Leadership in Healthcare Essay

The Irish health system is continuously under review and experiences regular change and transformation at every level. The impact of these ongoing changes within health and social care services affects almost every aspect of organizational culture, the way staff work and how each organisation plans and delivers services for the benefit of service users and local communities. The aims and goals of service provision for the health and social care division have changed throughout the years policies and reforms have been influenced heavily by rights and advocate groups and research conducted in the field intellectual disability.

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Halligan (2010) has argued that leadership is often believed to be the answer to the issues which impede or slow down progress. Undoubtedly leadership plays a major role in implementing change and improving services, but responsibility for service provision cannot stop with leaders of an organisation alone, other factors outside the leaders control affect the progress of a goal. Frontline managers are actively seeking advice and guidance on these changes and how to implement them.

Burnes (2000) states“what almost everyone would like is a clear and practical change theory which explains what changes organisations need to make and how they should make them”. Burnes also argues that many of the theories available are confusing and contradictory and appear detached from reality and practise. Bennis (1969) differentiates between theories of change, which focus on how organisations change and factors that produce change, and theories of changing, which focus on how change can be brought about and managed in organisations.

Management and leadership are important for the delivery of good health services. Although the two are similar in some respects, they may involve different types of outlook, skills, and behaviours. Good managers should strive to be good leaders and good leaders, need management skills to be effective. Literature has discussed the necessity of management and leadership for the delivery of quality health services. It has been argued that both leadership and management are similar, both have their own identity. X states that leadership is only one role of the manager, and Y finds that management is the ability to ensure the smooth running of an organisation and it does not necessarily mean that a manager can be a leader. Over time, researchers have proposed many different styles of leadership as there is no style of leadership that can be considered universal (Cox 2016).

Despite the many diverse styles of leadership, a good or effective leader inspires, motivates, and directs activities to help achieve group or organizational goals. Adversely, a poor leader does not contribute to organizational progress and can, in fact, diminish the organizational goal accomplishment. In the more dominant theories of leadership, leadership is considered a process that involves influence with a group of people toward the realization of goals (Wolinski, 2010). According to Naylor (1999), an effective leader must be visionary, passionate, creative, flexible, inspiring, innovative, courageous, imaginative, experimental, and initiates change. Management is often conveyed as a routine activity which keeps the organisation running smoothly. Cox (2016) describes management involves planning and organising staff members and resources to achieve objectives. There are as many different views of leadership as there are characteristics that distinguish leaders from non-leaders. While most research today has shifted from traditional trait or personality-based theories to a situation theory, which dictates that the leadership type used is determined by the leadership skills and characteristics of the leader (Avolio, Walumbwa, & Weber, 2009).

Charry (2012), observed an increased interest leadership studies during the early in twentieth century identified eight major leadership theories. While the earlier of these focused on the qualities that distinguish leaders from followers, more recent theories looked at other variables including situational factors and skill levels. Although new theories are emerging all the time, Charry identifies eight common concepts of leadership: Great man theory, trait theory, contingency theory, situational theory, behavioural theory, participative theory, transactional theory and transformational theory. Great man theories assume the ability to be a leader is a personality trait and that leaders are born, not made. These theories often portray leaders as heroic, mythic and destined to rise to leadership when needed. Traditionally the term great man was used because, at the time, leadership was thought of primarily as a male quality.

The trait theory is closely linked with great man theory; it assumes that people inherit certain qualities that make them better at leadership. Trait theories identify personality or behavioural characteristics that are commonly found in leaders. However research questions if particular traits are key features of leaders and leadership, yet there are people who possess those qualities but are not leaders, (Amanchukwu, Stanley and Ololube 2015). Inconsistencies in the relationship between leadership traits and leadership effectiveness eventually led researchers to search for new explanations for effective leadership. (Wedderburn- Tate, 1999). Contingency theories of leadership focus on environmental factors that may determine which style of leadership is best suited for a work situation. No single leadership style is appropriate in all situations (Amanchukwu, Stanley and Ololube 2015). Success depends upon many variables, including leadership style, qualities of followers and situational features (Charry, 2012). Contingency theory states that effective leadership depends on the degree of fit between a leader’s qualities and leadership style and that demanded by a specific situation (Lamb, 2013).

Situational theory proposes that leaders select the best course of action based upon situational conditions or circumstances. Different styles of leadership may be more appropriate for different types of decision-making. (Amanchukwu, Stanley and Ololube 2015). Behavioural theories of leadership are based on the belief that great leaders are made, not born. This leadership theory focuses on the actions of leaders not on intellectual qualities or personality traits. (Amanchukwu, Stanley and Ololube 2015). According to the behavioural theory, people can be taught to become leaders through training and observation. Naylor (1999) observed in the behavioural theory context that leaders are often described as being either autocratic or democratic. In a literature review by McAuliffe and Van Vaerenbergh, (2006) It has been observed that groups under these types of leadership perform differently. Autocratically led groups will work well so long as the leader is present. Research has shown that group members, however, tend to be unhappy with the leadership style and express negativity. The democratic led groups do nearly as well as the autocratic group. Group members have reported more positive feelings, however. Most importantly, the efforts of group members continue even when the leader is not present. (Amanchukwu, Stanley and Ololube 2015).

Lamb (2013) determines participative leaders actively seek participation and contributions from group members and help group members to feel relevant and committed to the decision-making process, (Amanchukwu, Stanley and Ololube 2015). A manager who uses participative leadership, rather than making all the decisions alone seeks to involve other people, improving commitment and increasing teamwork, which leads to better quality decisions and a more successful outcome (Lamb, 2013). Transactional theories, focus on the role of supervision, organization and group performance. These theories base leadership on a system of rewards and punishments (Charry, 2012). When employees are successful, they are rewarded and when they fail, they are reprimanded or punished (Charry, 2012). Transactional theory is often linked to the concept and practice of management and continues to be an extremely common component of many leadership models and organizational structures (Lamb, 2013). This theory has been widely used within health care organisations in the past. In recent years the HSE have implemented a strategy which promotes an increase in education and leadership programmes for managers and aspiring leaders within the HSE whose aims and objectives are to move away from the transactional approach to management and into the transformational method of management. (McAuliffe and Van Vaerenbergh, 2006).

Transformational theories focus on the interpersonal relationship formed between leaders and followers and incorporates elements of participative theory. In these theories, leadership is the process by which a leader interacts and communicates with others which results in increased motivation and morality in both followers and leaders, (Amanchukwu, Stanley and Ololube 2015). The transformational approach is often compared to charismatic leadership theories in which leaders with certain qualities, such as confidence, extroversion, and clearly stated values, are best able to motivate followers (Lamb, 2013). These leaders are focused on the performance of group members, but also on each person to fulfilling his or her potential. Leaders of this style often have high ethical and moral standards (Charry, 2012). The change currently being experienced in the health and social care division includes the set up of new services or the reorganization of current services in order to deliver better outcomes for people with intellectual disabilities. From a staffing perspective, these changes may involve new work locations, organisational structures, teams, roles, work practices or procedures. They often involve the joining of services, teams and professional groupings. This involves different ways of doing things, different values and challenging underlying assumptions.

Influences from voluntary and governmental bodies have pushed for change and reform of services for people with intellectual disability who now live and experience life a lot differently than they may have twenty years ago. There are two schools of thought which can both help or hinder achievement of an objective, planned and unplanned change. Planned change by its very nature is implemented through a careful process that can be adapted to suit the direction of the objective. Its execution can instil trust and a sense of pride within employees when a goal comes to fruition. Adversely unplanned change can cause distress and distrust. Unplanned changes are usually rapid and staff feel unprepared to cope with the new conditions under which they may be expected to operate. A good leader will be able to adapt to the changes and motivate staff to adapt to the changes also and to build on them. Theories of planned change specify ways to manage and control change processes. Theories of unplanned change, on the other hand, imply that change is to some degree a force in its own right, susceptible to channelling, but not necessarily to control or management. Ledwin’s (1951) work on change processes underpinned organisational development, and continues to influence modern designs of planned change.

Ledwin advocated three stages in organizational change processes: unfreezing, moving and re-freezing. Unfreezing happens when there is a new idea or directive or when the“old” way of doing something becomes useless or stagnant (Mc Dermott and Conway 2017). Moving is when people change and reform and begin to do things the“new” way. Re-freezing is the stage where the new practise becomes part of the organizational culture. Mc Dermott and Conway (2017) state that while Ledwin’s stage models are an effective tool for planned changes, they do not incorporate context or culture (Fitzgearld et al 2006). Some have criticised Lewdin’s work, suggesting the relevance of his three-stage model is limited to small-scale changes in predictable planned change, and not sustainable for the larger ongoing nature of change in many present-day organisations (Garvin 1993, Dawson 1994). Burnes (2000) makes the valid claim that“regardless of what their proponents may claim, we do not possess at present an approach to change that is theoretically holistic, universally applicable, and which can be practically applied”. McAuliffe (2000) argues therefore that“managers should be prepared to adopt a contingency approach choosing or developing the model to suit the particular situation”.

The progress achieved in the health and social care division illustrates that the objectives set out by the division are being met. The implementation of change often involves overseeing multiple competing priorities, as well as handling demands from external sources and employees who are resistant to the proposed changes and view them as a source of stress (Kerber and Buono 2005).Managing change is a challenge that most organisations experience. It can impact on people’s sense of identity and connection. This can create high levels of anxiety for people and, as a result, people may resist the change. Leaders need to be adaptable and skilled at managing emergent and unpredictable change. Research has indicated that leaders motivating staff towards change is difficult and by communicating the need for change effectively and sustaining any improvements that the change has achieved over time (Martin et al 2012).

Communication is a vital skill any manager should have. The ability to give and receive feedback should not be underestimated. Recommendations in change theory literature mutually agree that a communication plan is an integral part of implementing the change. Addressing the questions of how, what, when and why of change from the staff and service user’s perspective. Leaders need to implement this aspect to ensure a sense of clarity and openness (Sullivan and Decker 2006). Mc Dermott and Conway (2017) recommend that the change process, where possible, should be planned in a way that reduces the known or expected negative impacts on people. Leadership is about setting direction and instilling confidence in those that follow them.


The orientation towards a person-centred approach will ensure that the change process remains focused on the core purpose of the HSE, which is to enable people live inclusive and more fulfilled lives. By placing an emphasis on partnerships and engagement with communities it will be possible to increase the opportunities for learning about the evolving needs of service users and communities. The leadership roles and the skills needed to enable the change to be successful should be identified at this point in the change process. Leadership approaches need to be monitored and assessed for effectiveness long with a contingency plan should the approach be ineffective or problem causing. It is also important to work out which groups and individuals will be directly impacted upon by the change and who is essential to carrying it out. The culture of the organisation and relationships between people at all levels are important and this knowledge should be used in a constructive way to plan and monitor ongoing developments. It will also assist in planning how to manage concerns and resistance in the system.

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