CME2 - STRATEGIC MANAGEMENT AND LEADERSHIP FOR HEALTH PROFESSIONALS
|Year : 2014 | Volume
| Issue : 2 | Page : 82-86
Making sense of theories of leadership for capacity building
Sanjiv Kumar1, Vivek S Adhish2, Nandan Deoki3
1 Leadership and Global Health, International Clinical Epidemiology Network Institute of Global Health, New Delhi, India
2 Department of Community Health Administration, National Institute of Health and Family Welfare, New Delhi, India
3 UP Secondary Education Services Selection Board, Allahabad, Uttar Pradesh, India
|Date of Submission||04-Apr-2014|
|Date of Acceptance||10-Apr-2014|
|Date of Web Publication||19-May-2014|
Dr. Sanjiv Kumar
Professor Global Health and Leadership, INCLEN Institute of Global Health, F-1/5, 2nd Floor, Okhla Industrial Area, Phase 1, New Delhi-110020
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kumar S, Adhish VS, Deoki N. Making sense of theories of leadership for capacity building. Indian J Community Med 2014;39:82-6
| Introduction|| |
Leadership is defined as an ability to influence a group toward the achievement of goals.  There has been an explosion of literature on leadership. In 1999 alone, more than 2,000 books on leadership were published;  some of them even repackaging Moses and Shakespeare as leadership gurus.  Even though so much has been written about leadership, there is no consensus on the right mix of qualities of a leader. It is dangerous to overdefine the capabilities a good leader should have.  Adair was probably the first to demonstrate that leadership is a trainable and transferable skill, rather than being an exclusively inborn ability.  The best aspect of leadership is that we all can learn and develop leadership skills. Each one of us has some capacity for leadership though some of us are born with traits that make it easier to become leaders, but all of us can develop leadership skills. If you have the desire and the will power, you can become an effective leader.  David Thomas believes leaders are 90% made, may be even more.  It is common knowledge that good leadership is essential to improve productivity of an organization. A study by Barling et al.,  (1996) found a significant correlation between leadership training and attitudinal and financial outcome. The challenge lies in choosing most appropriate concepts of leadership to apply in various situations to achieve the organization's goals.
Historically, learning of leadership has passed through three distinct phases. The first phase is marked by reading about great leaders and trying to imitate their style. This phase lasted a long time and ended in the last century when leadership training industry grew rapidly replacing autobiographies by teaching people skills of leading. The third phase characterized by explosion of readings on leadership and promotion of leadership as a set of skills that can be acquired.  This article reviews the literature on concepts, theories, and models of leadership and proposes a simple model to capture different concepts of leadership to train health professionals in leadership skills.
Concepts and theories of leadership
There are numerous models and theories of leadership in the literature. Google search for leadership model produced about 16.1 million sites in 0.36 seconds. Leadership cannot be described simply in terms of the behavior, rather leadership involves collaborative relationship that leads to collective action grounded in the shared values of people working together to effect positive change.  Leaders establish direction by developing a vision, then align people by communicating this vision and inspiring them to overcome hurdles. Effective leadership may be a result of exhibiting the right behaviors at the right moment. 
Leader cannot have, and should not try to develop, all possible qualities seen among other leaders. Ancona et al.,  (2007) say, "It's time to end the myth of the complete leader: the flawless person at the top who's got it all figured out. In fact, the sooner leaders stop trying to be all things to all people, the better off their organizations will be." The leader holds fast to his basic values to set example for others.  He takes ultimate responsibility rather than consider his role as a privilege. Another essential element is that he earns trust. Effective leadership is not based on being clever; it is based primarily on being consistent. Leaders make their organization a high-performing organization that continuously produces outstanding results with the highest level of human commitment to success.
We can apply the ancient Chinese author Sun Tzu's concepts elaborated in the context of war to the health sector. According to him the leaders should fully know the tactics and operational methods (the basic concepts of public health and strategic management in the health set up), the terrain (health sector's and organization's internal environment and external factors influencing health and health care delivery), the enemy (in health context the determinants of health and disease, competing priorities within health and its determinants), weapons (the resources at hand and at call within and outside the organization), logistics (to deploy and use available resources effectively), information system (to keep a close watch on what is happening within and outside the organization), and soldiers (the staff and their morale) (adapted from Cantrell R L, 2003  ).
The ability to anticipate and deal with change sets good leaders apart from others. As the pace of change accelerates, there is naturally a greater need for effective leadership.  "Everyone of us has experiences, but we aren't all open to learning from those experiences in the same way."  One characteristic most leaders have in common is the capacity to learn and change throughout their lives."  As a health manager moves into a leadership role, his network must orient itself externally and toward the future to mobilize other sectors for social mobilization and addressing social determinants.  Good leaders tend to create their opportunities by 'selling' new ideas and winning support for them from those they seek to lead. They display strong transformational skills. 
The leadership theories that have emerged in the 20 th century can be grouped in five broad approaches summarized in [Table 1].  The earlier approaches included great man leadership theories that dominated prior to 1900 followed by theories that included trait, behavioral, power-influence, situational, and integrative aspects. Subsequently, theorists started to place strong emphasis on situational and environmental factors. Finally, theories of integration have developed around persons and situations, psychoanalysis, role attainment, change, goals, and contingencies. 
|Table 1: Summary of types of leadership models broadly grouped in five categories|
Click here to view
Jim Collins five levels of leadership, a suitable model for health professionals
There are numerous models and theories of leadership. It is important to pick up one that incorporates main features of leadership. The recent model of Jim Collins five levels of leadership based on a study of around 1500 most successful companies offers a very good model for leadership development among health professionals. The five levels are simple, clear, and can be easily applied to understand leadership competencies required among health professionals. The technical skills of level one are core competencies for health professionals and required at every level of leadership hierarchy. The leadership and management skills are required as technical competencies alone are not adequate to lead a team or higher level positions. In Jim Collins model, one level of leadership does not exclude the features of other levels. A health professional at higher level still needs to work on updating lower level skills such as technical competencies and team building. Below mentioned is how the five levels of this model can be applied to health professionals.
Level 1: Leader is a highly capable individual with appropriate technical qualification. He/She has the talent, knowledge, skills, and good work habits. He/She is competent to perform all the functions required for his/her job. To remain at this level of leadership hierarchy, he/she needs to continue to update his/her knowledge and skills through continued education.
Level 2: The health professional performs not only his/her tasks but contributes to the accomplishment of the team tasks. He/She uses his/her individual skills and capabilities to the achievement of group objectives. He/She has skills to work effectively with others in group settings. This leader is not only a technically highly capable individual who achieves his/her own tasks but also actively engages in the work of his team to ensure achievement of the team goals.
Level 3: Health professional becomes a competent manager, having acquired skills to organize people and resources toward the effective and efficient pursuit of set objectives. He/She is a competent professional and a team player who has become an effective health manager clear about the objectives and keeps the focus of human and other resources on achieving the objectives.
Level 4: At this level the competent manager of level 3 becomes an effective leader who catalyzes commitment of his organization to vigorous pursuit of a clear and compelling vision, stimulating higher performance standards. These leaders lead the organization well and leverage networks both inside and outside the organization to achieve results and adapt to changing environment successfully. At this level the predominant role is of a leader though certain managerial actions may be required depending on the situation. The orientation of the person reaching this level needs to change to look at the bigger picture both within and outside the health sector environment.
Level 5: According to Jim Collins Level 5, leaders are the most successful leaders and very few leaders operate at this level. These leaders embody all levels of the pyramid. These leaders build great organizations and leave behind capable individuals whom they have groomed and processes that sustain the great work even after the leader has left. The level 5 leadership produces excellent and lasting results by building great organizations and act with respect, care, and fairness for the wellbeing of all involved. 
Three domain leadership model for developing leadership skills
It is important to have a simple model to structure training and developing skills for effective leadership. The author has used this simple model [Figure 1] to capture the three domains of leadership for managing self for leadership domain in the center, managing and leading the team and the organization in the next domain, and managing, leading, and adapting to the internal and external environment in the third domain. This model provides a good framework for structuring training to develop leadership skills. It captures the leadership skills mentioned in Jim Collins' and other models. The three domains of the model represent three dimensions of leadership that are as follows:
Domain 1: Managing self for leadership domain
The self-management skills are essential for an effective leader. These include a mix of values and skills such as vision, charisma, integrity, self-awareness, communication skills, anticipating, managing, and adapting to change, time management, social and emotional competencies, and keenness to acquire and learn new things including technical areas of expertise. This predominantly makes him/her a good leader at level 1 of Jim Collins model and enhances his/her capabilities to move up the ladder of leadership. The leader should be a model of behavior, skills, and values he/she wants to inculcate in the team and staff in the organization.
Domain 2: Leading and managing the team and organization domain
This domain includes skills for developing individuals in the team and the organization to effectively work together for achievement of team and organizational goals. These skills move up from level 1 to higher levels of leadership of Jim Collins model. The leader enables the organization by developing individuals in his/her team and the organization. He/She builds, strengthens, and facilitates team spirit and work. Through his/her traits, skills, and attributes, he/she helps his/her team to execute his/her vision. He/She does this by developing skills in each individual in the organization through putting the right person in the right job, motivating, facilitating learning and skill development in the staff through training, coaching, and mentoring. He/She is strategic in his/her approach and aligns human and other resources to achieve the organizational goals to fulfill the vision. He/She is in constant touch with his/her employees through his/her formal and informal networks and keeps changing his/her approach based on what he/she learns through his/her network to maximize efforts to achieve organizational objectives. He/she transforms the individuals in the organization and motivates them to get the best out of them and channels every ones efforts so that they work in synergy to get the best results.
Domain 3: Leading, managing, and adapting to the external environment domain
The leader keeps an eye on what is going on outside the organization, how things in the sector and outside the sector are changing, and what are the implications for the organization. These skills are important even at level 1 but are very important for leaders at levels 4 and 5 of Jim Collins hierarchy of leadership. He/she keeps an eye on how the diseases pattern, trends, and projections and how factors within and outside health sector are contributing to this change. A good leader is in constant touch with the external environment within and outside the health sector that affects his/her organization. He/she keeps an eye on how the availability of technology and their application in health sector is changing or going to change the way health institutions function and are managed. The newer health interventions are changing management of health problems. He/she plans ahead and prepares his/her organization to benefit from these developments. He/she also keeps in mind how his/her organization contributes to benefit the society. No organization exists in vacuum, and its existence and growth is linked to the society, its norms and values. He/she actively engages himself and his/her employees in activities to benefit the society. The leader develops and uses a strong network of formal and informal contacts beyond the organization/team he/she leads to get a regular feedback on how the organization he/she leads is perceived.
Interaction between these three domains
The three domains of leadership capacity development in the model are very helpful in identifying skills to develop. However, these are not watertight compartments and there is a close relationship and overlap in these three domains. This is reflected in the double arrows in the model. The skills of the leader help him/her in learning from the changing environment in health and related sectors and develop and manage individuals and teams within the organization to adapt to that change. The leader also needs to review his/her personal skills and way of working, identify gaps, and acquire new skills and/or adopt new ways of working.
| Conclusion|| |
The literature has described a large number of successful leaders and their qualities; one can emulate and learn from them. But no one can just ape another leader. So the challenge facing prospective leaders is for them to be themselves but with more skills.  The foundation of effective leadership is thinking through the organization's mission, defining it, and establishing it, clearly and visibly.  Organizations are increasingly searching for managers who can exhibit transformational leadership qualities.  Most commonly listed leadership characteristics identified based on responses from more than 10,000 leaders in US listed honesty, competence, being forward-looking, inspiring, and credible. 
The Jim Collins' hierarchy of five levels of leadership offers a good model to apply to leadership among health professionals. The three domains of leadership capacity development model [Figure 1] incorporate the key skills of a good leader. This simple model provides a good framework for training to develop leadership skills and has been used by the author for training of mid and senior level health professionals. It looks at three domains of leadership that are (i) self-management skills required for a good leader, (ii) team and organizational management and leadership skills to lead the organization, and (iii) the skills required to network and influence outside the organization she/he leads, i.e. industry/sector the organization is part of an overall external and internal environment to lead the organization one step ahead of the change and into the future and how he/she makes his/her team achieve the organizational goals and contributes to benefit the society in the process. He/She develops and uses his/her formal and informal networks to get information and influences things within and outside the organization. A good leadership is needed in health set up to build a clear vision and steer the team by providing enabling environment to reach the vision and contribute to the overall good of the society.
| References|| |
|1.||Robbins SP. Organization Behavior. 10 th ed. New Jersey: Prentice Hall; 2003. |
|2.||Goffee R, Jones G. as quoted in Higgs M (2003) How to make sense of leadership in 21st Century Leadership and Organization. Dev J 2000;24:273-84. |
|3.||Goffee R, Jones G. Why Should Anyone be Lead by You? Harvard Business Review; 2000. |
|4.||Morrison M. ′Is diverse leadership observable? Qualitative orientations to leadership-in-action. Oxford: The Oxford Ethnography Conference, St. Hilda′s; 2007 |
|5.||Ancona D, Malone TW, Orlikowsky WJ, Senge PM. In praise of the incomplete leader. Harvard Business Review; 2007. |
|6.||Barling J, Weber T, Kelloway EK. Effects of transformational leadership training on attitudinal and financial outcomes: A field experiment. J Appl Psychol 1996;81:827-32. |
|7.||Blagg D, Young S. What Makes a Good Leader. HBS Bulletin. Available from: http://www.alumni.hbs.edu/bulletin/2001/february/leader.html [Last accessed on 2014 Apr 1]. |
|8.||Kellerman B. "Shooting an Elephant" - or Why Be Leadership Literate" in Leadership Excellence. 2011. |
|9.||House and Aditya 1997 as quoted in Gill R; 2006. p. 29. |
|10.||Drucker PF. The Essential Drucker. New York: Harper Collins Publishers; 2003. |
|11.||Cantrell RL. Understanding Sun Tzu on the Art of War. Centre for Advantage. Arlington; 2003. |
|12.||Kottler JP. In: Blagg D, Young S, editor. What Makes a Good Leader. HBS Bulletin. Available from: http://www.alumni.hbs.edu/bulletin/2001/february/leader.html [Last accessed on 2014 Apr 1]. |
|13.||Blagg D, Young S. Available from: http://www.alumni.hbs.edu/stories/Pages/story-bulletin.aspx?num=3059 [Last accessed on 2014 Mar 15]. |
|14.||Ibarra H, Hunter M. How Leaders Create and Use Networks. Harvard Business Review [Last accessed on 2007 Feb 15]. |
|15.||MacMillan H, Tampoe M. Strategic Management: Process, Content and Implementation. Oxford: Oxford University Press; 2000. |
|16.||Available from: http://www.businessballs.com/leadership-theories.htm#management-leadership-differences-grid [Last accessed on 2014 Mar 7]. |
|17.||Covey SP. The 8th Habit: From Effectiveness to Greatness. UK: Simon & Schuster; 2004. |
|18.||Wortman CB, Loftus EF. Psychology. New York: McGraw Hill; 1992. p. 385-418. |
|19.||Blake R, Mouton J. The Managerial Grid III: The Key to Leadership Excellence. Houston: Gulf Publishing Co.; 1985. |
|20.||Hersey P, Blanchard KH. Management of Organizational Behavior: Utilizing Human Resources. 3 rd ed. New Jersey: Prentice Hall; 1977. |
|21.||Lewin K, Lippit R, White RK. Patterns of aggressive behavior in experimentally created social climates. J Soc Psychol 1939;10:271-301. |
|22.||Tannenbaum R, Schmidt WH. How to Choose a Leadership pattern. Harvard Business Review; 1958. p. 95-102. |
|23.||Fiedler F. Theory of Leadership Effectiveness. New York: McGraw-Hill; 1967. |
|24.||House RJ, Mitchell TR. Path-goal theory of leadership. J Contemp Bus 1974;3:1-97. |
|25.||House RJ. Path-goal theory of leadership: Lessons, legacy, and a reformulated theory. Leadersh Q 1996;7:323-52. |
|26.||Bolman LG, Deal TE. Reframing organizations: Artistry, choice, and leadership. San Francisco: Calif, Jossey-Bass; 2008. |
|27.||Adair J. Effective Leadership Development. 2005. |
|28.||Kouzes, Posner. Leadership Challenge. 3 rd ed. Jossey-Bass; 2002. |
|29.||Scouller J. The three levels of leadership: How to develop your leadership presence, knowhow and skill. 2011. |
|30.||Blanchard K. Leading at a Higher Level Blanchard on How to be a High Performing Leader. Glasgow: Pearson Education, Prentice Hall Financial Times; 2007. p. 22. |