Chapter 6
Person-centred nursing leadership
Shaun Cardiff
Fontys University of Applied Sciences, Eindhoven, The Netherlands
Person-centredness is often talked about in terms of the practitioner-service user relationship, although the enactment of person-centredness has also been identified as a key attribute to effective workplace cultures (Manley et al. 2011). Once practitioners start to collectively engage with and reflect on the meaning of person-centred cultures, awareness grows of the relevance person-centredness has for their own relationships too (McCance et al. 2013) and the placement of effective staff relationships within the context domain of the Person-centred Nursing Framework.
Leadership is known to have a large impact on workplace/organisational cultures. Kouzes and Posner’s (2007) model of transformational leadership seems to be the preferred choice in practice development and person-centred work and literature. However, whilst showing positive outcomes, it can be argued that this model does not fully reflect the core values of person-centredness (Cardiff, 2014). This then raises the question: What would leadership look like if approached with the same values and beliefs underlying person-centred care? This chapter aims to answer this question using a conceptual framework (see Figure 6.2) developed during a 3-year participatory action research study aimed at exploring and developing person-centred leadership.
The leadership dance
Leadership relationships, like all human relationships, evolve constantly and are formed by two or more people interacting. In healthy relationships people feel safe, energised and connected. As we1 explored person-centredness within leadership relationships, we began to visualise it metaphorically as an Argentine tango between leaders and associates.2 In the Argentine tango partners respond to self, other, the music and context in a continuous movement between ‘open’ and ‘closed’ embraces (Jensen 2006). Although certain steps characterise the tango, they are not repeated in a set pattern. In a closed embrace the dancers seem to move as one, whilst individuality is clearly visible in an open embrace. Glance quickly at Figure 6.1.
Figure 6.1 A metaphor for person-centred leadership. Artist: George Vink.
Your gaze may initially be drawn to the female dancer. Her pose is unique, elegant, and she looks competent, exhilarated and free. Look again and see how her partner enables her to safely lean outwards, neither pushing nor pulling her into position. This stance would not have been possible if they were not connected. They are dancing on a sandy beach with a moving shoreline and potentially changeable weather conditions. This requires a different kind of wisdom than dancing inside a studio. Even using the same steps and movement, the imagery would be different in a studio. Similarly, a change of partners would create a new image too as each couple attends and responds to self, other and context differently.
Like the Argentine tango, we view person-centred leadership as a unique and constantly evolving relationship between people. In line with relational leadership theory (Uhl-Bien 2006), we found that person-centred leaders use a set of attributes and processes for being in relation and relational connectedness. The primary aim of the leader is to enable associate self-actualisation, empowerment and well-being (coming into own) within the possibilities and constraints of the context (Figure 6.2).
Figure 6.2 The person-centred leadership framework.
The relational domain
Embedded in the relational domain of person-centred leadership are six attributes that enable leader being in relation, and five processes for relational connectedness. Being in relation and relational connectedness help leader stancing (positioning self in relation to the other) and enablement of associate coming into own.
Leader attributes for being in relation
Contemporary professionals want to be led, not managed (Shelton & Darling 2001) and there is increasing evidence that good health-care practices are built on strong and healthy relationships in cultures that balance ‘counting with caring’ (Higgs et al. 2014). From an existential humanistic paradigm, leaders lead in relationship with others, and those being led are valued for who they are rather than as a means to an end. Person-centred leaders are authentically other-centred and caring. Being patient, optimistic and open helps them respond appropriately to each associate at each moment in time within each given context, and so helps create conditions for self-actualisation, empowerment and well-being (coming into own).
Some leaders may be concerned that these traits (see Box 6.1) prevent professional distancing or foster over-involvement. However, we found that by using intra- and interpersonal intelligences, person-centred leaders are able to move through different levels of engagement with associates, appropriately taking ownership of problems, or leaving problems where they belong. They do not seek followership but mutuality and reciprocity. They use enquiry and emotional intelligence to hear, read and understand the associate’s and own state of being, and are willing to show their own vulnerability. But being person-centred does not occur spontaneously. It requires reflexivity, asking: ‘What does this person need in order to come into their own? (How) Can I offer them what they need? What are possible consequences of my/our actions? Is this then the right thing to do, and for who?’
Box 6.1 Person-centred leader attributes
- Authentically other-centred and caring
- Intrapersonal intelligence (knowing self)
- Interpersonal intelligence (knowing other)
- Patience, optimism and openness
- Showing vulnerability
- Reflexivity
Processes for relational connectedness
Many leadership models work from an entity perspective, looking at leader attributes and behaviour rather than social/relational processes (Uhl-Bien 2006). Belonging and feeling recognised and safe are fundamental human needs (Maslow 1943) and nurses want to feel connected to their leaders (Anonson et al. 2013). Seeking inclusion (feeling welcomed, connected and part of a greater whole) without loss of distinctness (directing own agency) fosters survival and thriving (Kegan 1982). When personal and collective goals merge, the individual functions as part of the whole team without losing his or her individuality (Plas 1996). We identified five processes that enable relational connectedness and related individualism (Figure 6.3).
Figure 6.3 Processes for relational connectedness.
Sensing is the seeing, hearing, feeling and verifying an associate’s state of being. That nurses use their senses to assess service user well-being is well described in acute (Bundgaard et al. 2012) and long-term care (Martin et al. 2012; Sellevold et al. 2013), but not in leadership literature. Hersey et al. (2001) talk of diagnosing associate readiness/development, but their reductionist assessment only focuses on task performance. Person-centred leaders are more holistic. They appreciate how all aspects of human being can influence task performance and how knowledge of a person’s being need not be restricted to the personal narrative. Gathering data from different sources such as previous experience, colleague narratives or personnel records, the leader blends and interprets information before undertaking action, and will often seek verification from the associate.
In a person-centred approach to relationships the other is not reduced to one social role, or the here and now. There is recognition of how a person’s current being is influenced by the many contexts they inhabit as well as their past, present and future. This viewing and assessing of a person as an embodied and embedded being is named contextualisation. Whilst health-care literature continually emphasises the importance of an holistic approach, leadership literature seldom if ever discusses the importance of considering how all aspects of an associate’s life may be influencing/influenced by their work. However, we found that such consideration aids leader reflexivity for better/more appropriate associate support within the workplace.
To only consider the needs of one individual at any one time would be advocating individualism rather than related individualism. Being person-centred is about balancing the needs of the person before us with those we may (not currently) be engaged with. Decision-making becomes complex in a post-modern world full of diversity, and moral leaders cannot rely on any one set of rigidly applied principles (Thompson 2004). Consequently, leaders often find themselves dialoguing with associates and/or colleagues before deciding on action.
Whilst dialogue strives primarily for mutual understanding, communing
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