Leadership and Management Theories in Healthcare

Introduction

Coordination and guidance of people’s activities and efforts is an essential elements of management in any organization, and medical institutions are no exception. Administrators not only handle the current working routines but also guide the implementation of new practices. In this regard, leaders’ good skills and high competence are associated with better healthcare provision, patient and staff satisfaction, and cost reduction (Chatterjee et al., 2018). Moreover, good management plays an essential role in addressing the profound changes in the healthcare system due to the growing number of people with multiple chronic diseases. Therefore, hospitals constantly seek ways to improve the effectiveness of their administrators.

The modern research literature is abundant with various models that intend to analyze and explain managers’ functions, leadership styles, and surrounding factors that affect their behavior. However, most of the frameworks were developed primarily in the spheres outside healthcare (Chatterjee et al., 2018). Therefore, although the management principles should apply to all the areas, at least in theory, and in practice, that may not always be true. For this reason, the current essay seeks to discuss the most important management and leadership theories and critically investigate whether those frameworks are transferrable to the healthcare context, taking the United Kingdom as an example.

The Difference Between Leaders and Managers

Prior to reviewing the existing theoretical frameworks, it is necessary to elaborate on the differences between leadership and management based on the scholarly literature. In this regard, to describe the distinction between the two terms, the researchers often use the cliché phrase that “managers do things right… [whereas] leaders do the right things” (Mullins and Christy, 2016, p. 312). Such an idea is based on the notion that the former have authority due to their position in an organization while the latter – due to personal characteristics and natural charisma. Moreover, it is generally believed that managers aim at preserving the status quo in the company through the supervision and coordination of their subordinates. In contrast, leaders exhibit more innovative behavior and motivate people to work through inspiration and excitement (Chatterjee et al., 2018). Therefore, it is evident that two concepts differ based on the inherent traits and functions that people who have authority possess.

However, although the division between leadership and management is crucial from a theoretical perspective, in practice, it is sometimes difficult to determine whether a person in power acts as a leader or manager. Indeed, some administrators may possess the traits and display functions associated with the leadership, whereas some leaders may enact managers’ responsibilities (Chiu, Balkundi, and Weinberg, 2017).

In this vein, Mullins and Christy (2016) inquire: “How would you like to be managed by someone who doesn’t lead; or why would you want to be led by someone who doesn’t manage?” (p. 313). Moreover, leadership may generally refer to the process of leading people to a certain aim, and, in this regard, this connotation encompasses both concepts under review. For those reasons, Chiu et al. (2017) maintain that the terms management and leadership are used interchangeably. Therefore, for the purposes of the current paper, the two concepts are considered synonyms. Such a view is explained by the fact that the theoretical frameworks discussed further address the traits and roles of people who exert power in the group regardless of the origin of this authority.

Classic Leadership and Management Theories

Great Man and Traits Theory

Both the framework of leadership traits and the Great Man theory were developed based on the presumption that good managers possess certain qualities that other people of non-administrative positions lack. The characteristics can include charisma, wisdom, intelligence, creativity, and good communication skills, to name a few. It is noteworthy that both models assume these qualities inherent to the person from birth or due to unique life experiences (Kumar and Khiljee, 2016). Therefore, it is considered impossible to ‘grow’ leaders or teach managers to exert power more effectively.

However, that assumption that both theories posited was heavily criticized by some scholars. For instance, Mullins and Christy (2016) state that previous research could not identify many commonalities in characters between people who exert power except some general ones such as self-confidence and initiative behavior. Moreover, Dinibutun (2020) argues that possessing leadership traits is not firmly associated with effective management and, thus, solely constitutes one variable among others that determines the successful organization of work.

Finally, the new frameworks appeared since the development of Great Man and traits theories in the early 20th century, which opposed the latter models’ assumptions providing new evidence. In other words, new studies found that people can develop characteristics necessary to manage subordinates effectively. Therefore, both theories are currently considered outdated by the prevalent part of management researchers. However, despite abandoning the belief that people cannot be trained to become leaders, the investigations regarding certain traits that administrators possess are still quite common and fruitful for people’s understanding of the management phenomenon.

Action-Centered Leadership

Unlike the two frameworks mentioned above, the action-centered leadership model developed by John Adair views management from the functional perspective. In other words, the theory intends to describe the main responsibilities that managers have in an organization. Those responsibilities include addressing task-related, team maintenance, and individual needs (Ulabor, Akande, and Abiodun, 2020). The former implies that leaders should define and organize work and achieve organizational goals. The second task encompasses the building of an effective team and good corporate culture. Finally, the responsibilities towards individual needs include a personal approach to every worker – their demands and character.

All the aforementioned areas of the manager’s concerns are interrelated and figuratively can be described as three overlapping circles. Therefore, it is argued that the leaders should seek the balance between those needs and avoid concentrating too much just on one sphere to ensure the work’s success (Nagyova, Karacsony, and Gyurian, 2018). However, the equilibrium state would vary for different organizations and tasks. For this reason, managers should be primarily able to determine how to distribute their energy most effectively among responsibilities.

Path-Goal Framework and Contingency Theories

Contingency or situational models presume that there is no ideal management style that would fit all organizations and even the same institution equally at various periods of time. In contrast, these frameworks posit that the external environment, corporate culture, workers’ experiences, and knowledge, and the task’s nature dictate the best strategy that the leader should adopt (Khan, Nawaz, and Khan, 2016). Therefore, it is argued that administrators should first of all be flexible to change their behavior accordingly.

The path-goal model proposed by Robert House constitutes one of the most prominent contingency frameworks. The author recognizes four distinct manager behavior styles: directive, supportive, participative, and achievement-oriented leadership (Mullins and Christy, 2016). The former implies that subordinates are expected to follow the orders coming from the administration strictly, and their opinion is not considered most of the time. Next, the supportive leader is the one that considers employees’ well-being and welfare and, thus, acts in a friendly and compassionate manner. Third, participative management is the behavior style that assumes the administrator’s consultation with their subordinates regarding the actions that should be taken to accomplish a certain task. Finally, achievement-oriented leaders seek to increase workers’ performance and expertise by setting adequately challenging goals and openly showing their belief in employees’ abilities.

In line with other situational frameworks, path-goal theory introduces two variables that should determine an administrator’s behavior: the nature of the task and the personal characteristics of subordinates. If the manager chooses the correct behavior style based on those factors, they would be able to significantly improve workers’ motivation level and job satisfaction (Olowoselu, Mohamad, and Aboudahr, 2019). As a result, it is argued that a leader’s effectiveness is determined by the ability to choose the correct behavior strategy.

Transactional vs. Transformational Management

Also, researchers often apply two frameworks of transactional and transformational leadership to investigate the effectiveness of administrators’ actions. In this regard, the theories present contrasting management styles which are still equally necessary to organizations (Fletcher, Friedman, and Piedimonte, 2019). Transactional leadership is mainly associated with order and structure and, thus, is perfectly suitable for administrating routine tasks.

On the other hand, transformational leadership aims at pursuing certain organizational changes and, for this reason, may be very useful for entities that seek innovation. Moreover, while transactional managers mostly appeal to people’s self-interest and use rewarding and punitive measures, transformational managers attempt to motivate subordinates by communicating the vision of the future and inspiration. Therefore, based on the current purposes of the organization, there should be an emphasis on either transactional or transformational leaders.

Modern (Alternative) Leadership and Management Theories

In recent years the investigations have been increasingly interested in such aspects of leadership as manager’s knowledge and employee empowerment. In this respect, the theories of servant, evidence-based, and shared management were introduced. The idea of servant leadership encompasses the behavior and attitudes of the administrator that are primarily oriented towards increasing the well-being of the workers. Such people do not seek authority per se, but rather they see it as an instrument of creating additional benefits for the group (Allen et al., 2016). In this sense, servant manager is similar to House’s supportive leader, but with the difference that the former is always concerned about the goodness of employees whereas the latter behaves in such a manner occasionally.

The evidence-based leadership view was proposed as a solution to preventable medical errors. The theory is based on the findings that numerous treatment failures are caused by a lack of expertise or good management. For instance, Melnyk and Raderstorf (2019) maintain that preventable errors in healthcare provision constitute the third leading cause of death in the United States, accounting for between 250,000 and 400,000 cases each year. Therefore, actions based on scientific evidence are crucial for providing the best treatment for the patients.

Finally, a shared leadership approach was developed to facilitate the modern trends in business operations, including those in the healthcare sphere. They encompass increasing collaboration between various professionals, the growing complexity of the work, and grave competition between organizations (Sweeney, Clarke, and Higgs, 2019). In this regard, to address these challenges, it is suggested that managers should distribute some of their responsibilities among employees who possess greater knowledge and experience in a certain sphere (Forsyth and Mason, 2017). As a result, such diffusion of authority helps the organizations to be more effective and flexible.

Application of Management and Leadership Theories in Practice: A Case of the United Kingdom

Effective management is one of the most crucial issues in the medical sphere in the United Kingdom. For instance, Sonsale and Bharamgoudar (2017) state that nearly 50000 outsourced managers are employed in the National Health Service, accounting for 4% of the overall medical workforce. However, the authors argue that the healthcare system’s heavy reliance on the administration workers who do not have special medical education only hurts the quality of the provided services. Instead, it is suggested that institutions should grow more leaders from their own staff. Also, as was mentioned above, bad management may be one of the main reasons for preventable errors. Therefore, it is crucial to discuss whether the theories mentioned above are applicable in the healthcare context to guide necessary changes.

In this regard, it can be argued that the alternative theories are most relevant and important to achieve the current goals set by scholars and governmental organizations. For instance, practicing evidence-based leadership is associated with a significant increase in the quality of the provided services (Melnyk and Raderstorf, 2019). Except for implying the latest findings in the sphere of management, leaders should also seek to increase their knowledge concerning the medical sphere. Moreover, administrators should motivate their subordinates to apply scientific knowledge treatment methods. However, currently, hospital management is usually seen as one of the main barriers to evidence-based practice rather than the source of its support (Duncombe, 2018). As a result, Camargo et al. (2018) found that in the U.K., medical workers are not prepared to critically evaluate new research findings and transfer received knowledge into practice.

Also, applying the principles of shared and servant leadership in the context of healthcare would be increasingly beneficial as it would allow empowering common workers and increase their motivation and satisfaction. For instance, in the U.K., the Healthcare Leadership Model was developed to facilitate clinicians’ engagement with the management decisions (Forsyth and Mason, 2017). In another study conducted by Le Ng, Choi, and Soehod (2016), it was found that having a servant leader in the organization is negatively associated with workers’ turnover intentions. Therefore, even these few examples prove that shared and servant management are important frameworks to imply in practice.

More classic management frameworks can also be successfully adapted by healthcare leaders, especially in combination with alternative views on administrative functions. For instance, transformational leadership can be incorporated with evidence-based practice. In this case, the managers will understand the importance of communicating their ideas to subordinates, and their visions for a change would be grounded on research findings. Additionally, knowledge of the action-centered model would help administrators determine their responsibilities and understand that they should seek a balance between their functions to be effective.

On the contrary, it can be argued that Great Man and traits theories can be useful only for their attempt to determine some general characteristics of managers. However, the belief that ‘leaders are born but not made’ should be abandoned as recent findings disproved this proposition.

Conclusion

Overall, the current essay elaborated on a number of existing classic and alternative leadership and management theories. They included Great Man, traits, action-centered, path-goal, transactional, transformational, evidence-based, servant, and shared leadership frameworks. Although the discussed list of management approaches is by no means exhaustive, it is believed that all the most relevant and widely used concepts were covered. Moreover, the paper posited the necessity of leadership development in the U.K. healthcare system and analyzed whether and how previously discussed frameworks may be applied in practice.

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