Leadership Actions and Style

By Lukasz Mazur, UNC School of Medicine.

Implementing change  in healthcare is usually more than just a technical challenge; it is also a change management challenge.  Thus, it requires strong leadership. However, what kind of leadership?

At the organizational level, healthcare researchers show that leadership actions and style have contributed to rigid divisions of labor in many areas of healthcare, especially between nursing and management as well as nursing and physicians, negatively affecting healthcare innovations and improvements. Beyond the healthcare industry, scholars note that successful change requires strong and effective leadership.  This is particularly true for the multi-professional change efforts where different stakeholders have specific needs and challenges to be addressed. According to most change management experts, if organizational change is to be successful, leadership must be exerted at all levels via a blend of Transactional-Transformational Leadership (TTL) style.

TTL focuses on the relationship and interactions of the leader and follower. Transactional leadership defines the leader – follower relationship through a series of transactions or exchanges. Followers receive rewards or positive recognition when they comply with the wishes of the leader. Conversely, if they act against the leader’s wishes or expectations, followers receive punishment and negative reinforcement. Transactional leadership is a task oriented command-and-control approach to leading, where the emphasis is on what needs to be done and how to do it. Alternately, transformational leadership focuses on the relationship between the leader and follower. It is concerned with motivating and inspiring followers to do more than expected, and is contingent on followers having strong levels of trust, admiration, loyalty, and respect for the leader. Transformation leaders may be charismatic or highly inspirational, creating a vision of the future that followers buy into. They may also exhibit strong consideration for the professional or personal needs of followers, or intellectually excite followers to strive above and beyond the norm. Whereas transactional leadership focuses more on what to do and how to do it, transformational leadership focuses on why it needs to be done.

TTL has received a great amount of attention in the leadership research literature. Transformational leadership has been shown to result in greater follower job satisfaction, higher likelihood of followers helping others in the organization, higher trust in the leader, and higher organizational citizenship behaviors. More specifically, TTL has been used in healthcare to examine leader effectiveness of hospital CEOs, community health center medical directors, and nursing leaders. It is important to note that both transactional and transformational leadership behaviors may be appropriate, depending on the context and the nature of the leadership challenge. Research suggests that there is a dynamic interrelation between leadership style and the nature of the objective to be accomplished, whether it is geared toward exploration or exploitation. When organizations are operating within existing constraints and structures, seeking to exploit efficiencies for gain, there is value in transactional leadership behaviors. On the other hand, when organizations are attempting to adapt, innovate, and change in order to address new opportunities and new challenges, there is value in leader behaviors that are transformational.

As there is perhaps no ‘clear’ answer to what leadership style is ‘best’, as it depends on the end goal, and many contextual and confounding factors, it is important to note the importance of knowing what leadership style is actually being used.  Particularly in healthcare, administrators, physicians, and unit managers might find it useful to realize what style they use most and how it relates to their effectiveness in change management efforts.