Leadership is a challenging role, especially in the healthcare environment that is conventionally complex and inter-disciplinary. Finding a leader such as the interviewed DNS who understands various concepts in leadership practice such as crisis management, change and conflict management, and transformational leadership and is willing to steer the team to the achievement of organizational goals is important for any organization that intends to succeed.
The Director of Nursing Services (DNS) considers himself to be a servant leader based on his interactions with the team and how he goes out of his way to demonstrate the possibilities and expectations of the workplace through actions. Additionally, he feels that his leadership combines elements of strategic leadership and democratic practice and that his role is to remove the barriers that the team faces in practice. The responsibilities associated with leadership in this role include ensuring that members of his team are aware of their goals and have the necessary supported to achieve those goals through ensuring that practice objectives of individual nurses are aligned to the overall objectives of the board in the organization The DNS, therefore, adopts a nurse-centric leadership style with a focus on the organizational objectives.
The servant leadership style is characterized by the feeling of a natural desire to serve. It also includes a conscious choice to deliver service to others and results in the growth of those being led (Tarallo, 2018). The growth of others as an outcome of servant leadership implies that the servant leader, such as the DNS, has to be committed to other people’s growth by ensuring that their priority needs are met for them to realize personal growth in an organizational context. Servant leadership focuses on the growth of others with the belief that as they grow, they become more capable of delivering strong value to customers (Tarallo, 2018). The DNS’s approach to leadership, which is nurse-centric, thus exemplifies the focus that servant leadership has on others. It also becomes a baseline for guiding organizational change and innovation.
Leadership innovation is another important concept in leadership that is used to evaluate a leader’s effectiveness in any given circumstance, and the DNS recognized its need. According to Alsolami, Cheng, and Twalh (2016), leadership innovation helps define organizational problems, allocating resources for problem-solving and developing solutions that ensure sustainability in organizational performance. Understanding leadership innovation from the perspective of healthcare problems and challenges can help develop context on the concept. The DNS describes examples of situations that required leadership innovation to solve healthcare problems; specifically, the COVID-19 situation and working with patients in the healthcare facility are good examples of leading innovation and the need to be constantly aware of approaches to promoting effectiveness in operations. The inclusion of spirituality in addressing emerging challenges in handling COVID-19 was particularly an innovative approach to dealing with apprehension, anxiety, and fear related to the diagnosis of more COVID-19 cases in the healthcare facility. These outcomes and how the DNS managed to bring together different perspectives to find solutions and work with the teams to test procedures to protect other patients and the hospital staff from COVId-19 infection indicate effective leadership innovation and potential for further growth.
Various scholars emphasize the importance of leadership innovation. Alsolami et al. (2016) describe the role of leaders in driving progress towards the organizational mission and vision achievement and in developing innovative approaches to addressing challenges. Leadership innovation not only exhibits characteristics that are essential in managing day-to-day operations and which are commonly cited as leadership traits but also requires going beyond these to developing strategies for effective situational management. Leadership innovation encompasses elements of transformational leadership, charisma, and various competencies and attributes associated with innovativeness (Alsolami et al., 2016). The relevance of these attributes is seen in the DNS’s capability not only to exhibit exceptional competencies in challenges but also to inspire others to adopt specific approaches to infection prevention.
Healthcare leaders are not trained in emotional competence, and it is difficult to develop and practice it effectively. To some extent, emotional competence requires leaders to put aside their emotions and understand those of others to offer effective guidance while steering teams towards the realization of goals. The interview revealed the important place of emotional intelligence in healthcare is clear. The DNS mentioned having discussions on emotional intelligence and its basic principles, which include self-regulation, understanding the underlying causes of personal anxiety and addressing those causes, and initiating discussions about moods and anxiety. The interviewee noted that there is clear evidence of the possible influence of personal moods on workplace performance, and existing literature supports his assertion. The interviewee described specific scenarios in which his mood was able to influence his performance in the workplace.
The theoretical description of emotional intelligence as given based on the experiences of the DNS corresponds to that provided in previous literature. Emotional intelligence comprises self-awareness, which relates to the knowledge of one’s internal preferences, states as well as personal competencies and resources; and self-management, which relates to the ability to control one’s internal impulses, states as well as adaptability towards change (Boyatzis, 2018). The dimension of self-management implies the ability to keep disruptive emotions in check, to improve the expected standards of excellence as well as seeing the positive attributes of things that happen in life. These characteristics are required in any workplace since one can only be effective in managing others by first being able to self-manage. The ability to self-manage begins from an understanding of self and the awareness of individual strengths and weaknesses. Since change is inevitable, adaptability to change is part of conventional leadership and can also not be successful without understanding areas in need of change.
Crises are inevitable in any leadership position, and the ability to use personal competencies and an interdisciplinary approach to solving crises is a mark of exceptional leadership. During crises, followers look to their leaders for guidance and approval of suggested processes to ensure that any outcomes achieved during such crises reduce the impacts of the crises (McNulty & Marcus, 2020). Accordingly, leaders have to develop strategies for effective crisis management guidance to others. The situation described by the DNS during the interview can help create a picture of effective management during a crisis. In the discussion, the DNS mentioned that the most recent crisis he had to deal with related to COVID-19. Identifying approaches for reconfiguring the hospital amidst resistance from some of the communities served by the hospital required effective crisis management skills, given the relatively short timeline of disease emergence and the need for solutions. Additionally, the situation required the hospital and the DNS to work with other directorates managing COVID-19, complicating the communication process that had previously been linear. Besides these instances, the general manner in which the DNS handled the patients’ testing situation in the hospital also confirms effective crisis management skills. Specifically, identifying the need to test all patients coming to the facility and plan how to effectively manage the patients within a short period during which the number of cases was increasing indicates effective crisis management that should be timely and cost-effective.
During the interview with the DNS, there were no extensive discussions on spirituality; however, the interviewee mentioned being a pastor’s child and believing in God. Because of this faith in God, one of the decisions made during challenging moments when dealing with increasing rates of COVID-19 diagnosis in the facility was to involve chaplains in encouraging patients and healthcare workers of hope in the future and faith in God. The decision to involve spiritual intervention is a reflection of the DNS’s spirituality, and it can be deduced that faith is the basis of the DNS’s practice. Spirituality plays an important role in healthcare for healthcare leaders as well as other practice staff. According to Baldacchino (2017), core healthcare practice requirements, such as compassionate care, mortality, coping with grief, and the recovery process, have intricate links to spirituality as they relate to patients’ beliefs and those of healthcare provides. For instance, understanding compassionate care from the basis of spirituality and the call to be compassionate to others is an effective approach to promoting patient-centered care. Similarly, understanding a patient’s beliefs on mortality, grief, and recovery can help when one intends to incorporate approaches that use individual strengths to promote coping and recovery. For instance, it is easier for a healthcare provider to encourage acceptance of inevitable mortality among terminally-ill patients by focusing on the patients’ spirituality rather than relying on medical technology and information. Such spirituality-aligned practice can foster effective end-of-life preparation by healthcare providers.
Change and Conflict
Managing change is another subject that draws a lot of interest in leadership studies and the interview. Effective change management is progressive and requires all participants’ involvement in the change process from the beginning. According to Pomare et al. (2019), one of the biggest internal challenges to change implementation is resistance from employees, and it is mostly caused by a lack of awareness of the need for change and ineffective involvement or training to adopt the implemented change. During the interview, the DNS mentioned when the need and objective of a change were not effectively communicated up-front by a previous leader, and the responses of the staff were not entirely positive. In the mentioned situation, expansive discussions about the change resulted in more positive outcomes in the long run. Similarly, managing conflicts in an organizational setting requires understanding different perspectives and willingness to listen to others, as evidenced by how the un-communicated change was handled at the hospital.
Various studies have shown that conflicts are unavoidable in any organizational setting especially in contemporary times where diversity has become a cornerstone of organizational performance. The findings from the interview confirm the need for communication in order to ensure that conflict management is effective. In every organization, managing conflicts can be a challenge where there is no communication regarding the source of conflict, the perspectives of different parties to the conflict, and the opinions of those involved in the conflict resolution process. Unlike the approach discussed in the interview in which one party to the conflict (the employees) took the initiative to discuss their feelings with the manager, many organizations adopt different strategies to conflict resolution, most of which involve third parties. Similarly, change management can take different strategies and the application of different change management theories, the most commonly applied being Kurt Lewis’ 3-stage change management process.
From the interview, various concerns emerge around leading teams, including working in a culturally diverse environment, dealing with racism and diversity of opinion, and handling personal weaknesses as a leader. Some of these issues require recognition of their inevitability and developing strategies to encourage efficiency and focus on organizational goals among followers. For instance, the DNS mentions that he has experienced several instances of racism in his role as a healthcare practitioner and that it never bothers him much anymore. He, however, fears at times for his sons, who are also doctors. Similarly, he recognizes the value of diversity in the workplace and even appreciates working in a culturally diverse environment. Healthcare is an area in which diversity is of concern due to the role of diversity in promoting culturally competent care among healthcare professionals (White et al., 2019). Recognizing the importance of diversity, thus translates to understanding that teams will ultimately have different individuals with different competencies and backgrounds. Additionally, leading teams from the perspective shared by the DNS entails accepting divergence of opinions to promote innovativeness and patient-centered care. A healthcare environment is characterized by inter-disciplinary activity, and divergence in professionalism and opinions is inevitable; hence any leader should be capable of allowing others to communicate their opinions while also being willing to own up to mistakes and to learn from others.
As a team leader, there are various attributes that help in promoting effectiveness and the realization of team goals. According to Cobb (2012), a team leader should be able to motivate the team regardless of its composition; pursue effective conflict management approaches, to be a problem solver for the team; to maintain discipline among the team, and address non-performance issues in the team. From the responses to various questions in the interview, there is sufficient evidence that the DNS was capable of performing all these roles and satisfying the requirements of effective team leadership. For instance, problem-solving and maintaining discipline is best seen in the manner in which he handled the increase in COVID-19 cases in the organization. Motivation is also seen as a key consideration for the DNS, especially given his argument that he is always willing to put aside his ego and to recognize his own weaknesses where necessary. These attributes reflect qualities of effective team leadership, which should be embodied by every leader in every organization.
Transformational leadership is characterized by a leader’s ability to inspire others, which the interviewed DNS understands. The argument that a transformational leader does not refer followers to ‘how it has always been done, is particularly important to understand as it sets the backdrop based on which transformational leaders can clearly define the objectives they need to achieve and then motivate others to use different approaches to realize those objectives. From the interviewee’s perspective, transformational leadership relates to the combination of strong forethought, clear vision, and communication for the realization of desired goals. A transformational leader also needs to understand those he/she intends to motivate to identify the best strategies that would be appropriate for different groups of people. The DNS further asserts that besides continuously communicating with the followers, a transformational leader needs to make himself/herself vulnerable rather than portraying perfection. The employees also need to see the leader’s readiness to accept their mistakes, if any and to learn from others. In this way, a transformative leadership environment becomes friendly and supportive of growth and innovation by others.
The sentiments on transformational leadership, as shared by the interviewed DNS, correspond to those discussed in many scholarly articles on transformational leadership. According to Liu and Li (2018), for instance, transformational leadership is based on the foundation of motivation. Transformational leadership cannot occur where the leader cannot see potential in the followers and cannot attract their buy-in to his/her ideas. Thus, a transformational leader is capable of imposing his/her vision of the organization in the minds of others and inspiring them to support that mission without giving the impression of inadequacy or incompetence (Liu & Li, 2018). The balance between vision, guidance, and vulnerability, therefore, is quite important for transformational coaching.
Organizational management encompasses a wide variety of concepts and concerns. Understanding one’s leadership style can help in effective decision-making in all instances. Through the interview, various concepts have been explored in relation to leadership, including change and conflict management, emotional competence, and crisis management. Strategies for handling each of these issues are clearly described from a first-hand perspective. Therefore, the interview was instrumental in defining leadership from a healthcare organizational perspective and based on core concepts of leadership.
Alsolami, H. A., Cheng, K. T. G., & Twalh, A. A. M. (2016). Revisiting innovation leadership. Open Journal of Leadership, 5, 31-38. https://www.researchgate.net/publication/303887619_Revisiting_Innovation_Leadership
Baldacchino, D. (2017). Spirituality in the healthcare workplace. Religions, 8(260). www.mdpi.com › pdf
Boyatzis, R. E. (2018). The behavioral level of emotional intelligence and its measurement. Frontiers in Psychology. https://www.frontiersin.org/articles/10.3389/fpsyg.2018.01438/full
Cobb, A. T. (2012). Leading project teams: The basics of project management and team leadership. SAGE Publications, Inc. https://us.sagepub.com/sites/default/files/upm-assets/40262_book_item_40262.pdf
Liu, H., & Li, G. (2018). Linking transformational leadership and knowledge sharing: The mediating roles of perceived team goal commitment and perceived team identification. Frontiers in Psychology. https://www.frontiersin.org/articles/10.3389/fpsyg.2018.01331/full
McNulty, E. J., & Marcus, L. (2020, March 25). Are you leading through the crisis … or managing the response? Harvard Business Review. https://hbr.org/2020/03/are-you-leading-through-the-crisis-or-managing-the-response
Pomare, C., Churruca, K., Long, J. C., Ellis, L. A., & Braithwaite, J. (2019). Organizational change in hospitals: a qualitative case-study of staff perspectives. BMC Health Services Research, 19(840). https://link.springer.com/article/10.1186/s12913-019-4704-y
Tarallo, M. (2018, May 17). The art of servant leadership. SHRM Foundation. https://www.shrm.org/resourcesandtools/hr-topics/organizational-and-employee-development/pages/the-art-of-servant-leadership.aspx
White, J., Plompen, T., Tao, L., Micallef, E., & Haines, T. (2019). What is needed in culturally competent healthcare systems? A qualitative exploration of culturally diverse patients and professional interpreters in an Australian healthcare setting. BMC Public Health, 19(1096). https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7378-9