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Healthcare/ Leadership

CHAPTER 4 Chronology of Leadership Study and Practice

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One’s feelings waste themselves in use of words; they ought all to be distilled into actions and into actions which bring results.

Florence Nightingale

This chapter provides a historical summary and overview of leadership theory as it has evolved over the ages. Major theories and models are presented. Early documents (2300 B.C.) outlining leadership principles and definitions (400 B.C.) are addressed, with the discussion then proceeding through the contemporary and accepted models of the twentieth and twenty-first centuries. This chapter presents the theories and models in the original light that the creating authors intended. Strengths and weaknesses of each theory, as well as applications and strategies for use, are integrated into each theoretical overview.

LEARNING OBJECTIVES

· 1. Describe the progression of leadership thought as portrayed in theories and models from the “great man” and trait phase, to the behavioral phase, to the situational or contingency phase.

· 2. Distinguish constructs of a trait theory or model, a behavioral theory or model, and a situational or contingency theory or model of leadership, and interpret those constructs’ value in the present day.

· 3. Apply a behavioral theory or model and a situational or contingency theory or model of leadership, and demonstrate the application in an example based on a definition of leadership.

· 4. Compare and contrast, through the use of illustrative diagrams, two or more behavioral or situational/contingency theories or models of leadership.

· 5. From the progression of leadership thought, design, create, and explain a personal leadership model applicable to leading health organizations today.

· 6. Appraise and relate constructs and variables from the progression of leadership thought to your personal leadership model for leading health organizations today.

INTRODUCTION

The study of historical leadership is important for both graduate students and early careerists for several reasons. First, as with the study of any historical theory grounded in the literature, it is important to know where the study of the discipline began so that leaders do not repeat mistakes of the past or spend effort on advocating philosophies no longer considered relevant in the study of leadership. Second, early careerists will recognize opportunities and best practices discovered by predecessors that, if applied properly, can aid them in developing competencies in their own leadership practice. Third, leadership theories and models have built upon one another over time; contemporary leadership theories, models, and practices have a lineage stretching back for decades—if not centuries—that have paved the way and informed modern leadership thought.

These are the most salient reasons to study the history of leadership thought. In reality, hours-long discussions could be sustained pondering many other reasons to explore the history of the discipline. You can learn from the past and build upon the work and thinking of others to develop your leadership plan and model for your career in the health industry. For practical purposes, better-known theories and models are presented in this chapter; a thorough discussion of leadership theories and models could easily run to thousands of pages of text.

Which theories and models and which constructs and variables form the basis for your leadership model? Read this chapter critically not only to learn about leadership theories and models, but also to form the base of your leadership plan/model. This is not “just history,” but a focused exploration of leadership history through theory and models so you can learn from history and use it to your advantage. How will your career look if you are a better leader than anyone else? How will it look if you are one of a hundred or a thousand with similar leadership capabilities? Build your leadership plan to lead people and manage resources.

The progression of leadership thought is a constructivist approach over time; that is, early theories and models form the foundations or stepping stones for the next theories or models proposed. As you read about the theories and models, list the constructs and variables associated with each theory or model under the various phases of leadership thought and begin to identify which constructs and approaches are salient to health leadership in today’s environment. As you study the leadership progression of thought and research, think about which theories and models are descriptive, prescriptive, or both. Ultimately, you should begin to identify leadership constructs and approaches that resonate with your own philosophy, thereby enabling you to build a preliminary personal leadership model that you can utilize in your career.

There are three distinct phases of leadership thought: (1) “great man” and trait theories and models, (2) behavioral theories and models, and (3) situational or contingency theories and models ( Table 4-1 ). A fourth phase may now be in an early stage of development; this potential phase incorporates organizational culture into situational leadership practice.

Some theories and models from earlier phases did overlap somewhat with part of another phase of leadership thought. Nevertheless, in general, the theories and models presented in this chapter can be classified into a specific phase based on the constructs and variables they incorporate rather than the chronological time period in which they emerged. When leaders’ traits—for example, height or eye color—are utilized to distinguish them or measure success or select another leader, traits are the overriding factor of the theory or model. Likewise, when an individual “great” leader, such as Alexander the Great or George Washington, is identified and characterized for purposes of measuring success, identifying another leader, or role modeling, the basis of the theory or model is considered a “great man” phase approach. Upon reflection, great man and trait theories and models are very similar and, therefore, tend to be grouped together. Behavioral theories are behavior or action based. In other words, successful leaders perform some action or behavior or a set of actions or behaviors, such as showing concern for people by rounding (i.e., walking around the workplace talking with subordinates purposefully). Situational (or contingency) theories and models incorporate the context or situation or environment into the leadership approach to identify avenues for success that can be attributed to the leader. Situational leadership requires leaders to be flexible, and to build and develop the competencies, knowledge, skills, and abilities (especially situational assessment) needed to adapt styles and practices to the current situation. The “toolbox” of leadership—that is, the capability to use several styles, practices, or “tools”—is most important in situational leadership theories and models.

Table 4-1 Progression of Leadership Thought by Phase

“Great Man” and Trait Phase (Circa 450 B.C.–1940s)

Behavioral Phase (1940s–1960s)

Situational or Contingency Phase (1970s–Present)

Attempted to determine which specific traits make a person an effective leader. Great leaders are the focus of trait identification.

Attempted to determine which particular behaviors and styles leaders use to cause others to follow them. Which behaviors and styles were successful was a focus of the theories.

Attempts to explain effective leadership within the context of the larger work situation and environment where the leader adapts styles, strategies, and applications to best fit the situation or by selecting a leader who best fits the situation based on the leader’s style and strategies.

GREAT MAN AND TRAIT LEADERSHIP PHASE

Great man and trait theories and models concentrated on individual leaders who were considered “great,” with those leaders’ characteristics or traits being identified as reasons for their success. Other models focused simply on traits without identifying a great man. “Great women” were also identified, such as Joan of Arc, but to a lesser degree due to social norms and cultures that prevailed prior to the 1900s. Many “great leaders”—both women and men—could serve as the focus of a great man theory or model. The cultural norm through the early twentieth century was encapsulated by Dowd in 1936, who argued that there is no such thing as leadership by the masses. According to his view, the individuals in every society possess different degrees of intelligence, energy, and moral force, and in whatever direction the masses may be influenced to go, they are always led by the superior few. 1

Although pure trait theory has fell into obsolescence, traits of leadership are still very important to the subject of leadership. 2 Based more heavily on description, these theories and models propose emulation of what great leaders do and which traits they possess; prescription is indirect and “universal,” in that situational context and behavior adaption are not incorporated into this genre of leadership thought. Some of the more accepted (for their time) theories and models of this phase are presented here.

Xenophon: An Early Leader Theory (400 B.C.)

As early as 400 B.C., Xenophon ( Figure 4-1 ) first defined leadership and its impact on organizations; later, Bennis stated the converse notion—namely, that the most important (and underlying) issue is lack of leadership. 3 Today, leaders in a variety of organizations must understand the role and importance of effective leadership, leadership development, and succession planning in achieving organizational success. Unfortunately, leadership and leadership development do not confine themselves to a single checklist, comprehensive model, or flowchart. Xenophon wrote Anabasis, which served as a guide to Alexander the Great during his conquests. Restated in modern terms, Xenophon’s key idea was that leaders guide their people (their army) to success by demonstrating courage and modeling “leadership.” A key characteristic of a leader, from Xenophon’s perspective, was horsemanship; being a great horseman was critical to role-modeling leadership. In the warfare of the time, horses were essential, and mastery of horsemanship was a valuable leader attribute.

FIGURE 4-1 Xenophon.

Photo courtesy of MyOliveTrees [ www.myolivetrees.com ]

FIGURE 4-2 Niccolo Machiavelli.

Photo courtesy of Santiago Soto Borreiros

Xenophon’s writings included On the Cavalry Commander, 4 which described the successful military leader. The strength of this body of work was its focus on military leadership and its value as a unique source of wisdom for future leaders such as Alexander the Great. Weaknesses were its focus on characteristics and skills indirectly linked to subordinates’ performance or motivation.

Machiavelli: Narcissist Theory (1530)

Although leadership has been discussed from the earliest times, one of the first formal documents written about leadership and organizational structure was Niccolo Machiavelli’s The Prince (1527). Machiavelli ( Figure 4-2 ) suggested that the qualities of a good leader were to be malevolent and feared. The major theme of Machiavelli’s work was “The end justifies the means.” Although behavioral discussions are presented in Machiavelli’s work, the overtones of trait and great man approaches are clear throughout his book. At the same time, the lack of consideration of consequences and the inherent immorality of his strategies should be apparent. Strengths of this work are its pragmatic approach, which served as fodder for political science thought; its weaknesses are the cynical nature of the discussions. Also, the focus on leaders’ use of fear as a motivational tool is clearly suspect.

Carlyle, Galton, and James’s Great Man Theory (1840–1880)

From approximately 1840 to 1880, great man theorists Carlyle, Galton, and James studied great men from history who exhibited certain behaviors and possessed certain characteristics. They documented successful outcomes of these “great” leaders, such as prosperity, political standing, or affluence. Based on the study of these characteristics, the theorists suggested that to be a good leader, a person would have to emulate the characteristics of these men. Such characteristics often centered on an individual’s race and gender. Not surprisingly, many of the great men identified in the early chronicles were Anglican, male, and Caucasian (such as George Washington, depicted in Figure 4-3 ). In the past, some authors advocating this theory combined great man and trait theories into a common field of study; others did not.

In the early study of great man theories, an inordinate amount of weight was placed on certain immutable variables such as gender, race, height, and oration. Mutable variables, such as social class, education, and religion, factored heavily into the early great man theories as well. As the study of historical figures evolved, scholars began to examine commonalities among great historical figures and develop a finite list of traits associated with leadership. The primary focus on traits eventually evolved into a distinct discipline called trait theory. This niche concept suggested that leaders are defined by various characteristics, such as intelligence, extraversion, experience, education, confidence, and initiative. Possession of these traits was said to distinguish a leader from a follower in early trait-based theories. 5

FIGURE 4-3 George Washington: A great man theory icon.

Lewin, Lippitt, and White’s Trait Theory (1938–1939)

The emphasis on traits was solidified as an acceptable practice in 1938 and 1939 when Lewin, Lippitt, and White’s research emerged as the benchmark studies of their time. 6 , 7 These scholars studied the leadership styles of two groups of 10- and 11-year-olds in mask-making clubs. During the experiment, they noted that the two groups demonstrated two distinct leadership behavior types: authoritarian or democratic. The study led to the subsequent examination of the effects of these leadership styles on production, group tension, cooperation, and feelings of “we’ness” versus “I’ness.” Lewin, Lippitt, and White’s early work has become some of the more often-cited and highly quoted leadership and social psychology studies of the modern era. This work aided in the migration to the behavioral phase. Accordingly, much of the modern research in leadership theory traces its roots back to these early studies. Unfortunately, the failure of Lewin, Lippitt, and White’s theory to identify any single trait or behavior, or set of traits or behaviors, that could systematically explain leadership success across various situations promoted a paradigm shift in leadership study, such that researchers began to analyze the effects of situations on leader behavior.

Stogdill’s Leader Traits and Skills

Stogdill performed reviews of trait theory research well after the great man and trait phase of leadership had ended. From this analysis, he compiled a list of traits and skills of the successful leader from that literature. “However, Stogdill makes it clear that recognition of the relevance of leader traits is not a return to the original trait approach.” 8 Table 4-2 lists the traits and skills Stogdill found consistently in the trait literature.

Table 4-2 Stogdill’s Leader Traits and Skills

Traits

Skills

Adaptable to situations

Clever (intelligence)

Alert to social environment

Conceptually skilled (abstract to operational)

Ambitious and achievement oriented

Creative

Assertive

Diplomatic and tactful

Cooperative

Fluent in speaking

Decisive

Knowledgeable about group tasks

Dependable

Organized

Dominant

Persuasive

Energetic

Socially skilled

Persistent

Self-confident

Tolerant of stress

Willing to assume responsibility

Source: Adapted from Yukl, G. (1994). Leadership in organizations (3rd ed.). Englewood Cliffs, NJ: Prentice Hall, p. 256.

BEHAVIORAL LEADERSHIP PHASE

The behavioral phase of leadership study and thought emerged in the middle of the twentieth century, once theorists realized that the traits and great man arguments were unable to totally explain the phenomenon of leadership. In particular, the question of which actions and behaviors facilitated leadership success lay at the heart of leadership research of this period. An important assumption of this behavioral phase was the notion that leadership could be learned or nurtured.

Bandura’s social learning theory 9 emphasizes the importance of observing and modeling the behaviors, attitudes, and emotional reactions of others. People can learn through observation. According to Bandura, most human behavior is learned observationally through modeling: from observing others, one forms an idea of how new behaviors are performed, and on later occasions this coded information serves as a guide for action. Social learning theory explains human behavior in terms of continuous reciprocal interaction among cognitive, behavioral, and environmental influences. Social learning theory advocates that individuals imitate or copy modeled behavior from observing others, the environment, and the mass media. Earlier theories and models accepted the idea that leadership was inherited, genetic, and based on nature. Although it seems less dramatic now, this shift in thought from only nature being at work to a combination of nature and nurture being recognized as part of leadership marked a huge step in research and leadership practice ( Figure 4-4 ). Leadership could be learned! More prescription is assumed in these theories and models as compared to the earlier phase of leadership. Even so, the behavioral phase was built upon the great man and trait phase of leadership thought.

FIGURE 4-4 Leadership thought progression.

McGregor’s Theory X and Theory Y (1950)

At the sunset of the trait phase and the dawning of the behavior phase of leadership research, the concept of Theory X and Theory Y emerged. In the 1950s, McGregor hypothesized that leaders generally hold one of two contrasting sets of assumptions about people. He additionally suggested that these two dichotomous sets of assumptions would influence leadership behavior. For example, if managers/leaders assumed that their followers were lazy, indifferent, and uncooperative, then they would be treated accordingly (Theory X). Conversely, if they viewed their subordinates as energetic, bright, and friendly, they would treat them quite differently (Theory Y). These leadership attitudes toward followers would soon condition the leader to behave in a certain manner. In essence, this theory exemplifies a self-fulfilling prophecy.

Those leaders who hold Theory X assumptions would be autocratic and very directive and those who hold Theory Y would be democratic and consensus-building oriented. A Theory X leader would view a subordinate who was late as irresponsible and would require stricter control over his or her behavior, whereas a Theory Y leader might speculate that this same subordinate found his or her job boring and might need additional opportunities to stimulate the person and improve performance (and behavior). The real contribution of McGregor’s work was the suggestion that a manager/leader influenced a leadership situation by these two dichotomous assumptions about people.

· • Theory X: People are lazy, extrinsically motivated, not capable of self-discipline, and want security and no responsibility in their jobs.

· • Theory Y: People do not inherently dislike work, are intrinsically motivated, exert self-control, and seek responsibility.

Theory Y leaders assess themselves (internal modifiers) in areas such as preferred leadership style, motives and limitations, past experiences, and external modifiers such as characteristics of the task, time constraints, organizational norms, structure and climate, past history with group, economic and legal limits, and degree of stability of the organization. Once the assessment is complete, the Theory Y leader chooses a leadership style (which may include an autocratic style depending on the situation). A Theory X leader has one leadership style—autocratic—and has a limited view of the world; that is, he or she does not consider internal and external modifiers. There is also a hint of situational or contingency leadership research in McGregor’s theory. The weakness of this model is its dichotomous nature.

Stogdill and Coons’s Ohio Leadership Studies (1950)

In 1947, under the direction of Stogdill, the Ohio State Leadership Studies 10 were conducted. The goal of these studies was to determine whether a relationship exists between effective leader behavior and subordinates’ satisfaction and performance. Two dimensions of leader behavior that emerged from these studies were consideration and initiating structure. The consideration focused on psychological closeness between the leader and followers, whereas the initiating structure dealt with concern for actively directing subordinates toward job completion or goal attainment.

Surprisingly, some people who rated highly on both constructs of consideration and initiating structure were not always the most effective leaders. Further research along these lines indicated that both of these dimensions were needed for effective leadership. It was found to be more important for a leader to strike a balance in terms of what is appropriate for the situation than to consistently display high consideration and high structure at all times ( Table 4-3 ).

The following summaries delineate the conclusions of how effective leader behavior relates to follower satisfaction and performance: 11

Consideration

· 1. Employee satisfaction with a leader depends on the degree of consideration displayed by the leader.

· 2. Leader consideration affects employee satisfaction more when jobs are unpleasant and stressful than when they are pleasant and have low stress.

· 3. A leader who rates high on consideration can exercise more initiating structure without a decline in employee satisfaction.

· 4. Consideration given in response to good performance will increase the likelihood of future good performance.

Initiating Structure

· 1. Initiating structure by a leader that adds to role clarity will increase employee satisfaction.

· 2. Initiating structure by a leader will decrease employee satisfaction when structure is already adequate.

· 3. Initiating structure by a leader will increase performance when a task is unclear.

· 4. Initiating structure by a leader will not affect performance when a task is clear.

The major drawback to the Ohio State Studies was the limited consideration given to situational differences that may influence leader effectiveness. From this point, you can see the development of research (future studies) leaning toward situational leadership.

Table 4-3 Initiating Structure and Consideration

Manager’s Initiating Structure

Manager’s Consideration

High

Low

High

High performance

Low performance

Low grievance rate

Low grievance rate

Low

Low turnover

Low turnover

High performance

Low performance

High grievance rate

High grievance rate

High turnover

High turnover

Source: Adapted from Gordon, J. (1991). A diagnostic approach to organizational behavior (3rd ed.). Englewood Cliffs, NJ: Prentice Hall.

University of Michigan Leadership Studies (1950)

Conducted around the same time as the Ohio State Studies, the University of Michigan leadership studies sought answers to many of the same research questions as their Ohio State counterparts. Not surprisingly, the Michigan study results were similar to those conducted at Ohio State, thus supporting some convergent validity assumptions. Like the Ohio State Studies, the Michigan studies suggested that leaders could be grouped into one of two classifications: employee oriented or production oriented. The research suggested that highly productive supervisors spent more time planning departmental work and supervising their employees. The same supervisors spent less time working alongside and performing the same tasks as subordinates. The successful supervisors accorded their subordinates more freedom in specific task performance and tended to be employee oriented. In contrast, the employee-focused leader spent his or her time forging relationships and maintaining harmony in the work environment. Such a leader was less interested in written policies and formalized delegation of responsibilities. 12 In the end, leaders with both an employee orientation and a production orientation were the most successful.

Katz’s Skills Theory (1955)

In 1955, Robert Katz proposed three categories of skills leaders should have: technical skills, human skills, and conceptual skills. Technical skills relate to knowledge and capabilities the leader needs to be competent and proficient in certain activities. Human skills are nearly self-evident: They are the skills leaders need to relate to and to interact with other people. Such skills would include excellent communication skills, the ability to work with groups and teams, and the social skills to get each member of the team to perform at his or her maximum potential. Conceptual skills are a bit more difficult to define: They are the many skills that allow the leader to understand what needs to be done, how it should be done, and when to do it. Leaders need to be able to conceptualize ideas to be able to see the “big picture.”

Katz identified the level of importance that each of these three areas has for each level of management. The most important skills for top-level management are human and conceptual; the most important skills for mid-level management are human; and the most important skills for supervisory management are technical and human. Mid-level managers also need a fair degree of technical and conceptual skills, whereas technical skills are not as important for top-level leadership and conceptual skills are not as important for supervisory management. 13 , 14 A summary of the skills follows:

· • Technical skills: Knowledge about approaches, methods, processes, procedures, and techniques for conducting specialized work, and the ability to use those tools and equipment relevant to the activity

· • Interpersonal skills: Knowledge about human behavior and interpersonal relationships; the ability to understand the feelings, attitudes, and motivations of others; the ability to communicate and deal with conflict effectively; and the ability to build effective relationships

· • Conceptual skills: Analytical ability; logical thinking; proficiency in concept development and the capability to make sense of complex and ambiguous relationships; creativity in idea generation and problem-solving; and the ability to analyze events and perceive trends, anticipate changes, and recognize opportunities and problems (inductive and deductive reasoning)

· • Administrative skills (added as a fourth category by later researchers): the ability to perform particular types of managerial functions or behaviors (e.g., hiring, planning, organizing, budgeting, delegating, negotiating, coaching, mentoring, and conducting meetings)

Argyris’s Personality and Organization Theory (1957)

In 1957, Argyris published a seminal work called Personality and Organization. It was one of the first publications to relate organizational learning and success with a leader’s ability to achieve synchronization between his or her vision and goals with the subordinate’s or employee’s perception or tolerance of the vision and goals. To demonstrate this theory, Argyris posited two sets of organizational values he called “theories in use” and “theories in action.”

Theories in use suggest that, given a basic scenario dealing with organizational norms, cultures, or values in a stable environment, an individual’s outcome can be forecasted and predicted. The theory suggests there is an implicit acknowledgment of what we should do as leaders and managers; that is, the person’s predicted answers are conducive to the behavior and effort expected in the organization.

Theories in action are those activities that occur in the organization that are dissimilar from the predicted theories in use. For example, if organizational norms and behaviors call for a multicultural workforce and the personnel hired reflect only one gender or race, there could be a disconnect between organizational goals and organizational outcomes. In this case, the two may not be in synchrony. 15 – 17

This early leader theory on managing and leader organizations acknowledges that organizations are part and parcel of the humans who work in them. Sufficient training, branding, and communication of institutional norms, values, and objectives are the leader’s responsibilities.

Training and culture shifts can increase the effectiveness of a leader’s ability to ensure that the actions and thoughts executed come from the same (desired) agenda. 18 For example, multicultural sensitivity training can provide an opportunity for personnel in organizations to become more tolerant of different races and demographic characteristics. Extreme methods of applying this theory may include organizational reengineering, where personnel in the organization who are incapable of unlearning irrelevant predispositions and do not support the organization are moved to different parts of the organization or “right-sized” out of a job.

Blake and Mouton’s Managerial Grid (1964)

In 1964, Blake and Mouton offered what was then a very unique approach to leadership. Their managerial grid is a behavioral leadership model based on four constructs: concern for production, concern for people, motivation, and leadership style. Motivation can be negative (motivate by fear) or positive (motivate through desire and encouragement). Motivation is rarely shown (perhaps due to the difficulty in determining motivation type and amount).

Essentially, Blake and Mouton identified five different managerial styles based on the priority the individual leader assigns to product versus people: Country Club, Team Leader, Impoverished, Produce or Perish, and Middle of the Road. The first two styles place far more importance on people than on product, the second two emphasize product, and the last one rides the fence, emphasizing neither product/production nor the person or people/subordinates. Figure 4-5 depicts the managerial grid.

In the Mouton–Blake managerial grid, the least effective leadership style is the Impoverished style, because such a person does not really care about either product or people. The most effective is Team Leader, because such an individual places a high priority on both the product and the people and will look for win–win solutions that will satisfy the needs of all. This leader is not naive; he or she does realize that in some situations it is not possible to reach a solution that will satisfy everyone. Another key facet of the Mouton–Blake managerial grid is that each leadership approach is understood to be important and useful given certain circumstances and in certain situations. There are clear connections between Blake and Mouton’s work on the managerial grid and Hersey and Blanchard’s 1977 situational leadership model. Although the managerial grid is taught in most graduate management and leadership programs, there is no research validating its efficacy. 19 , 20

FIGURE 4-5 Blake and Mouton’s managerial grid.

Source: Reproduced from Blake, R., & Moulton, J. (1964). The Managerial Grid: The Key to Leadership Excellence. Houston: Gulf Publishing Company.

SITUATIONAL OR CONTINGENCY LEADERSHIP PHASE

We turn now to more recent research in leadership theory. Situational leadership theories and models—also called contingency models, because the leader model should change contingent (based) on the situation at hand—are more applicable to health organizations today because the healthcare environment is dynamic and stakeholder relationships are multifaceted and complex. Contingency or situational theories and models assert that no one way of leading works well in all situations. Instead, leaders need the ability to change styles and select those skills that best deal with the organizational situation at hand. Effective leaders diagnose the situation, identify an appropriate leadership style, and then determine whether its implementation is possible. At least four dimensions must be evaluated when assessing situational or contingent leadership research:

· • Subordinate: Expertise, experience, resources, motivation, task load, and knowledge of the job

· • Supervisor/leader/manager: Values, attitudes, level of influence, and level of authority

· • Task characteristics: Complexity, time, risk, autonomy, ambiguity, uncertainty, and workload

· • Organizational culture: Coupling, communication environment, ambiguity and uncertainty tolerance, balance of work, social and personal life, planning emphasis, decision-making alignment, employee enhancement, and level of knowledge management and learning orientation

The other significant element in situational leadership is the emergence of organizational culture within the situational context. Simply stated, culture is a group’s unique view of the world. Every organization—whether a family or a health system conglomerate—has an overriding organizational culture and various sets of subcultures. Leaders must attend to cultural issues to be successful.

Some researchers have suggested that leadership strategies in any setting have strong underlying similarities, but must change as the setting changes over time. Even if the health organization remains essentially the same, change in the environment, such as the recent changes in healthcare delivery, may require leaders to change their strategy/style to be effective. Culture comes into the discussion of leadership as an influence on leadership style selection; organizational culture has grown in importance over the last decade in that leaders can actually develop culture—not merely assess and adapt to it. This realization may be leading into another phase of leadership thought; this idea is discussed briefly in the next section of this chapter.

To provide a simple example of situational leadership in action, suppose that subordinates have the expertise and competence needed to perform an organizational task. In such a case, an employee-oriented leadership style will be more effective than a task-oriented leadership style. In contrast, if leader and follower both have the same attitudes, then followers may be more willing to accept a task- or production-oriented leadership style.

This phase of leadership—the phase currently in vogue—immerses behaviors into the context of the leadership situation and environment. Situational assessment skills are critical to this body of knowledge on leadership. Thus leaders can be “made” through nature, can be nurtured, and now must consider situational factors and adapt to those situations to be successful. Leaders must also adapt! This phase has more potential for prescription and not just description of theories and models. As illustrated in Figure 4-6 , leadership models are a progression wherein later approaches build on the knowledge of the past. A number of different models of leadership fit under the general category of contingency. Given that this phase constitutes the most widely accepted set of theories and models today, several approaches falling under this rubric are highlighted in this section.