Leadership theories in the context of healthcare management

chooseers theories in the background of healthcargon service counsellingDo healthcargon mangers need pencil lead theories? critic solelyy evaluate at least deuce lead theories in the mise en scene of healthc ar perplexity. According to Huczynski and Buchanan (2007), leaders is defined as the run of influencing the activities of an organize group in its effort towards goal setting and goal achievement. Grint (20052) describes lead as a function of relationship amid leading and followers, instead than simply focused on the person of the leader. According to Bass (199019), leading is an interaction surrounded by two or more members of the group that frequently involves a structuring or restructuring of the situations, perceptions and expectations of the members. Thus it brook be tell from the preceding(prenominal) definitions that lead is enacted d match slight relationships with others i.e. the followers and leading is widely distributed without the orga nization. healthcare brass sections near the world spend enormous amount of m one and only(a)nessy in infrastructure and renovating facilities in hospitals, but spend a relatively slight clip or effort for the management of people who thrash in it. Effective leading is therefore necessary for the smooth functioning of healthcare organization.According to G beneathman R. (2009), healthcare leaders should understand the reputation of the organization where they take a shit and should elaborate in harmony with physicians, nurses, technologists, administrators and other members of organization. The people who clear in healthcare organizations as leaders should understand the needs of the people they work with and should motivate them in order to increase their transaction. Thus the over altogether performance of the organization depends upon the behaviour of leaders with their followers. Failure to understand human need cornerstone result in downfall of the organization . Medical leaders should hang at the following questions Which is more useful way to deal with the workers, benefits much(prenominal) as salary raises and public praise, or sticks, such(prenominal) as little terror of termination and reduction in compensation? How can we improve workers performance, make tighter control or by increasing autonomy and em violencement? If the all-important(a) needs of the workers are not fulfilled it can affect their shipment towards organization and may result in financial instability of the organization.Leadership and management are often compared under the same platform. People are often confused and ask a question, Are managers leaders? The dissolving agent is NO, they differ from each other in many ways. Leadership is one of the roles that managers sport to play and is therefore a subset of management. According to Gopee and Galloway (2009), management is nigh measuring and monitoring performance against pre-determined goals, following policies and procedures, controlling and organizing the structure and systems, running(a) within resource allocation and maximizing output and productivity for the organization. Whilst on the other side lead is rough macrocosm visual modalityary, anticipating tilt, motivating and stimulate workers and focusing on development of individuals. Watson (1983), describes seven Ss models to distinguish between leaders and managers. According to Watson (1983), managers chiefly rely upon 3 Ss namely strategy, structure and systems, whereas leaders depends on 4 soft Ss called style, ply, skills and divided up goals. Hollingsworth (1999) suggests fundamental differences between leaders and managers. According to him managers do things right i.e. they are transactional, go leaders do the right things i.e. transformational, managers administer art object leaders innovate, manager focus on systems and structure while leaders focus on people. Thus leading is a two-way touch base on l eader-follower relationship while management is ground on relationship between the people on the job(p)s in the organization as individuals or groups. (Gopee and Gathway, 2009).Theories of LeadershipSeveral leadership theories have emerged over the past suggesting practical applications of leadership and its concept. Different leadership theories that are developed since 1920s are listed belowTime peak1920s1940sTheoryTrait or Great man systemBarnard (1938) for prescriptives Ghiselli and Wald Doty (1954) for the descriptives.Style or behavioural theoryBlake and Mouton (1964), Likert (1961) and McGregor (1960) snapIntelligence, initiative and ego-assurance.Participative culture, Re pitched a more democratic humanistic prelude to the use of man in agreements and come at the time of reception against scientific management.1960sContingency theoryFielder (1967), Schein (1980) and Vroom and Yetton (1973)An integrated way of looking at leadership, more specialised to task work group and position of leader within that work group. A topper fit approach.1980sPost contingencies theoryBennis (1992), Kotter (1982), Mant (1983) and Peters and Waterman (1982)This theory peculiarly focused on American Business leaders with some perceptive comments as tumefy as Anglo-Saxon leadership habits.1990sTransformational leadershipBass and Avolio (1993), Cunningham and Kitson (2000a, 2000b) and Sushter (1994)Four components. 1. idealise influence 2. Inspirational motivation 3. cerebral stimulation and 4. Individualised regard.Late 90s-2000sContemporary theories.Goleman (1999), Jumaa (2001),Alleyne (2002), Goffee and Jones (2000)Charismatic leadership connection leadershipServant leadershipTransactional leadershipTransformational leadershipAdapted from- Jasper M. and Jumaa M (2005), Effective health care Leadership,page-25-26Trait or Great man leadership theory.According to this theory authorized persons have inborn leadership characters. some studies were conducted by the end of 1950s which explored detail characteristics of effective leaders. (Handy 1993). These studies draw fundamental correlation between leadership effectiveness and following traitsIntelligence effronteryKnowledgeInitiativeSupervisory 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 primary(prenominal)lyIntelligence-Judgement-Decisiveness-Knowledge-FluencyPersonality-Adaptability-Alertness-integrity-NonconformityAbility-Cooperativeness Popularity-TactHowever the trait theory has plastered weakness and problems managethe traits are very difficult to define accurately or to understand fullymany exceptional leaders do not consume all identified leadership traitsit cannot be conclude 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 to solar day, trait theory has not been only disregarded. For example- Recent research study conducted by kouzes and Posner (2007) concluded that Admired Leaders were the likes ofly to draw out specific characteristics, whereas 50% or more respondents selected Honest (88%), Forward looking (71%), fitting (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 operative approach and focused on the fact that the perf ormance can be improved can be improved by training and the leadership skills can be developed over a period of time and perfected. He too suggested that organisations should not wait for leaders to come by their own rather grow their own by identifying employees which have certain potential to be a inviolable leader.Transactional and Transformational theories have gained popularity for Leadership in health care Organizations out of the various leadership theories available.Transactional leadership theory.Transactional theory of leadership is based on leading people by the virtue 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 fix system. In healthcare organisations this theory is related to the achievement of organizational goals which overly includes attending health of local populati on.( Gopee and Galloway, 2005)According to Bass and Riggio (2006), the transactional theory is based on the leaders who are winnerful or effective in such a way that they maintain equilibrium and harmony by fulfilling their roles gibe 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 corroborate employees behaviour towards meeting or exceeding established goals (McGuire and Kennerly 2006). Although this theory supports view quo and is more predictable but it has to a fault been criticised by various authors as it is lacking sight for future of the healthcare organisation. Thus the transactional theory of leadership has a very narrow focus and the leader can have a high self interest which may eventually lead to disturbance in the organisational structure.(Gopee and Galloway, 2009)Transformational leadership theoryTransformational leadership is widely support lead ership 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 high level of motivation and morality. In transformational leadership leaders motivate their followers by transcending their own self interests, elevating their needs and devising them a ingest 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 leave of the process whose main function is delivering organisations objective. This can be achieved by education identification, going beyond simple leader-follower transaction and developing and intellectually excite employees. (Vandenberghe et al. 2002).According to Murphy (2005), transformational leaders are visionary, self-confident, and self-aware in break of serv e professional boundaries to develop a multidisciplinary team approach towards patient care. Transformational leaders inspire the followers and motivate them to exercise leadership by encouraging their belief that have the potential to achieve high generates. Thus a transformational leader is the catalyst for creating refreshed innovative organisational paradigms (Murphy 2005 135). The transformational leadership style is depict by Markham (1998) as collaborative, consultative and consensus seeking and attributing power to inter ain 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 hexad transformational leadership processes in practiceAbility to develop a shared visionInspiring and communicat ingValuing othersChallenging and stimulatingDeveloping investEnablingUsing these processes, transformational leaders assist the people working with them to locomote empowered and take responsibility of ownership to practice challenges and solutions (Sashkin and Burke 1990). The concussion of transformational leadership does not restrict to development of individuals but it can as well as produce satisfying 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 pee 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 antecedently 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 cha rismatic leaders in the past but in todays modern era it go forth be difficult to call them 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 show 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 quartette central components (Bass 1998), (Plesek and Wilson 2001)Idealised influence (charisma)Inspirational motivation talented stimulationIndividualised considerationTransformational leadership topic has been debated since the past three decades because the above four components can study the potential for causing organisational harm and destruction if the leader in the fabric is support ed by mad intelligence (Goleman 2000a) to guide them through the swampy lowlands of organisational life (Schon 1983). According to Manley (2000) the transformational leadership approach is highly advantageous for the healthcare organisations as it has cocksure 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 determine (Bashor 2000).The key principle traind in applying the transformational leadership in healthcare organisation needs much openness and honesty in all interactions (Jasper 2005). The use of personal qualities (such as charisma, influencing skills and communication) needs to be equally equilibrate 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 sh ould be able to describe their ideas with clarity and details and should explicate about the future consequences. To achieve this vision one should start working for the future vision by reading from the past realities and should show a collective effort where everyone has an luck to participate in the creation (Fenton 2003). Intellectual stimulation can be achieved by maintaining mental and intellectual watchfulness and acuity which can be gained by encouraging open reprehension and debate of wide ranging evidence base thus it helps to form the backside 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 two organisations and interpersonal relationships. (Jumma and Jasper 2005).Thus it is seen that the two leadership approaches i.e. transformational and transactional approach are antithetic from each other. Transactional leadership mainly involves transaction between the managers and their managed people 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, disposition prysinto 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- concentred and orderlyCoaches and fosters sheltered scaningUses extrinsic rewardsHigh self-interestSees home and work as wearentities.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 (1987) think that transformational leadership alone can cause problem in long time. According to them transformational qualities must be coupled with more transactional qualities of day to day managerial role. According to Bass and colleagues, the transformational leader entrust disclose without the traditional management skills. (Marquis and Huston 2009). They believe both sets of characteristics should be present in same person in distinct 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 New 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 self-assurance (The NHS Plan, D H 2000). The centre launched the NHS Leadership Qualities Framework in 2002 (NHS Leadership centre 2003) the components of this poser 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 seeIntellectual flexibilitySeizing the futurePolitical astuteness advertize for resultsSelf beliefSelf awarenessSelf management causal agency 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 characterist ics, attitudes and behaviours that a leader must possess in order to deliver the NHS planSetting the standard for leadership in NHSAssessing and developing high performance in leadership consolidation leadership across the service and related agencyIndividual and organisational judicial decisionAdapting 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 regard. It was conducted in October 2003 and is probably the largest workforce survey in world. Total 572 organisations took part and most 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 agreeable with their jobs but so me part of the staff reported poorer work-life balance and higher level of work related stress. Thus healthcare commission urged NHS organisations to go over 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 consecrates in England responded to a questionnaire enquire 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 close to of the staff. 75% of staff was satisfied or very satisfied as well as satisfaction with the amount of responsibility. While in footing of staff engagement mixed results were seen. Around only 23% i.e. less than quarter of staff agre ed that senior managers involve staff in important decisions and only 22% agreed that communication 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 just about 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 questionnaires and methodology were designed by the NHS Surveys Advice Centre at chooser 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 big(a) in patient survey and 42% for the mental health survey. Results were promulgated in premier week of august 2004 and the Commission reported that patients gave positive opinions about the high quality care they received at the NHS. absolute 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 undischarged 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 f or the organisation. (Jasper and Jumaa 2005)Case study 3.The following slip-up study is based on my experience of working at a Multinational Pharmaceutical participation, Zydus-Cadila healthcare limited, India. It is an innovative global pharmaceutical participation that discovers, manufacture and markets a wide range of healthcare products. It produces products like progressive 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 operation of different departments like production, packaging, storage, marketing and submitting passing(a) 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, Production department, Quality-control department, RD (Research and development) department and the Marketing department. all(prenominal) of the department had a head person above them under whose direction 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 occurrence about the work. Right f rom the startle 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 lay claim each of us a particular work 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 mental process 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. slow over a time it was realised that the way he was l eading 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 professional at work while very jovial and friendly at home. He was totally task oriented and orderly person. He never accept 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 ever so 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 work personally and if he will notice any geological fault in our work would teach how to change by reversal 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 ultimatel y 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 generation of new ideas and concepts for the organisation. Many leadership theories have been developed since past and still it is infinitely 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 congenital skills and competences, or how much charisma you havebut whether you have a capacity to learn from you followers.