Los contextos como concreción de identidad cultural

It is clear from this analysis of key leadership theories and models that some concepts are more evidence-based and empirically-tested than others. Table 2 provides a summary of the main leadership models from the literature, outlining research gaps associated with each and highlighting aspects of the models which appear to be of potential relevance to this thesis.

Table 2. Summary of key leadership models and theories with potential research issues and gaps

Model or Theory Key Associated

Literature Research Gaps

Relevance to exploring links between NHS leadership and improvement Trait Theory Innate personality factors mean that leaders are born, not made. ‘Great Man’ and ‘Hero’ leadership.

Bernard 1926; Stodgill 1948, 1974; Mann 1959;

What is the relationship between leadership traits and organisational outcomes?

What are the links between leadership traits and different leadership contexts?

Focus on the individual leader Is personality a factor in leading effective NHS improvement? Skills Approach Focus on the capabilities of leaders : categorised into technical, human and conceptual skills. Leadership outcomes are related to leader capabilities

Katz 1955; Mumford, Zaccaro et al 2000

To what extent are research findings from US Army relevant to other sectors? How are the skills enacted in behavioural terms?

Technical, human and conceptual skills areas are still evident in current leadership frameworks What links are there between the skills and capabilities of NHS leaders and improvement?

Style Theory

Focus on what leaders do. Relationship- centred and task- centred styles (democratic and autocratic)

Katz & Kahn 1951; Hemphill & Coons 1957;

Likert 1961; Blake and Mouton 1964;

Bowers & Seashore 1966

How are leadership styles associated with organisational outcomes? Given the focus on leader actions, how are the styles enacted in behavioural terms?

Are different leadership styles evident amongst NHS improvement leaders?

Model or Theory Key Associated

Literature Research Gaps

Relevance to exploring links between NHS

leadership and improvement Situational Theory

The leader changes style to suit the competence and commitment of subordinates.

Hersey & Blanchard 1969;

How reliable and valid are the concepts? How does the theory apply to leading groups? How does the theory take account of different contexts?

What are the links between the theory and organisational

outcomes?

How might the differing nature of employees involved in NHS improvement affect the leadership required?

Contingency Theory

The leader changes style depending on the member relations, task structure and positional power held.

Fiedler 1964; 1967 Fiedler et al 1984

Why are certain leadership styles more effective in certain situations?

Are different leadership styles appropriate for different types of improvement work?

Path-Goal Theory

The leader adapts their style to optimise the motivation of their subordinate.

Evans 1970; House 1971

How do the leadership styles directly affect staff motivation?

To what extent is the motivation of staff, and appropriate leadership styles to support this, a key factor in leading NHS improvement?

Leader-Member Exchange (LMX) Theory

Centres on the quality of the relationship between leader and follower

Danserau, Graen & Haga 1975; Graen & Cashman 1975

How are high quality relationships between leaders and followers developed?

How do these

relationships manifest themselves and what are the behavioural

indicators?

Is the quality of

relationships between staff and leaders of particular significance to leading NHS service improvement? Transactional & Transformational Leadership Transactional leader maintaining order and control ; transformational leader as an inspirational change agent Burns 1978 Bass 1985 Bennis & Nanus 1985

Kouzes & Posner 1987

To what extent do transactional or transformational leadership enable the conditions for improvement and innovation?

What are the respective contributions of transactional and transformational leadership in achieving NHS service improvement?

Model or Theory Key Associated

Literature Research Gaps

Relevance to exploring links between NHS

leadership and improvement Servant & Ethical

Leadership

Providing a service to others; caring for and nurturing followers, underpinned by social responsibility

Greenleaf 1970 What is the evidence of the impact of servant or ethical leadership?

Are either of these models evident in leading NHS improvement? Shared Leadership Includes dispersed; distributed; and transmission concepts. Leadership at many levels and can be shared between people.

Bryman 1996 Gronn 2002 Buchanan 2007

What is the evidence that distributed

leadership is linked with performance?

Current study into distributed leadership in the NHS (Buchanan 2008)

How might shared leadership be linked to NHS improvement?

Leadership for Complexity

Including adaptive and integrative leadership; intended to address ‘wicked’ issues, typically through partnership; acknowledgement that there is no clear answer; ill-defined in behavioural terms

Heifetz & Laurie 1997

Grint 2005

Plamping et al 2010

Beyond the concepts, what is leadership for complexity in

behavioural or practical terms?

What impact does it have on outcomes?

What, if any, role do these models play in leading NHS service improvement?

Source: Developed by the researcher

2.3

A Theoretical Overview: The Improvement Literature

The concept of ‘improvement’ is extremely broad, drawing on and combining with further wide-ranging concepts, such as those of quality and safety. For the purposes of this review, the wider term of ‘improvement’ will be used, to encompass aspects which are more specifically described in the literature as quality improvement, safety improvement or other strands of improvement work.

Much of the literature concerning these areas provides descriptions, critiques and evaluations of improvement methodologies, developed as a set of approaches, tools, techniques and processes to support attempts to bring about improvement in the workplace. Most of these are industrial in origin, and have latterly been translated into the arena of healthcare and clinical quality improvement. Boaden et al (2008) note that in terms of healthcare improvement, there has been a need to consider both clinical and managerial aspects of the work, and hence healthcare improvement has drawn on both clinical and industrial improvement approaches to bring about developments.

The purpose of this section is not to describe or analyse the multitude of improvement approaches in their own right. Rather, it is to consider those improvement approaches which pertain to the improvement of healthcare specifically, and to consider what is known about the role of leadership within these. For the purposes of the research questions underpinning this study, the focus of this section is specifically to explore what the improvement literature tells us about any links or relationships between improvement and leadership. According to Lakshman (2006), ‘the role of leadership in managing quality is relatively unaddressed in the leadership literature.’ (p.41). This section considers the extent to which the converse is true: how far does the improvement literature address the role of leadership?

Along with the analysis of the leadership literature in Section 2.2, this section is intended to frame the overall study, and provide a starting point from which to further investigate how leadership is associated with improving healthcare. A brief overview of each main improvement approach is provided, followed by a short discussion of the role of leadership within the approach.