Leadership and community healthcare reform: a study using the Competing Values Framework (CVF)

Abstract

Purpose The Health Service Executive in Ireland seeks to further develop healthcare in the community. It has identified that this reform requires developing leadership amongst the staff. This study aims to identify what kind of leadership staff in community healthcare observe in practice and their leadership preferences. The core objective has been to identify the readiness of the organisation to implement the adopted national policy of integrated community care reform in terms of leadership development. Design/methodology/approach An online cross-sectional survey was conducted using the Organisational Cultural Assessment Instrument, based on the Competing Values Framework. This tool identifies four overarching leadership types: Clan (Collaborative), Adhocracy (Creative), Market (Competitive) and Hierarchy (Controlling). Participants (n = 445) were a representative sample of regional community health care employees. They were asked to identify presently observed leadership and preferred leadership in practice. The statistical analysis emphasised a comparison of observed and preferred leadership types. Findings Participants reported the current prevailing leadership type as Market (M = 34.38, SD = 6.22) and Hierarchical (M = 34.38, SD = 22.62), whilst the preferred or future style was overwhelmingly Clan (M = 40.38, SD = 18.08). Differences were significant (all p’s < 0.001). The overall outcome indicates a predominance of controlling and competitive leadership and a lack of collaborative leadership to implement the planned reform. Originality/value During reform in healthcare, leadership in practice must be aligned to the reform strategy, demonstrating collaboration, flexibility and support for innovation. This unique study demonstrates the importance of examining leadership type and competencies to indicate readiness to deliver national community health care reform.

Unraveling Determinants of Inclusive Leadership in Public Organizations

“…are more likely to acquire resources and attain visibility, legitimacy, and external support (Cameron & Quinn, 2011;Lavine, 2014;O'Neill et al, 2021). In such a culture, managers may be inclusive and invite different perspectives, as they may be viewed as bolstering creativity.…”

“…The CVF proposes that managers need to balance several tensions and competing demands between flexibility and stability and an internal and external focus. The combination of these dimensions results in four organizational culture types and related structures that determine different leadership strategies to gain effectiveness (Cameron & Quinn, 2011; Lavine, 2014; O’Neill et al, 2021). Figure 1 represents the CVF framework, in which there are two main dimensions shown by two axes.…”

“…The first axis represents a tension between competing demands of stability and control versus flexibility and discretion. At one end, culture is characterized by flexibility and spontaneity, while at the other end, stability, control, and order are emphasized in the organization (Cameron & Quinn, 2011; Lavine, 2014; O’Neill et al, 2021). The second axis represents an emphasis placed by the organization upon the internal organization versus the external environment.…”

“…Managers in such a culture are more likely to be entrepreneurial and willing to take risks and develop a vision for the future. They are more likely to acquire resources and attain visibility, legitimacy, and external support (Cameron & Quinn, 2011; Lavine, 2014; O’Neill et al, 2021). In such a culture, managers may be inclusive and invite different perspectives, as they may be viewed as bolstering creativity.…”

“…The overriding value in such a culture is the execution of rules. Managers are more likely to be conservative and cautious; to pay close attention to technical matters and to value control, stability, and efficiency (Cameron & Quinn, 2011; Lavine, 2014; O’Neill et al, 2021). Since the focus is on standardization and control with little room for discussion and the exchange of different perspectives and ideas, public managers are expected to show less inclusive leadership.…”