins ead, i is delega ed o o he s,
o i p oblems a e blamed upon he leade , o people abo e, people below, he sys em,
o changes in policies; in sho , o an ex e nal sou ce, ou o each o no wi hin manag-
ing powe .
Sub-issue 1. Th owing a ball in o ano he eam’s cou ; quali y is no he e due o a
lack o acili ies, acili ies a e no he e because o a lack o unding, unding is no he e
due o insu icien con ibu ions, and con ibu ion is no su icien due o excessi e sick
lea e. Sol ing p oblems pe pa es.
Sub-issue 2. Delega ion o powe is wi hheld due o a lack o managemen skills in
go e ning mo e so e eign and be e schooled subo dina es o dis an subsidia ies wi h
mo e g an ed au onomy.
Sub-issue 3. The ela ionship be ween pa ien s and heal h ca e p o essionals is bubbled
and le o i s espec i e ( ende ing o dismissi e) powe dynamics, i espec i e o admin-
Adm. Sci. 2025,15, 145 15 o 18
Au ho Con ibu ions: Concep ualisa ion, K.K.H. and T.S.; Me hodology, K.K.H.; Valida ion, P.H.M.;
Fo mal Analy-sis, K.K.H.; Resou ces, K.K.H. and T.S.; Da a Cu a ion, K.K.H. and T.S.; W i ing—
O iginal D a P epa a ion, K.K.H.; W i ing—Re iew & Edi ing, K.K.H. and P.H.M.; Visualisa ion,
K.K.H.; Supe ision, P.H.M.; P ojec Adminis a ion, K.K.H. All au ho s ha e ead and ag eed o he
published e sion o he manusc ip .
Funding: This esea ch ecei ed no ex e nal unding.
Ins i u ional Re iew Boa d S a emen : No applicable.
In o med Consen S a emen : No applicable.
Da a A ailabili y S a emen : Da a is con ained wi hin he a icle.
Con lic s o In e es : The au ho s decla e no con lic o in e es .
No es
1
We posi ion an indi idual as a ca ie o an a ibu e o heal h as well as a ca e ake o one’s heal h. In pu sui o his goal, he
indi idual eso s o na u e and heal h ca e wo ke s ha can help o main ain heal h and p e en o cu e inju y and diseases.
Heal h ca e wo ke s a e indi iduals ha can and a e willing o deli e such ca e. This basic uni o a hea h ca e ela ionship
is based on he assump ion ha an indi idual us s heal h ca e wo ke s and is willing o pay o heal h- ela ed se ices.
Recip ocally, i assumes ha heal h ca e wo ke s base hei ca e on ele an knowledge, good ca e, and alues aligned a ound he
p ese a ion and es o a ion o heal h unde any ci cums ances. E e y human (including all o he heal h ca e p o essionals) is a
po en ial pa ien ; heal h ca e wo ke s a e signi ican ly lowe in numbe . Thus, in socie y o a heal h ca e sys em, be i public,
p i a e, o bo h, binding he wo pa ies is es ablished.
2Anonymous, Pe sonal Communica ion o Au ho s, 29 h No embe 2024.
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