In the mind of the beholder : perspectives on healthcare managers' leadership

The managerial mission in healthcare services today entails challenging conditions that have implications for healthcare managers’ leadership. T hese circumstances, in combination with reports in the literature describing a consistent a ssociation between leadership and employee outcomes, have heightened the need for research on how healthcare manager’s leadership relates to psychosocial aspects in the workplace an d how leadership can be supported. The present studies aimed to advance knowledge in this area, considered both from the perspectives of the managers themselves and from th e viewpoints of other employees, such as the managers’ superiors, colleagues, and subordinat es. Therefore, the questions addressed in this research concerned the following: how leadersh ip is involved in perceptions of work environment and distress, from the poorly elucidate standpoint of healthcare managers themselves (Study I), and with the objective of gai ning a deeper understanding of the relationship between leadership and subordinates’ d istress (Study II); how to promote leadership by investigating that aspect in relation to the leader’s personality (Study III) and to the responsiveness to leadership development (Study IV), considered from the viewpoints of the managers and their superiors, colleagues, and s ubordinates. All four studies were based on questionnaire-derive d quantitative data collected in a randomized controlled trial evaluating a leadership development intervention. One of the questionnaires applied was a 360-degree feedback in strument, which enabled assessment of leadership from different perspectives. The sample consisted of first-line and second-line healthcare managers (n=193), their superiors (n=182 ), colleagues (n=366), and subordinates (n=1276). The statistical assessments performed inc luded cluster analyses, hierarchical multivariate or multilevel regression analyses, and alysis of variance. One of the key findings was that one leadership pro file was found to be characterized by lower leadership self-ratings and more negative per ceptions of work environment and distress compared to all other leadership profiles that were identified. This suggests that leadership profiles can explain variation in how healthcare ma nagers interpret and react to their work environment. Furthermore, higher levels of producti on-oriented leadership, which comprise aspects of order and structure, emerged as being re lated to lower levels of distress from the perspective of the subordinates. This indicates the impact of these aspects of leadership in a healthcare organization. The personality traits tha t predicted leadership ratings, and the perceptions of the effects of a leadership developm ent intervention on leadership, were inconsistent between different rater sources. Thus a pivotal finding is the level of disagreement between managers and their superiors, c lleagues, and subordinates with respect to perceptions of leadership. This raises q u tions about what constitutes leadership, how can it be measured and with what purpose—if lea dership is in the mind of the beholder. In conclusion, the results communicated in this the sis extend the current knowledge of healthcare managers’ leadership by demonstrating it s’ role in relation to work environment and distress. The present findings also elucidate t he relative quality of perceptions of leadership, suggesting that different rater sources have their own social constructions of the leadership phenomenon. A practical implication of t his observation is the need for awareness of the relative quality of perceptions of leadershi p to guide decisions regarding the purpose of assessing leadership and how it should be assessed. Al o, healthcare managers may want to upgrade the subjective significance of production-o riented behaviour in their leadership, behaviours traditionally termed as “management”.