What is leadership?
- demonstrating personal qualities
- working with others
- managing services
- improving services
- setting direction.
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Leadership for Healthcare Improvement and Innovation
Transformational leadershipA more recent strand of work on leadership has sought to emphasise the difference between so-called ‘transactional’ and ‘transformational’ leadership (Burns, 2004). Implied here is that true leadership is transformational, about setting a vision, facilitating change by inspiring and motivating people and guiding organisations towards successful change. By contrast, transactional leadership is associated more with the operational tasks of managing organisations, rather than changing them.There is empirical evidence that transformational leaders are likely to be more effective and produce higher levels of employee satisfaction than transactional leaders. It is also suggested that there is a direct relationship between transformational leadership and organisational innovation (Jung, et al., 2003). These results appear to be replicated across a number of countries and cultures. For example, studies investigating leadership in over 60 cultures determined that the outstanding leadership described in all situations was transformational leadership.
Management and leadershipThese distinctions have led to additional questions about the difference between ‘management’ and ‘leadership’? Some suggest leadership and management can be used interchangeably as concepts, as effective managers must also be leaders.Others however see leadership and management as quite distinct, associated mainly with ‘transactional’ leadership styles. According to this view, managers enforce their formal authority to encourage performance through punishment or reward (Yukl, 2006). By contrast, leaders are assumed to influence people’s thoughts and values and motivate them to work towards a shared future vision (Kotter, 1999). Leaders are seen as encouraging and implementing change by breaking down organisational barriers to move the company forward. Managers, on the other hand, encourage people to work within existing constraints to maintain stability and consistent organisational performance (Burns, 2004).Whilst managers provide essential tasks such as budgeting and organising resources, leadership produces organisational change and innovative thinking. This approach therefore emphasises a difference between leadership and management skills, while recognising that both may be needed. In order to be effective, organisations need leaders who demonstrate strong management and strong leadership skills.
Challenges and problems with leadership theoryThe problem of ignoring the organisational and environmental context when studying leadership is one of the major criticisms of the leadership theories. The reliance on the image of the heroic individual leader has led to a lack of consideration about emergent or informal leaders within an organisation (Yukl, 2006). In papers discussing transformational leadership, group or organisational success is usually attributed to the actions of the formal leader, something which is not reflected in the reality of modern organisations which usually have multiple leaders. The consideration of context or the existence of informal, emergent or shared leadership has until recently been neglected (we will return to this issue in later steps).Concerns have also been raised about the evidence base. It is frequently argued that leadership is a fundamental component in ensuring effective organisational performance and that management alone will not suffice for the adaptation and survival of an organisation. Leadership effectiveness is often evaluated by looking at market share, profits and stakeholder values in commercial firms, or other outcomes such as clinical quality, safety and efficiency in organisations such as hospitals. In a later step, we will review some of this evidence in the context of clinical leadership.Measuring leadership in this way relies on an assumption that there is a direct relationship between leadership effectiveness and performance outcomes. However, the way in which leadership outcomes are measured and assessed, or even whether leadership actually has a tangible effect on organisational performance is still fiercely debated. Assuming that leadership is a complex social process, it cannot easily be studied in isolation, while what is perceived as being effective leadership will vary with time, follower perceptions and the social context. This has led to the view amongst some researchers that the impact of leadership is best understood as operating discreetly and indirectly, creating an appropriate working culture, formulating future strategy and providing a symbolic figurehead.
ReferencesBurns, J.M. (2004) Transforming Leadership. New York: Grove Press.Fiedler, F.E. (1964) A contingency model of leader effectiveness. Advances in Experimental Social Psychology, 1: 149–190.Hersey, P. & Blanchard, K.H. (1988) Management and Organizational Behavior. Englewood Cliffs, NJ: Prentice-Hall.Jung, D.I., Chow, C. & Wu, A. (2003) The role of transformational leadership in enhancing organizational innovation: Hypotheses and some preliminary findings. The Leadership Quarterly 14: 525-544.Kirkpatrick, S.A. & Locke, E.A. (1991) Leadership: Do traits matter? The Executive, 5 (2): 48-60.Kotter, J.P. (1999) What Leaders Really Do? Boston: Harvard Business School Press.Likert, R (1961) New Patterns of Management. New York: McGraw-Hill.Yukl, G.A. (2006) Leadership in Organisations. London: Prentice Hall.
Leadership for Healthcare Improvement and Innovation
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