l identify characteristics of authentic leadership and discuss the consequences to the leader–
follower relationship when leaders are not authentic
l identify contemporary nurse-leaders who exemplify thought leadership and the innovative ideas they have suggested
l describe why quantum leaders need flexibility in responding to the complex relationships that exist between environment and context in work environments
l describe complexities that exist in the relationship between followers and leaders
l provide examples of the 21st-century shift from industrial age leadership to relationship age leadership
l develop insight into his or her individual leadership strengths
Throughout history, nursing has been required to respond to changing technological and social forces. In the last decade alone, a growing elderly population, health-care reform, reductions in federal and state government reimbursement as well as commercial insurance, and new quality imperatives such as value-based purchasing and pay for performance have resulted in major redesigns of most health-care organizations. In addition, the locus of care continues to shift from acute-care hospitals to community and outpatient settings, innovation and technological advances are transforming the workplace, and organizational cultures are increasingly shifting to externally regulated, safety-driven, customer-focused care. All of these changes have brought about a need for leader-managers to learn new roles and develop new skills.
The new managerial responsibilities placed on organized nursing services call for nurse administrators who are knowledgeable, skilled, and competent in all aspects of management.
Now more than ever, there is a greater emphasis on the business of health care, with managers being involved in the financial and marketing aspects of their respective departments.
Managers are expected to be skilled communicators, organizers, and team builders and to be visionary and proactive in preparing for emerging new threats such as domestic terrorism, biological warfare, and global pandemics.
In addition, the need to develop nursing leadership skills has never been greater. At the national level, nurse-leaders and nurse-managers are actively involved in implementing health-care reform and in addressing a potential international nursing shortage. At the organizational and unit levels, nurse-leaders are being directed to address high turnover rates by staff, an emerging shortage of qualified top-level nursing administrators, growing trends toward unionization, and intensified efforts to legislate minimum staffing ratios and eliminate mandatory overtime, while maintaining cohesive and productive work environments.
Moreover, ensuring successful recruitment, creating shared governance models, and maintaining high-quality practice depends on successful interprofessional team building, another critical leadership skill in contemporary health-care organizations. This challenging and changing health-care system requires leader-managers to use their scarce resources appropriately and to be visionary and proactive in planning for challenges yet to come.
In confronting these expanding responsibilities and demands, many leader-managers turn to the experts for tools or strategies to meet these expanded role dimensions. What they have found is some new and innovative thinking about how best to manage organizations and lead people as well as some reengineered interactive leadership theories from the later 20th century. This chapter explores this contemporary thinking about leadership and management, with specific attention given to emergent 21st-century thinking.
Zinni and Koltz (2009) suggest, however, that there is a profound leadership crisis in America in the 21st century and that contemporary leaders have failed to change with the times. They argue that this has occurred because the world is changing quickly and the traditional top-down hierarchical leadership approach has not evolved quickly enough to match the complexity of the 21st-century world. Single directive approaches to leading will no longer work and participatory enterprise models, which are not easy to develop, must replace them (Zinni and Koltz, 2009).
New research on leadership, including full-range leadership theory (see Chapter 2), is rediscovering the importance of organizational context, levels of analysis, and potential boundary conditions on transformational leadership. Indeed, many recent leadership and management concepts focus on the complexity of the relationship between the leader and the follower and much of the leadership research emerging in the second decade of the 21st century builds upon the interactive leadership theories developed in the latter part of the 20th century. As a result, concepts such as strengths-based leadership, Level 5 Leadership, servant leadership, principal agent theory, human and social capital theory, emotional intelligence (EI), authentic leadership, quantum leadership, and thought leadership have emerged as part of the leader-manager’s repertoire for the 21st century.
Strengths-Based Leadership and the Positive Psychology Movement Strengths-based leadership, which grew out of the positive psychology movement (began in the late 1990s), focuses on the development or empowerment of workers’ strengths as opposed to identifying problems, improving underperformance, and addressing weaknesses and obstacles (Wong, 2012). For example, paying attention to multiple points of view, searching for common ground, making continuous learning in the workplace a priority, and promoting collaborative relationships represent strengths-based leadership activities (Wong, 2012). Wong suggests that strengths-based leadership is part of the development of positive organizational scholarship, which focuses on successful performance that exceeds the norm and embodies an orientation toward strengths and developing collective efficacy in organizations.
While the types of activities encompassed in strengths-based leadership may vary, Gottlieb, Gottlieb, and Shamian (2012) suggest that there are eight strengths-based leadership principles that create the sustainable changes needed in health care and which provide a vision for current and future nursing leadership. These eight leadership principles are shown in Display 3.1.
Gottlieb et al. argue that consistently using these leadership principles will allow nurses to step forward and create a more holistic, humanistic, integrated, health-based, 21st-century health- care system that focuses on what is best, what works, and what has potential.
DISPLAY 3.1 Principles of Strengths-Based Leadership STRENGTHS-BASED NURSING LEADERSHIP
l Works with the whole, while appreciating the interrelationships among its parts
l recognizes the uniqueness of staff, nurse-leaders, and the organization
l creates work environments that promote nurses’ health and facilitates their development
l Understands the significance of subjective reality and created meaning
l Values self-determination
l recognizes that person and environment are integral and that nurses function best in environ- ments where there is a “goodness of fit” that capitalizes on their strengths
l creates environments that promote learning and recognizes the importance of readiness and timing
l invests in collaborative partnerships
Source: Adapted from Gottlieb, L. N., Gottlieb, B., & Shamian, J. (2012). Principles of strengths-based nursing leadership for strengths-based nursing care: A new paradigm for nursing and healthcare for the 21st century. Nursing Leadership, 25(2), 38–50.
Level 5 Leadership
The concept of Level 5 Leadership was developed by Jim Collins and published in his classic (2001) book, From Good to Great. Collins studied 1,435 companies to determine what separates great companies from good companies. What he found was that five levels of leadership skill (see Display 3.2) may be present in any organization. Truly great organizations, however, typically have leaders who possess the qualities found in all five levels. Thus, not only do Level 5 leaders have the knowledge to do the job, but they also have team building skills and can help groups achieve shared goals. They also though demonstrate humility and seek success for the team, rather than for self-serving purposes, a core component of another 21st-century leadership theory known as Servant Leadership. Level 5 leaders also know when to ask for help, accept responsibility for the errors they or their team make, and are incredibly disciplined in their work.
Servant Leadership
Although Greenleaf (1977) developed the idea of servant leadership more than 35 years ago, it continues to greatly influence leadership thinking in the 21st century. In more than four decades of working as director of leadership development at AT&T, Greenleaf noticed that most successful managers lead in a different way from traditional managers. These managers, which he termed servant leaders, put serving others, including employees, customers, and the community, as the number-one priority. In addition, servant leaders foster a service inclination in others that promotes collaboration, teamwork, and collective activism.
Greenleaf argued that to be a great leader, one must be a servant first.
Sutton (2009) notes that many individuals placed in positions of authority become less mindful of others’ feelings and needs. Meanwhile, their subordinates devote tremendous energy to watching and interpreting the actions of their leaders and the end result is a toxic tandem where employees feel underappreciated and overcontrolled. Sutton suggests that good
DISPLAY 3.2 Jim Collin’s Level 5 Leadership LEVEL 1: HIGHLY CAPABLE INDIVIDUAL
Leader makes high-quality contributions to their work; possesses useful levels of knowledge; and has the talent and skills needed to do a good job
LEVEL 2: CONTRIBUTING TEAM MEMBER
Leader uses knowledge and skills to help their team succeed; works effectively, productively, and successfully with other people in their group
LEVEL 3: COMPETENT MANAGER
Leader is able to organize a group effectively to achieve specific goals and objectives LEVEL 4: EFFECTIVE LEADER
Leader is able to galvanize a department or organization to meet performance objectives and achieve a vision
LEVEL 5: GREAT LEADER
Leader has all of the abilities needed for the other four levels, plus a unique blend of humility and will that is required for true greatness
Source: Adapted from Mindtools (1996–2013). Level 5 Leadership. Achieving “greatness” as a leader. Retrieved May 14, 2013, from http://www.mindtools.com/pages/article/level-5-leadership.htm
DISPLAY 3.3 Defining Qualities of Servant Leaders
l the ability to listen on a deep level and to truly understand
l the ability to keep an open mind and hear without judgment
l the ability to deal with ambiguity, paradoxes, and complex issues
l the belief that honestly sharing critical challenges with all parties and asking for their input is more important than personally providing solutions
l Being clear on goals and good at pointing the direction toward goal achievement without giving orders
l the ability to be a servant, helper, and teacher first and then a leader
l always thinking before reacting
l choosing words carefully so as not to damage those being led
l the ability to use foresight and intuition
l Seeing things whole and sensing relationships and connections
New Thinking about Leaders and Followers
Many contemporary scholars have expanded on Greenleaf’s work, particularly in terms of how followers influence the actions of the leader. While the positive effect of followers on leaders has been fairly well described in most discussions of transformational leadership, less has been said about potential negative impacts. For example, followers can and do mislead leaders, whether intentionally or not, as noted in principal agent leaders find ways to provide employees with more predictability, understanding, control, and compassion and the reward is long-term employee loyalty. Other defining qualities of servant leadership are shown in Display 3.3.