Situational leadership and its impact on healthcare management education

¶ … leadership is a theory, developed by Paul Hersey and Ken Blanchard, that argues "successful leaders should change their leadership styles based on the maturity of the people they're leading and the details of the task" (MindTools, 2014). This contrasts with most views prevailing in leadership scholarship, which tend to argue that leaders will have one leadership style. The underlying argument that Hersey and Blanchard are making is that in this world, there are so many different situations that arise that a single leader with just one leadership style will never be as effective as a leader who can adapt his/her style to suit the situation.

According to the Hersey-Blanchard situational leadership theory, there are four main leadership styles -- telling, selling, participating and delegating. These are then applied to four different maturity levels. The authors argue that at the lowest maturity level, the leader needs to focus on telling/directing, and then this goes up to a high maturity level where people can work on their own. Those people require leadership that is focused on delegating (MindTools, 2014). The middle levels require leadership styles such as selling, where the worker has limited ability and lacks motivation, so needs that sort of coaching from the leader. At maturity level three, which is where a lot of people are, participating is required. The participating leader "focuses on the relationship and direction, working with the team and sharing decision-making responsibilities" (MindTools, 2014).

In healthcare, there is no one leadership style that is appropriate. This is pretty much the principle of situational leadership, because task behavior is also an important variable, but also because the different employees have differing maturity levels. Most workers in health care are at least at the second level of maturity, which is characterized by followers who are willing to work on a task but maybe need help to complete it properly. For many jobs, there is a high learning curve, so many employees start at this level and move up to level 3. At level 2, situational leadership calls for "selling," where the leader explains the decision, the rationale, and seeks to motivate people that way. There might also be some teaching involved, a holdover from the lowest maturity level, but that depends on whether the task is high directive or low directive (Schermerhorn, 1997).

Many workers still fall into the third maturity level, which is characterized as "followers who are willing to help with the task, have the skills, but maybe lack the confidence." One would think that in the health care setting most people would have confidence but my experience is that unless the task is low directive (i.e. routine) most workers are not all that confident. In my workplace experience, I have seen many situations where the leader assumed that because someone is confident in their normal activities that they will be confident in non-routine activities, when it became readily apparent this was not the case. So there was a mismatch between the leadership style and the maturity level of the employee.

Most managers in healthcare seem to either assume that their workers are level 1 or level 4. Either they want to micromanage everything or they are laissez-faire in their approach. Fortunately in the case of the latter, many of the people that I have worked with have a lot of experience and training, and therefore can work independently. At maturity level 4, a worker has high task commitment, skills and has high confidence. Most doctors and nurses with experience fall into this category, and are managed accordingly. The appropriate situational leadership style for maturity level 4 is delegating, wherein the leader will "pass most of the responsibility onto the follower or group, while still monitoring progress" (MindTools, 2014).

From what I have seen in my own experience, this works pretty well. The manager keep track of things pretty well. They get reports that outline the important statistics that they want to track, and some managers also take an interest in individual cases. But it seems that a lot of the day-to-day work is left to the nurses and doctors, and that is good.

Where the system begins to break down is less in the daily management, which seems to fit the situational leadership delegating style but in the structure of the organization. My experience has shown healthcare to be a very bureaucratic field, which means that there are times when suddenly that delegating style is replaced by a telling style. This I find to be counterintuitive and a source of frustration among people I have worked with.