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Understanding an alternative approach to paramedic leadership
JOHNSON, David, BAINBRIDGE, Peter and HAZARD, Wendy
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JOHNSON, David, BAINBRIDGE, Peter and HAZARD, Wendy (2018). Understanding an alternative approach to paramedic leadership. Journal of Paramedic Practice, 10 (8), 1-6.
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Understanding a New Model of Leadership
Abstract
Leadership is an essential feature of the life of a paramedic. During incidents, whilst working
with multi-agency colleagues, and within organisations leadership is an expected quality of
all paramedics. Across health and social care organisations leadership is said to be of
pivotal importance to future success. These issues have led to a large investment in
leadership development programmes that organisations are now seeking to justify.
Leadership as a concept is, however, complex and multifaceted. The nature of leadership
has been debated over millennia and still disagreement exists as to how to define it. This
paper utilises Critical Interpretive Synthesis to consider how approaches to leadership have
developed over time. It concludes with a synthesising argument that leadership is a social
construct; as such no single definition will ever be appropriate, however, the four elements
that comprise the leadership equation should be considered if the paramedic leader in
organisations is to be effective.
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Introduction
Leadership is an essential feature of the life of a paramedic. Paramedics will be expected to
demonstrate leadership during incidents, whilst working with multi-agency colleagues and
within employing organisations. Simply, leadership (however it is defined) is an expected
quality of paramedics, be they in practitioner or management roles.
Leadership is said to be of pivotal importance to the future of health and social care
organisations (Dazi 2008, Ham 2011). Many authors (e.g. Alimo-Metcalf, Alban Metcalf 2006,
Vardiman et al 2006, Anderson et al 2009, Amagoh 2009, Hotho Dowling 2010) have
identified that organisations that are considered to have good leadership thrive, even when
times are difficult, and conversely, poor leadership is an often cited reason for organisational
failure. As a consequence, the need to develop leadership capacity has been identified as
an important issue in organisations across the world. Leadership is, however, a complex
multifaceted concept, which has been subject to much debate over millennia. In spite of this
debate and the development of many models of leadership, disagreement still exists as to
how it should be defined. This article seeks to explore a new theory of leadership that might
help paramedic practitioners, managers and leaders at all levels within the organisation
begin to understand their unique approach to their leadership role, whatever their particular
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experience and schooling of leadership, and wherever they are placed within the hierarchy
of the organisation.
Approaches to leadership
In current times there appears to be a constant cry for good leaders and for good leadership
to lead us out of our difficulties. As an example, at the 2011 Conservative Party Conference,
David Cameron (2011) stated
"In these difficult times, it is leadership we need, to get our economy moving, to get our
society working. Leadership works"
It is relatively easy to speak eloquently about the merits of leadership; people have been
studying it and attempting to do so for millennia. The difficulty is that whilst leadership is a
concept that most people instinctively understand, it becomes really difficult to closely define
what good leadership actually is or means (Crainer1998). Who decides when, to use
Cameron's comments, 'leadership works'? Northouse (2007) suggests that people are
captivated by the concept of leadership. But as they begin to explore this complex and
multilayered phenomenon, they develop their own understanding of what it is, and this
understanding is often really subjective.
In recent times, there has been an exponential increase in research activity into what
effective leadership within organisations is. In 1991 Fleishman et al (1991) identified sixty-
five different classifications of leadership. In 1995 Crainer (Mullins 2007) suggested that four
hundred definitions of leadership existed. Eight years later Bennis and Nanus (2003)
concluded that eight hundred and fifty different classifications had been developed. In 2003,
14,000 books related to leadership were on sale via the on line retailer Amazon.co.uk, by
2009 this had increased to 53,000 (Grint 2010). A similar search in July 2013 revealed that
this total had reached approximately 72,000 books. A scoping search in July 2013 of the
Sheffield Hallam University Library gateway using the word 'Leadership' indentified
approximately 1,600,000 items. When filtered to only consider peer reviewed publications,
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415,000 journal articles were identified. Research into effective leadership appears to have
experienced exponential growth. Simkins (2005 p10) commented that even though defining
effective leadership had proved elusive, ‘some still believe that this holy grail is within our
grasp, or at the least the search for it is not in vain'. Crainer (Mullins 2007p363) warns
however, that so many definitions of leadership can lead to "minefields of misunderstanding"
through which practitioners and researchers must tread carefully. Grint (2010) postulated
that the field had become so complicated that even the concept of leadership was now
contested.
A brief (recent) history
The majority of research studies in the first half of the 20th century were concerned with
attempting to define and refine behaviours, qualities or characteristics of leaders (Avolio
2007). This period of research, sometimes labelled trait theory, sometimes labelled 'great
man' theory, is characterised by the belief that leaders are born and not made. The search
was to indentify the characteristics or traits that made great leaders. Large numbers of traits
were identified. The significant problem that Mann (1959) discovered after reviewing all of
the studies conducted between 1900 and 1957 was that the correlation between leadership
and the identified personality variables (or traits) was inconsistent and, significantly, overall
quite low.
A series of models of leadership that fitted into an approach known as Contingency or
Situational Leadership followed. The concept behind these approaches was first identified by
Stodill in 1948. Stodill was engaged in a meta analysis of leadership traits and could not
indentify any significant results. He did, however, identify for the first time that the situation
played a large role in how the leader behaved. Research effort then focussed on validating a
number of contingency and situational modules. The majority of models from this period (a
number still have relevance today) consider that effective leadership is an artefact of the fit
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between the leader's characteristics and of the unique situation that they confront (Avolio
2007, Haslam et all 2011). Northouse (2007) suggests that leaders should adapt their style
to meet the needs of the situation.
In 1978 MacGregor Burns developed a new concept of leadership that he called
transformational leadership. A collection of similar transformational approaches emerged
during this time and became known as new paradigm approaches (Alimo-Metcalf, and
Alban-Metcalf 2005). The adaptation of the term transactional leadership also became
common and is considered the antithesis of transformational leadership. McGregor Burns's
concept gained momentum and in the 1990s was perhaps the most popular and the most
researched of the new paradigm approaches to leadership (Judge and Bono 2000, Alimo-
Metcalf, and Alban-Metcalf 2006).
Transformational leadership was felt to be a leadership style that fitted the needs of the
workforce.(Northouse 2007). Burns wanted to develop a concept that positively linked
leaders and their followers. The aim of his model was to transform people; to help them
become the best that they could become, so that together, the organisation and the people
in it could achieve so much more that had been originally expected. The model included
concern for ethics, standards and satisfying the needs of followers. (Alimo-Metcalf, and
Alban-Metcalf 2005)
Burns also distinguished transformational leadership from transactional leadership.
Transactional leaders rely on what is called the exchange or transaction that occurs between
the leader and the follower. So at a simple level if the follower, working in an organisation,
does what the leader requires of them, they will receive a salary that recognises their
contribution to common goals. This is the transaction or exchange. Burns believed that most
leadership models are transactional in nature. This approach is evident at all levels
throughout all types of organisations. Transactional leadership is often associated with the
term management.
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Research focussed on assessing the effectiveness of transformational models. As an
example, Alimo-Metcalf and Alban-Metcalf (2005) discovered, following a large study of
public sector organisations in the United Kingdom, that transformational leadership leads to
higher levels of satisfaction, motivation and productivity and lower levels of sickness
absence and employee turnover.
Whilst the popularity of transformational leadership continues, a model of leadership called
distributed or shared leadership has been gathering attention. This, again, is an area of
contested definitions (Currie and Locket 2011). The underlying concept is a recognition that
it is becoming increasingly difficult in complicated multi-skilled environments (like ambulance
services organisations) for a single person to be able to lead on all aspects of the
organisation. The leadership task is distributed or shared with others. To be effective,
distributed leadership is intended to be a whole organisation concept and culture, with all
members of the organisation able to take a lead when required (Hartley et al 2008).
The leadership space has become increasingly complex, increasingly contested and
increasingly noisy. With so many models of leadership, often supported by a strong evidence
base, it is increasingly difficult for practitioners, managers and leaders to understand how
and why they should behave. What is, perhaps, the latest leadership cloak that they should
put on in an attempt to follow the latest leadership fashion or fad? Should they become
transactional, transformational, or distributed?
There is perhaps a need to attempt to cut through this noise, to look for commonalities and
develop a theory that paramedics might find of use; whatever their particular leadership
schooling or approach.
Leaders of the future
Grint (2010) discusses tame and wicked problems in organisations. Tame problems may be
incredibly complex but solutions do exist. Wicked problems tend to have no known answers.
He suggests that leaders of the future will have to face many wicked problems. Handy
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(1989) suggests we are entering a new era where the only thing that we can be certain of is
that things will change. We can't anticipate how or when changes will occur only that they
will. He asserts that future leaders need the skills to be ready to adapt to this unknown world.
Drucker reports "We are in one of these great historical periods that occur every 200 or 300
hundred years when people don’t understand the world anymore and the past is not
sufficient to explain the future" (Cameron and Quinn 2011 p1). Watkins et al (2011p9)
suggest leaders will need to find new ways of working with people as they cope with the
"reality that change is continuous relentless and accelerating". Grint, Handy, Watkins and
Drucker don't refer to any particular sector, however their words seem to have a particular
resonance when considering the many complex issues that those who work within what has
traditionally been called Ambulance Services face, as we move into an uncertain and
challenging future.
The paramedic leaders of the near future will be dealing with many problems that require
solutions that don't yet exist. How will we cope with an ageing, better informed, high
expectation, instant messaging society? How will we continue to deliver our high quality
service when faced with what Hawkins and Smith (Chard et al 2013 p23) call "the unholy
trinity of: greater demand for services, higher quality expectations and less resource"? As
such the traditional models that may have been considered the maps for leadership within
Ambulance Services might no longer provide the direction needed.
A literature review utilised an approach called Critical Interpretive Synthesis to look for
commonalities across leadership models. Mays et al (2005) argue that management and
leadership research has many complexities. The real world research environment of
leadership research has been described as messy and inefficient (Edmondson &
McManus2007 p1155). Practitioners within the leadership and management community
have myriad backgrounds and derived knowledge from an eclectic and pragmatic array of
perspectives that might range from sociology and anthropology to economics and statistical
analysis (Easterby-Smith et al 1991, Gray 2009). As a consequence there is not a
consistently agreed approach to research within this field and many sources of legitimate
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evidence exist that might include quantitative, qualitative and grey literature findings. It is
argued that an effective leadership literature review would need to derive and synthesise
often complex information from multiple sources.
Critical Interpretive Synthesis (Dixon-woods et al 2006) is ideally suited to complex situations
with multiple sources of evidence.
Dixon-Woods et al state that although a number of approaches to enable synthesis of
qualitative data have been developed in recent years, very few methods allow for the
synthesis of evidence regardless of the study type. They believe this approach allows for this.
The Critical Interpretive Syntheses review concluded with a number of what are described as
synthesising arguments.
Synthesising argument 1 - Leadership is a Social Construct
Bass and Bass (2008) argue that we are subjected to leadership influences from birth and
throughout our lives. Our mothers, fathers, extended family, schools, etc all provide early
influences into how we perceive leadership. Our friends, work environment, profession,
colleagues and leaders all continue with this influence as we journey through life.
Social Constructivists believe that truth does not exist independently of human interpretation,
but instead meaning is attributed to an object as a consequence of its integration with the
human world. Crotty (1998 p42) suggested that constructivists believe "meaning is not
discovered but constructed". A constructivist world is not a static place, it has fluidity to it.
As we engage with the world we make sense of the concepts and objects that we encounter.
That sense making is influenced by our experiences. It may be our culture, our values, our
social class, it may be our profession, our organisation or our experience of leaders, but
whatever it is, the sense we make of an object like leadership will be shaped by our
experiences up until that time. This sense making may continually evolve as our exposure
and experience to the object increases.
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There are many models and ways in which leadership can be described. Researchers,
academics and philosophers have sought an answer to this difficult, complex and multi
faceted phenomenon and, despite over three thousand years of questioning and research, it
still appears to defy definition (Grint 2010 Crainer 1998). Northouse (2007p2) suggests that
although we "intuitively know what leadership is", when attempts are made to truly define it,
many different meanings emerge. Hernandez et al (2011) describes how although many of
the models that have been developed have helped our understanding we are still striving to
identify new and disparate approaches.
It is perhaps time to call off the search for Simpkin's "Holy grail" (2005 p10). There is no one
right answer or approach; leadership is a social construct and effective leadership is
constructed by our understanding of ourselves, the world that we live in, and the values and
experiences that we have had that have led us to become unique individuals. This will
change as our experiences change our perception of leadership in organisations. As Grint
(2005 p1471) suggests "the book is never closed but always open to contestation."
Synthesizing Argument - The Leadership Equation
Turnbull-James (2011p7) questions the popular view that leadership is beyond definition.
She reports that, the field has unified behind a basic assumption for some time, and "in its
simplest form leadership is a tripod" made up of the leader, the follower and the goal that is
to be attained. Others have recognised this position, as examples, Clark and Clark (1996
p25) didn't agree with what they describe as the "common perception of the elusive nature of
leadership". Their definition suggested that leadership is an activity, in which "leaders and
followers willingly subscribe to common purposes and work together to achieve them ".
Northouse (2007) defines leadership as "a process whereby an individual influences a group
of individuals to achieve a common goal"
Avolio (2007) suggests that the context in which the leader operates is an important
consideration to their approach to leadership.
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The four common elements that contribute to the majority of leadership models are
considered to be the leader, the follower, the operating context and common goals. These
could be considered as a unique equation.
Whatever model or approach to leadership that holds sway at any particular time, it appears
it is always a balance or a rebalance of the four elements of the leadership equation.
The menu of leadership styles has become rich and diverse. Practitioners may choose from
an eclectic array of approaches, many of which have a supporting evidence base. If there is
no clearly defined right approach, how then can effective choices be made? The leadership
equation allows for multiple realities of leadership. It asks leaders to consider the best way
for them to lead, regardless of the current fashion of leadership thinking. Leaders, at any
level in an organisation, should pay attention to the factors that contribute to the elements
that form the leadership equation. It is suggested that if all of the elements have been
scrutinised, analysed and uniquely considered by the individual leader and a balanced view
arrived at, the leader will have the best chance of success.
Conclusion
Leadership is a complex subject that has been studied extensively over a long period of time.
Its importance to effective and efficient organisations has been considered and restated
many times. This has led to a wealth of research seeking to identify the right approach to
successful leadership. Despite much energy and activity no single approach has been
indentified that provides an answer to this question, instead a wide and eclectic array of
Understanding The Leader
Understanding The followers
Understanding Common
Goalls
Understanding The Context
Understanding Effective
Leadership
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approaches is proposed. Through a critical interpretive synthesis of literature, a synthesizing
argument that suggests that leadership is a social construct has been propagated. There will
be no single right approach that is appropriate for all (Allio 2009). The literature however,
does suggest that, fundamentally, each leadership model contains a balance of four
elements the leader, the follower, common goals and the situation. In order for individual
paramedic leaders to be successful, consideration has to be given to how each of the
elements relate to each other. If the paramedic leader is able to do this, regardless of the
style that they adopt, it is suggested that they will be successful.
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