Followership and complexity are two emerging concepts in leadership. Discuss them both, including the importance of considering how they might contribute to patient safety, conflict resolution and more effective communication within healthcare teams, remembering that many different cultures may be represented in one healthcare team (which brings us back to complexity). Your discussion should also include a contrast between complexity leadership theory and traditional leadership theories that have mostly overlooked the influence of followership and complexity on leadership.
Traditional leadership defines a leader only as an individual who can influence followers through motivation, reward, manipulation, action, or punishment, (Bass, 2008 in Weberg, 2012). Such leadership describes a role rather than a set of behaviors, and places power in the position rather than in relationships, (Weberg, 2012).
It has been established that an essential part of leadership, followership, has been long ignored until recent. It is suggest that such oversight was due to misunderstanding over what followership entails, and how this relates to leadership, (Uhl-Bien, Riggio, Lowe, & Carsten, 2014, pg 1).
Leadership can only occur if there is followership, and such, following behaviors are a critical to the leadership process, (Uhl-Bien, Riggio, Lowe, & Carsten, 2014, pg 1). This insight suggests that leadership is incomplete without an understanding of followership, (Uhl-Bien et al., 2014, pg 2).
Followership theory is the study of the nature and impact of followers (subordinates) and following behavior that co-constructs leaders in the leadership process, (Uhl-Bien, Riggio, Lowe, & Carsten, 2014, pg 2).
Two dimensions have been described for followership behaviour; the degree of criticism and independency in thinking, and the classification in terms of mode of starting action, with the latter consisting of exemplary and passive followers, (Can & Aktaş, 2012, pg 85).
The first dimension characterizes the follower’s mode of thinking and how critical and independent is from the leader.
Critical thinking followers are aware of the behaviors expected from themselves and others, and are prepared to be innovative. These followers can constructively criticize their leader through independent thought. Dependent, non-critical thinking followers do not provide such thoughts, criticisms or innovation, and just simply ‘follow the leader’ without question, (Can & Aktaş, 2012, pg 85).
The second dimension focuses on followers’ mode of starting action. Model followers are self-sustained, and innovate decision-making. Passive followers do as asked, (Can & Aktaş, 2012, pg 85-86).
There are many theories on followership, (Chaleff, 2009, Kellerman, 2008, and Hurwitz & Hurwitz, 2015), however, this paper focuses on the work of Robert Kelley, as it is the most widely accepted framework, (Kelley, 1988, pg 142-148).
‘The Sheep/’ (low independence, passive) requires external motivation and constant supervision. ‘The Yes-People/Conformists’ (low independence, active) conformists committed to the leader and organization, and do not question decisions or actions. ‘The Pragmatics’ (average on both dimensions) have no stance on novel ideas unless the majority of have voiced support, and tend to reside in the background. ‘The Alienated’ (high independence, passive) are negative (often due to adverse past experiences) and often question decisions and actions of the leader or place obstacles in the way of progress. ‘The Exemplary Followers’ (high independence, active) are positive, engaged, and independent thinkers, showing characteristics of a leader themselves, (Kelley, 1988, pg 142-148, Can & Aktaş, 2012, pg 86-87). Exemplary followers are those most sought after and valuable to organizations, contributing to positive change and achievement of goals.
Complexity leadership theory
In contrast to traditional leadership, Complexity Leadership Theory (CLT) focuses on the strategies and behaviors of organizational and subunit creativity, adaptability, and development, (Uhl-Bien, Marion, & McKelvey, 2007). Three key types of leadership belong to this model: administrative leadership, enabling leadership, and adaptive leadership.
‘Complexity’ is distinct from ‘complicated’ in that the latter may contain many components to form a whole, however, the individual parts remain unchanged by each other. Complexity may also be composed of many subsections, but the components, or individuals, can invoke irreversible change on one another, (Uhl-Bien & Arena, 2017).
The healthcare sector, with its volatile regulatory environments, changing patient relationships, developing technologies, and evolving pay structures, poses an uncertain future, (Uhl-Bien & Arena, 2017). Leaders are trained to execute management mode and drive control in the face of challenges, and are biased toward order. The issue here is that order is the foe of adaptability, and can choke the interactive dynamics needed for effectively responses to complexity. Complex environments call for adaptive responses, and those organizations that enable such retort, capitalize on the collective intellect of groups and networks; engaging emergence, (Uhl-Bien & Arena, 2017).
Emergence occurs when agents (people, technology, information, resources, etc.) in a networked system synergize in an environment readied for change, generating a novel approach to the challenge. Adaptive responses spawn when such networked agents engage with the innovative solution, which meets the needs of the complex challenge. Such revolutions are generated by the collective whole; a rich collaboration of diverse people, ideas and pressures, fusing to generate emergence, (Uhl-Bien & Arena, 2017). The dynamic nature of emergence retires traditional management styles, and instead, calls for leaders to enable adaptive responses through creating conditions that fuel emergence, (Uhl-Bien & Arena, 2017). Enablement can be successfully achieved when certain conditions occur, such as information flows and pressures. Information flows allow agents to connect with a unified purpose or need, in which collaboration can occur to form an adaptive response. Pressures can release the tight-knit order of organizations, to seek novel opportunities to tackle challenges. Leaders who understand such conditions can interact with emergence events to influence outcomes, using tags and attractors. Tags are devices such as symbols, people, information or events that can catalyze an accumulative process, whereas an attractor gives energy towards it, (Uhl-Bien & Arena, 2017).
Complexity leadership draws from three types of leadership required for adaptability: operational leadership, entrepreneurial leadership and enabling leadership, (Uhl-Bien & Arena, 2017). Operational leadership centres around the configuration of systems and processes for effective execution of ideas into productive outcomes. Entrepreneurial leadership sources innovation, development and growth. Enabling leadership facilitates conditions that maintain and sustain adaptively. Enabling leadership is unique in that it is introduced by complexity thinking, and when engaged with operational and entrepreneurial leadership, allows organizations to flourish when faced with complex challenges, (Uhl-Bien & Arena, 2017).
An organization implementing complexity leadership allows leaders to build relationships with all stakeholders, achieving effective change in a supportive environment, (Joel, 2013).
(Uhl-Bien & Arena, 2017) – Hierarchical organizations can be resistant to change initiatives, resenting those who attempt to initiate it. Pressures loosen the system up for change, and can be a good driver for change, (Uhl-Bien & Arena, 2017). Complexity pressures typically involve a need for a novel solution, new partnerships, conflicting ideas/perspectives, and interdependence, (Uhl-Bien & Arena, 2017).
The role of complexity leadership on followers
The ultimate goal of any leader would be to change all follower types to ‘exemplary’ followers, more so the ‘alienated’ ones. A team of exemplary followers would allow for optimum performance, minimal or no resistance, and efficient completion of goals. However, with such a vast and diverse network of stakeholders, how could this possibly be achieved? Complexity leadership must know and engage with their colleagues, understand and try to change the resistance from the ‘alienated’ by involving them in the process to improve the situation, motivate ‘The Sheep’ to take responsibility and ownership, encourage the ‘conformists’ to contribute new ideas, bring the ‘pragmatics’ out of the background, and encourage the ‘exemplary’ to help leads the rest. Complexity leadership becomes a powerful tool when followers are fully understood, so that leadership can be adapted to each individual.
Recent findings have suggested that leader knowledge and value of patient care requisites, promotion of healthy working environments, quality of communication skills, and inspiration to staff through engagement, promotes significant improvement in performance and patient outcomes (Wong, 2015, p. 278). However, as much as complexity leadership can influence patient outcomes and safety, followership styles also play a key role. In an ever-growing pressurised healthcare setting, with low staffing levels and reduce resources, staff become tired and resentful, changing even exemplary followers into alienated ones.
A number of studies have shown that significant numbers of patients are harmed within healthcare settings, resulting in either increased length of hospitalization, permanent injury, or even death, (World Health Organization, 2017). A recent study claims medical errors are the third leading cause of death in the United States, and in the United Kingdom, an incident of patient harm is reported on average every 35 seconds, (World Health Organization, 2017). Patient safety is therefore a vital area for improvement globally.
Patient safety is delivered by a number of stakeholders, such as patient-facing healthcare professionals (GPs, consultants, surgeons, junior doctors, anaesthetists, nurses, health care assistants, etc), administrators, porters, cleaners, management, and even the patients themselves. Such stakeholders have an individual duty of care, which may vary from booking appointments, accurate diagnoses, maintaining a clean environment, transporting patients to the correct place in a timely manner, performing safe and accurate procedures, prescribing correct and safe medication, maintaining adequate policies, and adhering to advice and regimes given. Often, those who take on patient-facing roles, have a genuine interest in the safety and wellbeing of the patients they care for, and so will adhere to protocols put in place to maintain their safety. However, as most healthcare institutes currently suffer from enormous pressures involving understaffing, lack of resources, and inadequate funding, such staff face turmoil in ensuring patient safety. With this shared interest, however, these staff members form the basis for the desire for change, and could represent an ideal situation for complexity leadership to flourish. On the contrary, with so much at risk, a pragmatic- or sheep-like-follower style may persist for fear of novel and untested ideas adding to the problem.
Leaders who enable adaptive space (contexts and conditions that enable networked interactions to generate and develop novel ideas), understand two key dynamics which form adaptive complex systems: conflicting and linking up, (Uhl-Bien & Arena, 2017, pg 12-13).
Conflicting provides the diversity and ideological differences needed for creativity, and occurs when agents collaborate in cohesive groups. Although conflict is seen as a negative aspect, in complexity leadership, the range of differing or completing perspectives generates tension to change or adapt, (Uhl-Bien & Arena, 2017, pg 13). However, for conflicting to produce adaptive space, rich interconnectivity at network level needs to be engaged. At order level, managers step in and eradicate the conflict, often reverting to SOPs for decision-making. At a chaos level, agents become divided and fail to reach mutual points in order to link up, (Uhl-Bien & Arena, 2017, pg 13). Typical examples are when ‘alienated’, ‘conformist’ and ‘sheep’ followers engage in conflict.
In order for conflicting to be productive, there must be some shared need or perspective, which permits agents to link up, and emergence to occur. Linking up occurs when co-dependent agents share adequate common perspectives, such as a common need for change, so combine ideas that initiate novelty and strengthen emergence. Complexity leaders can enable such behaviour by bringing together those with concepts and a desire to change (such as ‘exemplary’ followers), and enabling them with the resources and opportunities to create novel solutions and approaches, (Uhl-Bien & Arena, 2017, pg 13).
More effective communication within healthcare teams
Communication is key to any effective working relationship. Clear expectations, behaviours, goals and boundaries are the fundamentals of leader-follower collaborations. Traditionally, such frameworks are designed and delivered by order leaders (management); however, complexity leadership opens the doors to collaborative discussion amongst all agents, over such decisions and implementation.
Traditional leadership theories – contrast between complexity leadership theory and traditional leadership theories that have mostly overlooked the influence of followership and complexity on leadership.
(Weberg, 2012) – Traditional leadership theories and models no longer adequately inform leader behaviors in health care (Plowman & Duchon, 2008). Historically, leader- ship theory has focused on special traits of leaders, situational demands, the interaction of leader traits and situational context, and the dyadic relationship between leader and follower (Bass, 2008). Traditional leadership research, according to Cherulnik, Donley, Wiewel, and Miller (2001), has only studied two out- comes: how leaders are chosen, and how well leaders function. These research traditions have defined a leader only as an individual who can influence followers through motivation, manipulation, action, reward, or punishment (Bass, 2008). Traditional leadership describes a role rather than a set of behaviors, and it places power in the position rather than in relation- ships (Plowman & Duchon, 2008).
Chaleff, I. (2009). The courageous follower: Standing up to & for our leaders. Berrett-Koehler Publishers.
Hurwitz, M., & Hurwitz, S. (2015). Leadership is half the story: A fresh look at followership, leadership, and collaboration. University of Toronto Press.
Joel, L. A. (2013). Advanced practice nursing: Essentials of role development. FA Davis.
Kellerman, B. (2008). Followership: How followers are creating change and changing leaders. Boston: Harvard Business School Press.
Kelley, R. E. (1988). In praise of followers (pp. 142-148). Harvard Business Review Case Services
Can, A., & Aktaş, M. (2012). Cultural values and followership style preferences. Procedia – Social and Behavioral Sciences, 41, 84–91. https://doi.org/10.1016/j.sbspro.2012.04.012
Uhl-Bien, M., & Arena, M. (2017). Complexity leadership: Enabling people and organizations for adaptability. Organizational Dynamics, 46(1), 9–20. https://doi.org/10.1016/j.orgdyn.2016.12.001
Uhl-Bien, M., Marion, R., & McKelvey, B. (2007). Complexity Leadership Theory: Shifting leadership from the industrial age to the knowledge era. Leadership Quarterly, 18(4), 298–318. https://doi.org/10.1016/j.leaqua.2007.04.002
Uhl-Bien, M., Riggio, R. E., Lowe, K. B., & Carsten, M. K. (2014). Followership theory: A review and research agenda. Leadership Quarterly, 25(1), 83–104. https://doi.org/10.1016/j.leaqua.2013.11.007
Weberg, D. (2012). Complexity Leadership: A Healthcare Imperative. Nursing Forum, 47(4), 268–277. https://doi.org/10.1111/j.1744-6198.2012.00276.x
Wong, C. A. (2015). Connecting nursing leadership and patient outcomes: State of the science. Journal of Nursing Management, 23(3), 275–278. https://doi.org/10.1111/jonm.12307
World Health Organization. (2017). Patient safety: making health care safer. Patient Safety: Making Health Care Safer. https://doi.org/10.1097/NUR.0b013e3181e3605f
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