HSYRC LOGO

1. LeadershipLost in Complexity? HSYRC LOGO Stiofán deBúrca 16th Oct 2009

2. LeadershipLost in Complexity! “Leadership is a complex process, complexity of actions is thus identified as leadership” (Fisher, 1985:185)

3. From Simplicity to Complexity Carlyle’s (1884) essay on heroes- - Great Man Theories- sought to reinforce the concept of leadership as a person endowed with unique qualities that captures the imagination of the masses - A one way effect! Stogdill`s (1948, 1974) and Mann`s (1959) reviews sounded the death-knell of the trait approach - Some Renaissance with Lord et al (1986), Kirkpatrick & Locke (1991) demonstrated that certain core traits contribute significantly to business leaders success. - General agreement that ‘conscientiousness` has the strongest positive correlation with job performance (Big 5 Factor Model: Barrick & Mount, 1991)

4. Trait Style Situational Contingency Path-Goal (Contingency) LMX Transformational (US) Transformational (UK) Leadership Approaches

5. Complex Adaptive Systems (i) Organisational life is systemic • connectedness is inescapable • interconnectivity is extended to the environment • predictable & unpredictable influences • collective influence, processes are essential to manage dynamic systems (Osborn et al, 2002)

6. (ii) No-one is ever in control of complex systems! (Luthans, 2002) • Highly centralised leadership is less effective: • the limitations of any one individual view • the multiplicity of competing views, and • the complex nature of member interactions (Chen & Velsor, 1996) • Conventional ideas of managerial control are questionable • Conventional understanding of leadership: • an influence on individuals or groups which ‘lumps all other roles together as `followers` • gives a highly simplistic view of interaction (Griffin, 2002:219)

7. (iii) Significantly limits the power of leaders with increasing complexity trying to ‘manage’ the chaos by controlling it, or relying on leaders to solve the problems or buying more consultants, are deeply problematic strategies; only mass leadership and collective responsibility are likely to solve problems (Grint, 2002) Leadership inas against of Healthcare Organisations is a better working concept- influencing and being influenced! (Griffin, 2002)

8. Healthcare Organisations & Controllability Acute Hospitals & Research Institutes - Unmanageable! (Berry, 1995) -The most complex human service organisations! (Drucker, 1991) - Leadership of Creative People Difficult for leaders lacking technical expertise to represent the group adequately, communicate effectively with group members, appraise needs & concerns, access interactions & develop & mentor junior staff (Mumford et al, 2002) • In a professional bureaucracy/adhocracy, the surrender of peoples’ ability (power & control) to define their reality to others is unlikely. • Consequently, replacing hierarchical leadership with patterns of more equalised interaction in which each has an obligation to define what is happening, & respond accordingly changes the very basis of organisations (Smircich & Morgan 1982)

9. Leader Behaviour Intervening Variables Criteria of Unit effectiveness Subordinate effort Role clarity and task skills Organization of work Cohesiveness and cooperation Resources and support services External coordination Situational Variables Situational Variables (“Neutralisers”) Situational Variables (“Substitutes”) Causal Relationships in the Multiple Linkage Model (Source: Yukl, 1998)

10. Substitutes for Leadership People are biased toward over attributing to leaders influence on events that are complex & difficult to understand (Shamir et al, 1993) 2 kinds of situations reduce the importance of leadership influence

11. Substitutes … Professionals are internally motivated by their values, needs & ethics Aspects of the situation that cause intervening variables to be at optimal levels As leadership substitutes increase, formal leadership is merely replaced by peer influence or alternative levels of leadership Where there is no authority hierarchy, leadership responsibilities are shared among members (Yukl, 1998:366)

12. Neutralisers Prevent leaders from acting in a specified way and nullify the effects of leaders actions. When subordinates are geographically dispersed with infrequent leadership contact, or when a highly cohesive work group provides mutual psychological support (Yukl, 1994;275) Many neutralisers make it difficult for leadership to succeed (Howlett et al, 1990) Self-managed groups (Howlett et al, 1990)

13. Leader Antecedents: • GMA/ personality attributes • Political will • Leader cognitions • Leader social capital • Leader interpersonal style • Leader Outcomes: • Performance evaluation • Promotions and mobility • Compensation • Power • Leader reputation • Leader Political Behaviour: • Action at individual, coalition, network levels • Proactive political behaviours • Symbolic influence • Combinations of tactics • Interpersonal style as a moderator • Context: • Organizational structure • Organizational culture • Accountability • Leader position • Prior episodes Target Outcomes: • Affective reactions • Cognitive reactions • Attitudes • Performance • Target Antecedents: • Target status/power • Personality attributes A Political Model of Leadership Source: Ammeter et al., 2002

14. Moderators An Emergent Model

15. Leadership & Domain Perspectives Domain perspectives (Policy, Managerial & Professional) elucidate the logic of the organisation's internal influencing capacity -- not merely accepting an imposed external reductionist logic of leadership (Kouse & Mico, 1979; deBúrca, 2003) - Are HCOs’ Vision & Purpose shared between domains on fundamentals? • e.g. Quality, Patient-Centredness - Is there a high level of alignment between shared purpose and domain roles in action? • Gaps are exposed upon delivery - Leader & Management roles are domain-defined & -oriented • Potential for role conflict and ambiguity!

16. Leadership is Contextual (i) Leaders are the product of their times, of their followers and opportunities (Westley & Mintzberg, 1989;30) - An emergent phenomenon (social constructionist) – it is not assumed that the construct of leadership is an integral part of formal hierarchical relationships (Meindl, 1995;332) - Socially constructed, so that one has to look at the whole system & its leadership (Osborn et al, 2002:798) - ‘Embedded’ in social & cultural beliefs & values and cannot be understood apart from the context in which it exists (Biggart & Hamilton, 1987:437)

17. (ii) Various contextual considerations: - These are not usually encompassed by the well-known theoretical approaches to leadership such as: - diversity, distance, professional adhocracy/ bureaucracy, empowerment, values, complexity and emergence, political dimensions and substitutes for & implicit theories of leadership (deBúrca, 2003, 2005) • There is a tendency in the literature to neglect the cultural & organisational context of leadership • although local influences on attitudes and behaviours … mediate the impact of the organisation on healthcare delivery (Alvesson 1992) • The stark contrast in the US & UK transformational models’ primary orientations: • the distant charismatic super-hero, • as against the proximate, concerned servant-leader (Bass & Avolio, 1993; Metcalfe & Metcalfe, 2001)

18. Case Study: Managers’ & Professionals’ Perceptions of Leadership Many Leadership Theories formed on basis of implicit theories (Di Tomas & Hooijberg, 1996)

19. Case Study: Leadership Defined@ Domain Perspectives Senior Managers Corporate Accountability Managers General Performance Senior Doctors Clinical Responsibility Senior Nurses Professional Morale & Influence on Practice Prototypes Managers Leadership synonymous with change, competence & Confidence Professionals Credible Attractor & Domain Influencer (deBúrca, 2003) Leadership Categorisation as a function of social context (Haslam, 2001) Epitomization of leadership as prototypical group member (Turner, 1991)

20. Shared & Dispersed Leadership (i) Essential in complex systems • A top-down approach to healthcare programmes cannot succeed - need room for local discretion - the benefit is in increased professional responsibility - distrust commonly ends in failure (Edmondson & Greenfield, 2000) - Fits with trend of flattened organisations - non hierarchical team-based structures - Shared/dispersed leadership in interdisciplinary teams is vital • as care becomes increasingly complex and resource constraints press even more tightly (Wells et al, 2003)

21. (ii) Sharing leadership roles is problematic given the hierarchical tradition of medical care • In principle, leadership may rotate according to member issues & specific competencies, • but in reality power resides in a privileged few, with vital functional members relegated to marginal roles (Cott, 1997)

22. (iii) Trust builds collaborative relationships (Luthans, 2002) - Associated with distributed leadership & ‘Real Teams’ - The most effective managers lead others to lead themselves (Sims & Lorenzi, 1992) - `Real Teams` • have complementary skills, • Are committed to a common performance, goals & approach, for which they hold themselves mutually accountable (Katzenbach & Smith, 1993) - Empowerment • is similar to delegated authority • encourages the use of individual initiative • and has authority and responsibility (Taylor & Ramsey, 1991)

23. Refocus on Leadership in Management! Why do leadership approaches isolate leaders from managers, and ignore broader managerial roles which leaders must perform? (Steers et al, 2006) • The defining difference is orientation: • leadership is associated with change • but management is grounded in the present state (Zalenznik, 1997, Kotter, 1990) - Leadership in the practice of management focuses upon delegation making processes - A middle ground delegational strategy is superior to various forms of leadership (Schriesheim & Neider, 1988) - Formal authority has potential power (Mintzberg, 1990; French & Raven, 1959)

24. - Leadership from a managerial perspective facilitates an alternative to leader-centric research and practice as, attending to one element is inadequate (deBurca,2003) - There is a tendency to focus on the potential benefits of transformational leadership at the expense of the positive impact of transactional leadership where a combination of the two may be most efficacious (Grint, 2005;105) - Leadership in US nursing studies conclude that the most successful leadership has both dimensions (Dunham & Klafehn, 1990; Kilker, 1994) - Clinical leadership also requires a judicious blend of effective management with transformational leadership (Lynne et al, 2005)

25. Deficits in Clinical Leadership Most healthcare providers have not been trained in the principles & practice of effective leadership and working in teams (Sachdeva, 1996) - There are inherent deficits in the preparation of clinicians for leader-manager roles and the expectations in their subsequent practice environment. - Doctors tend to be poor leaders and are suspicious of those who purport to be leaders (Smith & Simpson, 1996)

26. - A caricature of doctors ‘who would not be led’ and nurses who ‘did not know how to lead- too deferential- too accepting of a bureaucratic change of command (Strong & Robinson, 1990) - Inadequate fragmented practice is a consequence of a lack of effective leadership and interpersonal collaboration (Lynn et al, 2005)

27. Effective Clinical Leadership Conceptions of effectiveness differ: - task & goal attainment measures - multiple subjective ratings (Yukl, 1998) Effective Clinical Leaders (Pickett et al, 1995) - Have ability to critically analyse situations on several levels in transactional & people terms and act accordingly - Empower others to take clinical responsibility within a framework of co-ordinated action, mutual respect, guidance and support - Results are an indirect effect: Problem of linking leadership & outcomes e.g. low variance explanation for Leadership in consumer satisfaction and quality of life studies

28. Clinical Team Leaders Clinical Team Leaders have a dual focus and fuse managerial & clinical responsibility & facilitate self-organising processes according to need, as against structure (Lynn et al, 2005; Greenfield 2007) - Traditionally, doctors have been accorded and have assumed leadership of healthcare teams, regardless of their competence (Horowitz, 1970)

29. - Traditional ways of working & professional power, imbalances and has the effect of silencing members who wish to speak up, share authority and collaborate in problem solving and quality improvement (Edmondson, 2003) - Allocation of team leadership to the member with the most expertise rather than being linked to professional groups (Kane, 1975) - Mutual respect is highest in social worker-led teams and lowest in physician-led teams. Leadership by some disciplines may facilitate dynamics (Wells et al, 2006)

30. Clinical Leaders need: - To develop integrated teamwork, emphasising making team processes visible, reflected upon and actively managed (Hackett & Spurgeon, 1998) - Appropriate support to avoid them succumbing to profound disillusionment through constantly frustrated attempts to change work processes and practices (Greenfield, 2007) - To manage their own professional credibility and identity in the eyes of a diverse range of professional disciplines. - This may require the development of a complex superordinate professional identity that does not deny ones own distinctive clinical contribution.

31. Reflection: So, What next?

32. Ethical Leadership in Complex Systems To enable encompassing, integrative processes and actions for ethical and equitable purposes Evolve requisite New Ethical Leadership and Alternative Social Influencing Practices in working arrangements (At all levels, organisational settings and stakeholder networks) Shared and Dispersed Leadership Leaders who create leaders Substitutes for leadership Empowerment Connectivity Real Teams, Communities of Practice, Integrated Networks Internalised Professional Values, and Ethics