Understanding Leadership from the Inside: Using Ethnographic Methods to Examine How the Interplay between Leaders, Followers, and Group Context Shapes Leadership Outcomes

This paper outlines a novel method for leadership researchers and practitioners to understand how and why effective and ineffective leadership look different in different groups. Leadership is a complex and contextually dependent process influenced by the interplay between leaders, followers, the group, and their environment. The social identity approach to leadership describes how a group's identity shapes the ways in which people can lead effectively. It also implies that (in)effective leadership looks different across diverse groups and teams. Accordingly, it follows that there is no single correct way to lead. To explore these ideas, we propose ethnographic methods, where researchers and practitioners immerse themselves in a group environment, as a novel type of method for examining leadership in action. We suggest the social identity approach as a framework to help guide researchers' data collection and sense-making of leadership behaviours. Additionally, we explain that ethnographic data can be represented well through creative non-fiction stories that capture the context surrounding leadership behaviours. These stories could support leadership consultancy and development programs to demonstrate the complex interplay between leaders, followers, and the group context.

Healthcare leaders' experiences of implementing artificial intelligence for medical history-taking and triage in Swedish primary care: an interview study

BACKGROUND

Artificial intelligence (AI) holds significant promise for enhancing the efficiency and safety of medical history-taking and triage within primary care. However, there remains a dearth of knowledge concerning the practical implementation of AI systems for these purposes, particularly in the context of healthcare leadership. This study explores the experiences of healthcare leaders regarding the barriers to implementing an AI application for automating medical history-taking and triage in Swedish primary care, as well as the actions they took to overcome these barriers. Furthermore, the study seeks to provide insights that can inform the development of AI implementation strategies for healthcare.

METHODS

We adopted an inductive qualitative approach, conducting semi-structured interviews with 13 healthcare leaders representing seven primary care units across three regions in Sweden. The collected data were subsequently analysed utilizing thematic analysis. Our study adhered to the Consolidated Criteria for Reporting Qualitative Research to ensure transparent and comprehensive reporting.

RESULTS

The study identified implementation barriers encountered by healthcare leaders across three domains: (1) healthcare professionals, (2) organization, and (3) technology. The first domain involved professional scepticism and resistance, the second involved adapting traditional units for digital care, and the third inadequacies in AI application functionality and system integration. To navigate around these barriers, the leaders took steps to (1) address inexperience and fear and reduce professional scepticism, (2) align implementation with digital maturity and guide patients towards digital care, and (3) refine and improve the AI application and adapt to the current state of AI application development.

CONCLUSION

The study provides valuable empirical insights into the implementation of AI for automating medical history-taking and triage in primary care as experienced by healthcare leaders. It identifies the barriers to this implementation and how healthcare leaders aligned their actions to overcome them. While progress was evident in overcoming professional-related and organizational-related barriers, unresolved technical complexities highlight the importance of AI implementation strategies that consider how leaders handle AI implementation in situ based on practical wisdom and tacit understanding. This underscores the necessity of a holistic approach for the successful implementation of AI in healthcare.

Leadership development in genetic counseling graduate programs

Leadership is emerging as an important component of health professional training. This study aimed to characterize current leadership development in accredited genetic counseling programs. Semi-structured interviews with program leadership were conducted to explore their program's leadership curricula and their perspectives on the meaning of leadership and its place in genetic counseling training. Eleven interviews were conducted and focused on seven categories related to study goals. Using the Framework Method, themes were generated within the predefined categories. Categories and themes included Defining Leadership (Positional vs Non-positional, Beliefs about Leadership, Role of Leadership in the Field of Genetic Counseling), Leadership Curricula Origin and Delivery (Course-based and Longitudinal, Explicit vs. Implicit, Origin of Material), Role of Faculty and Students (Role of Faculty, Expectations for Students and Qualities of Students), Skills, Evaluation, Priority (Potential for Improvement, Barriers and Facilitators), and Standards (Current Incorporation, Potential Incorporation). All programs had some form of leadership development, but many participants lacked a personal or program definition of leadership. Leadership development varied in curricula and delivery, but most were longitudinal and faculty-driven, with communication, teaching, advocacy, and collaboration as commonly taught skills. However, leadership development opportunities were rarely labeled as such, and participants identified labeling current leadership development as the top area for improvement. Labeling leadership development could improve assessment of current efforts and the ability to address gaps in leadership curricula. This would lay the foundation for necessary intentional leadership development, in turn helping us better advocate for our patients and the profession.

When the boat comes in. An empirical study of leadership as emerging activities at Greenlandic fish factories

Based on empirical work at Greenlandic fish factories this article develops a more nuanced view on middle management activities. The empirical findings suggests that the leadership practice of middle managers invokes problematization as a collective achievement, based on experience and sensitivity. At the fish factory the middle management activities stand out as a bricolage practice happening as processual activities enacted in an interplay between many organizational actors. The processes where leadership emerges involves different perspectives that support appropriate problematization of the mundane activities as they unfold. Thus, the discussion of leadership is concerned with how middle managers emerge themselves in daily sensitivity work. This contrasts with conventional leadership research, much of which is turning leadership into an “it” assuming stable relations. The concepts of experience and sensitivity contributes to a more complex understanding of the mundane everyday leadership practice that unfold among various organizational actors.

The gaslighting of authentic leadership 2.0

This article is a response to Bill Gardner and Kelly McCauley’s ‘gaslighting’ critique of our text on the perils of authentic leadership. Against gaslighting 1.0 (evilly trying to convince people to doubt their perceptions), we propose gaslighting 2.0 (enlightenment). We argue that organizations face severe problems and challenges that cannot be solved by motivating managers to engage in introspection and being overly preoccupied by their own authenticity. A search for one’s true self is a personal journey of inner growth and heightened self-awareness that individuals, leaders and non-leaders may engage in and find highly beneficial, but outside any notion of exercising influence or power on others to reach career objectives or corporate goals. The broad use of simple recipes with claims of overwhelming positive effects is problematic. Leadership research is often based on highly problematic measures, making most efforts to capture the core phenomenon unreliable. That many people are attracted by simplistic, positive-sounding and ego-enhancing formulas is not the same as evidence for theoretical value and relevance of a truth claim. Taking aspiration as a critical element would call for the development and study of Aspirational Authentic Leadership Theory, which would be something quite different from the static study of how managers score in terms of being true to their values, a core self, and so on. In-depth process studies of managers trying to be authentic navigating dilemmas at work could be an alternative to focus further research on.

Leadership During a Pandemic: A Lexical Analysis

To manage pandemics, like COVID-19, leadership can enable health services to weather the storm. Yet there is limited clarity on how leadership manifested and was discussed in the literature during COVID-19. This can have considerable public health implications given the importance of leadership in the health sector. This article addresses this missed opportunity by examining the literature on leadership during a pandemic. Following a systematic search of nine academic databases in May 2021, 1,747 publications were screened. Following this, a lexical analysis of the results section was conducted, sourced from a corpus of publications across myriad journals. The results found a prevalence of references to “leader” as a sole actor, risking the perpetuation of a view that critical decisions emanate from a singular source. Moreover, “leadership” was a concept disconnected from the fray of frontline workers, patients, and teams. This suggests a strong need for more diverse vocabularies and conceptions that reflect the “messiness” of leadership as it takes shape in relation to the challenges and uncertainties of COVID-19. There is a considerable opportunity to advance scholarship on leadership via further empirical studies that help to clarify different approaches to lead teams and organizations during a pandemic.

Multilevel and multisite leadership development from a leadership-as-practice perspective: an integrative literature review

Purpose

This paper reviews what has been written on leadership development from the leadership-as-practice (L-A-P) perspective, which views leadership as emerging in everyday activities and interactions of a collective in a specific context. This paper aims to deepen the theoretical understanding of how leadership can be learned and developed from the L-A-P perspective.

Design/methodology/approach

An integrative literature review was undertaken to review and synthesise what has been written on the topic in journal articles and scholarly books.

Findings

The importance of the context and the practices that are embedded in it is the most central aspect affecting leadership development from the L-A-P perspective. This places workplace leadership development centre stage, but several papers also showed that leadership programmes have an important role. Not only collective capacity building is emphasised in the papers, but the importance of individual-level leader development is also recognised.

Originality/value

The contribution of this study is twofold: First, it brings the currently fractured information on L-A-P development together to enhance theory building by providing a synthesis of the literature. Second, a conceptual framework is constructed to show how the L-A-P perspective on leadership development can take both leadership development at the collective and individual levels into account, as well as the learning that takes place either inside or outside the workplace. This study’s results and framework show that the development has its own specific purpose and suggested methods in both levels, in both learning sites.

Trying out loud: Leadership development as experimentalism

Where does leadership development turn if its heroic ideals are no longer tenable? This study takes leadership practice, not the classroom, as its point of departure. Leadership studies have demonstrated the romance in leadership theory of an individual, stable, and coherent leadership figure, even if this figure does not connect to actual practices. In other streams of research, practice increasingly appears to be a resource for less presumptuous theorizing about leadership. These more situationally sensitive approaches call for equivalent leadership development practices, and extant literature in particular has escaped the confines of the executive management classroom to only a limited extent. While experiential learning has proved an efficient means of instigating and harvesting in-classroom experiences for subsequent reflection and learning, translating these experiences into (later) leadership practice has proved problematic. The mundanity of practice rarely corresponds to the theoretical exposés emanating from classrooms. Using a leadership development program (LDP) as our case, we explore accounts from managers carrying out in-practice experiments and analyze these processes in light of Dewey’s notion of experimentalism. Identifying a series of attributes associated with the experimental intervention, we illuminate some future avenues for situated leadership development as well as offer considerations for leadership development practice.

What does Success Look Like for Leaders of Integrated Health and Social Care Systems? a Realist Review

Introduction

Health and social care services in England are moving towards greater integration, yet little is known about how leadership of integrated care teams and systems can be supported and improved. This realist review explores what works about the leadership of integrated care teams and systems, for whom, in what circumstances and why.

Methods

A realist synthesis approach was undertaken in 2020 to explore English language literature on the leadership of integrated care teams and systems, complemented by ongoing stakeholder consultation.

Results

Evidence was identified for seven potentially important components of leadership in integrated care teams and systems: 'inspiring intent to work together'; 'creating the conditions'; 'balancing multiple perspectives'; 'working with power'; 'taking a wider view'; 'a commitment to learning and development' and 'clarifying complexity'.

Discussion

Research into the leadership of integrated care teams and systems is limited, with ideas often reverting to existing framings of leadership, where teams and organisations are less complex. Research also often focuses on the importance of who the leader is rather than what they do.

Conclusion

This review has generated new perspectives on the leadership of integrated care teams and systems that can be built upon, developed, and tested further.

Ambidextrous leadership: a narrative literature review for theory development and directions for future research

Purpose

This study seeks to provide a narrative literature review of existing empirical research, in order to better understand the processes and theory of ambidextrous leadership, as well as its influence on followers, employees and organizations.

Design/methodology/approach

Data from 26 studies were extracted and synthesied providing a critical discussion about the methodological and theoretical aspects of the studies identified in the review.

Findings

It was revealed the attributes for an effective ambidextrous leader, it was presented the recently proposed concept of ambidextrous leadership theory and it was noticed the main criticisms against the findings of the extant ambidextrous leadership literature. It was also identified many research gaps in the literature which in turn can guide academics in the development of ambidextrous leadership.

Research limitations/implications

The ambidextrous leadership theory represents a novel and unique approach to the domain of leadership for creativity and innovation. It is shared across hierarchical levels throughout the organization. Leaders have a significant effect on employees' behaviors and should determine its applicability to different situations. Organizations require ambidextrous managers who combine flexible, situational and versatile leadership styles developing ever increasingly new and divergent ideas. Many research gaps in the literature were also identified that can guide academics in the development of ambidextrous leadership.

Practical implications

Understanding that ambidextrous leadership is required to significantly influence ambidexterity and innovation allows organizations to direct their leadership selection and development.

Originality/value

This review contributes to the ambidextrous leadership literature by creating a holistic picture of where it has been and where it should go.

Community leaders as intermediaries: How everyday practices create and sustain leadership in five informal settlements in Cape Town

Community leaders are expected to navigate different social and institutional contexts, but they must do so without the direction, authority or legitimacy available to leaders within formal organisations. In this article, we draw on qualitative data from a participation initiative to explore how community leaders get involved in everyday maintenance of public services in informal settlements in Cape Town, in order to understand how they fulfil this intermediary role. Applying the lens of leadership-as-practice, we identify four practices that connect the communities and city, and which facilitate access to public services. We unpack how these practices emerge in and are shaped by the service maintenance system and material conditions of informality. We argue that community leaders fulfil their intermediary role through everyday improvisations to find ‘what works’, and in the process, they also create and sustain relations of dependence and interdependence that reinforce those very roles.

Barriers to leadership development: Why is it so difficult to abandon the hero?

Critical consensus holds that leader-centred leadership theories reproduce romanticism by exaggerating the impact of individual leaders. In contrast, a processual perspective views leadership as an ongoing social interaction involving all organisational actors. Developing such a processual leadership meaning, however, is not easy, especially as formal leaders are embedded in a business world that still supports the heroic image of a leader. Critical literature highlights the difficult road towards meaning development, on which leaders are confronted with various obstacles that can impede development. In order to better understand potential barriers to the development of a processual leadership meaning, we analyse the development of leadership meaning for EMBA students over the course of two years. In particular, we identify two hindering dynamics that show how a leader-centred leadership meaning becomes reconstructed and reinforced over time, despite receiving training input on a processual leadership meaning. Additionally, we generate insights on two patterns that explain why it is so difficult to abandon a heroic image by revealing the crucial role of one’s sense of self-as-a-leader. Finally, we provide important practical implications for future leadership development.

Exploring within the ‘black-box’ of leadership to make sense of the performative dynamics of conversation

This study emerges from a co-constructed autoethnography by a practitioner and two academic facilitators studying the leadership-as-practice processes within a small-to-medium sized private wealth business. The study set out to explore the performative dynamics of conversation constituted in, and emerging from, socially engaged talk through leadership in the flow of practice, referred to as ‘in-flow-ence’. The study proposes a dynamic metaphor theory that builds on in-flow-ence to capture the complexities of conversation and offer thoughts about ways to reconstitute leadership practice to bring about changes in trajectories of social action.

Epistemic Attitudes and Source Critique in Qualitative Research

In this essay, we explore and discuss current practices of source critique. In our empirical analysis of a sample of interview-based studies, we find that few studies show a careful and reflective stance toward their sources. In the majority of cases, we discern a tendency to either ignore basic issues of the trustworthiness of interview material or produce technical descriptions which seem to have no real effect on the actual assessment of the study’s sources. We suggest five epistemic attitudes which describe how scholars engage—or rather not engage—in source critique. To improve source critique, we suggest tactics of intra- and extrasource critique which seriously consider interactional dynamics behind and quality of interview content other than “truth” reporting, aiming to corroborate interview statements by carefully cross-checking interview material with observations and multiple sources.

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.