Examining leadership through critical feminist readings

PURPOSE: This paper seeks to explore a critique of the limitations of mainstream leadership research and publications and offers a critical management analysis through drawing on a feminist reading of leadership in organizations. DESIGN/METHODOLOGY/APPROACH: There has recently been witnessed a growing interest in the promotion of effective leadership within both organizational studies literature and organisational policy as the route to ensuring employee commitment and enhanced organisational performance and the achievement of ever demanding goals and targets. This turn to leadership is represented in both an upsurge of research studies and a proliferation in the promotion of leadership as the organisational panacea. An analysis of the literature on leadership was undertaken, giving due consideration to mainstream and more critical accounts in relation to illustrations drawn from the UK National Health Service (NHS). FINDINGS: This paper explores mainstream literature on leadership and finds it wanting, in terms of its failure to deliver a common understanding of the concept, in its generally uncritical accounts, and its inability to expose the androcentric nature of the core assumptions within hegemonic discourses of leadership. Drawing on critical feminist readings in relation to the UK NHS, a more critical account of leadership is presented. PRACTICAL IMPLICATIONS: Greater awareness is required for the adoption of culturally sensitive and locally-based approaches that take account of individuals' experiences, identities and power relations and that allows for the presence of a range of masculine and feminine workplace behaviours. ORIGINALITY/VALUE: This paper provides an overview of the dominant themes within the literature on leadership as they relate to the UK NHS, and presents a feminist critique of the more subtle ways in which notions of leadership in organisations fail to consider their potential for bias.     

"Knife before wife": an exploratory study of gender and the UK medical profession

PURPOSE: The paper aims to explore the increasing feminisation of the medical profession and career progression of women in the medical profession. Furthermore, the paper explores the implications of gender segregation in the medical profession for health service provision. DESIGN/METHODOLOGY/APPROACH: The paper presents an overview of studies in this area and draws upon primary, empirical research with medical practitioners and medical students. However, unlike most other studies the sample includes male and female participants. The research involved elite interviews and self-completion questionnaires in order to provide perspectives of both male and female medical practitioners and medical students. FINDINGS: The findings are consistent with those of other studies; that gender discrimination and segregation is still prevalent in the medical profession. But there are significant differences in perceptions between the genders. Moreover, it is concluded that the gendered career structure and organisational culture of the health sector and medical profession create a role conflict between personal and professional lives. The current difficulties in reconciling this role conflict create barriers to the career progression of women in the medical profession. RESEARCH LIMITATIONS/IMPLICATIONS: Further research in this area could include a longitudinal study of medical students and the impact of changes in the design of medical training and career structures to assess whether these changes enable female career progression in the medical profession. Further analysis is needed of gendered practices and career development in specific specialist areas, and the role of the medical profession, NHS and Royal Colleges should play in addressing gender and career progression in medicine. PRACTICAL IMPLICATIONS: Gender segregation (vertical and horizontal) in the medical profession will have implications for the attraction, retention and increased shortages of practitioners in hospital and surgical specialities with the resultant economic and health provision inefficiencies. ORIGINALITY/VALUE: The paper provides a review of literature in this area, thereby providing a longitudinal perspective of gender and the medical profession. Moreover, the research sample includes both male and female medical practitioners and medical students, which provides perspectives from both genders and from those who have experience within the medical profession and from those beginning their career in the medical profession. The research will be of value to the medical profession, the NHS and Royal Colleges of Medicine.     

Leadership transmission: a muddled metaphor?

PURPOSE: The purpose of this paper is to examine critically the concept of "leadership transmission", considering what theoretical and practical value this metaphor brings to the healthcare modernization agenda. DESIGN/METHODOLOGY/APPROACH: The paper develops understanding of the transmission metaphor, whilst theoretical perspectives on leadership are reviewed, including debates, which shed light on the concept by focusing on the phenomenon of distributed or dispersed leadership. FINDINGS: The transmission metaphor is perhaps misleading, by implying that "leadership can be caught" like a disease. However, defining leadership in terms of influence, a novel typology of transmission processes is introduced; top down (one-way), inter-organizational (bi-lateral), and dispersed (multi-directional). Recent research suggests that organizational changes are often led by the spontaneous concertive action of staff at all levels, not just by senior élite groups. The way in which dispersed influence processes arise, unfold, and are transmitted into organizational outcomes can be understood through theoretical narratives, which capture event sequences and combinations of factors unfolding over time in a given context. Given the scale and pace of the change agenda, healthcare modernization may indeed depend on widely dispersed leadership. PRACTICAL IMPLICATIONS: It is therefore necessary to establish the conditions in which leadership transmission is encouraged, to recognize, support, and develop the "unsung heroes" who assume change leadership positions, and to widen the agenda and coverage of NHS leadership development programmes. ORIGINALITY/VALUE: There is currently no other commentary, empirical or theoretical, academic or professional, which examines critically the concept of leadership transmission, while exploring the nature of this perspective, and its theoretical and practical value.     

Role of Directorates in Promoting Nursing and Midwifery Across the Various States of India: Call for Leadership for Reforms

Background:While the roles and responsibilities of nursing professionals have multiplied over the years, but there are huge concerns with regard to the development of the nursing workforce and human resources (HR) issues for their career growth. The major lacuna is in not involving the nursing professionals in policy framing and decision-making. As a result, there is a leadership crisis of the nursing workforce across India.Objectives:The paper, is part of the WHO supported study, entitled “Study on Nursing and Midwifery in India: a critical review”, is developed with the objective to review the current organizational and management structure for the nursing positions at the State Directorates in India and obtain a Leadership perspective to strengthen nursing management capacities to address maternal health issues.Results:Since none of the states have neither a Nursing Cell nor the post of Director Nursing, final decision-making powers rest with state health secretaries and medical directors. The nursing management structure majorly managed by senior policy makers from the medical fraternity, and provides very little scope for nursing professionals to participate in policy decision making to bring about reforms. There is no uniformity on HR issues concerning career graphs and pay structures across the states.Conclusions:In order to strengthen nursing as a profession and for facilitating their role at the policy level, more powers and autonomy needs to be given to them and this requires HR policy guidelines for nurses. Setting up a separate nursing directorate, to be headed by a senior nursing professional, is suggested in every state along with a strong nursing division at the National level. This total paradigm shift will empower nursing professionals to take up the leadership role at the policy level to bring about necessary reforms. Across the country, nursing professionals repeatedly echoed one requirement: To reframe nursing leadership at all levels.     

The entrepreneur: a new breed of health service leader?

PURPOSE: This paper aims to critically examine the notion of entrepreneurship in the UK National Health Service (NHS), promoted by government ministers and senior civil servants as part of the rhetoric of the modernisation agenda. DESIGN/METHODOLOGY/APPROACH: The paper explores literature on entrepreneurship in the private and public sector and qualitative case study evidence on the emergence (and non-emergence) of "entrepreneurs" who led the improving working lives (IWL) initiative in the UK National Health Service and discusses the issues involved. FINDINGS: The rhetoric serves an essentially ideological function, obscuring the real difficulty of securing effective and sustainable change, in organisations with deeply engrained power structures and as complex and intransient as the NHS in particular and health services more generally. PRACTICAL IMPLICATIONS: A "new breed of entrepreneurial leaders" may eventually appear but they face the challenge of surviving in the hierarchical NHS culture and in a climate of turbulent change created by the volatility of government policy. ORIGINALITY/VALUE: The paper shows that efforts to pursue entrepreneurship in the UK NHS have to overcome obstacles involving the interplay of power, gender and language.     

The relationship between organizational culture and performance in acute hospitals

This paper examines the relationship between senior management team culture and organizational performance in English acute hospitals (NHS Trusts) over three time periods between 2001/2002 and 2007/2008. We use a validated culture rating instrument, the Competing Values Framework, to measure senior management team culture. Organizational performance is assessed using a wide range of routinely collected indicators. We examine the associations between organizational culture and performance using ordered probit and multinomial logit models. We find that organizational culture varies across hospitals and over time, and this variation is at least in part associated in consistent and predictable ways with a variety of organizational characteristics and routine measures of performance. Moreover, hospitals are moving towards more competitive culture archetypes which mirror the current policy context, though with a stronger blend of cultures. The study provides evidence for a relationship between culture and performance in hospital settings.     

Clinical leadership in health care: a position statement

PURPOSE: This paper aims to briefly review leadership within the contemporary UK National Health Services (NHS) including Department of Health and Royal College of Nursing (RCN) initiatives. DESIGN/METHODOLOGY/APPROACH: It is argued that the concept of clinical leadership is a viable and important one, and is theoretically consistent with the contemporary social psychological literature on the importance of "local" leadership to effective organizational functioning. Field theory proposes that local influences (e.g. local management) on attitudes and behaviour will to a large extent mediate the impact of the organization (e.g. organisational structure and values) on (in this instance) health care delivery. FINDINGS: The reality of clinical leadership must involve a judicious blend effective management in the conventional sense with skill in transformational change in order to make real difference to the care delivery process. PRACTICAL IMPLICATIONS: For leadership initiatives to become truly culturally embedded into the "way we do things around here", they require more than just individual training and development. ORIGINALITY/VALUE: A view is offered for the practical interpretation of the clinical leadership concept in relationship terms. This will involve management of the relationship between health care professionals, between health care professionals and the "organizations" to which they are accountable and between health care professionals and service users.     

The impact of corporate memory loss: What happens when a senior executive leaves?

PURPOSE: The author is a nursing management practitioner, whose purpose in writing this paper is twofold: to examine the impact of corporate memory loss on a health care institution, caused by increasing retirement rates of senior executives; and to use this research as an opportunity for action learning where both the author and the institution can benefit from the learning outcomes. DESIGN/METHODOLOGY/APPROACH: Using qualitative research methods based on ethnographic interviewing techniques and grounded theory, the author interviews 12 senior executives from four diverse health care facilities. The purpose is to determine the point at which corporate memory loss, in the form of tacit knowledge in the heads of departing executives, becomes a problem for the institution. FINDINGS: The research determined that the requisite managerial competencies normally assumed for senior management positions are insufficient to minimize the negative impacts of corporate memory loss caused by departing senior executives. Effective knowledge management and knowledge transfer within the organization are fundamental for ongoing organizational effectiveness. RESEARCH LIMITATIONS/IMPLICATIONS: The research is limited to 12 senior executives. The grounded theory nature of the research provides a framework for more research in other institutions to test and further explore some of the findings. PRACTICAL IMPLICATIONS: One of the most significant threats facing the majority of health care organizations related to the aging workforce is the greater number of staff who are retiring from all levels within the organization. The development of techniques to reducing the impact of corporate memory loss on the culture of an organization will increase its effectiveness, help build continuity, and provide a more secure footing for the workforce of the future. ORIGINALITY/VALUE: The exit of knowledge workers is causing a major problem for Canada's health care organizations. This study throws more light on to this problem from the point of view of senior executives who have been specifically impacted by the problem of corporate memory loss.     

Gender differences in managerial characteristics in a female-dominated health profession

This study examines gender differences in characteristics of managers in terms of leadership roles, use of power, type of supervisory style preferred, career commitment, and work/family conflict for the female profession of physical therapy. A questionnaire sent to all members of the Private Practice and Administration Sections of the American Physical Therapy Association yielded 545 managers, 58 percent of whom were female. Females preferred to use a transformational supervisory style more than the men did but males used more masculine leadership traits. Females were as committed to their careers as males and reported the same work/family conflict as the men. These results raise questions as to why proportionately more males are managers in a female-dominated profession. Have health care executives promoted men over women even when the occupation is mainly female?     

Moving upstream or muddying the waters? Incentives for managing for health

OBJECTIVES: The objective of this study was to identify factors influencing the capacity of NHS managers to 'manage for health'. STUDY DESIGN: Semi-structured interviews (32) were carried out over the telephone or face to face with national stakeholders (15) and NHS senior managers (17) from four Strategic Health Authorities (SHAs) and five Primary Care Trusts (PCTs) in England. Interviews were transcribed and a qualitative analysis carried out. RESULTS: The current system of targets and incentives prioritised access to acute services, public health skills were too thinly spread, baseline data were inadequate, decision-making for public health investment was fragmented and evidence for effective interventions was scanty. Health improvement targets should be plausible, longer term and locally owned, but key factors in creating a proactive public health organisation were a strong public health ethos, and effective management and leadership skills. Strengthening the NHS's role in managing for health was welcomed, but enthusiasm was tempered by concurrent NHS policy initiatives and incentives pulling in opposing directions. CONCLUSIONS: Key NHS policy initiatives have been developed in isolation from each other. While their combined effect remains unpredictable, they may serve to threaten the welcome shift towards managing for health improvement.     

Organizational leadership and its relationship to regional health authority actions to promote health.

PURPOSE: The purpose of this paper is to examine organizational leadership and its relationship to regional health authority actions to promote health. DESIGN/METHODOLOGY/APPROACH: Through use of four previously developed measures of Perceived Organizational Leadership for Health Promotion, this paper focused on leadership as a distributed entity within regional health authority (RHA) jurisdictions mandated to address the health of the population in the province of Alberta, Canada. FINDINGS: First, examination of differentials between organizational levels (i.e. board members, n = 30; middle/senior management, n = 58; and service providers, n = 56) on ratings of the four leadership measures revealed significant differences. That is, board members tended to rate leadership components significantly higher than service providers and middle/senior managers: from across all 17 RHAs; and in low health promotion capacity and high health promotion capacity RHAs. Second, regression analyses identified that the leadership measures "Practices for Organizational Learning" and "Wellness Planning" were positively associated with health authority actions on improving population heart health (heart health promotion). The presence of a "Champion for Heart Health Promotion" and the leadership measures "Workplace Milieu" and "Organization Member Development" were also positively associated with health authority actions for health promotion. A subsidiary aim revealed low to moderate positive relationships of the dimensions of Leadership, Infrastructure and Will to Act with one another, as proposed by the Alberta Model on "Organizational Capacity Building for Health Promotion." ORIGINALITY/VALUE: This paper, conducted on the baseline dataset (n = 144) of the "Alberta Heart Health Project's Dissemination Phase", represents a rare effort to examine leadership at a collective organizational level.     

Developing an explicit strategy towards social responsibility in the NHS: a case for including NHS managers in this strategy

PURPOSE: To explore the concept of corporate social responsibility (CSR) within the UK National Health Service (NHS) and to examine how it may be developed to positively influence the psyche, behaviour and performance of NHS managers. DESIGN/METHODOLOGY/APPROACH: Primary research based upon semi-structured individual face to face interviews with 20 NHS managers. Theoretical frameworks and concepts relating to organisational culture and CSR are drawn upon to discuss the findings. FINDINGS: The NHS managers see themselves as being driven by altruistic core values. However, they feel that the public does not believe that they share the altruistic NHS value system. RESEARCH LIMITATIONS/IMPLICATIONS: The study is based on a relatively small sample of NHS managers working exclusively in London and may not necessarily represent the views of managers either London-wide or nation-wide. PRACTICAL IMPLICATIONS: It is suggested that an explicit recognition by the NHS of the socially responsible commitment of its managers within its CSR strategy would help challenge the existing negative public image of NHS managers and in turn improve the managers' self esteem and morale. ORIGINALITY/VALUE: This paper addresses the relative lacunae in research relating to public sector organisations (such as the NHS) explicitly including the role and commitment of its staff within the way it publicises its CSR strategy. This paper would be of interest to a wide readership including public sector and NHS policy formulators, NHS practitioners, academics and students.     

Spanning boundaries in pursuit of effective knowledge sharing within networks in the NHS

PURPOSE: The purpose of this paper is to examine power asymmetries in the delivery of genetics healthcare that inhibit knowledge sharing across sector, organisational and professional boundaries. DESIGN/METHODOLOGY/APPROACH: The paper is a longitudinal comparative case study approach, which encompasses semi-structured interviews and observation. FINDINGS: The paper finds politics to be significant in its influence on knowledge sharing across sector, organisational and professional boundaries, but this can be mediated by attending to human and social aspects of the context in which knowledge sharing was expected to take place. RESEARCH LIMITATIONS/IMPLICATIONS: The paper encourages research that evaluates the effect of increased emphasis on human and social aspects of organisational change in pursuit of the "dream" of spanning boundaries and improving knowledge sharing within the NHS. PRACTICAL IMPLICATIONS: The paper shows that structural change appears to be of limited effect in promoting knowledge sharing. Organisational and individual development, career management and performance systems are worthy of attention for the purpose of managing knowledge. ORIGINALITY/VALUE: The paper exposes this assumption as managerialist. Policy-makers assume that professionals are willing and able to share knowledge when delivering healthcare through networks.     

Organizational and market factors associated with leadership development programs in hospitals: a national study

Effective leadership in hospitals is widely recognized as the key to organizational performance. Clinical, financial, and operational performance is increasingly being linked to the leadership practices of hospital managers. Moreover, effective leadership has been described as a means to achieve competitive advantage. Recent environmental forces, including reimbursement changes and increased competition, have prompted many hospitals to focus on building leadership competencies to successfully address these challenges. Using the resource dependence theory as our conceptual framework, we present results from a national study of hospitals examining the association of organizational and market factors with the provision of leadership development program activities, including the presence of a leadership development program, a diversity plan, a program for succession planning, and career development resources. The data are taken from the American Hospital Association's (AHA) 2008 Survey of Hospitals, the Area Resource File, and the Centers for Medicare & Medicaid Services. The results of multilevel logistic regressions of each leadership development program activity on organizational and market factors indicate that hospital size, system and network affiliation, and accreditation are significantly and positively associated with all leadership development program activities. The market factors significantly associated with all leadership development activities include a positive odds ratio for metropolitan statistical area location and a negative odds ratio for the percentage of the hospital's service area population that is female and minority. For-profit hospitals are less likely to provide leadership development program activities. Additional findings are presented, and the implications for hospital management are discussed.     

An examination of the stages of change construct for health promotion within organizations.

PURPOSE: The purpose of this research is to examine the organizational stages of change construct of the transtheoretical model of behavior change. DESIGN/METHODOLOGY/APPROACH: Data on organizational and individual stages of change for tobacco reduction, physical activity promotion, and heart healthy eating promotion were collected from service provider, senior management, and board level members of provincial health authorities across three data collection periods. FINDINGS: Results revealed significant correlations between individual and organizational stages of change for management level respondents, but inconsistent relationships for service providers and no significant correlations for board level respondents. There were no significant differences between respondent levels for organizational stage of change for any of the promotion behaviors. In general, changes in stage failed to predict whether there was a belief in an organization's capability of addressing any of the health promotion activities. There was also a large amount of variance between individual respondents for most health authorities in their reported organizational stages of change for physical activity and healthy eating. PRACTICAL IMPLICATIONS: Based on the results of the present study it is concluded that there is little evidence that the organizational stages of change construct is valid. The evidence indicates that assessing individual readiness within an organization may be as effective as asking individuals to report on organizational stages of readiness. ORIGINALITY/VALUE: This paper reports on the validity of the organizational stages of change construct in a health promotion context and provides information for those who are considering using it.     

The snakes and ladders of National Health Service management in England

This article explores managerial careers in the National Health Service (NHS) through the lens of talent management, particularly focusing on how managers view barriers (snakes) and facilitators (ladders) to career progression. There is a significant literature on enablers and barriers to career progression, but much of this focuses on specific groups such as black and minority ethnic and female workers, and there is relatively little material on the general workforce of the NHS. The research design is a mixed method quantitative (questionnaire) and qualitative (interview and focus group) approach consisting of a quasi‐probability element that focuses on a maximum variety sample and a purposive element that seeks policy views at central and strategic health authority level, and examines talent management in high‐performing NHS organisations. Ladders are identified as follows: volunteering, secondment, networking, mentoring, academic qualifications, development, good role models/managers and appraisal/personal development plan. Snakes are identified as managing expectations; identity and cognitive diversity; location; sector; NHS toxic and favouritism culture; poor talent spotting; credentialism; exclusive approach to talent; and sustainability. It concludes that while previous conceptual and empirical work is fairly clear on any ladders, it is less clear on snakes. Copyright © 2013 John Wiley & Sons, Ltd.