Leadership theories in health care. Dr. Guy Lubitsh Ashridge Business School RCPsych Conference Edinburgh Congress

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1 Leadership theories in health care Dr. Guy Lubitsh Ashridge Business School RCPsych Conference Edinburgh Congress

2 Aims Evolution of classical leadership theories Implications for health care leaders Conclusions and future research

3 Trait theory People are born with inherited traits, some of which are suited to leadership. People who make good leaders have the right (or sufficient number of traits) Organisation = expression of leader s personality Deterministic it s written in the genes

4 Command and Control I'm extraordinarily patient provided I get my own way in the end. To me, consensus seems to be the process of abandoning all beliefs, principles, values and policies. So it is something in which no one believes and to which no one objects. Margaret Thatcher Only leader knows best - context, issues, solutions. Leader is expert and is the only person with the complete overview. Others follow willingly, or through power and pressure. Characterised by status, sought control, hierarchy and power differentials. What matters is will, fortitude, courage (and being right!). Heroic Organisation = army or machine Compliance, lack of initiative and taking of responsibility, entitlement and dependence

5 Transactional People are extrinsically motivated; reward and punishment works! Social systems work best with a clear chain of command When people agree to do a job, a part of the deal is that they cede all authority to their manager The primary purpose of a sub-ordinate is to do what their manager tells them Organisation = scientific management machine, reduce to parts Denies intrinsic motivation and the unexpected, focuses on the exceptional (good and poor), relies heavily on formal systems. Over time, can become de-motivational

6 SUPPORTIVE BEHAVIOUR Situational The best action of the leader depends on a range of situational factors, notably the motivation, commitment and capability of followers High High Supportive and Low Directive Behaviour S3 S2 High Directive and High Supportive Behaviour Organisation = system or organism S4 S1 Impersonal. Assumes best is knowable and leader has infinite range of responses Low Low Supportive and Low Directive Behaviour DIRECTIVE BEHAVIOUR High Directive and Low Supportive Behaviour HIGH MODERATE LOW D4 D3 D2 D1 High DEVELOPE D DEVELOPMENT LEVEL DEVELOPING 6

7 Visionary People will follow a leader who inspires them. Leader creates compelling images and visions, tells stories, and thereby creates energy to move towards a bright future People will follow a leader with passion who inspires them, often with devotion. Effective when people need motivating and in times of change The lengthened shadow of one great person Warren Bennis Organisation = purpose, energy and followership Can create dependency and hero worship

8 Relational It s personal! Leadership happens between people, in the moment. Not the property of leader or follower but of their interaction. Context is all important and is to be worked not fought. Leader is in charge but not in control. Containing anxiety and becoming the leader you can be (rather than ought to be) are central. Organisation = complex responsive process It s all too difficult, nothing really matters

9 Implications for leaders: in charge but not in control A useful analogy might be raising a child We do not normally begin with targets when they are born We do not normally perform a gap analysis and attempt to close the gap Instead, we create the conditions for growth and engage in the moment with intent and with all our resources and intelligence

10 Key domains in health care leadership Contextual leadership Technical leadership Defining quality and value Policy and strategy for healthcare The nature of organisations Views on leadership and innovation Organisation culture (conducive to quality improvement) Improvement science philosophies, methodologies, approaches and tools Approaches to sustaining improvement Developing improvement capability Relational leadership Personal leadership Organisation change Individual change The nature of groups and teams Power, politics, influence and conflict Engagement and communication Dynamics of relationships The patient experience Theories of learning, including reflective practice, personal growth and change Personal psychology (as relevant to a leader in healthcare) Self-awareness as a leader (impact, patterns, needs and motivations) Personal resilience

11 In conclusion, research shows Leadership in health care is about leading teams/people Traditional hierarchical-based leadership is now being replaced by Relational leadership Self-doubt may be a more valuable competency than self confidence. Four key domains of leadership in health care (personal, relational, contextual and technical) Future research is into shared, distributed and EQ leadership

12 References Avolio B. et al (2009). Leadership: current theories, research and future direction. Annu. Rev. Psychol. 60: Binney G. (2005)Living Leadership: A Practical Guide for Ordinary Heroes. Prentice Hall Nevicka et. al (2013) Uncertainty enhances the preference for narcissistic leaders. European Journal of Social Psychology

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