Leadership in

Healthcare

Tekle Ejajo (Assistant professor of HSM)

School of Public Health
 Session objectives
At the end of this session , the learner will be
able to:
‗ Describe the concept and myths of leadership;
‗ appreciate the leadership approaches/theories
‗ describe different types of leadership styles;
‗ Discuss the differences between leadership
and management;
‗ apply the management and leadership
practices to a challenge.
 Outline
• Definition
• Differentiating Management and
Leadership
• Managing and leading practices
• Core Leadership Theories
• Styles of Leadership
• Understanding your role as a leader
• The Leadership Style Matrix
What kind of leadership styles
and attributes do you need?
 Definition
• “Most authorities on the topic
define leadership as
– influencing others to do what
needs to be done, especially
those things the leader believes
need to be accomplished.”
Jo Manion, 2005
 Definition
• Influencing others:- seven I’s= it is building a wining
team
• Identify the result you want,….
• Illustrate your credibility,…
• Invest the time in getting to know the people you wish to
influence,…
• Invite them to share their ideas,…
• Investigate options that lead you to common ground,…
• Intend an outcome that meets everyone’s needs,……
• Improves as needed,…
 Definition…
• Max DePree (1989, p. xx) believes the
art of leadership is “liberating people
to do what is required of them in the
most effective and humane way
possible.”
• Implications
– a process of releasing the potential
already present within an individual
– enabling the follower to realize his or her
full potential
 Definition…
• Leadership is mobilizing the
interest, energy, and commitment
of all people at all levels of the
organization.
• Implication
– “It is routine, unromantic, and boring.
Its essence is performance.” P
Drucker, 1992
 Definition…
• Bardwick (1996) clearly states that
leadership is not intellectual or
cognitive but emotional.

• Implication: The leader should create

– confidence in people who are frightened
– certainty in people who were indecisive,
– action where there was hesitation,
– strength where there was weakness,
– expertise where there was floundering,
– courage where there were cowards,
– optimism where there was cynicism, and
– a conviction that the future will be better
 Definition…
• Management Sciences for Health
(2006) defines
– Leadership is Enabling Groups to Make
Progress in Complex Conditions.
– It is helping groups of people to identify
their critical challenges, and mobilizing
them to learn and take effective action.
– Leadership is an activity that takes
place at all levels, not a position of
authority
Leadership at all levels
• For effective health service delivery,
leadership is needed in all sectors and at
different levels, e.g.:-
– Political leadership (President, Ministers,)
– Professional leadership by health
professionals
– Leadership at central and local levels
– Household and community level leadership
so that communities and households take
charge of their health programs
– Leadership by partners that collaborate in
health service delivery
Definition…
 Who is a leader?

– As Bass stated “leaders are

agents of change, persons
whose acts affect other people
more than other people's acts
affect them.”

Influence Achieve
Leaders Exercise
followers’ objectives
leadership
behavior
behavior

Fig 1: The process of leadership (Longest,etal,2000)

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 Differentiating Management
and Leadership
• Common misconception:
– “The legitimate authority of a
position, such as holding a
management job or an elected
position, automatically confers
leadership skills on the person
holding that position.”
• Note the following points to
differentiate the two
 Differentiating…
• Efficiency Versus Effectiveness
– A manager is concerned with
efficiency, getting things done right,
better, and faster.
– A leader is more concerned with
effectiveness, asking: Are we doing
the right thing?
• The initial question is not “How can we
do this faster?” but “Should we be
doing this at all?”
 Differentiating…
• How Versus What and Why
– A good manager is usually one who
understands the work processes and can
demonstrate and explain to an employee how
to accomplish the work.

– In contrast, a leader focuses on what needs

to be done and why.
• He or she spends more time explaining the
general direction and purpose of the work, and
then the leader gets out of the way so that the
follower can do it.
 Differentiating…
• Structure Versus People
– Management is about systems,
controls, procedures, and
policies—all of which create
structure—whereas leadership
is about people.
 Differentiating…
• Status Quo Versus Innovation
– Managing the status quo are appropriate
managerial behaviors (Bennis, 1989),
leaders are more concerned with
innovation and creating new processes for
the future.

– A leader’s automatic response to a

problem or mistake is to consider ways to
capitalize on the opportunity that the
mistake has created.
 Differentiating…
• Bottom Line Versus Horizon
– Managers ask: Are we within
budget? Are we meeting our goals?
What’s the deadline?
• The manager’s emphasis is on counting,
recording, and measuring to ensure that
everything is on target.
– Managers keep their eyes on the
bottom line; leaders focus on the
horizon.
 Differentiating…
Conclusion
• None of this is to imply, however, that
there is not a need for good, capable
managers in today’s health care
organizations.

• Managers will always be needed, and

the role is so crucial (important) that
everyone in the organization must share
managerial responsibilities.
 Differentiating…
• Successful organizations
should have both
– good leadership to move toward
a better future and
– good management to make sure
that current operations run
smoothly, efficiently, and
produce the intended results.
Managing and leading practices
• When you lead well, you enable
others to face challenges to
creating the future that you all
envision.(picture s.th mentally)

• When you manage well, you ensure

that processes and procedures,
staff, and other resources are used
in an efficient and effective manner. 
 Sustainable Performance

Managing
Leading • PLANNING
Outcome - Organization
• SCANNING results defined and
Outcome - Awareness of resources assigned
conditions • ORGANIZING
• FOCUSING Outcome - Functional
Outcome - Clarity of structures, systems, and
processes for efficient
direction operations
• ALIGNING/MOBILIZING • IMPLEMENTING
Outcome - The whole is Outcome - Individuals at
greater than the sum of all levels are able to carry
the parts: synergy and out the organizational
complementarities direction
• INSPIRING • MONITORING &
Outcome - A culture that EVALUATING
encourages commitment Outcome - Improved
and creativity information and knowledge

04/08/2023 23
Managing and leading practices…

Managers who lead, 2005

Core Leadership Theories
1. Trait Theories – What Type of Person
Makes a Good Leader?
2. Behavioral Theories – What Does a
Good Leader Do?
3. Contingency Theories – How Does the
Situation Influence Good Leadership?
4. Power and Influence Theories – What
is the source of leader’s power?
 Trait Theories
• Trait theories argue that effective
leaders share a number of common
personality characteristics, or "traits.“

• Trait theories help us identify traits

and qualities (for example, integrity,
empathy, assertiveness, good
decision-making skills, and likability)
that are helpful when leading others.
Behavioral Theories
• Behavioral theories focus on how
leaders behave.(act)

• In the 1930s, Kurt Lewin developed a

framework based on a leader's behavior.
– Autocratic
– Democratic
– Laissez-faire

• Further developed into spectrum…

consultative, participatory, etc
 Contingency theories
• The best leadership style depends
on the situation.

• These theories try to predict

which style is best in which
circumstance.
Power and Influence Theories
• Take an entirely different approach –ways
that leaders use power and influence to get
things done, look at the leadership styles
that emerge as a result.

• French and Raven's Five Forms of Power

– Legitimate power
– Reward power
– Coercive power/Using force s one do s,th
– Expert power
– Referent power
 Styles of Leadership
• Visionary Leadership
– a leader develops a shared vision and
mission, secures(reliable) commitment to
them, and uses them to provide passion
and focus for all decisions, programs and
operations.

• Collaborative Leadership
– Leader promotes common values,
teamwork, alliances and
collegiality(powersharing) to find joint
solutions to problems. 30
 Styles of Leadership…
• Charismatic Leadership
– Leader uses charm, prestige, personal
stature to attract followers and persuade
them to move in a desired direction.

• Positional Leadership
– Leader uses power and authority of
his/her position to make decisions, direct
activities, and reward or punish
compliance.
31
 Styles of Leadership…
• Transformational Leadership
– Leader activates the motivation of followers by
appealing to their higher level needs, values and ideals.
• A New Level of Thinking
« Our current problems Can not be solved with the same
level of thinking which created them »
Albert Einstein

• Transactional Leadership
– Leader makes deals, offering money, praise,
recognition or other rewards in exchange for
compliance with his or her wishes. 32
 Styles of Leadership…
• Contingency Leadership
– Leader adapts different approaches for
different situations, pragmatically using “
whatever gets the job done.”

• Servant Leadership
– Leader encourages and helps others
achieve their own goals by securing
resources, removing obstacles and
coaching or mentoring them to improve
effectiveness. 33
 Styles of Leadership…
•  Laissez-Faire Leadership
– Gives the team members complete freedom
to do their work and set their own deadlines.
– Provides team support with resources and
advice, if needed, but otherwise don't get
involved.

• Bureaucratic Leadership
– Bureaucratic leaders work "by the book."
They follow rules rigorously, and ensure that
their people follow procedures precisely.
34
 Leadership attributes
• Important Characteristics of Leadership
– Goal Oriented
• Sees the bigger picture
• foresight and a sense of direction
– Enablement
• enable others to develop their potential to the
fullest through coaching, mentoring, etc
– Concern
• care about others
– Self-development
• “I can win attitude”
35
 Leadership attributes…
• Leadership skills
– Visioning skill/Strategic Planning
– Communication skill
– Negotiation skill
– Technical skill
– Conceptual skill
– Time management skill
– Team development skill

36
 Leadership attributes…
• What traits do leaders exhibit?
– Courage (prepared for opposition)
– Pride (shared pride)
– Sincerity (concern for other people)
– Adaptability (demonstrating flexibility)
– Influence (get followers)
– Multilingual abilities (learn language
of non supervisory employees and
seniors/specialists)
37
 Understanding your role as a
leader
Ask yourself Five key questions
1. What do we want to happen or
create?
2. What is happening now?
3. Why is their difference?
4. What do we need to change?
5. How do we take care of change and
accountability?
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 Understanding your role …

• You are a leader if:

– You believe that, working in concert
with others, you can make a
difference
– You create something of a value that
did not exist before
– You exhibit positive energy
– You actualize
– You welcome change
39
 Understanding your role …
• Roles expected of you as a leader
– Visionary and strategist
– Resource mobilization/effective
utilization
– Team building/Effective communication
– Effective partnership, collaboration,
networking, dialoguing, negotiating
– Empowerment (for broad-based action)
– Challenger (of processes)
– Change agent in a changing environment40
 Successful leadership
• Three key ingredients for successful
leadership (Bennis, 1989)
– A clear vision of what needs to be
accomplished
– Passion or an intense level of personal
commitment
– Integrity or character
• All three can be learned or perfected
through life’s experiences.
 Successful leadership…
• The best leaders are “people who
have a very delicate balance
between self-confidence and
humility.” (Harry Kraemer, 2003)
 Successful leadership…
• According to Jim Collins and his
associates (2001) successful
leaders were not high-profile
personalities and celebrity status
but just the opposite:
– “Self-effacing, quiet, reserved, even shy
—these leaders are a paradoxical blend
of personal humility and professional
will. They are more like Lincoln and
Socrates than Patton or Caesar”
 The Leadership Style Matrix
Flamholtz and Randle 2007
 Leadership gaps in healthcare
• Belief that past or current success automatically leads to
future success

• Reluctance to make changes rapidly enough to successfully

adapt to the changing external environment

• Overreliance on internal expertise and past experience

• Aversion to risk sharing with physicians and key stakeholders

and risk taking by executives and board members

• Attempts to control and dictate community health initiatives

rather than collaborate with community stakeholders