Journal of Nursing Management, 2011, 19, 1058–1069
Development of a model of situational leadership in residential
care for older people
BRIGHIDE M. LYNCH B S c ( H o n s . 1 s t ) , D i p . N , R G N 1, BRENDAN MC CORMACK
2
3
R N T , R M N , R G N and TANYA M C CANCE D P h i l , M S c , B S c ( H o n s . ) , R G N
D.Phil (Oxon.), BSc (Hons.), PGCEA,
1
Area Co-ordinator of Services for Older People, HSE Dublin North East, Primary, Community & Continuing Care
Services, Dundalk, County Louth, 2Director of the Institute of Nursing Research, University of Ulster, Jordanstown
and 3Mona Grey Professor for Nursing Research and Development, University of Ulster and Co-Director-Nursing
R&D, Belfast Health and Social Care Trust, University of Ulster, Jordanstown, UK
Correspondence
Brighide M. Lynch
31, Glen Court
Dublin Road
Newry, Co. Down BT358HH
UK
E-mail:
brighide.lynch06@yahoo.co.uk
L Y N C H B . M . , M c C O R M A C K B . & M c C A N C E T . (2011) Journal of Nursing Management 19,
1058–1069
Development of a model of situational leadership in residential care for older
people
Aim The aim of the present study was to present the process used to develop a
composite model of situational leadership enacted within a person-centred nursing
framework in residential care.
Background Transforming the culture of the residential unit from a restrictive
institution to a vibrant community of older adults requires transformational leadership. Situational leadership is one form of transformational leadership, which
claims that there is not one leadership style that works in all situations.
Method A model of situational leadership in residential care was developed through
a series of systematic steps that identified direct linkages between situational leadership and the main constructs of the Person-Centred Nursing Framework. The
process included reviewing the evidence, undertaking a comparative analysis,
identifying key concepts, connecting the concepts and developing a model.
Conclusion A conceptual model is presented which integrates person-centredness
with leadership thinking in order to effectively impact on the followerÕs performance in managing the care environment and delivering person-centred care.
Implications for Nursing Management Currently the model is being utilized in an
action research study to evaluate the role of leaders in the practice setting of longterm care. While some of the connecting concepts have been identified in the present
study, more work needs to be done to unravel these connections in further study of
leaders in practice.
Keywords: culture change, older people, person-centred practice, residential care,
situational leadership
Accepted for publication: 16 May 2011
Introduction
The purpose of the present paper was to present the
development of a model of situational leadership in
residential care which is integral to an action research
study evaluating the role of leaders in the practice set1058
ting of long-term care. The development of a proposed
new model of situational leadership in residential care is
built on the premise that transformational leadership is
situational leadership enacted within a person-centred
nursing framework and brings together previous
empirical research by McCormack and McCance
DOI: 10.1111/j.1365-2834.2011.01275.x
ª 2011 Blackwell Publishing Ltd
Leadership in residential care for older people
(2006, 2010) and Hersey and Blanchard (1982, 1997).
The synthesis of this research has been used to generate
the model of situational leadership in residential care. In
the present study, an overview is presented of the evidence from the literature that underpins situational
leadership and person-centred nursing, the methods
used to generate the model, underpinning constructs
and the potential of the model in practice.
Background and context
Long-term care facilities for older people have been
described as communities that combine the complex
tasks of providing for private lives in public places
(Peace et al. 1997). This complexity is seen most clearly
in the continuous tension around personal autonomy,
control and risk taking for residents, and staff anxiety
about, and responsibility for, safety and accountability
(Grant & Norton 2005). This system places efficient
deployment of staff and routine processes ahead of the
individual preferences of the residents. Research
undertaken in 2006, by Eamon OÕShea, looked at the
quality of life for older people in long-stay care settings
in Ireland and demonstrated that that the current model
of residential care does not always support older people
and indeed can be quite a restrictive form of long-term
care (National Council on Ageing and Older People
2006). Recent figures from the Department of Health
and Children in Dublin revealed that there are a total of
22 613 people resident in nursing homes in Ireland,
both public and private (Department of Health and
Children 2008). Since July 2009, the Health Information and Quality Authority (HIQA), an independent
body established under the Health Act 2007, has
responsibility for the registration and inspection of all
residential care services for older people in Ireland
(HIQA 2009). The purpose of the inspections is to ensure the delivery of quality care to older people in residential settings and to promote person-centred
practice. Nurse leaders now face increasing expectations to deliver the necessary changes in the culture of
long-term residential care and therefore require a different set of skills than in the past. In fact, those who
rely on older models of management will be far less
successful than those who either incorporate what still
works from previous styles with new styles or those
who adopt the new ways to supervise, set expectations,
develop accountabilities, shape behaviour and reinforce
organizational strategy. Given these challenges, there is
a need to consider ways in which a model of situational
leadership in residential care could be used in future
practice.
ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 1058–1069
Developing a model of situational leadership
in residential care
The main focus of a model of situational leadership in
residential care is on assisting the situational leader to
effectively impact on the followerÕs performance in
managing the care environment and delivering personcentred care. The process of developing the model
involved a series of systematic steps that identified direct linkages between situational leadership (Hersey &
Blanchard 1997) and the main constructs of the Personcentred Nursing Framework (McCormack & McCance
2010) and included: (1) reviewing the evidence, (2)
undertaking a comparative analysis and identifying key
concepts, (3) connecting the concepts and (4) developing a model.
Reviewing the evidence
Transformational leadership
In long-term residential facilities, the organizational
cultures are complex. They encompass attitudes, values
and practices that influence how people live and work
together. Culture has been defined as:
ÔA pattern of shared basic assumptions that the group
learned as it solved its problems of external adaptation
and internal integration, that has worked well enough
to be considered valid and, therefore, to be taught to
new members as the correct way to perceive, think, and
feel in relation to these problemsÕ (Schein 1992, p. 12).
Culture change is a philosophy and a process that
seeks to transform the residential unit from a restrictive
institution to a vibrant community of older adults and
the people who care for them. The focus of culture
change is to reinvent the nursing home so that the
dependency and deterioration that seems almost inevitable after nursing home admission is replaced by resident growth, creativity and a vastly improved quality of
life. A key principle of culture change is a person-centred practice whereby residents and staff become
empowered, self-determining decision makers (Shields
& Norton 2006). Case studies of early organizations
pursuing cultural transformation reveal that in order to
create major culture change it was beneficial to have
strong goal-orientated leadership (Green 2004, Chapin
2006). In many instances, the type of leadership required is transformational because culture change needs
enormous energy and commitment to achieve outcomes
(Bass 1999). Transformational leadership is the process
in which leaders and followers raise one another to
higher levels of morality and motivation (Burns 1978).
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B. M. Lynch et al.
A transformational leaderÕs main goal is to bring followers up to the level where they can succeed in
accomplishing organizational tasks without direct leader intervention. Bass (1985) states that this involves a
process in which transformational leaders analyse their
relationships with their followers by diagnosing leader–
follower relations, ensure they have an understanding of
the job demands and then match the maturity level or
readiness of followers to the situation. Thus, they are in
control of the situation and can identify successful ways
of dealing with people by selecting a style of leadership
that is both appropriate to the situation and to the
maturity level/readiness of the followers. In essence the
approaches used in transformational leadership can be
aligned to the Situational Leadership Theory put forward by Hersey and Blanchard (1982).
Situational leadership
Hersey and Blanchard (1982) state that the core competencies of a situational leader are the ability to diagnose the performance, competence and commitment of
others, to be flexible and to partner for performance.
The situational leadership model outlines four sets of
leadership behaviours that result from combining high
and low supporting behaviours (such as listening, providing feedback and encouraging) with high and low
directing behaviours (Ôtask-related behavioursÕ such as
demonstrating, instructing and monitoring). The four
resulting styles are:
• (S1) High directing/low supporting leader behaviour
is referred to as ÔdirectingÕ because this style is characterized by one-way communication in which the
leader defines the roles of followers, gives detailed
rules and instructions while monitoring closely that
they are followed and tells them what, how, when
and where to do various tasks (Irgens 1995).
• (S2) High directing/high supporting leader behaviour
is referred to as ÔcoachingÕ because with this style the
leader still provides a great deal of direction, but he/
she also attempts to hear followersÕ feelings about
decisions as well as their ideas and suggestions. While
two-way communication and support are increased,
control over decision-making remains with the leader.
• (S3) Low directing/high supporting leader behaviour
is referred to as ÔsupportingÕ because with this style
the locus of control for day-to-day decision-making
and problem-solving shifts from leader to follower.
The leaderÕs role is to provide recognition and actively listen and facilitate problem-solving/decisionmaking on the part of the follower.
1060
• (S4) Low directing/low supporting leader behaviour
is referred to as ÔdelegatingÕ because the style involves
letting the followers Ôrun their own showÕ. The leader
delegates as the followers are high in readiness and
maturity, have the ability, and are both willing and
able to take responsibility for decisions and implementation.
Blanchard et al. (1993) stated that the development
level of the follower refers to the Ôextent to which a
person has mastered the skills necessary for the task at
hand and has developed a positive attitude toward the
taskÕ (Blanchard et al. 1993, p28) and is based on
multiple dimensions of a personÕs competence and
commitment. The authors assert that the leader must
assess the developmental level of the follower and
adjust leading to the level demonstrated (Hersey &
Blanchard 1969). The appropriate leadership styles of
S1 (directing) to S4 (delegating) correspond to particular follower developmental levels, termed D1 to D4,
respectively.
The four developmental levels are:
• (D1) enthusiastic beginner, low on competence and
high on commitment;
• (D2) disillusioned learner with increasing competence
and low commitment;
• (D3) capable but cautious contributor, with moderate
to high competence and variable commitment; and
• (D4) self-reliant achiever who is high on both competence and commitment.
Although popular management textbooks routinely
include Hersey and Blanchard (1982, 1997) situational
leadership theory in their leadership chapter, the theory
has somewhat been overlooked within contemporary
healthcare and research into the concept of situational
leadership in nursing is limited (Johnson & dÕArgenio
1991, Sims et al. 2009, Solman 2010). However, the
competencies and skills of the situational leader as outlined by Hersey and Blanchard (1997) can be considered
for their appropriateness to support person-centred
practice. The person-centred nursing framework provides us with the opportunity to integrate person-centred
theory with situational leadership theory in order to
identify the level of support that is required throughout
the process of enlightenment, empowerment to that of
the transformative action.
Person-centred practice
McCormack (2003) states that the rights of individuals
as persons is the driving force behind person-centred
ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 1058–1069
Leadership in residential care for older people
health care and represents an attitude of respect for
ordinary individuals to make rational decisions and
determine their own ends. Carl Rodgers developed the
notion of client-centred counselling and was the first to
coin the term Ôperson-centred careÕ. He drew attention
to the need for the rebalancing of the expert–client
relationship to privilege the client and acknowledge
their capacity for self-actualization (Nay & Garratt
2009). Tom Kitwood adapted these ideas to the
dementia care setting and through his pioneering work
at the Bradford Dementia Care Centre fully articulated
the concept of person-centred care (Kitwood & Bredin
1992). It has been widely acknowledged in the literature
that KitwoodÕs ideas have provided a new sense of
direction and purpose for practitioners working with
older people in a range of care environments, including
long-term care (McCormack 2004, Nolan et al. 2004,
Nay & Garratt 2009).
McCormack (2004) argues that there are four concepts underpinning person-centred practice: being in a
relationship, being in a social world; being in a place
and being with self. These concepts, in essence, capture
all the defining characteristics as outlined above. In
their recent publication, Person-Centred Nursing: Theory and Practice, McCormack and McCance (2010) use
the definition of person-centredness developed in a
National Action Research Programme in Ireland, which
defines person-centredness as:
ÔAn approach to practice established through the
formation and fostering of therapeutic relationships between all care providers, older people and
others significant to them in their lives. It is underpinned by values of respect for persons,
individual right to self determination, mutual respect and understanding. It is enabled by cultures
of empowerment that foster continuous approaches to practice developmentÕ (McCormack
& McCance 2010, p. 31).
The development of the Person-Centred Nursing
Framework by McCormack and McCance (2010)
builds on the interconnectedness between caring and
person-centredness. The authors argue that both concepts are important for nursing practice and that the
attributes of caring are implicit within a philosophy of
person-centred nursing.
The conceptual origins of the Person-Centred Nursing Framework (McCormack & McCance 2006, 2010)
are located in empirical work by McCormack (2001,
2003), McCance et al. (2001) and McCance (2003).
Collectively they represent a synthesis of the then
available literature on caring and person-centredness
ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 1058–1069
with the focus on developing therapeutic relationships
(McCormack & McCance 2006). The Person-Centred
Nursing Framework comprises four constructs:
• Prerequisites: focus on the attributes of the nurse and
include, being professionally competent, having
developed interpersonal skills, being committed to
the job, being able to demonstrate clarity of beliefs
and values, and knowing self.
• The care environment: focuses on the context in
which care is delivered. In the original Framework,
McCormack and McCance (2006) identified six
characteristics of the care environment that enhance
or limit person-centred nursing. However, in
acknowledging the fact that significant work has been
undertaken to evaluate the impact of the care environment itself, McCormack and McCance (2010)
have added Ôthe physical environmentÕ as an additional characteristic of the care environment construct. Therefore the care environment construct
includes, an appropriate skill mix; systems that
facilitate shared decision making; the sharing of
power; effective staff relationships; organizational
systems that are supportive; and the potential for
innovation and risk taking and the physical environment.
• Person-centred processes: focus on delivering care
through a range of activities that operationalize person-centred nursing. This is the component of the
framework that specifically focuses on the patient,
describing person-centred nursing in the context of
care delivery and includes, working with patientÕs
beliefs and values; engagement; having sympathetic
presence; sharing decision making; and providing for
physical needs. In their more recent publication of the
framework, McCormack and McCance (2010) have
revised the component Ôproviding for physical needsÕ
and now use the term Ôproviding holistic careÕ.
• Expected outcomes: are the results of effective person-centred nursing and include: satisfaction with
care; feeling involved in care; having a feeling of
well-being; the existence of a therapeutic environment, described as one in which decision-making is
shared, staff relationships are collaborative, leadership is transformational and innovative practices are
supported. McCormack and McCance (2010) state
that in order to reach the centre of the framework
and deliver positive outcomes, for both patients and
staff, an account must be taken of the prerequisites
and the care environment, which are necessary for
providing effective care through person-centred
processes.
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Since its development, the Person-Centred Nursing
Framework has been used as a practical and systematic
framework for guiding the development of personcentred cultures. Two examples are:
• Within the Belfast health and Social Care Trust, a
learning and development programme is taking place
to enable nursing and midwifery teams to explore the
concept of person-centredness within their own setting in order to improve care delivery (McCance &
Gribben).
• In the Republic of Ireland an older personÕs national
practice development programme was commissioned
over a 3-year period with 18 residential care facilities
for older people. The main aim of the programme
was to develop person-centred practice (McCormack
& Dewing, McCormack & McCance 2010).
Comparative analysis and identifying key concepts
The centrality of concepts common to both McCormack and McCanceÕs (2010) conceptual framework
and Hersey and BlanchardÕs situational leadership
model (1997) are: a shared vision, competence, commitment and the situation or the care environment.
A shared vision
Bass et al. (2003) described transformational leadership
as inspiring a vision for staff that motivates staff to
achieve this vision. McCormack and McCance (2010)
state that the leader must develop the vision and then
put processes in place to constantly sell the vision to the
followers. The authors suggest that leaders need to
work with their teams to develop a shared vision for
person-centredness. Similarly, in their situational leadership model, Hersey and Blanchard (1997) pointed out
that when everyone supports the organizational vision it
creates a deliberate, focused culture that drives the desired outcomes. Once a leader has clarified and shared
the vision, he or she can focus on serving and being
responsive to the needs of the people, understanding
that the role of leadership is to remove barriers and help
people achieve the vision. Blanchard et al. (1993) suggested that the greatest leaders mobilize others by coalescing people around a shared vision.
Competence
Within the literature, there appears to be no generally
accepted definition of competence or agreement of the
exact phenomena that indicate competence (OÕConnor
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et al. 1999). The Nursing and Midwifery Council definition of competence is: Ô….the skills and ability to
practice safely and effectively without the need for direct supervisionÕ (UKCC 1999, p. 35). The practitioner
must possess the necessary knowledge as well as mastery in psychomotor, cognitive and affective skills to be
effective. From the mid 1980s, the originators of situational leadership began to develop their original joint
model in different directions, with fundamental conceptual differences. Blanchard et al. (1993) revised
some terminology in their latest model, called Situational Leadership II and replaced the term ÔabilityÕ with
ÔcompetenceÕ which refers to the skills and knowledge of
the follower which are developed when he/she receives
the leadership style they need from their managers.
Competence, as defined within the context of personcentred practice, is described as: Ômore than simply
undertaking a task or demonstrating a desired behaviour, but is more reflective of a holistic approach that
encompasses knowledge, skills and attitudesÕ (McCormack & McCance 2006, p. 474). While Ôdeveloped
interpersonal skillsÕ sits as a separate prerequisite within
the person-centred nursing framework, being professionally competent requires the nurse to have the ability
to communicate at a variety of different levels suggesting that competence is very closely linked to Ôdeveloped
interpersonal skillsÕ. Furthermore, McCormack and
McCance (2010) emphasize the point that the framework makes explicit the need for nurses to engage in
authentic humanistic caring practices that embrace all
forms of knowing and acting to promote choice and
partnership in care decision-making.
Commitment
ÔCommitment to the jobÕ is one of the prerequisites or
attributes of the nurse within the person-centred
framework and is indicative of dedication and a sense
that the nurse wants to provide care that is best for the
patient (McCormack & McCance 2010). In their recent
publication Person-Centred Nursing Framework: Theory and Practice, McCormack and McCance (2010)
suggest that commitment to the job can also be linked
to the idea of intentionality, a term that is often used
interchangeably with other terms such as intention, intent or will (Malinski 2009). Blanchard et al. (1993)
make a somewhat similar inference in their revised
situational leadership model, when the authors replace
the original word ÔwillingnessÕ with the word ÔcommitmentÕ. Based partly on feedback from managers and
early critiques of the theory, the authors found that
being unwilling in many countries was interpreted as
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Leadership in residential care for older people
stubborn resistance. Rather than being resistant,
individuals are more apt to lose their commitment to a
job because they feel overwhelmed. ÔCommitmentÕ is
identified as being a combination of confidence and
motivation. Motivation is the followerÕs interest and
enthusiasm in the task. Confidence is the followerÕs
sense of security or self- assuredness, the extent to
which the follower trusts that he or she has the ability
to work independently and perform the task well.
Situation or the environment of care (context)
Given the fact that situational leadership is based on the
premise that leaders use a different style depending
on the situation and the developmental level of the
followers (Hersey & Blanchard 1997), it follows that
the situational leader must focus on the impact of the
context in which care is delivered to ensure that the
follower functions effectively. Speaking directly about
health care, McDonagh (1998) states that leaders need
to use a flexible approach in order to influence or respond to the traits and changing environment of the
organizational culture. For example, the move to
managed care, the increasing complexity of the system,
multidisciplinary models of governance, the need for
more collaboration, the influence of human rights, a
patient-centred orientation and the impact of technology, among others (McDonagh 1998). Bateman and
Snell (2004) state that there are critical forces in the
healthcare environment, which need to be continuously
examined and evaluated in different situations to
determine the best choice of leadership style. These
forces include: the type of leadership style, the values of
the organization, the extent to which the team works
efficiently as a unit, the problem and the resources
needed to resolve it and the amount of time the leader
takes to make the decision.
McCormack and McCance (2010) provided a detailed exploration of the care environment in the context of person-centred nursing and suggest that Ôthe care
environment has a significant impact on the operationalisation of person-centred nursing and has the
greatest potential to limit or enhance the facilitation of
person-centred processesÕ. Goleman (2000) looked at
how emotional intelligence drives performance and in
particular, how it travels from the leader through the
organization to bottom-line results. The researcher
made the assertion that a leaderÕs emotional intelligence
creates a certain culture or work environment and
indicated that high levels of emotional intelligence create a caring environment in which information sharing,
trust, healthy risk taking and learning all flourish while
ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 1058–1069
low levels of emotional intelligence create a climate rife
with fear and anxiety.
Connecting concepts
Identifying the linkages between situational leadership
(Hersey & Blanchard 1997) and the main constructs of
the Person-Centred Nursing Framework (McCormack
& McCance 2010) was an important step in the
development of the model of situational leadership in
residential care and confirmed the strong relationship
between situational leadership and person-centred
practice. The process of connecting key concepts from
both conceptual frameworks helped to develop the
main focus of the model i.e. assisting the situational
leader to effectively impact on the followerÕs performance in managing the care environment and delivering
person-centred care.
A shared vision/person-centred outcomes
Hersey and Blanchard (1997) point out that when
everyone supports the organizational vision it creates a
deliberate focused culture that drives the desired outcomes. Therefore, within the model of situational
leadership in residential care there needs to be a shared
vision of what effective person-centred nursing looks
like in the minds of the leader and follower. This vision
is the desired outcomes for person-centred practice and
include: satisfaction with care; feeling involved in care;
having a feeling of well-being; and the existence of a
therapeutic environment, described as one in which
decision-making is shared, staff relationships are collaborative, leadership is transformational and innovative practices are supported (McCormack & McCance
2010).
Situation/the care environment
Hencley (1973) explained that Ôthe situation approach
maintains that leadership is determined not so much by
the characters of the individuals as by the requirements
of social situationÕ. In the model of situational leadership in residential care, we took the view of McCormack and McCance (2010) that there are multifaceted
characteristics and qualities contained within the environment of care that impact on the effectiveness of
person-centred nursing and that Ôthe situationÕ is
synonymous with the Ôcare environmentÕ. It follows then
that the situational leader must identify the salient
situational elements in the specific circumstances
(Blanchard et al. 2003) in which care is delivered.
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B. M. Lynch et al.
Developmental level/prerequisites of the follower
The model of situational leadership in residential care
aligns the construct ÔprerequisitesÕ, within the PersonCentred Nursing Framework (McCormack & McCance
2010) to the developmental levels, termed D1 to D4 in
situational leadership (Hersey & Blanchard 1982). The
developmental level equates with the followerÕs performance and is described by Hersey and Blanchard (1997)
as the degree of competence and commitment a person
has to perform a task without supervision. Similarly, the
Person-Centred Nursing Framework makes explicit the
assumption that in order for the nurse to perform
effectively in delivering person-centred care, specific
attributes need to be in place; these include, being professionally competent, having developed interpersonal
skills, being committed to the job, being able to demonstrate clarity of beliefs and values, and knowing self
(McCormack & McCance 2010).
Hence, the model of situational leadership in residential care illustrates that within the Person-Centred
Nursing Framework a situational leader may take on a
different leadership style based on the situation/the
environment in which the care is being delivered and the
prerequisites/developmental levels of the follower who
is delivering care through the person-centred processes.
Table 1 summarizes the connection of the key concepts
from both conceptual frameworks.
Table 1
Illustrating the connection of the key concepts of situational leadership (Hersey & Blanchard 1997) and the Person-Centred Nursing Framework
(McCormack & McCance 2010)
Situational leadership approach
1. Identify important outcomes
There needs to be a shared vision of what person-centredness
looks like in the minds of the leader and follower
2. Identify situational conditions
Focus on the impact of the context in which care is delivered
Diagnose the performance, competence and commitment of the
follower i.e. the developmental level – D1 enthusiastic beginner;
D2 disillusioned learner; D3 capable but cautious contributor; D4
self-reliant achiever
3. Match leadership style to the developmental level of the follower
and the situation
Having identified the developmental level of the follower and the
salient elements of the situation, the situational leader works with
the follower
Using a higher level of directive behaviour (directing or coaching)
when the situation and/or developmental level of the follower
require the leader to give detailed rules and instructions while
monitoring closely that they are followed
or
Using a higher level of supportive behaviour (supporting or
delegating) when the situation and/or developmental level of the
follower require the leader to provide comprehensive facilitating,
participating and involving behaviours
4. Situational leader changes their style/behaviour – takes the
follower through the developmental levels and changes their style
accordingly
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Delivery of effective care through
Person-Centred processes
1. Person-Centred outcomes
Involvement with care
Feeling of well-being
Creating a therapeutic culture in which
Decisions are shared
There is collaborative and effective staff relationships
Leadership is transformational
Innovative practices are supported
2. Impact of care environment
Focus on systems that facilitate shared decision-making;
the sharing of power; organisational systems that are
supportive; the potential for innovation and risk taking and
the physical environment
Diagnose the prerequisites of the follower – look at where
the follower is on developmental level trajectory (D1–D4)
i.e. level of -professional competence, interpersonal skills,
commitment to the job, ability to demonstrate clarity of
beliefs and values, and knowledge of self
3. Match leadership style to prerequisites of the follower and
the characteristics within the care environment
Having identified the prerequisites of the follower and the
salient elements in the care environment, the situational
leader works with the follower on any of the person-centred
processes (providing for physical needs, engagement,
working with the residentÕs beliefs and values, having
sympathetic presence and sharing decision making)
Using either a high directing/low supporting style of leadership (directing or coaching)-giving detailed rules and
instructions
or
Using a low directing/high supporting style of leadership
(supporting or delegating)-providing comprehensive
facilitating, participating and involving behaviours
4. Situational leader is flexible in leadership style – takes the
follower through the prerequisites/developmental levels in
order to manage the care environment and deliver effective
person-centred care
ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 1058–1069
Leadership in residential care for older people
Model development
Phase 1
The first phase of the modelÕs development is illustrated
in Figure 1. In this phase the leadership styles outlined
in the theory of situational leadership (Hersey &
Blanchard 1982) are aligned alongside the person-centred processes (McCormack & McCance 2010) illustrated in four distinct quadrants. The quadrants are
graded on an axis that indicates a combination of high
and low supporting behavious with high and low
directing behaviours. Although, the model illustrates S1
(directing) and S2 (coaching) as being aligned alongside
the person-centred processes of Ôproviding for physical
needsÕ, ÔengagementÕ and Ôworking with the residentÕs
beliefs and valuesÕ, it is important to note that any of the
four leadership behaviours can be directed at any one of
the five person-centred processes. In other words, the
situational leader can work with a member of staff on
any of the person-centred processes in a high directing/
low supporting way or a low directing/high supporting
way.
Phase 2
The second phase of the modelÕs development is illustrated in Figure 2. In this phase the impact of the care
environment, synonymous with Ôthe situationÕ, is highlighted in the shape of blue-coloured arrows coming in
from the right and left of the diagram. The colour blue
extends to the background of phase one of the model in
an effort to emphasize the continuity and relationship of
all the constructs. In developing the model of situational
leadership in residential care, we have removed the
characteristic Ôeffective staff relationshipsÕ from the care
environment construct and now identify it as one of the
outcome indicators expected from effective personcentred nursing facilitated through situational leadership. Bennis (1995) states that the desired outcomes of
an effective situational leader include collaborative and
effective employee relationships and the pooling of
employee knowledge. Successful situational leadership
is about providing focus and learning in a manner that
listens to employees at all the levels of the organization.
We have also removed the characteristic, Ôan appropriate skill mixÕ, from the care environment construct in
an effort to put a greater emphasis on the impact that
the remaining characteristics have on the leadership
styles, reflected in the four quadrants, (S1–S4) and on
the person-centred processes, represented in the Ôpetals
of the flowerÕ at the centre of the model. The model
illustrates that within the changing care environment of
residential care, nursing leaders need to continuously
examine and evaluate all five characteristics when
analysing a situation in order to determine the best
choice of leadership style.
Phase 3
The third phase of the modelÕs development is illustrated in Figure 3. In this phase we have aligned the
construct ÔprerequisitesÕ, within the Person-Centred
Nursing Framework to the developmental levels,
termed D1 to D4 in situational leadership. Instead of
Figure 1
First phase in the development of the model of situational leadership in residential care.
ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 1058–1069
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B. M. Lynch et al.
Figure 2
Second phase in the development of the model of situational leadership in residential care.
Figure 3
Third phase in the development of the model of situational leadership in residential care.
considering the developmental level as purely the degree
of competence and commitment a person has to perform a task without supervision (Blanchard et al.
1993), we now include the other three characteristics of
the prerequisite construct, namely, developed interpersonal skills, being able to demonstrate clarity of beliefs
and values, and knowledge of self (McCormack &
McCance 2010). In an effort to state more precisely,
the four follower developmental levels (from ÔdevelopingÕ to ÔdevelopedÕ), we have adopted the following
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characterizations: (1) the enthusiastic beginner, who is
characterized as low on professional competence,
interpersonal skills, clarity of beliefs and values, and
knowledge of self but high on commitment, and who
benefits from a directive style of leadership (directive
defined as low supportive behaviour in conjunction
with high directive behaviour); (2) the disillusioned
learner, who is characterized by gaining an increasing
level of professional competence, interpersonal skills,
clarity of beliefs and values, and knowledge of self in
ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 1058–1069
Leadership in residential care for older people
combination with low commitment, and who benefits
from a coaching style of leadership (coaching defined as
high supportive behaviour in conjunction with highdirective behaviour); (3) the capable but cautious contributor or performer, who is moderate to high on
professional competence, interpersonal skills, clarity of
beliefs and values, and knowledge of self but has variable commitment, and who benefits from a supportive
style of leadership (supportive defined as high-supportive behaviour in conjunction with low-directive behaviour); and (4) the self-reliant achiever, who is high on all
five prerequisites, and who benefits from a delegating
style of leadership (delegating defined as low supportive
behaviour in conjunction with low directive behaviour):
at this optimum development level, the follower has
fully developed all five prerequisites in order to deliver
effective person-centred care.
The broken lines between each of the four developmental levels, termed D1 to D4 in the diagram, represent the fluidity of the characteriations of the
developmental levels. The three grey-coloured arrows
represent the natural flow from D1 to D4 when the
situational leader takes the follower through the
developmental levels by diagnosing their performance,
competence and commitment, is flexible in leadership
style and partners the follower to improve their performance so that the follower manages the care environment and delivers person-centred care. The three
phases of the modelÕs development are brought together
illustrating the model in its entirety (Figure 4).
The model in practice
The model of situational leadership in residential care
will form part of a larger action research study evaluating the role of situational leadership in facilitating
sustainable culture change in long-term care facilities
for older people. It will be used to form the basis of a
collaborative and facilitated programme of development for leaders. However, while we have identified
some of the connecting concepts in the present study, a
lot more work needs to be done in unravelling some of
Figure 4
Model of situational leadership in residential care.
ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 1058–1069
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B. M. Lynch et al.
these connections in future studies of leaders in practice.
As there is a lack of a strong evidence-base for Hersey
and BlanchardÕs (1982, 1997) situational leadership
theory in the literature, the effectiveness of the processes
involved in the implementation of the model will
require rigorous testing through further research.
Conclusion
The present study presents a conceptual model that
integrates person-centredness with leadership thinking
in order to effectively impact on the followerÕs performance in managing the care environment and delivering
person-centred care. The model emphasizes the key
behaviours and contextual variables involved in the
process of developing others to accomplish the optimum outcome of effective person-centred nursing.
Currently the model is being utilized in an action research study by Lynch, McCormack and McCance (not
yet published) evaluating the role of situational leadership in facilitating sustainable culture change in longterm care facilities for older people.
Source of funding
No funding has been sought or obtained to conduct this
research from any of the following sources: institutional
support, non-commercial grants, commercial support,
support in kind or any other source.
Ethical approval
Ethical approval for this study has been received from
the University of Ulster Research Ethics Committee.
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