Leadership Theories in Health Care - Essay Example

Leadership Theories in Health Care Healthcare delivery systems are complex entities, which need to have dynamic and responsive workforce to cope with frequent organisational changes and other challenges. Therefore, clinicians should demonstrate leadership skills and act as role models at various levels of healthcare provision (DeRue and Wellman, 2009). For efficiency in healthcare organisations and improvement of patient safety and outcomes, health organisations must seek to redefine leadership using new paradigms that promote diffusion and development of improvements and innovations. The need for formal administrative leadership and the development of integrated leadership processes in all aspects of healthcare delivery (Turnbull and Ladkin, 2008). This paper draws literature on academic leadership and leadership development practice in the context of healthcare. It discusses three leadership theories and management in healthcare and outlines their implications to the healthcare sector. In an ideal world, leadership theories should inform leadership development practice. However, the current leadership development programs fail to articulate perspectives on leadership beyond a behaviour and value approach. The concept and practice of leadership has been explained through a wide range and ever growing theories. The theories that this paper will discuss are transformational leadership, path-goal leadership and charismatic leadership in the perspective of healthcare. Transformational leadership Followers, in this model of leadership, trust, admire and respect their leaders. Followers feel motivated to do more than just what they are/were originally expected. J.M Burns first introduced the theory in 1978, and was further developed by B.M Bass in 1985. Transformational leadership is built around four main components; charisma, inspiration, individual consideration, and intellectual stimulation (Probert and Turnbull, 2011). The most fundamental evolutionary force in transforming healthcare is the move from management to leadership in nursing (Mountford and Webb, 2009). In healthcare, the transformational leader will be the catalyst for broadening the perspective and scope, empowering nursing personnel at all levels and intensify the use of technology as they position the organization to shift from patient-centred health care to patient-directed outcomes. The main strength of transformational leadership lies in the fact that it effectively influences other leaders and followers on all levels of the organization, from one-on-one to the entire organization, which is fundamentally important in a healthcare environment. This style also strongly emphasizes the needs and values of the followers, which fit well with a service oriented industry like healthcare (Heather and Buguley, 2012). Weaknesses of this leadership style lies in the many broad components. Additionally, it treats leadership more as a personality trait than a learnt behaviour with leaders having the potential of abusing power. Path-Goal Leadership Path-Goal leadership focuses on establishing a clear path to the achievement of goals. The styles associated with path-goal leadership include: achievement-oriented, directive, participative and supportive leadership. Robert J. House founded the model and believed that how a leader behaves determines employee satisfaction, employee motivation as well as employee performance (Bayer and Witt, 2013). Healthcare organizations include various tasks and roles that vary from the highly skilled ones to the very routine ones and professional of occupations. The nature of work in healthcare organizations necessitates importance of favourable outcomes, clarity of accountability and responsibility with less tolerance to error and ambiguity with this giving a clear link between this theory and healthcare organization. This inevitable link resonates well with the definition of path-goal leadership seeks to establish a clear route or pat to gaol achievement. The main strength is based on the situational framework of being able to discern how participative, achievement oriented, supportive, and directive behaviours impact the productivity and satisfaction of followers. Despite its flexible nature, the theory appears ambiguous or unstructured. However, the nature and complexity of work in healthcare sector does not require ambiguity, anxiety or stress among employees as it requires directive or task oriented leaders (Entwistle and Beach, 2012). This would be true with highly trained professionals who may not require or even welcome directive leadership (path-goal leadership). Charismatic Theory A charismatic leader has inspirational qualities that emotionally connect with followers. Charismatic theory – developed by House (1971) – describes how charismatic leaders behave. Besides, the theory also distinguishes characteristics and situations where such leaders would be most effective. Contemporary healthcare environments more than ever characterized by discontinuous change, increased professional accountability, increased expectations from service users, as well as political pressure for efficiency, where they are expected to implement standardized easily measurable outcomes, and technologically driven change. Inevitably therefore, there is an increase in the focus on the role of management and leadership in health care or within the context of clinical practice (Mann, 2010). Braithwaite (2011) argues that today’s dynamic and chaotic healthcare arena, leadership and management should utilize qualities of transformational leadership, like charisma, to solving problems in an environment that is ever changing. Charismatic leadership style inspires followers to perform and feel appreciated, which encourages more productivity in a healthcare environment. The weaknesses associated with this leadership include that charisma, on its own, is not enough to make one an effective leader in an organization; such leaders care mostly about their own success and lack the necessary knowledge to really run the company (Colbert and Witt, 2013). Secondly, clarity is fundamental in healthcare, but charismatic leaders are known to get extremely caught up in their control and fail to see the looming dangers and risks. Similarities First, the similarities in the three theories stem from their main writers and people who created or developed them, which is a common thread between two of these theories. The main contributor to path-goal theory is House, and the same writer is associated with charismatic leadership theory. Others who contributed to this theory are Weber, Conger and Kanungo. However, the contributors to transformational leadership theory were Burns and Bass the introduction done by J.M Burns while B.M Bass further developed the theory. The theories draw a strong link between the behaviour of the leader and its influence on the followers. In transformational leadership theory, there is great emphasis on its placement of the relationship between the leader and the follower. The theory argues that the best approach to leadership is founded on a shared vision between the leader and the follower which serves to motivate and direct them (Probert and Turnbull, 2011). In this model, followers feel motivated to do more than just what they are/were originally expected to do. The same can be said about the importance of the intricate relationship between the leader and the follower in path-gaol leadership. This theory argues that a leader’s behaviour determines employee satisfaction, motivation and performance (Bayer and Witt, 2013). In the charismatic theory, sustaining the relationship between the leader and the follower is integral with the theory going further to introduce the element of intimate bonds where as Burns (2009) puts it, a charismatic leader is one who has an inspirational quality which fosters an emotional connection from followers. The third similarity is in their definition and characteristics of an ideal leader. Transformational leadership is built around four main components; charisma, inspiration, individual consideration, and intellectual stimulation (Probert and Turnbull, 2011). The leadership styles that are associated with path-goal leadership include achievement-oriented, directive, participative and supportive leadership. The theory states that a good leader provides clear directions, sets high goals, and is actively involved in goal achievement offering the necessary support to his employees (O’Reilly, et al., 2010, pp.109). An ideal charismatic leaders, as Garman (2010, pp.91) found out, “Are those that exude self-confidence, have strength and passion in what they believe in, and communicate high expectations and their confidence in others.” Such leaders have been described as able to handle intricacies, where they emerge during a crisis situation, communicating vision and making use of their personal power and unconventional strategies (Carroll, Levy and Richmond, 2008). Charismatic traits, in this theory, according to The Government Institute, (2009, pp. 24) include communication, vision, trust, delegation of authority and impression management. The fourth similarity is the consistency in describing the overall positive organizational outcomes of the leader-follower collaboration. Transformational leadership theory happens when two or more people working in an organisation engage with each other in a way that both the leader and the follower raise each other to higher levels of morality and motivation (Avolio, Walumbura and Weber, 2009). In healthcare, the transformational leader will be the catalyst for broadening the perspective and scope, empowering nursing personnel at all levels and intensifying the use of technology as they position the organisation to shift from patient-centred health care to patient-directed outcomes. Path-Goal leadership is a model of leadership that focuses on establishing a clear path to the achievement of goals. A leader who embraces this form of leadership creates more satisfied and creative leaders. Path-goal leadership theory is one of the current situational theories whose basic preposition is that one of the main functions of a leader is to foster the psychological states of their subordinates, which consequently results in increased motivation to perform and improved job satisfaction (Garman, 2011). Braithwaite (2011) argues that today’s dynamic and chaotic healthcare arena, healthcare leadership and management need to utilise qualities of transformational leadership like charisma, that focus on the people and on solving problems in an environment that is ever changing. Greig, Entwistle and Beach (2012) argue that a charismatic leader aids power circulation as well as power access. At a transformational dimension, charisma – idealized influence – plays a pivotal role in helping health care leaders to achieve optimal influence, as a management quality that empowers employees, fosters co-operation, creativity and innovation. Differences There are not as many differences between the leadership theories with these differences drawn from aspects are seemingly similar. However, it would be important to note that charisma as a trait of leadership in charismatic theory is a quality or a ‘gift’ that is attached on an individual, which sets them apart from the ordinary people where they are seen as wielding exception or even supernatural powers or qualities (Pierce, Longer and Locke, 2008). Charismatic theory of leadership intimates that followers in this style of leadership deduce heroic and extraordinary leadership abilities upon observing certain behaviours. The main reason why people working under charismatic leadership are inspired and put an extra effort in their work is due to the high level of esteem that they have for their charismatic leader (Mountford and Webb, 2009). Charismatic leaders are mostly born that way. However, it can also be learnt. Martin Luther King, John F. Kennedy and Ronald Regan are examples of charismatic leaders. Transformational leaders on their part inspire their followers to rise above their personal interests for the good of the organization. Such leaders are known to have extraordinary and profound effects on their followers (Taylor, 2009). Transformational leaders pay keen attention to their individual followers taking into account their various needs and concerns, promote intelligence, communicating high expectations, providing a vision and sense of mission, and have the potency of changing or impacting the follower’s awareness on issues by effectively helping them to look at things in a different perspective(s) (Reinertsen, Bisognano and Pugh, 2008). Additionally, followers of a leadership that is transformational put extra effort on their work out of being encouraged, excited and aroused by the transformational leader. Transformational leaders encourage their followers to be more creative and innovative and a good example of a transformational leader was President Abraham Lincoln. Other differences include the fact that charismatic leaders according to (Colbert and Witt, 2008) is that they have the tendency of wanting their followers to embrace a charismatic view of the world and to go no further, while in the case of a transformational leader, they will want to encourage the ability to query established views and those that have been put in place by the leader. Further, transformational leadership is also broader as compared to transformational leadership. Additionally, the tendency of a transformational leader to over rely on enthusiasm can restrain the willingness of such leaders to embark on research, study as well as logical reasoning. Path-goal theory of leadership is close to both transformational leadership and charismatic leadership though it emphasises on path as a contingency variable and the route that an organization must stick to so as to reach a goal. Ordinarily, the path is usually one that is characterised by struggle, and where everyone must do their part, which most of the time means too much work, so as to reach certain goals (DeRue and Wellman, 2009). Therefore, a path-goal leader plays a very important role in situations where paths and routes can be long, odious and frustrating, in trying to motivate them and working towards minimising the barriers. Path-goal leadership is the ideal style in situations where the management formulates goals related to “saving money” and “increasing profits” with leaders clarifying or streamlining these seemingly vague goals. Under path-goal leadership, followers perform well in their duties due to rewards, punishments, or repercussions for the outcome (Ovretveit, 2008). Advantages and disadvantages Transformational leaders are the most preferred in organizations undergoing major transformations, are in post-transformation phase, or they basically need a spark. Transformational leaders are equally endowed with charisma and are known for their ability to create vision and inspire others and get them into the fold. Transformational leadership demonstrate their very best in companies that have low morale (Mann, 2010). Transformational leadership often stand out from other leadership styles particularly in their ability to quickly discern the current position of a company and come up with measures to steer growth and improvement. Transformational leaders effectively communicate and articulate their vision to other leaders and followers with the aim of getting everyone on board (Heather and Buguley, 2012). The other advantage is leaders’ ability to inspire and motivate others to achieve the vision of the organisation. Leaders get employees of a company to optimise performance because they exhibit enthusiasm and passion as common traits in this leadership style. The main disadvantage is that despite a leader’s big vision, challenges in discerning detailed orientation exist. Hence, transformational leaders would need the support of more detail-oriented and organised people. The other disadvantage is the likelihood of falling into the trap of over reliance on emotion and passion while overlooking reality and truth through this style (Bisognano and Pugh, 2008). For charismatic leadership style, the main advantage is that such leaders exceptionally advance the vision and get people on board. As Bayer and Witt (2013, p. 381) noted, “Charismatic leaders are geniuses when it comes to helping people see the potentials and possibilities ... to buy into something that is bigger than themselves.” They have a mastery of weaving anecdotes and stories that inevitably recruits people into a big dream such as JFK’s leading of a nation in taking the first man to the moon. Secondly, charismatic leaders are inspiring, have positive attitude and optimism has a way of drawing people towards a cause. Such leaders inspire people to be at their very best and create work environments that are motivating to employees (Garman, 2010). The third advantage of charismatic leadership is that such leaders drive results. Leaders who are highly charismatic have the ability to make their followers achieve great results. The main disadvantage of charismatic leadership is due to the leader’s popularity. This can cause other team members to contrive their own values and beliefs, which could be in conflict with those of the leader. This could especially happen when an influential section of the followers start to get a sense that the direction they are heading towards is shaky. The second disadvantage with this style of leadership is that it can bring about lack of independence largely because followers under charismatic leadership tend to struggle to become more self-managing owing to the fact that the group identity can become caught up in that of their leader and their ego (Pearce, Conger and Locke, 2008). Thirdly a worst scenario with this kind of a leadership is that such a leader being seen as the ultimate hero may obscure the strength of the organization. This would happen when people start viewing the leader as being “the” organization, and the success of organization being identified with the leader person (Bisognano and Pugh, 2008), a good example of such a case is Richard Branson and Virgin Group. The main advantage of a Path-Goal leadership is its focus on establishment of a clear path to the achievement of goals. A leader who embraces this form of leadership creates teams that are more satisfied and also creative. Heifetz (2009, pp.57-58) found that it has been inferred that this function of a leader involves recognising and arousing the need of the subordinates for expected outcomes in which the leader exercises some control. The second function is increasing personal payoffs to their subordinates for the attainment of work goals. The third advantage is helping subordinates better realise their expectancies while finally this style helps to reduce frustration barriers, and increase opportunities for personal performance. Despite path-goal leadership theory being flexible in nature, it has also proven to be complex and counter intrusive, which is the main disadvantage of this style of leadership. Further, it is a style of leadership that integrates many conflicting sets of assumptions that make it an intricate theory for use in an organizational setting (Alivio and Yamminarino, 2009). Conclusion The findings point to leadership approaches associated with more effectiveness in achieving positive outcomes for healthcare workforce and organisations. Combined with knowledge from other independent reviews that transformational and relational leadership skills can be learnt (Braithwaite, 2011), the results present a fundamental moral imperative towards ensuring that our healthcare organisations are lead by people and teams with good relational skills, concern for employees, and are able to work collaboratively to achieve the preferred future for themselves and their employees, but also more importantly, for their patients and organisations (Colbert and Witt, 2013). Today, healthcare organisations face shortage of leaders, nurses and other professionals. Hence, implementing strategies that promote effective leadership is integral. Garman, et al. (2009) identifies the driving forces that impact today’s health systems as economic, demographic, social, environmental, political and technological. 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