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Healthcare Crisis and Transformational Leadership

Larry Barnes, for HealthLeaders Media, October 10, 2008

Inspirational leaders must be conscious of their impression on others because it will determine how they are respected, which will in turn affect their ability to influence. Impression management is important because people determine personal characteristics from limited information. The workers' perceptions of their leaders influence their confidence in the leaders. Leaders can manage the impression they make through their dress, speech, and appropriate connections with those they visibly interact. By managing the impression they make, leaders can make a positive impact on the success of their leadership.

Successful inspirational leaders establish high expectations of worker performance, and workers tend to meet expectations that can be difficult to achieve, but are reasonable. Workers who achieve high expectations also exhibit a sense of purpose that is expressed through strong feelings for the organization, its mission, and its vision. Leaders can increase their probability of success by managing the workers' expectations and sense of purpose.

Inspirational leaders must develop a realistic vision of the future that will motivate workers. The vision provides the goals that direct the activities of the organization. Leaders must be able to communicate the vision in such a persuasive manner that others are willing to commit to it. Successful implementation of a vision requires determination and persistence from leaders.

There are differences between charisma and inspiration. Charisma is related to workers' personal attraction to leaders. Inspiration is related to workers' attraction to a vision. Charismatic leaders may have both a vision and personal attraction for workers. Inspirational leaders do not have the same personal attraction as charismatic leaders, but they articulate a desirable vision.

Individual considerations. Individual considerations are related to interpersonal skills. Leaders exhibit concern for the workers' development through assignments that provide opportunities for growth. Important elements of individual consideration are insight and empathy. Considerate leaders know the developmental needs of each worker and should know what motivates and interests the workers. Through insight and empathy, leaders ensure worker's concern for organizational needs and their adoption of the organization's vision.

Intellectual stimulation. Intellectual stimulation is related to the encouragement for workers to become innovative and creative. It can cause workers to consider situations and issues in new and different ways. Four methods of intellectual stimulation have been identified, and leaders can use any or all of these methods.

  1. Leaders can rationally try to convince workers to solve problems.
  2. Existential leaders identify many possible solutions to a problem. An acceptable solution is developed by appropriately combining elements from the various possibilities.
  3. Leaders might use empirical data gathered from other sources to identify a solution.
  4. Idealist leaders can use intuition with a minimal amount of data to identify solutions to problems.

Transactional leadership
In contrast to transformational leadership, the principal concept in transactional leadership is the exchange that takes place between leaders and followers. Leaders define followers' actions as exchanges for something of value to workers. These leaders establish goals, provide directions, and reinforce behavior with rewards. In general, if the work and the environment do not motivate followers, leaders must provide incentives. This leadership style is defined by the dimensions of contingent reinforcement and management by exception.

Contingent reinforcement. Contingent reinforcement consists of rewards for workers who attain performance goals. The rewards are dependent on the workers' effort and attainment of specified goals. Leaders' behaviors can enhance this process. These behaviors include precise instructions, participation in standards development, support, and consistent performance.

The forms of contingent reward include benefits, praise, and recommendations. Benefits can take several forms such as pay increases, better assignments, a more desirable schedule, or additional time off. To be effective, praise must be based on work well done. Recommendations might take many forms, including additional pay, job advancements, bonuses, and recognition for outstanding job performance.

Management by exception. When leaders practice management by exception, they act on mistakes, faults, and failures to attain performance standards. Workers are informed of these deviations and punishments can be implemented. If performance standards are attained, workers are allowed to continue without additional direction.

Passive management by exception is when leaders take action after the deviations have been identified. Active management by exception is when leaders actively attempt to identify deviations by developing systems and processes to monitor for deviations.

Leadership continuum
Leaders can exhibit both transformational and transactional behaviors. This is especially relevant to healthcare chief information officers due to their need for vision development and execution of informational strategies of the organization. Transformational leadership enhances the effectiveness of transactional leadership; they are not mutually exclusive leadership styles. Transactional leadership satisfies the separate goals of leaders and workers, while transformational leadership ensures the close alignment of these goals.

This crisis of healthcare has been described as a point of inflection. Information technologies will have a significant role as healthcare organizations respond to this crisis, and these leadership styles can help healthcare information technology leaders more successfully address this healthcare crisis.


Larry Barnes is the vice president and chief information officer at Salina (KS) Regional Health Center. He also has a doctorate in management of organizational leadership.


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