Good leaders develop through a never ending process of self-study, education, training, and experience. Good leaders are continually working and studying to improve their leadership skills. The term leadership means different things to different people. Northouse’s (2007) define leadership is a process whereby an individual influences a group of individuals to achieve a common goal. This definition is supported by Faugier and Woolnough (2002) that they also define leadership is a process that involve the ability to influence or persuade people to achieve the organization goal. They also said that leadership exists in all level on the organization. Bryman (1992) states that most definition of leadership emphasizes three main elements that relates with leadership which are groups, influence, and goal.

In most organizations, there are two groups of leaders which are the governing body, and the chief executive officer and other senior managers. Same with health care organization, but in health care organization certainly hospitals has a third leadership group which are the leaders of the physicians and other licensed independent practitioners (whether employed or “voluntary”) who provide patient care in the organization. In a hospital, the physicians and other licensed independent practitioners are organized into a “medical staff” and the leaders of the medical staff contribute to the leadership of the organization.

In healthcare, decisions about a patient’s diagnosis and treatment are made by “licensed independent practitioners,” most commonly physicians, but also including other clinicians such as dentists, podiatrists, or psychologists who have been licensed by the state to diagnose and treat patients. A person without a license who diagnoses and treats a patient through activities that are covered by any of the licenses is deemed to be practicing illegally which means “practicing without a license.”

In a hospital, this third leadership group comprises the leaders of the organized medical staff. Only if these three leadership groups work together, collaboratively, to exercise the organization’s leadership function, can the organization reliably achieve its goals (as mentioned above: high-quality, safe patient care; financial sustainability; community service; and ethical behavior). A hospital is the most complex healthcare setting in which these three groups of leaders must collaborate in order to successfully lead the organization.

Leadership in today’s Health Care.

Traditionally in healthcare leadership has been hierarchical, often defined by position and job title in many instances no distinction was made between the term management and leadership. Power and authority were determined by the position of a person within the organizational structure. The most effective leader is the one who can accomplish the group purpose while carrying out the main tasks of leadership critical for success. In order to attain such level of leadership and success, several important issues come into play. The most essential and commonly known are: motivation, shared vision, good communication, good time management, and a situational approach to leadership. Appreciating these points and knowing how to enforce them within the relevant context of healthcare management makes all the difference in the success of a leader.

In a scenario involving aggressive behavior among health care providers, participants identified that, before responding, an appropriate leader should collect additional information to identify the core problems causing such behavior. Possibilities include stress, lack of clear roles, responsibilities, and standard operating procedures, and finally, lack of training on important leadership/management skills. As a result of these core problems, several potential solutions are possible, all with potential obstacles to implementation. Additional education around communication and team interaction was felt to be a priority. In summary, clinical leaders probably have a great deal to gain from augmenting their leadership/management skills.

Clinicians today frequently encounter situations in which they are ill prepared for the leadership and management challenges that they will face. In the critical care environment, resource limitations, increasing complexity of care and diversity of personnel involved make a poorly prepared leader vulnerable. Moreover, the current complex and stressful work environment results in a greater need for strategies to manage stress and conflict. Clinicians who are solely schooled in patient care but assume leadership roles are therefore at a great disadvantage.

In health care institutions, leadership skills are recognized as important across all disciplines. The quality of a leader is important to support the managerial function in all organization and not be forgotten in health care environment. So that, in order to get leadership skills, there are several aspect that leader needs in order to improve their skills. Necessary skills include effective communication among team members and subordinates also among customer (in this situation, patient is the customer). The leader must be an effective communicator to achieve high-level of motivation and visionary success. Good communication skills are a must in building confidence and loyalty among the group. It should be the goal of the organization to create a two way communication system that allows information to flow from leader to follower and vice versa, including dissent, should it occur. This provides the opportunity for followers to attain a degree of empowerment and authority in their own right. Achieving such communication requires a leader to have emotional intelligence in order to work with the basics of needs-based motivation, and to encourage a cooperative teamwork. Managing relationships and communication delivery with people is an unquestionable facet of leadership.

Conflict can be resolved when there has understanding of one’s own communication style as well as that of others and having the skills to resolve the arrived conflicts among team members and also management. Leadership training should be available for every team members in reducing error among team members or any miscommunication problem that arise.

Style of Leadership

As a matter of fact, there are three style of leadership which are aotocratic, bureaucratic and laissez faire. Autocratic ledership style is often considered the classical approach. In this style, manager is the only one retains as much power and decision making authority as possible. As Faugier and Woolnough (2002) agreed that autocratic leaders set an end goal without allowing others to participate in the decision making process. The manager does not consult employee, nor are they allowed to give any input. Employees are expected to obey orders from employer without receiving any explainations. The motivation environment is produced by creating a structured set of rewards and punishments. Some expert point out the disadvantage of autocratic leadership style but autocratic leadership is not all bad. Sometimes it is the most effective style to use. These situations can include; the effective supervision that can be provided only through detailed orders and instructions; new, untrained employees who do not know which tasks to perform or which procedures to follow; employees do not respond to any other leadership style and so on. Need to highlight that the autocratic leadership style should not be used when employees become tense, fearful, or resentful; employees expect to have their opinions heard; employees begin depending on their manager to make all their decisions; there is low employee morale, high turnover and absenteeism and work stoppage and so on.

Meanwhile, bureaucratic leadership is where the manager manages “by the book” which means that everything must be done according to procedure or policy. If it isn’t covered by the book, the manager refers to the next level above him or her. This manager is really more of a police officer than a leader. This statement supported by Faugier and Woolnough (2002) where they said that bureaucratic leadership occurs when a leader strictly adheres to upon the policies, rules and regulations. Bureaucratic leadership style can be effective when employees are performing routine tasks over and over; employees need to understand certain standards or procedures; employees are working with dangerous or delicate equipment that requires a definite set of procedures to operate and so on. However, this leadership style is ineffective when work habits forms that are hard to break, especially if they are no longer useful; employees lose their interest in their jobs and in their fellow workers; employees do only what is expected of them and no more and so on.

Difference with the autocratic style, laissez faire leadership leaves employees to their own devices in meeting goals, and is a highly risky form of a leadership where the leader switches between the above styles depending upon the situation at hand and upon the competence of the followers. This style of leadership effective to use when employees are highly skilled, experienced, and educated; employees have pride in their work and the drive to do it successfully on their own and when outside experts, such as staff specialist or consultants are being used. But, this style should not be used when it makes employees feel insecure at the unavailability of a manager.

Transactional leadership concerning day-to-day operation in unchanged organizational system (Lindholm et al., 2000). Burns (1978) said that transactional leadership refers to exchange that advance the purposes of each party in economic, political, or psychological ways. Howkins and Thornton (2002) stated that in transactional leadership, one person take the initiative for the activities, actions or exchanges. For that, one person can be seen as having greater power and control and each person having a different investment in that situation. Jones and Jenkins (2006) argue that ‘transactional leadership was seen as encouraging performance by making rewards contingent on delivery and only intervening actively when performance did not meet expectations’. Managers therefore focus on objectives, tasks, procedures and policies. It’s about being orderly and organised with limited freedom for staff and having results around efficiency (being capable), effectiveness (being successful), productivity (being competent) and order. Transactional management is not best suited for the current climate. Traditionally this approach has maintained the status quo, stifled change and disempowered staff. Historically nurses have been criticized for not contributing to policy formulation and placing far too much emphasis on day to day activities.

According to Burns (1978), transformational leadership define the need for change, create a vision, and inspire subordinates to achieve goals. This leadership style more focused on processes that motivate followers to perform to their full potential by influencing change and providing a sense of direction (Cook, 2001). Sofarelli & Brown (1998) argue that transformational leadership is a style which is ideally suited to the present climate of change because it actively encourages innovation and change. This basis of this style of leadership is its interpersonal nature. It is a process that changes and transforms individuals and is driven by a genuine concern for individual needs of those in the team who are the followers. In adopting this style of leadership, leaders have to place emphasis on supporting, encouraging, inspiring, projecting their ideas, working on the longer term rather than the short term and treating staff as human beings. In summary transformational leadership is about interaction with a focus on the management of change and empowering staff in your teams in order to achieve your shared vision in a collegial and collaborative manner

Recommendation: Developing Transformational Leadership in Nursing.

In today’s nursing practice, transformational leadership is more ideal and suitable. Furthermore, adopting transformational leadership in nursing or health care management will enable nurses in order to improve patient care. Nurses also can develop their communication, interpersonal and decision making skills by using transformational leadership. Other than that, by adopting transformational leadership, it can empower nurses to manage innovation, take risks, increase their autonomy and of course expand their role. Nurses also are more motivated and to work more effectively in interprofessional teams and at the same time develop networks and peer groups.

Conclusion

Determine the style of leadership is very important to running the organization so that the organization goals will achieved. To achieve some or all of this there will be a need for a significant cultural change in the culture of many organizations and this will be challenging for many. In addition, high performing clinical teams need information and systems in order to improve performance with regard to quality outcomes, good patient satisfaction survey results, education and training. Lastly, efforts by organizations and individuals to encourage and develop transformational and are needed to enhance nurse satisfaction, recruitment, retention, and healthy work environments, particularly in this current and worsening nursing shortage.