Leadership Is Said to Be

Leadership is said to be effective if it helps a company or entity to achieve its goals and realize outcomes that are consistent with the majority. Overall, the qualities necessary to make leadership effective even in a hospital setting has been consistent -- the need to motivate, encourage, support, direction, organization, and to provide access able goals. However, what has been debatable is how leaders acquire these necessary qualities -- the debate centers around whether leadership skills are innate or whether they can be acquired, and which leadership type tends to be most effective in certain environments. The overall body of this paper will examine leadership styles that are present at a hospital nursing unit with a focus on the style of transformational leadership. There will also be a critical analysis of change management and what environments are conducive to different strategies. The analysis will be conducted within the context of the case in s hospital nursing unit with sections outlining strategic management, leadership, and strategy in the healthcare systems.

The analysis will be rooted in formal management theory to explore the types of leaders that exist and are effective in healthcare -- especially transformational leadership, and the necessary skills and talents that leaders should have to develop effective service sectors. The literature surrounding leadership seems to posit that the necessary qualities and skills can either be born with or they are made, the types of leaders that exist seem to show a diverse set of hypotheses. However, what is clear is that the nursing literature views transformational leadership as an important aspect of change management and some authors have identified this leadership style as one of the most effective processes that can lead to efficiency in the long-run. The paper will explore these issues and will highlight how this type of leadership style can be implemented and is practiced within the healthcare sector. The combination of leadership, change management, and related formal nurse management theories provides an excellent platform for examining operations within a healthcare environment.

The issue of leadership and management is closely intertwined however, it is clear that there are many issues that set the two apart, the study below will provide a good foundation to examine leadership at a hospital nursing unit.

LEADERSHIP STYLES and CHANGE Management

According to Sturm (2009), organizational outcomes are usually considered the combination of inherent values and learned mission. The importance of an organization's leadership and management structure is due to the fact that it feeds operational excellence and ensures that strategic objectives are achieved. It is therefore imperative that the leadership be embedded in this critical process, why?

Organizations are living social organisms, and need a link between them to survive; the leadership provides that link,

Organizational outcomes and the leadership of an organization is the fundamental support of an institution and will fail without a strong one,

Sturm (2009) sates that organizational outcomes are critical business strategies, goals, missions, and outcomes.

As stated by Sturm (2009), the leadership styles, whether consciously or unconsciously helps to create, hone, and develop organizational outcomes from their own personal history, nature, socialization experiences, and perception of what it takes to succeed in the market place. Table 1 below presents the four core outcomes that an organization can adapt.

Table 1: Leadership Styles and the Four Core Organizational Outcomes

Type of Outcomes

Brief Description

Control

The outcome is all about certainty. The leadership style exists to ensure predictability, safety, accuracy, and dependability. The leadership develops an outcome that is centered on organizational goal achievement.

Collaboration

This outcome is about synergy. The leadership makes sure that unity, close connection with the customer and is centered on dedication with the customer.

Competence

This outcome is about distinction. The leadership exists to ensure that the development and business strategies are unmatched.

Cultivation

This outcome is about enrichment. The leadership exists to make sure the fundamental goals of the organization are embedded in the corporate structure and business strategy.

Adams (2010) argues that the leadership acts as the strategic driving force that guides the decisions and workers on all levels which has to be integrated with the outcomes of the organization by:-

Identifying credible strategic forces that embrace the leadership style associated with the organizational outcomes,

Prioritizing and analyzing risk associated with each organizational outcomes,

Providing multiple communication channels to meet consumers' needs and help workers and managers embrace the organizational structure.

The types of leadership that exist provide insight into whether leaders are made or born.

Trait theories and contingency theories, relate to leadership theories, stated by McGuire and Kennerly (2006). For the former, it is assumed that individuals possess certain skill or attributes, that are inherited qualities and allows an individual to be characterized as leaders because of those qualities. However, for the latter, environmental or situational factors determine the style of leadership that is best suited.

As stated by Leach (2005), there is a fundamental difference between the two leadership theories, since trait theory posits that, there exist a set of skills, which inevitably make an individual a leader, while contingency theory argues, that different skills are different leadership styles are needed based on the particular circumstance or situation.

Leach (2005) shows that trait theory identifies leaders via personal characteristics, and effective leaders seem to have these common characteristics. Contingency theory identifies the characteristic and style (which absorbs aspects of the trait theory), subordinates expectation and experience, and the nature of the task and environment as being the important elements that defines different leaders.

The necessary leadership theories have also found that the identified traits of leaders were expansive and not uniformed across individuals. In fact, many leaders were found not to have all or majority of the supposed traits that determine if an individual is a 'good leader', according to Atter (2008). Contingency theory on the other hand, defines a leader based on the task or situation, which is usually, defines or hones skills based on the environmental or situational factors

Fiedler's original model of leadership stated that there were two styles of leaders -- task oriented or relationship oriented. Callaghan (2006) used this model was identified as one of the firs contingency models, since it focused on the degree of structuring in the task and the leader's organizational power. Figure 1 below shows the major auspices of Fiedler's model of leadership. Ideally, Fiedler's model shows that the leader's ability is based on the leader's preferred style and the motivation of followers, that is, the effectiveness of the leaders has to do with how well the style of the leader matches the situation. Just as Callaghan (2006) showed the two basic leadership styles are task-oriented, where the focus is on accomplishing assignments and relations oriented or person centered, where good personal relations is the focus of the leader. This was also supported by Cummings, Macgregor, Davey, Lee, Wong, Lo, Muise, and Stafford (2010). The general concept or idea is that the effectiveness of a leader is based on situational contingency.

Figure 1: Fiedler's Leadership Styles and Situational Analysis

The Cognitive Resource theory as presented by Kanste (2008), modified the model of leadership described above by adding traits of the leader, that is, situations are identified under which individuals will use their intellectual abilities, natural skills, and knowledge to solve problems effectively. The overall conclusion from the extension is that, leaders with a higher level of intelligence and experience will outperform leaders who are less intelligent.

McGuire and Kennerly (2006) argue that it seems somewhat puzzling to have a concept of moral leadership, since it is sometimes assumed that morality should be embedded in most if not all leadership traits. However, moral leadership refers to the idea of authority that is standardized against some predetermined ideals of what is considered "good" and the "right way to act." This type of leadership does not have any characteristic or undertakes any action that is in conflict with the notions of morality.

Spirituality in organizational outcomes refers to the idea of an integrative approach to a set of inherent values within an organization that are developed via connectivity with one's emotions, other individuals, and more importantly a supreme being as argued by Ralston (2005). This type of structure usually solidifies an approach that allows individuals to realize their existence via a process that translates the needs of individuals based on the principles of spirituality into actions that guide work ethic.

Moral leadership seems fitting for an organization that embraces spirituality, why? Spirituality whether in religious or psychological terms also integrates or assumes a moral standard that is used to judge actions and/or behavior; as such, the necessary moral leadership standard can be complementary to the overall organizational outcomes. It should be noted that this harmonious union is only applicable, if the necessary values upheld by the practice of moral leadership does not contradict, any noted spiritual outcomes trait that the organization may have. Moral leadership also provides a good foundation on which to fulfill spiritual needs in the workplace, which sometimes creates a conducive and productive environment; this was noted by Cummings et al. (2010).

Transactional leaders use the extrinsic motivators, to get goals met within an organization, as stated by Suliman (2009). This type of leadership used internal reward or punishment mechanisms to get employees to follow their directive. Transactional leaders usually leave the current organizational structure and goals intact, since the characteristic of these leaders is not effective in situations that require change. Suliman, (2009) also argue that some leaders are very passive and only get involved if the necessary actions are contrary to the overall goal or achievement of the organization.

Visionary leaders are usually characterized as individuals who do not compromise their personal integrity for the overall goal of any organization or process. These leaders do not portray ordinary character traits, since they are usually concerned with direction or organizing action based on new possibilities or a progressive agenda as argued by McIntosh and Tolson (2009). These are usually interested in the creation of processes or procedures that are considered pivotal and usually affect the lives of individuals. Examples that immediately come to mind are like Martin Luther King Jr. Or Mahatma Gandhi, when this type of leader is mentioned.

Also supported by the analysis of Nielsen, Yarker, Randall, and Munir (2009) the evidence seems to show that the leadership styles that are used in practical settings require a fundamental integration of understanding employees, communicating, motivating, and helping to define the success of the entity by acting a transformational leader. Nevertheless, the leadership styles discussed above all seems to have essential strengths and depend on the organization and/or situation that are being presented.

TRANSFORMATIONAL LEADERSHIP at WORK -- ENGAGING the NURSING UNIT

Ralston (2005) argue that in using change management and recommendations and integrating the framework of a hospital nursing unit there has to be a focus on implementing policies and procedures that will increase efficiency at the hospital. This however, has to be accomplished via a leadership style that is focused on patient care, helps to achieve efficiency and develops teamwork. This type of multifaceted duty for a leader, the literature argues can only be supported via a transformational leadership model. In fact Cummings et al. (2010) present the following six principles are important to the overall strategic management implementation process and are integrated into change management and overhaul of a hospital nursing unit.

The strategic management program has to be compatible with the current organization outcomes and schedule.

Scheduling criteria has to be clearly defined so that the connection between achievements and rewards can be understood by the hospital nursing unit before activities commence.

The schedule has to be free of conflicts and should not interfere with productive activities of the hospital.

Programs should be scheduled for short life-cycles of six to 18 months with performance factors attached to understand its relative benefit to the organization

The schedule should not be used as a way to mask any inadequacies within the hospital that may require additional funding or program overview.

The scheduling process should be kept clean.

Similarly, transformational leadership and change management also require reviewing and monitoring the implemented process aimed at improving efficiency. Ralston (2005) states that, change management is the "planned systematic development and diagnosis of an organization so as to identify and execute a plan for improvement and how to provide adequate resources for an entity." Nevertheless, it is necessary to augment this process with a leadership style that will maximize the outcomes of workers. Lunn (2008) argue that transformational leaders usually seek to develop a vision for the organization. The important characteristic of this leader is that the necessary energy and commitment to the goals of the organization are translated to the followers in very passionate and energetic ways. Transformational leaders are usually charismatic, since it is necessary for them to have the trust of followers, and can usually provide the fostering and embracing of the common values embedded within the organizational outcomes, develops teamwork, acts as a problem solver, and aims to improve processes and procedures within the organization, states Lunn (2008).

However, it is noted that by McGuire and Kennerly (2006) that change management has allowed entities to continually be successful if it is effective at integrating leadership styles such as transformational leadership models within the strategy of the unit. This processes the helps the supervisors to be better at:

Identifying credible information services and products on affect the current insurance policies and procedures

Prioritizing and analyzing strategic, so that the current system can achieve its maximum efficiency

Using research methodology and other analytical tools to monitor the overall performance of the strategic management program chosen.

Review and seek measurable savings and reduction in total strategic management alternatives.

Evaluating the current hospital policies and strategic management options and test the models effectiveness in overcoming the potential administrative hurdles associated with high strategic procedures and/or activities.

AL-Hussami (2009) states that as the highest level of direction in an organization it is imperative that the roles of the leadership be identified as 'strategic roles', since they are the core of the organizational structure and are processes that have to be embedded via a process that is learnt and are developed as tasks and outcomes are processed within organizations. Figure 2 below identifies the strategic roles of the leadership.

Figure 2: Strategic Roles of the Leadership

It is common knowledge that motivating the workforce is a necessary prerequisite for effective leadership. Many companies have gained tremendous success, by enforcing being able to correctly identifying rewards to performance and hence motivating the workforce to support the organizational structure. Other organizations have failed to realize their strategic objectives because they have not realized how important the overall mechanism of the organization is. Leach (2004), shows that these roles of leadership can only be developed if they are practiced and used in situations that can benefit from the process -- that is effective leadership styles, especially transformational leaders are made from practice.

Transformational leadership and change management cab act as the champion of change at the hospital. Employees use the leadership as a model for the organization's direction and development. This is why a transformational leader within a nursing unit, has to be able to scan the external market environment and be able to predict and analyze the future changes within the industry. Employees have confidence in leaderships that act as "visionary, a problem solver, and a communicator, which are all processes that are learnt for leadership," states Sturm (2009). Sturm (2009) also posits to the fact that a transformational leadership has to set performance standards and promote these standards as part of the structure associated with the organizational structure. These standards are not arbitrary, but should be necessary prerequisites for the company to maintain a competitive edge in the nursing industry.

A hospital nursing unit with effective transformational leadership is a source of competitive advantage, if and only if, employees are motivated towards the outcomes, as argued by Stanley (2006). Atter (2008) also identified some major strategies that have proven to be common among numerous successful nursing units, which have used the change management timetable as a support mechanism for motivating employees to work towards corporate objectives. Transformational leadership and change management as integrative processes incorporates the following strategies:-

Strategy #1: Identify environmental factors that will utilize the skills and talent of the employees -- this will motivate the workers. It is clear that a motivated employee wants to contribute to work areas outside of their specific jobs and to help enhance the work environment by embracing the leadership.

Strategy #2: Correct rewards have to be based on performance designed to boost employee morale -- change management and leadership style has to support these programs thinking that paying the employee is enough is obviously an erroneous assumption. Research shows that workers are demoralized when they don't receive the recognition they want or feedback on how they are doing.

It is pointless to have a leader who has the ability and aptitude to predict market trends and make sound business decisions, but not be able to communicate these changes to the corporation; this Adams (2010) argues is what makes a transformational leader so effective within a nursing unit. The key to motivating employees towards a set of principles embraced by the organizational outcomes is via communicating the necessary information or changes to the corporation as needed, states Adam (2010).

As an essential strategist, the leadership sets the future direction of a company; the process for creating effective strategy inevitably involves a team-centered strategic planning approach. The success of the team depends solely on effective communication. Studies show that leaders who communicate with workers and get to know the work outcomes and integrate that process with the organizational outcomes have higher profit margins and smaller turnover ratios -- the outlined processes and procedures conducted by transformational leadership is to ensure that the hospital can be successful and the employees feel important to the overall strategic development of the hospital.

McIntosh and Tolson (2009) argue that without a capable management team who is informed of the organizational processes as well as embracing the organizational outcomes, then the operational processes of a company will be stagnant. In essence it is impossible for leader to not have traits similar to transformational leadership and function or be successful. Adding value to an organization is embedded in linking strategy to the organizational structure, which was the process that transformational leadership and change management used to achieve success at a hospital nursing unit. Callaghan (2006) argues that it is communication that allows a leadership to impart vital information, so that employees can become a part of the system and thus understands the organizational outcomes.

Whatever strategic and business strategies are chosen it is essential that the leadership is consistent with production/operational trends. In fact the following seven principles are important to the leadership. Transformational leadership and change management uses these processes, so as to help achieve efficient communication:

Communication channels have to be compatible with the current organization outcomes and schedule and have to be developed with change management and leadership style

There has to be a connection between achievements and rewards and this should be understood by the staff.

There has to a scheduled time at benchmarks to help with communication and motivating forces so as to acknowledge and communicate desired behavior and performance -- processes that are developed rather than enhanced with innate qualities in a leader

Change management and leadership style should integrate well with the distribution channels, so that it is does not interfere with productive activities.

The communication and motivating process should be kept clean and included in the taught change management and leadership style.

Optimizing communication functions implies that the leadership has a relationship with workers that involve providing feedback, evaluation of employee activities, and rewarding efforts geared towards effective communication is also essential. Effective communication implies that the leadership includes these differences within the communication plan development and the overall organizational structure as stated by Lunn (2008).

Since there can be fundamental problems related to the operations at a hospital nursing unit, action usually needs to be taken quickly and the plan has to incorporate elements of event identification, risk assessment, and a thorough financial analysis.

A hospital nursing unit would only stand to gain from the recommendations of change management framework if the hospital used the underlying strategies suggested and followed by transformational leadership after an internal assessment -- this would act as a strategic business element to increase efficiency.

At a hospital nursing unit the issues that require immediate attention can stem from capital constraints, state's regulatory roadblocks, and local related staff problems with the nursing unit. Internal issues related a nurse's workload, training and human resource management, ineffective medical payments infrastructure as well has high utilization and increased cost of healthcare adversely affected the operational and financial aspects of the hospital as it struggled to survive in the changing managed care environment. Risk assessment procedure undertaken by transformational leadership and change management needed to be integrated within the general operational plan includes: overview of nursing staff to understand the problems affecting the unit, tackling human resource problems, data collection to identify the frequency and severity of operational losses can be based on gathering information from external or internal stakeholders. The strategic development process involved quantifying unknown variables; however transformational leadership and change management needed to foster relationships with hospital personnel such as doctors and nurses who would be able to provide good estimates based on prior experiences. Patients were essential to the operations at the hospital and were also a primary source of information and can provide useful parameters that can be applied to methodologies to collect data,). The frequency and severity of potential problems a nurse manager can address can be identified through various mechanisms including, but not limited to notices of intention, claims, quality reviews, risk assessments, incident reports and survey findings. Risk identification and quantification can also be obtained from quality investigation on all departments and units operational processes to understand the severity of potential losses.