Leadership Theories Applied to Hospital Supervision

Introduction: Classifying My Supervisor's Leadership Style

According to Kurt Lewin, all leaders fall into three basic categories: autocratic, participative, and democratic. My current supervisor is best described as autocratic in her demeanor, though in a moderately benevolent way. I work as a respiratory therapist in a hospital. My supervisor must ensure that patients are seen in a timely fashion and that all medical personnel comply with basic safety regulations. She oversees the scheduling of various personnel who work on the ward and is responsible for handling conflicts between employees, as well as between employees and patients.

My supervisor tries to be fair, but her word is law. This is partly because she is accountable for serious complaints if hospital directives are not followed. It is essential that patients are treated in a respectful manner, and certain protocols must be followed to ensure that patients remain in good health. The need to check vital signs, for example, is not open to debate or democratic decision-making. Additionally, because high levels of stress among workers can create tension, there must be a fair and objective authority figure who can remain above workplace conflict.

Why Autocratic Leadership Dominates in Hospital Settings

One reason my supervisor may have adopted an authoritarian style is the relative youth and inexperience of many workers on the ward. She feels that to ensure things get done, she cannot afford to engage in prolonged debate and discussion. However, being insufficiently participative can also cause problems. A common source of conflict in an understaffed hospital is scheduling. Certain schedules are, for understandable reasons, more desirable than others — such as day versus night shifts, or avoiding weekends and holidays. Questions arise about how scheduling should be determined: should seniority take priority over the fact that a worker has recently worked more unpleasant shifts than others, or that she has young children? Workers may also have valuable ideas about making the day more manageable, such as scheduling more frequent breaks for people on long shifts or supporting younger and less experienced employees. When a supervisor adopts a dictatorial style, the potential benefits of a broader, more inclusive approach to leadership are often overlooked.

The organizational culture of the hospital tends to reinforce a very authoritarian style of leadership. The hospital is large and complex, and must manage many competing interests. Like many hospitals, it faces demands to cut costs while simultaneously providing more services to patients. There is a critical shortage of personnel, particularly nursing staff. Given that nearly all employees have their own ideas about how to improve things, it is often easier for administrators to make decisions in a top-down manner and issue directives rather than navigate the complexity of incorporating many different employee perspectives. The nature of healthcare is, in general, somewhat directive.

Drawbacks of an Autocratic Approach

One significant problem with an autocratic style is that it can result in very low morale. People enter the helping professions because they have a genuine desire to contribute to others' well-being. When they feel their efforts are being frustrated — by conflicts with insurance companies, slashed hospital budgets, or rigid top-down directives — they often resort to complaining and disengagement. Furthermore, highly trained professionals believe they possess the expertise to make sound decisions about their patients without being required to follow every procedure to the letter. An autocratic environment can feel demeaning to skilled staff who expect their judgment to be respected.