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4 LEADERSHIP IN HEALTH CARE,INTRODUCTION, So you want to find out about leadership but what does this mean exactly How. do you know that you are not already a leader You may be thinking that you have. only just started your career in one of the many health care professions and that. the leadership issue will not raise its head for some years but you could assume. some leadership roles early on Similarly you may have been a qualified practitioner. for some time and are about to move into a position that has a formal recognised. leadership role Whatever the reason this chapter will allow you to start to think. about leadership and its role in your life and career. The concept and theories of leadership have evolved and are continuing to do so but. how can a book on leadership help you to be a better leader Daft 2008 24 reminds. us that it is important to bear in mind that leadership is both an art and a science. Leadership is an art because many of the leadership skills and qualities required. cannot be learned and a science because there is a growing body of knowledge that. describes the leadership process By keeping this in mind we can understand how a. variety of leadership skills can be used to attain the best possible care for our patients. When first thinking about leaders in health care we may identify people like. Florence Nightingale 1820 1910 famous for her work at Scutari Hospital in the. Crimea collecting data the beginnings of research in nursing in order to improve. practice Mary Seacole 1805 1881 another nurse was refused an interview to go. to the Crimea Such was her belief that there was a real need for her talents there she. paid for herself to go and went on to be known as Mother Seacole She is now held. up as one of the first black women leaders Dr E L M Millar highlighted the need. for effective training within the Ambulance Service of the 1960s which ultimately. led to the current technician training and paramedic degree Kilner 2004 These. people did much for caring through their pursuit of improved standards and acting. as role models in the health care work they did In today s society you might think. of Tony Blair Nelson Mandela Barack Obama Benazir Bhutto or Indira Gandhi as. being renowned leaders Whoever you think of as an influential leader they must be. enthusiastic and love their chosen profession in order to command such respect and. to be able to infuse others with energy and enthusiasm Leadership involves people. being led so there must be those who are happy to be followers We must therefore. remember that effective leaders and effective followers may sometimes be the same. people playing different roles at different times This book will try to engender this. verve for effective leadership In order to address the identified learning outcomes. this chapter will introduce the nature of leadership comparing management and. leadership evolving theories of leadership and the art and science of leadership. RELATIONSHIPS BETWEEN LEADERSHIP,AND FOLLOWERSHIP, Owen 2009 xix postulates that one barrier in the definition of leadership is the belief. that leadership is related to seniority However he goes on to state that leadership. 01 Barr Dowding 4330 Ch 01 Part I indd 4 23 01 2012 8 07 18 PM. THE NATURE OF LEADERSHIP 5, is not about your position but about how you behave Think about the following. situation in relation to leadership, Sue Potter is a third year student on placement in the clinical area During the course of. the day she notices that a second year student in the same placement area often comes. to ask her for advice related to patient client care for a given situation Sue happily. explains the procedure to the other student highlighting the current research supporting. the action A qualified member of staff also approaches Sue for information related to. the research as it was an area of care he had not been involved with for some time Sue. was happy to tell the qualified person what she knew and then started to reflect on her. own abilities in leading and teaching She then started to examine why people felt that. they could come to her for information and support. Although Sue was not yet qualified she was clearly seen as a leader within that. situation The skills Sue demonstrated being approachable and teaching others. willingly are those of leadership Sue s example of supporting and sharing her. knowledge can be applied to any field of health care provision. It is important then to examine some of the variety of definitions of leadership. available Daft 2005 4 states that scholars and other writers have offered more. than 350 definitions of the term leadership and concludes that leadership is one of. the most observed and least understood phenomena on earth. Tappen et al 2004 5 suggest that there are a number of primary tasks involved. with being a leader,1 Set direction mission goals vision and purpose.
2 Build commitment motivation spirit teamwork, 3 Confront challenges innovation change and turbulence. So leadership would appear to be a people activity and occurs within group life it. is not something done to people Without followers there cannot be leaders and. without leaders there cannot be followers Haslam and Reicher 2011 2 so being. an effective follower is as important to the health care professional as being an. effective leader, Can you identify situations when you have been a leader and when you have been a follower. You might have been a leader during your time at school as a prefect sports team. captain or outside school as a girl guide boy scout youth club leader or even a. member of a parent teacher association Conversely you might also have identified. those same situations as being times when you were a follower Similarly there may. be times in your clinical area when you were a follower due to being unsure of. yourself but other times when you were a leader like Sue Followership is not a. 01 Barr Dowding 4330 Ch 01 Part I indd 5 23 01 2012 8 07 18 PM. 6 LEADERSHIP IN HEALTH CARE, passive unthinking activity On the contrary the most valuable follower is a. skilled self directed team member who participates actively in setting the team. direction invests his her time and energy in the work of the team thinks critically. and advocates for new ideas Grossman and Valiga 2000 Tappen et al 2004. 5 6 suggest that there are a number of things you can do in order to become a. better follower, 1 If you discover a problem clearly you would inform your team leader of the problem but. you might also offer a suggestion as to how it might be rectified. 2 Freely invest your interest and energy in your work. 3 Be supportive of new ideas and new directions suggested by others. 4 When you disagree with the ideas explain why, 5 Listen carefully and reflect on what your leader or manager says.
6 Continue to learn as much as you can about your speciality area. 7 Share what you learn with others, If you are to be an effective leader it is vital that you recognise the opportunities for. leadership all around you and that in these situations you act like a leader influenc. ing others in order to bring about change for a better quality of care provision. Leaders have to face some hard decisions in their work remembering at all times. that managing scarce resources such as equipment pharmaceuticals and transport. may not be easy and that managing people is much more complex. DEFINING LEADERSHIP, Leadership can be defined in a number of ways but is still an elusive concept. Indeed key authors cannot agree on the nature or essential characteristics of leader. ship but offer a variety of perspectives This indicates that leadership is thought to. be about relationships Leadership is a discipline that is evolving indeed Alvesson. and Spicer 2011 4 note the understanding interpretation and response to leader. ship is variable and complex On the one hand distrust and control are seen as. features while on the other support and close contact may be dominant Alongside. this on a more positive note Rafferty 1993 3 4 offers up the leadership notion. vision is driven from an emotional front with some practical ability to achieve that. vision leaders inspire you and others will follow and trust you They will trust in your. integrity Leaders care for the people they are leading serving Leaders try to strengthen. and promote these people They facilitate and help and encourage and praise. Bernhard and Walsh 1995 however identify leadership as a process that is used. to move a group towards goal setting and goal achievement and can be learned. whereas Stewart 1996 and Rafferty 1993 indicate that it is a combination of the. two Stewart 1996 3 recognises leadership as discovering the way ahead and. 01 Barr Dowding 4330 Ch 01 Part I indd 6 23 01 2012 8 07 18 PM. THE NATURE OF LEADERSHIP 7, encouraging and inspiring others to follow She agrees with the idea that leadership. involves the spirit personality and vision Rafferty 1993 3 4 thinks of leaders. as people who have that combination of conceptual ability. Can you find a definition that fits in with clinical leadership. Clinical leadership is a relevantly recent term and is seen as being about facilitating. evidence based practice and improved patient outcomes through local care Millward. and Bryan 2005 xv Stanley and Sherratt 2010 115 121 Working with common. definitions can lead into concept analysis a deeper process involving antecedents. attributes and consequences being unpacked Walker and Avant 1994 At a deeper. level leadership could be seen from various perspectives as being. A characteristic trait based in trait theory,A position based in the functional approach. A quality based in trait theory,A process based in functional approaches.
A power relationship style or the effect on group behaviour. These perspectives will be developed further in Chapter 4 How you view leadership. will influence your clinical beliefs values and behaviours Leadership must be a part. of caring Patients and clients deserve care that is well led at all levels of the NHS. health industry organisations,HEALTH CARE A CHANGING CONTEXT. Due to the driving technological forces and rising expectations our health service. has expanded to encompass a much greater provision than that envisaged when the. National Health Service NHS was set up in 1948 The NHS has its history in a. liberal socialist ideology of health being a right for all regardless of ability to pay. Its current complexity and philosophy has put great emphasis on leadership at all. levels It could also be said that the health service of today is seen by the public. almost as a religion or a system of belief This may be due to the expectation that. the health service can cure all ills The view that health is a much more sought after. and accessible commodity is stronger than it was in the past Sofarelli and Brown. 1998 conducted a leadership literature review and then strongly argued for the. need to move from the previous bureaucratic NHS management model to a model. of a leadership focused health service This new model is useful in order to cope. with the apparent dramatic change and uncertainty in the health service today. 01 Barr Dowding 4330 Ch 01 Part I indd 7 23 01 2012 8 07 18 PM. 8 LEADERSHIP IN HEALTH CARE, Bishop 2009 xii noted the emergence of significant policy changes The Darzi. Next Stage Review Department of Health DH 2008a highlighted the emer. gence of more clinician led services and the critical and main leadership role of. clinicians drawn from nursing and allied health professionals More recent policy. under the Coalition Government DH 2010a 2010b 2010c supports this contin. ued perspective, In support of this nurses and health care practitioners today need specific. leadership skills and clinical development in order to help them deal with this. rapidly changing situation in clinical care MacDonald and Ling 2002 Gopee. and Galloway 2009 Indeed this can relate to all health care professionals as. changes are occurring rapidly everywhere Rippon 2001 however argued that. leadership training per se will not produce the quality of leaders required to bring. through change A more sustainable solution lies with the development of what. he terms growth cultures in order to develop leaders with emotional intelligence. see Chapter 10 It is emphasised that leaders need to focus on inward rather than. outward bound experiences enabling a spiritual growth based on relationships and. awareness Wright 2000 Inward could mean greater self awareness and need. for learning whereas outward could relate to expected behaviours Depending on. the model the notion of growth cultures emotional intelligence and change will be. discussed further in Chapters 10 11 and 13,COMPARING LEADERSHIP AND MANAGEMENT. There appears to be some ambiguity between the notions of leadership and manage. ment Currently the terms leadership and management may be used interchangeably. because the differences between them may not always be straightforward Most of us. think we can recognise leadership but we may not find it easy to find it in ourselves. Jot down your ideas of the differences between a manager and leader in health care. Current thinking indicates that managers have formal authority to direct the work. of a given set of employees they are formally responsible for the quality of that. work and what it costs to achieve it Neither of these elements is necessary to be a. leader Leaders are an essential part of management but the reverse is not true you. do not have to be a manager to be a leader but you do need to be a good leader to. be an effective manager Table 1 1 reflects the differences between leadership and. management, The amount of time taken up in leadership activities might differ from person to.
person Sadler 2003 Cunningham 1986 in Sadler 2003 noted that leadership is. 01 Barr Dowding 4330 Ch 01 Part I indd 8 23 01 2012 8 07 18 PM. THE NATURE OF LEADERSHIP 9, Table 1 1 Differences between leadership and management. Leadership Management,Based on influence and,Based on authority and influence. An informal role A formally designated role,An achieved position An assigned position. Part of every health care Usually responsible for budgets. professional s responsibility hiring and firing people. Initiative Improved by the use of effective,leadership skills. Independent thinking, an integral part of the management role and as such may not be seen as a separate.
entity Figure 1 1 However Bennis and Nanus 1985 indicate that there are two. other models to be considered They are where leadership is seen as half and half of. the same concept see Figure 1 2 and where there is partial overlap see Figure 1 3. In each case the time taken for leadership functions will differ. Management,Leadership,Figure 1 1 Leadership within management. Source Sadler 2003 Reproduced with permission,Management Leadership. Figure 1 2 Leadership alongside management,Source Sadler 2003 Reproduced with permission. Management,Leadership,Figure 1 3 Leadership overlapping with management. Source Sadler 2003 Reproduced with permission, 01 Barr Dowding 4330 Ch 01 Part I indd 9 23 01 2012 8 07 18 PM.
10 LEADERSHIP IN HEALTH CARE, Overall management is defined in relation to the achievement of organisational. goals in an effective and efficient way This means that planning vision staffing. direction and resources are the main concerns that need to be controlled Managers. often seem to have a bad press due to the emphasis focusing instead on effective. leadership It should be remembered that management and leadership should work. together to achieve a common aim of effective quality patient care Dowding and. Barr 2002 discuss the potential effects of a wide variety of management. approaches on practice Examining these individually or in some detail is not. the remit of this book However if you consider the history of management. approaches it is evident that the way in which leaders and managers function. within the health care system is greatly influenced by the overall management phi. losophy in place Miner 1980 suggested that organisational knowledge goes hand. in hand with effective management, Therefore it is necessary to view the different elements of an organisation in. order to understand why it functions in a specific manner It can also help to clarify. or structure how you might be expected to behave in a given situation in order. to uphold the reputation of that organisation Similarly it may help us to adopt. management practices which while considered old might be the most appropriate. for a given situation,THE ART AND SCIENCE OF LEADERSHIP. Donahue 1985 indicated that nursing has been called the oldest of the arts and the. youngest of the professions Stewart 1918 in Donahue 1985 goes further to state. 01 Barr Dowding 4330 Ch 01 Part I indd 10 23 01 2012 8 07 19 PM. THE NATURE OF LEADERSHIP 11, that the science spirit and skill of nursing was beginning to develop as it became. apparent that love and caring alone could not ensure health or overcome disease. Nursing education in the past has concentrated on the science element or medical. model whereby nurses were told what to learn and when to learn it in relation to. the disease and the disease process More recently it has been recognised that the. patient is a person and not just a collection of symptoms Nursing then became. more art focused concentrating on holism rather than being medical science. focused concentrating on the disease process This has now changed to include a. holistic approach not only to deliver care in relation to a specific condition but also. to include the family and regular carers, Similarly in other professions related to health care delivery the initial purpose.
was to deliver care in relation to a specific condition demonstrating little concern. for the patient client as a whole Again this is changing for the better and in the. same way the notion of leadership and team working is becoming the way forward. for health care delivery, The concept of leadership has evolved over the last century and continues to. change That isn t to say that the old ways of doing things are not good but that. in today s business society there are different ways of getting things done ways. that enable management and leadership to work together Leadership is both an. art and a science An art because of the many skills and qualities that cannot be. learned via a textbook but a science because of the growing body of knowledge. that describes the leadership process leadership skills and the application of these. elements within a given practice area Knowing about leadership theories allows us. to analyse situations from a variety of perspectives to understand the importance. of leading an organisation to success and to suggest well thought out alternatives to. enhance a quality practice Studying leadership gives you skills that can be applied. not only within the workplace but also in your everyday life This book will lead you. through a variety of situations as an individual and a member of a corporate body. Summary of Key Points, This chapter has briefly looked at various aspects of leadership in order to meet the. identified learning outcomes These were, Discuss the notions of leadership and followership This was achieved by examining. how you might already be a leader in some situations and a follower in others. Also we examined what a variety of writers have said leadership is so that you can. select the definition that comes closest to your own perception of the role. Define leadership By selecting and understanding the multifaceted nature of lead. ership the benefits of effective leadership can be examined as Daft said leadership. 01 Barr Dowding 4330 Ch 01 Part I indd 11 23 01 2012 8 07 19 PM. 12 LEADERSHIP IN HEALTH CARE, is an emerging discipline that will evolve 2005 4 5 Don t expect to get it right. every time but with knowledge of leadership approaches see Chapter 4 you will. get it right most of the time, Discuss the importance of the changing context related to health care The National.
Health Service NHS emerged due to a socialist ideology of health being a right for. all regardless of ability to pay Leadership within the health service has always been. seen as important because of the size of the NHS, Compare leadership and management This perennial argument related to the dif. ferences or not between leaders and managers Much of the problem in under. standing the concepts relates to the fact that the two philosophies are so closely. linked and the words used are interchangeable hence the possible lack of differen. tiation when we think and speak of leaders, Debate the art and science of leadership Stewart 1918 states that the science spirit. and skill of nursing was beginning to develop as it became apparent that love and. caring alone could not ensure health or overcome disease. FURTHER READING, Bower F 2000 Nurses Taking the Lead Personal Qualities of Leadership Philadelphia PA. WB Saunders Company, Cook M J 2001 The attributes of effective clinical nurse leaders Nursing Standard 15. Cook M J and Leathard H 2004 Learning for clinical leadership Journal of Nursing. Management 12 6 436 44, Elias R 2010 How personality affects leadership Independent Nurse 22 40 1.
Mahoney J 2001 Leadership skills for the 21st century Journal of Nursing Management. Northouse P G 2012 Theory and Practice 5th edn London Sage Publications Chapter 2. Sadler P 2003 Leadership 2nd edn London Kogan Page. Stanley D and Sherratt A 2010 Lamp light on leadership clinical leadership and Florence. Nightingale Journal of Nursing Management 18 115 21. 01 Barr Dowding 4330 Ch 01 Part I indd 12 23 01 2012 8 07 19 PM.


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