Beyond TransformationalLeadership to GreaterEngagement:Inspiring Innovation in Complex Organizations
April 201460 Nurse Leader
G ood leadership that is both effective
and moral has been long recognized as
crucial to human achievement and well-being.1
Given the changing nature of healthcare organiza-
tions in the digital age, pressures for increased qual-
ity, expectations of lower costs, and the demand for
innovation, examination of our leadership models,
and exploration of new approaches are needed to
ensure that current leadership models do support
human achievement and well-being.
Kathy Malloch, PhD, MBA, RN, FAAN
Theories of leadership, according to Peter Gronn,2 waxand wane in keeping with the wider cultural, social, and
economic shifts and developments. Leadership theories canbe considered a product of the changing nature of work andhow authority in society as a whole is perceived. As thepeople, resources, and technology change, new behaviorsand structures are required. The historical evolution of lead-ership theories and models includes traits, processes, skills,competencies, relationships, and constructs about leadership.Each of these theories and models has been adopted to bestaddress the identified goals of an organization. According toGill,1 there are 92 categories of leadership, 276 definitionsof leadership, and over 1,000 constructs or statements relat-ing to leadership.
It is interesting to note that there is no single accepteddefinition or theory of leadership nor is there an agreed-upon paradigm for the study and practice of leadership.1
According to Kurtsman,3 there is no consensus as to whatleadership is, how leaders develop, or how to become a moreefficient leader. Despite this lack of consensus, leaders mustcontinually ensure that their efforts match the needs of theorganization and provide value to the users. At times, leadersunknowingly adopt 1 type of leadership in the hopes that itwill serve the entire organization when in fact the chosentheory or model may only address 1 aspect of leadership.Identifying the gaps and opportunities in our current leader-ship model can serve as the foundation to modify and extendcurrent leadership models. What is certain is that there are aplethora of strategies, styles, and traits that need to be consid-ered along with the environment to get to an optimal modelfor the time.
Thus, it is challenging to evaluate the effectiveness of anyleadership model completely. The purpose of this article is tobegin a dialogue about the advantages and limitations oftransformational leadership, the changing organizational envi-ronment, and explore complexity leadership as an approachto better meet current and future healthcare demands.
TRANSFORMATIONAL LEADERSHIPIt is no secret that transformational leadership has been wide-ly supported in healthcare organizations. Transformationalleadership is believed by many to be the desired leadershipstyle for contemporary leaders because visioning, empower-ment, and valuing are espoused. The pioneers of transforma-tional leadership, James MacGregor Burns4 and Bass andAvolio,5 provided this theory to address the limitations oftransactional leadership in the 1970s. Transformational leader-ship shifted thinking from a focus on exchanges betweenleaders and followers to that of visioning, valuing, andempowering leaders.
In transformational leadership theory, the leader behav-iors focus on addressing the individuals’ higher order needfor achievement, self-esteem, and self-actualization.1
Transformational leadership is a directive style and is saidto occur when both the leader and follower raise eachother’s motivation level and sense of higher purpose.Transformational leaders focus on the individual, empha-
size intellectual stimulation, and provide inspiration toachieve extraordinary goals. They are seen as courageousvisionaries and competent change agents, and perceiveerrors as opportunities for growth. In addition, higherlevels of morality are reinforced as individuals look beyondself-interest for the common good.
Although transformational leadership is highly regarded,the increasing changes in the environment have becomeoverwhelming and now require new tools and strategies.Specifically, the large amounts of data and interactions amongpeople in a digital environment in the organization, demandsfor faster service and turn-around, the expectation of evi-dence-driven interactions, and demands for change and inno-vation are overloading transformational leaders. Mosthealthcare leaders are struggling, not only with the complexi-ties of the ever-emerging healthcare system, but also withtheir own personal balance and well-being.
LIMITATIONS OF TRANSFORMATIONALLEADERSHIP On close examination, there are several gaps or limitationsin the transformational leadership model as it occurs inthe current healthcare environment that become apparent.These include:
• The focus is on the individual. Attention to organiza-tional culture, comprehensive thinking, and team work isnot included.
• The location of power and decision making is facilitatedand directed by the transformational leader. The assump-tion in this model is that power rests with the leader; theleader determines when and how to empower others.This limits capacity for decision making within thebureaucratic structure of committee processes.
• Visioning also rests with the leader. Organization anddirection emanate from the leader, the executive team,and the board of directors.
• Point of patient care responsiveness is dependent uponthe effectiveness of the transformational leader and caninvolve several levels of decision making until the deci-sion finally reaches the patient.
• Organizational context is not addressed within the theo-ry. The influence and impact of political, economic, orsocial factors do not drive the transformation of theindividual.
These behaviors, assumptions, and values can be viewedas restrictive and now crippling in a digital organization ledby a transformational leader. As previously noted, the com-plexity of a healthcare system in a digital environment con-tinues to increase exponentially. Current leaders andorganizations need capacity and resources to manage largeamounts of information more rapidly than is currentlydone. Activities and initiatives from multiple sources goingin multiple directions creates significant uncertainty and theneed for self-organizing by capable individuals to quicklymeet patient needs in innovative ways is significant. Mostimportantly, this rapid-fire work must be evidence drivenand result in value to users.
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There is a need to shift beyond motivating and empoweringof selected individuals to facilitating the work and relationshipsof all individuals in the organization. Shifting the emphasis onleadership as a role designated to a limited number of individu-als to leadership as a behavior expected from all individuals isneeded to increase quality, accuracy, and timeliness of interven-tions. Extending the expectation for accountability will serve tosupport the current rate of change and new knowledge creationby increasing the numbers of individuals available to respond—and reduce the current workload of transformational leaders.Visioning across the organization will increase the appropriate-ness of strategic actions as the point of care realities and needsare purposefully integrated. In most situations, it is believed thata combination of perspectives across the continuum of anorganization, from the executives to the leaders to the managersto the knowledge-based caregivers, would result in more realis-tic and innovative visions.
COMPLEXITY LEADERSHIP: CONSIDERATIONS OFAN ORGANIC LEADERSHIP MODELIt is exciting to know that transformational leadership can beeven better and that it too can be transformed. A new gener-ation of leadership that advances transformational leadershipand is better suited to meet the challenges and demands ofthe digital or information age should be considered and inte-grated into current leadership practices and expectations.
Complexity leadership is based on complexity theory andthe belief that complex organizational behavior is character-ized by nonlinear, emergent change; interaction and interde-pendency; unpredictability; autocatalytic behavior; anddynamic movement.6 This is much different from the trans-formational leadership model in which power is situated inthe transforming leader; transformation only occurs when thedesignated leader empowers and motivates the nonleader. Thefocus shifts from the leader as an individual to the entire teamas change agents. It is different from the leader-centric modelin that the leadership as a behavior belongs to everyone.Leadership is a fundamental behavior of every individualregardless of the formal title.
EXPECTATIONSGiven the lack of consensus on a leadership framework orparadigm, the author proposes the complexity leadershipmodel on the basis of the current challenges in the environ-ment. The challenges of data management, speed, quality, andadoption of innovation guide this recommendation. Giventhese challenges, there are several expectations of the newmodel. These include:
• Work is facilitated rather than directed. Individuals areexpected to be accountable and competent in their workand thus not need validation or permission to provideservices. Each individual is guided by licensure, compe-tence, and job description.
• A context or culture for change and innovation isadvanced. Knowledge, processes, and education are pro-vided to enhance the creative and innovative abilities ofall individuals within an organization. Individuals are
supported in challenging assumptions, taking courageousrisks, and proposing more effective ways to providepatient care.7
• Large amounts of data will be handled more efficient-ly and effectively because of the availability of pointof service for timely decision making. The number ofavailable individuals to address needs in a timely man-ner increases exponentially. Waiting times aredecreased significantly.
• Information flow is accelerated. More individuals doingthe work can process requests more quickly.
• Evidence-based practices are moved into practice morequickly. Once new research evidence is available, theindividual is held accountable for use of the most cur-rent evidence and in a competent manner in whichvalue-based outcomes result. Internet access providesreal-time access to current evidence.
• There is less rework at the point of care.• Systems-thinking consideration drives all decisions. The
interconnectedness of the organization’s relationships andmultifocal partnerships are realized and facilitated tocreate optimal decisions.
To meet these challenges, a complexity leadership modelis believed suitable in light of the following assumptions.According to Uhl-Bien and Marion,6 the goal of an organicor complexity leadership model is to stimulate innovation,creativity, and responsiveness while managing continuousadaptation and change without losing strategic focus orspinning out of control. This model should also retain thevalues of empowering and visioning from the transforma-tional leadership model.
• Every individual is capable of leadership behavior; leader-ship is a behavior, not a role restricted to a designated fewindividuals. Leadership is about making timely, evidence-driven decisions based on system values and principles.
• Leadership is exercised in every relationship. Whenever 2or more individuals are together, the dialogue and rela-tionship involve advancing someone’s ideas or goals.
• Leadership is a process centered on relationships and thewhole organization rather than on the individual. Theessence of leadership is not the individual, it is the relation-ship. Without an effective relationship between and amongindividuals, no system work can occur. Leadership occursat the intersection of relationships.
• Leadership is facilitated rather than directed. Guiding andcoaching individuals on what to do facilitate innovationand creativity better than telling them what to do serves toempower and strengthen organizational capacity.
• Leadership is organic rather than directive; it shouldcome from within an individual or local group ratherthan from distant individuals. Organic leadership is aboutself-determination, group buy-in, and the emergence ofa vision and plan for work at the point of care.8 Thewidespread engagement of individuals should best comefrom the grass roots or point of care individuals.
• All individuals are accountable for their competence,knowledge of current evidence, and the autonomous
April 201462 Nurse Leader
delivery of value-based interventions rendered to others;accountability is not designated to those apart from theactual work.
• Decision making occurs at the point of service. Themost competent and evidence-driven individuals shouldnecessarily be at the point where the care occurs andthus are able and accountable to do the right thing.
• Traditional leaders learn to let go of control and defer tothe experts at the point of care for decision making andaccountability. Complexity leaders ensure the necessaryadministrative functions occur and support an opera-tional infrastructure that facilitates rather than directs thework of individuals.7
• The wisdom of crowds is greater than the wisdom of anindividual. To be sure, innovation is about teamwork, notsolo work.
• Diversity or bringing diverse individuals together pro-motes more effective problem solving.
• Individuals naturally self-organize around problems andchallenges, and create effective solutions.
• One individual cannot lead all of the people toward theorganization’s goals in a timely and effective manner.
THOUGHTS FOR THE FUTURE Transformational leadership is about facilitating people; com-plexity leadership is about facilitating movement. In a com-plexity leadership model, leadership is distributed throughoutthe organization. Transformational leaders have already identi-fied the challenges of the current system, and they experiencethe realities of being overwhelmed on a regular basis. Movingto a more engaged and empowered workforce does not occurwithout careful planning and goal setting by the entire team.
The optimal structure might best be one of principles:principles of safety, respect, evidence, and timeliness. A struc-ture of principles could be more effective than a structure ofcommittees creating policies and procedures in the hopes andexpectations that they will be read and practiced. Moving theaccountability closer to the individual provides an empower-ing accountability framework. Think about it before you castthis off as something impossible in your organization.
Consider the possibility of there being no safety policies andonly an organizational principle that stated that all employeesare responsible and accountable for state-of-the-art safety prac-tice. Now, before you have heart palpitations, think about it—we have created so many redundancies because we expectindividuals to fail and fail regularly in providing state-of-the-artsafety practice. Now what is wrong with this picture? And whatabout holding each individual accountable for performancedemonstration rather than performance evaluations by thesupervisor? Wouldn’t it be more helpful to have an employeeidentify when and how they met the safety principle of theorganization? What a great opportunity for all of us to examineour dogma and get on to a more effective, efficient world—onethought at a time!
Evolving to a more effective leadership model is like anyother significant change and innovation process. Using thescience of change and innovation to advance new ideas
requires a clear definition or description of the challenge,engagement of the team in creating better processes, plannedimplementation strategies, estimation of the benefits of thechange, and an evaluation plan to determine the value andoutcomes to the team, the organization, and the patients. NL
References1. Gill R. Theory and Practice of Leadership. 2nd ed. Los Angeles, CA: Sage
Publications; 2011.2. Gronn P. Leadership: who needs it? School Leadersh Manag. 2003;23:267-
290.3. Kurtsman J. Common Purpose: How Great Leaders Get Organizations to
Achieve the Extraordinary. San Francisco, CA: Jossey-Bass; 2010.4. Burns JM. Leadership. New York, NY: Harper & Row; 1978.5. Bass BM, Avolio BJ, eds. Improving Organizational Effectiveness Through
Transformational Leadership. Thousand Oaks, CA: Sage Publications; 1994.6. Uhl-Bien M, Marion R. Complexity Leadership: Part I: Conceptual
Foundations. Ch. 1. Complexity Theory for Organizations and OrganizationLeadership; pp 1-16. Charlotte, NC: Information Age Publishing; 2008.
7. Porter-O’Grady T, Malloch K. Quantum Leadership: Advancing Innovation,Transforming Health Care. Sudbury, MA: Jones & Bartlett Learning; 2011.
8. Avery G. Understanding Leadership. London, UK: Sage Publications; 2004.
Note: The author receives royalties for the textbookQuantum Leadership: Advancing Innovation, Transforming HealthCare7 from Jones and Bartlett Learning.
Kathy Malloch, PhD, MBA, RN, FAAN, is president of KMLS,LLC, in Glendale, Arizona, professor of Practice at ASU College ofNursing and Health Innovation, Phoenix, Arizona, clinical professor,Ohio State University, College of Nursing, Columbus, Ohio, and aclinical consultant, API Healthcare, Inc., in Hartford, Wisconsin. Shecan be reached at [email protected].
1541-4612/2014Copyright 2014 by Elsevier Inc.All rights reserved.http://dx.doi.org/10.1016/j.mnl.2014.01.004
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