1. Application for different leadership theories/styles
Carol Westwell
MSc Leadership in Context Module

2. Learning Outcomes:
Explore the theories and styles of leadership relevant to practice
Understand the different theories and styles in various situations
Discuss adapting your style to the situation.

3. Background:
Effective leadership is crucial to the delivery of quality NHS care, particularly in the current economic climate (Ham 2003). These are unprecedented times for the NHS; at no other time in its life has the need for leadership been greater (Barr & Dowding 2008).
There is unparalleled change in the NHS; health professionals are being asked to be innovators and entrepreneurs (Hay Group 2009).
Given current uncertainty, leaders need to be able to operate using a right-for-the-moment leadership style, constantly being prepared to adapt how they respond to the complex and changing NHS environment (Howard 2010)

4. Behavioural theory
In the 1960s the focus of leadership theory switched from trait theory to behavioural theory. This differs by focussing on what leaders actually do.
Successful leadership behaviours can be differentiated from ineffective behaviours.
Blake and Mouton’s Leadership Grid is a well-known model of behavioural theory, that considers concerns for task and concerns for people to define a number of leadership styles.
By the very nature of healthcare organizations those styles with a low concern for people are unlikely to work and attempts at service improvement will suffer.
Those who assume leadership roles will certainly lose all credibility if they abandon their concern for fellow professionals. By contrast those leadership styles with a high concern for people may work better in healthcare. However, different contexts may require adaptations of leadership style (Shapiro 2011)

5. Contingency theory
This focuses on how leaders operate depending on the situation.
Different contexts require different leadership styles.
Effective leaders develop different ways of working with their followers depending on the situation and the needs and attributes of followers.
For example, a ‘telling’ style is required where followers require a great deal of direction and have a low competence and commitment to the task. By contrast, a ‘delegating style’ is used when followers have high competence and high commitment. The usefulness of contingency theory in healthcare is that it fully acknowledges the role of followership in quality improvement (Department of Health 2010).

6. Transactional leadership
This occurs where the leader, possessing clear authority, motivates by reward or punishment. Transactional leadership is still practised widely in healthcare settings. This is in part due to the grained hierarchical nature of professional relationships in healthcare settings. Transactional leadership may be useful in helping healthcare organizations meet operational and financial targets, but its role in service improvement is limited (Kouzes & Posner 2009).
Pastor and Mayo (2008) concluded that leaders who are focusing of performance actually show a transactional leadership style. The performance- focused attitude is not typical of a transactional leader. Transformational leadership could also be focused on both performance and self-realization of their followers. Pastor’s and Mayo’s viewpoint is actually distorting the reality. Organizational realities are much more complex and flexible than discussed in this paper (Dion 2012).

7. Transformational leadership
This theory states that people will follow a leader who inspires them through vision, passion and enthusiasm. In this respect transformational leaders can truly be seen as change agents, placing the concern and development of others above themselves. This may be far more beneficial for health service improvement. Engaging professionals to buy into a vision and allowing them to lead the process of change is likely to be more successful than other approaches. Rather than toppling resistance to change, transformational leadership acknowledges and deals with it.
In support of this theory, a study by (Alimo-Metcalfe & Alban-Metcalfe) analysing the qualities NHS workers preferred in their leaders identified a number of leadership qualities, including:
a concern for others,
empowering others to lead,
being team-orientated, and supporting a development culture, qualities that correspond closely to those of transformational leadership.
Pastor and Mayo (2008) believed that transformational leaders exert strong influence on followers by giving them individualised consideration, discussing about possibilities in the future, and acting with self-sacrifice.
Transformational leaders help their followers to perform beyond organisational expectations (Sarros and Santora, 2001). According to Odom and Green (2003), transformational leadership focuses on the moral development of the followers.

8. Situational leadership
Jumma (2008) states, what is needed of senior leaders in the NHS are judgements that are based on both numbers, which can guide resource utilisation; and stories, which indicate client satisfaction.
Stanley (2012) suggests that this style of leadership required is an intelligent and reflective synthesis of both transformational and transactional leadership. Blanchard (2013) refers to this as situational leadership. That is, choosing the right style for the given situation.
Moiden (2002) states, this requires real leadership skills to determine the right fit and relies on the individual’s self-awareness and perceptiveness, clinical and strategic knowledge in a framework of interpersonal skills to manage anxieties around change and conflict resolution.
This resonates with the humanistic values base of recovery in mental health, where compassion and empathy are core components, which lead us to do the right thing by staff and patients (Shepherd et al., 2014).

9. Entrepreneur Leadership:
An entrepreneur is described as: 'one who organises, promotes and manages risks for an activity' (McKenna et al 2004). Mericle (2004) claims an entrepreneur is 'the person who organises, operates and assumes the risk for the business adventure'. Dickenson- McKenna et al (2004) further suggests that entrepreneurship comes naturally to nurses because 'every day they assess, manage and make decisions about the risks to someone's wellbeing. They organise health care, promote patient realisation of optimum levels of wellness.

10. What is Entrepreneurial leadership?
Entrepreneurial leadership (EL) applies the key skills of the entrepreneur in the organisation to :
Be totally patient focused
Manage risk better –not minimise it.
Encourage innovation and creativity
Take proactive responsibility for own actions
Always seek to make positive change happen no matter who you are.
Leverage the whole organisation –delivery full service to patients in a fully integrated way.
Take a holistic view not just a local view

11. Appreciative Leadership: the background
Appreciative Leadership is developed on the foundation of Appreciative Inquiry, Whole Systems Thinking and Action Research.
The organisation is seen as a relationship to be explored and developed, teams as communities of purpose and practice, and individuals as thinkers and innovators.
Appreciative Leadership favours the generation of interdependencies, an openness to multiple realities, the promotion of conversation and inquiry among relevant people, the development of novel and creative ideas, and engagement that fosters a true desire to co-create the future.
The concepts that underpin Appreciative Leadership align well with the core business of the customer organisation in terms of delivering excellent care in a person-centred and compassionate way

12. Appreciative Leadership; Embedding Values, Delivering Difference, Through conversation and inquiry
Appreciative Leadership Approach - Positive engagement, people before processes
Caring for the organisation; the collective purpose
Caring for the relationships; the collective emotion
Caring for the information; the collective awareness
Values

13. Appreciative Leadership: Delivered in partnership
Grounded in: theory, best practice, practical application, challenge and support
Designed: with the organisation’s values at the heart (development reviews)
Delivered: through conversation and inquiry
Driven by:
Integrity
Respect
Excellence
Accountability
Compassion
Teamwork
Evaluated
Evaluated
Values
Evaluated

14. Adopting an Appreciative Leadership Approach to Whole System Change
With Appreciative Leadership, the focus of attention is on positive potential – the best of what has been, what is, and what might be. It is a process of positive change
Appreciative Leadership gives leaders a way of really motivating and engaging individuals in owning their own future. It alters who is involved and who has access to information – from some of the people to all of the people. It alters the results – from a best solution to the problem, to the boldest dream of positive possibility. In so doing, it can transform people and organisations.
The appreciative approach starts from the positive assumption that people have the capacity to be competent and can excel in a supportive environment. The assumption is that with the right environment and stimulus, people want to perform and contribute and that trust and encouragement work better than suspicion and coercion.

15. Appreciative Leadership through conversation and inquiry creates a thinking space for leaders to engage with the organisation, its purpose and values through:
Identifying and engaging with existing leadership strengths and how these support engagement, innovation, quality and person-centred service delivery
Exploring personal communication preferences and the impact on engagement, innovation, quality and person-centred care, defining commitment to personal improvement
Informing performance objectives and the content and process of the Action Research Project and agree these with Line Managers
Reviewing the impact of the Appreciative Leadership Programme and Action Research Project on engagement, innovation, quality and person-centred care

16. Compassionate leadership
The evidence that this leads to improved leadership or compassionate leadership is weak

17. Ethical leadership
Ethical leadership involves both acting and leading ethically over time & all the time
Why practice ethical leadership?
Ethical leadership models ethical behavior to the organization and the community.
Ethical leadership builds trust.
Ethical leadership brings credibility and respect, both for you and for the organization.
Ethical leadership can lead to collaboration.
Ethical leadership creates a good climate within the organization.
If you have opposition, or are strongly supporting a position, ethical leadership allows you to occupy the moral high ground.
Ethical leadership is simply the right way to go.
Ethical leadership affords self-respect (

18. How do you practice ethical leadership?
General guidelines:
Ethical leadership requires a clear and coherent ethical framework on which the leader can draw in making decisions and taking action.
Your ethical framework should agree with the ethical framework, vision, and mission of the organization or initiative.
Ethics should be a topic of discussion.
Ethics should be out in the open.
Ethical thought must be connected to action.
Ethical leadership is a shared process.

19. Specific components of ethical leadership:
Put the good of the organization and the general good before your own interests and ego.
Encourage the discussion of ethics in general and of the ethical choices involved in specific situations and decisions as an ongoing feature of the organizational culture.
Institutionalize ways for people to question your authority.
Don’t take yourself too seriously.
Consider the consequences to others of your decisions, and look for ways to minimize harm.
Treat everyone with fairness, honesty, and respect all the time.
Treat other organizations in the same way you treat other people – with fairness, honesty, and respect (Dion 2012)

20. Specific components of ethical leadership (cont.):
Collaborate inside and outside the organization.
Communicate.
Work to become increasingly culturally and interpersonally competent.
Take cultural sensitivity and cultural competence seriously.
Work to be inclusive.
Take your leadership responsibility seriously, and be accountable for fulfilling it.
Constantly strive to increase your competence.
Don’t outstay your usefulness.
Never stop reexamining your ethics and your leadership (Dion 2012)

21. Alimo-Metcalfe. , B. , & Alban-Metcalfe. , J. (2000) Leadership
Alimo-Metcalfe., B., & Alban-Metcalfe., J. (2000) Leadership. Heaven can wait. Health Service Journal, 11: 26e9. Blanchard., K. (2013), “Situational leadership theory”, available at: leadership../situational_leadership_frontline Barr J, Dowding L (2008) Leadership in Health Care. Sage Publications Limited, London. Department of Health. Equity and excellence: liberating the NHS. London: The Stationery Office, Dion., M. (2012),"Are ethical theories relevant for ethical leadership?", Leadership & Organization Development Journal. 33 , 1, 4 – 24 Ham., C. (2003) Improving the performance of health services: the role of clinical leadership. Lancet. 361: 1978e80. Howard., S. (2010) Adapting to the new NHS. Nursing Management. 17, 3. Jumma., M.. (2008), “The F.E.E.L” good factors in nursing leadership at board level through work-based learning”, Journal of Nursing Management, Vol. 16, pp Kouzes., J.M.,& Posner., B.Z. (2009) Five best practices. Leadership Excellence 26: 3e4. McKenna., H., Keeney., S., & Bradley ., M. (2004) Nurse leadership within primary care: the perceptions of community nurses, GPs, poiicy makers and members of the public. Journal of Nursing Management. 12, 1,69. Mericle ., T. (2004) Can Nurses Be Entrepreneurs? article_details.php?articlecode=12 Moiden, N. (2002), “Evaluation of leadership in nursing”, Nursing Management, Vol. 9 No. 7, pp Odom, L. and Green, M.T. (2003), “Law and the ethics of transformational leadership”, Leadership & Organization Development Journal, Vol. 24 No. 2, pp Pastor., J.C,. & Mayo., M. (2008), “Transformational leadership among Spanish upper echelons. The role of managerial values and goal orientation”, Leadership & Organisation Development Journal. 29, 4, Sarros, J.C. and Santora, J.C. (2001), “The transformational-transactional leadership model inpractice”, Leadership & Organization Development Journal, Vol. 22 No. 8, pp Shapiro., J. (2011) Leadership in the NHS. British Medical Journal. 3375, 342 Shepherd, G., Boardman, J., Rinaldi ,M. and Roberts, G. (2014), “Supporting recovery in mental health services: quality and outcomes”, a joint initiative from the Centre for Mental Health and Mental Health Network NHS Confederation, London. Stanley, D. (2012), “Clinical leadership and innovation”, Journal of Nursing Education and Practice, Vol. 2 No. 2, pp