The Essay Discusses The Importance Of Leadership In Healthcare.

'The delivery of healthcare requires strong leadership at all levels.'

Critically discuss this statement drawing on these concepts to illuminate your discussion. The concepts are

-leadership theories, clinical leadership, change management, interprofessional working, financial accountability and service planning, emotional intelligence, ethical leadership and nursing values.

Pick any of the three concepts out of these to ellaborate the topic.

Leadership holds a central role in any organization. Any organization is as strong as its leaders. The success and failures are highly influenced by the attitudes and cultures that are a product of the leadership(McNamara et.al 2011). The leaders are tasked with the responsibility of setting the objectives and then introducing measures to influence the employees to work toward the goal (Covey,2013). Leaders are visionary and set the tempo for the other employees. The objectives of are achieved through motivating the employees and encouraging teamwork to ensure pooling of efforts to attain a particular goal. The personal traits of a leader have an impact on the way they perform their mandate. There has always been a long-standing argument on the distinction between a leader and a manager and if a person can perform both functions. A leader is more concerned about developing and mentoring the employees within their day to day activities. A manager is more involved with coaching and ensuring a task can be performed as expected. Leadership is more inclined to employee development while managing is more goal oriented. A better leader is able to use a blend of management and leadership depending on circumstances and context (Jooste,2012).

In a healthcare, leadership is also core in organizing all the other components of a health system to achieve the desired results. According to Nelson et.al (2012), a health system has six building blocks. They include health service delivery, health workforce, health information, essential medicines, health financing and leadership. The functioning of these building blocks is catalyzed by leadership. in the healthcare setting, leadership involves leading, managing and governing. A good and strong leadership is able to steer the healthcare system to provide improved healthcare services. This is usually reflected in ways such as better-quality services, expanded availability of services, reduced cost and better access to services. Leadership was identified as a key factor in the achievement of the Millennium Development Goals (MDG)(Sachs,2012). There are many levels of leadership in a healthcare setting. The ministry or department of health in the country. In a healthcare facility, the management running it is responsible for offering leadership. A nurse is usually considered a leader in practice (Kosi?ska and Niebrój, 2012). They are expected to demonstrate strong leadership skills in dealing with other newly trained nurses. Some are in charge of wards and have to ensure they lead other employees in healthcare provision.

Leadership Theories

Leadership skills are integral in managing the healthcare system. Various concepts have been brought forward to provide a deeper understanding of leadership. Theories have been developed and observation of the traits and qualities have been documented (Coleman,2012). The issue has sparked a lot of discussions on whether a leader is born or made. Styles of leadership have also been on the scrutiny to identify when and which one applies at a particular time or circumstance. In this essay we will focus on three concepts in leadership that can be implemented in healthcare to produce the intended outcome. These concepts include change management, leadership styles and emotional intelligence (Northhouse,2017).

CHANGE MANAGEMENT

The only constant thing in life is change. The idea of change in any setting is completely inevitable. With the dynamic nature of various factors, change becomes very necessary. Change requires a person or organization to recognize the need to do so (Ekvall&Arvonen, 2014). A need may arise due to the variability of some factors. Change is usually an adaptive mechanism directed to increase the chances of efficiency or success. After recognizing the need to change, a plan is made then its implemented. The whole process of change is quite complex and requires proper management skills to ensure that it takes place.

Change management refers to a systematic and deliberate approach in dealing with transformation and transition within an organization’s goals, running processes or technology (Campbell,2012). In recent years, many organizations have been forced to change their methods of running their activities due to the development of newer technology. Many manually performed tasks were now automated. Some have been forced to lay off some employees while some have been forced to employ some specialists to manage the new technology. Some of the workers have been forced to retrain to satisfy the need of the market. Some of the laws that are formulated by the government also act as agents that necessitate change. Some changes affect the whole process of running activities and this becomes a real game changer in a particular industry.

The healthcare sector is not an exception on issues of change. The current advancements in technology have changed the way things were initially being done (Brettlecker et.al,2015). Protocols to managing certain conditions have changed owing to the ongoing research. In a more practical example, we can look at how the management of diabetes mellitus has changed. Early 90s diabetes could be managed by use of porcine or bovine insulin. With the advancement in technology, genetic recombination technology has paved way to synthesize pure insulin. This particular change was a major event in patient management. There is usually some resistance to change for fear of uncertainties. This is one of the examples of a change that would require planning and proper execution of the plan after addressing the fears.  In Ireland, despite the improvements in the health sector that have translated to a higher life expectancy, there has been a rising burden of disease and an increase in the requirement for care for the elderly. To solve these problems a proper change management process is necessary (Grol, Wensing, Eccles and Davis, 2013). It will require a consultative meeting with all the stakeholders held prior to chat a way forward.

Clinical Leadership

The tendency of change to destabilize the status quo makes many people unresponsive to it. change is a delicate issue. The transition and transformation from one state to another are often faced by resistance due to the fear of being made to do a thing in a way they are not initially used to. Change requires a strong leader who is visionary and revolutionary. Change can only be managed in stages (Hall and Hord, 2013). The initial stage of change is contemplating on it. When they are convinced it is necessary to change, they convince others to see things from their perspective. They should be good at articulating their thoughts and ideas in a very convincing manner. Once they have managed to make people join their ship, the process of change starts. It will involve forming a team that will spearhead the change. The team is better to lead by the leader who brought up the idea of changing. The team collects other people’s concerns and addresses in order to win them. They then formulate a plan on how to implement change and carry it through all the stages. The last change is reviewing or reporting on the progress that has been achieved. this stage addresses the upcoming issues and provides measures to reinforce the change (Porter-O'Grady. and Malloch, 2012).  

Change can be can be managed using the change management models. The models are developed as a guide to change and as a method to assess its success. the change models can be broadly categorized into the planned change model and emergent change models (Cameroon&Green,2015). The planned change models view change as a predetermined process that is guided by a well-researched and thought about the plan. This approach assumes that all the people involved feel the need to change. This is theoretically impractical owing to the different personalities of people and the diverse backgrounds they come from.  The emergent change model suggests that a change there is a less prescriptive or analytical approach. It does not lay so much emphasis on plans and projections (Esain, Williams and Massey, 2012). This approach is linked to the external forces that make it necessary to carry out a change process rather than internally motivated force.

One of the planned change model theorists is Kurt Lewin. He developed theories which include: field theory, group dynamics, action research and the 3-step model (Burnes, 2014). The first three theories contributed to the development of the 3-step model. The field theory is based on conducting a research on the environment within which the group of people work. it emphasizes the influences on the people that originate from the environment; their work environment and the group dynamics. Group dynamics theory bases its argument on the way individuals behave and respond to modifiers and the consequences of their reaction towards the work. it tries to explain why employees behave in the manner they do. The action research theory narrows down to the actual practice of analyzing a particular situation, the possible solutions and the consequences of the actions if taken (Carr and Kemmis, 2013). This theory draws on the field research to derive an understanding of the context within which the people are operating. It also derives an understanding of the people’s reaction from the group dynamics theory. Action research theory also proposes that there should be increased collaboration and participation to minimize resistance and increase the efficiency and effectiveness.

Change Management

The 3-step model is a more improved version of his earlier works. It proposes a three-step sequence of change; unfreeze, moving and refreezing (Argyris, 2015). Unfreezing involves destabilizing the status quo of individuals and the existing equilibrium. This helps create a feeling of instability among the individuals and they all feel the need to change. Instability can be created by making them aware of the necessity of change and the risks of not conforming to the change. It involves creating anxiety or guilt of not changing. they feel responsible to make the necessary change and thus act accordingly.  The step of moving is based on the field research and group dynamic theories. It involves conducting a research into the environment and the group's factors. Putting into account all the processes, develop a workable plan that can be implemented to bring about the intended change. Once the desired state is achieved, a new equilibrium, a quasi-equilibrium develops. This is the point the refreezing step is implemented (Klein, 2014). The achieved state should match people’s beliefs and environment. In nature this theory change can be equated to when a different shape of ice is required, it is unfrozen to liquid state then move to a container of the desired shape then refrozen.

Other models include; Kotter’s and Lippitt’s models (Barrow and Toney-Butler, 2017). These models apply the same principles though the stages are different. The emergent change is a new idea that is being developed with very few supporting theories. Most of the proponents of this approach are against the planned change model. They mostly draw reference to the Hinings and Greenwood’s model of change dynamics which suggests that changes are a product of an unanticipated consequence such as situational constraint which initiates a sequence of steps that makes people respond in a manner to live with the change (Boyce, 2014).

The success of a change process is dependent on the details of the way the process is carried out. A strong leadership aware of the change models will be able to avoid the consequences that may stem from not implementing the process in a more structured way. Both passive and active resistance will be avoided. This will maintain the productivity of the employees. The models encourage a more consultative approach which makes the employees partisan to the change process (Gil, Rico, Alcover, and Barrasa,2014. This is a source of motivation and they feel as equally responsible as the leader. Changes in the health sector may cut across the whole sector or some of its departments. Those in leadership should embrace the concept of change management to ensure a smooth and successful transition or transformation.

Leadership Styles

Change management model has been effective in Canada by the Canadian Health Services Research Foundation. It emphasizes on development of leadership to manage change. it provides a practical and applicable model. Governorship and guidance provides the mechanism that facilitates the alignment of objectives to the priorities. Stakeholders involvement is an opportunity to inform, consult and involve the affected individuals in change.

Provision of healthcare services involves a wide range of professions. Doctors, surgeons, psychiatrists, nurses, technologists and pharmacists. All these are different professions that are involved in providing healthcare services in a holistic manner. All these professions revolve around the interest of the patient. To ensure success in the provision of patient care, leadership plays an integral role in promoting the interdisciplinary approach (McAlearney, 2015). The current trends in patient care support this approach and many health facilities encourage it. to manage such a team of healthcare providers from different fields, a leader to lead the rest is usually necessary. They all have work in harmony for the sole interest of the patient well-being. For a diverse group of individuals to work towards a common goal or objective, they need a unifying factor that will bind them together. Leadership serves this function. All the healthcare practitioners will provide their input in an organized manner with due to consideration of other specialities. Leadership styles will differ depending on the types of leaders that are put in charge of the different sectors.  Different leadership styles will suit different circumstances and contexts. Good and strong leaders are able to adjust their styles of leadership to match the circumstance and promote the achievement of the set goal. The leadership styles have different success odds. Some are more preferred in the healthcare sector. For instance, many research studies have found transformational leadership preferred more and associated with higher success rates (Bryant,2012).

There are about five leadership styles that are applicable in a healthcare setting. They include Transactional, Transformational, Democratic, Authoritarian, Laissez Faire leadership styles (Franco&Ameilda,2011). In transactional leadership, the leader is preoccupied with ensuring compliance of the follower either by rewarding or punishing. More focus is directed towards supervision, organization and performance. The leader is involved in looking for faults or any deviations from the required standards and correcting them. this style stresses a particular performance for a specific task. It is a very ideal method in the management of a crisis and rolling out a plan or program that is very specific. Actions are reinforced through punishment for deviation or a reward for providing the anticipated results. It mostly emphasizes the employees performing the basic minimum in the task.

Emotional Intelligence

Transformational leadership is very popular in many organizations. In this type of leadership, the leader changes the people’s attitudes and perspective toward a certain task (Trofino,2013). They motivate the employees to surpass the expectations of their job. Individuals are motivated not just to achieve the goals or the objectives, but to do what they feel is the best they can. It assumes that the followers have reaches a level of self-actualization where their actions show that they have risen above self-interest and are motivated to work for the interest of the organization at large. This kind of leadership requires a very charismatic leader who highly advocates for the desired moral values. The leader informs the followers concerning the vision and motivates them to work towards its achievement.

Democratic leadership style supports the involvement of the staff in communication and decision making. This style motivates workers to give an account of the progress and feedback in performing a certain task (Woods,2012). This method focusses on the improvement of the process and eventually the performance rather than the mistakes of the team members. It would be applicable in a healthcare setting in order to put in measures that improve the service delivery as a process. Discuss with all the concerned parties serves as the best solution to counter resistance by some members. A democratic system in patient management will put into considerations the views and opinions of the other healthcare providers in order to improve the provision of health services.

An authoritarian leadership style is demonstrated in situations where the leader makes all the decisions without consideration of the staff’s attitudes and opinions. This method usually focuses on ensuring a certain task is completed without considering any other people’s opinions (Schuh, Zhang and Tian,2013. Negative reinforcement is implemented where necessary to ensure compliance. Information is considered a source of power and thus critical information may be withheld from them. This method has more of the negative effects and is harshly criticized for negative attitudes it sparks. However, on the positive side of thongs, it is very effective in an emergency and chaotic crisis. It provides the required compliance under the condition. It highly discourages trust and communication.

Laissez faire leadership is where the leader provides no direction or supervision (Deluga,2013). This is referred to a hands-off approach. The leader is minimally involved in the details of the activities that are being done.it requires a very highly motivated team who are willing and ready to take initiative and provide results with very minimal supervision. Decisions are rarely made and change rarely occurs. The members of the team are the key determinants of its success. in healthcare, this method may be used by a new leader who wants to learn how things are usually run in an organization. It offers a good opportunity to learn and understand the process before formulating a strategy to remedy any weaknesses.

Conclusion

In the healthcare setting, any of these styles may be applicable. Various studies have been performed to determine the effectiveness of leadership styles (Mannix, Wilkes& Daly, 2015). The interaction between the leaders and the teammates is largely bidirectional in transformational leadership and democratic leadership. the interaction becomes unidirectional between in a transactional and dictatorial leadership. a hands-off approach in Laissez Faire is devoid of an interaction between the leader and the followers (Eagly, Johannesen-Schmidt and Van Engen, 2012. Transformational leadership has been studied extensively in a clinical setting. It was associated with reduced medical errors. People can freely interact; a major barrier to communication is reduced. In some studies, it has been associated with reduced mortality in hospitals. It has also been associated with both increased patient satisfaction and staff satisfaction. It is also associated with lower turnover trends compared with other leadership styles. It encourages a good culture of communication and this makes the work climate more conducive for interaction between the healthcare practitioner and patient.

Leaders are expected to analyze the situation and decide on the best style (Delmatoff and Lazarus, 2014. They may use a blend of more than one style. However, it is not practically possible to only use only one style of leadership throughout. A strong leadership can be demonstrated when the styles are efficiently manipulated to suit the prevailing circumstance. The opportunities for leadership are numerous in healthcare. The influences of the styles implemented can be deduced from the achieved outcomes. The success or failure of the health system relies on the leadership styles applied in clinical leadership

Emotional intelligence refers to the ability to handle the emotions of one’s self and those of people around you. It refers to one being able to control their personal feeling and attitudes towards something or someone and work towards a common goal (Mayer and Geher, 2012). It involves understanding what other people are feeling and working effectively to satisfy their needs. It involves understanding how their influences can impact on other people and working in the best interest of everyone in the organization. Emotional intelligence is an important quality of an effective leadership. it is argued that the personal qualification such the satisfying the required level of education will only help a person get into the executive position in an organization. However, how effective their leadership will be in their tenure and in performing their everyday duties is dependent on high levels of emotional intelligence. Leadership involves dealing with people with emotions and feelings towards various aspects of the job. Their emotional wellbeing is contributed by the work environment which is created by the leaders to some extent. When a leader is able to understand the emotional need of the followers, they can put in measures that will meet their needs without adversely affecting them.

Emotional intelligence was a concept that was popularized by Daniel Goleman. He viewed emotions as having a major drive and influence on the outcome of a strategy or plan. he noted that even though all the other preparations are all made in the right way but fail to mobilize the followers to get emotionally prepared for it, it may end up failing or achieving minimal results than the ones anticipated. He considers emotionally mobilizing the followers a primary task whose failure can perpetuate to all levels. There is a strong correlation between emotions with productivity and performance. Both the verbal and nonverbal cues are important indicators of the emotional intelligence of a leader and this usually has a bearing on the general reaction of those being led. Emotional intelligence has five components that are used as to define it comprehensively. They include self-awareness, self-regulation, motivation, apathy and social skills. All these are important qualities in a good and strong leader.

Self-awareness refers to knowing how one feels towards a particular subject. It involves understanding that one’s actions have an impact on other people as feelings thus affecting their attitudes and the way they respond (Bratton, Dodd and Brown, 2011).  Being aware of the strengths, weaknesses and values and the effect they would have on other people. To have a better understanding of themselves, a leader should focus on self-reflection. It helps critically evaluate one’s strength and how it influences the morales of the employees. This value offers an opportunity to focus on the weaknesses and try to improve them in the best interest of their role in an organization. It enables them to work in a manner to enable other employees to develop themselves in the workplace.

Self-regulation refers to the ability to control one’s emotions. This concept focusses on one being composed and able to redirect and shun the disruptive emotions (Murphy, 2012). Strong feelings such as dislike or anger should be managed in a manner that other people are not affected by one’s state of mind. A leader should be able to remain calm in panic situations. They should be able to demonstrate the values that are necessary for survival in case of a crisis. They should be the source of encouragement and motivation during panic. In a healthcare setting, some situations such an outbreak is likely to create panic within the staff and the general population. A leader should be able to be the source of strength and reassurance. They should reduce the fear kampong the people while still not undermining the seriousness of an issue.

Apathy refers to the act of putting one’s self in another person’s shoes (Mannix, Wilkes& Daly,2015). A leader should be able to analyze the situation from the employees or the worker’s perspective. They should be cautious not to demand what is beyond an employee’s abilities. They should be able to show compassion and empathize with the followers when it is necessary. This offers an opportunity to understand people in a better way, their strengths and motivation in the phase of suffering. Leaders inspire trust through such acts and promote the psychological well-being of the followers.

Motivation is another quality of an emotionally intelligent leader.  Self-motivated leaders are able to focus on the goal and ensure high quality of work is delivered. A leader is able to assess the position they stand in relation to the achievement of the desired goal (Steers, Porter, Steers and Bigley, 2014). They can stop evaluate the progress and device a way to motivate them to achieve their goal.in the healthcare sector, self-motivated leaders create a culture of self-initiative among the followers. intrinsic motivation is the best way to ensure that individuals remain focused to the end goals. The healthcare sector is very expansive and all leaders need to work with an intrinsic motivation to ensure achievement of the healthcare goals.

A leader should have good social skills. They should be able to relate to other people through communication. they should listen to both appraisal and critiquing messages on the equal measure (Mumford, Campion and Morgeson, 2017). Understanding that conflicts always arise in one way or another they should be able to resolve them in an amicable manner considering the interests of the conflicting parties. It should be a win-win situation.

In an inter-professional interaction within a patient management team, conflicts are a major occurrence. Professionals in different specialities may disagree on the best course of action in the best interest of the patient. A leader of such a team should be good at resolving the conflicts while considering the opinions of everyone. Sometimes they have to choose a side and this should be done in a very careful manner to avoid hurting other peoples' feelings. The aspect of emotional intelligence is very integral in influencing the peoples’ actions and their behaviour. 

Conclusion

Leadership plays a critical role in the creating of an organizations’ vision. It guides the process of achievement of these objectives and evaluates the progress and the success achieved. leadership remains accountable and answerable for all that is done by the followers. they equally share the blame as they would have taken credit in case of success. The different concepts in leadership explain the major expectations placed on a leader and the qualities that will be essential for their jobs. Change management, leadership styles in clinical leadership and emotional intelligence are some of the concepts. Change is an important aspect in the phase unpredictable circumstances. Its management has a bearing on the outcome (Ennis, Happell, & Reid-Searl,2016). Different leadership styles are dictated by the circumstances. Emotional intelligence focused on the emotions and the great deal they have on attitudes and feelings of employees towards work. in healthcare, strong leadership is required to internalize the different concepts in of leadership and spearhead the desired change.

References

Argyris, C., 2015. Knowledge for action: A guide to overcoming barriers to organizational change. Jossey-Bass Inc., Publishers, 350 Sansome Street, San Francisco, CA 94104..

Barrow, J.M. and Toney-Butler, T.J., 2017. Change, Management.

Boyce, M.E., 2014. Organizational learning is essential to achieving and sustaining change in higher education. Innovative Higher Education, 28(2), pp.119-136.

Bratton, V.K., Dodd, N.G. and Brown, F.W., 2011. The impact of emotional intelligence on accuracy of self-awareness and leadership performance. Leadership & Organization Development Journal, 32(2), pp.127-149.

Brettlecker, G., Cáceres, C., Fernández, A., Fröhlich, N., Kinnunen, A., Ossowski, S., Schuldt, H. and Vasirani, M., 2015. Technology in healthcare. In CASCOM: Intelligent Service Coordination in the Semantic Web (pp. 125-139). Birkhäuser Basel.

Bryant, S.E., 2012. The role of transformational and transactional leadership in creating, sharing and exploiting organizational knowledge. Journal of Leadership & Organizational Studies, 9(4), pp.32-44.

Burnes, B., 2014. Kurt Lewin and the planned approach to change: a re?appraisal. Journal of Management studies, 41(6), pp.977-1002.

Cameron, E. and Green, M., 2015. Making sense of change management: A complete guide to the models, tools and techniques of organizational change. Kogan Page Publishers.

Campbell, R.J., 2012. Change management in health care. The health care manager, 27(1), pp.23-39.

Carr, W. and Kemmis, S., 2013. Becoming critical: Knowing through action research. Deakin University

Coleman, M., 2012. Theories of leadership. Leadership and strategic management in South African schools, pp.155-172.

Covey, S.R., 2013. Three roles of the leader in the new paradigm. The leader of the future, pp.149-160.

Delmatoff, J. and Lazarus, I.R., 2014. The most effective leadership style for the new landscape of healthcare. Journal of Healthcare Management, 59(4), pp.245-249.

Deluga, R.J., 2012. The effects of transformational, transactional, and laissez faire leadership characteristics on subordinate influencing behavior. Basic and Applied Social Psychology, 11(2), pp.191-203.

Eagly, A.H., Johannesen-Schmidt, M.C. and Van Engen, M.L., 2012. Transformational, transactional, and laissez-faire leadership styles: A meta-analysis comparing women and men. Psychological bulletin, 129(4), p.569.

Ekvall, G. and Arvonen, J., 2014. Change-centered leadership: An extension of the two-dimensional model. Scandinavian Journal of Management, 7(1), pp.17-26.

Ennis, G., Happell, B., & Reid-Searl, K. (2016). Intentional Modelling: A Process for Clinical Leadership Development in Mental Health Nursing. Issues In Mental Health Nursing, 37(5), 353-359. 

Mannix, J., Wilkes, L., & Daly, J. (2015). 'Watching an artist at work': aesthetic leadership in clinical nursing workplaces. Journal of Clinical Nursing, 24(23/24), 3511-3518. 

Mannix, J., Wilkes, L., & Daly, J. (2015). ' Good ethics and moral standing': a qualitative study of aesthetic leadership in clinical nursing practice. Journal of Clinical Nursing, 24(11/12), 1603-1610. 

McNamara, M. S., Fealy, G. M., Casey, M., Geraghty, R., Johnson, M., Halligan, P., & ... Butler, M. (2011). Boundary matters: clinical leadership and the distinctive disciplinary contribution of nursing to multidisciplinary care. Journal of Clinical Nursing, 20(23/24), 3502-3512. 

Esain, A., Williams, S. and Massey, L., 2012. Combining planned and emergent change in a healthcare lean transformation. Public Money and Management, 28(1), pp.21-26.

Franco, M. and Almeida, J., 2011. Organisational learning and leadership styles in healthcare organisations: An exploratory case study. Leadership & Organization Development Journal, 32(8), pp.782-806.

Gil, F., Rico, R., Alcover, C.M. and Barrasa, A., 2014. Change-oriented leadership, satisfaction and performance in work groups: Effects of team climate and group potency. Journal of Managerial Psychology, 20(3/4), pp.312-328.

Grol, R., Wensing, M., Eccles, M. and Davis, D. eds., 2013. Improving patient care: the implementation of change in health care. John Wiley & Sons.

Hall, G.E. and Hord, S.M., 2013. Implementing change: Patterns, principles, and potholes.

Jooste, K. ed., 2012. Leadership in health services management. Juta.

Klein, S.M., 2014. A management communication strategy for change. Journal of Organizational Change Management, 9(2), pp.32-46.

Kosi?ska, M. and Niebrój, L., 2012. The position of a leader nurse. Journal of nursing management, 11(2), pp.69-72.

Mayer, J.D. and Geher, G., 2012. Emotional intelligence and the identification of emotion. Intelligence, 22(2), pp.89-113. 

McAlearney, A.S., 2015. Leadership development in healthcare: a qualitative study. Journal of Organizational Behavior: The International Journal of Industrial, Occupational and Organizational Psychology and Behavior, 27(7), pp.967-982.

Mumford, T.V., Campion, M.A. and Morgeson, F.P., 2017. The leadership skills strataplex: Leadership skill requirements across organizational levels. The Leadership Quarterly, 18(2), pp.154-166.

Murphy, S.E., 2012. Leader self-regulation: The role of self-efficacy and multiple intelligences. In Kravis-de Roulet Leadership Conference, 9th, Apr, 1999, Claremont McKenna Coll, Claremont, CA, US. Lawrence Erlbaum Associates Publishers.

Nelson, E.C., Godfrey, M.M., Batalden, P.B., Berry, S.A., Bothe Jr, A.E., McKinley, K.E., Melin, C.N., Muething, S.E., Moore, L.G., Nolan, T.W. and Wasson, J.H., 2012. Clinical microsystems, part 1. The building blocks of health systems. The Joint Commission Journal on Quality and Patient Safety, 34(7), pp.367-378.

Northouse, P.G., 2017. Introduction to leadership: Concepts and practice. Sage Publications.

Porter-O'Grady, T. and Malloch, K., 2012. Quantum leadership: A resource for health care innovation. Sudbury, MA: Jones and Bartlett Publishers.

Sachs, J.D., 2012. From millennium development goals to sustainable development goals. The Lancet, 379(9832), pp.2206-2211.

Schuh, S.C., Zhang, X.A. and Tian, P., 2013. For the good or the bad? Interactive effects of transformational leadership with moral and authoritarian leadership behaviors. Journal of Business Ethics, 116(3), pp.629-640.

Steers, R.M., Porter, L.W., Steers, R.M. and Bigley, G.A., 2014. Motivation and leadership at work. McGraw-Hill.

Trofino, J., 2013. Transformational leadership in health care. Nursing Management, 26(8), p.42.

Woods, P.A., 2012. Democratic leadership: drawing distinctions with distributed leadership. International journal of leadership in education, 7(1), pp.3-26.