Leadership in Health and Social Care Education


Literature Review for FDTL Leadership Project



Introduction



Continuous and rapid change in UK health and social care has meant that many


professionals in the sector are undertaking new and challenging roles. Some of these


professionals are not trained or experience in leading and managing these changes


and it is therefore necessary that sufficient and dedicated education be provided.


Within the NHS, clinical (medical, nursing and social) staff are increasingly being


required to perform managerial duties, the responsibility of which is not necessarily


part of their basic training (2002). Further, clinical managers


often have difficulties in performing dual roles as they can be easily distracted by


operational demands and conflicting priorities. Various generic and applied


opportunities for management training are available – through formal educational


institutions, in-house activities and private organisations.


Alternatively, very few formal and dedicated leadership training opportunities exist.


Leadership development in the NHS has always been ad hoc and incoherent with too


few clinicians in leadership roles and too little opportunity for board members to


develop leadership skills. That will now change ( 2000).


This paper will argue that management and leadership are exclusive roles, with


different (and sometimes contradictory) objectives and functions.


(2000) propose that there are three avenues for learning to lead –


through trial and error, developing relationships, and education. This paper focuses on


formal educational activities. Formal leadership education needs to begin at medical


school. “Tomorrow’s doctors must be fully equipped to take on leadership roles with


enthusiasm and confidence” ( 2000).


Some authors question whether leadership can be “taught” at all ( 1998;1977)


 “There is no known way to train great leaders” ( 1977).


Regardless of this debate, the principles of management training cannot automatically


be applied to leadership education. If leadership education is to emerge as a


recognised developmental activity, considerable attention needs to be given to the


differences between management and leadership and the role of, and challenges


facing, leaders.


This paper will examine some definitions and concepts of leadership and explore how


leadership differs from management.



What is leadership?


(2002) suggests that leadership is often confused with concepts such as


power, authority, management, administration, control and supervision. However, the


essence of the leadership role and process is to inspire, develop and empower


followers.


Leadership is the process of influencing others to understand and agree about what


needs to be done and how it can be done effectively, and the process of facilitating


individual and collective efforts to accomplish the shared objectives (2002).


The NHS Modernisation Agency (2002) states that the


role of leaders in the NHS is to:


 Improve patients’ care, treatment and experience


! Promote a healthier population


! Enhance the NHS’s reputation as a well-managed and accountable organisation


! Motivate and develop staff.


 (2000) argues that there would be no leaders without followers, and the


relationship between the two requires a sense of community. Successful leadership


requires a clear strategic vision that resonates with the community. Leaders must be


able to generate and sustain trust among the community, but also question the


assumed objectives and processes (1997).


Leaders are responsible for drawing attention to the cultural factors that impede


organisational learning, to ensure that the organisation can avoid controlling the


symptoms rather than underlying causes. Leaders need to create processes by which


problems can be defined and ways in which organisational members can convey their


reality and avoid dominant and culturally acceptable definitions of the problem


( 2001).


 (1980) suggests that emotions in organisational life are


often repressed, suppressed or dismissed – seen to be taking away from the “real”


business of the organisation. However, “the consequence of this attitude is that


ritualistic activities and rationalization of behavior seem to be the norm and have


become the more acceptable ways of dealing with the routines of management”


(1980). The importance of emotions is exemplified through the


manifestation of stress-related conditions, such as premature death of executives,


output problems, work inefficiencies, labour turnover, strikes and absenteeism.


There is a need for greater awareness of the reasons and motivations for individual


and organisational action, and recognition of the emotional costs of corporate life. This


might lead to recognition of the limitations of rationality in organisational life.


 ( 1980) argues that everyone has the capacity for this type of


learning – however, there is a pressure to conform to previously learnt behaviours.


This leads to a neglect of dependency, affection, hostility, shame and guilt. Competent


leadership requires congruence between internal values and external reality – the


greater the disparity, the greater the need to exercise power. Leaders have the


potential to become paranoid – if this paranoia becomes pathological – through


illusions of grandeur or delusions of persecution – it can be self destructive to both the


individual and the organisation


In a later work,  (1984) propose that


organisations can be neurotic – paranoid, compulsive or depressive. Sometimes these


neuroses reflect the leadership style from the top, which permeates the entire


organisation. The neuroses then threaten the well-being and ultimate survival of the


organisation.


Change management is an area where effective leadership is paramount to successful


organisational development. More change requires more leadership – many


organisations have difficulties adapting to change (1990). The ability to manage


change is a key characteristic of a transformational leader. Transformational leaders


must be visionary, proactive, creative, innovative and supportive of alternate


viewpoints (2002).


 (2002) analysed a complex change


management project, involving collaboration between five North London medical


schools to develop community-based aspects of the undergraduate medical


curriculum. Among other problems such as, organisational tensions, role boundaries


and conflicting aims, leadership tension was one of the primary factors which mediated


the success of the change management project. Leaders were confused about the


aims of the project, which filtered through to the individual organisations –


administrators were then confused regarding the priorities of the project. MacFarlane


et al propose that at the commencement of a change management project, an


innovative leader is required – a charismatic visionary. The necessary skills and


abilities then change according to the subsequent development and maintenance of


the project – attention needs to be given to this development otherwise the aims of the


project can become confused and conflicts can arise


 (2000) research suggests that leaders who achieve the best


results do not rely on one leadership style, but incorporate multiple styles seamlessly


depending upon the situation. Leaders can achieve this by building a team with


members who employ the styles that the leader lacks, or by expanding one’s own style


repertoire.


In different stages of organisation, different kinds of leadership are appropriate. In a


mature or declining culture, such as the NHS, leaders need to overcome constraining


cultural assumptions. Declining cultures may be based upon behaviours which were in


the past appropriate, but are no longer so. Leaders must notice changes in external


conditions, reflect on them and respond appropriately. If an organisation does not


adapt to its changing environment it will die. A leader must are able to span


boundaries, and be aware of marginal sub-cultures and the over-riding cultural context.


In order to develop as a leader, it is important that there is a learning culture where


resources are allocated to development, and learning is rewarded (2002).


Further, leaders within learning cultures must accept that their own wisdom and


experience is limited and encourage a shared responsibility for learning. Hence, a


leader needs to know a culture before trying to change it, have vision for it and yet be


open to different perceptions of reality, embrace contradictions and acknowledge


mistakes.


(1996) proposes an eight stage process for leading change:


! Establish a sense of urgency


! Create a guiding coalition


! Develop a vision and strategy


! Communicate the change vision


! Empower employees for broad-based action


! Generate short-term wins


! Consolidate gains and produce more change


! Anchor new approaches in the culture


 (1985) proposes that organisational leaders create learning cultures by


recognising and rewarding appropriate behaviour and through managing and


containing anxiety. For this they must look inside themselves and question their own


assumptions – the prevailing cultures may reflect a leaders’ own assumptions,


including their neuroses. Schein believes that leaders must be comfortable within their


own weaknesses and open to diverse experiences.


We cannot achieve the cultural humility required to live in a turbulent culturally diverse


world unless we see cultural assumptions within ourselves. In the end, cultural


understanding and cultural learning start with self-insight.(1985).



Analytical


Imagination and creativity


Listening


Influencing


Enabling


Collaborative working


Technical competencies



CREDIBILITY



Human behaviour


Own role


Internal environment


External environment


National issues


Self-awareness Empathy Values


Self-confidence Integrity Vision



( 2002) propose that effective leadership should


incorporate various elements relating to knowledge, skills and competencies and


personal characteristics and behaviours. Figure 1 outlines the specific traits within


each of these elements, which are believed to relate to effective leadership.



Figure 1. Effective leadership – The key elements ( 2002)


(2001) propose that


personal characteristics are a more important indicator of successful leadership than


an actual job description. Personal traits, such as commitment to an issue and an


ability to develop linkages between perspectives and objectives, have considerable


influence on the effectiveness of a leader.


There is an alternative argument that, although personal characteristics are important


indicators of successful leadership, situational variables have the capacity to moderate


and constrain the relationship between attributes and effectiveness. The


characteristics of the followers, the nature of the work, the type of organisation and the


nature of the external environment all influence what would be considered to be the


most appropriate leadership style (2002).  (2001) also proposes


that personality is not necessarily an indicator of successful leadership.



Leadership versus management


Management and leadership are diverse roles which require different characteristics


and functions. Although the roles are often contradictory, they are complementary –


one cannot function without the other. Managers typically promote stability while


leaders promote change (2001). Figure 2 outlines some of the key comparisons


between management and leadership.



Figure 2. Comparing management and leadership (1990)


Management Leadership


Creating an agenda Planning and budgeting Establishing direction



Developing a human


network for achieving


the agenda


Organising and staffing Aligning people



Execution Controlling and problem


solving Motivating and inspiring



Outcomes Predictability and order Change


(2001) suggests that leadership sets a direction and develops a vision


for the future. However, management is more concerned with planning which is


deductive and orderly, not a process of producing change. Planning should


complement direction setting. Kotter proposes that most US organisations are


overmanaged and underled.


One of the most frequent mistakes that overmanaged and underled corporations make


is to embrace long-term planning as a panacea for their lack of direction and inability to


adapt to an increasingly competitive and dynamic business environment ( 2001)


 (2001) proposes that organisations cannot wait for leaders to emerge,


but must seek them out and develop their potential. Therefore, formal leadership


education and training should be of great importance to organisations.



Leadership education and training


Just as we need more people to provide leadership in the complex organizations that


dominate our world today, we also need more people to develop the culture that will


create that leadership (2001).


(2002) suggests the following rules for successful leadership:


! Articulate a clear and appealing vision


! Explain how the vision can be attained


! Act confidently and optimistically


! Express confidence in followers


! Use dramatic, symbolic actions to emphasise key values


! Lead by example


! Empower people to achieve the vision.


Most leadership training programmes are designed to increase generic skills and


behaviours necessary for effectiveness and advancement. Effective training should


involve clear learning objectives, clear and meaningful content, appropriate


sequencing of content, appropriate mix of training methods, opportunity for active


practice, relevant and timely feedback, enhancement of trainee self-confidence and


appropriate follow-up activities. Many leadership training programmes utilise particular


techniques such as, behaviour role modelling (demonstration and role playing in order


to enhance interpersonal skills), case discussion, business games and simulation


(analysis of complex problems and decision-making) ( 2002).


However, (2002) states that the most essential leadership skills are learnt


from experience, rather than through formal training programmes. However, learning


from experience is affected by the amount of challenge, the variety of tasks or


assignments, and the quality of feedback. proposes that action learning and


multisource feedback (such as 360-degree appraisal) are useful methods of enhancing


the learning from experience process.


It has been suggested that the term “training” should not be used when referring to


leadership education. “Training” implies the idea of receiving knowledge while a focus


on “development” or “learning” demonstrates the autonomy of the leadership role


( 2000).



Conclusion


This literature review has identified that leadership involves conceptualising a course


of action and influencing others to understand and agree on how it can be executed


effectively ( 2002). This review has explained that leadership and management


are exclusive concepts. While management is more concerned with promoting stability


and following a directive, the role of leadership is to create a vision and promote


organisational change. “Institutionalizing a leadership-centred culture is the ultimate


act of leadership” ( 2001).


There is some contention in the literature as to whether leadership can be taught or


learnt – is effective leadership linked to specific personality characteristics, indicating


that only certain individuals naturally make good leaders? ( 2001)


proposes that effective leadership has little to do with inherent personality


characteristics.  (2002) further suggests that there is little evidence of a


correlation between supposed leadership attributes and ultimate success. If it is


assumed that leadership can be formally developed, the literature would suggest that


leadership can not, and should not, be taught through traditional educational activities


aimed at management, such as MBA programmes, but needs to be developed through


dedicated educational activities.




Credit:ivythesis.typepad.com


0 comments:

Post a Comment

 
Top