Leadership Theory in Clinical Practice

Accepted Manuscript
Leadership theory in clinical practice
Jie-Hui Xu
PII: S2095-7718(17)30094-4
DOI: 10.1016/j.cnre.2017.10.001
Reference: CNR 113
To appear in: Chinese Nursing Research
Received Date: 23 March 2017
Revised Date: 18 June 2017
Accepted Date: 27 August 2017
Please cite this article as: Xu JH, Leadership theory in clinical practice, Chinese Nursing Research
(2017), doi: 10.1016/j.cnre.2017.10.001.
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MANUS CRIP TACCEP TEDACCEPTED MANUSCRIPT* Corresponding author
E-mail: [e-mail] (J. –H. Xu)
Cited information: Xu JH. Leadership theory in clinical practice. Chin Nurs Res. 2017; 4: xx-xx.
Leadership theory in clinical practice
Jie-Hui Xu *
Breast Health Center, Renji Hospital Affiliated to Shanghai Jiaotong University School of
Medicine, Shanghai 200127, China
A R T I C L E I N F O
Article history:
Received 23 March 2017
Received in revised form 18 June 2017
Accepted 27 August 2017
Published 20 December 2017
Keywords:
Leadership
Leadership theory
Clinical practice
Transformational leadership
Participative leadership
Transactional leadership
ABSTRACT:
In current clinical settings, effective clinical leadership ensures a high-quality health care
system that consistently provides safe and efficient care. It is useful, then, for health care
professionals to be able to identify the leadership styles and theories relevant to their nursing
practice. Being adept in recognizing these styles not only enables nurses to develop their skills to
become better leaders but also improves relationships with colleagues and leaders who have
previously been challenging to work with. This article aims to use different leadership theories to
interpret a common scenario in clinical settings in order to improve leadership effectiveness.
Ultimately, it is found that different leadership styles are needed for different situations, and
leaders should know which approach is most effective in a given scenario to achieve the
organization’s goals.
1. Introduction
In many areas of the developed world, modern hospital care is confronted by workforce
challenges, changing consumer expectations and demands, financial constraints, increasing
demands for access to care, mandates to improve patient-centered care, and issues regarding the
levels of quality and safety of health care. 1 Effective governance is crucial to maximize the
effective management of care in the hospital setting. Emerging from this complex literature is the
role of leadership in the clinical setting. 2 The importance of effective clinical leadership to

MANUS CRIP TACCEP TEDACCEPTED MANUSCRIPT2
ensure a high-quality health care system that consistently provides safe and efficient care has
been reiterated in scholarly literature and in various government reports. 3
Leadership is the process of influencing others to understand and agree about what needs to
be done and how to do it, and the process of facilitating individual and collective efforts to
accomplish shared objectives. 4 This definition shows the importance of leadership, which is an
important function of management and helps to maximize efficiency and to achieve
organizational goals. In clinical settings, effective clinical leadership has consistently been
identified as an essential component to ensure quality care and healthy workplaces. 5 The
importance of good leadership is becoming increasingly apparent within health care. This article
aims to use different leadership theories to interpret a common scenario in a clinical setting to
improve leadership effectiveness. Simultaneously, this article explores different leadership styles
and theories and explains how they relate to nursing practice.
The setting of the current scenario is in a surgical unit of a reputable public hospital in the
local area. At this large tertiary hospital, which holds more than 2,000 beds, hospital
administrators have devised a series of work policies. The night shift policy, one of the most
important policies in the hospital, states that no member of the staff is allowed to sleep while on
duty.
The nurse manager of the surgical unit assumes a leadership role in this scenario. She is
responsible for the management of registered nurses, medical assistants, office staff, performance
evaluations, budgets, shifts, and attendance for this unit. One day, she was told a nurse often
slept on her night shifts. To her surprise, the nurse not only took a nap at the nurse station on the
night shifts but also slept on the examining table in the examining room after midnight.
Obviously, the nurse was neglecting her duty and violating the night shift policy as well.
In this case, if the nurse did not recognize her mistakes and did not know that sleeping on
her night shifts was against policy, patient safety would be ignored and quality care could not be
provided, not to mention diminished patient satisfaction and negative outcomes. Hence, the unit
director had to take action. The biggest challenge for the unit director was getting the nurse to
acknowledge the mistake and subsequently change her behavior. The ultimate goal in this
scenario, however, is to prevent the nurse from sleeping on her night shift, to convince her to
take her job more seriously, and to encourage a positive attitude toward her work.
2. Leadership theories
2.1. Transformational leadership
The first theory that can be utilized in this scenario is the transformational leadership
theory. The concept of transformational leadership was originally identified by leadership expert
James MacGregor Burns. According to Burns, transformational leadership is a relationship
between the leader and the follower in which they motivate each other to higher levels, resulting
in value system congruence between the leader and the follower. 6 Later, Burn’s original
thoughts were extended by Bernard M. Bass, who believed that a strong vision and personality
are common traits among transformational leaders. 7 Moreover, they motivate their followers to
adjust expectations, opinions, and inspirations to work toward common goals. 8 Additionally, he
mentioned four components in transformational leadership: ideal impact, strong motivation,
intellectual stimulation, and personal consideration. 9
Evidence has shown that transformational leadership impacts follower satisfaction and
commitment to the organization. 10 Because of its impact on individual and institutional