Leadership in Health and Social Care - Literature review Example

Leadership in Health and Social Care By (Name) Unit Professor’s name University (Name) Course Date Introduction The ability of a person to influence others is called Leadership. Those exercising leadership mobilize people to behave in new ways that the leader values. Uhl-Bien (2006, p. 228), argues that leadership is exhibited through influencing people socially to achieve change. This essay will review the concepts of leadership, role of leadership in influencing change in health and social care as well as the barriers and facilitators to quality improvement in health and social care institutions (Donahue, Miller, Smith, Dykes, & Fitzpatrick, 2011; McCleskey, 2014). The concept of leadership One aspect of leadership is the ability to challenge the status quo and institute change tat propels the institution or community forward. It is worth noting that leadership is different from management in that leadership is not limited to the control of resources in an organisation. However, both leadership and management are needed to steer institutions. The two capabilities can be found in different people (Künzle, Kolbe, & Grote, 2010). Besides, leadership should be differentiated from having a formal authority. The mechanisms of influencing people does not necessarily require a position of formal authority. However, presence of formal authority and leadership often overlap to influence people towards achievement of particular goals. Leadership can be exhibited by people who are in formal authority but it can also be found in a person without formal authority (Sinclair, 2014). There are recent views that separate leadership from a leader as a person. In such as case, leadership interpreted as practices performed across a group to influence it achieve a certain agenda. However, when people are asked about leadership, they tend to think about individual leaders and their associated characteristics such as heroic, tough or ‘greatness’ which is often associated with men (Mittal & Dhar, 2015). Fletcher (2004) says that despite the high-level discussions about leadership as a set of practices, the mind-set of many people has not changed. Some people view leadership as a personal ability and those who have demonstrated leadership exemplary are viewed as individual heroes (Fletcher, 2004, p. 652). Brief history of leadership The first theories of leadership in the 20th century influenced people to think that some people were born leaders while others were born followers. The trait theory of leadership proposed that some people had unique characteristics and personalities that made them better leaders than others. Later on new theories such as transformational theory of leadership introduced new leadership concepts in the 1980s. It suggested that transformational leaders had learned the skill to motivate and inspire their followers towards achieving certain tasks. The transformational leaders were differentiated from transactional leaders in that the later was based on influencing people by giving them rewards and sanctions. The transformational leaders are also viewed as moral agents who have the ability to develop institutions by providing a convincing vision. Followers work towards achieving the set vision while enjoying the social architecture created for them to achieve self-actualisation, freedom, and high degree of consciousness (Bennis &Nanus, 1985, p. 218). Since advent of transformational leadership, several arguments and criticisms have been used to enhance the transformational leadership. For the example, Charisma in leadership is believed to change work by making it more meaningful (Conger &Kanungo, 1998, p. 17). However, scholarly work on leadership writing has demonstrated a return to the initial ideas that leaders have certain identifiable dispositions. Collins (200), argued that leaders have certain characteristics such as humility and fierce resolve to undertake responsibilities. He analysed American Chief Executive Officers from major companies. Today, leadership is expected to focus on relationship aspects. For example, it is expected to be participatory and democratic as well as collaborative (Collins, 2005). The struggle for women in leadership Leadership has been highly described and developed in masculine terms as revealed by historical trends of women in leadership. However, leadership is currently evolving to match the societal values and demands of equality and equity in leadership. The focus of women in leadership achieved momentum in 1970s. In 1980s, a second wave of feminism increased the agitation to promote gender equality and equity through affirmative action measures. At that time, women managers had experiences numerous challenges in their effort to perform in male dominated professions. The ability of women to perform equally as men was the major focus of scholars at that time. Hearn and Parkin (1986, p. 24) argued that there was excess optimism that women would bring about the desired change in business oriented leadership (Hearn and Parkin, 1986, p. 24). Later studies focussed on the differences between women and men leadership styles. However, several meta-studies came to a conclusion that the difference was quite minimal. There was similarity in motivation to achieve, ability to take risks and persistence among other skills that were initially regarded as important management qualities. The finding that women had same psychological ability to perform like men led to discovery that poor performance in women was caused by stereotypes and gendered assumptions. The discriminatory norms affected recruitment and promotion of women in leadership (Freedman, 2007). The above proposition was supported by women authors such as Kanter (1993) and Marshall (1984) who documented how certain practices were construed to exclude women from leadership by making them appear like women characteristics. The effectiveness of women in leadership and managerial positions was related to their sex but how they were limited by stereotypes. More scholarly work on women in leadership changed the focus from characteristics of women in leadership to include the broader aspects of gender relation in leadership and the society. The society had kept women in subordinate roles and entrusted them with extremely demanding responsibility of taking care for the family and children (Eagly, 2007). Later on, several studies documented the change of leadership style where they avoided “command and Control” style often associated with men. They were seen as more transformational and interactive in nature. Up to today, stereotypes have been used to undermine and disadvantage women who have joined leadership. The leadership characteristic have been carefully tailored to describe men in their aggressive, agentic and confident characteristics. Much more needs to be done to include describe leadership qualities in more neutral terms (Eagly, 2007). There is 50% literacy for women in Saudi Arabia while the literacy levels for men is 72%. Due to low literacy levels and the cultural context, women in Saudi Arabia constituted 4% of workforce in the year 2003. The official religion in Saudi Arabia is Islam. Involvement of women in leadership has been derailed by gender differences in the upbringing of children. The Islamic teachings anchored boys’ domination over girls. For example, the identity of girls is through her father or husband. Although there are structural and cultural challenges facing women, Saudi Arabia has witnessed increasing numbers of women in leadership positions. More capacity development for women, enactment of gender affirmative actions, and gender mainstreaming initiatives is essential to improve the status of women in leadership (Al-Ahmadi, 2011; Hamdan, 2005; Thompson, 2015) Role of leadership in health and social care Leadership is required in the implementation of the Sustainable Development Goal (SDG) number three and number five that relate on health and social care. The Sustainable Development Goal number three aims to promote wellbeing of people at all ages whereby by 2030, global maternal mortality will have reduced to less than 70 per 100, 000 live births, end preventable new born deaths, ensure universal access to health care services among other objectives. Moreover, the goal number five addresses the social care issues that relate to just and fair societies. It aims to empower all women and girls as well as achieve gender equality for all. Among the objectives of goal number five is elimination of all forms of violence, promote fair and shared responsibilities (Blazhevska, 2017; United Nations, 2016). Good leadership will provide a great opportunity for countries to collaborate with each other in addressing this ambitious development agenda and help in reducing inequalities and improve living standards without leaving anyone behind. There is a greater need for leaders to forge a broader inter-institutional partnership and engage the young people on the SDGs. This will ensure that young people play a key role in the realization of the SDGs. The initiative will also contribute to a brain trust of young leaders supporting initiatives related to the SDGs. There is also a need for public and private sector to combine efforts, experience, and knowledge to provide coordinated support to the Member States as they implement the development agenda (Blazhevska, 2017; United Nations, 2016). Qualities, theories and styles of Leadership Qualities of a leader The first quality of a transformative leader is a guiding vision. A leader is able to project an admirable future and communicate it to the followers in a convincing manner. In addition, he/she establishes achievable goals and objectives that are shared with followers. Together with followers, they work towards achieving those goals by overcoming challenges that threaten to be a hindrance. The second quality is that leaders have a passion in what they do. They believe in their goals and dedicate their focus in achieving them. Such passion is easily emulated by followers (Bethel, 2012; Prive, 2012). The third quality of a leader is integrity. They make promises that they are sure they can deliver. the fourth quality is honesty both in their professional and personal lives. Honesty enables them to build trustworthy relationships that steer the organisation progress. Moreover, effective leaders are trusted by their followers. Therefore, they are able to develop trusting working relationships that enables them to act on behalf of not only the organisation but also on behalf of the followers (Bethel, 2012; Prive, 2012). Besides, leaders have curiosity qualities that make them explore every aspect of their responsibility. It also involves determining the things that are essential to know to improve their success. Also, leaders have ability to take calculated risks aimed at achieving their objectives. Lastly, leaders have a sense of dedication to their work. They commit to work on behalf of their followers and do it in their best way possible (Bethel, 2012; Prive, 2012). Theories supporting leadership Theories that explain leadership are ever growing. Broadly, existing theories view leadership in one of the three aspects of leadership as a personality trait, leadership as a process or leadership as a combination of certain behaviours commonly known as leadership skills. a. Trait theory Trait theory states that people are born with certain characteristics that define them as leaders while others are born without those characteristics. It argues that the characteristics of effective leadership such as cognitive ability of the leader are qualities that a person is either born with or without. The trait theory has been addressed by hundreds of scholarly with some agreeing with it while other object to it. Zaccaro (2007) admits that there are leadership traits that make some leaders more effective than others. Therefore, leadership traits do matter. On the contrary Apelbaum, Audet and Miller (2003), noted that some of the said leadership traits are biases that are used to discriminate against women in leadership. They are societal expectations that associated with leadership roles. Another argument against trait theory is that it does not incorporate cultural, gender and ethnic diversity of people when enlisting leadership traits. The socio-environmental influence on individuals is not considered too. The assumption that people are born with leadership traits does not consider the important role of environmental and social influence that shape who people are or become. Besides, leaders with different skills and experiences have been observed to lead differently in various contexts (Appelbaum, Audet, & Miller, 2003). b. Contingency Theory This theory states that a leader’s effectiveness is contingent on how well the leader’s style matches a specific setting or situation. Contingency theory is differentiated from situational theory in that the later focuses on adapting to the situation. The contingency theory postulates that the effectiveness of a leader is based on how well the leader’s qualities and style match a given situation or context (Appelbaum et al., 2003). Contingency theory is a different view of leadership from trait theory. Contingency theory assumes that there are different situations that call for different leadership attributes. Hence, it postulates that there is no single characteristic of a leader. In contingency theory, leadership characteristics are matched with behaviours of the followers in addition to the situation or context at that time. However, this theory is challenged by the complex nature of contexts that can arise. In terms of organisation contexts, the theory fits well but cultural and social context or international context could be so diverse to apply contingency theory (Appelbaum et al., 2003). c. Path-Goal Theory The path goal theory aims to define the role of leaders. It states that the role of leaders is to motivate followers and provide an enabling environment where their followers can achieve the identified objectives. By solving followers’ challenges, an effective leader is able to motivate his/her followers to continue performing towards achievement of the desired goals. The path goal theory partly borrows from expectancy theory which states that people focus towards achieving a certain goal if they expect the outcome is worthwhile (Appelbaum et al., 2003). d. Transformation theory In this theory, the focus of leadership is to transform followers by way of motivating them and enabling them develop morality that leads to achievement of the desired goals. In transformation leadership, the leader engages with followers to create a bondage which is used to transform the followers and enable them to achieve their maximum potential. It is different from charismatic leaders where leaders with qualities such as extroversion are thought to be able to motivate people.   e. Transactional theory in transactional theory, a leader is expected to develop a system of rewards and punishment that motivate people to achieve a particular objective. The role of the leader is to create such a structure so that people can be rewarded for achieving the set objectives or can be punished for failing to achieve those objectives (Eagly, Johannesen-Schmidt, & Van Engen, 2003). Leadership Styles There are several leadership styles that keep changing based on situations and individuality of leaders and their followers. They include charismatic, autocratic, dictatorial and transformational leadership styles. The charismatic leader is charming, persuasive, depend on their commitment, and conviction in a cause. The leader works towards ameliorating the status quo for instance Martin Luther King Jr. In Autocratic style, the leader is authoritarian and exercises his/her control in all the decisions made with insignificant input from the subjects. The leader relies on his/ her own judgement and ideas to arrive at choices and takes no advice from the subjects (Alharbi & Yusoff, 2012). The dictatorial leadership style is implemented in a manner that the leader behaves as a dictator where he/she solely decides on how, why, when, where, and what actions should be taken. The dictatorial leader is punitive to employees who fail to follow directives. Lastly, the transformational leader focuses on delivering change in social systems and individuals. The leader works closely with his/ her subordinates in identifying change needs, enacting a vision, and implementing change in an organization (Ojokuku, Odetayo, & Sajuyigbe, 2012). In my role as an administrator, I have used servant leadership style. In this style, the role of a leader is seen as that of providing service to other people. It emphasizes the role of leaders as the one who attends to the employees and customers as well as the community. It involves a sense of humbleness where a leader is a service provider and not a supervisor or recipient of services from his followers (Greenleaf, 2002). Leadership in practice Leadership is viewed as challenging, interesting and in many other dimensions. While some people may avoid it, others look for it. People are motivated to take up leadership for various reasons. According to Frederick Herzberg, for people to be motivated in a certain role certain motivators must be accompanied by it. Such motivators include recognition, advancement, growth, achievement and responsibility. He emphasized that if people are motivated in a certain role, then they are getting positive feedback about their work, developing skills and improving their productivity. Moreover, people are motivated if they are given challenging work, which they can assume responsibility (Tomey, 2009, p. 102). However, people are dissatisfied with their roles if they feel they are unfairly treated in pay, status, benefits, job tenor, interpersonal relationships, and supervision. All the factors that cause dissatisfaction are called hygiene factors and it is argued they do not motivate people to improve performance although they can lower their morale towards a certain role (Tomey, 2009, p. 102). When motivational factors and hygiene factors are high, people are likely to be motivated to perform certain tasks with minimal complaints. If highly motivated people find their job interesting and challenging, they can ignore dissatisfaction factors. However, if there are high hygiene factors and low motivators, people see their roles as a paycheck (Tomey, 2009, p. 102) as demonstrated in Appendix figure 3. Taylor’s Monistic Theory (based on principles of scientific management) proposes that if energetic people with high productivity realize that they earn the same amount with a lazy worker who does much less than them, they lose motivation and abandon their optimal performance (Tomey, 2009, p. 100). Argyris’s Psychological Energy Theory proposes that people exert more energy to meet their needs than those of the organization. Therefore, the organization should tailor positions in a manner that meet individual goals. The larger the disparity between individual and organization goals, the higher the likelihood for dissatisfaction, conflicts, tension and subversion (Tomey, 2009, p. 103) Role of leadership in Quality management in the hospitals Leadership is crucial in realizing success in quality improvement interventions in hospitals (Sommerbakk, Haugen, Tjora, Kaasa, & Hjermstad, 2016). An institution may employ all best practices within the healthcare industry but it takes strong internal leadership to actualize the desired outcome of total quality management (Aggarwal et al., 2010) . Organizational leadership is vital in the creation of an environment that is suitable for the success of quality improvement interventions (Zaccaro, 2007). Leadership plays an important role in developing the institution’s strategy for quality improvement. This is manifested by the leader’s role in establishing an environment that strengthens the employees’ responsibility thus making it possible for the institution to meet its quality improvement goals (Tomey, 2009). The leader also leads the other employees by setting a suitable example for the to emulate thus delivering quality improvement goals (Asao, Mansi, & Banks, 2009) The leader exerts his influence on the employees who follow him/ her willingly towards the realization of quality improvement outcomes (Sinclair, 2014). In addition, the leader is a symbol of unity for the employees using his/ her unique talents thus ensuring high quality outcomes in every step of the designed interventions (Clarke, 2010). Generally, the leaders in a healthcare institution provide the essential influence on the employees who own and strive towards a quality improvement agenda (Donahue et al., 2011). Facilitators and Barriers to Quality improvement in Organizations The are several factors that influence the implementation of quality improvement interventions in healthcare institutions (Bieber & Annable, 2015). These include changing roles of professionals, formal meetings, and the educational strategies employed in quality improvement (Bethune, Soo, Woodhead, Van Hamel, & Watson, 2013; Clinton & Obama, 2006). Other factors include the political and economic contexts, the institution’s context, the social context, the patients, the professionals within the institution, and innovation (Batalden & Davidoff, 2007). Providing support to the staff and involving them is an essential facilitator for quality improvement in organizations (Beckett & Kipnis, 2009). In the absence of these factors, staff members lack the motivation to participate the interventions and instead resist the planned change (Crandall et al., 2012). In addition, lack of adequate staff coupled with insufficient funding negatively influence quality improvement changes (Rose, 2016; Sellers, Wong, & Kelz, 2017). Lack of cooperation from patients is a factor that undermines the success of quality improvement interventions for instance when implementing changes in the management of diabetic patients (Wittich et al., 2011; Wong, Etchells, Kuper, Levinson, & Shojania, 2010). In such a scenario, the quality improvement agents require a different approach in winning the patients’ cooperation (Powell, Rushmer, & Davies, 2009; Tanaka, Taniguchi, Wato, Yoshida, & Inaba, 2012; Winterberg, 2001). Other patient related factors include age differences that make it impossible to implement universal quality improvement strategies for both adult and young patients for instance in assessment of a specific cancer (Morrison & Headrick, 2008; Mwaniki, Vaid, Chome, Amolo, & Tawfik, 2014). Secondly, the implementation of change may also create tension amongst the patients thus leading to poor cooperation (Mainz, 2009; Windish, Reed, Boonyasai, Chakraborti, & Bass, 2009). Lastly, lack of the required expertise in a given specialty is a hindrance to the implementation of quality improvement interventions (Powell et al., 2009). Saudi Arabia healthcare industry has been characterised by slow adoption of innovation and resistance to change (Mohammed Al‐Borie & Tanweer Abdullah, 2013). Therefore, a refocus of the entire health and social care. Health policies are recommended to influence new vision, integration of health and social care services and to promote research that will be essential in determining the modifying services to the needs of the customers (Mohammed Al‐Borie & Tanweer Abdullah, 2013). References Aggarwal, R., Mytton, O. T., Derbrew, M., Hananel, D., Heydenburg, M., Issenberg, B., … others. (2010). Training and simulation for patient safety. 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Retrieved from http://search.proquest.com/openview/9d1acf4f7532a68ad8c120c055237db7/1?pq-origsite=gscholar&cbl=39817 Wittich, C. M., Reed, D. A., Drefahl, M. M., West, C. P., McDonald, F. S., Thomas, K. G., … Beckman, T. J. (2011). Relationship between critical reflection and quality improvement proposal scores in resident doctors. Medical Education, 45(2), 149–154. Wong, B. M., Etchells, E. E., Kuper, A., Levinson, W., & Shojania, K. G. (2010). Teaching quality improvement and patient safety to trainees: a systematic review. Academic Medicine, 85(9), 1425–1439. Zaccaro, S. J. (2007). Trait-based perspectives of leadership. American Psychologist, 62(1), 6. Appendices Appendix 1. Figures Figure 1. Leadership traits according to trait theory Figure 2. Illustration of path-goal theory Figure 3. Herzberg’s two-factor motivation-hygiene theory (Adopted from Tomey (2009, p. 103) Read More