Leadership in Health System
Dr. Shahram Yazdani
Shahid Beheshti University of Medical Sciences
School of Medical Education
Strategic Policy Sessions: 24
Defining leadership
Leadership is the process through which
an individual attempts to intentionally
influence another individual or group in
order to accomplish a predetermined set
of goals
Characteristics of leadership
Leadership is a process. It is
a verb, an action word, not a
noun.
Leadership manifests itself in
doing; it is a performing art.
Characteristics of leadership
Only individuals lead.
The locus of leadership is in
a person. Inanimate objects
do not lead, groups do not
lead, only people do.
Characteristics of leadership
The focus of leadership is
other individuals and groups.
A leader cannot exist without
followers.
Characteristics of leadership
Leadership entails influencing
followers, their thoughts (the
cognitive target of influence),
feelings (the affective target),
and their actions (the behavioral
target).
Influence is leadership’s center
of gravity and most critical
element.
Dr. Shahram Yazdani
6
Characteristics of leadership
The objective of leadership is
goal accomplishment .
Leadership is instrumental; it
is done for a purpose.
Characteristics of leadership
Leadership is intentional, not
accidental.
All of us unknowingly influence
others hundreds of times each
day, but those are not acts of
leadership.
What is leaders main tasks?
Leaders have two main tasks:
 To set a path, goal, or vision for the people
who are being led.
 To motivate people to pursue and eventually
achieve the goal.
Leadership Versus Management
A manager have different roles such as
formulating goals, developing strategies,
communicating, making decisions,
collecting information, planning,
organizing, monitoring, and resolving
conflicts;
But without leadership or with poor
leadership the organization is impaired.
Multidirectionality
Leadership is multidirectional.
A person can lead not only subordinates
in his organization but also peers,
superiors, and individuals and groups
outside the organization.
Leadership and Power
The more power a person possess, the
greater the potential that he or she will be
able to influence other individuals and
groups.
The key concept here is potential; one can
have power and not use it.
Sources of power
Office power: power associated with a
particular managerial office
Expert power: information, knowledge,
skill, abilities, and experience
Referent power: connection with other
individuals and groups who possess
influence
Reward / Coercive power: control of
incentives
Charismatic power: one’s own persona
Characteristics of Good
Leadership
What influences leadership effectiveness?
Nature
Nurture
Situational factor
The nature argument
Trait
Leadership
Effectiveness
And Success
The Nurture Argument
Trait
Abilities &
Behaviors
Leadership
Effectiveness
And Success
The Situational Argument
Situation
Trait
Abilities &
Behaviors
Leadership
Effectiveness
And Success
Stogdill - 1948 Research
Factors Affecting Leadership
Capacity

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Intelligence
Alertness
Verbal facility
Originality
Judgement
Achievement
 Scholarship
 Knowledge
 Athletic
accomplishments
Stogdill - continued
Responsibility

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Dependability
Initiative
Persistance
Aggressiveness
Self-confidence
Desire to excell
Participation

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Activity
Sociability
Cooperation
Adaptability
Humor
Stogdill - continued
Status
 Socioeconomic
position
 Popularity
Situation
 Task to be
accomplished
 Followers to be led
Kurt Lewin
o Kurt Lewin(1930): three type of
leadership
1.Autocratic Leadership (direction)
2.Democratic Leadership (facilitation)
3.Laissez-faire Leadership
Dr. Shahram Yazdani
22
Leadership Behavior Continuum
Manager centered
Follower centered
Use of
authority by
Manager
Freedom for
subordinates
Tell
Sell
Tell & Ask
Ask & Tell
Dr. Shahram Yazdani
Participate
Delegate
23
Path-Goal Model
Evans - 1970
Leader
Behavior
(style)
& House & Dressler -1974
Subordinate
Characteristics
Work
Environment
Characteristics
Subordinate Perceptions
Expectancy
Effort
Instrumentality
Performance
Reward
Dr. Shahram Yazdani
Valence
Motivation
24
Path Goal Model
Expectancy is the relation between
effort and performance
Instrumentality is the degree to
which a person perceives that
performance will lead to reward
Valence is the strength of a person’s
preference for different types of
reward
Path Goal Model
According to expectancy theory a
person will be highly motivated when
effort results in performance (high
expectancy) and when performance
leads to rewards (high
instrumentality) that are valued (high
valence)
Implications of Path Goal Model
The path between effort,
performance, and reward is
difficult. The leader must do
everything possible to turn what is
often a cow path into a well
designed, high-speed freeway
Individuals’ valences are
heterogenous
Implications of Path Goal Model
The contingency most under a
manager’s control is his own
leadership style:
 Instrumental behavior (defining objectives
and specifying the task to be performed)
 Participatory behavior (seeking follower
input on decisions that affect them
 Achievement-oriented behavior
(establishing goals and setting
expectations that challenge followers)
Factors affecting effectiveness of leadership
 Characteristics of the manager:
• Traits / dispositions
• Skills
• Values
 Characteristics of followers:
•
•
•
•
•
Skills
Knowledge
Experience
Responsibility
Understanding of goals and tasks
 Characteristics of situation:
• Time availability
• Nature of problem
Educating for Leadership (FP
Program in Iran)
 Individual Coaching
 Team Building and Teamwork
 Meeting Management
 Empowering and Delegation
 Conflict Negotiation
 Positional Bargaining
 Interest Based Bargaining
 Third Party Alternative Dispute
Resolution
 Consensus Building
 Stakeholder Analysis
 Advocacy
 Collaboration and Partnership Building
Any Question ?