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Table of Contents
NEWS AND VIEWS
Year : 2021  |  Volume : 4  |  Issue : 1  |  Page : 58-65

The importance of adopting leadership concepts in communicating medicinal culture of Chinese medicine in the Western world


Master of Arts in Leadership, Trinity Western University, Richmond Campus, BC, Canada

Date of Submission01-Sep-2020
Date of Acceptance10-Feb-2021
Date of Web Publication31-Mar-2021

Correspondence Address:
Prof. Tina Wu
Master of Arts in Leadership, Trinity Western University, 305-5900 Minoru Blvd, Richmond Campus, BC, V6X 2A9
Canada
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CMAC.CMAC_8_21

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  Abstract 


Cultures are beliefs, knowledge, and languages people use to communicate with others. In the same rationale, the communication between Chinese and Western medicinal cultures is the communication between two medicinal beliefs, knowledge, and languages. In this article, the key components of Chinese and Western cultures will be discussed to lay the foundations for better communication of Traditional Chinese Medicine (TCM) in the Western world. Besides the discussion of similarities and differences between the two cultures, the potential of being complementary to each other in practices will be explored. Moreover, in this article, using key leadership skills to enable better communication and practices of TCM in the Western world will be examined as well.

Keywords: Belief, Chinese medicine, communication skills, complementary, culture, leadership theories, Western medicine


How to cite this article:
Wu T. The importance of adopting leadership concepts in communicating medicinal culture of Chinese medicine in the Western world. Chin Med Cult 2021;4:58-65

How to cite this URL:
Wu T. The importance of adopting leadership concepts in communicating medicinal culture of Chinese medicine in the Western world. Chin Med Cult [serial online] 2021 [cited 2021 Apr 12];4:58-65. Available from: https://www.cmaconweb.org/text.asp?2021/4/1/58/312781




  Introduction Top


There are two major medicine systems used by professional health-care providers in China, one is Traditional Chinese Medicine (TCM), and the other is Western Medicine (WM). TCM treatment is based on the entire system of the body. Chinese medicine physicians, nurses, and other health-care providers focus on restore/maintain the balance (between yin and yang), harmony (between yin and yang), and vital energy (qi) flow in one's body. The results of a smooth flow bring healthy life to people. WM on the other hand focuses on science, logic, and hard evidence. “The Western physician starts with a symptom, then searches for the underlying mechanism– a precise cause for a specific disease.”[1] WM health-care providers use biomedical technologies, techniques, and drugs to prevent and treat illnesses and injuries, rehabilitate, and promote health in general.

There is a tension between TCM and WM practices.[2] In the West, TCM has been considered to be part of complementary alternative medicine. It involves a broad range of medicine practices sharing common concepts developed in China. TCM has been a tradition based on 3000 years of various forms of health practices including herbal medicine, acupuncture, massage (Tuina), exercise (Qigong), and dietary therapy.

There is tension between TCM and WM practices in the field. Based on a study done by Ren et al.,[2] in China, there has been the development of clinical practice guidelines (CPGs) to promote evidence-based medicine both for TCM and WM. There are expected to be equally reflected in Chinese CPGs. However, in the study, a total of 604 CPGs were identified, only a small number of them (12%) recommended TCM therapy and only five guidelines (7%) had applied evidence grading. It leads to the conclusion of a few Chinese WM CPGs recommend TCM therapies and very few provide evidence grading for the TCM recommendations. The findings may have resulted from limited communication between the two systems. How to solve the issues? The author recommends using leadership perspectives or skills to bridge communication between TCM and WM medicinal systems and cultures. Furthermore, the author recommends a communication training program for medical students and health-care professionals to apply the required leadership skills to bridge communication between TCM and WM cultures.

What is leadership? “Leadership is a process of social influence which maximizes efforts of others towards the achievement of a goal.”[3] For the communication between the two systems, the goal to be achieved would be through providing a facilitation training program to encourage dialogues between TCM and WM. Medical students (both from TCM and WM) are rarely motivated to take up leadership roles or activities during their medical schooling. The focus could be more on skills and knowledge training, rarely focus on formal training to prepare them for the leadership roles or activities after graduation.[4]

This paper aims to explore the possibility of using leadership training to develop students both from TCM and WM to facilitate better communication between them. The purpose of doing so is to encourage using leadership perspectives to the development of inclusion and integration of both systems in communication. In the end, it could be beneficial to patient-centered treatment and interventions. The outcomes could be a win-win approach for all – patients, practitioners, and the treatment systems involved.


  The Relationship between Culture and Communication Styles Top


To facilitate better communication between TCM and WM, we need to define the fundamentals behind the two systems, in other terms, we have to know the culture and the key communication concepts of the two systems – their similarities and differences.

Cultures

According to Webster Dictionary, “culture” is defined as the customary beliefs, social forms, and material traits of a racial, religious, or social group. Also, the Dictionary defines “culture” as the set of values, conventions, or social practices associated with a particular field, activity, or social characteristic. The following illustrates some of the key differences in TCM and WM communication styles rooted in the fundamental of their cultural backgrounds.

Culture and communication style

  • Direct communication or indirect communication style. As mentioned before, TCM culture emphasizes more on philosophical foundations of body and mind connection, while WM focuses more on scientific and direct approach communication style [Figure 1] and [Figure 2].
  • Self-concept and shared attitudes. The self-concept between TCM and WM is different as demonstrated in [Figure 3]. In the same rationale, the differences exist between the two on shared attitudes, values, goals, and practices that characterize intervention or treatment. In TCM, the shared attitudes of self are on the whole system of mind and body connection, while WM is more on individual organs or units. It is the set of shared attitudes determines the treatments or intervention patients will receive-TCM or WM [Figure 3].
  • Social practices. This type of communication style and culture is associated with one's concept of leaders and followers. It is the set of values, conventions, or social practices associated with a particular field, activity, or societal characteristic. In social practices, leaders usually are the leading role in the process and outcomes of the practices. In TCM, the leader usually plays the most important leading role in the decision-making process and team performance outcomes. Team members are followers of such practices in their medical practices; however, for WM, leaders usually function primarily in providing guidance and advice [Figure 4].
Figure 1: The cultural differences between East and West - How people express their opinion? Retrieved from https://imgur.com/gallery/x571q (February 8, 2021)

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Figure 2: The cultural differences between East and West - How people deal with problems? Retrieved from https://imgur.com/gallery /x571q (February 8, 2021)

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Figure 3: The cultural differences between East and West - How do people view themselves? Retrieved from https://imgur.com/gallery /x571q (February 8, 2021)

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Figure 4: The cultural differences between East and West - How do people view leaders? Retrieved from https://imgur.com/gallery /x571q (February 8, 2021)

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Goman indicates in her culture controls communication article:

In high-context cultures (Mediterranean, Slav, Central European, Latin American, African, Arab, Asian, and American-Indian) leave much of the message unspecified–to be understood through context, nonverbal cues, and between-the-lines interpretation of what is actually said. By contrast, low-context cultures (most of the Germanic and English-speaking countries) expect messages to be explicit and specific. The former is looking for meaning and understanding in what is not said – in body language, in silences and pauses, and in relationships and empathy. The latter place emphasis on sending and receiving accurate messages directly, and by being precise with spoken or written words.[5]

Goman also suggests that in low-context cultures, they disregard the importance of building and maintaining personal relationships when dealing with individuals from high-context cultures. The same communication rationale applies to TCM and WM practices. For TCM, the mind–body connection would take more time for communication and treatment/intervention, while, for WM, the aim is to cure the symptoms than to take time to build and maintain personal relationships.[5]

In TCM and WM communication dealings, reason and emotions both play a role; however, which one is dominant depends on the factor of affective (readily showing emotions) or emotionally neutral in one's approach. Members of neutral cultures do not tend to share their feelings but keep them carefully controlled and subdued. The approach is more task-oriented than in WM. In cultures with high-contexts, professionals show their feelings plainly as more likely in the TCM community.

For TCM and WM global medicinal community, there is no one single best approach to communicating with one another. The key to this cross-cultural success is to develop an understanding and deep respect for the differences and similarities as well.


  Leadership Skills to Facilitate on Culture and Communication Top


The author will introduce several important fundamental leadership perspectives/skills related to the topic discussed in this article to enhance the communication between TCM and WM. The leadership perspectives included are Trait Leadership Theory; Authentic Leadership theory; Servant Leadership Theory; Transformational Leadership Theory; and Situational/contingency Leadership Theory.

In the end, based on the required communication skills, a facilitation training program for medical students and medical professionals will be recommended.

Trait leadership theory

”Leader traits can be defined as relatively coherent and integrated patterns of personal characteristics, reflecting a range of individual differences, that foster consistent leadership effectiveness across a variety of group and organizational situations.”[6] This definition has three key components: (1) Leaders traits are not to be considered in isolation but rather as integrated as a cluster of attributes that influence leadership performance;[7] (2) Leader's traits concern the inclusiveness of a variety of personal qualities that promote stability in leader effectiveness. Traits have traditionally referred to personality attributes. However, in line with most modern leader trait perspectives, the qualities that differentiate leaders from nonleaders are far-ranging and include not only personality attributes but also motives, values, cognitive abilities, social and problem-solving skills, and expertise; (3) Leader traits specify leader attributes are relatively enduring, producing cross-situational stability in leadership performance; however, most personality and leadership researchers agree that actual behavior varies considerably across situations. The variability has been the crux for pure situational or person-situation models in personality theory.[7] More discussion on the leader's situational behavior will be included in the following situational leadership theory section.

In summary, according to Trait Leadership Theory, potential leaders to bridge communication between TCM and WM may need to have an integrated cluster of leadership attributes (e.g., accuracy in work, moral habits, decisiveness in judgment, speech fluency, interpersonal skills, and administrative abilities as stable leader qualities) for performance. Also, their motives, values, cognitive abilities, social and problem-solving skills, expertise are important traits. When considering the communication as a situation to connect the two systems, then, appropriate better handling quality of the situation will be an additional meaningful attribute to take into consideration.

Authentic leadership theory

According to Harter,[8] authenticity can be defined as “owning one's personal experiences, be their thoughts, emotions, needs, preferences, or beliefs, processes captured by the injunction to know oneself”[8] and behaving in accordance with the true self. Based on the initial definition of Authentic Leadership Luthans and Avolio,[9] and the underlying dimension of the construct posited by Gardner et al.,[10] and Illies et al.[11] Walumbwa et al.[12] defined Authentic Leadership as a pattern of leader behavior that draws upon and promotes both positive psychological capacities and a positive ethical climate, to foster greater self-awareness, an internalized moral perspective, balanced processing of information, and relational transparency on the part of leaders working with followers, fostering positive self-development.

In this definition, self-awareness refers to demonstrating an understanding of how one derives and makes meaning of the world and how that meaning-making process impacts the way one views himself or herself over time. It also refers to showing an understanding of one's strengths and weaknesses and the multifaceted nature of the self, which includes gaining insight into the self through exposure to others and being cognizant of one's impact on other people.[13] Relational transparency refers to presenting one's authentic self (as opposed to a fake or distorted self) to others. Such behavior promotes trust through disclosures that involve openly sharing information and expressions of one's true thoughts and feelings while trying to minimize displays of inappropriate emotions.[13] Balanced processing refers to leaders who show that they objectively analyze all relevant data before coming to a decision.

In summary, authentic leadership perspectives encourage leaders' selection criteria to connect TCM and WM as follows:

  • They are self-aware and genuine. Authentic leaders are self-actualized individuals who are aware of their strengths, their limitations, and their emotions. They also show their real selves to their followers. They do not act one way in private and another in public; they do not hide their mistakes or weaknesses out of fear of looking weak. They also realize that being self-actualized is an endless journey, never complete.
  • They are mission driven and focused on results. They are able to put the mission and the goals of the organization ahead of their own self-interest. They do the job in pursuit of results, not for their own power, money, or ego.
  • They lead with their heart, not just their minds. They are not afraid to show their emotions, their vulnerability, and to connect with their employees. This does not mean authentic leaders are “soft.” In fact, communicating in a direct manner is critical to successful outcomes, but it's done with empathy.
  • They focus on the long-term. Ideal leaders to connect TCM and WM would be leaders who realize that to nurture individuals and to nurture an organization requires hard work and patience, but the approach pays significant returns over time.


Servant leadership theory

Greenleaf first presented servant leadership theory in the Servant as a Leader essay. The servant-first model focuses on making sure that other people's highest priority needs are being served. In that essay, Greenleaf mentioned:

The servant-leader is servant first… It begins with the natural feeling that one wants to serve, to serve first. Then, conscious choice brings one to aspire to lead. That person is sharply different from one who is leader first, perhaps because of the need to assuage an unusual power drive or to acquire material possessions… The leader-first and the servant-first are two extreme types. Between them, there are shadings and blends that are part of the infinite variety of human nature.[14]

Throughout its development, numerous other theorists have contributed to our understanding of servant leadership. Spears outlined ten characteristics of servant leaders by analyzing the writings of Greenleaf. These ten characteristics are listening, empathy, healing, awareness, persuasion, conceptualization, foresight, stewardship, commitment to the growth of others, and building community.[15]

A servant-leader focuses primarily on the growth and well-being of people and the communities to which they belong. While traditional leadership generally involves the accumulation and exercise of power by one at the “top of the pyramid,” servant leadership is different. The servant-leader shares power, puts the needs of others first, and helps people develop and perform as highly as possible.

What is the effect of practicing servant leadership? Longbotham[16] presented a multiple regression model that is able to explain a significant percentage of the variance in the effectiveness of teams. The essential servant leadership variables identified were (a) providing accountability; (b) supporting and resourcing; (c) engaging in honest self-evaluation; (d) fostering collaboration; (e) communicating with clarity; and (f) valuing and appreciating.

In summary, to enhance the communication between TCM and WM, the servant leaders approach could enhance team effectiveness to a significant percentage level, in turn, produce encouragement, humility, and trust to team members on both sides. It could be a win-win outcome for all teams involved in the communication process.

Transformational leadership theory

Burns[17] and Bass[18] used the term “transformational leadership” to explain how transformational leadership could be measured, as well as how it impacts the follower's motivation and performance. A transformational leader is measured based on his/her influence on the followers. The followers demonstrate behaviors such as feeling trust, loyalty, and respect for the leader. The outcomes could be followers are willing to work harder than originally expected because they feel more than just self-gain, they have a sense of inspiring mission and vision in them, as well as a meaningful identity. The leader transforms and motivates followers through his/her idealized influence (attribute and behavior), intellectual stimulation, individual consideration, and inspirational motivation.

Besides, the transformational leader encourages followers to come up with new and unique ways to challenge the status quo and to alter the environment to support being successful.

To connect TCM and WM, transformational leadership can facilitate communication through the following fundamental elements:[19]

  • Idealized influence: Provides a role model for high ethical behavior, instills pride, gains respect, and trust. As a development tool, transformational leadership has spread already in all sectors of western societies, including governmental organizations.
  • Intellectual stimulation: The degree to which the leader challenges assumptions, takes risks, and solicits followers' ideas. Leaders with this style stimulate and encourage creativity in their followers. They nurture and develop people who think independently. For such a leader, learning is a value and unexpected situations are seen as opportunities to learn. The followers ask questions, think deeply about things, and figure out better ways to execute their tasks.
  • Inspirational Motivation– The degree to which the leader articulates a vision that is appealing and inspiring to followers/teammates. Leaders with inspirational motivation challenge followers/teammates with high standards, communicate optimism about future goals, and provide meaning for the task at hand. Followers/teammates need to have a strong sense of purpose if they are to be motivated to act. Purpose and meaning provide the energy that drives a group forward. The visionary aspects of leadership are supported by communication skills that make the vision understandable, precise, powerful, and engaging. The followers are willing to invest more effort in their tasks, they are encouraged and optimistic about the future, and believe in their abilities.
  • Individualized consideration: The degree to which the leader attends to each follower's/teammate's needs, acts as a mentor or coach to the follower, and listens to the follower's concerns and needs. The leader gives empathy and support, keeps communication open, and places challenges before the followers. This also encompasses the need for respect and celebrates the individual contribution that each follower can make to the team. The followers have a will and aspirations for self-development and have intrinsic motivation for their tasks.


Situational leadership theory

The situational theory of leadership suggests that no single leadership style is best. Instead, it all depends on the situation at hand and which type of leadership and strategies are best suited to the task. According to this theory, the most effective leaders are those able to adapt their style to the situation and look at cues such as the type of task, the nature of the group, and other factors that might contribute to getting the job done.[18],[20]

Hersey and Blanchard suggested that there are four primary leadership styles:

  • Telling (S1): In this leadership style, the leader tells people what to do and how to do it.
  • Selling (S2): This style involves more back-and-forth between leaders and followers. Leaders “sell” their ideas and message to get group members to buy into the process.
  • Participating (S3): In this approach, the leader offers less direction and allows members of the group to take a more active role in coming up with ideas and making decisions.
  • Delegating (S4): This style is characterized by a less involved, hands-off approach to leadership. Group members tend to make most of the decisions and take most of the responsibility for what happens.


The right style of leadership depends greatly on the maturity level (i.e., the level of knowledge and competence) of the individuals or group.

Hersey and Blanchard's theory identifies four different levels of maturity, including:

  • M1: Group members lack the knowledge, skills, and willingness to complete the task.
  • M2: Group members are willing and enthusiastic, but lack the ability.
  • M3: Group members have the skills and capability to complete the task, but are unwilling to take responsibility.
  • M4: Group members are highly skilled and willing to complete the task.


The Hersey-Blanchard model suggests that the following leadership styles are the most appropriate for these maturity levsels:

  • Low maturity (M1) – Telling (S1)
  • Medium maturity (M2) – Selling (S2)
  • Medium maturity (M3) – Participating (S3)
  • High maturity (M4) – Delegating (S4)


Furthermore, the Situational Leadership II (or SLII model) was developed by Kenneth Blanchard[21] and builds on Blanchard and Hersey's original theory. According to the revised version of the theory, effective leaders must base their behavior on the developmental level of group members for specific tasks. The developmental level is determined by each individual's level of competence and commitment. These levels include:

  • Enthusiastic beginner (D1): High commitment, low competence.
  • Disillusioned learner (D2): Some competence, but setbacks have led to low commitment.
  • Capable but cautious performer (D3): Competence is growing, but the level of commitment varies.
  • Self-reliant achiever (D4): High competence and commitment.


SLII also suggests that effective leadership is dependent on two key behaviors: supporting and directing. Directing behaviors include giving specific directions and instructions and attempting to control the behavior of group members. Supporting behaviors include actions such as encouraging subordinates, listening, and offering recognition and feedback.

  • Directing (S1): High on directing behaviors, low on supporting behaviors.
  • Coaching (S2): High on both directing and supporting behaviors.
  • Supporting (S3): Low on directing behavior and high on supporting behaviors.
  • Delegating (S4): Low on both directing and supporting behaviors.


Important situational factors

For enhancing the communication between Chinese and Western Medicinal cultures, the following are factors leaders must be aware of when assessing the situation. The factors include:

  1. Leaders need to consider the relationship between the leaders and the members of the group. Social and interpersonal factors can play a role in determining which approach is best.
  2. The leader needs to consider the task itself. Tasks can range from simple to complex, but the leader needs to have a clear idea of exactly what the task entails to determine if it has been successfully and competently accomplished.
  3. The level of authority the leader has over group members should also be considered. Some leaders have power conferred by the position itself, such as the capacity to fire, hire, reward, or reprimand subordinates. Other leaders gain power through their relationships with employees, often by gaining respect from them, offering support to them, and helping them feel included in the decision-making process.
  4. As the Hersey-Blanchard model suggests, leaders need to consider the level of maturity of each group member. The maturity level is a measure of an individual's ability to complete a task, as well as his or her willingness to complete the task. Assigning a job to a member who is willing but lacks the ability is a recipe for failure.



  Putting Communication in Action: Use Leadership Skills to Facilitate Conversation on Medicinal Culture of Chinese Medicine in the Western World Top


The author proposes the following certification training program to train medical students from both TCM or WM background, or medical professionals to enhance the communication exchange between the two systems proposed. The goal for training is to develop their leadership skills to facilitate better in-depth communication skills for a better quality of care provided to patients, and prevention measures provided to people living in communities. The quality and integrated health-care approach would enhance collaborations between TCM and WM practitioners to achieve better care for all parties involved.

What areas are the focus of this leadership training program designed for connecting both TCM and WM? Briefly, the design is for trainees to be skillful in the leadership areas listed down below. Trainees who completed the training program would be able to upgrade not only their skills in their medical practices but also becoming better facilitators/leaders soliciting dialogues between the two medicinal cultures. Graduates would be equipped with a basic understanding of intervention options available to patients from both TCM and WM. The goal for good facilitation is to provide holistic/integrated mind-body connection treatments to enhance patient care by maximizing the available/tangible health-care resources.

  • Area 1: Leadership skills to build relationships and trust with teammates or colleagues.


    • Skills to build relationships (e.g., people-oriented leadership skills) include those established between individual nurses, on teams, and with internal and external partners.


  • Area 2: Leadership skills to create an empowering work environment.


    • Leadership skills (e.g., authentic leadership skills) to nurture respectful, trusting relationships among people in a work setting.
    • Leadership skills to enable an empowered work environment (e.g., transformational leadership skills) that has access to information, support, resources, and opportunities to learn and grow, in a setting that supports professional autonomy and strong networks of collegial support.


  • Area 3: Leadership skills to create a culture that supports knowledge development and integration.


    • Leadership skills (e.g., servant leadership skills) to foster both the development and dissemination of new knowledge and instilling a continuous-inquiry approach to practice, where knowledge is used to continuously improve clinical and organizational processes and outcomes.


  • Area 4: Leadership skills to lead and sustain change.


    • Leadership skills (e.g., situational leadership skills) for active and participatory engagement in implementation (e.g., transformational leadership skills) of change projects, resulting in improved clinical and organizational processes and outcomes.


  • Area 5: Leadership skills to balance the complexities of the system, managing competing values, and priorities.


    • After completion of the certification program, the ideal facilitators will advocate for patients from integrated TCM and WM perspectives to obtain resources necessary for high-quality patient care. In the meanwhile, will recognize the multiple demands and complex issues that shape organizational decisions aiming at efficiency and effectiveness of best available health-care outcomes. Also, able to use evidence-based findings to support the optimal intervention/treatment outcomes.



  Conclusion Top


Although various forms of Chinese medicine are currently practiced in over 120 countries worldwide,[15] the communication of medicinal culture of Chinese medicine in the Western world is still limited. Based on Wong et al.,[22] they stated in their paper “Developing a modern language for traditional concepts would be a significant challenge; however, this also represents a great opportunity to make Chinese medicine more accessible to Western audiences”.

In this paper, the author proposes using leadership concepts/skills to be the communication tool/channel to the development of a modern language to enhance dialogue for TCM in the Western world. There are many ways to make it happen; however, it could mutually be beneficial for both TCM and WM if the leadership training program is offered to TCM first. “Leadership is a process of social influence which maximizes efforts of others towards the achievement of a goal.”[3] For communicating TCM in the western world, the goal to be achieved would be through a facilitation training program provided to medical professionals from TCM first to encourage dialogues between the two medicinal cultures. In the end, collaborations between the two medicinal cultures would encourage optimally integrated interventions available to patients in need (patient-focused-care/patient satisfaction). In return, the cost-effectiveness and efficiency produced at the end of the integration are outcomes for optimal medical practices.

Funding

None.

Conflicts of interest

None.



 
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