Leadership of Healthcare Professionals: Where Do We Stand? Research Paper Example

Introduction

In order to successfully review the application and relevance of different leadership analysis models in health care, it is important to determine the challenges that today’s health care managers face within organizations. The below essay will analyze the existing theories and models in order to develop an application based leadership assessment framework that would help the health care profession select the right candidates who have the essential traits and skills to manage diverse teams, and create leadership development programs that focus on the essential skills needed in today’s organizations. According to Al-Sawai (2013, p. 285), “the key aspects of the leadership role involves influencing group activities and coping with change”. The author of the current essay will focus on these two roles of leaders when designing an application based leadership assessment framework.

Leadership Assessment Review

According to Curtis, Vries  & Sheerin (2011, p. 307), leadership theories (and assessment frameworks developed based on them) consist of four types based on their approach: trait approach, behavior approach, contingency approach, and leader-member exchange approach.

One of the most commonly used, and the most respectable leadership models is the Dynamic Leadership Culture Model, and this framework will be the basis of the current research. The model is based on analyzing leaders’ and organizations’ leadership approaches and style in order to determine the strengths of each individual and the health care unit. The main benefit of using this assessment is that it can help leaders align individual leadership styles with the organization’s culture (Schein, 2006). Using four different styles, scores are assigned for each leadership style, on an individual and organizational level. Further, it helps organizations increase the cultural competency of the leadership and improve collaboration between managers and employees. Theories and models of leadership assessment tend to focus on one aspect of leadership: personal skills (Chemers, 1997), or behavior (Dynamic Leadership Culture Model). Some of them, however, focus on both of the aspects of leadership, determining both personality traits and behavioral patterns.

The Dynamic Theory of Personality and Emotions (Consedine, 1999) focuses on personality traits, and concludes that one’s personal preferences would determine their leadership behavior, as well as their attitude towards organizational culture. This assessment measures what individual leaders focus on in their daily job, and which tasks they prefer performing. The results of the assessment can also be used to compare individual level preferences and traits with those of the organization.

The Bolman & Deal Reframing Organization Assessment (Bolman & Deal, 1984) focuses on four different frames, and states that the scores of the assessment determine which leadership areas the given person would be the more effective in. It defines managers’ primary leadership orientation, and helps leaders identify their main development area. However, this leadership assessment does not provide a framework for aligning personal leadership traits with the organization’s culture, therefore, it is only applicable for leadership development.

The Type A and B Leadership Indicators assessment model  (Ledlow & Coppola, 2011, p. 30) also measures attitudes and preferences, focus areas of leaders. However, it puts more emphasis on behavior than skills. It is useful for evaluating leadership behaviors and communication styles.

The New Enneagram Test is designed to measure left or right brain dominance, in order to determine one’s way of thinking, attitude, and behavioral traits. It is also used to empower leaders in achieving higher self-awareness. A motivator, for example, is able to organize and lead people towards success, while an adventurer would avoid responsible and be too easily influenced.

From the above review of already developed leadership assessment models, it is evident that none of them focuses on personality traits, motivations, styles, communication, and task preferences at the same time. While most of the tests can determine which task the given individual would be most successful in, the relationship between results and management approaches is not always obvious. In order to develop a framework for assessing one’s leadership skills, approaches and preferences, it is also important to find ways of measuring leaders’ alignment with the organization’s culture. Apart from the Dynamic Leadership Theory Model and the The Dynamic Theory of Personality and Emotions, the above reviewed assessments provided no indication of leader-culture alignment strategies. Therefore, the authors would like to attempt to create a leadership assessment model that focuses on all the above areas and is relevant to the challenges of today’s health care organizations. Before the framework can be developed, however, it is important to analyze recent publications about the leadership areas that today’s leaders need to focus on, and those specific to health care.

Theories of Today’s Health Care Leadership

The author would like to start with reviewing the traditional trait, personality, and behavior based theories of leadership in order to examine their relevance and effectiveness for measuring health care leadership skills. Komives and Dugan (2011) state that the view on leadership went through a dramatic change during the 20^th Century. Systems became more open, shared vision and social justice became more important, while the primary role of sharing information was shifted towards creating knowledge. Starting with Burns’ (1978) theory on transformational leadership, the main focus of research was placed on vision and shared responsibility, instead of control. Greenleaf’s (1970) servant leadership model (discussed in detail below) stated that instead of exercising control and asserting authority, organizations can realize better outcomes when leaders are able to engage with individuals and support them in their goals. This approach assumes that it is the leader’s responsibility to find common grounds for aligning individual and organizational goals. The social change model of leadership development focused on value alignment even more, and stated that individual, group, and society-community values’ alignment can result in positive change. Further theories in the 20^th Century focused on shared leadership, moral approaches, and the importance of self-awareness (Komives and Dugan, 2011, p. 117). Some of the most relevant theories of leadership will be reviewed in detail below.

Al-Sawai (2013) lists several approaches that are required in today’s organizations to create a competitive advantage through leadership. These traits, developed from personality and leadership theories will be listed and analyzed below in order to determine the requirements and challenges today’s leaders face in the globalized world, and in particular in health care.

Transformational leadership

This type of leadership focuses on creating a vision and communicating it with people in order to encourage team members to perform tasks that improve organizational performance (Kark,  Chen &  Shamir, 2003)

Collaborative leadership

Collaboration within teams means that leaders are able to participate in meaningful discourse and allow team members to contribute. (Greenfield, 2007).

Conflict management

The organization’s rating on the scale of individualistic/collective determines the number and severity of conflicts. Effective leaders are able to turn conflict into collaboration and knowledge sharing exercises, while reinforcing the organizaton’s vision and mission, creating a common ground.

Shared leadership

The ability to share leadership and assign tasks to the most competent persons within the team does not only increase the overall effectiveness of the team, but empowers individuals, too.

Distributed leadership

The four characteristics of leaders required for this approach are sense making, relating, visioning, and inventing (Al-Sawai, 2013).

Ethical leadership

Stakeholder relationships in health care have a greater significance than in any other area of work.

Curtis, Vries  & Sheerin (2011) examined the role of leadership in health care. Their research adapts Dunhham and Fisher’s (1990) definition, nursing leadership is “..administrative competence, adequate education, business skills, clinical expertise and an understanding of leadership principles”. Other definitions that are quoted by Curtis, Vries  & Sheerin (2011) include empowerment of teams, transferring knowledge, and facilitating learning. As it is evident from the above definition, today’s health care leaders need to perform several tasks; from administration to human resources management and strengthening culture to maintain team cohesion. The challenging task of nursing management, therefore, calls for specific skills, attitudes, and approaches.  The American Association of Colleges of Nursing lists the core competencies and components of nursing leaders, and the list includes diversity awareness, technological skills, knowledge of the health care system, communication, and critical thinking skills.

Smith (2005) talks about a relevant theory about leadership: the idea of servant leadership. According to the author, servant leadership has different central tenets, and these will be compared with the tenets of leadership examined by other researchers. Servant leadership consists of the approach of service to others, holistic approach to work, promoting a sense of community, and sharing power in decision-making. Reviewing Al-Sawai’s (2013), two shared tenets are discovered: sharing leadership, and collaboration. This approach focuses not only on personality traits, but behaviors and outcomes as well. Personal characteristics of servant leaders include listening, empathic, abilities, healing, awareness, persuasion and conceptualization skills, foresight, stewardship attitudes, commitment to the growth of people, and abilities to build communities. While these personality traits are hard to measure, an effective system can be created In order to measure leadership approaches that result in the above outcomes.

Dixon (2000) developed an action plan for transforming nursing leadership into a culturally competent system. As the main focus of the current research is cultural alignment with leadership skills, the article provides some ideas on the development of the leadership assessment system for nursing leaders. The author (Dixon, 2000, p. 37) developed a method of aligning leadership approaches with the culture and environment of the organization, called: organizational fitness profiling. According to the author, (Dixon, 2000, p. 37) “’Organizational Fitness Profiling’ is a process that can help an organization’s leaders quickly learn employees’ views concerning the pros and cons of culture alignment.”. This definition is important, as the main focus of the leadership assessment development is to provide the same benefits and information as the Dynamic Leadership Culture Model, but providing more actionable information for prospective and existing leaders.

Leadership Assessment Application

In the previous assessment assignments, different findings have been brought into light regarding leadership skills needed in health care. Analyzing the leadership assessment results completed, a complex profile of models and application can be drawn up. The below table will show the leadership tenets each model measures, and the results.

The results of the personal assessments completed showed that I had a visionary approach towards leadership, and I was more people-focused, instead of task-oriented. The strongest trait in the Bolman & Deal Reframing Organization Assessment was human resources. My traits for A/B assessment showed that I aim to focus on competitiveness and social interaction at the same time. The results of the New Enneagram test revealed that my strongest leadership approach is the “Leader”, followed by Motivator and Peacemaker. The weakest traits and competencies defined in the Dynamic Leadership Culture Model assessment were management and science. From the above overview, it is evident that the above four tests measure different aspects of leadership. They are relevant to supporting self-discovery, however, provide little actionable results. In today’s dynamic environment and health care where change happens on a daily basis, individual approaches towards globalization, cultural diversity, democracy, and value alignment need to be measured as well, in order to provide results that clearly highlight leaders’ and organizations’ development areas. This is why there is a need for developing a new model that focuses on the main leadership challenges of health care professionals. The below described theory-based assessment tool is attempting to close the gap between competencies and their applications.

The results of my personal assessment are detailed below.

In the Dynamic Leadership Culture Alignment model, I scored high in art and leadership, however, my scores for science and management were lower. This result indicated that my strength is to create and communicate vision, lead people towards a common goal, and my weakness is to organize people’s roles and complete statistics. The below graphical illustration shows the detailed results. As the leadership model determines personal style, it fails to provide me with information on how to improve on development areas.

The results of the Bolman & Deal Reframing Organization Assessment  show similar results: I got a score of 22 on human resources leadership, 20 on symbolic traits, while only 11 in political and 7 on structural leadership traits. The limitations of the assessment are  also clear: they show the main leadership traits, but do not measure work-based leadership behavior in real leadership situations.

I also completed a New Enneagram test since writing the first paper, in order to look at some of the strengths of assessing real-life situations and work related behavior, as well as leadership and  personality traits. The results showed that I am mostly “The helper: The caring, nurturing type” (8) (9 Types, Web), and the “Skeptic: The committed, security-oriented type” (7) (9 Types, Web).

Application Based Leadership Model Development

Based on the above review of theories and new ideas about leadership challenges in health care, the new leadership assessment application framework needs to address different tasks, capabilities, and interpersonal skills. While all of the above assessment methods measure traits, behaviors, and skills related to leadership, they fail to focus on the specific characteristics needed in nursing. It has been revealed that today’s health care leaders need to be competent, knowledgeable, good organizers, communicators, and generally have strong vision they can use to empower their employees. They also need to be culturally competent, and open for change, unorthodox solutions, in order to deal with challenges. This means that when looking for a health care leadership assessment, the developers should focus on these specific skills. In the theoretical review part of the study, the main leadership and personality traits that can create a competitive advantage within the organization have been identified as:

1. leadership
2. vision
3. servant leadership
4. innovation
5. adaptability (change management)
6. cultural awareness
7. system-based thinking
8. people-based thinking

Therefore, the new leadership assessment model needs to determine individuals’ score on the different scales described below. The measurements will be focusing on behavior, attitudes, and cultural skills as well as personality traits. The authors of the current study believe that measuring all four aspects of leadership, the results would be more relevant to health care management, and provide organizations and individuals with actionable results.

One of the most useful and most relevant assessment that is aimed for health care professionals could be adjusted and used to measure one’s personality, approach, preferences, and leadership behavior. The Clark Assessment (Clark, 2009, p. 27). The assessment is designed to focus on tasks and challenges related to health care. Apart from the above developed questionnaire that leaders should fill out indicating their opinion by using a slider between the two opposite statements from -3 to +3, their answers to the below questionnaire developed by Clark  (2009) will be also recorded. This will enable the organization competing the assessment to examine not only the main leadership behaviors and traits, but also work-related approaches of the individual.

The main focus of the assessment will be work-related behavior patterns, as the author of the current research believes that these determine the culture of the organization, and in turn, they have an impact on team and unit performance as well. As an example, leaders who are not culturally competent would not be able to adapt working practices to the needs of diverse populations and minority team members. On the other hand, those who communicate and reinforce a shared vision will be able to create a team spirit that is based on taking shared responsibility. Those who are willing to share knowledge and power (power sharing and collaborative leadership) will increase the competencies of their team and increase the overall efficiency of the unit.

Conclusion

The author of the current study believes that aligning organizational, leadership, and individual preferences, values, and approaches is the best way of improving collaboration and efficiency of health care teams. The above outlined leadership assessment model is designed to take into consideration contemporary theories, such as the servant leadership theory, and the social change model. While the assessment tool has not been tried and tested on a large number of participants, the author would like to encourage future research that develops new categories of leadership approaches and clearly identifies leaders’ strengths and development areas. Further, the tool could be used to determine how the values and preferences of organizations are aligned with those of leaders and team members. This will allow the management of the health care unit determine whether or not the person selected for the leadership role is a good “cultural fit” for the role and the challenges ahead. Finally, the tool would help developing training programs that focus on individual needs, and improve the overall efficiency of leaders.

References

Al-Sawai, A. (2013) Leadership of healthcare professionals: Where do we stand? Oman Medial Journal, Jul. 2013.

Bolman, L. & Deal, T. (2013) Reframing organizations: artistry, choice, and leadership, 5th Edition. Wiley.

Burns, J. M. (1978) Leadership. New York: Harper & Row

Chemers, M. M. (1997) An integrative theory of leadership. Lawrence Erlbaum Associates, Publishers. London

Clark, C. (2009) Creative nursing leadership and management. Jones & Bartlett Learning.

Curtis, E., de Vries, J. & Sheerin, F. (2011) Developing leadership in nursing: exploring core factors. British Journal of Nursing, 2011, Vol 20, No 5

Consedine, N. (1999) A dynamic theory of personality and emotions. University of Canterbury.

Dixon, D. (2000) Leadership and culture alignment. Seven practical steps can help leaders bring different cultures together. Health Progress. Nov-Dec. 2000

Greenfield, D. (2007) The enactment of dynamic leadership. Leadership in Health Services. Vol. 20 No. 3, 2007 pp. 159-168

Greenleaf, R. (1977, 1991) The servant as leader. Indianapolis, IN: The Robert K. Greenleaf Center. [Originally published in 1970, by Robert K. Greenleaf]

Hartley, J. & Martin J. (2008) Leadership in healthcare. A review of the literature for health care  professionals, managers and researchers. Warwick Business School.

Josey-Bass Leadership Assessment. (n.d.) Online. Retrieved from http://www.josseybassbusiness.com/2013/07/assessment-leadership-orientations-self-assessment.html

Kark, R. Chen, G., &  Shamir B. (2003) The two faces of transformational leadership: Empowerment and dependency. Journal of Applied Psychology 88(2), 246-255.

Komives, S. & Dugan, J. (2011) Contemporary leadership theories. Political and Civic Leadership. SAGE Publications.

Ledlow. G. & Coppola, N. (2011) Leadership for health professionals. Theory, skills, and applications. Jones & Bartlett Learning. Sudbury.

Schein, E. (2006) Organizational culture and leadership. John Wiley & Sons,

Smith, C. (2005) The leadership theory of Robert K. Greenleaf. Management of Informative Organizations. 2005.