Health Service Management

Leadership
Prof S van der Walt
Booyens, Jooste and Sibiya Chapter 10
31 March 2022
 Course outline
• Define the concept of leadership
• Distinguish between leadership and management
• Explain the sources of power (handout & Booyens p 429 and p 209
Booyens, Jooste & Sibiya p212)
• Analyze the various leadership styles (Booyens, Jooste & Sibiya p212)
• Analyze the different leadership theories under the following headings:
• The great man theory,
• Trait theory
• Situational leadership
• Contingency theory and others
 Leadership
• Leadership is seen as a dynamic and interactive process that involves three
dimensions, namely the leader, the followers and the context.
• It is the process which is utilized to direct the behavior of a group to attain a
common goal.
• It is the use of one’s skills to influence others to perform to the best of their
ability.
• It is an interpersonal relationship in which the leader employs specific behavior
and strategies to influence individuals and groups towards setting goals and
attaining them in specific situations (Sullivan and Decker 1992:181)
 Leadership styles
Booyens p 407-409
• Autocratic leadership: Leader is task-oriented and uses positional and
personal power in an authoritarian manner. She retains all responsibility
for goal setting and decision making. Motivates followers through praise,
blame and reward
 Leadership styles
Booyens p 407-409
• Democratic leadership: Value the individual characteristics and abilities
of each team member. Use personal and positional power and co-operative
decision-making methods to draw out ideas from employees and motivate
them to set their own plans and control their own practices
 Leadership styles
Booyens p 407-409
• Participative leadership: Is a compromise between authoritarian and
democratic styles. The leader presents her of his analysis of problems and
a proposal for action to employees, inviting their criticism and comments.
 Leadership styles
Booyens p 407-409
• Laissez-faire leadership: Leaders who adopt this style abdicate
responsibility, leaving followers without direction, supervision or co-
ordination. They allow their followers to plan, execute and evaluate their
work in any way they like – there is NO leadership here.
 Advantages and Disadvantages of leadership styles
Jooste p 45-47

• Autocratic
• Democratic
• Participative
• Laissez-faire
 Leadership theories:
The great man theory(p207 Booyens, Jooste & Sibiya)

• Thomas Carlyle: the leader is different from the average person in terms of certain
inborn qualities.
• To be a leader, you need to be from a particular breed, since leaders are destined by
birth to lead while every other person had to be led.
 Leadership theories:
Trait theory

• Based on the great man theory. Recognizes that leaders possess certain innate
personality, intellectual, social and physical traits which distinguish leaders from
non-leaders. Great leaders are born and not made
 Leadership theories:
Situational leadership

• Various circumstances require different styles of leadership and the best

action to be taken by the leader is determined by a whole range of
situational factors.
• There is no single preferred style of leadership that is suitable for every
situation. Focus on the behaviors that the leader should adopt given a
particular situation.
 Leadership theories:
Contingency theory

• The environment that the leader functions in, determines the leader’s effectiveness.
• Fiedler’s contingency model – leadership effectiveness is dependent upon the
appropriate mix between the leadership style used by the leader in relating to
followers, and the degree to which the circumstances influence the leader.
• 3 Dimensions:
• Relationship between leader and followers (trust, respect and confidence)
• Task structure ( level to which assignments are organized)
• Position power (authority to influence employment, firing and promotion)
 Leadership theories:
Behavioral theory

• Do not agree that leadership traits are inborn

• Effective leadership is based on definable, learnable behavior
• Implies that any person can study the behaviors of successful leadership in
order to emulate them
 Leadership theories:
Participative theory

• Founded on democratic principles of connection, co-operation, inclusion,

ownership, agreement, mutual benefit and support among leaders and
their followers in the interactional process of leadership
• Leadership does not resolve around one single individual, but every team
member is involved
 Leadership theories:
Transactional theory

• Individuals are driven by reward and punishment and humans are largely
looking for ways to take full advantage of satisfying experiences while
reducing unsatisfying experiences
 Leadership theories:
Transformational leadership theory

• Focusing on communicating a shared vision, challenging assumptions,

searching for diverse perspectives from members of their team and
engaging in risk taking
• Known for inspirational motivation, vision and inspiration, charisma,
intellectual stimulation and individualized consideration for their
followers
 Consequences of poor leadership

• could increase costs,

• reduce efficiency and effectiveness,
• cause dissatisfaction among staff,
• ultimately resulting in lower patient satisfaction and society health level
 Key facets of quality leadership
p22-23 Jooste(Leadership in Health Service
Management)
• Focus
• Authenticity
• Courage
• Empathy
• Timing
 Transformational vs Transactional
leadership
• P211 in prescribed books
 Sources/forms of power
• Expert Power: When a leader has significant domain knowledge/skills. E.g. an expert
accountant influences how junior accountants go about their tasks
• Positional Power: Comes when a leader has a legitimately held position of authority. E.g.
typically, the CEO of an organization has the highest positional power
• Reward Power: Is evident when a leader can give, or take away, a reward. E.g. a leader
can influence a follower’s behavior by awarding a bonus, or taking away perks
• Coercive Power: This is felt when a leader creates the perception of a threat. E.g. a leader
has coercive power if her followers believe that she will initiate disciplinary action
• Personal Power: Influence gained by persuasion. E.g. a manager may have to rely on
nothing more than a friendly please and thankyou for an employee to perform a task
• A sixth power base was added later, the information power, which is the leader's ability
to obtain relevant information for subordinates.
 Summary
• Becoming an effective and efficient nurse leader does not happen
intuitively
• Typically the development of good leadership skills is a continuous and
enduring process which occurs over a period of time
• It requires conscientiousness and diligence on the part of the professional
nurse