Envisioning direction
Role . | Description . | Behavior Categories . | Description . |
---|---|---|---|
Innovator | The innovator is creative and envisions, encourages, and facilitates change. | Taking initiative Envisioning direction | Actions that leaders take that concern enacting an innovation. Can be found when examples of new programs or a merger of units are discussed. Actions of leaders aimed at preparing and planning for the longer term. Can be found in passages about strategy or the bigger lines. |
Broker | The broker is politically astute, acquires resources, and maintains the unit’s external legitimacy through the development, scanning, and maintenance of a network of external contacts. | Representing interests External analyzing Cooperating Giving input Managing boundaries | Actions of leaders focusing on promoting the interests of people or units within the organization. Also to have an effect on decisions taken by someone else or another level within the organization. When interviewee discusses standing for her/his people or when offering suggestions or pushing for a decision or plan. Actions of leaders that involve observation of environmental trends for example. Differs from seeking input, which involves more interaction and communication, whereas analyzing is observant. Actions of leaders that have to do with achieving common objectives. When interviewee discusses teaming up with peers. Actions of leaders to spread information and ideas and getting involved in decision-making. Can be found where getting involved, staying in contact, and talking to people, are discussed. Actions that leaders engage in to deal with or work around organizational boundaries, mainly regarding cooperation with other units or organizations. |
Director | The director engages in goal setting and role clarification, sets objectives, and establishes clear expectations. | Setting direction Setting scope conditions Explaining | Actions of leaders aimed at making decisions and taking a stance, for example, to end a project/process. Actions that leaders engage in to set, deal with or work around boundaries in the form of scope conditions or limitations. It is about drawing, passing on, and protecting lines. Actions of leaders to explain plans, information, and ideas. Can be found where staying in contact, talking to people, explaining plans, and getting involved are discussed. |
Coordinator | The coordinator maintains structure, does the scheduling, coordinating, and problem-solving, and sees that rules and standards are met. | Keeping business running Solving problems | Actions of leaders that have to do with steering processes and managing personnel. These concern the daily managing tasks instead of strategic decision-making. Actions of leaders as troubleshooters and mediators. Can be found in fragments about conflicts, crises, or anger for example. |
Monitor | The monitor collects and distributes information, checks on performance, and provides a sense of continuity and stability. | Internal analyzing Seeking information | Actions of leaders that involve observation of internal affairs, for instance about employee well-being or unit performance. Differs from seeking information, which involves more interaction and communication, whereas analyzing is observant. Actions of leaders to gather information to know what’s going on. Can be found when leaders discuss talking to people inside and outside their organization. |
Facilitator | The facilitator encourages the expression of opinions, seeks consensus, and negotiates compromise. | Building community Seeking input | Actions that build commitment of others in a process and a sense of “sharedness.” Can show when interviewee gives example of making plans together. Not the same as asking for input (though they regularly occur together), but really working on ownership and cohesion. Actions of leaders to gather ideas. Can be found when leaders discuss talking to people inside and outside their organization. |
Mentor | The mentor is aware of individual needs, listens actively, is fair, supports legitimate requests, and attempts to facilitate the development of individuals. | Coaching Motivating | Actions that leaders take in the supervisory relationship with their employees. Can show when interviewee discusses things like mentoring or keeping an eye on the human side. Actions of leaders to encourage people to participate or perform. Discussed in fragments about getting people to do something. |
Starting with open coding, an inventory of leadership behaviors was established by extracting key themes close to the wording used by participants. Co-occurring behaviors were grouped into categories of similar actions. This resulted in 13 categories of leadership behaviors. Axial coding linked these categories to the leadership roles as described by Denison, Hooijberg, and Quinn (1995) . The behavior categories then give more detailed substance to the role categories, and role categories can be seen as clusters of behaviors with a similar purpose. Five behavior categories seemed to fit several leadership role categories, which were then split up into more specific categories matching the description of the role categories. During the axial coding, there appeared no substantive distinction between behavior types matching the coordinator and producer roles, which were therefore merged. This resulted in a total of seven leadership roles encompassing 18 types of leadership behaviors. This coding scheme is presented in table 2 .
The coded data have been examined using coding stripes and matrix queries to seek patterns of co-occurrence of leadership behaviors and directions in which the behaviors were exercised. The units of analysis in this process were the situations discussed by the participants, in which they experienced ambiguity and were showing leadership behavior. All analyses of the coded transcripts are performed in NVivo. This pattern-seeking has led to a categorization of leadership behavior repertoire uses that varied in their complexity, as the next section will discuss.
Based on the interview data, different uses of the leadership behavior repertoire were uncovered, which are illustrated below. To illicit these accounts, participants were asked to tell about situations in which they were confronted with multiple simultaneous demands that produced tension and how they acted then. In response, participants described a rich variety of leadership behaviors, showing a repertoire consisting of a range of behavioral options. Throughout the interviews, participants reported on combining several behaviors to address issues they are facing. Thereby they often need to balance several objectives, create synergies, or work in parallel on multiple issues. Participants described different types of behavior repertoire uses, that vary in terms of the number of behaviors used and the number of directions in which they operate. The variety of leadership behavior repertoire uses can be categorized in four quadrants, which is displayed in table 3 . Important to emphasize is that leadership behavior repertoire uses concern behavior modalities, approaches in dealing with leadership situations, rather than traits or characteristics of people. Leaders use those behavior modalities differently between situations.
Variation of Leadership Behavior Repertoire Uses
1. Simple repertoire uses • Few behavior types • Few directions | 2. Moderately complex repertoire uses • Few behavior types • Many directions |
3. Moderately complex repertoire uses • Many behavior types • Few directions | 4. Complex repertoire uses • Many behavior types • Many directions |
1. Simple repertoire uses • Few behavior types • Few directions | 2. Moderately complex repertoire uses • Few behavior types • Many directions |
3. Moderately complex repertoire uses • Many behavior types • Few directions | 4. Complex repertoire uses • Many behavior types • Many directions |
The discussion below builds up in terms of leadership complexity (see also table 3 ): first simpler uses of the repertoire are discussed, followed by uses that involve more different types of behavior and more different directions.
Leaders do not always use a substantial part of their leadership behavior repertoire. Only a few types of behavior directed to a single type of actor can form a leader’s response to occurring needs. Leaders discussed situations in which they dealt with a single type of actor such as their employees or were engaged in issues that involved a single task. Such examples match with how public leadership behavior is often studied, in research with the common focus on the supervisor–employee dyadic relationship. Instances of this kind can be found concerning motivating and coaching employees or managing conflict between employees. Though these examples as shown below can be classified as simple repertoire uses, it should be noted that more often than not more than one type of behavior was used. This illustrates that delineating leadership behavior in a more limited conceptualization may be too simple and may not be congruent with leaders’ practice.
For example, a participant described how he had facilitated reintegration of employees who suffered from burn-out (interview 13). He describes using behaviors of the mentor and monitor roles in downward direction: signaling and discussing burn-out of an employee to acknowledge the existence of a problem, giving the employee autonomy to come up with his/her own plan to improve the situation, discussing the plan and directing towards solutions or assistance if necessary, and monitoring and discussing progress. Another example originates with an educational director. In a mentor role, she keeps an eye to the human behind the employee, facilitating him or her to make choices about the number of hours s/he wants to work when family situations change, but at the same time ensuring that all courses can be taught and sufficient staff capacity remains, using behaviors fitting a coordinator role (interview 14). These examples show that leaders keep the interests of employees in mind while simultaneously also considering the implications for an institute and continuity of teaching programs. Yet despite concurring demands on the leader, a relatively simple repertoire use is shown.
Another type of example that appeared several times concerns the broker role in upward direction. For instance, a head of the department discussed that part of his job is to shield off his staff from new rules and administrative burden as much as possible. In the case of new digital systems being introduced by the university, he raised his voice and objections repeatedly towards the faculty and higher levels within the university. As part of this, he also participated in a review committee, gathering experiences and problems with these systems from all parts of the university, to advise the university board to change the systems and reduce the burden on employees (interview 2).
Other times, participants described situations featuring more comprehensive uses of the leadership behavior repertoire. Leaders focus on a few behaviors fitting one role, but thereby engage a range of actors in various directions. This type of instance shows similarities with the network perspective from the literature. Examples regularly feature behaviors of a communicating and connecting kind but can take on more task-oriented behaviors in more complex contexts.
A vice-dean talked about a process to create a shared story about the newly developed strategy. The leadership behaviors mainly fall within the facilitator role, but were directed downwards, outwards, and partially also upwards. In this case, earlier efforts to engage various parts of the organization in the development of the new strategy had not been accomplished that the outcome resonated broadly and generated excitement for the future envisioned together for the strategy. She therefore organized different types of meetings with staff as well as students to discuss the important values and how the new faculty strategy would contribute to advancing these values. Seeking input, bringing perspectives together, and giving the various stakeholders a voice in creating a story brought about that a lively discussion and a sense of community around this story emerged as a basis for acting upon the strategy sustainably (interview 3).
Other illustrations of this quadrant feature participants who are active in collaborations across organizational boundaries - both internal boundaries within the university and outward boundaries. An example comes from a research group leader who also acts as chair of a university-wide multidisciplinary network. In her work for this network, she talks about using leadership behaviors fitting the broker role in upward, sideward, and downward directions. As chair of this network, this participant works on setting up collaborative teaching modules as well as integrating the network’s focal theme within existing programs at all faculties. This means that she is engaged a lot in talking to deans, department and education directors, and peers throughout the university to explain the relevance of incorporating the theme within university teaching, asking them to participate and allocate resources within their programs to develop such education, and coordinating between participating programs and teachers on the work floor. Bargaining is part of this process, as well as establishing commitment from the university board to leverage it in those negotiations. Keeping in touch and following up with all stakeholders in the various directions, representing interests, cooperating, and spotting opportunities all fit this broker role, but takes different shapes dependent on which type of actors in which direction she engages with (interview 16).
A similar yet different version of the more comprehensive repertoire use is found when leaders combine a variety of behaviors of multiple roles, but only use them in one direction. Such behavior repertoire uses share with much of the literature that leadership is exercised in relation to a single type of stakeholder. It differs, however, by involving a combination of diverse behaviors, that emphasizes that leaders draw on multiple roles in these relationships.
An illustration is given by a head of department, whose department went through turbulent times and faced declining revenues and austerity measures from the faculty. She described her leadership in keeping the department afloat in terms of various behaviors matching the director, facilitator, and broker roles directed downwards at the staff working in the department. Initially, she had to get the change process in motion, which meant that she stressed the urgency of the problem and the need to take action for survival. Moreover, she stepped in to mediate and resolve conflict to get resistant staff members on board. This required organizing numerous meetings, having conversations with people separately, explaining the situation, and convincing the staff to make changes to the program. Besides giving input, she sought perspectives and ideas of the staff to solve the problems, giving them the opportunity to reshape the program along their expertise and thereby also create ownership of the community. Still, as head of the department, she made the conditions clear in order to reach the goal of solving the financial problems. Throughout the process, she worked on building social cohesion, trust, and a sense of collective ownership of the department, not only through participatory decision-making but also by organizing social activities and creating physical signs of community (a picture wall, for instance) (interview 19).
A further example of this type of repertoire use is provided by an educational director, who discusses how he works on getting the teaching program staffed and ensures educational quality. To plan all courses and allocate staff, he uses a model that specifies how many hours are available to fulfill tasks. In this way, he provides transparency to his colleagues. When a teacher complains about their tasks and the time available, and that it would not be fair, he can use the model to show what needs to be done in a year and how all colleagues contribute to that. Besides his coordinator and monitor role behaviors, he also draws on mentor role behaviors, to make sure that supporting arrangements are in place for new teachers, for instance, training and assistance, and asking what tasks people would like to do and how he can help them. Building shared ownership by involving staff in discussions and asking them for plans to improve educational quality characterize his facilitator role (interview 7).
Lastly, complex combinations of leadership behavior repertoire options are commonly used. Leaders made use of multiple behaviors and engaged with actors in various directions. Cases that involve strategy and organizational change are commonly at the heart of such examples. All participants shared the conviction and experience that strategies, plans for change, and important decisions should not be made by a leader alone, but instead should be developed together with their staff. This is important within the complex ambiguous contexts of many public organizations, because leaders lead professionals who have strong intrinsic motivation and a high level of expertise, while at the same time, many leaders still participate—like their staff—in the primary process like a “primus inter pares.”
Exemplary for a complex leadership behavior repertoire use is a head of department who elaborated on a process of formulating a new strategy for his department. He combined the innovator, broker, facilitator, and director roles and thereby worked downwards and upwards. Taking initiative, seeking and giving input, setting boundary conditions, delegating tasks and giving autonomy to his staff within these limits, overseeing but not directing the process, creating engagement, representing interests to the faculty board and financial department, and setting direction by making the final decisions based on input from the bottom-up process were combined in this process. New plans were being developed, while at the same time he started preparing for implementation. This example also illustrates the relational character of leadership spanning multiple organizational levels and working with actors in multiple directions. The participant facilitated employees within his institute to create bottom-up plans and influenced them by providing boundary conditions, while at the same time, influencing stakeholders higher up in the organization to be able to implement the new plans without delay or difficulties (interview 18).
Another illustrative case is provided by an educational director, who initiated, developed, and realized a new international Bachelor program. She combined innovator, facilitator, monitor, and director role behaviors in various directions: downwards, sidewards, and outwards. Based on her analysis of developments in the educational environment, staff composition, and potential for future thriving, this educational director took the initiative to start talking about creating a new program. Together with coordinating and policy staff, she made sure the financial conditions would allow this initiative and she started seeking input from teaching staff in various rounds and through diverse channels. The process was intentionally participatory and efforts were made to ensure transparent communication with staff members. In this way, shared ownership and support for the program were created to make it a success. Additionally, in the logistical developments, she has sought help and cooperation with colleagues of other disciplines within the university, to learn from each other and unite their interests (interview 10).
The illustrated uses of the leadership behavior repertoire give rise to questions how this perspective can contribute to ongoing theorizing and research. This section outlines research directions that seem particularly fruitful to continue when conceptualizing leadership behavior as a repertoire. Moreover, several methodological suggestions to make progress along those substantive lines are discussed.
In line with most leadership research, we have found between-person variation: between participants, the emphasis on certain types of behavior differs. Whereas some participants seem to put their role as director more central, others more often act as facilitators or brokers. Nevertheless, all participants take on multiple roles and work in various directions, which makes clear that characterizing a leader by their most prominent style is too simplistic. Possibly of more theoretical importance then is the within-person variation. The same participant can show different uses of the repertoire in varying situations. Several interviewees explicitly state that using the same “recipe” in all situations is not helpful, that instead, it is necessary to have sensitivity to contextual variation and use various approaches adapted to the situation. Such within-person variation of leadership behavior implies that an adaptation process is ongoing and underlines the importance of looking at leadership integrally and contextually.
Increasing our understanding of how leadership itself takes shape is all the more important, because characteristics of the context in which leaders operate present challenges—not the least in public organizations. Leaders need to balance multiple needs from their environment while being constrained by the complex hierarchical structures that divide formal authority between leaders in different positions ( Getha-Taylor et al. 2011 ; Groeneveld and Van de Walle 2011 ). Simultaneously, leadership is of growing importance in the pursuit of organizational goals ( Shamir 1999 ). So far, however, this question is largely overlooked ( Porter and McLaughlin 2006 ; cf. Schmidt and Groeneveld 2021 ; cf. Stoker, Garretsen, and Soudis 2019 ). Though it is debated to what extent the public sector is special, it is widely acknowledged that various aspects of publicness and the political context impact on organizational structures and processes amongst which leadership takes shape ( ‘t Hart 2014 ; Pollitt 2013 ). Adopting a repertoire conceptualization of leadership behavior and continuing within-person focused research can further stimulate systematic investigation of the impact of context factors on leadership.
Moving the focus from leadership of persons to leadership in situations helps disentangling leadership’s complexity while integrating context in our understanding of leadership. Thereby we build on and set a step beyond recent work of Pedersen et al. (2019) and Kramer et al. (2019) . Leaders could be thought of as being sensitive to contextual variations between situations and consequently, that such context sensitivity translates into context-sensitive behavior: when a leader perceives the situation to be different, the behavior deemed appropriate would co-vary. 1 A repertoire conceptualization can help to make this visible. It can then be argued that such context sensitivity is connected to a behavioral response based on contextual adaptation ( Hooijberg 1996 ; Van der Hoek, Beerkens, and Groeneveld 2021 ). It is worthwhile to investigate the relationship between contextual needs and a leader’s individual skills, capacity, and preferences and what that means for how the repertoire is used. Follow-up studies should conceptualize and operationalize context variables specifically to avoid vague and irrelevant explanations and make situational variation meaningful.
Another step can be made by investigating how leadership behavior seen from this repertoire perspective relates to other organizational phenomena. In the existing literature, many studies show the effects of isolated parts of leadership on performance and employee attitudes (see Vogel and Masal 2015 ). From a repertoire perspective, leaders can substitute and compensate their behaviors, and they prioritize their roles and behaviors differently (possibly) depending on the context. As Van der Hoek, Beerkens, and Groeneveld (2021) show, for example, leaders are likely to consolidate their behaviors when ambiguity increases. We have observed various shapes that the repertoire can take, but it would be worthwhile to investigate, too, whether those shapes have different impacts on outcome variables and under which conditions those relationships exist.
It has been found that leaders can use various approaches to be effective ( Pedersen et al. 2019 ) and leadership is most effective when leaders draw on the variety of options of the repertoire ( Denison, Hooijberg, and Quinn 1995 ; Havermans et al. 2015 ; Hooijberg 1996 ). Using the repertoire’s full range of options makes that leaders can match the diversity of issues they are addressing with suitable action, as the opportunities to create a fit between demands and response increase. Also in research on ambidexterity of leaders, it was found that effectiveness to fulfill various requirements was enhanced when leaders draw on a range of different behaviors ( Mom, Fourné, and Jansen 2015 ). Moreover, as Smith’s (2014) study shows, the pattern of behavior and decisions over a longer stretch of time may have more important consequences for organizational outcomes than single actions and decisions. A repertoire conceptualization of leadership facilitates that combinations of behavior with their combined impact are highlighted and can be evaluated.
Our analysis has focused on the variety within leadership behavior repertoire uses. Nevertheless, variety is only one perspective on this complexity. Not only which behaviors are used and in which directions, but a temporal lens to study repertoires can also add supplementary insights. Firstly, timing of the use of the repertoire’s elements can vary. Leaders can undertake various actions in parallel, while at other times the different actions are more sequential. Moreover, the moment when leaders decide to start, stop or change their approach can differ. Also delaying or waiting involve this temporal factor. Our interview participants gave examples that indicate variation in timing. Another way in which we can learn more about the leadership behavior repertoire is by considering the duration and intensity of behaviors. Whereas leaders may spend only a single instance of short time on some activities, others may require full attention for either a longer or shorter time, or may be always ongoing in a monitoring fashion.
Several authors have called for attention for temporal factors such as timing, pace, rhythm, cycles, ordering, and trends in the study of organizational behavior (e.g., Ancona et al. 2001 ; Castillo and Trinh 2018 ; Johns 2006 ) and public management ( Oberfield 2014a ; O’Toole and Meier 1999 ; Pollitt 2008 ), though still very few empirical studies in public management have explicitly addressed this issue (e.g., Oberfield 2014a , 2014b ). By taking up a repertoire perspective to conceptualize leadership, more nuanced differences connected to subtle time variables could be illuminated.
Besides further developing the operationalization of the leadership behavior repertoire, the internal dynamics of the repertoire can be unpacked. Not only the elements of the repertoire themselves and how we look at them, but also how they are combined and balanced can be disentangled for deeper insights. Understanding why leaders use their repertoire as they do, how they combine and balance the various elements, and why so, helps to untangle the intricacies of the complexity of the leadership behavior repertoire. As referred to before, the internal dynamics may cause differential effects than when a single type of leadership is examined.
One relevant aspect concerns the extent to which leaders are on the one hand intentional, strategic, and proactive in choosing their leadership behavior, or reactive and habitual on the other hand ( Boyne and Walker 2004 ; Crant 2000 ; Miles and Snow 1978 ). Based on some indications in our data, variation exists in this respect. Sometimes leaders take a proactive approach and choose behaviors strategically to advance their goals. Building on findings by Havermans et al. (2015) , intentional switching and combining of various leadership behaviors can be expected. Other times, leadership behavior becomes a matter of reactively responding to what is thrown at a leader and defaulting to preferred styles.
Explanatory factors at the level of the leader may be relevant to consider. One way to understand such differences concerning the combinations leaders make, relates to the breadth of repertoire options available to them. In case leaders are aware of a large number of behavioral strategies they could adopt and have the skills to use them, this may lead to more varied repertoire uses and more variation between situations. On the other hand, having knowledge and skills of only a few behavioral options, leaders may be more inclined to use the same and a limited repertoire. How this relates to length of tenure in a position or experience in leadership roles more generally could be examined. A second explanation could be found in how leaders perceive their room for maneuver. Feeling in control or in the position to frame issues may help to make such conscious strategic combinations. Feeling overwhelmed by the sheer amount of demands or in a position of putting out fires, however, may put leaders under pressure to forgo proactive strategic behavior.
To pursue these substantive avenues for continued study, a number of methodological suggestions can be made that seem particularly suitable when using a repertoire conceptualization of leadership behavior.
Experimental methods are strongly encouraged and increasingly used in the field (e.g., Blom-Hansen, Morton, and Serritzlew 2015 ; Jacobsen and Andersen 2015 ). Experimental designs can be used to assess the extent to which leaders adapt their leadership behavior to context. The controlled design can systematically build on insights from rich literature about the public sector context as well as from research in the contingency tradition. By manipulating contextual variation in experimental tasks or vignettes ( Atzmüller and Steiner 2010 ; Barter and Renold 1999 ; Belle and Cantarelli 2018 ; Podsakoff and Podsakoff 2019 ), the specific effect of context on leadership behavior can be tested. A repertoire conceptualization may then reveal differentiation in how context factors influence leadership behavior. Since experimental conditions can be designed by the researcher, numerous potentially relevant contextual dimensions discussed in public management research can be investigated on their effects on leadership behavior repertoire uses. If participants are confronted with multiple manipulations each, within-person variation and adaptation can be examined ( Van der Hoek, Beerkens, and Groeneveld 2021 ).
Another strategy to study leadership repertoires is using event sampling methods ( Bolger, Davis, and Raffaeli 2003 ; Kelemen, Matthews, and Breevaart 2020 ; Ohly et al. 2010 ). These methods are based on within-person variation over time, whereby study participants can be asked to report their leadership behavior at various points in time or after specified events occur. In addition, they can be asked to provide information about the context and situation in which this leadership behavior was used as well as about results. Both quantitative multilevel designs and qualitative diary studies could each contribute new insights: hypothesized patterns can be assessed or perceptions of and considerations in various situations can be disentangled. Therefore, event sampling methods can be used to test whether leaders adapt their leadership behavior to changing situations. Secondly, this method offers opportunities to learn more about timing of changes in the repertoire use and reasons for doing so.
Finally, ethnographic methods such as shadowing and participant observation are suitable to study subtle differences in meaning-giving and leadership behavior repertoire use ( Alvesson 1996 ; Geertz 1973 ; Weick, Sutcliffe, and Obstfeld 2005 ). Observing leaders in various types of situations and asking questions related to those observations can give better insights in leaders’ interpretations of the context and their considerations when responding to a situation. In this way, the interaction between situational context and personal preferences and skills related to their repertoire can be studied. The balancing of different behavioral strategies by leaders can then be illuminated. This could add to develop the operationalization of the leadership repertoire as well as the understanding of its internal dynamics. Moreover, such methods are particularly useful to connect leaders’ own intentions of their leadership behavior to the perceptions of those around them to whom this behavior is directed. Since self-other disagreement is common in the study of leadership behavior ( Vogel and Kroll 2019 ), combining self-reported accounts with accounts of others can stimulate the repertoire’s validity if confirmed.
We see more of leadership when we look at the leadership behavior repertoire used in situations. Coaching, motivating, planning, solving problems should not be seen as stand-alone behaviors of a leader; instead, such actions are taken at the backdrop of and are impacted by the overall task of leading an organization, which involves many more leadership behaviors. This regularly evokes a more complex leadership repertoire use. Furthermore, the structures that divide authority of leaders and thereby make them interdependent, bring along that leadership behavior does not only comprise supervising employees or leading downwards, but that 360-degree action is frequently required. The relational character of leadership is omnipresent in such complex environments. Leaders have to work in different directions and need to switch their strategies and combine various types of leadership behavior to be able to influence and facilitate.
There are always trade-offs when defining a good concept, parsimony and depth being one of them in this case, and the utility for theory is the most important criterion when choosing the best concept ( Gerring 1999 ). In-depth studies on specific leadership elements have provided valuable evidence on the nature of certain behaviors, and their effects on various organizational outcomes. As a limitation, they ignore a symbiotic relationship between different behaviors. While more comprehensive, the repertoire approach has its own challenges, though. Due to its comprehensiveness, delineation of the concept as well as its operationalization and use in empirical studies is more complex.
The fragmentation of research in different, largely non-communicating parts of the literature may be developing a blind spot for the study of leadership behavior of individuals in public organizations: though it may describe the real world well in relatively simple situations, it prevents studying leadership behavior in a manner that covers the comprehensiveness of leadership in more complex situations common in public organizations. This study provides support for the importance of an integral approach that examines the combination of various leadership behaviors at the individual level in public management, because the ambiguous context of many public leaders forces them to draw on a broad repertoire of behaviors. Learning how leaders vary, combine, and balance their behavioral strategies is then essential, as it can provide further insights into obstacles and openings of effective leadership. The identified directions could be a guide for future research in this endeavor.
The premise of context sensitivity underlies research on contingency theory (e.g., Aldrich 1979 ; Donaldson 2001 ; Fiedler 1967 ; Lawrence and Lorsch 1967 ; Perrow 1970 ) and situational leadership (e.g., Graef 1997 ; Thompson and Vecchio 2009 ; Yukl 2008 ), though such studies generally focus on organizational structure or effectiveness as dependent on leadership or organizations’ external environment. Situational leadership theory ( Graef 1997 ; Thompson and Vecchio 2009 ; Yukl 2008 ) sees leadership itself as dependent on context, but specifically focuses on employees’ task maturity rather than a broader view of organizational context factors and narrows leadership to motivating subordinates.
- Can you tell me what it means to be [director/dean/board member/project leader] within this [department/institute/faculty] (tasks/running issues and projects)?
- What do you find hard about your role as […]? Can you tell about this in relation to a particular issue or event in which this featured. What did make that difficult?
- Do you experience dilemmas in your role as […]? Have you experienced moments where different things were hard to reconcile? Where did that tension come from?
- Do you experience dilemmas between your roles as […] and […]?
- You have different tasks and roles. How do you combine those (simultaneously)?
- Where do those needs originate from? Can you tell about this in relation to a particular issue or event in which this featured.
- What did you do then in that situation?
- Do you always do this in the same way, or is it dependent on the situation?
- What made you choose this approach?
Goals that allow room for multiple interpretations?
Working on both innovation/change as optimization/stability?
Complexity and dynamism in the environment of your [department/institute/faculty/group]?
- Do you experience tension here? Example? Where did that tension stem from?
- How did you deal with it?
- What do you mean by […]?
- Can you give an example of that (of last week/month)?
- What did you do then?
- Can you tell more specifically which actions you undertook to do that?
- Can you take me along in the process of […], how that went, what you were thinking?
- What did you find difficult about that?
- How did you do that?
- Can you elaborate?
- Have you missed a topic/did we not discuss something that you would like to bring to my attention?
- Did you participate in leadership training?
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2020, Leadership: A Comprehensive Review of Literature, Research and Theoretical Framework. In: Journal of Economics and Business, Vol.3, No.1, 44-64.
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Charles william hargett.
1 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine
2 Feagin Leadership Program
3 Department of Anesthesiology
4 School of Medicine
5 Department of Neurosurgery
Julie a neumann.
6 Department of Orthopaedic Surgery
7 Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC, USA
Despite increasing awareness of the importance of leadership in healthcare, our understanding of the competencies of effective leadership remains limited. We used a concept mapping approach (a blend of qualitative and quantitative analysis of group processes to produce a visual composite of the group’s ideas) to identify stakeholders’ mental model of effective healthcare leadership, clarifying the underlying structure and importance of leadership competencies.
Literature review, focus groups, and consensus meetings were used to derive a representative set of healthcare leadership competency statements. Study participants subsequently sorted and rank-ordered these statements based on their perceived importance in contributing to effective healthcare leadership in real-world settings. Hierarchical cluster analysis of individual sortings was used to develop a coherent model of effective leadership in healthcare.
A diverse group of 92 faculty and trainees individually rank-sorted 33 leadership competency statements. The highest rated statements were “Acting with Personal Integrity”, “Communicating Effectively”, “Acting with Professional Ethical Values”, “Pursuing Excellence”, “Building and Maintaining Relationships”, and “Thinking Critically”. Combining the results from hierarchical cluster analysis with our qualitative data led to a healthcare leadership model based on the core principle of Patient Centeredness and the core competencies of Integrity, Teamwork, Critical Thinking, Emotional Intelligence, and Selfless Service.
Using a mixed qualitative-quantitative approach, we developed a graphical representation of a shared leadership model derived in the healthcare setting. This model may enhance learning, teaching, and patient care in this important area, as well as guide future research.
Physicians must become effective healthcare leaders in order to influence the care of individual patients, the performance of diverse clinical teams, and the direction of major healthcare organizations and beyond. The importance of effective healthcare leadership is difficult to overestimate as leadership not only improves major clinical outcomes in patients, but also improves provider well-being by promoting workplace engagement and reducing burnout. 1 – 5 We define the ability to influence as the foundation of our definition of healthcare leadership: Healthcare leadership is the ability to effectively and ethically influence others for the benefit of individual patients and populations.
Over the last ten years, we have created, implemented, and refined several undergraduate medical education (UME) and graduate medical education (GME) leadership development educational programs. We have found that medical students, residents (synonymous with junior registrar), and fellows (postgraduate trainees; synonymous with advanced specialist registrar) are exposed to little intentional education to prepare them for their current and future personal and professional leadership challenges. Importantly, from a developmental and educational perspective, omitting topics such as leadership in medical education “is a powerful, if unintended signal, that these issues are unimportant”. 6 Our programs are not designed to prepare individuals for specific leadership roles. Rather, they facilitate individuals’ learning and development of leadership skills that will prepare them to influence many facets of life, including healthcare.
We have found that leadership models are extremely helpful for learners to grasp new concepts, make sense of lessons learned through their experiences, afford structure that facilitates lasting comprehension through reflection, and provide a basis for learner assessment and program evaluation. 7 In the formative years of our programs, we used business leadership models as the foundation to teach leadership skills. Our review of other leadership development schools and professions (for example, the Wharton School of Business - University of Pennsylvania, the Fuqua Business School at Duke University, the United States Service Academies, and the Department of the Army) were helpful, yet they lacked emphasis on subtle aspects unique to healthcare leadership. We then looked for explicit healthcare leadership models and found that few existed. Further, none seemed to facilitate effective leadership learning in UME and GME.
Our inability to find an appropriate healthcare leadership model led us to create a leadership model specific to healthcare. This model needed to be based on competencies that were recognized as the most important attributes for effective healthcare leadership. The purpose of the paper is to present the research process that resulted in the Duke Healthcare Leadership Model, as shown in Figure 1 .
The Duke Healthcare Leadership Model.
Note: ©2017 Dean C. Taylor, MD. All rights reserved.
The study was a mixed method study using a modified concept mapping approach to derive, prioritize, and thematically structure the fundamental competencies of healthcare leadership. Concept mapping is a mixed methods approach that combines qualitative group processes such as brainstorming and interpretive sorting with rigorous quantitative data analysis to produce a visual depiction of the composite thinking of the group. This process of structured conceptualization has been used to address complex issues in healthcare, and provides a framework that can guide action planning, program development or evaluation and measurement. 8 , 9 We used a comprehensive literature review and focus groups to develop a set of statements that described healthcare leadership competencies. Next, we implemented a card sorting task, followed by analysis and interpretation. Finally, we created and refined a graphical representation of healthcare leadership. These successive steps are illustrated in Figure 2 and will be explained in more detail in following sections. The study was approved by the Duke Health Institutional Review Board after it was determined to be exempt from full review. Participation was voluntary, and informed consent was not required.
Sequence of steps in the concept mapping approach to derive, prioritize, and thematically structure the fundamental competencies of leadership in medicine.
Building upon our prior meta-analysis exploring leadership curricula used to teach medical students, we performed an updated literature search and review of existing leadership models. 10 Information gleaned was used to develop semi-structured focus group interview questions, a list of common healthcare leadership attributes, and a script to be used in focus group discussions.
Participants were recruited to collect expert opinion on the leadership competencies required of a healthcare leader in any environment . Each focus group lasted approximately two hours, and was led by the same team of moderators. Moderators used the script developed from the semi-structured focus group interview questions to lead the discussions. One of the moderators took notes of the comments from the group members and from subsequent debriefing sessions. The focus groups were also asked to critique the leadership attributes identified from the literature. Participants were asked to rank the top 10 attributes required of a healthcare medical leader. The focus group data were analyzed through constant comparison analysis by identifying common themes through saturation within each group and across groups. An initial set of competency statements was derived and further refined by eliminating duplication and targeting specifically for healthcare settings. The resulting competency statements formed the basis for the quantitative card sorting and cluster analysis.
The sorting procedure was administered online with the open source program FlashQ. 11 Following an introduction with instructions, participants were presented with the focus group leadership competency statements in random order and asked to sort them in order of importance based on their individual point of view. More specifically, participants were asked to rate the relative importance of each leadership attribute based on its value or importance in contributing to effective leadership performance in real-world clinical situations. During the sorting process, participants placed one unique statement in each box on a grid with a fixed quasi-normal distribution. Competency statements could be allocated to a ranking position ranging from +5 (most important) to −5 (least important). Respondents could change the placement of cards until the final positioning of all statements reflected their ranking of the statements relative to each other in importance. After completing the card sorting, participants were asked to provide their rationale for placing the competency statements at the extreme ends (+5 or −5 columns) of the sorting grid. All responses were anonymous, though respondents could elect to enter demographic data, including sex, current role, and leadership experience.
Demographic data and importance scores were calculated using descriptive statistics. All data were analyzed with JMP Pro 13.0 (SAS Institute Inc., Cary, NC, USA). Cluster analysis is a statistical technique to find similar groups of cases in a data set and is particularly useful in the development of a classification or conceptual scheme. Hierarchical cluster analysis (Ward’s method, squared Euclidean distances) was used to classify leadership competency statements based on the similarity of individual sorting responses of each participant. Guided by the dendrogram and agglomeration schedule, investigators (CWH, JPD, DCT) determined the final number of clusters by consensus and based on the criterion that the clusters should reflect meaningful, distinct domains related to effective leadership in a healthcare setting.
We analyzed the quantitative data in conjunction with the qualitative data obtained from the focus group discussions and the statements provided by card sorting participants. This mixed methods analysis helped us define the primary healthcare leadership competency themes. Earlier versions of the model originated within our Feagin Leadership Program and the Leadership Education And Development (LEAD) Curriculum, which are internal initiatives within our UME and GME programs. The initial models were refined based on input and feedback obtained from multiple faculty, house staff, and residents over a three-year period.
The literature review found that healthcare leadership is a skill that must be 12 – 14 and can be 15 – 17 intentionally taught. Further, the literature review provided information on healthcare leadership attributes and content 18 – 25 that we used to guide the discussion to the semi-structured focus group interview questions. Thirty-nine healthcare leadership attributes were identified and used to determine the competency statements in the focus groups.
Three focus groups were carried out with a total of 19 participants, many being clinical faculty with administrative or leadership roles . From the 39 healthcare leadership attributes identified through the literature review, the focus groups’ work led to a set of 33 competency statements that represent important aspects of healthcare leadership (Supplementary material). These statements formed the basis for the card sorting task. Each one of the statements:
In addition to identifying the statements for our quantitative card sorting task, the focus groups also provided important qualitative data. All three focus groups emphasized that Patient Centeredness and Selfless Service are two competencies essential to effective healthcare leadership. Further, each focus group emphasized that Patient Centeredness was essential to any healthcare leadership model as this principle differentiated healthcare leadership from leadership in other fields.
Approximately 200 faculty (attending physicians and non-physician professionals) and learners (medical students, residents, and fellows) were recruited via email to participate in the card sorting exercise. Ninety-two participants responded (46 percent) (22 medical students, 29 physicians-in-training, 25 attending physicians, and 16 non-physician professionals). Sixty percent were men, and two-thirds reported prior formal leadership training. Table 1 presents a basic summary of the participants in the card sorting task. Table 2 summarizes the mean values for importance of the top competency statements.
Characteristics of participants in card sorting
Characteristics | Medical students (n=22) | Physicians in training (n=29) | Attending physicians (n=25) | Non-MD professionals (n=16) | Total (n=92) |
---|---|---|---|---|---|
Sex, no. (%) | |||||
Female | 8 (44%) | 14 (50%) | 7 (32%) | 4 (29%) | 33 (40%) |
Male | 10 (56%) | 14 (50%) | 15 (68%) | 10 (71%) | 49 (60%) |
Leadership training, no. (%) | |||||
Prior formal training | 12 (57%) | 15 (54%) | 19 (83%) | 11 (73%) | 57 (66%) |
Note: Discrepancies in totals are due to incomplete responses as demographic questions were optional.
Top competency statements ranked by mean (SD) importance score
Competency statements, mean (±SD) | Total (n=92) |
---|---|
Acting with Personal Integrity – behaving in an open, honest, and trustworthy manner | 3.07 (±2.24) |
Communicating Effectively – ability to communicate with patients and team; successfully navigating difficult conversations and providing feedback | 2.98 (±1.8) |
Acting with Professional Ethical Values – applying medical ethical principles to difficult situations | 1.98 (±2.27) |
Pursuing Excellence – striving for excellence in all areas of personal, team, and organizational life | 1.2 (±2.75) |
Building and Maintaining Relationships – listening to and supporting others, gaining trust, and showing understanding | 1.15 (±2.17) |
Thinking Critically – being able to think analytically and conceptually to evaluate and solve problems | 1.12 (±2.5) |
Through hierarchical cluster analysis, the competency statements fell into five domains. We labeled four of the domains based on the predominant themes of the competency statements in those domains: Integrity, Teamwork, Critical Thinking, and Emotional Intelligence. A fifth domain comprised a set of low-rated competency statements for which no unifying theme could be identified ( Figure 3 ). Fundamental leadership domains with mean importance scores for each leadership competency statement are presented in Table 3 .
Organization of competency statements based on hierarchical cluster analysis and mixed quantitative and qualitative assessment.
Five fundamental competency themes in leadership in medicine with mean importance score for each competency statement
Themes with statements, mean (±SD) | Medical students (n=22) | Physicians in training (n=29) | Attending physicians (n=25) | Non-MD professionals (n=16) | Total (n=92) |
---|---|---|---|---|---|
Acting with Personal Integrity | 2.86 (±2.51) | 2.24 (±2.52) | 3.56 (±1.85) | 4.06 (±1.18) | 3.07 (±2.24) |
Communicating Effectively | 2.77 (±2.09) | 3.59 (±1.78) | 2.76 (±1.64) | 2.5 (±1.51) | 2.98 (±1.8) |
Acting with Professional Ethical Values | 1.36 (±2.48) | 1.21 (±2.21) | 2.28 (±1.97) | 3.75 (±1.44) | 1.98 (±2.27) |
Pursuing Excellence | 1.41 (±2.5) | 0.83 (±2.9) | 1.16 (±3.1) | 1.63 (±2.36) | 1.2 (±2.75) |
Thinking Critically | 2.09 (±2.11) | 1.41 (±2.47) | 0.32 (±2.67) | 0.5 (±2.42) | 1.12 (±2.5) |
Having a Strong Knowledge Base | 0.09 (±3.29) | −1.03 (±2.98) | −2.36 (±2.94) | 0.56 (±2.58) | −0.85 (±3.13) |
Applying Knowledge and Evidence | −0.68 (±2.83) | −0.62 (±2.44) | −0.8 (±2.68) | −0.69 (±2.77) | −0.7 (±2.62) |
Maintaining Patient Centeredness | 0.86 (±2.92) | 0.28 (±3.22) | 0.36 (±2.94) | 1.56 (±2.58) | 0.66 (±2.96) |
Serving Selflessly | −0.45 (±3.43) | −1 (±3.36) | 0.72 (±2.7) | −0.56 (±2.71) | −0.33 (±3.13) |
Developing Self-awareness | 0.18 (±2.84) | −0.97 (±1.84) | 1.08 (±2.77) | 0.13 (±3.05) | 0.05 (±2.66) |
Continuing Personal Development | −0.45 (±2.32) | −0.55 (±1.86) | 0.04 (±2.52) | −0.88 (±2.03) | −0.42 (±2.19) |
Managing Self | −0.82 (±2.32) | −0.03 (±2.5) | −0.24 (±2.76) | −0.25 (±2.21) | −0.32 (±2.46) |
Cultivating Personal Resilience | −0.27 (±2.12) | −0.93 (±2.05) | −0.84 (±2.48) | −0.13 (±1.63) | −0.61 (±2.12) |
Maintaining Personal Balance | −1.09 (±3.04) | −1.24 (±2.89) | −0.88 (±2.76) | 0.38 (±2.45) | −0.83 (±2.83) |
Being Decisive | 0.23 (±2.74) | 0.17 (±3.16) | 0.08 (±2.16) | 1 (±1.86) | 0.3 (±2.59) |
Building And Maintaining Relationships | 1.68 (±1.96) | 1.17 (±2.11) | 0.88 (±2.51) | 0.81 (±2.07) | 1.15 (±2.17) |
Optimizing Team Dynamics | 0.59 (±3.11) | 1.55 (±1.96) | 0.24 (±1.54) | 0.44 (±2.58) | 0.77 (±2.33) |
Managing Personal and Team Performance | 0.27 (±1.96) | 0.34 (±2.21) | 0.44 (±1.66) | 0.31 (±2.44) | 0.35 (±2.02) |
Motivating | 1.05 (±2.19) | 0.86 (±2.22) | 1.24 (±2.13) | 0.44 (±2.99) | 0.93 (±2.31) |
Managing People | −0.09 (±2.56) | 1.72 (±1.89) | 0.28 (±2.3) | 0.56 (±2.73) | 0.7 (±2.4) |
Encouraging Contribution | 0.27 (±2.69) | 0.45 (±1.86) | 0.32 (±2.48) | −0.44 (±2.13) | 0.22 (±2.28) |
Fostering Vision | −0.09 (±3.46) | −0.1 (±2.91) | 0.16 (±3.05) | −0.19 (±2.64) | −0.04 (±3) |
Planning | 0.23 (±2.29) | 1.03 (±2.46) | 0.16 (±1.93) | −1.81 (±2.69) | 0.11 (±2.48) |
Developing and Implementing Strategy | −0.36 (±1.71) | −0.1 (±2.16) | 0.16 (±3.09) | 0.13 (±2.09) | −0.05 (±2.32) |
Managing Resources | −1.18 (±2.15) | 0.34 (±2.48) | −0.96 (±2.28) | −0.75 (±2.02) | −0.57 (±2.33) |
Adapting to Change | 0.36 (±2.06) | 0.83 (±2.39) | 0.36 (±1.93) | 0 (±2.16) | 0.45 (±2.14) |
Encouraging Improvement and Innovation | −0.09 (±1.8) | 0.55 (±2.1) | −0.24 (±2.7) | 0.81 (±2.79) | 0.23 (±2.34) |
Facilitating Transformation | −1.09 (±1.34) | −0.76 (±2.46) | −0.88 (±2.73) | −1.19 (±1.97) | −0.95 (±2.22) |
Developing Networks | −2.5 (±2.11) | −1.86 (±2.52) | −0.92 (±2.72) | −2.13 (±2.31) | −1.8 (±2.48) |
Evaluating Systemic Impact | −0.68 (±1.78) | −1.48 (±2.23) | −1.04 (±1.72) | −1.81 (±1.8) | −1.23 (±1.93) |
Understanding Situational Context | −1.05 (±2.28) | −1.55 (±2.06) | −1.52 (±2.06) | −2.69 (±1.74) | −1.62 (±2.1) |
Understanding Community Impact | −1.82 (±2.67) | −2.97 (±1.8) | −3.04 (±1.62) | −3.06 (±2.21) | −2.73 (±2.1) |
Understanding Historical Context | −3.59 (±1.79) | −3.38 (±1.72) | −2.88 (±2.32) | −3 (±2.34) | −3.23 (±2.01) |
Mixed methods analysis of the quantitative and qualitative data resulted in two additional competency themes for the healthcare leadership model. We used the qualitative input from the focus groups and the card sorting comments to separate Patient Centeredness and Selfless Service from the Emotional Intelligence domain ( Figure 3 ). The focus group affirming that Patient Centeredness is a unique, defining component found in effective healthcare leaders was confirmed through feedback and experience we received when testing early versions of the model in leadership education settings. We concluded that Patient Centeredness is more than a competency for healthcare leadership; it is a core principle.
We also identified the highly rated statement of “Communicating Effectively” (originally clustered in the Integrity domain) as essential to each domain, and not a separate competency. Similarly, “Pursuing Excellence”, although highly rated and part of the Critical Thinking domain, is a statement that is an aspirational goal and, as such, a part of each competency.
Finally, we modified the graphic representation of the model based on its use in teaching students, residents, and fellows, along with the feedback we received from these learners and faculty. The resulting model ( Figure 1 ) features that the central core principle of Patient Centeredness is surrounded by the overlapping five core competencies. We recognize Emotional Intelligence 26 , 27 as the core competency that holds the other competencies together, and therefore it is positioned as the “keystone” in the model; if Emotional Intelligence is removed, the model will crumble. Integrity and Selfless Service are intentionally positioned at the base of the model; although they may be difficult to teach, they are extremely important to effective healthcare leadership and must be recognized and emphasized as essential “foundational” core competencies. Critical Thinking and Teamwork are positioned as the “framework core competencies”, holding the model together and overlapping with the other three competencies.
From curricular, pedagogical, and assessment perspectives, a model serves as the foundational starting point for learning and as an organizing framework for the developing leadership curricula. The model presented here addresses this need. We used a concept mapping approach to create a model specific to the needs of learning in healthcare leadership.
Our model was developed based on a comprehensive literature review, focus groups, concept mapping, and hierarchical clustering. Each of the 33 competency statements is an important concept of healthcare leadership. Our methods determined which statements were most important and which coalesced into themes. We began with an initial model that had been drafted within our UME and GME leadership programs (the Feagin Leadership Progam and LEAD Curriculum). Those initial drafts were further refined over a three-year period based on feedback we received from numerous people within our institution with varied levels of healthcare experience and training (faculty, fellows, residents, students, administrators, and non-physician educators). That input led to a model that has face validity, is well accepted, and can be used in pedagogical processes that help all of us learn to be better leaders.
Recent literature emphasizes the importance and need for the intentional, explicit promotion of leadership development curricula and training in medical education. 28 – 31 Clearly, leadership development education should be intentional and not informal or implicit. The model presented here provides a framework for intentionally teaching leadership skills in healthcare education.
There continue to be efforts to appropriately characterize “content” 32 and define competencies. 33 Sonnino argues for two dozen competencies, the most important of which are finances and economics, emerging issues and strategic planning, personal professional development, adaptive leadership, conflict management, time management, ethical considerations, and personal life balance. 34 Seven of those eight align well with our model; we would argue that finances and economics are more managerial skills and context dependent. Further emphasizing the significance of leadership development in postgraduate medical education, in 2015 the Canadian residency CanMeds competency framework replaced their role of “manager” with that of “leader”. 35
There are several limitations to our study. Foremost, model creation is not an exact science. Our mixed methods approach involves subjective interpretation of how to organize overlapping concepts. For example, communication could be considered a separate competency. Instead, we chose to include communication as essential for all core competencies - learning to communicate better enables one to be better at each healthcare leadership competency. Others’ subjective assessments may have led to different interpretations.
This model is also derived from research done at a single institution, and as a result may not be generalizable to other settings. We do not suggest that ours is the only or best healthcare leadership model. It is offered as a model that others can use and refine for their own environments. The methods we describe can serve as a guide if others desire to create their own institutionally specific model. Nonetheless, this model has guided our teaching of skills and concepts that lead to improved competency in areas recognized as essential for effective, ethical healthcare leadership. It has subsequently led to an assessment of learners and an evaluation of our programs.
Models are most useful when validated. Preliminary validation of our model is complete. Our group is committed to re-validate the model in more diverse and larger healthcare settings. Our next steps involve developing, refining, and validating an evaluation instrument that assesses the competencies and core principle in the model. This work is underway through the Health Evaluation Assessment of Leadership. 36
We designed a leadership model specific to healthcare using concept mapping. The research led to a model based on the core principle of Patient Centeredness and core competencies of Emotional Intelligence, Integrity, Selfless Service, Critical Thinking, and Teamwork. We have found this model useful for teaching leadership skills, and are currently designing a relevant evaluation instrument.
Competency statement definitions.
The authors thank members of the Feagin Leadership Program for their extensive backing of this project. The authors acknowledge all of the participants of the focus groups and other non-author members of their team including Prinny Anderson, MBA, Med; Jane Boswick-Caffery, MBA, MPH; Matthew Boyle, MD; Thomas Mullin, MD; and John Yerxa, MD. We also thank Saumil Chudgar, MD, MS, for feedback and editing work on this paper.
The authors acknowledge the assistance of Donald T Kirkendall, ELS, a contracted medical editor, for his assistance in preparing the manuscript for submission.
The views, opinions, and/or findings contained in this report are those of the author(s) and should not be construed as an official Department of the Army position, policy, or decision. Citation of trade names in this presentation does not constitute an official DA endorsement or approval of the use of such commercial items.
Allison MB Webb is currently a resident in the National Capital Consortium’s program Combined Internal Medicine – Psychiatry Residency at Walter Reed National Military Medical Center, Bethesda, MD, USA. Nicholas E Tsipis is an Emergency Medicine Resident at Georgetown University Hospital/Washington Hospital Center, Washington DC, USA. Julie A Neumann is a sports medicine fellow at Kerlan-Jobe Orthopaedic Clinic. The authors report no conflicts of interest in this work.
Understanding of personal leadership style has been shown to be a key part of effective leadership practice. It has been a topic of interest for many decades as we have tried to understand, and replicate, what makes those considered to be ‘great leaders’ so successful. This article gives a brief introduction to different leadership ‘theories’, leadership ‘styles’ and the effect they have on the ‘climate’ in organisations. Having an understanding of the different approaches can help leaders be more effective through comprehending how and why they do what they do, as well as helping them identify where and when they need to adapt their style. By considering how our understanding of leadership has evolved, it is possible to show how effective leadership is not linked to one approach. It is a combination of knowledge, attitudes and behaviours with a focus on both the task in hand and concern for those undertaking that task. Furthermore this understanding supports impactful personal development, which creates positive climates in organisations where compassionate and inclusive leadership behaviours can, and do result in better outcomes for staff and patients.
https://doi.org/10.1136/leader-2020-000218
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Who, when flipping through a publication has not been tempted by the ‘personality quiz’, hoping to get the ‘mostly A, B or C’ that indicates we have the attributes for long and successful careers or lots of friends? While this level of ‘knowing how we are’ could be dismissed as flippant, when it comes to leadership, understanding our personal approach can be invaluable. If you asked people around you ‘what sort of leader do you think you are?’ they would most likely answer in the singular ‘I lead by example,’ ‘I build relationships with people,’ or ‘I don't tolerate underperformance’. They are unlikely to say ‘I do this here, and that on other occasions’ yet the most effective leaders are those who attune to their context, consciously adapt their practice and have an awareness of how their own style effects others. This article introduces the different theories and styles of leadership and how they can be used to create positive work climates. The key terms are given in table 1 .
A desire to understand what makes a successful leader is not new. For centuries there has been debate about what differentiated leaders from non-leaders, and leaders from followers. In a comprehensive review of leadership theories by Stogdill, 1 a number of categories were identified and in the 80+ years since Lewin et al 2 published their theory on patterns of behaviour in 1939, we have seen an evolution from trying to identify ‘common traits’ based on inherent characteristics of ‘great men and women’ through to the what we now understand to be the successful combination of person, place and approach. Looking further into this evolution, although this is not a comprehensive list, it is possible to group the stages of development as follows:
Trait theory—for example as seen in the work of Carlyle 3 and Stodgill 1 is concerned with the type of person that makes a good leader and the innate qualities and associated leadership traits they have. A meta-study by the Centre for Excellence in Management and Leadership 4 identified over 1000 leadership traits in the literature, which they distilled to 83 more or less distinct attributes. While no specific trait or combination was found to guarantee success, trait theory did help in identifying qualities that are helpful when leading others such as integrity and empathy.
Later, behavioural theory identified what good leaders do—effectively how they ‘lead well’. Examples include the Tannenbaum and Schmidt continuum 5 —seven stages of reducing control namely Tells, Sells, Suggests, Consults, Joins, Delegates and Abdicates; the Action-Centred Leadership Model of Adair 6 which sets out the three responsibilities of the leader—‘achieving the task, managing the team and managing individuals’ and the Blake Mouton Managerial Grid 7 also referred to as ‘The Power to Change’ which outlines two behavioural dimensions: Concern for Results and Concern for People.
Situational and contingency theory: looks at the leader in the context of where they lead. By considering how the leader’s success is directly influenced by their environment, it became possible to identify the conditions that support or constrain leaders as seen in work including Feidler 8 Vroom and Yetton 9 Yukl 10 ; Hersey and Blanchard 11 ; Thompson and Vecchio. 12
Transactional theories—as seen in the work of Weber 13 and later by Bass, 14 focuses on the leader getting results by using process and structures while applying reward and penalty in response. Within this are power and influence theory, exchange and path-goal theory by House 15 16 which concentrate on the relationship between leader and led as a series of trades or ‘leader-member exchanges’.
In more recent years, while the transactional and positive view of hero leadership has never entirely gone away, the notion of ‘Hero to Host’ 17 which describes the move to transformational and ‘new wave’ styles outlined by Burns 18 Bass 14 and Kouzes and Posner 19 among others. Transformational leadership not only serves to enhance the motivation, morale, satisfaction and performance of followers, but also sees the leader role model compassionate and inclusive behaviours, which are valued. In ‘Good to Great’ by Collins, 20 the Level 5 leader is described as possessing both indomitable will, but also humility and is often self effacing and shy, the opposite of what we might have previously described as leadership traits!
Every day, leaders in healthcare must constantly analyse complex situations, engage, motivate, empower and delegate. Many leaders now operate within complex adaptive systems—organisations that are an interconnected whole of many parts, which may and may not function effectively together depending on changing circumstances. This calls for leadership skills and behaviours that can move between each required activity with seemingly effortless ease and without loss of effectiveness.
Having an appreciation of different theories and styles also helps us identify our reaction to these changing situations. In considering the global COVID-19 pandemic, the leadership behaviours required, and experienced, may be different to anything encountered before. The effect of leadership in this situation is profound and will have a lasting impact. Displaying command behaviours may be necessary but uncomfortable, while teams may not be used to being directed with minimal consultation. Sustained pressure may have a negative effect, but it does not follow that leadership behaviours slide into being disrespectful or non-inclusive—it is about the leaders focusing on the task and ensuring individuals and teams are clearly instructed on the part they have to play; consulted where possible and informed of when and when they need to do as instructed.
However, knowing about ‘how we are’ is only part of the picture, equally important is understanding the effect we have on other. Goleman 21 found that the one of the biggest mistakes leaders make was to default to a style of personal choice rather than responding with the most appropriate in the situation, while Blanchard 22 suggests that 54% of leaders only ever apply one preferred leadership style regardless of the situation. The result is that almost half of the time, leaders are using the wrong style to meet their current objective or lead the people around them well.
The danger here is trying to be the most popular leader and everyone’s favourite, rather than developing an authentic repertoire of skills. If you have never considered your leadership style or the types of leadership behaviours you have there are a number of tools to help such as the National health Service Healthcare Leadership Model. Based on research of the behaviours of effective leaders, Storey and Holti 23 defined nine domains (Inspiring shared purpose: leading with care: evaluating information: connecting our service: sharing the vision: engaging the team: holding to account: developing capability and influencing for results) against which can leaders can self assess and gain pointers on how to strengthen their style.
Research by KornFerry Hay Group 24 shows an up to 70% of variance in climate and an up to 30% increase business performance can be directly attributable to the climate leaders create through their style of leadership. This includes feeling included, supported and having a role that is meaningful. To help leaders create a positive climate, Goleman 21 defined six leadership styles—see table 2 —which he then correlated with the type of climate each created for those around them. Those able to deploy the styles in the left column have been shown to create high performing teams in positive climates.
Leadership Styles and the climate they support (adapted from Goleman 21 )
These are not the only leadership styles: others include Autocratic leadership where leaders/managers make the decisions and employees follow orders as previously stated; laissez-faire leadership where the manager empowers employees but gives them few rules to follow with little oversight or direction: bureaucratic leadership where hierarchies and job titles to determine responsibilities and rules and servant leadership which focuses on the needs of employees, seeing them as the organisation’s most important resources and often treating them as clients, but only the six here were included by Goleman.
The effects of the leadership styles displayed and the effects they have on the climate within organisations has far reaching impact for team members. The ability to flex your leadership style and create a positive climate has been shown to create greater job satisfaction and pride in work, greater collaboration and creativity. Having an awareness of the effects of personal style, is therefore an essential part of a leaders toolkit and something every leader should have awareness of
Delivering health and care is highly complex and effective leadership calls for a match of style and approach to context and presenting challenge. Leadership styles is not a neat category of things, the increasingly interconnected world with ever-evolving technology has dictated a need for leaders who can adapt effortlessly as the situation dictates. Daniel Goleman 21 likens leading to being a golfer—one game but choosing the right club, at the right moment, for the next shot. Lets think about what this could look like: again, thinking about the COVID-19 pandemic the deteriorating clinical condition requires a leader who draws on all their experience, interprets the situation, takes control and ‘tells’ in order to get the best outcome for the patient—transactional and it’s wholly appropriate. At other times, that same leader will need to take time to build relationships and coach others in order to give the best care possible.
We all have a natural tendency towards our preferred style and when under pressure, there is evidence that we ‘revert to type’, relying on the most comfortable part of our personality to see us though. Unfortunately this means using fewer of the leadership skills that usually provide balance. Skilful, mature leadership is about leading ourselves as much as leading others. This level of understanding our style helps us recognise triggers that support adopting the right style for the given situation.
Different situations require different leadership style and each style can be considered a tool in itself. How we lead needs to be a combination of concern for the task in hand and also the people undertaking it, as both individuals and collectively as teams. We have looked briefly at small number of the plethora theories and styles that can help us understand how we lead. Leaders who understand themselves and can move effortlessly between a range of styles in response to changing situations have been found to have more positive outcomes for their teams and patients.
Twitter @clarepricedowd
Contributors CFJP-D completed all part of this paper:
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
A recent white paper highlights strategies for raising up student leaders through effective leadership education in pedagogy and learning outcomes.
By Ashley Mowreader
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Faculty members outline the learning outcomes and pedagogies to teach leadership to college students.
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Creating student leaders is something many institutions claim to do—one international database found there are more than 2,000 postsecondary institutions with formal curricula dedicated to student leadership—but curricular and co-curricular spaces for student leadership development lack a common practice or consensus in outcomes, according to a June white paper published in the Journal of Leadership Education .
The report’s authors, David Michael Rosch from the University of Illinois Urbana-Champaign, and Scott J. Allen from John Carroll University in Ohio, present a conceptual model for undergraduate leadership development, providing specific curricular and pedagogical approaches to meet mastery of the skill.
“The goal is to help people in higher education think in a more organized way about what they want to accomplish and how they can set their programs up to get there,” Rosch shared in a June 11 press release.
The background: Leadership, one of the National Association of Colleges and Employers’ eight career-readiness competencies , is a student’s ability to recognize and capitalize on personal and team strengths to achieve organizational goals.
Despite the common acceptance that engaged students are better prepared to lead modern organizations and communities than their less-engaged peers, there is limited evidence on how or why that is the case, according to the paper.
“We seek to advance not another new theory for leader development, but rather an argument for what leader development should be and why and how it should be taught in postsecondary education,” the authors wrote.
The model: Rosch and Allen’s model is centered on two key priorities: leadership skill mastery (defined as horizontal development) and increasing maturity in student meaning-making (vertical development).
Horizontal development includes communication and listening skills, decision-making techniques, conflict management, negotiation, influence strategies, and building and managing diverse and culturally competent teams. These skills are necessary but not always sufficient to lead practically. Mastery of conflict management concepts doesn’t mean much if a leader does not apply them in the appropriate context, showing how knowledge is paired with meaning-making.
Vertical development, therefore, is the practical application of leadership contexts using wisdom and maturity. Constructive developmental theory highlights how adults learn to take on the perspectives of those around them, confront the limitations of their own opinions and reframe their perspectives based on their environment and how context may shift.
Based on this theory, report authors argue it should be the goal of higher education institutions to not just teach leadership within textbook theory but also develop mental complexity to recognize how and when to apply tools.
Put in practice: To achieve these developmental goals, the authors borrow a model for adult learning and provide five orientations for learning—cognitive learning, behavioral learning, constructive learning, humanistic learning and social-cognitive learning.
The report authors describe five orientations:
The ideal leadership development course integrates the five orientations into learning outcomes and facilitates educational experiences not in siloed capacities, but in ways that allow students to use all skills.
Examples of this could be a multiple-choice exam to assess theoretical concepts, role playing to teach behaviors, essay reflection on ethical leadership practices and how that aligns with the students’ career goals or past behaviors, or learning from a guest with experience in the field.
“These forms of integration are common within many academic programs across disciplines,” the authors share. “Still, we call for the architects of these programs to be more intentional in building opportunities for learning across all five orientations to ensure that each is substantially represented within the student experience.”
Some skills that can benefit deep learning of these concepts include cognitive bias awareness, mindfulness, active listening, perspective-taking capacity, dialectical thinking, reflection and reflexivity.
Professors can also consider how their pedagogy can improve learning outcomes, such as norm setting, building a community-holding environment, supporting students’ emotions and ensuring appropriate amounts of challenge and support within the classroom.
Do you have a career prep tip that might help others encourage student success? Tell us about it.
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Abstract. The aim of this literature review paper is to show the most important differences between a manager and a leader and to present various definitions of leadership in the context of an ...
Research leadership is defined as the influence of one or more people on the research-related behaviour, attitudes or intellectual capacity of others. Three specific features of professorial research leadership are identified and examined: influence that enhances people's capacity to make appropriate choices, to achieve requisite standards, and ...
Despite increasing awareness of the importance of leadership in healthcare, our understanding of the competencies of effective leadership remains limited. We used a concept mapping approach (a blend of qualitative and quantitative analysis of group processes ...
Southern New Hampshire University, Malaysia Abstract- This research intends to explain effective leadership and how it can bring positive change that helps the organization to improve and be innovative in the current business environment. Effective leadership and change management will be discussed in this article and also how leadership affects other factors, for instance trust, culture and ...
To address this limitation of the literature, this paper presents a systematic review and critique of literature in this field. Our review of 105 studies suggests that there are statistically significant relationships between different types of leadership and learning at the individual, group, and organizational levels.
Understanding of personal leadership style has been shown to be a key part of effective leadership practice. It has been a topic of interest for many decades as we have tried to understand, and replicate, what makes those considered to be 'great leaders' so successful. This article gives a brief introduction to different leadership 'theories', leadership 'styles' and the effect ...
Despite ethical leadership is a crucial moral practice for organizations, prior studies reported the negative, non-significant, positive or even inverted u-shaped relationships between ethical leadership and employee unethical behaviors. Few studies have provided a comprehensive framework for explaining why. In this research, we propose three theoretical perspectives (i.e., moral cognition ...
A recent white paper highlights strategies for raising up student leaders through effective leadership education in pedagogy and learning outcomes.
As leadership is a key predictor of employee behavior in organizations, research focusing on leadership and UPB holds great potential for theoretical and practical advancements. The current paper presents a comprehensive systematic review of published research exploring leadership and UPB since 2010.
They conclude that successful school leadership is a function of structure and culture, supported by strategic thinking and analysis. Similar conceptual challenges are evident in assessing the links between school leadership and literacy in South African rural and township schools, as reported by Gabrielle Wills and Servaas van der Berg.
Abstract While demands on academic leadership in higher education have been increasing, there has been a lack of empirical studies exploring the effectiveness and impacts of leadership development interventions. In addition, recent studies suggest a model of leadership development based on an international approach.