Journal of Health Organization and Management Leadership in transformation: a longitudinal study in a nursing organization Riitta Viitala

Article information:

Downloaded by McMaster University At 13:03 30 January 2016 (PT)

To cite this document: Riitta Viitala , (2014),"Leadership in transformation: a longitudinal study in a nursing organization", Journal of Health Organization and Management, Vol. 28 Iss 5 pp. 602 - 618 Permanent link to this document: http://dx.doi.org/10.1108/JHOM-02-2014-0032 Downloaded on: 30 January 2016, At: 13:03 (PT) References: this document contains references to 62 other documents. To copy this document: [email protected] The fulltext of this document has been downloaded 652 times since 2014*

Users who downloaded this article also downloaded: Anneli Hujala, Sanna Laulainen, Kajsa Lindberg, (2014),"Powerless positions, silenced voices? – critical views on health and social care management", Journal of Health Organization and Management, Vol. 28 Iss 5 pp. 590-601 http://dx.doi.org/10.1108/JHOM-06-2014-0106 Johanna Andersson, Ewa Wikström, (2014),"Constructing accountability in inter-organisational collaboration: The implications of a narrow performance-based focus", Journal of Health Organization and Management, Vol. 28 Iss 5 pp. 619-634 http://dx.doi.org/10.1108/JHOM-10-2013-0220 Maria Andri, Olivia Kyriakidou, (2014),"Professional autonomy under pressure: towards a dialectical approach", Journal of Health Organization and Management, Vol. 28 Iss 5 pp. 635-652 http:// dx.doi.org/10.1108/JHOM-10-2013-0224

Access to this document was granted through an Emerald subscription provided by emerald-srm:191455 []

For Authors If you would like to write for this, or any other Emerald publication, then please use our Emerald for Authors service information about how to choose which publication to write for and submission guidelines are available for all. Please visit www.emeraldinsight.com/authors for more information.

About Emerald www.emeraldinsight.com Emerald is a global publisher linking research and practice to the benefit of society. The company manages a portfolio of more than 290 journals and over 2,350 books and book series volumes, as well as providing an extensive range of online products and additional customer resources and services. Emerald is both COUNTER 4 and TRANSFER compliant. The organization is a partner of the Committee on Publication Ethics (COPE) and also works with Portico and the LOCKSS initiative for digital archive preservation. *Related content and download information correct at time of download.

The current issue and full text archive of this journal is available at www.emeraldinsight.com/1477-7266.htm

JHOM 28,5

Leadership in transformation: a longitudinal study in a nursing organization

602 Received 10 February 2014 Revised 24 April 2014 21 May 2014 Accepted 5 June 2014

Riitta Viitala Department of Management and Organisation, University of Vaasa, Vaasa, Finland Abstract

Downloaded by McMaster University At 13:03 30 January 2016 (PT)

Purpose – Not only does leadership produce changes, but those changes produce leadership in organisations. The purpose of this paper is to present a theoretical and empirical analysis of the transformation of leadership at two different historical points in a health care organisation. It leans on the perspective of social constructionism, drawing especially from the ideas of Berger and Luckmann (1966). The paper seeks to improve understanding of how leaders themselves construct leadership in relation to organisational change. Design/methodology/approach – The empirical material was gathered in a longitudinal case study in a nursing organisation in two different historical and situational points. It consists of written narratives produced by nurse leaders that are analysed by applying discourse analysis. Findings – The empirical study revealed that the constructions of leadership were dramatically different at the two different historical and situational points. Leadership showed up as a complex, fragile and changing phenomenon, which fluctuates along with the other organisational changes. The results signal the importance of agency in leadership and the central role of “significant others”. Originality/value – The paper questions the traditional categorisation and labelling of leadership as well as the cross-sectional studies in understanding leadership transformation. Its originality relates to the longitudinal perspective on transformation of leadership in the context of a health care organisation. Keywords Leadership, Agency, Change, Transformation, Constructionism Paper type Research paper

Journal of Health Organization and Management Vol. 28 No. 5, 2014 pp. 602-618 r Emerald Group Publishing Limited 1477-7266 DOI 10.1108/JHOM-02-2014-0032

Introduction Health care organisations are demanding contexts for the exercise of leadership in Finland at the moment, as they are in most countries worldwide (e.g. Harding, 2005; Wikstro¨m, 2009; Fulop and Day, 2010; Endrissat and von Arx, 2013). Health care organisations have historically been built on rigid structures of authority and power (Isaac, 2011) where the duality of the structure encapsulating doctors and nurses – which seems to be carved in stone – creates extra tensions. Health care organisations in Finland are no exception. In addition to the professionals, administrators and politicians with divergent goals also create complexity within health care structures (Denis et al., 2001). At the moment the sector is under considerable pressure to improve cost efficiency and at the same time improve quality and access (Millar, 2003; Daniels et al., 2013). It is also witnessing considerable technical and medical developments alongside a tendency to build bigger administrative regions, centralise decision making and build bigger units. The changes are felt particularly hard among the leaders at the lower levels. They bear much of the responsibility for implementing the changes at a practical level and for maintaining quality of care (Hewison and Griffin, 2004). Some studies declare they often feel that they get inadequate support from their senior management (Apker, 2002; Dellve et al., 2007) and feel like cogs in a wheel lacking opportunities to participate in

Downloaded by McMaster University At 13:03 30 January 2016 (PT)

planning or decision making (Hewison and Griffin, 2004). Lower level leaders face a challenging situation, being caught between the reality of care (the expectations of patients and nurses) and the reality of management (the manifold regulations and expectations coming from the upper organisation) (Degeling and Carr, 2004; Kovjanic et al., 2012). Accordingly, more qualitative empirical research is needed into the realities experienced by frontline leaders in the midst of organisational changes (Hopkins, 2001). Not only does leadership produce organisational changes, but a context and its changes also produce leadership (Denis et al., 2010). It is not just the social context, but also the local and historical contexts that define leadership in organisations (Dachler and Hosking, 1995). The environmental context influences the way leadership manifests itself in an organisation, through for example, the incentives, provocations, restrictions, demands and pressures associated with it (Currie et al., 2009). This paper presents a longitudinal study of leadership transformation in the nursing function of one hospital. The study draws its methodology from the social constructionist and discursive approaches. The focus is on how the nurse leaders construe the leadership of their organisation at two different temporal and situational points. The results of the examination will improve understanding of the dialectics, tensions and oddities that may be embedded in the transformation of leadership in an organisational setting. The paper reveals some critical perspectives in relation to prevailing views on leadership. Initially, I question the dichotomisations and other simplifications of leadership and try to demonstrate its complex nature empirically. Second, I explain the need for longitudinal studies rather than snapshots to understand the nature of leadership (as also suggested e.g. by Currie et al., 2009). Moreover, I will test the relevance of the original ideas of Peter Berger and Thomas Luckmann in the healthcare context. Their book The Social Construction of Reality was published already in 1966 and they can thus be considered important pioneers in the approach of social constructionism in spite of the fact that they do not use the term in their book (they talk about sociology of knowledge when seeking understanding about how the reality is constructed). Later in the academic literature, both the term of “constructivism” and “constructionism” are concerned with the question of how we construct what we take to be “the real” (Gergen, 1999, p. 237). However, “constructivism” has most often referred to the psychological process of world construction, which takes place inside the mind. Berger and Luckman were especially concerned with the “real” constructs in social communities which are outcomes of communicational relations between people. This perspective is often labelled as social constructionism (Gergen, 1999, p. 237). Unfortunately, many recently published articles have bypassed the original argumentation of Berger and Luckmann. In the next section I examine the nature of the social constructing process of leadership and present some views of leadership ideals construed from the work of academics in leadership literature. Leadership as a socially constructed institution Leadership is seen here as a socially constructed product, which is at the same time institutionalised both in organisations and in a society and also continually being reproduced in everyday situations in communities (Berger and Luckmann, 1966, pp. 70-81; Meindl, 1998; Fairhurst and Grant, 2010). Leadership is, like any human activity, subject to “habitualization”, a process that precedes “institutionalization” (p. 71). Berger and Luckmann describe habitualization as a process where “the

Leadership in transformation

603

JHOM 28,5

Downloaded by McMaster University At 13:03 30 January 2016 (PT)

604

meanings involved become embedded as routines” and it thus “make(s) it unnecessary for each situation to be defined anew, step by step” (p. 71). In leadership this appears in the form of common leadership practices – the micro-level practical activities of leaders – constituting what they actually do, how they do it, when they do it and why they decide do it (e.g. Alvesson and Sveningsson, 2003; Denis et al., 2010; Raelin, 2011). An essential embodiment of institutionalisation is the presence of roles, which also control the institutionalisation (Berger and Luckmann, 1966, p. 92). Leadership roles are no different from any other type in drawing the people playing them into specific areas of socially objectivised knowledge, not only in a cognitive sense but also in relation to values, norms and emotions (Berger and Luckmann, 1966, p. 94). The knowledge concerns, for example, what leaders are supposed to do, how they are supposed to behave and how they are supposed to feel in certain situations. When there is a broad consensus on those areas, leadership can be seen as an institution, and Currie et al. (2009, p. 1737) confirm that by asserting “individual leadership is an institution”. In addition, followers act upon their expectations that the individuals in leadership roles possess exceptional traits, and therefore continually re-product the concept of leadership as an institution in everyday situations (Fairhurst, 2009). Even if some of the patterns in the institution of leadership seem to be steadily institutionalised on a macro-level, leadership should not be seen as a uniform and fixed phenomenon (Currie et al., 2009), because the realities of leadership may be very polyphonic in micro-level settings (e.g. Hujala and Rissanen, 2012). According to Berger and Luckmann (1966, p. 134) experts in society have a powerful role in defining, maintaining and legitimating realities. In the case of the institution of leadership, scholars are especially important agents in its modification (see Shapiro, 2005). Their ideas spread in the society for example, through university education, books and other publications, leadership training and consultancy. However, their message is not uniform. The field of leadership research is fortunately now polyphonic, and leadership ideologies advanced by academics have been in a state of transformation especially during the last few decades. More and more researchers question the traditional and static leader-centred view of leadership with its focus on traits, styles and situations (Meindl, 1995; Alvesson and Sveningsson, 2003; Zoller and Fairhurst, 2007). The alternative paradigm has largely been developed in the critical leadership studies school which views leadership as a dynamic process, which constructs in “a simultaneous interplay between leaders, managers, followers, and contexts as well as on their ambiguous and potentially contradictory conditions, processes and consequences” (Collinson, 2014, pp. 47-48). The core of the issue is communication, influence and interaction between people (e.g. Dachler and Hosking, 1995) and in this process both power and resistance play important roles (Zoller and Fairhurst, 2007; Alvesson and Spicer, 2012). One group of researchers have been trying to find some practical keys to develop better leadership practices. They have constructed ideal models, which could either implicitly or explicitly result in improved job well-being and performance in modern work organisations (“how leadership should be”). The other branch has concentrated on revealing and understanding organisational realities per se (“how the things are”) (e.g. Alvesson and Sveningsson, 2003; Tengblad, 2006). The last approach often leans on constructivist and discursive approaches. However, particularly the more practically oriented views produced in leadership research have always garnered support among practitioners and shaped thinking and practices in organisations (often in the form of – isms). From the cornucopia of

Downloaded by McMaster University At 13:03 30 January 2016 (PT)

leadership literature I present here on very general level two parallel and at least partially contradictory story lines discernible in the way leadership is construed by academics, and which have made their way into organisations. The first of these currents represents the traditional idea of leadership underlining a leader’s central role. This trend presents a leader’s role as a supporter for their followers. Leaders accepting this “new” leadership role have often been labelled coaches (Ellinger and Bostrom, 1999; Bowerman and Collins, 1999), facilitators (Macneil, 2001), servant leaders (Greenleaf, 1977) or leaders of learning (Senge, 1990; Viitala, 2004). This stream in literature constructs an ideal of a leader focused on helping their followers to learn, develop, innovate and improve performance on both group and individual levels (Boxall and Macky, 2009; Moen and Federici, 2012). This approach underlines the communicative and participative style in leadership, but is an ideal with considerable heroic connotations. The basic assumption behind this leader as supporter ideology is that leaders understand what their followers need and know how to provide it. The role of a follower is merely to be an object or a recipient. The ideas around the concepts mentioned above can be categorised as the contemporary neo-charisma theories (Zoller and Fairhurst, 2007). The other stream questions the traditional paradigm of focused leadership and especially criticises heroic leadership, where “the leader is the one who has power, authority, or charisma enough to command others” (Manz and Sims, 2001, p. 4). This alternative approach has often adopted the terms distributed leadership (Brown and Hosking, 1986; Gronn, 2000; Fulop and Day, 2010; Currie et al., 2009), and dispersed leadership (Bryman, 1996; Caldwell, 2003); shared leadership (Pearce and Conger, 2003), collective leadership (Denis et al., 2001) or collaborative leadership (Harris, 2008). Despite some diverse nuances they all refer to leadership practices that are non-authoritarian, collectivist and relational in nature ( Jackson, 2000; Buchanan et al., 2007). According to this ideology not only leadership and the role of a leader, but also the division of labour in relation to that role are constantly negotiated and collectively construed in organisations. However, Currie et al. (2009) describe the broad variation of distributed leadership in organisations as a continuum. Distributed leadership has been suggested as a model of leadership well-suited to healthcare organisations (e.g. Buchanan et al., 2007). How then do the practitioners see leadership? What is leadership for them? Barker (1997) investigated leadership constructs among practitioners and noted that in fact they are very traditional. Most people define leadership in relation to skills, abilities, knowledge, traits and activities. On the other hand, within those traditional frames of individual leadership, leadership itself tends to be construed inconsistently. Leadership may be a bundle of traits for someone, while someone else may see it as a variety of specific activities or skills. However, there are many studies pointing to the existence of a relatively stable leadership ideologies in organisations (Alvesson and Spicer, 2012). This paper focuses on the transformation of a leadership institution at the organisational level. According to Berger and Luckmann (1966, pp. 134-135) any institution can lose its original functionality or practicality and become “problematic”. It is typically external changes that put the dissolution processes into train (Berger and Luckmann, 1966, pp. 177-179). Criticism and polyphony rising inside an organisation may be a trigger for an transformation process in an institution. It requires reinterpretation both on the individual and collective level and it happens mostly via “conversational apparatus” which continually maintains the reality, but at the same time modifies it (Berger and Luckmann, 1966, p. 173). In reality the alternation process

Leadership in transformation

605

JHOM 28,5

Downloaded by McMaster University At 13:03 30 January 2016 (PT)

606

is often slow and sticky. When Andersson and Tengblad (2009) investigated the transformation of police work in line with new public management reforms, they noted, that the internalisation process was more efficacious on the higher hierarchical levels than on the operational level of police work. The study revealed that not only internal powers (like resources, prejudices or deep-rooted habits) but also external factors could hinder alternation. Correspondingly the study on the institutionalisation of distributed leadership in English schools by Currie et al. (2009) revealed that external factors like government policies and rural traits greatly influenced the institutionalisation process of the new kind of leadership. In concluding his empirical study conducted among top managers Tengblad (2006, p. 1455) stated that “managerial work is not as stable as described in Mintzberg (1973) but neither as changeable as the proponents of post-bureaucracy claim”. We still know relatively little about the transformation process of leadership. In the next section I present the design of the case-study research in more detail and analyse narratives gathered in a case organisation, which is a hospital (here, The Hospital). After that I wrap up the paper by summarising its findings, and by offering an evaluation of the study and some ideas for the future research agenda. Research design The context of the empirical study is a hospital, which offers the majority of psychiatric services provided by a big University Central Hospital in Finland. The services include psychiatric inpatient care, a psychiatric outpatient clinic and therapy services. This study focuses on its nursing body, the management of which is organised on four levels. Nurses are on the first level and the second level comprises charge nurses, who are the superiors of nurses. Each of them has one assistant charge nurse, who may also sometimes carry out nursing duties. The focus in this study is on these two groups and they are referred to in this paper simply as “nurse leaders” or “leaders”. On the third level there is a group of senior nursing officers, each of whom supervises a group of charge nurses. Their number includes the director of nursing services. On the top level there is the manager of the hospital. The main empirical material consists of hand-written texts produced by the nurse leaders. In them, the leaders informally describe and explain the leadership in The Hospital. I organised the writing sessions with help of one of the senior nursing officers, participated the writing sessions (lasting about one hour), instructed them, answered any questions that arose, ensured sufficient time was allocated, and collected the material. The leaders were given an opportunity to be interviewed instead of writing but all of them preferred to write. The first set of qualitative material was gathered in 2003 and the second in 2011(see Figure 1). The third, additional set of material was gathered via telephone interviews with five senior nursing officers in 2013. One of them was still working at The Hospital and the other four had retired since the first data-gathering period. I collated their views on the leadership philosophies and practices in The Hospital and information on the changes in The Hospital and its environment. I also gathered written documents, web site pages and articles periodically between 2001 and 2004, and from 2011 to 2014 to acquire a view of the changes in The Hospital and its environment. Since the end of the 1990s, The Hospital has gone through large-scale structural changes and faced increasing demands for cost control. Around the time of the data gathering in 2011 there were some wide-ranging structural changes underway. Wards and functions had been closed or transferred to other regions, integrated and merged.

The quantitative (pre)study 2000

Downloaded by McMaster University At 13:03 30 January 2016 (PT)

Year 1991 The Hospital had merged into a big central hospital Since the end of 1980’s leadership had been developed systematically

The first textual data (stories)

The second textual data (stories) 2011

2003

Interviews of nursing directors

Leadership in transformation

2013

Considerable structural changes in the organisation: units and functions were dropped out, integrated and adopted

607

Considerable developments in procedures and IT- tools Changes among the nursing directors: from 5 to 2 between 2003 and 2011 The manager of the hospital retired and a new started The hospital area is filling up with new buildings and new neighbours Increasing pressures for efficiency

Even the physical surroundings had changed greatly: the once beautiful hospital grounds had been built on by companies and other public service organisations. By the end of the 2010 many management systems (e.g. ICT-systems and monitoring procedures) had also changed. Many of those who had worked as leaders in 2003 had retired or left the hospital before 2011. The new nurse leaders had received less training to equip them for leadership tasks, but generally had higher education qualifications. Whereas the 2003 survey revealed nurse leaders typically had an upper secondary level education, by 2011 a master’s degree was a requirement for the nurse leader position. Furthermore, the number of charge nurses and chief nursing officers had diminished. In 2003 there were four senior nursing officers and the manager of The Hospital had a nursing background. In 2009 there were only two senior nursing officers and the manager of The Hospital was a doctor. The first set of material from 2003 includes the written accounts of 19 head nurses and 15 assistant head nurses. The second set of material from 2011 consists of narratives written by 14 head nurses and 11 assistant head nurses. In both groups the age varied from 34 to 62 years. Both men and women were included in both groups, with women the majority. In both groups some of the leaders already had several years of experience, while others were just developing their professional skills as leaders. The length of the texts varied from one to three pages. The majority of them were very open, at least partially because they remained anonymous. I refer to them here as narratives, a choice guided by Kohler Riessman (2008, p. 5) who offered as part of an example of what constitutes narrative, “discrete units of discourse, an extended answer by a research participant to a single question, topically centred and temporally organized”. Dunford and Jones (2000, p. 1029) crystallised a narrative as “something that is intended to persuade others towards certain understandings and actions”. However, “narrative” is often used interchangeably with “story” in writing (Dunford and Jones, 2000, p. 7). I used different techniques when addressing the material. At the first stage, I made a traditional content analysis and coded the themes. At the second stage, I investigated how common or dispersed the issues were in texts of the whole group and compared

Figure 1. The data-gathering period in The Hospital

JHOM 28,5

Downloaded by McMaster University At 13:03 30 January 2016 (PT)

608

the two different temporal sets of material (using a spreadsheet as a simple technical aid). These first two stages revealed the next main categories of contents in the narratives: leadership philosophy, the subjects’ own role as a leader, that of their supervisor, the management of The Hospital, decision making/participation, change, followers, patients, future, goals and demands, competences/learning and feelings. At the third stage, I studied how the nurse leaders connected things together in their texts and how rich were the descriptions of the different issues in detail (by using a Mind Mapping technique). These three first stages helped clarify the different issues, the relevant storylines and the interesting details in the material. The fourth and the most important stage examined how the nurse leaders construe leadership as revealed in their narratives on a collective level. Here I adopted discourse analysis with some degree of pragmatism (see Alvesson and Karreman, 2000). That is to say, I made interpretations beyond what the data objectively reveal in words and sentences, tried to perceive some patterns in the collective meaning making of the leaders, and took into consideration the local, social and historical context of The Hospital (see also Oswick et al., 2000; Hansen, 2006, p. 1059). I do not believe that the narrations reveal any definite truth of practical reality, but in them the nurse leaders merely transmit to me as a researcher (and at the same time to themselves) through their use of language how they construe leadership. Thus my purpose here is to recognise interesting contradictions, tensions, oddities and unacknowledged agendas in their constructs. In the next section I will discuss the findings. Findings The nurse leaders’ texts reflected a more uniform view of leadership than I expected. Moreover, a strong group thinking could be seen at both data gathering points despite them being very different. However, the shared view was very different when compared across the two sets of narratives. In the first material the negative accounts were exceptions and in the latter material the positive comments were exceptions. In the last data set, the nurse leaders constructed leadership as much more of a dialectical process in relation to the external environment. Leadership was also described as a broader phenomenon in the material from 2011, whereas the writings from 2003 showed leadership to be construed mainly as something close to the nurse leaders and a creation of their own. In 2003, the leadership was construed in a very uniform and positive way by the nurse leaders. This situation took place within organisational structures where both the roles and individuals in the roles had remained largely the same for a long time and thus the members in the community had a long shared history. An example of the texts in 2003: Leadership culture and managerial work are not bureaucratic and top down directed. This enables, among other things, a flexible and purposeful utilization of know-how and expertise. Keeping in contact with managers and vice versa is easy. Members of the working community have decision-making power and they have responsibility. Their expertise is believed in. When the members of the work community need help and for instance information, they can get it from each other and their superiors. A leader is someone who walks beside you, and is available when needed. Leaders and the management team enable the growth and the development of their employees (for example, training and counselling, and the meetings, and plans). I worked for a long time at another department as an assistant charge nurse but only a month at my new department. It has been easy to become a manager to a new workgroup even if it is big (more than 30 people). A supervisor receives feedback on

Downloaded by McMaster University At 13:03 30 January 2016 (PT)

their work from patients, members of the working community and their own superiors. Giving and receiving feedback is important. In the leadership culture the things that are highlighted are trust and open cooperation, and assistance at the right time so that the members of the community master their work and recognise its importance and possibilities (Leader 5/2003).

In 2003, the nurse leaders construed a surprisingly uniform and steadily legitimised institution of their leadership. That was revealed in the narratives in forms akin to what Berger and Luckmann (1966) described as “theoretical propositions, proverbs, moral maxims and wise sayings as explanatory schemes relating sets of objective meanings” (p. 112). When reporting on leadership at the hospital, the nurse leaders explained and justified to themselves the most important elements of their leadership. They reproduced the legitimisation with statements like “I am used to following the philosophy of WCT (Warmth, Closeness, and Trust)”, “Common rules are agreed upon together”, and “The common thread to leadership is that leadership needs to always support doing the basic work, and that the patients are being cared for and that the personnel are well”. A few of the leaders also acknowledged the benefits for their solid leadership institution arising from organisational changes. One of the leaders put it in this way: “A negotiating attitude; incorporating the employees into decision making; open discussion; and briefing have carried over the years and numerous units being closed down. It has made it possible to guarantee employees have a reasonably safe mindset about the continuation of things”. In the narratives the nurse leaders construed the leadership institution as implying both historicity and control. They referred to several reciprocal typifications of actions built over the course of a shared history. Berger and Luckmann (1966, pp. 92-94, 134) stress the meaning of individuals and groups as definers of reality. They said that “definitions are always embodied” (Berger and Luckmann, 1966, p. 134). It is the social organisation that permits the definers to do the defining and that takes place largely through roles. In the light of the narratives in 2003, the team of senior nursing officers had a central role in the defining of leadership and that role was largely unquestioned and praised. The senior nursing officers were definitely constructed as the significant others in the community by the nurse leaders. They were the principal agents for the maintenance of their subjective reality as leaders. The charge nurses and assistant charge nurses functioned as a sort of classical “chorus” in the dialectical relation with them in the maintenance process (see Berger and Luckmann, 1966, p. 170). The senior nursing officers themselves said that they had chosen to define and maintain a form of good leadership, and saw it as an important duty of their own leadership role. In 2003, the nurse leaders felt themselves completely taken care of, which according to Gemmil and Oakley (1992) refers to learned helplessness. However, the organisation was not stable even then. The new senior nursing officer brought different ideas of leadership that created a pluralism, which according to Berger and Luckmann (1966, p. 143) usually encourages scepticism and thus naturally “erodes the taken-for-granted reality of the status quo”. In the few divergent narratives of the senior nursing officer’s followers the scepticism was shaded with concern, fear, confusion and anxiety. Some of them construed the situation as something that will become “the new normal” for leadership in The Hospital. The new normal is construed as giving rise to incoherent, tenuous, cold and mistrustful leadership in the narratives written by nurse leaders in 2011. One leader explained: “Sometimes I feel that senior nursing officers do not trust charge nurses’

Leadership in transformation

609

JHOM 28,5

Downloaded by McMaster University At 13:03 30 January 2016 (PT)

610

and assistant charge nurses’ capabilities to consider and act for the best of their departments”. On that occasion the uniform narratives could not have been reflections of the long common history, because since 2003 many of the charge nurses and assistant charge nurses had changed, as had all of the senior nursing officers, bar one. In this set of narratives nurse leaders construe the new normal for leadership as leadership that is non-existent or vague. The narratives indicate that this idea of leadership had already become institutionalised among the nurse leaders. Alongside this development, leadership roles had also become more opaque. The institutional order in leadership had splintered, and accordingly it was no longer easy for the new nurse leaders to learn their role in terms of acquiring the routines necessary for its outward performance. That situations brought problems “initiating into the cognitive and affective layers of the body of knowledge that is directly and indirectly appropriate to this role” (see Berger and Luckmann, 1966, p. 94). The leaders surveyed constructed leadership and leadership roles as more akin to lonely riders now. An example of the texts in 2011: I have been a supervisor only for a short time, so my experience in leadership is still minor. I have been a follower for a long time. The supervisory work is certainly impacted by the situation in a society as a whole, and not only the economy of the hospital district. So, nursing management is clearly reflected in the quantity, not in the quality. Or they do not put as much effort into the quality as before. Nursing has to produce money for the hospital district within the frameworks of our bed-places/outpatient visits. The important thing that a new employee is told when entering the workplace is the number of patient visits which should occur during the day. The manager monitors the number of patient visits and gives feedback on it. Personally I find this a very bad trend today. Developmental discussions are rushed. There is no time to stop and consider things carefully. Leadership is issuing directions that have to be followed. It can be discussed, but the decision has already been made. The supervisor does not have many opportunities to make a difference in a big organisation. Decisions are made at a higher level. From the nursing point of view, leadership is nowadays short-sighted. The turnover among staff is high and I believe that something could be done about it. The director of nursing services most likely sees the situation, but cannot influence it alone. There is need for a broader society-level intervention in the financing and appreciation of nursing. Leadership has become distanced from employees. There is a feeling that it is not possible to influence our own activities as before (Leader 23/2009).

The two examples of narratives represent the differences between the two sets of material quite well. As the excerpts show, the narratives mostly consist of a variety of rather loose aspects and views without in-depth argumentation. Thus, in the next sections I examine the most distinctive discourses behind the narratives in more depth so as to understand how and where the leaders anchor themselves when constructing the leadership in the hospital for a researcher. The discourse on “good” and “bad” leadership The nurse leaders eagerly took on the role of evaluator of leadership in the texts. The dichotomies concerning good/desired/praised leadership and bad/repelled/criticised leadership were strongly present in the narratives. They also made explicit or implicit

Downloaded by McMaster University At 13:03 30 January 2016 (PT)

comparisons between past and present, here versus somewhere else, and of one supervisor and other supervisor. In 2002, leadership of the nursing organisation in The Hospital was described in terms that included “human”, “consistent”, “encouraging”, “supportive”, “ready to listen”, “based on cooperation”, “confidential”, and “equitable”. When describing leadership many mentioned the atmosphere, which was often described in terms of being “safe”, “communicative”, “appreciative”, “free”, “easy” and “supportive”. In 2011, the descriptions were primarily critical and negative. Leadership was often described as “authoritative”, “incoherent”, “bad”, “weak”, “scattered”, “managerial”, “distant”, “non-uniform”, “conservative”, and “non-existent”. This time the narratives rarely mentioned atmosphere compared to the first set of material. Some of the nurse leaders described it as “busy”, “non-communicative”, “negative” and “expectant”. There were also examples of polyphony in the material. In the first set of narratives some of the charge nurses constructed a “bad” leadership describing their own new supervisor (a senior nursing officer) as bossy and therefore in breach of the “rules of leadership here”. In the latter material some of the assistant charge nurses may say that even if they saw leadership in general as negative, they might praise their own supervisor. The view of ideal leadership seems to be common and written in traditional terms: good leadership is democratic, participative, appreciative, supportive, trusting and caring: bad leadership is the opposite. A dichotomy seems to be deep-rooted in the leaders’ mindset. The distinctive duality in the narratives on leadership could be described as a hard vs soft leadership approach. Their narratives showed how the nurse leaders longed for soft leadership with participation, collectivity, closeness, warmness, appreciation, dedication and care. At the same time they deprecated hard leadership, which attracted terms like managerial, authoritative, distant, disinterested and cold. The next two quotations demonstrate the transformation in this discourse: The atmosphere is respectful of each other, encouraging and based largely on positive feedback. The leadership atmosphere, which I have experienced personally, is warm, clearly structured, and demanding in its own way (Leader 26/2003). Leadership at our unit is in a rather severe state of change. Subordinates are easily left excluded in these developments. I feel that leadership is lost. Head nurses are doing their work very distantly from every day work and common practice (Leader 31/2011).

The discourse of “ownership” of leadership When they expressed on how they construed leadership in their texts, the leaders positioned themselves both as actors and as objects in both sets of data but with a differing emphasis. In light of the narratives during the ten-year period there was a shift from a positioning marked by the strong agency of nurse leaders towards one where they had something resembling a bystander position in the leadership of The Hospital. In general, the narratives in 2003 revealed a strong spirit of unity. The “we-discourse” encapsulated the pride and agency in relation to the positive state of the leadership in the organisation. The same we-discourse reflected the strongly established ways to lead: shared views and philosophies, as well as common everyday practices in leadership. Decision making was mainly described as participative. However, even in this discourse the presence of dichotomy between leaders and followers was strongly present and the nurse leaders construed leadership as clearly structured.

Leadership in transformation

611

JHOM 28,5

Downloaded by McMaster University At 13:03 30 January 2016 (PT)

612

The set of narratives gathered in 2011 paint a picture of the leaders as merely administrative implementers of decisions made at upper levels. The leaders wrote that they did not get information about changes and that they could not participate in development and decision making. They also reported a lack of constructive support even for the implementing role. By 2011, the we-discourse had been replaced with a “they-discourse”. By this time senior nursing officers no longer belonged to a group of “we leaders” but had become “they leaders different from us.” According to the respondents, senior nursing officers were now distant, overloaded and had lost contact with the practical level work. Many of the nurse leaders explained this by labelling the inexorable nature of what they saw as the new management reality. The next two quotations demonstrate the transformation in this discourse: Communication with supervisors is easy in both directions. The members of the work community have both responsibility and decision power. Our know-how is trusted. If the members of the work community need help, they will receive it from each other and from the supervisors [refers to senior nursing officers]. A supervisor is a partner, who is at my side and helps when needed (Leader 5/2003). Leadership is nowadays giving instructions from the top that have to be followed by us. Discussion is possible, that the decision has already been made at the top. A leader has few opportunities to influence things in a big organisation. The decisions are made on the upper level (Leader 51/2011).

The discourse of supervisors as need-satisfiers In their writings, the nurse leaders to a great extent construed leadership through their experiences with their own supervisors. The narratives revolved around two main themes: what do I get from my superior and how does s/he behave with me. The relationship between leader and superior was often described in emotive terms: warmness, closeness, trust, support, straightforwardness, appreciation, resoluteness, setting a good example, involvement and participation. The “caring leadership” discourse was strong. In 2011, the narratives depicted lonely and neglected leaders. They wrote that their superiors were distant and did not communicate with them, did not let them participate in decision making and did not trust them. The notions of the leadership on a meta-level produced what I term a “rejecting-discourse”. I found some tensions in the narrations of the leaders in the way they construed autonomy in relation to support. The amount of space devoted to support was surprising in both sets of material. Alongside it the subjects expressed their appreciation of their autonomy in a very consistent manner set it as an important resource in the first dataset. One leader expressed it in this way: “we have got a lot of autonomy and we get a lot of support from our superiors”. The last set of narratives was more mixed in this sense. In that set the leaders expressed regret at the disappearance of autonomy and the feeling of being left to get along by themselves. In the first set of writings, they construed autonomy as being built on collectivity, trust and supportiveness, while later they construed it as built more on necessity. In 2003, the nursing leaders described their superiors (the four senior nursing officers) and the manager of The Hospital as a largely collegial team with a homogenous leadership mindset often exemplified in the use of the words clear, consistent, warmth, closeness and trust (WTC). In 2009, the situation seemed to be very different, by that time the leaders construed leadership as distant, managerial, vague and fragmented.

The next two quotations demonstrate the transformation in this discourse:

Downloaded by McMaster University At 13:03 30 January 2016 (PT)

I feel that my superior knows me personally, as a human being. At the same time she has also been ‘demanding’. I put the word demanding in quotes because it shows the supervisor’s interest and active participation in what I do in my work (Leader 8/2003). The changes at the upper management level [refers to senior nursing officers and manager of The Hospital] have eroded support and nowadays the leader is relatively on her own (Leader 49/2011).

The discourse of change as an invisible hand In the first set of narratives (2003), the leaders constructed a picture of their reality that featured changes occurring but themselves standing on solid ground. In the material of 2003, changes were more like something that made things just a little uncomfortable. In the material from 2011, nearly everyone wrote about the changing internal or external environment of The Hospital. The changes were blamed for causing many discomforts. Some of the changes in question were societal level changes, as exemplified in statements like “health care is not appreciated”, “young professionals are not engaged to the work anymore”, and “politicians prefer outpatients in order to save money”. Some of them were organisational level changes reflected in statements like “only numbers matter nowadays”, “some functions from another hospital will be integrated with us”, “the units will be bigger”, “we will have to move to another building”, “my unit is twice as big as before because it has been combined with another unit”, and “a big turnover of nurses is a new problem here”. In the last set of material the leaders constructed leadership as something caused by changes, spoilt by changes, adapted to changes, restricted by changes and in general, influenced strongly by changes in their environment. They did not position themselves as leaders producing those changes or even actively responding to those changes. The picture they created in their writings in 2011 is similar to that of a stormy sea, where their large shared ship had fallen apart and left them reliant on small lifeboats carried by the waves. This time changes were described as pervasive, inexorable and erratic. In the narratives, change was construed as an “an invisible hand” in relation to leadership. Just as it was an individual actor in the game. The leaders positioned themselves as passive objects. The next two quotations demonstrate the transformation in this discourse: There are more and more new things. The work becomes more demanding. In the long run, it’s difficult to make plans, because changes in the [area] are so fast (Leader 28/2003). Constant changes and financial pressure have increased steadily and make managing people ever more challenging (Leader 21/2011).

Change has been defined as always emergent and temporal without any possibility of structural control (Caldwell, 2005, p. 104). Berger and Luckmann (1966, p. 179) say that “the most important conceptual requirement for alternation is the availability of a legitimating apparatus for the whole sequence of transformation”. They suggest that not only the new reality should be legitimated, but also the phases by which it is adopted and maintained, and that the abandonment or prohibition of all alternative realities is a further requirement. Therefore, someone must conduct the legitimation. “The old reality as well as the collectivities and significant others that previously mediated it to the individual, must be reinterpreted within the legitimating apparatus of the new reality” (Berger and Luckmann, 1966). The constructs of the nurse leaders indicate that this kind of legitimisation process did not take place.

Leadership in transformation

613

JHOM 28,5

Downloaded by McMaster University At 13:03 30 January 2016 (PT)

614

On a metaphorical level, the first set of narratives described leadership as like life in a small village, where people know each other and the common habits and values were familiar and deeply rooted. In that environment, people still care for each other and help when needed even if the silent pressure to behave in a certain way is sometimes onerous. Each of the members of the community has their own stable place in the well-known structure and thus life is predictable. The last set of narratives paint a picture of leadership that resembles a story of villagers moving to a strange city. They have to face new things all the time, faces are unfamiliar, and their own position in the strange social structures that are difficult to grasp is obscure. To sum up, the study at The Hospital generated more paradoxical observations than any clear results. The first of those concerns the positioning of leaders in relation to leadership. The original aim of this paper was not to examine the agency in leadership transformation, but it manifested strongly in the narratives. I agree with Caldwell (2005, p. 111) that it is not easy to define the role and scope of agency in organisational change, but the issue is definitely worth considering. The nurse leaders positioned themselves as agents in relation to leadership in a situation where they had a stronger and more unified team of senior nursing officers on the upper level. One might have expected that in the later situation with more distant senior nursing officers, the leaders would have been under more pressure to take an active role in leadership, but in this situation they positioned themselves as bystanders in relation to leadership. They criticised it, but they also complied with it. Some of the leaders made comparisons with the past situation in The Hospital, but the newcomers just judged the current situation. Conclusions This study supports the idea that leadership is a strongly collective and situational phenomenon. The collective interpretation of leadership reality may go through a radical metamorphosis along with organisational changes. Within this process, the common interpretation of blurred or lost leadership may also institutionalize in an organisation. Especially the feeling of own agency as well as the powerful role of “significant others” as leaders in common leadership creation seem to be pivotal. In the atmosphere of increasing change, the nurse leaders construed leadership as something gliding away from their orbit of control. The common frustration was revealed in the last set of narratives. The nurse leaders to a greater or lesser extent apportioned the blame for the demise of their accepted type of leadership on organisational changes. It is likely that no one intentionally planned, intentionally wanted, or even expected the changes in leadership; they just happened. One could now ask if organisational restructuring is something that easily causes leadership to fade in organisations. If so, we should be prepared to say goodbye more and more often to consistent and praiseworthy leadership. Is there, then, anything in the change of leadership that could have been conducted better during the organisational changes at The Hospital? Instead of definite answers, I will offer some suggestions of the powers that might have influenced the changed situation. One power might be the disappearing of the significant others in the social construction process of leadership mentioned above. The other power, related to the first one, could be that the conversation of leadership fell silent compared to the past. Conversation is, according to Berger and Luckmann, the most important vehicle of reality-maintenance. In the course of their conversations in everyday life, individuals routinely maintain, modify, and reconstruct their subject reality (see Berger and

Downloaded by McMaster University At 13:03 30 January 2016 (PT)

Luckmann, 1966, p. 172). Berger and Luckmann (1966) have also stated that “in order to maintain subjective reality effectively, the conversational apparatus must be continual and consistent” (p. 174). One of the nurse leaders stated her feelings when she said: “The employees coming into psychiatry have been trained for cooperation. It’s amazing how little real issues are talked about. This starts from the top managers and trickles down all the way through the organisation”. This lack of conversation is also a threat to the process of internalisation of individual leaders to the semantic fields of leadership in nursing or leadership in The Hospital. According to Berger and Luckmann (1966, p. 158) such role-specific vocabularies are important factors in the internalisation process. When the common language and common concepts with shared meanings disappear, individuals have to establish the format of their leadership themselves leaning on their individual preferences. Half a century ago Berger and Luckmann (1966, p. 184) that in societies marked by minimal distribution of knowledge and minimal division of labour, “everyone pretty much is what he is supposed to be”, and that situation facilitates socialisation. The more vague and pluralistic the realities are, the more difficult it is to socialise in them (Berger and Luckmann, 1966, p. 198). If communities and organisations constantly change, is it realistic to expect any stable leadership institutions anymore? If leadership in an organisation is always subjectively construed and continually changing face depending on its environment, we are entitled to ask whether it can ever be effectively labelled or categorised. The narratives of this study revealed that leadership constructs in reality have mixed ingredients in contrast to academically defined, coherent and separated “approaches”. In the narratives the leaders construed leadership ideals both in terms of neo-charismatic (or even heroic) leadership and very participative and even collegial leadership at the same time. These ingredients were interlocked in a complex and somewhat paradoxical way. Essentially, in their narratives the nurse leaders construed an ideal of collegial leadership as a form permitted and clearly managed by a charismatic and dedicated leader on a higher hierarchical level. Individual leaders described and interpreted leadership of The Hospital by mirroring it against the general ideals of leadership, as well as strongly against of her/his personal needs. Especially the need to be considered, appreciated and cared for as a follower showed up strongly in the material. The important conceptual anchors in the social construction of reality – and thus also leadership – are habitualization, legitimisation, roles and significant others as part of the institutionalisation process (Berger and Luckmann, 1966). In the light of this study, all of these perspectives are worth closer examination in future leadership research. However, I would add two additional perspectives in the list: the needs of the leaders in relation to their supervisors and the organisational changes which fracture the institutionalized leadership. A study of leadership at two different temporal and situational points in an organisation reveals a very different picture of leadership to that of a study examining leadership at only one of those points. Even if the nurse leaders construed a stable, shared and strong leadership institution in the beginning, only a little of it had remained in their constructions less than ten years later. Even if my research design did not make it possible to learn to understand the dynamics of the transformation process deeply, it revealed the fragile, sensitive and dynamic nature of leadership. Thus the story concretises the notion that leadership undergoes continual and sometimes even radical reconstruction in the community.

Leadership in transformation

615

JHOM 28,5

Downloaded by McMaster University At 13:03 30 January 2016 (PT)

616

My last contribution is to pose a question: is the transformation of leadership in The Hospital towards being more fuzzy simply a reflection of a more general tendency in society? Answering this question would call for wider research on leadership in a socio-constructionist direction, to adopt longitudinal research designs and apply an ethnographic approach. As Barker (2001) has stated “there is clearly a need to conceptualise leadership in a different way, and come to a more common understanding of what it is, if for no other reason than to cope with it”. References Alvesson, M. and Karreman, D. (2000), “Taking the linguistic turn in organizational research: challenges, responses, consequences”, The Journal of Applied Behavioral Science, Vol. 36 No. 2, pp. 136-158. Alvesson, M. and Sveningsson, S. (2003), “The great disappearing act: difficulties in doing ‘leadership’”, Leadership Quarterly, Vol. 14 No. 3, pp. 359-381. Alvesson, M. and Spicer, A. (2012), “A stupidity-based theory of organizations”, Journal of Management Studies, Vol. 49 No. 7, pp. 1194-1220. Andersson, T. and Tengblad, S. (2009), “When complexity meets culture: new public management and the Swedish police”, Qualitative Research in Accounting & Management, Vol. 6 No. 12, pp. 41-56. Apker, J. (2002), “Front-line nurse manager roles, job stressors, and coping strategies in a managed care hospital”, Communication Quarterly, Vol. 50 No. 2, pp. 75-81. Barker, R.A. (1997), “How can we train leaders if we do not know what leadership is?”, Human Relations, Vol. 50 No. 4, pp. 343-362. Barker, R.A. (2001), “The nature of leadership”, Human Relations, Vol. 54 No. 4, pp. 469-494. Berger, P. and Luckmann, T. (1966), The Social Construction of Reality, Penguin University Books, London. Bowerman, J. and Collins, G. (1999), “The coaching network: a program for individual and organizational development”, Journal of Workplace Learning, Vol. 11 No. 8, pp. 291-197. Boxall, P. and Macky, K. (2009), “Research and theory on high-performance work systems: progressing the high involvement stream”, Human Resource Management Journal, Vol. 19 No. 1, pp. 3-23. Buchanan, D., Caldwell, R. and Meyer, J. (2007), “Leadership transmission: a muddled metaphor?”, Journal of Health Organization and Management, Vol. 21 No. 3, pp. 246-258. Brown, M.H. and Hosking, D.M. (1986), “Distributed leadership and skilled performance as successful organization in social movements”, Human Relations (HR), Vol. 39 No. 1, pp. 56-79. Bryman, A.S. (1996), “The importance of context: qualitative research and the study of leadership”, Leadership Quarterly, Vol. 7 No. 3, pp. 353-370. Caldwell, R. (2003), “Models of change agency: a fourfold classification”, British Journal of Management, Vol. 14 No. 2, pp. 131-142. Caldwell, R. (2005), “Things fall apart? Discourses on agency and change in organizations”, Human Relations, Vol. 58 No. 2, pp. 83-115. Collinson, D. (2014), “Dichotomies, dialectics and dilemmas: new directions for critical leadership studies?”, Leadership, Vol. 10 No. 36, pp. 36-55. Currie, G., Lockett, A. and Suhomlinova, O. (2009), “The institutionalization of distributed leadership: a ‘Catch-22’ in English public services”, Human Relations, Vol. 62 No. 11, pp. 1735-1761. Dachler, H.P. and Hosking, D.M. (1995), “The primacy of relation in socially constructing organizational realities”, in Hosking, D.M., Dachler, H.P. and Gergen K.J. (Eds), Management and Organization: Relational Alternatives to Individualism, Aldershot, Avebury, pp. 1-29.

Downloaded by McMaster University At 13:03 30 January 2016 (PT)

Daniels, T., Williams, I., Robinson, S. and Spence, K. (2013), “Tackling disinvestments in health care services. The views of resource allocators in the English NHS”, Journal of Management Studies, Vol. 27 No. 5, pp. 762-780. Degeling, P. and Carr, A. (2004), “Leadership for the systemization of health care: the unaddressed issue in health care reform”, Journal of Health Organization and Management, Vol. 18 No. 6, pp. 399-414. Dellve, L., Skagert, K. and Vilhelmsson, R. (2007), “Leadership in workplace-health promotion projects: 1 and 2-year effects on long-term work attendance”, European Journal of Public Health, Vol. 17 No. 5, pp. 471-486. Denis, J.L., Lamothe, L. and Langley, A. (2001), “The dynamics of collective leadership and strategic change in pluralistic organizations”, Academy of Management Journal, Vol. 44 No. 4, pp. 809-837. Denis, J.L, Langley, A. and Rouleau, L. (2010), “The practice of leadership in the messy world of organizations”, Leadership, Vol. 6 No. 1, pp. 67-88. Dunford, R. and Jones, D. (2000), “Narrative in strategic change”, Human Relations, Vol. 53 No. 9, pp. 1207-1226. Ellinger, A.D. and Bostrom, R.P. (1999), “Managerial coaching behaviours in learning organizations”, The Journal of Management Development, Vol. 18 No. 9, pp. 752-771. Endrissat, N. and von Arx, W. (2013), “Leadership practices and context: two sides of the same coin”, Leadership, Vol. 9 No. 2, pp. 278-304. Fairhurst, G.T. (2009), “Considering context in discursive leadership research”, Human Relations, Vol. 62 No. 11, pp. 1607-1633. Fairhurst, G.T. and Grant, D. (2010), “The social construction of leadership: a sailing guide”, Management Communication Quarterly, Vol. 24 No. 2, pp. 171-201. Fulop, L. and Day, G.E. (2010), “From leader to leadership: clinician managers and where to next?”, Australian Health Review, Vol. 34 No. 3, pp. 344-351. Gemmil, G. and Oakley, J. (1992), “Leadership: an alienating social myth?”, Human Relations, Vol. 45 No. 2, pp. 113-130. Gergen, K. (1999), An Invitation to Social Construction, Sage, Thousand Oaks. Greenleaf, R.K. (1977), Servant Leadership: A Journey into the Nature of Legitimate Power and Greatness, Paulist Press, New York, NY. Gronn, P. (2000), “Distributed properties: a new architecture for leadership”, Educational Management and Administration, Vol. 28 No. 3, pp. 317-338. Hansen, H. (2006), “The ethnonarrative approach”, Human Relations, Vol. 59 No. 8, pp. 1049-1075. Harding, N. (2005), “The inception of the National Health Service”, Journal of Health Organization and Management, Vol. 19 No. 2, pp. 261-272. Harris, A. (2008), “Distributed leadership: according to the evidence”, Journal of Educational Administration, Vol. 46 No. 2, pp. 172-188. Hewison, A. and Griffin, M. (2004), “Leadership development in health care: a word of caution”, Journal of Health Organization and Management, Vol. 18 No. 6, pp. 464-473. Hopkins, K.M. (2001), “Manager intervention with troubled supervisors. Help and support start at the top”, Management Communication Quarterly, Vol. 15 No. 1, pp. 83-99. Hujala, A. and Rissanen, S. (2012), “Discursive construction of polyphony in healthcare management”, Journal of Health Organization and Management, Vol. 26 No. 1, pp. 118-136. Isaac, C. (2011), “Women leaders: the social world of health care”, Journal of Health and Organization and Management, Vol. 25 No. 2, pp. 159-175. Jackson, S. (2000), “A qualitative evolution of shared leadership barriers, drivers, and recommendations”, Journal of Management in Medicine, Vol. 14 Nos 3/4, pp. 166-178. Kohler Riessman, K. (2008), Narrative Methods for the Human Sciences, Sage, London.

Leadership in transformation

617

JHOM 28,5

Downloaded by McMaster University At 13:03 30 January 2016 (PT)

618

Kovjanic, S., Schuh, S.C., Jonas, K., Van Quaquebeke, N. and Van Dick, R. (2012), “How do transformational leaders foster positive employee outcomes? A self-determination-based analysis of employees’ needs as mediating links”, Journal of Organizational Behavior, Vol. 33 No. 8, pp. 1031-1052. Macneil, C. (2001), “The supervisor as a facilitator of informal learning in work teams”, Journal of Workplace Learning, Vol. 13 No. 6, pp. 246-253. Manz, C.C. and Sims, H.P. (2001), The New Superleadership: Leading Others to Lead Themselves, Berret-Koehler Publishers Inc., San Francisco, CA. Meindl, J. (1995), “The romance of leadership as a follower-centric theory: a social constructionist approach”, Leadership Quarterly, Vol. 6 No. 3, pp. 329-341. Meindl, J.R. (1998), “The romance of leadership as a follower-centric theory: a social construction approach”, in Dansereau, F. and Yammarino, F.J. (Eds), Leadership: The multiple-level approaches Part B: Contemporary and Alternative, Jai Press, Stamford, pp. 285-298. Millar, R. (2003), “Framing quality improvement tools and techniques in healthcare. The case of Improvement Leaders’ Guides”, Journal of Health Organization and Management, Vol. 27 No. 2, pp. 209-224. Mintzberg, H. (1973), The Nature of Managerial Work, Harper & Row, New York. Moen, F. and Federici, R.A. (2012), “The effect from external executive coaching”, Coaching: An International Journal of Theory, Research and Practice, Vol. 5 No. 2, pp. 113-131. Oswick, C., Keenoy, T.W. and Grant, D. (2000), “Discourse, organizations and organizing: concepts, objects and subjects”, Human Relations, Vol. 53 No. 9, pp. 1114-1123. Pearce, C.J. and Conger, J.A. (2003), Shared leadership. Reframing the Hows and Whys of Leadership, Sage, London. Raelin, J. (2011), “From leadership-as-practice to leadersful practice”, Leadership, Vol. 7 No. 2, pp. 195-211. Senge, P.M. (1990), “The leader’s new work: building learning organizations”, Sloan Management Review, Vol. 32 No. 1, pp. 7-23. Shapiro, S.P. (2005), “Agency theory”, Annual Review of Sociology, Vol. 31 No. 1, pp. 263-284. Tengblad, S. (2006), “Is there a ‘New Managerial Work’? A comparison with Henry Mintzber’s classic study 30 years later”, Journal of Management Studies, Vol. 43 No. 7, pp. 1437-1461. Viitala, R. (2004), “Towards a theory of knowledge leadership”, The Leadership and Organization Development Journal, Vol. 25 Nos 5/6, pp. 499-514. Wikstro¨m, E. (2009), “Contemporary leadership in healthcare organizations: fragmented or concurrent leadership”, Journal of Health Organization and Management, Vol. 23 No. 4, pp. 411-428. Zoller, H.M. and Fairhurst, G.T. (2007), “Resistance leadership: the overlooked potential in critical organization and leadership studies”, Human Relations, Vol. 60 No. 9, pp. 1331-1360. Further reading Collinson, D. (2005), “Dialectics of leadership”, Human Relations, Vol. 58 No. 11, pp. 1419-1442. Denis, J.L., Langley, A. and Pineault, M. (2000), “Becoming a leader in a complex organization”, Journal of Management Studies, Vol. 37 No. 8, pp. 1063-1099. Fairhurst, G. (2001), “Dualisms in leadership research”, in Jablin, F.M. and Putnam, L.L. (Eds), The New Handbook of Organizational Communication, Sage, Newbury Park, CA, pp. 379-439. Corresponding author Professor Riitta Viitala can be contacted at: [email protected]

To purchase reprints of this article please e-mail: [email protected] Or visit our web site for further details: www.emeraldinsight.com/reprints