Question

illustrate some examples to demonstrate good and poor leaders in health care

Answer 1

In recent years, there has been an upsurge in the use of the term ‘leadership’ to describe a range of activities connected to the organisation of patient care. Leadership’ is no longer attributed solely to those in formal leadership positions, but is seen to be the responsibility of healthcare professionals across all levels of healthcare organisations. Notions of traditional hierarchical practices have given way to arguments for distributed (or shared) leadership models. Modern theoretical discourses assert that leadership is a process involving leaders and followers acting within a fluid context so that people construct leader or follower identities moment-to-moment. Suggested benefits of such distributed leadership practices include improved patient experience; reduced errors, infection and mortality; increased staff morale and reduced staff absenteeism and stress. Using this ‘leadership lens’, those in non-formal positions of healthcare leadership (eg, medical trainees) are expected to undertake leadership throughout their careers and develop their leader identities.

While the healthcare literature contends that effective distributed leadership practices are necessary to improve healthcare workplace cultures, patient safety and quality of care, little is known about how these leadership processes are experienced by medical trainees. Within this paper we seek to understand better how the notion of ‘leadership’ has been embedded into frontline healthcare practice through narrative analyses of how medical trainees’ leader and follower identities are constructed.

Researching distributed leadership processes-

Until recently, the focus of scholarly activity in leadership has been on individuals as leaders. In healthcare, many studies have concentrated on the role of leaders rather than the processes of leadership. However, many leadership theorists criticise leader-centric research for its emphasis on individuals as leaders, how effective their activities are and how others (followers) act in response to their influence. Rather, leadership theorists argue that leadership can only be understood through exploring the underlying social systems in which leadership happens. As a product of co-construction, leadership is perceived as an on-going negotiation as part of a multifaceted interaction between social beings. Each interaction can be seen as socially and historically bound operating through language, within a socially-constructed context.

Some studies have explored leadership processes and the link between senior clinicians and the wider organisation. For example, combining interviews and observation, MacIntosh et al identified the extent to which interactions between clinicians and managers were two-way discussions, finding that each group presented themselves as less powerful than the other group and lacking agency. They described the clinician-manager relationships as having potential to limit the opportunities for distributed leadership processes.

While these studies have focused on wider organisational leadership processes our focus is on leadership that may occur day-to-day within the clinical context, where medical trainees potentially have their first experiences of leadership. Through this, our study seeks to add to the literature on distributed leadership in healthcare.

Methods-

- Study design- We undertook a qualitative study using group and individual interviews to elicit medical trainees’ personal incident narratives (PINs) of their experiences of leadership and followership. Ascribing to the notion that meanings are constructed by people as they interact with the world around them, our study draws on social constructionist epistemology.

We used narrative inquiry methodology. Narrative accounts of the healthcare workplace offer abundant resources for research. The narratives referred to in this paper are short, about discrete events and recounted in interactions in various contexts as sense-making tools. A narrative in this form makes the self the central character (or protagonist), either playing an active part within the story or as Chase describes as an: ‘interested observer of others’ actions’

A narrative is the shared construction between the narrator and his/her audience. Bound to this is the context in which the narrative is shared; the specific setting, audience and the reason the story is told. Pivotal to our paper is the concept of the ‘narrative turn’ in that narrators construct events through their story, expressing their feelings, beliefs and understandings about leadership processes. As such, the narrative becomes a construction of who the narrator is, who they wish to be and how they wish to be seen.

- The research team- The research team included three members with health professions backgrounds (one practicing general practitioner; one ex-physiotherapist; and one ex-clinical psychologist) and one social scientist. Team members had various personal experiences of leadership and management covering clinical, research and educational leadership, with all team members teaching leadership in healthcare at undergraduate and postgraduate levels.

This is needed to be done for all the good leaders in health care and if not done then it is the poor leaders.