1.5 Authentic leadership principles
The literature demonstrates an increasing interest in developing leaders who abandon self-interest while improving employees’ experiences and organisational performance (George, 2004; Boyatzis & McKee, 2005). The servant leadership approach epitomises this doctrine. Servant leadership focuses on accomplishing shared visions and goals by developing employees to their potential. Servant leadership promotes greater leader self-awareness, an internalised moral perspective, balanced processing of information and relational transparency of leaders working with followers to foster positive self-development (Walumbwa et al., 2007). Servant leadership stems from relying on the primary desire to serve (Russell, 2001; Block, 2013; Covey, 1992; Greenleaf, 1991).
Although there is agreement on the basic concept of servant leadership, the characteristics and behaviours of servant leadership in the literature are indeterminate and ambiguous (Russell & Stone, 2002). Servant leaders are motivated by the needs of others over self-interest. They place themselves as servants in their relationship with their followers (Greenleaf, 1991; Pollard, 1996). This mindset is quite different from traditional leadership approaches. Servant leadership emphasises personal integrity and long-term relationships with employees outside the organisation, serving whole communities and society (Liden et al., 2008). The dominant influence of servant leadership results from favourable relationships and referent power built on subordinate trust, loyalty, respect and satisfaction, derived from an employee-centred culture established by servant leaders (Rachmawati & Lantu, 2014). Servant leaders shift authority to followers; therefore, they are non-reliant on formal or institutional power to achieve outcomes. Servant leaders also positively affect the least privileged in society; they want to understand whether followers will benefit or, at least, will not be further deprived. If inequalities and social injustices exist, a servant leader tries to remove them (Graham, 2015).
Servant leadership
Authentic leadership falls within the servant leadership category. Historically, authentic leadership theory was founded in ancient Greek philosophy, which emphasised that authenticity is a construct that embodies being in control of one’s life through the Delphic maxim of ‘know thyself’ (Novicevic et al., 2016). Authentic leadership in the literature of the 1960s came to describe how an organisation reflects itself authentically through leadership (Gardner et al., 2011).
The literature describes authentic leadership as behaviour that defines the leadership role within an organisation (Seeman, 1966). Others argue that it applies to the entire organisation, meaning that all in the organisation behave authentically as if they were a single entity through their responses to responsibility ascribed within the organisation or their reactions to uncertainty and innate creativity (van Aken, 2016). Authentic leaders are mission-driven (George, 2004). Further, authentic leaders are persuasive in asserting that they create greater value than those more financially oriented (George & Sims, 2007).
Dimensions of authentic leadership
According to George, a leader authentically emphasises building legitimacy through honest relationships and ethical actions that, in turn, maximise the efforts of others to achieve the goal. There are five dimensions of authentic leaders (George, 2004):
- Pursue and display purpose and direction with a passion so people want to follow and thus show the purpose of leadership.
- Practice solid values. If one is not perceived to have integrity, there will be no basis for trust, adversely affecting followership.
- Authentic leaders are said to ‘lead with the heart’ and engage the hearts of those they serve, and therefore, align their interests with those they lead. An authentic leader requires empathy and compassion for the people they work with and the courage to make difficult decisions.
- Authentic leaders establish enduring relationships built on connectedness and a shared purpose of working together towards a common goal.
- Self-discipline is a key behaviour of authentic leaders to produce results. Authentic leaders take full responsibility for outcomes and hold others accountable for their performance. (George, 2004)
Characteristics of authentic leaders
George and Sims refined their description of authentic leaders’ behaviour to be consistent with personality and core values (George & Sims, 2007) of honesty, ethics and practicality (George et al., 2007). An analysis of contemporary literature produces five characteristics of authentic leaders:
- They emphasise building the leader’s legitimacy through honest relationships with followers with a sense of purpose, knowing what they are about and where they are headed (Northouse, 2019).
- They value followers’ input, built on an ethical foundation (George & Sims, 2007).
- They are positive and truthful, promote openness, and build trust with followers (Farid et al., 2020).
- They have a purpose which manifests as passion. Passionate people are interested in what they are doing, are inspired and intrinsically motivated, and care about their work (Northouse, 2019).
- They generate enthusiastic support from followers to improve individual and team performance (Thacker, 2016).
For each of the dimensions of authentic leadership, related characteristics need to be evident for a leader to be effective. Authentic leaders live their values, which is important as others determine a leader’s value through their behaviour. They help others see their work’s value and deeper purpose and create enduring and genuine relationships through connections. Importantly, authentic leaders convert their values into consistent actions on which others can rely.
The characteristics described above mean that authentic leaders display self-awareness, which is the ongoing process of reflection and re-examination of personal strengths, weaknesses and values, signifying that the leader does not stray from their core beliefs. Authentic leaders subscribe to relational transparency, which is the open sharing of their thoughts and beliefs balanced by a minimal exhibition of inappropriate emotions. Moreover, authentic leaders practice balanced processing, which is related to actively seeking opposing viewpoints and giving them fair consideration. They have an internalised moral perspective where the leader adheres to a positive ethical foundation in relationships and decisions and is resistant to outside pressures (George & Sims, 2007; Northouse, 2019; Walumbwa et al., 2011).
ACTIVITY
The following videos are three examples of discussions or webinars on value-based healthcare. They vary in length, so examine the time you have to view them in full.
VIDEO: VALUE-BASED HEALTH CARE – AUSTRALIAN DEVELOPMENTS AND OPPORTUNITIES FOR PUBLIC HOSPITAL
Source: Independent Health and Aged Care Pricing Authority (IHACPA) (11 minutes)
REFLECTION
Reflect on Porter’s value-based healthcare framework. Familiarise yourself with the key components of the framework: health outcomes that matter to patients, the cost of delivering these outcomes, integrated care and a strong focus on patient-centredness.
Reflecting on the current state of value-based healthcare implementation in Australia, what are the most significant barriers at the national and state levels that hinder the transition from innovative models of care to their mainstreaming in the public healthcare system?
Specifically, address the challenges posed by different funding regimes and rules across various sectors (hospital, aged care, primary care, disability care, social care) and the issue of clinical variation.
Discuss how the observed trends in activity-based management capabilities, including their rise and potential decline, impact the implementation of value-based healthcare. What strategies could be used to overcome these barriers and ensure a more cohesive and effective adoption of value-based healthcare principles across different healthcare sectors?
VIDEO: ALLIED HEALTH LEADERSHIP IN VBHC TRANSITION – QLD HEALTH ALLIED HEALTH FRAMEWORK FOR VBHC
Source: Australian Healthcare and Hospitals Association (53 minutes)
REFLECTION
Reflecting on the webinar about the value-based healthcare framework in Queensland and its focus on allied health, consider the following:
- Patient-centric care: reflect on how the shift to value-based healthcare prioritises patient experiences and outcomes. Think about the implications this has for healthcare delivery, particularly regarding measuring success. How does focusing on what truly matters to patients change how healthcare professionals approach treatment, and what roles do leaders have in the required shifts?
- Interdisciplinary collaboration: the framework emphasises a team approach, integrating various healthcare disciplines. Reflect on the importance of such collaboration and how it might impact patient outcomes. Consider this interdisciplinary approach’s potential challenges and benefits from the health leadership position.
- Measuring what matters: one of the key themes was measuring outcomes that are meaningful to patients. Reflect on the traditional ways healthcare outcomes are measured and how this new approach could lead to a transformation in care delivery. What challenges might arise in shifting focus from process-oriented metrics to outcome-oriented ones, and how might leadership be required to support these changes?
- Systemic change and funding models: reflect on the relationship between value-based healthcare and current funding models, like activity-based funding. Consider the changes necessary in funding and resource allocation to support a value-based approach fully.
- Adapting to patient needs and diversity: the framework suggests tailoring healthcare to the needs of specific patient groups. Reflect on achieving this, especially in diverse populations with varying healthcare needs. What steps could ensure equitable and effective care for all?
- Professional and leader development: consider the implications of this shift for your practice or healthcare professionals in general. How does embracing a value-based approach change the skill set and mindset required of healthcare workers and leaders?
- Future directions and innovations: reflect on the potential future innovations and improvements a value-based healthcare system might bring. How could technology, data analytics and patient feedback drive continuous improvement in healthcare? Finally, what roles do health leaders play in developing a value-based healthcare approach to healthcare across all sectors?
Use these reflections to deepen your understanding and consider practical ways these concepts could be implemented or advocated for in your professional context or healthcare setting.
VIDEO: MARGARET LEE – PUTTING VALUE-BASED HEALTHCARE INTO PRACTICE BY NURSES
Source: Agency for Care Effectiveness MOH (31 minutes)
REFLECTION
Reflecting on the presentation on healthcare leadership and the transformative approach at Alexandria Hospital, several key themes emerge that can be applied in healthcare leadership contexts:
- Adaptation to demographics and societal changes: understanding and adapting to changing demographics, such as an ageing population, is crucial. Reflect on how your healthcare practice or organisation is adjusting to these changes. Are there new services or care models that could better serve these shifting demographics?
- Person-centred care: the shift to a model organised around patient archetypes emphasises the importance of person-centred care. Consider how your healthcare setting can more effectively centre on the patient’s experience and needs. What practices can be implemented or improved to enhance patient-centred care?
- Interdisciplinary collaboration: the concept of a unified care team involving various specialists highlights the significance of interdisciplinary collaboration. Reflect on the current state of interdisciplinary collaboration in your organisation. How can communication and collaboration between different healthcare professionals be improved to benefit patient care?
- Technology integration: using technology, like for example Google Glass, for remote consultation and support demonstrates innovative approaches to healthcare delivery. Think about how technology is currently used in your healthcare setting. Are there opportunities to integrate new technologies to enhance care delivery or streamline processes?
- Value-based care: the movement towards value-based care, where the focus is on the quality rather than the quantity of care, is a key aspect of modern healthcare. Consider how your organisation measures and improves the quality of care. Are there initiatives or strategies that could be adopted to promote value-based care further?
- Sustainability and future planning: an emphasis on building sustainable practices and preparing for future challenges is vital. Reflect on your organisation’s sustainability practices and planning strategies. How are long-term challenges being addressed?