No Leaders Without Followers; No Followers Without Leaders
It is a universal truth that there will be no health service without a health workforce (WHO 2014). It is equally true that the delivery of the health service will require the right leadership in the right place at the right time with the right level of capability and credibility for it to be effective. Leadership is an essential health sector practice, which has a significant impact on both clinical and organisational outcomes (Delmatoff and Lazarus 2014; Longenecker and Longenecker 2014; Redknap et al. 2015: 266; Kumar and Khilijee 2016; Sarto and Veronesi 2016). Health sector leaders will have a focus on delivering to the patients, communities, and societies for which they have responsibility and to the workforce in their organisations and to meet the expectations of âgovernanceâ stakeholders, including shareholders in private sector health organisations or government agencies in public sector ones.
To satisfy such a diverse and wide-ranging group will require those who are in leadership roles to match up to stringent requirements in terms of capability and credibility and who are able to deliver excellence and transformation at times of volatility, uncertainty, complexity, and ambiguity. At the highest level, this means leaders with the knowledge of how to craft a long-term strategy and with the nous, traits, skills, attitudes, and behaviours to deliver it; it means creating a pipeline of those with leadership potential to ensure continuity of strategy and operations; and finally, it means ensuring that leadership, governance, policy, and stewardship are in harmony and aligned to identified organisational goals and objectives. Those in formal âleaderâ roles will provide direction to managerial, clinical, medical, technical, and professional groups, diverse healthcare workers, and all relevant stakeholders. However, leadership is not confined to the few people in the most senior roles. Instead it is a concept based on social relationships rather than organisational position. And so, a culture in which devolved leadership practice can take place effectively will also be critical. Leadership is situational and non-hierarchical (Goffee and Jones 2006); it is increasingly collaborative and dependent upon effective networking across agencies or business units. Both observations resonate in health sector organisations with unclear lines of demarcation between activity and with fluid organisational networks or matrices replacing hierarchical structures. Effective formal or positional leadership and a culture of devolved leadership provide the basis for an engaged followership which will contribute to quality of care and positive societal or business outcomes.
Leadership Is a Mysterious Process
It is not only the fact that leadership is important to success but also the fact that leadership style and approach are open to interpretation that creates such a fascination with the subjectâframed within the questions of identifying who âhas what it takesâ to be a leader and the type of leadership that is required. Leadership has a high profile but is also a âmysterious processâ (Howieson and Thiagarajah 2011). Whilst the person or competences required to be a leader can be readily defined and recognisable, that of the successful application of leadership is less predictable. Chapter 3 covers the debate about these areas and analyses some of the many theories surrounding leaders and leadership. The diversity of opinion occurs because leadership is not an abstract philosophical concept that can be easily categorised. It is a complex process with a series of social relationships between people in organisations as they move towards the achievement of objectives, a âprocess that involves the ability to influence and motivate individuals or groups towards common goalsâ (Ellis and Abbott 2014; Chobanuk and James 2015). In some instances a leader, such as a Chief Executive, will have an overall responsibility for delivering these goals through strategy setting, delegating part of her or his authority, and engaging the workforce. In others, appointed leaders (Heads of Department, Directors) will assume devolved responsibility for leadership in a specific unit or area as part of a formal executive process. But critically, leadership will also take place at many locations by those who donât have the âleaderâ title. A fundamental premise is that leadership is the act of engaging others to come together in the quest for a common objective, wherever the objective resides in the organisationâs structure and whoever takes responsibility for delivering it through people.
Given the potential benefits, it is no surprise that the profile of leadership has been raised. The question once asked of âhow are we going to develop the leadership skills, imagination and strategies required for implementing desirable policy measures and the overhaul of health care organisations?â (Levey et al. 2002: 68) remains particularly relevant today. Leadership is one of the solutions to the many challenges that the health sector faces, and there are calls throughout the world for more and better leadership (McDonald 2014: 227; Saravo et al. 2017: 2). Identifying appropriate concepts and adapting them to complex health environments is therefore a priority.
Healthcare Leaders âMobilise Intelligenceâ
But this is a challenge. Research has shown that there are more than 200 definitions of leadership âwith descriptions ranging from traits and characteristics to behaviours and processesâ (Chobanuk and James 2015). For some health sector organisations, leaders are transformational or charismatic, focusing on innovation and change, âleading from the front,â and making decisions quickly to respond to external forces or demands. For other health sector organisations, leaders are transactional, reflective, consultative, and inclusive, crafting a way for the organisation to deliver operational outcomes in complex social or political environments. The significant number of studies of leadership in health creates a patchwork of approaches and leadership styles. Amongst these are the generalist (Barr and Dowding 2008; Gopee and Galloway 2009; Gunderman 2009; Dye 2010); there are those which discuss transformational leadership (Levey et al. 2002; Maccoby et al. 2013; Choi et al. 2016), servant leadership (Tropello and Defazio 2014), ethical leadership (Sahne et al. 2015), complexity leadership (Weberg 2012), coaching as leadership style (Hicks 2014), authentic leadership (Read and Laschinger 2015), leadership for improvement (DaCosta 2012) and shared or distributed leadership (Fitzgerald et al. 2013; Rogers 2014). The amount of intelligence on the subject arises from studies in health leadership in the North American, Asian, and European health sectors, from insights on leadership in African healthcare (Amasawa and Crisp 2014), and from global agencies such as the World Health Organization. The scale and scope of these studies demonstrate the positive and also the contextual nature of leadership; they also reflect the willingness on the part of health sector organisations to embrace different ideas about the meaning of leadership and the role of leaders. Because of this, views of leadership have ebbed and flowed over time. As the popularity of transformational leadership wanes, authentic and inclusive leadership rise in its place; as hero leadership falls out of favour, distributed leadership becomes more popular. More recently, there is some agreement on the need to extend the definition of leadership beyond the ârole of ...