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Introduction
The question of leadership effectiveness has stormed the behavioral sciences for a long time. There has been extensive research on the effectiveness of leadership style and of theories in different areas of work such as business, nursing, education, military, and politics. The leadership in each case has been adjudged to be an important element in all forms of leadership studies as it is believed by behavioral scientists is that the head of the institution and her style of handling the organization makes a lot of difference to the way the institution is organized and works. One of the questions that is repeatedly asked by leadership researchers is who is going to lead. The question drives many of the functions and operations in an organization. However, behavioral scientists have dwelt over the leadership question somewhat differently, for they want to know who should rule. This is a question that desperately needs to be answered when general elections occur during electing the leader of the state, or there is supposed to be a change in leadership in an organization, selecting a new principal for an educational institution. This is an important task for it is imperative to evaluate leadership potential. Based on the judgment of leadership and its potential future in the organization is determined. If the answer to finding the right leader is done incorrectly, the consequences are adverse for teams, nations, armies, and even economies.
Studies on leadership in behavioral science literature are abundant. Volumes of research papers are published on the topic every year. Bass has conducted a meta-analysis of 7000 books, articles, and presentations on leadership research showing the vast number of research work done in the area (Bass, 1990). A few of the theories of leadership that were researched upon were path goal theory of leadership (House, 1996), leader-member exchange (LMX) (Graen & Cashman, 1975; Dienesch & Liden, 1986) , normative decision theory (Vroom & Yetton, 1973), and transformational and charismatic leadership (Yukl, An evaluation of conceptual weaknesses in transformational and charismatic leadership theories, 1999). However, the effectiveness of these theories may also be seen in different forms of organizations.
Research in healthcare leadership has increased considerably due to the increased demand and constrained faced by the authorities eager to reform health care systems (Brook, 2010; Fisher, Berwick, & Davis, 2009). Though there has been adequate discourse on the need of medical leadership, physicians have been ambivalent to take up a leadership role whether it was in their current operations or renewing of their ob roles for the future. However, most of the physicians due to leadership roles were disenfranchised and decided retreat to care delivery and taken a policy of wait-and see (Fisher, Berwick, & Davis, 2009).
The work that front line physicians do is challenging, and physicians who decide to take up leadership roles actually embrace leadership roles face significant amount of barriers in term so of financial constraint and status distinctions (Mountford & Webb, 2009). Further lack of training also causes a great impediment to their success as leader. The complexities that medical leadership involves leads to uncertainty, as most of the medical practitioners are unfamiliar with the leadership styles and therefore, are often ill-equipped to lead.
The implication of the leadership theories and their applications though not completely documented in medical academia, however, it is irrefutable that leadership is a vital part of modern organizations. Therefore, delegation of work to the proper department that operates independently is essential. Leadership also affects the quality of health care provided to the patients and therefore affects the decisions taken by the policy makers. In this respect, one must understand that leadership roles are not constraint to the top level of the management only but is dispersed to various levels of management and administration. Leadership may be required in every level of the management. This also includes tasks related to the management and administration. Various researchers and academicians have differentiated between the concept of management and leadership.
In academia, many believe that management is the method of bringing stability and order in work while leadership taken on a more transformative role to lead toward constructive change (Storey, 2006). In healthcare industry the importance of good leadership at all levels of the hierarchy is important as the service is related to the live of patients. Therefore, the leadership of the chief executive officer along with the others like the physicians, nurses, pathologists, etc. are all important for delivering the right service and proper functioning of the institution. Leadership research, therefore, relates to a gamut of leadership related topics such as personality, ethics, competency/skills, teambuilding ability, behavior, etc. Leadership research is not limited only to understand the leadership behavior of the leader but also the efficiency of the smaller leaders such as team leads in order to understand their effectiveness. Therefore, it is important to undertake a through literature review of the leadership theories in other fields such as management or political science has to offer related to leadership in order to embark on an analysis of the study of leadership effectiveness in healthcare service.
Definition of leadership in general management literature is varied and extensive. Leadership is defined based on various aspects such as traits, behaviors, influences, role relations and occupations. Peter Drucker has defined leadership is a unique manner: the only definition of a leader is one who has a follower (in Yukl, 2010, p. 20). Leadership may be defined as the behavior of an individual & directing the activities of a group toward a shared goal. (p. 21). Another definition of leadership is based on the verbalization of the visions and long-term goal of the leader and in helping in creation of an environment, which allows achievement of the set targets. Leadership has also been defined based on the leaders ability to understand what people are doing and how successful they are in working together with high degree of commitment. In other words, different researches believe leadership to be a different thing based on their perspective. No single research can point at leadership in completion, rather they just point at one aspect of leadership. Therefore, while understanding leadership theory one must understand that there probably are as many leadership theories as there are leadership researchers. Based on the understanding of the leadership theories that has been derived through an evaluation of the literature, the following chart has been made.
Table 1: Leadership Theories.
The difference between management and leadership roles has been extensively studied in literature. Various research articles published demonstrate the definition of effective leadership. Bass (1990) has mentioned that there are as many definitions so leadership as many as the number of researches available for it. However, a comparison of management roles and leadership has only made the researchers understanding of leadership clearer.
Abraham Zaleznik (1992) in his article published in Harvard Business Review discusses the difference between managers and leaders. He point out that leaders are those who are responsible to energize the system, and work almost like a catalyst. Zaleznik demonstrates that it is the manager who pursues control and discipline while the leader energizes the organization towards a specific goal:
A managerial culture emphasizes rationality and control. Whether his or her energies are directed toward goals, resources, organization structures, or people, a manager is a problem solver. & From this perspective, leadership is simply a practical effort to direct affairs, and to fulfill his or her tasks, a manager requires that many people operate efficiently at different levels of status and responsibility. (Zaleznik, 1992, p. 126)
Therefore, Zaleznik believed that managers were there to retain stability of the system while leaders are those who stimulate the system and steer it towards its goals.
Bennis and Nanus (1985) too have demonstrated various differences between leaders and managers. According to them, leaders are the one who are well connected with the important people. They also believe that leaders are more committed and seek greater commitment from their subordinates; they are more focused and are viewed by others as asset to the organization. Leaders are also supposed to share information with others adequately, and enable networking among subordinates that helps in easy flow of information. They are focused on how things are to be done, and they value secrecy in organization often leading to lack of proper communication. Managers tend to be more compliant themselves, they seek compliance from subordinates, and they are at awe with formal authority. These ideas have been used and built upon by many researchers in subsequent years.
Table 2 summarizes the differences between a manager and a leader. The stress is more on the conceptual and the practical differences between the operations of both. Historically, leadership literature has shown an unanimous agreement on the difference between the functionalities of a leader and a manager. However, there is still a lot of difference given by different researchers.
Table 2: The difference between Management and Leadership.
Based on the various leadership theories and researches, the next step is to formulate the research question for this particular research. This is a study of leadership in the healthcare domain, it is important to first define leadership as is understood in health care. Then the effectiveness of each leadership style and theory is to be analyzed based on past literature. The aim of the paper is to understand the leadership styles that can be effectively utilized in the healthcare industry. The paper will first trace the definitions of leadership in health care leadership literature. Then it will demonstrate the various approaches to leadership. The third step would be to discuss the most important leadership traits and skills for effective leadership in the health care industry. The fourth section would deal with determining the source of leaders sources of power and her influence on subordinates. The fifth section will deal with the process of leadership development. The sixth would demonstrate the dissimilarities between transactional and transformational leadership. The seventh section would describe the importance of emotional intelligence in leadership success.
Leadership in HealthCare Industry
Let whoever is in charge keep this simple question in her head (not how can always do this right thing myself, but) how can I provide for this right thing to always be done. Florence Nightingale (1969) (quoted in Oliver, 2006, 38).
These immortals words of Florence Nightingale are immensely important in leadership study as they point at the main patents of health care leadership important for providing high quality medical treatment to patients (Oliver, 2006).
Donnelly (2003) points out that leadership is not a static point but rather is a journey towards the greater goal of the organization. Therefore, the actions of leaders are easily reorganization. This is a difficult task for identifying an efficient leader is almost impossible. There are many literature that discusses whether leaders are born with their abilities to lead or they acquire those traits over time and through experience. In addition, other researchers have focused on the primary qualities required for a leader to become truly effective (Donnelly, 2003; Oliver, 2006).
One of the most important characters of a good leader is to be able to explore the motivations or beliefs that drive individuals and teams. A leader also can ascertain the perceived visions and goals of success by individuals and teams. In this respect, Oliver points out that a true leader requires the ability to critically appraise the team process and outcomes on the path to achieving a shared goal (Oliver, 2006, p. 39). Health care providers be it doctors, pathologists, or nurses, should have a clear insight into the leadership styles in order to have a clear picture of what is required to run a healthy and smooth flowing health care service. Therefore, the aim should be look for leaders within the organization rather than trying to create them. The root word for the word leader is path or course (Oliver, 2006). According to Adair (2011) it is a journey of a leader through the organization in achieving set goals and visions through appropriate use of power and authority.
Presently, both academicians and practitioners believe that all clinicians need to have leadership expertise so that they can take good clinical decision and help in imparting better medical care. Therefore, the need to develop a patient centered health care system has developed the need to have better and all-rounded leader at various level of the hierarchy (Cooper, 2003).
Oliver (2006) points out that a leader is an individual who demonstrate a specific set of behaviors that may differentiate her from others. Usually such different set of attributes or behavior is observable in groups. Oliver further says that two specific aspects are signs of a leader. They are Individual attributes or styles essential to become a successful leader and organizational skills required to manage the process of change (Oliver, 2006, p. 41).
The modern form of leadership was used in the 1990s with the charismatic leadership style that was also called the renaissance leadership style. This style of leadership aimed at utilizing power effectively and utilizing their leadership influence into influencing key players into supporting change. We have seen charismatic leadership in the leadership styles of Winston Churchill and J.F. Kennedy.
A connection between the transformational style of leadership and the charismatic leadership can easily be established. Oliver (2006) points out that charismatic leadership is less likely to delegate in a way that empowers the workforce. The focus is that of building collaborative structures and networks to effect change. (p. 42)
Trust on leadership ensures smooth conduct of the functions of an organization and helps in estimating the way a task may be completed. Leaders can become leaders only if there is a consensus among subordinates to nominate her as the leader. Without popular support, one cannot become a leader. Therefore, it is the subordinates who officially nominate a leader and allows her to have the title. However, it is upon an effective leader to utilize this recognition to her advantage and help in initiating change within the team is a mark of a successful leader. One of the key roles, therefore, that leaders have is to initiate change within organizations.
The most important aspect of being a change agent is to have a clear perspective and understand the requirement of the change process and that of the organization. a change process requires proper planning and communication of the change plan, which is the explicit role of a successful leader who acts as a change agent. The leader is expected to operate as a transformational leader in such situations. However, depending on the requirements of the project, inspirational or influencing leadership may be required. The competencies that a leader holds help him to ascertain his self-capabilities ad also allows the leader to understand how he could instruct and motivate his followers.
Application of Leadership Theories in Healthcare
Why understanding the theories of leadership in context of healthcare important? Further, why is it important to know the importance of the leadership theories and the one that can be applied in healthcare service? In order to answer this question, it is important to understand the way healthcare industry has transformed over the years. Further, it must be noted here that though the service sector has undergone tremendous change, it is important to understand that leadership must be able to handle the changing needs in the industry. With the exciting new changes in technology and other related developments, a leader too must be abreast with the increasing autonomy the sector is going to provide to its employees and the changes that it will bring to the nature of work. The leader must be abreast with the possibilities of new kind of works that may come ones way like writing policies, and implementing them, challenging the old, obsolete policies, and evaluating others. Effective leadership is an important thing that health care organizations have in order to provide high quality service as well as remain financially viable. All employees at different levels of the healthcare service, who require a supervisor to overlook their work and depend on other peoples performance, need to become a leader in the new healthcare system. Therefore, leadership quality is paramount to get work done. Based on our understanding of the present health care industry scenario we may present a few challenges that leaders may face.
Challenges of Transformation
One of the primary jobs of a leader in health care sector is to bring about changes that are required in the organizational operations. In order to make a health care facility completely successful and operational six major challenges has to be overcome by the leadership.
1st Leadership Challenge
The first challenge that is faced by the leader is to rearrange the cultural codes and values of the institution. This is understood through establishing a contrast between the health care systems and the cultural contrasts that may exist in the proposed changed system. If the older rules have to replaced by the new ones, it is the leaders duty to inform the rest of the organization. Therefore, it is the job of the leader to reframe the basic values and belief system of the organization. For instance, a healthcare professional is recruited based on her abilities and qualities as a health care provider, therefore, making it her responsibility to than any other professional attribute. His task therefore is to transform the professional work environment that previously existed in the organization. Rewriting the values of the organization more highly priced than the professional attributes necessary. Some of the autonomic values have to be reframed within the professional philosophy of the healthcare providers that would incur a transformational task. The changes that are transformational in nature requires participation of employees who are ready to change their core values and require a much different kind of leadership style than that of a transactional leader.
Transformational change, that requires to change the core value of the organization, particularly amalgamation of traits an behavior that are accumulated to authentic the qualities of a true leader, that are necessary for success in a changing environment. It will be upon the top managements to address the more difficult problems facing the organization through their established leadership systems. They will have to look into the authentic leadership traits that are required for the younger leaders to manage their tasks. Intrinsic traits allow leaders to possess desired values to drive the organization through changing times.
2nd Leadership Challenge
The second leadership challenge in faced in order to create capabilities for improvement in the organization. The challenge is brought about not by the nature of the challenge but rather by the breadth and length of the challenge that a leader faces. The goals of transformational vision are different from those of transactional leaders and hence they aim for not just theoretical improvement but ideal performance. Another condition entails that the teams will expose the strain in existing leadership and leaders and will demonstrate their weaknesses as opposed to the virtues of current leadership. This would help in areas of communication with the apparatus, spread of work, and the developmental aspects of new leadership. The superior leaders will be responsible to frame the execution plan for aggressive and widespread improvements both at the level of teams, projects, and organizations.
3rd leadership challenge
This pertains to the difficulty to collaborate across different precincts. Many of the problems today arise from fragmentation of health care patients care system in the course of treatment. For instance, lack of data sharing throughout the community is a cause of problem that results in waste and duplication in erroneous medications, tests, and lost opportunities. This causes a great hindrance to the medical preventive care. Similarly, leaders are also expected to collaborate with the competitors to establish a credible and transparent system that is to the best benefit of the public. This will lead to the transformation of the community wide medical system. Further performances of the leaders are affected through transformation need and the break out with older patients. The competitive propriety may develop fully into a collaborative system that nurtures relationships for the best interest of the organization. this is not something that mostly leaders do naturally, rather this is required for the strategic stewardship off the organization and enhance community care.
4th Challenge
For many of the health care facilities a problem arises to create a business culture that nurtures both business results as well impart community benefits. The tangle of mismatched and opposing payment policies actually creates a contradictory situation wherein leaders are baffled with the idea of doing good while conducting business. Therefore, the business value of the health care business will be determined not only by the profits the business makes but also by quality of care, it provides to its patients. Therefore, it would upon the leaders to transform the collaborative and the supply chain aspects of the business, to develop a new business environment that can sustain qualitative growth toward achieving organizational goals.
5th challenge
Given the turnover rates of CEOs in health care, it is highly likely that the transformational agenda will play out over the tenure of at least two CEOs, if not more. Drive system-level, rather than project-level results. Research has proved repeatedly that we can do small projects to land a boat on the coast. The tangle of mismatched and contradictory payment methods, regulatory constraints, and organizational business models that constitutes the American health care system does not provide an obvious way to do well by doing well. How will the transformational agenda become so deeply engrained in the culture, leadership succession, and other organizational systems that it would be difficult, if not impossible, for a new CEO to derail it? It will therefore be necessary for leaders in this transformation, in collaboration with purchasers, payers, and regulators, to develop new business environments that keep pace with and support the improvements in quality they are achieving within their organizations. Improvement capability is far too often left to a project-by-project approach, and seldom is linked consciously to a plan to drive far-reaching system-wide improvement in outcomes of interest to the community and patients.
6th Leadership Challenge
Look after consistency of reason over the lifelong transformational excursion. How has this studying technique influenced my private / pro objectives? This test is similar to that challenged by WWII guides acknowledging the attack of Normandy. By what means will consistency of intention be looked after over the lifelong? It is truly an additional thing to bind to a full-scale attack. Very frequently, exhibition change is seen as a pet task of the present CEO, as opposed to inserted into the DNA of the conglomeration itself. How have the aforementioned speculations affected my private expert style? That is what has been lost from extremely numerous medicinal services conglomerations approach to value. Converting a conglomeration will require significant investment.
what means can the aforementioned speculations be brought about in my private/master life? While the facts may confirm that certain properties of value for example wellbeing are basically basic standards (First Do No Harm), and hence ought not be put to certain math of business worth, it is likewise accurate that if medicinal services conglomerations bankrupt themselves, they cant perform the aids required by the neighborhood. For numerous current human services frameworks, there is no clear relationship between enhanced value and enhanced business comes about. It might be one thing to demonstrate at an activity level that one could bring a vessel on the seashore of Normandy and unload certain troops and weapons. This is a genuine issue in social insurance. What initiative speculations best fit my private quality framework? What is the quality of this activity? Pioneers will compose change to move conglomeration wide exhibition, not boutique ventures.
Leadership and Ethics
In most of the leadership studies, the main aim is to ascertain why one follows a leader and how does a leader make others follow her. Being a leader is a challenging job, for many followers would be looking up to you, and you will be responsible for the decision-makings of the organization or team.
Studies have indicated that insights is a component that influences moral behavior and fruitful business, however the intelligence identified writing shows that goodness is additionally a prerequisite to demonstrate that moral organizations are more fruitful (McKenna, 2011). If an individual comprehends his or herself, they can come to be more mindful of their ethical conduct, which can in turn, make them more conscious of the affections of others when they are undertaking their moral qualities and standards (Kakabadse & Rozuel, 2010).
Morals have expansive influence in all parts of life, which implies that it moreover has impact all hands on deck and organizational mentality. This compass can permit an individual to assemble an ethical viewpoint, which will give them the impetus to comprehend the issues to support them in fabricating a code of morals. Rainbow (2002) stated that a supporter of this hypothesis will never break his guarantees to a companion and dependably holds fast to the law. In other words, a supporter of this speculation will never break his guarantees to a companion and dependably holds fast to the law. Utilitarianism is an objective regulated hypothesis that underlines euphoria or the most stupendous useful for the most fantastic number and includes the capacity to expect the results of an activity (Altekruse, Engels, & Freeman, 2004).
Morals have extensive influence in all parts of life, which implies that it likewise has influence on organizational mentality. This compass can permit an individual to fabricate an ethical point of view, which will give them opportunity to comprehend the issues to help them in asse
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