Critically evaluate and compare key leadership styles and approaches, identifying their relevant

strengths, weaknesses, values and limitations for public health leaders seeking to drive innovation,
change and service improvement.

A CRITICAL EVALUATION AND

COMPARISON OF KEY LEADERSHIP STYLES
AND APPROACHES FOR DRIVING
INNOVATION, CHANGE AND SERVICE
IMPROVEMENT IN PUBLIC HEALTH

INTRODUCTION

Up until a few years after World War II, leadership was regarded as a personal

quality. Stogdill (1950 as referenced in Silva, 2016, p. 1) is believed to be the first to attempt

to define leadership as “the process (act) of influencing the activities of an organized group in

its efforts toward goal setting and goal achievement”. Since then, literature has been clouded

with numerous definitions of leadership. Kotter (1988 as referenced in Silva, 2016, p.

2) defined leadership as “the process of moving a group (or groups) in some direction

through mostly non-coercive means”. 

The lack of consensus on the definition of leadership drove Silva (2016) to find a definition

for leadership, one that factors already existing definitions. They concluded following their

study that "Leadership is the process of interactive influence that occurs when, in a given
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context, some people accept someone as their leader to achieve common goals". Leadership

has three major components; the leader, the follower, and the context and their definition

encompass all these (Silva, 2016). Agreeing with these components, Veldsman and Johnson

(2017) defined leadership as “acts of persuasive influence exercised by a collectivity of

individuals (= shared leadership) engaging a set of stakeholders (= mobilised followers) in

enabling and empowering ways concerning a joint course of action intended to bring about a

shared, desirable, future-referenced outcome (= dream) with the desired effect (= legacy)

within a specific context, past, present and future referenced”.

Organizations demand constant change to remain competitive and relevant. Effective change

usually comes with a change in organizational culture. “Organizational culture is a

combination of beliefs, values, rules, and symbols that are common to a group of people

(Veldsman and Johnson, 2017, p. 150)”. Every organization has a culture (which could be

good or bad) that has developed over time. Leaders in public health consider the culture of

their organization and plan the change process around it.

Kotter (2012) explains that change will often fail if people of higher levels of authority in an

organization are not involved in the change process. Hence individuals will find it difficult if

not impossible to effect change without leadership. Leaders activate change. Leadership is an

important influential factor in shaping organizational culture in public health services because

leaders value each worker, try to understand them and find means of involving everyone in

the change process via the concept of individual consideration (Lesneski and Bernard, 2011).

Leadership empowers and encourages workers, and involves them in the achievement of the

desired change process. Relentless leadership can build the continuous commitment of

followers for change in the public health service.

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Some essential requirements of leadership in public health services include emotional

intelligence, intellectual flexibility, situational awareness, evidence-based decision making,

strategic influencing, working understanding of public policy, innovation, political

astuteness, good communication skills, and integrity (Yphantides, Escoboza and Macchione,

2015).

DISCUSSION

The basic duty of public health organizations is to ensure preventive health through the

organized effort of and for society. Public health demands its leaders to involve everyone in

the decision-making process, collaborate with people from other relating disciplines, and

empower its followers toward achieving a collectively agreed goal. In order to drive

innovation, change and service improvement in this evolving discipline, public health

requires a more people-oriented leadership style (Lesneski and Bernard, 2011, p. 139). Some

key leadership styles suitable for driving change in public health are transformational

leadership, democratic leadership, charismatic leadership and transactional leadership. 

Transformational leadership

Transformational leaders use motivation and inspiration to drive innovation and change in an

organisation (Lesneski and Bernard, 2011). The strengths of transformational leadership are

fostering intellectual stimulation, individualized consideration, inspirational motivation and

idealized influence (Díaz-Sáenz, 2011). Through intellectual stimulation, followers are

challenged to learn more and motivated to come up with innovative ideas to aid in achieving

organizational goals. Individualized consideration is where leadership understands the

strength and weakness of each follower, makes them feel valued and encourage them to give

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out their best. Through inspirational motivation, transformational leaders build teamwork and

put up good behaviours with their idealized influence approach. This people-centred style

promotes creativity and wins the interest and commitment of its followers toward achieving

the organizational objective instead of individual goals.

A limitation to this leadership style is that it is not suitable for organizations whose workers

are unskilled and need supervision. Unfortunately, followers of a transformational leader tend

to return to their old ways of doing things once the leader, the source of motivation is absent

(Lesneski and Bernard, 2011). Another weakness of transformational leadership is the failure

of existing literature to measure the direct effect of transformational leadership on work

outcomes (Odumenu and Ogbonna, 2013). 

Transactional leadership

As the name implies, the transactional leadership style involves the exchange of rewards for

compliance and performance (Díaz-Sáenz, 2011). It values organization, supervision and

team performance. Transactional leaders spell out what is expected from followers and the

reward to be given if expectations are met. This leadership style is suitable in stable working

environments where specific tasks need to be completed.

Transactional leadership does not promote innovation and creativity since leadership spells

out exactly what is expected. Though it ensures effective supervision, transactional leadership

does not value organizational culture, good interpersonal relationships or the emotional needs

of its followers (Lesneski and Bernard, 2011). A limitation of this leadership style is its

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passive nature. Hence, transactional leaders wait for something to go wrong before finding

solutions (Odumenu and Ogbonna, 2013).

Democratic leadership

The democratic leadership style shares power with its followers. It emphasizes group

participation and group decision making though the final decision rests with the leader

(Fakhri et al., 2021). Leaders who use this approach believe that the sense of belongingness

created through participatory decision-making motivates the followers enough toward

organizational objectives (Fakhri et al., 2021). Democratic leadership welcomes innovative

ideas from followers, creates a good relationship with subordinates and reduces resistance to

change. The style values democracy, and respect for all and gives room for accountability.

However, the greatest limitation to democratic leadership is that it is time-consuming. A lot

of time is wasted in lengthy debates before coming to a consensus (Fakhri et al., 2021). Its

weakness is in the assumption that followers are endowed with the needed skills and hence

will be able to deliver on agreed plans without empowerment. Again, tasks are achieved more

slowly due to the liberty of followers to work at their own pace (Bhatti et al., 2012).

Charismatic leadership

Charismatic leaders “arouse enthusiasm and commitment in followers by articulating a

compelling vision and increasing followers' confidence about achieving it (Mittal, 2015)”.

Charisma is regarded as an innate quality characterized by good communication skills,

effective interpersonal relationships, creativity and the natural ‘charm’ to win the support of

followers. Her followers are motivated to execute the leader’s vision because they believe

that the leader is competent.

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Though attributed with much success, charismatic leadership is inherent and not all leaders

are born with such a quality. This makes it difficult to teach the skill to others or ensure its

continuity in an organization. Again, followers are over-dependent on the leader which can

result in the leader becoming too full of himself (Mittal, 2015). Charismatic leadership

demands constant image management least followers lose confidence in them.

With a genuine interest in improving the workforce, transformational leaders motivate their

followers for organizational change while transactional leadership uses reward and

punishment. Consequently, transactional leadership focuses on achieving specific objectives

while transformational leadership looks to achieving both organizational and individual

goals. Although transformational and transactional leadership styles are conceptually

different, Odumenu and Ogbonna, (2013) believe that applying the two simultaneously will

yield better organizational performance. To them, they are should be viewed as sides of the

same coin.

Transformational, democratic and charismatic leadership styles are people-oriented while

transactional leadership is task-oriented. Public health is a people-centred discipline

championing population health while collaborating with other related disciplines. Hence

more of a people-centred leadership style and less of a task-oriented leadership style is a

more appropriate strategy for an innovative organizational change.

Currently, there is an awareness of the need for strong public health leadership to solve the

unending public health issues and their related inequalities (Czabanowska, 2014). More

leadership training is encouraged for people in the public health discipline. While

transformational, transactional and democratic leadership styles can be taught, measurable

and reproducible, the charismatic leadership style is more innate making it difficult to teach.

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Innovation, creativity and collaboration are needed to drive innovation, change and service

improvement. These values are promoted by transformational, democratic and charismatic

leadership styles but are very minimal if not absent under a transactional leadership approach.

. These leadership styles organize discussion sessions with followers where innovative ideas

are welcomed. Transactional leadership does not promote creativity among followers. A

transactional leader brainstorms and defines exactly what he wants followers to do. Followers

who complete the tasks assigned to them are rewarded as promised.

The transactional leadership style can meet desired change on time. The juicy rewards that

transactional leaders promise are a catalyst for the quick execution of tasks assigned to

workers. Transformational, democratic and charismatic leadership styles on the other hand

give room for people to work at their own pace regardless of set timelines. This may delay

the change desired in a public health organization or department. 

The challenges and needs of public health service may vary from one another in terms of

context and followers. Hence adopting a particular leadership style may not be successful for

all situations. This is a real limitation to all existing leadership styles including the ones

discussed above. Public health leaders seeking innovation and change should therefore apply

the situational leadership theory in their approach. Situational leadership theory encourages

leaders to consider the situation at hand before deciding on a suitable leadership style to drive

the desired change. 

IMPLICATIONS

Vision is the pivot that change revolves around. Every leader has to create visions and

develop strategies consistent with the overall organizational objectives (Kotter, 2012). A

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leader should be able to understand current situations and identify problems or areas that need

improvement. While having the knowledge, skills and foresight to create the right vision is

crucial, leaders must welcome suggestions from others. Public health is continuously

evolving, and so are its challenges and demands. The traditional practices that worked years

back may not be effective in these contemporary times. The notion that a strategic idea that

works will come from one person is an error. A leader’s role, therefore, is to foster collective

vision creation by including perspectives from people within and outside the organization

(Hughes, 2014). This is where transactional leadership errs as it does not involve followers in

creating the vision or the working strategies.

It is the role of leaders to empower the people they lead. Empowerment involves helping

people to acquire the right knowledge and skills for assigned tasks (Goldsmith, 2010). This

can be achieved by identifying what skill or knowledge the change agents lack and offering

the right training, providing the needed resources, delegating tasks, giving workers autonomy

over assigned tasks, giving followers a voice in decision making, eliminating setbacks, and

offering rewards. An empowered workforce promotes career development, high productivity,

self-belief and self-satisfaction.

Again, it is the role of a leader to foster collaborations that create enabling work environment.

Collaboration can be instilled if leaders communicate the vision to followers, form teams

among workers, welcome ideas from others, assign tasks to people according to their

strengths and weakness, and acknowledge and award the outstanding performance of workers

(Hughes, 2014). These actions are also upheld in Kotter’s eight steps of change model which

teaches leaders how to implement change (Kotter, 2012). Collaboration also sets the tone for

an enabling working environment. Public health leaders should also extend collaboration to

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other bodies such as the government, health insurance companies, non-governmental

organizations, donor agencies, regulatory bodies and social groups.

One of the roles of a leader in facilitating innovation, change and quality improvement is to

strategically influence followers and sustain a commitment to an organization (Hughes,

2014). Having created or articulated the vision and steps to achieve it, the next step is to get

followers to buy into the vision. This is no small task, especially in public health which

involves people from other agencies and the population at large. Leaders need to build a good

relationship with all stakeholders while upholding the organizational culture, and systems,

imploring emotional intelligence and being open to criticisms and contributions from others.

Transformational, democratic and charismatic leadership styles value building relationships.

Followers will be motivated if leaders continuously interact with them throughout the change

period. This will build trust and credibility in the leader’s ideas.

CONCLUSION

“Leadership is the process of interactive influence that occurs when, in a given context, some

people accept someone as their leader to achieve common goals” (Silva, 2016). Leaders are

agents of change. Every organization needs leadership to drive home innovation, service

improvement or any desired change. Some essential qualities of a leader include emotional

intelligence, intellectual flexibility, situational awareness, evidence-based decision making,

strategic influencing, working understanding of public policy, innovation, political

astuteness, good communication skills, and integrity (Yphantides, Escoboza and Macchione,

2015). The roles of a leader concerning facilitating innovation, change and quality

improvement in public health service provision include vision creation, empowerment of

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workers, and foster collaboration, facilitating innovation, and creating a good work

environment.

Public health is a broad discipline that interacts with many different bodies as well as the

mass population. Hence a more people-centred leadership style is appropriate to champion

the desired change. Examples are transformational leadership, democratic leadership, and

charismatic leadership. Task-oriented transactional leadership could also be used in cases

when a task needs to be completed within the stipulated time.

Transformational, democratic and charismatic leadership styles welcome contributions from

followers and use the theory of individual consideration to improve individual performance.

This inspires followers to come up with innovative ideas and thus contribute to the overall

change process. Transactional leadership on the other hand uses rewards and punishment to

motivate its followers to complete a set of defined tasks; this does not inspire creativity.

Unlike the other leadership styles discussed above, the charismatic leadership style is more

inherent; cannot be taught. The transactional leadership style can achieve its set objectives

within a set time compared to the other leadership style that gives workers the liberty to work

at their own pace. Democratic leadership style for instance wastes a lot of time debating on a

matter before reaching a consensus.

Despite the key leadership styles discussed above, public health leaders are encouraged to

analyze every situation, the work environment and the type of followers before deciding on

which leadership style will be most appropriate. This approach is called situational leadership

theory.

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REFERENCE

1. Andersen, J.A. (2015) ‘Barking up the wrong tree. On the fallacies of the

transformational leadership theory’, Leadership & Organization Development

Journal.

2. Bhatti, N. et al.  (2012) ‘The impact of autocratic and democratic leadership style on

job satisfaction’, International business research, 5(2), p.192.

3. Czabanowska, K. (2014) ‘Leadership in Public Health: reducing inequalities and

improving health’, Eurohealth, 20(3), pp.28-31.

11 R2003D10506504
4. Díaz-Sáenz, H.R. (2011) ‘Transformational leadership’, The SAGE handbook of

leadership, 5(1), pp.299-310.

5. Fakhri, M. et al. (2021) ‘Democratic leadership practice to construct clan

organizational culture in family companies. The Journal of Asian Finance, Economics

and Business, 8(1), pp.803-811.

6.  Gasela, M. M. (2022) ‘The influence of organizational culture on performance in

public entities of south africa’, Africa's Public Service Delivery and Performance

Review, 10(1). doi:10.4102/apsdpr.v10i1.563.

7. Goldsmith, M. (2010) ‘Empowering your employees to empower

themselves’, Harvard Business Review, pp.33-51.

8. Hughes, R. L. et al. (2014) Becoming a Strategic Leader: Your Role in Your

Organization's Enduring Success. John Wiley & Sons, Incorporated.

9. Kotter, J. P. (2012) Leading Change. Brighton, MA: Harvard Business Review Press. 

10. Krzysztof, G. et al. (2022) ‘Global public health leadership: The vital element in

managing global health crises’, Journal of Global Health, 12. doi:

10.7189/jogh.12.03003.

11. Lesneski, C. D. and Bernard, J. H. (2011) Transforming Public Health Practice :

Leadership and Management Essentials. John Wiley & Sons, Incorporated.

12. Mittal, R. (2015) ‘Charismatic and transformational leadership styles: A cross-cultural

perspective’, International Journal of Business and Management, 10(3), p.26.

12 R2003D10506504
 13. Odumeru, J.A. and Ogbonna, I.G. (2013) ‘Transformational vs. transactional

leadership theories: Evidence in literature’, International review of management and

business research, 2(2), p.355.

14. Silva, A. (2016) ‘What is leadership?’, Journal of Business Studies Quarterly, 8(1),

1-5. 

15. Tavanti, M. (2008) ‘Transactional leadership’, Leadership: The key concepts, pp.166-

170.

16. Veldsman, T. and Johnson, A. (2017) Understanding Leadership : Perspectives from

the Front Line. KR Publishing.

17. Yphantides, N., Escoboza, S. and Macchione, N., 2015. Leadership in public health:

new competencies for the future. Frontiers in public health, 3, p.24.

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