Leadership theories in the context of healthcare management

Leadership theories in the context of healthcare whileagementDo healthcare human racegers need leading theories? Critically approximate at least two leadinghip theories in the context of healthcare management. According to Huczynski and Buchanan (2007), Leadership is defined as the process of influencing the activities of an organised group in its feat towards goal setting and goal achievement. Grint (20052) describes drawing cardship as a function of relationship among leaders and followers, rather than simply reduceed on the person of the leader. According to Bass (199019), leading is an interaction between two or to a greater extent members of the group that often involves a structuring or restructuring of the situations, perceptions and expectations of the members. thus it suffer be utter from the higher up definitions that leading is enacted with relationships with separates i.e. the followers and leadership is widely distributed throughout the organization. He althcare organisations around the world spend enormous meat of m unmatchabley in infrastructure and renovating facilities in hospitals, but spend a relatively less time or effort for the management of plenty who lead in it. impelling leadership is therefore necessary for the smooth functioning of healthcare organization.According to Gunderman R. (2009), healthcare leaders should understand the nature of the organization where they domesticate and should reverse in harmony with physicians, nurses, technologists, administrators and other members of organization. The people who work in healthcare organizations as leaders should understand the needs of the people they work with and should do them in order to increase their performance. Thus the overall performance of the organization depends upon the behaviour of leaders with their followers. Failure to understand human motivation endure end point in downfall of the organization. Medical leaders should find out at the followin g questions Which is more effective way to deal with the workers, benefits such as salary raises and prevalent praise, or sticks, such as threat of termination and reduction in compensation? How can we improve workers performance, through tighter control or by increase autonomy and empowerment? If the crucial needs of the workers are not fulfilled it can affect their commitment towards organization and whitethorn result in monetary instability of the organization.Leadership and management are often compared under the same platform. People are often conf subroutined and ask a question, Are managers leaders? The decide is NO, they differ from individually other in m whatsoever ways. Leadership is one of the roles that managers lease to play and is therefore a subset of management. According to Gopee and Galloway (2009), management is slightly measuring and monitoring performance against pre-determined goals, following policies and procedures, controlling and organizing the struc ture and systems, works within resource allocation and maximizing output and productivity for the organization. Whilst on the other side leadership is closely being heapary, anticipating change, motivating and inspiring workers and focusing on development of individualistics. Watson (1983), describes seven Ss models to distinguish between leaders and managers. According to Watson (1983), managers primarily rely upon 3 Ss namely strategy, structure and systems, whereas leaders depends on 4 soft Ss called style, lag, skills and shared goals. Hollingsworth (1999) suggests fundamental differences between leaders and managers. According to him managers do things sort out i.e. they are transactional, while leaders do the right things i.e. transformational, managers administer while leaders innovate, manager focus on systems and structure while leaders focus on people. Thus leadership is a two-way process based on leader-follower relationship while management is based on relationship between the people working in the organization as individuals or teams. (Gopee and Gathway, 2009).Theories of LeadershipSeveral leadership theories pay emerged over the past suggesting practical applications of leadership and its concept. incompatible leadership theories that are developed since 1920s are listed belowTime period1920s1940sTheoryTrait or Great man theoryBarnard (1938) for prescriptives Ghiselli and Wald Doty (1954) for the descriptives.Style or behavioural theoryBlake and Mouton (1964), Likert (1961) and McGregor (1960)FocusIntelligence, initiative and self-assurance.Participative culture, Represented a more democratic humanistic woo to the use of man in organisations and come at the time of reaction against scientific management.1960sContingency theoryFielder (1967), Schein (1980) and Vroom and Yetton (1973)An integrative way of tone at leadership, more specific to task work group and position of leader within that work group. A best fit lift.1980s property con tingencies theoryBennis (1992), Kotter (1982), Mant (1983) and Peters and Waterman (1982)This theory particularly foc apply on American Business leaders with just approximately perceptive comments as advantageously as Anglo-Saxon leadership habits.1990sTransformational leadershipBass and Avolio (1993), Cunningham and Kitson (2000a, 2000b) and Sushter (1994)Four components. 1. Idealised influence 2. Inspirational motivation 3. Intellectual stimulation and 4. Individualised consideration.Late 90s-2000sContemporary theories.Goleman (1999), Jumaa (2001),Alleyne (2002), Goffee and Jones (2000) charismatic leadershipConnective leadershipServant leadershipTransactional leadershipTransformational leadershipAdapted from- Jasper M. and Jumaa M (2005), Effective Healthcare Leadership,page-25-26Trait or Great man leadership theory.According to this theory certain persons boast inborn leadership characters. Many studies were conducted by the end of 1950s which explored specific characterist ics of effective leaders. (Handy 1993). These studies described world-shaking correlation between leadership effectiveness and following traitsIntelligenceSelf-confidenceKnowledgeInitiativeSupervisory abilityIntegrityBass (1990), based on several findings from studies developed a profile of traits that are marked in effective leaders. These are categorised in 3 areas mainlyIntelligence-Judgement-Decisiveness-Knowledge-Fluency constitution-Adaptability-Alertness-integrity-NonconformityAbility-Cooperativeness Popularity-Tactyet the trait theory has certain weakness and problems standardizedthe traits are in truth difficult to define accurately or to understand amplymany exceptional leaders do not possess all identified leadership traitsit cannot be concluded that a person is better or worse as a manager or leader only by possessing one or two traits.It is still questionable whether an individual could have all the traits for being a leader.However despite of many other leadership theories emerged today, trait theory has not been completely disregarded. For example- Recent research home(a) conducted by kouzes and Posner (2007) concluded that Admired Leaders were likely to draw out specific characteristics, whereas 50% or more respondents selected Honest (88%), Forward looking (71%), suitable (66%) and inspiring (65%). Around 28-47% of respondents selected intelligent, broad minded, straightforward, co-operative, dependable and imaginative as specific characteristics of effective leaders while less than 25% of people selected ambitious, caring, mature, courageous, loyal, self controlled and independent. However there is no evidence between the correlation of nature and the essential characteristics of leader nor on what an effective leader is. It can be seen as trait of position, or power or knowledge and wisdom. Kotter (1990) suggested the functional approach and rivet on the fact that the performance can be improved can be improved by training and the le adership skills can be developed over a period of time and completeded. He also suggested that organisations should not stop for leaders to come by their own rather grow their own by identifying employees which have certain potential to be a good leader.Transactional and Transformational theories have gained popularity for Leadership in Healthcare Organizations out of the various leadership theories available.Transactional leadership theory.Transactional theory of leadership is based on leading people by the sexual abstention of management position held in the organizational hierarchy. It is seen that in this theory leaders identify the needs of the followers and transact with them. Thus this theory is considered as a social exchange process based on the power and reward system. In healthcare organisations this theory is tie in to the achievement of organizational goals which also includes be health of local population.( Gopee and Galloway, 2005)According to Bass and Riggio (20 06), the transactional theory is based on the leaders who are successful or effective in such a way that they maintain equilibrium and harmony by fulfilling their roles according to the procedures and policies and use incentives to enhance employee loyalty and performance. The transactional leader sets goals, gives direction and uses rewards to strengthen employees behaviour towards meeting or exceeding established goals (McGuire and Kennerly 2006). Although this theory supports status quo and is more predictable but it has also been criticised by various authors as it is lacking vision for future of the healthcare organisation. Thus the transactional theory of leadership has a very narrow focus and the leader can have a naughty self interest which may eventually lead to disturbance in the organisational structure.(Gopee and Galloway, 2009)Transformational leadership theoryTransformational leadership is widely supported leadership approach for healthcare. According to Burnes (1978) , transformational leadership is identified as a process where one or more person engage in such a way that leaders and followers raise one another to higher level of motivation and cleanity. In transformational leadership leaders motivate their followers by transcending their own self interests, elevating their needs and making them certain of the mission of larger entity of the organisation where they belong. (Bass 1995). Transformational leadership is considered superior to the transactional leadership style as the whole workforce is developed as the part of the process whose main function is delivering organisations objective. This can be achieved by fostering identification, going beyond simple leader-follower transaction and developing and intellectually stimulating employees. (Vandenberghe et al. 2002).According to Murphy (2005), transformational leaders are visionary, self-confident, and self-aware in breaking professional boundaries to develop a multidisciplinary team app roach towards patient care. Transformational leaders jolly along the followers and motivate them to operation leadership by encouraging their notion that have the potential to achieve high aims. Thus a transformational leader is the catalyst for creating new innovative organisational paradigms (Murphy 2005 135). The transformational leadership style is described by Markham (1998) as collaborative, consultative and consensus seeking and attributing power to interpersonal skills and personal contact.Thus the transformational leadership allow the followers to develop ideas and aspirations on how things could be better in healthcare settings. It articulates a vision for betterment of the healthcare services and thus allows one to work for raising the standards of care and treatment. Manley (2001) identifies sextet transformational leadership processes in practiceAbility to develop a shared visionInspiring and communicatingValuing othersChallenging and stimulatingDeveloping want mod ifyUsing these processes, transformational leaders assist the people working with them to become empowered and take responsibility of ownership to practice challenges and solutions (Sashkin and Burke 1990). The impact of transformational leadership does not restrict to development of individuals but it can also produce significant changes in practice settings by influencing the organisational culture. One of the main features of the transformational leaders is that they can inspire other people to follow their clear vision and that they demonstrate self-confidence in their ability to articulate the vision and promote change.( Mullally 2001). Transformational leadership is also compared to that of a leadership style previously called as charismaticleadership which is now out of fashion. For example, people like Hitler, Churchill, Mussolini, Mao Tse Tung and The Reverend Moon have been perceived as charismatic leaders in the past but in todays modern era it will be difficult to call t hem as transformational leaders. Charismatic leaders are assumed to use their magnetic personalities to attract the followers. They are usually good orators and share their imaginary ideas with followers to create a common purpose. For example-Barack Obama demonstrate this ability during his election campaign and is believed to demonstrate complex ideas in a comprehensible manner to his followers.The concept of transformational leadership and its applications in complex organisations such as healthcare is based on tetrad central components (Bass 1998), (Plesek and Wilson 2001)Idealised influence (charisma)Inspirational motivationIntellectual stimulationIndividualised considerationTransformational leadership matter has been debated since the past three decades because the above four components can reflect the potential for causing organisational harm and destruction if the leader in the framework is supported by worked up intelligence (Goleman 2000a) to guide them through the swam py lowlands of organisational life (Schon 1983). According to Manley (2000) the transformational leadership approach is highly beneficial for the healthcare organisations as it has positive effects in the organisational change. An analysis of transformational leadership style in North America has shown qualities of integrity and honesty all strengthen by strong core of moral and ethical values (Bashor 2000).The key principle required in applying the transformational leadership in healthcare organisation needs practically openness and honesty in all interactions (Jasper 2005). The use of personal qualities (such as charisma, influencing skills and conference) needs to be equally balanced by high levels of understanding and personal insight. This can be achieved through self perception and feedback from other colleagues. The ability to inspire and motivate depends upon the process of visioning. The leaders should be able to describe their ideas with clarity and details and should e xplain virtually the future consequences. To achieve this vision one should start working for the future vision by learning from the past realities and should show a collective effort where everyone has an opportunity to participate in the creation (Fenton 2003). Intellectual stimulation can be achieved by maintaining mental and intellectual alertness and acuity which can be gained by encouraging open criticism and debate of wide ranging evidence base thus it helps to form the foundation of substantive change. The development of all individual towards their potential is one of the goals of transformational leadership. This can only be achieved by sharing thoughts of power bases in twain organisations and interpersonal relationships. (Jumma and Jasper 2005).Thus it is seen that the two leadership approaches i.e. transformational and transactional approach are different from each other. Transactional leadership mainly involves transaction between the managers and their managed peopl e while transformational leadership mainly focuses on various radical changes that can present challenges and growth for all.Comparison of Transformational and Transactional leadership approachesTransformational leadershipTransactional leadershipMerges own, followers and theorganisations goals, desire valuesinto common goal.Generates employee commitment to the vision.Challenges subordinateRewards informally and personallyIs emotional passionate about existing and new venturesSees home and work on a continuumAims to maintain equilibrium and status quoIs task-centred and orderlyCoaches and fosters sheltered learningUses outside rewardsHigh self-interestSees home and work as separateentities.Adapted from- Gallow and Gopee (2009), Leadership and Management in Healthcare, page-59Limitations of transformational theoryAlthough transformational leadership skills are highly desirable for effective functioning of an organisation, many management theorists like Bass, Avoliio and Goodheim (19 87) think that transformational leadership alone can cause problem in long time. According to them transformational qualities must(prenominal) be coupled with more transactional qualities of day to day managerial role. According to Bass and colleagues, the transformational leader will fail without the tralatitious management skills. (Marquis and Huston 2009). They believe both sets of characteristics should be present in same person in different proportion. In Johnsons (2005) research he suggested that highly effective managers require both vision as well as specific plan to carry out their plans for achieving goals.Concept of leadership within the British National Health ServiceThe bare-assed Labour Government included leadership as the part of their modernisation of the NHS and has been enshrined in the work of the NHS Leadership Centre, created in 2001as a part of NHS Modernisation dominance (The NHS Plan, DH 2000). The centre launched the NHS Leadership Qualities mannequin in 2002 (NHS Leadership centre 2003) the components of this framework contains 15 qualities organised in 3 clusters of setting direction, personal and delivering the service.Components of NHS Leadership Qualities FrameworkSetting directionPersonal qualitiesDelivering the serviceBroad scanningIntellectual flexibilitySeizing the futurePolitical astutenessDrive for resultsSelf beliefSelf awarenessSelf managementDrive for achievementPersonal integrityEmpowering othersHolding to accountLeading change through peopleEffective and strategic influencingCollaborative workingThese qualities reflect the values and beliefs intrinsic within the Governments political stance. Here the emphasis is on personal attributes and qualities as opposed to that of traditional source of authority and power or target driven incentives derived from business culture (Jumaa 2005). These qualities are considered as a set of key characteristics, attitudes and behaviours that a leader must possess in order to delive r the NHS planSetting the standard for leadership in NHSAssessing and developing high performance in leadershipIntegrating leadership across the service and related agencyIndividual and organisational assessmentAdapting leadership to suit changing context.Case studies to demonstrate effectiveness of leadership theories.Case study 1.To measure the effectiveness of the new leadership framework in NHS, healthcare commission (now-Care Quality Commission) conducted a NHS staff muckle. It was conducted in October 2003 and is plausibly the largest workforce survey in world. Total 572 organisations took part and around 203,911 NHS employees responded to the survey questionnaire. (www.cqc.org.uk) Results were produced before Healthcare Commission Executive Anna Walker. According to the survey more than 200,000 staff people told they liked working with NHS. Most of them were convenient with their jobs but some part of the staff reported poorer work-life balance and higher level of work rel ated stress. Thus healthcare commission urged NHS organisations to investigate and address these issues and try to get solution for it through more effective leadership approach.The fifth annual national survey of NHS staff was conducted between October and December 2007. In this survey 156,000 employees from all 391 NHS trusts in England responded to a questionnaire asking about their views and experience of working with the NHS. The aim of this survey was to look at the attitudes and experience of NHS staff so that the employers can review their own staff and take necessary action. The results of the survey showed that job satisfaction remained high among most of the staff. 75% of staff was satisfied or very satisfied as well as satisfaction with the amount of responsibility. While in price of staff engagement mixed results were seen. Around only 23% i.e. less than quarter of staff agreed that senior managers involve staff in substantial decisions and only 22% agreed that collo quy between staff and senior management is effective. While only 26% of staff were satisfied, or very satisfied with the extent to which trust values their work. This was the single most common reason given by those thinking of leaving their jobs. Along with this 8% of staff said they had experienced some discrimination at work in the previous 12 months. About 3% said they had been discriminated against their ethnic background.Thus it can be concluded from the above two studies that the NHS staff were generally satisfied with their jobs. However there were some areas where significant action is needed for improvement. The NHS should also make some effective plans to value staff and engage them successfully in important decisions-making. While NHS should also do more in order to improve the communication between staff and senior management.Case study 2.The Healthcare Commission also conducted 5 surveys in 2004 to find out patients overall experience about the new NHS. The questionnai res and methodology were designed by the NHS Surveys Advice Centre at Picker institute Europe. About 850 eligible people were identified from each trust that took part. A total of 568 NHS organisations and 312,348 patients took part. The response rate for the patients varied from 63% for the adult in patient survey and 42% for the mental health survey. Results were published in offshoot week of august 2004 and the Commission reported that patients gave positive opinions about the high quality care they received at the NHS. Majority of patients said they have trust and confidence in the clinical staff. They are listened to and treated with lot of dignity. Thus a great improvement in communication between the NHS staff and patients was seen and people were allowed to give their own suggestions regarding the facilities they would like to see as an improvement for the organisation. (Jasper and Jumaa 2005)Case study 3.The following case study is based on my experience of working at a Mu ltinational Pharmaceutical caller-out, Zydus-Cadila healthcare limited, India. It is an innovative global pharmaceutical company that discovers, manufacture and markets a wide range of healthcare products. It produces products like Active Pharmaceutical Ingredients (API) to formulations like tablets, capsules, syrups etc Along with this it also manufactures various animal health products and cosmeceuticals. Headquarter of the company is located in Ahmedabad, India. It also has its offices spread across four continents and different countries including USA, Europe, Japan, Brazil, South Africa and 25 other emerging markets. They employ around 10,000 employees worldwide and have one of the best Research and Development centre for drug research. The motto of the group is Improving peoples lives through innovation.I had an opportunity to work there as a trainee for my under graduation internship for a duration of 6 months. My role included looking after the process involved in operatio n of different departments like production, packaging, storage, marketing and submitting daily report to the manager. The whole company was perfectly organised and the management was distributed in a systematic manner depending on the type of department. There were different mangers according to the department like for Human-Resource department, output department, Quality-control department, RD (Research and development) department and the Marketing department. Each of the department had a head person above them under whose guidance all mangers used to work.According to me, the leadership approach in this organisation contained both transactional as well as transformational concepts of leadership theories. The manager under whom I used to work was a transactional leader. He was very particular about the work. Right from the start day of my training I found him a bit eccentric. He was not at all sociable with all of us working under him. He used to assign each of us a particular w ork for a day. For example- On the first day of my training I was told to go and check the ware house of the company where the finished goods were stored and to write the Standard Operating Procedure for dispensing the goods. Following his instructions we all went and did our report writing work. He came for a visit within 3 hours, gathered all of us and started asking questions about what we observed. Those who were unable to answer his question were scolded. He gave us first warning about our work and said those who will complete their work early and accurately will have the additional benefit i.e. they will be allowed to go home 1 hour early. This thing worked as an incentive amongst all of us and thus we became more enthusiastic towards our work. Slowly over a time it was realised that the way he was leading us was different from others. For him the sole purpose was getting the work done from us in such a way that each one of us feels excited about work. He was very professiona l at work while very jovial and friendly at home. He was totally task oriented and orderly person. He never accepted any ideas or suggestions from any of the followers. Thus he was more of a transactional type manager.The other type of manager under whom we were working is completely opposite of the above mentioned manager. He was our marketing department manager. He was a true example of transformational leader. The way he used to lead us was truly inspirational. He used to explain us the complete process before handling any work. He was very supportive at work and had a vision for companys success. His communication and motivation skills were excellent. Right from the first day of my training under him we liked working with him. He always welcomed new ideas and suggestions for marketing. He was very much focused about his vision and always strives hard to achieve it. He had good interactions with everybody in the team and always used to motivate us. He used to look at everybodys w ork personally and if he will notice any mistake in our work would teach how to correct it on the spot only. He used to ask for the feedback about his new ideas from each of us and correct himself if the feedback was not satisfactory. This shows his eagerness to work with the team which created positive effects on each of the team members. He was never after rewards from the company. His only aim was taking companys sales to the epitome of success. He was fully dedicated to the company and worked with whole heartedness. Thus all of us used to work with great enthusiasm under his leadership. So he can be described as a perfect example of transformational leader. Hence the company Zydus-Cadila Healthcare limited has a mixture of transformational and transactional leaders which ultimately results in the success of company.ConclusionThe essay here explains about various leadership theories in healthcare and its effectiveness by the use of some case studies. Healthcare organizations are complex in nature. It requires a well balanced management and leadership approaches to effectively run the organisation. Each individual in organisation should share their knowledge with others. This synergy among workers is the key part for times of new ideas and concepts for the organisation. Many leadership theories have been developed since past and still it is continuously adapting a new change for the effective leadership theory. Considering leadership in healthcare it is seen from the example of NHS in the UK that the combination of both transactional and transformational leadership theory may be the most efficacious for an organisation. Thus the healthcare managers require leadership theories and put them in practice to make it work effectively. However, according to Grint (2005105), one of the top secrets of leadership is not a list of innate skills and competences, or how much charisma you havebut whether you have a capacity to learn from you followers.