Nowadays, it represents a commonplace assumption among healthcare specialists that, in order for physicians and nurses to be able to address their professional responsibilities in the most effective manner, they must be thoroughly aware of what the concept of ethical leadership stands for. One of the main reasons for this is that both: the notion of leadership and the notion of ethics have traditionally been considered the integral part of the healthcare paradigm, as we know it.
The realities of today’s living, however, presuppose that, as time goes on, the actual significance of these notions will continue to attain ever more of the discursively innovative subtleties. Probably the most notable development, in this respect, has to do with the fact that the concept of transactional leadership in healthcare is being deemed increasingly outdated. This partially explains why it is specifically the transformational model of leadership, with the main characteristics of “idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration” (Borkowski, Deckard, Weber, Padron, & Luongo, 2011, p. 270), which is now being perceived as the one best suited for the domain of healthcare. The reason for this is that the concerned leadership-model is fully consistent with the assumption that, in order for healthcare administrators to be professionally efficient, they must be ‘visionary’ to an extent – the main trait of a transformational leader (Derue, Nahrgang, Wellman, & Humphrey, 2011). The development in question has been brought forward by the fact that, as time goes on, more and more healthcare professionals realize that the actual purpose of medicinal therapies is to heal rather than to eliminate unpleasant symptoms.
In its turn, this implies that the main indication of a leader’s effectiveness/ethicalness (in the field of healthcare), is his or her ability to proceed with taking care of its managerial tasks in the manner thoroughly consistent with the currently predominant socio-cultural discourse, and with the affiliated organization’s corporate culture (Salmela, Eriksson, & Fagerström, 2012; Blake, Mouton, Barnes, & Greiner, 1964). The rationale behind this suggestion has to do with both: the fact that the element of ethics plays a crucially important role, within the context of how physicians and nurses go about treating patients, and the fact that the very notion of ethics never ceases to remain in the state of continual transformation. As Dmin (2011) noted, “Ethics is a process of human inquiry. It evolves, matures, deepens. It requires intense re-interpretation and change” (p. 95). Whereas, as recent as a few decades ago it used to be considered thoroughly ethical, on the part of managers (leaders), to assume that their subordinates are able to attain self-actualization by the mean of being provided with the prospect of receiving good salaries alone, it nowadays effectively ceased to be the case (Nahavandi, 2014). As of today, it is namely a leader’s ability to provide subordinates with the chance to realize their full existential potential, which is being commonly deemed reflective of the extent of his or her professional adequacy – especially when the domain of healthcare is at stake.
This naturally prompts many authors to come up with the pioneering insights, as to what should be considered the indications of ethical leadership in healthcare. For example, according to Holmes (2010), among the most important psychological traits of a leader are ‘self-knowledge’, ‘compelling vision’ and ‘caring attitude’. It is understood, of course, that this suggestion does differ rather substantially from the conventional outlooks on what high-quality leadership is all about. The same can be said about Ehlen and Sprenger’s (1998) conceptualization of what account for the main indications that a particular healthcare worker does have what it takes to prove itself an ethical leader in the affiliated field, such as his or her willingness to tackle professional challenges in the manner consistent with the notions of ‘stewardship’, ‘advocacy’ and ‘confidentiality’.
Nevertheless, even though the mentioned authors do recognize the fact that the concept of ethical leadership in healthcare calls for the reassessment of many traditional approaches to managing/leading a team, this specific task is utterly challenging. The reason for this is quite apparent. The functioning of the healthcare system, in general, and the ability of healthcare workers to practice ethically sound leadership, in particular, cannot be discussed outside of what appears to be the state of economic affairs in the country – the idea that is being promoted throughout Levitt-Rosenthal’s (2013) article. As the author aptly pointed out, “The changes in healthcare delivery today include declining reimbursements… Maintaining a healthy bottom line in the midst of such change is increasingly challenging” (p. 29). This, of course, makes the objective of incorporating the paradigm of transformational leadership, as the essential element of healthcare in the West, even more perplexing.
There is even more to it – the earlier outlined qualitative characteristics of ethical leadership in healthcare do not correlate with the highly egocentric manner, in which Americans (Westerners) tend to perceive the surrounding social reality and their place in it. According Graber and Kilpatrick (2008), “Americans tend to value individualism higher than people in virtually all other countries, and tend to rate a collectivist or community identification lower than people in many other countries” (p. 182). This simply could not be otherwise, because in order for a practitioner of the transformational model of leadership to succeed in leading others, he or she must be capable of adopting a strongly defined communal outlook on what represents the best strategy for providing subordinates with the discursively appropriate performance-boosting incentives.
Many theoreticians of leadership in healthcare appear to be fully aware of this fact – hence, their insistence that there must be some ‘innate’ quality to the measure of professional commitment, on the part of healthcare workers (Franco & Almeida, 2011). This explains why it now became rather trendy among these theoreticians to resort to evoking the concept of Corporate Social Responsibility (CSR), as the methodological framework for the quality of healthcare services in the West to be continually improved. After all, this concept is not only concerned with ethics, as the main guiding principle behind just about any societal activity, but also with the model of transformational leadership, as such that often implies the appropriateness of obscuring the line between leaders and followers. In this respect, it would prove rather impossible to disagree with Luu (2012), who suggested that, “Transformational leadership (in healthcare) cultivates ethical CSR, which in turn positively impact brand equity” (p. 357). Apparently, there is indeed much rationale in the idea that the societal qualities of post-modernity do require the reassessment of the euro-centric (transactional) outlook on leadership in healthcare.
The main theoretical gap, in how the earlier mentioned authors went about conceptualizing the notion of ethically sound leadership in healthcare, appears to be essentially epistemological. It has to do with the fact that they did not pay enough attention to what accounts for the dialectical relationship between the currently deployed leadership-practices in the given field, on one hand, and the socio-economic situation in the West, on the other. Another notable gap is concerned with the failure of most of these authors to provide universally applicable definitions to such vaguely sounding notions as ‘ethics’ or ‘morality’. As a result, none of the insights into the discussed subject matter (contained in these articles/books), can be considered as such that represents an indisputable truth-value.
The main problem that is being brought forward by the earlier identified gaps is that just about every reviewed article/book appears to be marked by the lack of systemic soundness. That is, while arguing in favor of what they consider to be the best strategy for ensuring high-quality/ethical leadership in healthcare, most authors seem to have been primarily concerned with trying to gain additional academic credits, rather than with benefiting the professional domain of healthcare in any concrete way. This is the reason why, despite the apparent sophistication of many of the contained suggestions, as to how one should go about exercising the authority of a leader, it is rather unlikely that they may come in handy for healthcare workers, in the practical sense of this word. Apparently, it never occurred to many of the referenced authors that one’s extensive knowledge of the ‘theory of leadership’ does not presuppose this person’s ability to act as an effective leader in real life, and vice versa.
The implications of the mentioned problem statement for positive social change are quite apparent. The main of them can be formulated as follows: while scrutinizing the issue of effective/ethical leadership in healthcare, researchers should remain thoroughly aware of what accounts for the dialectical nature of the relationship between causes and effects. In its turn, this will require the discussion of the leadership-related issues in healthcare to be observant of the society’s overall stance on leadership/ethics. The rationale behind this suggestion derives out of the well-known fact that, in order for just about any theory of leadership to prove a practical asset, it must take into consideration the manner in which the potential beneficiaries tend to perceive the notion of leadership, in the first place.
It is rather doubtful that I can act as the efficient agent of social change, while advocating the adoption of the transformational model of leadership by the healthcare sector. The reason for this has been partially outlined earlier – people are naturally driven to adjust just about any abstract theory to be consistent with their deep-seated psychological predispositions, and not the other way around. Therefore, for as long as American society remains essentially euro-centric (transactional), there can be very little rationale in expecting the eventual legitimization of the transformational model of leadership by healthcare professionals in this country any time soon. Nevertheless, I can act as the agent of popularizing the concerned scenario, as such that indeed does make much sense.
In light of what has been said earlier, it will be thoroughly appropriate to conclude that the adoption of the transformational model of leadership by the healthcare sector will indeed help physicians and nurses to address their professional responsibilities. At the same time, however, there appear to be the lack of socio-economic preconditions for the necessity of such a development to be recognized by healthcare workers in the near future.
References
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Borkowski, N., Deckard, G., Weber, M., Padron, L., & Luongo, S. (2011). Leadership development initiatives underlie individual and system performance in a US public healthcare delivery system. Leadership in Health Services, 24(4), 268-280.
Derue, D., Nahrgang, J., Wellman, N., & Humphrey, S. (2011). Trait and behavioural theories of leadership: An integration and meta-analytic test of their relative validity. Personnel Psychology, 64(1), 7-52.
Dmin, E. (2011). Ethics leadership in research, healthcare and organizational systems: Commentary and critical reflections. Journal of Research Administration, 42(1), 88-102.
Ehlen, K. and Sprenger, G. (1998). Ethics and decision making in healthcare. Journal of Healthcare Management, 43(3), 219-221.
Franco, M., & Almeida, J. (2011). Organizational learning and leadership styles in healthcare organisations. Leadership & Organization Development Journal, 32(8), 782-806.
Graber, D., & Kilpatrick, A. (2008). Establishing value-based leadership and value systems in healthcare organizations. Journal of Health and Human Services Administration, 31(2), 179-197.
Holmes, E. (2010). Character, leadership, and the healthcare professions. The Journal of Research Administration, 41(2), 47-54.
Levitt-Rosenthal, N. (2013). Ethics, values, and decision making. Frontiers of Health Services Management, 30(1), 27-32.
Luu, T. (2012). Corporate social responsibility, leadership, and brand equity in healthcare service. Social Responsibility Journal, 8(3), 347-362.
Nahavandi, A. (2014). The art and science of leadership. Upper Saddle River: Pearson.
Salmela, S., Eriksson, K., & Fagerström, L. (2012). Leading change: a three-dimensional model of nurse leaders’ main tasks and roles during a change process. Journal Of Advanced Nursing, 68(2), 423-433.