Leadership evokes diverse reflections, thoughts, and images. These may entail followership, cleverness, influence, innovation, power, kindness, dynamic personality, and kindness, among others (Yukl & Mahsud 2010). Additionally, leadership could compel us to think about leaders whom we might have been working with at the moment or have worked within the past, and to ponder on the behavior and qualities of an effective leader (Daft 2004; Muchinsky 2006). Various researchers have also wrestled with various dimensions of leadership, going by the many definitions that are currently in existence. For example, Daft (2000) defines leadership as “the ability to influence people toward the attainment of goals”, Weihrich and Koontz (2005) define leadership as the ability to influence others so that they can been enthusiastically and willingly contribute towards the attainment of certain group objectives; while Sullivan and Graland (2010) infer that leaderships entails the ability of a leader to utilize his/her interpersonal skills to prevail on others to realise a specific goal. A careful assessment of these and other definitions of leadership reveal a common theme to all of the definitions namely, that leaderships entails influencing the beliefs, feelings, attitudes, and behaviours of other people (Spector 2006). This is also an indication that there can be no single universal definition of leadership, which is a welcome development as it enables us to gain useful insights into the various factors that affect leadership, and to offer diverse contexts on the concept (Hughes, Ginnett & Curphey 2006). More importantly, the many definitions of leadership enables us to explore in-depth what really makes a good leader. The focus of this essay is to try and answer this question from a health sector context. An attempt shall be made to identify the styles, behaviours, and qualities of a good leader based on diverse healthcare literature. Theses will in turn be related to the NHS Leadership Framework. The research findings will help in making recommendations on how the author can improve their individual leadership skills in light.
Leadership in healthcare
The Department of Health (2011) recognizes the ability to inspire, promote, and motivate the values of the NHS (National Health Service), empower and develop a reliable focus on patient needs as a key aspect of clinical leadership. Leaders are therefore charged with a key responsibility of drawing out effective performance form their followers. This encompasses guiding and persuading others to share in their developed vision, shared values, and expectations with the aim of improving their organisation’s overall effectiveness and set goals (Feather 2009). Winkler (2010) opines that in the past, leaders were regarded as possessing personality traits different from those of their followers. Grimm (2010) has identified purpose, confidence, ethical fitness, courage, and ability to prioritise as some of the personality traits of an effective leader. Whitehead et al. (2009) are of the view that even as we have natural leaders, everyone can be a leader as long as they have the necessary skills and knowledge. Accordingly, education is an ideal tool for advancing leadership skills (Mahoney 2001; Cummings et al. 2008). One way of advancing leadership skills and knowledge is by utilising the Leadership Framework that was designed to allow healthcare staffs to comprehend their development as leaders, and to aid and support nursing staffs identified as possessing leadership traits (NHS Leadership Academy 2011). The Leadership Framework is made up of seven domains, and hinges on the belief that leadership is not limited to individuals with selected leadership responsibilities. The framework also acknowledges that everyone can make a useful contribution towards the leadership process (Giltinane 2013). Similar sentiments have been echoed by Crevani et al. (2010) who have described leaders as individuals within a group who are capable of influencing that group.
Effective leadership demands that individuals demonstrate their strengths, abilities and values to deliver high quality services. This requires among others, the ability to develop self awareness, manage themselves, embracing continuous personal development, and acting with integrity
1. Developing self awareness
Effective leaders should acknowledge and express their individual principles and values. They must also demonstrate a deep understanding of how their own principles and values could differ be different from those of other groups or individuals. In addition, leaders should recognise their limitations and strengthens the effect of their behaviour on others, and how stress impacts on their individual behaviour. Another key component in developing self awareness involves identifying one's individual prejudices and emotions, as well as an understanding of how this could impact on their behaviour and judgement. Moreover, leaders must be bale to obtain, evaluate and act on feedback from diverse sources.
2. Working with others
Another way in which clinicians demonstrate their leadership skills is their ability to work with others in networks or teams with a view to improving and delivering services. Clinicians are thus required to demonstrate competence in developing and maintaining relationships, working within teams, developing networks, and encouraging contribution.
3. Managing services
Clinicians who are also effective leaders demonstrate a focus on realising the success of their organisations. To do so, clinicians ought to demonstrate competence in managing resources, planning, managing performance, and managing people.
4. Improving services
Clinicians who manifest effective leadership end up transforming the lives of patients through the delivery of improved and high quality health services. Moreover, effective leaders are also focused on improving service delivery. To execute this responsibility, clinicians are expected to demonstrate competence on ensuring patient safety, facilitating transformation, critical assessment, and encouraging innovation and improvement.
5. Setting direction
Clinicians manifesting effective leadership skills play a crucial role in facilitating in the realisation of the aspiration and strategy of the organisation. Their actions are also consistent with their values. In this case, the clinicians need to show competence in recognising the context for change, applying evidence and knowledge, assessing impact, and making decisions.
Healthcare leadership: Research, theories, and evidence
Al-Sawai (2013) identifies the ability to influence group activities and effective handling of change as some of the key elements of the leadership role. However, exploring the leadership of healthcare professionals is somewhat difficult considering that most of the current leadership theories were developed within the business setting and thereafter, applied to the healthcare sector. As such, additionally, moreover, some of the published researches give limited evidence that such leadership initiatives are linked to improved organisational outcomes or improvements in patient care if adopted by the healthcare organisations (Al-Sawai 2013). Nevertheless, leaderships The King's Fund (2015?) identifies leaderships as a key component in shaping organisational culture. It is important therefore to ensure that the required leadership strategies, qualities, and behaviours are developed. According to Drath et al. (2008), one of the main tasks of a leader is to ensure alignment, commitment, and direction within teams in an organisation. Alignment entails effective integration and coordination of work. Direction facilitates pride and agreement among individuals in terms of what the organisations has set its eyes on achieving, in line with its values, strategies, and vision. Common the other hand, commitment within an organisation is best exemplified by everyone prioritising on organisational success and taking the responsibility for this, as opposed to concentrating on individual success. This calls for effective leaders who will continually emphasise high quality, compassion, and safe care, and see to it that the voice of patients at all levels of health care provision are heard, and that they consistently attend to patient concerns, feedback (both negative and positive), experience, and concerns.
According to Feather (2009), successful organisations endeavour to build; on the emotional intelligence of their leaders through improved self-awareness, social awareness, self-management, and social skills. Walton (2012) defines emotional intelligence as the capacity to deal with the impact of emotions on relating with others. Even though a lot of research efforts have been directed towards studying emotional intelligence, the concept remains somewhat controversial. Moreover, not many studies have been done to assess its effectiveness (Cavazotte et al. 2012) Côté et al (2010) observe that not many studies have tested if there exists a relatiosnhisp between emotional intelligence and leadership. This is because certain personality traits are hard to control, and this could impact on leadership styles. Consequently, it becomes difficult to measure emotional intelligence (Cavazotte, Moreno & Hickman 2012).
Nonetheless, emotional intelligence is a key trait for leaders as it enables them to recognise their individual emotions and feelings, which is vital in identify their followers’ emotions correctly. Given the dynamic nature of the health care sector, some employees are likely to be overwhelmed by constant change. In such a situation, an emotionally intelligent leader is requires as they do not rush to cure, control, or fix the responses f employees to change. Instead, emotionally intelligence leaders empathize with the staffs’ concerns, by allowing them to articulate their feelings without pressure, guilt, or judgment (Feather 2009). Emotionally intelligent leaders also acknowledge that emotions could change with the situation at hand. The ability to manage emotions enables leaders to handle the challenges of failure or decisions that might have resulted in poor outcomes (Feather 2009).
Considering that health care systems are characterised by various departments, professional groups and specialities, which could constrain health care delivery, it is important that leadership takes advantage of such diversity in ensuring the attainment of organisational goals but more importantly, encourage staffs to work collectively towards the realisation of common objectives. Various leadership approaches could be adopted in enhancing the management of a rather complex health care sector. They include collaborative leadership, transformational leadership, transactional leadership, and situational leadership.
Collaboration refers to the cooperative and assertive process that develops when individuals cooperate in an organisation towards mutual benefit. Collaborative leadership entails communicating to co-workers and other staffs and involving them in making informed decision (Archer & Cameron 2008). Collaborative leadership is essential in healthcare management as is encourages sharing of experiences and knowledge, dialogue between various stakeholders, and minimises levels of complexity within the organisation. It also allows individuals with diverse levels of responsibility to actively engage with the leadership process and in this way, play a key role in communicating and validating needs, as well as in indentifying practice modifications needed to deal with changing demands. This calls for a synergistic work environment in which various stakeholders work together towards the effective implementation of processes and practices.
Transformational leaders identify followers’ potential and hence endevour to engage them fully by acting as mentors (Vinkenburg et al. 2011). Rolfe (2011) underscores the need for leaders to act as role models to their followers as a means of empowering them to become future leaders. Empowered followers have been shown to demonstrate enhanced organisational loyalty, job satisfaction and motivation, promote a positive working environment, and minimize sickness levels (Rolfe 2011). According to Bass (2008), transformational leaders articulate an obvious persuasive vision of the future, recognise individual differences, rationally inspire followers and support followers to realise their strengths.
Leaders ought to be honest, recognize individual achievements, and integrate followers in their decision making (Grimm 2010; Rolfe 2010). Backh and Eliis (2011) opine that a leader who has the support and trust of her or his followers is more likely to implement change successfully in comparison with a leader who does not enjoy the support and trust of her or his followers. Wong and Cummings (2007) have identified transformational leadership as a crucial element in enhancing patient outcomes. According to Malloy and Penprase (2010), transformational leadership can result in improved clinical environments and in this way, facilitate in the delivery of quality agendas and engage staffs in the process. Dierckx de Casterlé et al (2008) are of the view that well-developed transformational leadership enables nursing teams to assume additional roles, not to mention that nursing teams have more job clarity and improved empowerment.
In spite of the popularity of transformational leadership, Bass (2008) argues on the need to exercise caution because transformational qualities require being integrated with conventional transactional management skills. Accordingly, leaders might be completed to embrace an autocratic style in managing conflict of staff sickness. Similar sentiments have been echoed by Whitehead et al (2009) who urge on the need for effective leaders to have a plan, vision, and structure in order to accomplish set goals. Democratic leaders are a good example of the transformational approach. Democratic leaders hold the view that employees seek opportunities and the autonomy to prove their worth, and are also motivated to do well. They share responsibilities with followers as an indication of their being considerate. In this way, followers become independent, develop their individual leadership skills, thus reducing the leader’s risk of burnout and stress levels.
Transactional leadership involves rewarding obedient followers. This style of leadership hinges on contingent rewards and has been shown to have a positive impact on followers’ performance and satisfaction (Burke et al. 2006). A key limitation of transactional leadership is that because it is mainly concerned with management tasks, it fails to recognize the shared values of a team (Marquis & Huston 2009).
As a task-oriented approach, transactional leadership can be effective when faced with an emergency or in case one has to meet deadlines. According to Bach and Ellis (2011), the transactional approach could result in non-holistic patient care as the nurse focuses on the task that they require to complete, as opposed to focusing on the patient as whole. Autocratic leaders are a good example of the transactional approach. Bass (2008) opines that autocratic leaders are closed-minded, controlling, and power-oriented. They emphasise on loyalty, obedience, and strict adherence to existing rules. While autocratic leaders are more likely to fall out of favour with their team, this might transform into fondness and appreciation following the emergence of the positive outcomes of their leadership. Followers of an autocratic leader might depend too much on their leader so that in case the team leader is absent, they could underperform. Even as the Nursing and Midwifery Council (2008) urges all nurses to accountable for their actions. It is important to note that an autocratic leader assumes full responsibility. What this means is that autocratic leaders endure considerable pressure even as their followers remain comparatively stress-free.
Healthcare organisations constantly experience change (Grimm 2010) and as such, there is need for the top-tier leaders to motivate and support subordinate leaders to develop various styles of leadership as a means of managing diverse situations. In such a case, the situational leadership approach is necessary as it enables effective leaders to adjust their leadership styles to suit specific situations. For instance, transactional leaderships would be ideal in handling complicated or simple situations (Crevani et al. 2010). Lynch, McCormack and McCance (2011) have delineated the core competencies of situational leaders namely, the ability to recognise the competence, commitment, and performance of others, and being flexible. Grimm (2010) describes situational leadership as being ‘based on a relationship between the leader’s supportive and directive behaviour, and between the follower’s level of development’ (Grimm 2010). The situational leadership approach could prove useful for clinical nurse leaders while supervising nursing students or newly qualified nurses. This is because with the situational approach, the leader’s approach hinges on follower’s level of confidence and experience. While a newly qualified nurse might possess the basic level of clinical knowledge required to undertake tasks assigned to them, they, nonetheless, lack in confidence and experience. In such a situation, the leader needs to adopt a more direct role until such time as when the qualified nurse has gained the experience and confidence needed to perform their duties (Grimm 2010). Personality traits
There appears to be a well-established obsession with the personality traits of individuals assuming leadership positions. Yukl (2013) has identified key personality traits linked to effective leadership:
Eeffective leaders believe in their ability to surmount difficult situations, in addition to giving their followers a sense of efficacy and confidence. Effective leaders are confident and optimistic even when facing difficulties. Nonetheless, excessive self-esteem or self-confidence is not recommended as it makes leaders vulnerable to wrong or risky decisions.
High stress tolerance and energy level: effective leaders possess high levels of stamina which enables them to execute their duties effectively for longer periods (Chance & Chance 2002). They can also handle stressful situations calmly given their ability to communicate with confidence and calmness in the face of a crisis. Effective leaders have a high level of personal integrity, as evidenced by the behaviour and values that they espouse. They also tend to be transparent, trustworthy and honest (Chance & Chance 2002). These leaders also honour their promises to staff, patients, and other stakeholders within the healthcare setting and make use of their leadership mainly out of self-interest.
Effective leaders demonstrate a high level of emotional intelligence and maturity as evidenced by their being less susceptible to irritability, angry outburst, and moodiness. These leaders are optimistic and positive, and acknowledge their weaknesses and strengths (Woods & West 2014).
Certain competencies have been identified as being important for leaders in the health care setting. Technical competence is desirable as it enables leaders to win the respect of their followers. This is because it encompasses knowledge regarding the organisation, its structure, processes, and strategy (Willcocks 2012). Technical competence also involves knowledge about health care treatments, services, and technologies, as well as knowledge about the organisation’s environment.
Conceptual skills are also a desirable competence of an effective leader as it signifies their understanding of the intricate internal and external environments of the organisation. In this case, conceptual skills enable leaders to understand situations as opposed to viewing them as being too complex to understand or deal with. Being able to evaluate plans and make decisions are key aspects of organisational functioning and as such, leaders who possess conceptual skills are likely to enhance the confidence of their followers within the organisation.
Effective leaders within the healthcare setting also require interpersonal skills as this enables them to comprehend the feelings and needs of their followers, to scrutinize their individual behaviours, and to be responsive to how they react emotionally to others.
Yukl (2009) has identified four broad categories of behaviours essential for effective leadership. First, effective leaders are task oriented that is, they play a key role in planning, clarifying, soling problems, and monitoring operations. Effective leaders also tend to be change oriented as evidence by their ability to envision change, advocate change, facilitate collective learning, and promote innovation. Yukl (2009) further identifies effective leaders as being relations oriented given their ability to develop, acknowledge, support, and empower relationships and networks within the organisation. Finally, effective leaders are adept at external networking as evidenced by their external monitoring abilities.
Recommendations on improving own leadership skills
From the foregoing arguments, it is evident that leadership has varied dimensions to it, and that leadership influences people in the achievement of organisation goals. This is true for the heath care sector as well where effective leaderships is required to improve health care delivery to patients, and enhance patient and staff satisfaction. The NHS Leadership Framework recognises developing self awareness ability to manage services, setting of direction, improving services and working with others as some of the key domains for effective leaderships. Towards this end, various leadership styles are needed to influence change in diverse situations or settings. Therefore, we do not have a single leadership style that can generally be regarded as an effective over others. As a nurse practitioner who aspires to be a future nursing leader, I intend to engage in various training and development programmes as a means of enhancing my leadership competencies in conceptual and technical skills. I also intend to borrow valuable leadership traits from my mentor as a means of enhancing my effectiveness as a leader. The knowledge and skills gained will prove essential in identifying situation where I need to employ the ideal leadership skills.
Al-Sawai A (2013),’Leadership of Healthcare Professionals: Where Do We Stand? Oman Med J., vol. 28, no. 4, pp. 285-287.
Archer D & Cameron A (2008). Collaborative leadership – how to succeed in and interconnected world. Oxford: Butterworth Heinemann.
Bass BM (2008) The Bass Handbook of Leadership: Theory, Research, and Managerial Applications. Fourth edition. Free Press, New York NY.
Burke CS, Stagl KC, Klein C, Goodwin GF, Salas E & Halpin SM (2006),’ What type of leadership behaviors are functional in teams? A meta-analysis’, The Leadership Quarterly, vol. 17, pp. 288–307.
Cavazotte F, Moreno V & Hickmann M (2012).’ Effects of leader intelligence, personality and emotional intelligence on transformational leadership and managerial performance’, The Leadership Quarterly, vol. 23, no. 3, pp. 443-455.
Chance PL & Chance EW (2002) Introduction to Educational Leadership & Organizational Behavior: Theory Into Practice Eye On Education, Larchmont, NY.
Crevani L, Lindgren M, Packendorff J (2010),’ Leadership, not leaders: on the study of leadership as practices and interactions’, Scandinavian Journal of Management, vol. 26, no. pp.77-86.
Cummings G, Lee H, MacGregor T et al (2008),’ Factors contributing to nursing leadership: a systematic review’, Journal of Health Services Research and Policy, vol. 13, no. 4, pp. 240-248.
Daft RL (2000) Management. 5th edn. The Dryden Press, Philadelphia
Daft RL (2004) Management. 6th edn. Thomson/South-Western, Ohio.
Department of Health (2011). Developing the NHS Commissioing Board. London, DH
Feather R (2009),’ Emotional intelligence in relation to nursing leadership: does it matter?’, J
Nurs Manag., vol. 17, no. 3, pp. 376-82.
Drath WH, McCauley CD, Palus CJ, Van Velsor E, O’Connor PMG & McGuire JB (2008),’ Direction, alignment, commitment: Toward a more integrative ontology of leadership’, The Leadership Quarterly, vol. 19, pp. 635-653.
Grimm JW (2010),’ Effective leadership: making the difference’, J Emerg Nurs., vol. 36, no. 1, pp. 74-7.
Giltinane CL (2013),’ Leadership styles and theories’, Nursing Standard, vol. 27, no. 41, pp. 35-39.
Hughes RL, Ginnett RC, Curphy GJ (2006) Leadership: Enhancing the Lessons of
Experience. 5th edn. McGraw Hill, Boston.
Lynch B, McCormack B & McCance T (2011),’ Development of a model of situational leadership in
residential care for older people’, Journal of Nursing Management, vol. 19. no. 8, pp 1058-1069.
Mahoney J (2001),’ Leadership skills for the 21st century’, Journal of Nursing Management, vol. 9, no. 5, pp. 269-271.
Marquis BL & Huston CJ (2009) Leadership Roles and Management Functions in
Nursing: Theory and Application. 6th edn. Wolters/Kluwer/Lippincott Williams
and Wilkins, Philadelphia.
Muchinsky PM (2006) Psychology Applied to Work: An Introduction to Industrial and
Organisational Psychology. 8th edn. Thompson/Wadsworth, Australia.
NHS Leadership Academy (2011) The Leadership Framework. [Online]. Available at: http://www.leadershipacademy.nhs.uk/wp-content/uploads/2012/11/NHSLeadership-Framework-LeadershipFramework-Summary.pdf [Accessed 12 Nov 2016]
Nursing and Midwifery Council (2008) The code: Standards of conduct, performance and ethics for nurses and midwives. Nursing and Midwifery Council, London
Rolfe P (2011),’ Transformational leadership theory: what every leader needs to know’, Nurse Leader, vol. 9, no. 2, pp. 54-57.
Sullivan EJ, Garland G (2010) Practical Leadership and Management in Nursing.
Pearson Education Limited, Harlow
Spector PE(2006)Industrial and Organisational Psychology: Research and Practice.4th
edn. JohnWiley&Sons, New Jersey.
Vinkenburg CJ, van Engen ML, Eagly AH, Johannesen-Schmidt MC
(2011),’ An exploration of stereotypical beliefs about leadership styles: is transformational leadership a route to women’s promotion?’, The Leadership Quarterly, vol. 22, no.1, pp. 10-21.
Yukl G & Mahsud R (2010),’Why flexible and adaptive leadership is essential’, Consulting Psychology Journal: Practice and Research, vol. 62, no. 2, pp. 81-93
Yukl GA (2009) Leadership in Organizations (8th Edition) 8th Edition, Pearson New York
Weihrich H,& Koontz H (2005) Management: A Global Perspective. 11th edn.
Walton D (2012) Emotional intelligence: A Practical Guide. London: Icon Books Ltd.
Whitehead DK, Weiss SA & Tappen RM (2009), Essentials of Nursing Leaderships and
Management, 5 edition. Philadelphia: F.A. Davis Company.
Willcocks SG (2012),’Exploring leadership effectiveness: nurses as clinical leaders in the NHS", Leadership in Health Services, vol. 25, no. 1, pp.8-19.
Winkler, I. (2010). Contemporary leadership theories: Enhancing the understanding of the complexity, subjectivity, and dynamic of leadership. Heidelburg: Springer
Woods S & West MA (2014) The Psychology of Work and Organisations. (2nd ed ). London: Cengage Publishing.