Masters in Public Health

Leadership and leading

through change

Jo Nichols

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 Activities for today

11am-2pm Lecture

4-6pm Assignment guidance

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 Outcomes from today

• Be familiar with a range of leadership

approaches

• Better understand your own leadership

abilities

• Understand how change is managed and

how it impacts on your role

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 What we will cover

Leadership theories Context for change

Contemporary Healthcare
leadership Leadership Model

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 What is leadership?

“Leadership is the process of

influencing the activities of an
organized group in its efforts
toward goal setting and goal
achievement”
Stogdill, 1950 p3 cited in Huczynski and Buchanan 2001 p702

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6 Western, S (2019) Leadership. Sage
 Great Man Theory
• Assumptions
– Leaders are born and not made
– Great Leaders will arise when there is great need

• Background
– Early research based on study of existing great leaders, often
from aristocracy, few from lower classes. Therefore there was
a belief that leadership had something to do with breeding
– Great Man theory linked to the mythic domain - in times of
need, a Great Man would arise, almost by magic. Easy to
verify, with people such as Eisenhower and Churchill, Holy
figures

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 Trait Theory

• Assumptions
– People born with inherited traits
– Some traits are particularly suited to leadership
– Good leaders have the right (or sufficient)
combination of traits

• Background
– Early research on leadership was based on the psychological focus
of the day - people having inherited characteristics or traits
– Attention was put on discovering these traits, often studying
successful leaders
– Leadership no longer a right of birth!

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 Behavioural theories

• Assumptions
– People can learn to emulate and develop successful leadership
behaviours
– This means you can ‘escape’ your inherent abilities/traits etc. and
develop new ones

– Led to growth of leadership development, rather than psychometric

testing
– Can look at successful and unsuccessful leaders
– What might be a problem with this though?

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 Style theories

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 Situational Leadership

• Assumptions
- Best action of the leader depends on a range of
situational factors

• Style
- Factors that affect situational decisions include motivation and
capability of followers; relationship between followers and the leader

- Leaders' perception of the follower and the situation will affect

what they do rather than the truth of the situation

- The leader's perception of themselves and other factors such as

stress and mood will also modify the leaders' behaviour

Must know themselves

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 Transactional Leadership
Assumptions
• People are motivated by reward and punishment
• Social systems work best with a clear chain of
command
• When people have agreed to do a job, a part of the
deal is that they cede all authority to their manager
• The prime purpose of a subordinate is to do what
their manager tells them to do
• The use of leadership/management skills to mould
and develop a workforce to pursue the purpose of
the organization

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 Transformational Leadership
Assumptions
• People will follow a person who inspires them
• A person with vision and passion can achieve
great things
• The way to get things done is by injecting
enthusiasm and energy

• Tacit promise to followers that they

will be transformed in some way,
perhaps to be more like this amazing
leader

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 Transformational Leadership

• Passion and confidence can easily be mistaken for

truth and reality. Just because someone believes
they are right, it does not mean they are right.
• Transformational leaders can also lead the charge
right over the cliff and into a bottomless chasm!!
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 Transformational Leadership

• Relentless energy for change can wear people

out!

• Transformational Leaders see the big picture, but

not the details, where the devil often lurks

• When the organization does not need

transforming and people are happy as they are,
will Transformational leaders become frustrated?

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 10 Leadership Styles in 5 Minutes!

http://www.youtube.com/watch?v=XKUPDUDOBVo

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 Newer ideas of leadership

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 Post-Heroic Leadership
for Turbulent Times

• The turbulence and uncertainty of the

environment in which most organisations
are operating is a significant influence on
leadership styles

• Post-heroic leader’s major characteristic is

humility

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 Post-heroic leadership
Not all about the leader
• Distributed leadership (Alimo-Metcalfe)
• Virtual teams (Duarte and Snyder)
• Leaderful organisations (Raelin)

• Communities of practice
• Movements for change

• Everyone has leadership in their role – leading care

with patients – leading opinion amongst peers –
leading innovation in practice – leading in
accountability

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 ‘Post-heroic’ leadership

• Communities of practice involve mentoring of

incoming practitioners by experienced others,
and the sharing and passing on of knowledge
between peers

• Movements for change can have no visible

leadership but often spring from catalyst events,
magnified and gaining support through social
media (think of the @metoo movement,
@blacklivesmatter etc.)

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 No more heroic individuals

• Need for effective

teams greater than
need for heroic
individuals

• Everyone’s
responsibility

• This approach may be

appealing to you

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 Authentic leadership

• Authentic leadership (Bhindi and Duignan1997)

• Concerned with credibility and integrity

• George (2003)
• Concerned with serving others
• Values
• Moral perspective

• Congruent leadership (Stanley 2019)

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 5 foundations of authentic
leadership

• Purposeful
• Value centred
• Relational
• Self-disciplined
• Compassionate

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 Compassionate leadership

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 So, compassionate and
inclusive leadership -
that’s all very well but
what about…………….

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 The appeal of Narcissistic
leaders

• Daring
• Break new ground
• Disruptive in a positive way
• Personified with their organisation or idea
• Great at PR and media manipulation
• Charmers, use rhetoric to have mass appeal

26 (Maccaby in Rosenbach and Taylor 2006)

 The inevitable downside…

“They nurture grand schemes and

harbor the illusion that only
circumstances or enemies block
their success”(p243)

“…flagrant risk taking can lead to

catastrophe” (p248)

27 (Rosenbach and Taylor 2006)

 The inevitable downside…

• Emotionally isolated
• Quick to enrage if they perceive a
threat (and they often do!)
• Overly sensitive to criticism
• Tend to grandiosity with any
achievement
• Assume invincibility
• Do not listen
• Do not learn from others or from
mistakes
• Lack empathy
• Reactive

28 (Maccaby in Rosenbach and Taylor 2006)

 The Context and Nature of
Change
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 So what is it about change?

“Faced with the choice between

changing one’s mind and proving

that there is no need to do so,

almost everyone gets busy on the

proof!”

30 JK Galbraith in Bridges, W. (1991) Managing Transitions: Making the Most of

Change, Addison-Wesley NY
 The Level of Change

• Individual
• Group
• Organisational
• Society

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 Types of Change

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Many, many models
 The Stages of Change

Essentially most models suggest there are

3 stages to a planned change:

• preparing for the change (diagnosis)

• making the change happen (planning
and implementing)
• then making the change stick
(sustaining)

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 Lewin’s Change Process

The Change Process

Source Lewin (1951) Field Theory in Social Sciences. New York. Harper Row

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 A Model for Implementation - Making change happen …

Vision & values + Skills + Incentives + Resources + Action Plan = Change

Skills + Incentives + Resources + Action Plan = Confusion

Vision & values + Incentives + Resources + Action Plan = Anxiety

Vision & values + Skills + Resources + Action Plan = Resistance

Vision & values + Skills + Incentives + Action Plan = Frustration

Vision & values + Skills + Incentives + Resources = Treadmill

Source: Sarah Fraser

 Crystal ball gazing…

What sorts of change do you think are on

the horizon for your profession?

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 Factors that help change

• Training and Involvement

• Behaviours
• Senior leaders
• Clinical leaders
• Fit with goals and culture
• Infrastructure
• Creditability of benefits/evidence
• Adaptability
• Monitoring of progress

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 Becoming a change radical 

• Do we really ‘manage’ change?

• Do we ‘lead’ change?
• How has this changed in recent years?

http://www.theedge.nhsiq.nhs.uk/school/ http://fabnhsstuff.net/

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 Over to you!............

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 The Healthcare Leadership Model

41 https://www.leadershipacademy.nhs.uk/resources/healthcare-leadership-model/
 The Healthcare Leadership Model –
9 Dimensions

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 Select references
• Appelbaum S, Habashy S, Malo J , Shafiq H, (2012) "Back to the future: revisiting Kotter's 1996
change model", Journal of Management Development, Vol. 31 No 8, pp.764 - 782
• Coch, L. and French, J.R.P. (1948). Overcoming resistance to change, Human relations, 1, 512-532
• Dunphy, D. and Stace, D. (1993) ‘The Strategic Management of Corporate Change’ Human Relations
45, 8, 917-918.
• George, B. (2003) Authentic leadership: Rediscovering the secrets to creating lasting value. Jossey-
Bass.
• Gill, R. (2011) Theory and Practice of Leadership. 2nd Edition. Sage

• Gopee, N. and Galloway, J. (2017) Leadership and Management in Healthcare. Sage

• Huczynski, A and Buchanan, D. (2016) Organisational Behaviour. Pearson

• Maccoby, M. (1999) Narcissistic Leaders: The Incredible Pros, the Inevitable Cons, Harvard Business
Review. November 1999
• Martin, S (2006) Public service Improvement: Policies, progress and prospects. London: Routledge

• Mullins, L. J. (2016) Management and organisational behaviour. Pearson

• Northouse, P. (2018) Leadership Theory and Practice. 8th edition. London: Sage. (NB: earlier
editions still useful)
• Rees, G. and French, R. (2010). Leading. Managing and Developing People. 3rd Edition. London.
Chartered Institute of Personnel and Development.
• Rosenbach, W. and Taylor, L. (2006) Contemporary Issues in Leadership. Westview.
• Stogdill, R.M. (1974). Handbook of leadership: A survey of the literature, New York: Free Press
• Tannenbaum, A.S. and Schmitt, W.H. (1958). How to choose a leadership pattern. Harvard Business
Review, 36, March-April, 95-101
52 • Western, S (2019) Leadership. Sage