Abstract
The proposed leadership theory assists in making sure that followers gain leadership skills, and they become empowered. They can take on important leadership roles, which allow institutions to become supportive of leaders when they are making ethical decisions that have repercussions on health care stakeholders. The proposed solution comes from literature gaps presented in the literature review section that have also helped to come up with the problem statement for the study.
The problem identified and addressed is the lack of generalizability of leadership and ethics studies on health care given that many of the studies propose theoretical solutions to leadership without testing or presenting practical approaches that can guide practitioners. The literature also pointed out interrelationship between personal leadership capacities of health staffs and organizational environment attributes that affect the expression of ethics.
This has prompted the offered solution to embrace a system thinking approach where servant leadership affects organizational culture and in return, the effects lead to additional opportunities for expressing high-quality leadership. The resultant framework encourages leaders to delegate important work to subordinates, transforms institutions into learning centers for leadership, which is a practical way of addressing the demands for leadership, and helps to strengthen ethical resolves of leaders through the provision of a favorable organizational environment.
Introduction
An understanding of ethical leadership is important for physicians and nurses because of its relevance to the healthcare paradigm. They are expected to conduct themselves with the highest moral standards in society given that they work in has implications of the operations of institutions of health and the health status of patients and community members. Different leadership styles provide opportunities for the expression of ethics and the use of particular ethical principles at work.
The health care community has often relied on transactional leadership styles. There are many decision points for health care administrators such as organizational issues, interaction with suppliers, patient surgical intervention or end-of-life consideration. Meanwhile, most health care institutions have a systematic approach to ethics so that personnel can refer to the guidelines when ethical issues arise. Nevertheless, it is important for leaders to go through specific ethical challenges and then consider appropriate approaches for the different situations. They must also offer practical insights that help to improve response to ethical issues.
Some factors are necessary for handling ethical challenges successfully. They include being ethically conscious, committed, courageous, competent, consistent and candid (Buell, 2009). Common unrecognized ethical issues include the promotion of unrealistic expectations, rationalizing inappropriate or incompetent behavior and failing to acknowledge mistakes.
In the following literature review, the problem of lacking ethics and leadership in health care is addressed with an intention of presenting the impact of the deficiency on overall healthcare. The paper’s evidence on ethics and leadership helps to guide reforms in health care training institutions that seek to impact future leaders with the necessary ethical skills. The study is generating information that articulates the opportunities and developments of health reform. It provides practitioners with guidelines on the right way of coming up with policy agenda that meets the present needs of ethics and leadership such that there is an overall increase in the supply of leaders with a grounded and responsive, ethical bearing that health institutions need.
Revised Literature Review and Problem Statement
Transformational style of leaderships works in health care because of being an idealized influences and offering necessary inspiration and motivation to staffs. It also comes with intellectual stimulation and individuated consideration (Borkowski, Deckard, Weber, Padron, & Luongo, 2011). The demand for professional efficiency is the key driver towards the preference for transformational kind of leadership (Deitchman, 2013). All health care practice concerns the improvement of patient’s health and improvement of overall community heath. This requires visionary leadership that transformational style provides (Derue, Nahrgang, Wellman, & Humphrey, 2011).
Research by Murphy and Fillatre (2009) explore values and virtue that inform ethical leadership in health care offering valuable insight but failing to offer practical examples that can help practitioners. The study’s findings can only be generalized to the Canadian health care sector without specific institution mentions. Cline, Frolic, and Sibbald (2013) provide a roadmap to help new healthcare ethics leaders set up new ethics programs in varied healthcare institutions.
The report is a collective report on the author’s experiences as ethics leaders in three Ontario healthcare organizations and, therefore, offers real world benefit to other practitioners. It notes that development or renewal of ethics programs is time-intensive and politically risky. However, the burden often lies with one visible ethics leader and there is risk caused by lack of confidence of the leader in personal ability and knowledge on the best way to proceed.
Overall, ethics leaders need to share their experiences more with researchers and publisher to address the problem. Treasure (2001) reviews the definitions of leadership in health care and notes that most used versions focus on job titles and entitlements rather than the work done by individuals in the context of their institution’s progress. Cooper, Frank, Gouty and Hansen (2003) expand the concept to show that professional healthcare providers are held responsible for technologic and financial decisions and the ethical consequences, what they decide. They note that the education of nurses has undergone revisions led by nurse leadership to ensure nurses can take on the responsibility. Unfortunately, the study has a low response rate for its survey and is not generalizable. The study notes that nurse will rely more on professional resources, but their action depend mainly on the organizational environment (Dmin, 2011).
The article by Finkel (2005) clarifies expectations of ethics in the healthcare context in reviewing the work of Stuart Wesbury Jr, who made significant progress in pharmacy, hospital administration and academia then became the presided of the American College of Health Care Executives where as a leader he promoted chances for others. Leaders who put their institutions on the map and show an example of what is achievable in health ethics standards are what the healthcare industry needs currently. Rather than accept positions as the results, health care leaders need to challenge themselves to find out additional avenues for serving those who have trusted them with leadership positions (Finkel, 2005).
For Mannix, Wilkes and Daly (2015), the research task was to explore the way aesthetic leadership is embodied by clinical leaders in the nursing workplace. They note that there are different scenarios where the application of best practices works or do not work for particular patients when embracing ethical leadership. The research highlights the themes of being true to their beliefs, not all policies fit every patient and being open to people’s concerns.
These themes summarize the ethical leadership challenges and opportunities that the studied population faced in their day-to-day leadership activities. It is one of the studies with generalizable results regarding what is needed for ethical leadership. Its practical nature comes from its study of nurses in the clinical setting, which covers their normal working environment. Thus, the variables reviewed in the study are likely to match other variables affecting leadership execution of clinical leaders in similar settings (Franco & Almeida, 2011). The research reported that aesthetic leadership that comes with a strong moral purpose was useful.
Maupin and Warren (2012) explain that the U.S. is undergoing a health care reform. Nevertheless, racial and ethnic health disparities persist and this is a great concern for health leadership. If the situation continues then, the current leadership will be failing at providing all Americans with the same quality and years of healthy life. The fact that since 1985 to date there has been little changes in the fate of African American populations when accessing healthcare is worrying. The study points to the gap in research that should be evaluated. For Graber and Kilpatrick (2008) the suggestion is that studies must be put in place to explain why there are disparities despite the adoption of best practices.
In the U.S. health care reform, randomized controlled trials are underused because the principles of research with humans limit the conditions for deviations from the standard of care. Thus, most care is only available under the present system, yet reforms require comparison to find out a better system (Kahn & Hofmann, 2015). Based on the “principle of equipoise”, it is acceptable to compare different results when the strategy that yields the best results is unknown. However, the health care system only regards a single payment system where there is a single-payer financing option. The ethics of supporting the system or finding an alternative to compare remains debatable (Kahn & Hofmann, 2015).
The study by Hwang, Sharfstein, and Koller (2015) confirms ongoing reform process in U.S. healthcare. It notes that states across the country are leading major changes in health care payment and delivery. They are pursuing bundled payments while others have eliminated the fee-for-service payment to hospitals. Some other changes include statewide cost growth target establishment and the creation of a statewide network of multiplayer medical homes to improve health outcomes.
These examples show a variation of policies in the healthcare leadership of the respective states. Importantly, all the changes fall within the radar of the national healthcare program. They have led to the improvement of health care outcomes and access at lower costs. The aim of Hwang et al. (2015) was to recognize state-led reform limitations. As a result, the study helps practitioners to appreciate the opportunities and challenges that abound in the current transition period of the U.S. health care. Importantly, states govern the environment for health leadership. States act as providers of health care services, and they are collectors of data and they act as grantees of health as well as conveners. Bringing out their different roles is important in providing data about the generalizability of other research findings concerning leadership and ethics.
Giganti (2004) that a leader must be the primary agent of organizational integrity highlights the importance of the Hwang et al. (2015) study. In addition to that, there is the need for systemized thinking. While health workers can be morally upright individuals, their organizations have no guarantee of having moral integrity. Policies, practices and integrity help to show an organization’s moral integrity (Luu, 2012). It is possible to have a morally deficient organizational culture despite the intentions that upright managers push to the rest of the staff at the organization. With systems thinking for health ethics, a framework arises that takes into account the connections between all the systems working in an organization and their effects on one another.
The studies conducted on leadership and ethics have shown that there are attributes good for leaderships, and several aspects of ethics worth considering. Nevertheless, there are important trends appearing in the research. Apart from the few studies that highlight actual coordination of leadership activities in a health institution, many studies look at the theoretical or conceptual perspectives of morality and leadership in the healthcare context.
Studies like Holmes (2010) have elaborated on the physiological traits of leadership. The review has also brought out systemized, and organizational context is thinking, on what leadership has to be, and on the general environment, which supports the leadership. Evidently, most of the authors reviewed, who represent the studies done on the subject in the past one-and-a-half-decade point towards reforms. The entire structure of healthcare is changing with policies, approaches and conceptualizations. There is a consensus on the changing definition and demand for ethics and leadership.
Thus, the real gap in the literature is the availability of findings on the alternative ways of organization and leadership other than the present ones that are being hailed as inadequate. Studies like Levitt-Rosenthal (2013) show that healthcare delivery continues to change to offer room for transformational leadership. No study is presenting the implementation of such leadership and its acceleration of ethical practice realization of the practical result of the leadership effect. The problem is that many studies that look into ethics and leadership are merely providing utopian perspectives of what ought to be and how to deal with challenges presented by organizational environments, without seeking practical significance.
Personal Public Health Leadership Theory
Health organizations require effective leadership that takes responsibility for morality and provides a framework for transforming the organization’s ethic. This must happen despite the environmental and conceptual challenges. The development and utilization of such leaders also requires a systemized approach that recognizes their expression of leadership according to the opportunities accorded to them. Thus, it appears that there is a mutual relationship between health organization leadership seeking ethical expression with organizational situational support for expression of ethical conduct (Effelsberg, Solga, & Gurt, 2014).
The personal public health leadership theory for the present study is that leadership should be distributed. Following the participation-delegation-empowerment model, leaders are supposed to work towards the improvement of other organization’s member’s leadership opportunities. When leaders mentor, coach and give their subordinates opportunities for participating in important decision-making task and carrying out delegated leadership roles, those subordinates learn leadership. In recognition of a scarcity of public health leaders capable of taking ethical responsibility, there is need to remove additional man-made challenges that create additional complexities to the problematic public health field.
The health leadership problem is a global one, and it requires massive financial and human resource investments. Unfortunately, these factors are also in scarce supply, and they contribute to the myriad of policies aimed at managing them. These policies are also some of the fabricated features that lead to difficulties in the expression of ethics in leadership. The shortage of competent health leaders can be addressed by the current leadership, which calls for effective dissemination of research information to the leaders such that they can improve the development process of new leaders.
Although there are aspects of traditional leadership theories that offer insights into the proposed personal public health leadership theory, the main element rests with servant leadership. The main goal is to address the challenges that abound in public health leadership as hinted above. Therefore, leaders must serve their institutions and their followers. The empowerment of subordinate will be efficient when undertaken from a servant leadership perspective.
Beyond that, the proposed theory also relies on contemporary theories of transformational and charismatic leadership that collectively emphasize on the promotion of teams, emotions and common values for the organization. However, my theory advances these theories by offering a platform for their operation. These theories are employed in current settings but succumb to organization limitations. While they help to understand the way leaders influence followers, they need to achieve more in terms of organizing policy and culture, hence the need for servant leadership.
Servant leadership offers room for participation, delegation, and empowerment, which form the foundation for reaching new heights in organizational conduct. It also provides the best framework for the development of new leaders. The current health care environment is in a crisis. There is a shortage of leaders capable of taking ethical responsibility. There is also a lot of challenges that institutions provide for their policies and culture, which hinder the effective practice of leadership.
Addressing the problem from the leadership angle requires that the leadership proposed to be able to influence organizational change. The theory offered here will lead to rapid development of new leaders with appropriate ethical skills and strength withstands organizational manipulation. Therefore, the collective resistance will lead to a new culture that solves the problem of lacking ethics in current leadership while ensuring that there is a sufficient number of new competent leaders being realized in the health care sector.
Revised Visual Representation of Your Public Health Leadership Theory
Table 1: Illustration of proposed servant leadership theory and its influence on literature and problem statement.
My leadership theory confirms to current notions of leadership such as the matching of leadership style with the right situation. Some situations require mobilization and the servitude type of leadership can encompass transactional leadership traits to promote effective negotiation. The same leadership theory comes in handy when there is a need for rallying followers to a particular cause, where charismatic attributes can be employed. The table above shows the leadership theories that go well with the proposed servant leadership theory, showing that the existing theories have been unable to fill literature gaps. However, when confined within the proposed theories, there are solutions that suffice multiple health situations.
By focusing on social relations of people at an organizational level, the theory remains scalable upwards to the health care sector and downwards to a specific health institution (Shickle, et al., 2014). Its generalizability meets the challenge identified in the literature about most studies failing to apply to the general situation in health care leadership and also not offering practical solutions for health care staff that have to make ethical choices whenever they are exercising decision-making as part of their leadership. Focusing on the mutual relationship between leadership and organization environment has also helped the theory to meet challenges exposed by the literature review.
On one end, the individual actions of a leader serve as outcomes for followers and beneficiaries of subordinate staff’s action at an institution. On the other hand, each act of a leader serves as a guideline for subordinate staff to use when facing similar challenges in their respective work assignments. Therefore, rather than have a leader being responsible for difficult decisions within an organization alone, the percolation of examples throughout the organization makes every member a custodian of the leadership practice. Therefore, the impacts of such leadership can be tested beyond the direct reach of the leader. This essential contribution helps to fill the research gap concerning leadership effectiveness after completion of health reforms.
The theory is considering the relationship between leaders and subordinates together with that of their respective organization. The theory shows that leadership depends on the skills that a leader has and on their effective application (Morgeson, DeRue, & Karan, 2010). This implies that without system thinking, it will be impossible for the leader to direct change in subordinates and the organization. Leaders have always to consider the implication of the example shown by their decisions and actions (Mumford, Zaccaro, Harding, Jacobs, & & Fleishman, 2000). Thus, the theory compels all leadership to practice system thinking to enable effective execution of plans and intentions for various health organizations.
Empirical Evaluation Plan for a Public Health Leadership Theory
The servitude leadership theory is designed to address the shortage of public health professional leaders and the challenges that affect the dissemination of ethics and leaderships qualities within organizations. The literature reviewed in the paper showed that there are deficiencies in the research presented about the effectiveness of leadership after considering ongoing health care reforms. Practitioners are implementing various health care reforms at institutional and national levels yet they do not have generalizable research findings of the effect of leadership and the mutual relationship between leadership and ethics performance of organizations.
The servitude/servant leadership theory proposed is based on the notion that leaders can inspire effective organization policy agenda change when they mentor, coach and give subordinates the opportunity to take part in important decision-making (Savaya & Waysman, 2005).
The theory developed can be accessed base on a model that looks at the theory as an input variable and its performance indicators as intermediaries while its outputs are the effects that the theory brings when applied to an institution that has undergone health care reforms or is undergoing health care reforms. In the literature examined, the theories used have been examined using random controlled trials meant to test the validity of the theories. Researchers have considered their study populations are hospital staffs, who are interviewed before and after the implementation of leadership changes to determine organizational effects on effective leadership expressions. Also, studies have also focused on surveys on the expected role of leadership or definition of leadership using cross-sectional surveys of health institution staff members.
In evaluating the theory, the research’s data collection will use both structured and unstructured questionnaires. They will be administered to leaders and subordinate staffs at health institutions. The collected data will use collection instruments that capture qualitative and quantitative data focusing on three main components of the proposed theory. These components are participation, delegation, and empowerment. They will also focus on the prescribed model of the theory’s intervention. This model starts with the theory then follows activities of the delegation, participation, empowerment, mentoring and coaching.
The third step of the influence stage is the performance indicators. They include the level of subordinate confidence to do particular leadership tasks, the degree of involvement in the subordinates on important decision-making roles and the level of participation of subordinates that corresponds to the motivation for building new skills. This also indicates the motivation to organizational success. The fourth step of the model is the outputs, and they include the number of subordinates who have taken on a leadership position in organizations in a given year.
The fifth stage of evaluating the theory looks out outcomes such as the ability of effectively and constantly performs ethically the tasks of the earned or promoted leadership position. Finally, the model considers the impact that the outcomes have on society and particular institutions such as the reduction in a shortage of skilled health leaders and orientation of organization environment to support further ethical practice in leadership.
The evaluation research will about to find out the mechanisms available at using servant leadership theory as proposed in the study for increasing the effectiveness of leadership. The research’s problem statement will be that there is a lack of sufficient literature on the connection between servant leadership theory and organization ability to operate amid ethical dilemmas facing organization members at different decision-making points. The dilemmas call for the appointment of new leaders and equipping them with the right skills. There is a need to evaluate whether servant leadership theory is sufficient at meeting the output and outcome goals of ethics and leadership. It should be considered after healthcare reforms and whether these solutions are generalizable.
In the data analysis part, the information collected will be considered according to its relevance as indicators for the effectiveness of the new theory and the outputs that have implications for health practice. The findings of the research will show that the targets set before the research are achieved as part of the outcomes. It will also show trends of new leaders being supported to take institutions through ethical decision-making processes through a distributed leadership framework. The findings will also offer practical and generalizable solutions to practitioners of an aspect of their leadership to change such that they cultivate the organic formation of new leadership capabilities within the respective organizations.
In the evaluation, the results of collected data will be compared, and a conclusion about theory effectiveness will be made as well as its validity in responding to the literature gaps identified in the literature review. The focus will be on the subordinates equipped to take effectively on leadership roles and the shift in their attitudes about leadership goals and organizational goals, which affects organizational culture and, therefore, provides a system thinking solution to leadership reform as part of overall health care reform. When the findings meet a significant number of expectations, then it will be safe to conclude that the theory is effective and relevant for a reformed health system where leadership roles and their transferability within and across institutions are possible by following leadership service approaches.
Conclusion
The field of public health has to respond to challenges in the delivery of health care to populations around the world. These challenges require effective leadership at times of crisis and when a systematic approach to reforms is needed. With ongoing reforms of health care such as modes of funding and payment, as well as involvement and dissemination of research about the reforms and for influencing the reforms, there have been gaps in the expression of ethics by health leadership.
The problem is noted as a lack of appropriate examples or guidelines by current research on the right leadership necessary for influencing appropriate change in organizational environment variables to sustain progress in ethical reforms. From the literature reviewed in this paper, the gaps were mainly in the attachment of leadership style and approaches to actual use in institutional contexts. It appeared like most research was merely presenting additional leadership theories rather than testing the theories’ validity and generalizability in a reformed health care environment.
Studies have shown that there is the need for reforming approaches at training leaders for health care sector while stakeholders are expressive of the looming shortage in leadership, especially for strict ethical dilemma situations involving medical research, administration, and patient care. The proposed leadership theory is servant leadership that infuses attributes of transformational leadership and charismatic leadership for the health care industry. It follows a system thinking that supports mentorship, coaching and offering subordinates leadership opportunities as part of grooming them and as part of a distributed leadership framework.
In the process, organizations can change their culture by having leaders and leadership ethical consideration at all points of their decision-making thus addressing the current shortage of leadership or approaches to generalize research and practice.
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