As a researcher in leadership development and a teacher in post-secondary business education, I recognize the importance of constantly making connections between the the way leaders learn and he or she’s relevant organizational context. In this essay, I examine three definitions and theories of leadership: authentic, global, and physician leadership. My purpose is to weave these characterizations of leadership with the essential beginnings of a leader’s development. In an effort to expand the sense of knowing how leaders learn, its possible to accelerate the learning during the developmental process.
The theory of authentic leadership integrates many concepts in the evolving topic of leadership development (Avolio, 2011).
Goleman’s model of four domains of emotional intelligence was significant in leadership education because the domains made the connection between competencies and leadership, adding clarity to the distinction between leading self and leading others (Goleman, Boyatis, & McKee, 2002). Emotional intelligence alerted us to the importance of relationships, especially between the leader and followers. Also, the introduction of leadership competencies provided momentum for new ways of learning leadership. The critical tool of coaching emerged as the way to learn through dialogue and conversations with beginnings in the 1990s through the practice of executive coaching in Europe (Kets de Vries & Korotov, 2007).
Leadership is my topic in research and teaching. In teaching I discovered that students cling to the traditional mindset that once they identify their strengths and weaknesses, they put most of their energy into improving their weaknesses. Students without life or work experience may jump to the assumption that they need to change their personality. To help prevent such harmful leaps in thinking, I found the work by Marcus Buckingham helpful in my teaching development. This podcast is about 45 minutes and contains substantive comments regarding the strengths-based leadership development approach that originated with Buckingham .
In the 1990s, executive coaching became the way for teaching leaders goal orientation and helping them to shift from directional leadership styles to more relationship based modes . In executive coaching a learning space emerges; one where discovery and transformative experience are possible (De Haan, Berties, Day & Sills, 2010). Research on coaching for leadership development is substantive in education for physician and nurses, teachers, and in psychology (De Haan & Duckworth, 2012; Garcia, 2009). In business, Griffiths and Campbell (2009) noted the rapid growth of coaching during the 1990s; Levinson (2009) used case studies to measure the financial impact of coaching; and Bowser (2012) reported that coaching for leadership development contributed to the financial value of business.
Avolio (2012) made enormous contributions to the topic of leadership development, especially with his explanations of the full range leadership model. He continues to write and lead centres of leadership in American universities, most recently at the University of Washington. Avolio conceptualizes the process of leadership development by beginning with a validation of self by asking the powerful coaching questions that provoke leaders to reflect and question themselves. His personally reflects on his transition form one leadership role to another, giving evidence to the experience of leadership development in his published books. A keen sense of leader self-awareness guides the leader through the transition to a new role, by always being attentive to and mindful of where he is at this moment in time and where he wants to take his followers.
As cited by MacIntyre (2014), Avolio (2011) reveals the contrast emerging between management and leadership within the Western world. In North American organizations, the distinction began in the late 1980s as corporations struggled with the reality of global markets. Relevant to this paper is the definition of leadership that begins to characterize the behaviors of leaders and managers. Both managers and leaders acquire and manipulate the visible assets of land, buildings, equipment, computing power, and human capital. A consequence of globalization is the shift in the leader’s mindset that less tangible assets become the most significant: speed, learning and development, intellectual property, and big data. This contrast between managers and leaders continues. Characterizing leadership is the focus on the future, an eye on the horizon, in effort to prepare organizations better for the ambiguities of change.
The Emergence of Global Leadership
In the late twentieth century, the business environment in the Western world became more dynamic and uncertain as new technology, economic, and political change forced business, government, and healthcare organizations to deliver service differently. In the 1980s, globalization provided the impetus for change in the Western world, opening new markets, forcing established players to compete more aggressively, and dramatically changing business organizations (Sirkin, Hemerling, & Bhattacharya, 2008). In North America, many corporations were unprepared for the sweeping change and stumbled through massive downsizing of organizational structures to adapt to the new reality of global business (Moss Kanter, 1997). By the 1990s, the dismantling of the USSR opened new markets for Russia and East European countries; new players emerged in global energy markets; and a new source of talent in mathematics, computer science, and medicine became accessible globally.
Technological change had a significant impact on traditional organizational structures, where the manager’s role primarily related to coordination across functions and businesses. Personal computers, networking innovations, and the cell phone enabled paperless communication and influenced change in organizational structures by eliminating layers of management in corporations and government services. Industry structures also changed as technology enhanced manufacturing and produced the global supply-chain; and call center technology shifted most customer service from Western to Asian countries. Company owners, political leaders, and executives identified competencies as one ingredient to connect individual performance to the frequency of change. Competency based learning placed a stronger focus on the future and on a broader range of strategic factors relevant to the organizational system. By the end of the twentieth century, managing in the global context required adaptability and flexibility; and the ability to lead change was the impetus for implementing leadership development programs (Millikin & Fu, 2003). Better transition
Quinn, Anderson, & Finkelstein (2005) designed an implementation process for leadership development in 1996. It involved four levels of development: awareness, application, adoption, and advancement or achievement. Within the four levels was a comprehensive thirteen-step program for the leader to move through a full range transformational learning experience. The learning included creation of a personal self-image, planning for leadership potential, tracking behavior, and seeking feedback. The implementation process embraced a comprehensive leadership development program with many of the learning activities that comprise learning leadership in 2016.
In healthcare environments, technological change imposes requirements for professional development programs that encourage professionals to adopt innovation and new medical practices. In professions, such as law, engineering, nursing, and teaching, professionals retain expertise through a combination of licensing and regulatory mandates that are unique to states or countries. Technical expertise is the easiest to recognize and reward in a profession and programs for updating technical expertise take priority. Around the globe, the Internet provided patients with enormous information power and raises their expectations of healthcare services. For example, the ability to book or pay online for healthcare services changed the business of private medical clinics and had implications for stakeholders like health benefits providers, patient financing sources, health regulators, and the business taxation systems. A broader range of stakeholders now participates in the interaction between the patient and the healthcare professional. When an injured Dutch police officer flies to Canada to receive an innovative healthcare service, the clinic leader takes responsibility for the medical care and manages the cross-cultural business transactions on behalf of the patient. For the clinic to market and deliver services globally, the clinic’s healthcare professionals are competent leaders in a technical area of medical practice and in global business.
Advancements in adult learning and in curriculum development combined to accelerate leadership development (Kassotakis & Rizk, 2015). Leadership education includes learning the history of leadership , where a leader gains access to the prevailing theory and practice of leadership. Often the missing elements in formal education programs are the facilitated learning and group learning that enhances visioning and relationship building. Learning leadership skills includes attention to the distinction between leadership and management; even though new definitions and interpretations prevail, the literature reveals an intricate entanglement of terminology (Avolio, 2011). Managers and leaders both acquire and manipulate capital, human resources, intellectual capital, and the tangible assets of property, equipment, and computing power. The distinction includes a manager’s focus on the current operations while a leader views a longer time horizon, a stronger focus on the future, and a visioning capability (Thomas & Carnall, 2008).
The history of management education provides a useful example for combining highly technical and analytical content with new ways of learning management and leadership (Avolio, 2011; Datar, Garvin, & Cullen, 2010; Mintzberg, 2004). In business education, graduate programs include courses in the global context of management and strategic leadership to prepare professionals for leading and managing in the changing world of the new millennium (Datar, Garvin, & Cullen, 2010; McKenna & Maister, 2002). Rowe, Heykoop, and Etmanski (2015) developed a master’s degree in global leadership and defined global leadership in terms of a competency framework. The framework organized competencies into three domians: personal leaderhsip, leading diversity in the cross-cultural context, and leading sustained change given the complexities of the global context.
Rowe et al. offered a glimpse at the development process for an educational program in global leadership; they concluded it was a challenging endeavor, one requiring collaboration and guidance from a Consultative Committee (p. 195). For the community, the formation of a consultative group on leadership development initiates the theme of leadership as relevant to the growth of the community.
Foundational to the understanding of global leadership is the recognition that leadership is a process, not an outcome or product of attending an educational program. Leadership development is a continuous process of transforming oneself and others, learning to identify situational factors and adapting to multiple roles. Leaders evolve through a combination of experience, learning, and behavioral change; and learning to lead requires recognition of the developmental nature of leadership and attention to the relationships between leaders and followers (Avolio, 2005). The emphasis on relationship building originates from the concept of transformational leadership and the dual roles of leaders and followers, who move in alignment intellectually and with a common moral purpose (Burns, 1978). Bass showed an association between a leader’s moral values and the full range, transformational leadership style (Bass 1998a. 1998b; Bass & Avolio, 1994; Bass & Steidlmeier, 1999; Jandaghi, Matin, & Farjami, 2009). Bass’s research contributed to the design of learning programs for leadership development; and in the late twentieth century, organizations began to train and develop for global leadership skills and competencies. Learning to lead began to place more emphasis on areas like reflective practice, professional conversations, and building community. In healthcare, staying informed about advances in medicine is more challenging than in the past; learning leadership helps professionals adapt to change and enables them to shape the future of medicine. The dynamics of healthcare change redefine the competencies of healthcare professionals to pursue development that enables them to adapt and work collaboratively across disciplines and cultures (McKinney & Waite, 2015).
Leadership Development for Global Leadership
Leadership is about building relationships and the ability of the leader to influence change in others, whether he or she is leading a team, an organization, or a medical practice (Daft, 2015). Global leadership development requires a program of planned learning, designed for global contexts in ways that enhance the leader’s ability to navigate cross-cultural situations (Rowe, Heykoop, and Etmanski, 2015). Leadership development programs commonly include learning current concepts and frameworks of leadership plus inclusion of experiential learning to integrate and apply the higher level or meta-cognitive skills, such as self-discovery and shared reflection. The prefix “meta” indicates an higher level of thinking, intended to develop the leader’s skills and abilities in areas like self-knowledge, emotional resilience, and personal drive (Buckley & Monks, 2008). Bird and Stevens (2013) identified three sub-dimensions of meta-cognitive skills specific to cross cultural intelligence: awareness, planning, and checking. Awareness is the leader’s ability to assess his or her sensitivity to a situation; planning includes the anticipation and preparation anticipates and prepares for leading the situation; and checking is the leader’s ability to monitor his behavior and actions for consistency with his plan (p. 125).
Kaagan (1999) defined leadership development as the process of teaching leadership and suggested a mix of learning activities that promoted a safe, shared, adult learning experience. He taught leadership that began with substantive learning of leadership theory followed by applied practice through a curriculum of learning activities. The learning activities integrated Schon’s (1983) model of reflection-in-action, introducing professionals to tools for learning more disciplined thinking through reflection and inquiry. By teaching leaders to use these skills, they learned to pause and examine their assumptions, reflect on individual experience, share, and test their assumptions with others, and reconstruct the experience in a future situation (Bolman & Deal, 2003; Senge, Kleiner, Roberts, Ross, & Smith, 1994). Shared reflection introduces a leader to an examination of situational factors and draws upon the multiple perspectives of others to develop different ways of thinking about his roles as a leader. Reflective practice shows integration of the Bass’s transformational leadership style. Kouzes and Posner (2016) stress the importance of shared reflection in teams; and a means for connecting leaders to the experience of other leaders.
Skill development for leaders includes learning how to communicate through dialogue and professional conversations. Sloan (2006) taught professionals dialogue techniques to practice communicating with credibility and to become better listeners (p. 104). Leader credibility is an earned value, one gained through the leader’s actions and behavior (D’Aprix, 2009; Kouzes & Posner, 2011; Posner & Kouzes, 1988). Different teaching techniques help leaders to accelerate their learning of conversational skills, particularly executive coaching and mentoring (Griffiths & Campbell, 2009; Joo, Sushko & McLean, 2012). Executive coaching facilitates learning leadership; the leader begins reflective practice, tests his or her leadership behavior, and receives feedback from the coach before moving on to more learning (Kets de Vries & Korotov, 2007). In contrast to a coaching approach, mentoring provides the leader with an advisor who uses personal stories to describe and explain professional experience. Both coaching and mentoring are face-to-face learning modes that contribute to leadership development.
Henein and Morissette (2007) are Canadian researchers who used an apprenticeship model to describe a leadership development approach that combined formal and informal education into a cycle of experiential, adult learning. For an apprentice, learning involves working with artisans, mentors, and gaining adequate practice to refine new skills. Educational programs that include practicums or internships utilize the apprenticeship model. Henein & Morissette’s learning cycle included mentoring and coaching support from leaders within the organisation, community building within and outside of the company around the theme of leadership, formal education to learn about models and frameworks, and a practice field to apply and integrate leadership learning.
When large organizations experience rapid changes in their environments, executives and top managers require the agility to adapt and lead others; company’s struggle over the selection of leaders with the appropriate mix of technical skills and business acumen. (Moss Kanter, 1997). This presents a challenge to senior leaders and executives who wrestle with the dilemma of funding the preferred educational strategies to develop leaders (Datar, Garvin, & Cullen, 2010). When leaders learn competencies in global leadership, they are more likely to remain with an organization and contribute strategically to the growth of the organization Themes are also important in leadership development programs because they reflect the accumulated values of the profession or organization (Alexandrou, Swaffield, & MacBeth, 2014). The purpose of mentoring programs show connection to ld encourage communication among members of a community; support ty connections and Leadership development initiatives incorporate shared values and beliefs by including events and activities that encourage the community to activity communicate and share leadership experiences through mentoring , shared values and beliefs of the of the community should be reflected in the design of leadership development programs to sustain the professional community.
Leadership development is a process that takes place over a period of years; it is a continuous process, requiring attention to the leader’s context, the country in which he practices, and the forces of change that influence the growth of the healthcare practice. Leadership education is the combination of learning and development that fosters and supports the leader’s growth and the design of the educational program is specifc to a target population or cohort of leaders. In Canada, Henein & Morissette (2006) described leadership education as an invisible field of study with a lack of leadership education and developmental pathways for leaders. In a global community like TAM, one remedy is to initiate programs for leadership development that coincide with the annual conferences. This approach is particularly significant for professionals who operate in independent, private practice and look to the annual conference for an opportunity to share their knowledge, learn about new medical practices, and network with members of the TAM community.
In the US, nursing education was the first profession to integrate leadership development into the undergraduate university curriculum (Fullerton, Lantz, Quayhagen, 1992). In Canada, Kilty (2005) reviewed programs for nursing leadership development and she found a vibrant culture for leadership development within the profession. Kilty’s status report captured nursing leadership in a graphic representation of four domains: research, teaching, clinical practice, and administration (p. 5). She identified leadership competencies for change, caring, leading self, leading others, policies and politics, managing, teambuilding, project management, communicating, and visioning (p. 29). Programs for learning nursing leadership utilized multi-media sources for learning and gave attention to community building through mentoring, networking, coaching, and on-the-job practice. Throughout Canada, nursing leadership development programs were available through nursing associations, union sponsored programs, educational institutes, nursing centers, and in university nursing programs. Nursing leadership development programs existed in Australia, Sweden, the US, and the UK. One impressive initiative was known as Leadership for Change (LFC) and involved 50 countries in the Caribbean, in Latin America, in the south Pacific, in East, Central and southern Africa and in Southeast Asia. LFC used an action-learning approach for nurse leaders and potential leaders; and the program design included five inter-related components: workshops, individual development planning, team projects, structured learning activities between workshops, and mentoring. These program components were adapted to meet differing requirements of the host countries. By attending the LFC program, nursing professionals learned how to address the changing health care policy within their countries and, at the same time, how to improve their health care practice. Another example of a profession that incorporated learning leadership into university programs for the profession of engineering, MacIntyre (2016) proposed a framework for learning leadership in engineering education, including three components of leadership practices, leadership education with formal and informal sources, and building a community of leaders within the profession.
For physicians, leadership literature on the differences between their medical and leadership roles is recent. Barnhart (2012) characterized the role of the physician leader as the “physician whiplash” to emphasize the measures of success as a physician are completely contrary to success as a leader. Barnhart showed how medicine became more team based and the necessity of the physician to adapt by learning leadership skills in teamwork, cross-disciplinary collaboration, and adopting a future orientation. The tension to adapt from technical expert and problem-solver is comparable for new leaders in business, nursing, and education; struggle is letting go of their expertise. For physicians, leadership meant letting go of the immediacy of the trusted expert to venturing outside of comfortable boundaries, encountering resistance, and learning to share responsibility (p. 34). Another way of expressing this tension is the leader’s willingness to take the risk of leading without the contingency of owning the knowledge.
By the twenty-first century, leadership emphasized growth through collaboration and the leaders’ role to reinforce a clear alignment between the vision, moral focus, and ethical behavior of the organization (Kouzes & Posner, 2016; Melina, Burgess, Falkman, & Marturanao, 2013). Advancements in new ways of learning and integration of courses on leadership programs proved to accelerate leadership development in business, schools, post-secondary education, and in nursing (Kassotakis & Rizk, 2015). Formal education includes delivery of univeristy based management and leadership programs; they provide access to leadership theory, models and frameworks, and the history of exemplary political and business leaders. Usually, the missing elements of leadership development in formal education are access to the facilitated learning and the group learning that enhances visioning and relationship building. According to Ely and Rhode (2010) leadership development is a combination of learning conceptual frameworks of leadership, practice to integrate and apply the skills of leadership, self-discovery of one’s leadership identity, and support through coaching and mentoring to sustain the leader’s growth. Learning to lead in new ways evolved quickly and enabled leaders in many professions to emerge and grow.
Reflective practice is self-exploration, an examination of one’s beliefs and values and questioning the assumptions and reasoning behind one’s actions and behavior. Use of reflective practice began with Schon’s (1983) work on teaching business professionals how to reflect and remains a seminal work in management education. Brookfield (1995) integrated reflective practice into education for new teachers and claimed that the teachers improved their ability to facilitate student learning. Densten and Gray (2001) stressed the importance of integrating reflective practice into learning leadership to help leaders connect leadership theory to their experience of leadership.
Cunliffe (2009) went beyond the practice of self-reflection to emphasize critical thinking and taught leadership using a philosopher’s metaphor of three intertwining threads including relational leadership, moral activity, and reflexivity. Reflexivity incorporates reflection through conversations, a means of questioning accepted assumptions and behavior in business decision-making through open dialogue among group members. Relational leadership builds on social learning, in the recognition that leaders exist only in the context of their relationships with followers, emphasizing the leader’s role cannot exist in isolation of his followers. Cunliffe’s (2009) inclusion of moral activity might be a response to the corporate scandals and unethical behavior of the first decade of the twenty-first century in the US and the UK. Her research deepened understanding of how to teach leadership, with attention to strengthening the leader’s ability to develop relationships and lead with a moral purpose.
Programs for leadership development require a combination of experiential learning and programmed learning, including understanding the history of leadership education and practicing skills in a way that helps the leaders integrate meta-cognitive skills. Meta-cognitive skills refer to thinking about how one is thinking, a reflective focus on learning how to lead through examination of one’s inner before attempting to lead others (Buckley & Monks, 2008). Self-discovery through reflective practice initiates meta-cognitive thinking; and as the leader evolves, reflective practice may achieve mindfulness explain (Tuleja, 2014). Self-discovery contributes to increasing a new leader’s self-awareness and it is a learned practice (Nagy & Edelman, 2014). An integral part of the learning experience is the support of other leaders in the profession, who provide a mixture of advocacy, coaching, and mentoring to sustain the new leader’s growth. Advocacy Mentoring relies on a supportive community of experienced leaders who willingly invest their time to share knowledge, and experience through leadership stories (Kouzes & Posner, 2016; Loehr, 2007). Coaching
In Scotland, Alexandrou, Swaffield & MacBeath (2013) identified professional conversations as the mechanism for teacher leaders to move from their private reflection, to dialogue, and to public exchange in their field of practice. Leaders whose career pathway is in a corporate, health, or government setting are more likely to learn professional conversations as part of in-house training and executive coaching services, or through executive management programs (Hannum, Martineau & Reinelt, 2007; Sloan, 2006). The key benefit of learning how to engage in a professional conversation is an accelerated leadership development; and for leaders whose post-secondary education is in education or applied sciences, executive coaching teaches them conversational skills, preparing them for the multi-faceted demands of leading others. (Adams et al, 2011). Research on leadership and coaching is more substantive for physician and nursing education (Garcia, 2009), in psychology which profession? (De Haan & Duckworth, 2012), and in women’s leadership development (Ely, Ibarra & Kolb, 2011). New ways of teaching leadership emerged as group learning replaced individual reflective practice and taught the leaders relational leadership (Cunliffe, 2009; Eriksen & Cunliffe, 2010). As noted by Garcia (2009), the leader’s thinking is incomplete unless it incorporates dialogue and reflection with others. Leaders require a practice field for shared reflection, experience, and deliberate learning. Garcia’s approach suggested a practice field that expands critical thinking to a wider range of issues related to the organization’s culture and its social responsibility.
Community of Leaders
Integral to learning leadership is the support of experienced leaders, whose roles include both coaching and mentoring to support development and growth. In many professions, learning to lead encompasses both formal education and practice in a vibrant practice field. Ideally, the profession acknowledges the importance of leadership development and forms communities of learning and practice to nurture and sustain a professional culture that values leaders. The presence of community includes actions by respected leaders and role models in the profession; including communicating a commitment to the growth of new leaders and a willingness to challenge the status quo or barriers to leadership development (Kouzes & Posner, 2016). Skills for leadership development include envisioning the future, teamwork, and the ability to learn from followers. Leadership involves multiple roles of leading and following, of cooperation and collaboration, and of mediation and conflict resolution (Stoner & Stoner, 2013). For professionals working in healthcare systems, efforts are collective and intended to inspire and exceed the expectations of patients (McKinney & Waite, 2015). By learning the leadership skills to communicate and interact more effectively with their patients and colleagues, health care professionals enhance their leadership and contribute to growth of a community of like minded individuals.
In the context of learning leadership, Avolio (2011) reinforces the importance of interaction between leaders as trigger events for leadership development. For example, when a senior male leader acknowledges the leadership qualities of an emerging female leader, she leaves the meeting feeling validated. Her experience of receiving positive reinforcement from a senior leader contributes to her leadership development. The senior leader is a role model who demonstrated his ability to encourage the new leader, and he initiated a relationship with his follower. Learning leadership includes interaction and conversation; the example cited suggests the importance of a senior leader initating a relationship with his follower that opens the way for more dialogue and conversation.
Community of practice is metaphor for a learning process that is socially constructed, interactive, and conversational (Nixon & Brown, 2013). The intent is to open a learning space that enables leaders to share tacit knowledge and move towards a vision of leadership for the profession. Coordination of formal and informal learning takes place through networking, mentoring, coaching, and professional conversations (Alexandrou, Swaffield & MacBeth, 2013; Debebe, 2011). The purpose of a community is to create a culture of leadership development in which professionals articulate, share, and learn leadership. Building on a capacity for shared learning, the leaders in the profession begin an incremental movement to define the most relevant dimensions and context for their community (Fairman & Mackenzie, 2014; Rowe, Heykoop, & Etamnski, 2015). Dinpolfo, Silva & Carter (2012) reinforced the proactive responsibilities of senior leaders to develop leaders by investing time to sponsor and promote inclusive leadership development. Like the intricacies of management education versus leadership education, leadership development requires a combination of learning that is transformational, contextual, and experiential. As noted by Garcia (2009), the leader’s thinking is incomplete unless it incorporates dialogue and reflection with others. Leaders require a practice field for shared reflection, experience, and deliberate learning; this is the purpose of community.
In the TAM community, private practice of alternative and traditional medicine are often small, with healthcare professionals working independently and focused on the operational details of their clinic. These professionals require inspiration and support from within the community to recognize and appreciate the benefits of leadership development. While healthcare professionals are effective problem-solvers in their technical specialties; leadership development enhances their capabilities and provides a global mindset that is comfortable with change.
Assessing Leadership Potential Using the Leadership Practices Inventory
The Leadership Practices Inventory (LPI) is a self-assessment tool used to give a leader a portrayal of his or her current leadership strengths. The purpose of self-assessment is to quantify and describe the leader’s behavior; for the health care professionals in TAM, the results of the LPI provide a view of his leadership and a source of information for reflection. When the leader reflects on the assessment results, the experience contributes to self-understanding and provides a powerful beginning for the leader to create a leadership philosophy. Leadership philosophy begins with a focus on the leader’s strengths, and providing a positive and generative beginning.
Kouzes and Posner (1987) developed a transformational leadership model based on analysis of thousands of case studies in which individuals described a personal-best leadership experience. Kouzes and Posner (1988, 1990, and 1993) designed the Leadership Practices Inventory (LPI) as a behavioral based assessment for leaders, in contrast to the available assessments using psychological measures. The authors represented the transformational nature of leadership as it originated from Burns (1978); that is, leadership is a learned behavior developed through the study of the leadership practices. The LPI organizes thirty statements of successful leaders into five leadership practices: Model the Way, Inspire a Shared Vision, Challenge the Process, Enable Others to Act, and Encourage the Heart. The leader completes the assessment by rating the frequency of the behavior on a 10-point Likert scale. Descriptions of the five practices include the following:
- Modeling the Way includes role modeling and actions to affirm shared values.
- Inspire a Shared Vision is the articulation of the future through a visioning process involving all stakeholders.
- Challenge the Process includes leader actions that foster risk taking, creation of innovative ways of improvement, including shared reflecting.
- Enable Others to Act are the actions to create learning processes and build trusting relationships.
- Encourage the Heart is the behavior to demonstrate appreciate, and celebrate the values and achievements of followers. (Posner, 2013).
Kouzes and Posner (2002) measured the reliability of the LPI based on the internal consistency of the participant’s ratings of the 30 statements of leadership behavior that summed to form the total score for the five practices. The Cronbach alpha reliability on each of the five practices showed an acceptable reliability (α > .70) for Inspire a Shared Vision, Enabling Others to Act, and Encourage the Heart. Challenge the Process had questionable reliability (α > .60), while Model the Way had unacceptable reliability (α < .60). As cited in Posner (2015), he summarized the internal reliability of the LPI across many different sample populations. In health care industries, he cited reliability of 0.70 to 0.88 for home health care agency directors (Troudt, 1994) and reliability from 0.89 to 0.92 for healthcare managers (Nash, 2009; Strack, 2001).
In terms of validity of the LPI, Kouzes and Posner (2002) identified face validity of the LPI as accounting for most of the validity. due to the subjective evaluation of the LPI by leaders who participated previously in the research. The authors reported that participants identified with the language of leadership used in the thirty statements of the LPI. The participants comfort with the vocabulary contributed to the conclusion that the LPI had face validity (p. 14). Other measures of the validity of the LPI included the statistical measure of factor analysis to support the discriminatory validity of the LPI (Field & Herold, 1997; Carless, 2001; Herold & Fields, 2004). Vito and Higgins (2009) used factor analysis to test the construct validity of the LPI for use by a specific group of police managers. They found the LPI was valid for police leadership performance and for assessing the leadership capabilities in law enforcement agencies (p. 317).
The LPI is a psychometrically evaluated instrument (Fields & Herold, 1997; Kouzes & Posner, 1993, 2002). It has proven construct validity for groups in nursing, teaching, educational leadership, and law enforcement, despite significant changes in the business environment over the past decades (Clavelle, Drunkard, Tullai-McGuinnes & Fitzpatrick, 2012; Duygulu & Kublay, 2010; Foli, Braswell, Kirkpatrick, & Lim, 2014; Tourganeau & McGilton, 2004; Posner, 2010; Vito & Higgins, 2010). Research on the leadership practices for a sample of Canadian women engineers revealed an ease with valuing relationships across cultures, disciplines, and multiple domains of business, health, and government (MacIntyre, 2014). For the professional women engineers, Enable Others to Act was the dominant leadership practice, demonstrating a collaborative style of interaction and engagement, a reliance on trust and commitment, and respectful behavior between leaders and followers. Leadership actions that enhance relationships between leaders and followers includes active listening, attention to the diverse perspectives of followers, and support for decisions made by followers. The results of the LPI for the women engineers also revealed their comfort with strengthening their followers’ capability, including followers’ aspirations for leadership, which is a significant role of a transformational leader (Jandaghi, Matin & Farjami, 2009).
Waite, McKinney, Glasgow, & Meloy (2014) used a student’s version of the LPI to assess leadership skills of a cohort of undergraduate healthcare students in an interdisciplinary 9-month leadership program at a private, American university. The program included courses for three consecutive terms. In the first term, students engaged in self-examination by questioning their beliefs, values, reliance on power structures, sensibilities to diversity, and personal experiences that influenced their thoughts and actions. This learning process deepened their self-awareness and enabled them to articulate a leadership philosophy. In the second term, students explored group dynamics by assessing their behavior in teams, how well they communicated, resolved conflict, and planned. By addressing topics like prejudice, privilege, stereotyping, social identity, oppression, and personality, the health care students began to assess their capacity for leading. In the third term, students addressed the community roles of leaders through learning activity designed with a lens of social justice. They explored the social determinants of health, sources of power and inequalities, and the generative community to organize and promote health. Teaching or pedagogical strategies that facilitated the leadership learning included reflective exercises, leadership briefs, group debates, engaging guests and panel speakers, individual and team projects, service learning projects, diversity and privilege exercises, fishbowl activities, cultural autobiography, mind mapping, and action learning projects (McKinney & Waite, 2015, p. 12-13). For the educators who designed this 9-month leadership development program, they realized students entered the health care environment better able to function on diverse, interdisciplinary teams and more confident about leadership roles at the beginning of their professional careers.
In health care, evidence of successful global leadership resides in achievement of measurable improvements in health outcomes. In the short-term, measures include a comparison of the use of an health care service from one period to another; or changes in the knowledge, attitudes, and receptivity of the health care services by a patent or client group. The content of a leadership development program includes designed learning for reflective practice, professional conversations, and building community. Learning leadership includes leadership practices to describe and quantify the leadership of individuals and to characterize the leadership of the TAM community; secondly, leadership education requires attention to design of leadership experiences that resonate and build confidence to lead; and thirdly, formation of a community of leaders who advocate and further leadership development.
Defining expected outcomes of the leadership development program for TAM requires input from the members themselves and this depends upon the challenges that are both within the local practice and the external forces imposing change on the health care systems. As suggested in this paper, the TAM community should consider planning for leadership development by forming a consultative team and articulating a vision of leadership for the health care professionals in TAM. Preliminary questions for members of the community to consider as they explore initiatives for leadership development are the following:
- What defines global leadership in traditional and alternative health care?
- What are the characteristics of a global leader in TAM?
- Why is global leadership important to health care practice?
To connect leadership development content to the context of the health care professional’s work environment, with specific attention to the cross-cultural issues of global, health care business. Ultimately, the measurement of the results of the global leadership development program are the changes in health service delivery, such as increase in the number of patients or improved quality of service.
Physician leadership relates to developing emerging leaders at all levels of health care organizations. Regardless of the industry domain, the developmental nature of leadership requires experiential learning that sensitizes the leader to the different contexts they encounter. Leadership development includes learning reflective practice, relationship building, and forming a community of like-minded leaders. Learning how to lead is an intricate and dynamic process, involving a readiness to change roles, giving leadership to others, and a keen sensitivity to awareness. Learning meta-cognitive skills remains the challenge for new leaders, regardless of age or recognized seniority in an organizational context.
Leadership involves a diversity of stakeholders in which the physician leader initiates the conversations. This requires an open systems mindset and the ability to go beyond technical specifics to influence a wider, inter-disciplinary team in health care context. Teaching physicians reflective practice in this era of distractability is one of the challenges of leadership development. The best way to address the barrier of distractability is to improve the meta-cognitive skills of the individual. Physicians may excel at problem-solving in a specifc area of medicine, yet leadership requires a very different way of thinking and learning. Leadership development is a combination of experiential learning and programmed learning, including the conceptual frameworks of leadership together with a practice field to integrate and apply the skills of leadership, such as self-discovery of leadership identity and a movement towards mindfulness. Integral to this learning is the support of other leaders in the community, who provide a mixture of collegiality and shared learning that helps to sustain the leader’s growth.
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