Leadership within a Performance Management Framework Setting

2

Important Disclaimer: All information and content in this Material is provided in good faith by the WA Department of Health, and is based on sources believed to be reliable and accurate at the time of development. The State of Western Australia, the WA Department of Health and their respective officers, employees and agents, do not accept legal liability or responsibility for the Material, or any consequences arising from its use. Owner: Department of Health, Western Australia

Contact: Performance Directorate

Version: 1.0

Approved by:

Karen Lopez, A/Director Performance

Date: 1st December 2015

Links to: Performance Management Framework Strategic Directions 2014-2015 and Beyond http://intranet.health.wa.gov.au/performance/services/bi_is.cfm Workforce Engagement in a Performance Management Framework Setting http://ww2.health.wa.gov.au/~/media/Files/Corporate/general%20documents/Performance/PDF/20150324-Workforce-Engagement-within-PMF-setting-v3.0.ashx

3

Contents

Acronyms ................................................................................................................................... 4

Context ........................................................................................................................................ 5

1 Introduction ......................................................................................................................... 6

1.1 Background ..................................................................................................................... 6

1.2 Aim of report ................................................................................................................... 7

2 Overview .............................................................................................................................. 8 2.1 Transformational leadership ........................................................................................... 9

2.2 Leader-member exchange theory ................................................................................. 11

2.3 Path-goal leadership theory .......................................................................................... 12

2.4 Implicit leadership theory .............................................................................................. 13

3 Leadership Toolkit ............................................................................................................ 14

3.1 Mindfulness ................................................................................................................... 14

3.2 Emotional intelligence ................................................................................................... 15

4 Leadership Programs ....................................................................................................... 16

5 Conclusion ........................................................................................................................ 17

6 Glossary of terms ............................................................................................................. 18

7 Document control ............................................................................................................. 19

8 References ........................................................................................................................ 20

4

Acronyms DG Director General

DOH Department of Health WA

PMF Performance Management Framework

SA Service Agreement/s

UK United Kingdom

US United States

WA Western Australia

5

Context The Annual Performance Management Framework (PMF) 2015-16 guides the Department of Health to perform its role as the System Manager. The PMF is based on a performance management cycle which comprises performance reporting, performance monitoring and evaluation, and performance management. Effective leadership supports the PMF to improve the delivery of quality healthcare for all Western Australians.

The Performance Directorate’s mission is to measure and inform health system performance by ensuring an accountable, sustainable system that delivers better healthcare outcomes. Leadership is integral to creating an environment that delivers better performance and is crucial for the effective implementation of the PMF.

In November 2013, the Performance Management Strategic Directions 2014-15 and Beyond Consultation Framework1 (Strategic Framework) was released. A key direction in the Strategic Framework is to foster workforce engagement to enable all staff within WA Health to work towards achieving better patient, community and health system outcomes. The research shows that effective workforce engagement is more likely to be achieved through quality leadership.2,3

6

1 Introduction 1.1 Background There is considerable pressure on health systems world-wide to contain costs, improve performance and maximise value for money against a backdrop of rising consumer expectations, technological advances and growing demand.4 The essence of health reform in Australia is to address these challenges through the implementation of innovative solutions and process improvements. A critical element of health reform is leadership that engages and motivates workforce behaviour so that process improvements become firmly embedded.

Beyond health reform, good leadership is essential. Research shows that leadership is a key attribute of high performing healthcare systems.4 A significant body of work highlights that leadership quality impacts on staff satisfaction and commitment as well as individual and collective effectiveness.4,5,6,7 Similarly, leadership also plays an important part in motivating staff to achieve common goals.7,8 The King’s Fund published an evidenced-based Leadership and Engagement for Improvement in the NHS paper in 2011 that established the importance of effective leadership.9 The paper concluded that health systems that lead and engage staff deliver:

• better patient experiences

• few errors

• lower infection rates

• lower mortality rates

• stronger financial outcomes

• higher staff morale

• less absenteeism

• less stress.

In 2015, the Performance Directorate released the Workforce Engagement within a Performance Management Framework Setting paper which:

• established effective evidence-based workforce engagement strategies

• provided an understanding of the barriers to improve workforce engagement

• highlighted case studies where workforce engagement strategies have been successfully implemented.

It is clear from the Workforce Engagement within a Performance Management Framework Setting paper that leadership is an important part of workforce engagement.2

Managers and leaders are terms often used interchangeably in organisations to describe staff who have a higher level of authority.10 The research literature, however, suggests there is a difference between the two, with managers typically focused on directing others to achieve tasks and budgets while leaders concentrate on influencing, motivating, and enabling others to achieve a vision.11

7

A leader may or may not have a managerial role within an organisation.12 People can influence others without any formal authority. These individuals are referred to in the literature as informal leaders. Although an informal leader may not have positional power they are much closer to the frontline and have crucial information that is much harder for a formal leader to obtain.13 It has been recognised that health services and hospitals have an inverted power structure, in which people at the bottom generally have greater influence over decision-making than those who are nominally in control at the top.14 A recent shift away from the ‘great leader’ model towards a shared leadership and collaborative approach is evident. 15

Regardless of managerial responsibilities, all WA Health staff have the opportunity to be leaders within their own spectrum of influence and have the opportunity to contribute to the realisation of a sustainable health system that provides safe high quality healthcare.

1.2 Aim of report The aim of this report is to complement the Workforce Engagement within a Performance Management Framework Setting paper and to provide WA Health staff with an evidence-based overview of leadership styles and strategies that may be effective within a PMF setting so that all WA Health staff are empowered to work towards achieving better patient, community and health system outcomes.

More specifically this report aims to:

• provide a general understanding of leadership theories

• investigate effective evidence-based leadership styles and strategies

• identify case studies, practical solutions and strategies

• offer a leadership reference tool which includes an overview of four common leadership theories.

8

2 Overview A literature review highlights a significant number of leadership theories aimed at defining and understanding effective leadership.21 There is a substantial body of work investigating the application and effectiveness of leadership theories within an organisational setting.

Early leadership research focused on determining what are the traits or characteristics of an effective leader.16,21 It was clear from the initial findings that the search for universal leadership traits or characteristics was elusive.16,21 The research was subsequently expanded to include leadership behaviours.17

As the body of leadership research grew it became evident that the effectiveness of different leadership styles was also dependent on the context and situation.18,19,20 This led to the emergence of situational leadership theory. Several situational theories have been developed and are based on the premise that the situation determines the personal traits and behaviours required to be an effective leader.

A growing list of contemporary leadership theories have emerged that expand the situational leadership model by recognising the importance not only of the leader, the situation and the context but also the followers. Many of the leadership theories that have emerged have intuitive appeal but lack empirical evidence to support their effectiveness.

It is clear from the research that the application of effective leadership is complex and no one approach is best suited to all circumstances.44 A leadership style that is successful in some situations may not be effective in others.9,21,44

Although leadership styles may vary depending on a range of factors and circumstances it is clear from the literature9-27,30-45 that effective leadership will:

• inspire

• motivate

• empower

• boast morale

• build teamwork

• facilitate creativity and innovation

• achieve improvements.

In contrast, the research9,22,23 also highlights that poor leadership can result in workforce resistance, frustration, cynicism and a lack of workforce motivation.

This report examines four common leadership theories in more detail. The four leadership theories selected include transformational leadership24, leader-member exchange theory25, path-goal leadership theory20, and implicit leadership theory26. Each theory offers different leadership perspectives and provides further insight into effective leadership strategies.

9

2.1 Transformational leadership27,28,29

In 1978, James Burns introduced a concept of transformational leadership where leadership is aligned to a collective purpose based on the shared beliefs, needs and values of both the leader and their followers.30 Leaders and followers transform each other to a higher level of morale and motivation.30,31,32 The aim of the theory is to inspire and empower so that normal levels of performance are exceeded.24 Figure 2 shows the four key leadership behaviours and the five characteristic traits of a transformational leader.

Figure 2: Transformational Leadership Behaviours and Traits33,34and case stud

A range of transformational leadership strategies to inspire and empower team members are detailed below.

Transformational Personality Traits Extraversion – engaging and inspirational Neuroticism – has anxiety related to productivity Openness to experience – creative and emotional Agreeableness – a natural concern for others Conscientiousness – strong sense of direction

Transformational Leadership Strategies34 • Encourage intrinsic motivation and positive development of others. • Create an ethical climate based on shared values and higher ethical standards. • Raise awareness of moral standards and foster higher moral maturity in others. • Highlight important priorities. • Use persuasive appeal based on logic and reason. • Encourage others to look beyond self-interest to the common good. • Promote cooperation and harmony. • Use authentic, consistent means. • Appeal to the ideals of others. • Provide individual coaching and mentoring. • Allow freedom of choice for others.

Inspirational Motivator Leader acts as a role model and ‘walks the talk’

Individual Consideration Leader has genuine concern and feeling for others

Intellectual Stimulation Leader challenges others to be

innovative and creative

Idealised Influence Leader has the ability to

inspire and motivate others

10

The case study below highlights the ability of transformational leadership theory to play an important role in the achievement of organisational objectives in a healthcare setting.

Transformational Leadership at an organisational level Cone Health is a US based not-for-profit healthcare provider employing over 10,000 staff in more than 100 locations including six hospitals, three ambulatory care centres and three outpatient surgery centres. The leaders at Cone Health set the goal of becoming one of the top ranked healthcare providers for major quality measures. To realise this goal it recognised that a ‘business as usual’ management style would not suffice and they needed a highly motivated and empowered team that put patients and their safety first. The first step was an increased focus on improving listening skills so that staff were mindful of the voice of the patient and the voice of colleagues. The focus was then expanded to help leaders inspire and motivate the employee base. This included teaching leaders how to relinquish the past and embrace the future. Training also taught the power of language to create a different response in people so that they are able to embrace a possibility bigger than themselves. Cone Health increased its efforts to include all staff by staging hands-on meetings at every level. To empower physicians, Cone Health also created a dedicated physician leadership academy to identify and train rising stars with leadership potential. The training program included personal assessments measuring leadership competencies and personality attributes as well as assessments on an individual’s willingness to approach and accept change. Mentoring and coaching was built into every stage of the program which included feedback. To ensure that the importance of leadership development became embedded, Cone Health’s leadership competency model was revised and integrated into every manager’s performance assessment. The leadership model comprised key competencies including: Accountability Visionary strategic leadership Relationship building People leadership Patient-centred service orientation Talent development Breakthrough thinking.

Performance assessments were supported by individual development plans with access to the required tools and resources. Within a year of commencing the transformational leadership initiative Cone Health was able to increase staff engagement from 51 to 87 per cent and reduce staff turnover from 21 to 13 per cent. In 2014, five Cone Health hospitals were named ‘Top Performer on Key Quality Measures’ in the United States. In 2015 Cone Health built on this success and was recognised as being the number one health system in North Carolina in eight patient safety categories.

CASE STUDY27,28,29

11

2.2 Leader-member exchange theory35 The leader-member exchange theory focuses on the importance of the two-way relationship between leaders and followers.36 The theory recognises that the relationship between leaders and followers is mutually interactive and is based on trust, respect and commitment.37 The theory recognises that not all leader-member relationships within a team are the same. Within teams there are members who have low quality leader exchanges and there are members who have high quality leader exchanges. The research shows that high quality leader-member exchanges lead to teams with greater satisfaction, higher employee commitment, better job performance and lower staff turnover.38 Figure 3 illustrates the impact of low and high quality of leader-member exchanges can have on commitment.

Figure 3: Leader-member exchange Impact change reference39

To improve the quality of leader-member exchanges it is critical that leaders examine their own behaviours and perceptions.

Developing High Quality Leader-Member Exchanges35 • Find out how satisfied your team members are with your performance as a leader. • Identify which team members have low quality exchanges with you and ask yourself the

questions: - Why have they fallen out of favour with you? - Can you identify what they did to lose your trust? - Are they truly incompetent? - Why do they have low motivation? - Do they exhibit bad behaviour? - Are the facts comparable with your perception?

• Try and re-establish the relationship with members who have low quality exchanges with you by meeting with them one-on-one.

• Find out if they are happy in their job. • Find out what motivates them. • Ask them what you can do to make their work more challenging and engaging. • Provide training and support including mentoring and coaching. • Set team goals together.

Leader Member Exchanges

High Quality Exchanges Increased Commitment

Low Quality Exchanges Limited Commitment

12

2.3 Path-goal leadership theory Path-goal leadership theory is based on a leader’s behaviour being contingent on the satisfaction, motivation and performance of subordinates.40 A leader engages in behaviours that is contingent on employee and environment factors.40

Figure 4 highlights each step within the path-goal leadership theory.

Figure 4: Path-goal leadership theory process40case study

The theory suggests that to achieve effective leadership it is important that the leadership behaviour selected for each situation considers both employee and environmental factors.41

Choosing the right leadership behaviour type41 Within the path-goal leadership theory there are four types of leadership behaviours. The selection of the appropriate behaviour type is a subjective decision that is dependent on both employee and environmental contingencies. A leader needs to carefully consider each team member’s skills and experience as well as the task and the team dynamics in order to select the appropriate behaviour.

• Achievement-orientated leader behaviour A challenging approach where teams are expected to work to their highest level to achieve set goals.

• Directive path-goal behaviour An authoritative approach that lets subordinates know what is expected and how the task should be performed.

• Participative leadership behaviour A consultative approach that seeks collaborative input from the team.

• Supportive leadership behaviour An empathic approach when appropriate assistance and guidance is provided to team members who are in stress.

Employee contingences Skills Experience

Environmental contingences Task structure Team dynamics

Leadership behaviour selection Achievement-orientated Directive Participative Supportive

Effective Leadership

13

2.4 Implicit leadership theory Implicit leadership theory is a cognitive-based theory built on the notion that team members develop implicit assumptions about a leader’s characteristics, traits and qualities.42 These assumptions shape a team member’s perception of the leader and influences their behaviours and responses to the leader.42 Perception is the way in which we all interpret our experiences.41 Leaders need to understand that their actions and behaviours help shape each team member’s perception of them.41 Figure 5 illustrates how a team member’s perception43 guides their behaviours and responses to the leader.

Figure 5: Implicit leadership theory process40case study

Leaders need to consider how each team member is likely to perceive a decision, action or directive and tailor their own behaviours and actions to best fit the employee and the situation. For a leader to choose the right behaviours and actions a high level of emotional intelligence is required.

Team member‘s past and current

experiences

Leader‘s

actions and behaviours

Team member forms a

perception of a leader’s

characteristics, traits and qualities

Team member‘s behaviours and responses are guided by their

established perception of

the leader

The Gillings School for Global Public Health at the University of North Carolina’s developed and implemented an emotional intelligence leadership development program to foster better relationship management and enhance decision-making. The program focused on: interpersonal skills, communication skills and professionalism personal competences such as self-perception, self-expression, stress management and

decision-making social competences such as social awareness and social responsibility.

For five consecutive years, participating physicians have rated the overall program five out of five as providing a strong foundation for personal and work success.

CASE STUDY44

14

3 Leadership Toolkit All the leadership theories in this report require good decision-making skills and effective relationship management. Research shows that mindfulness and emotional intelligence are two strategies that can improve decision-making skills and relationship management. 44,45,52

3.1 Mindfulness Mindfulness is a technique that enables leaders to achieve clarity of thought.45 Mindfulness is the practice of being aware of the present moment and your own stream of thoughts without reactivity or judgement.45 An extensive body of research shows that mindfulness reduces workplace stress, enhances job satisfaction and improves clarity of thought and decision-making.45 The essence of mindfulness is to be in the present moment to calm a frenetic mind.46,47,48,49 For further information on the concept and practical application of mindfulness refer to: http://wachs.hdwa.health.wa.gov.au/index.php?id=10527&tx_ttnews%5Btt_news%5D=2543&cHash=30a34bf6377d34c9186163dc4ce414ca

Guest house exercise Within this exercise you are invited to view your mind as a guest house. Thoughts and emotions are guests that stay for a while and then leave. In your guest house you have both welcome and unwelcome guests. The exercise suggests that you simply acknowledge and accept your feelings and emotions attached to each thought knowing that they will pass.

Simple exercises to improve mindfulness46-49

Exam

ple

One

Ex

ampl

e Tw

o Ex

ampl

e Th

ree

Two minute meditation exercise Close your eyes and let your thoughts drift away. Do not try and suppress your thoughts and simply recognise that they will come and go. Concentrate your focus on the natural rhythm of your breath. Feel the release of stress flow out as you exhale and enjoy the sense of peace and relaxation as you breathe in.

Mindfulness eating exercise For this exercise you will need a sultana. Slowly eat the sultana using all your senses. Look, feel and taste the sultana. Embrace the whole experience and savour the moment. The slower you eat the sultana the more the exercise brings you into the moment.

Mindfulness listening exercise In this exercise you are invited to open your ears in a non-judgement way. Play a piece of music or a song that is unfamiliar to you. Close your eyes and get lost in the journey of the sound for the duration of the song. The exercise allows you to become immersed in the song without preconception or judgement of the genre, artist, lyrics or instrumentation.

Exam

ple

Four

15

3.2 Emotional intelligence Emotional intelligence describes the ability of an individual to use emotional information about themselves and others to guide thinking, decision-making and behaviours.50 Emotional intelligence skills assist healthcare leaders to understand, engage and motivate a team.44 A high level of emotional intelligence requires both personal and social competencies so that leaders are able to effectively manage relationships.44,51,52,53

• Self-actualisation – The ability to live a meaningful and enjoyable life.

• Emotional self-awareness – The ability to recognise and understand your own feelings and emotions and why you have those feelings and emotions.

• Self-regard – The ability to accept and respect the fact that you are inherently a good person with strengths and weaknesses.

Personal Competencies44,51

Self-

Perc

eptio

n

• Independence – The ability to engage in objective decision-making that is free from your emotional dependencies.

• Assertiveness – The ability to openly express your thoughts and emotions in a socially acceptable, non-destructive and inoffensive manner.

• Emotional expression – The ability to openly express both verbally and non-verbally your feelings and emotions.

Self-

Expr

essi

on

• Stress tolerance – The ability to withstand stressful situations and adverse events.

• Flexibility – The ability to adjust your thoughts, emotions and behaviours to unexpected situations and circumstances.

• Optimism – The ability to have a positive outlook and weather difficult situations without becoming overwhelmed.

Stre

ss

Man

agem

ent

• Problem solving – The ability to find solutions to problems when emotions are involved.

• Impulse control – The ability to limit or resist the temptation to act impulsively without thought.

• Reality testing – The ability to recognise when personal bias or emotion will reduce objectivity.

Dec

isio

n-M

akin

g

• Empathy – The ability to recognise and appreciate the emotions of others.

• Interpersonal relationships – The ability to maintain mutually beneficial relationships based on openness, compassion and trust.

• Social responsibility – The desire and willingness to contribute to society and to embrace a shared concern for the greater good.

Social Competencies44,51

Soci

al

Aw

aren

ess

16

4 Leadership Programs The Institute of Health Leadership is an integral part of WA Health’s commitment to leadership development and capacity building. The Institute of Health Leadership offers leadership programs that enhance leadership capacity at all levels so that WA Health is able to deliver a safe, high quality, sustainable health system for all Western Australians.54 The Institute of Health Leadership runs a series of leadership and training programs54:

• Coaching Skills Program – The program aims to expand the leadership skills by using a coaching style of conversation to influence and create better service outcomes.

• Consultant Development Program – The program aims to assist consultants to develop

the critical knowledge they need to fully undertake their roles.

• Emerging Leaders Program - The program has been designed to promote the skills and tools required to be an effective leader.

• Health System Management Program – The program aims to develop Hospital Executive

staff to increase resource effectiveness.

• Masterclasses – Masterclasses aim to inspire and develop the leadership skills of all WA Health staff.

• Medical Service Improvement Program – The program aims to support medical staff to

complete improvement projects. For up-to-date information on the full list of current Institute for Health Leadership programs and resources refer to: http://intranet.health.wa.gov.au/leadership/home/

17

5 Conclusion Every employee in WA Health, regardless of managerial responsibilities, is able to be an informal leader within their own spectrum of influence.

This report provides an evidence-based overview of leadership styles and strategies so that all WA Health staff are empowered to work towards achieving better patient, community and health system outcomes.

The evidence shows that effective leadership can inspire, motivate, empower, boast morale, build teamwork, facilitate creativity and innovation, and achieve improvements. In contrast, the research also highlights that poor leadership can result in workforce resistance, frustration, cynicism and a lack of workforce motivation.

Effective leadership requires good decision-making skills and effective relationship management. The research shows that mindfulness and emotional intelligence are two strategies that can improve both of these skills. To assist in the development of these skills an overview of mindfulness and emotional intelligence has been included in this report.

There are a large number of leadership theories. Contemporary leadership theory has expanded from an initial focus on leadership traits, characteristics and behaviours to include the context, the situation and the followers.

This report provides an overview of four common leadership theories including transformational leadership theory, leader-member exchange theory, behaviour flexibility theory, path-goal theory and implicit leadership theory. Each theory offers a different leadership perspective and provides insight into effective leadership strategies.

While the research shows that no one theory is a panacea for every circumstance this report can be used as a leadership reference tool to aid improvement champions within WA Health to develop effective leadership strategies.

Leadership training is an important part of staff development and capacity building. The Institute of Health Leadership is integral to WA Health’s commitment to leadership development. The Institute of Health Leadership offers programs that enhance leadership capacity at all levels. For up-to-date information on the Institute of Health Leadership programs and resources refer to: http://intranet.health.wa.gov.au/leadership/home/.

18

6 Glossary of terms Active listening is a communication technique which enables the listeners to understand what is being said and confirms a shared understanding. Improvement Champion is an individual within the organisation that is an active advocate of the improvement and seeks opportunities to be an agent of change. Organisational objectives are outlined in the Strategic Intent and are long term goals achieved over a number of years. The objectives should align with Government ambitions and targets and incorporate other commitments made through Intergovernmental Agreements and National Partnership Agreements. Performance management is the management and governance system that regulates and addresses poor performance.

19

7 Document control VERSION DATE AUTHOR COMMENTS

1.0 1st December 2015

Anthony Jones Approved by the Karen Lopez, A/Director Performance

20

8 References

1 Department of Health. (2013). Performance Management Strategic Directions 2014-15 and Beyond Consultation Framework, Performance Directorate, Department of Health, Perth. Available from: http://activity/file.axd?file=2014%2f2%2fStrategic+Directions_Final.pdf (accessed November 2015).

2 Department of Health. (2013). Workforce Engagement in a Performance Management

Framework Setting, Performance Directorate, Department of Health, Perth. Available from: http://ww2.health.wa.gov.au/~/media/Files/Corporate/general%20documents/Performance/PDF/20150324-Workforce-Engagement-within-PMF-setting-v3.0.ashx (accessed November 2015).

3 The King’s Fund. (2015). Leadership and Leadership Development in Health Care: The

Evidence Base, The King’s Fund, London. Available from: http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/leadership-leadership-development-health-care-feb-2015.pdf (accessed November 2015).

4 Hurst, J. and Jee-Hughes, M. (2001). ‘Performance Measurement and Performance

Management in OECD Health Systems’, OECD Labour Market and Social Policy Occasional Papers, No. 47, OECD Publishing.

5 Baker, G. R., MacIntosh-Murray, A., Porcellato, C., Dionne, L., Stelmacovich, K., Born, K.

(2008). High Performing Healthcare Systems, Longwoods Publishing, Toronto. 6 Gerstner, C. R., Day, D. V. (1997). Meta-analytic review of leader-member exchange

theory: correlates and construct ideas. Journal of Applied Psychology, vol. 82, 827-44. 7 Kouzes, J. M., Posner, B. Z. (2012). The Leadership Challenge (5th Edition). John Wiley

and Sons, Hoboken, USA. 8 Avolio, B. J., Walumba, F. O., Weber, T. J. (2009). Leadership: current theories, research

and future directions. Annual Review of Psychology, vol. 60, 421−49. 9 The King’s Fund. (2012). Leadership and Engagement for Improvement in the NHS,

Together we can, The King’s Fund, London. Available from: http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/leadership-for-engagement-improvement-nhs-final-review2012.pdf (accessed September 2013).

10 Day, S. (2015). Leaders and Managers – Why we need both (Edition Number 292). PS News Online, Perth, Australia. Available from: http://www.psnews.com.au/wa/469/features/leaders-and-managers-why-we-need-both (accessed November 2015).

21

11 Kotterman, J. (2006). Leadership versus Management: What’s the Difference? Journal for

Quality and Participation, Summer Edition, 13−17. 12 West, M., Eckert, R., Steward, K., Pasmore, B. (2014). Developing collective leadership for

health care, The King’s Fund, London. Available from: http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/developing-collective-leadership-kingsfund-may14.pdf (accessed November 2015).

13 Heifetz, R. (1994). Leadership without easy answers. Harvard University Press.

Cambridge, USA. 14 Ham, C. (2003). Improving the performance of health services: the role of clinical

leadership. The Lancet, vol. 361, 1978−80. 15 King’s Fund. (2011). The Future of Leadership and Management in the NHS, The King’s

Fund, London. Available from: http://www.kingsfund.org.uk/sites/files/kf/future-of-leadership-and-management-nhs-may-2011-kings-fund.pdf (accessed November 2015).

16 Stogdill, R., M. (1948). Personal factors associated with leadership: a survey of the

literature. Journal of Psychology, vol. 25, 35−71. 17 Ralph, M., Stogdill, R. M., Coons, A. E. (1957). Leadership behaviour: Its Description and

Measurement, Bureau of Business Research Monograph No. 88, Ohio State University, Columbus, USA.

18 Fielder, F. E. (1967). A Theory of Leadership Effectiveness. McGraw-Hill. New York, USA. 19 Hersey, P., Blanchard, K. (1982). Management of Organizational Behavior: Utlizing

Human Resources. Prentice Hill, Englewood, New Jersey, USA. 20 House, R. J. (1971). A path goal theory of leadership effectiveness. Administrative Science

Quarterly, vol. 16, 321−38. 21 Health Workforce Australia. (2012). Leadership for the Sustainability of the Health

System: Part 1 – A Literature Review, January 2012, Health Workforce Australia, Canberra.

22

Mantler, J., Godin, J., Cameron, S. J., Horsburgh, M. E. (2013). Cynicism in hospital staff nurses: the effect of intention to leave and change over time. Journal of Nursing Management, [ePublication ahead of print].

23

Baumeister, R. F. (1991). Meanings of life. New York, USA. 24 Bass, B., M. (1990). From transactional to transformational leadership: learning to share

the vision. Organisational Dynamics, vol. 18, no. 3, 19-31.

22

25 Graen, G., Cashman, J. (1975). A role-making model of leadership in formal organizations:

a development approach. Kent State University Press, Ohio, USA. 26 House, R., Javidan, M., Hanges, P., Dorfman, P. (2002). Understanding cultures and

implicit leadership theories across the globe: and introduction to project GLOBE. Journal of World Business, vol. 37, issue. 1, 3-10.

27 Rosenberg, N. O. (2014). Transformational Leadership: For Cone Health, ‘unleashing the

tiger’ of transformation begins with empowerment. Insigniam Quarterly, Special Healthcare Issue. 2014, 1-3.

28 Cone Health. (2014). Cone Health Earns’ Top Performance on Key Quality Measures

Recognition from the Joint Commission, Cone Health, North Carolina, USA. Available From: http://www.conehealth.com/news/2014-news-releases/cone-health-earns-top-performer-on-key-quality-measures-recognit/

29 Cone Health. (2015). Cone Health Tops State in Several Areas for Care and Safety, Cone

Health,, North Carolina, USA. Available From: http://www.conehealth.com/news/2015-news-releases/cone-health-tops-state-in-several-areas-for-care-and-safety-/

30 Burns, J. M. (1978). Leadership. Harper and Row. New York, USA. 31 Burns, J. M. (2003). Transforming Leadership: A New Pursuit of Happiness. Atlantic

Monthly Press. New York, USA. 32 Stewart, J. (2006). Transformational Leadership: An Evolving Concept Examined through

the Works of Burns, Bass, Avolio and Leithwood. Candian Journal of Educational Administration and Policy, issue. 54, 1−28.

33 Bass, B. M., Riggio, R. (2005). Transformational Leadership (2nd Edition). Psychology

Press. Oxford, UK. 34 Bass, B. M., Avolio, B. J. (1993). Transformational Leadership: A response to critiques. In

Chemers, M. M., Ayman, R. (1993) Leadership theory and research: Perspectives and Directions (pp 49-80). Academic Press. San Diego, USA.

35 Mindtools. (2016). The Leader-Member Exchange Theory: Getting the Best from all Team

Members. (Mindtools website). Available from: https://www.mindtools.com/pages/article/leader-member-exchange.htm (accessed November 2015).

36 Graen, G. B., Schiemann, W. (1978). Leadership-member agreement: A vertical dyad

linkage approach. Journal of Applied Psychology, vol. 63, 206-212. 37 Graen, G. B., Hui, C., Taylor, E. A. (2006). Experienced-based learning about LMX

Leadership and fairness in Project Teams: A Dyadic Directional Approach. Academy of Management and Learning Education. vol. 5, no. 4, 448-460.

23

38 Erdogan, B., Liden, R. C. (1993). Social Exchange in the Workplace: A Review of Recent

Developments and Future Research Directions in Leader-Member Exchange Theory. In Neider, L. I., Schriesheim, C. A. (2002). Leadership. Information Age, Greenwich,USA.

39

Trueland, J. (2014). Cost benefits, EHI ehealth Insider, London, UK. Available from: http://www.ehi.co.uk/Features/item.cfm?&docId=423 (accessed July 2014).

40 House, R. J., Mitchell, T. R. (1974). Path-goal theory of leadership – Lessons, legacy, and

reformulated theory. Journal of Contemporary Business, Vol. 3, 1−97. 41 Mindtools. (2015). Path-Goal Theory – Discovering the Best Leadership Style. (Mindtools

website). Available from: https://www.mindtools.com/pages/article/path-goal-theory.htm (accessed November 2015).

42 Forsyth, D. R. (2009). Group dynamics. Wadsworth. New York, USA. 43 Otara, A. (2011). Perception: A Guide for Managers and Leaders. Journal of Management

and Strategy, vol. 2, no. 3, 21-24. 44 Fernandez, C. S. P., Peterson, H. B., Holmstrom, S. W., Connolly, A. (2012). Developing

Emotional Intelligence for Healthcare Leaders, Emotional Intelligence – New Perspectives and Applications, InTech. Croatia. Available from: http://cdn.intechopen.com/pdfs-wm/27249.pdf (accessed November 2015).

45 Glomb, T. M., Duffy, M. K., Bono, J. E., Yang, T. (2011). Mindfulness at Work. Personnel

and Human Resource Management, Vol. 30, 115-157. 46 Dr Jenny Brockis. (2011). Mindful eating: How eating a sultana can improve your attention.

(Dr Jenny Brockis website). Available from: http://www.drjennybrockis.com/dr-jenny-brockis/mindful-eating-how-eating-a-sultana-can-improve-our-attention (accessed November 2015).

47 Heble, S. P. (2012). Trust the Universe and go with the flow. Xlibris. Bloomington, USA. 48 Mindfulness Bristol. (2015). The Guest House Mindfulness Exercise. (Mindfulness Bristol

website). Available from: http://www.mindfulnessbristol.co.uk/about-mindfulness/the-guest-house-mindfulness-exercise/ (accessed November 2015).

49 Pocket Mindfulness. (2015). Six Mindfulness Exercises you can try today. (Pocket

Mindfulness website). Available from: http://www.pocketmindfulness.com/6-mindfulness-exercises-you-can-try-today/ (accessed November 2015).

50 Coleman, A. (2008). A Dictionary of Psychology (3rd Edition). Oxford University Press.

Oxford, UK.

24

51 Antonakis, J., Ashkanasy, N. M., Dasborough, M. (2009). Does leadership need emotional

intelligence? The Leadership Quarterly, Vol. 20, No. 2, 247−261. 52 Harms, P. D., Crede, M. (2010). Emotional Intelligence and Transformational and

Transactional Leadership: A Meta-Analysis. Journal of Leadership and Organizational Studies, Vol. 17 No. 1, 5−17.

53 Stein, S. J. (2011). The Complete EQ-I Model. Multi-Health Systems. Toronto, Canada. 54 Institute of Health Leadership. (2015). Leadership Programs Offered. (Institute of Health

Leadership website). Available from: http://intranet.health.wa.gov.au/leadership/home/ (accessed November 2015).

This document can be made available in alternative formats on request for a person with a disability.

© Department of Health 2015

Copyright to this material is vested in the State of Western Australia unless otherwise indicated. Apart from any fair dealing for the purposes of private study, research, criticism or review, as permitted under the provisions of the Copyright Act 1968, no part may be reproduced or re-used for any purposes whatsoever without written permission of the State of Western Australia.