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Stiofán deBúrcaStiofán deBúrca16th Oct 200916th Oct 2009

LeadershipLeadershipLost in Complexity?Lost in Complexity?

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LeadershipLeadershipLost in Complexity!Lost in Complexity!

““Leadership is a complex process, Leadership is a complex process, complexity of actions is thus identified as complexity of actions is thus identified as leadership” leadership” (Fisher, 1985:185)(Fisher, 1985:185)

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From Simplicity to ComplexityFrom Simplicity to Complexity

Carlyle’s (1884) essay on heroes- Carlyle’s (1884) essay on heroes- - Great Man Theories- sought to reinforce the concept - Great Man Theories- sought to reinforce the concept

of leadership as a person endowed with unique of leadership as a person endowed with unique qualities that captures the imagination of the massesqualities that captures the imagination of the masses

- A one way effect!- A one way effect!

Stogdill`s (1948, 1974) and Mann`s (1959) Stogdill`s (1948, 1974) and Mann`s (1959) reviews sounded the death-knell of the trait reviews sounded the death-knell of the trait approachapproach- Some Renaissance with Lord et al (1986), Kirkpatrick - Some Renaissance with Lord et al (1986), Kirkpatrick

& Locke (1991) demonstrated that certain core traits & Locke (1991) demonstrated that certain core traits contribute significantly to business leaders success.contribute significantly to business leaders success.

- General agreement that ‘conscientiousness` has the - General agreement that ‘conscientiousness` has the strongest positive correlation with job performance strongest positive correlation with job performance (Big 5 Factor Model: Barrick & Mount, 1991)(Big 5 Factor Model: Barrick & Mount, 1991)

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Leadership ApproachesLeadership ApproachesLeadership Theories/Approaches

Approach Focus Instrument Strength Weaknesses Trait Personal characteristics TLQ: 10 items 5 scale

Perceptions of Leader & selected obs e.g. subordinates/peers. Myers-Briggs Type Indicators

Intuitive appeal & research validated benchmarks to evaluate

Not linked with outcomes or situations. No limit or definitive trait list. Not useful for training

Style What leaders do as against what they are! Two behaviours- Task & Relationship

LBDQ (Stogdell, 1963) primarily for research Leadership Grid (Blake & Case, 1991) for training & development

Extended scope of L. Study to include behaviours Extensive research Underscores 2 core dimensions i.e. task & relationships. Underscores own L. behaviours

Can’t associate behaviours with outcomes Research unable to identify a universal set of L. behaviours for effective L Fails to support fully Lit high task & high relationship as the most effective Ls

Situational Preferred style for each of 4 situations to match development level in a task situation

4 quadrants in model: work situations & preferred style (Blanchard et al, 1992)

Adapt style to situation A standard for training Ls Clear set of prescriptions

Insufficient research Unclear how subordinates move from low to high & change Use in group settings?

Contingency Style & situations characterised by 3 factors-leader/ member relations, task structure & position power

LPC (Least Preferred Co-Worker) measure - 18 set of adjectives - Low, Mid, High in

task/ socio-independent /relationship motivated

(Fiedler & Chamers, 1984)

Shift emphasis to contexts- link L & situations Empirical Research base Useful to develop L profiles

Black box problem- LPC scale does not correlate well with other standard L measures (Fiedler,1993) Problem of projection of another to self Lacks face validity

Path-Goal (Contingency)

Selected style provides what’s missing

Path-Goal LQ (20) 4 L Styles-match leader behaviours with subordinate characteristics & task (House & Dessler 1974; House, 1976)

Theoretical framework- how style affects productivity & satisfaction Underscores ways L help subordinates

Too many assumptions eg. LBs & members motivation Too L orientated Poor research support

LMX L-M (dyadic) relationships as pivotal concept in L process. Recent emphasis is L making

LMX 7Q- measures quality of exchange- respect, trust, obligation- (Graen & Uhl-Bien, 1995)

Links high quality LMX to positive organisational outcomes

In-groups & elitism fails to explain intricacies of creating high quality exchanges

Transformational (US) Encompassing Ls need to understand & adapt to the needs & motives of followers L as change agent & role model

MLQ (Bass & Avolio, 1993) MLQ- 6 (Bass & Avolio, 1992) 7 factors & 3 groups Transformational, Transactional & Laissez Faire

Reliable & valid studies over the years

Lacks professional clarity Often interpreted too simplistically as either-or. Trait-like. Heavy focus- on Senior LBs US Bias Factor structure questioned

Transformational (UK) Emphasises what L does for the individual A far more accessible L

TLQ (Alimo-Metcalfe & Alban- Metcalfe, 2001) 9 Factors- ‘general concern for others’ first & most important factor- twice as much variance as remaining 8 factors together

Developed & tested in NHS & LG context A far greater sense of proximity, openness and humility as against US distant charismatic hero

Few published studies & little independent confirmatory assessment of validity & reliability

Adapted from Peter G. Northouse (1997) Leadership: Theory and Practice. Sage Publications, Thousand Oaks, Cal

Trait

Style

Situational

Contingency

Path-Goal (Contingency)

LMX

Transformational (UK)

Transformational (US)

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Complex Adaptive SystemsComplex Adaptive Systems

(i) Organisational life is systemic(i) Organisational life is systemic- connectedness is inescapableconnectedness is inescapable- interconnectivity is extended to the interconnectivity is extended to the

environment environment - predictable & unpredictable influencespredictable & unpredictable influences- collective influence, processes are essential collective influence, processes are essential

to manage dynamic systems to manage dynamic systems (Osborn et al, 2002)(Osborn et al, 2002)

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(ii) No-one is ever in control of complex systems! (ii) No-one is ever in control of complex systems! (Luthans, 2002)(Luthans, 2002)

- Highly centralised leadership is less effective:Highly centralised leadership is less effective:- the limitations of any one individual view the limitations of any one individual view - the multiplicity of competing views, and the multiplicity of competing views, and - the complex nature of member interactions the complex nature of member interactions (Chen & (Chen &

Velsor, 1996)Velsor, 1996)

- Conventional ideas of managerial control are Conventional ideas of managerial control are questionablequestionable

- Conventional understanding of leadership:Conventional understanding of leadership:- an influence on individuals or groups which ‘lumps all an influence on individuals or groups which ‘lumps all

other roles together as `followers`other roles together as `followers`- gives a highly simplistic view of interaction gives a highly simplistic view of interaction (Griffin, (Griffin,

2002:219)2002:219)

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(iii) Significantly limits the power of leaders (iii) Significantly limits the power of leaders with increasing complexity with increasing complexity trying to ‘manage’ the chaos by controlling it, trying to ‘manage’ the chaos by controlling it,

or relying on leaders to solve the problems or relying on leaders to solve the problems

or buying more consultants, or buying more consultants,

are deeply problematic strategies; are deeply problematic strategies;

only mass leadership and collective responsibility only mass leadership and collective responsibility are likely to solve problems are likely to solve problems (Grint, 2002)(Grint, 2002)

Leadership Leadership inin as against as against ofof Healthcare Healthcare Organisations is a better working concept- Organisations is a better working concept- influencing and being influenced! influencing and being influenced! (Griffin, 2002)(Griffin, 2002)

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Healthcare Organisations & Healthcare Organisations & ControllabilityControllability

Acute Hospitals & Research Institutes - Unmanageable! Acute Hospitals & Research Institutes - Unmanageable! (Berry, 1995)(Berry, 1995)

-The most complex human service organisations! -The most complex human service organisations! (Drucker, (Drucker, 1991)1991)

- - Leadership of Creative People Leadership of Creative People Difficult for leaders lacking technical expertise to represent the Difficult for leaders lacking technical expertise to represent the

group adequately, communicate effectively with group members, group adequately, communicate effectively with group members, appraise needs & concerns, access interactions & develop & appraise needs & concerns, access interactions & develop & mentor junior staff (Mumford et al, 2002)mentor junior staff (Mumford et al, 2002)

- In a professional bureaucracy/adhocracy, the surrender In a professional bureaucracy/adhocracy, the surrender of peoples’ ability (power & control) to define their reality of peoples’ ability (power & control) to define their reality to others is unlikely. to others is unlikely.

- Consequently, replacing hierarchical leadership with patterns of Consequently, replacing hierarchical leadership with patterns of more equalised interaction in which each has an obligation to more equalised interaction in which each has an obligation to define what is happening, & respond accordingly changes the define what is happening, & respond accordingly changes the very basis of organisations (Smircich & Morgan 1982)very basis of organisations (Smircich & Morgan 1982)

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Causal Relationships in the Multiple Causal Relationships in the Multiple Linkage ModelLinkage Model

Leader Behaviour

Intervening Variables

Subordinate effort Role clarity and task skillsOrganization of workCohesiveness and cooperation Resources and support services External coordination

Situational Variables (“Neutralisers”)

Situational Variables

Criteria of Unit

effectiveness

Situational Variables (“Substitutes”)

(Source: Yukl, 1998)

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Substitutes for LeadershipSubstitutes for Leadership

People are biased toward over attributing to People are biased toward over attributing to leaders influence on events that are leaders influence on events that are complex & difficult to understand (Shamir complex & difficult to understand (Shamir et al, 1993)et al, 1993)

2 kinds of situations reduce the importance 2 kinds of situations reduce the importance of leadership influenceof leadership influence

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SubstitutesSubstitutes … …

Professionals are internally motivated by their Professionals are internally motivated by their values, needs & ethicsvalues, needs & ethics

Aspects of the situation that cause intervening Aspects of the situation that cause intervening variables to be at optimal levelsvariables to be at optimal levels

As leadership substitutes increase, formal As leadership substitutes increase, formal leadership is merely replaced by peer influence leadership is merely replaced by peer influence or alternative levels of leadershipor alternative levels of leadership

Where there is no authority hierarchy, leadership Where there is no authority hierarchy, leadership responsibilities are shared among members responsibilities are shared among members (Yukl, 1998:366) (Yukl, 1998:366)

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Neutralisers Neutralisers

Prevent leaders from acting in a specified way and Prevent leaders from acting in a specified way and nullify the effects of leaders actions.nullify the effects of leaders actions.

When subordinates are geographically dispersed When subordinates are geographically dispersed with infrequent leadership contact, or when a with infrequent leadership contact, or when a highly cohesive work group provides mutual highly cohesive work group provides mutual psychological support (Yukl, 1994;275)psychological support (Yukl, 1994;275)

Many neutralisers make it difficult for leadership to Many neutralisers make it difficult for leadership to succeed (Howlett et al, 1990)succeed (Howlett et al, 1990)

Self-managed groups (Howlett et al, 1990) Self-managed groups (Howlett et al, 1990)

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A Political Model of LeadershipA Political Model of Leadership

Source: Ammeter et al., 2002

Leader Antecedents:

GMA/ personality attributes Political willLeader cognitions Leader social capital Leader interpersonal style

Leader Outcomes:

Performance evaluation Promotions and mobilityCompensation PowerLeader reputation Context:

Organizational structure Organizational cultureAccountability Leader positionPrior episodes

Leader Political Behaviour:

Action at individual, coalition, network levels Proactive political behaviours Symbolic influenceCombinations of tacticsInterpersonal style as a moderator

Target Outcomes:

Affective reactionsCognitive reactionsAttitudesPerformance

Target Antecedents:

Target status/powerPersonality attributes

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An Emergent ModelAn Emergent Model

Contextual Contextual InfluencesInfluences

The SystemThe System Change Change

InterventionsInterventions

DomainDomain

Outcomes Outcomes

External External People People

Current & Current & Antecedent Antecedent

MediatorsMediators

InternalInternal Operational Operational SystemSystem

ModeratorsModerators

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Leadership & Leadership & Domain PerspectivesDomain Perspectives

Domain perspectives Domain perspectives (Policy, Managerial & Professional)(Policy, Managerial & Professional) elucidate the elucidate the logic of the organisation's internal influencing capacitylogic of the organisation's internal influencing capacity-- not merely accepting an imposed external reductionist logic of leadership -- not merely accepting an imposed external reductionist logic of leadership

(Kouse & Mico, 1979; deBúrca, 2003)(Kouse & Mico, 1979; deBúrca, 2003)

- Are HCOs’ Vision & Purpose shared between domains on - Are HCOs’ Vision & Purpose shared between domains on fundamentals? fundamentals?

- e.g. Quality, Patient-Centrednesse.g. Quality, Patient-Centredness

- Is there a high level of alignment between shared purpose and - Is there a high level of alignment between shared purpose and domain roles in action?domain roles in action?

- Gaps are exposed upon deliveryGaps are exposed upon delivery

- Leader & Management roles are domain-defined & -oriented- Leader & Management roles are domain-defined & -oriented- Potential for role conflict and ambiguity!Potential for role conflict and ambiguity!

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Leadership is ContextualLeadership is Contextual

(i) Leaders are the product of their times, of their (i) Leaders are the product of their times, of their followers and opportunities followers and opportunities (Westley & Mintzberg, (Westley & Mintzberg, 1989;30)1989;30) - An emergent phenomenon (social constructionist) – it - An emergent phenomenon (social constructionist) – it

is not assumed that the construct of leadership is an is not assumed that the construct of leadership is an integral part of formal hierarchical relationships integral part of formal hierarchical relationships (Meindl, 1995;332)(Meindl, 1995;332)

- Socially constructed, so that one has to look at the - Socially constructed, so that one has to look at the whole system & its leadership whole system & its leadership (Osborn et al, 2002:798)(Osborn et al, 2002:798)

- ‘Embedded’ in social & cultural beliefs & values and - ‘Embedded’ in social & cultural beliefs & values and cannot be understood apart from the context in which cannot be understood apart from the context in which it exists it exists (Biggart & Hamilton, 1987:437)(Biggart & Hamilton, 1987:437)

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(ii) Various contextual considerations: (ii) Various contextual considerations:

- These are not usually encompassed by the well-known - These are not usually encompassed by the well-known theoretical approaches to leadership such as: theoretical approaches to leadership such as: - diversity, distance, professional adhocracy/ bureaucracy, - diversity, distance, professional adhocracy/ bureaucracy,

empowerment, values, complexity and emergence, political empowerment, values, complexity and emergence, political dimensions and substitutes for & implicit theories of leadership dimensions and substitutes for & implicit theories of leadership (deBúrca, 2003, 2005)(deBúrca, 2003, 2005)

- There is a tendency in the literature to neglect the cultural & There is a tendency in the literature to neglect the cultural & organisational context of leadershiporganisational context of leadership

- although local influences on attitudes and behaviours … mediate the although local influences on attitudes and behaviours … mediate the impact of the organisation on healthcare delivery (Alvesson 1992)impact of the organisation on healthcare delivery (Alvesson 1992)

- The stark contrast in the US & UK transformational models’ The stark contrast in the US & UK transformational models’ primary orientations:primary orientations:

- the distant charismatic super-hero, the distant charismatic super-hero, - as against the proximate, concerned servant-leader as against the proximate, concerned servant-leader (Bass & Avolio, (Bass & Avolio,

1993; Metcalfe & Metcalfe, 2001)1993; Metcalfe & Metcalfe, 2001)

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Case Study: Managers’ & Professionals’ Case Study: Managers’ & Professionals’

PerceptionsPerceptions of of LeadershipLeadership

MatchedMatchedAlignment Alignment ExpectationsExpectations IndicationsIndications

1.Primary1.Primary (M & P)(M & P) ++ (M & P)(M & P)

2.Secondary2.Secondary (M or P)(M or P) ++ (M & P)(M & P)

3.Tertiary3.Tertiary ( M )( M )

( P )( P )

++

oror

++

( M )( M )

( P )( P )

Leadership AttributesLeadership Attributes

(M&P)(M&P) Confidence, Trust & Confidence, Trust & TeamworkTeamwork

M:M:

P:P:

Integrity, participative styleIntegrity, participative style

Nature, vision, respect, Nature, vision, respect, discernment, people discernment, people behavioursbehaviours

P:P: Innate & people Innate & people behaviours behaviours

Many Leadership Theories formed on basis of implicit theories (Di Tomas & Hooijberg, 1996)Many Leadership Theories formed on basis of implicit theories (Di Tomas & Hooijberg, 1996)

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Case Study: Leadership DefinedCase Study: Leadership Defined@ Domain Perspectives @ Domain Perspectives

Senior ManagersSenior Managers Corporate Accountability Corporate Accountability ManagersManagers General PerformanceGeneral PerformanceSenior DoctorsSenior Doctors Clinical ResponsibilityClinical ResponsibilitySenior NursesSenior Nurses Professional Morale & Influence on Professional Morale & Influence on

Practice Practice PrototypesPrototypes

Managers Managers Leadership synonymous with change, Leadership synonymous with change, competencecompetence & Confidence& Confidence

Professionals Professionals Credible Attractor & Domain Credible Attractor & Domain Influencer (deBúrca, 2003)Influencer (deBúrca, 2003)

Leadership Categorisation as a function of social context Leadership Categorisation as a function of social context (Haslam, 2001)(Haslam, 2001)

Epitomization of leadership as prototypical group member Epitomization of leadership as prototypical group member (Turner, 1991)(Turner, 1991)

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Shared & Dispersed LeadershipShared & Dispersed Leadership

(i) Essential in complex systems (i) Essential in complex systems - A top-down approach to healthcare programmes A top-down approach to healthcare programmes

cannot succeedcannot succeed- need room for local discretion- need room for local discretion

- the benefit is in increased professional responsibility- the benefit is in increased professional responsibility

- distrust commonly ends in failure (Edmondson & Greenfield, - distrust commonly ends in failure (Edmondson & Greenfield, 2000)2000)

- Fits with trend of flattened organisations- Fits with trend of flattened organisations- non hierarchical team-based structures- non hierarchical team-based structures

- Shared/dispersed leadership in interdisciplinary teams is vital - Shared/dispersed leadership in interdisciplinary teams is vital - as care becomes increasingly complex and resource as care becomes increasingly complex and resource

constraints press even more tightly (Wells et al, 2003) constraints press even more tightly (Wells et al, 2003)

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(ii) Sharing leadership roles is problematic (ii) Sharing leadership roles is problematic given the hierarchical tradition of medical given the hierarchical tradition of medical carecare- In principle, leadership may rotate according In principle, leadership may rotate according

to member issues & specific competencies,to member issues & specific competencies,- but in reality power resides in a privileged few, but in reality power resides in a privileged few,

with vital functional members relegated to with vital functional members relegated to marginal roles (Cott, 1997)marginal roles (Cott, 1997)

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(iii) Trust builds collaborative relationships (iii) Trust builds collaborative relationships (Luthans, 2002)(Luthans, 2002)

- Associated with distributed leadership & ‘Real - Associated with distributed leadership & ‘Real Teams’Teams’- The most effective managers lead others to lead - The most effective managers lead others to lead

themselves (Sims & Lorenzi, 1992)themselves (Sims & Lorenzi, 1992)- `Real Teams` - `Real Teams`

- have complementary skills, have complementary skills, - Are committed to a common performance, goals & Are committed to a common performance, goals &

approach, for which they hold themselves mutually approach, for which they hold themselves mutually accountable (Katzenbach & Smith, 1993)accountable (Katzenbach & Smith, 1993)

- Empowerment - Empowerment - is similar to delegated authorityis similar to delegated authority- encourages the use of individual initiativeencourages the use of individual initiative- and has authority and responsibility (Taylor & and has authority and responsibility (Taylor &

Ramsey, 1991)Ramsey, 1991)

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Refocus on Refocus on Leadership in Management!Leadership in Management!

Why do leadership approaches isolate leaders from Why do leadership approaches isolate leaders from managers, and ignore broader managerial roles which managers, and ignore broader managerial roles which leaders must perform? (Steers et al, 2006)leaders must perform? (Steers et al, 2006)

- The defining difference is orientation:The defining difference is orientation:- leadership is associated with change leadership is associated with change - but management is grounded in the present state (Zalenznik, but management is grounded in the present state (Zalenznik,

1997, Kotter, 1990)1997, Kotter, 1990)- Leadership in the practice of management focuses upon - Leadership in the practice of management focuses upon

delegation making processesdelegation making processes- A middle ground delegational strategy is superior to various forms - A middle ground delegational strategy is superior to various forms

of leadership (Schriesheim & Neider, 1988)of leadership (Schriesheim & Neider, 1988)- Formal authority has potential power (Mintzberg, 1990; French & - Formal authority has potential power (Mintzberg, 1990; French &

Raven, 1959)Raven, 1959)

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- Leadership from a managerial perspective facilitates - Leadership from a managerial perspective facilitates an alternative to leader-centric research and practice an alternative to leader-centric research and practice as, attending to one element is inadequate as, attending to one element is inadequate (deBurca,2003)(deBurca,2003)

- There is a tendency to focus on the potential benefits - There is a tendency to focus on the potential benefits of transformational leadership at the expense of the of transformational leadership at the expense of the positive impact of transactional leadership where a positive impact of transactional leadership where a combination of the two may be most efficacious combination of the two may be most efficacious (Grint, 2005;105)(Grint, 2005;105)

- Leadership in US nursing studies conclude that the - Leadership in US nursing studies conclude that the most successful leadership has both dimensions most successful leadership has both dimensions (Dunham & Klafehn, 1990; Kilker, 1994) (Dunham & Klafehn, 1990; Kilker, 1994)

- Clinical leadership also requires a judicious blend of - Clinical leadership also requires a judicious blend of effective management with transformational effective management with transformational leadership (Lynne et al, 2005)leadership (Lynne et al, 2005)

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Deficits in Clinical LeadershipDeficits in Clinical Leadership

Most healthcare providers have not been trained in Most healthcare providers have not been trained in the principles & practice of effective leadership the principles & practice of effective leadership and working in teams (Sachdeva, 1996)and working in teams (Sachdeva, 1996)- There are inherent deficits in the preparation of - There are inherent deficits in the preparation of

clinicians for leader-manager roles and the clinicians for leader-manager roles and the expectations in their subsequent practice expectations in their subsequent practice environment.environment.

- Doctors tend to be poor leaders and are suspicious of - Doctors tend to be poor leaders and are suspicious of those who purport to be leaders (Smith & Simpson, those who purport to be leaders (Smith & Simpson, 1996)1996)

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- A caricature of doctors ‘who would not be led’ - A caricature of doctors ‘who would not be led’ and nurses who ‘did not know how to lead- and nurses who ‘did not know how to lead- too deferential- too accepting of a too deferential- too accepting of a bureaucratic change of command (Strong & bureaucratic change of command (Strong & Robinson, 1990)Robinson, 1990)

- Inadequate fragmented practice is a - Inadequate fragmented practice is a consequence of a lack of effective leadership consequence of a lack of effective leadership and interpersonal collaboration (Lynn et al, and interpersonal collaboration (Lynn et al, 2005)2005)

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Effective Clinical Leadership Effective Clinical Leadership Conceptions of effectiveness differ:Conceptions of effectiveness differ:

- task & goal attainment measures- task & goal attainment measures- multiple subjective ratings (Yukl, 1998)- multiple subjective ratings (Yukl, 1998)

Effective Clinical Leaders (Pickett et al, 1995)Effective Clinical Leaders (Pickett et al, 1995)- Have ability to critically analyse situations on several - Have ability to critically analyse situations on several

levels in transactional & people terms and act accordingly levels in transactional & people terms and act accordingly - Empower others to take clinical responsibility within a - Empower others to take clinical responsibility within a

framework of co-ordinated action, mutual respect, framework of co-ordinated action, mutual respect, guidance and supportguidance and support

- Results are an indirect effect:- Results are an indirect effect:Problem of linking leadership & outcomes Problem of linking leadership & outcomes e.g. low variance explanation for Leadership in consumer e.g. low variance explanation for Leadership in consumer

satisfaction and quality of life studiessatisfaction and quality of life studies

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Clinical Team LeadersClinical Team Leaders

Clinical Team Leaders have a dual focus Clinical Team Leaders have a dual focus and fuse managerial & clinical and fuse managerial & clinical responsibility & facilitate self-organising responsibility & facilitate self-organising processes according to need, as against processes according to need, as against structure (Lynn et al, 2005; Greenfield structure (Lynn et al, 2005; Greenfield 2007)2007)- Traditionally, doctors have been accorded and - Traditionally, doctors have been accorded and

have assumed leadership of healthcare have assumed leadership of healthcare teams, regardless of their competence teams, regardless of their competence (Horowitz, 1970)(Horowitz, 1970)

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- Traditional ways of working & professional - Traditional ways of working & professional power, imbalances and has the effect of power, imbalances and has the effect of silencing members who wish to speak up, silencing members who wish to speak up, share authority and collaborate in problem share authority and collaborate in problem solving and quality improvement (Edmondson, solving and quality improvement (Edmondson, 2003)2003)

- Allocation of team leadership to the member - Allocation of team leadership to the member with the most expertise rather than being with the most expertise rather than being linked to professional groups (Kane, 1975)linked to professional groups (Kane, 1975)

- Mutual respect is highest in social worker-led - Mutual respect is highest in social worker-led teams and lowest in physician-led teams. teams and lowest in physician-led teams. Leadership by some disciplines may facilitate Leadership by some disciplines may facilitate dynamics (Wells et al, 2006)dynamics (Wells et al, 2006)

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Clinical Leaders need:Clinical Leaders need:

- To develop integrated teamwork, emphasising making - To develop integrated teamwork, emphasising making team processes visible, reflected upon and actively team processes visible, reflected upon and actively managed (Hackett & Spurgeon, 1998)managed (Hackett & Spurgeon, 1998)

- Appropriate support to avoid them succumbing to - Appropriate support to avoid them succumbing to profound disillusionment through constantly frustrated profound disillusionment through constantly frustrated attempts to change work processes and practices attempts to change work processes and practices (Greenfield, 2007)(Greenfield, 2007)

- To manage their own professional credibility and identity - To manage their own professional credibility and identity in the eyes of a diverse range of professional disciplines.in the eyes of a diverse range of professional disciplines.- This may require the development of a complex superordinate - This may require the development of a complex superordinate

professional identity that does not deny ones own distinctive professional identity that does not deny ones own distinctive clinical contribution.clinical contribution.

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Reflection: Reflection:

So, What next?So, What next?

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Ethical Leadership Ethical Leadership in Complex Systemsin Complex Systems

To enable encompassing, integrative processes and actions for ethical and To enable encompassing, integrative processes and actions for ethical and equitable purposesequitable purposes

Evolve requisite New Ethical Leadership and Alternative Social Influencing Evolve requisite New Ethical Leadership and Alternative Social Influencing Practices in working arrangementsPractices in working arrangements

(At all levels, organisational settings and stakeholder networks) (At all levels, organisational settings and stakeholder networks)

Shared and Dispersed LeadershipShared and Dispersed LeadershipLeaders who create leadersLeaders who create leaders

Substitutes for leadership Substitutes for leadership EmpowermentEmpowermentConnectivityConnectivity

Real Teams, Communities of Practice, Integrated Networks Real Teams, Communities of Practice, Integrated Networks Internalised Professional Values, and EthicsInternalised Professional Values, and Ethics