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Practitioner leadership: a missing link in leadership theory

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Abstract

Purpose – In the collective or distributed leadership models that are now increasingly dominant in the literature about leadership in public services, the role of the “practitioner as leader” takes on powerful significance. The purpose of this paper is to address a gap in this corpus of research, which is a critical analysis of what constitutes the role of the practitioner leader, and the strengths and limitations of these informal leaders as agents of organisational change. Design/methodology/approach – The paper develops a critical comparative analysis of the role of ordinary teachers and doctors as leaders, as a way of gaining purchase on what comprises and shapes the role of practitioner leader and the potential of this form of leadership to be a driver for quality improvements in the public sectors of education and health. Findings – Traversing traditional academic divides and comparing medical and teacher leadership provides a clearer picture of how professional and organisational culture strongly influences the roles that practitioner leaders can take up and the influence they can wield. This comparison also shows that building capacity of practitioner leadership in the public services should be approached as an expansion of professional identity, rather than an “added extra” for keen few. Originality/value – Importantly, this critical comparative review indicates that practitioner leadership is best understood and fostered as a particular ethical stance, rather than a special form of power or knowledge and that it occupies an interstitial space in between formal leadership structures and ordinary practitioners. This is both its strength and its weakness as a form of leadership.

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... Postheroic models of leadership such as shared leadership (also known as collective leadership) emphasise the role of multiple actors, who actively take up leadership roles formally and informally. 1 Leadership moves away from the attributes which identify it as a noun and metamorphoses to become an active process, a verb. 11 Shared leadership is seen as highly practical in the healthcare setting 12 13 as the nature of delivering healthcare requires much collaboration. 14 The benefits of shared leadership impact on four perspectives: individual, coworker, organisational and societal. ...
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... Professional and organisational culture strongly influences the roles that practitioner leaders can take up and the influence they can wield. 58 Ham et al. 59 investigated, via 22 qualitative interviews, the experiences of doctors who become Chief Executives of UK National Health Service organisations and found that medical managers tended to be "keen amateurs" rather than trained managerial professionals. Kisa and Ersoy, 60 via a 31 item time management questionnaire, found that medical managers have poor time management skills. ...
... Professional and organisational culture strongly influences the roles that practitioner leaders can take up and the influence they can wield. 58 Ham et al 59 investigated, via 22 qualitative interviews, the experiences of doctors who become Chief Executives of UK NHS organisations and found that medical managers tended to be 'keen amateurs' rather than trained managerial professionals. Kisa and Ersoy, 60 via a 31-item time management questionnaire, found that medical managers have poor time management skills. ...
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Chapter
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Including abstract, graph., bibl. The recent emergence of distributed leadership has been very marked. In England, it has received official endorsement. But the evidence-base which supports this endorsement is weak: there is little evidence of a direct causal relationship between distributed leadership and pupil attainment.What therefore might explain its rise to prominence? Here three possible explanations are considered: first, it accords with the contemporary reform of the public services; second, it is legitimated by an appeal to a culture wherein all categories and classifications are rendered increasingly permeable; and third, it is regarded as functional for the 'new work order'.
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No After reviewing the literature on leadership that culminated in what has been described as the ‘New Paradigm’, this article discusses the research which has led to the development of what might be regarded as a ‘New New Paradigm’ model. The research was based on a gender-inclusive and black and minority ethnic-inclusive sample of over 3,500 managers and professionals, at different levels (chief executives, top, senior and middle managers), working in the UK National Health Service and local government. The model that emerged, which led to the development of a diagnostic 360-degree feedback instrument, the Transformational Leadership Questionnaire, has been found to be sufficiently robust as to generalize to private sector and other public sector organizations. Apart from having been inclusive at all stages of its development, the model is new in that it is based on a ‘nearby’ rather than ‘distant’ or ‘heroic’ approach to leadership, using a Grounded Theory methodology. It leads to an understanding of leadership that goes beyond transformational models and, recognizing the significance of Greenleaf’s concept of ‘servant leadership’, focuses on the development of the individual, in an organizational context.
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An examination of the effects of top management, board, and physician leadership for quality on the extent of clinical involvement in hospital CQI/TQM efforts. A sample of 2,193 acute care community hospitals, created by merging data from a 1989 national survey on hospital governance and a 1993 national survey on hospital quality improvement efforts. Hypotheses were tested using Heckman's two-stage modeling approach. Four dimensions of clinical involvement in CQI/TQM were examined: physician participation in formal QI training, physician participation in QI teams, clinical departments with formally organized QA/QI project teams, and clinical conditions and procedures for which quality of care data are used by formally organized QA/QI project teams. Leadership measures included CEO involvement in CQI/TQM, board quality monitoring, board activity in quality improvement, active-staff physician involvement in governance, and physician-at-large involvement in governance. Relevant control variables were included in the analysis. Measures of top management leadership for quality and board leadership for quality showed significant, positive relationships with measures of clinical involvement in CQI/TQM. Active-staff physician involvement in governance showed positive, significant relationships with clinical involvement measures, while physician-at-large involvement in governance showed significant, negative relationships. Study results suggest that leadership from the top promotes clinical involvement in CQI/TQM. Further, results indicate that leadership for quality in healthcare settings may issue from several sources, including managers, boards, and physician leaders.
Article
Notes that medical participation in organization-wide quality programmes and leadership of quality is commonly viewed as the key to a successful programme. Reviews and reports research into doctors' involvement in such programmes as distinct from doctors' involvement in medical quality activities. Reveals the lack of systematic evidence on the subject, suggests areas for future research, and summarizes what is known. Gives recommendations based on reported research and experience for quality training for doctors and how medical managers might engage their colleagues and other professions in quality programmes.
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The lag between the publication of clinical and health-services research and the application of this information is substantial and delays health-care improvement. A wide range of corrective strategies are being used to address this issue. Evolution in the use of significant opinion leaders is described. Hospital quality improvement projects, undertaken by the Healthcare Education and Research Foundation (HERF), are used to illustrate the roles assumed by clinical opinion leaders. Specific theoretical frameworks are reviewed that are fundamental to successful implementation of opinion leader strategies, as well as key research on the use of clinical opinion leaders. Over the past 12 years, HERF has identified the need to address not only the information needs of clinicians and organizations but also the social and organizational factors that interfere with the application of research and guidelines. The complexity of this task cannot be underestimated. However, armed with well-developed guidelines and the opportunity to work within structured guideline implementation programs with well-defined objectives and systematically applied methods, HERF's experience suggest local clinicians and communities can meet this challenge.
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This paper derives from a grounded theory study of how Medical Directors working within the UK National Health Service manage the moral quandaries that they encounter as leaders of health care organizations. The reason health care organizations exist is to provide better care for individuals through providing shared resources for groups of people. This creates a paradox at the heart of health care organization, because serving the interests of groups sometimes runs counter to serving the needs of individuals. The paradox presents ethical dilemmas at every level of the organization, from the boardroom to the bedside. Medical Directors experience these organizational ethical dilemmas most acutely by virtue of their position in the organization. As doctors, their professional ethic obliges them to put the interests of individual patients first. As executive directors, their role is to help secure the delivery of services that meet the needs of the whole patient population. What should they do when the interests of groups of patients, and of individual patients, appear to conflict? The first task of an ethical healthcare organization is to secure the trust of patients, and two examples of medical ethical leadership are discussed against this background. These examples suggest that conflict between individual and population needs is integral to health care organization, so dilemmas addressed at one level of the organization inevitably re-emerge in altered form at other levels. Finally, analysis of the ethical activity that Medical Directors have described affords insight into the interpersonal components of ethical skill and knowledge.
Perspectives on integrating leadership and followership”
  • W Küpers