Leadership and Management Principles

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http://evolve.elsevier.com/Huber/leadership/

LEADERSHIP AND CARE MANAGEMENT DIFFERENTIATED

In nursing, leadership is studied as a way of increasing the skills and abilities needed to facilitate clinical outcomes while working with people across a variety of situations and to increase understanding and control of the professional work setting. A long history and rich literature surround leadership theories, much of it from outside of nursing. Nursing has drawn from both classic and contemporary thinkers. Bennis (1994) made a strong argument for leadership, stating that quality of life depends on the quality of leaders. He noted three reasons why leaders are important: the character of change in society, the de-emphasis on integrity in institutions, and the responsibility for the effectiveness of organizations. Fiedler and Garcia (1987) argued that leadership is one of the most important factors that determine the survival and success of groups and organizations. Effective leadership is important in nursing for those same reasons, specifically because of its impact on the quality of nurses’ work lives, being a stabilizing influence during constant change, and for nurses’ productivity and quality of care.

Leadership theory often is discussed separately from management theory. Some say leadership and management are two very different things. Yet clearly there is overlap in that one can be both leading and managing in some cases. The area of overlap may not be clear or explained. Some have seen management as a subset of leadership. The premise of this book is that leadership and management are not identical ideas. This can be seen in their distinct definitions.

If the delivery of nursing services involves the organization and coordination of complex activities in the human services realm, then both leadership and management are important elements. The leader’s focus is on people; the manager focuses on systems and structure (Bennis, 1994). Thus although both are used to accomplish goals, each has a different focus. For example, a nurse may use leadership strategies or management strategies to motivate others, but the desired outcome of the motivation is likely to be different. However, leadership and management have some shared characteristics. In this area of overlap, the processes and strategies look similar and may be employed for a similar outcome or blended together to accomplish goals.

Leadership and management are equally important processes. Because they each have a different focus, their importance varies according to what is needed in a specific situation. Hersey and colleagues (2013) thought that leadership was a broader concept than management. They described management as a special kind of leadership. This view would position management as a part of leadership, not as a distinct concept. However, according to the definitions, characteristics, and processes, the concepts of leadership and management are different, but at the area of overlap they look similar. For example, directing occurs in both leadership and management activities (the area of overlap), whereas inspiring a vision is clearly a leadership function. Both leadership and management are necessary. Mintzberg’s (1994) idea was that nursing management occurred in an interactive model rather than through a stepwise linear process.

An evidence-based approach to differentiating nursing leadership from management was taken to identify discrete competencies through an integrative content analysis of the literature base (Jennings et al., 2007). In 140 articles reviewed, they found 894 competencies, of which 862 (96%) were common to both leadership and management. Thus the overlap area appeared to be larger than previously thought. However, leadership and management do serve distinct purposes. Perhaps it is time to apply leadership and management concepts and competencies by setting, level of role responsibility, career stage, and social context to more fully apply the evidence base to practice.

The focus of each is different: management is focused on task accomplishment and leadership is focused on human relationship aspects. They may be sequential, and they are interrelated. Clearly, a balance of the two is necessary. There is a “gray area” in which the foci of their outcomes overlap. This overlap occurs where the two processes are integrated or synthesized to accomplish goals and where the same strategies are employed even though the goals may differ.

Leadership is an activity of human engagement and a relationship experience founded in trust, communication, inspiration, action, and “servanthood.” The leadership role is so important because it embodies commitment and forward-reaching action. Arising from a drive to make things better, leaders use their power to bring teams together, spark innovation, create positive communication, and drive forward toward group goals.

Leadership is important to study, learn, and practice in today’s complex, rapidly changing, turbulent, and chaotic health care work environment. Such an environment generates challenges to the nurse’s identity, coping skills, and ability to work with others in harmony. It also presents the opportunity to lead, challenge assumptions, consolidate a purpose, and move a vision forward. Leadership is important for nurses because they need to possess knowledge and skill in the art and science of solving problems in work groups, systems of care, and the environment of care delivery. The effectiveness of an individual nurse depends partly on that individual’s competence and partly on the creation of a facilitating environment that contains sufficient resources to accomplish goals. The nurse leader combines clinical, administrative, financial, and operational skills to solve problems in the care environment so that nurses can provide cost-effective care in a way that is satisfying and health promoting for patients and clients. Such an environment does not simply happen; it requires special skills and the courage and motivation to move a vision into action. Thus the study of nursing leadership and care management focuses critical thinking on what it takes to be a nursing “environment architect,” transition leader, and manager of care delivery services.

“The nurse leader plays a critical role in the business of the healthcare organization and the quality and safety of the services provided” (O’Connor, 2008, p. 21). Strong evidence for the nurse leader’s critical role both in the business of a health care organization and in the quality and safety of service delivery has been laid out by the Institute of Medicine (IOM) (2004), the American Nurses Credentialing Center’s (ANCC) Magnet Recognition Program® (ANCC, 2008a, b), and the American Organization of Nurse Executives (AONE) (2005). The IOM focus is on the following five areas of management practice:

• Implementing evidence-based management

• Balancing tensions between efficiency and reliability

• Creating and sustaining trust

• Actively managing the change process through communication, feedback, training, sustained effort and attention, and worker involvement

• Creating a learning environment

The ANCC’s magnet program acknowledges excellence in nursing services and leadership based on these five components: transformational leadership, structural empowerment, new knowledge, exemplary professional practice, and empirical outcomes (Wolf et al., 2008). The AONE 2005 nurse executive competencies are described in the following five domains of skill:

• Communication and relationship management

• Leadership

• Business skills and principles

• Knowledge of the health care environment

• Professionalism

Taken together, these source documents overlap and converge on the primary attributes, knowledge domains, and skills that nurse leaders need to lead people and manage organizations in health care.

THE TWO ROLES OF A NURSE

Nursing is a service profession whose core mission is the care and nurturing of human beings in their experiences of health and illness. Nurses have two basic roles: care providers and care coordinators. The first role is more often the role that is recognized. The acute care medical model in hospitals over time came to be the primary focus of attention and jobs for nurses. In this illness-focused model, the nurse’s care provider or “doing” role was the most important and valued aspect of nursing. Little reward came from the “thinking” and integrating skills nurses were capable of. With a shift to primary care and care coordination, the nurse’s care management role has become more prominent, needed, and valued. The delivery of nursing services involves the organization and coordination of complex activities. Nurses use managerial and leadership skills to facilitate delivery of quality nursing care.

THE LEADERSHIP ROLE

Leadership is a unique role and function. It can be part of a formal organizational managerial position, or it can arise spontaneously in any group. Certain characteristics, such as being motivated by challenge, commitment, and autonomy, are thought to be associated with leadership. Effectiveness is a key outcome of leadership efforts in health care. It has been suggested that there is a scarcity of leaders and a crisis in leadership in nursing. The IOM has raised awareness about patient safety and quality of care issues, and the Magnet Recognition Program® is one evidence-based nursing response. In times of chaos, complexity, and change, leadership is essential to provide the guidance, direction, and sense of stability needed to ensure followers’ effectiveness and satisfaction.

The focus on leadership as a crucial need arises from the impact of significant changes that have occurred in the organization, delivery, and financing of health care during this period of time that has been characterized as turbulent and tumultuous because of “waves of chaos.” Under such circumstances, nurses are challenged to respond with leadership. Nurses can best respond by demonstrating vision, adapting to changes, seeking new tools for dealing with the new health care environment, and leading the way with client-centered strategies.

Both nurses and the health care delivery systems in which they practice need leaders. Potential health care leaders likely will possess “a passion to make things better, a commitment to values, a focus on creativity and innovation, and the knowledge and skills necessary to identify health care needs and then to mobilize and array the human and other resources necessary to achieve goals and effect outcomes” (Huber & Watson, 2001, p. 29). Exhibiting quiet but respected competence, a leader may be the wise or go-to person within the group, a superior problem solver, a strategic communicator, or someone who is emotionally intelligent and strong in interpersonal relationship skills. Leaders may grow gradually out of a smoldering issue or erupt through a crisis event. Clearly, “something changes as leadership blossoms” (Huber & Watson, 2001, p. 29).

LEADERSHIP OVERVIEW

Leadership is a natural element of nursing practice because the majority of nurses practice in work groups or units. Possessing the license of an RN implies certain leadership skills and requires the ability to delegate and supervise the work of others. Leadership can be understood as the ability to inspire confidence and support among followers, especially in organizations in which competence and commitment produce performance.

Leadership Skills

Leadership is an important issue related to how nurses integrate the various elements of nursing practice to ensure the highest quality of care for clients. Every nurse needs two critical skills to enhance professional practice. One is a skill at interpersonal relationships. This is fundamental to leadership and the work of nursing. The second is skill in applying the problem-solving process. This involves the ability to think critically, to identify problems, and to develop objectivity and a degree of maturity or judgment. Leadership skills build on professional and clinical skills. Hersey and colleagues (2013) identified the following three skills needed for leading or influencing:

1. Diagnosing: Diagnosing involves being able to understand the situation and the problem to be solved or resolved. This is a cognitive competency.

2. Adapting: Adapting involves being able to adapt behaviors and other resources to match the situation. This is a behavioral competency.

3. Communicating: Communicating is used to advance the process in a way that individuals can understand and accept. This is a process competency.

Among the important personal leadership skills is emotional intelligence. Based on the work of Goleman (2007), relational and emotional integrity are hallmarks of good leaders. This is because the leader operates in a crucial cultural and contextual influencing mode. The leader’s behavior, patterns of actions, attitude, and performance have a special impact on the team’s attitude and behaviors and on the context and character of work life. Followers need to be able to depend on role consistency, balance, and behavioral integrity from the leader. The four skill sets needed by good leaders are as follows:

1. Self-awareness: Ability to read one’s own emotional state and be aware of one’s own mood and how this affects staff relationships

2. Self-management: Ability to take corrective action so as not to transfer negative moods to staff relationships

3. Social awareness: An intuitive skill of empathy and expressiveness in being sensitive and aware of the emotions and moods of others

4. Relationship management: Use of effective communication with others to disarm conflict, and the ability to develop the emotional maturity of team members

Gittell (2009) emphasized the centrality of relationship management because patient care is a coordination challenge. She noted that relational coordination drives quality and efficiency outcomes and health care performance. Relational coordination is defined as “coordinating work through relationships of shared goals, shared knowledge, and mutual respect” (p. xiii). Relational coordination focuses on relationships between roles rather than between individuals.

These interpersonal relationship skills are crucial to the work of leadership. The chaos and complexity of the seismic shifts in health care structure, delivery, form, technology, and content have made visible the urgent need for leaders to emerge, mobilize, and encourage followers. Leaders are pivotal for connecting the efforts of followers to organizational goals. This is both tricky and risky and may be overwhelming (Porter-O’Grady, 2003). However, good leaders are anchors to the vision and the larger mission, guides to coping and being productive, and champions of energy and enthusiasm for the work.

DEFINITIONS

There are a variety of definitions of leadership. Leadership is defined here as the process of influencing people to accomplish goals. Key concepts related to leadership are influence, communication, group process, goal attainment, and motivation. Hersey and colleagues (2013) defined leadership as a process of influencing the behavior of either an individual or a group, regardless of the reason, in an effort to achieve goals in a given situation. Burns (1978) noted that leadership occurs when human beings with motives and purposes mobilize in competition or conflict with others to arouse, engage, and satisfy motives.

Most leadership definitions incorporate the two components of an interaction among people and the process of influencing. Thus leadership is a social exchange phenomenon. At its core, leadership is about influencing people. In contrast, management involves influencing employees to meet an organization’s goals and is focused primarily on organizational goals and objectives. Bennis (1994) listed a number of distinctions between leadership and management. He noted that the leader focuses on people, whereas the manager focuses on systems and structures. The leader innovates and conquers the context. Another distinction is that a leader innovates, whereas a manager administers. Kotter (2001) noted that managers cope with complexity whereas leaders cope with change.

Management is defined as the coordination and integration of resources through planning, organizing, coordinating, directing, and controlling to accomplish specific institutional goals and objectives. Hersey and colleagues (2013) defined management as the “process of working with and through individuals and groups and other resources (such as equipment, capital, and technology) to accomplish organizational goals” (p. 3). They identified management as a special kind of leadership that concentrates on the achievement of organizational goals. If this idea were visualized, it would appear as concentric circles—not as separate but overlapping circles.

Leadership is a broad concept and a process that can be applied to any group. Grant (1994) noted that leadership, management, and professionalism have different but related meanings, as follows:

• Leadership: Guiding, directing, teaching, and motivating to set and achieve goals

• Management: Resource coordination and integration to accomplish specific goals

• Professionalism: An approach to an occupation that distinguishes it from being merely a job, focuses on service as the highest ideal, follows a code of ethics, and is seen as a lifetime commitment

LEADERSHIP AND MANAGEMENT ROLES

A distinction can be made between leadership and management roles. Management activities are concerned with managing the resources of an organization. The idea of management can generate a negative reaction when it is equated with the “command and control” concept of authoritarian and bureaucratic organizations. These management models do not fit well with an environment that is constantly changing. Certain pressures influence the role of the manager and demand new skill sets to facilitate clinical work. Examples include when technology changes more quickly than clinicians are able to learn and adapt to it, when management duties extend to include temporary workers employed by others (e.g., outsourced functions and agency nurses), and when a radical organizational shift to an accountable care organization (ACO) is necessary. The demands of management work are increasing in amount, scope, complexity, and intensity and thus increase role stress and leave less time to plan and focus on unit management (Porter-O’Grady, 2003).

BACKGROUND ON LEADERSHIP

Leadership can be best understood as a process. Much attention has been focused on leadership as a group and organizational process because organizational change is heavily influenced by the context or environment. Nurses need to have a solid foundation of knowledge in leadership and care management. This applies at all levels: nurse care provider, nurse manager, and nurse executive. However, the depth and focus of care management roles and skills may vary by level. For example, the nurse care provider concentrates on the coordination of nursing care to individuals or groups. This may include such activities as arranging access to services, providing direct care, doing referrals, and supporting a patient’s family. At the next level, the nurse manager concentrates on the day-to-day administration and coordination of services provided by a group of nurses. The nurse executive’s role and function concentrate on long-term administration of an institution or program that delivers nursing services, focusing on integrating the system and building a culture (Mintzberg, 1998).

LEADERSHIP: FIVE INTERWOVEN ASPECTS

Hersey and colleagues (2013) noted that the leadership process is a function of the leader, the followers, and other situational variables. The leadership process includes five interwoven aspects: (1) the leader, (2) the follower, (3) the situation, (4) the communication process, and (5) the goals (Kison, 1989). Figure 1-1 shows how these components relate to one another. All five elements interact within any given leadership moment.

FIGURE 1-1 Components of a leadership moment.

LEADERSHIP THEORIES

Hersey and colleagues (2013) have done a thorough overview of leadership and organizational theory through the situational leadership school of thought. From an early awareness of the leader’s need to be concerned about both tasks and human relationships (output and people) sprang a long history of leadership theories that can be grouped as trait, attitudinal, and situational (Hersey et al., 2013). The trait approach focuses on identifying specific characteristics of leaders. The attitudinal approach measures attitudes toward leader behavior. The situational approach focuses on observed behaviors of leaders and how leadership styles can be matched to situations. Leadership theories have evolved away from an early focus on the traits or characteristics of the leader as a person because it was found that it is not possible to predict leadership from clusters of traits. However, several authors have developed lists of traits common to good leaders (Bass, 1985; Bennis & Nanus, 1985), and interest remains in the characteristics to look for in good leaders. Further background on the history of leadership research can be found online (e.g., www.sedl.org/change/leadership/history.html).

Trait Theories

Characteristics of Leadership

In the trait approach, theorists have sought to understand leadership by examining the characteristics of leaders. Presumably, leaders could be differentiated from non-leaders. The trait approach has generated multiple lists of traits proposed to be essential to leadership. Bennis (1994) identified a recipe for leadership that contained six ingredients: a guiding vision, passion, integrity (including self-knowledge, candor, and maturity), trust, curiosity, and daring. Leaders arise in a context, and they are said to be made, not born. They appear to learn leadership skills in stages (Bennis, 2004). Thus leadership skills can be both taught and learned. It is important for nurses to recognize that they can learn, practice, and improve their personal leadership competencies.

Drucker (1996) noted that effective leaders know the following four things:

1. The only definition of a leader is someone who has followers.

3. Leaders are visible and set examples.

4. Leadership is not rank but responsibility.

Leaders need to ask the right questions, such as these: What needs to be done? What can I do to make a difference? What are the goals? What constitutes performance and results?

Leaders are active, not passive. The risk-taking element of leadership involves taking action. Leaders engage their environment with behaviors of doing, influencing, and moving. These are action terms. Pagonis (1992) noted that to lead successfully a leader must demonstrate two active, essential, and interrelated traits: expertise and empathy. Leaders are those who talk about adventures into new territory and take the risks inherent in innovation (Kouzes & Posner, 1995). Leadership means giving guidance and using a focused vision.

A leader may see the need to chart a course that is new or unknown, unpopular, or risky because it challenges those with vested interests who have much to lose. In a way, nursing’s struggle for greater economic parity in health care is courageous and risky. Clancy (2003) noted that leaders need to “consistently find the courage to hold true to their beliefs and convictions” (p. 128). Both ethical fitness and moral courage form the backbone of making necessary and hard—but right and unpopular—decisions. Cost containment, patient’s rights, safe staffing, stress and anger, and ethical dilemmas all challenge the leader to identify right from wrong and act from his or her sense of conviction. The leadership courage continuum runs from “good coward” (cannot muster courage to make tough choices) to “reckless courage” (shoot from the hip). Leaders need to be willing to make tough choices plus overcome the fear associated with them.

Research by Bennis and Thomas (2002) indicated that extraordinary leaders possess skills required to overcome adversity and emerge stronger and more committed. They suggest that “one of the most reliable indicators and predictors of true leadership is an individual’s ability to find meaning in negative events and to learn from even the most trying circumstances” (Bennis & Thomas, 2002, p. 39). “Crucible” experiences shape leaders. These are trials, tests, and transformative experiences that force leaders to question themselves and what matters and to hone their judgment. Consequently, leaders come to a new or altered sense of identity. Crucible experiences can occur from positive or negative triggers, but leaders see them as opportunities for reinvention. Great leaders possess the following four essential skills:

1. The ability to engage others in shared meaning

2. A distinctive and compelling vocal tone

3. A sense of integrity

4. A combination of hardiness and ability to grasp context, called “adaptive capacity”

Characteristics such as knowledge, motivating people to work harder, trust, communication, enthusiasm, vision, courage, ability to see the big picture, and ability to take risks are associated with important leadership qualities in research findings. For example, Bennis and Nanus (1985) studied 90 chief executives from 1978 to 1983 and found that there were two key leadership traits. One is a guiding set of concepts, and the other is the ability to communicate a vision. Kouzes and Posner (1995) defined the following five behaviors that correlated with leadership excellence:

1. Challenging the process: Leaders go beyond the status quo to search for opportunities, experiment, and take risks to achieve lofty goals.

2. Inspiring shared vision: Leaders envision the future and enlist others in sharing the dream.

3. Enabling others to act: Leaders foster collaboration and develop and strengthen others so that the whole team performs well.

4. Modeling the way: Leaders set an example and structure events so that incremental progress is celebrated as small wins.

5. Encouraging the heart: Leaders appreciate and recognize individual contributions and formally celebrate accomplishments.

These five practices can be seen as the way leaders get extraordinary things done through people in an organization. The practices and qualities of leadership help nurses enrich their own style and contribute to a more productive workplace. This model of leadership has been used in nursing research (Patrick et al., 2011).

One research-based nursing model (Mathena, 2002) identified the following six core behaviors critical for nursing leadership success:

1. Visioning

2. Interdisciplinary team building

3. Workload complexity analysis

4. Work process analysis

5. Stakeholder analysis

6. Interactive planning

Vision and Trust

Although the lists of leadership characteristics and competencies vary somewhat, the functions of visioning, setting the direction, inspiration, motivation, and enabling systems and followers are at the core of leadership activity. Bennis (1994) discussed what has come to be called “the vision thing.” The one specific defining quality of leaders is vision— the ability to create a vision and put it into operation.

Leadership is founded on trust: “Trust is the emotional glue that binds leaders and employees together and is a measure of the legitimacy of leadership” (Malloch, 2002, p. 14). Organizations that focus on sustaining a healing culture rebuild organizational trust by focusing on trust in relationships with employees. Behaviors that build trust include sharing relevant information, reducing controls, and meeting expectations. Trust-destroying behaviors include being insensitive to beliefs and values, avoiding discussion of sensitive issues, and encouraging competition via winners and losers. Nurses can be aware of the crucial nature of trust in the leadership and management relationship. Trust goes both ways and needs to be nurtured. Nurses can start by examining their own behaviors and then taking deliberative actions to strengthen trust in the environment.

Followers expect that leaders will provide a sense of vision and a sense of direction with standards for achieving the group’s goals. Leaders can create an environment that is positively charged for productivity or that allows followers to languish without direction or mission. It is possible that leaders can create a negative climate that becomes destructive to the group. If the leader plays a major role in creating a group’s culture and ethos, then closing down communication, breeding distrust and competition, and neglecting positive motivation can sow the seeds of group disintegration. Thus the characteristics possessed and used by the leader can make a crucial difference in the functioning and effectiveness of any group.

Leadership Dos and Don’ts

The long history of leadership theory has highlighted the importance of focusing on both of the two basic leadership elements of tasks and relationships. These are core to all leadership in all situations. The Trait Approach has led to long lists of skills and characteristics associated with successful leaders. These can be distilled into leadership dos and don’ts.

A profile of leaderships dos includes honesty, energy, drive, tenacity, creativity, flexibility, visibility, emotional stability, knowledge, conceptual skills, and leadership motivation. Among these characteristics, honesty (defined as trustworthiness) and energy are at the top of the list. Leadership is founded on trust and does not survive without it. Leadership is hard, sustained work that requires a great deal of energy and sputters without it.

A profile of leadership don’ts includes untrustworthiness, insensitivity to others, aloofness, over-managing, abrasiveness, inability to think strategically or staff effectively, inability to build a team, and focusing on internal organizational politics (overly ambitious). Among these characteristics, untrustworthiness is a fatal flaw, and insensitivity to others is a likely cause for ineffective leadership (Hersey et al., 2013).

Leadership Styles

As leadership theories evolved, leadership came to be viewed as a dynamic process and an interaction among the leader, the followers, and the situation. Leadership theory began to move beyond a focus on traits to explore the concept of leadership styles. Styles of leadership range from authoritarian to permissive to democratic and from transactional to transformational. The individual nurse’s task is to determine in which environments he or she functions best and is most comfortable or where he or she most likely will succeed. This facilitates placement for success and a better match between leader and follower.

Leadership styles are defined as different combinations of task and relationship behaviors used to influence others to accomplish goals. They are sets or clusters of behaviors used in the process of effecting leadership. Leaders need to be concerned about both tasks to be accomplished and human relationships in groups and organizations. Hersey and colleagues (2013) said that leadership styles are the consistent behavior patterns exhibited in influencing the activities of others by working with and through them, as perceived by those others. Different styles evoke variable responses in different situations. The way people influence others through actions taken and the perspectives of other people is related to leadership efforts and constitutes leadership style. The two major leadership terms are task behavior and relationship behavior, and a leader’s leadership style is some combination of task and relationship behavior. Hersey and colleagues (2013) defined these terms as follows:

• Task behavior: The extent to which leaders organize and define roles; explain activities; determine when, where, and how tasks are to be accomplished; and endeavor to get work accomplished

• Relationship behavior: The extent to which leaders maintain personal relationships by opening communication and providing psychoemotional support and facilitating behaviors

Tannenbaum and Schmidt (1973) suggested that a leader might select one of many behavior styles arrayed along a continuum. The continuum ranges from democratic to authoritarian (or subordinate-centered to leader-centered). Their work suggested that there are a variety of leadership styles (Figure 1-2) or points along the continuum. They discussed three distinct styles: authoritarian, democratic, and laissez-faire. Some individuals are able to integrate styles and flexibly match to the situation at hand, but this is rare.

FIGURE 1-2 Continuum of leader behavior.

Authoritarian

The authoritarian leadership style uses primarily directive behaviors. Decisions of policy are made solely by the leader who tends to dictate tasks and techniques to followers. Leaders tell the followers what to do and how to do it. This style emphasizes a high concern for task. Authoritarian leaders are characterized by giving orders. Their style can create hostility and dependency among followers; it may also stifle creativity and innovation. On the other hand, this style can be very efficient, especially in a crisis.

Democratic

This approach implies a relationship and person orientation. Policies are a matter of group discussion and decision. The leader encourages and assists discussion and group decision making. Human relations and teamwork are the focus. The leader shares responsibility with the followers by involving them in decision making. In nursing, interdisciplinary teamwork is a major element in effectiveness. The democratic style makes output appear to move more slowly and is thought to take longer than using an authoritarian style. Group consensus needs time and facilitation to be fostered. Furthermore, the needs of disenfranchised minority groups must be balanced. Intergroup cohesion is a focus with this style. The challenge of the democratic style is to get people with different professional backgrounds, personal biases, and psychological needs together to focus on the problem and next action steps. Motivating participation is a constant challenge.

Laissez-Faire

This style promotes complete freedom for group or individual decisions. There is a minimum of leader participation. A leader using this style may seem to be apathetic. Because the style is based on noninterference, a clear decision may never be formulated. The laissez-faire style results in a decision, conscious or otherwise, to avoid interference and let events take their own course. The leader is either permissive and fosters freedom or is inept at guiding a group. Followers may need greater structure than the leader gives them. Despite its potential drawbacks, this style has advantages when used with groups of fully independent care providers or professionals working together.

Overall, one style is not necessarily better than another. Each has advantages and disadvantages. There are situational and contextual factors to consider when choosing a style. Styles should vary according to the appropriateness of the situation with reference to an evaluation of effectiveness. Flexibility is important. For example, if a nurse prefers to operate in a democratic style yet suddenly a code situation occurs, then the nurse must rapidly switch from a democratic to an authoritarian style. Some democratic leaders cannot vary their style sufficiently to handle crises. On the other hand, in a staff meeting, an authoritarian leader may be ineffective with a group of professionals and would need to be flexible enough to switch to a democratic or laissez-faire style, depending on the circumstances. The basic needs are for leader self-awareness and knowledge of the group’s ability and willingness levels before examining the situational elements and choosing a leadership style. Self-awareness is key to strategically using leadership styles.

Feminist Leadership Perspective

Leadership styles appear to have a gender component. The feminist perspective on leadership was presented by Helgeson (1995a, b). She identified female leadership as a weblike structure—dynamic and continuously expanding and contracting. It is characterized by a concern for family, community, and culture. The inclination is for a democratic power style, and the emphasis is on the importance of establishing relationships, maintaining connections with others, and deriving strength from empowering others. By contrast, leadership approaches described by men tend to be influenced by the military and participating in team sports. Men tend to spend their time on meetings and tasks requiring immediate attention, focusing on completion of tasks and achievement of goals. Women tend to focus on process; men tend to focus on achievement and closure. Women tend to be more flexible and value cooperation, connectedness, and relationships. Exploring the feminist perspective on leadership is valuable in that it provides food for thought as health care organizations and the nurses working in them struggle with not wanting to let go of the familiar hierarchy management style yet needing to reconfigure to the circular or web structure to be effective. It is not known whether gender differences are permanent characteristics or are culturally mediated artifacts that blur with time.

ATTITUDINAL LEADERSHIP THEORIES

Hersey and colleagues (2013) identified a second approach to leadership research that focused on the measurement of attitudes or predispositions toward leader behavior. Occurring mainly between 1945 and the mid-1960s, the attitudinal approaches began with the Ohio State Leadership Studies and included the Michigan Leadership Studies, Group Dynamics Studies, and Blake and McCanse’s Leadership Grid.

Leader behavior was described as having two separate dimensions, as follows:

1. Initiating structure and consideration in the Ohio State Leadership Studies

2. Employee orientation and production orientation in the Michigan Leadership Studies

These dimensions are similar to the authoritarian (or task) and democratic (or relationship) ideas of the leader behavior continuum. The Group Dynamics Studies highlighted goal achievement (similar to task) and group maintenance (similar to relationship) elements of leadership behavior (Cartwright & Zander, 1960).

Blake and Mouton (1964) used task and relationship concepts in their grid, which was later modified by Blake and McCanse (1991). The following five types of leadership or management styles, based on concern for production (task) and concern for people (relationship), emerged:

1. Impoverished: This style uses minimal effort to get the work done.

2. Country club: This approach emphasizes attention to the needs of people to effect satisfying relationships.

3. Authority-obedience: This style strives for efficiency in operations.

4. Organizational man: This approach works on balancing the necessity to accomplish the task with maintaining morale.

5. Team: This style promotes work accomplishment from committed people and interdependence through a common cause, leading to trust and respect.

Hersey and colleagues (2013) noted that Blake and Mouton’s (1964) conceptualization tended to be an attitudinal model that measured the values and feelings of managers, whereas the Ohio State model included both attitudes and behaviors and focused on leadership. Both the leadership style (task versus relationship) and the attitude of the leader about leadership behaviors are important. However, attitudinal theories still did not fully capture the leadership experience because the environment and its complexity were not factored in.

Situational Theories

A third phase of leadership theories grew out of a group of contingency theories whose central idea was that organizational behavior is contingent on the situation or environment. This means that which theory or style is the best all depends on the situation at hand. What is needed by the leader is diagnostic ability. The leader observes and analyzes which abilities and motives are present in the followers. With sensitivity, cues in the environment can be identified and used to make choices regarding leadership style. One choice a leader has is to alter his or her own behavior and the leadership style used. Personal flexibility and leadership skills are needed to vary one’s style when the followers’ needs and motives change or vary. The ability to diagnose, choose, and alter behavior to implement a leadership style best matched to the situation is a critical skill needed for effective leadership. Thus no one leadership style is optimal in all situations. The nature of the situation needs to be considered. Styles can be chosen to match the situation (Hersey et al., 2013).

Fiedler’s Contingency Theory

As situations become more complex, leadership becomes more difficult. Fiedler (1967) developed a Leadership Contingency Model to explain how to apply this idea. He classified group situational variables of leader-member relations, task structure, and position power into eight possible combinations, ranging from high to low on these three major variables. Leader-member relations refers to the type and quality of the leader’s personal relationships with followers. Task structure means how structured the group’s assigned task is. Position power refers to power that is conferred on the leader by the organization as a result of the assigned job. Fiedler examined the favorableness of the situation from the perspective of the leader’s influence over the group. The most favorable situation occurs with good leader-member relations, high task structure, and high position power. The least favorable situation occurs when the leader is disliked, has an unstructured task, and has little position power. With Fiedler’s model, group situations can be analyzed to determine the most effective leadership style.

Fiedler (1967) examined which style (task-oriented versus relationship-oriented) would be most effective for each of eight situations. A key general principle is that the need for task-oriented leaders occurs when the situation is either highly favorable or very unfavorable. A task-oriented style is needed for situations on the extremes, whereas a relationship-oriented style is needed when the situation is moderately favorable.

For example, a staff nurse goes into a nursing unit meeting not wanting any extra assignments but hoping that some of the ongoing problems will be solved. If the nurse has a reasonably good relationship with the leader, the leader should use a high-relationship style with the nurse. The leader should use selling, convincing, encouraging, and motivating strategies. The leader should make the nurse feel good about his or her ability to accomplish a task, provide something of quality, and work with other people. If, however, the staff nurse’s mind is closed about any changes or if passive-aggressive or subversive actions occur, then the leader needs be more directive. A possible reaction might be to give the nurse an assigned task. On the extremes of highly favorable or highly unfavorable situations, leaders need to use task-oriented behavior to get the work moving. In the middle of the continuum, a high-relationship style is needed, again to foster productivity.

In Situational Leadership® theory,* leadership in groups is never a static circumstance. The situation is dynamic and subject to change. In a very difficult situation, relationships may be the leader’s preferred emphasis. However, if interpersonal relationships are not an immediate problem or if the group is on the verge of collapse, then strong authoritative direction is needed to get the group moving and accomplishing. For this situation, the task-oriented leader is a more effective match between leader and job. However, groups do not remain static; they move back and forth through stages. When the problem no longer is just the need to get the group moving but also includes solving numerous interpersonal conflicts, a relationship-oriented leader is better matched to the situation. Eventually, as the situation progresses, a relationship-oriented leader can become less effective. This occurs because once the group has less conflict, individuals may begin to coast along and positive motivation may be lost as individuals become apathetic. Once again, a task-oriented style is called for—challenging individuals by using the motivation they need to continue to produce. Because of the factor of constant change, maintaining good leadership is complicated for any group. One way to foster effective leadership is to evaluate leaders according to Fiedler’s contingency model (1967) and then use this information to increase leaders’ awareness of their natural style tendency: relationship-oriented or task-oriented. Fiedler’s measure for leadership style is the Least Preferred Coworker (LPC) scale (Fiedler & Chemers, 1984). The LPC is an 18-item semantic differential scale that is the personality measure of Fiedler’s contingency model (Fiedler & Garcia, 1987).

Favorable or unfavorable situations are determined in part by the receptivity of the followers, but they are also determined by whether the larger environment is positive or negative. An example of an unfavorable situation in nursing is the following:

A nurse’s job is to lead and manage a hospital’s critical care area, which has serious morale problems. The nurse is new and has a master’s degree but soon discovers that a majority of the followers have long tenure on the unit and both educational and experiential backgrounds that are very different. There may be values clashes between the leader and the followers. The task is to change the environment, but the nurse discovers that this work group has maintained its traditions over a long period.

This is an unfavorable situation and a leadership challenge. Fiedler’s theory (1967) suggests that the best leadership style under unfavorable circumstances is task-oriented.

Hersey and Blanchard’s Tri-Dimensional Leader Effectiveness Model

Hersey and colleagues (2013) described the Tri-Dimensional Leader Effectiveness Model first developed by Hersey and Blanchard. First, a two-dimensional model was constructed, in which task behavior and relationship behavior were displayed on a grid from high to low and were divided into four quadrants: (1) high task, low relationship; (2) high task, high relationship; (3) high relationship, low task; and (4) low task, low relationship (Figure 1-3). These quadrants represent four basic leadership styles: telling, selling, participating, and delegating. As applied to the continuum of authoritarian versus democratic styles, telling would be authoritarian and participating would be democratic. The two most common leadership styles are selling and participating. Selling requires the most from a leader, who must provide high amounts of guidance and support. Movement into a participative leadership style requires much less structure and task-directive behavior from the leader because the individual or group is performing but is not quite confident enough in its own ability for the leader to completely let go. The individual or group wants to talk about things.