LEADERSHIP FOR HEALTH PROFESSIONALS ESSAY ASSIGNMENT PAPERS: UNDERSTANDING LEADERSHIP AS A THEORY

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Leadership for Health Professionals Essay Assignment Papers: Understanding Leadership as a Theory

Leadership for Health Professionals Essay Assignment Papers: Understanding Leadership as a Theory
Leadership for Health Professionals Essay Assignment Papers: Understanding Leadership as a Theory
UNDERSTANDING LEADERSHIP AS A THEORY © Elnur/ShutterStock, Inc. Opinion is that exercise of the human will which helps us to make a decision without information. John Erskine, The Complete Life This chapter presents students and early career executives with a sound understanding of theory. Theory is explored in terms of both anatomy (parts of the whole) and physiology (relationships with each other) to better explore the complexity of theory itself before applying it to the study of leadership. It is difficult for students of leadership to fully embrace all the nuances of leadership study if they first do not understand what a theory is—and how the study of leadership theory fits in with the general dynamics of applying specific leadership theories to the practical world.
LEARNING OBJECTIVES 1. Describe why the study of theory is important in the study of leadership in health organizations. 2. Define and distinguish the basic elements and relationships of a theory. 3. Demonstrate the utility of theory in the study of leadership, leadership principles, and leadership applications. 4. Describe and compare two or more conceptual models, and discuss how the models relate to theory and support the discussion of leadership. 5. Design a simple model of leadership principles or applications (from constructs and concepts in this chapter or other literature) and summarize the relationships between the model’s theoretical elements and the application of leadership principles. 6. Justify and defend the constructs in a simple model of leadership. Leadership for Health Professionals Essay Assignment Papers: Understanding Leadership as a Theory
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WHY STUDY THEORY? Although the study of theory may seem nonessential and without practicality in a leadership course, you should ask yourself two simple questions: First, what is a theory? Second, what is leadership? If you can answer the second question without answering the first, there may be a gap in your understanding of the complexities of the art and science of leadership—and how leadership theory supports the development processes of early career executives. The authors of this text have more than 50 years of combined experience in health leadership positions in civilian and military health organizations and in academia. We have been educated academically and trained practically in the understanding, application, synthesis, and evaluation of leadership. As a result, we feel that it may not be possible to fully embrace all the fundamentals of leadership and leadership theories without first understanding the complex relationships in theory structure and processes. Failing to understand theory may result in students of leadership not understanding what they are reading. More importantly, lack of theoretical methods knowledge could lead to misinterpretation, resulting in an inability to apply leadership knowledge, skills, and abilities in the organizational world. Consider one of the early leadership theories posited by scholars in the mid-1800s—something called the “great man” theory. In essence, this theory suggested that to be a “great man,” one had to emulate the specific “traits” of the acknowledged leaders of the time. There is overlap between great man and trait theories of leadership. What is missing is an understanding of what great means and how the specific traits define the word great for us to study. In reality, the great man theories of the early 1800s offered us no benchmark for success and no road map for others to follow. Essentially, the words great and trait were not universally understood or applied. As a result, the theory offered no utility for education or application. Simply put, the behavior of great leaders and their traits were observed and emulated without any attempt to understand the foundations of behaviors or influence of traits. Another example is the transformational leadership theory, which was introduced in 1978.1 This theory suggests that leaders can inspire followership by raising subordinate goals toward higher levels of motivation through developing a spirit of trust, respect, and loyalty. For example, John F. Kennedy’s presidency is often characterized as inspiring the civil rights movement and a manifest destiny toward U.S. exploration of space. In support of this proposition, a janitor at NASA was once asked what he was doing cleaning a building after hours when he was not authorized to receive overtime pay for the work. His reply: “I am helping to put a man on the moon.” President Kennedy was successful in transforming the perceptions of the janitor to view his job not only as a task, but also as one part of a greater vision—the U.S. quest for space exploration. Kennedy was an astute student of leadership. As a result, he was able to recognize the core values necessary to change individual behavior and form followership among the masses.2 Scholars of leadership theory can deconstruct Kennedy’s natural abilities and provide tools, skills, and a road map for young scholars and early careerists to follow. Deconstructing “transformational theory” provides developmental insights that young executives can build on until their natural abilities associated with maturity and experience develop over time. Deconstructing theory and methods of theory building can greatly assist in this effort. Understanding the elements of a theory, models, and the components of theories and models are critical for analyzing, synthesizing, and evaluating which elements and components of a personal leadership model would be best for you in your career, and allow you to determine how to put them into practice. As former University of Alabama football coach Paul “Bear” Bryant said, “We beat most teams because we have a plan.” You need a leadership plan (your model) as well to be the best you can be in your career. The rest of this chapter starts to build the foundation for you to develop your leadership plan, your model.
WHAT IS A THEORY? Theory is the primordial soup from which complex questions can be modeled and discussed in bounded rationality where like-minded executives can agree on issues and causality. It is important to know that there is no one accepted definition of theory within the organization behavior literature. In layperson’s terms, a theory is an advanced form of an idea or an opinion that has some basis in the empirical world. Regardless of the definition selected, a theory must be capable of support by qualitative measures or quantitative data. If a theory is incapable of initial development based on qualitative or quantitative properties, the burgeoning theory may not have evolved past the opinion or idea phase, and it may not be valuable to the profession or the advancement of knowledge. The term theory is derived from an ancient Greek word meaning to contemplate, to contemplate the divine, or to speculate. Simply put, a theory is a way to capture and represent a set of ideas, constructs, variables, and observations within a context to demonstrate how a part of the world works, or could work better. A theory intends to evaluate variables that are operationally defined and measured in a dynamic world. Theories are analytical structures that seek to illustrate how linked ideas, domains, constructs, and variables perform under various conditions by using quantitative, qualitative, or combined methods. “A particular feature of science (including social science) is that it is continually evolving as a result of the scientific method which calls for a constant testing of ideas and observations of scientific facts, theories, and models.”3 Theories start out as models that have been developed using empirical thinking. Qualitative information and analysis (also known as theory building methods) such as observation and literature review start this empirical process. Quantitative analysis (also known as theory testing methodology) tests models as hypotheses to determine if the model represents the world better than what was known before. This empirical hypothesis testing can be performed as qualitative research alone in certain cases, but may also be carried out in combination with quantitative methods (a process called triangulation). Definitions of the term theory support the notion that a theory provides for an integration of ideas within a context of a phenomenon. “A theory is a set of interrelated principles and definitions that present a systematic view of phenomena by specifying relationships among variables with the purpose of explaining natural phenomena.”4,5 Another definition suggests that a theory is “Any set of hypotheses or principles linked by logical or mathematical arguments which is advanced to explain an area of empirical reality or type of phenomenon.”6,7 As discussed previously, the terms model and hypothesis nudge their way into the discussion; this is especially true in the study of leadership.
THEORY AS A CONCEPTUAL MODEL In this section you will learn to visualize theory as a conceptual model. A conceptual model is a conceptual description of something abstract. It is not uncommon in business practices for executives to develop models to represent certain ideas and concepts. The model itself, like a photograph, breaks down barriers of communication, thereby making it easier for individuals to view the model and understand complex relationships. Models serve as representations of the world or phenomena around us; they are particularly useful for understanding, analyzing, and evaluating how the world works around us. Figure 3-1 shows an example of a conceptual model for a hospital. In this basic model, hospital performance is achieved as a result of an organization’s inputs and outputs. In this case, the inputs are constructs (to be discussed later) of hospital types, structural units, and the environment. The outputs in this model are the result of the previous three constructs combining to form some sort of recognized output. Finally, the performance of the hospital is based on the efficiency of those outputs being earmarked as high or low. If the output is high, there is no need for leadership to take action. If the output is low, the conceptual model guides leaders back to the relationship between constructs so that additional action can be taken. The basic conceptual model shown in Figure 3-1 helps us to evaluate hospital efficiency in a manner that is complex, yet easily understood by outside agents and stakeholders. FIGURE 3-1 A conceptual model. Leadership for Health Professionals Essay Assignment Papers: Understanding Leadership as a Theory.
OVERVIEW OF THEORY This section presents a brief overview of theory and explores how a theory can be deconstructed into constructs, variables, and measures. Readers are instructed on how to use visual and graphical tools to create a conceptual model that measures a specific outcome of leadership principals. Model building is a necessary precursor to performance-based management development, health system examination, policy formulation, and conducting quantitative analysis—to name only a few of its potential uses. Nevertheless, understanding the process of building empirically measurable healthcare and leadership models may be one of the more underrated aspects of leader development in today’s healthcare system. This chapter places specific emphasis on creating conceptual models of leadership that can be used to measure the outcomes of various theories. Leadership for Health Professionals Essay Assignment Papers: Understanding Leadership as a Theory
DIFFERENTIATING BETWEEN THEORIES AND MODELS The terms theory and model are used interchangeably in much of the literature. A theory is a hypothesis that has undergone scientific and practical scrutiny, albeit at various levels of intensity, to determine its value, truth, and validity. A theory does not “just happen” quickly, but rather develops over time after significant scrutiny by multiple scholars, practitioners, and researchers has proven the model is worthy of theory status. A model is a simplified abstraction of reality; it has not yet met a level of academic and practical scrutiny for scientific validation, so its value has yet to be determined. Both theories and models require ecological validity to represent and present reality well, so that scholars and practitioners can study and use them. It is more difficult to prove value, truth, and validity in the leadership discipline than it is in a basic science such as chemistry or physics. Consequently, one could argue that leadership theories and models are really hypotheses—that is, speculations about how a phenomenon actually behaves or works: A [social] scientific theory is a synthesis of well-tested and verified hypotheses about some aspect of the world around us. When a [social] scientific hypothesis has been confirmed repeatedly by experiment, it may become known as a [social] scientific law or scientific principle.8 In the leadership literature, the terms theory and model are much more prevalent than the terms law and principle, mostly due to the social requirement and nature of leadership: People’s beliefs, values, attitudes, and behaviors often change, and situations are dynamic. Going back to the structure of theory, constructs, and variables, an example can explain this social sciences–based methodology. Many leadership theories include interpersonal relationships as a category within their theories. Within the category of interpersonal relationships, one of the constructs is communication. As a construct, communication is broad and has many possible variables that can be measured. For example, conflict management style may be a variable within the construct of communication. Conflict management style, as a variable, can be measured using a survey to determine the leader’s dominant style from six previously identified conflict management styles. Because a theory, to be useful, needs to adjust and work well in a dynamic world, recommending a conflict management style based on a particular situation would be more helpful than just relying on chance to pick the correct conflict management style out of six possibilities. Thus, in this example, a situational variable (observations from the situation) can interact with a variable from the interpersonal relationships category and communication construct, and specifically the conflict management style variable, to provide a recommended conflict management style. From a social sciences and academic perspective, this approach serves as a structure to facilitate studying, teaching, and learning about leadership. From an application viewpoint, however, the leadership theory in practice would be transformed into knowledge, skills, and abilities. Continuing with the same example, the practicing leader understands that interpersonal relationships are important and can describe and explain why this subject is important in general, but also based on the constructs included under this category. This is an example of knowledge. Focusing on the communication construct and the conflict management style variable, the practicing leader can identify the type of situation at hand and apply observations from the environment to the leadership theory to reveal a recommendation for the appropriate conflict management style to use in this situation. This is an example of ability. Even though the recommended conflict management style may not be the leader’s dominant or preferred style, the leader uses the recommended style in this particular situation. This is an example of a skill. If the leader can use any of the six conflict management styles dictated by the situation as appropriate, he or she would be more skillful than a leader who can use just two or three conflict management styles. To increase the value of studying leadership, building your knowledge of theories and models is critical. Developing an ability to take apart leadership theories and models and separate them into their component domains, constructs, and variables is vital. Also, developing the ability to assess the situation or environment of leadership is important. Lastly, developing, refining, and maintaining skills associated with analyzing and using constructs and variables of leadership theories and models are paramount. As you study and master the knowledge and practice the abilities and skills of the various theories and models, your leadership acumen will improve. Leadership for Health Professionals Essay Assignment Papers: Understanding Leadership as a Theory.
THEORIES, MODELS, CONSTRUCTS, VARIABLES, AND MEASUREMENTS History has recorded leaders’ exploits for thousands of years. Anthropology, archeology, social anthropology, political science, business, communication, and other disciplines have all made valuable contributions to the basic foundations of leadership theory and practice. The health professions place leadership foundational theories and models and the practice of leadership into the complex environment of promoting health, preventing disease and injury, diagnosing and treating disease and injury, rehabilitating human bodies and functions, and facilitating dignity at the end of life. In this arena, leadership, as a complex topic, is coupled with a complex environment, the health industry, which creates a multilayered and integrative system in which the health leader must perform. To use leadership theories and models, it is important to understand the scholarly building blocks of these foundations and to extend or bridge scholarly and theoretical perspectives to the applied or practical use of leadership knowledge, skills, and abilities. Leadership is an interdisciplinary field of study of the social sciences. Leadership is a social phenomenon: It involves individuals, groups, and populations, and focuses on how those people interact given the multitude of beliefs, values, attitudes, and behaviors in society. Leadership can be simple or very complex depending on how complicated the social environment appears to both the leaders and the led. As a science (in this case, a social science), leadership is explained, taught, learned, and documented in the literature. Within this knowledge base, theories and models combine domains, constructs, and variables that can be measured to describe, prescribe, or both describe and prescribe how to think about, practice, and evaluate leadership. Given that leadership knowledge comes from several disciplines, it is important to use social sciences–based methods to provide clarity to the study of leadership. That clarity is provided through a structure that uses theories, models, constructs, variables, and measurement as a common language and guide to leadership inquiry, practice, and evaluation. ANATOMY OF THEORY The anatomy of theory can be broken down into specific units of analysis—namely, the theory itself, followed by subordinate constructs, variables, and operationalized measures. Surrounding these elements is the environment of discussion, an enclosure called bounded rationality. When discussing theoretical constructs, variables, and measures, it is first necessary to frame these elements within a plausible discussion group. By framing constructs, variables, and measures in a bounded rationality, an “out of bounds” area is revealed that helps researchers stay within certain parameters of discussion.9 Contained within this bounded rationality is the physiology of theory (discussed in the next section). The physiology of theory describes the interaction among constructs, variables, measures, and other elements. In this regard, the interaction of constructs within theory is helpful for developing propositional statements. This consideration is important in the early stages of qualifying theoretical relationships before quantitative data become available for testing or disconfirmation of the theory. Forming more concrete and testable relationships within the theory are the relationships between variables known as hypotheses. Propositional and hypothetical relationships are discussed in greater detail later in this chapter. Also contained within the bounded rationality of theory are contextual factors and confounders. Contextual factors are generally known elements that exist in the same environment as constructs, variables, and measures. The interaction of contextual factors on certain constructs and variables may be known in advance and can be controlled for through awareness and intervention. Confounders are properties in the environment that are generally not known in advance and may interact with theory to produce unanticipated effects. Figure 3-2 depicts theory as a conceptual model for visual representation and understanding. A conceptual model is a “conceptual description” of the key elements of a phenomenon under study. The conceptual model should be parsimonious (simple) and offer graphic representations of theoretical elements that help outsiders understand the issue(s) being investigated at a glance. A conceptual model may include the actual theory, as well as constructs, variables, measures, confounders, and contextual factors. Some conceptual models, however, consider only specific constructs as well as certain elements specific to the unit of analysis under study.
PHYSIOLOGY OF THEORY The physiology of theory can be described in terms of the relationships within the theoretical model. Two of these relationships are expressed in terms of hypotheses and propositions (Figure 3-3). A proposition is a statement of opinion, based on some degree of preliminary study or heuristics, which is offered as a true or valid statement. Although the statement may not always be true or valid, it is offered as such until evidence of disconfirmation is provided. The aphorism “time is endless” is an example of a propositional statement between constructs. Another classic example of a propositional statement combining constructs is “the right to bear arms.” This propositional statement is offered as a statement of fact as if it were true; however, the interpretive nature of this proposition continues to be repeatedly addressed in the United States. FIGURE 3-2 Anatomy and physiology of a theory. A hypothesis is a testable relationship between two variables. The purpose of hypothesis testing is to discover causal relationships or associations between variables. Hypothesis statements are the foundation for all social sciences research and form the basis for the advancement of knowledge. The words model, hypothesis, and theory are each used quite differently in science. Their use in science is also quite different [than] in everyday language. To scientists the phrase “the theory of . . .” signals a particularly well-tested idea. A hypothesis is an idea or suggestion that has been put forward to explain a set of observations. It may be expressed in terms of a mathematical model. The model makes a number of predictions that can be tested in experiments. After many tests have been made, if the model can be refined to correctly describe the outcome of all experiments, it begins to have a greater status than a mere suggestion. Scientist do not use the term “the theory of . . .” except for those ideas that have been so thoroughly tested and developed that we know there is indeed some range of phenomena for which they give correct predictions every time. (But, language being flexible, scientists may use “a theory” as a synonym for “a hypothesis,” so listen carefully.) Today, any set of scientific ideas referred to as “the theory of . . .” is a well-tested and well-established understanding of an underlying mechanism or process. Such a theory can never be proved to be complete and final—that is why we no longer call it a “law.” However, it is the same kind of well-tested set of rules, with an established area of applicability, as the older ideas called “laws.”10 In essence, a theory is a representation of the world that has been confirmed to be reasonably true, valuable, and valid. Some theories (and some models) are better than others; some are very specific to particular situations, whereas others are broad or even universal. Theories and “those hoping to be theories” (i.e., models) represent an aspect of our world or a methodology to improve our world through a structured process grounded in language and approaches of the scientific method used by scholars and theorists. At the next lower level, theories (as well as models) integrate and combine constructs. FIGURE 3-3 Conceptual model of theory physiology. CONSTRUCTS The building blocks of theory are constructs. In our proposed conceptual model building, constructs are visualized as circles. It is critical to the study of organization behavior to have a clear understanding of what a construct is. Failing to have a clear understanding of constructs will result in an inability to understand many important leadership concepts. By definition, a construct is a latent variable that lacks empiricism (taste, touch, see, smell, hear). Elements that are empirical have tangible, physical properties; for example, an apple possesses empiricism insofar as it can be tasted, touched, seen, and smelled. It does not matter that the apple does not make noise. Because an apple possesses attributes related to four of the five empirical senses, we can say that an apple is not a construct because it can be rationalized through empirical properties. Any physical element or property that can be described through at least one of the five senses does not qualify technically as a construct. Said another way, a construct is an organizing device that captures a topic, subject area, or smaller and specific theory or model within a larger theory or model. For example, communication is a construct within a larger leadership theory. Constructs organize and combine multiple variables that are closely linked into one grouping or subheading within the structure of the theory or model. The critical feature of constructs derives from the term closely linked. Constructs must make sense in relation to the real world; thus they must have ecological validity. Constructs, then, are the basic building blocks for grouping variables within a model or theory. It is commonplace to see the term concept associated with constructs. A concept is a method of organizing or categorizing an abstract topic or reality under a construct. A concept should be linked logically to the construct. A group of concepts under a construct must have cohesion that is logical or holds true to reality (ecological validity). Concepts, in essence, are either variables or constants. Variables and constants are located at the lowest level within the organization of the construct. Another classic example of a construct is the term quality. Quality is a construct that cannot be discussed without identifying it through other measurable properties or variables. The well-known statement, “Quality is in the eye of the beholder,” generalizes the difficult problem we have describing quality. Other latent variables, such as health, love, happiness, pain, efficiency, effectiveness, performance, satisfaction, organizational survival, leadership, success, and motivation, are all examples of constructs. What makes constructs difficult to study is that different people may have different opinions of how to define them. Providers encounter this issue frequently when trying to understand a patient’s level and tolerance for “pain.” Pain is clearly a construct (or said another way, a personal concept and/or belief) that is difficult to communicate, may not be visible to another person, and clearly is perceived differently by different age groups. Although adults may have greater success in describing pain to a provider in regards to how it affects activities of daily living (ADLs), as well as frequency and duration of pain, children have less of a vocabulary and experience with describing pain. As a result, many pediatricians use a model called the Pain Rating Scale (Figure 3-4).11 As you can see, the model describes the concept of pain using a 10-point scale. Associated with the scale are emoticons. Studies have shown that children as young as 4 years old can associate levels of happiness and sadness using emoticons in a manner more consistent with their peers than ordinary language. This example shows how the use of modeling in health care is essential for standardizing relatively simple concepts like pain between a patient and a provider. Unfortunately, many other communication efforts dealing with constructs in leadership are not as easily modeled and accepted. As a result, it is often necessary for health leaders to develop standardized models and measures in order to communicate exact intent. Next we present a universal technique for communicating leadership constructs. We do this by defining constructs with empirical properties we call variables and measures. FIGURE 3-4 Pain Rating Scale. VARIABLES Flowing from constructs are variables. In model building we use rectangles to visually depict a variable. A variable is “a property associated with a concept that varies when measured.”12 Variables are also empirical units that can be identified through one of the five senses. Accordingly, a variable is an element that has precise meaning in the physical world. Generally, variables are universally understood and easily described. Weight is a good example of a variable. When discussing weight with peers or colleagues, universally understood concepts of pounds, ounces, or tons are immediately recognized as valid descriptors of weight. If a variable is incapable of being defined with a generalized descriptor, it may cause problems in communication with leadership peers. Take, for example, a colleague who suggests that her new china cabinet is very “heavy.” Based on this description alone, can we accurately describe the weight of the cabinet, or do we need more information? How about a provider who suggests that he just encountered a “large customer” at the pharmacy. Might large mean physically obese, tall, or perhaps even muscular? For this reason, variables by themselves are not adequate to communicate concepts in leadership and model building. The notion of “something that can be measured, and whose measurement can vary or change” is the essence of a variable. An example of a common variable in the health professions is patient body type, which is a variable that can be described by both height and weight. Height can be measured, yet varies by person, as does weight. In contrast, a constant is a property that “does not vary”13; it is unchanging. Variables are essential to leadership theory confirmation through model and hypothesis testing because they are the properties or items that are tested to see whether the theory is confirmed. The importance of variables is that they vary; they change so that empirical testing can be accomplished. If the model is full of constants that do not vary, how could you test whether the model is true to reality? Moreover, how could such a model help someone to be a better leader if everything stayed the same?
CONSTANTS Constants are those concepts that do not vary; however, depending on what you are studying, a concept may be either a constant or a variable. An example would be the study of prostate cancer: Would gender be a variable or a constant in this study? Although gender is important, only males get prostate cancer. Given that gender would not vary, it is a constant in this example. High-risk pregnancy would be another example where gender would not vary, because only females would be included in the study. In contrast, in a population-based heart disease study, gender could vary, because each observation could be either male or female; thus gender would be a variable in this situation. The variable—gender in this case—would be

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