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. These circumstances, in combination with reports in the literature describing a consistent association between leadership and employee outcomes, have heightened the need for research on how healthcare manager’s leadership relates to psychosocial aspects in the workplace and 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 the viewpoints of other employees, such as the managers’ superiors, colleagues, and subordinates. Therefore, the questions addressed in this research concerned the following: how leadership is involved in perceptions of work environment and distress, from the poorly elucidated standpoint of healthcare managers themselves (Study I), and with the objective of gaining a deeper understanding of the relationship between leadership and subordinates’ distress (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 subordinates.

All four studies were based on questionnaire-derived quantitative data collected in a randomized controlled trial evaluating a leadership development intervention. One of the questionnaires applied was a 360-degree feedback instrument, 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 included cluster analyses, hierarchical multivariate or multilevel regression analyses, and analysis of variance.

One of the key findings was that one leadership profile was found to be characterized by lower leadership self-ratings and more negative perceptions 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 managers interpret and react to their work environment. Furthermore, higher levels of production-oriented leadership, which comprise aspects of order and structure, emerged as being related 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 that predicted leadership ratings, and the perceptions of the effects of a leadership development intervention on leadership, were inconsistent between different rater sources. Thus a pivotal finding is the level of disagreement between managers and their superiors, colleagues, and subordinates with respect to perceptions of leadership. This raises questions about what constitutes leadership, how can it be measured and with what purpose—if leadership is in the mind of the beholder.

In conclusion, the results communicated in this thesis extend the current knowledge of healthcare managers’ leadership by demonstrating its’ role in relation to work environment and distress. The present findings also elucidate the relative quality of perceptions of leadership, suggesting that different rater sources have their own social constructions of the leadership phenomenon. A practical implication of this observation is the need for awareness of the relative quality of perceptions of leadership to guide decisions regarding the purpose of assessing leadership and how it should be assessed. Also, healthcare managers may want to upgrade the subjective significance of production-oriented behaviour in their leadership, behaviours traditionally termed as “management”.

List of scientific papers

I. Lornudd C, Bergman D, Sandahl C, von Thiele Schwarz U. Leadership Profiles in Relation to Managers’ Work Stress. [Submitted]

II. Lornudd C, Tafvelin S, von Thiele Schwarz U, Bergman D. (2015). The mediating role of demand and control in the relationship between leadership behaviour and employee distress: A cross-sectional study. International Journal of Nursing Studies. 52(2):543–554.
https://doi.org/10.1016/j.ijnurstu.2014.08.003

III. Bergman D, Lornudd C, Sjöberg L, von Thiele Schwarz U. (2014). Leader personality and 360-degree assessments of leader behaviour. Scandinavian Journal of Psychology. 55(4):389–397.
https://doi.org/10.1111/sjop.12130

IV. Lornudd C, Bergman D, Sandahl C, von Thiele Schwarz U. A Randomised Study of Leadership Interventions for Healthcare Managers. [Submitted]