Conceptualisations on Leadership


For many years, leadership continues to be one of the captivating issues in institutions, society and the nation at large. The term eludes a unified definition due to its complex and subjective nature (Pardey, 2007). Hence Pardey (2007: 9) likens it to a "good art", recognised when seen but difficult to describe. The debate is still ongoing as to whether leadership is an innate ability (Marquis and Huston, 2006) or can be acquired (De Pree, 1989; Grant and Massey, 1999). Notwithstanding, I believe that leadership can be learnt in spite of the fact that certain traits help us to lead effectively. Several theories of leadership have been developed with an emphasis on traits (Hibberd, Smith and Wylie, 2006; Mann, 1959; Marquis and Huston 2006), behaviour (Mintzberg, 1973; White and Lippitt, 1960), situation (Fieldler, 1967; Hershey and Blanchard, 1972), social exchange (Bass, 1985; Burns, 1978) and organisational dynamics (Bass, 1985; Bass, Avolio and Goldheim, 1987; Burns, 1978). The work of behavioural theorists give insights into autocratic, democratic and laissez-faire "leadership styles" which has a lot of impact on organisational performance (Bass, 1981). In spite of the various conceptualisations on leadership, many authors agree that it is a process (Barrow, 1977; Hollander, 1985; Trice and Beyer, 1992), involves influence (Charney, 2005; Grayson and Baldwin, 2007; Tappen, Weiss and Whitehead, 1998), occurs in groups (Berger and Luckmann, 1966), requires an adaptive goal seeking approach (Katz and Kahn, 1978) and exist at all levels (Faugier and Woolnough, 2002).Nonetheless, leaders are believed to be ordinary people who do extraordinary things (Kouzes and Posner, 1995; Peters and Waterman 1995) through the effective use of power (Kanter, 1977) in creating the future (Kerfoot, 1998). This implies that leaders are judged mainly by the consequences of their behaviour and not on any physical characteristics. There have also been debates concerning leadership and management for m (Grant and Massey, 1999; Hibberd et al. 2006). Notwithstanding, I agree with Hershey and Blanchard's (1982) view of leadership as an influence process and management as a goal achievement endeavour. This is because leadership can stimulate people into performing to their utmost capacity, unlike management that only aims at getting intended results. In today's health care system, nursing leadership needs to focus on people and problem solving in an ever-changing environment (Davidhizar, 1993). This essay is a reflection of my own personal leadership development and the process which helped me in producing the plan. Gibb's (1988) reflective cycle will be used in guiding the reflective process due to its simplicity. The essay will commence with my personal and professional leadership background, followed by my personal leadership development plan. It will continue with a reflection on the process which helped me in developing the plan and finally end with conclusions on my action plans for the future.


n this section, I will briefly describe, analyse and evaluate my personal and professional leadership background using Gibb's reflective cycle (1988). I am a registered general nurse who was recently working at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. It is the only teaching hospital in the Ashanti Region and the second largest hospital in Ghana. The hospital serves as referral centre for the Ashanti Region and some parts of the Eastern, Central, Northern and Western Regions of Ghana (Buabeng, Matowe and Plange-Rhule, 2004). As a general nursing officer in this hospital, I have rotated through the various units of the hospital but was currently, working at a general surgical ward. Both preoperative and postoperative patients are admitted into this 35 bedded large unit. My main responsibilities were assessing, planning, implementing and evaluating nursing care given to these patients (GHS, 2005). From my experience, I realised that pain was a predominant complaint of these patients due to the trauma caused by surgery. Notwithstanding, this symptom did not receive any special attention in terms of its assessment and management. This could be attributed to the lack of a structured pain assessment using a valid tool, inadequate staff, attitudes towards pain, fear of analgesic side effects, lack of knowledge and understanding on the pain experience (Brevik and Stubhaug, 2008; Dolin, Cashman and Bland, 2002; Taylor and Stanbury, 2009). Upon reflecting and evaluating my previous performance, I realised that effective influence is an area I need to develop further. This is due to my own assessment of my inadequate influencing skills which is being supported by an encounter I had with a postoperative patient in pain and my inability to persuade the nurses on the need to change this practice after dealing successfully with the patient. By virtue of these challenges, I decided to advance my nursing practice in the area of postoperative pain assessment and management. From a leadership perspective, I would like to focus on influencing change in practice that would be beneficial for patients, staff and the institution as a whole. Some of the anticipated benefits include shorter hospital stay, early wound healing, reduced complications, reduced infections, patient satisfaction, best practices and policies, and institutional integrity (Wasylak, Abott, English and Jeans, 1990; Watwill, 1989; Sydow, 1989).


Personal Development Plan is an outline of objectives of an individual's learning needs based on an assessment of previous performance, and thus, developing realistic strategies for future goal attainment (Rughani, 2001). It helps an individual to identify areas for further development and promotes lifelong learning. In this section, my personal leadership development plan will be presented in terms of my learning objective, actions, resources and time. Learning Objective Improve my knowledge and understanding on the skills used in influencing people to bring about change in practice (of pain assessment and management). Actions Reviewing the literature on influential tactics. Discussing with some influential people on how they developed their skills. Reflecting on every influence situation to assess my strengths and weaknesses. Evaluating my personal development in the area of influencing people to change their practice. Resources The resources required include material (textbooks, electronic databases, internet, journals), human (influential people) and time. Time I will need about three months to improve my knowledge and skills on influencing change. However, this would be continued to continuously enhance my knowledge, attitude and skills.


Influence Change in Practice Influence is the ability to persuade someone to act or think in a certain way without exerting force (Handy, 1973). This requires the deliberate use of actions to bring about a desired change that would not have occurred otherwise. Although influence has the power of producing an effect, it can result in resistance, compliance (Cartwright, 1949), or commitment (Grayson and Baldwin, 2007). Nonetheless, achieving results with some degree of acceptance or co-operation is most preferable. In the light of this, strategic influence is an indispensable element in leadership (Grayson and Baldwin, 2007; Tappen, Weiss and Whitehead, 1998) so as to produce positive outcomes (Charney, 2005). Personally, I define leadership as an influential process of achieving goals, by appealing to people's emotion and challenging them of the need to focus on a particular vision. Assessment A very important step in becoming a person of influence is that of self awareness (Duval and Wicklund, 1972); it comprises of a person's character, feelings, motives and desires. According to Wicklund (1975), it is the capacity to assess others' evaluation of the self and incorporating them into one's self evaluation. On the basis of my own and others' evaluation, I have a strong self awareness. This is supported by an incident which occurred during clinical practice whereby a colleague shouted at me while I was delivering care. Due to my strong self awareness, I remained calm knowing very well that my anger could impact on patients' health, and my relationship with other colleagues. This is in agreement with the views of Carver (1974), Diener and Wallborn (1976), Wicklund and Duval (1971) that, self awareness prior to an act leads to appropriate conduct. Notwithstanding, I later approached that colleague and we solved our differences amicably. According to Hale (2006), the establishment of a healthy relationship is critical in the influence process. This aspect of influence is considered as a strength that will attract me to others for the commencement of the influence process. Through unassailable rapport, I will get into contact with the stakeholders (nurses, anaesthetist, doctors, managers) involved in the assessment and management of pain. As proposed by Maxwell and Dornan (1997), attentive listening helps the influencer to explore the perspectives of others and to have a positive attitude towards them. Upon critical reflection, this is an area I need to improve upon so that I can explore the similarities and differences in views, and argue in favour of the desired change (Hale, 2006). A very important factor after the influencer has logically presented arguments for a proposed change, is to have faith and believe in the target's capabilities (Maxwell and Dornan, 1997). By so doing, they will be empowered to take on challenges and willingly strive towards goal attainment. In addition, this will boost their confidence and stimulate their interest in the desired change [ibid]. Having recognised this aspect of influence, I need to develop further on my ability to encourage and believe in people's capacities. Assertiveness is another key to successful influence; it requires the leader to give genuine and constructive criticisms (Maxwell and Dornan, 1997). Upon reflection, I need to improve upon this boldness aptitude due to my tremendous worry about people's emotions. In addition to assertiveness, acknowledging people's achievements can encourage and motivate them to develop further towards a goal [ibid]. Maxwell and Dornan (1997) describe integrity and role modeling as alternative ways of influencing people. On reflection, I consider these to be strengths due to my sincerity. Mentoring and developing others to be of influence is another important factor that can motivate others to change (Maxwell and Dornan, 1997). Having recognised this as a weakness, I need to improve upon this aspect so as to assist others to grow personally, and to empower them to be of influence towards the attainment of change. Influential Tactics In the process of influencing subordinates, peers and superiors; several tactics can be employed. These include consultation, inspirational appeal, rational persuasion, pressure tactics, coalition, legitimating, ingratiation, exchange and personal appeals (Yukl and Tracey, 1992). Consultation, inspiration and rational persuasion tries to change the target's attitude with regards to the appropriateness of the request and can be used at all levels; pressure, coalition and legitimating are usually ineffective since the targets become resentful for being manipulated; ingratiation and exchange are reasonably effective for influencing subordinates and peers; personal appeals also appears to be fairly effective for influencing subordinates and peers [ibid]. Based on the direction of influence, I will utilise the appropriate tactics so as to achieve the desired change. Grayson and Baldwin (2007: 9) classifies these tactics into logical, emotional and cooperative appeals since individuals are influenced through their "head, heart and hands". From these approaches, it can realised that influence can take the form of a particular tactic or a combination of tactics depending on the nature of the expected change. Through individual encounters and seminars, internalised information would help facilitate the change process (Burkey, 1993; Jackson, 2000; Wright, 1989). I would justify the need for the change with the supporting evidence (Jackson, 2000; Marzalek-Gaucher and Coffey, 1991), emotional appeal to the staff and demonstrate the confidence that I have in them (Grayson and Baldwin, 2007). Demonstrations would be given to staff after which they would be allowed to practice and report any challenges for continual feedback and support. In spite of the fact that change is a complex and difficult process in organisations (Boshof, 2005), a leader's influential ability can help facilitate this course (Sutton, 1999). Primarily, the leader needs to identify a problem (Marzalek-Gaucher and Coffey, 1991; Vestal, 1995), conduct an investigation and plan towards it (Bair and Gray, 1992). Having been exposed to the assessment and management of pain in other parts of the world such as in the United Kingdom, I have identified a problem with this practice in our clinical setting. On the basis of this, I have planned of developing a questionnaire to the stakeholders concerned to explore their "knowledge, attitude and practice" regarding pain assessment and management. Desirably, a patient satisfaction survey would also be conducted in order to explore their "perceptions, experiences and expectations" on pain. Following this, seminars would be held at our institution to address the findings of the survey. During these seminars, standardised assessment and management of pain will be discussed using the appropriate influential tactics for facilitating change. One of the early and popular insights of change management is the Force Field Analysis model proposed by Lewin (1951). According to him, change is likely to occur when the restraining forces are reduced to allow for progress towards goal attainment [ibid]. Several strategies such as information broadcasting, disconfirming held beliefs, provision of psychological safety and command (Tappen, 1995) can be used in minimising resistive factors. However, the first three approaches will be used due to the transformational nature of the leadership in our organisation. Moreover, the restrictive factors such as inadequate knowledge and understanding of the pain experience and the insecurity with new approaches will have to be addressed in order to increase the driving forces for the change (in the assessment and management of pain). During the stage of minimising restrictive forces, Lewin's (1951) three-stage process of unfreezing the moment, changing to a new situation and refreezing the situation has been deduced into a model of influence by Sutton (1999). Unfreezing is a very difficult stage since it would require staff to move away from the old comfortable ways of assessing and managing pain into new and unfamiliar approaches (Peters and Tseng, 1983). Notwithstanding, this challenge can be overcome with continual staff support (Maxwell and Dornan, 1997). Evaluation An important but often neglected factor in the influence process is that of preparation (Hale, 2006). This suggests that this stage is very crucial to achieving my goal of influencing people to change their practice. As part of the preparation, I have read the literature and have spoken to some influential people about how they went about developing their skills. My reason for doing this is because there is no science of change (McWhinney, 1992) and that, integrating theory and practice is vital in improving my skills. Notwithstanding, different situations will require different influencing styles. I intend to continue my discussion with some influential people in our setting to find out strategies that worked for them as well.


In this section, my conclusions and action plans towards this influence process will be presented using Gibb's reflective cycle. In today's health care environment, the positive and lasting outcomes of change can only be realised through a leader's influence (Maxwell and Dornan, 1997). Successful staff involvement can be help in realizing this process (Grayson and Baldwin, 2007; Oakley and Krug, 1994). Surprisingly, there is no science of influencing change amidst the alarming interest and concern about leadership and management (McWhinney, 1992). Many of the recommendations of this process are the result of people's experiences more than on research (Wilson, 1992); implying that there are no facts about the pattern or layout in which change would occur. Indisputably, the course of change cannot be directed with any certainty (Tappen, 1995), but can be influenced and predicted within an array of possibilities. This implies that genuine assessment of strengths, weaknesses, opportunities and threats plays an important aspect in the course of influencing change. Upon reflection and reading the literature on "influencing change in practice", I have identified my strengths, weaknesses, opportunities and threats for this influence process using the SWOT analysis model (Macmillan and Tampoe, 2000; Pearce II and Robinson Jr, 2000; Rabin, Miller and Hildreth, 2000). On that basis, I consider the following leadership qualities to be my strengths; self awareness, rapport building, integrity and role modeling. Notwithstanding, I need to improve upon genuine listening, understanding others, believing in people's capacities, being assertive and mentoring to help others develop. Some of the opportunities for this change include the hospital's interest in quality care and the ability of the staff to learn this new approach. However, loss of security in new routines and the inadequate knowledge are the threats that would be minimized in order to effect this change. Some of the plans towards this influence process include: developing a questionnaire on "the assessment and management of pain" that will address the knowledge, attitude and practice of health care professionals in my organisation. A patient satisfaction survey would also be conducted to explore the "perceptions, experiences and expectations" of patients in pain. Workshops and seminars would also be organised in small groups to our hospital staff to address the findings. Following this, continuous evaluation of the "assessment and management of pain" would be conducted in order to address challenges and offer continual support until the change is realised. In case the change do not happen as planned, a reevaluation would be conducted to find out the reasons so as to devise alternative strategies. From the literature, I have acknowledged that influencing change takes time to become established. (Tiffany and Lutjens, 1998). As a result, continual evaluations and support would be the foundation of this change in practice. Moreover, as an incoming nurse educator, I have planned of influencing the authorities concerned to incorporate this subject into our educational curriculum so as to ensure the continuity of the transformation that will be happening in clinical practice. On conclusion, this assignment has enabled me to prepare towards a very important aspect of my leadership, which is about influencing people to achieve an institutional change in the "assessment and management of pain" in our hospital. As Pardey (2007: 96) puts it "the plan is the route map not the purpose of the journey", this personal development plan is going to guide me to continually improve upon my influencing skills until this short term goal is accomplished.

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