Leadership and management

  • Leadership and management skills are integral to the successful delivery of quality improvement initiatives.
  • Management can be considered in terms of principles, theories, structures, behaviours and techniques.
  • Effective leaders adapt their style to the needs of their team, the task and the characteristics of their organisation.
  • An understanding of the factors that influence behaviour is as important for achieving change within organisations as it is for helping individuals.
  • Leadership and management are not synonymous. A manager is an individual who holds an office to which certain roles including managing others, are attached, whereas leadership is one of the roles attached to a manager.
  • Management in healthcare is about getting things done to improve the care of patients. Management competencies are crucially important to health professionals for ensuring systems are in place to monitor and maintain quality of care: the stuff of ‘clinical governance’.
  • Leadership skills help doctors become more actively involved in planning and delivery of health services and also in support roles in research, education and health politics. Just being in a senior position will not make you a leader.
  • Both leaders and managers wield power and must have the ability to influence others to achieve organisational aims

Dimensions of management

It is useful to think of management as having several different dimensions:

Principles: management is about people, securing commitment to shared values, developing staff and achieving results. These help determine the culture of organisations.

Theories: management is underpinned by a plethora of different theories and frameworks. These, in turn, shape the language – and jargon – of management.

Structures: the way organisations are set up (e.g. as bureaucracies, open systems, matrices, networks).

Behaviours: personal and organisational.

Techniques: including communication skills, management by objectives, finance, accounting, planning, marketing, project management and quality assurance.

Management tasks

We can also think about management in terms of the tasks or actions a manager needs to perform:

Defining the task: break down general aims into specific manageable tasks.

Planning: be creative – think laterally and use the ideas of others. Evaluate the options and formulate a working plan. Turn a negative situation into a positive one by creative planning.

Briefing: communicate the plan. Run meetings, make presentations and write clear instructions. The five skills of briefing are Preparing, Clarifying, Simplifying, Vivifying (making the subject alive), Being yourself.

Controlling: work out what key facts need to be monitored to see if the plan is working, and set standards to measure them against. To control others, you need also to be able to control yourself (e.g. managing your time to best effect).

Evaluating: assess the consequences of your efforts. Some form of progress report and/or debriefing meeting will enable people to see what they are achieving. The people as well as the task need evaluating, and the techniques of appraisal are important tasks for the leader of the team.

Motivating: simple ways often work best. Recognition, for instance, of someone’s efforts, be it by promotion, extra money or, more frequently, by personal commendation, seldom fails. Success motivates people and communicates a new sense of energy and urgency to the group.

Organising: see that the infrastructure for the work is in place and operating effectively.

Setting an example: research on successful organisations suggests that key factors are the behaviour, the values and the standards of their leaders. People take more notice of what you are and what you do than what you say.

Communicating: be clear and focused. Who needs to know what in order to get your aims realised?

Housekeeping: manage yourself – your time and other resources. Have coping strategies for recognising and dealing with pressure for yourself and others.

Sources of power

Types of leadership

Modern theories have proposed two types of leadership: transactional and transformational:

Transactional leadership attempts to preserve the status quo, while transformational leadership seeks to inspire and engage the emotions of individuals in organisations.

Transactional leadership concentrates on exchanges between leaders and staff, offering rewards for meeting particular standards in performance, whereas transformational leadership highlights the importance of leaders demonstrating inspirational motivation and concentrates on relationships.

Tools for analysing change

Leaders and managers in increasingly complex and rapidly changing environment of healthcare are concerned with understanding the need for and managing change. A number of conceptual tools can be helpful.

‘Forcefield analysis’ was developed by Kurt Lewin (1947) to help understand drivers and barriers to change: reducing forces resisting change is considered to be more effective than strengthening driving forces, but it is important to address both.

A PESTLE analysis (Chartered Institute of Personnel and Development 2013) can be used to analyse the context in which a specific change is occurring:


What is happening politically (e.g. government policy) that could affect your organisation?


What environmental issues (e.g. carbon reduction requirements) affect your organisation?


How do social factors (e.g. population growth, ageing) affect your organisation?


How does changing technology (e.g. new drugs, medical devices) affect your organisation?


What legal factors (e.g. medico-legal requirements) influence your organisation?


What are the implications of finances and economics (e.g. taxes, payment models) on your organisation?

The transtheoretical model describes the process of behaviour change in terms of five different motivational states for adoption of an innovation (Prochaska and Diclemente 1983).

Precontemplation (not yet ready for change)

Contemplation (thinking about change)

Preparation (for change)

Action (to implement change)

Maintenance of change.

The innovation curve

Everett Rogers’ classic model of how people take up an innovation can help us to understand different people’s responses to change (Rogers 2003).

Individuals’ ‘change type’ may depend on the particular change they are adopting. This depends on the perceived benefits, the perceived obstacles and the motivation to make the change. People are more likely to adopt an innovation:

•provides a relative advantage compared with old ideas
•that is compatible with the existing value system of the adopter
•that is readily understood by the adopters (less complexity)
•where the results of the innovation are more easily noticed by other potential adopters (observability).

Organisational culture for change

Change is often affected by the organisation within which people work. How organisations function is a combination of their culture and structures. Organisational culture has been described as a set of norms, beliefs, principles and ways of behaving that together give each organisation a distinctive character. Handy (1999) describes four types of organisational culture which are dependent on power, role, task or person.

Developing a strategy for change

Theories of management, leadership and change can be used to develop a strategy for change.