Valuation and handling of

dialogue in leadership
A grounded theory study in Swedish hospitals
C. Grill
Occupational and Environmental Medicine, Institute of Medicine at Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden, Research and
Development Unit (R&D) General Practice and Public Health, Halland County
Council, Falkenberg, Sweden, and Institute of Stress Medicine, ISM,
Gothenburg, Sweden
G. Ahlborg
Occupational and Environmental Medicine, Institute of Medicine at Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden, and Institute of
Stress Medicine, ISM, Gothenburg, Sweden, and
E.C. Lindgren
Research and Development Unit (R&D) General Practice and Public Health,
Halland County Council, Falkenberg, Sweden, and School of Social & Health
Sciences, Halmstad University, Halmstad, Sweden
Abstract
Purpose Leadership can positively affect the work environment and health. Communication and
dialogue are an important part in leadership. Studies of how dialogue is valued and handled in
rst-line leadership have not so far been found. The aim of this study is to develop a theoretical
understanding of how rst-line leaders at hospitals in western Sweden value and handle dialogue in
the organisation.
Design/methodology/approach The study design was explorative and based on grounded
theory. Data collection consisted of interviews and observations. A total of 11 rst-line leaders at two
hospitals in western Sweden were chosen as informants, and for four of themobservation was also used.
Findings One core category emerged in the analysis: leaders communicative actions, which could
be strategically or understanding-oriented, and experienced as equal or unequal and performed
equitably or inequitably, within a power relationship. Four different types of communicative actions
emerged: collaborative, nurturing, controlling, and confrontational. Leaders had strategies for creating
arenas and relationships for dialogue, but dialogue could be constrained by external circumstances or
ignorance of the frameworks needed to conduct and accomplish dialogue.
Practical implications First-line leaders should be offered guidance in understanding the
consequences of consciously choosing and strengthening the communication component in leadership.
Originality/value The positive valuation of dialogue was not always manifest in practical action.
One signicant consequence of not using dialogue was that information with impact on organisational
efciency and nances was communicated upwards in the management system.
Keywords Leadership, Communication, Hospitals, Sweden
Paper type Research paper
The current issue and full text archive of this journal is available at
www.emeraldinsight.com/1477-7266.htm
The authors are grateful to the Board of Directors of the Institute of Stress Medicine and the
Scientic Advisory Panel at the Halland County Council for nancial support, to all rst line
leaders (managers) who participated and Gudrun Swan and Andrea Ihrman for carefully
transcribing the interviews.
JHOM
25,1
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Received 16 October 2009
Revised 2 December 2009
Accepted 7 January 2010
Journal of Health Organization and
Management
Vol. 25 No. 1, 2011
pp. 34-54
qEmerald Group Publishing Limited
1477-7266
DOI 10.1108/14777261111116815
In leadership, communication is one of the most important and meaningful tasks
(Mintzberg, 1973, 1998). Leadership in modern organization is focused on relationships,
teamwork, participation in decisions, and innovation, and these factors are created and
manifested through communication. Leadership focused on these factors can promote
a positive work environment. Through a reciprocal process, leaders and employees
inuence one another through communication, over time and in a variety of settings
(see Jackson and Parry, 2008). Yet in theoretical and empirical organizational research,
leadership and communication have mostly been studied separately (Tourish and
Jackson, 2008). Such is also the case with dialogue, which has constituted a separate
eld of research, mainly conducted by organizational management and sociolinguistic
and social psychology scholars. Further empirical studies to understand leadership
(managerial) communication are needed, especially studies closely examining
everyday talk among leaders (and managers) and their colleagues and employees
(Svennevig, 2008) since in talk they are doing leadership (Clifton, 2006).
Dialogue is often used in daily practice without distinguishing dialogue from
communication, and has become a watchword in health care management. Researchers
warn against overusing the dialogue concept for all sorts of phenomena since this can
lead to misunderstandings about the nature of this communication (Bokeno, 2007;
Linell, 2009). Since the leadership task interacts with the work environment, and
leadership is practised in communication and dialogue, it is useful to study how
rst-line leaders/managers communicate, and how they value and handle dialogue as a
special form of communication. Studies of how dialogue is handled at this operational
level of leadership/management have not been found. Accordingly, the aim of this
study was to develop a theoretical understanding of how rst-line leaders at hospitals
in western Sweden value and handle dialogue in the organization.
Communication, dialogue and leadership
This study is focused on communication and especially dialogue in leadership by
rst-line leaders and managers. First-line leaders/managers have two professional
roles, namely, leadership and management. In management, they deal with control,
decision-making, analysis and results i.e. they exert legitimate power and control. In
leadership, they focus on group processes, inuencing trust and empowering others
(Sofarelli and Brown, 1998). First-line leaders/managers spend an average of 68 per
cent of their working hours communicating orally (Ahrman et al., 2009) for a variety of
purposes in order to inuence actions and emotions in the various arenas of the work.
In communication, leadership is exerted and constructed. Research on how
leadership can positively affect the work environment, as well as learning, operational
quality, and health, and at the same time decrease stress is extensive (Nyberg, 2008;
Nyberg et al., 2005, 2008; Isaksson, 2008; Greeneld, 2007; Skagert et al., 2008). Leaders
(managers) skills in the sense of openness, reciprocity and empathy have been
reported to contribute to higher learning among workers (see Ford and Angermeier,
2008), have a positive impact on teamwork (Horton-Deutsch and Sherwood, 2008;
Isaksson, 2008; Holmberg and A

kerblom, 2006; Cummings et al., 2005; Sundgren et al.,

2005) and have been shown to prevent worker stress (Stordeur et al., 2001), while lack
of communication with superior managers has, conversely, been proven
counterproductive and a cause of stress among the leaders/managers themselves
(Skagert et al., 2008). Trust in leadership between leaders/managers and employees has
Dialogue in
leadership
35
also proved to have a positive impact on job satisfaction and efciency (Bryman, 2004).
Leadership that emphasizes relationships, communicates visions and captures ideas
reduces absenteeism (Ahlberg et al., 2008; Hogstedt et al., 2004) and employee turnover
(Sellgren et al., 2007). Leaders/managers who provide opportunities for feedback can
contribute to a better understanding, and to experiencing meaning in and better
handling work (Kira, 2003; Eklof et al., 2004); also, they promote workers development,
both professionally and personally (Backstrom et al., 2006; Greenness, 2003; Kira,
2003). Feedback, appreciation and respect (Dellve et al., 2007; Vinberg and Gelin, 2005)
from leaders/managers also have a positive impact on workers self-reported health
and well-being (van Dierendonck et al., 2004; Kira, 2003; Szucs, 2003).
Research shows that leadership as described above is appreciated and apparent in
Scandinavian leadership (management) contexts (Greenness, 2003). Moreover,
Scandinavian leadership is characterized by at organizations with delegated
responsibility and accountability, and an empowering environment which stimulates
creativity, innovation and collaboration (Buus, 2004).
Communication is at the heart of the leadership process (Tourish and Jackson, 2008),
and dialogue is often referred to as a desirable and important part of communication
(Linell, 2009). Leadership with a focus on relationships, teamwork and participation
uses communication which contains some important elements that characterize
dialogue: openness, reciprocity, authenticity and trust. In workplace leadership,
communication and dialogue have been studied by organizational management and
socio-linguistic and socio-psychological scholars, through analysing talk, conversation
or discourse between leaders (and managers) (Isaacs, 1999; Deetz, 1995; Putnam, 2008;
Clifton, 2006; Nielsen Femo, 2009; Asmu and Svennevig, 2009; Svennevig, 2008) and
between leaders/managers and subordinates (Boden, 1994; Holmes and Stubbe, 2003;
Asmu, 2008; Cooren, 2007).
Dialogue theories based on traditional humanist psychological theory depart from a
consensus perspective (Heath et al., 2006), which claims that use of dialogue in the
workplace can improve understanding among workers and between workers and
leaders (Isaacs, 1999; Senge, 1990), promote learning in subordinates when used by
leaders in an authentic dialogue (Schein, 1993; Mazutis and Slawinski, 2008) and
promote higher worker participation and a good working climate (Wilhelmsson and
Doos, 2002). Reective dialogue by leaders and managers, which consists of listening
to yourself, can help examine underlying assumptions and alter mental models
(Isaacs, 1999; Schein, 1993; Jacobs and Heracleous, 2005). The social constructionist
perspective, which emphasizes the signicance of context to how leaders interact and
communicate with those they lead (Fairhurst, 2008), is based on a conict perspective
on society (Heath et al., 2006) and stresses the constant construction and restructuring
of relations through workplace communication. Dialogue as a phenomenon, however,
is described by both perspectives in much the same way, though with somewhat
different ends and effects, namely shared creation of meaning, and deconstruction of
individual meaning, respectively.
According to Isaacs (1999) denition, dialogue is shared by two or more parties,
and is based on the Greek sense of the word as meaning oating through, which
describes dialogue as a fabric woven of talk and silence, give and take, listening and
expressing. It constitutes a shared creation of meaning, is spontaneous and intense and
incorporates the components of listening, respecting, suspending and voicing.
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Dialogue entails exploration of each others true thoughts and honest opinions and
differs from discussion, in which the participants put priority on debate,
problem-solving, decision-making and conclusion (Isaacs, 1999; Schein, 1993). A
dialogue is an open and honest conversation in which partners stand their ground
while being fully open to others points of view and ready to allow themselves to be
surprised (Buber, 1970) and inuenced (Deetz, 1995).
Method
The explorative study design was based on grounded theory (Strauss and Corbin,
1990). Aimed at generating a theory or model, the roots of grounded theory are found in
symbolic interactionism. The basic premises of symbolic interactionism are that
meaning is constructed and modied through human interaction and that human
beings base their actions on the meaning they ascribe to situations.
Informants
The study sample consisted of 11 rst line leaders (managers) who were strategically
selected to ensure the necessary breadth and variation of the sample. The selection
criteria, which included age, sex, hospital size, unit size and tenure as a rst line leader
(manager), resulted in the set of characteristics shown in Table I.
Data collection
Interviews. The interviews were conducted by the rst author (CG), a sociologically
schooled psychotherapist with extensive experience of communications training in
occupational settings. They were performed as in-depth interviews of 60-90 minutes.
The questions dealt with the valuation of dialogue and ongoing and planned handling
of dialogue in the form of conversation structures and processes in the hospital
department where the informant was a leader. In addition to these general questions,
the informants were asked follow-up questions relevant to the area, which were
modied according to that which emerged in the interview, in line with the principles
of grounded theory (Strauss and Corbin, 1990). The interviewer rst contacted
prospective leaders by phone to gain their consent to send an information letter by
e-mail and contact them again by phone a week later for their decision. All but one
Characteristics Number of informants
Sex Male 3
Female 8
Age 40-50 6
51-60 3
61- 2
Hospital size City University hospital 7
Small city hospital 4
Years as leader 1-5 years 3
6-10 4
.11 4
Number of subordinates (span of control) 10-20 4
21-60 5
61-100 2
Table I.
Key characteristics of
rst line leaders and their
organizational settings
Dialogue in
leadership
37
leader agreed to participate through a personal interview. A time was agreed and the
leaders chose whether they wanted to be interviewed at work or at the interviewers
research station. Seven of them chose the latter alternative. The leader who declined,
assigned lack of time, instead agreed to a brief interview by telephone.
Observations. Observations were carried out to study how the leaders handle
dialogue in practice. The structure of the observations was low, meaning that the
observer is known to the group but does not participate in the groups work (Einarsson
and Hammar Chiriac, 2002, p. 3). The observer (CG) used an observation protocol based
on the theory generated from the interviews performed for the study, with observations
based on the conversations duration, initiator and participants, the place and topic of
communication and a column for other observations (Mintzberg, 1973). Everything
said by and to the leader was transcribed more or less exhaustively, as well as
non-verbal and extra-verbal communication.. All observations were performed over
about half a day and the observer shadowed the leaders (Floren and Tell, 2004) for
about one hour before and after the workplace meetings to observe how
communication occurred in the corridors. The observations took place in the
settings of workplace meetings between the leader and subordinate personnel and
management meetings attended by the head of department, managerial colleagues and
administrative staff.
Ethical considerations
The study was approved 2005 by the regional Ethics Committee at the University of
Gothenburg (242-05). The informed consent requirements were met by sending written
information about the conditions for participation in the study, voluntariness and the
right to withdraw from participation at any time. Participants were given one week to
consider the matter before consent was requested. The condentiality requirement was
observed so that individuals in the study cannot be identied.
Data analysis
Data collection and analysis were performed in parallel throughout the research
process in accordance with the grounded theory tradition (Strauss and Corbin, 1990). A
multidisciplinary group with skills in psychology, education and occupational
medicine participated in the analysis process. The initial interview was rst read
several times to become acquainted with the contents. Open coding was performed in
the second phase, in which substantive codes that describe the substance of the data
were named and then combined into sub-categories with more abstract designations.
This was followed by axial coding, which involves going back and forth between
inductive and deductive thinking. Categories were then developed by making constant
comparisons between individuals and incidents, data and category, category and
category. Theoretical sampling was thereafter used to saturate the categories, which
was accomplished with previously collected data and memos written during the course
of the work. In the next step of axial coding, a coding paradigm was developed to sort
the relationships, context, actions and interactions found in data, along with strategies
for and the consequences of dialogue, the studied phenomenon. One example of axial
coding with the coding paradigm was:
I feel relatively comfortable with dialogue in the performance appraisal (phenomenon) and in
that context, I try not to control things; the employee controls what it will be about (strategy),
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but, depending on who is sitting in the chair alongside or across from me, it plays out in
various ways (context), but in this case the individual employee thought it was obviously a
one-way communication frommy side and that there was no room for dialogue (consequence).
Selective coding involved nding the core category that contained the most essential
elements or factors in the derived data. Colloquial speech was interpreted as analytical
concepts; for instance, I get someone who sees things with different eyes became
perspective switching.
A core category emerged after the initial interviews, which contained not only
dialogue, but many different types of communication that most often complicated or
impeded dialogue in the workplace. The subsequent interviews and observations were
made to test and re-examine the emerging model until new aspects no longer appeared.
The core category was generated from the codes, sub-categories and categories. The
core category, Leaders communicative actions proved to have various dimensions.
The actions were strategically or understanding-oriented and were experienced as
equal or unequal or practiced equitably or inequitably, within a power relationship.
Based on these dimensions, four types of communicative actions (categories) emerged:
collaborative actions, and nurturing, controlling and confrontational actions. This
social process as a whole is shown in a model (Table II) that provides an understanding
of how the leaders valued and handled dialogue in the workplace. It also provides an
understanding of whether the parties were engaged in dialogue or some other form of
communication.
Results
The leaders communicative actions (core category) seen in the rst line leaders were
sometimes handled consciously and intentionally, sometimes unconsciously and
unintentionally. The leaders communicated at three levels of the decision hierarchy in
the organisation: vertically upwards with their head of department; horizontally with
their peers (leaders); and vertically downwards with their employees. Most leaders said
they valued dialogue highly, but that did not automatically mean the leaders used
dialogue much in the workplace. The observations conrmed that shown by the
interviews, and produced additional information; among else, it became clearer that the
concept of dialogue meant different things to the leaders. It emerged in the interviews
that dialogue was a concept leaders used to varying extents and with varying
meanings. The leaders described several different types of communicative actions as
dialogue, and the dialogue that did take place was sometimes described as another
form of communication than dialogue.
The strategically and understanding-oriented dimension
When the leaders used strategically oriented communicative actions (see Table II),
they did so based on the belief that instructions, in the form of clear and
Leaders communicative actions
Understanding-oriented Strategically-oriented
Equal Collaborative Confrontational
Unequal Nurturing Controlling
Table II.
The model explaining
leaders valuation and
handling of dialogue
Dialogue in
leadership
39
straightforward communication about the prerequisites and guidelines for the work,
could be effective in the workplace. In these cases, the communication was often
one-way and rational. When the leaders used understanding-oriented communicative
actions (see Table II), a high degree of interaction and interpersonal exchange took
place. Here, the emotional content of the communication was also experienced as
meaningful.
The equal and unequal dimension
Both the strategically and understanding-oriented handling of communication could
occur in either an equal or unequal power relationship between the conversation
partners (see Table II), which could be either formal or informal. The formal basis for a
power relationship was the leaders decision-making position in the organisation:
superior, equal, or subordinate. The informal basis for a power relationship instead had
to do with how the leaders personally experienced the power relationship. When the
power relationship was experienced as equal, the leader felt free to state opinions and
disagreements related to the work, regardless of the formal power position. In these
cases, there was a respectful and permissive climate between the dialoguing parties,
even if the conversation could become heated. In the power relationship experienced as
unequal, the leader felt inhibited or controlled by the other partys formal or informal
power position.
Collaborative communicative actions
The collaborative communicative actions (see Table II) were dialogic, learning and
terse. It provided an opportunity for development and joint exploration of ones own
and others thought-worlds and experienced world in an equal manner. Time had to be
set aside when the communication was meant to be a dialogic or learning one.
When the leaders used dialogic communication, they described it as open and
creative in conversations about the work situation. As a result, the leaders felt free to
think aloud and talk spontaneously about experiences and thoughts. This was
experienced as a form of encounter between two individuals who could express their
true opinions. It was described as a conversation in which the parties exchanged
experiences, for no special purpose, which took place in a calm and permissive
conversation climate in which each party listened and awaited the other. Dialogic
communication with employees was seen as a way of preventing conict and was said
to be best conducted as an ongoing conversation. Leaders who felt secure in their
position and not dependent on the head of department for their jobs felt equal and
could therefore engage in dialogic communication with the head of department. When
the leaders were, as a group, given guidance in their managerial role by a psychologist,
they also experienced these conversations as genuinely collaborative and this gave
them the courage to let down their guard and reveal their difculties. Dialogic
communication was experienced as health-promoting because it facilitated
participation, cooperation, job satisfaction and a sound psychological work
environment:
We have a group within the ward who work specically with wellness factors. Dialogue is
important here // . . . .// that people have the courage to talk to each other, and communicate
with each other. //. . .// that there was no defending of status or anything like that (1).
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The leaders believed they could engage in dialogue with subordinates, but some felt
dialogue was possible only between equals, since the superior otherwise dominates the
conversation.
When the collaborative communication was learning, the conversation partners
exchanged experiences, thoughts, opinions and advice on various topics in a two-way,
reective conversation. The following example illustrates how one leader turned to a
peer for a learning dialogue:
And then I usually approach my fellow manager and discuss things with her, and listen to
how she would solve the problem, and say this is how I have solved it, and what do you
think?, and so on. I get someone who sees things with other eyes (1).
In learning communications in workplace encounters, the conversations were creative
and worked as a kind of brainstorming. Learning communication between leader and
employees was seen as promoting higher quality of care through conversations about
behaviours and exchanges of values, reactions and feelings. When absent managerial
colleagues were discussed at a management meeting, other colleagues could use
learning communication to prevent continued negative communication about their
absent peers.
Terse communication was short and occurred in an open atmosphere, but was
goal-oriented with regard to cooperative solutions and measures and how good care
could best be achieved. As a result, there was limited scope for consideration and
reection. Older leaders believed that a more open culture has developed in healthcare,
in which the bosses word is no longer law and they could instead be challenged,
especially by younger workers. Leaders believed that they are often given too much
conversational latitude, which is a barrier to openness in conversations about issues
such as quality of care. To prevent this, they created arenas for terse communication in
which they did not personally act as the conversation leaders.
Nurturing communicative actions
The nurturing communicative actions (see Table II) were healing, explorative and
motivational. Nurturing communication was often used with the purpose of
understanding and supporting others, but could by extension take over
responsibility from the other, and become over-protective. The patently unequal
power relationship emerged clearly in nurturing communication.
When leaders supported employees who were in crisis, the leaders listened to them
and conrmed their experiences, so that the communication was healing. This could be
accomplished with a kindly tone or gesture. The leaders comforted and the
subordinates were allowed to relate their feelings, what had happened, and tell about
their mistakes at work:
Supporting this person means they must be allowed to give their version, talk about how
stressful it was and how bad they feel . . . (2).
Healing communication was also protective, in that it relieved employees of having to
assume too much responsibility and in that the leaders made it a priority to be
available to x problems and lighten the workload on their employees.
When the nurturing communication was explorative, the leader interviewed the
employee in a friendly manner with a view to helping. The purpose was sometimes to
discover what additional skills an employee needed, or what skills he or she possessed
Dialogue in
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41
and could share with others. Some leaders described heads of department as having an
interview style that helped the leaders explore the complicatedness that arose in their
managerial role. This claried their own thought processes and set their minds at ease.
Nurturing communication that was motivational involved the leaders encouraging
their employees in their personal plans. The communication inspired and elicited or
reinforced their own ideas. It also induced employees to keep working towards the
organisations set objectives. The leaders sometimes also gave employees advice about
how they could maintain a healthy work/life balance. The heads of department also
encouraged and motivated the leaders, but often outside the context of the formal
performance appraisal.
Controlling communicative actions
Controlling communicative actions (see Table II) were instructive and one-way,
sceptically interrogative, evasive, dismissive, accusatory, patronising, forbidding and
insincere. They dominated so that the relationship in the conversation became unequal.
When communication from superior managers was controlling, it could trigger stress
symptoms, anxiety and fear in the leaders, which inhibited them from communicating
information, often important information, upwards in the line.
When the controlling communication was instructive and one-way, information was
given in an objective, cordial manner and had to do with decisions and factual
information. It also meant the communication was one-way and occurred when scope
for conversation was limited. Leaders sometimes talked too fast, so much so that
employees did not understand. Sometimes they believed that they were having a
dialogue with their employee about a mistake made in their nursing tasks, while the
employee experienced it as a one-way communication. When leaders did not clearly
understand what kind of communication they had chosen or how it was experienced,
the problems could remain unresolved:
The union and the employee thought it was a one-way communication, and that there was no
room for dialogue. And that made me think a lot about whether that was true . . . or why she
had experienced it that way. When I didnt feel it was like that in the least (5).
The leaders sometimes felt they were subjected to excessive one-way communication
from their heads of department, but sometimes they wanted instructive, one-way
communication that gave them a clear and concise basis for action. Attention was
called to behavioural norms at work through one-way instructions based on prevailing
organisational values, but expectations on employees to participate in organised group
social activities during non-working hours were sometimes expressed as well.
Instructive, one-way communication could also mean that leaders directed the content
of the conversation because they had specic goals for the communication and the
topic. They acted as informal chairpersons, even when they did not have the chair:
I have to direct the dialogue at workplace meetings held for a purpose (4).
Leaders also encountered control from their own managers when certain decisions
were to be implemented. When they disagreed with the decisions, they nevertheless
directed them downwards out of loyalty.
When controlling communication was interrogative, it was not always the
questions themselves that made the experience a difcult one, but how they were
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asked. This could happen when leaders asked employees invasive questions about
health problems, until the employees, as the leader put it, admitted to illness.
Informants also said that an interrogation could occur when higher managers criticised
how they had used their allotted resources, and the consequence was a certain amount
of fear in them:
We were called into controlling meetings where we had to stand up //. . .. . .// and then it is
mainly about the budget in front of our section manager and then its both my boss
and me. // . . . .// We have to be accountable for what we have done, you know, and its a
little scary (11).
The controlling communication could also be evasive when leaders and heads of
department withheld information from each other, whether important factual
information, opinions, or experiences at management meetings. Leaders withheld
certain information from higher management to conceal their own skills gaps, which
was described as a barrier to efcient operational development. They sometimes felt
peer pressure to refrain from giving constructive criticism, or even suggestions or
ideas, to other leaders at the same level. Evasion also occurred through not responding
when spoken to or not answering a question, or through body language, such as
looking away or chatting with colleagues during a management meeting.
Communication failed totally when the leaders found it difcult to communicate
with others for various reasons. This could happen, for instance, when they did not feel
understood by their own managers, when they were accused of something or felt they
were under suspicion, or in groups where the atmosphere was one of rivalry and
jockeying for position. They also complained of getting no response from their
employees when the other party did not want to converse or at workplace meetings
where silence prevailed:
I dont really have a lot of talkative people working for me . . . ..// . . . .I would like to have a
few people like that, people who are passionate and committed, here at work, but I dont have
any (11).
Communication could also fail when there was no room, spatially or temporally, for
communication. The leaders could develop stress symptoms serious enough to require
immediate medical attention, which they saw as a consequence of controlling and
evasive communication.
Controlling communication that was dismissive was described by leaders as
occurring when they encountered a superior and authoritarian attitude where dialogue
was not welcome. Being denied the opportunity to communicate was experienced as
frustrating and could trigger passivity. The superiors dismissed them by stating that it
was not the managers area of responsibility, in purely formal terms. Leaders also felt
their concerns were trivialised when they told their heads of department that they felt
stressed and drained. Despite this, they sometimes felt understanding for dismissive
communication from heads of department. They could also be dismissive themselves,
when they made it clear they did not want to hear any criticism of their leadership from
their own employees.
The controlling communication was sometimes accusatory, meaning that leaders
were given criticism from above that was experienced as oppressive. Things they had
said in a particular context were repeated by someone else to superior managers, who
then criticised them. They could sometimes get upset and accuse their employees,
Dialogue in
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43
especially when the employees criticised one another or invaded each others areas of
responsibility:
So, I was really angry, but I think it was a little unfair. I didnt understand, so I couldnt
discuss things objectively or feel any empathy at all (3).
The controlling communication could also be patronising when superior managers
made disparaging remarks and leaders felt unfairly treated, for instance when they
were unable to return to work after an illness at the same level of efciency:
But then when I got sick, they said it was only because I couldnt hack it //. . .//It got personal
and it was very uncomfortable //. . .// after all, it was really hard to come back//. . .// and I had
to ght an uphill battle, because people thought, oh, we have to change this because you cant
handle it (6).
Disparaging remarks could also be made during management meetings about people
or organisations outside the group sphere. This communication was difcult for
listeners to stop or respond to because it was not directed at anyone present; it tended
to bring out similar attitudes in some colleagues, while frightening and silencing
others. Among themselves, leaders used derogatory nicknames for certain groups of
employees or commented that they could fool them.
The controlling communication by which leaders forbade employees to act in a
particular way, or heads of department did the same to them, made sense to them when
it involved forbidding unprofessional behaviour or backbiting. That which they
experienced as negative was when they were personally stopped by their head of
department to discuss issues at the management meetings, or when their peers implied
that they should not freely express their thoughts and opinions prior to decisions at
management meetings this was experienced as strange:
Youre not supposed to make a lot of fuss, and that applies even in operational
management. . . Sometimes I totally disagree with a decision that goes against my convictions
. . . when that happens, its important that before any decision is taken, there must be a forum
in which I am allowed to say that I actually dont agree. But that turned out to be not
particularly popular, which I think is strange (11).
When the controlling communication was insincere, leaders could encounter yes-men
among employees, who did not mean what they said. Another variant was that the
leaders themselves showed insincere interest, for instance when they tried to make an
effort to remember and talk about their employees personal lives while hiding their
actual lack of interest.
Confrontational communicative actions
The confrontational communicative actions (see Table II) were argumentative and
boundary-setting. It occurred in situations where the leaders felt there was an equal
power relationship in the communication between themselves and the participants. In
these situations, open conicts could be managed among equals, even if they were
experienced as uncomfortable.
The confrontational, argumentative communication involved the clash of opinions
in discussion. This resembled a debate and occurred between people with strong
opinions, sometimes in a supervisory situation, where the confrontations were
described as constructive criticism.
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The confrontational, territorial communication entailed setting a boundary, either
upwards in the line or at the same decision level. The leaders sometimes objected and
set boundaries in relation to their heads of department, in order to improve their own
work environment:
The head of the department went to my employees and asked them //. . .// without me
knowing a thing about it. That does not exactly set the stage for constructive dialogue. I
objected and said this doesnt feel right, I feel that you are undermining my position(6).
They could also take a stand and tell their managerial peers that they should refrain
from making disparaging remarks about others. In the confrontational, angry
communication, they could also initiate heated discussions with their colleagues or, if
they felt equal, their heads of departments.
Discussion
Discussion of ndings
Collaborative communicative actions. The study showed that leaders engaged in
genuine dialogue (Isaacs, 1999) only when the communicative action was
understanding-oriented and the power relationship was experienced as equal. The
equality between interlocutors is also emphasised by Habermas (1984) in his rationalist
view of ideal dialogue. The leaders used a collaborative communicative action, which
in dialogue meant taking pains to be emotionally present, truly listen, and wait for the
conversation partner when there were pauses in the conversation. Openness and
creativity were also experienced as important to facilitating dialogue in the
conversation. This approach is similar to that described in communication theory as
giving dialogic moments (Black, 2008; Cissna and Anderson, 1998; Isaacs, 1999;
Stewart and Zediker, 2000), in which the essence of the dialogue is innocence and
openness (Heath et al., 2006). This takes courage (Poulos, 2008) because it is risky to
openly expose ones opinions. The ndings showed that the prerequisites for genuine
dialogue most often were that the leaders experienced or were in an equal power
relationship with the conversation partner. An established, trusting relationship was
another prerequisite for reaching the dialogic moment and is also an important part in
the emerging authentic leadership theory (Wong and Cummings, 2009) and authentic
dialogue proposals (Mazutis and Slawinski, 2008). Similar ndings have been reported
in another study (Floren and Tell, 2004). On the other hand, it has been shown that
trust grows out of the type of communication people encounter from each other in
conversation, and not after any certain amount of time together (Andersen, 2005).
However, both factors may still be regarded as interacting a certain amount of time
is needed to evaluate the others communicative actions and judge the other as
trustworthy. Opinions differ among dialogue theorists and practitioners about the
prerequisites for achieving dialogue. According to the humanist ideal, it is thought
possible to achieve dialogic conversation by applying rules to the conversation
(Stewart and Zediker, 2000; Isaacs, 1994). Others believe dialogue cannot be forced and
that the conversational arena signicant to creating dialogue appears spontaneously
(Black, 2008; Cissna and Anderson, 1998) or that the content of the conversation may
bring conicts and confrontation to the fore in revealing invisible workplace norms,
possibly allowing them to be overstepped in the conversation (Deetz and Simpson,
2004). The point is not to resolve the disagreement, but to allow it, that is, for the
Dialogue in
leadership
45
conversational partners to be exposed to each others differing perspectives (Wood,
2004). A prerequisite for dialogue is therefore to reect and come to an agreement on
the direction and framework of the conversation (White, 2008; Krippendorff, 1994);
paving the way for dialogue.
The leaders wanted to use dialogue in their work because they believed it promoted
health, learning and quality of care. This seems reasonable since in leadership
research, dialogue is described as an instrument for creating favourable conditions for
social interaction and learning processes (Kira, 2003; Mazutis and Slawinski, 2008). On
the other hand, the usage of the word instrument for dialogue, leads one to believe
that this can be a case when the concept of dialogue is being overused (Linell, 2009) by
leaders, making subordinates mistakenly expect the dynamic, creative, trusting and
in-depth exploring atmosphere of genuine dialogue (Bokeno, 2007). Communication
seen as an instrument with episodic, structured, strategic or efcient traits
counteracts genuine dialogue (Bokeno, 2007). In a health-promoting organisation,
emphasis is, beyond learning, on the importance of open communication to active
co-creation of the work environment (Whitelaw et al., 2001) and an empathetic
managerial approach has positive impact on quality of care (Cummings et al., 2005).
Nurturing communicative action. The leaders also used a nurturing communicative
action. When it was healing, explorative and motivational, it provided support and
harmony to working relationships and the work environment. However, it took place in
an unequal power situation and could thus become over-protective. Good authority is
expected to provide security, safety, and protection (Sennet, 1980). This type of
relationship is natural and necessary in nursing contexts and the hospital setting,
towards the patients, but can become far too caring in relationships and
communication between leaders and subordinates. When caring and power are
combined, the result is paternalism, which may be regarded as egotistical
benevolence or the authority of false love (Sennet, 1980). Paternalism also showed
up in the norms for the working community and the desired social interaction
communicated by the leaders when they expected employees to participate in certain
group activities with their co-workers outside working hours. Self-governed leisure
time may be restricted when the individuals behaviour is controlled by the expectation
communicated by the leader, and instead become socially governed (Kelly, 1983).
Conversely, inspirational communication during working hours was a nurturing style
that inspired vitality and commitment to the organisations targets.
The controlling communicative action. The controlling communicative action was
considered efcient in terms of time. It was one-way and used by leaders when they
wanted their employees to perform certain acts. Even if the leaders wanted to use
dialogic communication, there was not always sufcient scope for the employees to
speak freely, and the communication thus became directive and instructive.
Controlling communicative actions were sometimes difcult to manage because they
limited opportunities for creative and enriching dialogue. Some were intentional and
some were unwanted. When the communication is dismissive, accusatory and
disparaging, the resulting feelings of vulnerability and shame may be particularly
difcult to talk about, since these feelings are inherently regarded as shameful to have
and to be affected by (Nathanson, 1992).
The ndings show that the leaders position of power in and of itself could affect the
conversation until it became a one-way communication instead of the dialogue they
JHOM
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were after. This unequal power relationship is asymmetrical and the dominance of one
partner affects the opportunities for conversation (Linell, 1990). Leaders sometimes
complained about a lack of active participation from their employees in communication
at workplace meetings. One reason for this may be the effect of the leaders position of
power. Studies of group conversations in child-care settings, and municipal
organisations (Granstrom, 1986) have shown that the person with a formal position
of power is also given greater conversational latitude by the group. The power
relationship may also be informally determined, since the emotional conditions and
other personal traits, such as condence and verbal uency, of the participants in the
communication also affect the relationships of dominance (Deetz and Simpson, 2004).
The leaders related that the accusatory and competitive conversational tone that
sometimes prevailed at management meetings impaired opportunities for dialogue
because it caused the atmosphere in the group to become dismissive and evasive.
Research has shown that workplace communication may become systematically
distorted when the conversation partner who has more ample power resources uses
turns of phrase and sentences to halt communication and control the conversation
(Deetz, 1995). Competitive communication is found in most groups, and where the line
between this being a destructive or constructive communication should be drawn is
debatable (Boalt Boethius, 1996.) However, if it evolves to become disparaging, it may
become harmful.
When the controlling communicative action was patronising, it was associated with
rivalry. A competitive atmosphere, which in this study is associated with rivalry, may
exacerbate self-reported stress (Akre et al., 1997). It also emerged that the leaders
feelings of fear were a common barrier to speaking freely. Fear can, in and of itself, be a
necessary warning signal to the individual in the workplace that outspokenness will
have adverse consequences. However, another study shows that emotional control in
relationships, that is, when people repress negative feelings or show feigned positive
feelings at work, has negative impact on job satisfaction and self-reported health (Glas
and Einarsen, 2008). The consequences of fear that emerged in the ndings were that
important information was not communicated vertically or horizontally in the
organisation, and that needed improvements in employee skills and quality of care were
neglected. Information that affected the hospitals nances and efciency was also
stymied as an effect of controlling communication. It was also apparent that leaders
were personally and adversely affected when they did not have adequate dialogue with
their head of department, which was sometimes due to the head of departments own
stressful work situation. They sometimes felt frustrated and made passive by this, but
kept up a front. This has been conrmed in another study which shows how leaders
experience additional stress and pressure when denied the opportunity to communicate
with their own bosses (Skagert et al., 2008). Controlling communication could also be
insincere, which the leaders felt was irritating when they encountered it, even though
they used it themselves. It is difcult for a leader to be equally interested in and to like all
of her subordinates, which means insincere communication from the boss may be the
kinder alternative. However, necessary information is also lost through insincere
communication, and the manipulative use of dialogue may poison what could otherwise
have been a healthy conversation (Heath et al., 2006).
Confrontational communicative actions. There was an equal balance of power in the
confrontational communicative action. Critical and boundary-setting discussions
Dialogue in
leadership
47
occurred here, in which opinions clashed. By extension, there was an opportunity to
exchange perspectives, since the conversation partners were equal. This confrontation
may be designated as feedback and can also incorporates commitment to an issue
(Wikstrom, 2000) as a key component. A controversy, which is a collision of proposals
may if genuine and fruitful also be healthy for the dialogue (Heath et al., 2006). A
confrontation may be dialogue-reaching. The humanist emphasis that dialogue must
contain understanding and empathy may prevent conversation partners from being
open to new ideas and perspectives. Accordingly, being confrontational and
emphasising differences in point of view may pave the way for dialogue (Deetz and
Simpson, 2004; Black, 2008). When the leaders experienced equality here in the
confrontational communication with their heads of department it seems to be
associated with a sense of having the personal option to resign their position at any
time. This type of attitude may be seen as a stress management strategy by leaders, an
exit strategy of a sort (Skagert et al., 2008). This may be understood to mean that they
feel inner freedom in the idea that they can walk away from their job whenever they
like. As a result, the experienced power relationship does not present a barrier to
conversation and, for instance, the conversation partners do not have to watch what
they say.
The boundary-setting confrontational communicative action was experienced as
positive in that it provided constructive development for leaders personalities and
work environments. Mainly, it had to do with resisting overwork and preserving their
health. Confrontation was used when dialogue had been avoided or had failed. In order
to have an impact, it was sometimes expressed in the form of anger. This type of
work-related anger can also be healthy (Harenstam, 2004)
Methodological discussion
The criteria for judging the rigour of a grounded theory are plausibility,
reproducibility, generalisability, concept generation, systematic conceptual
relationships, density, variation and the presence of process and broader
conditions (Strauss and Corbin, 1990). Plausibility is dened as the degree to
which the research and theoretical formulations t reality, increase understanding
and are useful. The model generated in this study was assessed as plausible and
practically useful because the described model increases understanding of and
helps explain how leaders value and handle dialogue in the workplace.
Reproducibility means that the same theoretical perspective, the same rules for
data collection, data analysis and similar conditions must make it possible for
others to develop a similar theoretical explanation. The meticulous description of
the structure and performance of the analysis process have followed established
guidelines according to Strauss and Corbin. Theoretical sampling is required to
attain generalisability, that is, to enable better and more precise assumptions that
the same phenomenon may exist elsewhere than in the specic situation. Attaining
generalisability began with strategic sampling, that is, variations of experiences
and behaviours in leaders were collected. Theoretical sampling was used in the
next phase to develop the categories and dene their properties, and likewise to
nd relationships among the concepts and to assess whether they were useful and
relevant. Concept generation and relationships are judged based on technical
versus common-sense meanings, and indications of systematic connections. Density
JHOM
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indicates that there are categories like conditions, context and consequences that
are dimensionalised through their properties. Variation refers to the existence of a
set of variations in the reported categories. Strauss and Corbins coding paradigm
was used to develop the categories through concept generation, relationships,
density and variation, which involved constant comparisons of data at various
levels. Also important to grounded theory is theoretical sensitivity, meaning the
researchers ability to perceive subtle meanings in data. This theoretical sensitivity
arises from theoretical knowledge and professional and personal experience. The
rst authors (CG) ideas and preconceptions on the studied phenomenon of
dialogue were used initially in the research process as a research question. Over
the course of the analysis process, a group of researchers had recurring
discussions on the meaning and contents of the data, what is important to focus
on in the data, and the emergent theory. The composition of the research group,
whose members had disparate experiences and scientic backgrounds, made it
possible to cycle between focus and distance in order to maintain the balance
between creativity and scientic standards.
Conclusion
First line leaders ascribed positive value to dialogue, but the valuation was not always
manifest in practical action. They had certain strategies for creating arenas and
relationships for dialogue, but dialogue could be constrained by external
circumstances or ignorance of the frameworks needed to conduct and accomplish
dialogue. One signicant consequence of not using dialogue was that information with
impact on the organisational efciency and nances was not communicated upwards
in the management system.
Practical and research implications
The rst line leaders (managers) and their superiors could be offered training in the
forms of communication they use at various times and the associated consequences. In
support of their mandate with respect to the work environment, the rst line leaders
(managers) and their superiors could also be offered guidance in consciously choosing
and strengthening the forms of communication they want to use. One possible
recommendation for further research might be to develop an instrument for studying
the extent to which various communication actions occur and their consequences, and
likewise, to perform an intervention study to explore the impact on rst line leaders
(managers) and heads of department of training in the communication component of
leadership and its potential consequences.
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Corresponding author
Christina Grill can be contacted at: christina.grill@lthalland.se
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