Leadership, which describes individual behavior in directing group activities towards a shared objective, entails influencing and managing change. Though most leadership theories were created for the business context, some are applicable to the healthcare setting because they improve organizational and patient outcomes. Compared to other organizations, healthcare systems are unique in that they are made up of many departments, professional groups, and specialties characterized by nonlinear relationships. The intricacy of healthcare systems is unmatched due to the constraints associated with multidirectional objectives, distinct disease areas, and multidisciplinary personnel. Al-Sawai (2013) notes that the different groups within healthcare organizations have subcultures that might conflict with one another. Therefore, leadership is required in the healthcare industry to efficiently utilize the available resources and exploit the diversity within the organization to attain positive patient and organizational outcomes. The identification of leadership theories and styles relevant to the healthcare industry is necessary to respond to the current changes and demands within the industry.
The leadership theories that are most applicable to the healthcare environment are transformational, collaborative, and shared leadership theories. Transformational leadership is a theory that exceeds the conventional styles of transactional leadership that is characterized by organization, supervision, and group performance. Originally developed by James McGregor burns and expounded upon by Bernard Bass, transformational leadership is about a shared vision (Al-Sawai, 2013). The leader and the follower inspire each other to attain higher levels of performance, leading to a value system congruence. Bass underlined the traits of transformational leaders, which include a strong personality and vision, and the ability to motivate followers to alter their views, expectations, and inspirations towards a common objective (Xu, 2017). Furthermore, he elucidated the four elements of transformational leadership: ideal influence, intellectual inspiration, robust motivation, and individual consideration.
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Research studies have shown that transformational leadership has positive impacts on follower commitment and satisfaction, which means that it is applicable to all organizations including healthcare ones (Al-Sawai, 2013). Moreover, transformational leadership focuses on change, which makes it ideal for the healthcare environment. The healthcare industry experiences constant changes aimed at enhancing the safety and quality of care. Effective leadership is needed to lead and implement changes at all levels of the organization. Healthcare leaders are change agents who utilize their personality traits and qualities to inspire followers to attain their objectives, empower them, and share their vision. Transformational leaders develop trust with their followers, which is achieved by exercising openness, fairness, and honesty with their subordinates and motivating them to be free thinkers. Consequently, they use effective communication strategies to lead followers to accomplish ultimate objectives.
Although transformational leadership is effective in the healthcare setting, it has certain disadvantages. One of these is the possibility of the influences to backfire if a leader takes risks that are not thought out or is self-serving. The assumption that subordinates will be motivated to achieve common objectives is another drawback because in some cases such as during change management, they may not be motivated all the time. Other drawbacks are the risky nature of the model and the likelihood of selective prioritization of employees.
The other leadership theory applicable to the healthcare environment is collaborative leadership. Under this leadership style, individuals collaborate towards a shared benefit, similar to organizational symbiosis. A leader using collaborative leadership conveys information to coworkers and related organizations to enable them to make their decisions. Collaborative communication promotes the management of healthcare organizations by enhancing dialogue between different stakeholders, lowering complexity in the organization, and sharing of experiences and knowledge. The application of the theory requires a synergistic environment, wherein separate parties are encouraged to collaborate towards the execution of effective processes and practices. The resulting collaboration enhances understanding of different subcultures and enables interdependency and integration among various stakeholders, while individuals are unified through shared values and visions, and the outcome is synergistic working practices that can attain results that are greater than individual efforts. Organizational leadership should be the first to model collaborative leadership behaviors to be able to elevate motivation levels and cultivate interdependence between various practitioners.
Therefore, collaborative leadership offers a framework that allows team members to create ways of working together to achieve their goals. The shift towards patient-centered homes and Accountable Care Organizations that are carried out by teams of providers who share information about patients makes collaborative leadership theory useful in the current environment (Al-Sawai, 2013). These changes in the industry are encouraging collaboration or a team-centered approach to care. Some of the most important traits for collaborative leadership are teamwork, continued learning, and emotional intelligence. Particularly, emotional intelligence comprises the ability to communicate, motivate, and manage conflicts, which has positive implications on organizational, patient, and employee outcomes.
Collaborative leadership has some disadvantages that may make it ineffective in the healthcare setting. One disadvantage of the theory is that it can encourage group, which can impede creativity within the healthcare organization. Though its objective is to create relationships and promote collaboration, collaboration can lead to groupthink if not implemented effectively. Collaborative leadership can also lead to a clash in working styles ( Waite et al., 2014) . If a leader does not implement the style effectively, it can contribute to lower productivity because of conflicts in working styles. Other drawbacks of the theory include the creation of ambiguous roles and the high cost of implementation.
Shared leadership is the other leadership theory relevant to the healthcare environment. Several studies have shown that independent healthcare personnel with direct obligations to their patients do not react positively to authoritarian leadership to lead highly skilled professionals ( Garman et al., 2010) . The need for effective collaborative relationships is the foundation for the application of the shared leadership theory in the healthcare environment because it supports continuous learning, shared governance, and the creation of effective relationships.
Shared leadership refers to system-level leadership or management that invests employees in the decision-making process. The model allows individuals to develop and manage within a team, which is necessary for creating a functional working environment and increasing job satisfaction. Teamwork is central to the shared leadership model, which emphasizes on recognizing team values and augmenting team effectiveness to improve practices. The outcomes of shared leadership include the adoption of leadership behaviors by individual employees, greater independence, and better patient outcomes (Xu, 2017). However, various factors can limit the creation of shared team leadership. These include staff turnover, poor team ethos, inadequate goal setting, and absence of responsibility, uninteresting work, and heavy workloads. Nonetheless, when shared leadership is developed and fostered within healthcare settings, it can also impact the practices of individuals and groups beyond the core team.
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Although shared leadership has significant benefits to a healthcare organization, it has certain drawbacks. One of the drawbacks is the possibility of fostering arguments or conflicts. Since the objective of shred leadership to find common ground through shared knowledge and experiences, conflicts, or arguments may emerge if all team members do not share the common vision. Another drawback of this theory is the need for leaders to have certain experiences for its implementation to be effective. These include team-building skills and emotional intelligence, among others ( Waite et al., 2014) .
Considering that transformational, collaborative, and share leadership theories have certain limitations, it is better to use multiple theories in the healthcare environment. The complexities of the current healthcare setting demand the use of multiple theories to suit the situation. Using a single leadership theory may be one-sided and may not respond to the needs of all employees ( Garman et al., 2010) . Furthermore, employees respond to different leadership styles. Therefore, applying multiple theories enables leaders to engage with all employees. For example, during times of change, a healthcare organization may require the perspectives of a transformational leader and the teamwork and emotional intelligence of a collaborative leader.
Though many leadership theories have been developed, most of them are geared towards the business environment. However, there are certain theories that are applicable to the healthcare setting. Transformational, collaborative, and shared leadership theories are beneficial to the healthcare environment. Considering that the current healthcare environment is dynamic and these theories have inherent drawbacks, applying multiple theories in the healthcare setting is advisable. According to Xu (2017), using multiple theories allows healthcare leaders to exploit the benefits of these theories while minimizing their drawbacks. For example, transformational leadership may be effective during change management, but collaborative leadership may be effective when managing disparate teams. Additionally, it enables them to be responsive to situations that may require a different leadership approach.
References
Al-Sawai, A. (2013). Leadership of Healthcare Professionals: Where Do We Stand? Oman Med J; 28 (4): 285–287.
Garman, A.N., Brinkmeyer, L., Gentry, D., Butler, P., & Fine, D. (2010). Healthcare leadership ‘outliers’: An analysis of Senior administrators from the top U.S. hospitals. J Health Adm Educ ; 27 ( 2 ):87-97.
Waite, R., McKinney, N., Smith, M., & Meloy, F. (2014). The Embodiment of Authentic Leadership. Journal of Professional Nursing; 30 (4).
Xu, J. (2017). Leadership theory in clinical practice. Chinese Nursing Research; 4 (4): 155-157.
