LEADERSHIP IN HEALTHCARE
A “ROAD MAP” AND LITERATURE REVIEW FROM WARWICK
Professor Jean Hartley/Emeritus Professor John Benington
Institute of Governance and Public Management (IGPM)
Warwick Business School
Tel: 024 7652 4505
Email: jean.hartley@wbs.ac.uk / j.benington@warwick.ac.uk
Literature review commissioned by the NHS Service Delivery Organisation:

Review the literature on leadership in healthcare

Set this in the wider context of the literature about leadership (to ensure access to wider theory and evidence)

Ensure the review is contemporary – look for papers in press as well as already published

Draw out lessons for policy, practice and research

Provide a clear “road map” of the field of leadership in healthcare.
THE PROBLEM
Existing reviews and introductions to papers often tend to tell a story – about the historical development of leadership studies (eg trait theory, behavioural theory, contingency theory, transformational theory etc) but how far are these actually
theories? Why is there so much focus on history rather than contemporary issues? There are many universalistic offerings about leadership (and leadership is often assumed and not defined) – universal traits/practices/behaviours. “This is what
leadership is.” Often highly normative. Little theory building and little clarification of concepts.
THE REVIEW AND THE WARWICK ROAD MAP
The literature review recognised the complexity of contemporary leadership, which often has to focus not just on the organization but on networks and partnerships to achieve change and improvement. The road map identifies six elements of
leadership as being important in any setting. It shows that personal capabilities are only one of 6 elements of the framework, lifting analysis out of some of the traditional focus on the person, Instead, the review takes the view that leadership is
socially constructed and grounded in particular organisational and social cultures. The implications for leadership development are to ensure that each of the six elements of the road map are taken into account in designing programmes and other
experiences to enhance leadership.
Concepts
Leadership
Lack of clarity in the
literature about the
concept of
leadership:
 Person
 Position
 Process
 Performance
Leadership
Challenges
(outcomes)
What is leadership for? What are
the purposes of leadership?
 Trade-offs between challenges
 Adaptive leadership
 Managing change: mergers and
acquisitions; managing
improvement and innovation;
managing failure and
turnaround
Consequences
 Managing partnerships
Capabilities
Leadership
Characteristics
Leadership
Context
 Formal and informal
leadership
 Managerial, clinical and
political leadership
 Direct (face-to-face) and
indirect leadership
 Individual and shared
leadership
 Context provides opportunities and
constraints on leadership behaviours
 But also a constitutive approach –
leadership is also about shaping
context
 Three key contexts – policy and
political context of the NHS: strategic
context: internal (organizational)
context
Capabilities
Leadership
Consequences
Leadership
 The dangers of long lists
abstracted from context
 Capabilities of individuals and
teams
 Leadership constellations
 Managing context and coalitions
 Transformational and
transactional leadership;
adaptive leadership
 Lot of assertion about effectiveness of
leaders/leadership but less evidence.
 Effectiveness by attributions (ie reverse
causality)
 Need to think about public value outcomes not
just the immediate consequences
 Impact of leadership on: efficiency/process
reliability; human resources and relations; and
innovation and adaptation
Concepts
Leadership
Challenges
Characteristics
Context
THE OUTPUT
To read more:
Hartley J with Martin J and Benington J (2008 as a report, and in press as a book) Leadership in healthcare: A review of the literature for health care professionals, managers and researchers.