Essay: Inspired Leadership: Examining Joe’s Transformational Leadership Theory in Mental Health Nursing



“Identify inspirational leader and investigate their leadership theory (mental health nursing)”;

This essay will firstly identify an individual whom I, as a student mental health nurse, have perceived to be a role model and inspirational leader in clinical practice, and investigate the leadership theory and approach of this individual. Secondly, the essay will critically analyse and reflect upon leadership theory with regards to my role model and to contemporary nursing and health care practice. Lastly, the essay will discuss any potential implications of the leadership approach to future practice.

In accordance with the National Health Services’ (NHS) Confidentiality Policy (2014), all evidence used in the case study will be anonymised and no personally identifiable information will be used. To respect the individual and to protect their identity, I will refer to my role model as Joe, which is a pseudonym. Equally, I gained consent from Joe to carry out this essay (NHS 2014).

Nurses and midwives are conditioned by the Nursing and Midwifery Council (NMC) to ‘act as a role model of professional behaviour for students and newly qualified nurses and midwives to aspire to’ (NMC, 2015: 15). Therefore, all nursing practitioners who engage with student nurses in the clinical learning environment have a potential to be seen as a role model (Vinales, 2015).

The role model I have chosen to identify for the purpose of this essay is Joe; I was privileged to work alongside him whilst completing my semester-long five-specialism placement. He is a registered mental health nurse and currently managing a small, NHS community-mental-health team. My reason for choosing Joe is primarily because I believe he embodies the definition of a positive clinical role model. Joe is competent in his role, actively enjoys nursing, provides excellent patient care, and inspired confidence in my ability as a student nurse (Morton-Cooper & Palmer 2000, Wiseman 1994). In the same way, as a leader Joe promoted qualities recognised by contemporary nursing literature as fundamental to good leaders and managers in health care settings (Ellis & Bach, 2015). These include charisma, intelligence and a vision to deliver the best available treatment and care to his service users, in line with contemporary nursing values (Ellis & Bach, 2015).

Over the three months working with Joe and interacting with his team, I discovered that I was not alone in my opinion. Throughout my placement I never heard a bad word spoken against him, nor did I sense any negativity when he was present in the office. Furthermore, Joe has previously won a recognition award for his leadership within the team, for which he was nominated and judged by his peers and seniors. Therefore, he appeared the perfect leader to identify for the purpose of this essay.

There is no unified definition of leadership; some believe that leadership is a performance art of balancing the needs of a group of followers against the goals and targets of an organisation (Gill, 2006), whereas others see leadership as a science and process of mobilising others to achieve goals through shared values, motives and access to resources (Burns, 1978).

However, a notable contemporary definition of leadership comes from Northouse (2015a: 3); he believes that leadership is built on four key principles: ‘(a) Leadership is a process, (b) leadership involves influence, (c) leadership occurs within a group context, and (d) leadership involves goal attainment’. Like Burns (1978), Northouse (2015a, 2015b) essentially sees leadership as a process that individuals engage with to influence a group of people to achieve a common goal.

In addition to the vast definitions of leadership, a number of leadership theories have emerged; these have evolved and absorbed ideas from different industries and disciplines over the past century (Northouse, 2015b). Theories range from the “Great Man” approach, which focuses on the qualities of great historic political, military and social leaders, to the situational approach, which proposes that different situations evoke different types of leadership (Northouse, 2015a).

Through reading contemporary leadership literature and observing and interacting with Joe whilst on placement, I believe his leadership approach is most comparable to transformational theory. As suggested by the name, this approach is interested in transforming the views and beliefs of followers to achieve a shared dream or goal (Tourish, 2013). First developed by Burns (1978), he proposes that transformational leaders initiate change through creating a connection with their followers that enhances motivation and morality. Leaders achieve this by taking an interest in their followers in order to understand and help them reach their full potential and achieve the followers’, the groups’ and the leaders’ goals (Burns, 1978).

As this theory advanced, Bass (Bass 1985, Bass & Avolio 1990) elaborated on Burn’s (1978) work and split transformational theory into four characteristics: idealised influence (charisma), inspirational motivation, intellectual stimulation and individualised consideration. The essay will now explore examples of where I believe Joe practiced Bass’s (Bass 1985, Bass & Avolio 1990) characteristics as a leader.

According to Bass (Bass 1985, Bass & Avolio 1990), transformational leaders firstly use idealised influence and charisma to attract their followers and be perceived as role models. Like the definition of a role model, idealised influence invites followers to identify with the leader and imitate their values and behaviours (Northouse, 2015a). I believe one of the main reasons I was drawn to Joe is because the competence and skill he displayed in practice reflected those nursing values and behaviours I have been taught in university. These include the “6C’s”: care, compassion, competence, communication, courage and commitment, which embody the NHS’s vision for compassion in practice (Cummings & Bennett, 2012).

Equally, during his time working with the community team Joe has won an award recognising his competence in nursing practice and ability to deliver effective care. This indicates that he is extremely respected and trusted not only by his fellow team members, but also senior members of his NHS Trust. Being respected by senior figures is significant to idealised influence because it signifies that Joe’s values and beliefs are ethical and that he can be trusted to do the right thing (Northouse, 2015a).

Throughout my placement, I observed Joe motivating team members by maintaining a positive attitude and putting positive spins on tasks or incidents that were challenging or caused negativity in the team. An example of this was when the team achieved disappointing feedback from a physical health documentation audit, which the team had been working hard towards. Instead of blaming the team for their disappointing result, Joe reflected with the team on their excellent work and welcomed feedback from them on how to achieve better results. By trusting in their feedback and believing that they could improve on the initial audit, Joe was able to inspire motivation in the team. This is an example of Bass’s second characteristic inspiration motivation; as explained by Bass (Bass 1985, Bass & Avolio 1990), transformational leaders have high expectations and belief in their followers and use this to inspire motivation. Equally, in regards to the example, it also has the ability to boost team morale and reinforce a belief in the team’s capabilities when team morale is low (Northouse, 2015a).

Thirdly, Joe promoted intellectual stimulation by being extremely interested in any ideas or suggestions team member had towards improving the care and treatment being provided by the team. Intellectual stimulation is a process whereby the leader evokes innovation and prompts followers to challenge their organisation, leader and personal values to promote self-confidence (Northouse, 2015a). During a discussion, I presented an idea on how to improve attendance to a community-based therapeutic group by sending out a text message reminder 24 hours before the group. This would be accessible to all service users who attend the group and agree to receive a text messages from their care coordinator. Although this was something that the team had not attempted before, Joe welcomed my idea and agreed to give it a trial. This gave me the self-confidence to carry out the idea, which fortunately resulted in an increase in attendance to the group and motivated service users to engage with the team. Although this is a personal experience, I observed similar scenarios where Joe initiated discussion and debate around contemporary nursing issues in team meetings to generate a productive dialogue to improve practice.

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Finally, the aspect of transformational leadership I respected most about Joe was his ability to give individualised consideration to all his followers. Individualised consideration is a leader’s ability to listen to the needs of their followers and offer support on an individual or group basis (Northouse, 2015a). Essentially, transformational leaders want their followers to reach their full potential and achieve their personal goals as well as the goals of their organisation and leader. On every interaction with Joe, he greeted me warmly and showed a genuine interest in my personal wellbeing and progress with the team. This was not something exclusive to me; I observed him do this with all team members, from administration staff to the consultant psychiatrist. As acknowledged by Northouse (2015a), by doing this Joe provided a supportive climate and  personalised direction and support to all his followers.

In addition to these characteristics, transformational leaders are known to have a strong vision that emerges from the collective interests of those involved in the team or organisation (Northouse, 2015). By observing and interacting with Joe it is clear that his vision is to deliver the best available care and treatment to service users in his care. To help achieve his vision, Joe welcomes feedback from service users, families and team members to help improve the service. By doing this, Joe is not only a transformational leader to team members but also to service users in his care, which exemplifies professional standards on working in partnership (NMC 2015, The National Institute of Health and Care Excellence (NICE) 2011).

Joe is not alone in adopting a transformational approach; according to Northouse (2015a), transformational theory is fast becoming the most researched and accredited learning theory of our time. Furthermore, this approach has been linked to hugely successful contemporary leaders. Significant examples of these are former Apple CEO Steve Jobs, and Mohandas Gandhi (Northouse 2015a, Steinwart & Ziegler 2014). Naturally, this evidence supports my belief that the leadership style adopted by Joe is both appropriate and effective for someone I perceive a positive clinical role model.

In addition to leadership theory, Douglas (1960) proposes that leaders are essentially guided by one of the two following theories: theory X, that people do not want to work and need direction, and theory Y, that people want to work and are self-motivated. This philosophy has been used in literature as a mode to determine an individual’s leadership style, which is essentially based on their assumption of their followers (Northouse, 2015b).

In their principal research, White and Lippitt (1968) found that there are three dominant leadership styles: authoritarian, democratic and laissez-faire.

The authoritarian leader perceives followers in line with theory X; they believe they are in charge and feel the need to covey this to their followers (Northouse, 2015a). Within a team scenario, these leaders dictate tasks to the team and separate themselves on a constructed higher plane (White & Lippitt, 1968). Although this approach can be perceived as hostile and discouraging, there are some who believe that this approach works well in emergency health care situations where precision is essential (Northouse, 2015b).

Democratic leaders agree with theory Y. By description, this style corresponds with transformational theory (Northouse, 2015b), and the leadership style of Joe. Democratic leaders work on the same level as their followers: they listen and support them to achieve their goals without being dictatorial (White & Lippitt, 1968). As a result, this generates job satisfaction, positivity and motivation within the team, a skill that Joe has demonstrated thoroughly in the discussion above. In contrast, laissez-faire is unlike both the above styles; these leaders neither control nor nurture their followers and have minimal influence on followers (Northouse, 2015b). This style is associated exclusively with negative consequences and as a result has no credible place in health care leadership (Northouse, 2015a).

Although each style is different in approach, White and Lippitt (1968) observed that, unlike leadership theories, these styles overlap one other and are used by leaders interchangeably to tackle different challenges. On interaction with Joe, he agreed with this and stated that in a situation where immediate action from the team is required, he may have to initiate an authoritarian stance to ensure the task is completed.

This essay will now critically analyse and reflect on the transformational leadership approach of Joe and identify any implications that this approach presents to future practice. A common debate when discussing the leadership approach of managers is whether they are actual are or just presumed leaders because they are in a position of power (Gill, 2006). Northhouse (2015) speaks of this in terms of power to influence, which both managers and leaders possess independently of one another. According to Kotter (1996), the distinction is down to change: if change is needed within an organisation, a leader is essential, but if there is no need for change then a manager is key.

Zaleznik (1977) suggests that leaders and managers are two different types of person; leaders are emotionally involving and active, whereas managers problem-solve and have no emotional involvement. This is explained by Kotter (1996) in terms of their role; Managers coordinate staffing, budgeting, planning and problem-solving, whilst leaders fundamentally motivate, inspire, establish direction and align people. These theories suggest that if Joe is perceived to be a good leader he is not necessary an effective manager and vice versa.

However, Northouse (2015a) recognises that, although different in their approaches, both leaders and managers influence and work with groups of people to achieve common goals. This view is shared by Sandler (2003), who views leadership on par with management; Sandler (2003) believes that leadership either lies within, alongside or overlaps the role of management and is fundamentally essential for managerial success. Although I have little knowledge about Joe’s abilities as a manager, on reflection – considering the ever-evolving climate within the NHS and need to improve services in line with legislation and standards – I believe having leadership skills is essential in his role (Cummings & Bennett, 2012).

Literature proposes that there are many strengths in adopting a transformational leadership approach. According to Northouse (2015a), the strong emphasis transformational leaders have on their followers’ needs, values and morals are uplifting in terms of leadership. This factor allows followers to be a prominent part of the leadership process and shared vision of the organisation, and sets the approach apart from all others (Bryman, 1992). In the same way, Nicolson et al. (2011) agree that transformational leadership is an appropriate conceptual resource to deploy in the NHS, as its workforce is a mix of professionals from different ethnic, class and cultural backgrounds. All these professionals have varied needs and abilities and are caring for a population with similar diversities and needs, and would benefit from the transformational approach (Nicolson et al. 2011).

As a consequence, transformational theory has been named the most influential leadership theory in health care, with research linking the approach to staff satisfaction, performance, organisational climate and turnover intentions (The Kings Fund, 2015). The Kings Fund (2015) also found that evidence suggests that if a leader in health care is using the transformational approach with their team, it is a good predictor of quality outcomes.

However, although transformational theory has been linked to some great contemporary leaders and results, the approach has gained notable criticisms in its ability to influence groups against organisations and perceived social norms (Northouse, 2015a). Historically, in the media, the transformational style has been linked to leaders of cultic organisations and the development of extreme political and inhumane organisations (Tourish, 2013). Famously, the approach has been associated with Reverend Jim Jones, the leader of the People’s Temple. Jones, a respected religious leader, led 909 Americans to a “utopian” compound and subsequently to their death in an apparent mass suicide in 1978 (Bass & Riggio, 2008).

This introduces the idea of pseudotransformational leaders, Bass and Riggio (2006) state that true transformational leaders get their commitment, loyalty, power and esteem from their followers. Conversely, pseudotransformational leaders use their gained power for personal motives and use manipulation, threats and promises to stimulate fear and compliance in their followers.

Examples of this leadership approach were found in the Francis report (2013): Francis exposed major failings, inadequate care and lack of compassion by nursing staff and management in the Mid Staffordshire NHS Trust. He found that leaders within the trust had manifested a culture of fear, which prevented nurses from speaking out against bad practice due to threat of bulling by peers (Francis, 2013). Francis (2013) raised concern about the leadership of the NHS and highlighted a need for change. This emphasises a need for nurses to be self-aware to ensure they are working within all legislation and standards set by the NMC (2015), independently of what their leader or manager promotes.

Although I found the leadership style adopted by Joe effective and in line with my nursing values, something to consider is whether his transformational approach echoes the leadership vision held by the NHS. In 2013, following the Francis (2013) report, the NHS published a paper outlining their vision towards a new leadership model. This model is built of three main elements (NHS Leadership Academy , 2013: 8):

1. Provide and justify a clear sense of purpose and contribution

2. Motivate teams and individuals to work effectively

3. Focus on improving system performance

Like all contemporary nursing practice, this leadership model is based on the best available research evidence (NHS Leadership Academy, 2013). Elements one and two are underpinned by transformational theory and the drive for change-focused leadership. The NHS Leadership Academy adopted this approach because they envision ordinary practitioners achieving great things through motivating and inspirational clinical leaders. In contrast, the NHS Leadership Academy (2013) offers a cautionary take on the transformational approach in reference to element three. They propose that to improve systems and performance, leaders need to focus on maintaining transparency and humility within the organisation rather than becoming heroic, super-human leaders. This corresponds with the findings of the Kings Fund (2011) research project that identified a need for the NHS to move away from the heroic leadership model (turn-around chief executives) and build an inclusive leadership model for all. This paper confirms that the approach adopted by Joe is essentially in line with the NHS’s vision and a contributing factor to his respect and success as a leader.

Although this new leadership model based around transformational leadership provides a hopeful vision for the NHS, there are those who criticise the approach as a sustainable concept. Northouse (2015a) stresses that transformational theory is built around personality traits and predisposition rather than transferable skills and behaviours. This makes training people to adopt the approach problematic, as teaching personality traits or changing or excising traits is extremely difficult. However, some argue that simply increasing knowledge of the approach within organisations and teams can lead to team motivation (Northouse, 2015a).

Looking ahead to leadership in future nursing practice, contemporary healthcare literature proposes a need for a new leadership style to replace traditional approaches (Piggot-Irvine et al. 2014). The Kings Fund (2012) found that for leadership to be effective, staff must be engaged. If not, evidence suggests that there are more errors, more infections and higher mortality rates in services. If the leadership style of management can increase staff engagement, the Kings Fund proposes that staff will be less stressed, less prone to absenteeism and staff morale and motivation will rise (The Kings Fund, 2012).

As an extension of Chief Nursing Officer Jane Cummings’ strategy, Compassion in Practice (Cummings & Bennett, 2012) 2014 saw a drive towards a stronger NHS through compassionate leadership. As defined by NHS England (2014), compassionate leaders must have the ability to detect the unspoken and the explicit concerns of others. Equally, they must have a repertoire of emotional resources and practical tools to create a supportive and constructive care environment (NHS England, 2014).

To establish the characteristics and skills required to be compassionate leader, NHS England (2014) completed a piece of research that interviewed graduates of the NHS Leadership Academy. The NHS Leadership Academy is an educational programme within the NHS that was developed extensively as a consequence of recommendations by Francis (2013) (NHS Leadership Academy, 2015). Francis highlighted a need for a professional training school within the NHS that offered a common management- and leadership-training programme (NHS Leadership Academy, 2015). The academy asked alumni to reflect on their learning and in single words state what a compassionate leader meant to them. Results found that the top desired characteristic of a compassionate leader was emotional intelligence. Emotional intelligence in respect to leadership can be defined as a leader having the ability to assess and understand the emotional states of themselves and others (Malik et al. 2014).

Emotional intelligence is recognised by contemporary literature as an essential skill required by health care leaders. Emotional intelligence is split into 5 components: self-awareness, self-regulation, social skills, empathy and motivation (Henwood 2014, Barr & Dowding, 2012). Kumar (2013) proposes a positive correlation between emotional intelligence and transformational leadership traits, and believes that leaders can improve their performance by adopting both approaches. Although transformational leaders can already offer personalised support, Kumar (2013) suggests that emotional intelligence helps leaders consider the personal motivations and learning styles of their followers (Kumar, 2013). By doing this, leaders set tasks and delegate opportunities to the appropriate followers, which consequently improves outcomes and job satisfaction (Kumar, 2013).

Although this essay has presented evidence that suggests that Joe’s leadership approach is effective in healthcare settings, Joe must ensure that he is practicing in line with the ever-evolving common vision of the NHS, as recommended by Francis (2013). Therefore, I recommend that Joe engage with the NHS Leadership Academy and the extensive leadership training programmes they offer.

Subsequently, as a nearly-qualified mental health nurse, I will be entering a profession where I must uphold the Code (NMC, 2015) and be a model of integrity and leadership to my peers and service users. This essay has heightened the need for me to be self-aware and grounded by evidence-based practice and values, in order to ensure that I am influencing others in a positive way, in line with contemporary practice. Equally, like my recommendation to Joe, I aspire to attend the NHS leadership academy and become a great clinical leader.

In conclusion, this essay has identified Joe, a manager of a small mental health community team, as a role model and inspiration leader. Through reading contemporary leadership literature and observing and interacting with Joe, I identified that his leadership approach was most comparable with transformational leadership theory. Consequently, the essay defined leadership and investigated transformational theory alongside examples of Joe’s leadership approach observed by myself in practice.

Being a manager of an NHS service and a leader using the transformational approach, Joe’s leadership style befitted critical analysis and reflection around the suitability of using this approach in his role. The essay explored both positive and negative implications of adopting a transformational approach in regard to team management and leadership within organisations. Analysis found that Joe’s approach is in line the NHS and healthcare’s vision for effective leadership and is a potential contributing factor to his success as a leader.

However, the essay did highlight that the NHS wants to move towards compassionate leadership, and suggested that Joe engage with the NHS Leadership Academy to ensure that the best available evidence supports his values and practice. Equally, as an aspiring future nursing leader, the evidence presented in this essay has highlighted the values and approach I must emulate to become a successful leader. As for my current values as a nearly qualified mental health nurse, this essay has verified my initial belief that Joe is a worthy model and leader to admire and aspire to be.