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    Marcella M. Pyke, RDH, MHS, FACMPE
    Researchers claim that over the past 60 years approximately 65 different classification systems have been established to help delineate the elements of leadership.1

    The trait perspective on leadership suggests that individuals are born with specific characteristics that differentiate them from non-leaders. Statements such as “She is a natural leader” support the trait theory that effectiveness is an innate quality that separates leaders from others. These distinct features may be evident when physically meeting someone, while other leadership attributes are not as noticeable until you interact with that individual.

    Leaders do not exist unilaterally without others to influence. This confirms the mutual need for synchronization to ensure that the full leadership process transpires. Influence and the ability to steer others toward a vision is an essential element of leadership. Leaders use their passion and energy to engage others so that they believe in the group’s common goal. This requires that both the leader and followers work together in the same direction and for the same purpose. Leadership is a process and involves influencing others, occurs within a group and entails attaining the same goals.2          
    Management and leadership are process concepts that may overlap; although they are frequently used interchangeably, they are not the same. Both are crucial for organizations to be successful, but management is leadership put into action3. Like leaders, followers play a part in the management process. Leadership, however, creates a vision, initiates constructive change and seeks continuous improvement in reaching a goal, while management is responsible for implementation and securing stability to accomplish common strategies. Not all managers develop into leaders, but all effective leaders must also be able to manage4.

    Leadership theories

    Having certain personality traits is one of the most common concepts surrounding leadership theories. The “great man” theory supports the belief that leaders are born and not made to be leaders during their lifetime5 Trait theory supporters feel that born leaders possess attributes that set them apart from others. These leaders serve in positions of authority and power because they have natural attributes that help them thrive when the need arises.

    Studies show that the five dominant leadership traits are intelligence, self-confidence, determination, integrity and sociability6. Intelligence is defined as having the ability to assess issues, possess complex problem-solving skills and demonstrate social judgment competences. This type of intelligence helps promote effective leadership. Self-confidence helps leaders influence others and to portray their beliefs in the decisions they make, even when others do not agree.

    For example, Steve Jobs remained self-confident while developing his inventions, even though others doubted his products. Through the commitment to an idea or goal, leaders can engage others to follow. When obstacles hinder a plan, a leader depends on his or her determination to keep striving and reach the goal. A leader’s perseverance is critical in the face of challenges.

    Integrity is a core quality of honesty and credibility. These qualities convince people to believe in leaders and follow their direction. Finally, sociability makes it possible for leaders to establish stable relationships among groups. The ability to interact and be engage is another classic qualitative leadership trait.

    Leaders are expected to make decisions,8 and effective leaders stand out because they are both courageous and skilled at making the right decisions, especially when the stakes are high and their decisions affect others9. If a leader does not make the right decision, the group’s support may diminish.

    Researcher Fred Kiel uses the phrase “keystone leadership skills” to include vision, strategy, executive team development and accountability to support the decision-making process10. A leader must define and present a clear vision, which requires participation at all levels of an organization. Top executives are not the only people who understand a new vision; it must be embraced by everyone. Similarly, the strategic plan to meet the objectives of the organization’s vision must also involve all departments and divisions. The strategic plan must be communicated to all staff to ensure commitment. These principles and goals can only be achieved through an executive team that’s as passionate as the leader. These team members need to be able to articulate the same message and demonstrate the same level of cooperative commitment in their roles. Lastly, leaders must create a culture of accountability. Expectations and boundaries need to be clearly defined and disseminated within the organization.

    The following excerpts from Warren Buffett’s memo11 to his management teams explain his own boundaries and accountability and behavior:

    As I’ve said in these memos for more than 25 years, we can afford to lose money – even a lot of money. But we can’t afford to lose reputation – even a shred of reputation. ...Sometimes your associates will say, “Everybody else is doing it.” This rationale is almost always a bad one if it is the main justification for a business action. It is totally unacceptable when evaluating a moral decision...”12  

    There are creative leaders who may not appear to be stereotypical leaders. Natural leaders may project influence through unconventional means. Since leadership is a process, it is not limited to a position13. Regardless of position or level, it is possible for individuals to serve in leadership roles if they influence outcomes and inspire others. Nontraditional creative thinking by diverse groups is recognized as a way to contribute to productivity14. These individuals may not have a prominent title, but they can help change the culture and achieve strategic goals. 

    The skills approach focuses on the behavior of a leader, which can be learned through training. Skills are what leaders can use to accomplish tasks; whereas, traits are what makes leaders who they are.15 Robert Katz originated the three-skills approach to offset the difficulty in finding people with leadership traits. Katz believed that there are three basic skills leaders need:
    1. Technical – knowledge and technical ability, commonly called the “hands-on” approach;
    2. Human – the ability to work well with all levels of people; referred to as “people skills”;
    3. Conceptual – ideas to help the organization state its mission and move forward16.
    It is perceived that these three skills apply to middle management who could develop into lower-level leaders. Unlike the trait approach, the skills approach assumes that leadership behaviors can be learned, rather than just inherited. An individual could continue to develop his or her skills and experience, which could enhance his or her leadership abilities.

    As a result of their years of experience and outcomes, the skills approach works well for law enforcement and military leaders. Facing difficult scenarios on a daily basis helps these individuals learn from each situation. In addition, they use these experiences to identify the best methods for dealing with similar situations. They trend their case experiences to determine the most effective behaviors and procedures to use depending on the circumstance.

    Through repetition and continuous experiences, the military utilizes the skills approach for leadership development. Leadership concepts are applied to all roles and never change. The application of these skills concepts expands as the rank responsibilities increase17. By learning from experiences and outcomes, the skills approach helps individuals acquire leadership skills.

    Personality assessments can be used to assist with leadership development. A Marine Corps’ top leadership principle is: “Know thyself and seek self-improvement.”18. To help improve leadership proficiencies, an individual may devise a learning plan as a tool for self-development.

    The situational leadership approach requires leaders to be flexible and adjust their styles based on circumstances, which prompts them to employ different behaviors to achieve desired results for specific situations. The situational approach triggers leaders to change their style to accommodate the needs of the followers or situation. One type of leadership style is not always practical for every circumstance. A leader needs to adjust the style to balance his or her directive and supportive behaviors according to the situation. Directive behaviors include telling people what to do, how to do it, when to do it and who is to do it. They provide specific instructions on how to achieve common goals. Supportive behaviors involve the two-way communication skill set, which includes listening, encouraging, facilitating, clarifying and giving emotional support.

    Unlike situational leadership, the contingency theory is based on the changing circumstances versus the leader’s need to adjust his or her style. It assumes that the leader cannot change his or her behavior/style and will not be helpful in all situations. Instead, the contingency theory recommends finding the right leader for the right situation. This theory postulates that situations are different, and leaders need to be matched to appropriate situations to adequately respond to issues. Depending on the issue, a leader may need to be directive, supportive, participatory or goal-oriented. This approach is limiting because it is difficult to determine the most appropriate style before the situation unfolds. This theory may apply when prospectively identifying an effective leadership style for an anticipated project but would not be feasible during a crisis or unplanned occurrence.    

    Transformational leadership represents a process that results in changing or transforming people. It appeals to the followers’ values and sense of purpose to achieve a unified goal. Charismatic leaders are similar to transformational leaders as they consider others’ concerns. Charisma is considered a unique personality trait that allows leaders to connect with others and spark movement toward their cause. Energy motivates, but charisma inspires20. Charismatic leaders convince others to act through their infectious passion, firm conviction in their beliefs and clarity of purpose. 

    Although most deem charisma as an inborn trait that can be used to persuade, others believe that this trait can be developed. Studies indicate that charisma can be learned by perfecting the ability to engage others. By extending yourself, others will feel that you are present and mindful of their needs21. Trait theorists state that specific characteristics cannot be learned because they are innate and primarily stem from genetics. Behaviors, however, are observable actions that can be evaluated and modified with appropriate training. Although an individual may not be born with specific personality traits, researchers believe that the behaviors of a charismatic leader can be developed, thus inducing desired results in followers22.

    The servanthood theory is founded on the premise that a true leader serves the best interest of others and puts their needs first23. Similar to charisma training, an individual can be sensitized to project the servanthood approach. According to Peter Northouse, the 10 core characteristics of servanthood leadership are: 
    1. Listening: The interactive process of communicating with followers
    2. Empathy: Understanding what followers are thinking and feeling
    3. Healing: Helping followers with their personal problems
    4. Awareness: Understanding the affect you have on others
    5. Persuasion: Convincing others to act
    6. Conceptualization: Visualizing long-term goals
    7. Foresight: Predicting future needs
    8. Stewardship: Taking responsibility for leadership actions
    9. Commitment to growth: Helping each person in the organization grow personally and professionally
    10. Building community: Fostering the creation of a secure community24
    By focusing on these servanthood philosophies, an individual can cultivate the skill set to become a more effective leader.

    The issues of morality and ethics are well-regarded factors that contribute to the esteem and respect earned by leaders. The qualities of ethical leadership encompass respect, service, integrity, trust and community26 Integrity is of particular importance as it is considered the bedrock of a leader’s foundation27 and allows followers to trust in the leader’s values. Without trust, followers will not believe in the same vision, and the mission of the organization will not be carried out.

    Similarly, morality plays a central role as a virtue that a leader demonstrates through his or her interactions with other people. Albert Einstein professed that “The most important human endeavor is striving for morality in our actions28

    Even though there is no clear answer about what makes someone a leader, the healthcare industry needs to become more aware of the evolving research on the psychology of leadership. Today’s medical groups and organizations would benefit from the integration of methodologies to assist with the early identification of viable leaders. Leaders carry the responsibility to make an organization better and recruiting and mentoring the next generation of qualified and talented leaders is essential for the viability of any organization. The sustained success of any entity is dependent on this constant transitioning of effective leaders
     

    Notes:

    1. Fleishman EA, Mumford MD, Zaccaro SJ, Levin KY, Korotkin AL and Hein MB. “Taxonomic efforts in the description of leader behavior: A synthesis and functional interpretation.” Leadership Quarterly, 1991, 2(4), 245-287.
    2. Northouse PG. Leadership theory and practice. Los Angeles: Sage Publications, 2016, 2.
    3. Mohler A. The conviction to lead. Bloomington, MN: Bethany House Publishers, 2012, 26-27.
    4. Ibid.
    5. Spector BA. “Carlyle, Freud, and the Great Man Theory more fully examined.” Leadership, 2016, 12(2), 250-260.
    6. Northouse.
    7. Northouse, 38-39.
    8. Hewlett SA. Executive presence. New York: HarperCollins Publishers, 2014.
    9. Mohler.
    10. Kiel F. Return on character. Boston: Harvard Business Review Press, 2015.
    11. Ibid.
    12. Ibid., 98.
    13. Maxwell JC. The 5 levels of leadership. New York: Center Street, 2011.
    14. Mueller J. Creative change. New York: Houghton Mifflin Harcourt Publishing Company, 2017.
    15. Northouse, 44.
    16. Katz RL. “Skills of an effective administrator.” Harvard Business Review, 1955, 33(1), 33-42.
    17. Morgan A, Lynch C, and Lynch S. SPARK: How to lead yourself and others to greater success. New York: Houghton Mifflin Harcourt Publishing Company, 2017.
    18. Ibid. 23.
    19. Barsh J and Lavoie J. Centered leadership. New York: Crown Business, 2014.
    20. Sinek S. Start with why. New York: Penguin Group, 2009, 134.
    21. Ben-Shahar T and Ridgway A. The joy of leadership. Hoboken, NJ: John Wiley & Sons, 2017.
    22. Maxwell JC. The 21 indispensable qualities of a leader. Nashville, TN: Thomas Nelson, 1999.
    23. Ibid.
    24. Northouse, 227-229.
    25. Conger J. “The dark side of leadership.” Organizational Quarterly, 1990, 19, 44-45. 1990.
    26. Northouse.
    27. Sinek S. Leaders eat last. New York: Penguin Group, 2014.
    28. Michelli JA. Leading the Starbucks way. New York: McGraw-Hill, 2014, 69.

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