Embedded Files
The Leadership in HPE module asked me to look again at a story I thought I already knew. Twenty-six years in the Faculty of Medicine and Health Sciences, a parallel decade in digital health within the Western Cape Department of Health and Wellness, and a familiar identity as public health medicine specialist, senior lecturer and informatics lead. What the module did, gently but persistently, was make space for a further identity to come into view: educational leader and change agent. This entry is an attempt to hold that shift honestly, and to record what reading and writing my way through the assignment changed in how I see the work.
The assignment itself focused on a curriculum question I have been circling for some time: how to introduce Design Science Research as a methodological foundation for the design of digital health artefacts in public health medicine. Working through it under the discipline of a leadership lens, rather than a methodological one, surfaced things about my own practice that I had not previously named.
What: professional identity formation
What: professional identity formation
The identity I walked in with was built around research methodology and health information systems, taught across undergraduate, registrar and MPhil levels, and extended through health system work. It was a real identity, and a useful one. What it did not do was account for the work of shaping how others come to understand and practise these things, which is an educational act and carries its own responsibilities.
The module's readings on leaders did not give me a new identity. They gave me a clearer view of one that had been forming quietly. Juntrasook helped me name what I had been doing without claiming it: leadership exercised through agenda-setting, convening and methodological coaching, rather than through a positional title. That naming raised the standard. Lieff and Albert pressed the point further. Their description of medical education leaders, who lead from a felt sense of purpose and an inner drive to learn, recognised something I value in myself. It also exposed the gaps. I read widely, but not always outside my own methodological territory. I seek feedback, but I am more comfortable giving it.
Price-Dowd has stayed with me most quietly. Her placement of self-awareness as the foundation of leadership means the identity work begins with how I attend, before it begins with what I propose. The work I am proudest of rested on a quality of attention I had not previously named as a leadership practice.
What has shifted, then, is less the identity itself than the standard against which I want it measured.
So what: a retrospective reading of the eCCR experience
So what: a retrospective reading of the eCCR experience
For years I led the design and scaling of electronic medical record artefacts, of which the electronic Continuity of Care Record (eCCR) is the most visible. The artefacts worked. Several scaled. What I was slower to admit is that I was designing complex sociotechnical artefacts without the theoretical scaffolding that a colleague in civil or software engineering would have treated as a precondition. Engineers in the built environment do not begin a bridge without materials science, structural analysis and design theory. I was building the equivalent in health without that foundation, and I was training registrars to do the same.
Scharmer's language of downloading, of reproducing a received frame without examining it, helped me see why I had not pressed harder on this before. I had treated the absence of a design-theoretic tradition in public health medicine as a disciplinary fact rather than as a gap to be filled. The retrospective reading is not comfortable, but it is useful. The eCCR work was good work; it was also evidence of a pattern that needed naming, and naming it is where the leadership move began.
Figure 1: The Missed U: a retrospective reading of the eCCR development journey through Scharmer's Theory U, showing where the work entered the left side of the U through suspension and sensing, but did not consistently traverse the deeper turns of presencing and crystallising before moving back up the right side.
Looking at this diagram now (Figure 1), I can see that the team and I did much of the U-process work without the language to name it. The sensing was real, and so was the prototyping. What was missed was the pause between the two: the moment of stepping back from received frames long enough to allow a different design logic to emerge, rather than refining the discharge summary we already knew. The leadership lesson is not that we should have done the eCCR differently. It is that I now have a responsibility to teach the next cohort to recognise the U for what it is, so that they can choose deliberately whether to traverse it fully, partially, or not at all. The Missed U is therefore both a personal account and a teaching artefact.
Scharmer's language of downloading, of reproducing a received frame without examining it, helped me see why I had not pressed harder on this gap earlier. I had treated the absence of a design-theoretic tradition in public health medicine as a disciplinary fact rather than as a problem the discipline could address. The eCCR work was good work; it was also evidence of a pattern that needed naming, and naming it is where the leadership move began.
Now what: readiness to change and leadership styles to embrace
Now what: readiness to change and leadership styles to embrace
Readiness, read honestly, is not the same as enthusiasm. I entered this module with conviction about Design Science Research and with a series of initiatives already under way. The module pressed me to ask whether my readiness extended to changing my own defaults, not only to changing curricula. The answer is beginning to be yes, though unevenly. The practical sign of it has been sequencing: introducing design-theoretic language in descriptive form first, and letting the concept earn its own place, rather than launching with a label that invites resistance.
Building the change strategy in the assignment forced me to think about leverage at three levels at once. The dual-lens framework I developed for the conceptual layer of the assignment is shown below.
Figure 2: Dual-lens framework integrating Senge's systemic disciplines and Scharmer's social field theory across three layers of depth: the surface layer of structural and curriculum challenges, the middle layer of conversational quality with stakeholders, and the deepest layer of the interior condition of the change agent.
The reason this framework matters for my leadership journey is that it refuses to let me treat any one layer as sufficient. For most of my career I worked at the surface layer, designing artefacts and proposing systems. The dual-lens reading insists that the quality of conversation with the people who will use, teach, or endorse a methodology matters as much as the methodology itself, and that both are shaped by the interior condition I bring to the work. This is an uncomfortable claim because it places responsibility for systemic change partly inside the change agent rather than entirely in the structures around them. It is also, I think, the right claim.
The schematic below applied this reading to the specific question of bringing Design Science Research into public health medicine.
Figure 3: Three-level change schematic distributing leadership and change management literature across the immediate teaching context, the wider community of practice, and the institutional structures of the professional college, with Kotter's dual operating system as the unifying spine.
What this schematic taught me, beyond its content, is that holding three levels at once is harder than holding any one of them. Kotter's argument for a guiding coalition makes sense to me at the institutional level; Senge's argument that systemic change depends on a shift in mental models makes sense at the community-of-practice level; the interior work makes sense at the level of the teaching encounter. The temptation to default to whichever level feels most familiar in a given moment is real. The schematic functions, for me, as a check against that drift.
The leadership styles I want to embrace, drawing on Goleman's repertoire, are predominantly coaching and affiliative, with a democratic register in committee work and a pacesetting register reserved for the narrow set of decisions where it genuinely helps. McKimm's adaptive leadership describes the temperament the work asks for: patient, layered, willing to let the problem be reframed when the context moves. The styles I want to use less are the directive and pacesetting modes I have leaned on in delivery-focused settings, where they get short-term results at the cost of the slower learning that the work actually needs.
Three areas of development remain clearly in view. The first is listening, in its empathic and generative forms, particularly in the settings where the pull towards downloading is strongest for me. The second is feedback literacy in its receiving direction: I am more comfortable giving structured feedback than sitting with it as a shared reflective space, and the iterative nature of the work I am now leading will expose this gap quickly. The third is the scholarly craft of writing about this work in a register and evidence base that HPE peers will find fully legible, which is a slower transition than I first assumed.
None of the three is solved by a technique. Each is an attentional discipline, and each will be visible in the ePortfolio over time, or absent from it, which will tell its own story. Commitment, in this reading, is not a declaration. It is the ongoing practice of two habits of mind that the assignment helped me name: the willingness to suspend a familiar frame long enough to notice what a new situation is actually asking for, and the discipline of designing learning that makes the theoretical foundation of a practice visible to those who will carry it forward.
How this module may reshape my Teaching Philosophy
How this module may reshape my Teaching Philosophy
The Theatre of Reflective Design metaphor that anchors my current philosophy still holds, but this module has shifted what I think the stage manager is responsible for. Until now I framed the role mainly in terms of setting conditions, structuring activities and ensuring feedback loops worked. The leadership readings have added a quieter responsibility: the quality of attention I bring to the space before any of that structuring begins. Price-Dowd's positioning of self-awareness as the foundation of leadership, and Scharmer's reading of downloading as the default that prevents new understanding from emerging, both point to the same revision. Designing learning well is not only a matter of what I put on the stage. It is also a matter of how I attend to what is already there, and whether I can suspend my own frame long enough to let learners' realities reshape the production.
The second shift concerns what I am preparing learners for. My current statement frames teaching as cultivating reflective practitioners who can connect practice to principles. The module has pressed me to add a further commitment: preparing learners to lead change in adaptive conditions, where the problem itself has to be reframed and there is no template to follow. McKimm's distinction between technical and adaptive challenges has given me language for what my mid-career health professional learners actually face, and Juntrasook's reading of leadership as exercised through many forms beyond positional authority gives them permission to claim the role. When I revise the philosophy formally, I expect the values and the metaphor to remain, but the description of what the theatre is rehearsing for will need to expand from reflective practice towards reflective practice that carries change.
FOUNDATIONAL READING
FOUNDATIONAL READING
Goleman, D. 2000. Leadership that gets results. Harvard Business Review, 78(2): 78–90.
Juntrasook, A. 2014. 'You do not have to be the boss to be a leader': contested meanings of leadership in higher education. Higher Education Research and Development, 33(1): 19–31.
Kotter, J.P. 2014. Accelerate: building strategic agility for a faster-moving world. Boston: Harvard Business Review Press.
Lieff, S. and Albert, M. 2010. The mindsets of medical education leaders: how do they conceive of their work? Academic Medicine, 85(1): 57–62.
McKimm, J., Ramani, S., Forrest, K., Bishop, J., Findyartini, A., Mills, C., Hassanien, M., Al-Hayani, A., Jones, P., Nadarajah, V.D. and Radu, G. 2023. Adaptive leadership during challenging times: effective strategies for health professions educators. Medical Teacher, 45(2): 128–138.
Price-Dowd, C.F. 2020. Leadership development: understanding leadership styles. British Journal of Healthcare Management, 26(11): 1–4.
Scharmer, C.O. 2016. Theory U: leading from the future as it emerges. 2nd ed. Oakland: Berrett-Koehler.
Senge, P.M. 2010. The fifth discipline: the art and practice of the learning organization. 2nd ed. London: Random House.
Editorial support:
Anthropic's Claude Opus 4.6
Graphic generation:
Google Gemini's Nano Banana
Page updated
Google Sites
Report abuse