Leadership moments: Understanding nurse clinician-scientists' leadership as embedded sociohistorical practices

Nurse clinician-scientists are increasingly expected to show leadership aimed at transforming healthcare. However, research on nurse clinician-scientists' leadership (integrating researcher and practitioner roles) is scarce and hardly embedded in sociohistorical contexts. This study introduces leadership moments, that is, concrete events in practices that are perceived as acts of empowerment, in order to understand leadership in the daily work of newly appointed nurse clinician-scientists. Following the learning history method we gathered data using multiple (qualitative) methods to get close to their daily practices. A document analysis provided us with insight into the history of nursing science to illustrate how leadership moments in the everyday work of nurse clinician-scientists in the "here and now" can be related to the particular histories from which they emerged. A qualitative analysis led to three acts of empowerment: (1) becoming visible, (2) building networks, and (3) getting wired in. These acts are illustrated with three series of events in which nurse clinician-scientists' leadership becomes visible. This study contributes to a more socially embedded understanding of nursing leadership, enables us to get a grip on crucial leadership moments, and provides academic and practical starting points for strengthening nurse clinician-scientists' leadership practices. Transformations in healthcare call for transformed notions of leadership.

The "Way" Toward E-leadership: Some Evidence From the Field

Recently, leadership literature has faced the challenge of dealing with a growing pervasive diffusion of information and communication technologies that are deeply changing relationships among workers. Consequently, leadership is continuing to develop through the support of these technologies. This emerging phenomenon has been labeled e-leadership, and it has been studied with the objective of understanding the differences it exhibits from traditional leadership. Our research seeks to examine whether enterprises, which use leadership as an important “tool” to manage workers as effectively as possible, are conscious of this evolution, whether their behavior is supportive of the related needs, and how they are organizing themselves to face the problems and opportunities arising in this new context. The present study involved 15 Italian companies. Through in-depth interviews based on face-to-face meetings using a semi-structured questionnaire with enterprises’ representatives, we explored the extent of these changes. We developed the analysis across two points in time in order to verify if a change was observable with regard to the way these enterprises considered and managed e-leadership. It was also possible to enhance the role of the technologies themselves in leadership, which in the same period has seen a rapid evolution toward mobile and social developments. Our results help to illuminate that, on the one hand, awareness with regard to e-leadership has increased and, on the other hand, the pervasiveness of technologies is playing a relevant role in the change of leadership together with renewed attention toward soft competencies. We identify four different typologies of e-leadership, which summarize different ways of conceptualizing it, and indicate their main features. We should add that this topic is becoming extremely relevant because of the critical crises organizations are now facing (such as the COVID-19 emergency we are experiencing at the present time) and the urgency of adopting e-instruments, which seem now to be the main path to managing the present situation and the aftermath it inevitably will have. Despite this research being carried out before such an event has happened, we believe that its results may further enrich the current lively debate.

Boards of directors' influences on occupational health and safety: a scoping review of evidence and best practices

Purpose

To review the literature and identify research gaps in the role and influence boards of directors of companies have in occupational health and safety (OHS).

Design/methodology/approach

This was done in a scoping review built on a structured search in MEDLINE (PubMed), EMBASE, PsycINFO, Sociological Abstracts, CCInfoWeb, EconLit, Web of Science, CINAHL and gray literature. Citations and reference lists were tracked. Inclusion criteria were publication in English. Exclusion criteria were studies covering companies using subcontractors to arrange OHS, or with <250 employees.

Findings

Forty-nine studies were included. The majority contained empirical data (n = 28; 57%), some were entirely normative (n = 16; 33%), and a few contained normative claims far beyond empirical data (n = 5; 10%). Empirical studies gave no insight into the scope of impact of board activities on OHS, and no studies assess the causal mechanisms by which board activities influence OHS outcomes. Most studies focused on both health and safety (n = 20; 41%) or only safety (n = 15; 31%). Context might explain the focus on safety rather than health, but is not clearly elucidated by the studies. Several studies are describing leadership behavior, although not framed as such. A narrative summary is presented to facilitate future research.

Research limitations/implications

Future research should include: (1) which board activities influence OHS, (2) how board activities influence OHS, (3) the influence of context and (4) the leadership role of boards of directors.

Originality/value

This study identifies a total lack of research on the basic mechanics of the relationship between boards and OHS.

Shared leadership: Struggles over meaning in daily instances of uncertainty

Research presented in this article advances existing work on shared leadership and organizational sensemaking by an empirical demonstration of the organizing properties of leadership in daily instances of uncertainty. Drawing on conversation analysis combined with ethnographic data collected during 12-month fieldwork, this article spells out the conversational mechanisms and discursive practices used by leadership actors in the process of sensemaking directed towards organizationally relevant goals. Through a fine-grain analysis of an extended troubles-telling sequence in a particular meeting encounter, this study shows how conversation analysis–inspired research can be used to add a more nuanced understanding of a substantive area of social life, such as shared leadership which is achieved in interaction and which involves various leadership actors, regardless of their hierarchical positions and organizational roles.

Accomplishing leadership-in-interaction by mobilizing available information and communication technology objects in a virtual context

Leadership-in-interaction is a somewhat underdeveloped area of research which to date has concentrated on talk-in-interaction to the detriment of other modalities. Consequently, this paper seeks to illustrate how social actors make use of different modalities to accomplish leadership, which we conceptualize as the creation of direction, alignment, and commitment. Through multimodal conversation analysis this paper explores interactions between actors in virtual contexts, a particularly interesting empirical setting as the context offers specific constraints on everyday workplace interaction. By zooming in on the interaction using transcripts of naturally occurring interaction, we find that the accomplishment of leadership, direction, alignment, and commitment, in a constrained virtual context can appear mundane. However, at the same time the accomplishment of leadership calls for the mobilization of several multimodal resources (both talk and information and communication technology objects). The analysis makes it evident that the actors mobilize objects to draw on their situated affordances, in the accomplishment of direction, alignment, and commitment. With a fine-grained analysis of naturally occurring data, we illustrate that leadership is a collective achievement. We also expand the understanding of leadership in practice, especially in virtual contexts, by demonstrating how actors utilize objects and verbal resources in the co-production of leadership.

The negotiation of sharing leadership in the context of professional hierarchy: Interactions on interprofessional teams

While there is growing recognition of leadership as a collective phenomenon, the question of how leadership is shared in the context of hierarchical asymmetry has been neglected in the collective leadership literature. Our article addresses this gap by examining how sharing leadership is negotiated in team interactions that are steeped in asymmetry deriving from the professional hierarchy. Adopting a leadership-in-interaction approach, we draw on fine-grained analysis of observed interactions on interprofessional teams from two health care organizations to compare the discursive strategies used by professionals in a superior hierarchical position to the ones used by those in inferior positions to share leadership. These strategies are organized into a matrix of interactional moves that resist or enact the professional hierarchy. Empirical vignettes are provided to demonstrate how sharing leadership and hierarchical leadership can be co-present and even intertwined in an interaction. We show that leadership is shared (or not) as a result of how the professional hierarchy gets negotiated in interactions. More specifically, we conclude that the sharing of leadership in this context tends to occur prior to decision making, especially around problem formulation, if the interactional climate allows. Furthermore, it requires concrete effort: Those in superior positions of influence mindfully relax the hierarchy whereas those in inferior positions create moments of sharing leadership through resistance and struggle.

How trainee hospital doctors lead work-based projects

Purpose

The purpose of this study is to explore how trainee hospital doctors led work-based projects undertaken on an accredited development programme in England.

Design/methodology/approach

This is a case study of a leadership programme for hospital-based specialty trainees. The programme included participants leading work-based projects which were submitted for academic accreditation. Accounts of 35 work-based projects were thematically analysed to explore how participants led their projects.

Findings

Leadership was often informal and based on a series of individual face-to-face conversations. The establishment of project teams and the use of existing communication processes were often avoided. The reasons for this approach included lack of opportunities to arrange meetings, fear of conflict in meetings and the personal preferences of the participants. The authors discuss these findings with reference to theory and evidence about conversations and informal leadership, highlighting the relevance of complexity theory.

Research limitations/implications

The data are limited and drawn from the best accounts written for a specific educational context. There is therefore limited transferability to the leadership work of hospital-based specialty trainees in general. Future research into medical leadership might explore the micro practices of leadership and change, particularly in informal settings.

Practical implications

Leadership development programmes for trainee hospital doctors might concentrate on developing skills of conversation, particularly where there are or may be perceived power imbalances. Exploring conversations within the theory of complex responsive processes should be considered for inclusion in programmes.

Originality/value

This paper adds some detail to the general understanding of learning leadership in practice.

The experiential understanding group-and-leader managerial course: long-term follow-up

Purpose

The purpose of this paper is to report on the results of an experiential leader development course titled understanding group-and-leader (UGL).

Design/methodology/approach

The study sample consisted of 61 course participants (the managers) and 318 subordinate raters. The development leadership questionnaire (DLQ) was used to measure the results of the course. The measurements were made on three occasions: shortly before the course, one month after the course and six months after the course.

Findings

The managers’ self-evaluations did not change significantly after the course. However, the subordinate raters’ evaluations of their managers indicated a positive trend in the scales of developmental leadership and conventional-positive leadership one month and six months after the course.

Research limitations/implications

The study was based on a comparatively small sample with a number of drop-outs. The study lacked a control condition.

Practical implications

From an organizational point of view, it could be argued that it is justifiable to send managers to such a course, as there is a good chance for an improvement in their leadership style as rated by subordinates.

Social implications

The integration of group processes and leadership behavior in the context of experiential learning seems to be a fruitful path to leader development.

Originality/value

Longitudinal studies on the results of experiential learning for managers are sparse. This is the first quantitative evaluation of a course that more than 80,000 individuals have taken.

The supervisors who became leaders: Leadership emergence via changing organizational practices

This paper examines leadership and leader emergence as a contextual process. The paper argues that the emergence of leader identities is a contextual process which is premised on relations between organizational actors and practices. We adopt a social constructionist view on leadership emergence, applying a practice theory perspective on an empirical case of supervisory leadership emergence. Our empirical material consists of informant accounts and corporate documentation of a multiyear organization development project. The empirical narrative explores how the expectation set for a group of supervisors in the organization to act as leaders of production was initially impaired by a lack of participation in central organizing activities. The organization development project reformed the supervisory work to include more tasks related to production activities, which facilitated a new interpretation of the supervisors as leaders. We analyse how the inclusion of supervisors in the daily production practices induced an identity change where the supervisors came to be identified as leaders in production. We argue that contextual changes at the level of organizing practices can influence leadership and leader emergence.

Peer-to-peer shadowing as a technique for the development of nurse middle managers clinical leadership

Purpose The purpose of this study was to explore the experiences and impact of peer-to-peer shadowing as a technique to develop nurse middle managers' clinical leadership practices. Design/methodology/approach A qualitative descriptive study was conducted to gain insight into the experiences of nurse middle managers using semi-structured interviews. Data were analysed into codes using constant comparison and similar codes were grouped under sub-themes and then into four broader themes. Findings Peer-to-peer shadowing facilitates collective reflection-in-action and enhances an "investigate stance" while acting. Nurse middle managers begin to curb the caring disposition that unreflectively urges them to act, to answer the call for help in the here and now, focus on ad hoc "doings", and make quick judgements. Seeing a shadowee act produces, via a process of social comparison, a behavioural repertoire of postponing reactions and refraining from judging. Balancing the act of stepping in and doing something or just observing as well as giving or withholding feedback are important practices that are difficult to develop. Originality/value Peer-to-peer shadowing facilitates curbing the caring disposition, which is essential for clinical leadership development through unlocking a behavioural repertoire that is not easy to reveal because it is, unreflectively, closely knit to the professional background of the nurse managers. Unlike most leadership development programmes, that are quite introspective and detached from context, peer-to-peer shadowing does have the potential to promote collective learning while acting, which is an important process.

The absent follower: Identity construction within organisationally assigned leader–follower relations

This article seeks to add to our understanding of processes of identity construction within organisationally assigned leader–follower relations through an exploration of the role of the absent, feminised follower. We situate our work within critical and psychoanalytic contributions to leader/ship and follower/ship and use Lacan’s writings on identification and lack to illuminate the imaginary, failing nature of identity construction. This aims to challenge the social realist foundations of writing on leader–follower constellations in organisational life. We examine our philosophical discussion through a reflective reading of a workplace example and question the possibility of a subject’s identity construction as a follower. If a subject is unable to identify him/herself as follower, he/she cannot validate others as leaders, rendering the leader–follower relationship not only fragile but phantasmic. We highlight implications of our exploration of the absence of follower/ship and endless, unfulfilled desire for leader/ship for future research and practice.

A randomised study of leadership interventions for healthcare managers

Purpose

The purpose of this paper was to assess two different leader development interventions by comparing their effects on leadership behaviour and evaluating their combined impact after two years, from the viewpoints of both the participating managers and external raters.

Design/methodology/approach

The study was a longitudinal randomised controlled trial with a cross-over design. Health care managers (n = 177) were first randomised to either of two 10-month interventions and a year later were switched to the other intervention. Leadership behaviour was rated at pre-test and 12 and 24 months by participating managers and their superiors, colleagues and subordinates using a 360-degree instrument. Analysis of variance and multilevel regression analysis was performed.

Findings

No difference in effect on leadership behaviour was found between the two interventions. The evaluation of the combined effect of the interventions on leadership behaviour showed inconsistent (i.e. both increased and decreased) ratings by the various rater sources.

Practical implications

This study provides some evidence that participation in leadership development programmes can improve managers’ leadership behaviours, but the results also highlight the interpretive challenges connected with using a 360-degree instrument to evaluate such development.

Originality/value

The longitudinal randomised controlled design and the large sample comprising both managers and external raters make this study unusually rigorous in the field of leadership development evaluations.

The bumpy road to exercising leadership: Fragmentations in meaning and practice

The present study focuses on a manager’s understanding of leadership and how this guides – or does not guide practice. The paper reports an empirical in-depth study of a middle manager in an international manufacturing company. We link our discussion to both – the mainstream leadership studies, which assume that managers have a solid type of leadership behavior, and authors with a meaning-oriented, linguistic approach to leadership, in which language, self-awareness, and behavior are linked. The present study suggests that leadership attempts can vary, be divisive, and that a manager’s advocacy efforts are driven by a multitude of different, partly opposing, forces, meaning a decoupling of ideas and behavior in leadership practice. The paper raises the question of whether managers’ meanings of leadership correspond with what they do in practice.

Leadership between decks

Purpose

– The purpose of this paper is to understand the role of interaction in the process of leadership. Interaction has been claimed to be a leadership competence in earlier research into leadership in the Royal Navy. The aim of this research is to define how interaction works within naval teams.

Design/methodology/approach

– The research uses Grounded Theory. Following a series of leadership discussions in separate focus groups, discussion topics were coded and subjected to recursive qualitative analysis. The grounded approach is used to synthesise and develop existing leadership theory strands as well as to extend the trait-process approach to leadership.

Findings

– The research discovers the key interaction behaviours of engagement, disengagement and levelling. Our findings support recent developments in follower-centric perceptions of leadership and in interaction specifically. The authors develop engagement theory by combining it with the less well researched area of leadership resistance. The authors then re-frame resistance as social levelling, a more comprehensive interaction mechanism.

Research limitations/implications

– The research is highly contextual because of its qualitative approach. Some of the detailed reactions to leadership behaviours may not found in other naval or military teams and are unlikely to be generalisable to non-military environments. However, the mechanism described, that of engagement, disengagement and levelling is considered highly generalisable if not universal. Rather than develop new theory fragments in an already confusing research environment, the authors fuse engagement and resistance theory to extend trait-process theories of leadership. The result is a coherent and integrative model of leadership dynamics which frames leadership in the mundane interaction of leaders and followers.

Practical implications

– Interaction as a competence is strongly supported as is the encouragement of cultures which promote interaction. Selection procedures for future leaders should include interaction skills. The use of subtle methods of resistance are highlighted. Such methods may indicate poor interaction long before more overt forms of resistance are apparent.

Social implications

– The continual monitoring of leaders and implied ambivalence towards leadership could be critical to our understanding of leadership. A dynamic feedback circle between leaders and followers may be a more useful paradigm for the characterising of leadership throughout society. A better understanding of the power of followers to frame and re-frame leadership would help to manage the expectations of leaders.

Originality/value

– This research uniquely uses Grounded Theory to extend current theories (competence based leadership and trait-process theories of leadership), explaining the complexity of leadership interaction. The research also synthesises and develops engagement and levelling (resistance to leadership) theories for the first time. As such the project suggests a full range model of follower response to leadership including subtle forms of resistance to power. The value of group-level analysis using focus groups is recommended, especially for other collective leader-follower approaches to leadership. The research is of interest to those studying leadership process theories, competencies, leader-follower traditions, engagement and power/resistance research.

Is there leadership in a fluid world? Exploring the ongoing production of direction in organizing

Although the idea of leadership being a process is clearly stated in leadership definitions, most researchers focus on individuals rather than observing and studying processes. This contradiction has been highlighted by a number of scholars turning to leadership processes and practices, thereby drawing attention to the interactional and social aspects of the phenomenon. Such contributions mostly take process perspectives in which entities still play an important role. In this article, I therefore aim at contributing to leadership studies based on a process ontology by exploring one central aspect of leadership work, the production of direction, processually. I do so by building on geographer Massey’s conception of space, thus adding a spatial dimension that enables me to conceptualize direction as the development of an evolving relational configuration. In order to empirically explore such a conceptualization, two constructs are proposed: the construction of positions and the construction of issues. The reading of leadership work thus produced leads me to suggest ‘clearing for action’ as a means of conveying the spatio-temporal and constructive (reality constructing) character of leadership work.

‘Should I Stay or Should I go?’ Exploring Leadership-as-Practice in the Middle Management Role

This article explores dilemmas in middle manager work through the perspective of leadership-as-practice. An autoethnographic account is outlined of how a dilemma is addressed by a middle manager. The account shows how a dilemma faced by a middle manager needs to be understood as situated within the flow of activity that is itself nested in a context of roles and relationships as well as the strategic context. The authors show how the outcome of the dilemma became accommodated within the emergent practice in the organization with no sense of recognition of the dilemma’s impact. The notion of middle manager agency within leadership-as-practice is explored through aspects of moral disengagement. The article problematizes two aspects: firstly, that normative ethical theorizing has been unable to cater for the complexity of middle manager work seen through the practice lens; second, that notions of leadership as ‘leader’ appear absent from the narrative describing middle manager work when seen through the lens of traditional leadership theory. Finally, the article gives insight and structure to researching leadership-as-practice.

Employee perceptions of managers’ leadership over time

Purpose

– This paper aims to explore if and how employees in a healthcare organisation perceive changes in their managers’ leadership behaviour over time.

Design/methodology/approach

– An interview study was conducted with employees whose managers had participated in a two-year leadership development programme offered by their employer, Healthcare Provision Stockholm County. Qualitative content analysis was applied, and the interview discussions focused on areas in which the majority of the informants perceived that a change had occurred over time and their answers were relatively consistent.

Findings

– The majority of employees did discern changes in their managers’ leadership over time, and, with very few exceptions, these changes were described as improvements.

Practical implications

– The knowledge that employees perceived changes in their managers’ leadership supports investments in leadership development through courses, programmes or other initiatives.

Originality/value

– The present findings contribute to a deeper empirical understanding of leadership as it is practised over time in everyday contexts among employees in healthcare organisations.

Leaders as ventriloquists. Leader identity and influencing the communicative construction of the organisation

Traditionally leadership studies have focussed on psychological and quantitative approaches that have offered limited insights into the achievement of leader identity as an interactional accomplishment. Taking a discursive approach to leadership in which leaders emerge as those who have most influence in communicatively constructing the organisation, and using transcripts of naturally occurring decision-making talk, the purpose of this paper is to make visible the seen but unnoticed discursive resources by which leader identity emerges in talk. More specifically, using actor network theory as a methodology, this paper focusses on how the director of an organisation ventriloquises (i.e. makes another actor speak through the production of a given utterance) other entities to do leadership. Findings indicate that leadership is achieved by making relevant to the interaction hybrid presences of actants that allow certain organisational players to influence the communicative construction of the organisation and so manage the meaning of organisational reality. In this way, social actors talk into being a ‘leader identity’, which is not necessarily a purely human physical presence, but can also be a hybrid presence of human and nonhuman actants, which are dislocated across time and space. The hybrid production of presence(s) also allows leaders to enact authority as a way of influencing others to accept their version of organisational reality.

Project Leadership in Becoming: A Process Study of an Organizational Change Project

Drawing on the current research in general leadership, we propose that a process ontology is relevant and rewarding for project leadership studies. We argue that project leadership can be studied as the ongoing social production of direction through the construction of actors' space of action, involving continuous construction and reconstruction of (1) past project activities and events; (2) positions and areas of responsibility; (3) discarded, ongoing, and future issues; and (4) intensity, rhythm, and pace. Through an ethnographic case study of an organizational change project, we show how space of action and hence the project direction are in constant flux and becoming.

Small stories, positioning, and the discursive construction of leader identity in business meetings

Stories are considered to be an essential part of organisational life and thus of leadership. However, to date research into stories and leadership has concentrated on big stories and life narratives and has tended to overlook the identity work that small stories perform as part of everyday workplace interaction. Working from the premise that leaders are managers of meaning, and using transcripts of naturally-occurring stories that were video-taped during a business meeting, this paper uses positioning theory as a research methodology to explain how leadership and leader identities are achieved through narrative both at a discourse (little-d) and Discourse (big-D) levels. Findings indicate that certain participants at the meeting are able to use discursive resources to manage the meaning of the organisation in both the story world and the real world and so do leadership and talk into being a leader identity.

Leadership as boundary work in healthcare teams

This paper proposes that boundary work is inherent to leadership practices in healthcare settings, and explores this phenomenon in interprofessional healthcare teams. Specifically, the study focuses on leading through and across boundaries in four interprofessional healthcare teams operating in the area of mental health services. We give special consideration to the specific contexts of these teams, and address the boundaries that are constructed and managed in interactions. Our qualitative study revealed that leadership can be exercised by different members and at different levels within the teams, and that it involves managing the boundaries between (a) roles of different members of the leadership constellation, (b) leadership and clinical roles, (c) formal leaders and other members of the team, (d) different professions, (e) personal life experiences and professional work, and (f) the team and what members consider to be the environment. We identify different types of boundary work tactics that involve opening, closing, and contesting/negotiating boundaries. In addition, we address the potential consequences of each of these tactics. We consider the implications of our findings to leadership research and practice in healthcare contexts and beyond.

Organizing, changing and learning: A sensemaking perspective on an ongoing ‘soap story’

This article adopts a sensemaking perspective to explore changing and learning in an organization that has been making the same product for more than 175 years. Using an insider/outsider methodology, this case provides evidence of dynamic, ongoing processes of changing and learning across time, albeit without formal change intervention. We conclude that organizational becoming, learning and change are found in the juxtaposing of order and disorder, frames of past learning and cues of present action. This balance between the past and emerging present is advanced as a way of seeing organizational learning, which is sensitive to process and time.

From leadership-as-practice to leaderful practice

Consistent with views that see leadership emerging from social practices rather than from the external mind, this paper contributes to an emerging movement in leadership studies known as ‘leadership-as-practice’ (L-A-P). This movement looks for leadership in its music and activity rather than in the traits and heroics of individual actors. The article distinguishes L-A-P from the individualistic approach by explaining its intersection with its dualistic counterpart, theory; with the agency—structure problem; and with relationality and meaning in organizations. It calls for a modification in classic approaches to research methodology and to leadership development. L-A-P is advised to consider its natural affinity with democratic participation through leaderful practices that systematically privilege the co-creation of social organization.