Leadership & Management in Health & Social Care: Taking the step up…
By Daniel Dutton, Oct 2019
The health and social care sector in the UK is in dire need of great leaders and managers.
This article explains what a health and social care practitioner needs to know to make the progression to a management or leadership role. It looks into various models of management and leadership and explores the skills needed for both roles. It also looks at how the managerial and leadership skills can complement one another and how to manage situations where they appear to be in conflict with one another.
But first, it is important to be able to differentiate between a leader and a manager.
The Difference Between Leaders and Managers
Zaleznik (1977) says that ‘managers and leaders are two very different types of people‘ and explains that managers are concerned with organisation, coordination and utilising resources in efficient ways to produce the desired outcomes. They tend to be risk averse and reactive towards situations. Leaders on the other hand are willing to take risks and are concerned with forging new paths and enthusing others with their ideas and their ideals. They are proactive and are able to envisage what changes may occur in the future and prepare for them.
Kotter (1990) also believes that leadership and management are different. He explains that management is about planning, organising, controlling and putting processes and systems in piace. Leadership is about setting a direction, inspiring others and anticipating and coping with change. Kotter concludes from this that “Leadership is therefore rooted in the maxim that the more change there is, the more leadership is required”.
In a typical organisation, one could say that leaders are the board of directors that create the vision whilst managers are the people that coordinate the practical tasks that enable that vision to become a reality. Or, as Stewart (1997) states ‘management is essentially about people with responsibility for the work of others and what they do operationally, whereas leadership is concerned with the ability to influence others towards a goal’.
Several models of leadership and management have been developed by theorists and these will be explored next.
Leadership Theories
Lewin et al. (1939) identified three primary leadership styles; autocratic, democratic and laissez-faire.
An autocratic leader will make all the decisions themselves and tell their team exactly what they want them to do and how to do it. It can be considered authoritarian and dictatorial as team members have little to no say in how work is carried out. This style would be useful in situations where decisions need to be made quickly, close oversight is required, processes must be streamlined or poor performance needs to be addressed. However, it does stifle creativity and cooperation, can be demoralising for the team and paralyse operations when the leader is not present. Some examples of where this style would be effective include an accident and emergency department or an army platoon in a warzone because decision-making must be swift and centralised.
A democratic leader will make their goals and priorities clear but will ask for input from their team and discuss ideas. They will usually, however, make the final decision themselves. This style leads to staff feeling involved and empowered in the decision-making process which can be good for morale and there is the opportunity to get a lot of viewpoints from different perspectives. However it can lead to decisions being made more slowly because input from the team will be diverse and time will need to be made for discussion, negotiation and compromise. There is also a risk of poor decisions being made if the team are unskilled or inexperienced. An example of where this style would be effective are in the day-to-day running of a residential home, providing the decisions being made are not mission-critical or time-sensitive.
A laissez-faire leader will hand over the decision-making process to their team. They will explain what is expected from them but will allow them the freedom to decide for themselves how this is achieved. The team will feel empowered and trusted and not have constraints that could impede their creativity however there may be confusion over individual roles in the team and work could go off-task. It works best for teams that are highly skilled, highly motivated and experienced in their work. An example of this style working effectively would be with a group of experienced research scientists that are passionate about making a cutting-edge medical breakthrough.
Lewin concluded from his research that the democratic approach appeared to be the most effective.
Tannenbaum and Schmidt (1958) built on Lewin’s ideas by developing the Leadership Behaviour Continuum. They suggested that when making decisions, a leader has seven options that range from an autocratic style where the leader makes the decision themselves to a laissez-faire style where the team makes the decision (see fig. 1). They advise that the option that a leader chooses for a particular decision-making process will depend on the nature of the decision and the capability of the team. 
Fig. 1 – Continuum of leadership behaviour (Tannenbaum & Schmidt)
This builds on Lewin’s theory by demonstrating that not one single leadership style is correct for all situations and a good leader will be flexible enough to be able to adapt their style when needed.
However, Fiedler (1958) argues that “A leader is effective when his or her style of leadership fits with the situation.” Fiedler’s Contingency Theory of Leadership says that a leader’s effectiveness is contingent on their leadership style matching the situation. So, for example, a leader with a natural autocratic style will only be able to thrive in a setting where this leadership style is required. This suggests that an individual’s leadership style is fixed and cannot be adapted to other situations. It divides leaders into two broad categories. People-oriented leaders have good interpersonal skills and rely on relationships with others to accomplish tasks whilst task-oriented leaders focus on the task and use positional power or authority to achieve their aims.
Hersey and Blanchard (1982) developed the Situational Leadership Model which focuses on leaders adapting their style to the situation and puts forward four styles of leadership; telling, selling, participatory and delegative. Telling is the most directive and involves giving clear instructions for team members to follow. Selling involves a little collaboration and persuasion on the part of the leader but ultimately they still make the decisions. The participatory style involves more collaboration and may even pass some decision-making to the team. And the delegative style involves passing on most of the responsibility and decision-making to the team.
The style that Hersey and Blanchard recommend depends on the experience/ability and motivation/confidence of the team. Teams that are inexperienced and unmotivated require the telling style, teams that are inexperienced but motivated require the selling style, teams that are experienced but unmotivated require the participatory style and teams that are experienced and motivated require the delegatory style. In addition, the telling and delegatory styles are more task-oriented and less relationship-oriented whereas the selling and participatory styles are less focussed on the task and more about the relationships between the leader and their team.
Both Fiedler’s Contingency Theory and the Situational Leadership Model identify leadership styles as being either task-focused or people-focused however Fiedler’s Contingency Theory states the the style used is rigidly based on the leader’s personal traits whereas the Situational Leadership Model argues that the leader can change their style based on the task in hand.
From my own experience, I would agree that a good leader can change their style where necessary. I have worked with leaders that have built a new teams and from the outset utilised a lot of structure, processes and direction to ensure that everyone works to plan. Over time, as the team increased in experience and confidence the manager shifted towards a more collaborative style where team members had more input into how things were run and later still when roles and responsibilities were well-established within the team and new leaders began to naturally emerge, they moved to a more delegative style.
I also believe that leadership style can be adapted on the individual level as well as the team level. For example, in my own team I know that there are members that I can trust to delegate tasks to and have confidence that they will be done to a high standard and in a timely fashion. This is due to their experience and the trust we have built up in one another over time. There are other members that perhaps do not have the experience or motivation to complete tasks for me to the standard I expect but I do value their opinions on things and will always seriously consider their ideas. For these people, I tend to use a more democratic and collaborative style. And there are also members of my team that are new to the care industry and inexperienced and I understand that they will require more support and direction whilst they gain experience so use a more autocratic style.
Management Theories
Management theories can be divided into three broad categories; classical, behavioural and modern.
Classical management theories developed during the first half of the twentieth century when mass production and factories were prevalent and there was a need to manage resources as efficiently as possible for maximum profit.
Fayol (1949) provided one of the first definitions of management as to ‘forecast and plan, to organise, to command, to co-ordinate and to control’. He developed a list of principles such as division of work, authority and discipline as being important to effective management.
Urwick (1943) believed that there are ten principles for effective management.
The first principle is the objective of the organisation, which should be well understood so that the team is directed in the right direction. This is followed by specialisation, which involves understanding the strengths and weaknesses of your team so that you choose the right person for the right task. Coordination is organising the time and creating unity and authority is having a clear chain of command. Everyone should fully understand their own responsibilities and all roles and job descriptions should be clearly defined. Correspondence is the link between work roles and team members understanding the responsibilities of others. Span of control relates to the number of reports/people team members of responsible which should be no more than 5-6 to prevent individuals becoming overwhelmed. Next is balance, which is ensuring all areas of an organisation are working effectively as poor performance in one area can have a detrimental effect in another. Finally, continuity ensures that there are plans for reorganisation when required and in contingencies.
Taylor (1911) developed a scientific system for accurately achieving the maximum efficiency in a production environment. It involved identifying the best possible way to do something and instructing team members how to do it so that anyone could become an expert in that particular role. This meant there was very little waste in time and other resources but team members were required to work in a rigid and structured way.
Although classical theories centre around maximising production with little regard for the motivation of staff other than adequate remuneration there may still be some contemporary situations where they can still be useful such as unskilled production line and factory work. In these environments, which often pay minimum wage and have a high turnover of staff, having efficient processes in place means that productivity continues almost seamlessly when employees leave and new staff take their place. This type of management considers people to be a resource that can be replaced when necessary rather than looking at employees as individuals.
Behavioural management theories shift the focus from the task itself to the people performing it. Psychology, sociology and more person-oriented methods became central to management.
Mayo (1946, 1949) carried out several studies to investigate ways of increasing productivity and concluded that output increased when employees were given individual attention, they felt a sense of belonging in their team and their contributions were valued. This brought a more humanistic approach to management and recognised the value of ‘soft’ skills in a manager.
In contemporary settings, this human relations approach can be used by managers to motivate staff without the need for traditional incentives such as financial reward. This can be beneficial, for example, for small businesses without the cashflow to provide their staff with competitive remuneration.
Modern management theories focus on management in a fast-paced world with increasing complexities and seeks to incorporate task-based and people-based management with other resources such as technology.
Quantitative Management Theory uses mathematical and statistical models and computer simulation to aid decision-making and problem-solving. Computers are used to analyse vast arrays of historical data to make accurate predictions about the future. Contemporary settings that may use this approach include large-scale manufacturers for managing their stock control automatically or allocating customer service staff or other resources by computer to reduce customer waiting times.
Woodward (1965) conducted research that suggested the best management approach was contingent on the situation. Woodward’s Contingency Theory is similar to Fiedler’s Contingency Theory of Leadership in that management structures, processes, responsibilities, accountabilities and span of control should differ depending on the size and type of business and the systems and technologies that they utilised. For example, successful small businesses that relied on the skills of the workers more than machines had a more humanistic approach whereas successful large corporations that used automated machines for the majority of their productivity had a more task-oriented approach.
Leadership Skills
Kouzes and Posner (2003) stipulate that “Credibility is the foundation of leadership” and identify several characteristics of admired leaders, the most important being honesty, forward-looking, competent and inspiring. These skills align with a leader’s primary functions, which are to provide direction, invoke inspiration and manage change. A leader must be trusted above all else so that they can invoke respect and loyalty in their team and can ‘sell’ their vision to others. They must also be able to creatively envision the future and persuade others to help them to achieve their goals.
Leaders tend to be open to taking risks, look for ways to do things in new and different ways and encourage positive changes.
Other skills related to effective leadership include communication (to make their vision understood), creativity (to find innovative solutions) and flexibility (to deal with constant change).
Managerial Skills
Whereas the leader will provide the vision and motivate others to work towards it, it is the manager that deals with the fine details.
Looking back at Urwick’s principles of effective management, it is evident that the manager must use the resources they have available to best effect to achieve their objectives. This means an effective manager must be rational and logical when allocating resources and setting goals so that they are realistic and achievable. They must also be well-organised and analytical to ensure the best use of resources as well as having sound planning skills. They must also be able to coordinate others so that they work in the most efficient manner. Communication skills are also essential for making processes and procedures easily understood by team members.
Managers are often risk-averse because they are most comfortable with the status quo and understand that change often has a negative effect in the short term.
Leadership & Management in Synergy and Conflict
It can be seen that the requisites of effective management tend towards structure, organisation and coordination whereas the requisites of leadership tend towards values, ideas and the ability to inspire.
It can also be deduced that managers should also have some leadership skills and leaders should have some managerial skills. A manager without leadership skills would be able to organise people and processes to do something but there would be no motivation to do it whereas a leader without managerial skills would instill a desire in others to achieve something but nothing would get done!
Therefore, it is essential that both leaders and managers combine both leadership and managerial skills to best effect.
The venn diagram below (fig. 2.) shows that there are many traits that are common between a leader and a manager. Communication, negotiation and decision-making are important in both roles. 
Fig. 2. The Leadership-Management Continuum (Taken from Leadership and Management: A Strategy for the Social Care Workforce, Skills for Care, 2004)
However, an effective manager will choose to utilise further leadership skills to help achieve their aims. If a manager can inspire their subordinates to achieve goals with their charisma and persuasion, they will be able to create a highly-motivated workforce with good morale. Sometimes managers must make decisions that are not popular with the workforce. In these cases, leadership skills can help to explain to team members why the decision was made and convince them of its necessity. By demonstrating honesty, integrity and competence over the long-term managers can build a team that wants to work for them rather than simply fulfilling their contractual obligations.
Similarly, an effective leader will make use of management skills to help achieve their objectives. When deciding which direction to take, it is useful for a leader to have an idea of the practical aspects that will be required to move forward with it. This can keep goal-setting realistic and measurable. Once a leader has set their vision, they can use planning, organisation and coordination skills to direct resources into achieving it in the most efficient way.
Although leadership and management can often complement one another, there may be times when they conflict.
For example, a leader will embrace change and innovation and so may want to try out new ideas that they have for improving a service. This could mean taking risks, which could have an adverse effect on current managerial structures and processes, particularly in the short term. For those with a managerial focus, there will be a hesitancy about upsetting the status quo without good reason. For those with a focus on leadership, the potential long-term improvements would outweigh any short-term problems.
For a leader to flourish they need to innovate, imagine and think creatively. Oftentimes this can result in chaos, which a leader is happy to tolerate because it helps them to understand the bigger picture. Managers, however, thrive on order, logic and stability so a chaotic environment can be difficult for them to accept. A leader will often find that managerial structure can limit options and impede progress.
Similarly, managerial skills are predominantly task-focused so the humanistic approach exhibited by strong leaders may be lost in the day to day work. A manager may be caught up in getting the job done without thinking about which particular individual team member may be best suited to perform it.
To manage these dilemmas, we can take ideas from contingency theories. The leader/manager must be able to adjust which approach they use for the particular situation. This means collating the information they need to make an informed decision and weighing up the pros and cons of each choice before formulating a solution. This could also involve using advisers that have different viewpoints (e.g. tasks and people) to aid the decision-making process.
Another strategy to deal with a conflict would be to work out a compromise between the managerial goals and the leader’s vision. For example, if a leader envisions a new way of working, it could be rolled out slowly, perhaps to a single team to begin with, to test efficacy and whilst not disrupting organisation-wide systems.
Conclusions
Leadership and management are two distinctly different roles, however in the modern world it is important that leaders can demonstrate managerial skills and managers can demonstrate leadership skills to achieve the best outcomes. When managerial and leadership roles conflict, it is important that any decisions are weighed up appropriately to take into account both perspectives and, where necessary, a compromise can be reached. Leaders and managers must be able to adapt their styles to the situations that they face so a solid understanding of management and leadership theory is essential.
References
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