PROCEEDINGS OF THE 13th INTERNATIONAL MANAGEMENT CONFERENCE
“Management Strategies for High Performance”
31st October – 1st November, 2019, BUCHAREST, ROMANIA
WHAT TYPE OF LEADERSHIP IS SUITABLE FOR HOSPITAL MANAGEMENT?
Taşkın Kılıç a*, Sancak Keskin b
Ordu Üniversity, Turkey
Artvin Health Directorate, Turkey
a
b
ABSTRACT
Hospitals have matrix structure that combined of vertical and horizontal levels as well as many
different areas of expertise. They are also important health institutions with urgent and
unpostponable properties where supply and demand cannot be fully controlled. In today's rapidly
changing conditions, the leadership characteristics of the manager taken part in leader position in
the hospital that play a role in the sustainable diagnosis and treatment of human health, is an
important factor for managing of institutions successfully. In this framework, this study aims to deal
with conceptually the most appropriate leadership characteristics of senior managers in hospital
management. This research has been examined theoretically the leadership concepts in the existing
literature and analyzed the relationship between these concepts and hospital management. Today's
hospitals are rapidly changing environmental conditions, complex and matrix structure in which
many different professions work together, as well as organizations in a sector where errors and
uncertainties are not tolerated. Therefore, strategic leadership is the most appropriate leadership
approach to manage these institutions within the existing leadership types. In addition, it can be
stated that there is a necessary for a new type of leadership that combines different units to
coordinate, influence followers, transform the system and set vision for the hospitals.
KEYWORDS Leadership, Hospital Management, Health Management
1. INTRODUCTION
Leader: A leader is a person who has followers (Drucker, 1996). According to Zalenik (1992), a
leader is a person who uses force to influence other people's thoughts and actions. The Concept of
Leadership: The Concept of Leadership is the interaction process between two or more members of
the group including the regulation or restructuring of perceptions and expectations (Bass, 1990). In
another definition, Leadership is the art of influencing others to achieve their maximum
performance for performing any task or project (Cohen, 1990).
1.1. Leadership Theories:
a-) Big Man Leadership Theory: According to this theory introduced by Carlyle (1841) in the 19 th
century, leadership is congenitally characteristics not afterward. In other words, a number of
legendary and mystical features such as charisma, intelligence and appearance are believed to be
decisive in the formation of leadership and this capacity is congenital or fateful. The reason of
giving “big man” name to the theory is a clear indication that the leadership phenomenon is a manspecific skill in the military field (Ololuble, 2013).
b-) Traits Leadership Theory: Unlike the big man theory, this theory suggests that differential
characteristics such as demographic, skill and personality, each individual from the others as well as
*
Corresponding author. E-mail address: taskinkilic79@hotmail.com
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PROCEEDINGS OF THE 13th INTERNATIONAL MANAGEMENT CONFERENCE
“Management Strategies for High Performance”
31st October – 1st November, 2019, BUCHAREST, ROMANIA
some congenital and genetically traits, provides advantages for the leadership (Cowley, 1931; Derue
et al. (2011). These characteristics are integration of congenital traits receiving by genetic
transmission and subsequently acquired characteristics such as age, being healthy, personality type
(extroversion, responsibility, etc.), cognitive capacity, emotional control, energy, desire, selfconfidence, values, problem solving and social skills and knowledge (Stogdill, 1948; Zaccaro et al.,
2004).
c-) Behavioral Leadership Theory: This theory deals with the leader according to his / her
propensity towards work or person (CISL, 2017, https://www.cisl.cam.ac.uk/). Lewin et al. (1939)
developed three different behavioral leadership models: “democratic, autocratic and full freedom
leader”. An autocratic leader is a kind of leader who holds all authority and dictates his orders to
subordinates and does not add them to decisions. The democratic leader takes all decisions and
processes with a common sense by discussing in the group. He helps subordinates by encouraging
them. The leader who gives full freedom is a leader who does not take the initiative, does not
participate in the work of groups or individuals, responds only if he is asked something and
liberates his subordinates completely (Lewin et al. 1939).
Apart from Lewin's studies, Ohio State University has defined a leadership behavior based on
person and structure with a dual model in the field of behavioral leadership (Halpin and Winer,
1957). In addition, Likert (1967) who is director of the research team at the University of Michigan
and introduces a new approach to behavioral leadership theory called Sistem-4 purposes leadership
model which goes from authoritarian leadership behavior: System 1: Exploiter-Autocratic
Leadership, System 2: Charitable-Autocratic Leadership, System 3: Participatory Leader, and
System 4: Democratic Leader to democratic leadership behavior.
d-) Situational theory: proposed in the late 1960s deals with leadership approach resulting from
the interaction of the leader, his followers and the circumstances. The basic thesis of this theory is
that there is no single and general leadership style for all conditions, and the conditions in which is
the main factor determining the leadership style (Mittal, 2015).
e-) Modern Leadership Approaches
Transformational Leadership Approach: Transformational leaders can achieve superior
leadership performance with their reformist aspects. In addition, such leaders have the vision and
willpower to transform the system in case of requiring innovation and transformation (MacGregor,
2003, www.ttb.org.tr/mevzuat/index.php?option = com_content& view = article&id = 311:yataklitedavkurumlari-letme-yetmel&catid=2:ymelik&Itemid=33).Transformational leaders are prominent
with willpower, self-confidence, vision, perseverance, excitement, courage and charisma (Bass,
1990).
Interactive Approach: Interactive leader provides for execution of the system within the existing
order it by protection of the existing system and culture. In addition, this leader prioritizes to
increase productivity by focusing on the process and using the time effectively without any taking
risks (Bass, 1985). The interactive leader is able to balance evenly by rewarding the performances
of his followers and meet his expectations (Graen and Cashman, 1975).
Charismatic Leadership: Charisma is expressed as a special magnetic attraction, charm, or the
magic of leadership that evokes a sense of commitment and admiration for a public figure
(webster.com, 2018, https://www.merriam-webster.com/dictionary/charisma). Max Weber (1947)
was the first theoretician to address “charismatic” power and authority. Weber (1947) identified
three types of leadership styles: traditional, legal and charismatic. According to Weber, charismatic
power arises from the leader's exemplary and extraordinary qualities or beliefs not from traditions,
rules, positions or laws. According to this approach, charismatic individuals are separated from
normal people with their supernatural features. From this point of view, Weber focused on
charismatic leadership considering with religious and political leaders.
Although it is stated in the related literature that it is difficult to define clear and specific
characteristics (Tucker, 1968, https://www.jstor.org/stable/20023840) and to reach a common
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PROCEEDINGS OF THE 13th INTERNATIONAL MANAGEMENT CONFERENCE
“Management Strategies for High Performance”
31st October – 1st November, 2019, BUCHAREST, ROMANIA
consensus about who is or is not a charismatic leader. Conger and Kanungo (1994), who conducted
research on this subject, identified six descriptive traits belonging to the charismatic leader. These
are vision and impressive speech, sensitivity to the environment, unusual behavior, taking personal
risks, sensitivity to the needs of members of the organization, the desire to change the status quo.
House and Mitchell (1975) stated the characteristics of charismatic individuals as follows: High
level of self-confidence, able to control and influence others, strong commitment to their own
beliefs and ideas.
Strategic Leadership: Strategic Leader manages all processes and resources, from elections and
decisions (formulating the system) to their implementation by considering environmental changes
(Hosmer, 1982). According to Hambrick and Pettigrew (2001), strategic leadership is an approach
that focuses on the decisions and activities of the top management of the organization, while general
leadership is a phenomenon observed at all levels of the organization. Strategic leadership in
organizations is distributed among different individuals who are responsible for creating the future
of the business, not one person. Especially the top management teams play an important role here.
Top management teams are small groups of managers (3 to 10 people) (Ülgen and Mirze, 2004).
The global economy and the new competitive structure of today make a common mind to be formed
by senior management teams necessary for strategic leadership practices (Uğurluoğlu and Çelik,
2009).
1.2. Hospital: Hospital is an institution in which the patients and the injured, suspected of the
disease and those who want to have their health checked, are examined, diagnosed, treated and
rehabilitated in an outpatient or inpatient manner, and are also given birth (Regulation on Inpatient
Treatment Institutions-Article-4). Hospitals are important for people and the health system. They
are mediator for coordination and integration of medical care. They play an important role in
supporting other outreach and home-based health care providers (including primary health care).
They also provide an environment for the education of doctors, nurses and other health
professionals and provide a critical basis for clinical research (Who.int, n.d.,
https://www.who.int/hospitals/hospitals-in-the-health-system/en/).
1.3. Characteristic of Hospitals (Kavuncubaşı and Yıldırım, 2010; Tengilimoğlu et al; 2014)
Activities in Health Institutions are complex and changeable.
The Organizations which operates in Matrix (Functional and project-based) form.
Services are urgent and unpostponable.
The level of specialization in health institutions is high.
There is a high level of dependency and coordination among the units
Management is binary structure: administrative and medical.
The most important determinants of funding are doctors. Therefore, the autonomy of this
occupational group is high.
Tolerance to error and uncertainty is low.
It is difficult to define the outputs with perceptible indicators.
They provide 24-hour uninterrupted service.
They serve with high technology.
2. CONCLUSIONS
Hospitals are complex, chaotic, requiring advanced expertise, where errors and uncertainties are not
tolerated, output and inputs cannot be measured clearly and serve all segments of the society with
24-hour high technology. Management of these institutions should be more specific than that of
general enterprises. Therefore, when the types of leadership are considered, it will be concluded that
the most appropriate type of leadership for hospital management is strategic leadership. Because,
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PROCEEDINGS OF THE 13th INTERNATIONAL MANAGEMENT CONFERENCE
“Management Strategies for High Performance”
31st October – 1st November, 2019, BUCHAREST, ROMANIA
strategic leaders act both by considering internal and external environmental conditions, and they
perform the management activity with team philosophy and team philosophy by transferring
different units and responsibilities of the hospital to different people, not alone. This basic approach
is suitable for hospital management. Because different professions such as doctors, who have high
level of expertise, at the same time from pharmacy, dietitian, quality to human resources manager,
have come together for the same purpose. It will not be effective to approach these professional
groups with autocratic or other leadership styles. Therefore, strategic leadership is the most
appropriate leadership style for the hospitals in today's changing and competitive conditions.
While it would be appropriate to manage hospitals under strategic leadership in normal conditions,
in times of growth, contraction, change and crisis. It can be stated that situational leadership,
charismatic leadership or transformational leadership approaches can be used. In addition, it may be
suggested that a new type of leadership should be developed in accordance with the post-modern
hospitals (digital, lean, smart, etc.).
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