- Leadership
‘A process whereby an individual influences a group of individuals to achieve a common goal’ (Northouse, 2013, p. 5)
Management focuses on the organisation of people’s endeavours as they work to achieve set goals that contribute to ensuring an organisation functions effectively and efficiently. A preference for approaches that emphasise employee empowerment is clear in current management practices, evidenced by a move away from hierarchical structures and the adaptation of contemporary leadership techniques.
- Management
Planning, organising, leading and controlling resources in order to achieve an organisation’s goals
Leadership theories
Evolvement
Leadership features in management, psychological and sociological sciences literature spanning over 100 years (Millward & Bryan, 2005). Early theories focus on the characteristics and behaviours of successful leaders. In later theories, consideration of the role of followers and the context for leadership is evident. Irrespective of their point in time, all theories have an individualistic viewpoint of leadership, discussing the concept in relation to one person’s actions (Bolden, Gosling, Marturano & Dennison, 2003; Martin, 2007). The majority of the research generated may be categorised into one of four major approaches:
Table 2.1 offers an overview of the evolvement of leadership theories.
- Theory
An idea or group of ideas based on a set of principles presented to explain a phenomenon, account for a specific situation or underpin an approach to future actions
| Great man theories | Based on the belief that leaders are exceptional people, born with innate qualities, destined to lead. The use of the term man was intentional since until the latter part of the twentieth century leadership was thought of as a concept which is primarily male, military and Western. |
| Trait theories | The lists of traits or qualities associated with leadership exist in abundance and continue to be produced. They draw on practically all the adjectives in the dictionary to describe a positive or virtuous attribute. |
| Behaviourist theories | These concentrate on what leaders actually do rather than on their qualities. Different patterns of behaviour are observed and categorised as ‘styles of leadership’. This area has probably attracted the most attention from practising managers. |
| Situational leadership | This approach sees leadership as specific to the situation in which it is being exercised. It also proposes that there may be differences in required leadership styles at different levels in the same organisation. |
| Transactional theory | This approach emphasises the importance of the relationship between leader and followers, focusing on mutual benefits attained from a form of contract through which the leader delivers reward and recognition in return for the commitment or loyalty of the followers. |
| Transformational theory | The central concept being change and the role of leadership in envisioning and implementing the transformation of organisational performance. |
Leadership theories in contemporary healthcare
Leadership involves the facilitation of change, the creation of a learning environment, the shaping of the cultural norms and values of an organisation and the sharing of a vision (Barr & Dowding, 2012). These components are essential in assisting all professionals to navigate their work in the complexities of the healthcare delivery context. Today’s healthcare leader needs ‘to create space for other people to generate new and different ideas; to encourage meaningful conversation between people; and to assist people in becoming more effective, agile, and prepared to respond to complex challenges’ (Martin, 2007, as cited in Singh & Sahay, 2009, p. 434). Healthcare leaders may utilise a mixture of theories, models and conceptual frameworks to guide their conduct.
- Framework
A comprehensive resource to support and sustain practices by the identification of parameters, creation of a common language, inclusion of guiding principles and provision of a prescriptive approach to work within
Servant leadership
Servant leadership places emphasis on ‘leadership as service’ (Parris & Peachey, 2013; Sendjaya et al., 2008; van Dierendonck, 2011; all as cited in Orazi et al., 2014, p. 39) that relies heavily on ‘relationship-orientated behaviours’ (Northouse, 2009, as cited in Orazi et al., 2014, p. 39). Yoshida, Sendjaya, Hirst and Cooper (2013, as cited in Orazi et al., 2014, p. 39) describe it as ‘a holistic approach to leadership that encompasses the rational, relational, emotional, moral, and spiritual dimension of the leader–follower relationship such that followers enhance and grow their capabilities’, which results in the development of a greater sense of self-worth. This approach is suitable for leading multidisciplinary teams through change processes, as it relies on the establishment and maintenance of ‘mutual trust and empowerment of followers’ (Howatson-Jones, 2004, p. 22).
Howatson-Jones (2004, pp. 23–24) claims that ‘trust is the cornerstone of the servant leader model of leadership, in that collegiate relationships are based on mutual respect and feedback, and direct in-the-field access to leaders … This model of leadership can help build trust and provide the support structures required to negotiate change successfully, while developing those involved to move forward and mature … The interdependence of this model contrasts with the traditional power models, and requires considerable maturity’. Servant leadership supports the role of a values-based approach to leadership, as it promotes positive organisational and individual outcomes.
Transactional leadership
In transactional leadership, the leader acts as an agent of change, making meaningful exchanges with employees that result in improvements in productivity (Al-Mailam, 2004). Characteristics of this approach are focused on the activities taking place at a daily operations level, with employee motivation being achieved through financial remuneration in exchange for services (Bass & Avolio, 1990).
A task-orientated style of leadership can have a positive influence on performance specifically, as an increased quality of internal communication through goal-setting, monitoring and feedback ensures that knowledge is generated to improve effectiveness and increase efficiencies (Bryant, 2003). The degree to which the leader and followers agree on the transactional aspects of the work equates to the level of the leader’s positive influence on performance and organisational commitment, and on the level of trust in the leader (Whittington, Coker, Goodwin, Ickes & Murray, 2009).
Transactional leaders operate well in structured environments, where goal-setting and efficient routines can lead to positive outcomes. Transactional leadership is effective in crisis situations, when a clear direction is needed for the common good and deviance is not tolerated (Orazi et al., 2014).
Transformational leadership
The crux of transformational leadership is being able to inspire a commitment among colleagues to collectively achieve the vision of a preferred future (Leach, 2005). Transformational leaders infuse pride and motivation in others, create a shared understanding and ownership of the future vision of an organisation and demonstrate open consideration of employees’ ideas (Burns, 1978). They engage peers across periods of change and prioritise the provision of resources needed to achieve goals (Hocker & Trofino, 2003), which makes the approach suitable in organisations requiring change, development, initiative and creativity in turbulent and uncertain environments (Bass & Avolio, 1990).
Collaborative decision-making, mentoring, a patient focus and the use of ethical frameworks are all supported by transformational leadership (Hocker & Trofino, 2003). Specific constructs that see it feature predominantly in healthcare management include participatory management, individual consideration, charisma and intellectual stimulation (Upenieks, 2003). The creation of a shared values system and sense of purpose provides transformational leaders with opportunities to mould how staff at individual and group levels may view themselves and their organisation (Martin & Henderson, 2001).
The approach of the transformational leader encourages an evolvement of the basic values, beliefs and attitudes of followers that informs their approach to work, which results in a greater level of empowerment to achieve the vision and mission of the organisation. The benefits are visible in a greater level of productivity, heightened employee morale and positive personal and professional growth (Gopee & Galloway, 2014).
Charismatic leadership
In an early study of charismatic leaders, charisma was defined as a particular persona that an individual can have that sets them apart and, as a consequence, sees them treated as the host of some exceptional qualities (Weber, 1947). The qualities credited to charismatic leadership may also be attributed to transformational leadership and include refined interpersonal skills, self-confidence, courage, the ability to imagine different and better futures, the ability to communicate vision and a willingness to take risks (Taylor, 2007a). Charismatic leaders demonstrate a preference for relationship-oriented behaviours (Northouse, 2009). They are highly motivated leaders characterised by a confidence in their skills and have a disposition that projects determination and inspires followers to cope in times of uncertainty. In this sense, charismatic leaders are entrepreneurial, making sacrifices and taking risks to achieve what they believe is the most beneficial outcome for the organisation (Orazi et al., 2014).
A leadership style that often emerges in times of crisis, charismatic leadership has a capacity to generate excitement, enthusiasm and loyalty while exhibiting the skills required to carry out the identified tasks (Taylor, 2007b). Given the investment required of those who opt for this leadership style, concern exists over their ability to retain its enchantment over a sustained period, strengthening the argument that organisations are more effective if they invest in the development of leadership capacity across all levels of staff (Conger & Kanungo, 1988).
Authentic leadership
Regarded as being in the formative phase of development and a newcomer to leadership research, authentic leadership is highly desirable in a period in which people are seeking genuine and trustworthy leaders (Northouse, 2013). It suggests that to be able to lead, individuals must be true to themselves and to their guiding values system, or set of principles, and must act in accordance with them in a consistent manner (Marquis & Huston, 2015). Authentic leaders have distinguishing characteristics that include understanding of their own purpose through ongoing self-reflection, consistency between their beliefs and actions, genuine compassion for their followers, establishment of strong connections and practice of self-discipline through striving for professional and personal balance (Shirey, 2006). A high level of self-knowledge, commitment to enhancing their own leadership capacity and engagement in an interpersonal process with colleagues to nurture skills in others feature in this style of leadership (Northouse, 2013; Shirey, 2006).
Clear benefits of authentic leadership are the inspiration and excitement it can generate in others to achieve a level of performance that is regarded as success. Such success confers benefits at an individual and an organisational level. It results in favourable personal outcomes that may include feelings of self-efficacy and job satisfaction, which creates increased organisational commitment, with the positive organisational outcomes verified by growth, meeting of financial targets and fulfilment of a service need (Shirey, 2006). Individuals and organisations benefit from authentic leaders who demonstrate transparency in their intentions and exhibit a seamless link between espoused values, actions and behaviours (Luthans & Avolio, 2003).
E-leadership
E-leadership occurs in a context where work is mediated by information technology. The introduction of advanced information technology in healthcare organisations is changing the approach to healthcare leadership (Avolio & Kahai, 2003), and given the continued growth and application of information technology in the healthcare sector, theorists suggest that e-leadership will become routine rather than the exception in organisational leadership (Zaccaro & Bader, 2003).
In response to greater reliance on technology to interact with colleagues, leaders find themselves conducting many of the processes of leadership through electronic channels (Zaccaro & Bader, 2003). Leaders and followers have a greater level of access to information and to each other, which is changing the nature and content of their interactions. The purpose of e-leadership is to enhance the relationships among organisational members that are defined by an organisation’s structure (Avolio & Kahai, 2003).
The challenges facing leaders who operate in circumstances where communication is no longer an interaction in person extend to building trust, maintaining open lines of communication and being open to subtle cues of concern (Barr & Dowding, 2012). Leaders adopting this approach are encouraged to facilitate communication and provide opportunities for shared learning (Avolio & Kahai, 2003).
Management theories
Skilled management has significant positive effects on productivity, profitability and the ability of organisations to adapt and change to meet emerging challenges. To achieve this in healthcare services, approaches to management need to be based on investment in skills, opportunities for employee engagement in the workplace and quality positions that provide incentives for employees to contribute (Orazi et al., 2014). In their practice, healthcare managers may use a combination of the theories discussed below.
Evolvement
During the Industrial Revolution, Frederick Winslow Taylor developed the four principles of scientific management that, if adhered to, would see productivity increase (see below). The works of Henri Fayol and Max Weber, produced in the late 19th and early 20th century, sought to combine theory with practice in addressing the fundamental issue of how organisations should be structured (Wren & Bedeian, 2009). The ‘management functions of planning, organisation, command, coordination and control’ were first identified by Henri Fayol (1925). These were expanded by Luther Gulick (1937) with the introduction of the seven activities of management: planning, organising, staffing, directing, coordinating, reporting and budgeting (Marquis & Huston, 2015).
A shift occurred during the 1920s when the focus turned to people rather than equipment. Several theories were generated in the human relations era, including participative management, the Hawthorne effect, theory X and theory Y, and employee participation (Marquis & Huston, 2015).
Approaches
Scientific management
A branch of the classical management perspective, scientific management theory proposes that efficiency and labour productivity are improved by scientifically determined jobs and management practices. Applying the four principles of management developed by Fredrick Winslow Taylor in the late 1800s, scientific management aims to improve the performance of individual workers through the use of analytical procedures to increase workplace efficiency (Daft & Marcic, 2013). Taylor’s (1911, pp. 12–77) four principles of management are listed below:
- Develop a science for each element of the job to replace the old rule-of-thumb method.
- Scientifically select employees and then train, teach and develop them to do their job.
- Supervise employees to ensure that the work is completed in accordance with the prescribed methods for doing their job.
- Divide the work and responsibility almost equally between managers and employees.
Organisational behaviour
Contemporary views on motivation, leadership, trust, teamwork and conflict management are informed by research on organisational behaviour (Robbins, Bergman, Stagg & Coulter, 2011), which addresses individual, group and organisational processes in terms of the impact of the individual on the organisation and the impact of the organisation on the individual (Davidson & Griffin, 2006). Advocates of the approach believe that people are the most important asset of an organisation and should be managed accordingly. Theorists’ work in this area has served as a foundation for management practices such as employee selection procedures and employee motivation programs (Robbins et al., 2011).
Hawthorne effect
A series of studies conducted in the 1920s and 1930s at the Hawthorne Works, at the Western Electric Company in Chicago, provide insight into individual and group behaviour (Mayo, 1953). Experiments established that psychological factors are an important variable in worker output and that the need for social acceptance affects output more than financial incentive (Davidson & Griffin, 2006). There is some debate concerning the rigour of several of the studies, but there is consensus that their importance in stimulating interest in seeing employees as more than extensions of production machinery far outweighs how academically sound the research was (Daft & Marcic, 2013). The studies are viewed as having had a significant impact on management beliefs about the role of human behaviour in organisations (Robbins et al., 2011). They identified the need for a new paradigm of management thought and have led to managers being equipped to handle the human element in the workplace (Davidson & Griffin, 2006).
Human relations movement
Instigated by the findings of the Hawthorne studies, the human relations movement is based on the notion that truly effective control comes from within the individual worker as opposed to an authoritarian approach (Daft & Marcic, 2013). The importance of employee satisfaction resulting in improved performance is advanced by the philosophies of Abraham Maslow and Douglas McGregor.
Maslow (1943) observed that individuals’ problems often stem from an inability to satisfy their needs. This resulted in his creating a hierarchy of needs that starts with psychological needs and progresses to safety, belonging, esteem and self-actualisation needs. The theory remains influential in contemporary approaches to management (Daft & Marcic, 2013).
McGregor’s (1960) work challenges the classical perspective and human relations assumptions about human behaviour through theory X and theory Y, which specify the extreme attitudinal position held by managers. Theory X represents the negative view of workers consistent with scientific management, and theory Y the positive approach, which aligns with the human relations perspective. McGregor advocates a theory Y approach to managing people (Davidson & Griffin, 2006).
Systems approach
In the 1960s, attention turned to analysing organisations from a systems perspective, generating a theory that focuses on systems and how they work and function within an organisation. The relationships between the parts are seen as equally important as the properties of the parts themselves (Davidson & Griffin, 2006).
- System
‘A set of interrelated and interdependent parts arranged in a manner that produces a unified whole’ (Robbins, Bergman, Stagg & Coulter, 2011, p. 56)
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