Examine the role and importance of traditional and more recent leadership theories and concepts for the health and care setting.

Learning outcomes:

• Examine the role and importance of traditional and more recent leadership theories and concepts for the health and care setting.
• Analyse the value of using theoretical models when building an effective leadership team in a health and care setting.
• Explain the role of leaders, the relevance of leadership styles and desired leadership personality characteristics in leading change in health and care settings.
• Discuss recommendations on how to lead teams during transitional periods in a health and care setting to achieve maximum organisational performance.
• Graduate attribute: Discipline expertise - Knowledge and understanding of the chosen field. Possess a range of skills to operate within this sector, have a keen awareness of current developments in working practice being well-positioned to respond to change.

Lesson 1: Introduction to Leadership

Leadership is a complex and multifaceted concept that can be challenging to define. However, at its core, leadership is about the ability to influence and guide others towards a common goal or vision. A great leader is someone who inspires and motivates their team, communicates effectively, and is accountable for their actions.

• Leadership is ‘organising a group of people to achieve a common goal` (Lin and Hsiao,
  2014), and social influence on others stipulate better work performance and team spirit.
• Managing means getting results with the available resources. It is about organising, planning, processes and procedures. Someone can be both a leader and a manager.

To conceptualise leadership, we will employ three main approaches:

1. Focus on a person- personal qualities of a leader.
2. Focus on a position- the leadership position in the organisation.
3. Focus on a process- the social processes and interactions of leadership.

Hartley and Bennington, 2015, p. 7 (of chapter 2)

Hartley, J. and Bennington, J., (2015). Leadership for healthcare [online]. Cambridge University Press. Available from: https://links.arden.ac.uk/t68ijk

Leadership task: HC leadership task is to ensure direction, alignment and commitment within teams and organisations.

Individual leadership in HC services:

• Effective leaders in health and social care services emphasise continually that safe, high quality, compassionate care is the top priority. 
• They offer supportive, available, empathic, fair, respectful, compassionate, and empowering leadership. 
• They ensure everyone is clear about what they are required to do and give helpful, positive feedback and performance, including appreciation. 
• They promote continuous development of the knowledge, skills, and abilities of staff in order to improve quality of patient care. 

Team leadership: Team leaders ensure there is shared leadership in teams and members are fully involved in appropriate decision making; responsibility for decisions is delegated to members appropriately; and there are constructive debates about how to provide and improve high quality patient care. The same is applicable when social care is considered. 

Source: West et al, 2015.

 

The Big 5 theory

The theory claims that we can describe ourselves with five main characteristics:

1. Open
2. Conscientious
3. Extravert
4. Agreeable
5. Neurotic

This theory was introduced by Lewis Goldberg. However, it is not solely his idea. His predecessors, Gordon Allport and Henry Odbert first formed a list of 4500 terms related to personality traits in 1936.

Low Score	Trait	High Score
Practical, conventional, prefers routine.	Openness (Imagination, feelings, actions, ideas)	Curious, wide range of interests, independent.
Impulsive, careless, disorganised.	Conscientiousness Competence, self-discipline, thoughtfulness, goal driven.	Hardworking, dependable, organised.
Quiet, reserved, withdrawn.	Extroversion Sociability, assertiveness, emotional expression.	Outgoing, warm, seeks adventure.
Critical, uncooperative, suspicious.	Agreeableness Cooperative, trustworthy, good-natured.	Helpful, trusting, empathetic.
Calm, even-tempered, secure.	Neuroticism Tendency toward unstable emotions.	Anxious, unhappy, prone to negative emotions.

Leadership theories provide frameworks for understanding and studying leadership. There are numerous leadership theories, each offering unique perspectives on what makes an effective leader:

• Great Man Theory (Miller, 2022)

Great leaders are simply born with the necessary internal characteristics, such as charisma, confidence, intelligence, and social skills, to be natural-born leaders. Great man theories assume that the capacity for leadership is inherent—that great leaders are born, not made.

• Trait Theory (early 1900s)

Trait theories assume that people inherit certain qualities and traits that make them better suited to leadership. Trait theories often identify a particular personality, or behavioural characteristics shared by leaders. For example, traits like extroversion, self-confidence, and courage are all traits that could potentially be linked to great leaders.

• Contingency Theory

Contingency theories of leadership focus on particular variables related to the environment that might determine which particular style of leadership is best suited for the situation.

• Situational Theory

Situational theories propose that leaders choose the best course of action based upon situational variables. Different styles of leadership may be more appropriate for certain types of decision-making.

• Behavioural Theory

Behavioural theories of leadership are based on the belief that great leaders are made, not born. This leadership theory focuses on leaders’ actions, not on their mental qualities or internal states. According to this theory, people can learn to become leaders through teaching and observation.

https://www.verywellmind.com/leadership-theories-2795323

Transactional Vs. Transformational Leadership

Transactional leaders occur when followers are moved to complete their roles as agreed with a leader in exchange for a reward.

• Focus on goals
• Use rewards and punishments for motivation
• Are reactive in nature

Transformational Leaders move followers to awareness about what is important, and away from own self-interests.

• Focus on vision
• Use charisma and enthusiasm for motivation
• Are proactive in nature

Lesson 2: Traditional Leadership

Leaders in the past have generally belonged to one of three categories (Leaders Excellence, 2022):

1. Political leaders- Hammurabi (1790 B.C.)
2. Military leaders- Jan Zizka (1360-1424)
3. Religious leaders

Leader is someone who has capacity, courage, vision, skills and knowledge. The role of the second leader is to gather other followers.

What is Contemporary Leadership?

Contemporary leadership theories focus on adaptability, collaboration, and inclusivity, emphasising the relationships between leaders and followers. They often recognise the complexity of modern organisations and the need for leaders to inspire, motivate, and empower others (Benmira, and Agboola, 2021).

Key characteristics of Contemporary Leadership:

• Leadership is seen as a shared process rather than a top-down role.
• Emphasis on emotional intelligence, ethics, and adaptability.
• Leaders are facilitators, fostering collaboration and engagement among team members.
• Greater focus on diversity, innovation, and well-being in the workplace.

There are 5 principles of ethical leadership:

1. Respects others
2. Serves others
3. Shows justice
4. Manifests honesty
5. Builds community

What is Compassionate Leadership?

What is compassion?

Gilbert (2013) defines compassion as ‘a sensitivity to suffering in self and others with a commitment to try to alleviate and prevent it.’

What is Compassionate Leadership?

West & Bailey (2019) propose that compassionate leadership entails listening with fascination to those they lead, arriving at a shared (rather than imposed) understanding of obstacles that they encounter, empathising with and caring for them, and then taking action to help or support them.

West (2017) identifies 4 compassionate leadership competencies outlining how they relate to problem solving and innovation.

• Attending
• Understanding
• Empathising
• Helping

Servant Leadership (Sandling, 2024)

10 principles of servant leadership:

1. Listening
2. Empathy
3. Healing
4. Awareness
5. Persuasion
6. Conceptualisation
7. Foresight
8. Stewardship
9. Commitment to the growth of people
10. Building community

Authentic Leadership (Brewer, and Devnew, 2022)

Authentic leadership is a leadership style characterised by transparency, integrity, and a strong adherence to individual values and beliefs, where leaders are self-aware and genuine in their relations with followers. This approach fosters trust and collaboration, aiming to create a positive organisational culture.

Examples:

• Staying true to your core values
• Taking personal responsibility
• Understanding your purpose
• Ethical decision-making
• Reflective and self-awareness
• Acknowledging limitations

Agile Leadership

Agile leadership is about not only driving and promoting change, but also about being the change. Those who lead by example and actively engage in their own development, inspire people. This is through action rather than words. (Behrens, 2016).

 

Traditional Leadership

Traditional leaders see power as belonging to and stemming from authority. Underpinned by hierarchy, it assesses power on longevity, first and foremost. Thus, the longer you stay, the higher you climb up the ladder. As you climb, so your power amasses and expands.

https://holtbyturner.co.uk/traditional-vs-contemporary-leadership-real-estate/

Differences between traditional and contemporary leadership

Aspect	Traditional Leadership	Contemporary Leadership
Decision-making	Top-down, leader-driven	Collaborative, team-focused
Focus	Authority and structure	Empowerment and adaptability
Follower Role	Compliance and obedience	Engagement and contribution
Core goal	Efficiency and stability	Innovation and growth

Positive contributions of traditional leadership theories

• Clarity and Structure

For example, in emergency situations, a directive leadership style ensures timely decisions and precise task delegation, reducing confusion.

• Authority in Crisis Management

A task-oriented leadership approach can help achieve operational efficiency during vaccine rollouts or disaster management.

• Standardisation and Stability

Ensuring compliance with safety protocols and accreditation standards in healthcare organisations.

• Focus on Leader Characteristics

Traits like decisiveness and resilience are crucial for healthcare managers facing resource constraints.

Limitations of Traditional Leadership Theories in the current HC sector

• Limited Focus on collaboration and empowerment

Impact: In complex cases requiring input from diverse professionals, such as mental health care, traditional models may fail to harness the full potential of the team.

• Inflexibility in Dynamic environments

Impact: Rigid leadership structures may hinder innovation in areas like telehealth or personalised care.

• Overemphasis on Authority

Impact: This can lead to higher burnout rates and lower job satisfaction among healthcare workers.

• Neglect of Emotional Intelligence and Well-being

Emotional intelligence and well-being, critical for healthcare workers, are not primary focuses in traditional theories.

Impact: Leaders may fail to address staff burnout and mental health issues, impacting team morale and patient care quality.

How do you balance traditional and contemporary approaches in HC?

Many health and care organisations are adopting hybrid approaches. Such as:

• Crisis leadership: Using traditional directive leadership for emergencies but complementing it with transformational leadership to rebuild morale post-crisis.
• Collaborative Decision-Making: combining task-orientated strategies from traditional models with servant leadership principles to empower multidisciplinary teams.
• Training Programs: incorporating both traits (i.e., emotional intelligence, adaptability) into leadership development.

Why this matters in Health and Care settings?

Traditional leadership models can be useful for maintaining order in high-pressure, rule-driven environments like hospitals, Care homes or Nursing homes.

Contemporary leadership approaches are better suited for fostering collaboration, addressing health inequalities, and ensuring patient-cantered care.

Leaders in health and care must often combine elements of both models, adapting to specific challenges in dynamic environments.

What is management?

Management is the process of coordinating and overseeing the activities of an organisation to achieve defined objectives efficiently and effectively. It involves planning, organising, leading, and controlling resources, such as human, financial, and informational resources to meet organisational goals (Robbins & coulter, 2018).

What is Ethical Leadership?

Ethical leadership is one that is rallying, bringing people together in an inclusive and fair manner. So, it is important that we see ourselves as belonging to society and leading society considering the views of society. Ethical leadership has to do with rising above one’s individual interests and addressing the collective interests of society.

 

The positive impact of ethical leadership

Desired outcome	Connected to
Reduce pressure to compromise standards	Strong top mgmt. commitment to workplace integrity
Reduce observed misconduct	Strong top mgmt. commitment to workplace integrity
Increase reporting of misconduct when observed	Strong supervisor commitment to workplace integrity
Reduce retaliation against reporters	Strong top mgmt. commitment to workplace integrity
Keep valued employees	Strong top mgmt. commitment to workplace integrity

Ethical Leadership Principles

1. Ethical leaders respect others. They are sensitive to their impact on others and care
   about this impact. They listen to others, are tolerant of opposing points of view, and
   “treat others as ends in themselves and never as means to an end” (Kant’s Moral
   Philosophy).
2. Ethical leaders serve others. They have a calling to serve and engage in servant
   leadership
3. Ethical leaders are just. They place a high priority on fairness and justice when making
   decisions, including demonstrating fairness towards individuals as well as the broader
   community.
4. Ethical leaders are honest. They demonstrate honesty and integrity, which helps to
   build trust, strengthen relationships and enhance their personal power.
5. Ethical leaders build community. They are aware of the needs and aspirations of their
   communities and look to align their leadership activities to help meet community
   goals.

Lesson 3: Leadership in Healthcare Settings

The Healthcare Leadership Model has been developed by the NHS leadership academy in order to help individuals who work in the health sector to become better leaders. This model would enable health care professionals to focus on specific areas and improve certain characteristics to become effective leaders in the long-term. Examine the role and importance of traditional and more recent leadership theories and concepts for the health and care setting. However, over time, this model has been known to be an effective tool for any individual to use (not just healthcare professionals) to become effective leaders in their day-to-day lives.

The NHS healthcare leadership model is one that can be used by any individual to become a better leader in their day-to-day lives. Individuals do not specifically need to be in any clinical or service setting to be able to use this health leadership model and can be used by individuals who are leading a very small number of individuals or a high number of people. The model has 9 total dimensions of leadership, which can be explored by an individual at their own pace. Each of these dimensions are attributed to different aspects of leaders and should be examined carefully in order to reflect and improve.

What makes health and social care leadership different?

• Expertise in management as well as in the subject field
• Need for efficiency and quality of service delivery
• Safety
• Greater pressure to achieve immediate outcomes
• Receivers of the services are ‘in great need of them’
• Work is focused on ‘dealing with humans and human emotions’ (compassion)
• Very limited space for errors in decision-making. 

Warwick Six C Leadership Framework

Concept: Leadership investigated as specific to the individual, position and process. Definition of leadership given.

Characteristics: Comparison of those with formal roles and informal leadership roles.

Context: Because the context (for example, political and economic context, policy context, organisational context) both creates opportunities for and places constraints on action and is also a source of potential leverage for leaders. In particular, healthcare raises critical questions about the importance of the political, economic, social and institutional context, which has perhaps been underplayed in many analyses of healthcare leadership.

Challenges: The challenges of leadership – which concern the principal purposes, goals or aims that leaders and leadership attempt to address– are explored. These challenges are crucial to leadership, and it can be argued that ‘the primary task’ or public value goals of leadership are central to understanding leadership effectiveness, although not all leadership studies address this question of purpose.

Capabilities: These are the qualities (for example, traits, skills, abilities, mindsets, behaviours) that are thought to distinguish ‘leaders’ from ‘followers’ and/or to contribute to successful or effective leadership.

Consequences: The review examines the consequences of leadership, rigorously questioning the extent to which the claims of a link between leadership and performance are justified, both in terms of evidence of causation and also because of attributional processes.

Lesson 4: Introduction to Compassionate Leadership

Gilbert (2013) defines compassion as ‘a sensitivity to suffering in self and others with a commitment to try to alleviate and prevent it’.

Compassion is being able to be with someone or a situation without judging it. It is about creating and holding the space for what needs attention. It is about being there as a resource that might help, but not necessarily needs to fix things.

Compassion is also not the same as sympathy or empathy, which usually weakens one of the involved parties (read my article about the difference between them). Compassion is not having pity but seeing the strength of others and keep the focus on it.

Compassion is about being equal as human beings. In the workplace this means that we make a distinction between having different roles (with different tasks and decision-making responsibilities) and being equal as a human being.

Leadership to me is having a vision, creating energy, inspiring others, being a change agent, a coach and a facilitator. So, it is something else that managing a team or an organisation. Managing means getting results with the available resources. It is about organising, planning, processes and procedures. Someone can be both a leader and a manager. What is often noticed in larger companies is that most people have more managing qualities than leadership ones since the latter weren’t developed in the education system nor in the workplace.

A Compassionate Leader is someone:

• Who is open minded.
• Who balances:
• Masculine and feminine energy (whether they are a man or a woman).
• Technology and humaneness.
• Doing and being.
• Down-to-earthiness and spirituality.
• Fun and getting stuff done.
• Who is vulnerable (which is a source of strength to be present with someone).
• Who is focused on personal development to raise to their own consciousness and that of their organisation.
• Who is curious about differences and offers a safe space for them to be present.

Academic literature suggests that compassion within the context of the workplace is relational, and process orientated. A review of compassion at work noted six key organisational aspects that are relevant to compassion (Dutton, Workman & Hardin (2014)):  

• Shared values - a set of values that an organisation and its people perceive to be important.  
• Shared beliefs - actual organisational beliefs held by employees.  
• Norms - the normative organisational behaviours that shape how employees act and respond to one another.  
• Organisational practices - practices which support and shape compassion in the workplace.  
• Structure and quality of relationships - the quality of human connections between employees, either dyadic or across the organisational network. 
• Leaders’ behaviours - the importance of leaders’ actions, specifically the signalling and modelling of appropriate behaviours and response to employees’ suffering.