An Occupational Perspective on
LEADERSHIP
Theoretical and
Practical Dimensions
New chapters address:
• Followership in the context of leadership
• A systems approach to leadership
• Shared leadership
• Transforming health care with leaders for change
An Occupational Perspective on Leadership: Theoretical and Practical
Dimensions, Third Edition demonstrates the potential of occupational
therapy leadership and encourages the next generation of students
and clinicians to advance their understanding and application of
occupational therapy and leadership theory for best practices.
®
MEDICAL/Allied Health Services/Occupational Therapy
I N C O R P O R A T E D
I N C O R P O R A T E D
SLACK
SLACK
®
Theoretical and Practical Dimensions | THIRD EDITION
The Third Edition includes new theoretical perspectives, case
examples, and adapted learning activities to further meet the needs
of students and entry-level professionals.
An Occupational Perspective on LEADERSHIP
An Occupational Perspective on Leadership: Theoretical and Practical
Dimensions, Third Edition is essential for occupational therapy
students, practicing clinicians, and administrators. Building upon
the two previous editions, Drs. Sandra Dunbar-Smalley and Kristin
Winston provide an in-depth exploration of leadership theories
alongside the application of occupational therapy theoretical models
to leadership practice within the occupational therapy profession.
Dunbar-Smalley | Winston
THIRD EDITION
THIRD EDITION
An Occupational Perspective on
LEADERSHIP
Theoretical and
Practical Dimensions
EDITORS
Sandra Dunbar-Smalley
Kristin Winston
SLACK Incorporated
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Editors
Sandra Dunbar-Smalley, DPA, OTR/L, FAOTA
Provost
AdventHealth University
Orlando, Florida
Kristin Winston, PhD, OTR/L, FAOTA
Program Director
Master of Science in Occupational Therapy
Associate Professor
University of New England
Portland, Maine
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Dedication
To leaders who ensure that justice, humility, and equality
are embedded into their practices and their lives.
—Sandra and Kristin
Contents
Dedication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
About the Editors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Contributing Authors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Foreword to the Third Edition by Charles Christiansen, EdD, OTR, FAOTA. . . . . . . . . . . . . . . . . . xv
Foreword to the Second Edition by Charles Christiansen, EdD, OTR, OT(C), FAOTA. . . . . . . . . xvii
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix
Section I
Introduction to Theoretical Perspectives. . . . . . . . . . . . . . . . . . . . . 1
Chapter 1
Leadership Theories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Sandra Dunbar-Smalley, DPA, OTR/L, FAOTA
Chapter 2
Situational Leadership and Occupational Therapy. . . . . . . . . . . . . . . . . . . . . . . . 15
Kristin Winston, PhD, OTR/L, FAOTA
Chapter 3
Transformational Leadership Theory
and the Model of Human Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Patricia Bowyer, EdD, MS, OTR, FAOTA, SFHEA
and Steven Fowler, DNP, CRNA, APRN
Chapter 4
Collective Leadership: A Quantum Shift in Health Care
System Behaviors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
DeLana Honaker, PhD, CLT, OTR, FAOTA
Chapter 5
Servant Leadership and the Person-Environment-Occupation Model . . . . . . . 57
James Laub, EdD; Sandra Dunbar-Smalley, DPA, OTR/L, FAOTA;
and Lynelle F. Callender, DNP, RN, INS
Section II
Leadership Person Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Chapter 6
Exploring the Leader in You . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Jan G. Garbarini, PhD, OTR/L and Kristin Winston, PhD, OTR/L, FAOTA
Chapter 7
Ethical Considerations in Leadership. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Lisa L. Clark, MS, OTR/L, CLT and James Marc-Aurele, OT/L, MBA
Chapter 8
The Impact of Generational Characteristics on Leadership in
Occupational Therapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Sonia F. Kay, PhD, OTR/L
Chapter 9
The Kawa Model: An Exploration of Communication and Leadership. . . . . . 123
Kristin Winston, PhD, OTR/L, FAOTA
and Brianna Black Kent, PhD, RN (ret.)
Chapter 10
A Systems Approach to Leadership in Occupational Therapy:
An Ongoing Narrative.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Nicole R. Quint, DrOT, OTR/L
Chapter 11
The Dance of Leadership and Followership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Terry Morrow Nelson, PhD
Chapter 12
Shared Leadership. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Deena L. Slockett, EdD, MBA, RT(R)(M)
viii Contents
Section III
Contextual Influences on Leadership. . . . . . . . . . . . . . . . . . . . . . 179
Chapter 13
Transforming Health Care With Leaders for Change. . . . . . . . . . . . . . . . . . . . . . 181
Tara Griffiths, DrOT, OTR/L and Laura Schmelzer, PhD, MOT, OTR/L
Chapter 14
Leadership in the Community. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Marge E. Moffett Boyd, PhD, MPH, OT/L
and Tami Lawrence Buck, PhD, MSOT, OTR/L
Chapter 15
Leadership in Academic Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Scott Truskowski, PhD, OTRL;
Teresa Plummer, PhD, MSOT, OTR/L, CAPS, CEAS, ATP
and Yvette Hachtel, JD, MEd, FAOTA
Chapter 16
Appreciative Inquiry: A Road to Effective Leadership. . . . . . . . . . . . . . . . . . . . 241
Carol Lambdin-Pattavina, OTD, MSOT, OTR/L, CTP
Chapter 17
Teams and Occupational Therapy Practitioner Leadership. . . . . . . . . . . . . . . . 255
Lesly Wilson James, PhD, MPA, PMP, OTR/L, FAOTA;
Jason D. Mahilo, MOTR/L, TCR, LSVT-BIG;
and Jacqueline Reese Walter, PhD, OTR/L, CHT
Section IV
Leadership Narratives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
A Note on Antiracist Leadership. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Sandra Dunbar-Smalley, DPA, OTR/L, FAOTA
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Kristin Winston, PhD, OTR/L, FAOTA
Career and Leadership: A Personal Perspective. . . . . . . . . . . . . . . . . . . . . . . . . . 275
Sue Baptiste, MHSc, OT(Reg), OT(C), FCAOT
JUMP! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
Audrey Comeau, MS, OTR/L
Toward a Different Understanding of Leadership:
A Personal and Professional Journey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Thomas J. Decker, EdD, OTD, OTR/L and Gustavo Reinoso, PhD, OTR/L
Lessons Learned Along the Way of My Leadership Journey. . . . . . . . . . . . . . . . 291
Elizabeth Francis-Connolly, PhD, OT/L, FAOTA
Career and Leadership: A Personal Journey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
Said Nafai, OTD, MS, OTR/L, CLT, CAPS
Bossy = Leader: Using Your Strengths for Unconventional Leadership. . . . . . 301
Jacquelyn M. Sample, DrOT, MEd, OTR/L
Appendix. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Financial Disclosures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
About the Editors
Sandra Dunbar-Smalley, DPA, OTR/L, FAOTA, completed her undergraduate degree at Loma
Linda University in Loma Linda, California; her Master of Arts in Occupational Therapy from
New York University in New York City; and her Doctor of Public Administration degree from
Nova Southeastern University in Fort Lauderdale, Florida. The last degree exposed her to organizational behavior, leadership, management, and strategic planning content, all of which have
influenced her work in occupational therapy.
Sandra is currently the provost at AdventHealth University. She was previously the assistant
dean of professional development and education in the College of Health Care Sciences at Nova
Southeastern University. Her responsibilities included the coordination of the Center for Academic
and Professional Excellence, which incorporates a Leadership and Management Academy for
faculty who desire to develop and improve their leadership skills. Sandra’s belief that everyday
leadership provides numerous opportunities to encourage personal and professional growth has
been reinforced by the process of compiling another edition of An Occupational Perspective on
Leadership: Theoretical and Practical Dimensions.
Kristin Winston, PhD, OTR/L, FAOTA, completed her bachelor’s degree in occupational
therapy at the University of New Hampshire in Durham, New Hampshire. She went on to complete a Master of Education degree at the University of Vermont in Burlington, Vermont, with a
specialization in early childhood special education. Kristin’s PhD in occupational therapy was
earned at Nova Southeastern University in Fort Lauderdale, Florida. It was while studying at Nova
Southeastern University that Kristin first had an opportunity to explore the topic of leadership
under the guidance of Sandra Dunbar-Smalley, who continues as a leadership mentor.
Kristin currently serves as program director and associate professor in the Master of Science
in Occupational Therapy program at the University of New England where she continues to study
and teach leadership concepts. She has held several formal leadership positions in clinical, academic, and community organizations and has also participated in informal leadership opportunities in those settings. Kristin is a graduate of the College of Health Care Sciences Leadership and
Management Academy at Nova Southeastern University and the American Occupational Therapy
Association Academic Leadership Institute.
Contributing Authors
Sue Baptiste, MHSc, OT(Reg), OT(C), FCAOT (Leadership Narrative)
Professor Emerita
School of Rehabilitation Science
McMaster University
Hamilton, Ontario, Canada
Patricia Bowyer, EdD, MS, OTR, FAOTA, SFHEA (Chapter 3)
Professor and Coordinator of Post Professional Programs
Texas Woman’s University
Institute of Health Sciences
Texas Medical Center
Houston, Texas
Marge E. Moffett Boyd, PhD, MPH, OT/L (Chapter 14)
Assistant Professor of Occupational Therapy (Retired)
Coordinator of Graduate Academics and Community Outreach
Dominican College of Blauvelt
Orangeburg, New York
Tami Lawrence Buck, PhD, MSOT, OTR/L (Chapter 14)
Contributing Faculty
Post Professional Programs
University of Saint Augustine for Health Sciences
Saint Augustine, Florida
Lynelle F. Callender, DNP, RN, INS (Chapter 5)
Online Vice Chair of Nursing
AdventHealth University
Orlando, Florida
Charles Christiansen, EdD, OTR, FAOTA (Forewords)
Rochester, Minnesota
Professor Emeritus
The University of Texas Medical Branch at Galveston
Galveston, Texas
Lisa L. Clark, MS, OTR/L, CLT (Chapter 7)
Manager, Cardio-Pulmonary Rehabilitation Program
Community Health & Wellness
Mid Coast–Parkview Health
Brunswick, Maine
Audrey Comeau, MS, OTR/L (Leadership Narrative)
Occupational Therapist
Virginia Hospital Center
Arlington, Virginia
xii Contributing Authors
Thomas J. Decker, EdD, OTD, OTR/L (Leadership Narrative)
Associate Professor
Department of Occupational Therapy
Dr. Pallavi Patel College of Health Care Sciences
Nova Southeastern University
Clearwater, Florida
Steven Fowler, DNP, CRNA, APRN (Chapter 3)
Associate Professor
DNAP Program
AdventHealth University
Orlando, Florida
Elizabeth Francis-Connolly, PhD, OT/L, FAOTA (Leadership Narrative)
Dean, School of Interdisciplinary Health and Science
University of Saint Joseph
West Hartford, Connecticut
Jan G. Garbarini, PhD, OTR/L (Chapter 6)
Program Director (Retired)
Assistant Professor and Research Coordinator
Graduate Occupational Therapy Program
Dominican College of Blauvelt
Orangeburg, New York
Tara Griffiths, DrOT, OTR/L (Chapter 13)
Associate Professor and Associate Chair in Occupational Therapy
College of Health Professions
The University of Findlay
Findlay, Ohio
Yvette Hachtel, JD, MEd, FAOTA (Chapter 15)
Professor Emerita
School of Occupational Therapy
Belmont University
Nashville, Tennessee
DeLana Honaker, PhD, CLT, OTR, FAOTA (Chapter 4)
CEO/President Well Versed, LLC & KidLife
Amarillo, Texas
Lesly Wilson James, PhD, MPA, PMP, OTR/L, FAOTA (Chapter 17)
Associate Professor
School of Occupational Therapy
Lenoir-Rhyne University
Columbia, South Carolina
Contributing Authors xiii
Sonia F. Kay, PhD, OTR/L (Chapter 8)
Associate Professor of Occupational Therapy (Retired)
Adjunct Faculty
Department of Occupational Therapy
Dr. Pallavi Patel College of Health Care Sciences
Nova Southeastern University
Fort Lauderdale, Florida
Brianna Black Kent, PhD, RN (ret.) (Chapter 9)
Associate Professor
Assistant Dean of Professional Development and Education
Director, Coalition for Research and Education Against Trafficking and Exploitation (CREATE)
Dr. Pallavi Patel College of Health Care Sciences
Nova Southeastern University
Fort Lauderdale, Florida
Carol Lambdin-Pattavina, OTD, MSOT, OTR/L, CTP (Chapter 16)
Assistant Professor
Occupational Therapy
University of New England
Portland, Maine
James Laub, EdD (Chapter 5)
Professor of Leadership
MacArthur School of Leadership
Palm Beach Atlantic University
West Palm Beach, Florida
Jason D. Mahilo, MOTR/L, TCR, LSVT-BIG (Chapter 17)
Regional Director of Sales
Accentcare HH Midwest Region
Chicago, Illinois
James Marc-Aurele, OT/L, MBA (Chapter 7)
Senior Program Manager
Point32Health
Canton, Massachusetts
Said Nafai, OTD, MS, OTR/L, CLT, CAPS (Leadership Narrative)
Associate Professor, Founder and President, Occupational Therapy Association of Morocco
School of Health Sciences, Occupational Therapy
American International College
Springfield, Massachusetts
Terry Morrow Nelson, PhD (Chapter 11)
Associate Dean of Student Affairs/Associate Professor
Dr. Pallavi Patel College of Health Care Sciences
Nova Southeastern University
Fort Lauderdale, Florida
xiv Contributing Authors
Teresa Plummer, PhD, MSOT, OTR/L, CAPS, CEAS, ATP (Chapter 15)
Associate Professor of Occupational Therapy
School of Occupational Therapy
Belmont University
Nashville, Tennessee
Nicole R. Quint, DrOT, OTR/L (Chapter 10)
Professor and Doctoral Capstone Coordinator, Occupational Therapy
Dr. Pallavi Patel College of Health Care Sciences
Nova Southeastern University
Fort Lauderdale, Florida
Gustavo Reinoso, PhD, OTR/L (Leadership Narrative)
Associate Professor
Department of Occupational Therapy
Dr. Pallavi Patel College of Health Care Sciences
Nova Southeastern University
Clearwater, Florida
Jacquelyn M. Sample, DrOT, MEd, OTR/L (Leadership Narrative)
Pediatric Occupational Therapist
Disability Advocate
Columbia, Missouri
Laura Schmelzer, PhD, MOT, OTR/L (Chapter 13)
Assistant Professor
School of Exercise and Rehabilitation Sciences
University of Toledo
Toledo, Ohio
Deena L. Slockett, EdD, MBA, RT(R)(M) (Chapter 12)
SVP Operational Strategy and Learning
Professor
AdventHealth University
Orlando, Florida
Scott Truskowski, PhD, OTRL (Chapter 15)
Associate Professor and Department Chair
Occupational Science and Therapy Department
Grand Valley State University
Grand Rapids, Michigan
Jacqueline Reese Walter, PhD, OTR/L, CHT (Chapter 17)
Associate Professor
Occupational Therapy Department
Jacksonville University
Jacksonville, Florida
Foreword to the Third Edition
You gain strength, courage, and confidence by every experience in which you really stop to look fear
in the face. You must do the thing you think you cannot do.
—Eleanor Roosevelt
This third edition of An Occupational Perspective on Leadership: Theoretical and Practical
Dimensions is being published at a most extraordinary time. It emerges during a global pandemic
that has already rapidly transformed the lives of the world’s population in ways that few could have
imagined. As I sit here thinking about this historical event, and about this book and its aims, I realize a truly rare and remarkable social consequence of this viral invasion: Everyone, everywhere, is
experiencing the same life-changing phenomenon simultaneously. This likely has never occurred
before within the recorded history of the planet, and for many it arrives gift-wrapped with “spare
time” to think about what it means for each of us and the world we will inhabit in the months and
years ahead.
As we reflect on this crisis, each of us may likely agree that our reactions include amazement
at the scope and speed of the changes to our lives; grief at the deaths, illnesses, and economic losses
that have resulted; fear about the ubiquitous threat of infection and the safety of those we love; and
anxiety about the future. The uncertainty of what the world will be like when the pandemic is over
is distracting. We yearn for reassurance and hope, but we also need factual information to prepare
for the conditions that may result. We seek trustworthy and competent leaders to inform us, to
guide us through this uncertainty, and to foster that important sense of community that provides
reassurance, strength, courage, and hope. In fact, the word encourage derives from the Latin word
for heart, so to encourage is to “make strong or hearten.” Good leaders strive to encourage those
they serve.
It is no coincidence that history has shown that leadership reveals itself best during times
of crisis and transition. Often, this is exemplified by the leaders of nations. Abraham Lincoln,
Winston Churchill, Franklin Roosevelt, and Nelson Mandela are examples of legendary leaders
who rose to the challenges of their time and earned the respect and support of followers in their
respective nations and beyond. Historians make it clear that these leaders were not without personal flaws, and that they also experienced fear and uncertainty. Yet, they found within themselves
the wisdom to remain humble and listen appreciatively to their knowledgeable advisors, the conviction to trust their values, the integrity to accept their responsibilities, and the courage to live
outside themselves and think creatively and act boldly in the service of others. Such characteristics
and behaviors can predictably enlist and inspire others to become helpful participants in finding
ways through the darkness and chaos of crisis.
In the COVID pandemic, many leaders demonstrated these virtues. When histories of this
period are written, it is possible, even likely, that the leaders who stood out will not be national
figures or elected officials, but local volunteers and professionals working on the front lines and
risking their own well-being in the service of others. There have been countless stories of such
individuals inspiring others and reaffirming the truth that authentic leadership arises from the
heart.
These leaders also stand out because they are seen against the backdrop of an infrastructure
made grossly inadequate by longstanding neglect. The social and economic catastrophe that
resulted makes it seem inevitable that the pandemic will lead to structural changes in societal and
health programs that can better contend with pandemics and other global crises in the future.
xvi Foreword to the Third Edition
Such structural changes will undoubtedly affect occupational therapy, too, in ways that are
now unknowable. What should be apparent, though, is that the manner in which the profession
embraces opportunities for creating better practices and structures that are durable and adaptable
will be important. This will require that leaders within the profession seize the moment, apply the
lessons of history, and demonstrate the principles elaborated in this important and timely book.
They will be most successful if they remember that the values that inspired the field’s founding can
serve as a powerful motivator for both providers and their clients. Those values honor and connect
the life stories of clients with the increasingly scientific, economic-driven, and impersonal world of
health care. If this return to core values occurs, good things will happen. Let it be so.
—Charles Christiansen, EdD, OTR, FAOTA
February 2022
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Foreword to the Second Edition
In the earliest years of civilization, leaders evolved informally based on family ties, strength,
age, or popularity. While some leaders were generous and wise, others were ruthless and ignorant. Power was based on position or earned by conquest, and leadership training was typically
learned by experience. In the 21st century, we know that leading people effectively requires more
than titles, power, popularity, or armies. In fact, like competency in any art or science, leadership
requires study, experience, and genuine commitment to the point that being effective seems deceptively easy (but, of course, isn’t).
Throughout my career, I have been an avid student of leadership, attempting to apply its principles in various positions of influence and advocating for the importance of succession planning
and leadership development. I have learned that knowledge of people and groups provides a key
beginning for becoming an effective leader, but truly effective leadership requires a keen knowledge of self, character (the right values), mentorship by competent leaders, an honest appraisal of
failures, and good communication skills. Invariably, it helps if one has experience being a good
follower, has a passion for learning, and understands that leadership is a privilege to serve others
that must be unselfishly honored.
In thinking about leadership, I am always reminded of these lines in the Tao Te Ching by the
Chinese sage Lao-Tzu (translation by Stephen Mitchell):
When the Master governs, the people are hardly aware that s/he exists.
Next best is a leader who is loved.
Next, one who is feared.
The worst is one who is despised.
If you don’t trust the people, you make them untrustworthy.
The Master doesn’t talk, s/he acts.
When her/his work is done, the people say, “Amazing: we did it, all by ourselves!”
To me, these lines communicate key messages about leadership, such as the importance of
humility and patience, trust, being approachable, and leading quietly and effectively to empower
by example. Many of these lessons are features of servant leadership.
Sandra Dunbar and Kristin Winston have assembled a talented group of authors to prepare
the second edition of this well-regarded leadership text. Their use of buildings and structures as
metaphors for understanding leadership principles is quite effective, and in this edition they have
worked hard to integrate occupational therapy theory with lessons of leadership. As occupational
therapy celebrates its centennial year, effective leaders will continue to be vital to ensure that the
profession and its members are providing vital, client-centered, life-relevant services throughout
the next 100 years.
—Charles Christiansen, EdD, OTR, OT(C), FAOTA
June 2014
Introduction
We are what we build.
—Lois Farfel Stark
There have been significant social, health, and political shifts, both on a national and global
level, since the 2015 publication of An Occupational Perspective of Leadership: Theoretical and
Practical Dimensions. Now, more than ever, it is necessary for occupational therapists and occupational therapy assistants to equip themselves with leadership knowledge and application skills.
This is our imperative to adequately meet societal demands and engage in efforts for a more just
and equitable global community.
Continuing the building metaphor for leadership, new bricks are part of the architectural
plans in our ever-evolving landscape of leadership opportunities. This third edition of the textbook incorporates updates on the intersection of leadership and occupational therapy theories, as
well as posits perspectives not included in previous editions, such as the construct of followership.
In order for leadership to be effective, it is important to include followership considerations to
enhance our understanding of the essential intertwining between group members with different
roles. Another new aspect in this edition is the introduction to appreciative inquiry. This positive
approach to understanding group perspectives and forging a way forward to establish a vision is
a resource that can help leaders develop blueprints to manage the most challenging of situations
within organizations. In addition, shared leadership is introduced, as we flatten the hierarchy
in groups and invite others to lead along with us while recognizing the essential power of diversity. These additional building blocks are intended to further fortify the foundation for optimal
leadership.
With constant change around us, the leadership imperative today also includes agility, foreshadowing, effective communication, and innovative thinking. For anyone who gets comfortable
with the familiar and resists sensible change, they will find it difficult to use new tools and engage
in the stimulating work of the “smart” organization. Authentic occupational therapy has always
been adaptive and creative. The best of leadership is as well.
—Sandra Dunbar-Smalley, DPA, OTR/L, FAOTA
If you want to have a strong structure, build the foundations the right way.
—Eraldo Banovac
Introduction to
Theoretical Perspectives
I
Leadership Theories
1
Sandra Dunbar-Smalley, DPA, OTR/L, FAOTA
Learning Objectives
1. Recognize the essential need for leadership knowledge and skill development.
2. Describe leadership from multiple perspectives.
3. Identify key leadership theories.
4. Identify essential leadership competencies.
5. Understand the relevance of leadership theories to occupational therapy.
A great leader’s courage to fulfill their vision comes from passion, not position.
3
—John Maxwell
Dunbar-Smalley S, Winston K, eds.
An Occupational Perspective on Leadership:
Theoretical and Practical Dimensions, Third Edition (pp 3-14).
© 2022 SLACK Incorporated.
4 Chapter 1
Occupational therapists and occupational therapy assistants serve in leadership roles within a
variety of work environments. These unique opportunities are often experienced without a formal
understanding of leadership theory or a methodical way of gaining leadership competencies.1 As
the occupational therapy profession continues to progress, it is essential that occupational therapy
students and practitioners enhance their ability to learn key leadership principles to gain and sustain leadership roles in health care and community arenas.
In addition to advancing to leadership roles, it’s imperative that each practitioner envision
themselves as a change agent, capable of influencing others and making a difference for clients and
communities. In an ever-changing leadership landscape, the ability to adapt, be open to varying
perspectives, stay abreast of current evidence, and promote innovation are critical for professional
survival.2 Recent global public health events and a heightened awareness for social justice certainly
heighten the need for effective leadership for managing not only the work environment challenges
but significant health crises that impact every occupational aspect of life.
Leadership Defined and Described
Leadership has been defined in various ways throughout business and organizational behavior
literature. Fleishman et al indicate as many as 65 different classifications in a review of 50 years of
literature.3 Bass, a well-recognized author on the subject of leadership, also suggests many ways to
classify leadership perspectives.4
The trait theory, or personality perspective, is focused on particular traits that an individual
possesses related to leadership skills. Early theorists believed that people were born with characteristics that enabled them to be effective in getting others to accomplish a designated goal.
Individuals with qualities such as strong social skills, empathy, and a charismatic presence were
considered born leaders.4
The style approach to leadership was an enhancement to trait theory, with the inclusion of
consideration of the actions of leaders. Blake and McCanse revised previously developed descriptions of leadership styles based on the degree of concern for production and concern for people.5,6
They concluded that there are 5 leadership styles, which they formerly related to management
styles: authority-compliance management, country club management, impoverished management,
middle-of-the-road management, and team management. Table 1-1 provides an adaptation of the
brief descriptions, which parallel well-recognized categories of leadership styles, such as democratic (team management) and authoritarian (authority-compliance).
An opposing view to the trait theorists’ perspectives is the situational approach. Situational
theories indicate an emergence of leadership based on various factors that arise within an environment. Emergent leadership occurs when situational demands create a leader among a group that
will address the needs within a particular environment.6 With these 2 perspectives alone, it may be
easily understood how the controversy between the born leader versus developed leader viewpoints
has remained a continuous discussion in leadership scholarship. Some early authors agreed that
a combination of these 2 ways of thinking was needed for effective leadership to occur. One may
recognize a need to rise to the occasion in a leadership situation, but unless an individual has some
inherent qualities that will allow them to successfully lead, they will not be as effective.7,8
Power is often discussed in relation to leadership. There are various types of power, including power based on a position of authority and power based on personal characteristics. People in
positions of power, such as CEOs, teachers, and ministers, may use their status to influence the
thoughts and behaviors of others.6 Personal power refers to the type of authority that is granted to
someone based on their ability to meet the needs of followers. If a leader is viewed as productive,
compassionate, and competent, they are more likely to establish personal power than a person who
is unresponsive to team members and lacks the necessary skills to get the job done. Individuals can
use power in negative and positive ways, but if a leader can use power to benefit the common good
and move toward the collective vision of a particular group, this is the optimal use.
Leadership Theories 5
Table 1-1
Leadership Style Descriptions
LEADERSHIP STYLE
Authority-compliance
management
Social club management
Deprived management
Fence management
Team management
DESCRIPTION
Heavy emphasis on task, low emphasis on people
Results driven
Lack of emphasis on communication
Low concern for task
High concern for people
Low emphasis on production
Emphasis on social needs
Helpful and comforting climate
Lack of concern with people and tasks
Uninvolved leadership
Indifferent and apathetic
Compromising
Some emphasis on task, some emphasis on people
Avoidance of conflict
Strong emphasis on tasks and on interactions
Participatory and engaged
Clear about priorities
Open-minded
Enjoyable work environment
Leadership in the 21st century is perceived quite differently from the way it was in earlier eras,
when a sage or other individual might be thought to have all the answers to organizational difficulties. Modern definitions and descriptions vary greatly, but some common themes arise from
the most recent literature, including the attainment of a common goal, the recognition of leadership complexity, influencing the behaviors of others, and the need to create a vision.9,10 For the
purposes of this book, and to allow the reader to grasp a foundational perspective for subsequent
chapters, the following definition will be used for leadership:
Leadership is a process that involves a significant degree of complexity through
interactive and relational operations in order to meet the goals of individuals or
groups.
This definition acknowledges the multiple aspects of leadership by describing leadership as
“complex.” This descriptor was selected to exemplify the fact that being an effective leader takes
intentionality and hard work. The process of leadership preparation, engaging in action, reflecting,
adapting, and engaging again, creates a cycle that is well worth the journey. This cycle is illustrated in
Figure 1-1. Leadership requires not only interactions with team members and/or followers, but it also
incorporates a degree of relationship building, with efforts to meet the goals of individuals or groups.
This relationship building is part of the essential preparation for key action that will help drive
change or influence others’ behaviors. The action taken can relate to the theoretical perspectives
6 Chapter 1
Figure 1-1. Leadership cycle.
that are described in this chapter. Theory enables the occupational therapist to consider best steps
for dealing with challenging and even everyday circumstances involving leadership. Theoretical perspectives are not the only way a leader may decide an action. Experience, evidence-based literature,
and mentoring all serve as resources for engaging in leadership best practices.
Reflection is becoming a lost art in our faster-paced societies. Careful considerations of how
we do something, deep thought about how we could have done something differently, and additional processing for how we will strategize and be intentional about making personal change are
leadership skills that may appear challenging to some. However, this reflective and reflexive practice can be transformative for individuals, as well as for your clients and teammates in any setting
that you may lead. Acknowledging our mistakes and continuously making self-improvements are
part of the adaptation stage in the leadership cycle. This will lead to different action in the next
phase. Creating opportunities for feedback among your peers further enhances your ability to act
even more effectively at this point in the cycle.
It is important to understand that the leadership process in each situation may not be linear
or cyclical. An individual may have to make a quick decision, or they may have opportunities to
do group discussions in the adaptation stage, or any number of variances, so it is important to
expect changes and to be flexible. Overall, these expanded views of the definition of leadership
will enable the occupational therapy practitioner to see themselves as an active participant in their
leadership journey.
Leadership Competencies
Although descriptions and definitions of leadership vary in the literature, there are specific
skills identified for optimal leadership that are relatively consistent.11,12 The chapter “Exploring
the Leader in You” (Chapter 6) in this text explores ways to assess your own leadership and further
develop your skills for competent practice. However, it is first important to recognize what competent leadership practice entails.
Today’s leader is challenged with ongoing political and social changes, which have a significant impact on health care. In addition, the complexity and ambiguity of organizational structures
and functions make it increasingly challenging to lead within a shifting context. It is essential that
Leadership Theories 7
leaders develop specific competencies to address the complexity of current work environments.
From the author’s own experience, these include cultural humility, interprofessional value, effective communication, and ethical decision making, among others.
Table 1-2 illustrates the levels of competency in essential aspects of contemporary leadership.
Level 1 is the lowest level, progressing to the most advanced skills, at level 3. Leaders may be at
various levels within the grid, but thoughtful reflection regarding where one is located in each of
these basic areas is helpful for meeting the demands of complex leadership situations.
Multiple resources provide details about these and other leadership competencies; Table 1-2
provides an overview of the range of skills within the most basic areas for effective leadership.11,12
Each one of the areas is worthy of a thorough study, and the reader is encouraged to seek out additional readings through the chapter learning activities. The application of leadership theories is
enhanced with the development of these specific competencies.
Leadership Theories
Throughout this text, various leadership theories will be described and applied to different
health care contexts. Theories describe, explain, and predict behavior and relationships between
phenomena.13 Some of the most common leadership theories include situational leadership,
servant leadership, and transformational leadership.14–17 Specific chapters are designated for the
expansion and exploration of these particular theories and their potential relationship to occupational perspectives. However, current literature includes less common and newer approaches
to leadership that are described in this chapter, including path-goal theory, Theory U, and attributional leadership theories.18–20 The reader is invited to continue exploration and application of
these theories in academic and clinical realms, following this introduction.
Path-Goal Theory
The path-goal theory emphasizes the accomplishment of follower goals through the motivational efforts of the leader. Georgopoulos et al, Evans, Dessler, and House and Mitchell are among
the best known authors on this theory.21–24 Although this theory dates back a few decades, its
application to the occupational therapy profession is a timely effort, based on the significant needs
of employees in the changing economic health care policy context. The path-goal theory is based
on the premise that employees need to be motivated in order to perform well and experience job
satisfaction. In addition, considerations need to be made regarding the specific work task, the
structure of the task, and how this influences an employee’s overall motivation.6
With situational approaches to leadership, the leader takes an adaptive approach and shifts their
style based on the readiness aspects of the follower. Path-goal theory recognizes the style of the leader
and the follower as well as environmental factors, but it focuses the attention on what motivates the
employee. The leader’s role is to provide the incentives or means for the employee’s path to be clear to
reach their goal.18 The leader offers something, and, in exchange, the follower produces something.21
Barriers that limit an individual’s goal attainment are analyzed and removed so that the employee
can more easily move forward to accomplish tasks in the work environment.
There are 4 main types of leadership behaviors offered by path-goal theory: directive, supportive, participative, and achievement oriented.24 Each of these is stated to have a particular impact
on the motivation of an employee or follower, but the degree of influence will depend on the characteristics of that follower. The directive approach is, as its name suggests and entails, just telling
team members, with specific parameters, what they need to do. Supportive leadership, in this
theory, is characterized by a friendly and respectful approach to employees, even to the point of
considering followers equal to management. Participative leadership goes another step and invites
Intentional effort to
understand the roles
and responsibilities of
other team members in
the health care arena.
Ability to explain
various health care
team member roles and
optimal collaboration
with team members
with positive client
outcomes.
Level 3
Active engagement and
participation in cultural
aspects, with intentional
efforts to immerse oneself
in continuously learning
about other cultures
within and external to the
work environment.
INTERPROFESSIONAL
VALUE
Recognition that various
professionals work
together on behalf of
the client.
Level 2
Understanding and
appreciation of cultural
differences and pursuit
of information to further
understanding.
CULTURAL HUMILITY
Level 1
Acknowledgment and
awareness of differences
among ethnic groups and
individuals with varying
abilities, religious and/or
spiritual beliefs, and sexual
orientations.
EFFECTIVE
COMMUNICATION
Listening skills that
provide enough time for
individuals to express
themselves. An ability
to accurately assess
verbal and nonverbal
communication while
responding in a tactful and
clear manner.
Knowledge of conflictresolution strategies,
motivational strategies,
and leadership theories
that enhance interpersonal
skills.
Ability to engage in
successful dialogues
and formulate solutions
beyond self-interest in
a collaborative manner,
applying conflict
resolution, leadership, and
other pertinent theoretical
perspectives.
Consistent literature
exposure to gain varying
perspectives on issues,
intentional dialogue
to understand other
viewpoints.
Positive engagement with
others who have different
opinions and thoughts,
pursuit of alternative ways
to see health care dilemmas
and actively participate in
solution finding, high degree
of comfort with ambiguity,
and flexibility of thought.
Ability to apply ethical
theories and decisionmaking models, discuss
alternative solutions
with key players, and
support effective and
efficient solutions while
considering all pertinent
information.
PERSPECTIVE THINKING
Recognition of various
viewpoints when discussing
health-related aspects of
client care, as well as healthoriented policies.
Understanding of ethical
theories and decisionmaking models and their
significance to health care
practice.
ETHICAL DECISION
MAKING
Understanding of
formal and informal
organizational rules
and policies, as well as
professional codes of
ethics. Recognition of
institutional and personal
values.
Leadership Competency Levels
Table 1-2
8 Chapter 1
Leadership Theories 9
the followers to actually be a part of key decisions within the work environment. Achievementoriented leadership is described as a style that promotes optimal performance of followers through
appropriate high-level challenges and high expectations.24
In path-goal theory, any of these leadership styles can be used with a variety of individuals. A
leader needs to assess what is preventing an employee from achieving their goals and then implement strategies using the most appropriate style to remove the barriers to optimal job performance.
Similar to situational theory, which is discussed further in Chapter 2, path-goal theory suggests a need to understand team member characteristics and consider styles that match the team
member’s needs. For instance, if a worker is unsure of their tasks and when to do them, a more
directive approach will be successful. They need to know the structure of the tasks and expectations to have their path unblocked. Again, however, the focus in path-goal theory is to provide an
environment that will increase an employee’s motivation, job satisfaction, and performance. In
path-goal approaches, the leader will only provide what is needed by the team member, including
motivational level, environmental factors, and the specifics regarding the tasks.
Occupational Therapy Application of Path-Goal Theory
Occupational therapists are able to relate to the specific aspects of path-goal theory, given
our familiarity with the Person-Environment-Occupation (PEO) perspective.25 The PEO Model
describes the transactional relationships among person, occupation, and environment; outlines
major concepts and assumptions; and applies these ideas to an occupational therapy practice situation. The model recognizes and celebrates the complexity of performance of occupations within
different environmental contexts. Occupational performance is a result of an optimal fit between
the person, their occupation, and their environment.25
In path-goal theory, the “path” may be parallel to occupational performance. Barriers to performance in everyday functions are analyzed by an occupational therapist in the same way that a
leader might try to decipher what prevents satisfaction and motivation in an employee. The “tasks”
in path-goal theory may be related to the specific occupations one must engage in for fulfillment
and productivity. An analysis of these parts will lead to a plan that will enable a person to be more
successful. This “plan” in path-goal theory may be likened to a treatment plan that requires a
variety of therapist styles to reach certain goals. At times, the occupational therapist will have to
incorporate incentives, remove barriers, or even provide clearer instructions in order for the client
to reach success. This comparison to our familiar theoretical roots may assist us in recognizing key
points in leadership that are feasible for application in various environments.
Currently, there is limited research on leadership theory in direct application to occupational
therapy practice. Leadership theory and leadership behaviors can be effectively utilized to guide
therapeutic intervention and facilitate successful outcomes for our clients. Table 1-3 provides an
example of path-goal theory when working with clients in a clinical setting.
Theory U
Theory U emerged a few years ago, when Scharmer19 published a text that provided significant
detail about a new perspective on leading. This contemporary literature creates a way of viewing
leadership with an eye to the future, to enable leaders to create a vision that is able to adapt to the
ever-changing contexts in which we live and work. The recognition of economic and political
strife, as well as failures in education, business, and government, provides an opportunity for the
development of a new view on how to lead in changing times. Traditional ways of leading cannot
continue to be effective, with varying social and political shifts that continuously challenge us to
develop more effective ways to function within our communities and organizations.
10 Chapter 1
Table 1-3
Four Types of Leadership Behaviors
BEHAVIOR
Directive behavior: Set guidelines,
clarify expectations, and give
specific guidance on the tasks to be
accomplished.
Supportive behavior: Show concern
and respect for the followers’ needs
and preferences and create a friendly,
supportive environment.
Participative behavior: Collaborate
with clients to make decisions.
Achievement-oriented behavior: Set
challenging but realistic goals to push
clients to excel and have confidence
that they can attain goals.
APPLICATION
Education on precautions to adhere to
following surgery, energy conservation
techniques, or home exercise programs that are
new to the client and are important for safety or
increasing participation.
Establishing a therapeutic relationship by
creating an occupational profile and getting
to know the values and goals of the client,
practicing from a perspective of client-centered
and occupation-centered care.
Encourage and facilitate a collaborative process
in which the client guides the treatment
sessions and is an active partner in problem
solving and setting goals for therapy.
Creating the “just-right challenge” in
intervention to motivate the client to achieve
their greatest potential; being intentional in
terms of choosing or guiding interventions that
help move the client forward toward their goals.
Reproduced with permission from Cleveland K, Winston K. Bridging theory and practice through leadership.
Poster presented at 93rd Annual Conference of the American Occupational Therapy Association; April 24–28,
2013; San Diego, CA.
Scharmer proposes that we take the initiative to facilitate and support the needed changes
within our society and organizations, which will make us more accountable to each other for the
good of everyone. When we make intentional efforts to identify issues and improve conditions,
positive things can take place. Attending to needed change requires a concerted effort and determination that anyone can develop. This is done through the 3 main features of Theory U: an open
mind, an open heart, and an open will.19
The open mind experience relates to the identification that one’s assumptions may be taken
for granted and new knowledge may help to enlighten a perspective. For example, the occupational
therapist who is working with someone from another country with which they are unfamiliar
will have assumptions about that culture. The therapist may approach the client with stereotypes
in mind and not really take the time to ask the client about their culture and understand its
relationship to occupational performance. An open mind will allow for new learning and new
perspectives. A leader with an open mind will seek out new information in order to stay current
and competent, as well as to meet the demands of the changing environment. This is helpful when
planning for a department’s future with decreased reimbursement and a changing demographic,
or when helping employees reach their professional goals.
An open mind can also be thought of in a broader sense, in regard to occupational therapy
becoming widely recognized. In order to lead in this century, occupational therapists must develop
an open mind to listen to our global communities, strive to eradicate occupational injustice, and
focus on authentic occupational therapy for meeting society’s needs.
Leadership Theories 11
Developing an open mind is an important aspect for leading into the future, but without the
reflective activity of an open heart, action for change may be minimal. An open heart requires a
process of deep attention to understand our part of a particular issue and take personal responsibility for our feelings and thoughts related to it. An open heart is related to observing the status
quo and assessing whether change is actually needed. In addition, recognizing our part in inhibiting needed change is another perspective of an open heart that is critical to pay attention to in
developing optimal leadership skills.
Finally, an open will refers to the determination to make the actual change necessary for a
better organization, country, and even a better world. Political uprisings in so many countries
within the past few years are a testament of an open will at work in a collective sense. People have
weighed within their own minds, through reflection, what is needed to make necessary change for
the greater good and then have made widespread efforts to foster or ensure societal changes, even
in the face of great challenges.19
Occupational therapy practitioners have numerous opportunities to do reflective work and
take action to improve the lives of clients and the organizations in which they work. There are
many occupational therapy leaders who take this to the next step of an open will by ensuring the
necessary change on community, national, and international levels, to bring attention to widespread issues that impact more than a few clients. This type of exemplary leadership relates to the
aforementioned concepts in Theory U.
Developing these core features enables occupational therapy practitioners to sense the future and
lead in a more visionary manner than ever imagined. Scharmer19 refers to presencing as the ability to
sense one’s future potential in the highest sense, making essential things happen. This combination
of “presence” and “sensing” allows an individual to see themself as they will become, thus creating
the path to goal attainment, based on the possibilities of the future. As occupational therapy practitioners, we are actually expecting this type of presencing from our clients on a daily basis. Imagining
this process for ourselves could lead to far more powerful leadership within the profession.
Scharmer’s Theory U19 is illustrated by an actual U shape that incorporates 5 movement
processes along the path of the U. At the top left of the U is co-initiating, which is the ability to
listen to others and follow one’s own life passions. Just below this movement is co-sensing, which
is the ability to understand one’s own fullest potential, using an open mind and open heart in the
process. At the bottom of the U shape is co-presencing, which is providing oneself the opportunity
to reflect and allow one’s new knowledge and understanding to emerge. On the right side of the
U shape are co-creating and co-evolving movement processes. Co-creating is exploration of the
potential action one could take in the future. A trial-and-error process will allow a person to see
if there is a particular avenue they want to explore. The last movement process, co-evolving, is the
actual participation in growth experiences that include the sensing, understanding, and realization of optimal plans that support and enhance leader contexts.
Occupational Therapy Application of Theory U
An occupational therapist in an academic setting was asked to consider a newly created
administration position. This position entailed the formulation of continuing education for area
clinicians and professional development initiatives for the faculty in the college, which included
multiple disciplines in the health professions.
The open mind of this process included the envisioning of a new way for occupational therapy
to make a significant difference in an academic setting. The opportunity of helping to create the
role was an unexpected challenge, but the occupational therapist sought out information from
other universities and developed knowledge about similar roles as a way to feel more comfortable.
The open heart approach to this work-role transition included a mindfulness of past mistakes
in administrative roles and a deep reflection on what leadership strengths could add to the position
and what skills needed improvement. Adjustment to different support staff and administrators
12 Chapter 1
within the same college posed new challenges. Different personality styles and work expectations
resulted in difficult interactions. Further reflection revealed that former patterns of interacting
primarily with occupational therapists in a work setting would not be as effective with the varying
roles present in the new position.
The open will aspects of this work-role transition included a vision of a successful department with the development and implementation of creative professional development activities
(co-sensing). With that in mind, different strategies were integrated for action to achieve this goal.
Discussions were held with key people to clarify roles and expectations (co-initiating). Goals were
set for the professional development initiatives (co-creating). Now, after 1 year in the role, the
growth between work partners is evident, and outcomes are positive (co-evolving).
This brief overview of Theory U is just a window into a thought-provoking and detailed perspective. The reader is encouraged to continue to explore this contemporary approach to leadership and be intentional about their leadership exploration and growth, using the principles of this
theory as a guide.
Attributional Theory of Leadership
Attributional theory actually dates back to Fritz Heider,26 who described attributions as the
cognitive processes individuals use to understand cause and effect in problem-solving situations.
This allows for more effective interactions in the contexts in which we work. Attributional theory
has gained more attention in recent years, with notable applications to leadership.27,28 These contributions to the literature have included the identification of strategies used to make attributions,
such as consensus and consistency of team member behaviors, as well as explanations and descriptions of attributional processes.20,27,28
Occupational Therapy Application of Attributional Theory
To illustrate how attributions play a role in everyday leadership, consider potential employee
behaviors, such as failing to document notes on clients in a timely manner. The leader uses observation to understand the failure to follow through on tasks. The leader may ascertain a lack of
effort on the part of the team member, rather than an inability to perform, and therefore provide
a more severe response to the team member. This lack of understanding the multiple factors
involved in apparent poor performance presents a need to more fully understand the complex
nature of performance.
The cognitive process of assessing cause and effect is an ongoing mental exercise in leadership
contexts. There is difficulty in assessing thought processes, motivational levels, and the rationale
for certain behaviors. This example provides a view of the many challenges of attribution research.
Measuring thoughts, feelings, and their relationship to actions is a difficult task researchers clearly
identify.28 In addition, there are numerous factors that impact a leader’s decision making in managing employees that may be unrelated to attributions, such as departmental policies, costs, and
administrative expectations. Gender, experience level, culture, age, and personality traits also
influence attribution and must be considered in evaluative processes.
Regardless of the challenges to researching this aspect of leadership, there continues to be a
consistent effort to use attributional theory to understand and explain leader decision making and
actions. Martinko et al28 even argue that attributions are a significant reason for the observed variance in leadership behaviors, and they clearly identify this area of study as critical for understanding the dynamics of leadership. A distinction is made between perceiving attributions as related to
personal characteristics versus the more in-depth causal approach that uses information sources
to lead to conclusions. Both approaches have been linked to attribution theory, but it is the latter
that provides the leader with a more substantive approach to analyzing their everyday leadership
by considering the impact of gender, context, race, and experience, among many other factors.
Leadership Theories 13
Lakshman27 provides a critical analysis of previous literature on attributional theory, indicating the negative influences, such as the view of a poorly performing team member, on attribution
processes. He proposes a more positive approach by identifying desirable leader behaviors and
perceptions, based on a positive attributional model of leadership. When leaders use “attributional
accuracy,” it leads to high-quality performance from team members. This is the more correct
assessment of attributes based on multiple factors that may impact an individual’s job performance. Expert attributional processes, including the use of more complex cognitive processes,
involve a more in-depth evaluation of the potential reasons and influences on decision making
and actions. Rather than concentrating on an individual’s weaknesses and how to fix them, this
newer approach involves the identification of the team member’s strongest qualities and the causal
factors that create high-performing individuals.
A leader who is able to assess environmental influences on performance, understand the
multiple reasons for performance variations, and appreciate the complexities of organizational
challenges, and who has a high level of interest in effective resolution, will be more likely to engage
in attributional accuracy. In the previous example of a poorly performing team member, an effective leader will gather more data in the assessment process, including observations and discussions with the employee as well as evaluating contextual supports and barriers for performance.
Occupational therapists routinely use these types of cognitive processes in serving clients but need
to recognize the effectiveness of applying evaluative processes in leadership contexts as well.
Leadership theories are essential tools for application in the many health care work arenas.
Informal and formal leadership roles are enhanced with the integration of theoretical perspectives.29 Just as the use of occupational therapy theories, frames of reference, and models serve
as essential foundations for client evaluation and treatment planning, leadership theories serve
occupational therapy practitioners well in the development and implementation of leadership initiatives. As the profession seeks to be widely recognized and globally connected, even addressing
widespread public health issues, it is essential that its leadership standards are high and highly
effective.
Learning Activities
Tier 1
1. Explore 2 other resources or references related to either Theory U or attributional
leadership theory. Identify at least 2 main points that were not included in this chapter
summary.
2. Describe specifically how you think understanding leadership theory can assist the
occupational therapy profession to become better recognized and/or stay true to its
authentic occupation roots in practice.
3. Review Table 1-2 and find at least 3 additional resources on conflict resolution, ethical
decision making, and/or cultural competence or cultural humility. Discuss your findings and their relationship to effective leadership with at least one peer and/or the class.
Tier 2
1. Compare one other contemporary leadership theory to a theory in this chapter. Use at
least 3 book, journal, and/or reputable web references to support your verbal or written
statements.
2. Explain the application of one of the theories in a current school or work situation.
3. Describe how you would apply a leadership theory for using occupation to make a
societal difference.
14 Chapter 1
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